Commentary

Science and Ideology: A Call for Action

 

Consider the following hypothetical scenario.  A promising new intervention for people with diabetes is developed.  Health Canada provides funding to a highly accomplished group of academic health scientists, who have no financial conflicts of interest with respect to the new intervention, to conduct research on its effectiveness.  Their work shows that the new intervention significantly reduces the incidence of a variety of major diabetic complications.  Despite a careful search for possible adverse effects of the intervention, none are detected.  Over a 3 year period, the group’s research findings are published in leading medical journals, including the New England Journal of Medicine, the Lancet, CMAJ, and BMJ.

 

In response, the federal government calls the research inconclusive, and states its position that the only acceptable therapies for diabetes are ones that either prevent or completely cure this condition.  Critics voice their concern that the availability of an intervention that reduces the risk of diabetic complications may encourage people with diabetes to eat more food and become more obese.  The government indicates that unless additional research can address these concerns within a year, it will likely move to ban the new intervention.  Meanwhile, federal funding for research on the intervention is terminated, and institutions other than the one at which the research was initially conducted are forbidden to provide the intervention.  Whispered accusations arise that the researchers who conducted the studies are “biased” in favor of the intervention, although no objective evidence of such bias is ever presented.

 

Although this tale seems far-fetched and even Orwellian, it becomes true-to-life if one substitutes “drug addiction” for “diabetes,” and the “new intervention” is a supervised safer injection facility for injection drug users. In a series of peer-reviewed research articles, the supervised injection facility in Vancouver has been shown to provide a number of benefits, including reduced needle sharing, decreased public drug use, fewer publicly discarded syringes, and more rapid entry into detoxification services by persons using the facility.[1] [2] [3] [4]  The opening of the facility was not associated with any increase in levels of crime, public disorder, or injection drug use.1 [5] 

 

Despite this body of evidence, Federal Health Minister Tony Clement released an official statement in September 2006 in which he claimed “Right now the only thing the research to date has proven conclusively is drug addicts need more help to get off drugs.”[6]  It remains a distinct possibility that the federal government will not renew the current exemption that allows the supervised injection facility to operate legally, thus forcing the program to close in December 2007.[7]  The fact that the treatment of substance abuse appears to have been judged in this instance by an entirely different standard than the treatment of other common conditions, such as diabetes, suggests that ideology and politics have trumped science.

 

This case is an alarming example of a recent trend towards the increased politicization of science.[8]  Rather than embracing evidence-based policy-making, some politicians have sought to ignore or denigrate scientific findings because of a rigid, ideologically-driven agenda. This tendency is most apparent in the United States, where the Bush administration has sought in a number of egregious cases to subvert science for political reasons.  Political appointees at NASA have engaged in a coordinated effort to suppress scientific statements that might challenge the Bush administration’s policies on climate change.  The top climate scientist at NASA, Dr. James E. Hansen, recently said that he was “threatened with ‘dire consequences’ if he continued to call for prompt action to limit emissions of heat-trapping gases linked to global warming.”[9]  The 24-year-old NASA press officer who was attempting to restrict reporters’ access to Dr. Hansen and edit public statements by NASA scientists to conform with the Bush administration’s political ideology had not completed university and had no scientific background.[10]  His primary job qualification was that he had worked for President Bush’s 2004 reelection campaign.9

Although “evidence-based medicine” is a widely accepted paradigm, the health sciences are not immune from improper political interference.  In an example that has remarkable parallels to that of the supervised injection facility, the U.S. Congress banned the use of federal funds to support needle exchange programs in 1988 amid ideologically charged accusations that such programs would encourage illegal drug use.  Despite an accumulated body of scientific evidence demonstrating that needle exchange programs reduce HIV seroconversion among injection drug users[11] and a 1997 NIH consensus statement concluding that needle exchange programs reduce needle sharing and do not increase drug use,[12] the U.S. ban on funding for needle exchange remains in effect to this day.[13]  Given this unenlightened approach to drug policy, it is hardly surprising that the Bush administration specifically singled out Canada’s only supervised injection program for harsh criticism when it opened in 2003, before any evidence was available regarding the program’s effectiveness or lack thereof.[14]

In 2006, concerns about the increasing politicization of science prompted the formation of Scientists and Engineers for America, a grassroots organization that counts 15 Nobel laureates among its Board of Advisors.[15] As this group declares, “[t]he principal role of the science and technology community is to advance human understanding.  But there are times when this is not enough.  Scientists and engineers have a right, indeed an obligation, to enter the political debate when the nation’s leaders systematically ignore scientific evidence and analysis, put ideological interests ahead of scientific truths, suppress valid scientific evidence and harass and threaten scientists for speaking honestly about their research.”[16]

 

We wish to state our deep concern regarding the subversion of science for ideological ends, and express our commitment to speak out against this threat.  We propose the following principles to help guide researchers and policy makers alike in these matters.  First, research evidence must be subjected to the same high standards of scientific scrutiny and peer review, regardless of whether the research findings support an unpopular ideology, challenge a popular one, or evoke little or no controversy at all.  Unless policy makers possess the advanced training and expertise needed to analyze a research study on the basis of its scientific merit, they must neither ignore an accumulated body of research evidence nor attack the validity of a specific study simply because they disagree with its findings on ideological grounds. 

 

Second, it is absolutely unacceptable to accuse researchers of bias simply because their findings run contrary to one’s own ideological tenets.  Any charge of bias must be supported by factual evidence, such as the existence of a financial conflict of interest or an explicit identification and analysis of bias in the researchers’ methodology.

 

Third, occasions may arise when policy makers may legitimately decide on ethical, moral, political, or economic grounds to severely restrict or even prohibit the use of an intervention or therapy that scientific inquiry has shown to have certain health benefits.  In these situations, policy makers must make the basis for their decision explicit and transparent, rather than resorting to deceptive claims that cast doubt upon the effectiveness of the treatment.

 

Scientists must be willing to speak out in the public arena when the accumulated body of evidence points clearly to a scientific truth that runs counter to powerful vested interests or entrenched ideologies.  We believe this is such an occasion.  The data show that Vancouver’s supervised injection facility is an intervention that reduces drug-related harm, with no discernable adverse effects.  If the federal government chooses to close this facility and prohibit such programs throughout Canada, then it must clearly specify the nature of its objections to a health intervention whose effectiveness is supported by scientific evidence.

 

 

Stephen W. Hwang, MD, MPH

Centre for Research on Inner City Health, St. Michael’s Hospital

University of Toronto, Toronto, ON

 

 

Word Count: 1,242

 

 


References



[1] Wood E, Tyndall MW, Montaner JS, Kerr T. Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. CMAJ. 2006;175(11):1399-404. 

 

[2] Wood E, Kerr T, Small W, Li K, Marsh DC, Montaner JS, Tyndall MW. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. CMAJ. 2004;171(7):731-4.

 

[3] Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. Lancet. 2005;366(9482):316-8.
 
[4] Wood E, Tyndall MW, Zhang R, Stoltz JA, Lai C, Montaner JS, Kerr T. Attendance at supervised injecting facilities and use of detoxification services. N Engl J Med. 2006;354(23):2512-4.

 

[5] Kerr T, Stoltz JA, Tyndall M, Li K, Zhang R, Montaner J, Wood E. Impact of a medically supervised safer injection facility on community drug use patterns: a before and after study. BMJ. 2006;332(7535):220-2.

 

[6] Health Canada News Release 2006-85.  “No new injection sites for addicts until questions answered says Minister Clement.”  September 1, 2006.  Available at: http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/2006/2006_85_e.html

 

[7] Wainberg MA. The need to promote public health in the field of illicit drug use. CMAJ. 2006;175(11):1395.

 

[8] Rosenstock L, Lee LJ. Attacks on science: the risks to evidence-based policy. Am J Public Health. 2002;92(1):14-8.
 

[9] Revkin AC.  NASA chief backs agency openness.  New York Times. February 4, 2006, p. A1

 

[10] Eilperin J. Censorship is alleged at NOAA.  Scientists afraid to speak out, NASA climate expert reports.  Washington Post. February 11, 2006, p. A7.

 

[11] Gibson DR, Flynn NM, Perales D. Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS. 2001;15(11):1329-41.

 

[12] Interventions to Prevent HIV Risk Behaviors. NIH Consensus Statement Online. 1997 Feb 11-13;15(2):1-41. Available at: http://consensus.nih.gov/1997/1997PreventHIVRisk104html.htm

 

[13] Rovner J. USA continues federal ban on needle-exchange funding. Lancet. 1998 May 2;351(9112):1333.

 

[14] Gandey A. US slams Canada over Vancouver's new drug injection site. CMAJ. 2003;169(10):1063.

 

[15] Dean C. Scientists form group to support science-friendly candidates. New York Times.  September 28, 2006.  p. A18.

 

[16] Scientists and Engineers for America. Welcome Message. Available at: http://www.sefora.org