Chris​ Simms: Trump and the role of data driven resistance in global health

Chris_sims“Resistance” is an evocative term common to the natural and social sciences where it denotes the act of resisting, opposing, or withstanding. In the so called hard sciences it is easily identified and measured. A physicist, for example, will gauge resistance in ohms; in medicine, the intrarenal arterial resistance index (RI) is used to calculate resistance to blood flow; and in microbiology, drug resistance is measured by levels of minimum inhibitory concentration (MIC).

However, in the behavioural sciences, resistance is more subjective and often carries a moral dimension. Where acts of political oppression or social injustice are involved, questions may arise as to who is the aggressor and who is the resistor, although both may lay claim to the latter. (For example, while both the apartheid South Africa backed Mozambique National Resistance Movement and Nelson Mandela’s armed resistance appropriated the appellation résistance, physician or human rights groups that monitored war crimes in the region had no difficulty distinguishing between the two.)

Given President Donald Trump’s actions over the past fortnight and the reactions they have elicited, a discussion of “resistance” seems relevant. His executive order to ban nationals of seven Muslim majority countries from entering the US—detrimental to the wellbeing of 100 000 immigrants and refugees and their families—caused spontaneous demonstrations at home and abroad.

The Wall Street Journal objected to the ban, saying it was based on weak analysis of incomplete data. Resistance came from multiple quarters, including US diplomats, the US attorney general, civil rights groups, and, eventually, by the federal courts, which have stayed the ban nationwide, at least temporarily. Trump’s response to the stay was to tweet “the opinion of this so called judge” is “ridiculous.”

Resistance to Trump’s muzzling of government scientists who might object to his aggressive energy policy and dismantlement of environmental protections has drawn less attention, yet is especially relevant to global health. His administration has for now banned federally employed scientists from disseminating material, including information on climate change, telling them to decline calls from reporters and cancel media meetings.

In addition, the Centers for Disease Control and Prevention (CDC) felt compelled to cancel a long planned conference on climate change and health scheduled for this month. The executive director of the American Public Health Association said of the cancellation of the meeting: “We can take this as a strategic retreat.” And public health scientists in the US Department of Health and Human Services, also muzzled, are concerned that they will be unable to comment on the impact on ordinary people if Obamacare is repealed.

The scientific community has responded by creating “a resistance movement” on Twitter, while well respected journals such as Nature and Science have been strongly advocating against the anti-science, anti-intellectualism movement sweeping in. Professional associations for science writers and public health officials have reacted with what they call “a great push”—to inform and influence public opinion.

However, Canada’s experience with a coalition of government and powerful resource extraction industries suggests that the effectiveness of resistance may be limited. Prime Minister Stephen Harper (2006-15) gutted environmental regulations and muzzled federal government scientists. Not only did his government restrict their publications and media releases, they also sent political aids to monitor government scientists’ presentations at conferences.

One indicator of the disquieting effect this had was revealed by a survey of 4000 Canadian federal scientists, which showed that 90% felt they were not allowed to speak freely about their work with the media, and that if they possessed knowledge of a departmental decision that could harm public health, safety, or the environment, 86% felt they would encounter censure or retaliation for speaking to the media about it.

A public health issue that re-emerged last week, and which seems to capture the irrationality of the anti-science sentiment of the new government—as well as the populism on which it is based—is Trump’s long held belief in a possible link between the vaccination for measles, mumps, and rubella (MMR) and autism. His support for anti-vaccine activists (anti-vaxxers) recently drew attention when Robert Kennedy (a campaigner against MMR) said that he would head up a committee for the Trump administration to investigate the link (although Trump’s team later said that nothing had been decided).

With the number of measles outbreaks increasing globally (due in part to the autism scare), Nature said that “scientists must fight back with the truth about the debunked link.” However, like populism, this idea attracts because it panders to those that dwell in the domain of losses, on their fear and anxiety, who are vulnerable to post-truth, “alternate facts,” and prefer anecdotes and personal stories rather than scientific data. Not surprisingly, research into the psychological profile of anti-vaxxers is consistent with populist desires: a need to feel empowered and to reject authority, especially when imposed by big government programmes or regulations.

The ultimate worry for some observers is that these trends may threaten democratic processes. In the Canadian experience, Harper’s response to resistance from First Nations groups, demonstrations, and legal actions taken by environmental and human rights NGOs was ruthless: employing police and tax revenue agencies to harass and intimidate. In the process, he diminished the country’s international reputation, from which Canada is only now recovering.

This month the Trump administration begins a concerted effort to dismantle the rules and regulations of the oil and gas and banking industries set in place by Obama to protect the environment and avoid a reoccurrence of the 2008 Great Recession. With Trump’s party controlling Congress, an effective judiciary becomes particularly important. It is in this context that the president’s anti-science posture, along with his mocking of (what he called) “the so called judge” who stayed the ban on Muslims, worries many observers. Pursuit of autocratic rule and demagoguery that benefits the very rich is not what the founding fathers of the United States had in mind—and it needs to be resisted in all quarters.

Dr Chris Simms teaches at Dalhousie University, School of Health Administration, Halifax, Canada; he spent many years living and working in Africa’s health sector.

Competing interests: None declared.