Two recent pieces of news from the Trump administration have raised my hackles in the past few days. Yesterday the Washington Post reported on news from the CDC: they've been forbidden to use* strongly cautioned against using selected words and phrases in the reports they prepare for next year's budget. One of those phrases is evidence-based.
This is dangerous. Even worse, it is dangerous in a way that a fourth-grader should be able to explain.
The foundation of science is familiar to everyone: we start with an idea that might be true, and we look empirically at the evidence for and against it. Evidence-based medicine is all about distinguishing between the codswallop remedies and the lifesaving treatments. It's harder than you might think. It matters.
I started working as an allied health servicer provider in 1995, and I have watched patients and families and practitioners alike seizing onto bogus ideas in the hope that they could ease suffering. Across both the disciplines in which I am credentialed, I have seen practices move in and out of favor. I have seen everybody in town rush to get certified in some fancy new (profitable) therapy approach -- which was roundly discredited in a randomized controlled trial a decade later. I have seen us reverse course, as a body, on the specific advice we give to people in pain.
We get better at helping people when we rely on the evidence. An important way to reduce healthcare costs is to stop charging people for treatments that don't work, or don't work very well. But we can only determine which treatments those are by means of meticulous empirical investigations, because it's really tricky for healthcare providers to distinguish among results caused by natural resilience or the placebo effect, and results caused by our actual treatment.
The only people who benefit consistently from a healthcare market unconstrained by empirical evidence are people with something to sell. I don't think that's a coincidence.
Trump is also arguing that we would be a better society if we deregulated ourselves. Look how many more regulations we have now than we did in 1960, he said this week. Many people have pointed out the public health costs of returning to an era in which cars had no seatbelts. My specific concern is related to infant safety. Babies can't speak up for themselves, so we as a society speak up on their behalf. We have regulations specifically to protect babies. (You wouldn't think this would need to be explained to a president who was elected in large part because pro-lifers turned out for him, but there you go.)
In 1960, most US babies were fed with a concoction based on diluted evaporated milk. It was 20 years before the passage of the Infant Formula Act, a response to an event in which creative formula manufacturing caused harm to US babies. These days most US babies are breastfed, at least initially. We have regulations to protect their mothers' milk, keeping toxic chemicals in human milk down within reasonable limits. The move to turn the EPA into the Environmental Pillaging Agency will alter environmental levels of known neurotoxins, with unpredictable but almost certainly adverse consequences. A minority of US babies are formula-fed; regulations keep the food they receive within acceptable ranges for critical nutrients. When formula companies get it wrong, babies die. They are maimed -- they suffer irreparable brain damage. They fight avoidable and potentially fatal infections. (Darn it, I'm writing in an hurry and I can't find the page I've linked to before, with the long list of US formula recalls. Please share in the comments if you know what I'm talking about.)
Regulations save lives. They may also narrow profit margins, but profit margins cannot be our highest goal.
In recent days I've also seen Catholics continuing to talk about how much they like President Trump. Oh, Catholics, this is important: the idea that "science-based" is a dirty word is not compatible with a Catholic worldview. The idea that in the pursuit of profit we can be cavalier with the well-being of the vulnerable -- infants and those who are suffering -- is also not compatible with a Catholic worldview.
This is not acceptable. Let's say so unequivocally.
*UPDATED: It appears that the Post's source for this story was describing advice from CDC officials intended to anticipate objections from the Trump administration, rather than a clear edict from the administration itself. I continue to assert that a climate hostile to science is a climate that must be changed.
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