Centuries of restraint fall: Top journals assail Trump’s science denialism

medjournals-300x196They are a unique combination — august publications in science and medicine that  harken back for centuries yet now inform 21st century practitioners about the latest advances in their fields. And now these leading scientific journals say the present moment  forces them to abandon their prized political neutrality to oppose the science denialism of the incumbent leader of the free world.

This is an unprecedented and uncomfortable development for the New England Journal of Medicine, Nature, Scientific American, and Lancet Oncology (a journal for cancer specialists). They have never taken a political stand of this kind in their histories, dating to 1812 for NEJM, 1845 for Scientific American, and 1869 for Nature.

Their editors say they would much prefer to stay out of presidential endorsements  and to keep their focus on publishing important, rigorous research and peer-reviewed information about advancements in the fields of science and medicine.

But as NEJM declared, without naming President Trump:

“Covid-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.”

Scientific American was blunter, arguing:

“The evidence and the science show that Donald Trump has badly damaged the U.S. and its people—because he rejects evidence and science. The most devastating example is his dishonest and inept response to the Covid-19 pandemic, which cost more than 190,000 Americans their lives by the middle of September. He has also attacked environmental protections, medical care, and the researchers and public science agencies that help this country prepare for its greatest challenges …”

Nature emphasizes its deep disappointment in what it sees as not only the incumbent’s assault on health and medicine but also the environment:

“No U.S. president in recent history has so relentlessly attacked and undermined so many valuable institutions, from science agencies to the media, the courts, the Department of Justice — and even the electoral system. Trump claims to put ‘America First’. But in his response to the pandemic, Trump has put himself first, not America. His administration has picked fights with the country’s long-standing friends and allies, and walked away from crucial international scientific and environmental agreements and organizations: notably, the 2015 Paris climate accord; the Iran nuclear deal; the United Nations’ science and education agency UNESCO; and even, unthinkable in the middle of a pandemic, the World Health Organization (WHO). Challenges such as ending the Covid-19 pandemic, tackling global warming, and halting the proliferation and threat of nuclear weapons are global, and urgent. They will not be overcome without the collective efforts of the nation states and international institutions that the Trump administration has sought to undermine.”

A constrained but clear take

Science magazine, founded in 1880, has not joined prestige publications in the field in putting out an official condemnation of Trump and his men. The editors of Science note that theirs is a flagship of the nonpartisan, nonprofit, 120,000-member American Association for the Advancement of Science and has constraints that other publications might not.

Still, the publication has offered this editor’s view on the revelations by Washington Post journalist Bob Woodward that Trump knew early on about the likely deadliness of the coronavirus but declined to share that crucial scientific information with the public:

“As he was playing down the virus to the public, Trump was not confused or inadequately briefed: He flat-out lied, repeatedly, about science to the American people. These lies demoralized the scientific community and cost countless lives in the United States. Over the years, this page has commented on the scientific foibles of U.S. presidents. Inadequate action on climate change and environmental degradation during both Republican and Democratic administrations have been criticized frequently. Editorials have bemoaned endorsements by presidents on teaching intelligent design, creationism, and other anti-science in public schools. These matters are still important. But now, a U.S. president has deliberately lied about science in a way that was imminently dangerous to human health and directly led to widespread deaths of Americans. This may be the most shameful moment in the history of U.S. science policy.”

In its latest edition, the magazine reported in more “straight news” fashion (as a magazine might try) about the complexities of evaluating the administration’s record on science, notably because Congress has funded programs and initiatives that the White House opposed.

As for Lancet Oncology — the decades-old, British, cancer specialists’ journal — its editors asked a tough question in its recent headline on its endorsement editorial, posting: “Will cancer care be a winner in the U.S. election?” The piece also said this of the president:

“During his tenure, Trump has repeatedly politicized, undermined, and slashed funding to U.S. federal scientific and health agencies, including the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, the National Cancer Institute (NCI), and the Environmental Protection Agency. Some of Trump’s appointments of new directors of these agencies have attracted controversy for appearing to be politically driven, rather than based on expertise or suitability for the role. In his 2021 fiscal year budget proposal, Trump aimed to cut the NCI budget by $559 million, reduce NIH spending by 7%, and axe $44 million of funding to the CDC’s cancer prevention programs. Fortunately, Congress rejected these enormous cuts, but the proposals are indicative of the Trump administration’s attitude to cancer research funding.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal, not only due to the pandemic, but because of the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.

Guidance for the uncertain, even if they are experts

If patients confront perplexities about fast-moving changes in science and medicine, doctors and scientists also have been hit with an avalanche of reading to stay current — and this is one reason why pillars of peer publishing in these fields play a key role even in the time of the internet. Experts rely on their journals’ sagacity to steer them about important developments with direct effects on patient care.

I’ve written before that patient-consumers need to be thorough in their own research, skeptical about information presented to them (including studies in respected, peer-reviewed medical and scientific journals), and rigorous in their thinking about issues affecting their lives, notably health care. Other publications, especially daily newspapers, interview political candidates and review their records, then offer endorsements up and down the voting ticket. The best of these kinds of works can provoke thought, dig into information that might not be accessible to most of us, and make a clear and compelling case. (The New York Times, to no surprise, has published not only its endorsement of Democrat Joe Biden but also a detailed and devastating critique opposing Trump, including for his “relentless and cynical campaign against the institutions most responsible for turning science into sound policy.”)

The works are not gospel truth. That said, when any notable institution makes a course change and does something it has never  after centuries of accomplishment, well, it is worth a long hard look. It also should merit more than a moment’s consideration when 81 American Nobel Laureates in physics, chemistry, and medicine endorse a presidential candidate while his opponent does not muster any similar kind of enthusiasm. Sure, some folks defy meteorology to frolic on the beach as hurricanes approach. Some folks build houses in zones where blazes are bound to occur, no matter what firefighters tell them. Some people belt down too much booze while smoking packs of cigarettes each day — to heck with what the doctors warn.

Holden Thorp, Science’s editor, wrote a good summary of the thinking by those who put out works considered important in crucial fields and their advocacy for them, especially in difficult times. His article’s headline (“Not throwing away our shot”) may summon up not only opposition to a hurried approval of the prospective coronavirus but also the hit musical “Hamilton” and the duties of those concerned about country, concluding:

 “Readers who don’t think Science and its publishing peers should write about politics often tell us to ‘stick to science.’ We are sticking to science, but more importantly, we’re sticking up for science.”

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