Dr. Jay Bhattacharya, the new director of the National Institutes of Health, has inherited an agency in crisis. Everyone knows it.
Some think it began this year, with dramatic funding cuts and a hostile takeover by 20-year-old DOGE coders chugging energy drinks in some backroom. Others think it began years ago, with the disastrous handling of the Covid-19 pandemic.
To close observers, the original crisis began well before any of this, in the dawning realization that a lot of medical research is junk that can’t be reproduced, that promised cures have fizzled and that Americans shell out more money on health care than people in other wealthy countries and yet we are sicker and die younger. When all this is true, can we really say the so-called crown jewel of American medical science is succeeding?
Dr. Bhattacharya has promised to fix the decades-old problems at the government’s research funding juggernaut. He spent his career as a Stanford health economist, publishing over 100 studies on chronic disease, health outcomes for marginal populations, the cost of health care and why research funders don’t take enough risks.
He’s perhaps best known to the American public as one of the most outspoken critics of the public health establishment during Covid — a foil to Dr. Anthony Fauci, the former longtime director of the National Institute of Allergy and Infectious Disease. It’s surely why President Trump first eyed him for the job. In the earliest days of Covid, Dr. Bhattacharya became a leading skeptic of lockdowns and of whether the virus was as lethal as health leaders then believed. In October 2020, he co-authored the Great Barrington Declaration, a manifesto that advocated a dramatic shift toward “focused protection” for high-risk people like nursing home patients, while everyone else should “resume life as normal.” Critics called it let it rip.
The rest is history. The pandemic became defined as an epic struggle of the Dr. Fauci/President Joe Biden camp against the Dr. Bhattacharya/Trump camp. The Fauci camp won the battle. The Bhattacharya camp won the war.
In reading his research, listening to his interviews, talking to his colleagues and interviewing him directly, I came to see Dr. Bhattacharya as a firebrand, yes, but only by circumstance. He believes that science has been going down blind alleys, defending ideas “not because they’re good ideas, but because the people that have those ideas are powerful.”
His real dream is for the Covid and D.E.I. culture wars to wind down so he can be the one to forge science’s new peace — to enact deep reform that brings new purpose to the agency. “I love the N.I.H.,” he said during his confirmation hearing in March. He told me in May of his deep belief in scientific reason. “The power of science to solve problems is almost limitless,” he said.
This all sounds great. And many of the moves he’s made so far, like restricting risky virus research and requiring more oversight for funding recipients abroad, were badly needed.
But it is tough to square his lofty talk of reason with the blunt instrument the Trump administration has been wielding: culling grants that use words like “diversity,” whether it refers to race or airborne toxins; halting vast medical grant portfolios for powerhouses like Harvard over allegations of antisemitism; dramatically slowing grant payouts across the board; and a proposal to slash the N.I.H. budget by a staggering 39 percent.
Then there is the axing, ordered by Health Secretary Robert F. Kennedy Jr., of nearly $500 million in Health and Human Services Department funding for research into mRNA vaccines for respiratory illnesses, including Covid and flu. Dr. Bhattacharya wrote a Washington Post opinion essay defending this move by his boss as a “necessary pivot” to rebuild public trust. This is peculiar: If the problem is that the government isn’t delivering enough breakthroughs, why kill the most famous example this century of the government doing exactly that?
Below Dr. Bhattacharya is an entrenched bureaucracy. Above him are powerful bosses, focused so far on crackdowns. The hope is that his earnest belief in the promise of science will produce political strength, enough to move past punishment and bring new vitality to American science. The question is whether he is in over his head.
Reader, be honest: Do you know what the N.I.H. does, beyond, well, health stuff?
The formal answer is that the agency is the largest funder of medical research in the world. Technically, it is 27 separate institutes and centers, focused variously on cancer, allergy and infectious diseases, alcoholism, aging and so on. Last year, it allocated $37 billion in grants, training and other funding to research institutions around the country, and $5 billion for research on its own campuses.
Unlike, say, the Department of Education, the N.I.H. has long been a political darling. For decades, it’s been a favorite vehicle for lawmakers from both parties to roll out glitzy new programs. Congress more than tripled its funding in real dollars from 1980 to 2003, where it has roughly stayed since.
And yet if you talk to policy researchers across the political spectrum, their complaints are endless:
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That the agency favors incremental research over new cures.
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That the process for picking grants doesn’t encourage breakthroughs, but enforces herd thinking.
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That medical researchers have to spend vast amounts of their time — by some estimates, 40 or 50 percent — writing grant proposals.
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That the scientific work force is graying: Between 1986 and 2021, of the advanced degree holders who got early-career grants from N.I.H., the share who were younger than 40 fell from 36 percent to just 8 percent.
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That all these decades later, we still don’t have the cure for cancer or Alzheimer’s, obesity rates are skyrocketing, life expectancy is flatlining and health care costs more than ever.
“We’ve built a system that’s really good for scientists to produce papers,” said Dr. Robert Cook-Deegan, a professor at Arizona State University and one of the most influential scholars of N.I.H. reform, “but we haven’t produced a system that’s really good at translating those papers into health outcomes.”
Many reformers agree that the N.I.H. has become too cautious, like an investor who always picks reliable, boring bonds over high-risk, high-reward start-ups. Dr. Bhattacharya’s own research has shown this to be true. In 2018 and 2020, he co-authored studies showing that the N.I.H. has become “more conservative” and less willing to fund novel “edge science,” such as cancer therapies that use a patient’s own immune cells.
If you listen to the priorities Dr. Bhattacharya laid out during his confirmation hearing, you’ll hear some sharp notes of Covid reckoning. But the melody — we need more replication, bolder research bets and better health outcomes — is an old refrain, one reformists have been singing since long before the pandemic.
These are worthy goals. But how is it going?
Asked, for example, about Mr. Trump’s proposed 39 percent cut to the N.I.H., Dr. Bhattacharya told me he is “obligated to not attack the proposals the administration put forward.” Instead, he pointed to a letter the president had sent to his top science adviser, pledging that America would lead the world in 21st-century biomedicine. “I’m going to work my hardest to implement that policy,” he told me.
His signature policies so far, especially on D.E.I., gain-of-function research (experiments that make pathogens more dangerous, and that may well have caused the Covid pandemic) and closing reporting loopholes that left the agency in the dark about what foreign research partners like the Wuhan lab were doing, may look like red meat for the MAGA base. But they also address real mistakes that bolster his argument that science has become a monoculture, too afraid to upset the party line. One of his big ideas for reform is to steer power away from the N.I.H. director to the heads of the agency’s 27 centers. This would ensure a diversity of ideas, which leads to the truth faster, he argues.
Ultimately, Dr. Bhattacharya believes that America is at risk of stagnating in medical science, and that to make America healthy again, the main thing needed is to make science more rational and open. This is what he repeatedly calls his “matter of faith.”
Dr. Bhattacharya is at his most compelling, his most charismatic when he hits these notes. Researchers who know him consistently told me that, sure, he bucked the establishment on Covid, but was eminently sane about it, not a rote contrarian. Robert P. George, a Princeton political philosopher and a colleague of both mine and Dr. Bhattacharya’s, told me he is “a person of absolutely impeccable integrity.”
What comes through as the unifying theme of Dr. Bhattacharya’s pandemic work and his theory for reforming the N.I.H. is this: There is nothing so wrong with science that it can’t be fixed by more and better science, letting all ideas be debated with honesty, smarter cost-benefit analysis and a more rational process.
Take Alzheimer’s research. Nearly every scientific research reformer will cite the fact that the N.I.H. funded vast amounts of research based on a single theory of the disease that largely turned out to be wrong.
Dr. Bhattacharya argues that this happened because science is structured around authority. “You have, in field after field after field, a kind of set of dogmatic ideas held by the people who are at the top of the field. And if you don’t share those ideas, you have no chance of advancing within those fields,” he told me.
He told Congress that he believes there are promising ways to prevent Alzheimer’s that haven’t received support because they don’t align with the “dominant narrative,” as he called it. “This is why I’m so interested in replication,” he told me, referring to the need for researchers to repeat each other’s findings, because it “turns over the determination of what’s true to nature rather than authority.”
It’s a plausible diagnosis and a good prescription. Science can’t answer questions if it’s conformist. But there’s another way to think about the problem.
Dr. Susan M. Fitzpatrick, a former biochemist, has pointed not to ideology but the mechanics of research. Large-scale medical studies rely on standardized methods, one of which is testing theories on mice. But mice don’t get Alzheimer’s, only humans do. So studying them might be useless. Yet, she wrote, this approach “dominates federal funding and academic science” on Alzheimer’s research because it easily produces the publications and citations that careers depend on.
From this angle, the N.I.H. looks like a big factory that churns out research papers. Dr. Bhattacharya is like a new manager trying to figure out why sales are down and proposing more diversity in the product line.
For the sharpest reformers, like Dr. Cook-Deegan and Dr. Fitzpatrick, the issue isn’t which group of scientists’ ideas win out. It’s that when countless jobs and storied institutions depend on the mills to keep churning, it stops mattering what comes out on the other end. The question is not whether the factory’s settings are wrong but whether it should be a paper factory in the first place.
Perhaps the best way to look at the N.I.H. is as a small country. It’s been around since 1887 and has a budget of $48 billion, larger than the defense budget of Taiwan or the entire G.D.P. of Iceland. It has a federalized structure for its dozens of states.
It even has a stable elite (lab scientists at prestige universities), an insecure elite (grad students and flyover-state scientists), a working class that feels unrepresented (clinicians), and a shadow elite some suspect of really pulling the levers (pharma). It has a mythology of its past glories. It’s anxious that greatness now lies behind it.
The malaise scholars describe sounds like the problems of a stagnant nation: deeply entrenched interests, lack of political representation and institutions that have lost a clear goal beyond preserving themselves. Notably absent in the class structure of the N.I.H. are patients, who are supposed to be its main beneficiary. No wonder it’s not delivering for them.
This suggests that the answer lies in the lowly world of politics. Dr. Bhattacharya is looking for answers in the lofty world of ideas.
The debate over vaccines is an obvious issue where these two worlds might tug him in opposite directions. A flashpoint for vaccine skeptics is the belief that vaccines cause autism. Multiple studies looking collectively at over a million children show no causal link. Definitive proof is rare in medicine, but that is very strong evidence. And yet public belief in this idea persists.
Dr. Bhattacharya says he’s persuaded that the observational studies disprove any link; he’s said in multiple interviews that vaccines are one of the most effective interventions of modern medicine. This suggests he really is driven by truth, since that idea seems nearly unsayable now in anti-establishment circles. But it also makes his vigorous defense of those who do believe otherwise, including Mr. Kennedy, all the more curious.
Dr. Bhattacharya thinks conducting even higher-quality research, like the gold standard, randomized controlled trials, would address the concerns of people unconvinced by the existing data. But many suspect that Mr. Kennedy’s coming federal study on the causes of autism will use poor methodology to shoehorn a link to vaccines that he’s determined to find.
I asked Dr. Bhattacharya: What if scientists performed the best study imaginable, it found no link, and people still believed there was one anyway?
His answer was that public behavior really does follow evidence. Use of the measles, mumps and rubella vaccine, for example, is still very high, at 93 percent of kindergartners, whereas uptake of the Covid-19 vaccine is at only about 13 percent of children and teens. “That reflects the scientific evidence on the necessity of those vaccines,” he said. In his view, “the public is more sensible” than the Centers for Disease Control and Prevention is on this issue, because they correctly see one vaccine as more beneficial than the other, whereas by putting both vaccines on the childhood schedule, the C.D.C. implies that they are similarly useful. “People are much more reasonable when it comes to science than you think,” he said. “And using force to try to get people to agree with you in science has no place, actually, in science. Reason is the way forward.”
This is a sharp answer. And as a directional matter, I think Dr. Bhattacharya is right. On countless critical questions in the pandemic we saw a pattern where the authorities would circle the wagons of “settled science” to stifle debate, when in reality the science was not settled. When the Great Barrington Declaration was published, Francis Collins, then head of the N.I.H., blasted the authors as “fringe epidemiologists,” and privately emailed Dr. Fauci, “There needs to be a quick and devastating published take down of its premises.” There was also the ever-shifting guidance we were given — don’t mask, now do mask; two weeks to slow the spread, then two years; the six-foot rule; the virus is not airborne; don’t even ask if it came from a lab.
At the time, Americans were told that all this was just what the science said. Later, authorities grudgingly acknowledged they had largely been making this up as they went along because they didn’t know the answers yet. Of course they didn’t. But maybe if they had projected less panicky confidence in the science, they would have had a clearer incentive to do more of it and get some answers.
In crucial ways, Dr. Bhattacharya’s story still sounds off — as if there is a pure world where everyone is as rational as he is, a world just waiting for us to get back to it.
Take Sweden, which figures repeatedly in his public comments as the fabled Country That Got Covid Right — the country that believes in science, the place America could be. In important ways this is true: Sweden wisely avoided the greatest mistake of the pandemic by minimizing school closings. It averted learning losses. It didn’t impose lockdowns.
To Dr. Bhattacharya, as he said in a 2023 interview, this shows that “We could’ve avoided all the suffering caused by the lockdowns: the closed businesses, the unemployment, all of that.” And it was all possible because Swedes “trust Swedish public health because they were honest about their mistakes, honest about their reasoning.”
I don’t think he has either part of this story right. When you look at the observable behavior of Swedes during Covid, you see something different. In Stockholm, the number of trips on the train and tram taken in April 2020 was 60 percent below pre-pandemic levels. A year later, it was still depressed by 50 percent. A comprehensive economic analysis found that the pandemic induced a “drastic economic recession” in Sweden, including a 48 percent drop in hotel and restaurant sales in the initial months, and unemployment at the highest level since the Great Recession, persisting into late 2021.
Sweden’s behavior was more like America’s than different. For all it got right, it did not achieve the core goal of the Great Barrington Declaration — focusing protection on the vulnerable minority, while society broadly carried on normally.
The difference, as researchers have shown, is that Sweden achieved through voluntarism what so many other countries achieved through legal force. That is not because Swedes have unusually honest scientists, but because they have an unusual union with the state — powerful social services that create powerful trust. I know Swedes who believe that their government’s pandemic response was much more coercive than Americans understand, both in enforced restrictions and follow-our-advice-or-else pressure.
I revisit Covid here not to settle scores, but because it was the time when Dr. Bhattacharya put his political theory of science to the test. And the theory failed. The difference was not in ideas but in social arrangements, ones alien to us because Sweden is another country.
Dr. Bhattacharya’s ideas for making science more reliable, more innovative, more honest and better at making America healthy seem, by and large, a breath of fresh air. But it is all just so … polite. So neat.
Does this sound like the world we are living in now?
From a health secretary who has suggested that the polio vaccine killed more people than it saved, to over 1,000 public health experts saying that breaking the Covid lockdowns in 2020 to join racial justice protests was “vital to the national public health,” the old social contract for science has shattered. Strange new forces are on the loose. Even if he didn’t mean to, Dr. Bhattacharya helped set them free. These forces may now have more say over him than he has over them.
The mRNA vaccine decision was the clearest test case yet of how his idealism will go once released into the wild. In The Washington Post, he acknowledges that the Covid vaccines saved millions of lives without known safety problems. He notes unanswered questions, around dosing and side effects. But when push came to shove, his response to these questions was not, let’s answer them with science, as he told me, but: Shut the science down. It turns out that the power of science to solve problems has limits after all.
The problem with Dr. Bhattacharya is not that he’s cynical, as his critics say. It’s that his theory is naïve about power, and so could easily become a mouthpiece for it. America’s golden age of innovation, backed by levels of public investment that make us the envy of the world, has been nice while it’s lasted. If we want to keep it going, this moment may call less for a fresh infusion of reason than some new animating spirit, not a new Galileo but a new Robert Moses, Carl Sagan, or J. Robert Oppenheimer. Let us hope that Jay Bhattacharya still has it in him. The country needs it.
Ari Schulman is the editor of The New Atlantis: A Journal of Technology & Society.
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Wants to Fix Science.
Is He in Over His Head? appeared first on New York Times.
