The media is getting Trump's biomedical policy decisions wrong b/c it refuses to discuss the big picture

6 examples of missing the forest for the trees

The lay media is critical of nearly every action Trump is taking in biomedicine. They call it “a War on Science.” Yet, in many cases, they are missing the underlying story. If they probed deeper they would find the central issues in American biomedicine that we should be discussing. Let me give 6 examples of missing the forest for the trees.

#1 The trees: FDA delays a meeting to find US expert consensus on flu vaccine strains.

The forest: the FDA almost always picks the same strains as the WHO. And there is no evidence that the current selection process is anything other than a guessing game. Each year, fly vaccine effectiveness varies and is often poor, in part because these guess are bad. (From our paper)

The FDA and WHO are using a method that is NOT optimized. In our paper, we provide a different idea. A-B testing of strain selection, and other factors. It’s time to reform the flu vaccine process for the 21st century.

#2. The trees: Some universities are cutting biology PhD slots

The forest: the US trains too many biology PhD students. Of course, universities are cutting the mission driven aspects of their work— and not their bloated bureaucracy (as only a fool would do), but one has to wonder if the number of biology PhDs is optimized for society or free labor for labs.

It is the latter as I explain here:

#3 The trees: the NIH proposed a cut in indirect funds

The forest: We have no idea if the NIH is optimally giving out taxpayer money

As I say in Sensible Medicine, “There is a societal obligation to use taxpayer money wisely. Some cite data suggesting that each dollar we spend at the NIH generates 2-3 dollars in return. Obviously, it is difficult, if not impossible, to estimate this accurately, and the cited study is not high quality science (it is also NIH funded, #noconflict), but let me say right off the bat: I have no doubt that investments in science generate massive return. And yet, I am also sure: there is colossal waste in the system.”

#4 The trees: Study sections are delayed— Researchers are scared they will lose funding

The forest: We have a system where most lead scientists spend the MAJORITY of their time .

This system exists because we use study sections to decide what to fund. And we do that with literally no evidence it selects for better science than any other method. Based on the poor correlation between percentile scores and productivity, myself and others believe we should randomize NIH grant giving to the status quo or a lottery. The latter may save a huge chunk of time and money and may achieve similar outcomes.

#5 The trees: RFK Jr canceled an oral covid vaccine trial

The forest: What should federal government subsidize? Should we subsidize for profit companies working in a space with the highest returns on investment at a moment in time when there is no longer an active pandemic emergency?

#6 The trees

The forest

You get the picture. In all these cases, there is a deep need for reform. The media owes it to the public to present the deeper questions. Now is an opportunity to reform a system that is resistant to change because it enriches and empowers some people. Reforming this system is part of the pledge of the current administration and something the public wants. Reasonable people can debate how to reform it, but to present any attempt or proposal or opening gambit for change as “War on Science” is dishonest. Furthermore, the bigger truth is that we are still on the edges. Health care is a 2.5 trillion dollar juggernaut and the most sizable and important arenas have not even yet been tackled.

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