Stick to the Science

A year ago I wrote about disturbing news from the Pew Research Center that trust in science, and in scientists, had fallen since the pandemic. I am slightly relieved to report that a new follow-up study by Pew indicates that trust is up slightly – but still way below where they were pre-pandemic.

Trump won, but, with RFK Jr and his ilk, will science lose? Adriana Zehbrauskas for The New York Times

Overall, 76% of Americans express fair or a great deal of confidence in scientists to act in the public’s best interests (versus 87% in April 2020). The public is about evenly split about how active a role scientists should take in policy debates – 51% think they should, 48% think they should stick to science. A year ago those numbers were flipped.

I think about all this in the context of the proposed members of President-elect Trump’s health team, whose takes on “science” are often considered out of the mainstream.

Trump surprised many a few months ago when he brought Robert F. Kennedy Jr. into his fold. Over the years, RFK Jr., an environmental lawyer by background, has expressed numerous startling views about health and our healthcare system. According to Jennifer Nuzzo, the director of the Pandemic Center at Brown University, RFK Jr. “is just in a category by himself. R.F.K. Jr. just willfully disregards existing evidence, relies on talking points that have been consistently debunked.”

Nonetheless, Trump vowed: “I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on the medicines.” He has now named him as his candidate for Secretary of Health and Human Services.

The team behind RFK Jr. have their own unconventional views. A quick rundown:

Dr. Dave Weldon for CDC Director: He has a long history of vaccine skepticism, and while in Congress authored the Weldon Amendment, which provided protections for anti-abortion healthcare workers and organizations. Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, told The New York Times: “The notion that this man who held a series of false beliefs about science and medicine could rise to the position where he would head the C.D.C. is in some sense frightening.”

Dr. Marty Makary for FDA Commissioner: During the pandemic, he expressed a great deal of sympathy for letting herd immunity work, and opposed vaccine mandates/masking requirements. He has charged: "the greatest perpetrator of misinformation has been the United States government with the food pyramid," and – very similar to RFK Jr’s views -- has said: “We have poisoned our food supply."

Dr. Mehmet Oz for CMS: On his long-running TV show, Dr. Oz was known for advocating a variety of dubious health claims, and was especially known for marketing supplements, about which he once admitted “don’t have the scientific muster to present as fact.”

Dr. Jay Bhattacharya for NIH Director: He was the coauthor of the controversial “Great Barrington Declaration,” which decried what the authors thought was government overreaction to COVID and called for more “focused protection.” He particularly was critical of Dr. Fauci.

Dr. Janette Nesheiwat for Surgeon General: In theory, she supports vaccines, but she has also touted the “transformative power of prayer,” and has hawked her own line of dietary supplements.

Benjamin Mazer, writing in The Atlantic, says: “But what unites them all—and what legitimizes them in the eyes of this next administration—is a lasting rage over COVID.” He further explains:

The world, as Kennedy, Makary, Bhattacharya, and their compatriots variously understand it, is dreadful: SARS-CoV-2 was likely created in a lab in Wuhan, China; U.S. officials tried to cover up that fact; and the government responded to the virus by ignoring scientific evidence, violating citizens’ civil rights, and suppressing dissent.

As a result, many experts are wary. “When we get into another firefight with a microbe, we need all hands on deck, and we need the best science and the best public health practice to come forward,” Michael T. Osterholm, a University of Minnesota infectious-disease expert, told The Washington Post. “I’m not confident at this point that this administration can do that.”

“It seems that these picks are more focused on talking points of the past (and some unsubstantiated) than preparing for the future,” Katelyn Jetelina, a California epidemiologist tracking bird flu and other outbreaks, also told WaPo.

Some more mainstream experts see the picks as part of the libertarian “medical freedom” movement. “We’ve gone back to the idea of ‘every man his own doctor,” Howard Markel, an emeritus professor of pediatrics and history at the University of Michigan, told KFF Health News. He called it a bad idea then, and a bad idea now.

“Science is losing its place as a source of truth,” Dr. Paul Offit told WSJ. “It’s becoming just another voice in the room.”

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The sad thing is that we do need major changes. CDC made many blunders during the pandemic. Over the past forty years, we have allowed the food industry to create an obesity crisis. The FDA is riddled with conflicts of interests, and its regulation has often been ineffective. Our payment structures for Medicare and Medicaid are at best antiquated and at worse incentivize expensive and often ineffective care. I could go on.

“We are playing with fire with the shake-ups and choices, but at this point change is needed,” Dr. Michael Mina, an epidemiologist and former Harvard professor, told NYT. “At least there’s a better chance of positive change compared to complacency and more of the same.”  Even the liberal Editorial Board of WaPo agrees the FDA needs an overhaul.

Neal Barsky, writing in The Guardian, argues to give RFK Jr. a chance:

He recognizes the inordinate control the pharmaceutical and food industries over healthcare policy, and the revolving door that exists among congressional staffers, pharmaceutical lobbyists and corporate executives…He advocates banning pharmaceutical advertising on television, and wants to clamp down on the corporate ties to federal agencies such as the Food and Drug Administration and National Institute of Health.

Mr. Barsky’s key advice: “Lose the conspiracies and stick to the science.”

The Pew report found people generally don’t think scientists make better policy decisions than others, and are split about equally as to if scientists base decisions on facts or are as biased as the rest of us. These appointees are going to test our views on science versus science that is really just someone’s opinion.  

I’m hoping all Trump’s appointees take Mr. Barsky’s advice and stick to actual science. And I’m hoping that in its zeal to get rid of the “deep state” we don’t lose the expertise that we still very much need.