Science’s Rightful Place
Written by Jeremy Berg
In his first inaugural address, U.S. President Obama said, “We’ll restore science to its rightful place…” He subsequently used this phrase to frame a number of activities across his administration.*While I, like many in the scientific community, was pleased with this declaration, I found the term “rightful place” to be thought-provoking.
The word “rightful” is usually taken to mean legitimate or morally appropriate. Yet, the word “right” has multiple meanings; it can mean morally good or justified, as noted above, but it can also mean true or correct as fact. It is the latter meaning that is essential for the position of science in government.
The ability for science to get the facts right also has profound implications for health care. While I was a professor at Johns Hopkins University School of Medicine during the 1990s, the AIDS epidemic continued to accelerate in the absence of effective treatments. There were serious discussions of how to manage the crisis as hospital beds filled with AIDS patients, with projections that the capacity to handle the situation would soon be overwhelmed. The identification of human immunodeficiency virus (HIV) as the cause of AIDS, the demonstration that two enzyme activities (reverse transcriptase and protease) were essential for the viability of the virus, and the development of combination therapies that included inhibitors of both enzymes stopped acceleration of the epidemic in developed countries. Remarkably, it was recently reported that individuals in the United States infected with HIV are now more likely to die from smoking-related diseases than from AIDS. The adverse health effects of tobacco, of course, had previously been established by scientific investigations, but those results were met with denial of the facts and considerable political resistance, delaying policy changes and societal benefits.
American surgeon Bernard Fisher nicely framed the importance of the scientific method for getting the facts on which policies and practices can be based. In the 1960s, Fisher questioned the notion of radical, deforming operations as the best way to treat breast cancer. On the basis of laboratory results, he believed that breast cancer could be a systemic rather than a local disease. From this basic science insight, Fisher proposed that some breast cancer surgeries failed to prevent metastasis because the cancer had already spread at the time of surgery. He led a clinical trial comparing radical mastectomy with more limited surgery in the face of considerable opposition, including accusations of unethically risking patients’ lives. The trial found no significant difference in the results of the two approaches. Fisher described his approach to mediating scientific discussions with the statement, “In God we trust; all others require data.”
The United States will face many issues related to climate change, medical and public health challenges including vaccines and other technologies, and the roles of computers and artificial intelligence tools in society, among other national and global matters. In 2017, let respect for data and rigorous analysis establish the rightful place for science in the new U.S. administration.