Mike's Blog

Tuesday evening, March 25, the US Senate, in a strict party-line vote, confirmed Jay Bhattacharya as the NIH Director. For those googling Jay, be forewarned that while Battacharya is not in the same league as Smith or Jones, a PubMed search on just the last name will yield >17K citations. Even adding his first initial, still yields nearly 700 entries. Jay is Stanford trained (BA, MA, MD, and PhD with the MA and PhD in economics). The bulk of his career has also been with Stanford. He had a brief stint at the RAND Corporation, as well as a visiting professorship with UCLA (economics department) and a research fellowship with the Hoover Institution. He has been wearing multiple hats at Stanford that span medicine, economics, and health policy. Of particular note (more on this later) is his position as a research associate with the National Bureau of Economic Research (NBER), which is most well-known for calling the start and end dates for economic recessions.

So, what are we likely to expect from a Jay tenure at the helm of the NIH? Historically, NIH Directors have typically developed initiatives that reset or reorient the biomedical research agenda based on a combination of current health issues, emerging science, and most importantly, emerging technologies as well as their own particular interests. For example, Elias Zerhouni (2002-2008) is responsible for creating the CTSA Program as part of ‘reinventing the clinical enterprise’ within his NIH Roadmap for Medical Research initiative. Francis Collins (2009 – 2021) injected genomics into nearly every aspect of research and also created NCATS (currently the home for the CTSA Program) as well as the HEAL initiative in response to the opioid crisis. Monica Bertagnolli during her short tenure initiated a focus on primary care and recognized the emerging potential of data science for all facets of the biomedical research enterprise.

Jay’s Senate conformation hearing didn’t offer much in the way of guidance beyond a focus on enhanced academic tolerance for differences of opinion, (with the need articulated eloquently in a recent NYTimes opinion piece. A cursory review of his publications reveals an eclectic smorgasbord of topics that fall mainly into the health and health care policy buckets. Of note are a couple of articles that might not float to the top of a quick and dirty PubMed search. Back in 2018, Jay published an article from the NBER entitled, “Does the NIH Fund Edge Science.” The term ‘edge science’ refers to the equally nebulous term ‘novel ideas’ or as described in the article, “The regular exercise of trying out new ideas.” The takeaway from this work is that from the 1950’s forward, NIH support for ‘edge science’ had been steadily increasing as a percentage of its overall funding but began a precipitous drop-off around 2000 that has not reversed. Some salient remarks from this piece to highlight include, “provide indirect support for the idea that NIH review committees are risk-averse” and of particular relevance for the CTSA community, “projects that build on novel clinical ideas are not favored by the NIH” as compared to basic science ideas. In 2020, another NBER manuscript followed up this work to propose that the evolution of the academic evaluation of scientific productivity has gradually transitioned to an overemphasis on publication citations as the major determinant of academic success resulting in a somewhat perverse incentive structure that favors or encourages incremental science, rather than novel or ‘edge science.’

Regardless of how much influence this work will inform future initiatives at the NIH, the bottom line is that the NIH engine that drove the success of late 20th century biomedical research to positively impact health and healthcare appears to be sputtering in terms of its impact on 21st century medicine, at least from the perspective of overall health statistics. The CTSAs are uniquely positioned to take the lead in pursuing our own emphasis on ‘edge science’ that delivers to every American, the most cutting edge, next generation health care and health advice we can offer. Creating the health care and health care delivery systems that will define 21st century health and medicine is what the CTSA Program was designed to deliver!

It's only in the froth of “managed chaos” that human potential can grow and thrive.

-From the publisher’s summary of Linda Nagata’s Going Dark