Francis Collins: National Institutes of Health (NIH)
嘉宾：Francis Collins
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§01Transcript · 00:00–09:02
The following is a conversation with Francis Collins,
director of the NIH, the National Institutes of Health,
appointed and reappointed to the role by three presidents,
Obama, Trump, and Biden.
He oversees 27 separate institutes and centers,
including NIAID, which makes him Anthony Fauci's boss.
At the NIH, Francis helped launch
and led a huge number of projects
that pushed the frontiers of science, health, and medicine,
including one of my favorites, the BRAIN Initiative,
that seeks to map the human brain
and understand how the function arises
from neural circuitry.
Before the NIH, Francis led the Human Genome Project,
one of the largest and most ambitious efforts
in the history of science.
Given all that, Francis is a humble, thoughtful, kind man.
And because of this, to me,
he's one of the best representatives of science in the world.
He's a man of God,
and yet also a friend of the late Christopher Hitchens,
who called him, quote,
"One of the greatest living Americans."
This is the Lex Friedman Podcast.
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And now, here's my conversation with Francis Collins.
Science at its best is a source of hope.
So for me, it's been difficult to watch,
as it has during the pandemic,
become at times a source of division.
What I would love to do in this conversation with you
is touch some difficult topics
and do so with empathy and humility
so that we may begin to regain a sense of trust in science,
and that it may once again become a source of hope.
I hope that's okay with you.
- I love the goal.
- Let's start with some hard questions.
You called for, quote,
"Thorough, expert-driven, and objective inquiry
"into the origins of COVID-19."
So let me ask,
is there a reasonable chance that COVID-19 leaked
from a lab?
- I can't exclude that.
I think it's fairly unlikely.
I wish we had more ability to be able to ask questions
of the Chinese government
and learn more about what kind of records
might have been in the lab
that we've never been able to see.
But most likely, this was a natural origin of a virus,
probably starting in a bat,
perhaps traveling through some other intermediate,
yet to be identified host,
and finding its way into humans.
- Is answering this question within the realm of science,
do you think, will we ever know?
- I think we might know if we find that intermediate host.
And there has not yet been a thorough enough investigation
to say that that's not going to happen.
And remember, it takes a while to do this.
With SARS, it was 14 years before we figured out
it was the civet cat that was the intermediate host.
With MERS, it was a little quicker
to discover it was the camel.
With SARS-CoV-2, there's been some looking,
but especially now, with everything really tense
between the US and China,
if there's looking going on,
we're not getting told about it.
- Do you think it's a scientific question
or a political question?
- It's a scientific question,
but it has political implications.
- So the world is full of scientists
that are working together,
but in the political space,
in the political science space, there's tensions.
What is it like to do great science
in a time of a pandemic when there's political tensions?
- It's very unfortunate.
Pasteur said science knows no one country.
He was right about that.
My whole career, in genetics especially,
has depended upon international collaboration
between scientists as a way
to make discoveries, get things done.
Scientists, by their nature,
like to be involved in international collaborations.
The Human Genome Project, for heaven's sake,
2,400 scientists in six countries working together,
not worrying who was gonna get the credit,
giving all the data away.
I was the person who was supposed
to keep all that coordinated.
It was a wonderful experience.
And that included China.
That was sort of their first real entry
into a big international, big science kind of project,
and they did their part.
It's very different now.
- Continuing the line of difficult questions,
especially difficult ethical questions.
In 2014, US put a hold on gain-of-function research
in response to a number of laboratory biosecurity incidents,
including anthrax, smallpox, and influenza.
In December 2017, NIH lifted this ban because, quote,
"Gain-of-function research is important
"in helping us identify, understand,
"and develop strategies and effective countermeasures
"against rapidly evolving pathogens
"that pose a threat to public health."
All difficult questions have arguments on both sides.
Can you argue the pros and cons
of gain-of-function research with viruses?
- I can.
And first, let me say this term, gain-of-function,
is causing such confusion that I need to take a minute
and just sort of talk about what the common scientific
use of that term is and where it is very different
when we're talking about the current oversight
of potentially dangerous human pathogens.
As you know, in science, we're doing gain-of-function
experiments all the time.
We support a lot of cancer immunotherapy at NIH.
Right here in our clinical center,
there are trials going on where people's immune cells
are taken out of their body, treated with a genetic therapy
that revs up their ability to discover the cancer
that that patient currently has, maybe even at stage four,
and then give them back as those little ninja warriors
go after the cancer.
And it sometimes works dramatically.
That's gain-of-function.
You gave that patient a gain in their immune function
that may have saved their life.
So we gotta be careful not to say,
"Oh, gain-of-function is bad."
Most of what we do in science that's good
involves quite a bit of that.
And we are all living with gains-of-function every day.
I have a gain-of-function 'cause I'm wearing
these eyeglasses, otherwise I would not be seeing you
as clearly.
I'm happy for that gain-of-function.
So that's where a lot of confusion has happened.
The kind of gain-of-function which is now subject
to very rigorous and very carefully defined oversight
is when you are working with an established human pathogen
that is known to be potentially causing a pandemic,
and you are enhancing or potentially enhancing
its transmissibility or its virulence.
We call that EPPP, Enhanced Potential Pandemic Pathogen.
That requires this very stringent oversight,
worked out over three years
by the National Science Advisory Board on Biosecurity
that needs to be looked at by a panel
that goes well beyond NIH to decide,
are the benefits worth the risks in that situation?
Most of the time, it's not worth the risk.
Only three times in the last three or four years
have experiments been given permission to go forward.
They were all on influenza.
So I will argue that if you're worried
about the next pandemic,
the more you know about the coming enemy,
the better chance you have to recognize
when trouble is starting.
And so if you can do it safely,
studying influenza or coronaviruses like SARS, MERS,
and SARS-CoV-2 would be a good thing
to be able to know about,
but you have to be able to do it safely
because we all know lab accidents can happen.
I mean, look at SARS where there have been lab accidents
and people who have gotten sick as a result.
We don't want to take that chance
unless there's a compelling scientific reason.
That's why we have this very stringent oversight.
The experiments being done
at the Wuhan Institute of Virology
as a subaward to our grant to EcoHealth in New York
did not meet that standard
of requiring that kind of stringent oversight.
I want to be really clear about that
'cause there's been so much thrown around about it.
Was it gain of function?
Well, in the standard use of that term
that you would use in science in general,
you might say it was,
but in the use of that term that applies
to this very specific example
of a potential pandemic pathogen, absolutely not.
So nothing went on there that should not have happened
based upon the oversight.
There was an instance where the grantee institution
failed to notify us about the result of an experiment
that they were supposed to tell us
§02Transcript · 09:04–18:05
where they mixed and matched some viral genomes
and got a somewhat larger viral load as a result,
but it was not EPPP.
It was not getting into that zone
that would have required this higher level of scrutiny.
It was all bat viruses.
These were not human pathogens.
- So they didn't cross a threshold
within that gray area that makes for an EPPP?
- They did not.
And anybody who's willing to take the time
to look at what EPPP means and what those experiments were
would have to agree with what I just said.
- What is the biggest reason
it didn't cross that threshold?
Is it because it wasn't jumping to humans?
Is it because it did not have a sufficient increase
in virulence or transmissibility?
What's your sense?
- EPPP only applies to agents
that are known human pathogens of pandemic potential.
These were all bat viruses derived in the wild,
not shown to be infectious to humans.
Just looking at what happened
if you took four different bat viruses
and you tried moving the spike protein gene
from one into one of the others
to see whether it would bind better to the ACE2 receptor.
That doesn't get across that threshold.
And let me also say,
for those who are trying to connect the dots here,
which is the most troubling part of this,
and say, well, this is how SARS-CoV-2 got started,
that is absolutely demonstrably false.
These bat viruses that were being studied
had only about 80% similarity in their genomes
to SARS-CoV-2.
They were like decades away in evolutionary terms.
And it is really irresponsible for people
to claim otherwise.
- Speaking of people who claim otherwise,
Rand Paul, what do you make of the battle of words
between Senator Rand Paul and Dr. Anthony Fauci
over this particular point?
- I don't want to talk about specific members of Congress,
but I will say it's really unfortunate
that Tony Fauci, who is the epitome
of a dedicated public servant,
has now somehow been targeted for political reasons
as somebody that certain figures are trying to discredit,
perhaps to try to distract from their own failings.
This never should have happened.
Here's a person who's dedicated his whole life
to trying to prevent illnesses from infectious diseases,
including HIV, in the 1980s and '90s,
and now probably the most knowledgeable
infectious disease physician in the world,
and also a really good communicator,
is out there telling the truth
about where we are with SARS-CoV-2
to certain political figures who don't want to hear it,
and who are therefore determined to discredit him,
and that is disgraceful.
- So with politicians,
they often play games with black and white.
They try to sort of use the gray areas of science
and then paint their own picture.
But I have a question about the gray areas of science.
So like you mentioned, gain of function is a term
that has very specific scientific meaning,
but it also has a more general term.
And it's very possible to argue that the,
not to argue, not the way politicians argue,
but just as human beings and scientists,
that there was a gain of function achieved
at the Wuhan Institute of Virology,
but it didn't cross a threshold.
I mean, there's a, it's a, but it could have too.
So here's the thing.
When you do these kinds of experiments,
unexpected results may be achieved,
and that's the gray area of science.
You're taking risks with such experiments.
And I am very uncomfortable that we can't discuss
the uncertainty in the gray area of this.
- Oh, I'm comfortable discussing the gray area.
What I'm uncomfortable with is people deciding
to define for themselves what that threshold is
based on sort of some political argument.
The threshold was very explicitly laid out.
Everybody agreed to that in the basis
of this three years of deliberation.
So that's what it is.
If that threshold needs to be reconsidered,
let's reconsider it, but let's not try to take
an experiment that's already been done
and decide that the threshold isn't what it was,
'cause that really is doing a disservice
to the whole process.
- I wish there was a discussion,
even in response to Rand Paul,
and I know we're not talking about specific senators,
but just that particular case, I'm saying stuff here.
I wish there was an opportunity to talk about,
given the current threshold, this is not gain of function,
but maybe we need to reconsider the threshold
and have an actual, that's an opportunity
for a discussion about the ethics of gain of function.
You said that there was three studies
that passed that threshold with influenza.
That's a fascinating human question,
scientific question about ethics,
because like you said, there's pros and cons.
You're taking risks here to prevent
horribly destructive viruses in the future,
but you also are risking creating
such viruses in the future.
With nuclear weapons and nuclear energy,
nuclear energy promises a lot of positive effects,
and yet you're taking risks here.
With mutually assured destruction,
nations possessing nuclear weapons.
- Oh my.
I hope we're not going there.
- Well, we're not, but a lot of people argue
that that's the reason we've,
nuclear weapons is the reason we've prevented world wars,
and yet they also have the risk of starting world wars.
And this is what we have to be honest about
with the benefits and risks of science,
that you have to make that calculation.
What are the pros and what are the cons?
- I'm totally with you, but I want to reassure you, Lex,
that this is not an issue that's been ignored.
- Yes.
- That this issue about the kind of gain of function
that might result in a serious human pathogen
has been front and center in many deliberations
for a decade or more,
involved a lot of my time along the way, by the way,
and has been discussed publicly on multiple occasions,
including two major meetings
of the National Academy of Sciences,
getting input from everybody,
and ultimately arriving at our current framework.
Now, we actually, back in January of 2020,
just before COVID-19 changed everything,
had planned and even charged
that same National Science Advisory Board on Biosecurity
to reconvene and look at the current framework and say,
"Do we have it right?
"Let's look at the experience over those three years
"and say, is the threshold too easy, too hard?
"Do we need to reconsider it?
"Let's look at the experience."
COVID came along, the members of the board said,
"Please, we're all infectious disease experts.
"We don't have time for this right now,
"but I think the time is right to do this."
I'm totally supportive of that,
and that should be just as public a discussion
as you can imagine about what are the benefits and the risks.
And if somebody decided, ultimately,
this came together and said,
"We just shouldn't be doing these experiments
"under any circumstances,"
if that was the conclusion,
well, that would be the conclusion,
but it hasn't been so far.
- If we can briefly look out
into the next hundred years on this.
I apologize for the existential questions,
but it seems obvious to me
that as gain-of-function type of research and development
becomes easier and cheaper,
it will become greater and greater risk.
So if it doesn't no longer need to be contained
within laboratories of high security,
it feels like this is one of the greatest threats
facing human civilization.
Do you worry that at some point in the future,
a leaked man-made virus
may destroy most of human civilization?
- I do worry about the risks.
And at the moment where we have the greatest control,
the greatest oversight,
is when this is federally funded research.
But as you're alluding,
there's no reason to imagine that's the only place
that this kind of activity would go on.
If there was an evil source that wished to create a virus
that was highly pathogenic in their garage,
the technology does get easier.
And there is no international oversight about this either
that you could say has the same stringency
as what we have in the United States.
So yes, that is a concern.
It would take a seriously deranged group or person
to undertake this on purpose,
given the likelihood that they too would go down.
§03Transcript · 18:08–27:17
We don't imagine there are going to be bioweapons
that only kill your enemies and don't kill you.
Sorry, we're too much alike for that to work.
So I don't see it as an imminent risk.
There's lots of scary novels and movies written about it,
but I do think it's something we have to consider.
What are all the things that ought to be watched?
You may not know that if somebody is ordering
a particular oligonucleotide from one of the main suppliers
and it happens to match smallpox, they're gonna get caught.
So there is effort underway to try to track
any nefarious actions that might be going on.
- In the United States or internationally?
Is there an international collaboration
of trying to track this stuff?
- There is some.
I wish it were stronger.
- This is a general issue, Lex, in terms of,
do we have a mechanism, particularly when it comes
to ethical issues, to be able to decide what's allowable
and what's not and enforce it?
I mean, look where we are with germline genome editing
for humans, for instance.
There is no enforcement mechanism.
There's just bully pulpits and governments
that get to decide for themselves.
- So you talked about evil.
What about incompetence?
Does that worry you?
I was born in the Soviet Union.
My dad, a physicist, worked at Chernobyl.
That comes to mind.
That wasn't evil.
That was, I don't know what word you wanna put it.
Maybe incompetence is too harsh.
Maybe it's the inherent incompetence of bureaucracy.
I don't know.
But for whatever reason, there was an accident.
Does that worry you?
- Of course it does.
We know that SARS, for instance, did manage to leak
out of a lab in China two or three times,
and at least in some instances, people died.
Unfortunately, quickly contained.
All one can do in that circumstance,
because you need to study the virus and understand it
in order to keep it from causing a broader pandemic,
but you need to insist upon the kind of biosecurity,
the BSL two, three, and four framework
under which those experiments have to be done.
And certainly at NIH, we're extremely rigorous about that,
but you can't count on every human being
to always do exactly what they're supposed to.
So there's a risk there, which is another reason
why if we're contemplating supporting research
on pathogens that might be the next pandemic,
you have to factor that in,
not just whether people are gonna do something
that we couldn't have predicted,
where all of a sudden they created a virus
that's much worse without knowing they were gonna do that,
but also just having an accident.
That's in the mix when those estimates are done
about whether the risk is worth it or not.
- Continuing on line of difficult questions.
(laughing)
- We're gonna get to fun stuff after a while.
- We will soon, I promise.
You are the director of the NIH.
You are Dr. Anthony Fauci's, technically his boss.
- Yep.
- You have stood behind him.
You have supported him,
just like you did already in this conversation.
It is painful for me to see division and distrust,
but many people in politics and elsewhere
have called for Anthony Fauci to be fired.
When there's such calls of distrust in public
about a leader like Anthony Fauci,
who should garner trust, do you think he should be fired?
- Absolutely not.
To do so would be basically to give the opportunity
for those who wanna make up stories about anybody
to destroy them.
There is nothing in the ways in which Tony Fauci
has been targeted that is based upon truth.
How could we then accept those cries for his firing
as having legitimacy?
It's a circular argument.
They've decided they don't like Tony,
so they make up stuff and they twist comments
that he's made about things like gain of function,
where he's referring to the very specific gain of function
that's covered by this policy.
And they're trying to say he lied to the Congress.
That's simply not true.
They don't like the fact that Tony changes
the medical recommendations about what to do with COVID-19
over the space of more than a year.
And they call that flip-flopping and you can't trust the guy
'cause he says one thing last year and one thing this year.
Well, the science has changed.
Delta variant has changed everything.
You don't want him to be saying the same thing
he did a year ago.
That would be wrong now.
It was the best we could do then.
People don't understand that
or else they don't want to understand that.
So when you basically whip up a largely political argument
against a scientist and hammer at it over and over again
to the point where he now has to have 24/7 security
to protect him against people
who really want to do violence to him,
for that to be a reason to say that then he should be fired
is to hand the evil forces the victory.
I will not do that.
(sighs)
- Yet there's something difficult
I'm going to try to express to you.
So it may be your guitar playing.
It may be something else, but there's a humility to you.
It may be because you're a man of God.
There's a humility to you that garners trust.
And when you're in a leadership position,
representing science,
especially in catastrophic events like the pandemic,
it feels like as a leader,
you have to go far above and beyond your usual duties.
And I think there's no question
that Anthony Fauci has delivered on his duties,
but it feels like he needs to go above
as a science communicator.
And if there's a large number of people
that are distrusting him,
it's also his responsibility to garner their trust,
to gain their trust.
As a person who's the face of science,
are you torn on this?
The responsibility of Anthony Fauci, of yourself,
to represent science,
not just the communication of advising what should be done,
but giving people hope, giving people trust in science,
and alleviating division.
Do you think that's also a responsibility of a leader,
or is that unfair to ask?
- I think the best way you give people trust
is to tell them the truth.
And so they recognize that when you're sharing information,
it's the best you've got at that point.
And Tony Fauci does that at every moment.
I don't think him expressing more humility
would change the fact that they're looking for a target
of somebody to blame,
to basically distract people
from the failings of their own political party.
Maybe I'm less targeted, not because of a difference
in the way in which I convey the information,
I'm less visible.
If Tony were out of the scene and I was placed in that role,
I'd probably be seeing a ratcheting up
of that same targeting.
- I would like to believe that if Tony Fauci said
that when I originally made recommendations
not to wear masks,
that was given on our best available data,
and now we know that is a mistake.
So admit with humility that there's an error.
That's not actually correct,
but that's a statement of humility.
And I would like to believe, despite the attacks,
he would win a lot of people over with that.
So a lot of people, as you're saying,
would use that, see that, here we go,
here's that Dr. Anthony Fauci making mistakes.
How can we trust him on anything?
I believe if he was,
that public display of humility to say that I made an error,
that would win a lot of people over.
That's kind of my sense,
to face the fire of the attacks on politics,
like politicians will attack no matter what.
But the question is the people,
to win over the people.
The biggest concern I've had
is that there was this distrust of science
that's been brewing.
And maybe you can correct me,
but I'm a little bit unwilling to fully blame
the politicians,
'cause politicians play their games no matter what.
It just feels like this was an opportunity
to inspire people with the power of science.
The development of the vaccines,
no matter what you think of those vaccines,
is one of the greatest accomplishments
in the history of science.
- It is indeed.
- And the fact that that's not inspiring,
listen, I host a podcast.
§04Transcript · 27:18–37:04
Whenever I say positive stuff about the vaccine,
I get to hear a lot of different opinions.
- I bet you do.
- The fact that I do is a big problem to me,
because it's an incredible,
an incredible accomplishment of science.
And so I'm sorry,
but I have to put responsibility on the leaders,
even if it's not their mistakes.
That's what the leadership is.
That's what leadership is.
You take responsibility for the situation.
I wonder if there's something
that could have been done better
to give people hope
that science will save us
as opposed to science will divide us.
- I think you have more confidence
in the ability to get beyond our current divisions
than I do after seeing just how deep
and dark they have become.
Tony Fauci has said multiple times
the recommendation about not wearing masks
was for two reasons,
a shortage of masks, which were needed in hospitals,
and a lack of realization early
in the course of the epidemic
that this was a virus
that could heavily infect asymptomatic people.
Has that changed?
He changed.
Now, did he make an error?
No, he was making a judgment
based on the data available at the time,
but he certainly made that clear over and over again.
It has not stopped those who would like to demonize him
from saying, "Well, he just flip-flopped.
"You can't trust a guy.
"He says one thing today and one thing tomorrow."
- Well, masks is a tricky one.
So I'm actually-- - It is a tricky one.
- Early on, I'm a co-author on a paper,
one of many, but this was a survey paper
overlooking the evidence.
It's a summary of the evidence we have
for the effectiveness of masks.
It seems that it's difficult
to do rigorous scientific study on masks.
- It is difficult.
- There's a lot of philosophical and ethical questions
I want to ask you.
Well, within this,
it's back to your words and Anthony Fauci's words.
When you're dealing with so much uncertainty
and so much potential uncertainty
about how catastrophic this virus is in the early days,
and knowing that each word you say may create panic,
how do you communicate science with the world?
It's a philosophical, it's an ethical,
it's a practical question.
There was a discussion about masks a century ago
and that too led to panic.
So, I mean, I'm trying to put myself in your mind
and the mind of Anthony Fauci in those early days,
knowing that there's limited supply of masks.
Like, what do you say?
Do you fully convey the uncertainty of the situation,
of the challenges of the supply chain?
Or do you say that masks don't work?
That's a complicated calculation.
How do you make that calculation?
- It is a complicated calculation.
As a scientist, your temptation would be
to give a full brain dump of all the details
of the information about what's known and what isn't known
and what experiments need to be done.
Most of the time, that's not gonna play well
in a soundbite on the evening news.
So you have to kind of distill it down to a recommendation
that is the best you can do at that time
with the information you've got.
- So you're a man of God.
And we'll return to that to talk about
some also unanswerable philosophical questions.
But first, let's linger on the vaccine
because in the religious, in the Christian community,
there was some hesitancy with the vaccine.
- Still is.
- Still is.
There's a lot of data showing high efficacy
and safety of vaccines, of COVID vaccines,
but still they are far from perfect as all vaccines are.
Can you empathize with people who are hesitant
to take the COVID vaccine
or to have their children take the COVID vaccine?
- I can totally empathize,
especially when people are barraged
by conflicting information coming at them
from all kinds of directions.
I've spent a lot of my time in the last year
trying to figure out how to do a better job of listening
because I think we have all got the risk
of assuming we know the basis for somebody's hesitancy.
And that often doesn't turn out to be what you thought.
And the variety of reasons is quite broad.
I think a big concern is just this sense of uncertainty
about whether this was done too fast
and that corners were cut.
And there are good answers to that.
Along with that, a sense that maybe this vaccine
will have long-term effects that we won't know about
for years to come.
And one can say that hasn't been seen with other vaccines.
And there's no particular reason to think
this one's going to be different
than the dozens of others that we have experience with.
But you can't absolutely say,
no, there's no chance of that.
So it does come down to listening
and then trying in a fashion that doesn't convey a message
that you're smarter than the person you're talking to
'cause that isn't gonna help
to really address what the substance is of the concerns.
But my heart goes out to so many people
who are fearful about this because of all the information
that has been dumped on them.
Some of it by politicians, a lot of it by the internet,
some of it by parts of the media
that seem to take pleasure in stirring up this kind of fear
for their own reasons.
And that is shameful.
I'm really sympathetic with the people
who are confused and fearful.
I am not sympathetic with people
who are distributing information that's demonstrably false
and continue to do so.
They're taking lives.
I didn't realize how strong that sector of disinformation
would be.
And it's been in many ways more effective
than the means of spreading the truth.
This is gonna take us into another place.
But Lex, if there's something I'm really worried about
in this country, and it's not just this country,
but it's the one I live in,
is that we have another epidemic besides COVID-19,
and it's an epidemic of the loss of the anchor of truth.
The truth as a means of making decisions,
truth as a means of figuring out
how to wrestle with a question like,
should I get this vaccine for myself or my children,
seems to have lost its primacy.
And instead, it's an opinion of somebody
who expressed it very strongly,
or some Facebook post that I read two hours ago.
And for those to become substitutes for objective truth,
not just, of course, for vaccines,
but for many other issues,
like was the 2020 election actually fair?
This worries me deeply.
It's bad enough to have polarization and divisions,
but to have no way of resolving those
by actually saying, okay, what's true here,
makes me very worried about the path we're on.
And I'm usually an optimist.
- Well, to give you an optimistic angle on this,
I actually think that this sense
that there's no one place for truth
is just a thing that will inspire leaders
and science communicators to speak,
not from a place of authority,
but from a place of humility.
I think it's just challenging people
to communicate in a new way, to be listeners first.
I think the problem isn't that
there's a lot of misinformation.
I think that people,
the internet and the world are distrustful
of people who speak as if they possess the truth
with an authoritarian kind of tone,
which was, I think, defining
for what science was in the 20th century.
I just think it has to sound different in the 21st.
In the battle of ideas, I think humility and love wins.
And that's how science wins,
not through having quote-unquote truth.
'Cause now everybody can just say, "I have the truth."
I think you have to speak, like I said,
from humility, not authority.
And so it just challenges our leaders to go back
and learn to be, pardon my French, less assholes
and more kind.
And like you said, to listen,
to listen to the experiences of people that are good people,
not the ones who are trying to manipulate the system
or play a game and so on,
but real people who are just afraid of uncertainty,
of hurting those they loved and so on.
So I think it's just an opportunity for leaders
to go back and take a class on effective communication.
§05Transcript · 37:07–46:46
- I'm with you on shifting more from where we are
to humility and love.
That's gotta be the right answer.
That's very biblical, by the way.
- We'll get there.
I have to bring up Joe Rogan.
I don't know if you know who he is.
- I do.
- He's a podcaster, comedian, fighting commentator,
and my now friend.
- And Ivermectin believer too.
- Yes, that is the question I have to ask you about.
He has gotten some flack in the mainstream media
for not getting vaccinated.
And when he got COVID recently,
taking Ivermectin as part of a cocktail of treatments.
The NIH actually has a nice page on Ivermectin saying,
quote, "There's insufficient evidence to recommend
either for or against the use of Ivermectin
for the treatment of COVID-19.
Results from adequately powered, well-designed,
and well-conducted clinical trials are needed
to provide more specific evidence-based guidance
on the role of Ivermectin in the treatment of COVID-19."
So let me ask, why do you think there has been
so much attack on Joe Rogan and anyone else
that's talking about Ivermectin
when there's insufficient evidence for or against?
- Well, let's unpack that.
First of all, I think the concerns about Joe
are not limited to his taking Ivermectin.
Much more seriously, his being fairly publicly negative
about vaccines at a time where people are dying.
700,000 people have died from COVID-19.
Estimates by Kaiser are at least 100,000 of those
were unnecessary deaths of unvaccinated people.
And for Joe to promote that further,
even as this pandemic rages through our population,
is simply irresponsible.
So yeah, the Ivermectin is just one other twist.
Obviously, Ivermectin has been controversial
for months and months.
The reason that it got particular attention
is because of the way in which it seemed
to have captured the imagination of a lot of people,
and to the point where they were taking doses
that were intended for livestock.
And some of them got pretty sick as a result
from overdosing on this stuff.
That was not good judgment.
The drug itself remains uncertain.
There's a recent review that looks at all of the studies
of Ivermectin and basically concludes
that it probably doesn't work.
We are running a study right now.
I looked at that data this morning
in a trial called ACTIV6, which is one of the ones
that my public-private partnership is running.
We're up to about 400 patients who've been randomized
to Ivermectin or placebo, and should know,
perhaps as soon as a month from now,
in a very carefully controlled trial,
did it help or did it not?
So there will be an answer.
Coming back to Joe, again, I don't think,
the fact that he took Ivermectin,
hoping it might work, is that big a knock against him.
It's more the conveying of, we don't trust what science says,
which is vaccines are gonna save your life.
We're gonna trust what's on the internet
that says Ivermectin and hydroxychloroquine
really do work, even though the scientific community
says probably not.
- So let me push back on that a little bit.
So he doesn't say, let's not listen to science.
He doesn't say don't get vaccinated.
He says it's okay to ask questions.
- I'm okay with that.
- How risky is the vaccine for certain populations?
What are the benefits and risks?
There's other friends of Joe and friends of mine,
like Sam Harris, who says, if you look at the data,
it's obvious that the benefits outweigh the risks.
And what Joe says is, yes,
but let's still openly talk about risks.
And he often brings up anecdotal evidence
of people who've had highly negative effects from vaccines.
Science is not done with anecdotal evidence.
And so you could infer a lot of stuff
from the way he expresses it,
but he also communicates a lot of interesting questions.
And that's something maybe you can comment on is,
there's certain groups that are healthy.
They're younger, they exercise a lot,
they get nutrition and all those kinds of things.
He shows skepticism on whether it's so obvious
that they should get vaccinated.
And the same is he makes this,
he kind of presents the same kind of skepticism for kids,
for young kids.
So with empathy and listening my Russian ineloquent
description of what Joe believes,
what is your kind of response to that?
Why should certain categories of healthy and young people
still get vaccinated, do you think?
- Well, first, just to say,
it's great for Joe to be a skeptic, to ask questions.
We should all be doing that.
But then the next step is to go and see what the data says
and see if there are actually answers to those questions.
So coming to healthy people,
I've done a bunch of podcasts besides this one.
The one I think I remember most
was a podcast with a worldwide wrestling superstar.
- Very nice.
- He's about six foot six and just absolutely solid muscle.
And he got COVID and he almost died.
And recovering from that, he said,
"I've got to let my supporters know."
'Cause you can imagine worldwide wrestling fans
are probably not big embracers of the need for vaccines.
And he just turned himself into a spokesperson
for the fact that this virus doesn't care
how healthy you are, how much you exercise,
what a great specimen you are.
It wiped him out.
And we see that.
The average person in the ICU right now with COVID-19
is under age 50.
I think there's a lot of people still thinking,
"Oh, it's just those old people in the nursing homes.
"That's not gonna be about me."
They're wrong.
There are plenty of instances of people
who were totally healthy with no underlying diseases,
taking good care of themselves, not obese,
exercising who have died from this disease.
700 children have died from this disease.
Yes, some of them had underlying factors like obesity,
but a lot of them did not.
So it's fair to say younger people are less susceptible
to serious illness, kids even less so
than young adults, but it ain't zero.
And if the vaccine is really safe and really effective,
then you probably want everybody to take advantage of that.
Even though some are dropping their risks more than others,
everybody's dropping their risks some.
- Are you worried about variants?
So looking out into the future,
what's your vision for all the possible trajectories
that this virus takes in human society?
- I'm totally worried about the variants.
Delta was such an impressive arrival on the scene
in all the wrong ways.
I mean, it took over the world
in the space of just a couple months
because of its extremely contagious ability.
- Viruses would be beautiful if they weren't terrifying.
- Yeah, exactly.
I mean, this whole story of viral evolution,
scientifically, is just amazingly elegant.
Anybody who really wanted to understand
how evolution works in real time, study SARS-CoV-2,
'cause it's not just Delta, it's Alpha,
it's Beta, and it's Gamma,
and it's the fact that these sweep through
the world's population
by fairly minor differences in fitness.
So the real question many people are wrestling is,
is Delta it?
Is it such a fit virus
that nothing else will be able to displace it?
I don't know.
I mean, there's now Delta-AY4,
which is a variant of Delta
that at least in the UK seems to be taking over
the Delta population
as though it's maybe even a little more contagious.
That might be the first hint
that we're seeing something new here.
It's not a completely different virus.
It's still Delta, but it's Delta plus.
You know, the big worry, Alex,
is what's out there that is so different
that the vaccine protection doesn't work?
(laughs)
- And we don't know how different it needs to be
for the vaccine to start working.
That's the terrifying thing about each of these variants.
It's like, it's always a pleasant surprise
that the vaccine seems to still have efficacy.
- And hooray for our immune system, may I say,
because the vaccine immunized you
against that original Wuhan virus.
Now we can see that especially after two doses
and even more so after a booster,
your immune system is so clever
that it's also making a diversity of antibodies
to cover some other things that might happen to that virus
to make it a little different.
§06Transcript · 46:48–55:13
And you're still getting really good coverage.
Even for beta, which was South Africa, B1351,
which is the most different, it looks pretty good.
But that doesn't mean it will always be as good as that
if something gets really far away from the original virus.
Now, the good news is we would know what to do
in that situation.
The mRNA vaccines allow you to redesign the vaccine
like that and to quickly get it through
a few thousand participants in a clinical trial
to be sure it's raising antibodies
and then bang, you could go.
But I don't wanna have to do that.
There will be people's lives at risk in the meantime.
And what's the best way to keep that from happening?
Well, try to cut down the number of infections
'cause you don't get variants
unless the virus is replicating in a person.
- So how do we solve this thing?
How do we get out of this pandemic?
What's, like if you had like a wand or something
or you could really implement policies,
what's the full cocktail of solutions here?
- It's a full cocktail.
It's not just one thing.
In our own country here in the US,
it would be getting those 64 million reluctant people
to actually go ahead and get vaccinated.
- There's 64 million people who didn't get vaccinated?
- Adults, yes.
Not even counting the kids.
64 million.
Isn't that astounding?
Get the kids vaccinated.
Hopefully their parents will see that as a good thing too.
Get those of us who are due for boosters boosted
because that's gonna reduce our likelihood
of having breakthrough infections and keep spreading it.
Convince people that until we're really done with this
and we're not now,
that social distancing and mask wearing indoors
are still critical to cut down the number of new infections.
But of course, that's our country.
This is a worldwide pandemic.
I worry greatly about the fact
that low and middle income countries
have for the most part not even gotten started
with access to vaccines.
And we have to figure out a way to speed that up
because otherwise that's where the next variant
will probably arrive.
And who knows how bad it will be
and it will cross the world quickly
as we've seen happen repeatedly in the last 22 months.
- I think I'm really surprised, annoyed, frustrated
that testing, rapid at-home testing
from the very beginning
wasn't a big, big part of the solution.
It seems, first of all, nobody's against it.
That's one huge plus for testing.
It's everybody supports.
Second of all, like that's what America is good at
is like mass manufacturer stuff.
Like stepping up, engineer stepping up
and really deploying it.
Plus without the collection of data
is giving people freedom, is giving them information
and then freedom to decide what to do with that information.
It's such a powerful solution.
I don't understand.
- Well, now I think the Biden administration
is I think emphasized like the scaling
of testing manufacturers.
So, but I just feel like it's an obvious solution.
Get a test that's cost less than a dollar to manufacture,
cost less than a dollar to buy
and just everybody gets tested every single day.
Don't share that data with anyone.
You just make the decisions.
And I believe in the intelligence of people
to make the right decision to stay at home
when the test is positive.
- I am so completely with you on that.
And NIH has been smack in the middle
of trying to make that dream come true.
We're running a trial right now in Georgia,
Indiana, Hawaii.
And where's the other one?
Oh, Kentucky.
Basically blanketing a community with free testing.
- That's beautiful.
- And look to see what happens as far as stemming
the spread of the epidemic and measuring it by wastewater
'cause you can really tell whether you've cut back
the amount of infection in the community.
Yeah, I'm so with you.
We got off to such a bad start with testing.
And of course, all the testing was being done
for the first several months in big box laboratories
where you had to send the sample off
and put it through the mail somehow
and get the result back sometimes five days later
after you've already infected a dozen people.
It was just a completely wrong model,
but it's what we had.
And everybody was like, oh, we got to stick with PCR
because if you start using those home tests
that are based on antigens lateral flow,
probably there's gonna be false positives
and false negatives.
Okay, sure, no test is perfect,
but having a test that's not acceptable
or accessible is the worst setting.
So we, NIH, with some requests from Congress,
got a billion dollars to create this program
called Rapid Acceleration of Diagnostics, RADx.
And we turned into a venture capital organization
and we invited every small business or academic lab
that had a cool idea about how to do home testing
to bring it forward.
And we threw them into what we called our shark tank
of business experts, engineers, technology people.
People understood how to deal
with supply chains and manufacturing.
And right now today, there are about 2 million tests
being done based on what came out of that program,
including most of the home tests
that you can now buy on the pharmacy shelves.
We did that and I wish we had done it faster,
but it was an amazingly speedy effort.
And you're right, companies are really good.
Once they've gotten FDA emergency use authorization,
and we helped a lot of them get that,
they can scale up their manufacturing.
I think in December, we should have about 410 million tests
for that month ready to go.
And if we can get one or two more platforms approved,
and by the way, we are now helping FDA
by being their validation lab.
If we can get a couple more of these approved,
we could be in the half a billion tests a month,
which is really getting where we need to be.
- Wow, yeah, that's a dream.
That's a dream for me.
It seems like an obvious solution, engineering solution.
Everybody's behind it.
It leads to hope versus division.
I love it.
Okay.
- A happy story.
- A happy story.
- I was waiting for one.
- Yeah, all right.
Well, one last dive into the not happy,
but you won't even have to comment on it.
- Well, comment on the broader philosophical question.
So NIH, again, I said Joe Rogan
as the first one who pointed me to this.
NIH was recently accused of funding research of a paper
that had images of sedated puppies
with their heads inserted into small enclosures
containing disease carrying sand flies.
So I could just say that this story is not true,
or at least the,
I think it is true that the paper
that showed those images cited NIH as a funding source,
but that citation is not correct.
- That was not correct.
- Yeah.
But that brings up a bigger philosophical question
that it could have been correct.
How difficult is it as a director of NIH
or just NIH as an organization
that's funding so many amazing deep research studies
to ensure the ethical fortitude of those studies
when the ethics of science is,
there's such a gray area between what is
and what isn't ethical?
- Well, tough issues.
Certainly animal research is a tough issue.
- I was going to bring up,
it's a good example of that tough issue,
is in 2015, you announced that NIH
would no longer support any biomedical research
involving chimpanzees.
So that's like a one example of looking in the mirror,
thinking deeply about what is and isn't ethical.
And there was a conclusion that biomedical research
on chimps is not ethical.
- That was the conclusion.
That was based on a lot of deep thinking
and a lot of input from people
who have considered this issue
and a panel of the National Academy of Sciences
that was asked to review the issue.
I mean, the question that I wanted them to look at was,
are we actually learning anything that's really essential
from chimpanzee invasive research at this point?
Or is it time to say that these closest relatives of ours
should not be subjected to that any further
§07Transcript · 55:16–1:04:05
and ought to be retired to a sanctuary?
And that was the conclusion,
that there was really no kind of medical experimentation
that needed to be done on chimps in order to proceed.
So why are we still doing this?
Many of these were chimpanzees that were purchased
because we thought they would be good hosts for HIV/AIDS,
and they sort of weren't.
And they were kept around in these primate laboratories
with people coming up with other things to do,
but they weren't compelling scientifically.
So I think that was the right decision.
I took a lot of flack
from some of the scientific communities said,
"Well, you're caving in to the animal rights people.
And now that you've said no more research on chimps,
what's next?"
Certainly when it comes to companion animals,
everybody's heart starts to be hurting
when you see anything done that seems harmful
to a dog or a cat.
I have a cat, I don't have a dog.
And I understand that completely.
That's why we have these oversight groups
that decide before you do any of that kind of research,
is it justified?
And what kind of provision is going to be made
to avoid pain and suffering?
And those have input from the public
as well as the scientific community.
Is that completely saying that every step
that's happening there is ethical by some standard
that would be hard for anybody to agree to?
No, but at least it's a consensus
of what people think is acceptable.
Dogs are the only host for some diseases
like Leishmaniasis, which was that paper
that we were not responsible for,
but I know why they were doing the experiment.
Or like lymphatic filariasis,
which is an experiment that we are supporting in Georgia
that involves dogs getting infected with a parasite
because that's the only model we have to know
whether a treatment is gonna work or not.
So I will defend that.
I am not in the place of those who think
all animal research is evil,
'cause I think if there's something that's gonna be done
to save a child from a terrible disease or an adult,
and it involves animal research
that's been carefully reviewed,
then I think ethically, while it doesn't make me comfortable,
it still seems like it's the right choice.
I think to say all animal research
should be taken off the table is also very unethical
'cause that means you have basically doomed a lot of people
for whom that research might have saved their lives
to having no more hope.
- And to me personally,
there's far greater concerns ethically
in terms of factory farming, for example,
the treatment of animals in other contexts.
- Oh, there's so much that goes on
outside of medical research that is much more troubling.
- That said, I think all cats have to go.
That's just my off the record opinion.
That's why I'm not involved with any ethical decisions.
I'm just joking internet, I love cats.
- You're a dog person.
- I'm a dog person, I'm sorry.
- You've seen the New Yorker cartoon
where there are two dogs in the bar having a martini,
and one is saying they're dressed up in their business suits
and one says to the other,
"You know, it's not enough for the dogs to win.
"The cats have to lose."
(laughing)
- That's beautiful.
So a few weeks ago, you've announced
that you're resigning from the NIH at the end of the year.
- I'm stepping down.
I'm still gonna be at NIH in a different capacity.
- Different capacity, right.
And it's over a decade of an incredible career
overseeing the NIH as its director.
What are the things you're most proud of
of the NIH in your time here
as its director, maybe memorable moments?
- There's a lot in 12 years.
Science has just progressed in amazing ways
over those 12 years.
Think about where we are right now.
Something like gene editing,
being able to make changes in DNA,
even for therapeutic purposes,
which is now curing sickle cell disease.
Unthinkable when I became director in 2009.
The ability to study single cells
and ask them what they're doing and get an answer.
Single cell biology just has emerged
in this incredibly powerful way.
Having the courage to be able to say,
"We could actually understand the human brain,"
seemed like so far out there.
And we're in the process of doing that
with the Brain Initiative.
Taking all that we've learned about the genome
and applying it to cancer,
to make individual cancer treatment really precision,
and developing cancer immunotherapy,
which seemed like sort of a backwater
into some of the hottest science around.
All those things sort of erupting,
and much more to come, I'm sure.
We're on an exponential curve of medical research advances,
and that's glorious to watch.
And of course, COVID-19,
as a beneficiary of decades of basic science,
understanding what mRNA is,
understanding basics about coronaviruses and spike proteins,
and how to combine structural biology,
and immunology, and genomics into this package
that allows you to make a vaccine in 11 months.
Just, I would never have imagined that possible in 2009.
So to have been able to kind of be the midwife,
helping all of those things get birthed,
that's been just an amazing 12 years.
And as NIH director, you have this convening power,
and this ability to look across the whole landscape
of biomedical research,
and identify areas that are just like ready
for something big to happen,
but isn't gonna happen spontaneously
without some encouragement,
without pulling people together from different disciplines
who don't know each other,
and maybe don't know how to quite understand
each other's scientific language,
and create an environment for that to happen.
That has been just an amazing experience.
I mean, I mentioned the BRAIN Initiative as one of those.
The BRAIN Initiative right now,
I think there's about 600 investigators working on this.
Last week, the whole issue of Nature Magazine
was about the output of the BRAIN Initiative,
basically now giving us a cell census
of what those cells in the brain are doing,
which has just never been imaginable.
And interestingly, more than half of the investigators
in the BRAIN Initiative are engineers.
They're not biologists in a traditional sense.
I love that.
Maybe partly 'cause my PhD is in quantum mechanics.
So I think it's really a good idea
to bring disciplines together and see what happens.
That's an exciting thing.
And I will not ever forget having the chance
to announce that program in the East Room
in that White House with President Obama,
who totally got it and totally loved science,
and working with him in some of those rare moments
of sort of one-on-one conversation in the Oval Office,
just him and me about science.
That's a gift.
- What's it like talking to Barack Obama about science?
He seems to be a sponge.
I've heard him, I'm an artificial intelligence person,
and I've heard him talk about AI.
And it was like, it made me think,
is somebody like whispering in his ear or something?
Because he was saying stuff that totally passed the BS test,
like he really understands stuff.
- He does.
- That means he listened to a bunch of experts on AI.
He was explaining the difference
between narrow artificial intelligence and strong AI.
He was saying all this,
both technical and philosophical stuff.
And it just made me, I don't know,
it made me hopeful about the depth of understanding
that a human being in political office can attain.
- That gave me hope as well, and having those experiences.
Oftentimes in a group, I mean, another example
where I was trying to figure out,
how do we take what we've learned about the genome
and really apply it at scale
to figure out how to prevent illness,
not just treat it, but prevent it,
out of which came this program called All of Us,
this million strong American cohort of participants
who make their electronic health records
and their genome sequences and everything else available
for researchers to look at.
That came out of a couple of conversations
with Obama and others in his office.
And he asked the best questions.
That was what struck me so much.
I mean, a room full of scientists,
and we'd be talking about the possible approaches,
and he would come up with this
§08Transcript · 1:04:07–1:12:52
incredibly insightful, penetrating question.
Not that he knew what the answer was gonna be,
but he knew what the right question was.
- I think the core to that is curiosity.
- Yeah.
- I don't think he's even like,
he's trying to be a good leader.
He's legit curious.
- Yes, legit.
- That he, almost like a kid in a candy store
gets to talk to the world experts.
He somehow sneaked into this office
and gets to talk to the world experts.
And that's the kind of energy that I think leads
to beautiful leadership in the space of science.
- Indeed.
Another thing I've been able to do as director
is to try to break down some of the boundaries
that seem to be traditional
between the public and the private sectors
when it comes to areas of science
that really could and should be open access anyway.
Why don't we work together?
And that was obvious early on.
And after identifying a few possible collaborators
who are chief scientists of pharmaceutical companies,
it looked as like we might be able
to do something in that space.
Out of that was born something called
the Accelerating Medicines Partnership, AMP.
And it took a couple of years of convening people
who usually didn't talk to each other.
And there was a lot of suspicion, academic scientists saying,
oh, those scientists in pharma, they're not that smart.
They're just trying to make money.
And the academic scientists getting the wrap
from the pharmaceutical scientists,
all they wanna do is publish papers.
They don't really care about helping anybody.
And we found out both of those stereotypes were wrong.
And over the course of that couple of years,
built a momentum behind three starting projects,
one on Alzheimer's, one on diabetes,
one on rheumatoid arthritis and lupus.
Very different, each one of them trying to identify
what is an area that we both really need to see advance
and we could do better together.
And it's gonna have to be open access,
otherwise NIH is not gonna play.
And guess what, industry?
If you really wanna do this,
you gotta have skin in the game.
We'll cover half the cost, you gotta cover the other half.
- I love it.
Enforcing open access, so resulting in open science.
- Millions of dollars gone into this.
And it has been a wild success.
After many people were skeptical,
a couple of years later we had another project on Parkinson's
more recently we've added one on schizophrenia.
Just this week, we added one on gene therapy,
on bespoke gene therapy for ultra rare diseases,
which otherwise aren't gonna have enough commercial appeal.
But if we did this together,
especially with FDA at the table, and they have been,
we could make something happen,
turn this into a sort of standardized approach
where everything didn't have to be a one-off.
I'm really excited about that.
So what began as three projects is six,
and it's about to be seven next year
with a heart failure project.
And all of us have gotten to know each other.
And if it weren't for that background,
when COVID came along, it would have been a lot harder
to build the partnership called ACTIV,
which has been my passion for the last 20 months,
accelerating COVID-19 therapeutic interventions
and vaccines.
I was at our leadership team meeting this morning.
It was amazing what's been accomplished.
That's pretty much a hundred people who dropped everything
just to work on this, about half from industry
and half from government and academia.
And that's how we got vaccine master protocols designed.
So we all agreed about what the end points had to be.
And you wondered why are there 30,000 participants
in each of these trials?
That's 'cause of ACTIV's group mapping out
what the power needed to be for this to be convincing.
Same with therapeutics.
We have run at least 20 therapeutic agents through trials
that ACTIV supported in record time.
That's how we got monoclonal antibodies that we know work.
That's been, that would not have been possible
if I didn't already have a sense of how to work
with the private sector that came out of AMP.
AMP took two years to get started.
ACTIV took two weeks.
We just kept the lawyers-
- Wow, to get a hundred people over?
- Yeah, kept the lawyers out of the room and away.
(laughing)
- Now you're gonna get yourself in trouble.
(laughing)
I do hope one day the story of this incredible vaccine,
development of vaccine protocols and trials
and all this kind of details,
the messy, beautiful details of science and engineering
and that led to the manufacturing, the deployment
and the scientific test.
It's such a nice dance between engineering
in the space of manufacture of the vaccines.
You start before the studies are complete,
you start making the vaccines just in case
if the studies prove to be positive,
then you can start deploying them.
Just like so many parties, like you said,
private and public playing together.
That's just a beautiful dance that is one of the,
is one of, for me, the sources of hope
in this very tricky time where there's a lot
of things to be cynical about in terms
of the games politicians play and the hardship experience
of the economy and all those kinds of things.
But to me, this dance was a vaccine development
was done just beautifully and it gives me hope.
- It does me as well.
And it was in many ways, the finest hour
that science has had in a long time being called upon
when every day counted and making sure
that time was not wasted
and things were done rigorously, but quickly.
- So you're incredibly good as a leader of the NIH.
It seems like you're having a heck of a lot of fun.
Why step down from this role after so much fun?
- Well, no other NIH director has served more
than one president after being appointed
by one, you're sort of done.
And the idea of being carried over
for a second presidency with Trump
and now a third one with Biden is unheard of.
I just think, Lex, that scientific organizations benefit
from new vision and 12 years is a really long time
to have the same leader.
And if I wasn't gonna stick it out
for the entire Biden four-year term,
it's good not to wait too late during that
to signal an intent to step down
'cause the president's gotta find the right person,
gotta nominate them, gotta get the Senate to confirm them,
which is a unpredictable process right now.
And you don't wanna try to do that
in the second half of somebody's term as president.
This has gotta happen now.
So I kind of decided back at the end of May
that this should be my final year.
And I'm okay with that.
I do have some mixed emotions 'cause I love the NIH.
I love the job.
It's exhausting.
I'm traditionally for the last 20 months anyway,
working 100 hours a week.
It's just, that's what it takes to juggle all of this.
And that keeps me from having a lot of time
for anything else.
And I wouldn't mind, 'cause I don't think I'm done yet.
I wouldn't mind having some time to really think
about what the next chapter should be.
And I have none of that time right now.
Do I have another calling?
Is there something else I could contribute
that's different than this?
I'd like to find that out.
- I think the right answer is you're just stepping down
to focus on your music career.
(laughing)
But-- - That might not be
a good plan for anything, very sustainable.
- But I think that is a sign of a great leader
as George Washington did stepping down at the right time.
- Ted Williams.
- Yes.
- He quit when, I think he hit a home run on his last at-bat
and his average was 400 at the time.
- No one to walk away.
I mean, it's hard, but it's beautiful to see in a leader.
You also oversaw the Human Genome Project.
You mentioned the Brain Initiative,
which has, it's a dream to map the human brain.
And there's the dream to map the human code,
which was the Human Genome Project.
And you've said that it is humbling for me
and awe-inspiring to realize
that we have caught the first glimpse
of our own instruction book, previously known only to God.
How does that, if you can just kind of wax poetic
for a second, how does it make you feel
that we were able to map this instruction book,
look into our own code and be able to reverse engineer it?
§09Transcript · 1:12:57–1:22:33
- It's breathtaking.
It's so fundamental.
And yet, for all of human history,
we're ignorant of the details
of what that instruction book looked like.
And then we crossed a bridge
into the territory of the known.
And we had that in front of us,
still written in a language
that we had to learn how to read.
And we're in the process of doing that
and will be for decades to come.
But we owned it, we had it.
And it has such profound consequences.
It's both a book about our history.
It's a book of sort of the parts list of a human being,
the genes that are in there and how they're regulated.
And it's also a medical textbook
that can teach us things that will provide answers
to illnesses we don't understand
and alleviate suffering and premature death.
So it's a pretty amazing thing to contemplate.
And it has utterly transformed the way we do science.
And it is in the process of transforming
the way we do medicine,
although much of that still lies ahead.
You know, while we were working on the Genome Project,
it was sort of hard to get this sense of a wow-ness
because it was just hard work.
And you were getting, you know, another megabase.
Okay, this is good.
But when did you actually step back and say, we did it.
It's the profoundness of that.
I mean, there were two points, I guess.
One was the announcement on that June 26, 2000,
where the whole world heard, well, we don't quite have it,
but we got a pretty good draft.
And suddenly people were like realizing,
oh, this is a big deal.
For me, it was more when we got the full analysis of it,
published it in February, 2001, in that issue of Nature,
paper that Eric Lander and Bob Waterston and I
were the main authors.
And we toiled over and tried to get as much insight
as we could in there about what the meaning of all this was.
But you also had this sense that we are
such beginning readers here.
We are still in kindergarten trying to make sense
out of this 3 billion letter book.
And we're gonna be at this for generations to come.
- You are a man of faith, Christian,
and you are a man of science.
What is the role of religion and of science in society
and in the individual human mind and heart like yours?
- Well, I was not a person of faith when I was growing up.
I became a believer in my 20s,
influenced as a medical student by a recognition
that I hadn't really thought through the issues
of what's the meaning of life?
Why are we all here?
What happens when you die?
Is there a God?
Science is not so helpful in answering those questions.
So I had to look around in other places
and ultimately came to my own conclusion that atheism,
which is where I had been,
was the least supportable of the choices
because it was the assertion of a universal negative,
which scientists aren't supposed to do.
And agnosticism came as an attractive option
but felt a little bit like a cop-out.
So I had to keep going, trying to figure out
why do believers actually believe this stuff?
And came to realize it was all pretty compelling.
That there's no proof.
I can't prove to you or anybody else that God exists,
but I can say it's pretty darn plausible.
And ultimately, what kind of God is it caused me
to search through various religions and see,
well, what do people think about that?
And to my surprise, encountered the person of Jesus Christ
as unique in every possible way
and answering a lot of the questions
I couldn't otherwise answer.
And somewhat kicking and screaming, I became a Christian.
Even though at the time, as a medical student
already interested in genetics,
people predicted my head would then explode
'cause these were incompatible worldviews.
They really have not been for me.
I am so fortunate, I think, that in a given day,
wrestling with an issue,
it can have both the rigorous scientific component
and it can have the spiritual component.
COVID-19 is a great example.
These vaccines are both an amazing scientific achievement
and an answer to prayer.
When I'm wrestling with vaccine hesitancy
and trying to figure out what answers to come up with,
I get so frustrated sometimes and I'm comforted
by reassurances that God is aware of that.
I don't have to do this alone.
So I know there are people like your friend, Sam Harris,
who feel differently.
Sam wrote a rather famous op-ed in the New York Times
when I was nominated as the NIH director
saying, "This is a terrible mistake."
You can't do this. - Oh no, Sam.
You can't have somebody who believes in God
running the NIH.
He's just gonna completely ruin the place.
- Well, I have a testimonial.
Christopher Hitchens, a devout atheist, if I could say so,
was a friend of yours and referred to you as,
quote, "One of the greatest living Americans,"
and stated that you were one of the most devout believers
he has ever met.
He further stated that you were sequencing the genome
of the cancer that would ultimately claim his life
and that your friendship,
despite their differing opinions on religion,
was an example of the greatest armed truce in modern times.
What did you learn from Christopher Hitchens about life
or perhaps what is a fond memory you have of this man
with whom you've disagreed but who is also your friend?
- Yeah, I loved Hitch.
I'm sorry he's gone.
Iron sharpens iron.
There's nothing better for trying to figure out
where you are with your own situation
and your own opinions, your own world views,
than encountering somebody who's completely in another space
and who's got the gift, as Hitch did,
of challenging everything
and doing so over a glass of scotch or two or three.
Yeah, we got off to a rough start
where in an interaction we had at a rather highbrow dinner,
he was really deeply insulting of a question I was asking,
but I was like, okay, that's fine.
Let's figure out how we can have a more civil conversation.
And then I really learned to greatly admire his intellect
and to find the jousting with him,
and it wasn't all about faith, although it often was,
was really inspiring and enervating, energizing.
And then when he got cancer,
I became sort of his ally,
trying to help him find pathways through the various options
and maybe helped him to stay around on this planet
for an extra six months or so.
And I have the warmest feelings
of being in his apartment downtown
over a glass of wine, talking about whatever.
Sometimes it was science, he was fascinated by science.
Sometimes it was Thomas Jefferson.
Sometimes it was faith.
And I knew it would always be really interesting.
- So he's now gone.
- Yeah.
- Do you think about your own mortality?
Are you afraid of death?
- I'm not afraid.
I'm not looking forward to it.
I don't wanna rush it,
'cause I feel like I got some things I can still do here.
But as a person of faith, I don't think I'm afraid.
I'm 71.
I know I don't have an infinite amount of time left,
and I wanna use the time I've got
in some sort of way that matters.
I'm not ready to become a full-time golfer.
(laughing)
But I don't quite know what that is.
I do feel that I've had a chance
to do amazingly powerful things as far as experiences,
and maybe God has something else in mind.
I wrote this book 16 years ago,
"The Language of God," about science and faith,
trying to explain how, from my perspective,
these are compatible, these are in harmony.
They're complementary if you are careful
about which kind of question you're asking.
And to my surprise, a lot of people
seemed to be interested in that.
They were tired of hearing the extreme voices,
like Dawkins at one end, and people like Ken Ham
and Answers in Genesis on the other end,
saying if you trust science, you're going to hell.
And they thought there must be a way
that these things could get along,
and that's what I tried to put forward.
And then I started a foundation, BioLogos,
which then I had to step away from to become NIH director,
which has just flourished, maybe because I stepped away,
I don't know. (laughing)
But it now has millions of people
who come to that website, and they run amazing meetings.
And I think a lot of people have really come to a sense
that this is okay, I can love science, and I can love God,
and that's not a bad thing.
So maybe there's something more I can do in that space.
§10Transcript · 1:22:37–1:26:47
Maybe that book is ready for a second edition.
- I think so.
But when you look back, life is finite.
What do you hope your legacy is?
- I don't know, this whole legacy thing
seems a little bit hard to embrace.
It feels a little self-promoting, doesn't it?
I sort of feel like in many ways,
I went to my own funeral on October 5th
when I announced that I was stepping down,
and I got the most amazing responses from people,
some of whom I knew really well,
some of whom I didn't know at all,
who were just telling me stories
about something that I had contributed to
that made a difference to them.
And that was incredibly heartwarming, and that's enough.
I don't wanna build an edifice,
I don't have a plan for a monument or a statue,
God help us. (laughing)
I do feel like I've been incredibly fortunate,
I've had the chance to play a role
in things that were pretty profound
from the Genome Project to NIH to COVID vaccines,
and I ought to be plenty satisfied
that I've had enough experiences here to feel pretty good
about the way in which my life panned out.
- We did a bunch of difficult questions in this conversation,
let me ask the most difficult one,
that perhaps is the reason you turned to God,
what is the meaning of life? (laughing)
Have you figured it out yet?
- Expect me to put that into three sentences?
- We only have a couple of minutes, so please hurry up.
(laughing)
- Well, that's not a question
that I think science helps me with,
so you're gonna push me into the faith zone,
which is where I'd wanna go with that.
I think, well, what is the meaning, why are we here,
what are we put here to do?
I do believe we're here for just a blink of an eye,
and that our existence somehow goes on beyond that
in a way that I don't entirely understand,
despite efforts to do so.
I think we are called upon in this blink of an eye
to try to make the world a better place,
to try to love people, to try to do a better job
of our more altruistic instincts,
and less of our selfish instincts,
to try to be what God calls us to be,
people who are holy, not people who are
driven by self-indulgence.
And sometimes I'm better at that than others.
(laughing)
But I think that, for me as a Christian, is a pretty clear,
I mean, it's to live out the Sermon on the Mount.
Once I read that, I couldn't unread it,
all those beatitudes, all the blesseds.
That's what we're supposed to do.
And the meaning of life is to strive for that standard,
recognizing you're going to fail over and over again,
and that God forgives you.
- Hopefully to put a little bit of love
out there into the world.
- That's what it's about.
- Francis, I'm truly humbled and inspired
by both your brilliance and your humility,
and that you would spend your extremely
valuable time with me today.
It was really an honor.
Thank you so much for talking today.
- I was glad to, and you ask really good questions.
So your reputation as the best podcaster
has borne itself out here this afternoon.
- Thank you so much.
Thanks for listening to this conversation
with Francis Collins.
To support this podcast, please check out
our sponsors in the description.
And now, let me leave you with some words
from Isaac Newton, reflecting on his life and work.
I seem to have been only like a boy,
playing on the seashore and diverting myself
in now and then finding a smoother pebble
or a prettier shell than ordinary,
whilst the great ocean of truth
lay all undiscovered before me.
Thank you for listening, and hope to see you next time.
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