Discrediting His Own Agencies

[Note to readers: This post was written two weeks ago before I went on vacation during which time I had no Internet access.  Clearly things of greater importance to our democracy (eg the President's threats to nullify the elections) have happened while I've been away, but now that I'm almost back I thought I'd share this anyway and get to the more recent issues as soon as I can.]

Throughout the coronavirus pandemic, President Trump has sought to contradict or delegitimize medical opinion about various aspects of the virus. 

• As he has acknowledged in the Bob Woodward interview tapes, he has deliberately downplayed the danger of the pandemic from the very beginning.
• He has touted various unproven treatments (hydroxychloroquine, ingestion of bleach, ultraviolet light), several of which were bizarre from any point of view, none of which has been proven effective; he even pressured the Food and Drug Administration (FDA) for emergency use authorization (EUA) for hydroxychloroquine, which was later withdrawn because of safety considerations.
• He has refused to recommend strongly or even model mask-wearing or social distancing.
• He has been pushing to re-open schools and the general economy, even in parts of the country with high infection rates.
• He has removed the acknowledged expert on the coronavirus and its epidemiology Anthony Fauci from press briefings and blocked some of Fauci’s other media appearances.
  

Trump is now moving on from delegitimizing specific scientific conclusions to delegitimizing his own administration’s supposedly nonpolitical agencies. 

• In a joint appearance with FDA Commissioner Steven Hahn just before the Republican National Convention, Trump announced that the FDA was approving the use of convalescent plasma from recovering COVID-19 patients because it was a “powerful therapy” with an “incredible rate of success,” claiming that the treatment would save thirty-five out of one hundred COVID-19 patients from dying.  That statement turned out to demonstrate an extraordinary misunderstanding of scientific data.  The President’s statement and especially Commissioner Hahn’s strong defense of it were widely criticized by experts in the field.

This announcement came just after a statement by the President attacking the FDA, stating:

The deep state, or whoever, over at the FDA is making it very difficult for drug companies to get people in order to test the vaccines and therapeutics …  Obviously, they are hoping to delay the answer until after November 3rd [the date of the presidential election].

• Still today he is publicly anticipating the November 1 approval of a coronavirus vaccine, which most experts consider highly unlikely.  Those experts are concerned that the President will exert pressure on the FDA for an early EUA even without adequate data.
• On August 26, the White House coronavirus task force abruptly changed previous government testing guidelines for asymptomatic people who have been exposed to the virus.  The new guidance    

replaces advice that everyone who has been in close contact with an infected person should get tested to find out whether they had contracted the virus. Instead, the guidance says those without symptoms “do not necessarily need a test.”

While there is some disagreement among medical experts about the technical soundness of the advice, most agree that the new guidelines are misleading and can be confusing.  Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security, criticized 

the administration for releasing important recommendations under the CDC [Center for Disease Control and Prevention] name without allowing its officials to discuss them. She also said the White House intervened in the drafting of the CDC guidance about masks and reopening of churches and schools, so “that process has really poisoned people’s view of guidelines.”

• More recently Trump appointed neuro-radiologist Scott Atlas MD as a new medical advisor.  Atlas is neither an epidemiologist nor an infectious disease expert, but his radical, non-scientific views on the virus have been more closely aligned with the President’s “especially in regard to reopening schools, avoiding lockdowns, and resuming some sports.”
• And most recently, Paul Alexander, a political appointee advising the Department of Health and Human services (HHS), has sent repeated emails to the CDC seeking changes in the Morbidity and Mortality Weekly Reports (MMWR) and demanding that they be delayed until he could review and make edits.  In its various manifestations the MMWR has been published weekly on issues in public health since 1878.  Because of its up-to-date reporting on the most significant current issues, its rigorous scientific vetting and accuracy, and its interpretation of difficult data making it accessible to all, it has been one of the most important medical publications since at least … well, at least since I depended upon it repeatedly when I began medical practice in the 1970s.  Not surprisingly, the Trump Administration considers any accurate scientific information about the coronavirus epidemic to be potentially political and therefore must be “reviewed” by political appointees.  As an example, Alexander wrote to CDC Director Robert Redfield asking that the agency modify two already published reports that, Alexander claimed, mistakenly inflated the risks of coronavirus to children and undermined Trump’s push to reopen schools.  In another example, a report that hydroxychloroquine was not effective was delayed for several weeks as it was being “reviewed.”
  

The biggest problem here is not so much the confusion that the President is creating about specific issues; it is, rather, that Trump is undermining confidence in precisely those institutions that the country depends upon for objective information and advice untainted by political concerns.  Without those trustworthy sources, the government is free to spew propaganda without fear of objective refutation.  In this upside-down world, any politically inspired assertion has a claim on the truth equal to scientific fact or logical conclusion. 

The President is taking us to the point where there will be no source of information in the government that we can trust to tell the truth.  If the President is telling us that we can no longer trust the experts to tell us the truth about something objective as medical data, what will be the public reaction when we need leadership about something that is truly controversial?  For instance, especially given the growing fear of vaccinations (due in large part to irresponsible propaganda from the anti-vax movement), how many people will refuse to get the vaccine against the coronavirus when it is available?  The efficacy of the treatment of the pandemic will depend upon the trust we have in the institutions and experts who have studied the matter deeply and objectively.

The strength of our democracy depends upon our ability to work together and, ultimately, to trust one another.  Trust in others whom we don’t know, trust in institutions is incredibly fragile.  To the extent our leaders undermine that trust, they undermine our survival as a democracy.