Did Anthony Fauci have a “conflict of interest” because his wife is Chief of Bioethics at NIH?

A couple of weeks ago, I wrote about how antivaxxers and COVID-19 conspiracy theorists project their view of how the world works on Anthony Fauci and the NIH by falsely portraying the NIH grant funding process like the way a mob boss doles out favors to those who support him the most strongly and withholds them from those who are insufficiently loyal. As I put it at the time, Anthony Fauci is not akin to Michael Corleone taking tribute and loyalty at the end of The Godfather; there’s a process governed by law and scores of regulations to rank grant applications based on scientific merit. In the case of the National Institute of Allergy and Infectious Diseases (NIAID), from which Dr. Fauci retired at the end of last year after a tenure lasting nearly four decades. Basically, for longstanding grant funding mechanisms, Institute and Center directors (like Anthony Fauci) don’t have a lot of input into which applications are funded, although they do sign off on the funding decisions and are on the final committee that evaluates the highest scored grants.

Which brings us to Elon Musk.

If you’re active on Twitter, as I have been for around a decade on and off, you know that two months ago Elon Musk completed his purchase of Twitter. The details of how he made an offer, tried to back out of completing the sale, and ultimately decided to go through with it aren’t important for my discussion, nor is his tumultuous tenure as owner and CEO of Twitter that has seen him not just gut Twitter’s already insufficient ability to combat disinformation on its platform—or his recently allowing some of the worst of the worst antivaxxers back onto the platform. Nor is his having drafted useful idiots like Matt Taibbi and Bari Weiss to go through Twitter company emails, Slack discussions, and documents in order to cherry pick bits that he’s used to amplify conspiracy theories that Twitter somehow “suppressed free speech” and promoted an establishment narrative about COVID-19, the 2020 elections, the January 6 insurrection and more. (Actually, all of that matters, but it’s not the main topic that I want to write about today.)

Less than a week ago, Musk Tweeted this:

Almost no one seems to realize that the head of bioethics at NIH – the person who is supposed to make sure that Fauci behaves ethically – is his wife 🧐 https://t.co/CpWHNCqc8y

— Elon Musk (@elonmusk) December 28, 2022

“Almost no one”? That’s hilarious, because this is a conspiracy theory that’s been popular in COVID-19 minimizing circles for a long time, particularly in concert with the claims that Fauci somehow personally greenlit “gain of function” research at the Wuhan Institute of Virology. The idea is, of course, pure projection, in which Fauci is portrayed has having personally funded such research, I’m not going to delve into whether the research was truly “gain-of-function” here (maybe another time), but I am going to point out that the grants used to fund whatever research was going on in Wuhan was funded through a grant awarded using the usual funding mechanisms of study sections scoring grants.

The point for purposes of this post is that, if you don’t know how the NIH works, the claim amplified by Elon Musk that there is a huge conflict of interest because Anthony Fauci’s wife Dr. Christine Grady is the chief of bioethics at NIH might seem convincing—or at the very least, odd—but this concept is based on a misunderstanding of what the NIH Department of Bioethics does and what Grady and Fauci’s roles are in the NIH. There’s also more than a hint of misogyny there in that the idea that Dr. Grady would be a rubber stamp for her husband is also tinged with the assumption that her career is somehow dependent on that of her husband, when in fact she has authored or co-authored over 170 papers in her own right as well as edited numerous book chapters. She was also elected to the National Academy of Medicine, which is a BFD, as few physicians and scientists are considered eminent and accomplished enough to be elected to this body.

According to the NIH Department of Bioethics website:

The NIH Clinical Center is the world’s largest research hospital and has been the primary site of NIH clinical research since the 1950s. Bioethics is integral to the mission and activities of the CC and the NIH, as ethical questions and challenges are inherent in the conduct of scientific research and in the translation and application of scientific and technological advances to the clinic and the laboratory. The Department of Bioethics, launched in late 1996 and built on a pre-existing foundation of bioethics activities at NIH, marked a major commitment to bioethics by the Clinical Center, and especially by its director, Dr. John Gallin. Dr. Gallins goal was to create a premier center for bioethics to complement and inform the NIH’s cutting-edge program of biomedical research. In this stimulating environment of scientific discovery and burgeoning new technologies, the Department of Bioethics has flourished, wrestling with major policy issues, offering educational and clinical services, and developing numerous research projects to help advance and inform clinical practice and clinical research as well as public policy debate.

The Department of Bioethics is a center for research, training, and service related to bioethical issues. The Department conducts conceptual, empirical, and policy-related research into bioethical issues; offers comprehensive training to future bioethicists and educational programs for biomedical researchers and clinical providers; and provides high quality ethics consultation services to clinicians, patients, and families of the NIH’s Clinical Center and advice to the NIH IRBs, investigators, and others on the ethical conduct of research.

The Department of Bioethics run by Dr. Fauci’s wife Dr. Grady also runs a consult service offering bioethics consults to doctors and investigators at the NIH Clinical Center:

The Department of Bioethics provides a Bioethics Consultation Service, the goal of which is to provide analysis and facilitate discussion about a range of ethical issues that can arise in caring for patient subjects or during the course of research conducted at the Clinical Center. The Consultation Service is open to anyone with an ethical question or concern, including investigators, subjects, families, physicians, nurses, administrators, social workers, and pastoral care providers. Anyone who works at the NIH or participates in research at the NIH Clinical Center can request a consult. Consultations are usually performed by a small consult team comprised of members of the Department of Bioethics and members of the Clinical Center Ethics Committee and (on exceptional occasions) by the full Ethics Committee. Since the Clinical Center is a research hospital, many of our consults focus on research ethics questions (e.g. enrolling research participants, balancing research and clinical care, research with vulnerable populations, etc.).

The department also runs a fellowship program that offers two-year postbaccalaureate and postdoctoral research fellowships.

Unfortunately, because Musk made this claim about how Fauci’s wife is supposedly responsible for making sure that he behaves ethically, rebuttals other than on Twitter were somewhat slow. Bruce Y. Lee published a discussion of Musk’s claim, although it was days later:

Elon Musk claimed that Dr. Fauci’s wife is "the person who is supposed to make sure that Fauci behaves ethically." Others like @gorskon @AlastairMcA30 pushed back on this
Here I cover for @Forbes what Dr. Christine Grady really does at @NIHClinicalCntr https://t.co/M0cS3QUzmL

— Bruce Y. Lee (@bruce_y_lee) January 1, 2023

Lee notes:

The NIH Clinical Center is separate from NIAID. Instead, an institutional review board (IRB) has to review every study that uses human subject for any ethical concerns and then offer approval before the study can commence. Such IRBs typically are situated at the institutions where the research is going to be conducted. Thus, once again, Grady is “NOT the person who makes sure Dr Fauci acts ethically,” as Alastair McAlpine, MD, a pediatric infectious disease specialist at BC Children’s Hospital in Vancouver in Canada, tweet-responded to Musk

What amuses me, though, is that Musk was so off-base that even Fox News published a rebuttal to his misinformation, Here’s what Anthony Fauci’s wife actually does at NIH. In the article, reporter Thomas Catenacci also notes something that I hadn’t been entirely clear on, even as I knew that Dr. Grady was not responsible for overseeing Dr. Fauci from a bioethics standpoint:

In addition, Grady’s office conducts bioethics research, not internal ethics investigations. The HHS has an independent inspector general which conducts internal investigations into operations at the NIH and its many institutes and centers.

“Dr. Grady is the Chief of Bioethics at the NIH Clinical Center and a member of the NIH research community,” the NIH told Fox News Digital in a statement. “To be clear, the Department of Bioethics is distinct from the NIH Ethics Program. The NIH Department of Bioethics in the NIH Clinical Center is a center for research, training, and services related to bioethical medical and research issues.”

It makes sense that the Department of Health and Human Services (HHS) would have its own inspector general to investigate potential ethics violations, as the NIH is part of HHS. After all, the regulatory machinery behind the Common Rule, which is the term that describes the set of regulations governing human subjects research and the ethical framework around all such research, is overseen by the Office for Human Research Protections (OHRP), which is part of the HHS, not the NIH. (Specifically, OHRP is part of the Office of the Assistant Secretary for Health in the Office of the Secretary of HHS and is responsible for regulatory oversight of all federally-funded biomedical research.)

This is not the worst disinformation that Elon Musk has promoted since taking over Twitter, but it grated at me nonetheless. It’s red meat to the conspiracy crowd, which is already prone to believe that during his career Dr. Fauci used to give out grant funding as rewards for “toeing the line” with respect to the “NIH-approved” narrative about science since the pandemic hit. However, it also seems just plausible enough to those who aren’t down the conspiracy rabbit hole and don’t understand that the Department of Bioethics and the NIAID are separate entities under the umbrella of the NIH and that the Department of Bioethics is an advisory, training, and research department, not a regulatory or enforcement agency.

Again, it comes to a standard belief common to conspiracy theorists that everything is transactional, that no one does anything that isn’t some sort of quid pro quo. This is a trait to which businessmen like Elon Musk are also prone, given that successful business dealings are the very definition of quid pro quo in that both parties to a transaction expect to get something for what they give, but conspiracy theorists crank up the idea to 11 and assume that everything is quid pro quo. It’s one reason why antivaxxers, quacks, and other medical conspiracy theorists are so fond of the pharma shill gambit, as they find it difficult to imagine that people like me would spend so much time and effort countering their pseudoscience, conspiracy theories, and disinformation if someone wasn’t paying us. Naturally, they assume that it’s big pharma who must be providing the funds.

What the world is finding out since Musk took over Twitter is that he’s just another run-of-the-mill conspiracy theorist, but unfortunately a run-of-the-mill conspiracy theorists who’s worth billions of dollars and is one of the richest (but no longer the richest) people in the world. Unfortunately, he’s plenty rich enough to bring in Great Barrington Declaration shills like David Zweig, who was the house propagandist for the American Institute for Economic Research) to continue as one of use useful idiots or just plain propagandists to continue the “Twitter files.” His amplification of the conspiracy theory about Dr. Fauci and his wife Dr. Grady is a relatively small but very telling bit of the disinformation he now spreads.