James' World 2

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President-elect Donald Trump wants Jay Bhattacharya, a physician-scientist and economist at Stanford University, to lead the National Institutes of Health. The NIH is a global powerhouse of science. Its mission is “to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.”

Most politicians, even when criticizing the agency, recognize the good it has done in building effective public health measures. Cancer death rates continue to decline, for example, because of the work NIH investigators have done around prevention, detection, and treatment.

Bhattacharya does not see the agency’s successes this way. In his podcast Science from the Fringe, Bhattacharya recently said he is amazed by “the authoritarian tendencies of public health.” He struck a similar theme in a Newsmax interview: “[We need] to turn the NIH from something that’s [used] to control society into something that’s aimed at the discovery of truth to improve the health of Americans.”

The scientists who apply for NIH funding, sit on peer review panels, and administer grants would be surprised to hear they control society. They do science. The claims of authoritarianism are a screen for pushing a particular agenda that is likely to damage the NIH. Bhattacharya’s science agenda is political: to set concerns for personal autonomy against evidence-based public health science. This is not appropriate for NIH leadership.

Bhattacharya has never explained how the NIH controls society, given its role as a research institution, and it is hard to see how it does except perhaps in setting research priorities and awarding funding based on expert review. Is he

against public health legislation that has controlled lead emissions in vehicles, enforced vaccine requirements for children attending public schools, and promoted folate fortification in bread and fluoride in drinking water? This legislation has improved population health in terms of cognitive performance, infectious disease burden, neural tube defects in pregnancy, and oral health, respectively. Is this the kind of control he fears?

Public health authorities decide on a health promotion measure for a population based on the science, often for people vulnerable and unaware of health risks, when health benefits are clear. NIH research provides the evidence for these public health measures. It is fair to debate the quality of scientific evidence and benefit to population health relative to restrictions on autonomy and choice, but establishing mechanisms for population health risk and making recommendations based on this evidence are not authoritarianism, and making such a comparison is not the way to do good science or build trust.

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