A Prescription for Saving Public Health: Science in a Post-truth World
RFK Jr. and Donald Trump pose an existential threat to public health science. Here's what we need to do now.
The perverse alliance of Donald Trump, Elon Musk, and RFK Jr embodies a transition in our relationship to truth and its discernment that threatens to unravel the fabric of public health and the science that supports it. Trump untethered us from the truth and declared sacrifice for the common good a fool’s errand. Elon Musk insisted that any resistance to lies, hatred, and dangerous misinformation is censorship and money defines what is right. Empowered by Trump and Musk, RFK Jr seeks to lead public health with the belief that expertise is an unnecessary annoyance and uninformed intuition is the best guide to policy. It is time for the public health science to save itself.
Yes, I’m looking at you, epidemiologists.
The unwritten rules of academia insist that true scientists must not dirty their hands with advocacy, that staking out a political position leaves you and your research susceptible to accusations of bias, and that public criticism of others in academia is unseemly.
Fuck that bullshit.
That ethos has allowed everyone from neuroradiologists to biophysicists to simply declare themselves to be epidemiologists. That passivity allows every truck driver and troll with a Twitter account to respond to every epidemiological study with undesired conclusions with some trope about correlation not being causality as if actual epidemiologists had never considered the challenge of discerning evidence of causal relationships from observational data, much less spent decades in training and research with that task at the epicenter of everything they were working on.
"Trusting the experts is a function of religion and totalitarianism... In democracy, we question everybody." – RFK Jr.
It has been particularly stunning to watch a cadre of economists (yes, I’m looking at you, Jay and Emily among others) shift into conducting epidemiological studies without missing a beat with an implicit data-are-data mentality, as if the statistical analysis is the difficult part when any epidemiologist worth their salt knows that collecting and understanding the limits of those data are the true challenges of epidemiology. Imagine if epidemiologists suddenly started forecasting housing prices or brain surgeons started doing open heart surgery. This is that stupid.
Now we have someone with open disdain for experts on the brink of running public health. We can expect that he will surround himself with sycophantic pseudo-experts as he runs roughshod over the systems that have allowed us to discern the truth and protect public health.
The Public Science Debate
So, what should the scientific community in general and the epidemiological community in particular do in response to this existential threat to the integrity of public health policy and the science that supports it? When social media creates and fosters the illusion that an X account and access to Google and ChatGPT defines expertise, how do those who’ve spent a lifetime understanding a field of inquiry position themselves and share their collective insight in a meaningful way.
In the statement accompanying its award honoring Jay Bhattacharya, the two-year-old American Academy of Letters and Sciences, lauded him for his intellectual courage in taking a “stand for the public’s right to unrestricted scientific discussion and debate.” Given that the award was going to someone who was ONLY restricted on Social Media while appearing some 40 times on Fox News, the statement seems to suggest that the public has a right to hear any and all scientific perspectives on social media without regard to the accuracy or consequences of that perspective.
In many ways, this statement encapsulates the daunting challenged posed by the trio of Trump, Musk, and RFK Jr. It implies that the public should be privy to and part of the scientific debate, presumably on social media. Discussing science on social media is like trying to play football with the fans on the field. Many of those fans think that training and experience does not make one a better football player, or that being a great tennis player qualifies you to play quarterback. Chaos ensues.
Saving Public Health
In the long term, there is much that needs to happen to improve understanding of public health and the science that supports it. We need to reimagine our broken system for disseminating science built around an archaic, plodding, and exploitative system of paywalled journals and peer review that only serves the $20 billion/year science publishing industry. We need to create ways for scientists to utilize the power of social media to rapidly advance science without the fans on the field. We need to create better firewalls in academia that check the influence of wealthy donors on research outcomes. And finally, we must end the taboo on advocacy. The people who best understand the science should be encouraged rather than discouraged from voicing their opinions on the science and its implications for public policy. That does not mean theirs should be the only voice, but they must be heard.
But this will take years. We have 66 days.
This administration plans to hit the ground slashing and burning. We need to act before that happens. Public health scientists can and must band together to speak with a collective voice and to provide easy to understand and access resources debunking the lunacy of RFK Jr. and the cadre of scientific poseurs he has gathered around him.
Specifically, for each RFK claim about public health, we need:
An easy to access library of relevant research that is collaboratively annotated by all interested public health scientists with relevant expertise.
Regularly updated summaries and, where possible, meta-analyses of that research. These summaries must include the full range of views of the scientific community with links to relevant evidence in the library mentioned above. Where there is significant disagreement, we need some quantifiable indicator of the level of support within that community for various interpretations of the research.
Lists of specific misinformation promulgated by RFK and others in his orbit with concise, easily understood, point by point refutations that points to the research summaries.
I am currently working with other public health scientists and science writers to build these resources and am actively looking for support from scientists, writers, and software developers as well as financial backers to make this happen. Please message me if you are interested in supporting this effort.
With the absurd nomination of RFK Jr. to head HHS, there has never been a more important time for scientists to become advocates. Make no mistake. He and the Trump administration pose an existential threat to the credibility of public health scientists, a potential physical threat to the safety of public health scientists, and a long-term threat to the health of the American public.