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JAMA Forum Archive, 2012-2019: Health policy commentary from leaders in the field
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Science and the Trump Administration

In its first 6 months, the Trump administration has sent a few different signals to the scientific community. On one hand, President Trump has proposed major budget cuts to scientific funding agencies, including the National Institutes of Health. On the other, the administration has announced some promising initiatives, such as the US Food and Drug Administration’s (FDA’s) effort to reduce nicotine in cigarettes to nonaddictive levels.

March for Science, Washington, DC

(Image: Wikimedia, Becker1999)

Attention-grabbing headlines do not always reflect major changes. Indeed, Congress has so far resisted making significant cuts to most scientific funding, and many hurdles remain before promising proposals such as the FDA’s can reach fruition.

Below such highlights, however, is an emerging pattern: In cases in which scientific evidence or insight might threaten the achievement of major ideological or political objectives, the Trump administration is starting to disrupt usual scientific processes—without acknowledging doing so. For example:

  • President Trump has sought to revitalize the coal industry. In August, the US Department of the Interior halted a study by the National Academies of Sciences, Engineering, and Medicine of the health effects of mountaintop-removal coal mining that had been requested by West Virginia officials. The Department justified the action by referring to a budgetary review, even though the study was halfway complete and amounts to a tiny share of the agency’s budget.

  • The administration has pulled out of international efforts to address climate change. In recent weeks, websites at the National Institutes of Health have been altered to drop the phrase “climate change” and remove access to a document titled “Climate change and human health.” The Environmental Protection Agency (EPA) took down a website on climate science that, according to the Washington Post, had been available for nearly 2 decades. Meanwhile, the EPA administrator has asserted the fringe view that that carbon dioxide is not a primary contributor to global warming, and political appointees at the EPA have pressured scientists to change testimony about the dismissal of scientific advisers and broken precedent to intercede in the scientific grant review process.

  • Vice President Pence has championed the cause of abstinence-only sex education. In July, the administration cut short a major national grant program to address teen pregnancy that supported comprehensive approaches, while providing a misleading description of the effectiveness of the program.

These actions, and others like them, represent more than disagreeing with scientific advice. The administration is beginning to interfere with the development and expression of the evidence itself.

If President Trump were to say, “I support the coal industry, regardless of the health consequences of mountaintop-removal coal mining,” or, “I object to the Paris climate accord on economic grounds, regardless of the evidence of harm from climate change,” or “I think it is immoral to invest in teen pregnancy prevention programs that work,” then at least the trade-offs would be clear to the public. Instead, the administration is obscuring the health impacts of its agenda.

It is no coincidence that threats to science are emerging at a time when the administration has appointed so few scientists to top positions at the White House or in federal agencies. In fact, in some cases, individuals with few credentials and discredited beliefs have been nominated for scientific positions. For example, the administration’s nominee for chief scientist at the US Department of Agriculture has no significant scientific credentials and has expressed views on climate change and sexuality and that are at odds with scientific consensus.

Under these circumstances, it is no surprise that scientists can be spotted marching in the streets and even running for elected office. This is the “fight fire with fire” approach to using political power to shore up the integrity of science.  One potential risk, however, is that if consensus scientific positions turn into partisan rallying cries, the ability for scientific understanding to rise above the polarization of our political life may be compromised.

A complementary approach is for the scientific community to recommit itself to the creation and distribution of the highest quality scientific evidence and analysis. It is promising that as the administration has disbanded scientific advisory panels, some have announced plans to continue to meet anyway and publish their reports.

It may also be necessary for professional scientific organizations focused on one set of issues to monitor and object to threats to scientific integrity in other fields. The threat to scientific processes is cross-cutting; if one National Academies report can be disrupted, why not another?  If one grant can be disrupted midcycle, why not another?

It is still early in the administration’s term. The White House could yet bring in a strong science adviser and pull back from undermining scientific activities. But it is also possible that the actions on coal mining, climate science, and teen pregnancy are just the beginning. If so, long-standing efforts to improve reproductive health care, ensure access to vaccines, and reduce racial and ethnic health disparities may be especially vulnerable.

The scientific community should be on high alert for specious justifications for inappropriate actions. In a 2016 graduation address at the California Institute of Technology, surgeon and writer Atul Gawande, MD, spoke about the risk posed by growing mistrust of the scientific process and the emergence of pseudoscience as a cultural force. He stated:

Science’s defenders have identified five hallmark moves of pseudoscientists. They argue that the scientific consensus emerges from a conspiracy to suppress dissenting views. They produce fake experts, who have views contrary to established knowledge but do not actually have a credible scientific track record. They cherry-pick the data and papers that challenge the dominant view as a means of discrediting an entire field. They deploy false analogies and other logical fallacies. And they set impossible expectations of research: when scientists produce one level of certainty, the pseudoscientists insist they achieve another.

It’s not that some of these approaches never provide valid arguments. Sometimes an analogy is useful, or higher levels of certainty are required. But when you see several or all of these tactics deployed, you know that you’re not dealing with a scientific claim anymore. Pseudoscience is the form of science without the substance.

Today’s danger is related to this warning. The administration is at risk of adopting the form of scientific leadership without the substance.

About the author: Joshua M. Sharfstein, MD, is Associate Dean for Public Health Practice and Training at the Johns Hopkins Bloomberg School of Public Health. He previously served as Secretary of the Maryland Department of Health and Mental Hygiene, as the Principal Deputy Commissioner of the US Food and Drug Administration, and as Commissioner of Health for Baltimore. He is a consultant for Audacious Inquiry, a company that has provided technology services and other support to Maryland’s Health Information Exchange. A pediatrician, he lives with his family in Baltimore.
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