This message is repeated over and over again in press conferences, public hearings, and executive orders. President Donald Trump and his health secretary, Robert F. Kennedy Jr.they want us to obey the government. “Gold Standard” Science.
Scientists say the problem is that they often do the opposite by relying on preliminary research, fringe science, or mere intuition to make claims, question proven treatments, and even set policy.
This week, the nation’s top public health agency Website changed to contradict scientific conclusions Vaccines do not cause autism. The move shocked medical experts across the country.
Dr. Daniel Jernigan, who resigned from the Centers for Disease Control and Prevention in August, told reporters Wednesday that President Kennedy “seems to be moving from evidence-based decision-making to evidence-based decision-making.”
It was the latest example of the Trump administration’s challenge to established science.
In September, the Republican president said: medical advice Weak evidence or not based on evidence. He directly told pregnant women and parents not to take acetaminophen. Tylenol active ingredients. He reiterated the fraudulent and long-disproved link between autism and vaccines and said his assessment was based on intuition.
“I’ve always had very strong feelings about autism and how it happens and where it comes from,” he said.
in 2 day conference This fall, President Kennedy’s hand-picked CDC vaccine advisers posed the following questions: Vaccinate your baby against hepatitis Bvaccination has long been shown to significantly reduce illness and death.
“The arguments raised about safety are not based on evidence other than case reports and anecdotes,” said Dr. Flor Muñoz, a pediatric infectious disease expert at Baylor College of Medicine and Texas Children’s Hospital.
in the country Worst year for measles More than 30 years later, Kennedy Questioning the measles vaccine meanwhile defend unproven treatments and claim it children who are not vaccinated The person who died was “already ill.”
Scientists say the process by which drugs and vaccines are brought to market and recommended in the United States has generally relied on gold-standard science. This process is so rigorous and transparent that many other countries around the world follow the guidance of US regulators and give the OK to treatments only after US approval.
gold standard science
Science and medicine are complex and cannot all be tested the same way, so gold standards may differ. This term simply refers to the best evidence that can be gathered.
“It completely depends on what question you’re trying to answer,” says Dr. Jake Scott, an infectious disease physician and researcher at Stanford University.
What will produce the best possible evidence?
There are many different types of research. The most rigorous are randomized clinical trials.
Two groups of subjects are randomly created that are identical in every way except for the drug being tested, the treatment, and other questions. Many are “blind studies,” meaning neither the subjects nor the researchers know who is in which group. This helps eliminate bias.
It is not always possible or ethical to perform these tests. Such cases sometimes occur in vaccine trials. “There is so much data showing that vaccines are safe and effective that it would be unethical to withhold vaccines from certain groups,” said Jessica Steyer, a public health scientist and founder of the podcast Unbiased Science.
It may be impossible to study the long-term effects of an action. For example, scientists cannot study the long-term benefits of exercise by keeping a group from exercising for years.
Instead, researchers must conduct observational studies, tracking participants and tracking their health status and behaviors without manipulating variables. Studies like this helped scientists discover that fluoride reduces tooth decay, and subsequent laboratory studies showed how fluoride strengthens tooth enamel.
However, studies are limited because they can often prove only correlation, not causation. For example, several observational studies have raised the possibility of an association between autism risk and acetaminophen use during pregnancy. But some people just can’t find the connection. The big problem is that this type of study can’t determine whether the painkillers really made a difference, or whether it was the fever or other health problem that caused the need for the pills.
Real-world evidence is particularly strong
Scientists can learn more when they observe how something affects many people in their daily lives.
Real-world evidence can be valuable in proving how effective something is and whether there are rare side effects that could never be detected in clinical trials.
Such evidence regarding vaccines has proven useful on both counts. Scientists now know that some vaccines can cause rare side effects and can warn doctors to be careful. The data demonstrated that the vaccine provides exceptional protection against the disease. For example, measles has been eradicated in the United States, but it still occurs. Among unvaccinated groups.
The same data proves the safety of the vaccine.
“If the vaccine had caused a wave of chronic disease, our safety systems, which can detect a one-in-a-million event, would have known that. They don’t know it yet,” Scott said. US Senate Subcommittee In September.
The best science is open and transparent
Simply publishing a paper online does not mean it is open and transparent. Here are some specific things to look for:
— Researchers set a hypothesis before starting a study and do not change it.
— The authors disclose conflicts of interest and sources of funding.
— This study has been peer-reviewed by subject matter experts who have no connection to that particular study.
— The authors present their work and publish and explain the data underlying their analysis.
— They cite reliable sources.
This transparency allows science to check itself. Dr. Stephen Woloshin, a professor at Dartmouth College, has spent much of his career challenging the scientific conclusions underlying health policy.
“I’m able to do that because I’m transparent about what they did, what the underlying sources were, and you can draw your own conclusions,” he said. “That’s how science works.”
Know the limitations of anecdotes and single studies
Anecdotes can be powerful. They are not data.
Case studies are sometimes published in top journals to help doctors and other professionals learn from specific situations. But because each situation is different, they are not used to deciding how to treat large numbers of patients.
Even a single study must be considered in the context of previous research. New one-off blockbuster studies that appear to definitively answer all questions or reach conclusions that contradict other well-conducted studies should be considered very carefully.
Uncertainty is built into science.
“Science is not about achieving certainty,” Woloshin says. “It’s about trying to reduce uncertainty to the point where you can say, ‘I’m confident that if I do X, I’ll get Y.’ But there are no guarantees.”
Are you doing your own research? Questions to ask
If you come across a research paper online, in a news article, or cited by an official to change your mind about something, ask questions like:
— Who investigated? What is their expertise? Will they disclose any conflicts of interest?
— Who paid for this research? Who will benefit from it?
— Has it been published in a reputable magazine? Has it been peer reviewed?
— What questions are researchers asking? Who or what are they studying? Do they compare evenly across groups?
— Is there a “Limitations” section where the authors point out what the study cannot prove, other factors that could influence the results, or other potential blind spots? What does it say?
— Are you making a bold and decisive claim? Does it fit with the scientific consensus or challenge it? Is it too good to be true or too bad?
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AP Medical Writers Lauran Neergaard in Washington and Mike Stobbe in New York contributed to this report.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. AP is solely responsible for all content.
