Speaking up for science in an era of disinformation

On 6 November Donald Trump was re-elected president of the United States after an election campaign characterised by fear, lies, and disinformation. Trump’s campaign featured his insistence that he was cheated out of winning in 2020—a lie that has left many Americans distrustful of their voting system.

Martin McKee and colleagues describe how the rapid spread of such disinformation, particularly on social media, poses a threat to societies and democracies everywhere (doi:10.1136/bmj.q2485). They argue that it can be countered only if social media platforms are adequately regulated and if we can effectively expose disinformation and not be afraid to speak out.1

Trump’s pre-election threats that he would curb press freedoms and target journalists suggest that speaking out may become harder (www.theguardian.com/us-news/2024/nov/10/trump-journalist-media-press-freedom).2 In his victory speech he referred to the media as the “enemy camp” (www.theguardian.com/us-news/2024/nov/06/trump-media-enemy-camp-speech).3 Even before he won the election, the possibility of his victory had a silencing effect on some parts of the mainstream media. The Washington Post and the LA Times refused to make a presidential endorsement ahead of the election, in a move away from tradition (www.theguardian.com/commentisfree/2024/oct/25/news-election-endorsements-washington-post-la-times).4

Another big concern is what Trump’s presidency will mean for health. Abortion and reproductive rights will likely come under further attack, the “global gag” rule may be reinstated, global health funding and gun safety policies are at risk, and there are fears about plans for health insurance and healthcare administration (doi:10.1136/bmj.q2459 doi:10.1136/bmj.q2456 doi:10.1136/bmj.q2461).567 His second term will be bad for the health of the planet too, if he delivers on promises to drill for more oil and gas and a rollback of environmental protections (doi:10.1136/bmj.q2461).7 Discussion about the climate emergency is already vulnerable to disinformation (doi:10.1136/bmj.q2187).8 While campaigning Trump called climate change a “hoax,” further fuelling this false narrative, despite recent hurricanes in the US providing evidence of the devastating harm that a changing climate is inflicting on communities.

Another cause of preventable harm in the US that needs urgent attention is surgical adverse events. New research finds that more than a third of patients admitted for surgery experienced an adverse event (doi:10.1136/bmj-2024-080480).9 Helen Haskell, a patient safety advocate, says that inaccurate or incomplete medical records may be hampering efforts to understand the underlying causes of these errors and emphasises the need to put patients at the centre of their safety (doi:10.1136/bmj.q2437)10—a view echoed by the surgeon Scarlett McNally (doi:10.1136/bmj.q2478).11

An error that all doctors fear is not recognising and acting on the clinical symptoms of an unwell child. Hospital early warning systems have been designed to help with this. But what works in a hospital doesn’t always translate to general practice. Helen Salisbury, a GP, explains how not everything can be solved by algorithm but requires “baseline knowledge supplemented by repeated experience” (doi:10.1136/bmj.q2484).12

Identifying the abuse, neglect, and exploitation of children is difficult, even for the most knowledgeable healthcare professionals, write Andrea Asnes and Gunjan Tiyyagura (doi:10.1136/bmj.q2364).13 As well as the use of clinical decision tools, they encourage careful adherence to guidelines and protocols to standardise practice and remind clinicians to act consistently to eliminate bias. Clinicians should raise concerns early on with a safeguarding expert and carefully document the evidence.

A patient centred approach is encouraged to help improve communication, especially as young people may not always recognise themselves as victims of exploitation. The clinicians’ role to advocate on behalf of young people is vital: a package of articles in this week’s journal provides in-depth advice for practising clinicians (doi:10.1136/bmj-2024-079497 doi:10.1136/bmj-2023-079054).1415