President Trump’s nominee for NIH director extolled the importance of transparency—just days after HHS rescinded a Nixon-era policy intended to enhance it.
Paul Goldberg, editor and publisher of The Cancer Letter, and Jacquelyn Cobb, associate editor, discuss Jayanta Bhattacharya’s stance on the mass firings sweeping through HHS, Trump’s proposed cap on indirect costs, and more this week on The Cancer Letter Podcast.
This episode is available on Spotify and Apple Podcasts.
During his confirmation hearing before the members of the Health, Education, Labor, and Pensions Committee March 5, Bhattacharya listed his five primary goals at NIH:
- Chronic disease
- Reliability
- Scientific dissent
- Innovation
- Regulation of gain-of-function research
As for the questions on everybody’s minds:
When asked about mass firings, Bhattachharya said he has no intention of firing anyone at NIH.
And in regards to indirect costs, Bhattachharya does not think the system needs to be reworked. Instead, he believes increased transparency, including audits of university spending of indirect costs, would help reduce distrust about where the money goes.
Other stories mentioned in this podcast include:
- Survey reveals most Americans are uninformed about HPV. A vaccine can prevent cancer—most people don’t take it
- Column from former NCI Director Kimryn Rathmell: Raising awareness—for everyone
- Regeneron Science Talent Search finalists press on at a time of uncertainty
- Guest editorial by Michael P. Castro: The new therapeutic imperative in cancer management: Sequence, biosimulate, treat
- Fred Hutch marks “50 years of doing hard things”
The following is a transcript of this week’s In the Headlines, a weekly series on The Cancer Letter podcast:
Jacquelyn Cobb (00:00): This week on The Cancer Letter Podcast…
HHS used it to err on the side of making things more public, more transparent. and now, right before Bhattacharya’s likely confirmation, HHS has rescinded this waiver. So, the new policy says, and I’ll read it verbatim, “The extrastatutory obligations of the Richardson Waiver impose costs on the department and the public are contrary to the efficient operation of the department and impede the department’s flexibility to adapt quickly to legal and policy mandates. Effective immediately, the Richardson Waiver is rescinded and is no longer the policy of the department.”
So, intense, just by itself. And also quite hard to reconcile with Bhattacharya saying that transparency is probably his number one thing that he brought up throughout the hearing.
Paul Goldberg (00:48): Well, yeah. I don’t know if he even knew about this.
Jacquelyn Cobb (00:51): Oh, no, he didn’t. He didn’t. Senator—
Paul Goldberg (00:54): He had no idea.
Jacquelyn Cobb (00:55): Yeah, no. Senator Andy Kim of Massachusetts asked him if he knew about it, and he literally just did not know. He was not aware of this.
Paul Goldberg (01:15): You are listening to The Cancer Letter podcast. The Cancer Letter is a weekly independent magazine covering oncology since 1973. I’m your host, Paul Goldberg, editor and publisher of The Cancer Letter,
Jacquelyn Cobb (01:29): And I’m your host, Jacquelyn Cobb, associate editor of The Cancer Letter. We’ll be bringing you the latest stories, groundbreaking research and critical conversations shaping oncology.
Paul Goldberg (01:39): So, let’s get going.
Jacquelyn Cobb (01:49): How’s it going, Paul?
Paul Goldberg (01:51): Oh, great. This is a fantastic time to be a journalist.
Jacquelyn Cobb (01:56): It really, really is. And you’re back in DC now, right in the center of it all.
Paul Goldberg (02:00): I am. It’s the center of the universe.
Jacquelyn Cobb (02:03): Yeah. Did you get a bunch of skiing in?
Paul Goldberg (02:06): I did a lot of cross country this year. Yeah. There was a lot of snow in Vermont, in Stowe.
Jacquelyn Cobb (02:15): Yeah. You left before all the wind started; right?
Paul Goldberg (02:19): Right. And the rains and so forth. We needed to get back to do a couple of things that were kind of important to do in town, so…
Jacquelyn Cobb (02:29): Yeah. Good timing though. I heard it was like negative three degrees on the mountains and stuff. Insane.
Paul Goldberg (02:35): Yeah, that’s fine. Negative three degrees. Give me that.
Jacquelyn Cobb (02:39): You are stronger and braver than I.
All right. Well, I can walk us through last week’s headlines.
Claire reported on a recent survey showing that most Americans are very uninformed about HPV. Kimryn Rathmell wrote a column about colon cancer awareness and the importance of cancer awareness more broadly.
We had a story about the high school finalists of the Regeneron Science talent search, which features high schoolers’ perspective on the current uncertainty facing oncology and science right now.
We had a guest editorial by Michael P. Castro about the rising importance of biosimulation in treating patients, and a historical article documenting 50 years of history at Fred Hutchinson Cancer Center.
Sounds like maybe a short introduction, but it’s because we’re talking about two of the stories in depth this week. So, we’re going to be focusing on our lead story about the confirmation hearing for Jay Bhattacharya’s nomination for director of NIH, as well as our now-weekly roundup of everything happening in Washington right now.
Paul Goldberg (03:44): Well, Jacquelyn, maybe we should begin with the Bhattacharya hearing. What was it like? How does it actually differ from the Kennedy hearing?
Jacquelyn Cobb (03:56): In every way, basically. Bhattacharya was very levelheaded in a time of a lot of chaos—at RFKs hearing, and also just more broadly. He took questions from both sides of the aisle that were getting at some pretty controversial or high-emotion subjects like the mass firings, the caps on indirect costs, the funding freezes all stuff that we’ve covered in recent weeks. And he responded with pretty reasonable answers.
He did have two or three phrases that he leaned on quite heavily throughout the hearing that definitely helped his case in that way. I have them, they’re in the story, but I’ll read them out now. It’s, “I’m not involved or I was not involved with the decisions of the NIH up until now,” and “If I’m confirmed, my commitment is to make sure that all scientists at the NIH and all scientists that receive funding from the NIH have the resources they need to do their lifesaving research.”
And I could be wrong about this, but if I remember correctly from last week, I think he used that exact phrasing multiple times in the hearing. So, he was prepared to be this levelheaded, calm voice amidst all the chaos.
He also used this quote, I think three times, or something along the lines of this quote, three times:“I don’t believe that either the HHS secretary (RFK) or the President would ever ask me to do that.”
And that came in handy quite a few times. But the most notable, at least in my opinion, was when someone asked him if he would break the law if directed by President Trump.
But I will say, he said, “I don’t think Trump or RFK would ask me to do that,” and Senator Hassan said that “That’s a disappointing answer,” and then goes on to ask him another question.
But then, I will say in his defense, that he then uses his next answer, the first thing he says is that “I will not break the law.” So, that could be sort of misleading [to say] that that was his only answer. He did, he did claim full-on that he would not break the law.
Paul Goldberg (05:56): One aspect of his testimony that everybody is curious about is what did he say about indirect costs specifically, and what specifically did he say about staff cuts?
Jacquelyn Cobb (06:10): Yeah, I mean, indirect costs, he had sort of what we talked about on the podcast a few weeks ago when we talked about indirect costs.
He said that he doesn’t really think that a whole new system is necessary. And he understands the value of indirect costs in general. I mean, the senator who asked the question, I forget off the top of my head now, but she brought up the fact that Stanford has an indirect costs percentage at more than 50%. So, he himself has experienced the importance of indirect costs as a researcher.
But he did say that there’s a need for more transparency, that people have mistrust as to where this money is going.
He called it just a tip on top of the research money through the grant. And he said that people need to know where this money is going. So, he called for audits on, again, where this money is going, and increased transparency, which I think, I mean, we’ve talked about it before; right, Paul? That not many people are really fighting against that. That’s not a bad idea.
Paul Goldberg (07:18): No, it’s not. And it’s also a very old question, which has never been fully answered. Maybe it can’t be, I don’t know.
But you open that Pandora’s box and you’re going to find all kinds of interesting things that are not going to be done. And I think that’s kind of our job is to look for those things.
Jacquelyn Cobb (07:38): Yeah.
Paul Goldberg (07:40): So, he did answer it in a way that was not doctrinaire. What about staff cuts?
Jacquelyn Cobb (07:46): Yeah, staff cuts, if I remember correctly, he did lean on his phrases that he used. He said that he was not involved with the staff cut decisions that Elon Musk and DOGE have really orchestrated. But he did say that he doesn’t have any intention of making further staff cuts, and [that] he would review the cuts that have already happened once he likely gets confirmed.
He also did use his other stock answer, saying that his commitment is to the mission of NIH, and he wants there to be adequate staff and adequate funding so that the mission of the NIH can continue.
Paul Goldberg (08:28): Mm-hmm.
Well, the thing that absolutely scares everyone right now is that the mission of the NIH will not continue, and that at least some of the money will end up being administered—doled out—in block grants. Which would require Congress to go along with all of that. Actually, even the indirect costs matter would require Congress to get involved. So, who knows? But the interesting thing is that what I’m hearing you say is that there was a note of sobriety or sort of good measure and not necessarily ideological zeal in what you heard.
Jacquelyn Cobb (09:18): Yeah, he definitely walked the line. He, again, used these phrases to sort of distance himself from the craziness happening with Musk and Trump and RFK, but every time he actually spoke about it, he was very in support of their, MAHA—Make America Healthy Again—focus on chronic diseases. He honestly made their goals seem more levelheaded just by talking about them in the way that he did.
Paul Goldberg (09:47): There are ways, and there are ways to do all of these things very smartly.
Jacquelyn Cobb (09:54): Yeah. Yeah.
Paul Goldberg (09:55): And there are people who could, in a reliable way, guide them through it. So, he sounds like he might be the person who would be asking for advice from the right people.
Jacquelyn Cobb (10:07): Yeah. Hopefully. We’ll see. We see if he gets confirmed, too.
Paul Goldberg (10:12): No, I think that’s that.
Jacquelyn Cobb (10:14): I would agree, but technically not until Wednesday.
Paul Goldberg (10:19): Yeah. interesting. Well, maybe we should talk for a moment about a press release that dropped on the NIH website on Thursday evening. So, at four or five o’clock. Well, we were able to manage getting it into The Cancer Letter, but it was a very interesting issue involving how grants at NIH are reviewed.
Jacquelyn Cobb (10:50): Yeah.
Paul Goldberg (10:52): Maybe we should talk about that a bit.
Jacquelyn Cobb (10:53): Yeah, please tell me about it, Paul. I mean, you covered it. I saw it. We have some experience covering things at the last minute, especially Thursday evenings, but this one we had to get in.
Paul Goldberg (11:04): Well, to me, the question is “Why wasn’t it Friday evening?” Because if you really want to bury something, you bury it on Friday evening. I don’t know where that advice comes from, but I also have no earthly idea where that policy change came from.
Jacquelyn Cobb (11:26): Yeah.
Paul Goldberg (11:26): Because it clearly isn’t Bhattachharya, because he is not in place. And here is NIH announcing a hugely important change in how grants are reviewed throughout NIH, without the NIH director present.
And I must add that I follow this stuff pretty closely, as do you. I have never heard of that one.
But that one, let me just get to that, is the vast majority of grant applications etc., go through centralized review at NIH, so CSR—Central for Scientific Review. I don’t have the exact numbers. I think it’s ~80%, and the small percentage goes through the institutes and centers.
Now they’re going to route everything away from the institutes and centers and into the centralized CSR review. Sounds benign. Could be benign. The only question that I keep hearing people ask is what does it do with SPOre grants or the cancer center grants? Do they kind of go into the common pot, or should they go through NCI? We’ll see. Maybe they will make exceptions. It could be a very interesting question of why it’s happening, how it happened, or even really whether it’s actually happening.
Jacquelyn Cobb (13:18): Yeah.
Paul Goldberg (13:19): Because nobody knows how that. I mean, there could be people who know, but I don’t know who they are.
Jacquelyn Cobb (13:26): Yeah.
Paul Goldberg (13:27): <laugh> about how this thing materialized.
Jacquelyn Cobb (13:29): Yeah. Yeah. So weird. I’m really eager to see how that plays out, because I remember reading that section that you wrote on, I guess Thursday night or Friday morning, and I was like, “What does this mean?” And you were like, “We just don’t know yet.”
Paul Goldberg (13:42): I have no clue. Yeah. This is not the last time we’re writing about it. It is the first time, for sure.
Jacquelyn Cobb (13:52): Yeah.
Paul Goldberg (13:53): There are people losing sleep over this at cancer centers and SPOREs, but then again, they aren’t sleeping very much at the moment. Lose a little more sleep. Who cares? It’s marginal.
Jacquelyn Cobb (14:12): Oh my God, that’s so sad.
Well, I think the last thing we wanted to talk about today was the Richardson Waiver, which is another thing that’s changing before Bhattacharya comes in. Do you want me to dive into that a little bit, Paul?
Paul Goldberg (14:29): Yeah, a little bit, yeah. Can you read what it does?
Jacquelyn Cobb (14:34): Yeah. I’ll explain:The Richardson Waiver is a Nixon-era policy, circa 1971, that was intended to enhance the transparency of rules and regulations related to public property loans, grants, benefits, or contracts. HHS used it to err on the side of making things more public, more transparent.
And now, right before Bhattacharya’s likely confirmation, HHS has rescinded this waiver. So, the new policy says, and I’ll read it verbatim, “The extra statutory obligations of the Richardson Waiver impose costs on the department and the public are contrary to the efficient operation of the department and impede the department’s flexibility to adapt quickly to legal and policy mandates. Effective immediately, the Richardson waiver is rescinded and is no longer the policy of the department.”
So, intense, just by itself. And also quite hard to reconcile with Bhattacharya saying that transparency is probably his number one thing that he brought up throughout the hearing.
Paul Goldberg (15:35): Well, yeah. I don’t know if he even knew about this.
Jacquelyn Cobb (15:38): Oh, no, he didn’t. He didn’t. Senator—
Paul Goldberg (15:41): He had no idea.
Jacquelyn Cobb (15:42): Yeah, no. Senator Andy Kim of Massachusetts asked him if he knew about it, and he literally just did not know. He was not aware of this.
Paul Goldberg (15:51): Well, let’s go back a moment here. Let’s take a little pause to appreciate the irony of the situation. This is 1971, the Nixon Administration’s transparency action. Okay. The Nixon administration was not known for transparency. At least, not voluntarily.
Jacquelyn Cobb (16:12): Yeah.
Paul Goldberg (16:12): But here’s something that the Nixon administration said that as part of good governing and good policy at HHS we are going to go above and beyond the requirements of the Administrative Procedure Act and make this stuff available. So, it’s interesting.
NCI doesn’t use a whole lot of this. NIH also. But FDA does; CMS does. And then NCI as well, probably some. It’s hard to figure out.
Jacquelyn Cobb (16:52): Yeah.
Paul Goldberg (16:53): It’s not immediately obvious, but basically, without the Richardson Waiver, we’re not going to know about a lot of things that are going to be done.
Jacquelyn Cobb (17:04): Public comment periods are basically, they don’t have to happen anymore. Is that correct?
Paul Goldberg (17:10): Yeah. Rulemaking changes. It becomes more streamlined. Things run on time.
Jacquelyn Cobb (17:15): Yeah. Well…
Paul Goldberg (17:16): Or not.
Jacquelyn Cobb (17:21): Yeah. Absolutely.
We covered a lot of ground here. Is there anything else you want to bring up from last week? I think this was a really good conversation.
Paul Goldberg (17:29): Well, I think we covered a lot. I keep repeating this, and somebody should hit me over the head if I say it again, but I’ll say it again. Anyway. This is a great time to be a journalist.
Simultaneous (sort of): Time. To be a journalist <laugh>.
Paul Goldberg:Maybe we should say it in unison.
Jacquelyn Cobb (17:47): <laugh>. That was what I was trying to do, but… I don’t know how it worked on Riverside.
Paul Goldberg (17:50): Let’s try it again. Let’s give it another try. 1, 2, 3. It’s so great.
Simultaneous (sort of): This is a great time to be a journalist.
Paul Goldberg:Well see you next week. We’ll try it again. <laugh>.
Jacquelyn Cobb (18:07): Bye.
Thank you for joining us on The Cancer Letter Podcast, where we explore the stories shaping the future of oncology. For more in-depth reporting and analysis, visit us at cancerletter.com. With over 200 site license subscriptions, you may already have access through your workplace. If you found this episode valuable, don’t forget to subscribe, rate and share together, we’ll keep the conversation going.
Paul Goldberg (18:31): Until next time, stay informed, stay engaged, and thank you for listening.
