Here’s the latest from the crossroads of faith, media & culture: 09/16/24

Christian/scientist. As both a believing Christian and a scientist who has been at the forefront of several extraordinary scientific milestones over the last 40 years—including, among others, the discovery of the cystic fibrosis gene in 1989 and the mapping of the human genome in 1995 – Dr. Francis S. Collins may represent the epitome of balancing the tenets faith and science. I recently spoke with him about his new book, The Road to Wisdom: On Truth, Science, Faith and Trust in which he writes about his personal path to finding that balance – and the issues he has faced along the way, notably as director of the National Institutes of Health from 2009 through 2021 (serving Presidents Barack Obama, Donald Trump and Joe Biden).

JWK: First of all, I’d like to ask you how your prostate cancer battle is going.

Dr. Francis S. Collins: I’m doing quite well. I am (about) four months after the surgery which was a robot-assisted radical prostatectomy, trying to do everything possible to remove what had turned into a very aggressive cancer to achieve a complete cure that way. So, far everything looks encouraging. The margins were clean. The lymph nodes were negative. The first measure of the PSA, which is an indication about whether there were cancer cells left behind, was essentially zero – which is the answer you want. So, I’m feeling quite encouraged.

JWK: Thank God for that. I know you wrote about this in the Washington Post. From your own experience, what do you want people to know about prostate cancer?

FSC: Well, I think men have not been particularly good at talking about this condition. The women have done much better talking about breast cancer than we men have talking about prostate cancer – although they are somewhat similar in terms of their frequency and their threat to shorten your life. So, I’m trying to be as public about it as possible to encourage men to take advantage of the fact that we now actually have pretty good means of detecting the cancers that really need attention – a lot of them don’t because they’re so slow growing – and getting something done about them. The imaging is now so much better. The capability of following that PSA and deciding when you need a biopsy, all of those things, if properly applied, really ought to make it possible for a lot of men to avoid that outcome that we all want to avoid – which is to have cancer that’s spread to bone, liver or brain that ends up shortening your life but could potentially have been prevented.

So, yeah, everything I can to do get this topic more broadly out there for men to consider talking to their doc about “Hey, is it time for me to have a PSA? Is it time for me to have a scan to see whether we can actually see if there is something not right there?” or “What’s the timing for biopsies?” All of that seems like a conversation that hasn’t happened enough. If there’s anything I can do to create more of a willingness to get engaged that way and save some lives or some suffering, it feels like I should do that.

JWK: That’s great. I’m glad you’ve gotten good word, so far – and hope it continues. Tell me about your book, The Road to Wisdom. Why did you write it?

FSC: I couldn’t help myself. I had the experience – as the person who had the privilege of leading the Human Genome Project, then being the director of NIH and seeing a lot of really exciting scientific advances happen and then Covid came along. I actually think the scientific response to Covid was nothing short of spectacular. The ability to develop highly safe and effective vaccines in eleven months was wildly beyond what most people thought would be possible – and yet it happened. That seemed like a moment when we were turning the corner from what had been a terrible year of 2020 – as, in some instances, thousands of people were dying a day – but what I hadn’t realized is that not everybody saw this as the same triumph as the scientists did.

Over the course of the coming year, as vaccines became widely available and free, some 50-million people said “No thank you.” The consequences of that are tragic. The Kaiser Family Foundation estimates 234,000 people died unnecessarily between June of 2021 and April of 2022 because of a decision not to get vaccinated and then falling ill and losing their lives. That made it really clear to me that the things that were in our society in terms if divisiveness, in terms of polarization were not just unfortunate and not just frustrating and unsettling. They were truly tragic. Because of distrust of what the scientific evidence seemed to suggest about the safety and effectiveness of the vaccines, 50-million Americans said “No thank you.” As a result, we lost 234,000 people who died unnecessarily of Covid-19 when when they could have been saved.

JWK: Do you think there may have been some mistakes made in the messaging and that the concern over misinformation began to appear to some to be censorship? Could that have impacted the messaging regarding the safety and effectiveness of the vaccine?

FSC: Absolutely. So, I had to look at this situation and say “How did we get here?” That’s a lot of what I write about in the book. Certainly, there was a lot of confusion, a lot of mixed messages, coming from different sources. As someone who was at that time in 2020 working for Donald Trump and in 2021 working for Joe Biden, I was part of that effort to try to share information with the public that could be utilized to make wise decisions. I think we did not do a great job of conveying that information in a fashion that explained what we were sure of and what we weren’t so sure of. Recognize that we were learning things about this virus on an almost daily basis and yet you had to take action when people were dying all around you to make some recommendations that weren’t necessarily going to be the perfect answer – but it was the best you could do at that point.

We should have said every time there was a recommendation from CDC or from the White House “This is best we could do right now but it might have to change in the coming weeks. Don’t be surprised if that happens.” We didn’t say that enough. So, when the recommendations did change a few weeks later, people began to wonder “Do these guys know what they’re talking about?”

On top of that, there were other voices that entered the fray that were not always helpful. Certainly, social media was rife with all kinds of recommendations that maybe were not based on any kind of real evidence but caught people’s attention – and politicians got engaged with messages that may have had more to do with politics than science and medicine. People began to wonder “Who do we trust? Maybe we won’t trust any of these people.” As a result, a lot of people died.

That’s the situation that drove me to feel like “I’ve got to think about (if) there’s something I can do – if I have a little bit of credibility in some kind of community – to try to point to this as a situation that really needs our close attention.” If we’ve lost our anchor to whether there is such a thing as objective truth, we’re in trouble. If we’ve stopped trusting scientific conclusions to tell us truths about nature, we’re in trouble.

If our faith communities – and I’m part of one; I’m an Evangelical Christian – have also gotten pulled into perspectives, often times on the basis of political messages that are really not the foundation of our faith and (we) have lost that as a way to address a crisis, then that’s another issue that needs serious attention.

All of this kind of fits into this question of “What is trust?” How do you decide who to trust or what institution to trust? What sources do you have to help you with that? How can we do a more effective job – for ourselves, for our families, for our communities – in trusting things that turn out to be reliable?

JWK: In your book, you have kind of a diagram where you talk about the levels of truth.

FSC: Yes.

JWK: At the center is Necessary Truth. Then, going out from that, there are Firmly Established Facts, Uncertainty and Opinion. So, what exactly is Necessary Truth?

FSC: Necessary Truths would be the things that absolutely have to be the way they are in any imaginable universe. A lot of this is just mathematics. 2+2 is equal to 4. It doesn’t matter whether you like that or not, it just is. The area of a circle is pi r2. That student on the math test that says it’s something else should not be allowed to say it’s just his opinion. These are things that just are that way. Most of it’s math.

JWK: So, talking about Covid, where does debate over the vaccine and its efficacy and safety fit into that circle?

FSC: Yeah. The next circle out from Necessary Truth is what I would call Established Facts – things which have been, by scientific or other established means of determining evidence, decided upon. This is true. It doesn’t matter whether you like it or not. It’s just true. The Earth goes around the Sun and not the other way around.

For Covid, you would want to say “Are the vaccines safe and effective?” Where does that fit? Given the trials that were done of more than 30,000 people for each of the mRNA vaccines, the Pfizer vaccine and the Moderna vaccine, that showed 95% efficacy and virtually no evidence of safety problems – that was the most rigorous kind of trial you could imagine, all those results being released in late November 2020 – you could put into the zone of Established Facts that those vaccines, at that time for the virus that was originally spreading, the one from Wuhan, were safe and effective.

Over time, the virus evolved, developed new tricks in its spiked protein – particularly that omicron version that was so different it was almost like starting over again. We did learn that, with very large numbers of people being vaccinated, there was a risk to young men of myocarditis – a risk of something like one in ten-thousand young men. Fortunately, all reversible. So, you could say “Okay, safe and effective? Let’s be a little care about that.” That doesn’t mean there could not be rare side effects.

JWK: Of course, some young men did die of it, right?

FSC: That’s not right. No young men have died of myocarditis. It’s all been reversible. There have been individuals with the other vaccines – the Johnson& Johnson vaccine and the AstraZeneca vaccine which had blood-clotting (problems). There were some deaths from those. That’s why those are not used.

JWK: I think some the criticism of the vaccine was that, while it might have been appropriate for older people and people at particular risk for health reasons, that perhaps younger people and children should not have been pushed to get it. What do you say to that?

FSC: That’s a really important conversation to have – because it’s really about benefits and risks, isn’t it? For older people – where likelihood of a severe illness, even a fatal illness – is a lot higher then the benefits of getting vaccinated becomes pretty significant. For younger people, that risk goes down – but it’s not zero. I believe 800 or 900 children died of Covid. People don’t talk about that. So, then you have to say, okay, then what was the risk of the vaccine? If the risk is essentially very close to zero then even for a low likelihood of a fatal outcome, it’s probably worth getting vaccinated. It kinda comes down to that tradeoff.

The other thing to point out is, if we’re really trying to eliminate this disease and eliminate its spread to vulnerable people, it’s good if even those are not likely themselves to be at high risk for serious illness or death get immunized so that they can’t get infected and spread it to other vulnerable people around them. That was a lot of the logic that said we should go ahead and try to vaccinate everybody as soon as we know that the vaccine is safe because that’s how we’re gonna protect some of the vulnerable folks who might otherwise get exposed.

JWK: The other side would say it should be a choice. The mandates are what a lot of people objected to. People were losing their jobs.

FSC: I think the mandates came came in at a time where there was already a lot of concern, a lot of resistance. This further, I think, extended people’s unhappiness with the way this was playing out. I can see the logic behind it. You have a circumstance where you have a highly infectious disease and there is a way to stop its transmission by getting everybody vaccinated. Then, there is some motivation in a rare circumstance – this was done back in 1905 for smallpox – to insist that people get vaccinated, not just for their own good but for their neighbors. This is an opportunity to do something not just about you but about the people around you. Mandates, as a means of forcing that, obviously did not sit well with the people who had not been really interested in getting vaccinated already.

JWK: Do you feel that there might have been less opposition to the vaccine if the mandates were not there – and that maybe more people would have gotten them?

FSC: I think, by the time the mandates were actually put forward, most people had already made up their mind. So, I don’t think it made people more resistant. People were already in that space. It certainly didn’t turn out to be a particularly effective strategy. I wish that we had not had to do it. This is what I’m writing about in the book. Why was it so necessary when the scientific evidence was utterly compelling that these vaccines – for almost everybody – have a benefit that’s considerably greater than the risk. Why would not, therefore, a scientifically sophisticated, rational society just say “Okay, roll up my sleeve!” Other countries didn’t have to do mandates. In mean in Denmark everybody said “Yeah, I’ve looked at the data. I want this vaccine. Give it to me now!” Somehow, in our country, I think particularly because everything was already polarized, politicized, divided amongst people’s opinions this got caught up in that. Vaccines should never have been a political issue but they became so.

JWK: Some people have expressed suspicion of how the drug industry has benefited from the pandemic – companies like Pfizer – and that there wasn’t enough attention given to things we had on the shelf that could maybe have more safely treated Covid. We went straight to vaccines. I’m not saying they weren’t useful but there was a feeling that Big Pharma was really pushing the vaccines for their own profit.

FSC: I don’t think that’s a fair assessment of the way that it actually played out. Operation Warp Speed, put in place in the Trump Administration, was built upon the premise that we really have to do everything possible both for treatments and for prevention. The prevention’s gonna be the vaccine. That’s what got a lot of the attention. I will tell you, I’ve spent countless hours – I was working 100 hours a week in 2020 – trying to also pull together all of the ideas about treatments, convening all of the drug companies that might have ideas in that space as well and then trying out various proposed already-approved drugs that somehow might turn out to have benefit for Covid-19. We ran 26 rigorous clinical trials in the space of only eight or nine months to try to see what would work. Most of those ideas failed. That’s not too surprising when you’re trying to repurpose a drug that was really designed for something else. A few of them worked. The monoclonal antibodies worked. That’s something which probably had a significant role in improving the possibility of President Trump’s survival. Other things, including things that people were very excited about, like hydroxychloroquine and ivermectin, those rigorous trials basically showed no benefit – which is a result that a lot of people didn’t want to hear because they wanted to believe those were gonna be the answer. Unfortunately, when you look at the science, they were not.

JWK: I don’t want to stay on this forever but, as long as we’re talking about it, I think a lot of the controversy from the public’s point of view – not the scientists’ point of view but the public’s point of view – was that ivermectin, for example, was really dismissed in the media, on cable talk shows and what have you, as “horse medicine” when it has been used for treating people. That fact was never really very often made clear on the liberal cable networks anyway.

Also, I have to say I used to book a Catholic news program called Currents News. We had on an expert  from the Catholic Medical Association. I didn’t book him for any particular political reason but he told me that he believed that hydroxychloroquine was effective. He said, in his patients, he thought it was effective.

The media – I’m not saying you – sometimes seemed to have a political agenda in putting down these treatments.

FSC: I’m glad you brought it up because there certainly was a lot of opinion flying about. Certainly there were people – maybe like the doc you talked to – who on the basis of their own anecdotal experience thought that it was working. Keep in mind, most people who got Covid – without any treatment – got better. So, if you have a bunch of patients who have the disease and you give them hydroxychloroquine and a lot of them get better, you’re inclined to say “Aha! It worked!” but that doesn’t prove a thing.

Part of what I’m trying to put forward in my book is that, when it comes to a question like that, one has to set aside anecdotes. You have to also set aside our tendency to have some sort of cognitive bias like “I think I want this to work because somebody I care about said so.”

How do you figure it out? You do the rigorous testing that medical research has developed – this randomized double-blind controlled trial where you actually have a bunch of people with Covid and you randomize which one’s gonna get the drug and which one’s gonna get a placebo that looks exactly the same. Even the people who are giving the pill don’t know which one they have just given and you follow over the course of a few weeks and you find out “Was there a difference?” That’s the only way you really know. That was done for hydroxychloroquine. That was done for ivermectin. There was no difference.

JWK: Two more questions on this and then I want to move onto other subjects. What are your thoughts on the Wuhan lab leak – which was dimissed early on – and what are you thoughts on gain-of-function research?

FSC: Oh, boy. We’re really getting into this territory. I have written about it in the book. I think, again, these are topics that have generated a lot of heat and not necessarily enough careful reflection on what we know and what we don’t know – and, particularly, the importance of being careful about terminology. When people say “lab leak” what exactly does that imply?

JWK: I think it implies an accident. I don’t think many people are saying it happened on purpose – but that the lab was the origin of the virus.

FSC: Well, already, you said “origin” and you said “lab leak.” Can I try to draw a distinction here that I think is almost always glossed over – and I think it’s done great harm to this conversation.

First of all, let’s ask the question (if) the original SARS Covid 2 virus was human engineered. Was it built in a lab? The answer is no. I think resoundingly no. When you look at the sequence – the letters of the code of that virus – it is not a virus that somebody who was intending to make something that would be highly infectious to humans would look like. It broke all the rules from everything that we knew previously about coronaviruses. That was nature of the paper that was written, which has now been much attacked, on proximal origins – where the world’s experts and virologists, many of them outside the US, looked at the data and said “This is not a human-engineered virus.” Can we just sort of state categorically that that’s the bottom line? I don’t know how many different experts have to look at it and draw that conclusion. All of the people in the security business agree this was not a human-engineered virus. Full stop.

Now, okay, but how did it get to humans? Is it possible that this naturally occurring virus was secretly under study in the Wuhan Institute of Virology and it got loose by an accident? There is absolutely no data to support that…You can’t exclude it but it does seem odd to say that must be answer when there’s no evidence for it.

JWK: Some people would say that the fact that the lab is there and that’s where the outbreak started there amounts to circumstantial evidence. Maybe that’s not proof but it sorta suggests something.

FSC: That’s enough to make you wonder, for sure – and then to want to get more data.

On the other hand, the other thing that’s right there is the Wuhan wet market. The data that was (gathered) by swabbing surfaces at the wet market in early January of 2020 shows that there’s plenty of evidence the virus was in a particular corner of that wet market where they were, in fact, selling and butchering wild animals – including racoon dogs which are now known to be a very good host for this virus.

I think, if people stood back from their prior ideas about what they think the answer would be and looked at all the evidence, they would probably say most likely this was a naturally occurring virus that was traveling in some kind of a host after it left bats – maybe the racoon dog – and then was spread to humans at that wet market.There’s very compelling data to support that – but not absolutely conclusive.

My view, I’d say I’m at like 70% on the side that this is fully naturally occurring, 30% that maybe it was being secretly studied at the Wuhan Institute – without any evidence to include that. I’m ready to change my odds if somebody provides (convincing) data. For people who have already decided it’s a lab leak – which apparently most Americans now believe – come on, folks. There’s no evidence to really support that.

JWK: What are your thoughts on gain-of-function research. Is it something that’s positive or is it too dangerous? A lot of people feel like increasing the effectiveness of a virus might not be a great idea.

FSC: Well, it’s a very important question. Obviously, at NIH – the largest supporter of biomedical research in the world – we worry a lot about that. The original conversation was more about influenza. A positive of doing that kind of very careful research under tightly controlled conditions is that it might give you a hint about to watch for in some future pandemic where you would know what to look for in terms of the virus acquiring even more dangerous characteristics because you’d manipulated it…and learned that there are certain changes in the virus that would be a source for concern. That would have to be very carefully argued.

NIH had incredibly rigorous oversight requirements on any research like that and, basically, almost none of that was being supported by NIH, certainly none that could have had any connection with what happened with Sars Covid 2. There are people who have tried to then connect some dots there – maybe for their own political reasons – to say that somehow, because NIH was supporting some research in China on bats – not of the type that was gain-of-function in the sense that required that very careful oversight – that there must have been some link there and that that research led to the pandemic. That is just not defensible. In fact, I think it’s really unfortunate that people continue to propagate such statements without any evidence to support them.

JWK: Could the money have been used by the Chinese government on such things without American approval?

FSC: The Chinese have plenty of their own money. I have no idea on what exactly their constraints might have been in this kind of category. We don’t have any control over that.

Note: In Part Two of our conversation, Dr. Collins talks more about his definition of wisdom, balancing science and faith, whether he believes in miracles, his friendship with atheist writer Christopher Hitchens, his own journey from atheism to Christianity and the profound impact of his work mapping the human genome. 

John W. Kennedy is a writer, producer and media development consultant specializing in television and movie projects that uphold positive timeless values, including trust in God.