Francis Collins: National Institutes of Health (NIH)

Francis Collins (02:42.760)

while to do this. With SARS, it was 14 years before we figured out it was the civet cat

Francis Collins (02:49.240)

that was the intermediate host. With MERS, it was a little quicker to discover it was

Francis Collins (02:52.920)

the camel. With SARS COVID 2, there's been some looking, but especially now with everything

Francis Collins (02:58.480)

really tense between the US and China, if there's looking going on, we're not getting

Lex Fridman (03:03.060)

told about it.

Lex Fridman (03:05.040)

Do you think it's a scientific question or a political question?

Lex Fridman (03:07.840)

It's a scientific question, but it has political implications.

Lex Fridman (03:12.420)

So the world is full of scientists that are working together, but in the political space,

Francis Collins (03:17.240)

in the political science space, there's tensions. What is it like to do great science in a time

Lex Fridman (03:24.300)

of a pandemic when there's political tensions?

Francis Collins (03:27.960)

It's very unfortunate. Pasteur said science knows no one country. He was right about that.

Francis Collins (03:35.880)

My whole career in genetics, especially, has depended upon international collaboration between

Francis Collins (03:42.600)

scientists as a way to make discoveries, get things done. Scientists, by their nature,

Francis Collins (03:48.760)

like to be involved in international collaborations. The Human Genome Project, for heaven's sake,

Francis Collins (03:55.160)

2,400 scientists in six countries working together, not worrying who is going to get

Francis Collins (03:59.920)

the credit, giving all the data away. I was the person who was supposed to keep all that

Francis Collins (04:04.200)

coordinated. It was a wonderful experience, and that included China. That was sort of

Francis Collins (04:08.840)

their first real entry into a big international, big science kind of project, and they did

Lex Fridman (04:15.080)

their part. It's very different now.

Francis Collins (04:19.560)

Continuing the line of difficult questions, especially difficult ethical questions. In

Francis Collins (04:26.760)

2014, U.S. put a hold on gain of function research in response to a number of laboratory

Francis Collins (04:32.880)

biosecurity incidents, including anthrax, smallpox, and influenza. In December 2017,

Francis Collins (04:38.880)

NIH lifted this ban because, quote, gain of function research is important in helping

Francis Collins (04:44.480)

us identify, understand, and develop strategies and effective countermeasures against rapidly

Francis Collins (04:49.820)

evolving pathogens that pose a threat to public health. All difficult questions have arguments

Lex Fridman (04:56.440)

on both sides. Can you argue the pros and cons of gain of function research with viruses?

Francis Collins (05:03.400)

I can, and first let me say this term, gain of function, is causing such confusion that

Francis Collins (05:11.200)

I need to take a minute and just sort of talk about what the common scientific use of that

Francis Collins (05:16.760)

term is and where it is very different when we're talking about the current oversight

Francis Collins (05:22.600)

of potentially dangerous human pathogens. As you know, in science, we're doing gain

Francis Collins (05:28.820)

of function experiments all the time. We support a lot of cancer immunotherapy at NIH. Right

Francis Collins (05:36.440)

here in our clinical center, there are trials going on where people's immune cells are taken

Francis Collins (05:41.400)

out of their body, treated with a genetic therapy that revs up their ability to discover

Francis Collins (05:46.720)

the cancer that that patient currently has, maybe even at stage four, and then give them

Francis Collins (05:52.880)

back as those little ninja warriors go after the cancer. It sometimes works dramatically.

Francis Collins (05:59.020)

That's gain of function. You gave that patient a gain in their immune function that may have

Francis Collins (06:03.220)

saved their life. We've got to be careful not to say, oh, gain of function is bad. Most

Francis Collins (06:08.580)

of what we do in science that's good involves quite a bit of that. We are all living with

Francis Collins (06:15.080)

gains of function every day. I have a gain of function because I'm wearing these eyeglasses.

Francis Collins (06:18.920)

Otherwise, I would not be seeing you as clearly. I'm happy for that gain of function. That's

Francis Collins (06:25.800)

where a lot of confusion has happened. The kind of gain of function which is now subject

Francis Collins (06:30.560)

to very rigorous and very carefully defined oversight is when you are working with an

Francis Collins (06:36.960)

established human pathogen that is known to be potentially causing a pandemic and you

Francis Collins (06:43.000)

are enhancing or potentially enhancing its transmissibility or its virulence. We call

Francis Collins (06:50.240)

that EPPP, enhanced potential pandemic pathogen. That requires this very stringent oversight

Francis Collins (07:01.040)

worked out over three years by the National Science Advisory Board on Biosecurity that

Francis Collins (07:08.520)

needs to be looked at by a panel that goes well beyond NIH to decide are the benefits

Francis Collins (07:14.560)

worth the risks in that situation. Most of the time, it's not worth the risk. Only three

Francis Collins (07:21.840)

times in the last three or four years have experiments been given permission to go forward.

Francis Collins (07:28.440)

They were all on influenza. So I will argue that if you're worried about the next pandemic,

Francis Collins (07:35.680)

the more you know about the coming enemy, the better chance you have to recognize when

Francis Collins (07:40.160)

trouble is starting. And so if you can do it safely, studying influenza or coronaviruses

Francis Collins (07:47.660)

like SARS, MERS, and SARS CoV2 would be a good thing to be able to know about. But you

Francis Collins (07:53.720)

have to be able to do it safely because we all know lab accidents can happen. I mean,

Francis Collins (07:59.600)

look at SARS where there have been lab accidents and people have gotten sick as a result. We

Francis Collins (08:05.280)

don't want to take that chance unless there's a compelling scientific reason. That's why

Francis Collins (08:09.280)

we have this very stringent oversight. The experiments being done at the Wuhan Institute

Francis Collins (08:16.160)

of Virology as a subaward to our grant to EcoHealth in New York did not meet that standard

Francis Collins (08:24.800)

of requiring that kind of stringent oversight. I want to be really clear about that because

Francis Collins (08:29.280)

there's been so much thrown around about it. Was it gain of function? Well, in the standard

Francis Collins (08:34.760)

use of that term that you would use in science in general, you might say it was. But in the

Francis Collins (08:39.520)

use of that term that applies to this very specific example of a potential pandemic pathogen,

Francis Collins (08:48.320)

absolutely not. So nothing went on there that should not have happened based upon the oversight.

Francis Collins (08:55.920)

There was an instance where the grantee institution failed to notify us about the result of an

Francis Collins (09:02.300)

experiment that they were supposed to tell us where they mixed and matched some viral

Francis Collins (09:07.280)

genomes and got a somewhat larger viral load as a result. But it was not EPPP. It was not

Francis Collins (09:15.400)

getting into that zone that would have required this higher level of scrutiny. It was all

Francis Collins (09:19.680)

bat viruses. These were not human pathogens.

Lex Fridman (09:22.920)

So they didn't cross a threshold within that gray area that makes for an EPPP?

Francis Collins (09:29.200)

They did not. And anybody who's willing to take the time to look at what EPPP means and

Lex Fridman (09:34.860)

what those experiments were would have to agree with what I just said.

Lex Fridman (09:39.280)

What is the biggest reason it didn't cross that threshold? Is it because it wasn't jumping

Lex Fridman (09:43.800)

to humans? Is it because it did not have a sufficient increase in virulence or transmissibility?

Lex Fridman (09:50.160)

What's your sense?

Francis Collins (09:51.160)

EPPP only applies to agents that are known human pathogens of pandemic potential. These

Francis Collins (10:00.960)

were all bat viruses derived in the wild, not shown to be infectious to humans. Just

Francis Collins (10:07.600)

looking at what happened if you took four different bat viruses and you tried moving

Francis Collins (10:11.640)

the spike protein gene from one into one of the others to see whether it would bind better

Lex Fridman (10:17.200)

to the ACE2 receptor. That doesn't get across that threshold.

Lex Fridman (10:21.280)

And let me also say, for those who are trying to connect the dots here, which is the most

Francis Collins (10:26.160)

troubling part of this, and say, well, this is how SARS CoV2 got started. That is absolutely

Francis Collins (10:32.600)

demonstrably false. These bat viruses that were being studied had only about 80% similarity

Francis Collins (10:40.320)

in their genomes to SARS CoV2. They were like decades away in evolutionary terms. And it

Francis Collins (10:46.080)

is really irresponsible for people to claim otherwise.

Francis Collins (10:51.600)

Speaking of people who claim otherwise, Rand Paul, what do you make of the battle of words

Lex Fridman (10:58.440)

between Senator Rand Paul and Dr. Anthony Fauci over this particular point?

Francis Collins (11:03.920)

I don't want to talk about specific members of Congress, but I will say it's really unfortunate

Francis Collins (11:09.440)

that Tony Fauci, who is the epitome of a dedicated public servant, has now somehow been targeted

Francis Collins (11:17.480)

for political reasons as somebody that certain figures are trying to discredit, perhaps to

Francis Collins (11:23.920)

try to distract from their own failings. This never should have happened. Here's a person

Francis Collins (11:29.320)

who's dedicated his whole life to trying to prevent illnesses from infectious diseases,

Francis Collins (11:35.880)

including HIV in the 1980s and 90s, and now probably the most knowledgeable infectious

Francis Collins (11:43.000)

disease physician in the world, and also a really good communicator, is out there telling

Francis Collins (11:49.280)

the truth about where we are with SARS CoV2 to certain political figures who don't want

Francis Collins (11:54.620)

to hear it, and who are therefore determined to discredit him. And that is disgraceful.

Lex Fridman (12:00.520)

So with politicians, they often play games with black and white. They try to sort of

Francis Collins (12:06.480)

use the gray areas of science and then paint their own picture. But I have a question about

Francis Collins (12:13.560)

the gray areas of science. So like you mentioned, gain of function is a term that has very specific

Francis Collins (12:19.160)

scientific meaning, but it also has a more general term. And it's very possible to argue

Francis Collins (12:25.120)

that the, not to argue, not the way politicians argue, but just as human beings and scientists,

Francis Collins (12:31.320)

that there was a gain of function achieved at the Wuhan Institute of Virology, but it

Francis Collins (12:38.440)

didn't cross a threshold. I mean, there's a, it's a, but it could have too. So here's

Francis Collins (12:44.160)

the thing. When you do these kinds of experiments, unexpected results may be achieved. And that's

Francis Collins (12:50.660)

the gray area of science. You're taking risks with such experiments. And I am very uncomfortable

Lex Fridman (12:58.400)

that we can't discuss the uncertainty in the gray area of this.

Francis Collins (13:03.280)

Oh, I'm comfortable discussing the gray area. What I'm uncomfortable with is people deciding

Francis Collins (13:08.740)

to define for themselves what that threshold is based on sort of some political argument.

Francis Collins (13:14.900)

The threshold was very explicitly laid out. Everybody agreed to that in the basis of this

Francis Collins (13:21.880)

three years of deliberation. So that's what it is. If that threshold needs to be reconsidered,

Francis Collins (13:27.440)

let's reconsider it, but let's not try to take an experiment that's already been done

Lex Fridman (13:32.360)

and decide that the threshold isn't what it was, because that really is doing a disservice

Francis Collins (13:37.640)

to the whole process.

Francis Collins (13:38.880)

I wish there was a discussion, even in response to Rand Paul, I know we're not talking about

Francis Collins (13:44.240)

specific senators, but just that particular case, I'm saying stuff here. I wish there

Francis Collins (13:48.680)

was an opportunity to talk about, given the current threshold, this is not gain of function.

Lex Fridman (13:55.080)

But maybe we need to reconsider the threshold and have an action. That's an opportunity

Francis Collins (13:58.400)

for discussion about the ethics of gain of function. You said that there was three studies

Francis Collins (14:02.920)

that passed that threshold with influenza. That's a fascinating human question, scientific

Francis Collins (14:07.760)

question about ethics, because like you said, there's pros and cons. You're taking risks

Francis Collins (14:14.920)

here to prevent horribly destructive viruses in the future, but you also are risking creating

Francis Collins (14:24.960)

such viruses in the future. With nuclear weapons and nuclear energy, nuclear energy promises

Francis Collins (14:33.480)

a lot of positive effects, and yet you're taking risks here. With mutually shared destruction,

Francis Collins (14:40.200)

nations possessing nuclear weapons, a lot of people argue that nuclear weapons is the

Francis Collins (14:49.880)

reason we've prevented world wars, and yet they also have the risk of starting world

Francis Collins (14:55.960)

wars. And this is what we have to be honest about with the benefits and risks of science,

Lex Fridman (15:01.880)

that you have to make that calculation. What are the pros and what are the cons?

Francis Collins (15:06.160)

I'm totally with you, but I want to reassure you, Lex, that this is not an issue that's

Francis Collins (15:10.840)

been ignored. That this issue about the kind of gain of function that might result in a

Francis Collins (15:16.520)

serious human pathogen has been front and center in many deliberations for a decade

Francis Collins (15:22.400)

or more, involved a lot of my time along the way, by the way, and has been discussed publicly

Francis Collins (15:28.100)

on multiple occasions, including two major meetings of the National Academy of Sciences,

Francis Collins (15:34.400)

getting input from everybody and ultimately arriving at our current framework. Now, we

Francis Collins (15:39.480)

actually back in January of 2020, just before COVID 19 changed everything, had planned and

Francis Collins (15:47.480)

even charged that same National Science Advisory Board on Biosecurity to reconvene and look

Francis Collins (15:55.880)

at the current framework and say, do we have it right? Let's look at the experience over

Francis Collins (16:00.080)

those three years and say, is the threshold too easy, too hard? Do we need to reconsider

Francis Collins (16:06.320)

it? Let's look at the experience. COVID came along, the members of the board said, please,

Francis Collins (16:10.920)

we're all infectious disease experts. We don't have time for this right now. But I think

Francis Collins (16:14.840)

the time is right to do this. I'm totally supportive of that. And that should be just

Francis Collins (16:18.920)

as public a discussion as you can imagine about what are the benefits and the risks.

Lex Fridman (16:23.320)

And if somebody decided, ultimately, this came together and said, we just shouldn't

Francis Collins (16:27.560)

be doing these experiments under any circumstances. If that was the conclusion, well, that would

Lex Fridman (16:31.720)

be the conclusion. But it hasn't been so far.

Francis Collins (16:35.200)

If we can briefly look out into the next hundred years on this. I apologize for the existential

Francis Collins (16:42.960)

questions. But it seems obvious to me that as gain of function type of research and development

Francis Collins (16:52.200)

becomes easier and cheaper, it will become greater and greater risk. So if it doesn't

Francis Collins (16:59.200)

no longer need to be contained within laboratories of high security, it feels like this is one

Francis Collins (17:07.440)

of the greatest threats facing human civilization. Do you worry that at some point in the future

Lex Fridman (17:12.880)

a leaked manmade virus may destroy most of human civilization?

Francis Collins (17:18.600)

I do worry about the risks. And at the moment where we have the greatest control, the greatest

Francis Collins (17:24.760)

oversight is when this is federally funded research. But as you're alluding, there's

Francis Collins (17:30.440)

no reason to imagine that's the only place that this kind of activity would go on. If

Francis Collins (17:36.040)

there was an evil source that wished to create a virus that was highly pathogenic in their

Francis Collins (17:42.520)

garage, the technology does get easier. And there is no international oversight about

Francis Collins (17:49.640)

this either that you could say has the same stringency as what we have in the United States.

Lex Fridman (17:55.000)

So yes, that is a concern. It would take a seriously deranged group or person to undertake

Francis Collins (18:03.560)

this on purpose, given the likelihood that they too would go down. We don't imagine there

Francis Collins (18:10.720)

are going to be bioweapons that only kill your enemies and don't kill you. Sorry, we're

Francis Collins (18:16.120)

too much alike for that to work. So I don't see it as an imminent risk. There's lots of

Francis Collins (18:24.560)

scary novels and movies written about it. But I do think it's something we have to consider.

Lex Fridman (18:31.040)

What are all the things that ought to be watched? You may not know that if somebody is ordering

Francis Collins (18:36.280)

a particular oligonucleotide from one of the main suppliers, and it happens to match smallpox,

Francis Collins (18:44.880)

they're going to get caught. So there is effort underway to try to track any nefarious actions

Francis Collins (18:51.480)

that might be going on.

Francis Collins (18:52.480)

In the United States or internationally? Is there an international collaboration of try

Lex Fridman (18:55.960)

to track this stuff?

Francis Collins (18:57.440)

There is some. I wish it were stronger. This is a general issue, Lex, in terms of do we

Francis Collins (19:03.560)

have a mechanism, particularly when it comes to ethical issues, to be able to decide what's

Francis Collins (19:09.120)

allowable and what's not and enforce it. I mean, look where we are with germline genome

Francis Collins (19:13.720)

editing for humans, for instance. There is no enforcement mechanism. There's just bully

Lex Fridman (19:18.300)

pulpits and governments that get to decide for themselves.

Francis Collins (19:22.000)

You talked about evil. What about incompetence? Does that worry you? I was born in the Soviet

Francis Collins (19:26.360)

Union. My dad, a physicist, worked at Chernobyl. That comes to mind. That wasn't evil. I don't

Francis Collins (19:35.200)

know what word you want to put it. Maybe incompetence is too harsh. Maybe it's the inherent incompetence

Francis Collins (19:40.120)

of bureaucracy. I don't know. But for whatever reason, there was an accident. Does that worry

Lex Fridman (19:44.800)

you?

Francis Collins (19:45.800)

Of course it does. We know that SARS, for instance, did manage to leak out of a lab

Francis Collins (19:50.880)

in China two or three times. At least in some instances, people died, fortunately quickly

Francis Collins (19:56.760)

contained. All one can do in that circumstance, because you need to study the virus and understand

Francis Collins (1:00:04.400)

Taking all that we've learned about the genome and applying it to cancer to make individual

Francis Collins (1:00:09.920)

cancer treatment really precision. And developing cancer immunotherapy, which seemed like sort

Francis Collins (1:00:15.880)

of a backwater into some of the hottest science around. All those things sort of erupting.

Lex Fridman (1:00:22.640)

And much more to come, I'm sure. We're on an exponential curve of medical research advances,

Lex Fridman (1:00:28.080)

and that's glorious to watch. And of course, COVID 19, as a beneficiary of decades of basic

Francis Collins (1:00:35.400)

science, understanding what mRNA is, understanding basics about coronaviruses and spike proteins

Lex Fridman (1:00:41.080)

and how to combine structural biology and immunology and genomics into this package

Francis Collins (1:00:46.320)

that allows you to make a vaccine in 11 months. Just I would never have imagined that possible

Francis Collins (1:00:52.160)

in 2009. So to have been able to kind of be the midwife, helping all of those things get

Francis Collins (1:00:57.800)

birthed, that's been just an amazing 12 years. And as NIH director, you have this convening

Francis Collins (1:01:05.200)

power and this ability to look across the whole landscape of biomedical research and

Francis Collins (1:01:10.340)

identify areas that are just like ready for something big to happen. But it isn't going

Francis Collins (1:01:16.240)

to happen spontaneously without some encouragement, without pulling people together from different

Francis Collins (1:01:21.120)

disciplines who don't know each other and maybe don't know how to quite understand each

Francis Collins (1:01:24.940)

other's scientific language and create an environment for that to happen. That has been

Francis Collins (1:01:29.880)

just an amazing experience. I mean, I mentioned the Brain Initiative as one of those. The

Francis Collins (1:01:35.400)

Brain Initiative right now, I think there's about 600 investigators working on this. Last

Francis Collins (1:01:41.280)

week, the whole issue of Nature magazine was about the output of the Brain Initiative basically

Francis Collins (1:01:46.320)

now giving us a cell census of what those cells in the brain are doing, which has just

Francis Collins (1:01:51.760)

never been imaginable. And interestingly, more than half of the investigators in the

Francis Collins (1:01:59.040)

Brain Initiative are engineers. They're not biologists in a traditional sense. I love

Francis Collins (1:02:04.460)

that. Maybe partly because my PhD is in quantum mechanics. So I think it's really a good idea

Francis Collins (1:02:10.640)

to bring disciplines together and see what happens. That's an exciting thing. And I will

Francis Collins (1:02:16.600)

not ever forget having the chance to announce that program in the East Room in that White

Francis Collins (1:02:23.000)

House with President Obama, who totally got it and totally loved science and working with

Francis Collins (1:02:29.560)

him in some of those rare moments of sort of one on one conversation in the Oval Office,

Francis Collins (1:02:35.240)

just him and me about science. That's a gift.

Francis Collins (1:02:38.120)

What's it like talking to Barack Obama about science? He seems to be a sponge. I've heard

Francis Collins (1:02:44.600)

him. I'm an artificial intelligence person. And I've heard him talk about AI. And it was

Francis Collins (1:02:49.800)

like, it made me think, is somebody like whispering in his ear or something? Because he was saying

Francis Collins (1:02:54.000)

stuff that totally passed the BS test, like he really understands stuff.

Lex Fridman (1:02:58.600)

He does.

Francis Collins (1:02:59.600)

That means he listened to a bunch of experts on AI. He was explaining the difference between

Francis Collins (1:03:04.240)

narrow artificial intelligence and strong AI. He was saying all this, both technical

Lex Fridman (1:03:08.920)

and philosophical stuff. And it just made me, I don't know, it made me hopeful about

Lex Fridman (1:03:14.940)

the depth of understanding that a human being in political office can attain.

Francis Collins (1:03:18.680)

That gave me hope as well, and having those experiences. Oftentimes in a group, I mean,

Francis Collins (1:03:24.340)

another example was trying to figure out, how do we take what we've learned about the

Francis Collins (1:03:28.380)

genome and really apply it at scale to figure out how to prevent illness, not just treat

Francis Collins (1:03:34.080)

it, but prevent it, out of which came this program called All of Us, this million strong

Francis Collins (1:03:40.160)

American cohort of participants who make their electronic health records and their genome

Francis Collins (1:03:45.280)

sequences and everything else available for researchers to look at. That came out of a

Francis Collins (1:03:50.120)

couple of conversations with Obama and others in his office, and he asked the best questions.

Francis Collins (1:03:58.720)

That was what struck me so much. I mean, a room full of scientists, and we'd be talking

Francis Collins (1:04:03.440)

about the possible approaches, and he would come up with this incredibly insightful penetrating

Francis Collins (1:04:09.400)

question. Not that he knew what the answer was going to be, but he knew what the right

Francis Collins (1:04:12.060)

question was.

Francis Collins (1:04:13.360)

I think the core to that is curiosity. I don't think he's even like, he's trying to be a

Francis Collins (1:04:19.760)

good leader. He's legit curious.

Lex Fridman (1:04:22.120)

Yes.

Francis Collins (1:04:23.120)

Legit.

Francis Collins (1:04:24.120)

That he, almost like a kid in a candy store, gets to talk to the world experts. He somehow

Francis Collins (1:04:29.520)

sneaked into this office and gets to talk to the world experts. That's the kind of energy

Lex Fridman (1:04:35.520)

that I think leads to beautiful leadership in the space of science.

Francis Collins (1:04:40.640)

Indeed. Another thing I've been able to do as director is to try to break down some of

Francis Collins (1:04:45.000)

the boundaries that seem to be traditional between the public and the private sectors.

Francis Collins (1:04:49.360)

When it comes to areas of science that really could and should be open access anyway, why

Francis Collins (1:04:54.000)

don't we work together? That was obvious early on. After identifying a few possible collaborators

Francis Collins (1:05:03.160)

who are chief scientists of pharmaceutical companies, it looked like we might be able

Lex Fridman (1:05:08.740)

to do something in that space.

Francis Collins (1:05:10.560)

Out of that was born something called the Accelerating Medicines Partnership, AMP. It

Francis Collins (1:05:16.320)

took a couple of years of convening people who usually didn't talk to each other. There

Francis Collins (1:05:21.640)

was a lot of suspicion. Academic scientists saying, oh, those scientists in pharma, they're

Francis Collins (1:05:27.220)

not that smart. They're just trying to make money. The academic scientists getting the

Francis Collins (1:05:32.280)

rap from the pharmaceutical scientists, all they want to do is publish papers. They don't

Lex Fridman (1:05:36.160)

really care about helping anybody.

Francis Collins (1:05:38.360)

We found out both of those stereotypes were wrong. Over the course of that couple of years,

Francis Collins (1:05:44.400)

we built a momentum behind three starting projects, one on Alzheimer's, one on diabetes,

Francis Collins (1:05:50.120)

one on rheumatoid arthritis and lupus. Very different, each one of them trying to identify

Lex Fridman (1:05:54.280)

what is an area that we both really need to see advance and we could do better together.

Lex Fridman (1:06:00.520)

It's going to have to be open access, otherwise NIH is not going to play. Guess what, industry?

Francis Collins (1:06:05.400)

If you really want to do this, you got to have skin in the game. We'll cover half the

Francis Collins (1:06:08.960)

cost. You got to cover the other half.

Lex Fridman (1:06:10.720)

I love it. Enforcing open access, resulting in open science.

Francis Collins (1:06:16.600)

Millions of dollars gone into this and it has been a wild success. After many people

Francis Collins (1:06:21.000)

were skeptical, a couple of years later, we had another project on Parkinson's. More recently,

Francis Collins (1:06:27.880)

we added one on schizophrenia. Just this week, we added one on gene therapy, on bespoke gene

Francis Collins (1:06:35.520)

therapy for ultra rare diseases, which otherwise aren't going to have enough commercial appeal.

Francis Collins (1:06:41.320)

If we did this together, especially with FDA at the table, and they have been, we could

Francis Collins (1:06:45.800)

make something happen, turn this into a standardized approach where everything didn't have to be

Francis Collins (1:06:51.080)

a one off. I'm really excited about that.

Lex Fridman (1:06:54.760)

What began as three projects is six and it's about to be seven next year with a heart failure

Lex Fridman (1:06:59.680)

and all of us have gotten to know each other. If it weren't for that background when COVID

Francis Collins (1:07:06.040)

came along, it would have been a lot harder to build the partnership called ACTIV, which

Francis Collins (1:07:11.160)

has been my passion for the last 20 months, accelerating COVID 19 therapeutic interventions

Lex Fridman (1:07:17.440)

and vaccines.

Francis Collins (1:07:18.440)

We just had our leadership team meeting this morning. It was amazing what's been accomplished.

Francis Collins (1:07:23.320)

That's pretty much 100 people who dropped everything just to work on this, about half

Francis Collins (1:07:28.380)

from industry and half from government and academia. That's how we got vaccine master

Francis Collins (1:07:34.520)

protocols designed. We all agreed about what the endpoints had to be and you wondered why

Francis Collins (1:07:40.520)

are there 30,000 participants in each of these trials? That's because of ACTIV's group mapping

Lex Fridman (1:07:46.440)

out what the power needed to be for this to be convincing.

Francis Collins (1:07:51.240)

Same with therapeutics. We have run at least 20 therapeutic agents through trials that

Francis Collins (1:07:58.080)

ACTIV supported in record time. That's how we got monoclonal antibodies that we know

Francis Collins (1:08:02.880)

work. That would not have been possible if I didn't already have a sense of how to work

Francis Collins (1:08:12.200)

with the private sector that came out of AMP. AMP took two years to get started. ACTIV took

Francis Collins (1:08:17.680)

two weeks. We just kept the lawyers.

Lex Fridman (1:08:20.600)

Wow, to get 100 people over?

Francis Collins (1:08:21.920)

Yeah, kept the lawyers out of the room and away we went.

Francis Collins (1:08:25.920)

Now you're going to get yourself in trouble. I do hope one day the story of this incredible

Francis Collins (1:08:34.120)

vaccine development of vaccine protocols and trials and all this kind of details, the messy

Francis Collins (1:08:38.080)

beautiful details of science and engineering that led to the manufacturing, the deployment

Lex Fridman (1:08:44.280)

and the scientific test. It's such a nice dance between engineering in the space of

Francis Collins (1:08:48.960)

manufacturing the vaccines. You start before the studies are complete, you start making

Francis Collins (1:08:53.840)

the vaccines just in case that if the studies proved to be positive, then you can start

Francis Collins (1:08:59.160)

deploying them just like so many parties, like you said, private and public playing

Francis Collins (1:09:05.280)

together. That's just a beautiful dance that is one of the, for me, the sources of hope

Francis Collins (1:09:11.840)

in this very tricky time where there's a lot of things to be cynical about in terms of

Francis Collins (1:09:20.800)

the games politicians play and the hardship experience of the economy and all those kinds

Francis Collins (1:09:24.480)

of things. That to me, this dance was a vaccine development was done just beautifully and

Francis Collins (1:09:31.800)

it gives me hope.

Francis Collins (1:09:33.240)

It does me as well. And it was in many ways the finest hour that science has had in a

Francis Collins (1:09:38.880)

long time being called upon when every day counted and making sure that time was not

Lex Fridman (1:09:44.960)

wasted and things were done rigorously, but quickly.

Francis Collins (1:09:50.240)

So, you're incredibly good as a leader of the NIH. It seems like you're having a heck

Lex Fridman (1:09:56.360)

of a lot of fun. Why step down from this role after so much fun?

Francis Collins (1:10:02.320)

Well, no other NIH director has served more than one president after being appointed by

Francis Collins (1:10:09.640)

one. You're sort of done. And the idea of being carried over for a second presidency

Francis Collins (1:10:14.160)

with Trump and now a third one with Biden is unheard of. I just think, Lex, that scientific

Francis Collins (1:10:20.440)

organizations benefit from new vision and 12 years is a really long time to have the

Francis Collins (1:10:26.720)

same leader. And if I wasn't going to stick it out for the entire Biden four year term,

Francis Collins (1:10:33.440)

it's good not to wait too late during that to signal an intent to step down because the

Francis Collins (1:10:39.120)

president's got to find the right person, got to nominate them, got to get the Senate

Lex Fridman (1:10:43.080)

to confirm them, which is an unpredictable process right now.

Lex Fridman (1:10:47.680)

And you don't want to try to do that in the second half of somebody's term as president.

Francis Collins (1:10:52.840)

This has got to happen now. So, I kind of decided back at the end of May that this should

Francis Collins (1:10:56.860)

be my final year. And I'm okay with that. I do have some mixed emotions because I love

Francis Collins (1:11:04.840)

the NIH. I love the job. It's exhausting. I'm traditionally for the last 20 months anyway,

Francis Collins (1:11:13.440)

working 100 hours a week. It's just, that's what it takes to juggle all of this. And that

Francis Collins (1:11:19.800)

keeps me from having a lot of time for anything else. And I wouldn't mind because I don't

Francis Collins (1:11:24.680)

think I'm done yet. I wouldn't mind having some time to really think about what the next

Lex Fridman (1:11:30.000)

chapter should be. And I have none of that time right now. Do I have another calling?

Francis Collins (1:11:35.240)

Is there something else I could contribute that's different than this? I'd like to find

Lex Fridman (1:11:40.200)

that out.

Francis Collins (1:11:42.800)

I think the right answer is you're just stepping down to focus on your music career.

Lex Fridman (1:11:49.760)

That might not be a good plan for anything very sustainable.

Lex Fridman (1:11:54.080)

But I think that is a sign of a great leader as George Washington did stepping down at

Lex Fridman (1:11:59.080)

the right time.

Francis Collins (1:12:00.080)

Ted Williams.

Lex Fridman (1:12:01.080)

Yes.

Francis Collins (1:12:02.080)

He quit when I think he hit a home run on his last at bat and his average was 400 at

Lex Fridman (1:12:07.920)

the time.

Francis Collins (1:12:08.920)

No one to walk away. I mean, it's hard, but it's beautiful to see in a leader. You also

Francis Collins (1:12:15.200)

oversaw the human genome project. You mentioned the brain initiative, which has, it's a dream

Francis Collins (1:12:22.540)

to map the human brain. And there's the dream to map the human code, which was the human

Francis Collins (1:12:29.580)

genome project. And you have said that it is humbling for me and awe inspiring to realize

Francis Collins (1:12:34.920)

that we have caught the first glimpse of our own instruction book, previously known only

Francis Collins (1:12:41.240)

to God. How does that, if you can just kind of wax poetic for a second, how does it make

Francis Collins (1:12:48.400)

you feel that we were able to map this instruction book, look into our own code, and be able

Lex Fridman (1:12:55.360)

to reverse engineer it?

Francis Collins (1:12:59.360)

It's breathtaking. It's so fundamental. And yet, for all of human history, we're ignorant

Francis Collins (1:13:06.520)

of the details of what that instruction book looked like. And then we crossed a bridge

Francis Collins (1:13:13.420)

into the territory of the known. And we had that in front of us still written in a language

Francis Collins (1:13:19.120)

that we had to learn how to read. And we're in the process of doing that and will be for

Francis Collins (1:13:23.740)

decades to come. But we owned it, we had it. And it has such profound consequences. It's

Francis Collins (1:13:31.000)

it's both a book about our history. It's a book of sort of the parts list of a human

Francis Collins (1:13:38.840)

being, the genes that are in there and how they're regulated. And it's also a medical

Francis Collins (1:13:43.960)

textbook that can teach us things that will provide answers to illnesses we don't understand,

Lex Fridman (1:13:51.400)

and alleviate suffering and premature death. So it's a pretty amazing thing to contemplate.

Lex Fridman (1:13:57.240)

And it has utterly transformed the way we do science. And it is in the process of transforming

Francis Collins (1:14:03.320)

the way we do medicine, although much of that still lies ahead. You know, while we were

Francis Collins (1:14:09.320)

working on the Genome Project, it was sort of hard to get this sense of a wellness, because

Francis Collins (1:14:17.160)

it was just hard work. And you were getting, you know, another mega base, okay, this is

Francis Collins (1:14:21.840)

good. But when did you actually step back and say, we did it? It's the profoundness

Francis Collins (1:14:29.240)

of that. I mean, there were two points, I guess. One was the announcement on that June

Francis Collins (1:14:33.640)

26, 2000, where the whole world heard, well, we don't quite have it, but we got a pretty

Francis Collins (1:14:37.800)

good draft. And suddenly, people are like realizing, oh, this is this a big deal. For

Francis Collins (1:14:45.400)

me, it was more when we got the full analysis of it, published it in February 2001. And

Francis Collins (1:14:50.560)

that issue of Nature paper that Eric Lander and Bob Waterston and I were the main authors,

Lex Fridman (1:14:55.980)

and we toiled over and tried to get as much insight as we could in there about what the

Francis Collins (1:15:01.400)

meaning of all this was. But you also had this sense that we are such beginning readers

Francis Collins (1:15:07.160)

here. We are still in kindergarten, trying to make sense out of this 3 billion letter

Francis Collins (1:15:13.360)

book. And we're going to be at this for generations to come.

Francis Collins (1:15:19.320)

You are a man of faith, Christian, and you are a man of science. What is the role of

Lex Fridman (1:15:25.920)

religion and of science in society and in the individual human mind and heart like yours?

Francis Collins (1:15:35.360)

Well, I was not a person of faith when I was growing up. I became a believer in my 20s,

Francis Collins (1:15:42.760)

influenced as a medical student by a recognition that I hadn't really thought through the

Lex Fridman (1:15:48.000)

issues of what's the meaning of life? Why are we all here? What happens when you die?

Francis Collins (1:15:55.440)

Is there a God? Science is not so helpful in answering those questions. So I had to

Francis Collins (1:16:01.000)

look around in other places and ultimately came to my own conclusion that atheism, which

Francis Collins (1:16:07.160)

is where I had been, was the least supportable of the choices because it was the assertion

Francis Collins (1:16:12.800)

of a universal negative, which scientists aren't supposed to do. And agnosticism came

Francis Collins (1:16:20.280)

as an attractive option but felt a little bit like a cop out, so I had to keep going

Francis Collins (1:16:24.640)

trying to figure out why do believers actually believe this stuff? And I came to realize

Francis Collins (1:16:30.580)

it was all pretty compelling, that there's no proof. I can't prove to you or anybody

Lex Fridman (1:16:34.960)

else that God exists, but I can say it's pretty darn plausible.

Lex Fridman (1:16:39.920)

And ultimately, what kind of God is it that caused me to search through various religions

Lex Fridman (1:16:45.520)

and see, well, what do people think about that? And to my surprise, encountered the

Francis Collins (1:16:51.640)

person of Jesus Christ as unique in every possible way and answering a lot of the questions

Francis Collins (1:16:58.840)

I couldn't otherwise answer. And somewhat kicking and screaming, I became a Christian,

Francis Collins (1:17:06.880)

even though at the time, as a medical student already interested in genetics, people predicted

Francis Collins (1:17:12.720)

my head would then explode because these were incompatible worldviews. They really have

Francis Collins (1:17:18.580)

not been for me. I am so fortunate, I think, that in a given day, wrestling with an issue,

Francis Collins (1:17:27.200)

it can have both the rigorous scientific component and it can have the spiritual component. COVID

Francis Collins (1:17:33.360)

19 is a great example. These vaccines are both an amazing scientific achievement and

Francis Collins (1:17:39.760)

an answer to prayer. When I'm wrestling with vaccine hesitancy and trying to figure out

Lex Fridman (1:17:45.880)

what answers to come up with, I get so frustrated sometimes and I'm comforted by reassurances

Lex Fridman (1:17:53.020)

that God is aware of that. I don't have to do this alone.

Lex Fridman (1:17:58.720)

So I know there are people like your friend, Sam Harris, who feel differently. Sam wrote

Francis Collins (1:18:05.200)

a rather famous op ed in the New York Times when I was nominated as the NIH director saying,

Francis Collins (1:18:12.920)

this is a terrible mistake. You can't have somebody who believes in God running the NIH.

Lex Fridman (1:18:21.400)

He's just going to completely ruin the place.

Francis Collins (1:18:23.560)

Well, I have a testimonial. Christopher Hitchens, a devout atheist, if I could say so, was a

Francis Collins (1:18:31.440)

friend of yours and referred to you as, quote, one of the greatest living Americans and stated

Francis Collins (1:18:37.120)

that you were one of the most devout believers he has ever met. He further stated that you

Francis Collins (1:18:41.880)

were sequencing the genome of the cancer that would ultimately claim his life and that your

Francis Collins (1:18:46.440)

friendship, despite their differing opinions on religion, was an example of the greatest

Lex Fridman (1:18:52.560)

confirmed truth in modern times.

Lex Fridman (1:18:55.520)

What did you learn from Christopher Hitchens about life or perhaps what is a fond memory

Lex Fridman (1:18:59.560)

you have of this man with whom you've disagreed, but who is also your friend?

Francis Collins (1:19:05.800)

Yeah, I loved Hitch. I'm sorry he's gone. Iron sharpens iron. There's nothing better

Francis Collins (1:19:13.920)

for trying to figure out where you are with your own situation and your own opinions,

Francis Collins (1:19:19.200)

your own worldviews, than encountering somebody who's completely in another space and who's

Francis Collins (1:19:24.720)

got the gift, as Hitch did, of challenging everything and doing so over a glass of scotch

Francis Collins (1:19:30.360)

or two or three.

Francis Collins (1:19:33.200)

We got off to a rough start in an interaction we had at a rather highbrow dinner. He was

Francis Collins (1:19:41.360)

really deeply insulting of a question I was asking. I was like, okay, that's fine. Let's

Francis Collins (1:19:48.280)

figure out how we could have a more civil conversation. Then I really learned to greatly

Francis Collins (1:19:53.320)

admire his intellect and to find the jousting with him. It wasn't all about faith, although

Lex Fridman (1:20:00.320)

it often was. It was really inspiring and innovating, energizing.

Francis Collins (1:20:05.720)

Then when he got cancer, I became his ally, trying to help him find pathways through the

Francis Collins (1:20:13.000)

various options and maybe helped him to stay around on this planet for an extra six months

Francis Collins (1:20:19.120)

or so. I have the warmest feelings of being in his apartment downtown over a glass of

Francis Collins (1:20:28.520)

wine talking about whatever. Sometimes it was science. He was fascinated by science.

Francis Collins (1:20:35.320)

Sometimes it was Thomas Jefferson. Sometimes it was faith. I knew it would always be really

Lex Fridman (1:20:42.560)

interesting.

Lex Fridman (1:20:43.560)

He's now gone. Do you think about your own mortality? Are you afraid of death?

Francis Collins (1:20:51.120)

I'm not afraid. I'm not looking forward to it. I don't want to rush it because I feel

Francis Collins (1:20:55.560)

like I got some things I can still do here. As a person of faith, I don't think I'm afraid.

Francis Collins (1:21:02.480)

I'm 71. I know I don't have an infinite amount of time left. I want to use the time I've

Francis Collins (1:21:08.560)

got in some sort of way that matters. I'm not ready to become a full time golfer, but

Francis Collins (1:21:17.840)

I don't quite know what that is. I do feel that I've had a chance to do amazingly powerful

Francis Collins (1:21:25.560)

things as far as experiences, and maybe God has something else in mind.

Francis Collins (1:21:31.640)

I wrote this book 16 years ago, The Language of God, about science and faith, trying to

Francis Collins (1:21:37.440)

explain how, from my perspective, these are compatible. These are in harmony. They're

Francis Collins (1:21:44.120)

complementary if you are careful about which kind of question you're asking. To my surprise,

Francis Collins (1:21:50.520)

a lot of people seem to be interested in that. They were tired of hearing the extreme voices

Francis Collins (1:21:56.480)

like Dawkins at one end and people like Ken Ham and Answers in Genesis on the other end

Francis Collins (1:22:02.760)

saying, if you trust science, you're going to hell. They thought there must be a way

Lex Fridman (1:22:07.480)

that these things could get along, and that's what I tried to put forward.

Francis Collins (1:22:10.720)

Then I started a foundation, BioLogos, which then I had to step away from to become NIH

Francis Collins (1:22:16.440)

director, which has just flourished, maybe because I stepped away. I don't know. It

Francis Collins (1:22:21.320)

now has millions of people who come to that website and they run amazing meetings. I think

Francis Collins (1:22:26.640)

a lot of people have really come to a sense that this is okay. I can love science and

Francis Collins (1:22:31.320)

I can love God, and that's not a bad thing. So maybe there's something more I can do in

Lex Fridman (1:22:36.000)

that space. Maybe that book is ready for a second edition.

Lex Fridman (1:22:39.680)

I think so. But when you look back, life is finite. What do you hope your legacy is?

Francis Collins (1:22:47.920)

I don't know. This whole legacy thing is a little bit hard to embrace. It feels a little

Francis Collins (1:22:54.960)

self promoting, doesn't it? I sort of feel like in many ways, I went to my own funeral

Francis Collins (1:22:59.520)

on October 5th when I announced that I was stepping down and I got the most amazing responses

Francis Collins (1:23:05.760)

from people, some of whom I knew really well, some of whom I didn't know at all, who were

Francis Collins (1:23:10.240)

just telling me stories about something that I had contributed to that made a difference

Francis Collins (1:23:16.000)

to them. That was incredibly heartwarming, and that's enough. I don't want to build

Lex Fridman (1:23:21.640)

an edifice. I don't have a plan for a monument or a statue. God help us.

Francis Collins (1:23:27.600)

I do feel like I've been incredibly fortunate. I've had the chance to play a role in things

Francis Collins (1:23:33.200)

that were pretty profound from the Genome Project to NIH to COVID vaccines, and I ought

Francis Collins (1:23:39.840)

to be plenty satisfied that I've had enough experiences here to feel pretty good about

Lex Fridman (1:23:46.520)

the way in which my life panned out.

Francis Collins (1:23:50.720)

We did a bunch of difficult questions in this conversation. Let me ask the most difficult

Francis Collins (1:23:54.640)

one, that perhaps is the reason you turned to God. What is the meaning of life? Have

Lex Fridman (1:24:03.160)

you figured it out yet?

Lex Fridman (1:24:07.400)

Expect me to put that into three sentences.

Francis Collins (1:24:09.400)

We only have a couple of minutes. At least hurry up.

Francis Collins (1:24:15.640)

Well that's not a question that I think science helps me with, so you're going to push me

Francis Collins (1:24:19.280)

into the faith zone, which is where I'd want to go with that. What is the meaning? Why

Francis Collins (1:24:25.120)

are we here? What are we put here to do? I do believe we're here for just a blink of

Francis Collins (1:24:30.780)

an eye and that our existence somehow goes on beyond that in a way that I don't entirely

Francis Collins (1:24:37.000)

understand despite efforts to do so. I think we are called upon in this blink of an eye

Francis Collins (1:24:43.920)

to try to make the world a better place, to try to love people, to try to do a better

Francis Collins (1:24:50.200)

job of our more altruistic instincts and less of our selfish instincts, to try to be what

Francis Collins (1:25:01.480)

God calls us to be, people who are holy, not people who are driven by self indulgence.

Lex Fridman (1:25:12.040)

And sometimes I'm better at that than others. But I think that for me as a Christian is

Francis Collins (1:25:17.720)

a pretty clear, I mean, it's to live out the Sermon on the Mount. Once I read that,

Francis Collins (1:25:24.520)

I couldn't unread it. All those beatitudes, all the blessings, that's what we're supposed

Francis Collins (1:25:32.360)

to do. And the meaning of life is to strive for that standard, recognizing you're going

Francis Collins (1:25:37.320)

to fail over and over again, and that God forgives you. Hopefully to put a little bit

Francis Collins (1:25:44.020)

of love out there into the world. That's what it's about. Francis, I'm truly humbled and

Francis Collins (1:25:51.480)

inspired by both your brilliance and your humility and that you would spend your extremely

Francis Collins (1:25:58.120)

valuable time with me today. It was really an honor. Thank you so much for talking today.

Francis Collins (1:26:02.040)

I was glad to. And you asked a really good question. So your reputation as the best podcaster

Francis Collins (1:26:08.760)

has borne itself out here this afternoon. Thank you so much. Thanks for listening to

Francis Collins (1:26:13.560)

this conversation with Francis Collins. To support this podcast, please check out our

Francis Collins (1:26:17.320)

sponsors in the description. And now let me leave you with some words from Isaac Newton

Francis Collins (1:26:22.880)

reflecting on his life and work. I seem to have been only like a boy playing on the seashore

Lex Fridman (1:26:29.680)

and diverting myself in now and then finding a smoother pebble or prettier shell than ordinary.

Francis Collins (1:26:35.960)

Whilst the great ocean of truth lay all undiscovered before me. Thank you for listening and hope

Francis Collins (1:26:43.200)

to see you next time.

Francis Collins (20:03.840)

it in order to keep it from causing a broader pandemic, but you need to insist upon the

Francis Collins (20:09.760)

kind of biosecurity, the BSL 2, 3, and 4 framework under which those experiments have to be done.

Francis Collins (20:17.680)

Certainly at NIH, we're extremely rigorous about that, but you can't count on every human

Francis Collins (20:22.480)

being to always do exactly what they're supposed to. There's a risk there, which is another

Francis Collins (20:27.840)

reason why if we're contemplating supporting research on pathogens that might be the next

Francis Collins (20:34.200)

pandemic, you have to factor that in, not just whether people are going to do something

Francis Collins (20:39.320)

that we couldn't have predicted, where all of a sudden they created a virus that's much

Francis Collins (20:42.500)

worse without knowing they were going to do that, but also just having an accident. That's

Francis Collins (20:47.120)

in the mix when those estimates are done about whether the risk is worth it or not.

Francis Collins (20:54.440)

Continuing on line of difficult questions.

Lex Fridman (20:56.320)

We're going to get to fun stuff after a while.

Francis Collins (20:58.960)

We will soon, I promise. You are the director of the NIH. You are Dr. Anthony Fauci's, technically

Lex Fridman (21:10.660)

his boss.

Francis Collins (21:11.720)

Yep.

Francis Collins (21:12.720)

You have stood behind him. You have supported him, just like you did already in this conversation.

Francis Collins (21:17.920)

It is painful for me to see division and distrust, but many people in politics and elsewhere

Francis Collins (21:25.160)

have called for Anthony Fauci to be fired. When there are such calls of distrust in public

Lex Fridman (21:31.220)

about a leader like Anthony Fauci, who should garner trust, do you think he should be fired?

Francis Collins (21:38.280)

Probably not. To do so would be basically to give the opportunity for those who want

Francis Collins (21:47.960)

to make up stories about anybody to destroy them. There is nothing in the ways in which

Francis Collins (21:54.240)

Tony Fauci has been targeted that is based upon truth. How could we then accept those

Francis Collins (22:02.520)

cries for his firing as having legitimacy? It's a circular argument. They've decided

Francis Collins (22:08.860)

they don't like Tony, so they make up stuff and they twist comments that he's made about

Francis Collins (22:14.720)

things like gain of function, where he's referring to the very specific gain of function that's

Francis Collins (22:19.620)

covered by this policy, and they're trying to say he lied to the Congress. That's simply

Francis Collins (22:24.800)

not true. They don't like the fact that Tony changes the medical recommendations about

Lex Fridman (22:31.000)

what to do with COVID 19 over the space of more than a year. They call that flip flopping

Lex Fridman (22:36.820)

and you can't trust the guy because he says one thing last year and one thing this year.

Francis Collins (22:40.320)

Well, the science has changed. Delta variant has changed everything. You don't want him

Francis Collins (22:45.620)

to be saying the same thing he did a year ago. That would be wrong now. It was the best

Francis Collins (22:49.520)

we could do then. People don't understand that or else they don't want to understand

Francis Collins (22:53.760)

it. So when you basically whip up a largely political argument against a scientist and

Francis Collins (23:01.400)

hammer at it over and over again to the point where he now has to have 24 seven security

Francis Collins (23:06.520)

to protect him against people who really want to do violence to him. For that to be a reason

Francis Collins (23:11.920)

to say that then he should be fired is to hand the evil forces the victory. I will not

Francis Collins (23:17.600)

do that. Yet there's something difficult I'm going to try to express to you. So it may

Francis Collins (23:27.160)

be your guitar playing. It may be something else, but there's a humility to you. It may

Francis Collins (23:33.760)

be because you're a man of God. There's a humility to you that garners trust. And when

Francis Collins (23:45.920)

you're in a leadership position representing science, especially in catastrophic events

Francis Collins (23:51.400)

like the pandemic, it feels like as a leader, you have to go far above and beyond your usual

Francis Collins (23:59.800)

duties. And I think there's no question that Anthony Fauci has delivered on his duties,

Lex Fridman (24:07.080)

but it feels like he needs to go above as a science communicator. And if there's a large

Francis Collins (24:11.840)

number of people that are distrusting him, it's also his responsibility to garner their

Francis Collins (24:20.080)

trust to gain their trust as a person who's the face of science. Do you, are you torn

Francis Collins (24:27.400)

on this? The responsibility of Anthony Fauci of yourself to represent science, not just

Francis Collins (24:34.160)

the communication of advising what should be done, but giving people hope, giving people

Francis Collins (24:41.400)

trust in science and alleviating division. Do you think that's also responsibility of

Lex Fridman (24:47.320)

a leader or is that unfair to ask?

Francis Collins (24:50.640)

I think the best way you give people trust is to tell them the truth. And so they recognize

Francis Collins (24:55.380)

that when you're sharing information, it's the best you've got at that point. And Tony

Francis Collins (24:59.920)

Fauci does that at every moment. I don't think him expressing more humility would change

Francis Collins (25:06.920)

the fact that they're looking for a target of somebody to blame, to basically distract

Francis Collins (25:12.740)

people from the failings of their own political party. Maybe I'm less targeted, not because

Francis Collins (25:19.480)

of a difference in the way in which I convey the information. I'm less visible. If Tony

Francis Collins (25:25.640)

were out of the scene and I was placed in that role, I'd probably be seeing a ratcheting

Francis Collins (25:31.320)

up of that same targeting.

Francis Collins (25:34.480)

I would like to believe that if Tony Fauci said that when I originally made recommendations

Francis Collins (25:42.600)

not to wear masks, that was given on the, on the, our best available data. And now we

Francis Collins (25:48.320)

know that is a mistake. So admit with humility that there's an error. That's not, that's

Francis Collins (25:54.620)

not actually correct, but that's a, that's a statement of humility. And I would like

Francis Collins (26:00.520)

to believe, despite the attacks, he would win a lot of people over with that. So a lot

Francis Collins (26:07.760)

of people, as you're saying, would use that, see that here we go, here's that Dr. Anthony

Francis Collins (26:13.720)

Fauci making mistakes. How can we trust them on anything? I believe if he was that public

Francis Collins (26:20.880)

display of humility to say that I made an error, that would win a lot of people over.

Francis Collins (26:28.240)

That's my, that's kind of my sense to face the fire of the attacks from politics. You

Francis Collins (26:34.680)

have to, like politicians will attack no matter what, but the question is the people, to win

Francis Collins (26:40.960)

over the people. The biggest concern I've had is that there was this, this stress of

Francis Collins (26:47.240)

science that's been brewing and I'm, maybe you can correct me, but I'm a little bit unwilling

Francis Collins (26:53.360)

to fully blame the politicians because politicians play their games no matter what. It just feels

Francis Collins (27:00.520)

like this was an opportunity to inspire people with the power of science. The development

Francis Collins (27:05.880)

of the vaccines, no matter what you think of those vaccines is one of the greatest accomplishments

Francis Collins (27:11.440)

in the history of science. And the fact that that's not inspiring, listen, I host a podcast.

Francis Collins (27:19.360)

Whenever I say positive stuff about the vaccine, I get to hear a lot of different opinions.

Francis Collins (27:25.840)

The fact that I do is a big problem to me because it's an incredible, an incredible

Francis Collins (27:31.080)

accomplishment of science. And so I, I, I, I, I'm sorry, but I have to put responsibility

Francis Collins (27:38.840)

on the leaders, even if it's not their mistakes. That's what the leadership is. That's what

Francis Collins (27:44.120)

leadership is. You take responsibility for the situation. I wonder if there's something

Francis Collins (27:48.640)

that could have been done better to give people hope that science will save us as opposed

Lex Fridman (27:56.480)

to science will divide us.

Francis Collins (28:00.840)

I think you have more confidence in the ability to get beyond our current divisions than I

Francis Collins (28:07.120)

do after seeing just how deep and dark they have become. Tony Fauci has said multiple

Francis Collins (28:14.000)

times the recommendation about not wearing masks was for two reasons, a shortage of masks,

Francis Collins (28:20.560)

which were needed in hospitals and a lack of realization early in the course of the

Francis Collins (28:26.000)

epidemic that this was a virus that could heavily infect asymptomatic people. As that

Francis Collins (28:34.760)

changed, he changed. Now, did he make an error? No, he was making a judgment based on the

Francis Collins (28:40.080)

data available at the time, but he certainly made that clear over and over again. It has

Francis Collins (28:45.520)

not stopped those who would like to demonize him from saying, well, he just flip flopped.

Francis Collins (28:51.680)

You can't trust a guy. He says one thing today and one thing tomorrow.

Francis Collins (28:55.480)

Well, masks is a tricky one. So I'm actually early on, I'm a coauthor on a paper, one of

Francis Collins (29:02.800)

many, but this was a survey paper overlooking the, the evidence. It's a summary of the evidence

Francis Collins (29:09.400)

we have for the effectiveness of masks. It seems that it's difficult to do rigorous scientific

Francis Collins (29:17.120)

study on masks.

Lex Fridman (29:18.120)

It is difficult.

Francis Collins (29:19.120)

There's a lot of philosophical and ethical questions I want to ask you, but within this,

Francis Collins (29:26.000)

it's back to your words and Anthony Fauci's words. When you're dealing with so much uncertainty

Lex Fridman (29:33.760)

and so much potential uncertainty about how catastrophic this virus is in the early days,

Lex Fridman (29:40.960)

and knowing that each word you say may create panic, how do you communicate science with

Francis Collins (29:47.800)

the world? It's a philosophical, it's an ethical, it's a practical question. There was a discussion

Francis Collins (29:56.520)

about masks a century ago and that too led to panic. So, I mean, I'm trying to put myself

Francis Collins (30:06.480)

in the mind, in your mind, in the mind of Anthony Fauci in those early days, knowing

Francis Collins (30:10.700)

that there's limited supply of masks. Like, what do you say? Do you fully convey the uncertainty

Francis Collins (30:17.220)

of the situation of the, of the challenges of the supply chain? Or do you say that masks

Lex Fridman (30:23.960)

don't work? That's a complicated calculation. How do you make that calculation?

Francis Collins (30:32.600)

It is a complicated calculation. As a scientist, your temptation would be to give a full brain

Francis Collins (30:41.060)

dump of all the details of the information about what's known and what isn't known and

Lex Fridman (30:46.080)

what experiments need to be done. Most of the time that's not going to play well in

Francis Collins (30:51.160)

a soundbite on the evening news. So you have to kind of distill it down to a recommendation

Francis Collins (30:55.960)

that is the best you can do at that time with the information you've got.

Lex Fridman (31:01.340)

So you're a man of God. And we'll return to that to talk about some, some also unanswerable

Francis Collins (31:08.740)

philosophical questions. But first let's linger on the vaccine because in the, in the religious,

Lex Fridman (31:15.580)

in the Christian community, there was some hesitancy with the vaccine.

Francis Collins (31:19.200)

Still is.

Francis Collins (31:20.200)

There's a lot of data showing high efficacy and safety of vaccines, of COVID vaccines,

Lex Fridman (31:27.900)

but still they are far from perfect as all vaccines are. Can you empathize with people

Lex Fridman (31:33.120)

who are hesitant to take the COVID vaccine or to have their children take the COVID vaccine?

Francis Collins (31:39.000)

I can totally empathize, especially when people are barraged by conflicting information coming

Francis Collins (31:44.980)

at them from all kinds of directions. I've spent a lot of my time in the last year trying

Francis Collins (31:50.920)

to figure out how to do a better job of listening because I think we have all got the risk of

Francis Collins (31:59.100)

assuming we know the basis for somebody's hesitancy. And that often doesn't turn out

Francis Collins (32:06.240)

to be what you thought. And the variety of reasons is quite broad. I think a big concern

Francis Collins (32:14.780)

is just this sense of uncertainty about whether this was done too fast and that corners were

Francis Collins (32:20.180)

cut and there are good answers to that. Along with that, a sense that maybe this vaccine

Francis Collins (32:28.100)

will have longterm effects that we won't know about for years to come. And one can say that

Francis Collins (32:33.920)

hasn't been seen with other vaccines and there's no particular reason to think this one's going

Francis Collins (32:38.080)

to be different than the dozens of others that we have experience with. But you can't

Francis Collins (32:41.980)

absolutely say, no, there's no chance of that. So it does come down to listening and then

Francis Collins (32:49.540)

trying in a fashion that doesn't convey a message that you're smarter than the person

Francis Collins (32:57.460)

you're talking to because that isn't going to help to really address what the substance

Francis Collins (33:02.580)

is of the concerns. But my heart goes out to so many people who are fearful about this

Francis Collins (33:09.540)

because of all the information that has been dumped on them. Some of it by politicians,

Francis Collins (33:16.220)

a lot of it by the internet, some of it by parts of the media that seem to take pleasure

Francis Collins (33:24.380)

in stirring up this kind of fear for their own reasons. And that is shameful. I'm really

Francis Collins (33:31.700)

sympathetic with the people who are confused and fearful. I am not sympathetic with people

Francis Collins (33:38.220)

who are distributing information that's demonstrably false and continue to do so. They're taking

Francis Collins (33:44.060)

lives. I didn't realize how strong that sector of disinformation would be. And it's been

Francis Collins (33:54.740)

in many ways more effective than the means of spreading the truth. This is going to take

Francis Collins (34:00.740)

us into another place. But Lex, if there's something I'm really worried about in this

Francis Collins (34:06.260)

country, and it's not just this country, but it's the one I live in, is that we have another

Francis Collins (34:10.980)

epidemic besides COVID 19. And it's an epidemic of the loss of the anchor of truth. That truth

Francis Collins (34:20.740)

as a means of making decisions, truth as a means of figuring out how to wrestle with

Francis Collins (34:27.100)

a question like, should I get this vaccine for myself or my children, seems to have lost

Francis Collins (34:33.300)

its primacy. And instead, it's an opinion of somebody who expressed it very strongly,

Francis Collins (34:42.780)

or some Facebook post that I read two hours ago. And for those to become substitutes for

Francis Collins (34:51.440)

objective truth, not just, of course, for vaccines, but for many other issues, like

Francis Collins (34:58.820)

was the 2020 election actually fair? This worries me deeply. It's bad enough to have

Francis Collins (35:06.020)

polarization and divisions, but to have no way of resolving those by actually saying,

Francis Collins (35:12.660)

okay, what's true here, makes me very worried about the path we're on. And I'm usually an

Francis Collins (35:18.180)

optimist.

Francis Collins (35:19.180)

Well, to give you an optimistic angle on this, I actually think that the sense that there's

Francis Collins (35:27.220)

no one place for truth is just a thing that will inspire leaders and science communicators

Francis Collins (35:35.100)

to speak, not from a place of authority, but from a place of humility. I think it's just

Francis Collins (35:39.740)

challenging people to communicate in a new way, to be listeners first. I think the problem

Francis Collins (35:46.940)

isn't that there's a lot of misinformation. I think that the internet and the world are

Francis Collins (35:59.380)

distrustful of people who speak as if they possess the truth with an authoritarian kind

Francis Collins (36:06.340)

of tone, which was, I think, defining for what science was in the 20th century. I just

Francis Collins (36:12.780)

think it has to sound different in the 21st. In the battle of ideas, I think humility and

Francis Collins (36:20.100)

love wins. And that's how science wins, not through having quote unquote truth. Because

Francis Collins (36:27.260)

now everybody can just say, I have the truth. I think you have to speak, like I said, from

Francis Collins (36:34.300)

humility, not authority. And so it's just challenges our leaders to go back and learn

Francis Collins (36:40.480)

to be, pardon my French, less assholes and more kind. And like you said, to listen, to

Francis Collins (36:48.260)

listen to the experiences of people that are good people, not the ones who are trying to

Francis Collins (36:52.580)

manipulate the system or play a game and so on, but real people who are just afraid of

Francis Collins (36:58.380)

uncertainty of hurting those they loved and so on. So I think it's just an opportunity

Francis Collins (37:03.700)

for leaders to go back and take a class on effective communication.

Francis Collins (37:09.020)

I'm with you on shifting more from where we are to humility and love. That's got to be

Francis Collins (37:14.780)

the right answer. That's very biblical, by the way.

Francis Collins (37:18.500)

We'll get there. I have to bring up Joe Rogan. I don't know if you know who he is.

Francis Collins (37:24.060)

I do.

Lex Fridman (37:25.060)

He's a podcaster, comedian, fighting commentator, and my now friend.

Lex Fridman (37:30.460)

And Iver Mecton believer too.

Francis Collins (37:32.700)

Yes. That is the question I have to ask you about. He has gotten some flack in the mainstream

Francis Collins (37:38.620)

media for not getting vaccinated. And when he got COVID recently, taking Iver Mecton

Francis Collins (37:44.540)

as part of a cocktail of treatments. The NIH actually has a nice page on Iver Mecton saying

Francis Collins (37:50.380)

quote, there's insufficient evidence to recommend either for or against the use of Iver Mecton

Francis Collins (37:57.100)

for the treatment of COVID 19 results from adequately powered, well designed and well

Francis Collins (38:02.860)

conducted clinical trials are needed to provide more specific evidence based guidance on the

Lex Fridman (38:07.900)

role of Iver Mecton in the treatment of COVID 19.

Lex Fridman (38:12.500)

So let me ask, why do you think there has been so much attack on Joe Rogan and anyone

Lex Fridman (38:17.460)

else that's talking about Iver Mecton when there's insufficient evidence for or against?

Francis Collins (38:24.980)

Well let's unpack that. First of all, I think the concerns about Joe are not limited to

Francis Collins (38:30.120)

his taking Iver Mecton. Much more seriously, his being fairly publicly negative about vaccines

Francis Collins (38:37.260)

at a time where people are dying. 700,000 people have died from COVID 19 estimates by

Francis Collins (38:44.420)

Kaiser or at least 100,000 of those were unnecessary deaths of unvaccinated people. And for Joe

Francis Collins (38:50.900)

to promote that further, even as this pandemic rages through our population is simply irresponsible.

Lex Fridman (39:00.840)

So yeah, the Iver Mecton is just one other twist. Obviously Iver Mecton has been controversial

Francis Collins (39:05.900)

for months and months. The reason that it got particular attention is because of the

Francis Collins (39:11.540)

way in which it seemed to have captured the imagination of a lot of people and to the

Francis Collins (39:16.740)

point where they were taking doses that were intended for livestock and some of them got

Francis Collins (39:21.780)

pretty sick as a result from overdosing on this stuff. That was not good judgment. The

Francis Collins (39:28.940)

drug itself remains uncertain. There's a recent review that looks at all of the studies of

Francis Collins (39:35.500)

Iver Mecton and basically concludes that it probably doesn't work. We are running a study

Francis Collins (39:41.540)

right now. I looked at that data this morning in a trial called active six, which is one

Francis Collins (39:47.660)

of the ones that my public private partnership is running. We're up to about 400 patients

Francis Collins (39:52.980)

who've been randomized to Iver Mecton or placebo and should know perhaps as soon as a month

Francis Collins (39:58.820)

from now in a very carefully controlled trial, did it help or did it not? So there will be

Francis Collins (40:04.620)

an answer coming back to Joe again. I don't think the fact that he took the Iver Mecton

Lex Fridman (40:11.020)

and hoping it might work, uh, is that big a knock against him. It's more the conveying

Francis Collins (40:16.140)

of we don't trust what science says, which is vaccines are going to save your life. We're

Francis Collins (40:21.240)

going to trust what's on the internet that says Iver Mecton and hydroxychloroquine really

Francis Collins (40:25.340)

do work, even though the scientific community says probably not.

Lex Fridman (40:28.260)

So let me push back in that a little bit. So he doesn't, he doesn't say, let's not listen

Francis Collins (40:34.080)

to science. He doesn't say the vaccine don't get vaccinated. He says it's okay to ask questions.

Francis Collins (40:44.020)

I'm okay with that. How risky is the vaccine for certain populations? What are the benefits

Lex Fridman (40:50.600)

and risks? There's other friends of Joe and friends of mine, like Sam Harris, who says,

Francis Collins (40:57.800)

if you look at the data, it's obvious that the benefits outweigh the risks. And what Joe says

Francis Collins (41:04.780)

is yes, but let's still openly talk about risks. And he often brings up anecdotal evidence

Francis Collins (41:11.960)

of people who've had, uh, highly negative effects from vaccines. Science is not done

Francis Collins (41:18.780)

with anecdotal evidence. And so you could infer a lot of stuff from the way he expresses

Francis Collins (41:24.780)

it, but he also communicates a lot of interesting questions. Uh, and that's something maybe

Francis Collins (41:30.260)

you can comment on this. You know, there's certain groups that are healthy. They have,

Francis Collins (41:36.660)

they're younger, they have, they exercise a lot. They get the all, you know, nutrition

Lex Fridman (41:41.740)

and all those kinds of things. He shows skepticism on whether it's so obvious that they should

Francis Collins (41:48.960)

get vaccinated. And the same is he makes this, he kind of presents the same kind of skepticism

Francis Collins (41:55.240)

for kids, for young kids. So with empathy and, uh, you know, listening my Russian ineliquent

Francis Collins (42:07.480)

description of what Joe believes, what, what is your kind of response to that? Why should

Lex Fridman (42:13.680)

certain categories of healthy and young people still get vaccinated? Do you think?

Francis Collins (42:18.320)

Well, first just to say it's great for Joe to be a skeptic, to ask questions. We should

Francis Collins (42:22.380)

all be doing that. But then the next step is to go and see what the data says and see

Francis Collins (42:26.760)

if they're actually answers to those questions. So coming to healthy people, I've done a bunch

Francis Collins (42:32.740)

of podcasts besides this one. The one I think I remember most was a podcast with a worldwide

Francis Collins (42:40.820)

wrestling superstar. Very nice. He's about six foot six and just absolutely solid muscle.

Lex Fridman (42:48.240)

And he got COVID and he almost died. And recovering from that, he said, I've got to let my supporters

Francis Collins (42:57.800)

know because you can imagine worldwide wrestling fans are probably not big embracers of the

Francis Collins (43:04.320)

need for vaccines. And he want, he just turned himself into a spokesperson for the fact that

Francis Collins (43:13.060)

this virus doesn't care how healthy you are, how much you exercise, what a great specimen

Francis Collins (43:18.920)

you are. It wiped him out. And we see that, you know, the average person in the ICU right

Francis Collins (43:26.520)

now with COVID 19 is under age 50. I think there's a lot of people still thinking, Oh,

Francis Collins (43:31.880)

it's just those old people in the nursing homes. That's not going to be about me. They're

Francis Collins (43:35.080)

wrong. And there are plenty of instances of people who were totally healthy with no underlying

Francis Collins (43:40.680)

diseases, taking good care of themselves, not obese exercising who have died from this

Francis Collins (43:46.200)

disease. 700 children have died from this disease. Yes. Some of them had underlying

Francis Collins (43:54.500)

factors like obesity, but a lot of them did not. So it's fair to say younger people are

Francis Collins (44:00.400)

less susceptible to serious illness, kids even less so, and then young adults, but it

Francis Collins (44:07.900)

ain't zero. And if the vaccine is really safe and really effective, then you probably want

Francis Collins (44:15.540)

everybody to take advantage of that. Even though some are dropping their risks more

Francis Collins (44:20.240)

than others, everybody's dropping their risks. Some, are you worried about variants? So looking

Francis Collins (44:26.520)

out into the future, what's your vision for all the possible trajectories that this virus

Francis Collins (44:33.000)

takes in human society? I'm totally worried about the variants. Delta was such an impressive

Francis Collins (44:40.800)

arrival on the scene in all the wrong ways. I mean, it took over the world in the space

Francis Collins (44:47.460)

of just a couple months because of its extremely contagious ability. Viruses would be beautiful

Francis Collins (44:53.960)

if they weren't terrifying. Yeah, exactly. I mean, this whole story of viral evolution

Francis Collins (44:58.460)

scientifically is just amazingly elegant. Anybody who really wanted to understand how

Francis Collins (45:03.360)

evolution works in real time, study SARS CoV 2, because it's not just Delta, it's Alpha,

Francis Collins (45:09.920)

it's Beta, and it's Gamma, and it's the fact that these sweep through the world's population

Francis Collins (45:16.520)

by fairly minor differences in fitness. So the real question many people are wrestling

Lex Fridman (45:23.280)

is, is Delta it? Is it such a fit virus that nothing else will be able to displace it?

Francis Collins (45:30.280)

I don't know. I mean, there's now Delta AY4, which is a variant of Delta that at least

Francis Collins (45:37.520)

in the UK seems to be taking over the Delta population as though it's maybe even a little

Francis Collins (45:43.800)

more contagious. That might be the first hint that we're seeing something new here. It's

Francis Collins (45:49.320)

not a completely different virus. It's still Delta, but it's Delta Plus. You know, the

Francis Collins (45:55.720)

big worry is what's out there that is so different that the vaccine protection doesn't work.

Lex Fridman (46:07.480)

And we don't know how different it needs to be for the vaccine to start working. That's

Francis Collins (46:12.440)

the terrifying thing about each of these variants. It's like, it's always a pleasant surprise

Francis Collins (46:18.120)

that a vaccine seems to still have efficacy.

Lex Fridman (46:21.200)

And hooray for our immune system, may I say, because the vaccine immunized you against

Francis Collins (46:27.080)

that original Wuhan virus. Now we can see that especially after two doses and even more

Lex Fridman (46:35.840)

so after a booster, your immune system is so clever that it's also making a diversity

Francis Collins (46:42.080)

of antibodies to cover some other things that might happen to that virus to make it a little

Francis Collins (46:47.760)

different. And you're still getting really good coverage. Even for beta, which was South

Francis Collins (46:54.440)

Africa B1351, which is the most different, it looks pretty good. But that doesn't mean

Francis Collins (47:00.680)

it will always be as good as that if something gets really far away from the original virus.

Francis Collins (47:06.200)

Now the good news is we would know what to do in that situation. The mRNA vaccines allow

Francis Collins (47:11.720)

you to redesign the vaccine like that and to quickly get it through a few thousand participants

Francis Collins (47:19.160)

in a clinical trial to be sure it's raising antibodies and then bang, you could go. But

Francis Collins (47:23.200)

I don't want to have to do that. There will be people's lives at risk in the meantime.

Lex Fridman (47:28.720)

And what's the best way to keep that from happening? Well, try to cut down the number

Francis Collins (47:32.240)

of infections because you don't get variants unless the virus is replicating in a person.

Lex Fridman (47:37.400)

So how do we solve this thing? How do we get out of this pandemic? What's like, if you

Francis Collins (47:44.200)

had a, like a wand or something, or you could really implement policies, what's the full

Francis Collins (47:51.080)

cocktail of solutions here? It's a full cocktail. It's not just one thing. In our own country

Francis Collins (47:56.800)

here in the US, it would be getting those 64 million reluctant people to actually go

Francis Collins (48:01.920)

ahead and get vaccinated. There's 64 million people who didn't get vaccinated? Adults.

Francis Collins (48:05.840)

Yes. Not even counting the kids. 64 million. Isn't that astounding? Get the kids vaccinated.

Francis Collins (48:13.640)

Hopefully their parents will see that as a good thing too. Get those of us who are due

Francis Collins (48:18.240)

for boosters boosted because that's going to reduce our likelihood of having breakthrough

Francis Collins (48:22.060)

infections and keep spreading it. Convince people that until we're really done with this,

Lex Fridman (48:27.600)

and we're not now, that social distancing and mask wearing indoors are still critical

Francis Collins (48:32.880)

to cut down the number of new infections. But of course, that's our country. This is

Francis Collins (48:39.200)

a worldwide pandemic. I worry greatly about the fact that low and middle income countries

Francis Collins (48:45.400)

have for the most part, not even gotten started with access to vaccines. And we have to figure

Francis Collins (48:50.480)

out a way to speed that up because otherwise that's where the next variant will probably

Francis Collins (48:56.880)

arrive. And who knows how bad it will be. And it will cross the world quickly as we've

Lex Fridman (49:01.820)

seen happen repeatedly in the last 22 months.

Francis Collins (49:05.960)

I think I'm really surprised, annoyed, frustrated that rapid at home testing from the very beginning

Francis Collins (49:14.540)

wasn't a big, big part of the solution. First of all, nobody's against it. That's one huge

Francis Collins (49:20.780)

plus for testing. Everybody supports. Second of all, that's what America is good at is

Francis Collins (49:28.400)

mask manufacturer stuff, like stepping up, engineers stepping up and really deploying

Francis Collins (49:33.680)

it. Plus, without the collection of data is giving people freedom, is giving them information

Lex Fridman (49:39.680)

and then freedom to decide what to do with that information. It's such a powerful solution.

Francis Collins (49:44.040)

I don't understand. Well, now I think the Biden administration is, I think, emphasized

Francis Collins (49:49.520)

like the scaling of testing manufacturers. But I just feel like it's an obvious solution.

Francis Collins (49:54.120)

Get a test that costs less than a dollar to manufacture, costs less than a dollar to buy.

Lex Fridman (49:59.480)

And just everybody gets tested every single day. Don't share that data with anyone. You

Francis Collins (50:03.980)

just make the decisions. And I believe in the intelligence of people to make the right

Lex Fridman (50:08.280)

decision to stay at home when the test is positive.

Francis Collins (50:11.120)

I am so completely with you on that. And NIH has been smack in the middle of trying to

Francis Collins (50:15.720)

make that dream come true. We're running a trial right now in Georgia, Indiana, Hawaii.

Lex Fridman (50:25.440)

And where is the other one? Oh, Kentucky. Basically blanketing a community with free

Lex Fridman (50:32.000)

testing.

Francis Collins (50:33.000)

That's beautiful.

Lex Fridman (50:34.000)

And look to see what happens as far as stemming the spread of the epidemic and measuring it

Francis Collins (50:39.100)

by wastewater because you can really tell whether you've cut back the amount of infection

Francis Collins (50:43.460)

in the community. Yeah, I'm so with you. We got off to such a bad start with testing.

Lex Fridman (50:50.780)

And of course, all the testing was being done for the first several months in big box laboratories

Francis Collins (50:55.840)

where you had to send the sample off and put it through the mail somehow and get the result

Francis Collins (50:59.940)

back sometimes five days later after you've already infected a dozen people. It was just

Francis Collins (51:04.320)

a completely wrong model. But it's what we had. And everybody was like, oh, we got to

Francis Collins (51:08.720)

stick with PCR because if you start using those home tests that are based on antigens,

Francis Collins (51:13.480)

lateral flow, probably there's going to be false positives and false negatives. Okay,

Francis Collins (51:18.280)

sure. No test is perfect. But having a test that's not acceptable or accessible is the

Lex Fridman (51:24.960)

worst setting.

Lex Fridman (51:26.220)

So we, NIH, with some requests from Congress, got a billion dollars to create this program

Francis Collins (51:32.560)

called Rapid Acceleration of Diagnostics, RADx. And we turned into a venture capital

Francis Collins (51:39.040)

organization, and we invited every small business or academic lab that had a cool idea about

Lex Fridman (51:42.920)

how to do home testing to bring it forward. And we threw them into what we called our

Francis Collins (51:47.040)

shark tank of business experts, engineers, technology people, people who understood how

Francis Collins (51:52.600)

to deal with supply chains and manufacturing. And right now today, there are about two million

Francis Collins (51:59.760)

tests being done based on what came out of that program, including most of the home tests

Francis Collins (52:05.600)

that you can now buy on the pharmacy shelves. We did that. And I wish we had done it faster,

Lex Fridman (52:10.400)

but it was an amazingly speedy effort. And you're right, companies are really good. Once

Francis Collins (52:15.640)

they've got an FDA emergency use authorization, and we helped a lot of them get that, they

Francis Collins (52:20.440)

can scale up their manufacturing. I think in December, we should have about 410 million

Francis Collins (52:28.000)

tests for that month ready to go. And if we can get one or two more platforms approved,

Lex Fridman (52:34.080)

and by the way, we are now helping FDA by being their validation lab. If we can get

Francis Collins (52:39.400)

a couple more of these approved, we could be in the half a billion tests a month, which

Francis Collins (52:44.880)

is really getting where we need to be.

Francis Collins (52:47.040)

Wow. Yeah, that's a dream. That's a dream for me. It seems like an obvious solution,

Francis Collins (52:52.160)

engineering solution. Everybody's behind it, at least to hope versus division. I love it.

Lex Fridman (52:57.720)

Yeah.

Francis Collins (52:58.720)

A happy story.

Lex Fridman (52:59.720)

A happy story.

Francis Collins (53:00.720)

I was waiting for one.

Francis Collins (53:02.680)

Yeah. All right. Well, one last dive into the not happy, but you won't even have to

Francis Collins (53:07.480)

comment on it. Well, comment on the broader philosophical question. So NIH, again, I said,

Francis Collins (53:15.240)

Joe Rogan is the first one who pointed me to this. NIH was recently accused of funding

Francis Collins (53:20.480)

research of a paper that had images of sedated puppies with their heads inserted into small

Francis Collins (53:25.720)

enclosures containing disease carrying sand flies. So I can just say that this story is

Francis Collins (53:32.720)

not true, or at least the... I think it is true that the paper that showed those images

Lex Fridman (53:40.280)

cited NIH as a funding source, but that citation is not correct.

Francis Collins (53:45.160)

That was not correct.

Francis Collins (53:46.720)

Yeah. But that brings up a bigger philosophical question, that it could have been correct.

Lex Fridman (53:54.760)

How difficult is it as a director of NIH or just NIH as an organization that's funding

Lex Fridman (53:59.240)

so many amazing deep research studies to ensure the ethical fortitude of those studies when

Francis Collins (54:07.600)

the ethics of science is... There's such a gray area between what is and what isn't ethical.

Lex Fridman (54:14.000)

Well, tough issues. Certainly animal research is a tough issue.

Francis Collins (54:19.920)

I was going to bring up as a good example of that tough issue is in 2015, you announced

Francis Collins (54:26.320)

that NIH will no longer support any biomedical research involving chimpanzees. So that's

Francis Collins (54:32.160)

like one example of looking in the mirror, thinking deeply about what is and isn't ethical.

Lex Fridman (54:39.480)

And there was a conclusion that biomedical research on chimps is not ethical.

Francis Collins (54:45.120)

That was the conclusion. That was based on a lot of deep thinking and a lot of input

Francis Collins (54:49.120)

from people who have considered this issue and a panel of the National Academy of Sciences

Francis Collins (54:54.840)

that was asked to review the issue. I mean, the question that I wanted them to look at

Francis Collins (55:00.880)

was, are we actually learning anything that's really essential from chimpanzee invasive

Francis Collins (55:06.800)

research at this point? Or is it time to say that these closest relatives of ours should

Lex Fridman (55:14.080)

not be subjected to that any further and ought to be retired to a sanctuary?

Lex Fridman (55:19.240)

And that was the conclusion that there was really no kind of medical experimentation

Lex Fridman (55:24.520)

that needed to be done on chimps in order to proceed. So why are we still doing this?

Francis Collins (55:29.840)

Many of these were chimpanzees that were purchased because we thought they would be good hosts

Francis Collins (55:36.640)

for HIV AIDS, and they sort of weren't. And they were kept around in these primate laboratories

Francis Collins (55:43.140)

with people coming up with other things to do, but they weren't compelling scientifically.

Lex Fridman (55:48.420)

So I think that was the right decision. I took a lot of flak from some of the scientific

Francis Collins (55:52.960)

community said, well, you're caving in to the animal rights people. And now that you've

Francis Collins (55:57.320)

said no more research on chimps, what's next? Certainly when it comes to companion animals,

Francis Collins (56:05.520)

everybody's heart starts to be hurting when you see anything done that seems harmful to

Francis Collins (56:12.520)

a dog or a cat. I have a cat, I don't have a dog. And I understand that completely. That's

Lex Fridman (56:18.320)

why we have these oversight groups that decide before you do any of that kind of research,

Lex Fridman (56:24.500)

is it justified? And what kind of provision is going to be made to avoid pain and suffering?

Lex Fridman (56:32.500)

And those have input from the public as well as the scientific community. Is that completely

Francis Collins (56:39.300)

saying that every step that's happening there is ethical by some standard that would be

Francis Collins (56:47.400)

hard for anybody to agree to? No, but at least it's a consensus of what people think is acceptable.

Francis Collins (56:54.740)

Dogs are the only host for some diseases like leishmaniasis, which was that paper that we

Francis Collins (57:02.040)

were not responsible for, but I know why they were doing the experiment, or like lymphatic

Francis Collins (57:06.400)

filariasis, which is an experiment that we are supporting in Georgia that involves dogs

Francis Collins (57:13.040)

getting infected with a parasite, because that's the only model we have to know whether

Francis Collins (57:16.940)

a treatment is going to work or not. So I will defend that. I am not in the place of

Francis Collins (57:23.600)

those who think all animal research is evil, because I think if there's something that's

Francis Collins (57:28.440)

going to be done to save a child from a terrible disease or an adult, and it involves animal

Francis Collins (57:33.820)

research that's been carefully reviewed, then I think ethically why it doesn't make me comfortable,

Francis Collins (57:39.400)

it still seems like it's the right choice. I think to say all animal research should

Francis Collins (57:45.280)

be taken off the table is also very unethical, because that means you have basically doomed

Francis Collins (57:50.960)

a lot of people for whom that research might have saved their lives to having no more hope.

Lex Fridman (57:58.200)

And to me personally, there's far greater concerns ethically in terms of factory farming,

Lex Fridman (58:03.480)

for example, the treatment of animals in other contexts.

Francis Collins (58:06.800)

There's so much that goes on outside of medical research that is much more troubling.

Francis Collins (58:12.560)

That said, I think all cats have to go. That's just my off the record opinion. That's why

Francis Collins (58:17.860)

I'm not involved with any ethical decisions. I'm just joking internet ethic. I love cats.

Lex Fridman (58:22.360)

You're a dog person.

Francis Collins (58:23.360)

I'm a dog person. I'm sorry.

Francis Collins (58:24.360)

Have you seen the New Yorker cartoon where there are two dogs in the bar having a martini

Lex Fridman (58:29.920)

and one is saying they're dressed up in their business suits and one says to the other,

Lex Fridman (58:34.200)

you know, it's not enough for the dogs to win. The cats have to lose.

Francis Collins (58:39.680)

That's beautiful. So a few weeks ago, you've announced that you're resigning from the NIH

Lex Fridman (58:47.680)

at the end of the year.

Francis Collins (58:48.920)

I'm stepping down. I'm still going to be at NIH at a different capacity.

Francis Collins (58:53.660)

Right. And it's over a decade of an incredible career overseeing the NIH as its director.

Lex Fridman (59:02.360)

What are the things you're most proud of, of the NIH in your time here as its director

Lex Fridman (59:07.660)

may be memorable moments?

Francis Collins (59:12.920)

There's a lot in 12 years. Science has just progressed in amazing ways over those 12 years.

Francis Collins (59:22.680)

Think about where we are right now. Something like gene editing, being able to make changes

Francis Collins (59:28.040)

in DNA, even for therapeutic purposes, which is now curing sickle cell disease. Unthinkable

Francis Collins (59:35.040)

when I became director in 2009. The ability to study single cells and ask them what they're

Francis Collins (59:42.400)

doing and get an answer. Single cell biology just has emerged in this incredibly powerful

Francis Collins (59:48.800)

way. Having the courage to be able to say we could actually understand the human brain

Francis Collins (59:57.000)

seemed like so far out there. And we're in the process of doing that with the Brain Initiative.