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Ignorance is Strength: The Trump Administration Declares War on Science

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Benjamin Kalinkowitz
August 31, 2018

The current administration seems to have a science problem. In just a year and a half, the EPA removed independent scientists from their science boards and limited the role of scientific studies in decisionmaking; multiple federal agencies removed references to climate change or discussion of how climate change will affect their mission from their websites; and HHS deleted data on Obamacare enrollment and made it harder to find information about ACA subsidies or covered services. Last month’s deletion of The National Guideline Clearinghouse (NGC) is just the latest example of a systematic effort to remove not only the role of science in federal decisionmaking, but the public’s ability to critically review federal policy. Ending the NGC, a database for physicians and other providers to keep abreast of new research and guidelines distilling major studies into usable best practices, removes a key resource for physicians looking for updated information. While the administration argued the database was a prime example of government over-spending on programs that were beyond the Federal government’s purview, and that ending it was a cost-saving measure, closing the database will ultimately cost the government more money, and potentially have fatal effects for Americans depending on doctors’ up-to-date knowledge.

While doctors are often portrayed as privileged and wealthy in American culture, the realities of life in all but the most lucrative specialties is much different. Health care providers are being squeezed on all sides. While patients complain that their doctors rush through visits, providers spend almost half of their workday on administrative insurance tasks, all while health insurance companies and Medicare have reduced payments to a level that requires doctors to see more and more patients in a day to just break even. At the same time, steadily increasing copays and deductibles drive patients to wait until they have multiple or urgent concerns before seeing a doctor. Today’s physicians have less time in the day to see more and more increasingly complex patients.

The speed of scientific innovation only compounds these issues. The amount of time available to teach foundational topics in medical school can be shockingly short – students might only have an hour or two over the course of their classroom training to spend on the mechanics of our most common drugs, like Tylenol. Residency provides an opportunity for on-the-ground learning, but once a doctor moves into practice, the opportunities for journal clubs, rounds and continuing education decrease. Countless new studies, pharmaceuticals and interventions appear each year; the best course of action in any given case is a constantly moving target. While responsible doctors surely keep up as much as possible with new research, it is impossible to see a full case load and still have time to sift through new research to find the most valuable and pertinent insights. This is where the NGC has been crucial: by highlighting the best and most promising research and offering guidelines for evolving best practices, the database helps doctors to stay at the forefront of new innovations. And because it is a government designed and controlled resource, doctors can rely on its impartiality.

Discontinuing future updates and making the database completely unavailable causes grave harm to patients as well. To the patient, the loss of the NGC means they may not be getting the best medical advice from their trusted medical provider, which, in turn, could mean that they undergo unnecessary or ineffective care. When the patient is using a federal health insurance program (Medicare, Medicaid or using the Obamacare healthcare exchanges) those increased costs for subpar care are passed onto the American public.

Of course, these actual monetary costs and the health care they buy are only part of a larger problem of political philosophy. In a government that increasingly touts the libertarian view that the market is freedom, removing access to information produces the opposite effect. By limiting doctors’ ability to offer their patients up-to-date care, the current administration decreases freedom of choice and puts a thumb on the scale for corporate-driven capitalism at the cost of American lives.

The Trump administration’s attempts to distance the executive branch from scientific knowledge is more than the expected shift in values from a Democratic administration to a Republican one.  The deletion of data, in this case and others, is an attempt to reshape our national conversation by limiting access to knowledge. Rather than making research-based arguments for policy change, this administration is just deleting disagreeable data. While we may disagree on what our national values are and what the role of the federal government should be in implementing those values, we should all be able to agree that more information is better than less. In order for the American public to have informed conversations about policy and vote their values, they must be able to find out what pollutants are emitted by coal plants, how many people utilize Obamacare, or the best way to manage diabetes. The government and its public administrators have a duty to bring data to the public.

Author: Benjamin Kalinkowitz, PT, DPT, MPA earned his Masters in Physical Therapy from Hunter College-CUNY, his Doctorate in Physical Therapy from the University of Kansas, and his MPA from the University of Nebraska at Omaha. Dr. Kalinkowitz has been a practicing physical therapist for over 10 years, having spent 8 years working at the Department of Veterans Affairs, and currently in practice at a hospital based outpatient clinic in New Jersey. All views expressed are the author’s alone, and do not necessarily represent the views of his current or former employers. He can be reached at: [email protected] or on Twitter @BenKalinkowitz

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