Dr. Jay Bhattacharya is an outstanding choice to be the next director of the National Institutes of Health for the incoming Trump administration. He has a rare opportunity to reform and revitalize a crucial institution that has become sclerotic.
I am a cardiologist at Johns Hopkins Medicine who has a longtime interest in health policy. During Covid, I watched in alarm as Dr. Bhattacharya was maligned and sidelined for raising necessary and thoughtful objections to draconian Covid policies, such as lockdowns and school closings. Both these policies and the attacks on Dr. Bhattacharya were promoted by top NIH officials. So it is indeed “poetic justice” that he is now going to be in charge. Dr. Bhattacharya has said his mandate is to bring change to the NIH. Here are my ten suggestions for where he should start.
1. Term limits of 5–10 years for all institute directors.
Dr. Anthony Fauci led the National Institute of Allergy and Infectious Diseases (NIAID) for 38 years. The NIH can’t afford to have any more such leaders exercising control of entire fields for decades. Over those decades, Dr. Fauci accumulated political clout that he exerted to increase funding for infectious disease research. But ultimately, this led to the distortion of funding priorities (see #9). Such power may result in tunnel vision rather than a director adapting to the needs of the public. Regular turnover of leadership brings fresh ideas and a healthy reassessment of priorities.
2. Direct more funding to research in primary and early stage chronic disease prevention.
A foundational principle of the Make America Healthy Again (MAHA) agenda is that the U.S. spends too much on “sick care” relative to prevention of illness. That is, we focus on the treatment of people with full-blown chronic disease. This treatment often results in patients being on multiple medications for years—which benefits pharmaceutical companies. We spend too little on understanding and preventing chronic disease. This issue was an important, and unexpected, one in the presidential election. The public voted for preventing illness, and the NIH should listen. Keeping people healthy longer is a good use of public money.
3. Reduce financial conflicts of interest and provide greater transparency on them.
During Covid, the NIH, research universities, and individual scientists received millions in royalty payments from a vaccine manufacturer using the new mRNA technology. I am not against institutions and individuals profiting from their scientific discoveries. But in this case, NIH leaders wielded their enormous influence to insist that these vaccines were essential to ending the pandemic. When legitimate questions were raised about the efficacy and safety of Covid vaccines, along with objections to vaccine mandates, this conflict of interest undermined public confidence in both the vaccines and the NIH. The NIH should require that all industry payments to individual scientists and to the various institutes be made available to the public in an easily searchable database.