What Will the March for Science Mean for Medicine?

Miriam E. Tucker

April 21, 2017

The upcoming March for Science on Saturday represents issues of critical importance to biomedical science, public health, and clinical medicine, and as such will serve as a call-out to members of the medical community to become science advocates, say physicians who are involved in the April 22 event.

Physicians serve on the organizing committee and will be among the key participants in the March for Science, which will take place in Washington, DC, and in more than 500 satellite locations worldwide.

According to the March for Science website, the event will be a "celebration of science" that "champions robustly funded and publicly communicated science as a pillar of human freedom and prosperity. We unite as a diverse, nonpartisan group to call for science that upholds the common good and for political leaders and policy makers to enact evidence-based policies in the public interest."

At least 25 organizations representing clinical medicine have announced their support of the march, including the American College of Physicians (ACP), the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American Society for Hematology, and the American Association for Cancer Research. In addition, the Endocrine Society and the Society for Neuroscience are among the march's partnering organizations.

"We wouldn't have good evidence-based medicine without science. If science progress were to stall tomorrow, medical progress would stall with it," march co-organizer Joanna Spencer-Segal, MD, PhD, an endocrinologist and neuroscientist at the University of Michigan, Ann Arbor, who has worked on advocacy efforts for both the Endocrine Society and the Society for Neuroscience, told Medscape Medical News.

She pointed out that the broad heading of "science" encompasses a wide range of areas within medicine, including clinical trials, basic science in drug development, social science, and health services research. "This is all science, and we're marching for all of it."

Christine Laine, MD, editor-in-chief of the ACP's journal Annals of Internal Medicine, will be participating in the Philadelphia satellite march. What she'd like to see the march accomplish is "hopefully motivating physicians to be advocates for evidence-based medicine and to advocate for research funding and for not politicizing decisions about health."

In an Annals editorial published online April 18 entitled "Alternative Facts Have no Place in Science," Dr Laine, along with Executive Deputy Editor Darren B. Taichman, MD, PhD, write, "The initial impetus for the March for Science seems to have been the Trump administration's characterization of climate change as a hoax. However, current sociopolitics threaten not only climate science but many other scientific disciplines. The politicization of science, in which parties select the knowledge they are willing to pursue and the data they are willing to promote or denigrate, is a peril we must face head-on."

Medical science faces "particularly dire threats," the editors say, including the adverse health effects of climate change, antivaccine attitudes, and suppression of research into the impact on public health of gun ownership and gun control laws.

Also of great concern to medicine, President Trump's proposed budget, released in mid-March, would cut National Institutes of Health funding by 18.3%, or $5.8 billion. "This draconian cut would come at a time when biomedical investigators already face substantial challenges to securing public funding for the important laboratory and clinical research that they do to improve health," Dr Laine and Dr Taichman write.

Dr Spencer-Segal noted that the funding issue is the "first piece of the puzzle," with the second being advocacy for incorporating already-existing science into policy making, such as the studies showing health outcomes in states that did or did not expand Medicaid under the Affordable Care Act. "A lot of research has already been done that shouldn't be thrown out the window," she said.

"Flint Is What Happens When Science Is Dismissed"

Mona Hanna-Attisha, MD, director of the Hurley Pediatrics Program and assistant professor of pediatrics at Michigan State University, is one of three honorary march co-chairs and will speak at the DC event.

In 2015, "Dr Mona" exposed the water crisis in Flint, Michigan, after detecting that the number of children with elevated levels of lead in their blood had doubled following a switch of the city's water source from the Detroit River to the Flint River in April 2014.

Rather than waiting for peer review and publication, she presented the information at a press conference in September 2015. Michigan officials initially discounted her findings, but finally relented and declared a state of emergency. Since January 2016, Dr Hanna-Attisha has headed a multidisciplinary task force charged with mitigating the harm done to Flint's children from lead exposure.

"Flint is what happens when science is dismissed, when experts are dismissed, and, most importantly, when people are dismissed," she told Medscape Medical News.

She hopes that the march will inspire more physicians, and particularly pediatricians as voices for children, to become public health advocates. "It was science that uncovered this crisis.... I took a very public risk and spoke out. My message is to urge other scientists and physicians to take those risks and to use science to get into the often uncomfortable world of advocacy for the benefit of their communities. If we don't do that as a community, we risk seeing many more Flints to come."

After Dr Hanna-Attisha speaks, she'll introduce 8-year-old "Little Miss Flint" Mari Copeny, whose 2016 letter to President Obama about the water problem garnered both a response and a visit by the president. "She is an absolute role model, so smart, so brave, and so resilient…. She's a messenger of hope. She's only 8 and already declared she's running for president in 2024!"

"We Have to Stand Up and Explain Why [Science] Is Important"

Another prominent physician, Paul A. Offit, MD, chief of infectious diseases at the Children's Hospital of Philadelphia and professor of pediatrics at the University of Pennsylvania Medical School, will speak at the Philadelphia event. Dr Offit is widely known for his vaccine expertise and advocacy, for which he has earned wide praise in the medical community, and at the same time derision and even occasional death threats from individuals who oppose vaccines.

At the march, he'll address the larger issue of science denialism. "Science is losing its place as a platform for truth.... I hope the march will galvanize everyone who sees the value of science," he told Medscape Medical News.

Dr Offit is particularly troubled by President Trump's selection of climate change skeptics Scott Pruitt and Rick Perry as head of the Environmental Protection Agency and as Secretary of Energy, respectively, as well as Education Secretary Betsy DeVos and Vice President Mike Pence, both of whom have made comments suggesting that they question evolution.

But, Dr Offit also pointed out that science denialism isn't limited to political conservatives, since many of the antivaccine activists and those who embrace "natural" remedies over evidence-based treatments are aligned with the political left. "Certainly science denialism isn't all right wing.... I would argue the liberals have their own war on science."

Educating the public about the importance of science to daily life is an urgent priority, he said. "The public casts their votes based on what they know. We live in a world where science and technology are critical, yet most people don't know anything about science and technology.... We have to stand up and explain why this is important to everyone."

"An Event That's Based on Principles and Not a Political Ideology"

Some scientists have publicly expressed their opposition to participation in the march out of concern that, despite the organizers' intent to keep it nonpartisan, the event is inescapably political. Similarly, some organizations, such as the Society of General Internal Medicine (SGIM), have elected to stay neutral.

Dr Spencer-Segal said, "Some organizations and their leadership are nervous about potential political implications of official endorsement, which we totally understand, even though really the March for Science is a nonpartisan endeavor. It can't be apolitical. Of course it's political, but it really is nonpartisan."

In the case of SGIM, because the group's annual meeting is taking place in Washington, DC, this week and is ending on Saturday morning, a group of attendees are planning to head over to the march that afternoon.

The organizer of that effort, Tyler Winkelman, MD, a health policy researcher at the University of Michigan and a Robert Wood Johnson Clinical Scholar, told Medscape Medical News that although SGIM "has been very clear it's a nonpartisan organization," at the same time "[it] has been supportive of members who wish to voice their concerns or want to publicly advocate to improve their patients' health and well-being."

Dr Winkelman noted, "If you read the march website, I would say it's an event that's based on principles and not a political ideology. I really think people will come to the march to support the principles and values they believe in as scientists and not as politicians."

But, he also said, "We will not improve health to the degree that we all want if we stay isolated in our clinics and our hospitals.... I think that in order for physicians to maximize the health and well-being of our communities, we have to engage publicly."

Medscape Medical News made repeated attempts to elicit comment from the US Department of Health and Human Services, but they had not responded by publication time.

None of the physicians quoted in this story have disclosed any relevant financial relationships.

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