Thursday, October 15, 2020

Should scientific publications endorse political candidates?

The New England Journal of Medicine and Scientific American are widely considered to be the preeminent medical research and popular science journals in the world. Since their respective foundings in 1812 and 1845, their editorial staffs have had the opportunity to weigh in on at least 43 American Presidential elections. That they both refrained from doing so until this year is testimony to the traditional separation between science and politics, and the recognition that their subscriber bases are ideologically diverse enough that publicly supporting a major party candidate could lead to many cancelled subscriptions. Nonetheless, both journals recently decided that if there was ever a year to endorse a Presidential candidate, it was 2020.

Here's an excerpt from Scientific American's full-throated endorsement of former Vice President Joe Biden:

The evidence and the science show that Donald Trump has badly damaged the U.S. and its people—because he rejects evidence and science. The most devastating example is his dishonest and inept response to the COVID-19 pandemic, which cost more than 190,000 Americans their lives by the middle of September. He has also attacked environmental protections, medical care, and the researchers and public science agencies that help this country prepare for its greatest challenges. That is why we urge you to vote for Joe Biden, who is offering fact-based plans to protect our health, our economy and the environment. These and other proposals he has put forth can set the country back on course for a safer, more prosperous and more equitable future.

In contrast, the New England Journal of Medicine editors mentioned neither President Trump nor his Democratic challenger by name in "Dying In A Leadership Vacuum," but it's clear that they blame the federal government, and by extension its elected leader, for the United States' failure to control the pandemic:

Our current leaders have undercut trust in science and in government, causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies. ... Some deaths from Covid-19 were unavoidable. But, although it is impossible to project the precise number of additional American lives lost because of weak and inappropriate government policies, it is at least in the tens of thousands in a pandemic that has already killed more Americans than any conflict since World War II. Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment.

Setting aside financial consequences, the danger of a scientific journal, or a medical blog for that matter, taking a partisan stand is that at least some of its readers will perceive it as politically biased and either view all subsequent content through a lens of suspicion or abandon it completely. The handful of times I have endorsed or criticized a prominent politician on Common Sense Family Doctor, there has been a backlash in the form of angry comments and lost subscribers. Because my goal is to reach and influence as many people as possible, I carefully cultivate my reputation as a "straight shooter" on health care and other factors that affect personal and community health.

On the other hand, election results have huge heath consequences, especially in the midst of a pandemic that has already killed more than 216,000 Americans and hospitalized hundreds of thousands more. It's indisputable that the outcomes of our national response have been abysmal compared to that of high-income countries. A study in JAMA this week reported that since May 10, the United States has had more COVID-19 deaths per 100,000 persons than 18 comparable nations; since June 7, we've had nearly 8 times as many deaths per capita than Canada, 23 times as many as Switzerland, and 90 times as many as Finland.

I've written before about how the different ways in which the two major political parties view liberty - as "freedom to" versus "freedom from" - have shaped their perspectives on civil rights and health care legislation. Some people (mostly Democrats) who support more stringent federal and state public health measures to suppress the virus argue that these are necessary to protect the freedom of individuals (and particularly, vulnerable persons) to live their lives without contracting a crippling or potentially fatal disease for which effective therapies and vaccines aren't yet available. Others (mostly Republicans) who oppose these measures or feel that they've gone too far do so from a desire to be free from onerous (and often arbitrary) restrictions on private and public gatherings, schools, businesses, and mask mandates. The scope of this partisan divide is exaggerated by the media's obsessive coverage of behavioral outliers (e.g., mask-less partying college students) and polls that supposedly show mounting distrust in a COVID-19 vaccine that doesn't yet exist. The truth is, the vast majority of Americans want to mitigate the spread of the disease, and nonpartisan behavior change strategies can improve our adherence to protective behaviors regardless of our Presidential preferences.

Returning to the question that is the title of this post, my feeling is that a Presidential endorsement in a scientific journal isn't going to change anyone's mind, but could damage the publication's credibility with some portion of its readers. So you won't see American Family Physician endorsing a candidate in this or any future election as long as I'm a deputy editor, and Common Sense Family Doctor won't be jumping on a Presidential bandwagon, either. What you will get from me is the evidence above that America has thus far done a very poor job fighting the virus. How much of that failure is the fault of President Trump and his administration, and whether a Biden administration could do better, should play a role in who earns your vote, as it did mine.