Medicine and public health have been taking it on their evidence-based chins lately. A new legion of social media “experts”, indifferent to established facts, supply a rapt mass audience all manner of crackpot opinions about Covid, cancer, autism, vaccines, vitamins, immune-boosters, anti-ageing remedies, chelation and detoxification. Celebrity public health menaces like Gwyneth Paltrow peddle nostrums and elixirs of no value while being fawned over by the press. Even worse is the growing tendency of lawmakers to mangle and censor science in public health messages and policies.
Examples of that tendency abound. Florida, a noted leader in permitting non-scientists to tell eminent doctors and prizewinning researchers what to do, keeps enacting versions of the Firearm Owners’ Privacy Act, which restricts physicians’ ability to deliver gun-safety messages to patients and children. States including Pennsylvania, Ohio, Colorado and Texas, meanwhile, have passed legislation restricting the disclosure of health information about exposure to chemicals used in fracking. Pennsylvania physicians, for instance, have to submit a written request for the information and sign a non-disclosure agreement drafted by the drilling companies.
Idaho, meanwhile, is on an anti-science rampage reminiscent of 20th-century totalitarian regimes in Germany, China and the Soviet Union. Just this year, two Republican lawmakers introduced a bill that would criminalise the administering of mRNA vaccines to any person or mammal in the state. This will undoubtedly surprise and horrify cancer patients as mRNA-platformed vaccines for melanoma and other cancers begin to appear.
Reproductive health is a particularly egregious free-fire zone for legislators. Some states require doctors to instruct patients falsely that having an abortion increases their risk of breast cancer. Legislators in Arizona and Arkansas insist physicians tell women that drug-induced abortions are “reversible” (they are not). Many states have now passed total or near-total bans on abortion regardless of what doctors think their patients’ health may require, based on erroneous views about when pregnancy, fetal heartbeats or awareness of pain begin.
Back in Idaho, new legislation recognises “ectopic and molar pregnancies” as conditions that can legally be treated by abortion, but exceptions for thousands of other pregnancy complications remain non-existent. Doctors perhaps ought to consult the farmer/rancher speaker of the Idaho House of Representatives for further medical insights.
Judges, too, seem to think they know better than the FDA about which drug to approve, telling women when and how they can obtain and use the abortion pill Mifepristone.
And it is known, if little remarked upon, that the Trump administration censored American public health authorities’ ability to provide information about Covid by subjecting announcements and statements to review by non-scientist politicians and commissars. While many in the US scientific community and elsewhere bemoan Chinese censorship over the origins of Covid, too few have bashed the US government’s efforts to quash the truth in the pandemic’s early days. Trump advised people to drink bleach and wait for warm weather. His public health experts were not permitted to say anything. A few grimaced off-camera. Some went so far as to twirl a scarf.
This is not good enough. Medical and scientific bodies are far too often silent even as political representatives – in Orbán’s Hungary, Bolsonaro’s Brazil or Modi’s India as much as Trump’s America – intrude in scientists’ labs and doctors’ offices to produce what they believe to be an ideologically satisfactory conclusion. Besides a Fauci or two, where are the outraged voices of the scientific and medical communities, organisations, honour societies and foundations? Why aren’t deans, chairs, provosts and Nobel prizewinners shouting their opposition from the rooftops?
Recently, a British doctor and academic went viral when he hit back hard at a right-wing media network’s outlandish claims about Covid vaccines, excoriating the Fox-style network, GB News, for “spewing out” misinformation. “I sometimes wonder why you exist,” the doctor calmly told the startled presenter. We need more of this. Biomedical practitioners must recognise their obligation to fight their corner: to speak in the public sphere, to engage local audiences, to reach out to young people.
Scientists and doctors must vigorously cultivate a wide audience if their findings are to be heard and if public funding is to continue. This means teaching them about communication and giving them time and professional credit for doing it, such as writing for outlets beyond disciplinary journals.
It is also time for professional groups and funders to ally with legal and regulatory experts to ensure freedom of speech, harsh penalties for censorship, strict protections for whistleblowers and backing for appropriate institutions and expert bodies that are attempting to convey sound science but are being silenced.
The old days of a values-free science speaking truth to power are over. It no longer suffices to invoke expertise as a reason to be heard. It is no longer tenable to sneer at “popularisation”. Power has decided it does not always want to hear what science and medicine believe. That means it is imperative to form a new moral, legal and professional infrastructure to ensure that the public’s health and well-being is guided by more than ideology, vested political interests and anti-science dogma.
Arthur L. Caplan is Drs William F. and Virginia Connolly Mitty professor of bioethics at New York University.
