US medical scholars vow to tackle climate, immigration and guns

Never before has the role of evidence and expertise in US policymaking been more at threat. But now one of the nation’s prominent scholarly societies is leading a charge to change that.

The National Academy of Medicine is promising to use its weight as the medical field’s pre-eminent professional body to tackle hot-button societal problems that might be seen as going far beyond its traditional remit – including climate change, immigration and gun control.

The commitment, as spelled out by the academy’s president, Victor Dzau, envisions the nearly 50-year-old body known for its elite membership rolls and authoritative scientific analyses as taking far more aggressive steps to get its suggestions implemented.

“We are at a point with the academy that these are things we must do,” Professor Dzau, a former chancellor for health affairs at Duke University, said. “If we don’t step up, then we won’t be doing our job.”

Professor Dzau acknowledged that some details of the approach – which he outlined at the academy’s annual meeting this month in Washington – are still to be decided. But he cited some previous academy successes in generating grass roots pressure for policy changes by emphasising the broader public health implications of issues that it has studied – if necessary to the point of frightening people.

Past examples include a 1999 report on medical errors that instigated policy reforms by estimating such mistakes cost tens of thousands of lives annually. One key lesson from that case, Professor Dzau explained, was: “The public gets very alarmed, and therefore action can be taken.”

Newer examples, he said, included efforts by the academy to highlight the public threat of burnout in the medical profession, and to help doctors and medical schools reduce the sector’s heavy reliance on opioids in pain management.

If the need to tackle these pressing societal problems is urgent, so is the need to challenge increasing scepticism about scientific evidence among US policymakers. Donald Trump’s rejection of the scholarly consensus around the climate crisis, for example, has left many academics in despair.

When Mr Trump announced the first seven members of his Council of Advisors on Science and Technology last week, just one was an academic – Birgitta Whaley, professor of chemistry at the University of California, Berkeley. The rest were drawn from industry.

The Association of American Medical Colleges, which represents hundreds of medical schools and teaching hospitals, and dozens of academic societies, offered encouragement for the idea of scientists doing more than just writing studies.

“One way to tackle issues like gun violence, increased maternal mortality among African American women, and increasing overdose deaths, is through research to inform our actions,” said the AAMC’s chief scientific officer, Ross McKinney. “Research alone will not be sufficient to prevent these tragedies.”

Professor Dzau’s vision for a more activist National Academy of Medicine, however, faces challenges that include doctors and academics preferring more limited ideas of their societal roles, and the academy’s own status as a non-profit entity that is legally prohibited from political lobbying.

For the latter, Professor Dzau sees room to orchestrate other groups that can push for policy changes. Once such groups are provided with key scientific data, he said, the academy can leave them to handle the politics. “Suddenly,” Professor Dzau said, “we are acting, not just advising.”

Provoking change in university faculty attitudes was tougher, he said. Institutions have long struggled to get their staff to work and cooperate with colleagues beyond their academic silos. Such habits are reinforced by promotion and tenure practices that faculty are reluctant to upend, and by sharp field-based divisions within funding agencies, Professor Dzau said.

But many institutions are showing clear recognition of the need to somehow force that change, Professor Dzau said. “We are having that conversation and people are interested,” he said.

An even bigger challenge across medicine, however, was the deeply ingrained preference for fighting diseases rather than preventing them in the first place. “There is a bias toward drugs,” said Anthony Mazzaschi, chief advocacy officer at the Association of Schools and Programmes of Public Health. “I have heard it referred to as ‘the charisma of the magic bullet’.”

Mr Mazzaschi noted that Professor Dzau outlined his plan only days after the US National Institutes of Health issued a report highlighting that problem. The NIH study was intended to ask why black scientists win proportionately far fewer NIH grants than their white counterparts, and its conclusion showed that black scientists tend to explore human-centred preventative behaviours rather than pursue new drugs and devices.

Professor Dzau said he long recognised the problem that the NIH identified, and hoped that US universities would give preventative and behavioural studies a stronger place in their educational offerings and reward structures. “Universities have to achieve that balance about what’s important to society,” he said.

He also acknowledged the possibility that the National Academy of Medicine could consider pushing that process forward by quantifying the imbalance and illustrating its effects on public health.

In the meantime, Professor Dzau said he hoped that the academy could help make progress on major problems such as climate and immigration by finding incremental but important advances such as the work it did after the Sandy Hook school massacre. In that instance, he said, the academy helped funding agencies understand that federal law hadn’t actually banned research involving gun safety, but only forbade any work aimed at promoting gun control.

Nevertheless, years later, federal support for gun research has remained well below levels provided for public health threats of similar magnitudes. And Mr Mazzaschi predicted that, despite its admirable ambitions, the National Academy of Medicine, and any like-minded university researchers, would keep hitting huge roadblocks if their work reached the point of meaningfully threatening the powerful forces behind such intractable policy stalemates as climate, guns and immigration.

“Many federal grant administrators go out of their way to avoid controversy,” he said. “So applications that have the potential to rock the boat have higher waves through which to sail.”

paul.basken@timeshighereducation.com