BMJ: Trump Administration Worrying for Science, Health Policy

Alicia Ault

February 21, 2017

Donald Trump's presidency has "raised worrying questions about its likely impact on science and health policy," write several BMJ editors in an editorial published online today.

The administration seems to place little value on facts or analysis, and may not be considering the consequences of its pronouncements and policies on biomedical research and the health of Americans and citizens around the world, the authors said. The editorial was written by José Merino, BMJ US clinical research editor, Elizabeth Loder, BMJ head of research, Kamran Abbasi, BMJ executive editor, and Ashish Jha, who is KT Li professor of health policy at the Harvard TH Chan School of Public Policy.

"We are particularly concerned that Trump's administration is acting in ways that will suppress research and limit communication on scientific topics that it deems politically inconvenient," wrote the authors.

They said scientific communications at the Environmental Protection Agency were being vetted by political appointees before public presentation, and that communications with the public had been restricted for employees at various agencies, including the departments of Agriculture, Interior, and Health and Human Services. Federal websites are being scrubbed of scientific information, they continue, adding that a reversal of the Affordable Care Act could damage health, and that new immigration policies could harm recruitment and training of doctors and scientists and worsen physician shortages.

The BMJ editors are not alone in their concern, said Michael Halpern, deputy director of the Center for Science and Democracy at the Union of Concerned Scientists, a nonprofit advocacy organization in Washington, DC.

"You have a President who isn't afraid to attack individuals who he deems enemies, and it's not out of the realm of possibility that a scientist who published information he didn't like could become subject to his wrath," Halpern told Medscape Medical News.

He said reports of a "gag order" on communications at various federal agencies has led to anxiety and uncertainty — in part because the administration has created confusion by not specifically stating its communications policies in writing.

Officials at various federal agencies have told reporters there is no such "gag order." When contacted by Medscape Medical News, the National Institutes of Health, for instance, said, "[The US Department of Health and Human Services] and its agencies continue to communicate fully about its work through all of its regular communication channels with the public, the media and other relevant audiences. There is no directive to do otherwise."

But Halpern said federal scientists he's spoken with have heard otherwise, which is leading to self-censoring. "In an uncertain time, people tend to keep their heads down so they don't get chopped off," he said.

Even so, "scientists are justifiably concerned," which is motivating some to speak out, he continued. "That's why you're seeing editorials like this," said Halpern, referring to the BMJ piece.

Other scientific organizations have also been registering alarm about the Trump administration. In November 2016, more than 2000 scientists signed a letter to Trump and Congress, asking them to "adhere to high standards of scientific integrity and independence in responding to current and emerging public health and environmental threats."

In early February, 180 medical and scientific organizations called on the administration to rescind the Executive Order that would bar immigrants from predominately Muslim nations from the US, saying that it "will reduce US science and engineering output to the detriment of America and Americans."

A Call to Action

The BMJ editors said the editorial's aim was to "reaffirm our commitment to fostering and applying the best evidence for policy and practice, to be an open forum for rigorous debate that challenges the status quo and holds us all to account, to speak truth to power and support others who do the same, and to actively campaign for a better world, based on our values of transparency, independence, and scientific and journalistic integrity."

Other organizations have also urged scientists to stand up and speak out. "Taking action is the best course when science is threatened or when science can illuminate public issues," wrote Rush Holt, PhD, Chief Executive Officer of the American Association for the Advancement of Science (AAAS), in an editorial in Science in early February.

Scientists should not remain silent, Dr Holt said. They should avoid politicizing science, but, also shouldn't be lulled into thinking that the facts will speak for themselves. "One need not avoid — indeed, should not avoid — applying relevant science in political or societal situations where it can help address problems," he wrote.

He said the immigration order had caused multiple registrants — including the head of The World Academy of Sciences, from Sudan — to bow out of the annual AAAS meeting held in Boston February 16-20. "The denial of entry is a detriment for the individuals, and it is also an affront to science," wrote Dr Holt. "To me, the very real damage to science outweighs the very thin claim of enhanced national security."

In a separate editorial in Science, AAAS President Barbara Schaal, PhD, called on the administration to include credible scientists as advisers, "not individuals who reject proven science on issues of critical public importance such as vaccines or climate change."

Dr Schaal, dean of the Faculty of Arts and Sciences at Washington University, St Louis, wrote, "Science cannot thrive when policy-makers — regardless of political party affiliation — use disagreements as an opportunity to attack scientific conclusions that counter a political agenda."

It's been decades since scientists could credibly say they should stay above the political fray, Halpern said. "Because science is so important to policy making it's become a political football on contentious issues," he told Medscape Medical News.

"People are going to be talking about the science whether scientists are there to participate or not, so they better be there at the table," he said.

The authors and Halpern disclosed no relevant financial relationships.

BMJ. Published online February 21, 2017. Abstract

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