This message is repeated over and over again in press conferences, hearings and decrees: President Donald Trump and his Minister of Health, Robert F. Kennedy Jr.., say they want the government to follow “gold standard” of science.
Scientists say the problem is that they often do the opposite, relying on preliminary studies, fringe science or mere guesswork to make claims, question proven treatments or even set policies.
This week, the nation's leading public health agency changed my website To contradict scientific conclusion that vaccines do not cause autism. The move shocked health experts across the country.
Dr. Daniel Jernigan, who retired from the Centers for Disease Control and Prevention in August, told reporters Wednesday that Kennedy appears to be “moving from evidence-based decision-making to evidence-based decision-making.”
It was the latest example of the Trump administration challenging existing science.
In September, the Republican president announced medical consultation based on weak or no evidence. Speaking directly to pregnant women and parents, he advised them not to take acetaminophen. Active Ingredient of Tylenol. He has repeatedly cited a false and long-debunked link between autism and vaccines, saying his assessment is based on guesswork.
“I’ve always had very strong feelings about autism and how it came about and where it came from,” he said.
IN two-day meeting This fall, vaccine advisers chosen by Kennedy for the CDC raised questions about Vaccination of children against hepatitis Ba vaccine that has long been proven to significantly reduce morbidity and mortality.
“The debate that has been raised regarding safety is not based on any evidence other than case reports and anecdotes,” said Dr. Flor Muñoz, a pediatric infectious disease expert at Baylor College of Medicine and Texas Children's Hospital.
During the country worst year for measles for more than three decades Kennedy question the measles vaccine Bye support for unproven treatments and claiming that unvaccinated children the deceased were “already sick.”
Scientists say the process of bringing drugs and vaccines to market and recommending them in the United States has so far generally been based on the scientific gold standard. The process is so strict and transparent that much of the rest of the world follows the lead of U.S. regulators, greenlighting treatments only after U.S. approval.
Gold standard of science
The gold standard may differ because science and medicine are complex and everything cannot be tested the same way. The term simply refers to the best possible evidence that can be collected.
“It totally depends on what question you're trying to answer,” said Dr. Jake Scott, an infectious disease physician and researcher at Stanford University.
What provides the best evidence?
There are many different types of research. The most rigorous is the randomized clinical trial.
It randomly creates two groups of subjects that are identical in every way except the drug, treatment, or other issue being studied. Many of them are “blind studies,” meaning neither the subjects nor the researchers know who is in which group. This helps eliminate bias.
Conducting such tests is not always possible or ethical. This sometimes happens with vaccine trials: “Because we have so much data showing how safe and effective they are, it would be unethical to withhold vaccines from a certain group,” said Jessica Steyer, a public health scientist and founder of the Unbiased Science podcast.
Studying the long-term effects of behavior may not be possible. For example, scientists would not be able to study the long-term benefits of exercise if one group did not exercise for many years.
Instead, researchers should conduct observational studies in which they follow participants and track their health and behavior without manipulating any variables. Such studies helped scientists discover that fluoride reduces tooth decay, and later laboratory studies showed how fluoride strengthens tooth enamel.
But research has limitations because it can often only prove correlation, not causation. For example, some observational studies have suggested a possible association between the risk of autism and acetaminophen use during pregnancy. but I couldn’t find any further connection. The big problem is that these kinds of studies can't determine whether the painkillers actually made any difference or whether the need for the pills was caused by a fever or other health problem.
Real evidence can be especially convincing
Scientists can learn even more when they see how something affects large numbers of people in their daily lives.
This real-world data can be valuable in proving how well something works, as well as when rare side effects occur that may never be detected in trials.
Such vaccine data has proven useful in both respects. Scientists now know that some vaccines can cause rare side effects and can warn doctors to be on the lookout. Data has proven that vaccines provide exceptional protection against disease. For example, measles has been eliminated in the United States, but it still occurs. among unvaccinated groups.
The same data proves that vaccines are safe.
“If vaccines had caused a wave of chronic diseases, our safety systems, which can detect a 1-in-a-million event, would have seen it. They didn't,” Scott said US Senate Subcommittee in September.
The best science is open and transparent
Simply publishing an article on the Internet is not enough to call it open and transparent. Specific things to pay attention to include:
— Researchers formulate their hypothesis before the study begins and do not change it.
— The authors disclose their conflicts of interest and sources of funding.
— The study was peer-reviewed by subject matter experts who have no connection to this particular study.
— Authors showcase their work by publishing and explaining the data behind their analysis.
— They cite reliable sources.
This transparency allows science to control itself. Dr. Steven Voloshin, a professor at Dartmouth College, has spent much of his career challenging the science behind health policy.
“I can only do this because they are open about what they did, what the main inputs are, so you can come to your own conclusion,” he said. “That's how science works.”
Know the limits of anecdotes and anecdotal studies
Anecdotes can be powerful. They are not data.
Case studies may even be published in leading journals to help doctors or other professionals learn from a particular situation. But they are not used to making decisions about how to treat large numbers of patients because each situation is unique.
Even individual studies should be considered in the context of previous studies. A new one-off blockbuster study that seems to provide a definitive answer to every question or leads to a conclusion that contradicts other well-conducted studies requires very careful consideration.
Uncertainty is built into science.
“Science is not about achieving certainty,” Voloshin said. “It's about trying to reduce uncertainty to the point where you can say, 'I firmly believe that if we do X, we'll see outcome Y.' But there is no guarantee.”
Doing your own research? Questions to ask
If you come across a research paper online, in the news, or on an official link that changes your mind about something, here are some questions you should ask:
— Who conducted the research? What is their expertise? Do they disclose conflicts of interest?
— Who paid for this research? Who might benefit from this?
— Has it been published in a reputable journal? Has it been peer reviewed?
—What question do researchers ask? Who or what are they studying? Do they even make comparisons between groups?
— Is there a “limitations” section where authors point out what their study cannot prove, other factors that might influence their results, or other potential blind spots? What does this say?
— Does he make bold, unambiguous statements? Does this fit with or challenge the scientific consensus? Is it too good or bad to be true?
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AP Medical Writers Laurent Neergaard in Washington and Mike Stobbe in New York contributed to this report.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education and the Robert Wood Johnson Foundation. AP is solely responsible for all content.
