Standing up for science in the era of Trump

The points articulated by these authors are spot on. Recently Mikhail Gorbachev wrote "Politicians and military leaders [today] sound increasingly belligerent and defense doctrines more dangerous. Commentators and TV personalities are joining the bellicose chorus. It all looks as if the world is preparing for war." Mr. Gorbachev further noted the reduction by 80% of the two superpowers' nuclear arsenals in the 1980s was made possible by leaders' awareness that nuclear war is unacceptable: "Nuclear war cannot be won and must never be fought. Our two nations will not seek military superiority . . . Today, however, the nuclear threat once again seems real"(1).

Now, 30 years later, as these two nations' leaders control 90% of the world's remaining nuclear arsenals, one recalls the important role American, Soviet/Russian, British and other physician advocacy organizations played in educating their public and leaders that nuclear war is not winnable or medically survivable. Physicians traveled the world, held conferences presenting evidence-based projections of population morbidity and mortality, engaged the media, and met with political leaders to describe the impact of nuclear weapons on medical personnel/infrastructure and public health -- the former eliminated in the first minutes of a nuclear exchange and the latter becoming, effectively, non-existent.

Yet, while physicians have questioned the U.S. president's mental health (2), their efforts to educate this new generation of leaders and the international public about the impact of nuclear weapons use, and advocating against expansion of nuclear arsenals, have been minimal. So too has been education and evidence-based advocacy by physicians and their leadership organizations against various assaults on science - from undermining scientific consensus on global warming to the health value/risk of vaccines. As the leader of the Union of Concerned Scientists stated, the "President [is] basing statements and policies on beliefs rather than on evidence" (3).

The international public must come to understand that when multinational collaborative networks are profoundly disrupted, east-west or north-south, risk increases of a lethal pathogen overcoming disease control efforts and causing a pandemic across our highly mobile, interdependent world. While the U.S. cannot avoid all conflict, it is another matter for the Trump administration to generate new, preventable conflicts, or to heighten tensions that disrupt the cooperative international relations upon which effective control of infectious disease outbreaks depend. Physicians and public health practitioners around the globe need effective relationships among governments, clinicians and public health workers in the collective global and their own national self-interest (including with China, Mexico and Europe).

Physicians must advocate in the public’s health interest, again seizing the imperative to educate their national leaders and communities on critical health issues, just as they did in the 1980s to reduce risk of nuclear conflict and facilitate negotiations that dramatically reduced nuclear arms. Education must recognize the rising risk of nuclear conflict and that a variety of evidence-based health policies are being undermined by rapidly escalating assaults on science. Physician advocacy could increase awareness of the need to reduce greenhouse gases to prevent continued global warming, and advance more accurate understanding that the benefits of immunization far outweigh its actual, not alleged, risk.

One recent example of physician effectiveness in such education/advocacy is The Medical Society Consortium on Climate & Health, consisting of 11 major American medical societies representing over half of all U.S. physicians (4). The Consortium formed in response to surveys of physicians where a large majority was already observing harmful health impacts of climate change among their patients. Physicians want their professional societies to engage education and advocacy on global warming in the interest of disease prevention, to protect the public health and the health of their own patients. The Consortium’s objective is to educate the public and policymakers about the existing and imminent harmful health effects of climate change for the American public, about the imperative/opportunity to reduce emission of greenhouse gases and how we can achieve immediate, lasting health benefits by accelerating the transition to clean energy (4).

U.S. politicians are most visibly leading the effort to undermine/ignore peer review science. But this phenomenon is occurring internationally, and Britain is not immune. If physicians do not emerge as effective advocates for science versus political social media or internet myth, are they culpable as immunopreventable disease takes the lives of children, or when deaths and illness related to climate warming ascend the ranks of leading causes of morbidity and mortality? Observing that the U.S. political system has entered unprecedented terrain in their depths of dysfunction is cliché, if true. What is not cliché is that our nation’s 800,000 physicians, and physicians of all nations, have a collective and individual responsibility – and demonstrated capability – to help their public and their leaders recognize the greatest threat to their health: policies based on fact-absent allegation, myth and ignorance rather than science. Now, perhaps more than ever before, physicians must engage.

References
1. Gorbachev M, It all looks as if the world is preparing for war. Time, February 13, 2017, page 22.
2. Blow CH et al., Mental health professionals warn about Trump. New York Times, February 13, 2017.
3. Kimmell K, in Kruger J and Worland J, How a war on science could hurt the US - and its citizens. Time, February 13, 2017, page 18.
4. American Public Health Association, Medical Society Consortium on Climate and Health. Announced March 15, 2017. APHA.org