Science Friday - Former NIH Director Reflects On Public Mistrust In Science

Episode Date: September 26, 2024

In 2021, Dr. Francis Collins stepped down after a dozen years leading the National Institutes of Health. He had just overseen the government’s response to the COVID-19 pandemic,in the early days of changing public health guidance as scientists learned more about this new virus. He was also involved in the quickest development of a vaccine in history.Now, he’s had some time to reflect on how the US arrived at such a divisive place about COVID-19 and vaccines, how trust in science has dwindled, and what we can do about it.Ira sits down with Dr. Collins to talk about the lessons from his new book, The Road to Wisdom: On Truth, Science, Faith and Trust, and why he decided to speak publicly about his prostate cancer diagnosis.Transcripts for each segment will be available after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

How did the COVID-19 pandemic end up eroding public trust in science? Well, a big part of it is what seems to be a loss of appreciation of the fact that there is such a thing as objective truth. It's Thursday, September 26th, and you're listening to Science Friday. I'm SciFri producer Shoshana Bucksbaum. Back 2021, Dr. Francis Collins stepped down after a dozen years leading the national. Institutes of Health. He had just overseen the government's response to the COVID-19 pandemic and a time of shifting public health guidance, as scientists learned more about this new virus, and he was involved in the quickest development of a vaccine in history. Now he's had some time

to reflect on how our country arrived at such a divisive place about COVID-19 and vaccines, how trust in science has dwindled and what we can do about it. And he's written a new book, all about this, the Road to Wisdom on Truth, Science, Faith, and Trust. Here's Ira with that conversation. Dr. Collins, welcome back to Science Friday. Hey, Ira, it's great to be with you, and please call me Francis. Okay, okay, Francis. The book's title, Road to Wisdom, why did you decide to make wisdom the central focus of your book? What is the wisdom you're talking about here? Well, what is wisdom anyway? It's certainly based on not, knowledge, and as scientists, we're all about trying to discover things that add to knowledge.

But wisdom adds some additional layers to that, a moral framework, for instance, judgment, insight, common sense, the ability to sift through a difficult decision when you don't have enough information and try to do the wise thing. I think we all really strive to be on a road leading to wisdom. I do. It's not a destination you just get to and you're done. But I think we all really strive. I think individually and collectively, we're kind of in a bad place right now where a lot of us have spun out, hit a pothole, somehow ended up in the ditch. And this book is a call to try to pull ourselves back together again and get re-anchored to things like truth, science, faith, and trust so that we can travel that road more productively and help humans not just fight with each other, but flourish.

Tell me more about that ditch. What do you see as that ditch? What is it to you? Well, a big part of it is what seems to be a loss of appreciation of the fact that there is such a thing as objective truth in our society. And facts that are well established in history or by scientific approaches to understanding nature aren't sometimes just a matter of opinion. And alternative facts get put forward as if they had the same weight. That's a very dangerous place. And that certainly causes some falling into ditches if you're looking for wisdom. Yeah, let's talk about an event in particular. You describe participating in an event with Wilkinson, a Christian conservative podcast host. And the event has an intriguing title,

an elitist and a deplorable walk into a bar, right? He's been vocally opposed to the government's handling of COVID-19. Many people in your position would have declined the invitation. So why did you decide to participate in that? Well, Ira, I was really troubled as I stepped down from NIH about how we got so polarized about something that's a scientific issue, the management of COVID. And I needed to understand more about why such a significant fraction of the public, good, honorable people, didn't see it the way that I did. So I signed up to join a group called Braver Angels, which intentionally brings people together who have very different opinions about hot topics, like, oh, abortion, for instance, or gun control, or immigration or public health.

And taking part in a number of those sessions, I met Wilk, who had a firebrand's approach to criticizing what had been done with COVID, but was willing to listen to alternative perspectives. And that's what Braver Angels really tries you to get you to do, to listen, not to plan your snappy response, but to actually understand the perspective. and I began to get it. Here's a guy from Minnesota, runs a trucking company. What happened with COVID seemed to him to be driven by recommendations that were a good fit for a big urban city like New York, but not a very good fit for his small town.

And his business got injured and his kids got hurt by being out of school for a long time. And he was puzzled by the shift in recommendations about what to do about things like masks. And so he got pretty disillusioned. I needed to hear that. I needed to actually take on some responsibility for some of the science communication that could have been better. And so we agreed that in this gathering of the Braver Angels annual meeting in very symbolically located Gettysburg, Pennsylvania, that he and I would have a debate in front of

this part blue, part red audience, and try to model how you can disagree but not be disagreeable, how you can express your view, but also be sure you're listening to the other person. And I still think Wilk is wrong about a lot of stuff. He thinks I'm wrong about a lot of stuff. But we're pretty good friends who enjoy having a beer together. Yeah. So no minds were changed here. You know, I think they were altered a bit.

My mind was changed in terms of my understanding of how the one-size-fits-all approach to COVID public health recommendations wasn't a very good fit in the heartland. And the next time, we ought to try to do better about that. Partly, I got to say, it was not a good fit because we decimated our public health. system in the years before this, so there wasn't much local expertise that could be drawn on. But still, there was an important lesson there. I learned that, so my mind was affected. You mentioned admitting failures in communication during this COVID, as you just said. And you write in the book, quote, I learned that failure is not an affront to science. It's an element of science, right? Failure is standing on the shoulders of giants who may have failed, right?

What is failure in your own career? and what do you think you learned most from it? Well, going to the communication part, I think we failed to explain the uncertainty of the situations we were facing during 2020, where we knew only a little bit about this virus and had to make recommendations that were the best we could do. And we would have benefited the public, I think, to be more in tune with that. So they didn't think we actually had definitive answers when they were still forthcoming. For me, personally, failure has been a big part of how I've learned about science.

And in the book, the very first couple of pages, I talk about my very first effort to be a molecular biologist as a postdoc at Yale, carrying out an experiment that I had great hopes for and was an absolute and complete utter disaster after six months of work with nothing retrievable from it. And I almost quit. But then I realized, after a lot of consultation with more experienced people, this is maybe the most important thing you've ever done. Figure out how did that failure happen. How did you not really plan thoughtfully that experiment in a way that could have anticipated this was going to go wrong? And then the next time, you'll be in a much better position to do something that works. You know, during your career, and I remember we have talked about this in our past conversations,

you have always been held up as a model of a religious person, a Christian, who is able to not let your Christian views absolutely interfere with your science and your approach to being a scientist? How does that happen? How are you able to do that? Well, I know people are puzzled about that. At least some are. I think it comes down to what kind of question is being asked

and which framework do you use to try to answer it. If it's a question about how nature works, hey, that's a scientific question. Let's use all the tools of science and let's be as rigorous as we possibly can in assessing the data before we accept a conclusion. But if it's a broader question, like, why am I here and why is there something instead of nothing? And what really are the ethical boundaries and where did they come from in terms of our decisions about what kind of science we actually believe is moral?

Then there's got to be another perspective, at least for me, to try to settle into that space. I don't keep my scientific perspective and my faith perspective often separate parts of my brain. I think they interact pretty effectively. but I do feel really careful about not mixing up the questions that are being asked and using the wrong approach to them. You know, faith is a way to answer fundamental questions that start with why. Science gives you the answers to the how in wonderful ways. But I want to know both how and why. But what about when people who are faith leaders spread health misinformation like we've seen during COVID,

and then their followers also mistrust science, like we've said. How do you navigate that when leading the NIH? Yeah. Well, that certainly has happened, but let's be clear, there's a lot of misinformation being spread by people who have no faith basis at all that are simply out there spreading conspiracies and maybe making money as a result. And social media has greatly accelerated the dangers there of how information can suddenly go viral that had no basis in fact at all. With faith leaders, I've done my best to try to stay connected

with that group. These are wonderful, honorable people trying to do what they can to take care of their flocks and barraged by messages coming at them. And sadly, also at the present time, I'm mixing up of faith foundations and political messages, which has done, I think, harm to the basic ways that many people look at faith traditions. So we have a lot of work to do there, too. And so a wonderful document just came out, signed by hundreds of evangelical pastors and leaders, calling the church to come back to its foundations on truth and love, your neighbor, and grace, and not being so quickly seduced into this idea that you need to have political power.

Political power is the opposite of what most faith traditions, certainly Christians, were called to, but we've lost that thread somewhere. We've talked about the pandemic showing a widening gap in the trust in science and the scientific process among different groups of people. And it's not just COVID where that crisis of confidence in science exists because I can recall 15, 20 years ago on this show talking about vaccinations. And there are people who told us on that show that they just, just don't trust anything their government tells them, right?

You know, here's the research and shown, oh, but it's done by the government. How do we get that trust back in government talking about health? And it's certainly accelerated during COVID. Yeah. More than 50 million Americans declining to take the vaccine that was sponsored by a wonderful partnership between industry and academia and government and showed remarkable efficacy and safety. And yet 50 plus million people said, no, thank you. And these are good honorable people, but that suspicion about government has been allowed to grow and has had those flames fanned

by lots of voices out there, including some people in the government itself, who seem to enjoy the chance to come forward to a microphone and trash the whole institution that they supposedly are part of. All this performance, which seems to be a lot more appealing to some political figures and actually governing has led us into this even more contentious space. So how do we deal with that? I think again in the book, The Road to Wisdom, there's a real call here to each of us to examine our own portfolio of facts and make sure there are not things in there that found their way into your belief system based upon something that wasn't actually true. That's a bit of work. And then how do we, going forward, set up a better filter to distinguish

facts from fakes. And that means you look at the source that expertise really matters. And somebody who's worked on a project or on issue for 20 years is more reliable than somebody who just posted something on Facebook. A lot of that has gotten muddled up and mixed. And a really outrageous claim ought to be looked at with particular care to be sure that it's not somebody manipulating you. That would be a good start. There's a group called More in common that has studied our society and has this concept of the hidden tribes that make up these various sectors of our now divided and polarized communities. And they would argue, and I think this is true in my own experience, that about two-thirds of us are really kind of disgusted with all

the vitriol and the animosity and the fact that the fringes on the left and the right get all of the attention and seem to make all the noise, two-thirds of us are in what more in common calls the exhausted majority, just like we're checked out a little bit here. Like, I don't know what to do. The book basically calls to people in that space, and I think a lot of them are scientists, maybe listening to this program, to say, it's not a good idea to check out. We are the future. We're the hope here. We are the solution, but it's going to require each of us to take on a personal attitude that goes beyond saying things don't have to be like this, to saying, I don't have to be like this. And even to consider making a pledge, which is in the book in the last chapter and is posted

on the Braver Angels website, making a commitment to a couple of things. One is not to spread around things unless you're sure they're true. Another is to try to actually get to know people who disagree with you, like I did with Wilkinson, so that we become less poise. polarized, more willing to do the bridging between different opinions, which is what a healthy society would do. Speaking about personal things, I want to pivot a little bit to talk about something more personal with you, and that is you being diagnosed with prostate cancer this past spring. Why did you decide to talk about that very personal thing publicly?

Well, of course, it was not a diagnosis that I was hoping would ever happen to me, but there it was. I had been followed closely for four or five years with what appeared to be a not very threatening type of very low-grade prostate cancer. But then it changed and became much more aggressive and action had to be taken. I was aware that an awful lot of men around me, as they heard about this, kind of cringed, like, oh, boy, that's something I don't want to talk about. But, you know, we've made a lot of progress, Ira, in terms of early screening, early detection. better imaging, targeted biopsies.

There's all kinds of ways now to make prostate cancer a precision medicine approach. But a lot of people don't know that yet, and they're afraid of it. So I figured, okay, I'm going to tell the world, even if it does make people a little bit cringy and see if it will wake up some component of the population, the men, to whether they might want to consider being a bit more careful about their own surveillance. And I hope it helped. Yeah, well, yeah, and one of your big career milestones was leading the human genome project. And as director of NIH, you oversaw so many important scientific breakthroughs.

Are we just at the beginning of what we're going to learn from that project? Lots more to learn. What do you expect to happen? Absolutely at the beginning. Although it's clear we've also accomplished a lot of interesting things. My own prostate cancer had a detailed genomic analysis done and identified a driver mutation that might have been responsible for why it suddenly became much more aggressive. This was so interesting being on the receiving end instead of the producing end of genomic

science. So cancer has been totally turned upside down by the ability to look at each individual's tumor and figure out what's driving those good cells to go bad. But in many other places as well, certainly if you go to a number, newborn ICU and try to figure out how to make a diagnosis in a child who's terribly sick and you don't know why genome sequencing has changed that dramatically and oftentimes providing a potentially life-saving intervention that you wouldn't have thought about. And certainly when you see how we're using this therapeutically, my gosh, the revolution here in having two FDA approved gene therapies

for sickle cell disease, all of that's possible because we have such physical. facility now with DNA analysis. And it's just the beginning. Certainly, we are getting to the point over a lot of hard work in a long time of being able to use this information for each of us in terms of prevention and doing precision health in the way that currently is more one-size-fits-all. But a lot of that is going to be emerging in larger and larger ways in the next 10 years, especially as individual sequencing has dropped from its original $400 million. now down to less than $500 per person. Yeah, that is an incredible drop.

I want to talk a bit about your work on hepatitis C. I know you've been very active in this. And last year, President Biden appointed you to lead this White House task force to eliminate hepatitis C. What motivated you to get involved in this work? And how is it progressing? The development of direct acting antiviral, small molecules, against hepatitis C, by two companies, Gilead and Ambee, I believe ranks as one of the most amazing achievements of medical

science in the last 20 years. This is a terrible disease that currently infects about 4 million Americans, and without that treatment, those folks are headed for liver failure, liver cirrhosis, liver cancer, and early death. So why haven't we solved this? Because the drugs have been approved for eight years. It's because a lot of the people who need the treatment are in underserved populations. They may be people who have experimented with intravenous drugs. They may be people in the prison system, where in some prisons as many as 20 or 30 percent of people there are hep C positive, again, because of the interaction with drugs. This is not right. If we have the chance to cure people, first of all, it's not right morally. It's also not right economically, because the cost of taking care of all these cases of liver failure who might need a transplant or

liver cancer that doesn't respond very well is in the tens of billions of dollars for our country if we do nothing. So how can you look at that situation and say, oh, well, if we can save potentially tens of thousands of lives, which I think we can't, then we just got to do it. So the good news is there is now a bipartisan. And President Biden put money. He did in the budget proposal. Of course, the Congress has to decide to go along with that. That's the phase we're in right now. And there's bipartisan support with a lot of other bipartisan interest. What we're waiting on right now, almost day by day, is will a congressional budget office come forward with their estimate of what this would actually lead to in 10 years.

I strongly predict it will show cost savings because of all the health care needs that we will not have to pay for. So we are waiting CBO to give that official statement about cost savings. If it is, then I believe this could get voted on positively before the end of the year. And President Biden would most certainly sign it. And we could launch this program in 2025. And we could save tens of thousands of lives and tens of billions of dollars. That is hopeful.

And I don't share your optimism about before the end of the year. But who knows, right? It is an election year. Maybe people will see it as a positive thing to run on. Wouldn't it be nice to have something? everybody could agree, it's like a really good thing. We're still, I think, capable of that, even despite all of the animosity. Yeah.

Well, my last question is about looking a bit towards the future. And, of course, I'm going to talk about artificial intelligence, because it's in everything. And it's shown really being very helpful in medicine, in diagnostic medicine. Are you as wary of AI as other people are? No, because my focus like yours has been on medicine and science where AI provides this remarkable set of opportunities. Look at the Brain Initiative, which is now 10 years along and is really beginning to uncover some amazing things about how those 86 billion neurons between your ears do what they do in complicated circuits. We wouldn't be able to sort that out very well if we didn't have AI to help us. Look at what AI is done for imaging, whether it's x-rays or retinal photographs.

we are so much further along because of that capacity. I do worry that if you apply AI to electronic health records, which also has a lot going for it, it could basically take the health disparities that we know our system is riddled with and turn them into a necessary future instead of an unfortunate past. But people are tuned to that. The other larger risks about AI taking over everything, I track those. I'm not an expert on those. But when it comes to the medicine part, boy, I hope we push it as hard as we can.

It's going to do a lot of good and save a lot of suffering. Francis, I want to thank you for taking time to be with us today. And it's a wonderful book. I hope everybody gets a chance to read it. And wishing you good luck and whatever comes after your book. Have another book in mind? Or where might we see you popping up? I have no idea.

You know, when I stepped down as NIH director, I thought, okay. Maybe I'll just coast from here, but then I got pulled into the White House almost immediately, and here we are. Dr. Francis Collins, former director of the National Institutes of Health in Bethesda, Maryland, and author of the new book The Road to Wisdom on Truth, Science, Faith, and Trust. That's all the time we have for today. Lots of folks help make the show happen, including John Dancosky, Dave Petersmith, Robin Casmer, Phyllisomeres. tomorrow a roundup of the week's top science news and the story of a fish that tastes with its legs.

Yes, you heard that right. I'm sci-fi producer Shoshana Bucksbaum. Catch you next time and thanks so much for listening.