Science Isn’t Waste Or Fraud

The daily damage being done by the Trump administration has given rise to a grim debate: how much of the wreckage can be remedied, or at least ameliorated, and how much is irremediable? How many of the attacks on purportedly “wasteful” and/or “fraudulent” expenditures are really based upon the appalling ignorance of those leveling the attacks–their profound lack of understanding of how things work?

Example: The sudden and draconian cuts to scientific and medical research don’t just threaten to cripple US global research prominence. They’ve thrown a wrench into promising research into cures for diseases like Alzheimers, Parkinson’s and Cancer. 

Last week, the news media reported on two breakthroughs: the use of advances in gene editing to cure a baby born with a rare genetic disorder; and a new blood test to detect Alzheimers. The exciting aspect of the technique used to cure the 9½-month-old baby is its potential to help people suffering with thousands of other uncommon genetic diseases. The blood test makes it possible to detect Alzheimer’s disease much earlier. As one doctor pointed out, the test will allow primary care physicians to order a blood test and, if that test is positive, immediately refer a patient to a neurologist. He predicted that the test will “dramatically change clinical care.”

These advances and others like them didn’t emerge from a few weeks experiments in a laboratory. They built on years of scientific research, much of which had no immediate relevance to the reported advancements.

Most Americans don’t recognize the importance of basic research–it simply isn’t salient to citizens the way cuts in Medicaid or attacks on Social Security are. And very few Americans understand the long-term and disastrous effects of abrupt terminations of multi-year grants.

As Josh Marshall has argued at Talking Points Memo,

Basic and applied research generates huge dividends for a society. But its immediate and salient relevance to the average voter varies greatly. Theoretical physics is very worth funding and has many real world applications. But its relevance to — and just as importantly, its political traction with — a middle income couple in your average community where he’s a bus driver and she’s a nurse may not be crystal clear. Yet everyone knows a family member or loved one or friend stricken with cancer, or conditions tied to aging and dementia, heart disease, or any number of other conditions against which medical science is making steady progress. The point is so obvious it barely merits arguing: People fear death and disease. They look to science for hope of cures and some promise of long and robust lives. For two or three generations, that hope has been tied to researchers, somewhere, perhaps operating with something akin to magic but consistently producing new and wonderful things….

The challenge is that the world of biomedical research is insular. It operates with a system of internal governance and mores that are broadly understandable to people who’ve been exposed to university life, especially in the sciences. But that’s a very, very rarified discourse — peer review, study sections, fundamental vs. applied research, pipelines of new researchers, etc. Let’s start with just the foundational point that almost no one has any fucking idea what any of those terms and concepts mean. And for most things, that’s fine. Society should be well-run and knowledgeable enough to keep its scientists and researchers funded so that they don’t need to focus on the song and dance of making the case for what they do in the public square. Unfortunately, that’s not the world we’re living in right now.

Researchers have an additional and under-ordinary-circumstances very understandable desire not to overpromise or give false hope. This is rooted both in ethical imperatives and the uncertainty-driven empiricism that is the hallmark of any good scientist. But at the moment, it is a big problem because it is providing an unmerited advantage to those who are using lies to shut down medical research in the U.S. 

Marshall’s essay is worth reading in its entirety, but his essential point is that people with big megaphones–those in the various “disease communities”– should inform the general public about what is happening. Loudly. As he says, “The more widely known this becomes, the more salient it becomes, the worse it will get for those people who are pushing these cuts, or at least trying to make them permanent through the 2026 budget process.”

Trump and Musk gave carte blanche to know-it-all interns who have no comprehension of how science or government works. Millions of Americans will suffer unnecessarily as a result.

Welcome to MAGA (Morons Are Governing America) world.

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Measles, Lies And Politics

In our politically polarized country, it’s tempting to see arguments about the efficacy of medical interventions like vaccines as examples of “non-political arguments.” True, the less-kind among us (I plead guilty) tend to view “anti-vax” parents as deranged left-wing versions of rightwing conspiracy theorists, or less judgmentally, arguably sane but credulous people who haven’t had access to accurate information. We don’t, however, see this particular controversy as a particularly political argument.

A recent, very thoughtful article in The New Yorker disagrees, calling the measles vaccine a “quintessentially political issue.”

Vaccination is a basic political issue, because it is the subject of community agreement. When a high-enough percentage of community members are immunized, a disease can be effectively vanquished. In epidemiological terms, this is known as “herd immunity,” which cannot be maintained below a certain threshold. When enough people reject the community agreement, they endanger the rest. Willfully unvaccinated adults and children can spread diseases to those who cannot be vaccinated or haven’t been vaccinated, such as infants and people with a compromised immune system; these vulnerable populations would probably be safe in conditions of herd immunity. Vaccination and the refusal to vaccinate are political acts: individual decisions that affect others and the very ability of people to inhabit common spaces.

The author cites evidence that a majority of anti-vaxxers are educated white people who have ample access to credible public-health information and scientific studies about vaccination. Much like those who refuse to believe that climate change is real, they simply choose to reject the science; they choose not to believe the medical consensus. As Frank Bruni recently wrote in the New York Times,

Their recklessness and the attendant re-emergence of measles aren’t just a public health crisis. They’re a public sanity one, emblematic of too many people’s willful disregard of evidence, proud suspicion of expertise and estrangement from reason.

The irrationality triggered by anti-vaccination propaganda is yet another example of the current raging conflict between facts and lies in America–a conflict exacerbated by social media. According to the author of the article in The New Yorker, there are even some reports that Russian trolls have been exploiting anti-vax fears as part of the Russian effort to use disinformation to splinter American public opinion.

What would cause well-educated parents to believe that the entire scientific and medical community is lying to them about the risks of vaccination?

The article attributes this reaction to current levels of public distrust–distrust of authority, of government, and especially of a complex, overly-expensive, profit-driven medical system that has few incentives for robust public-health interventions.

The solution to under-vaccination lies not in getting the right kind of information and messaging to the “vaccine-hesitant” but in changing the politics of health care. Political agreement is unlikely among partners who do not trust each other, and near impossible when one side is explicitly profiting from the other. The American health-care system is ill-suited to protect public health, because a profit-driven industry cannot serve as the guardian of public good.

It’s hard for people to trust the credibility of pharmaceutical companies when those companies are jacking up the price of insulin and other life-saving drugs.

The role of trust is something to consider as lawmakers debate the pros and cons of “Medicare-for-All” and  universal systems like those in place in most other modern countries.

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