Improving Science & Restoring Trust in Public Health | Dr. Jay Bhattacharya

US life expectancy flat since 2012 despite record research spending

NIH Director Jay Bhattacharya reveals that American life expectancy has been essentially flat since 2012, while European countries continued to advance. During the pandemic, US life expectancy dropped sharply and only recently returned to 2019 levels. Meanwhile, Sweden recovered within a year. The investments in research are not translating to the NIH mission.

"Since 2012, there's been no increase in American life expectancy."

NIH-funded papers go free: no more paying to read taxpayer-funded research

Bhattacharya announces that starting July, all NIH-funded research papers will be freely available to the public immediately upon publication, accelerating a policy initiated by his predecessor. Currently, journals charge up to $12,000 to publish a paper funded by taxpayers, then sell it back to the public for $30-50.

"My predecessor, Monica Bercnoli, who was the NIH director, the Nationalist for Health Director before me, she made a decision, a really great decision, essentially to say, if the NIH supports a scientist's work, and then that work leads to a journal publication, that publication ought to be available free to the public immediately upon publication. You're not allowed as an NIH-funded scientist to publish in a journal that doesn't have that as a policy. That policy was due to go into effect in December of this year. I think it's a great policy because I agree with your analysis entirely. If the American taxpayer pays for the research, why shouldn't the American taxpayer be able to read the research for free? Because they already paid for it. Why do they pay a second time on the back end after the research is published? And it's not like it's free if you're a university employee. The university has to purchase a very costly subscription to the journal in order for a faculty member to read the papers. Now, I'm lucky enough I can access pretty much any paper in the world, but that's because Stanford spends millions and millions of dollars, and it's made worse. I forgot the one real stinger in this. When you publish a paper, you use taxpayer dollars to pay the journal. That's correct. Thousands of dollars to publish it, then they sell it back to the general public. Nature charges $12,000 for like the major – Oh my goodness. It's good. So it's – but okay, so – So that's a racket. Right. Yeah. Sorry. I realize I'm talking more than I'm asking questions. No, no. This is – I mean like I'm agreeing with you. So like – so I – Monica Bertinelli, the previous NIH director, in December of this year was – she made a policy that those papers have to be able to the public for free. I made a decision. One of my first things I did was I said, why wait till December? Let's just do it in July. Great. Thank you. And so starting in July, what you just said will no longer be the case. The Americans and everybody will have access to the papers that the Americans are already paid for, if they're NIH-funded, for free. Thank you. On the behalf of – literally, this isn't a political statement. On the behalf of myself and every other American citizen, thank you. We've been paying for this research forever and have had to pay to get it back. I mean, it's not like journal editors make that much money, but the journals make a fortune. So Macmillan Press, El Xavier, I've done my homework on this. We're talking billions of dollars in income. And the marginal cost of publishing now is expectantly zero. It's just, you put it online, right? And there's, I mean, yeah, there's some cost for maintaining the webpage and all that, and there's some editorial staff, but like the level of investments that the public had been making for the NIH to then be asked to pay $30, $50, $100 for the papers itself that are published, I mean, it's just insulting."

Indirect costs and the concentration of science at elite universities

Bhattacharya explains the indirect costs (IDC) debate -- how Stanford gets $550K on top of every $1M grant for infrastructure costs. This system creates a ratchet that concentrates federal science funding at a select few coastal universities, disadvantaging brilliant scientists at other institutions.

"Right. So actually, I just preface my remarks by saying that there was litigation against that 15%, which essentially said the government couldn't impose that 15%. So it's been blocked? Yes. So right now, the rates are whatever they were. They're not the 15% based on that court order. I can't comment on the litigation, and I can't comment as a result of, I'm now a member of the government. It's like, I'm not allowed to do that. But I do want to talk about the broader issues related to indirect costs. And I want to put it a broader context, right? So the context is this, right? So in the mid-40s, Vannevar Bush, who was like one of the main science administrators in the United States, he made an argument that the federal government should partner with universities in organizing the scientific infrastructure of the United States. The universities were tremendously important parts of the scientific infrastructure, and the federal government had an appropriate role in supporting the universities of the country to do scientific research of interest to the American people, right? So the indirect costs kind of structure came out of that commitment. And frankly, it makes sense to me, right? It's appropriate that the federal government have some role in deciding how to support the universities of the country to be organized around research that is in the American interest. The question is, how much should it be? How should it be structured? In what way? Those are the key policy issues that we're really talking about. We're not talking about should there be some federal support for the universities. The question is how? Let me just step back and talk about like the current structure, the way it works, because it's really non-intuitive, right? So first, you're a brilliant scientist. You apply to the NIH. You get a grant that gives you a million dollars a year. I'll just make a clean number, right? So a million dollars for the next five years. The federal government is going to give you money to run your lab and do all this kind of stuff. You work at Stanford. Stanford has a 55% indirect rate. So that's on top of the million dollars a year, the administrators at Stanford then will get $550,000, right? So for your million dollars of work, the taxpayers will pay one and a half million dollars roughly to Stanford a year, right? So that's... Now, as you said correctly, that half a million dollars will go to the fixed cost of doing research, right? The stuff that's, now, that, as you said correctly, that half a million dollars will go to the fixed cost of doing research, right? The stuff that's like not specific to the lab you're running, the people you have to hire to do the work that you propose, but the fixed cost, the building, the maintenance, all the stuff. Someone's got to take the biohazard stuff away, all that stuff. And it's not just you. There are other folks who are using the same material, like radioactive materials. And so they can support many, many research projects, not just one, right? So it's funding that kind of work, right? And again, that's a legitimate use of that money. So, right. Here's the way that the economics of this work. In order to get fixed cost support, you have to have brilliant scientists like you that can win NIH grants. Right? If you don't win NIH grants, Stanford doesn't get the 550. Right? But in order to attract brilliant scientists, you have to have the infrastructure where the scientists can do their work. so it's a ratchet right so in order to have the money the infrastructure support fixed support you have to have science have the infrastructure where the scientists can do their work. So it's a ratchet, right? So in order to have the money, the infrastructure support, fixed cost support, you have to have scientists. In order to have the scientists, you have to have the infrastructure. It's a ratchet that essentially makes it so that we concentrate the federal support for the money to a select few universities. They're winners and losers. And so the scientific infrastructure of the country is concentrated in relatively few universities, mainly on the coast. And there are brilliant scientists in other places that are not at those select few universities that have trouble getting NIH grants, even though they're brilliant scientists. It draws the federal support away in a structure that essentially says lots and lots of states, lots and lots of institutions are going to have trouble getting the infrastructure support that they need in order to have the scientists come there. So that's the basic economics of the way indirect costs actually work. And so the question is, is that the right structure? There's also questions about, you know, like, so for instance, your science involves, you're a basic scientist, your science involves lots and lots of fixed costs, right? Radioactive disposal, all this stuff. The research I did, epidemiology, health policy, statistics, it's basically a computer. Me with a data set and a computer, I can hire some biostatisticians to help me or – We call that a carpet lab. Yeah. And so like do the universe – does the university need the same indirect cost support to support my fixed costs as it does yours? And the answer is obviously no. And yet that's the structure we currently have. So there are policy questions to be answered about have we structured the indirect cost support in the right way? Are we inducing the right incentives? Can the American taxpayer be sure that we're auditing the use of the indirect costs appropriately? Those are the policy questions I think that are an issue in the indirect cost fight. Again, I won't get into the litigation. I'm not allowed to actually comment on that. So I wanted to abstract it to a higher level because I think the policy question is not should the federal government support universities to do this kind of research to to have sort of the facilities. The question is how should it be distributed across the country? To what extent should the researchers get it versus the administrators get it? And then on the back of that, there's also other research institutions that have very different indirect cost recovery rates for the same university, right? So like, you know, I think Gates Foundation is, I don't know the exact number, like 15%, something on that order, whereas the NIH is 50% to the same university. That looks funny. The question is, I mean, sometimes I've heard, well, the Gates Foundation puts more of the money into the directs, right? So that maybe they'll charge you for the rental cost of the building or something. I don't know exactly, but- I'm very familiar with foundation versus NIH money, and it differs by foundation, but typically a university, and I've been at two, I'm tenured at Stanford, but my lab started off at University of California, San Diego, a public university. Typically when foundation money comes in, the university imposes a minimum of about 8% administrative costs just for handling, like just to do the paperwork, to pay the admins that do the handling. There's something very important in what you're bringing about. There are actually two issues. So I want to backtrack to one issue to make sure that people really understand this, because I realize that some of this might sound a little bit down in the weeds, but it's just so important. The first thing that I really want to draw up from earlier in our conversation is you pointed out that the current model of NIH is that taxpayer dollars pay for the basic research and for the exploration of whether or not the findings from that basic research will benefit disease. If there's any technology, device, drug, whatever, that is brought to the public through the private sector. Put differently, the taxpayers fund the research and development, but they don't capture any of the upside from the private companies that make money selling you the SSRI, selling you the not hopefully someday novel Alzheimer's treatment. We don't yet have a satisfactory treatment for Alzheimer's as we'll get into. So the general public who are not basic scientists, in other words, if I take off my hat as a basic scientist and I say, yeah, I'm a taxpayer. I give a significant amount of my income to the state of California and to the federal government. I like science. I certainly would like to live a long, healthy life. And I hope some of that science helps me do that. But I'm going to have to buy back the results of what I paid for. That's where I think a lot of the general public sit. And I'm not saying they don't like, appreciate, and respect science and scientists. But to any rational person, you don't need a degree in economics to say, that kind of sucks. I'm paying – and made worse, if I want to read a paper that was published with the work that I provided for my tax dollars, I have to buy that from the journal. By the way, that changes in July. Okay. Yeah. I mean, this is a huge issue. That's one of the decisions I made. Yeah, it's $34. Not anymore. Listen, I've been grateful to publish in Nature and Science. You know, these are like Super Bowl rings for scientists. I'm sure it's part of the reason I got tenure at Stanford. And I had great fun doing the work. And I believe in the work. It stood the test of time. But were I not an employee of Stanford that pays for the subscriptions to those journals, I have to buy the work back using my tax dollars that funded the work. This is crazy. This is like me giving you the money for the supplies to build a home. I get to, you get to live in the home. I don't even get to see the home. I have to purchase a ticket to see the home. That's how irrational it is from the perspective of somebody who's just not understanding the pipeline of basic to applied research. So let's just, I want to return to that briefly because this relates, in my opinion, directly to IDC. So that's a crazy picture for anyone that doesn't understand how one piece relates to the next, relates to the next. And now that I'm in public, I'm in media, I'm public facing, what I've come to learn is that the general public is very smart. Max Delbrook was right. Assume infinite intelligence and zero knowledge, but it's very hard for people to connect more than two or three dots. They're busy. So we could talk all day about how this leads to that, leads to this, the brick on the wall model, and then there's this treatment. And they're like, I'm paying for this stuff and I can't even read the paper about it, let alone glean the positive benefits without paying out the nose. Yeah. So a couple of things. Let me go backwards because you had two major issues you brought up. So first, the journal thing."