Posted on by rjonakait

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.

Posted on by rjonakait

The Texas Tragedy

Does Trump bear responsibility for deaths in the Texas floods? Do Elon and Doge? They recklessly slashed government, including the National Weather Service. (Funny how Musk was a genius when upending departments, but now, according to Trump, he is off the rails. Mature people don’t change that radically in only a few months.) We do know that the NWS was understaffed in Texas, but we can’t know how results would have been different if positions had not been vacant.

The harm from Trump policies will often be unknowable. How much will farmers and others be hurt by cuts to weather forecasting? We can’t really know.

Trump, Musk, and Kennedy, Jr., have decimated the National Institutes of Health. We can assume discoveries will not be made that would have been made without the chainsaw, but we don’t know what those discoveries would have been.

Trump is transforming FEMA. Will recoveries from natural disasters be…well, more disastrous? That may be almost impossible to measure.

Sometimes we might be able to assess damage. How have telephone wait times increased after cuts to the IRS? But often the measurable harm will not be known for a while. IRS revenue collection may drop but that will take time to learn. Sometimes the harm will happen only after the Trump presidency ends (and IT WILL END). We won’t know about deaths or illnesses from the vaccine and other health policies of the HHS. Already consequential, the full effects of the decimation of USAID will not be known for a long time.

Sometimes the consequences will be hidden from us. Tariffs are akin to a sales tax, but unlike the sales tax, the consumer will not see the explicit cost of tariffs at checkout. We will only see the new list price of the product. And we won’t see some business practices that tariffs encourage. For example: A friend runs an upscale sportswear company. During Trump’s first term, he made shirts in China for the American market. Trump instituted a fifteen percent duty on such goods. The retailer for the friend’s product had been charging $145 for each shirt. A fifteen percent increase would have been $167. The retailer, however, decided to use the tariff to raise the price to $185. That extra $18 is also a consequence of the tariffs, but its cause is invisible to the consumer.

Sometimes trickery is used for dampening negative consequences. So, for example, Trump’s recent legislation is expected to remove many people from Medicaid. Rural hospitals that depend on Medicaid are expected to close, bringing suffering to many small communities. If the cuts to Medicaid are a good idea, they are a good idea now. Nevertheless, that Big (Beautiful? Bullshit?) Bill delays their implementation. The delay is not for any sensible policy reason. Instead, Trump and the Republicans anticipate a backlash, but they hope it won’t peak until after the midterm elections and will have waned by 2028.

This might make you (even more) cynical about Trump and Republicans, but my cynicism extends deeper. We don’t know whether more staffing at the National Weather Service or a different warning system might possibly have lessened the Texas tragedy, but we should find out. This is a job for Congress. Hearings should be held seeking information about what happened and about possible changes going forward. The goal should be to see whether new legislation is warranted. But Republicans who control Congress will not hold such hearings for fear they may suggest that Trump made mistakes. Moreover, if such hearings were held, the Democrats would not seek information but use them to score partisan points. They would be like Jim Jordan in a clip I recently saw. He was questioning New York Governor Kathy Hochul. He asked if she knew how a local sheriff had responded to an immigration issue. She predictably ducked the question, and he predictably insisted that she answer. It was all a charade. Jordan knew the answer to his question. In a real hearing, our congresspeople would be seeking information by asking questions where they did not already know the answer. When was the last time you saw that?

We should be trying to learn from the Texas tragedy, but that won’t come from Congress, for, unfortunately, this Congress is not there to solve problems.

Posted on by rjonakait

Snippets

I told Lisa the librarian that I thought that all librarians should be named Marian. To my surprise, she did not know the reference.

Steve Bannon on his podcast said: “A lot of MAGAs on Medicaid. . . . Medicaid is going to be a complicated one. Just can’t take a meat ax to it, although I would love to.” How revealing. Bannon, and no doubt many like him, are not concerned about our healthcare system generally, and certainly not about healthcare for those in the country’s bottom economic quarter. (Almost 25% of Americans get assistance from Medicaid.) He is only concerned because many Trump supporters get Medicaid. (If they weren’t MAGA, would he describe them as on the government dole?) Otherwise, he would only want to destroy Medicaid.

Congressman Rich McCormick, a Republican from Georgia, said that the GOP could do a better job of showing “compassion.” Is there a compassion switch? Can you “show compassion” if you don’t have it in the first place?

“All political parties die at last of swallowing their own lies.” John Arbuthnot.

The fired government workers do get compassion from many, as they should. Most government employees, like most Americans, live paycheck to paycheck, and the sudden loss of a job for them and their families is a tragedy many of us can immediately comprehend. What we don’t see is the harm down the road. What are the consequences if weather forecasts become worse, or if waiting times at VA hospitals are longer? How do you measure what is foregone from lost medical research or the increase in waste, fraud, and corruption that results from fired IRS workers?

We may not know precisely what is lost from the firings, but we know that foreseeable losses will come. On the other hand, there are always unintended consequences that are not foreseen. I was reminded of that from Troy Senik’s biography, A Man of Iron: The Turbulent Life and Improbable Presidency of Grover Cleveland. Senik writes that the Pendleton Civil Service Reform Act of 1883 sought to eliminate patronage for appointment to government jobs. Under the patronage system, those who got employment were assessed a portion of their salaries to kick back to the political parties who secured the positions. Senik says that it was estimated that up to 75% of party funding came from such assessments. With that spigot turned off, parties turned to wealthy individuals and interest groups to fund electoral politics. Thus, job appointments based on merit had the unintended consequence of providing more power to the rich.

V13: Chronicle of a Trial, a magnificent book by Emmanuel Carrère (translated from the French by John Lambert), contains compassion, but also horror, inhumanity, humanity, bewilderment, and much more. On November 13, 2015, jihadists launched attacks in Paris. Luckily, if there was anything like luck that day, suicide bombers arrived late to a packed football game and could not get in. They blew themselves up outside where the crowds were thin. Others allied with them shot randomly at restaurant terraces and cafes killing more, but the major carnage was at the Bataclan theatre, a concert venue of 1,500 hosting apparently a mediocre American rock group, Eagles of Death Metal. Nearly a hundred people were slaughtered in the hall. Six years later a trial started, which took on the name V13, for Friday (Vendredi) the Thirteenth, the day of the attack. Carrère reported on the nine-month trial for a French magazine, and those columns form the basis of the book. At times extremely hard to read (“confetti of human flesh”) but always compelling, V13 is remarkable. Reading it now, I could not help but think about October 7 and its aftermath. One of those on trial in Paris (the defendants were all second stringers since all those who did the actual killing were dead) maintained that the massacres were in response to the loss of innocent lives in Syria from French bombings and said, “Everything you say about us jihadists is like reading the last page of a book. What you should do is read the book from the start.”