David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and former President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.
Yesterday, my Apple Watch reprimanded me for failing to close my activity rings. I had a pretty good excuse, however: I was on a plane from New York to San Francisco. Besides, I had done my customary workout earlier in the day; I just wasn’t wearing my watch at the time. There was some irony in it all as well, as my meeting at the other end of that flight was in Cupertino. My Apple Watch was admonishing me while I was flying it home.
I heard from a public health colleague this week, whose work and time are partly funded by the Centers for Disease Control and Prevention, that the CDC did not want to be acknowledged as a funding source in a research paper addressing gun violence. Apparently, CDC scientists have marching orders to be more concerned about unflattering facts about gun violence, than about gun violence itself. That’s ideology 1, epidemiology 0. The score does not improve after that. In high-profile media coverage you have likely seen, we learned that the Trump Administration had, in an early indication of its ominous priorities, effectively issued gag orders to the USDA and the EPA. Apparently, we the people are to be kept uninformed not only about guns, but also about such matters of minor importance as our food supply, and the environment. And perhaps everything else, too, since the White House message to the press was: just keep your mouth shut. The new normal, apparently, is to stand our ground- except where facts are concerned. We want no part of those. Let’s be clear, silence where science ought to be is a grave threat to us all. Those of you who are avowed fans of science as I am need no convincing. To anyone else: well, there is no one else. Just about everyone is a fan of science, it’s just that some don’t realize it. Everyone using the Internet; everyone who has ever flown on a plane or driven across a suspension bridge; anyone who has ever gone out to enjoy the spectacle of a perfectly predicted eclipse or meteor shower…is a fan of science. So, too, is everyone who has ever thrown a light switch. Apparently, the switch is being turned off in the White House to keep disquieting facts in the shadows. The EPA, for instance, told us about lead in the water in Flint, Michigan. In a world where the EPA is muzzled, we might still be in the dark about that. The USDA tells us about food-borne outbreaks, and recalls. Silence, in this case, aids and abets the designs of salmonella. Admittedly, the conclusions of science can be inconvenient. The problems in Flint, for instance, began with a focus on cost cutting. Science pointed out that the brains of children were being mortgaged to pay for it. Does any parent, whatever your stock portfolio, think this is something we’d be better off not knowing? And lead in Flint is just one entry in an infamous parade that puts profit ahead of public health. If recent concerns about BPA, or glyphosate, or dioxin fail to convince you, it’s time to see Erin Brockovich again. We are all dependent on the unfettered work and the unmuzzled communication of the EPA, and USDA, and FDA, and CDC to make informed decisions about the risks around us. Unless you have a toxicology lab in your garage, or are conducting elaborate epidemiologic surveillance in your basement, you are very unlikely to learn about them on your own. Absent access to the work of agencies serving the public health, we’d be none the wiser, a few might well be richer, and the rest of us sicker without knowing why. Conspiracy theorists could blame it all on vaccines, or sunspots. Good science is an enemy to no one, since it advances understanding and knowledge, and thus choice. Good science empowers us with options. In medicine, we speak of “informed consent,” because uninformed consent is oxymoronic. Censorship, of course, keeps us uninformed- or worse, misinformed. Ignorance is the ultimate form of repression. Scientists are the first to acknowledge that the sounds of science are not always, immediately, perfectly in tune. It can take any number of revisions to get the lyrics and melody of truth just right. But this very process leads us robustly and reliably toward truth and understanding. This very process informs and empowers us, as reliably as the progress from Kitty Hawk to the moon and Mars and beyond; from Morse to Microsoft; from miasms to the microbiome; from van Leeuwenhoek to Hubble; from the iron lung to drug-eluting intracoronary stents and pharmacogenomics. Science reliably, robustly, relentlessly informs and empowers us. In a world of science silenced at the whim of tyrants, the sun would still revolve around a flat earth. Polio would still menace every parent’s beloved child come spring. And the lead would still be flowing in Flint. We would know nothing about dioxin, or BPA, or hexavalent chromium. The first we would learn about the mass extinctions we are inducing would be the disappearance of the last remaining lion, and tiger, and bear. And our first clue about climate change would be the cooking of our own goose in it, to an irrefutable cinder. I have a friend who told me he voted for Trump for one reason only: the Second Amendment. I have a question for him and others like him: what purpose can the Second Amendment possibly serve when the First Amendment is desecrated? When science is subordinated to silence, and the press to propaganda- only tyrants control the flow of information. However patriotic your intentions, you will be aiming your arms at all the wrong targets. It is the pernicious nature of propaganda in the service of tyranny that it can convert even true patriots into pawns. In the guise of pop-culture diversion, Captain America: The Winter Soldier, conveys this very point. Science informs and empowers, and is the enemy only to those who have cause to fear truth and understanding. Silence where science ought to be- sciLence- serves the unscrupulous secrets that favor shadows, and the profits of few over the good of many. SciLence is a vividly clear danger to us all that is suddenly, alarmingly present.
Lately, I am hearing from friends and colleagues with prominent voices in health and medicine – in some cases voices much more prominent than my own- that members of their large following are advising them to stop talking about politics. Sometimes my friends tell me this directly; sometimes I see such commentary in their social media feed. I see it in my own, too, as well as my email inbox every day.
The events culminating in our election outcome were characterized as the advent of a “post truth era.” We have since devolved from post-truth, to “alternative facts:” essentially, a choice between bald-faced lies about verified reality- or delusion, calling out for medical care. Either way, we are being fed a daily diet of unpalatable (to most of us), insalubrious (for all of us) deceit.