Professor Jeffrey Flier is a distinguished service professor and Higginson Professor of Physiology and Medicine at Harvard Medical School. He is the former dean of Harvard Medical School. We talked about the recent (and sudden) change in NIH funding. First a note on Professor Flier. He is not a normal medical school dean. He is active online. He speaks candidly, often critically. He and Vinay wrote together in STAT news during the pandemic. It was a great honor to talk with him for 47 minutes about the NIH news. Here is the Tweet that went crazy viral Friday afternoon. I had only a superficial understanding of grant funding. It turns out that every time a scientist earns an award, the institution receives extra funding known as indirect costs. The extra funds are given to support the infrastructure of the research center. Weirdly, as you will hear, some of the biggest research centers earn the highest percentages of indirect funds. The controversy stems from the sudden and massive cut in these indirect costs. It is an understatement to call the online reaction polarized. It was totally utterly hyper-polarized. Here is Elon Musk. Richard EbrightThere is absolutely no defensible basis for non-uniform indirect cost rates and absolutely no defensible basis for >=60% indirect costs. The previous system was a colossal fraud.Micheal Eisen It’s like saying you’re going to save money on a football team by cutting all the linemen.Anil Makam Whoa. Better accountability was needed where these expenses went, but this is draconian cut. Many institutions will struggle to support scientific infrastructure.C. Michael Gibson Woah…The government used to pay academic institutions 60% + on top of the costs of research grant to cover “Indirect costs.” That number just dropped to 15%. The viability of US academic medical centers & research is at risk.And of course Vinay Prasad, who also wrote Ten Things to Know about the NIH change. Good! This was the greatest slush fund ever created. It made researchers with NIH dollars invincible. Universities shielding them at all costs, even when research was fraudulent. This money was used to support initiatives, which Americans rejected, like DEI training & admin bloat.Sensible Medicine is a reader-supported publication. This is a free post but please consider becoming a paid subscriber as we aim to remain free of advertising support Here are some quotes I received via email from unnamed NIH funded researchers: A lot of the indirects go to admins who are increasingly important for grant submission process because it is unnecessarily cumbersome. I've been on 3 NIH funded grants. All from the same team. Each one was sillier than the prior.Another person—from the Southern US I submitted an R01 a few months ago and it’s difficult to navigate everything alone without admin support. The process for grant submission could be improved a lot And there should be more focus on important questions and more clinical trials.Another—from the MidwestUnless I wanted to study goofy BS, I realized my chances were hopeless. So the only other option was to stay and truly advance in the academy was to align with industry. And yet another from the MidwestThis overhead reduction is long overdue. Universities have been eating at the free buffet for a long time. They will, however, quickly figure out ways to take money away from researchers. I expect that lab space rent, personnel fees, and supply costs that the universities charge the investigators will become much higher in the coming year.Lastly, the US government wants to keep the additional indirect costs, I get that. Universities will find ways to bridge the gap by taking more money from investigators. The initial pain will be at the administrator level, but early investigators will bear the brunt of this in the coming 1-2 years. It's not a great time to be in academic medicine, esp as an investigator reliant on grants. Thank you for your support. Thank you Professor Flier. JMM This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

Dive into a lively discussion about RFK Jr.'s recent hearings, blending humor and personal anecdotes. Explore the clash between eulogy and resume values in medicine, and rethink healthcare leadership qualifications. Learn about the 'Mom Index' as a critique of academic pressures and NIH funding issues. Discover how community notes can enhance transparency in research. Finally, the hosts argue for radical reforms in governance, stressing the importance of deep, meaningful changes over quick fixes in healthcare systems.

I recently recorded a conversation with Michael Easter from the TWO/PERCENT, a Substack and podcast. Michael offers “practical, accurate, and useful health, performance, and mindset information,” and in a space where there is a lot of drive, I find him remarkably thoughtful.Our conversation is on the podcast feed. Below are my notes for our conversation with links to many of the things we discussed.Adam Cifu, MDSensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.I am skeptical of wellness celebrities and influencers. They annoy me because they tend to pick, choose and extrapolate data to fit their agenda. Because good medical advice is mostly personal and boring, many influencers cross over to data-free sensationalism to hold an audience.Michael Easter is a rare exception. On the TWO/PERCENT he somehow manages to be a sane, thoughtful – I might even say Sensible – health personality. I got to know Michael when he invited me to be on his podcast to talk about my article on the cult of the healthy lifestyle. Before talking to him, I dove into a bunch of Michael’s work and was impressed by its quality. I should have known that a person who would invite someone who had come out against the healthy lifestyle on his show dedicated to the healthy lifestyle was someone I’d like.My Questions:For people who don’t already follow you, tell me about the 2%. Where does that come from and how to you extrapolate its meaning?* Tell me a bit about yourself, how did you end up here?* In my intro, I mentioned that I think you are a rational “health influencer.” How have you managed this?* Is it a challenge to keep things fresh while telling people to stay active, eat less, and don’t do stupid things?* How do you see the balance of educating and inspiring?I wanted to talk to you about a couple of recent posts that I thought epitomized your approach.The benefits of silence was a post about introducing silence into your life. This is something that really doesn’t need data, but you went deep into the data, and then acknowledged how aware you are of the possible confounding. (People’s whose houses are on loud streets die earlier. That might be the noise but they are also poorer and are exposed to more particulate air pollution…).* What got you interested in that topic?The downsides of blood tests and full-body MRIsThis was a discussion with Dr. Bobby Dubois about the potential benefits and harms of screening tests. I’ve written a ton about this, but I was so impressed with the clarity of the conversation and, although you guys came out pretty negative on the topic, you were honest about the potential benefits and the reasons people find these attractive.* You seem to have a lot of respect for the audience. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

The podcast delves into the emotional weight of making tough medical decisions as a patient. It highlights how these choices often outweigh the pressures faced by physicians. Case studies showcase the complexities involved, emphasizing the need for patients to navigate this challenging terrain with the support of their doctors. The interplay between patient autonomy and physician guidance takes center stage, revealing the bravery required in these high-stakes situations.

Dr. Margaret McCartney, a Glasgow-based general practitioner and PhD holder, passionately advocates for evidence-based medicine while challenging the efficacy of disease screening. In this discussion, she critiques the misconceptions surrounding early medical testing and reveals how conflicts of interest can skew healthcare recommendations. McCartney underscores the importance of rigorous evaluation in medical practices, calling for better regulation and transparency in the UK healthcare system. Plus, her love for cycling adds a fun twist to her serious insights!

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

I had the pleasure of being interviewed by Michael Easter. Michael is behind the TWO/PERCENT Substack where he offers “practical, accurate, and useful health, performance, and mindset information.” I’ve listened to, and read, a bunch of Michael’s content. Not only is it enjoyable but it seems, well, sensible. Our conversation was inspired by my Coming Out Against the Healthy Lifestyle post. I hope you enjoy our conversation and maybe find another substack to follow.Adam CifuSensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.Our conversation covers:* Why Adam wrote the post and the rise of the cult of the healthy lifestyle.* The benefits, realities, and limits of adopting healthy lifestyle changes.* How the belief that all health can be improved with better diet and exercise can lead patients to wrongly believe they are responsible for all of their health issues.* Why criticism of modern medicine is on the rise.* How “medical reversal” highlights the need for evidence-based practices.* The rise of longevity and why many longevity practices often lack robust evidence.* Why personalized healthcare is essential for effective treatment.* Problems with over-medicalization.* How finding the right doctor can be a challenging process. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

Andrew Foy, a practicing cardiologist in Pennsylvania, dives into the implications of political events on healthcare and the principles of medical conservatism. He critiques the commercialization of health and addresses the complexities surrounding vaccine policies, urging a more evidence-based approach. The discussion touches on the societal factors contributing to chronic diseases like obesity, while advocating for improved drug safety systems. Foy also examines the financial conflicts within medicine and the need for transparency in public health decisions.

4 mistakes people make in systematic reviews This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe