\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News\u2019 weekly health policy news podcast, \u201cWhat the Health?\u201d A noted expert on health policy issues, Julie is the author of the critically praised reference book \u201cHealth Care Politics and Policy A to Z,\u201d now in its third edition.\t\t<\/p>\n This week, KFF Health News\u2019 \u201cWhat the Health?\u201d presents a conversation with Francis Collins, former National Institutes of Health director and White House science adviser.<\/p>\n Collins, the longest-serving presidentially appointed head of the nation\u2019s crown jewel of biomedical research, spoke last month with KFF Health News\u2019 chief Washington correspondent, Julie Rovner. He has a new book out, called \u201cThe Road to Wisdom: On Truth, Science, Faith, and Trust.\u201d<\/p>\n In this interview, Collins discusses what may lie ahead for NIH in the coming Trump administration; how he and other science leaders failed to communicate to the public during the covid-19 pandemic; and his work with the group Braver Angels, which aims to facilitate conversations among people who disagree on policy issues.<\/p>\n \t\t\t\t\tClick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: Francis Collins on Supporting NIH and Finding Common Ground<\/strong>\t\t\t\t<\/p>\n [<\/em>Editor\u2019s note:<\/em><\/strong> This transcript was generated using both transcription software and a human\u2019s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong> Hello, happy new year, and welcome back to \u201cWhat the Health?\u201d I\u2019m Julie Rovner, chief Washington correspondent at KFF Health News. Usually I\u2019m joined by some of the best and smartest health reporters in Washington, but today we have a special holiday episode for you. Last month, I got the chance to chat with Francis Collins, former director of the National Institutes of Health, about a variety of subjects. Regular podcast listeners will know we used some of the excerpts of that discussion a couple of weeks ago, but today we\u2019re bringing you the entire interview. I hope you enjoy it, and we\u2019ll be back with all the news starting next week. So, here we go.\u00a0<\/p>\n I am so pleased to welcome to the podcast Dr. Francis Collins, former director of the National Institutes of Health, and former White House science adviser and former director of the National Human Genome Institute, who led the effort to map the human genome. He also has a new book out this holiday season called \u201cThe Road to Wisdom: On Truth, Science, Faith, and Trust.\u201d\u00a0<\/p>\n Dr. Collins, it\u2019s so great to have you here.\u00a0<\/p>\n Francis Collins:<\/strong> Hey, Julie, it\u2019s great to be with you. We go way back on a lot of interesting topics in health and medical research, and let\u2019s get into it here.\u00a0<\/p>\n Rovner:<\/strong> I want to start with some very basics because we have lots of student listeners and people who know a lot about health policy but less about science. So what is the NIH, and how does it work?\u00a0<\/p>\n Collins:<\/strong> It is the largest supporter of biomedical research in the world. The National Institutes of Health, supported by the taxpayers with money that\u2019s allocated every year by the Congress, is the main way in which, in the United States, we support basic medical research, trying to understand the details about how life works and how sometimes things go wrong and disease happens, and then carries those discoveries forward to what you might call the translational part, take those basic findings and try to see how could they actually improve human health in the clinic. And then working with industry, make sure if there\u2019s an idea then for an intervention of some sort that it gets tested rigorously in clinical trials and, if it works, then it\u2019s available to everybody.\u00a0<\/p>\n So when you look at what\u2019s happened over the course of many decades in terms of advances in human health, like the fact that reductions in heart attacks and strokes have happened rather dramatically, the cancer death rates are falling every year, where does that come from? An awful lot of that is because of the NIH and the thousands and thousands of people who work on this area, supported by those dollars that come from NIH, both a little bit in our own location in Bethesda, Maryland, but most of the money goes out to all those universities and institutes across the country and some outside the country.\u00a0<\/p>\n Rovner:<\/strong> Yeah, I was going to say, I happen to live right up the street from the campus in Bethesda, but I know that that\u2019s not where most of the money goes. It goes to the rest of the country.\u00a0<\/p>\n Collins:<\/strong> Right. Eighty-five percent of the dollars are given out to people who write grant applications with their best and brightest and boldest ideas, and they get sent and reviewed by peers who have scientific expertise to be able to assess what\u2019s most likely to make real progress happen. And then, if you get the award, you have three to five years of funding to pursue that idea and see what you can learn. Unfortunately, even though the budget for NIH has been reasonably well treated, especially in the last, oh, eight or nine years, it\u2019s still the case that most applications that come into NIH get rejected. Only about 20% of them can be actually paid for with the current budget we have. So, sad to say, a lot of good ideas are left on the table.\u00a0<\/p>\n Rovner:<\/strong> And yet, for more than three decades now, the NIH has been kind of a bipartisan darling with strong financial support from Democrats and Republicans in both the White House and in Congress. Now we have an administration coming in that\u2019s calling for some big changes. Could NIH honestly use some reimagining? It\u2019s been a while.\u00a0<\/p>\n Collins:<\/strong> Oh, sure. I mean, I was privileged to be the NIH director for 12 years. I did some reimagining myself in that space. One of the first things I did when I got started was to create a whole new part of NIH called NCATS, the National Center for Advancing Translational Science, because it seemed that some of these really exciting basic science discoveries just sort of landed with a thud instead of moving forward into clinical applications. NCATS has done a lot to try to change that. So yeah, there\u2019s always been this sense of this is the crown jewel of the federal government, but it could even be better. So let\u2019s try to work on that.\u00a0<\/p>\n I hope that\u2019s what\u2019s going to happen in this next iteration \u2014 find things to fix. If it\u2019s more an idea of let\u2019s just blow the whole thing up and start over, then I\u2019m opposed, because I think the rest of the world just has this great admiration for NIH. Many of them would say this is the most amazing engine for medical discovery that the world has ever known. Let\u2019s certainly optimize it if we need to. But my goodness, the track record is phenomenal. And the track record is both about advances in health and it\u2019s also about economic growth, which people are rightly concerned about as well. Every dollar that NIH gives out in a grant returns $8.38 in that return on investment to the economy within a few years. So if you wanted to just say, \u201cWell, let\u2019s just try to grow the economy,\u201d and didn\u2019t even care about health, NIH would still be one of your best bets.\u00a0<\/p>\n Rovner:<\/strong> So one of the things that Robert F. Kennedy Jr., who\u2019s [President-elect Donald] Trump\u2019s pick to lead HHS [the Department of Health and Human Services], has talked about is taking a break from the federal government researching infectious diseases and concentrating on chronic diseases instead. Do you think that\u2019s a good idea for the NIH?\u00a0<\/p>\n Collins:<\/strong> Well, NIH does a lot on chronic diseases. Let\u2019s be clear about that. Infectious disease has certainly gotten a lot of attention because of covid and the controversies around that. Although, let me also step back and say what was done during covid, the development of a vaccine in 11 months that is estimated to have saved 3.2 million lives in the U.S. alone, is one of the most amazing scientific achievements ever and shouldn\u2019t be somehow pushed aside as if that wasn\u2019t a big deal. That was a huge deal. But infectious diseases are still out there, and with everything that we see now with things like H5N1, there\u2019s a lot of work that needs to be done.\u00a0<\/p>\n Sure, chronic diseases deserve a lot of attention, but let\u2019s look at what\u2019s happening there with cancer, with Alzheimer\u2019s disease, with diabetes, with heart disease. Those are huge current investments at NIH. Could we look at them closely and ask are they being absolutely optimally spent? That\u2019s always an appropriate question to ask, but it\u2019s not as if this has been sort of ignored.\u00a0<\/p>\n Look at the project that I had something to do with starting called All of Us, which is an effort to look at all kinds of illnesses in a million people, a very diverse group, and figure out how not to just do a better job of treating chronic disease but how to prevent it. That\u2019s an incredibly powerful resource that\u2019s now beginning to build a lot of momentum, and there\u2019s a place where maybe even a little bit more attention to All of Us could be helpful, because we could go faster.\u00a0<\/p>\n Rovner:<\/strong> So it\u2019s not just either\/or?\u00a0<\/p>\n Collins:<\/strong> No, it shouldn\u2019t be either\/or. And, I mean, look around your own family and the people you care about. What are the diseases that still need answers? There\u2019s plenty of them, and they\u2019re not all in one category or another. This is what NIH has always been charged to do. Look across the entire landscape, rare diseases as well as common diseases, infectious diseases, as well as things that are maybe caused by environment or diet. All of that has to be the purview, otherwise we\u2019re not really serving all the people.\u00a0<\/p>\n Rovner:<\/strong> So, you\u2019re unique in many ways, but a big one is that you\u2019ve managed to simultaneously be a person of faith and a person of science. So often those things are at odds. Why is that so difficult for so many people? You don\u2019t seem to have a lot of trouble with it.\u00a0<\/p>\n Collins:<\/strong> I don\u2019t, but there\u2019s a long history here. Maybe it helps me that I did not grow up as a person of faith. I was an atheist when I was in graduate school studying quantum mechanics, and then I went to medical school and discovered that my answers to really important questions like What\u2019s the meaning of life?<\/em> were a bit thin. Atheism didn\u2019t help me so much, and I really felt I had to do some work to explore that and, ultimately, over a couple of years of that work, came to the conclusion that for me, both in terms of the rational arguments and also the sort of spiritual calling, that I felt that I couldn\u2019t be an atheist anymore, and I became a Christian.\u00a0<\/p>\n Everybody predicted around me that my head would explode because this was going to be incompatible with my scientific loves, one of which was genetics, but it never happened. I think we have a lot of preconceived ideas about what has to be the perspective of faith or the perspective of science. When you look more closely, there\u2019s actually more room there to figure out how these two ways of finding truth, ways of knowing, can actually inform each other. And for me, being able to have all of the questions on the table, not just the science questions or not just the faith questions but all of them that you can think through on a given Thursday, feels like a good thing, and it\u2019s incredibly enriching. But I am sorry that not everybody sees it that way.\u00a0<\/p>\n Anybody listening to this that wants to look at a good dialogue about this that\u2019s going on quite vigorously, go to the website BioLogos, B-I-O-L-O-G-O-S. A couple million people there are engaged in deep and very civil discussions about how science and faith can speak to each other in useful ways.\u00a0<\/p>\n Rovner:<\/strong> Well, that\u2019s kind of a perfect segue because one of the things you write about in your new book is how we\u2019ve become a society that\u2019s distrustful, not just of science but of all expertise. How can the scientific community start to rebuild that trust that we used to have?\u00a0<\/p>\n Collins:<\/strong> Well, let\u2019s be clear, trust in everything has been deteriorating. Institutions across the board have lost trust by various surveys that Gallup does, and that\u2019s part of, I think, a reflection of society kind of falling into this place of skepticism and even cynicism and a likelihood to assume that anything that sounds like expertise might also be elitist and might not be good for me. This is a dangerous place to be. Society has to have institutions that are reliable and dependable and kind of create a \u201cconstitution of knowledge\u201d that Jonathan Rauch writes about. But right now, all of that seems a bit in jeopardy. And science is just one of those sources of truth that now some people are questioning. But can I trust what science has said about something?<\/em> Well, we all have to, I think, learn our own skill set, again, about how to assess information and the sources of it and whether it should be trusted. And we should not be using where we currently live, in a particular bubble, as a means of deciding whether to accept a claim or not, because there\u2019s a lot of stuff happening in bubbles that isn\u2019t true.\u00a0<\/p>\n So part of it is our own need to come back to that kind of filtering. But for scientists, I think we are very much in the space now of having to be more in the world, in the arena, and willing to listen to objections and not get defensive and come back again with thoughtful, winsome explanations about how science works and how science is self-correcting. And even though sometimes science makes mistakes, they won\u2019t be mistakes for very long, because somebody will come along and figure out that wasn\u2019t right and it\u2019ll get corrected. That should be very reassuring. But oftentimes today, that information is less well understood. Maybe part of what happened during covid is that much of the science information seemed to be coming down from elitist voices like me that weren\u2019t as close to the community as people would\u2019ve wanted to see and maybe would\u2019ve had more trust in. So we\u2019ve got to diversify the sources of science communication and not have it be so much focused in just a few places.\u00a0<\/p>\n Rovner:<\/strong> Do scientists need to be more humble, if you will? I mean, more honest about there\u2019s a lot of things we don\u2019t know, and we\u2019re getting new information every day, and that might change what we say? I feel like there wasn\u2019t maybe enough of that during covid.\u00a0<\/p>\n Collins:<\/strong> I totally agree, and I talk about that in the book. I wish those times when I was shoved in front of a camera during 2020 and \u201921 and asked \u201cOK, what should the public do today to protect themselves?\u201d that I would\u2019ve started the answer with: \u201cWell, there\u2019s a lot we don\u2019t know yet, but let me tell you the best we can do with the information we have. But don\u2019t be surprised if a week or a month from now that information changes. This is how science works, and we\u2019re in the process of learning about this diabolical virus, and we don\u2019t have all the data yet.\u201d I wish we\u2019d said that more often. Yeah, I think all sources, if you want to be regarded as reliable, you need to have integrity. You\u2019ve got to be honest. You\u2019ve got to have competence. You have to have done the work. And, I\u2019m sorry, a lot of what\u2019s on social media does not meet that standard.\u00a0<\/p>\n Rovner:<\/strong> No, I think\u2014\u00a0<\/p>\n Collins:<\/strong> And then you\u2019ve got to have \u2014 and humility. Like you said, humility. I think anybody who\u2019s basically saying, \u201cWell, I know something about this area, so now I know something about everything\u201d \u2014 celebrities, listen up here \u2014 that is probably not the kind of source that you want to necessarily attach yourself to. But it happens a lot. So integrity, competence, humility, use those as your standards for deciding whether to trust a particular source or an institution.\u00a0<\/p>\n Rovner:<\/strong> I know you\u2019re active in a group called Braver Angels, which you\u2019ve described as marriage counseling for our country, which clearly we need.\u00a0<\/p>\n Collins:<\/strong> We do.\u00a0<\/p>\n Rovner:<\/strong> Can you tell us a little bit about that?\u00a0<\/p>\n Collins:<\/strong> So, they got started eight years ago with increasing sense of the polarization, the divisiveness, and, \u201cWait a minute. This isn\u2019t what we want to be. How do we bring people back together?\u201d And they create an environment where people on opposite sides of an issue \u2014 maybe it\u2019s gun control or immigration or public health \u2014 have to actually get together and listen to each other, for starters. No, and you\u2019re not allowed to start shouting. You have to listen carefully to what the opposite side says about their view on this well enough that you can speak it back to them and say, \u201cHere\u2019s what I heard you say,\u201d and have them say, \u201cYeah, that\u2019s what I said.\u201d We don\u2019t do that very well.\u00a0<\/p>\n Right now, in those circumstances, it\u2019s more like: \u201cOK, they just said this. Let me plan what I\u2019m going to say back to prove them wrong.\u201d And you have this snappy response back and forth, and nobody actually changes their view at all. Having done a lot of these sessions with Braver Angels, I\u2019ve learned things that I didn\u2019t know before about how people, for instance, who felt the covid response was ham-handed in their particular local environment. Yeah, I can kind of see how it was, and ideally it would\u2019ve been better if we\u2019d had a more appropriate response that depended on community circumstances instead of trying to do one size fits all. Of course, it was all a crisis and we didn\u2019t have much chance to do that, but they\u2019ve got a point. If you\u2019re in the heartland somewhere, all of the things that were decided, much of which seemed to be particularly relevant to the big cities, didn\u2019t seem like it was a great fit for them.\u00a0<\/p>\n That\u2019s an example of a kind of thing. And I\u2019ve become friends with a lot of the people who initially I thought, \u201cWell, I could never get along with that person,\u201d but now I understand who they are. And we still disagree, and I still think they\u2019re wrong about things and they think I\u2019m wrong about things, but we can have that disagreement and not be disagreeable, and we can actually go to the bar afterwards and have a beer. It\u2019s OK. We need a lot more of that.\u00a0<\/p>\n Rovner:<\/strong> Yes, we do. Well, you had a very long and decorated career. Is there one more big thing you hope to accomplish before you actually retire? I know you\u2019re still busy in your lab.\u00a0<\/p>\n Collins:<\/strong> Busy in my lab, and I am still working on a project that I started when I was the president\u2019s science adviser, which is an effort not to create a new solution to a disease but to get it implemented. And that is the disease called hepatitis C. And I continue to be the lead for the White House in trying to get a program underway that would find, test, treat, and cure as many of the 4 million Americans who are currently infected with this viral disease. We have a cure for this disease. It\u2019s amazing \u2014 one pill a day, 12 weeks, 95% effective, no side effects. And yet, because many of the people who are infected are not in the best place \u2014 they might be on Medicaid, they might be uninsured, they might be in the criminal justice system, because a lot of this relates to intravenous drug use \u2014 they don\u2019t have access. And they\u2019re all trying to get back on their feet and they\u2019re not going to get back on their feet if we don\u2019t do something about this, and then end up with a terrible outcome of cirrhosis, liver cancer, and early death.\u00a0<\/p>\n I watched my brother-in-law die of this, and it is a horrible disease, and it\u2019s totally preventable now. So we have a program, which I am totally confident if we can get it launched, maybe even in the next few weeks, this could save thousands and thousands of lives \u2014 and also, by the way, billions of dollars for health care that won\u2019t be needed for all those transplants and liver cancer treatments because we\u2019ll prevent them.\u00a0<\/p>\n So I am a bit obsessed about this. Maybe you\u2019re sorry you asked if I had one more thing. This is the one more thing that I am totally devoted to getting into the end zone.\u00a0<\/p>\n Rovner:<\/strong> No, that\u2019s super cool, and also, what a great example of something that medical research has done to help health care in the United States.\u00a0<\/p>\n Collins:<\/strong> Absolutely. We just have to do the implementation part. How hard can it be?\u00a0<\/p>\n Rovner:<\/strong> A good place to leave it for now. Dr. Francis Collins, thank you so much for joining us. I hope we can call on you again.\u00a0<\/p>\n Collins:<\/strong> Please do, Julie. It\u2019s always great to talk to you. Thanks for everything you\u2019re doing to spread the word about what we can do about health care. We can do a lot.\u00a0<\/p>\n Rovner:<\/strong> I hope so. Thank you.\u00a0<\/p>\n OK. That\u2019s this week\u2019s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We\u2019d appreciate it if you left us a review. That helps other people find us, too. Special thanks again this week to our temporary producer, Taylor Cook, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. We\u2019re at whatthehealth@kff.org, or you can still find me at X, @jrovner<\/a>, and increasingly at Bluesky, @julierovner.bsky.social<\/a>. We\u2019ll be back in your feed next week. Until then, be healthy.\u00a0<\/p>\n \tTaylor Cook \tEmmarie Huetteman To hear all our podcasts,\u00a0click here<\/a>.<\/em><\/p>\n And subscribe to KFF Health News\u2019 \u201cWhat the Health?\u201d on\u00a0Spotify<\/a>,\u00a0Apple Podcasts<\/a>,\u00a0Pocket Casts<\/a>, or wherever you listen to podcasts.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n
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