The Host Julie Rovner KFF Health News @jrovner Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News weekly health policy news podcast, What the Health? A noted expert on health policy issues, Julie is the author of the critically praised reference book Health Care Politics and Policy A to Z, now in its third edition.

This week, KFF Health News What the Health? presents a conversation with Francis Collins, former National Institutes of Health director and White House science adviser.

Collins, the longest-serving presidentially appointed head of the nations crown jewel of biomedical research, spoke last month with KFF Health News chief Washington correspondent, Julie Rovner. He has a new book out, called The Road to Wisdom: On Truth, Science, Faith, and Trust.

In this interview, Collins discusses what may lie ahead for NIH in the coming Trump administration; how he and other science leaders failed to communicate to the public during the covid-19 pandemic; and his work with the group Braver Angels, which aims to facilitate conversations among people who disagree on policy issues. Click to open the transcript Transcript: Francis Collins on Supporting NIH and Finding Common Ground [Editors note: This transcript was generated using both transcription software and a humans light touch. It has been edited for style and clarity.] 

Julie Rovner: Hello, happy new year, and welcome back to What the Health? Im Julie Rovner, chief Washington correspondent at KFF Health News. Usually Im joined by some of the best and smartest health reporters in Washington, but today we have a special holiday episode for you. Last month, I got the chance to chat with Francis Collins, former director of the National Institutes of Health, about a variety of subjects. Regular podcast listeners will know we used some of the excerpts of that discussion a couple of weeks ago, but today were bringing you the entire interview. I hope you enjoy it, and well be back with all the news starting next week. So, here we go. 

I am so pleased to welcome to the podcast Dr. Francis Collins, former director of the National Institutes of Health, and former White House science adviser and former director of the National Human Genome Institute, who led the effort to map the human genome. He also has a new book out this holiday season called The Road to Wisdom: On Truth, Science, Faith, and Trust. 

Dr. Collins, its so great to have you here. 

Francis Collins: Hey, Julie, its great to be with you. We go way back on a lot of interesting topics in health and medical research, and lets get into it here. 

Rovner: I want to start with some very basics because we have lots of student listeners and people who know a lot about health policy but less about science. So what is the NIH, and how does it work? 

Collins: It is the largest supporter of biomedical research in the world. The National Institutes of Health, supported by the taxpayers with money thats allocated every year by the Congress, is the main way in which, in the United States, we support basic medical research, trying to understand the details about how life works and how sometimes things go wrong and disease happens, and then carries those discoveries forward to what you might call the translational part, take those basic findings and try to see how could they actually improve human health in the clinic. And then working with industry, make sure if theres an idea then for an intervention of some sort that it gets tested rigorously in clinical trials and, if it works, then its available to everybody. 

So when you look at whats happened over the course of many decades in terms of advances in human health, like the fact that reductions in heart attacks and strokes have happened rather dramatically, the cancer death rates are falling every year, where does that come from? An awful lot of that is because of the NIH and the thousands and thousands of people who work on this area, supported by those dollars that come from NIH, both a little bit in our own location in Bethesda, Maryland, but most of the money goes out to all those universities and institutes across the country and some outside the country. 

Rovner: Yeah, I was going to say, I happen to live right up the street from the campus in Bethesda, but I know that thats not where most of the money goes. It goes to the rest of the country. 

Collins: Right. Eighty-five percent of the dollars are given out to people who write grant applications with their best and brightest and boldest ideas, and they get sent and reviewed by peers who have scientific expertise to be able to assess whats most likely to make real progress happen. And then, if you get the award, you have three to five years of funding to pursue that idea and see what you can learn. Unfortunately, even though the budget for NIH has been reasonably well treated, especially in the last, oh, eight or nine years, its still the case that most applications that come into NIH get rejected. Only about 20% of them can be actually paid for with the current budget we have. So, sad to say, a lot of good ideas are left on the table. 

Rovner: And yet, for more than three decades now, the NIH has been kind of a bipartisan darling with strong financial support from Democrats and Republicans in both the White House and in Congress. Now we have an administration coming in thats calling for some big changes. Could NIH honestly use some reimagining? Its been a while. 

Collins: Oh, sure. I mean, I was privileged to be the NIH director for 12 years. I did some reimagining myself in that space. One of the first things I did when I got started was to create a whole new part of NIH called NCATS, the National Center for Advancing Translational Science, because it seemed that some of these really exciting basic science discoveries just sort of landed with a thud instead of moving forward into clinical applications. NCATS has done a lot to try to change that. So yeah, theres always been this sense of this is the crown jewel of the federal government, but it could even be better. So lets try to work on that. 

I hope thats whats going to happen in this next iteration find things to fix. If its more an idea of lets just blow the whole thing up and start over, then Im opposed, because I think the rest of the world just has this great admiration for NIH. Many of them would say this is the most amazing engine for medical discovery that the world has ever known. Lets certainly optimize it if we need to. But my goodness, the track record is phenomenal. And the track record is both about advances in health and its also about economic growth, which people are rightly concerned about as well. Every dollar that NIH gives out in a grant returns $8.38 in that return on investment to the economy within a few years. So if you wanted to just say, Well, lets just try to grow the economy, and didnt even care about health, NIH would still be one of your best bets. 

Rovner: So one of the things that Robert F. Kennedy Jr., whos [President-elect Donald] Trumps pick to lead HHS [the Department of Health and Human Services], has talked about is taking a break from the federal government researching infectious diseases and concentrating on chronic diseases instead. Do you think thats a good idea for the NIH? 

Collins: Well, NIH does a lot on chronic diseases. Lets be clear about that. Infectious disease has certainly gotten a lot of attention because of covid and the controversies around that. Although, let me also step back and say what was done during covid, the development of a vaccine in 11 months that is estimated to have saved 3.2 million lives in the U.S. alone, is one of the most amazing scientific achievements ever and shouldnt be somehow pushed aside as if that wasnt a big deal. That was a huge deal. But infectious diseses are still out there, and with everything that we see now with things like H5N1, theres a lot of work that needs to be done. 

Sure, chronic diseases deserve a lot of attention, but lets look at whats happening there with cancer, with Alzheimers disease, with diabetes, with heart disease. Those are huge current investments at NIH. Could we look at them closely and ask are they being absolutely optimally spent? Thats always an appropriate question to ask, but its not as if this has been sort of ignored. 

Look at the project that I had something to do with starting called All of Us, which is an effort to look at all kinds of illnesses in a million people, a very diverse group, and figure out how not to just do a better job of treating chronic disease but how to prevent it. Thats an incredibly powerful resource thats now beginning to build a lot of momentum, and theres a place where maybe even a little bit more attention to All of Us could be helpful, because we could go faster. 

Rovner: So its not just either/or? 

Collins: No, it shouldnt be either/or. And, I mean, look around your own family and the people you care about. What are the diseases that still need answers? Theres plenty of them, and theyre not all in one category or another. This is what NIH has always been charged to do. Look across the entire landscape, rare diseases as well as common diseases, infectious diseases, as well as things that are maybe caused by environment or diet. All of that has to be the purview, otherwise were not really serving all the people. 

Rovner: So, youre unique in many ways, but a big one is that youve managed to simultaneously be a person of faith and a person of science. So often those things are at odds. Why is that so difficult for so many people? You dont seem to have a lot of trouble with it. 

Collins: I dont, but theres a long history here. Maybe it helps me that I did not grow up as a person of faith. I was an atheist when I was in graduate school studying quantum mechanics, and then I went to medical school and discovered that my answers to really important questions like Whats the meaning of life? were a bit thin. Atheism didnt help me so much, and I really felt I had to do some work to explore that and, ultimately, over a couple of years of that work, came to the conclusion that for me, both in terms of the rational arguments and also the sort of spiritual calling, that I felt that I couldnt be an atheist anymore, and I became a Christian. 

Everybody predicted around me that my head would explode because this was going to be incompatible with my scientific loves, one of which was genetics, but it never happened. I think we have a lot of preconceived ideas about what has to be the perspective of faith or the perspective of science. When you look more closely, theres actually more room there to figure out how these two ways of finding truth, ways of knowing, can actually inform each other. And for me, being able to have all of the questions on the table, not just the science questions or not just the faith questions but all of them that you can think through on a given Thursday, feels like a good thing, and its incredibly enriching. But I am sorry that not everybody sees it that way. 

Anybody listening to this that wants to look at a good dialogue about this thats going on quite vigorously, go to the website BioLogos, B-I-O-L-O-G-O-S. A couple million people there are engaged in deep and very civil discussions about how science and faith can speak to each other in useful ways. 

Rovner: Well, thats kind of a perfect segue because one of the things you write about in your new book is how weve become a society thats distrustful, not just of science but of all expertise. How can the scientific community start to rebuild that trust that we used to have? 

Collins: Well, lets be clear, trust in everything has been deteriorating. Institutions across the board have lost trust by various surveys that Gallup does, and thats part of, I think, a reflection of society kind of falling into this place of skepticism and even cynicism and a likelihood to assume that anything that sounds like expertise might also be elitist and might not be good for me. This is a dangerous place to be. Society has to have institutions that are reliable and dependable and kind of create a constitution of knowledge that Jonathan Rauch writes about. But right now, all of that seems a bit in jeopardy. And science is just one of those sources of truth that now some people are questioning. But can I trust what science has said about something? Well, we all have to, I think, learn our own skill set, again, about how to assess information and the sources of it and whether it should be trusted. And we should not be using where we currently live, in a particular bubble, as a means of deciding whether to accept a claim or not, because theres a lot of stuff happening in bubbles that isnt true. 

So part of it is our own need to come back to that kind of filtering. But for scientists, I think we are very much in the space now of having to be more in the world, in the arena, and willing to listen to objections and not get defensive and come back again with thoughtful, winsome explanations about how science works and how science is self-correcting. And even though sometimes science makes mistakes, they wont be mistakes for very long, because somebody will come along and figure out that wasnt right and itll get corrected. That should be very reassuring. But oftentimes today, that information is less well understood. Maybe part of what happened during covid is that much of the science information seemed to be coming down from elitist voices like me that werent as close to the community as people wouldve wanted to see and maybe wouldve had more trust in. So weve got to diversify the sources of science communication and not have it be so much focused in just a few places. 

Rovner: Do scientists need to be more humble, if you will? I mean, more honest about theres a lot of things we dont know, and were getting new information every day, and that might change what we say? I feel like there wasnt maybe enough of that during covid. 

Collins: I totally agree, and I talk about that in the book. I wish those times when I was shoved in front of a camera during 2020 and 21 and asked OK, what should the public do today to protect themselves? that I wouldve started the answer with: Well, theres a lot we dont know yet, but let me tell you the best we can do with the information we have. But dont be surprised if a week or a month from now that information changes. This is how science works, and were in the process of learning about this diabolical virus, and we dont have all the data yet. I wish wed said that more often. Yeah, I think all sources, if you want to be regarded as reliable, you need to have integrity. Youve got to be honest. Youve got to have competence. You have to have done the work. And, Im sorry, a lot of whats on social media does not meet that standard. 

Rovner: No, I think 

Collins: And then youve got to have and humility. Like you said, humility. I think anybody whos basically saying, Well, I know something about this area, so now I know something about everything celebrities, listen up here that is probably not the kind of source that you want to necessarily attach yourself to. But it happens a lot. So integrity, competence, humility, use those as your standards for deciding whether to trust a particular source or an institution. 

Rovner: I know youre active in a group called Braver Angels, which youve described as marriage counseling for our country, which clearly we need. 

Collins: We do. 

Rovner: Can you tell us a little bit about that? 

Collins: So, they got started eight years ago with increasing sense of the polarization, the divisiveness, and, Wait a minute. This isnt what we want to be. How do we bring people back together? And they create an environment whre people on opposite sides of an issue maybe its gun control or immigration or public health have to actually get together and listen to each other, for starters. No, and youre not allowed to start shouting. You have to listen carefully to what the opposite side says about their view on this well enough that you can speak it back to them and say, Heres what I heard you say, and have them say, Yeah, thats what I said. We dont do that very well. 

Right now, in those circumstances, its more like: OK, they just said this. Let me plan what Im going to say back to prove them wrong. And you have this snappy response back and forth, and nobody actually changes their view at all. Having done a lot of these sessions with Braver Angels, Ive learned things that I didnt know before about how people, for instance, who felt the covid response was ham-handed in their particular local environment. Yeah, I can kind of see how it was, and ideally it wouldve been better if wed had a more appropriate response that depended on community circumstances instead of trying to do one size fits all. Of course, it was all a crisis and we didnt have much chance to do that, but theyve got a point. If youre in the heartland somewhere, all of the things that were decided, much of which seemed to be particularly relevant to the big cities, didnt seem like it was a great fit for them. 

Thats an example of a kind of thing. And Ive become friends with a lot of the people who initially I thought, Well, I could never get along with that person, but now I understand who they are. And we still disagree, and I still think theyre wrong about things and they think Im wrong about things, but we can have that disagreement and not be disagreeable, and we can actually go to the bar afterwards and have a beer. Its OK. We need a lot more of that. 

Rovner: Yes, we do. Well, you had a very long and decorated career. Is there one more big thing you hope to accomplish before you actually retire? I know youre still busy in your lab. 

Collins: Busy in my lab, and I am still working on a project that I started when I was the presidents science adviser, which is an effort not to create a new solution to a disease but to get it implemented. And that is the disease called hepatitis C. And I continue to be the lead for the White House in trying to get a program underway that would find, test, treat, and cure as many of the 4 million Americans who are currently infected with this viral disease. We have a cure for this disease. Its amazing one pill a day, 12 weeks, 95% effective, no side effects. And yet, because many of the people who are infected are not in the best place they might be on Medicaid, they might be uninsured, they might be in the criminal justice system, because a lot of this relates to intravenous drug use they dont have access. And theyre all trying to get back on their feet and theyre not going to get back on their feet if we dont do something about this, and then end up with a terrible outcome of cirrhosis, liver cancer, and early death. 

I watched my brother-in-law die of this, and it is a horrible disease, and its totally preventable now. So we have a program, which I am totally confident if we can get it launched, maybe even in the next few weeks, this could save thousands and thousands of lives and also, by the way, billions of dollars for health care that wont be needed for all those transplants and liver cancer treatments because well prevent them. 

So I am a bit obsessed about this. Maybe youre sorry you asked if I had one more thing. This is the one more thing that I am totally devoted to getting into the end zone. 

Rovner: No, thats super cool, and also, what a great example of something that medical research has done to help health care in the United States. 

Collins: Absolutely. We just have to do the implementation part. How hard can it be? 

Rovner: A good place to leave it for now. Dr. Francis Collins, thank you so much for joining us. I hope we can call on you again. 

Collins: Please do, Julie. Its always great to talk to you. Thanks for everything youre doing to spread the word about what we can do about health care. We can do a lot. 

Rovner: I hope so. Thank you. 

OK. Thats this weeks show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. Wed appreciate it if you left us a review. That helps other people find us, too. Special thanks again this week to our temporary producer, Taylor Cook, and our editor, Emmarie Huetteman. As always, you can email us your comments or questions. Were at [email protected], or you can still find me at X, @jrovner, and increasingly at Bluesky, @julierovner.bsky.social. Well be back in your feed next week. Until then, be healthy.  Credits Taylor Cook Audio producer Emmarie Huetteman Editor

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