Editorials

Standing up for science in the era of Trump

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j775 (Published 21 February 2017) Cite this as: BMJ 2017;356:j775
  1. Jose G Merino, US clinical research editor13,
  2. Ashish Jha, KT Li professor of health policy, 2,
  3. Elizabeth Loder3,
  4. head of research,
  5. Kamran Abbasi, executive editor3
  1. 1Department of Neurology, University of Maryland, School of Medicine, Baltimore, MD
  2. 2Harvard T H Chan School of Public Policy, USA
  3. 3The BMJ
  1. Correspondence to: J Merino jmerino{at}bmj.com

Be fair but challenging, critical but constructive

Any president of the United States is entitled to implement policies that reflect personal ideology and political beliefs. The public may disagree on the merits and drawbacks of these policies, but as long as the supporting arguments are based on facts and comply with constitutional principles then so be it. In its first weeks, however, Donald Trump’s presidency has raised worrying questions about its likely impact on science and health policy.1 2 Many of the new administration's pronouncements seem to place little value on facts or analysis. They also seem lacking in careful consideration of the consequences for biomedical research, healthcare, and ultimately the health of people in the US and the rest of the world.3

Concerns

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. All scientific communications from the Environmental Protection Agency may need to be approved by political appointees before being presented or published.2 Scientists from the Department of Agriculture, the Department of the Interior, and the Department of Health and Human Services (which includes the National Institutes of Health) are restricted in their communications with the public.3 Scientific information on government websites is being removed and becoming inaccessible.3 Some agencies are responding through self censorship, cancelling key scientific meetings out of fear of retribution from political appointees.4 Members of the president’s cabinet, including those responsible for energy and the environment, deny the evidence on climate change without attempting to counter the overwhelming scientific consensus with better or even different information.5 6 Proposals to reform the Food and Drug Administration will scale back the agency’s ability to ensure the safety and efficacy of approved drugs, harming not only people in America but those in other countries that often follow the FDA’s lead.7

Trump’s policies in other areas also have the potential to damage health. Instant repeal of the Affordable Care Act, without a viable alternative, will surely prove damaging.8 His immigration policy will disrupt the flow of scientific ideas and knowledge, hinder recruitment of scientists to American institutions, limit training opportunities for international physicians, and worsen national shortages of healthcare workers.9 A federal hiring freeze will restrict the ability of government agencies to fulfil their research and clinical missions.10 Cutting funding to international health organisations and global health projects will harm women and worsen the health of vulnerable populations.11 Investments in global health are some of the best investments the US can make—not only do they help people in poor countries live healthier lives, but they help to make societies more prosperous and less susceptible to political instability.12 These policy choices are at odds with a core principle that health policy decisions should be based on transparent and reproducible science.

More than just “alternative facts”

Of course, Trump isn’t the first politician to flout scientific principles or favour “alternative facts.” Whenever someone of prominence snubs or distorts science, it is up to the scientific community to hold them to account.13 But this situation seems different and more worrisome. The United States is a powerful nation with a profound influence on the health of the world’s population. It is one of the largest funders of global health, and offers unparallelled research capacity, innovative technology and products, and a skilled healthcare workforce. That power and influence, if misdirected, will damage efforts to create a healthier, stronger world, one that supports women’s health, condemns torture and other human rights abuses, treats refugees and migrants with dignity and hospitality, and ensures that all people, especially the most vulnerable, have access to high quality healthcare.

How should science and medicine respond to these challenges? The BMJ’s solution is 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.

The Trump administration’s early policies risk head-on collision with the scientific and health communities. The BMJ’s ongoing campaigns for open science and open data, the health effects of climate change, and corruption and conflict of interest in healthcare are some examples of where conflict may occur. At this early stage it seems unlikely that the administration will change its course and promote open discourse, based on respect for scientific evidence and data. But whichever way Trump turns, the scientific and healthcare communities must commit to serving the best interests of patients and the public. Arguments, whichever side of the debate they fall on, should be based on data, evidence, and, ultimately, the scientific method. Clinicians, researchers, and policy makers in the US and elsewhere need independent evidence and open debate. That is our promise to The BMJ’s community. By arming ourselves with the fruits of science, being guided by facts and evidence, we can create a healthier planet, not just for Americans but for all who share this planet.

Footnotes

  • Competing interests: The authors have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

References

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