Whither NIH and Life Expectancy?

My latest copy of Imprimis, a publication of the beloved-by-conservatives Hillsdale College, has the essay “Launching a Second Scientific Revolution” by Jay Bhattacharya, Director of the National Institutes of Health. He explains how he is reshaping the NIH to address what he says are three great problems that science now faces.

First, he notes that many published scientific results turn out not to be true (how many, he doesn’t say). Bhattacharya states that this problem can be addressed if NIH funds more replication research. This, he says, will make it easier to find whether scientific ideas have validity.

Second, he wants to address “scientific stagnation.” He maintains that present scientific research does not advance the ball as far as it once did: “For every dollar we spend on science, we get far less scientific advancement than we did over the past five decades. Another way of looking at this is that for every additional research paper in biomedicine, there are fewer improvements in health per paper.” He maintains that NIH funds “old ideas” too often and does not give enough grants to young scientists who are more likely to have new ideas. “The NIH needs to start funding ideas on the bleeding edge of science—ideas that may not work but that offer the greatest chance of advancing science.” [By the way, there has always been a category of grants funded under a heading something like “High Risk, High Payoff.”]

Finally, he believes that NIH funding is too concentrated in a small number of institutions. Good scientists at other places often have difficulty in competing for grants, and he seeks to change that by separating funding that goes to the researcher from funding that goes to institutions for equipment and other costs.

These are concerns worth addressing, but there are other problems at NIH that Bhattacharya apparently does not want to discuss. Thus, as the spouse wrote in the recent post of June 11 “Whither Biomedical Science?”, “Beginning in February 2025 the Trump administration terminated 2,300 ongoing research grants, amounting to cuts of almost $4 billion.” These cuts were made without any evidence that the grantees were failing to do the kind of good science that Bhattacharya claims to want. Nature Briefing reports today that grants that have passed peer review and are set for funding are being held up as they are scrutinized for terms such as “racism,” “fossil fuel,” or “sexual minority,” inclusion of which makes a grant “not clean.” What is the Director’s position on the administration’s slashing of scientific budgets and withholding grant funding on grounds that are different from Bhattacharya’s goals of replication and bleeding edge science?

The Director also suggests that science has moved backwards. He states that the scientific revolution took away from ecclesiastical authorities the power to decide scientific questions and placed scientific questions with a lot of smart scientists.  “Unfortunately,” he continues, “we find ourselves back in a situation today, as demonstrated a few years ago by the Covid lockdowns, mask mandates, and vaccination requirements, where a relatively small number of people—directors of government agencies like the National Institutes of Health, heads of international agencies like the World Health Organization, and editors of prestigious journals—have the power to say what is true or false in science.” At a minimum, this statement is ironical but more likely hypocritical.

As the June 11 post by the spouse makes clear, scientists no longer will control what scientific research will be undertaken. This time it is not an ecclesiastical authority in charge but a nonscientific, secular one. A Trump executive order requires that “discretionary awards must…demonstrably advance the President’s policy priorities.” The Office of Management and Budget (OMB), which has the task of implementing Executive Orders, has recently promulgated new rules that will apply to the funding of scientific grants. These prohibit money going to recipients that facilitate DEI. As the spouse said, “Technically, awards are granted to institutions, not to individuals. This means that even if a scientific study has nothing to do with DEI, funding can be withheld if the formal recipient of the grant (e.g., a university) engages in something that is determined to be in violation of the administration’s DEI policies. This appears to be designed to punish institutions that are in presumed non-compliance at the expense of what might be relevant and meritorious science.”

Furthermore, “and more insidiously, the OMB regulations would give final approval authority not to a scientific advisory council, but rather to a political appointee whose job it will be to ensure that grant applications are consistent with administrative priorities, do not espouse ‘anti-American’ (undefined) ideas, and are in the ‘national interest’ (undefined). This can and will lead to decisions based on political considerations (undefined), not scientific merit.” What should we make of a Director of the NIH who is outraged at vaccination mandates urged by scientists and health professionals during a pandemic that killed millions but who now serves a system that gives the final approval for scientific research to nonscientist political appointees using vague guidelines that are not scientific?

Bhattacharya also praised the NIH. “Almost every modern advance in biomedicine has, at its root, an NIH investment. NIH is, by far, the single largest public funder of biomedical research in the world, providing 85 percent of funding in every single area of biomedicine.” That’s great, but, of course, that may not be true in the future as the administration seeks to cut scientific budgets. After praising medical advances stemming from NIH activities, he, however, sounds a note of warning: “But when we look at life expectancy in the United States since 2010—and this is not the case in most European countries—we find that there has been no improvement despite the huge investments we have made in medical research.” He presents a graph comparing life expectancy in Sweden and the United States. People on average live nearly eight years longer in Sweden, which has shown a steady increase in that expectancy. The U.S. has had major dips in life expectancy starting in 2018 and again in 2025. (Bhattacharya does not mention who was president when those decreases occurred.) He goes on to state: “We have huge chronic disease problems. We can solve them—but we can only solve them if we fix science.”

The notion, however, that inadequate science is the reason for the difference in life expectancy rates between Sweden and the United States is balderpiffle. The results of NIH and other scientific research are published and available to all. It is not some sort of science available to Swedes but not Americans that allows the Swedish to live longer. If Bhattacharya wants to understand the differences in Swedish and American life expectancies, he should examine other aspects of Swedish government and society.

Swedes do not have to worry about paying doctors. The healthcare system is government funded. Swedes do not have to worry about going bankrupt if sick. Incapacitated Swedes continue to get wages if certified ill by a doctor.

Sweden provides for paid parental leave up to sixteen months. Sweden provides for cash benefits to families with children under sixteen as well as housing allowances for families. It provides public daycare for children under seven. These are some of the reasons that the infant mortality rate in Sweden is about one-third of America’s.

Education is free from preschool through university. Swedes don’t suffer from the stress of educational debt.

Poverty is lower and less entrenched than in the United States. Swedes have shorter working hours with generous vacations and holidays. They are eligible for old age social security at sixty-one. All this correlates with longer life expectancies.

Sweden does have one of the highest tax rates in the world, but it has led to more than longer life expectancies. Surveys of the happiest people always have the Scandinavian countries, including Sweden, with their high tax rates at the top of the list, far outranking the United States.

If Bhattacharya wants longer American life expectancies, he should be looking first to reforming our healthcare, welfare, education, and social support systems. But, of course, people in this conservative administration will not last long if they advocate reforms to make us more like Sweden, even if we would be healthier and live longer.

Instead, we have cut the budget for SNAP, the Supplemental Nutrition Assistance Program, which helps people with lower incomes to buy groceries essential for health and nutrition. The One Big Beautiful Bill has cuts of up to $1 trillion to Medicaid with millions of our poorest neighbors projected to lose coverage. Medicare changes will increase costs or reduce access for many. Subsidies for health insurance have been cut causing many to abandon health insurance altogether. And unless changes are made to the program, social security benefits will see a reduction as early as 2032. These “reforms” are not the kind that will decrease our life expectancy gap with civilized nations but will only increase the divide.

For Preexisting Conditions, Spouse Means Wife

The Democratic candidates for president all have healthcare. All would have protections for pre-existing conditions. One of Trump’s major 2016 promises was to repeal Obamacare and replace it with something better although neither he, nor the Republicans, ever put forward a healthcare plan. Trump, however, has said that “we will always protect patients with pre-existing conditions.” Even so, he is currently asking the courts to strike down the Affordable Care Act, including its protections for pre-existing conditions, although we are still awaiting his healthcare proposal. (I am not holding my breath waiting for it. That would be bad for my health.)

I have had personal concerns about insurance coverage for a preexisting condition. (Funny word, “preexisting.” It seems to mean existence before existence. That doesn’t seem possible. When it comes to insurance, it really means an already-existing condition, but for some reason we use what should be the nonsensical “preexisting.”) I had a bad shoulder. I would have said that I had a dislocation problem, but that was not accurate. The bone did not come completely out of joint. I could pull the arm back into place with my free arm. I might have called it a partial dislocation, but the doctor who replaced my shoulder joint recently defined it as a subluxation.

The original subluxation had happened when playing football in college (that is how I usually explain it, leaving out the fact that it was intramural football), with the next one about six months later. When the bone partially slipped out of joint, it hurt like hell with residual pain for days afterward.  Over time, those disconcerting events happened with increasing frequency. Five years after the initial injury, it was time to get the joint repaired.

I did not have health insurance of my own. I was finishing what I hoped was my last year of schooling, and back then the only health insurance I was aware of was tied to employment. I had already accepted a job to start the following September. I would have health insurance through this employer, but I undertook the fun job of reading the policy and found the preexisting-conditions clause. The plan would not cover any health condition that existed when I first became insured.  Instead, the preexisting condition would only qualify for coverage two years down the road, assuming I was still in the same job. Waiting that long to have the shoulder surgery would not have been the end of the world. It was not as if I had cancer or imminent liver failure or was going blind. But it meant a couple more years of painful, partial dislocations and the awkward lifestyle changes that I had adopted to minimize them—not lifting my arm above my head, sleeping in ways so that rolling over would not cause the subluxation, and so on. It also meant living with a constant level of pain that could be tolerated but still was not exactly fun.

The spouse, however, had a job, and she had a health insurance benefit. I read that policy, too. It said that spouses of the insured were covered, and since she had been working for a while, the preexisting limitation did not preclude my shoulder surgery. I went to a famous shoulder surgeon who was ready to do my repair, but both he and the hospital wanted a notice from the insurance company that my treatment would be covered. We went to the benefits administrator at the spouse’s work, who, to our surprise, said that the company’s insurance would not cover me for anything. “How can that be!?!” I exclaimed. I showed her the clause in the many-paged policy mandating coverage for “spouses” of the insured. The wife was the insured, we all agreed, and she and I were married, so I was the “spouse.” Ergo, I was covered. “No,” the administrator patiently explained, “‘spouse’ meant ‘wife.’” That is what it had always meant, the bureaucrat stated. We learned that female spouses were considered beneficiaries under the plan because, apparently in those distant days, no husband of a female employee had ever sought to be covered under this provision of the policy before. The women utilizing the plan were either single, or if married, had husbands who had their own insurance or were too proud to seek spousal coverage.

I was flabbergasted, but not so much so that I could not pronounce the word “sue.” There are advantages to being a lawyer, even though back then I had little idea how to bring a suit. But the threat produced a further consideration by the wife’s employer and insurance carrier. With much grumbling, they decided that they would cover my shoulder surgery.

The wife left that job a little while later. After I had the surgery.