It is well known that distrust of science is the sine qua non of science denial, and that distrust extends to all of the institutions, mechanisms, and trappings of science that do not tell them what they want to hear. That quacks and antivaxxers have a pathologic distrust of big pharma is unsurprising, but they also distrust a number of other pillars that support science, including the National Institutes of Health (NIH). Part and parcel of that distrust is a narrative that applying for and successfully obtaining NIH funding for your scientific research represent an intolerable financial conflict of interest (COI), every bit as severe as the more commonly accepted financial COI of accepting funding from pharmaceutical companies or policy think tanks. Before the pandemic, I used to hear this sort of nonsense mainly from people who had never received an NIH grant or served on an NIH study section. Unfortunately, that isn’t the case any more.
Yesterday, I saw Dr. Jay Bhattacharya amplifying such a claim:
What about Dr. Aaron Kheriaty? I’ll include his thread here so that you don’t have to visit Twitter to see it:
Far be it from me to argue that the NIH is beyond reproach or that the NIH grant funding decision process isn’t without significant shortcomings, but Dr. Kheriaty’s proposal is just plain unworkable—and full of stereotypes, such as the idea that California has more of a problem with mental illness than any other state. One also wonders which states would control funding for cancer research or cardiovascular disease, given that, although there are geographic disparities in incidence for both, these diseases affect every state to a large degree.
Contrary to Dr. Kheriaty’s characterization, the NIH was set up the way it was in order to try to insulate it as much as was feasible against gross political manipulation (although, admittedly, it doesn’t always work, as Republicans and the odd Democrat have occasionally tried to demonstrate). To sprinkle the NIH budget among 50 states would not only greatly dilute the impact of that $45 billion, but would spread it to a number of states that have indeed been nakedly political about public health and science, such as Texas or, even worse, Florida, where Gov. Ron DeSantis brought in Dr. Joseph Ladapo to run the state’s public health infrastructure. Dr. Ladapo, you might recall, was a member of the quack group America’s Frontline Doctors, which was dedicated to promoting unproven treatments like hydroxychloroquine during the summer of 2020 and then pivoted to ivermectin, promoting antivaccine misinformation about COVID-19 vaccines, and pandemic grift running a prescription mill for this similarly ineffective repurposed drug. Unsurprisingly, he is a big fan of the Great Barrington Declaration, which advocated a “let ‘er rip” approach to the pandemic in order to achieve “natural herd immunity” more rapidly. It was always an approach to the pandemic that could never have worked.
Moreover, unlike the federal government and the NIH, states don’t have the dense network of laws and regulations built up over the last several decades in order to try to keep the NIH insulated from the worst partisan political influences. I suspect, of course, that that’s the point of Dr. Kheriaty’s suggestion: To dilute the overall effect of the NIH budget and instead turn it into an ideological or partisan patronage machine for science. As for the claim that all scientists who have received NIH funding have some sort of hopeless COI because of it, that’s just part of the whole antiscience narrative that seeks to cast doubt on all the usual structures and mechanisms undergirding the scientific enterprise and thereby cast doubt on the findings of science itself.
Let’s look at the narrative, though, in which Dr. Bhattacharya claims that it’s a “deep conflict of interest” to have someone like Anthony Fauci be involved with public health policy. I’m just going to say it right now. Dr. Bhattacharya is peddling disinformation, because that’s not how the NIH funding process works—and, as I will show, he almost certainly knows it. Dr. Fauci has been the Director of the National Institute of Allergy and Infectious Diseases (NIAID) since the mid-1980s. The NIAID is just one institute in the NIH, the others including the National Cancer Institute (NCI, the institute that I’m most familiar dealing with), National Eye Institute (NEI), National Heart, Lung, and Blood Institute (NHLBI), and several others. The National Center for Complementary and Integrative Health (NCCIH)—which as such a long history of funding quackery—is also part of the NIH, but as a center it has a lower status than as an institute.
The implied idea behind the narrative being promoted by Drs. Bhattacharya and Kheriaty is that you have to hew to the ideological beliefs of an institute director like Dr. Fauci in order to have a chance of obtaining grant funding from the NIH. Whether these two realize it or not, it’s an old idea that I’ve seen peddled by antivaccine sources like Robert F. Kennedy, Jr. and others going way back. I like to point out that it’s all projection. Grifters don’t do anything without being paid and don’t pay anyone who doesn’t serve their interests; so they assume that everything else in the world works that way too, including the NIH. Similarly, conspiracy theorists like antivaxxers and COVID-19 are very prone to believing that there must be a quid pro quo for everything; so they are very gullible when it comes to claims that scientists are all in the thrall of Anthony Fauci because they depend on the NIH for funding.
One reason why this is nonsensical is that Dr. Fauci is only the director of one institute out of 20 institutes and the National Library of Medicine. He has no power over what happens in the other institutes. More importantly, this idea that investigators have to hew to whatever the ideological line of the current administration at any given institute happens to be is a vast exaggeration. Obviously, the NIH director and individual institute directors have considerable power to shape the priorities of the NIH and their respective institutes, but they have to do so within the constraints of the law, regulations, and Congressional funding. Again, I’m not going to claim that the NIH funding process isn’t flawed. It is, and it could use a number of improvements. Whatever its real flaws, however, being a grift machine in which investigators must kowtow to the NIH leadership (like Dr. Fauci) or risk having one’s funding cut off is not one of them. To understand why, all you have to know is how the process actually works.
Let’s say that you’ve submitted a grant application to the NIH to try to win funding your research. Let’s first look at what the NIH says about the peer review process by which it will be evaluated:
The NIH dual peer review system is mandated by statute in accordance with section 492 of the Public Health Service Act and federal regulations
governing “Scientific Peer Review of Research Grant Applications and Research and Development Contract Projects”. NIH policy is intended to promote a process whereby grant applications submitted to the NIH are evaluated on the basis of a process that strives to be fair, equitable, timely, and free of bias.
The first level of review is carried out by a Scientific Review Group (SRG; also referred to as study sections) composed primarily of non-federal scientists who have expertise in relevant scientific disciplines and current research areas.
The second level of review is performed by Institute and Center (IC) National Advisory Councils or Boards. Councils are composed of both scientific and public representatives chosen for their expertise, interest, or activity in matters related to health and disease.
Only applications that are recommended for approval by both the SRG and the Advisory Council may be recommended for funding. Final funding decisions are made by the IC Directors.
Or, in more detail:
The NIH uses a two-stage review process. In the first stage, two to five reviewers individually evaluate each grant application by assigning a preliminary rating using the NIH’s reverse 9-point scale (1 = exceptional, 9 = poor) and writing a critique describing the application’s strengths and weaknesses. Most typically, three reviewers are assigned to an application: a primary, a secondary, and a tertiary reviewer, ranked in order of the relevance of their expertise. Reviewers then convene in study section meetings, where they discuss the applications that received preliminary ratings in the top half of all applications evaluated. After sharing their preliminary ratings and critiques, the two to five assigned reviewers discuss the application with all other study section members, all of whom assign a final rating to the application. This final rating from all members is averaged into a final “priority score.” In the second stage, members of NIH’s advisory councils use this priority score and the written critiques to make funding recommendations to the director of the NIH institute or center that awards the funding. Reviewers in study sections are prohibited from discussing or considering issues related to funding and instead are encouraged to rate each application based on its scientific merit alone.
- NIH program staff members examine applications and consider the overall impact scores given during the peer review process, percentile rankings (if applicable) and the summary statements in light of the Institute/Center’s priorities.
- Program staff provide a grant-funding plan to the Advisory Board/Council. Council members have access to applications and summary statements pending funding for that IC in that council round.
- Council members conduct a Special Council Review of grant applications from investigators who currently receive $1 million or more in direct costs of NIH funding to support Research Project Grants (see NOT-OD-12-140). This additional review is to determine if additional funds should be provided to already well-supported investigators and does not represent a cap on NIH funding.
- The Advisory Council/Board also considers the Institute/Center’s goals and needs and advises the Institute/Center director concerning funding decisions.
- The Institute/Center director makes final funding decisions based on staff and Advisory Council/Board advice.
Aha! Cranks say, the institute and center directors make the final funding decisions, no matter how reviewers are supposedly encouraged to rate each application on scientific merits alone! There’s your grift! Not exactly.
In actuality, the institute directors mostly sign off on decisions that have already been nearly finalized after multiple layers of review, starting with the study section review that determines a priority score, then program staff and Advisory Board/Council review. That’s not to say that the institute director doesn’t have influence, but it’s not how cranks like to describe it, namely as near total power to decide who does and does not get funded based on a whim. The places where the director has influence tend to be at the margins and by setting the overall priorities of the institute. Believe it or not, the NIH review process strives to be as close to a meritocracy as a human evaluation can be. Moreover, if you submit a grant that gets a score that puts it, say, in the 3rd percentile (top 3% of grant scores) and the payline is, say, the 10th percentile, you’re going to get the grant. If you’re on the borderline, it’s possible to call up your program official assigned to your grant to make a pitch (and sometimes it will even help), but in general it’s the NIH study section peer review system that determines which grant applications are funded, not the IC directors.
Again, no one is claiming that the NIH review process is a perfect (or even near-perfect) system, to the point where one Twitter denizen responded:
Dr. Wallach noted that an investigator can submit the same grant twice and get wildly different scores, something that’s been noted in the literature. There are also known to be racial disparities in priority scores received for grant applications, and those aren’t the only problems. There are lots of other problems with the grant evaluation and funding process at the NIH that could use reform and improvement. It’s just that none of these problems includes Dr. Fauci or any other IC director whispering to investigators whose ideological views they don’t like, “Nice grant application you submitted there. It’d be a shame if something happened to it.” Yet that’s exactly the picture that people like Dr. Kheriaty and Dr. Bhattacharya are painting for their followers about COVID-19 public health policy.
We’ve met Dr. Kheriaty before. You might recall that he is a former professor of psychiatry and human behavior at the medical school and director of the medical ethics program at UC-Irvine Health and was fired from posts at the medical school for refusing to be vaccinated against COVID-19. Naturally, he’s now on Substack, which, like so many other Substack blogs, is full of rants about “coercion” and support for bad science like the Great Barrington Declaration. He also appeared on an episode of The Highwire with Del Bigtree entitled “Natural Immunity” Is Our Way Out of the Pandemic. Let’s just say that, if even UC-Irvine (home of homeopathy-loving “integrative medicine“) can’t stomach you, you’re probably really bad at science. He doesn’t appear to have had any NIH grants, if a search on NIH RePORTER is any indication; so, given that generally you have to have had an NIH grant to be invited to be a standing member of a study section I’m pretty sure that he’s never served on an NIH study section (although I could be wrong, given that ad hoc reviewers are sometimes invited for their special expertise). I thus conclude that Dr. Kheriaty could be speaking from ignorance, although if he’s been in academic medicine for a while it’s hard to imagine that he doesn’t have at least some vague idea of how NIH study sections work.
In contrast, Dr. Bhattacharya almost certainly must know that his narrative is disinformation; that is, unless he’s fallen so far down the rabbit hole that he’s now become a true believer in his own conspiracy theories and, much like the dealer who gets high on his own supply, has lost touch with reality when it comes to the conspiracy theories he peddles. Just look at his CV on the Stanford website if you don’t believe me. Granted, it hasn’t been updated since 2016, but it shows that he has served on multiple NIH study sections. He therefore knows how they run, how grant applications are actually evaluated, and that the narrative he is promoting is divorced from reality, whatever the real problems with NIH review process might be. If you look him up in NIH RePORTER, you’ll find that he’s been principal or co-investigator on a number of NIH grants too. Does that mean he’s been hopelessly ideologically captured by institute directors overseeing his grants?
The bottom line is that the idea that NIH-funded investigators and those seeking NIH funding (almost all of us at one time or another) have an irreconcilable COI that makes us unwilling (or at least reluctant) to counter Dr. Fauci’s statements and recommendations about the COVID-19 pandemic is a form of projection common in right-wing libertarian thinking of the sort promoted by the kinds of “free market” think tanks behind COVID-19 minimization and statements like the Great Barrington Declaration, of which Dr. Bhattacharya was an author.
Cranks see the world in terms of quid pro quo, be it financial or ideological. If they were in charge, they would only fund projects with which they agreed or whose principal investigator is not a scientific or ideological foe. As a result, they assume that the NIH must function this way when it doesn’t. Whatever its flaws in peer review and its process of determining which grants are funded (and there are significant flaws), using the grant process to stifle “dissent” about COVID-19 public health policies is not one of them, and I suspect that Dr. Bhattacharya, at least, knows it—or once did know it before he got high on his own stash of COVID-19 misinformation and disinformation after he co-authored the Great Barrington Declaration and in the process became a useful idiot for not one but two different astroturf promoters of antivaccine and public health disinformation (AIER and the Brownstone Institute), and turning into one of social media’s foremost “science Kardashians” promoting misinformation. (Sorry, I couldn’t resist.)
Indeed, Dr. Bhattacharya and his fellow Great Barrington Declaration authors Martin Kulldorff and Sunetra Gupta are excellent cautionary examples that demonstrate what happens when legitimate scientists get high on their own stash of ideological pseudoscience, misinformation, and conspiracy theories and become useful idiots for ideological actors like Jeffrey Tucker and Phil Magness. It most definitely isn’t pretty, and the descriptor “legitimate” eventually becomes “once-legitimate” and “crank.” The process might be slow or rapid, but it does appear to be almost inevitable.