America's Autism Crisis and How AI Can Fix Science with NIH Director Jay Bhattacharya

Dr. Jay Bhattacharya is one of the country’s top medical experts and a 24-year professor of medicine at Stanford. After being censored and deplatformed during COVID for his role in opposing harsh lockdowns, he was appointed Director of the National Institutes of Health by President Trump in 2025. a16z General Partners Erik Torenberg, Vineeta Agarwala, and Jorge Conde join Dr. Bhattacharya to discuss the administration’s role in tackling the autism crisis, how to restore public trust in health authorities, how to make the NIH more dynamic and efficient, and how to streamline publishing and restore academic freedom.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  The American people are not stupid. In fact, they're quite smart. And when we talk to them in ways where we show respect for their intelligence with data, allow people to disagree, but then have the evidence right there in front of people. I think people will respond with trust where the evidence actually leads. We need kind of that Silicon Valley spirit. We should stop punishing scientists who fail. If they fail productively, let them publish in a journal to explain why they're, what they learned from it. Like that Silicon Valley spirit, I think, needs to come to science a little bit more.

• 0:31Speaker 01

  Autism funding, old drugs with new promise, and a reset on American science. Today, we're joined by Dr. Jay Bhattacharya, director of the NIH with A16Z Health and Bio, General Partners, Vanita Agarwala, and Jorge Conde. We cover the NIH's new $50 million Autism Initiative, Leukoviren's potential, and fresh scrutiny of Tylenol and pregnancy. We also dig into the replication crisis, bold funding models, rebuilding public trust, and how AI can transform healthcare from drug discovery to clinical care. Let's get into it.

• 1:08Speaker 01

  Well, Dr. Bhattacharya, thank you so much for coming on the podcast. We're stoked to have you.

• 1:11Speaker 00

  I'm delighted to be here. So good to talk with you. I'm a little jealous I'm not in Menlo Park to be there with you on this.

• 1:15Speaker 01

  Exactly. And we're talking Monday, September 22nd. There's big news coming out today. The Times piece on you just came out, and I want you to reflect on that as well. But maybe you could share with us the big news and why it's so impactful.

• 1:28Speaker 00

  Sure. So roughly six months ago, when I first started this job, Secretary Kennedy challenged me to help get answers for families with autistic kids. I mean, the prevalence has been rising for decades, like 1 in 31 kids. I think this is the CDC's latest numbers on this. That's an incredible number. And we don't have answers. A lot of times, families, they have these behavioral therapies that don't really work very well for a lot of their kids. We don't know the cause, so we don't know how to prevent it. And so I launched, worked really hard to launch this new initiative. 50 million new dollars, 250 teams applied for large research grants. And we're going to announce today that 13 teams are going to be granted, you know, these grants for this Autism Data Science Initiative. The other thing, there's two other things that are going to get announced today that

• 2:11Speaker 00

  it sort of came out of this process of working with Mehmet Oz at the Center for Medicare and Medicaid Services and Marty McCary and Secretary Kennedy, Marty McCary is the FDA Commissioner. One is a drug, a very common old drug called Lucoverone. It's basically like a, it's folic acid, it's called, but it's like, it serves almost like a way to deliver folate to the brain where for, when some kids have folate processing deficiency, folate is, you know, something you get in vegetables, right? But some kids have this difficulty processing folate. Turns out that a lot of doctors have experience using folic acid, Lucoverone, in treating autistic kids and kids who have this folate deficiency in their brains, that, it actually works. And 20% of the kids, I think, restore speech, up to 60% of the kids, they get much better.

• 2:54Speaker 00

  Now, not every autistic kid's going to get better with this. You have to have the specific thing that's happening in your brain, but, you know, making that more widely available, I think is a really good thing. The other one is a sort of a caution on Tylenol and acetaminophen. That is a, you know, obviously a very common pain reliever. It's used, it's the only sort of pain reliever and fever reducer used, recommended during pregnancy. But there's been new evidence that's emerged and what actually highlighted by a new study put out by the dean of the Harvard School of Public Health, just recently, actually, that suggests that use in pregnancy can correlate with subsequent autism diagnoses later on for the kids. Now, I think there's a lot of controversy still over that in the scientific literature,

• 3:36Speaker 00

  but it's enough, I think, to say to moms, look, just be careful. I mean, you know, you don't use it all the time, use it only really when you really need it for high fevers, just to think prudently about it. I don't want to panic anybody, it's not the kind of result that should panic anybody. It's just a reminder that you should use any medicine carefully, especially during pregnancy.

• 3:57Jorge Conde?

  Will there be any revised guidelines around the use of acetaminophen in pregnancy to help, to help, you know, moms and parents sort of make a decision or have a judgment call on what they should do?

• 4:09Speaker 00

  There will be, yeah. So that's something that Dr. McCary, the FDA Commissioner is working on. And there'll be also, you know, changes in, in like how Medicare pays, CMS, Medicare and Medicaid pay for Lucoverin. So it's a cross-agency collaboration for all of that. So both the guidelines for parents, as well as sort of payment for, for the new, for drugs. And then we got the, I'm the most boring part. I just get to launch vast, interesting science projects for the, for over the next, that hopefully will produce answers over the next few years.

• 4:36Vineeta Agarwala?

  And you're also paying attention to preterm birth and you've launched a really fascinating initiative there to, again, you know, launch not only fascinating science projects, hopefully, but also science projects which lead to clinical insight into why that's happening to moms across America. And so, you know, that's another really interesting adjacency, if you will, to some of the announcements that you just made today.

• 5:01Speaker 00

  Yeah. I mean, the preterm birth thing is, it's really interesting. Like, we have worse outcomes in the United States than Europe does. And, you know, we don't really have great answers for why. I mean, there's lots of contributors to preterm birth. Of course, prenatal care is so important during pregnancy. Making sure you have access to that is really important. So that, that's part of it, but it's not the whole answer. And we have to, we need to get answers to families on all these things that concern us. I concern, I've heard from so many people around the country telling me, asking me, answers to these questions hard without excellent science. And that's my job is to make sure that we have rigorous, excellent science to address these questions. It's hard because, you know, like it's, science is difficult, right? You get an answer you think is right. And then, you know, eggs were bad for me in, when I was 18, it turns out, like, but then like later,

• 5:45Speaker 00

  it turns out eggs are great for you. And I, you know, I was fearful eating eggs forever because the science in 1985 told me that eggs are bad for you. And of course, now eggs are good for you. Just, you know, it's one of those things where like, the science is difficult, but we have to hold ourselves to higher standards. We have to be, when we talk about people about science, that's the rigorous and reproducible, something I've been focused on really sharply as my time as an ICE Director is to make sure that we invest in replication, that the standard for truth in science ought to be replication, independent teams. You don't, just don't believe me just because I have it. I say something is true. You know, other people, independently looking at the same thing, should arrive with the same answer. Then we know more likely, we have more confidence that it's true, rather than just, you know, the high authority says so.

• 6:32Jorge Conde?

  For the layperson listening to this, what's been the cause for the loss, I'll say, the loss of vigor in science? Or the law, or the challenges around being able to replicate science? What is the underlying cause for this trend?

• 6:47Speaker 00

  I mean, the underlying problem is just that science is hard. I mean, that's really the bottom line. And then the secondary cause is that there's just a lot of it, a lot more than there was. Like, once upon a time, you know, you go back to 1900 or something, every scientist knew each other, or basically knew almost every other scientist, and everyone was checking each other. That was just a normal course. Now you have vast fields where it's very specialized, and it's hard to get people to check other people's work. There's no return for it. If I spend my career checking other people's work, I'm not going to get a professorship at a fancy university. And science is hard, right? It's very easy for a scientist to latch on to an idea and say, "This is right. I know this is right." But it may not be right. And so what matters is other people looking at it find the same thing.

• 7:32Speaker 00

  But often, when other people look at it, they don't find the same thing. But we don't learn about that, right? There's been, the last two decades, there's been a replication crisis in science with increasing realization. The standards we hold ourselves to science in determining truth are too low. We basically, you can get a paper published a peer-reviewed journal. You know, I've had 180 of them myself, which I apologize for every one. But the thing is, the fact that it's published in a journal doesn't mean it's right. It doesn't mean it's true. It's useful. That's my expression of my belief about that scientific idea. I think most of my things are true. But every scientist thinks that everything they publish is true. That's not enough. You have to have replication. You have to have other people checking each other's work, because it's so easy to convince yourself in science that you're right.

• 8:17Speaker 00

  And so it's really those two things. The volume of science means that people are so specialized, and there's no returns. There's no incentives to check each other's work as much as we ought to. And then the publication standards are too, because science is too hard. Science is so hard. Publication standards are not high enough, really. That's really the reason for the replication crisis.

• 8:36Erik Torenberg?

  Well, first, I just want to comment. There was a joke going around yesterday, sort of a quote tweet on Twitter in response to sort of any potential reduction in autism, that someone said this is a direct attack on Silicon Valley startup productivity. And what will this mean for startups? But, yeah.

• 8:51Speaker 00

  My goodness.

• 8:52Erik Torenberg?

  Exciting news there. Say more, just in terms of... Maybe we could zoom out. You mentioned you took over six months ago. What are your reflections so far in terms of your activity and achievements to date? And then what you hope to achieve going forward?

• 9:04Speaker 00

  Well, I mean, we've done a lot. So like, one of the first things I did was we looked at, you know, the way we fund foreign collaborations, right? So it turns out that we fund foreign collaborations, but it's very difficult for the NIH to check that the money is going to the right things. We couldn't audit, like the Wuhan lab. The NIH had sent money to the Wuhan lab, but we couldn't audit it. So we put in a new system. Like, I think foreign collaboration is really important for science, but we need to do it in a way where I can look to the American people in the eye and say, "Look, we're actually tracking the money. We're checking to make sure things are going in the right place, doing the right thing." I put in a new system. The frustrating thing about that is like, we put that in, and all of a sudden, I'm seeing reports that I want to end all foreign collaborations, which, I mean, couldn't be further from the truth. I just want to make sure that we do

• 9:48Speaker 00

  it in a way that's auditable. I can go in front of Congress and say, "Yeah, I know we sent money to Wuhan lab, and here's the lab notebooks that they worked on," which we couldn't do under the old system. We've changed the way that we evaluate grants. So we have a fantastic, at the NIH, we have a great way of evaluating grants called the Center for Scientific Review. It's the world's best peer review organization. Turns out that a bunch of the institutes, the 27 institutes, a bunch of the institutes had their own parallel review system. So we centralized that, made it so that everyone is viewed the same way. The other thing, actually, this is related to Silicon Valley. It's something we're working on right now. Okay, you guys are going to tell me that I don't know anything about Silicon Valley, even though, because I didn't work for A16Z, but I'll just tell you, my view

• 10:31Speaker 00

  of this is like, the reason why you all are so successful is that if you, as A16Z, you have a portfolio of 50 projects, and you fund 50 of them, and 49 of them fail, and the 50th is, you know, Google or something, you view that portfolio as a tremendous success.

• 10:47Speaker 00

  And the people that those 49 companies, they're going to get a second chance, especially if their failure was productive.

• 10:54Speaker 00

  You don't punish failure that much. You're willing to have a portfolio where you think big, right? That, I think that spirit needs to come to science. I did publish work before the pandemic, asking essentially, is the NIH willing to think big? And too often, the answer in recent decades has been no. If you look back in the 1980s and 1990s, the NIH was funding ideas that were like zero, one, two years old. The typical scientific project funded by the NIH in the early 2000s and 2010s was like six, seven, eight years old. We just became too scared of trying new ideas out. We need kind of that Silicon Valley spirit so that, and we should stop punishing scientists who fail. If they fail productively, let them publish in a journal to explain what they learned from it.

• 11:36Speaker 00

  Like that Silicon Valley spirit, I think, needs to come to science a little bit more.

• 11:41Jorge Conde?

  And do you think that the, that the mechanism for reviewing the grants, say, at the NIH, became overly cautious? Or did the scientists themselves become overly cautious?

• 11:50Speaker 00

  Well, I mean, those were closely linked. It's a peer review organization. I mean, I sat on those scientific panels for a decade, two decades, and I watched what happens, right? So suppose a new idea comes in front of me, right? Well, I'm really good at methods and especially methods related to the old idea that this new idea is not competing with my idea, right? And so like I look at the new idea, I go, this, there's no way it can work. And I say that to this peer review panel and everyone says, yeah, there's no way it can work. So easy to do, right? I'm sure you face the temptation too at A16. So you get, you get a thing or you look at the thing, you're like, this is, this is, this guy's a, obviously a genius, but he has an idea that couldn't possibly work. And that temptation is very strong.

• 12:31Speaker 00

  And too often in science, we say, yeah, in, in scientific funding, we say, yeah, we don't want to give, we don't want to try it out. And yeah, most new ideas are going to fail. That's just normal. You expect that to happen. But if you don't leave room for people to try them out, you're never going to make big advances. And I think that's what happened to the culture of biomedical science the last few decades is, is too focused on like incremental progress, not enough on enormous. Now, of course, there have been big improvements, big, big scientific discoveries, right? But I don't want to downplay that. That's true. But we spend a lot of money and per dollar we spend, a whole bunch of like scientists of economists who have looked at this and the science of science folks who have looked at this say that we are getting too few advances per dollar that we spend.

• 13:16Speaker 00

  That's because the culture is too conservative.

• 13:20Vineeta Agarwala?

  Yeah, it's interesting. It's sort of why many great venture partnerships, you know, ourselves included, are not consensus-driven. You can't drive, you can't require unanimous consent to fund a big, bold idea because someone's going to say, hey, no, there's no way that's going to work. And someone has to be willing to take that bet.

• 13:41Vineeta Agarwala?

  I'm curious, and correct me if this is kind of not how you think about the NIH structurally, but it occurs to me, kind of as an outside observer of the organization, you know, again, for listeners, our country is one of the world's largest federally-funded, you know, federal funder of biomedical research across 27 different institutes, over $35 billion in funding. You know, there's a massive organization funding essentially across multiple sub-disease categories, the most important research that we believe will advance our health as a population. And it seems to me that there are two big categories in which the NIH has to get decision-making right.

• 14:23Vineeta Agarwala?

  One is allocation and sort of how you decide how much should go to immunology versus infectious disease versus maternal health and, you know, versus autism and behavioral health. And, you know, there's kind of this fundamental values-based, you know, population input-based, you know, citizenship input-based, whatever it might be. There's some, you know, risk-return-based methods that you have to do to decide how do you allocate funds across these different areas. And then there's an execution challenge. Okay, once you've decided you're going to allocate this quantum of capital in research funding to this area, how do you pick the right investigators? How do you keep them honest? How do you drive data return?

• 15:08Vineeta Agarwala?

  How do you measure productivity on an ongoing basis? How do you incentivize ongoing risk-taking in a multiple-year project? How do you get your agreement straight with an international, you know, funding, you know, research partner? All of these are sort of all in the bucket of execution. Is that a reasonable way for people to think about the NIH? Like, you've got to nail allocation and then nail execution, and you're in it to reform both?

• 15:31Speaker 00

  So, okay, first of all, you're like, you're, you're very well trained as an economist. That's very, very clear to me because that's exactly the right way how an economist.

• 15:38Vineeta Agarwala?

  It was your class.

• 15:41Speaker 00

  I, I, I mean, but, but no, I mean, that's exactly right, right? So first, there's a decision about where, which diseases should we focus on?

• 15:51Speaker 00

  That's in, it, it's not only a scientific problem, it's also a political problem. Like the, and it, it ought to be a political problem for the reasons you just articulated, right? You, it, it, um, the, the things that we focus on to reflect the, uh, the, the real needs of the people that fund us. If we're just doing science for science's sake and we're just wandering around without producing answers or improvements for people's lives, well, the question is, why should they fund us? And the, and it's actually Congress that decides this. Congress and the president together in the budget decide where does the money go? You know, how, how much to infectious diseases? How much to heart disease? How much to cancer? How much to pediatric disease conditions?

• 16:34Speaker 00

  You know, like, there's a whole allocation that reflects the political will of the people as well as the scientific need, uh, opportunities, right? So it's a, it's a, it's a mix of the two that decides that. And I think it's so completely appropriate that, that that be the case.

• 16:49Vineeta Agarwala?

  So let me, let me push back on that. Why? Why, why do people know enough about science and our ability to make progress in important disease areas? They may not even know the names of the diseases. They may not know anything about the true prevalence. They may, they, they've, we've enabled them to be productive in careers entirely outside biomedical science expressly so that the experts can weigh in on where science is going to improve their health on an ongoing basis. And so you may say, oh, that's, you know, um, that's an overly paternalistic view. Or you could say, well, that's what people decided they wanted. They didn't want to have to worry about exactly what research needed to be done. They decided to offload that cognitive load to you, um, at the NIH.

• 17:33Vineeta Agarwala?

  And they, they may not want a voice in that. Or, you know, you know, at least that's kind of one argument I'd make, uh, in response to the idea that allocation should be political. How, how do you, how would you respond to that?

• 17:45Speaker 00

  Well, I think so something let me let me get to back to the second half of your characterization because that's where the scientific sort of expertise comes in, right? So within each area, it is absolutely vital that scientists have their say, right? That they can they can say, well, this idea for addressing Alzheimer's is promising. This idea for for addressing, you know, autism is promising. And then they can and then scientists can check themselves and say, well, is this is this actually promising? Right? So it's and the NIH's role is to mediate that, take that scientific input and make portfolio decisions that will actually advance health in those areas. Right? That's that's that's basically my job. And so so that I think the scientists have their say.

• 18:31Speaker 00

  But in the the question of where should the money go, right? So let me just go back to HIV epidemic, just to give us some sense of what can go wrong. Right? So it the early rise in HIV did not was not met with a sufficient response by the NIH. But we're talking very, very early in the early 80s of money going to research on this vital topic. And and it was the political movement of HIV patients coming together, saying, look, it's really important that we address this that led to the NIH actually taking that real public health threat seriously. Right?

• 19:10Speaker 00

  This if you leave it to scientists themselves, or I should say ourselves, I'll say two things. One is we don't reflect the will of the people like we we're not good at mediating between different population groups. I mean, and it's it's not right, right? There's no philosopher king that can decide, well, this much money should go to HIV. This much money should go to cancer. This much money should go to pediatric conditions. It's the will of the people. And so really, I don't see any other way to do it. You know, I was like Winston Churchill says, said that democracy is the is the is the worst worst system of government on earth, except for all the others. I mean, we don't have philosopher king, leaving it to scientists is not an answer.

• 19:52Speaker 00

  Like, the people really should have some say in where where that allocation happens, I think. The other part of it is that frankly, I mean, this is something related to what we just talked about before. Scientists, if you ask us, we're not actually good at predicting the future of the future in terms of like our, will this investment result in productivity? I mean, actually, frankly, neither is Silicon Valley, right? You can't say, you can't promise me that every single project you pick is going to work for your portfolio, you cannot, right? And so scientists play a vital role in deciding what scientific opportunities there are, letting us know, and then we can make decisions. But the portfolio decision, that's not exactly a scientific decision.

• 20:36Speaker 00

  That's an economic, microeconomic, small E kind of decision. And then the macroeconomic decision is where these areas we should go to. It really shouldn't just be scientists that decide that. Of course, there's an interplay, right? So if there's a scientific opportunity in a particular area, I want to be able to reflect back to Congress and say, well, this is a great area. You should fund this right now because, you know, there's huge advances in cell-based therapy for sickle cell disease. We definitely need to fund that, right? And then Congress can move based on that scientific opportunity. But that's an exchange between, you know, the people and the scientists, not just a one-way street.

• 21:13Vineeta Agarwala?

  I like that. That's insightful.

• 21:15Erik Torenberg?

  It's awesome.

• 21:15Vineeta Agarwala?

  Yeah, I mean, it seems like a more interdisciplinary approach to allocation and execution. That includes an understanding of how much we're spending, how much it costs on a go-forward basis, what the economic impacts might be of getting the research right.

• 21:33Vineeta Agarwala?

  No, thanks for sharing that view. I think it's important for people to understand that you're trying to bring more voices to the allocation question and more rigor to the execution question, but both are not as straightforward as it may seem.

• 21:50Speaker 00

  Yeah, this is a weirdly complicated job. I thought being a professor was complicated, but this turns out this is a little more complicated than that.

• 21:56Erik Torenberg?

  Are there certain areas you feel were under-allocated or over-allocated? If you could, you know, just wave a wand?

• 22:03Speaker 00

  Oh, we're all, every area is under-allocated, of course.

• 22:09Speaker 00

  I mean, I think the thing is about the under allocation is I don't know if it's a question of money, but if you look at the trends in public health over the last decade and a half, the United States has seen no increase in life expectancy. We have enormous overhang of patients, people with heart disease, actually cancer, we've seen big improvements in life expectancy or sort of life expectancy after getting cancer, but huge increases in the incidence of cancer, type one, type two diabetes, autism, we've talked about a whole host of other chronic conditions. I mean, and we've made big advances in other places, right? So the question is like, how can we address the biggest health needs of

• 22:53Speaker 00

  the country? Right? It seems like we're really good at like, and we should be good at some of the, some, some conditions that have lower prevalence. Like we've made tremendous advances in HIV. It's a huge cause for celebration, right? We still have some way to go. Forty thousand people got HIV last year. We can end the HIV epidemic. We should still invest in that. But at the same time, what about all the people that died of heart attacks? What about all the people that died, died, have, have, you know, type two diabetes that are suffering from, you know, blindness because they're, you know, because they have, you know, bleeding in their eyes or in their retinas. I mean, like, so you have, what, what about the, the people with kidney failure that, that the prevalence is rising? What about all, we have to, we have to look at the practical health needs of the country that are people

• 23:38Speaker 00

  are, where people are suffering and make sure that we address our science to those things. It's, and we, I don't think we've done that as much as we ought to. And just look to macroeconomics. You don't have any increase in life expectancy in this country in over a decade. Science isn't the only reason why, like the, the fact that the NIH, I mean, the NIH contributes to that, but, but it's not the only answer. Obviously, it's very complicated. But the NIH ought to contribute to that. Things, the science we do should translate over to better health for people. And so really those areas where people are suffering the most, that's where I want our, our, sort of, I would say is under allocated.

• 24:11Jorge Conde?

  I love this idea of comparing or analogizing the NIH to almost like a portfolio manager, right? Where, and, you know, similar to what we do as, as venture capitalists in Silicon Valley. And if I really wanted to abuse your analogy, which I will, if you'll allow me for a second, you know, the people are almost like your limited partners are the ones that tell you, these are the sort of the theses and the fund areas we want you to go after. And you all are the investors, the venture capital investors that have to do the portfolio management and picking and all of that. You said a few minutes ago that a lot of the grants in the NIH are going to older ideas. And there's lots of data that shows they're also going to more established, older scientists

• 24:54Jorge Conde?

  at the very high, highly regarded institutions. The equivalent of that would be if we only funded 30-year executives that came out of large, established companies and ignored the young up-and-comers coming right out of the university or dropping out of school or whatever. You've talked a little bit about that question, like, how do you reform the process, the execution, to use Vinita's phrasing, on selecting for the innovation that, if you will, bubbles up from the bottom?

• 25:26Speaker 00

  And it's a hard question, actually. It's something that's at the top of my mind. And actually, what you just described is exactly what we've been doing in science for a long time. So, the data out of the NIH is that in the 1980s, if you were 35, you actually had a chance of getting a large NIH grant. Like, that was the median age of the first large NIH grant, you were 35 years old. Now, you're in your mid-40s. We tell young investigators, you gotta do

• 25:52Jorge Conde?

  Which, by the way, is super young, to be clear. Mid-40s, super young. Just wanted to be clear about that.

• 25:58Speaker 00

  I mean, I'm 57, so, like, I don't know. I mean, they all seem like babies to me. But the thing is, you have, just like as in Silicon Valley, the new ideas come from younger investigators, right? So, I did a study a few years back where I looked at, it turns out that the age of the ideas in your published work ages by every, by one year for every year of chronological age. So, my ideas get one year older every year that I age. The very best scientists fight like crazy to stop that. So, every two years of chronological age for Nobel Prize winners, their ideas in their papers age by a year. If you want the newest ideas, you have to let the young people have their, have a try.

• 26:44Speaker 00

  And we're just bad at that. Like, young people, we fund, we fund them and then they drop out and they leave for, for other places. That wasn't true back, like, back, back in the seventies and eighties. The, the culture of biomedicine says you have to have one, two, three postdocs before you have a shot at an assistant professor job. And as a result, the ideas that we support are just, they're just older. I mean, not necessarily a bad thing. I mean, of course, you should, in the portfolio, have some support for older ideas that were, that are still promising. But if you don't also fund some of the newer ideas, the portfolio is going to produce fewer advances as a whole than if you, than if you do, right?

• 27:24Speaker 00

  You have to have a, you have to diversify in that sense. To solve that problem is hard. So the NIH has been trying to solve this now for, for two decades and we made no progress.

• 27:34Speaker 00

  So first, we have to, we have to, I think, I mean, I'll just give you some sense of where we got backwards. You know, we used to have a, a system of peer review where in order to be a peer reviewer, you had to have a, a large grant. Now, think about that. I got a large grant. I'm in my fifties and I see an idea that challenges my thirty years of work. And I'm a reviewer on a panel. It's really hard to, like, open your mind and say, well, I might have been wrong. That system, that got changed, but now, so that we no longer have that rule. But like, it's, it's the mindset. You, you have to allow.

• 28:19Speaker 00

  So what I've done is I've, I've asked the institute directors, I've given them the authority essentially, to expand what they can do in terms of the portfolio. I'm not going to judge them to make, just like with Silicon Valley, I'm not going to judge them to, on, does every single grant succeed? I'm going to judge them on the portfolio as a whole. Does it translate over to better health for, for the people that they're, for the disease that they're, like, trying to address, or the diseases they're trying to address? Does it result in big advances in biological knowledge, right? I'm going to assess the portfolio as a whole. And then the other thing is, is that, does it match the strategic vision of the institute? The institutes, they have these, like, fantastic strategic plans. Like, you know, you go look at them, say, your, your eyes will say, you'll, you'll get, and you go, like, your eyes will get big with the science that they're proposing. And yet, what they actually end up funding,

• 29:04Speaker 00

  based on their peer review panels, is often, they'll get 10 great proposals on one part of the strategic plan and like nothing on another part of the strategic plan. And so like you, I'm going to encourage them to be able to pick the portfolio so that matches the strategic plan. I'm going to reward them for rewarding and empowering early career investigators more. Right? So I'm going to build incentives into the decision making by the institute directors so that they have incentives to solve these longstanding problems. We have to solve the new investigator problems. And I'm going to start to evaluate long-established investigators, because I do believe that play a pretty fundamental role still.

• 29:47Speaker 00

  But in like, how well do they advance the careers of the early career investigators that work with them? Right? So if they're good at that kind of mentorship and career advances, I'm going to reward them in their grants. I'm going to start evaluating the grants for that, for that, too. So because the grant portfolio has to be sustainable in the long run producing new ideas. I mean, that's, we should, we need to just, and if we don't have the early investigators sort of getting the support they need, we're going to start to stagnate.

• 30:17Vineeta Agarwala?

  I love to hear the interest in advancing early career investigators, but we can't have that conversation without talking about the universities from where they tend to come. And so, you know, I was a product of NIH MSTP funding. I did my MDP HD with the generous support of the NIH. And my peers and colleagues, you know, in my class and, you know, decades behind, coming up, get trained on those grants today. How can you work with, you know, with the administration to ensure continuity for the training grants that, you know, NIH does believe

• 31:00Vineeta Agarwala?

  are going to fuel the pipeline of early career investigators, who, as you say, you know, are perhaps most likely to bring change, big ideas, you know, and take big swings.

• 31:14Speaker 00

  Yeah, we, as you know, you're biophysics, right? So we have, we have a range of, a range of like ways that we support early care investigators. So there's, there are these awards for pre-docs, pre-docs meaning undergrads. And that's really important. Like, we want to make sure that the undergraduate, the very talented undergraduates who are interested in biomedicine and research biomedicine have, have the support to do this. If, if, there's also like, if support for, for post-docs, right? So for, for people who are getting their PhD and then post-docs. I want to, it's going to be hard, but we have to structure things so that, that the, the

• 31:57Speaker 00

  range of investments we make actually translate over to people wanting to stay in biomedicine. I mean, that, we have a lot of people who drop out, but I think the main problem isn't that, that support for the early, I think we have a lot of portfolios pretty good on that. We could do better, but, but that's pretty good. The problem is, like, after you've had this career in biomedicine, how do you, like, do, of this research training, do you have support to, like, make the next leap into an assistant professor job? And too often, it's too hard to do that. You can't get the support you need to do that. There's these K awards that we have that, it's really difficult to get them. I think we have to do better at that, and we have to reward universities that are better at that.

• 32:41Speaker 00

  There's problems all across the system, but I think that, that missing link is really the, you know, you finish your MD and your PhD, and then can you get that assistant professor job? Or are you going to be asked to do 17 different post-docs where you have a chance? Right now, that system is set up to make it difficult.

• 32:59Erik Torenberg?

  You, you mentioned earlier that we're not making advancements in, in life expectancy. Why are we lagging? Why, why are some European countries doing better? And, and what are the highest leverage points, you think, to, to, to get back to improving there?

• 33:12Speaker 00

  Well, I think, I think the key thing is, we have to, a lot of our science is, is, you know, this replication question we talked about earlier is very important. We have to solve that. That, that, that will help a lot. And then this portfolio thing, I think both of, both of those things actually will, will, will, will, will address the scientific rigor problem and the sort of conservatism problem. As far as like addressing life expectancy, that that really needs to be, it's in a sense not just a scientific problem. Like, we have to, we have to essentially get a message from the people that we want, that they want scientists to address those problems. Like, that's just what we talked about earlier, the political, political nature of, of that kind of allocation decision.

• 33:54Speaker 00

  But, you know, that's exactly what the Mahabharata movement represents. The Mahabharata movement is a, it's basically a cry for help from the American people, saying, "Look, all these chronic disease problems, all these problems with our, with our kids, and we're sick, we're much, doing much worse than folks in, in Europe in terms of our health." With, you mean, it's, and that essentially is a, a call for the NIH to reform itself to address those problems. It's a, and to me, it's a tremendous opportunity. And, you know, this, this is why I agreed to take this job. I mean, I was perfectly happy being a professor. But it's, but it's, you know, once in a lifetime opportunity to make the NIH really work for the American people. You know, and I think having that political movement behind me, behind us is really important for that.

• 34:39Vineeta Agarwala?

  Last week, you announced some really interesting initiatives around academic freedom. And many folks know your voice kind of reached the national stage in part because of your ardent desire to see academic freedom respected, protected across the country. And, you know, it sounds like you're looking for ways to improve publishing fundamentally so that people feel freedom at all levels, including early career investigators, to share their view on science that they think might be interesting. And we need to figure out, to your point earlier, how to make the point that anything published is not necessarily fact, but it's one opinion backed by one set of data and

• 35:23Vineeta Agarwala?

  one set of analysis and one set of perspectives, and you'd like more of those to flourish in the public arena. Say more about the role that you want NIH to play in protecting academic freedom.

• 35:35Speaker 00

  First, at the NIH, I found out that a lot of folks at the internal investigators in the NIH, in order to publish their work, had to seek permission from their supervisors. I changed that, like, no more permission. If you're an NIH researcher, you have a scientific paper, you don't have to get permission. For me, if I, people are going to publish research that I don't agree with. That's wonderful. They should be able to do that. Also, the places that, like, the universities, I think, need to be absolutely committed academic freedom for excellent science to happen. And, you know, like, there's been a lot of, like, angst over the administration's actions with the universities over the last few months regarding holding them to high standards regarding,

• 36:19Speaker 00

  you know, anti-Semitism and so on. But there's also been a message that we really do want academic freedom at the universities. Scientists really able to say what they think and explore where they will, or else they're not good environments for research. As far as journals, that's a complicated question, but there's, the problem right now is that the scientific journals, there's essentially a duopoly. A very few number of companies, for-profit companies, control very large number of journals, and they charge tens of thousands, $10,000 per article for science that they didn't do, that the American people paid for.

• 36:57Speaker 00

  They want, they actually had a sort of a, if you, a policy where if a regular person wanted to go find a scientific article, they had to go, there was a paywall, where they pay like $50, $100. We got rid of that paywall for NIH-funded research. There's still a lot to do in this area. We need more academic freedom. We need more openness in scientific publishing, and I'm working on policies to do that.

• 37:22Jorge Conde?

  So Jay, you know, one of the, one of the key questions, you know, for the, for the American public, they're looking for, for better outcomes, better health. One of the big avenues that, of course, this country uses and has really had as a gold standard in the past is, you know, having this extraordinary public health infrastructure. But I think what's also true is, over the course of the last several years, there's a lot of mistrust now in terms of public health. How do you sort of rebuild that trust for the public? Because, obviously, you know, if there's no trust, the, the, the message can only be so effective. And so how do we build those bridges back to the extent that you think they need rebuilding?

• 38:02Speaker 00

  You know, I think the problem with public health and lack of trust in it, you have to point to the pandemic. You have no choice, right? If you look at, you think back to the pandemic and you remember the Plexiglas that was everywhere. There's still, every time there's a Plexiglas, it makes me, fills me with rage, but that's another story. And there was no science behind that, right? There was like the, you wear a mask when you walk into a restaurant and you take it off when you sit down. You know, you, again, no science behind it, a whole host of like things, and they were really damaging things like closing schools. Where again, the science was so weak that, and now kids are like years behind in their, in their education as a result. And they'll be paying the price for that for years.

• 38:45Speaker 00

  And so a lot of, the American people have lost trust in public health for reasons I can completely understand.

• 38:52Speaker 00

  And so the question then is, what can we do about it? And to me, the key thing is, there's two things that have to happen, like two, two very broad things. Like one, I, I think we have to restore gold standard science. Like that presidential EO on gold standard science is so important because what it says is, it articulates things that we thought all science already knew or committed to, like replication is really important. Unbiased peer review, humility in how we talk about the limitations of our scientific findings. There's a whole host of things where you read it and go, wow, this is, this is, I thought science already did that. And so if we actually do that, I think that's a major part of this.

• 39:31Speaker 00

  The second thing is, we have to, just like we talked about earlier, about the role of the people and the politics in deciding what scientific priorities, what like areas of science to fund, and then scientists to decide what priorities within the science areas to fund and the portfolio analysis.

• 39:49Speaker 00

  We have to convey to the people that we are their partners in scientific investigation and in public health. Public health, folks in public health are servants of the people. And too often during the pandemic, it came across like we were sitting above people, telling you what to do, telling you if you don't take this vaccine, you can't go to work, you can't get a job. You know, I mean, it was heartbreaking to watch because if, I believe very fundamentally, that when science works as partners with people, like has this almost servant attitude toward people, you can do a lot of good. You can do a lot of good. But I think really that kind of humility and a return to sort of gold standard science,

• 40:33Speaker 00

  that's the way to solve the problem of trust. It's going to take a long time, though, because I mean, I've talked to so many people around the country and it's not, we're nowhere near solving that public trust problem.

• 40:43Jorge Conde?

  Dan, I think it's an especially challenging thing as you look forward, and I'd love to hear your thoughts on, you know, how do you convey, you know, recommendations and guidance in the face of uncertainty and incomplete information, right? Because going back to your point, like in an ideal world, you're always resting on top of, you know, gold standard science, you know, but, you know, a lot of times, science, you know, there's a lot of unknowns in the science. Science is hard, going back to what you were saying earlier. And so how do you communicate to, you know, a population, a nervous populace, you know, a sense of a recommendation or even guidance in a world where you yourself have incomplete information?

• 41:26Speaker 00

  I think you just have to be honest, right? So if I asked a question about, I mean, God forbid, there's another pandemic during my watch, and then I'm asked, okay, how should we manage, is it right to wear a mask or something, right? And I don't, there's no good scientific evidence. I'm going to just say that. I you know that well, the it's the knowledge I agree, I was a medical student once I have an M D. So like I can tell you this from firsthand experience. You're at the first two years of med school, you do a bunch of class work. The third year, you finally get to see patients, right? So you go walk into a patient room and you're wearing a white coat and you know, nothing or very little. I mean, you know, you could fill with knowledge about biochemistry. You can like write, you know, chemical equations. So

• 42:11Speaker 00

  your your fingers get tired. But what you can't do is understand what a patient really needs. And so you hear you sit down in front of the patient, they tell you their stories. Wonderful. Like they put their trust in you. And you are tempted to tell them things to answer their needs that they're asking you, but you don't know the answer. You just don't because you're a third year med student. Of course, you don't know the answer. And there's a there's a like, because you're wearing the white coat and because you're someone looking at you wanting the answer, putting their trust in you, you feel this urge to like, say things you don't know. You know, you you start like freelancing. And that's just a terrible mistake, right? As a third year medicine, you learn that you should just say, I don't know. I'm going to look it up. I'll look, they'll look the

• 42:56Speaker 00

  answer for you. You'll get back to you. I'll consult with people who know more than I do. You have to be humble. And especially in the face of new things, you know, new new pandemic, or new or or genuine scientific uncertainty. We in public health have to be humble and say, Look, I'm we're not sure. But here's how we're working to try to get an answer. We're going and we have to convey that uncertainty. And we can't blame the public. Now, I've gone around, talked to lots of folks in in public health and science. And they're like, Well, what we have to do is we have to teach the public more about science and make sure they understand that science isn't always perfect and science like moves, you know, you may have eggs are great one day and eggs are terrible one another

• 43:38Speaker 00

  day. That's because we have new science. To me, that's like blaming the public. It's not the public doesn't understand that science is hard. They understand it fundamentally. Like they just this is not a complicated thing in the sense of like, I mean, everyone knows within the public, the science is hard. The problem is that scientists conveyed certainty about things they had no business conveying certainty about and then changed people's lives for the worse as a result of it during the pandemic.

• 44:06Vineeta Agarwala?

  And say, I acknowledge that there, you know, that the pandemic was a particular challenge with respect to both communication and certainty in the midst of uncertainty.

• 44:17Vineeta Agarwala?

  But how do we acknowledge that challenge and not lose trust in some of the bedrocks of public health advancement that we've made over the last several decades? Whether that's newborn vaccinations, you know, HHS held a listening tour and an advisory update on Hep B vaccination in babies. And it's great that we're looking at all of the data holistically there. But in some of those cases, you know, some folks would argue there is substantially less uncertainty than there was in the wake of a new pandemic with a new virus with no data, with new, you know, completely new infections, you know, than there is in the

• 45:01Vineeta Agarwala?

  context of something like a Hep B. So how do we, you know, and please don't feel the need to respond to that specific vaccine example, but how do we not make it so that even when you do have relative certainty and you come out and say, hey, this is not perfect, but we were pretty darn sure this is a good idea? How do you then make it so that people don't say, well, you know, last time you said you didn't know, so I don't know?

• 45:26Speaker 00

  Right. So I think I don't know is a good answer when you don't know. When you have a little more evidence, a lot more evidence, like just take the MMR vaccine. Like, I mean, if you want to prevent measles, take the MMR vaccine. I mean, it's the best way to prevent measles. And measles can be a deadly disease. Like, I vaccinated my kids with MMR. I was really happy I did.

• 45:45Vineeta Agarwala?

  Me, too.

• 45:46Speaker 00

  And I think that that, you know, I think that that kind of certainty, you know, it's science, right? So nothing is known, like tomorrow that someone might come along and they overturn, you know, Newtonian physics and all of a sudden you're talking about relativity or something, right? You'll always leave open that possibility. But some things we do know with certain, with like much more certainty. I'm not saying that we should all have false humility. I think we should have humility for the things we just should actually have humility about, right? But at the same time, When we have an area of more scientific certainty, we have to leave open room for academic freedom so that people can have their say,

• 46:30Speaker 00

  that they think differently. We don't cancel them. We don't, we just, we reason with them. And we say, look, you think, you think, you say X, Y, Z, but look at all this other evidence. MMR is a good example. There's other evidence that, that, that shows you differently. And they'll just have a public discussion. It's okay. I mean, it's okay that have that contradiction. And then, and then, and then I think what will come across is when there is actual excellent science replicated, I, I, maybe I'm naive, maybe I'm, but I don't think so. I, I think that wins scientific debates. And you can look, there's evidence for this, right? So the uptake of MMR in this country, the MMR vaccine is like 95% of American parents vaccinate their kids with MMR.

• 47:14Speaker 00

  The evidence is, and, and I think it's like 13% of American parents vaccinate their kids for the COVID vaccine. I think that reflects the scientific evidence regarding the relative merits of those vaccines. The American people are not stupid. In fact, they're quite smart. And when we talk to them in ways where we show respect for, for their, their, their intelligence with, with data, allow people to disagree, but then have the evidence right there in front of people. I think people, people will respond with trust where the evidence actually leads. I mean, I just, I got, maybe that's just a matter of faith for me, but I don't see any other way forward.

• 47:52Erik Torenberg?

  You mentioned that the, the three priorities of NIH that you have are nutrition, chronic disease, and integrating AI. Maybe can you flesh out a little bit on the last two, where, what you see as most promising in terms of reducing the disease burden and then also in terms of integrating AI?

• 48:08Speaker 00

  I've seen some like fantastic new ideas regarding Alzheimer's disease. For instance, a colleague of mine at Stanford did, has this like fantastic papers, set of papers he published using an old shingles vaccine called Zostavax. He found that in excellent observational studies that it would, that if you had Zostavax, it reduces the likelihood of developing cognitive decline for Alzheimer's disease by up to 20%, 30%. I mean, it's pretty substantial for a, a pretty innocuous, safe vaccine that's no longer used actually because it didn't work for shingles.

• 48:41Speaker 00

  I mean, imagine if you had a very simple, cheap way to prevent thirty percent of Alzheimer's cases or delay Alzheimer's for years. There's all these like huge advances I've seen that you know, just need a little bit of scientific love. I think we just need to focus on those, have the, make our portfolios focused on those, be willing to take risks in terms of like, on things that look like they're new ideas. And we're gonna, we're gonna make a lot of progress. And AI, by the way, I think is gonna play a tremendous role in that. I just, you know, everyone knows about the protein folding and AlphaFold. That has done an amazing job in turbocharging biomedical drug development. Because now you don't need to like sit there

• 49:22Speaker 00

  and wait and you can just do your computations, figure out what the, how the protein folds, what the target sites will look like, and then ask which of these drug products are like more likely to actually work, without having to do very expensive biological, you know, lab work. You start through the lab work, but they focus on lab work in more promising ways. In the way that we deliver medicine, right? So you can have AIs help radiologists do a better job at making sure they catch things, make them catch everything. Even simple things, like you know, you go to your doctor, the doctor sits there looking at the computer the entire time rather than you, because they're like filling out their electronic

• 50:06Speaker 00

  health records. Have an AI assistant listen to the conversation, fill out the form for the doctor. So they're just checking afterwards for just a couple of minutes, and they're spending all their attention on you, right? All of this needs research, by the way. I mean, does this gonna help patients? We have to ask those questions. But to me, that's a tremendous promise. Like, those simple things can transform biomedical research and how patients are treated. So that's why AI is so important to me as a potential tool. It does need research. I mean, I don't wanna, we can't have AI hallucinating on us and then treating patients based on hallucinations. But you know, that's a matter of research to fix those kind of, those kind of problems.

• 50:44Vineeta Agarwala?

  We heard that HHS rolled out across, you know, agency-wide, an enterprise-secure version of ChatGPT, which is, seems like a terrific

• 50:57Vineeta Agarwala?

  Achievement from the perspective of internal HHS and NIH operations even, right, to be able to look up internally, how new is an idea? Simple queries and data kind of fluidity of that kind seems important. What's the future? Is an AI going to write the institute's strategic roadmap? And an AI submit a grant? And an AI review panel, review the grant? And, you know, where are we going to play a role as scientists?

• 51:26Speaker 00

  I mean, I don't. Okay, so to that question.

• 51:32Vineeta Agarwala?

  The answer is no.

• 51:33Speaker 00

  Yeah. I mean, I think AIs are really good at summarizing existing knowledge. The training data you give it helps it. It's fantastic at that kind of thing. Really developing brand new ideas that challenge existing paradigms. I don't, I mean, I don't, your experience with AIs, but they're not quite as good at that. It's really, it's, we have, just to put a new policy in place where I'm limiting the number of new public applications you can have, like to, we can have, you know, six a cycle or something. We have people writing 60 applications and very clearly AI-generated. And then we have, you know, it's, it's.

• 52:13Vineeta Agarwala?

  Yeah, that's maybe the present, not the future.

• 52:16Speaker 00

  Yeah. Yeah, so I think AI is really important, as I said. I think it's, but it has to, we have to do research to understand how it can be used to help people. And I think people, scientists are still going to have a tremendously important role. The new AI system rollout at NIH is just exciting. We're actually been working on a new system also, specific to NIH, again, to protect, in ways that protect patient privacy and all that. But it rolled out across the NIH so that people can like interact with it in ways that help NIH-specific tasks as well. So I mean, I think that's all very exciting, but it's an augmentation of capacity rather than a substitution of capacity. It'll make people way more productive.

• 53:01Speaker 00

  It'll help us address some of the key problems, but scientists are still gonna, I mean, we still have work to do as scientists.

• 53:08Vineeta Agarwala?

  We do. If I could just end on one last question. If you had one message for the rising star scientist contemplating a career in science where they can bring the best of their abilities to making science better, smarter, faster.

• 53:26Vineeta Agarwala?

  You know, a scientist embarking on a new PhD in a brave new field. A scientist thinking about starting a new company to advance the work that they're doing. A scientist at the NIH running a lab. What is your one message to the individual scientist who's out there, you know, hoping to make the biggest impact they can?

• 53:49Speaker 00

  I mean, science is incredible. Like, it has almost limitless capacity to advance human well-being. And it's the individual scientist who believes in their idea. Keeps knocking on the door even when the door is closed over and over again until it opens. That's who really makes a big difference in this world. I would say, please, stay in science, keep knocking that door, and change the world with it, because that's the only way the scientists can do that. I love this story of Max Perutz. I don't know if you've heard of him. He was a University of Cambridge researcher in, I think, the 50s. And he had this idea that he could figure out the structure of myoglobin. It sounds like a very geeky kind of thing.

• 54:31Speaker 00

  It's like, but it's, but back then, there was no protein folding field, really. I mean, it was like, and he was a student. And all his professors kept telling him, "Pick an easier problem, Max. This is crazy. Why are you spending all your time? You're never going to finish." And for a decade at the University of Cambridge, he wandered around. Everyone knew he was a genius, but he was like, got nowhere. He's not just working at it until finally he figured it out. And it's just transformed like a whole host of things in biomedicine. And, you know, he eventually won the Nobel Prize. It's, you know, it's the kind of thing where I ask myself, do we have a scientific sort of infrastructure today that would allow a Max Perutz to do what he did back then? And I would love to make that happen through the sort of the power of the NIH, to allow

• 55:16Speaker 00

  the Max Perutz of the world, the new ones who are now sitting there with great ideas, to be able to try them out and change the world with them.

• 55:28Vineeta Agarwala?

  Fantastic.

• 55:29Jorge Conde?

  So maybe on that note, just looking to the future, if we end where we started, where you know, you talked about the NIH's highest ambition is to improve the health of the American people, whether that's measured in life expectancy or the rate of chronic disease that Americans suffer from. If you had to guess where we're going to see the biggest and best gains, is that going to come from, you know, how we manage patients, so the management of disease, you know, new molecules for treating disease, or modifications in terms of how we all live?

• 56:08Speaker 00

  Yes.

• 56:09Vineeta Agarwala?

  Yes, yes, yes.

• 56:10Speaker 00

  Yes to all of the above. I mean, you know, I am a big believer in portfolios when I have uncertainty. So I don't know how to answer your question because I see promising advances in all three of those, all three of those topics. And I think we have to invest in all of the above in order to see where the most promising things go. Like, who would have predicted that the GLP-1s, you know, would, actually, we saw a reduction in average body weight in this country the first time in, you know, decades last year

• 56:41Speaker 00

  because of Gila monster molecule that somehow turns out to, you know, when you, if you just do the right biology.

• 56:48Vineeta Agarwala?

  There was a scientist knocking on some kind of door to make that happen, right?

• 56:52Speaker 00

  Yeah, I just, I mean, it's, that's the only thing about science. It's hard, it's hard to predict where the best things are going to happen. And so you have to like have a portfolio. But all of those areas to me sound, look like they're very promising. And as I've gone around the country, talked to people, I'm excited about all of it. So I can't wait to see what we produce.

• 57:09Jorge Conde?

  Do either of you have a prediction to that question? Or is it also? Well, this is the debate we have every week in terms of where we want to invest, you know, that.

• 57:16Vineeta Agarwala?

  Our answer is yes, yes, yes, too.

• 57:17Jorge Conde?

  Correct, all of the above. Well, it's a great place to close. Dr. Bhattacharya, thanks you so much for coming on the podcast.

• 57:24Vineeta Agarwala?

  Thank you.

• 57:24Speaker 00

  Thank you so much.

• 57:25Jorge Conde?

  Thanks for being here.

• 57:25Speaker 00

  Have a great day.

• 57:28Speaker 01

  Thanks for listening to the A16Z Podcast. If you enjoyed the episode, let us know by leaving a review at ratethispodcast.com/A16Z. We've got more great conversations coming your way. See you next time. As a reminder, the content here is for informational purposes only, should not be taken as legal, business, tax, or investment advice, or be used to evaluate any investment or security, and is not directed at any investors or potential investors in any A16Z fund. Please note that A16Z and its affiliates may also maintain investments in the companies discussed in this podcast. For more details, including a link to our investments, please see A16Z.com/disclosures.