It's hardly "holding my nose" to demand that a report coming down from the world's preeminent biomedical research agency be held to the same basic standard as an undergraduate biology essay. Fake citations, really? I like Jay and Vinay but others like RFK and Oz have *zero* credibility and are an embarrassment.
My dude thinks $$$ being “reorganized” but what is actually happening is NIH is being cut off and is in a death spiral. This admin is killing NIH not restructuring it.
Thank you for a sensible discussion on prioritizing medical research funding. I was at UCSF as a surgical resident the same time you were. The number of patients with HIV was staggering especially at San Francisco General Hospital. While I did not directly treat them I was the designated surgical resident who placed chest tubes in patients with PCP pneumonia induced pneumothorax. I started putting heimlich valve tubes in so patients could go home for their remaining days. By the time I finished my training including a fellowship plus a few years in a molecular lab therapies for HIV had improved. A retrovirus may very well elude development of a vaccine but thank goodness we have effective therapeutics to reduce HIV viral load to near zero. During the pandemic we failed miserably at therapeutics, essentially throwing spaghetti against the wall and hoping it would stick. If there is to be funding for infectious diseases emphasis on therapeutics against viruses is where the focus needs to be. Thanks again Dr Marine.
Thank you Dr. Marine. The number in regards to funding for HIV vaccines research and Cardiovascular disease efforts should open everyone's eyes. Funding is limited and working towards supporting dis eases that the majority of people have makes sense to me. Bravo RFK jr and MAHA on this one
I am glad you found one thing that Mr.Kennedy did right and used your excellent academic credentials to give credence to this incredibly underwhelming unqualified individual occupying our nation’s most important public health position. He got “something “right and all of the multitudes of people who don’t have your intelligence or education will wave your editorial in their neighbors faces and tell them how smart and on base this brilliant Doctor thinks Mr. Kennedy does his job. This is the problem with MAGA and MAHA. In their world one attaboy makes up for a thousand aw heck’s. In the real world as you know, the reverse is true. All the damage caused by this man is not made up by some inadvertent brilliant blunders that you so strongly advertise. Where have you heard that more money is going to go to cardiovascular research? I would argue for more money going to prenatal care and research into decreasing infant mortality. Adding a few more years on to your fathe or uncle or even me pales in comparison with giving a mother a healthy baby and that baby the best chance to reach average US lifespan.
Unfortunately what you forgot is that even a broken clock is correct two times every day. You found one time Mr. Kennedy was correct. I wish you would spend half as much wordsge on all his mistakes. I know you don’t have enough years to live to achieve that goal.
Outstanding post! Almost nobody knows the figures you quoted and it's important that the public be more educated to avoid politicization of the practice of medicine. I agree the MAHA movement has a lot of help to shake up the status quo, and can be very good for us all to embrace. I also see a lot of damage from the CVD world in my ALF business.
I didn't realize the HIV funding was still so large, so a very informative post, thank you. Re-allocation is no more and no less than correcting course, keeping the vehicle between the lines. Taxpayers should not be blinded by the spin of media - nor should patients continue to suffer when we can help them in any way.
So you're a left winger with an elite attitude maybe, from the opposite view... It's a shame it comes down to that divisiveness. We all have something to contribute and not for nothing, I've healed people from diabetes in their 80's and cut insulin use to 1/3, as well as had residents on many meds, anti-psychotics and all... We have made a huge difference in the healthspan of many people over the years.
Why is it that everywhere we turn, it's recommended to eat healthier, stay hydrated, exercise and many other things we specialize in... Yet to a random blog responder, I'm "A right winger with no education in science or medicine." Very sad indeed. I wish you a better day than seeing someone's opinion you disagree with, seems to have given you today.
Thank you for this! I have read very little about HIV in recent years and this was incredibly insightful. And for me, it underscores the constant necessity to dig a little deeper when I feel a knee-jerk opinion forming about something I hear in passing ;-)
I assume that all who comment here have read "Sensible Medicine," before this post, and understand the very significant waste in our research dollars on faulty or inconsequential studies funded by you and me! I'm all for re-evaluation of all programs!! I am hopeful that the food chain changes proposed will be more helpful than all the research on discreet disease types! In a "perfect world(impossible)" we will not need any research! As suggested on Sensible Medicine before, we need more research to determine processes and procedures that result in better health and health care. There is tremendous knowledge that goes unused by the vast majority of the population. The knowledge far surpases our use of that knowledge. Kind of a restatement of both Charlie and Suzie preceeding comments.
Great column. I think the insight that governmental priorities can deviate widely from public needs should be generalized. This type of mismatch appears almost everywhere in the health care sector that governments control. E.g., there seems to be a consensus that we have a shortage of GPs because GP are underpaid. Accepting the premise, this is another mismatch. Readers of SM likely have their own favorite examples.
I completely agree with the redistribution of funds. I do, however, believe that there is a lot of knowledge out there that’s not being used to educate the public on how to prevent CV disease. It’s largely preventable with good diet, exercise and stress mgmt. So, how about an educational approach to start.
What bothers me is the quick and dirty cutting of the HIV vaccine research. I have the opportunity to spend two years at the NIH in the 1970s what people don’t understand is that in a relationship with all the departments whether it’s cancer, infectious diseases behavior, etc.
Vaccine research in HIV has yielded tremendous understanding of both the evasive nature of viruses and bacteria as well as deception that HIV seems to have regarding immunity. Great discoveries, and cancer, regarding immunity, genetics, oncology, I resulted from the understanding of the mechanisms of HIV and its resilience. Many of the nucleotides treatments that have remarkably change a uniformly lethal disease into a chronic disease with also control of person to person infection have come about as a result of understanding the biology of HI resulted from the understanding of the mechanisms of HIV and it’s resilience. Many of the nucleotides treatments that have remarkably change a uniformly lethal disease into a chronic disease with also control of person to person infection have come about as a result of understanding the biology of HIV.
What concerns me is the broad swath for anything that’s smacks of vaccine, and RFK’s, (a non physician) urgency to delete. This also melds well with the anti-DEI association of HIV with “ not – normal sex“.
Yes, there is no vaccine yet. But the ancillary plethora of knowledge in immunology, malignancy, genetics, generalized viral biology have come out of the study of this virus and the “failure“ of this research to yield a vaccine. One area of research, can complement and augment seemingly unrelated areas of research.
BTW, cardiovascular death is still the leading cause of death in this country. Yet we have no cured it have we? Using the same logic in Dr. Marine’s well written post, should we elminate all funds for cardiovascular research at the NIH? I would argue that the advances in HIV treatment that have significantly been contributed to by the vaccine research are more impressive than the advances in treatment of CV DISEASE.
The most recent publicly available estimate comes from early 2025. According to the CDC, between October 2024 and May 2025, there have been an estimated 30,000–50,000 COVID‑19 deaths in the U.S..
But heck, they don't matter. We are in a "post COVID" world now.
Who wants to tell him: there has historically ALWAYS been 45000 to 70000 Flu deaths in this country also! (except in 2020 when is miraculously disappeared 😉)
Who wants to telll the uncritical nonthinker that Infuenza is not COVID and that 50,000 deaths actaully matter? SARS Cov2 is a beta coronavirus and influenza is an orthomyxovirus. They are completely unrelated taxonomically and clinically. Infuenza does kill tens of thousands of Americans annually nearly all unneccessarily because like COVID mRNA vaccination, influenza immunization reduces mortality by 90 - 95%. What troubles me more isn't the factual mistatements, it is the deep lack of concern for human suffering, the cavalier disregard for life that such an attitude displays and the ignorance of infection control. Influenza's decline in 2020 and 2021 wasn't a miracle, it was the result of the adoption of standard infection control practices. Rhinovirus nasopharyngitis was also dramatically reduced. The discipline is called Infection Prevention. It used to be called Infection Control and sadly some physicians weren't taught about it.
Hey — I came across your writing and really liked how you think.
I’m exploring something similar from a different angle — writing about human behavior through a system design lens (like debugging internal patterns).
Just started publishing on Substack. If you ever get a moment to read, I’d genuinely value your perspective.
Also happy to support your work — feels like there’s an interesting overlap here.
Sounds like being a right-winger is more of your thing than being science-minded.
That's fine, but you should be honest. You're just making excuses for Trump and the MAGA cult.
It's hardly "holding my nose" to demand that a report coming down from the world's preeminent biomedical research agency be held to the same basic standard as an undergraduate biology essay. Fake citations, really? I like Jay and Vinay but others like RFK and Oz have *zero* credibility and are an embarrassment.
My dude thinks $$$ being “reorganized” but what is actually happening is NIH is being cut off and is in a death spiral. This admin is killing NIH not restructuring it.
Thank you for a sensible discussion on prioritizing medical research funding. I was at UCSF as a surgical resident the same time you were. The number of patients with HIV was staggering especially at San Francisco General Hospital. While I did not directly treat them I was the designated surgical resident who placed chest tubes in patients with PCP pneumonia induced pneumothorax. I started putting heimlich valve tubes in so patients could go home for their remaining days. By the time I finished my training including a fellowship plus a few years in a molecular lab therapies for HIV had improved. A retrovirus may very well elude development of a vaccine but thank goodness we have effective therapeutics to reduce HIV viral load to near zero. During the pandemic we failed miserably at therapeutics, essentially throwing spaghetti against the wall and hoping it would stick. If there is to be funding for infectious diseases emphasis on therapeutics against viruses is where the focus needs to be. Thanks again Dr Marine.
Thanks for your comment. It was a great time and place to train.
Thank you Dr. Marine. The number in regards to funding for HIV vaccines research and Cardiovascular disease efforts should open everyone's eyes. Funding is limited and working towards supporting dis eases that the majority of people have makes sense to me. Bravo RFK jr and MAHA on this one
Dr. Marine,
I am glad you found one thing that Mr.Kennedy did right and used your excellent academic credentials to give credence to this incredibly underwhelming unqualified individual occupying our nation’s most important public health position. He got “something “right and all of the multitudes of people who don’t have your intelligence or education will wave your editorial in their neighbors faces and tell them how smart and on base this brilliant Doctor thinks Mr. Kennedy does his job. This is the problem with MAGA and MAHA. In their world one attaboy makes up for a thousand aw heck’s. In the real world as you know, the reverse is true. All the damage caused by this man is not made up by some inadvertent brilliant blunders that you so strongly advertise. Where have you heard that more money is going to go to cardiovascular research? I would argue for more money going to prenatal care and research into decreasing infant mortality. Adding a few more years on to your fathe or uncle or even me pales in comparison with giving a mother a healthy baby and that baby the best chance to reach average US lifespan.
Unfortunately what you forgot is that even a broken clock is correct two times every day. You found one time Mr. Kennedy was correct. I wish you would spend half as much wordsge on all his mistakes. I know you don’t have enough years to live to achieve that goal.
David M. Schalk MD
You seem oddly upset to have to admit RFK is right about cutting wasteful public research funding… 🧐
"wasteful"
What an arse.
Outstanding post! Almost nobody knows the figures you quoted and it's important that the public be more educated to avoid politicization of the practice of medicine. I agree the MAHA movement has a lot of help to shake up the status quo, and can be very good for us all to embrace. I also see a lot of damage from the CVD world in my ALF business.
I didn't realize the HIV funding was still so large, so a very informative post, thank you. Re-allocation is no more and no less than correcting course, keeping the vehicle between the lines. Taxpayers should not be blinded by the spin of media - nor should patients continue to suffer when we can help them in any way.
"I agree the MAHA movement has a lot of help to shake up the status quo, and can be very good for us all to embrace."
So you're a right winger with no education in science or medicine.
To you, I'm "whatever" you think I am.
So you're a left winger with an elite attitude maybe, from the opposite view... It's a shame it comes down to that divisiveness. We all have something to contribute and not for nothing, I've healed people from diabetes in their 80's and cut insulin use to 1/3, as well as had residents on many meds, anti-psychotics and all... We have made a huge difference in the healthspan of many people over the years.
Why is it that everywhere we turn, it's recommended to eat healthier, stay hydrated, exercise and many other things we specialize in... Yet to a random blog responder, I'm "A right winger with no education in science or medicine." Very sad indeed. I wish you a better day than seeing someone's opinion you disagree with, seems to have given you today.
Renal disease seems to have lacked appropriate funding while being a big part of Medicare expenditures.
Thank you for this! I have read very little about HIV in recent years and this was incredibly insightful. And for me, it underscores the constant necessity to dig a little deeper when I feel a knee-jerk opinion forming about something I hear in passing ;-)
I assume that all who comment here have read "Sensible Medicine," before this post, and understand the very significant waste in our research dollars on faulty or inconsequential studies funded by you and me! I'm all for re-evaluation of all programs!! I am hopeful that the food chain changes proposed will be more helpful than all the research on discreet disease types! In a "perfect world(impossible)" we will not need any research! As suggested on Sensible Medicine before, we need more research to determine processes and procedures that result in better health and health care. There is tremendous knowledge that goes unused by the vast majority of the population. The knowledge far surpases our use of that knowledge. Kind of a restatement of both Charlie and Suzie preceeding comments.
"and understand the very significant waste in our research dollars on faulty or inconsequential studies funded by you and me!"
Whine more, right winger.
Sensible Medicine is just a libertarian cult. It's not science based, it's just a bunch of anti-social right wingers that are OK with marijuana.
Great column. I think the insight that governmental priorities can deviate widely from public needs should be generalized. This type of mismatch appears almost everywhere in the health care sector that governments control. E.g., there seems to be a consensus that we have a shortage of GPs because GP are underpaid. Accepting the premise, this is another mismatch. Readers of SM likely have their own favorite examples.
I completely agree with the redistribution of funds. I do, however, believe that there is a lot of knowledge out there that’s not being used to educate the public on how to prevent CV disease. It’s largely preventable with good diet, exercise and stress mgmt. So, how about an educational approach to start.
I'm not sure it's a lack of education. Most people know being obese and sedentary puts them at risk, but knowledge isn't enough for many.
My post was written while sitting in very slow stop and go traffic. Forgive the typos
Ben Hourani MD, MBA
I appreciate Dr. Marine’s opinion.
What bothers me is the quick and dirty cutting of the HIV vaccine research. I have the opportunity to spend two years at the NIH in the 1970s what people don’t understand is that in a relationship with all the departments whether it’s cancer, infectious diseases behavior, etc.
Vaccine research in HIV has yielded tremendous understanding of both the evasive nature of viruses and bacteria as well as deception that HIV seems to have regarding immunity. Great discoveries, and cancer, regarding immunity, genetics, oncology, I resulted from the understanding of the mechanisms of HIV and its resilience. Many of the nucleotides treatments that have remarkably change a uniformly lethal disease into a chronic disease with also control of person to person infection have come about as a result of understanding the biology of HI resulted from the understanding of the mechanisms of HIV and it’s resilience. Many of the nucleotides treatments that have remarkably change a uniformly lethal disease into a chronic disease with also control of person to person infection have come about as a result of understanding the biology of HIV.
What concerns me is the broad swath for anything that’s smacks of vaccine, and RFK’s, (a non physician) urgency to delete. This also melds well with the anti-DEI association of HIV with “ not – normal sex“.
Yes, there is no vaccine yet. But the ancillary plethora of knowledge in immunology, malignancy, genetics, generalized viral biology have come out of the study of this virus and the “failure“ of this research to yield a vaccine. One area of research, can complement and augment seemingly unrelated areas of research.
BTW, cardiovascular death is still the leading cause of death in this country. Yet we have no cured it have we? Using the same logic in Dr. Marine’s well written post, should we elminate all funds for cardiovascular research at the NIH? I would argue that the advances in HIV treatment that have significantly been contributed to by the vaccine research are more impressive than the advances in treatment of CV DISEASE.
Ben Hourani MD, MBA
I didn't realize we were in a "post COVID" world.
Those of us in red states are.
The most recent publicly available estimate comes from early 2025. According to the CDC, between October 2024 and May 2025, there have been an estimated 30,000–50,000 COVID‑19 deaths in the U.S..
But heck, they don't matter. We are in a "post COVID" world now.
.
Who wants to tell him: there has historically ALWAYS been 45000 to 70000 Flu deaths in this country also! (except in 2020 when is miraculously disappeared 😉)
Who wants to telll the uncritical nonthinker that Infuenza is not COVID and that 50,000 deaths actaully matter? SARS Cov2 is a beta coronavirus and influenza is an orthomyxovirus. They are completely unrelated taxonomically and clinically. Infuenza does kill tens of thousands of Americans annually nearly all unneccessarily because like COVID mRNA vaccination, influenza immunization reduces mortality by 90 - 95%. What troubles me more isn't the factual mistatements, it is the deep lack of concern for human suffering, the cavalier disregard for life that such an attitude displays and the ignorance of infection control. Influenza's decline in 2020 and 2021 wasn't a miracle, it was the result of the adoption of standard infection control practices. Rhinovirus nasopharyngitis was also dramatically reduced. The discipline is called Infection Prevention. It used to be called Infection Control and sadly some physicians weren't taught about it.