The Nation’s Science and Health Agencies Face a Credibility Crisis: Can Their Reputations Be Restored?
This article is part of the magazine, "The Future of Science In America: The Election Issue," co-published by LeapsMag, the Aspen Institute Science & Society Program, and GOOD.
It didn't have to be this way. More than 200,000 Americans dead, seven million infected, with numbers continuing to climb, an economy in shambles with millions out of work, hundreds of thousands of small businesses crushed with most of the country still under lockdown. And all with no end in sight. This catastrophic result is due in large part to the willful disregard of scientific evidence and of muzzling policy experts by the Trump White House, which has spent its entire time in office attacking science.
One of the few weapons we had to combat the spread of Covid-19—wearing face masks—has been politicized by the President, who transformed this simple public health precaution into a first amendment issue to rally his base. Dedicated public health officials like Dr. Anthony Fauci, the highly respected director of the National Institute of Allergies and Infectious Diseases, have received death threats, which have prompted many of them around the country to resign.
Over the summer, the Trump White House pressured the Centers for Disease Control, which is normally in charge of fighting epidemics, to downplay COVID risks among young people and encourage schools to reopen. And in late September, the CDC was forced to pull federal teams who were going door-to-door doing testing surveys in Minnesota because of multiple incidents of threats and abuse. This list goes on and on.
Still, while the Trump administration's COVID failures are the most visible—and deadly—the nation's entire federal science infrastructure has been undermined in ways large and small.
The White House has steadily slashed monies for science—the 2021 budget cuts funding by 10–30% or more for crucial agencies like National Oceanic and Atmospheric Administration (NOAA) and the Environmental Protection Agency (EPA)—and has gutted health and science agencies across the board, including key agencies of the Department of Energy and the Interior, especially in divisions that deal with issues they oppose ideologically like climate change.
Even farmers can't get reliable information about how climate change affects planting seasons because the White House moved the entire staff at the U.S. Department of Agriculture agency who does this research, relocating them from Maryland to Kansas City, Missouri. Many of these scientists couldn't uproot their families and sell their homes, so the division has had to pretty much start over from scratch with a skeleton crew.
More than 1,600 federal scientists left government in the first two years of the Trump Administration, according to data compiled by the Washington Post, and one-fifth of top positions in science are vacant, depriving agencies of the expertise they need to fulfill their vital functions. Industry executives and lobbyists have been installed as gatekeepers—HHS Secretary Alex Azar was previously president of Eli Lilly, and three climate change deniers were appointed to key posts at the National Oceanic and Atmospheric Administration, to cite just a couple of examples. Trump-appointed officials have sidelined, bullied, or even vilified those who dare to speak out, which chills the rigorous debate that is the essential to sound, independent science.
"The CDC needs to be able to speak regularly to the American people to explain what it knows and how it knows it."
Linda Birnbaum knows firsthand what it's like to become a target. The microbiologist recently retired after more than a decade as the director of the National Institute of Environmental Health Sciences, which is the world's largest environmental health organization and the greatest funder of environmental health and toxicology research, a position that often put her agency at odds with the chemical and fossil fuel industry. There was an attempt to get her fired, she says, "because I had the nerve to write that science should be used in making policy. The chemical industry really went after me, and my last two years were not so much fun under this administration. I'd like to believe it was because I was making a difference—if I wasn't, they wouldn't care."
Little wonder that morale at federal agencies is low. "We're very frustrated," says Dr. William Schaffner, a veteran infectious disease specialist and a professor of medicine at the Vanderbilt University School of Medicine in Nashville. "My colleagues within these agencies, the CDC rank and file, are keeping their heads down doing the best they can, and they hope to weather this storm."
The cruel irony is that the United States was once a beacon of scientific innovation. In the heady post World War II years, while Europe lay in ruins, the successful development of penicillin and the atomic bomb—which Americans believed helped vanquish the Axis powers—unleashed a gusher of public money into research, launching an unprecedented era of achievement in American science. Scientists conquered polio, deciphered the genetic code, harnessed the power of the atom, invented lasers, transistors, microchips and computers, sent missions beyond Mars, and landed men on the moon. A once-inconsequential hygiene laboratory was transformed into the colossus the National Institutes of Health has become, which remains today the world's flagship medical research center, unrivaled in size and scope.
At the same time, a tiny public health agency headquartered in Atlanta, which had been in charge of eradicating the malaria outbreaks that plagued impoverished rural areas in the Deep South until the late 1940s, evolved into the Centers for Disease Control and Prevention. The CDC became the world's leader in fighting disease outbreaks, and the agency's crack team of epidemiologists—members of the vaunted Epidemic Intelligence Service—were routinely dispatched to battle global outbreaks of contagions such as Ebola and malaria and help lead the vaccination campaigns to eradicate killers like polio and small pox that have saved millions of lives.
What will it take to rebuild our federal science infrastructure and restore not only the public's confidence but the respect of the world's scientific community? There are some hopeful signs that there is pushback against the current national leadership, and non-profit watchdog groups like the Union of Concerned Scientists have mapped out comprehensive game plans to restore public trust and the integrity of science.
These include methods of protecting science from political manipulation; restoring the oversight role of independent federal advisory committees, whose numbers were decimated by recent executive orders; strengthening scientific agencies that have been starved by budget cuts and staff attrition; and supporting whistleblower protections and allowing scientists to do their jobs without political meddling to restore integrity to the process. And this isn't just a problem at the CDC. A survey of 1,600 EPA scientists revealed that more than half had been victims of political interference and were pressured to skew their findings, according to research released in April by the Union of Concerned Scientists.
"Federal agencies are staffed by dedicated professionals," says Andrew Rosenberg, director of the Center for Science and Democracy at the Union of Concerned Scientists and a former fisheries biologist for NOAA. "Their job is not to serve the president but the public interest. Inspector generals are continuing to do what they're supposed to, but their findings are not being adhered to. But they need to hold agencies accountable. If an agency has not met its mission or engaged in misconduct, there needs to be real consequences."
On other fronts, last month nine vaccine makers, including Sanofi, Pfizer, and AstraZeneca, took the unprecedented stop of announcing that their COVID-19 vaccines would be thoroughly vetted before they were released. In their implicit refusal to bow to political pressure from the White House to have a vaccine available before the election, their goal was to restore public confidence in vaccine safety, and ensure that enough Americans would consent to have the shot when it was eventually approved so that we'd reach the long-sought holy grail of herd immunity.
"That's why it's really important that all of the decisions need to be made with complete transparency and not taking shortcuts," says Dr. Tom Frieden, president and CEO of Resolve to Save Lives and former director of the CDC during the H1N1, Ebola, and Zika emergencies. "A vaccine is our most important tool, and we can't break that tool by meddling in the science approval process."
In late September, Senate Democrats introduced a new bill to halt political meddling in public health initiatives by the White House. Called Science and Transparency Over Politics Act (STOP), the legislation would create an independent task force to investigate political interference in the federal response to the coronavirus pandemic. "The Trump administration is still pushing the president's political priorities rather than following the science to defeat this virus," Senate Minority Leader Chuck Schumer said in a press release.
To effectively bring the pandemic under control and restore public confidence, the CDC must assume the leadership role in fighting COVID-19. During previous outbreaks, the top federal infectious disease specialists like Drs. Fauci and Frieden would have daily press briefings, and these need to resume. "The CDC needs to be able to speak regularly to the American people to explain what it knows and how it knows it," says Frieden, who cautions that a vaccine won't be a magic bullet. "There is no one thing that is going to make this virus go away. We need to continue to limit indoor exposures, wear masks, and do strategic testing, isolation, and quarantine. We need a comprehensive approach, and not just a vaccine."
We must also appoint competent and trustworthy leaders, says Rosenberg of the Union of Concerned Scientists. Top posts in too many science agencies are now filled by former industry executives and lobbyists with a built-in bias, as well as people lacking relevant scientific experience, many of whom were never properly vetted because of the current administration's penchant for bypassing Congress and appointing "acting" officials. "We've got great career people who have hung in, but in so much of the federal government, they just put in 'acting' people," says Linda Birnbaum. "They need to bring in better, qualified senior leadership."
Open positions need to be filled, too. Federal science agencies have been seriously crippled by staffing attrition, and the Trump Administration instituted a hiring freeze when it first came in. Staffing levels remain at least ten percent down from previous levels, says Birnbaum and in many agencies, like the EPA, "everything has come to a screeching halt, making it difficult to get anything done."
But in the meantime, the critical first step may be at the ballot box in November. Even Scientific American, the esteemed consumer science publication, for the first time in its 175-year history felt "compelled" to endorse a presidential candidate, Joe Biden, because of the enormity of the damage they say Donald Trump has inflicted on scientists, their legal protections, and on the federal science agencies.
"If the current administration continues, the national political leadership will be emboldened and will be even more assertive of their executive prerogatives and less concerned about traditional niceties, leading to further erosion of the activities of many federal agencies," says Vanderbilt's William Schaffner. "But the reality is, if the team is losing, you change the coach. Then agencies really have to buckle down because it will take some time to restore their hard-earned reputations."
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A new type of cancer therapy is shrinking deadly brain tumors with just one treatment
Few cancers are deadlier than glioblastomas—aggressive and lethal tumors that originate in the brain or spinal cord. Five years after diagnosis, less than five percent of glioblastoma patients are still alive—and more often, glioblastoma patients live just 14 months on average after receiving a diagnosis.
But an ongoing clinical trial at Mass General Cancer Center is giving new hope to glioblastoma patients and their families. The trial, called INCIPIENT, is meant to evaluate the effects of a special type of immune cell, called CAR-T cells, on patients with recurrent glioblastoma.
How CAR-T cell therapy works
CAR-T cell therapy is a type of cancer treatment called immunotherapy, where doctors modify a patient’s own immune system specifically to find and destroy cancer cells. In CAR-T cell therapy, doctors extract the patient’s T-cells, which are immune system cells that help fight off disease—particularly cancer. These T-cells are harvested from the patient and then genetically modified in a lab to produce proteins on their surface called chimeric antigen receptors (thus becoming CAR-T cells), which makes them able to bind to a specific protein on the patient’s cancer cells. Once modified, these CAR-T cells are grown in the lab for several weeks so that they can multiply into an army of millions. When enough cells have been grown, these super-charged T-cells are infused back into the patient where they can then seek out cancer cells, bind to them, and destroy them. CAR-T cell therapies have been approved by the US Food and Drug Administration (FDA) to treat certain types of lymphomas and leukemias, as well as multiple myeloma, but haven’t been approved to treat glioblastomas—yet.
CAR-T cell therapies don’t always work against solid tumors, such as glioblastomas. Because solid tumors contain different kinds of cancer cells, some cells can evade the immune system’s detection even after CAR-T cell therapy, according to a press release from Massachusetts General Hospital. For the INCIPIENT trial, researchers modified the CAR-T cells even further in hopes of making them more effective against solid tumors. These second-generation CAR-T cells (called CARv3-TEAM-E T cells) contain special antibodies that attack EFGR, a protein expressed in the majority of glioblastoma tumors. Unlike other CAR-T cell therapies, these particular CAR-T cells were designed to be directly injected into the patient’s brain.
The INCIPIENT trial results
The INCIPIENT trial involved three patients who were enrolled in the study between March and July 2023. All three patients—a 72-year-old man, a 74-year-old man, and a 57-year-old woman—were treated with chemo and radiation and enrolled in the trial with CAR-T cells after their glioblastoma tumors came back.
The results, which were published earlier this year in the New England Journal of Medicine (NEJM), were called “rapid” and “dramatic” by doctors involved in the trial. After just a single infusion of the CAR-T cells, each patient experienced a significant reduction in their tumor sizes. Just two days after receiving the infusion, the glioblastoma tumor of the 72-year-old man decreased by nearly twenty percent. Just two months later the tumor had shrunk by an astonishing 60 percent, and the change was maintained for more than six months. The most dramatic result was in the 57-year-old female patient, whose tumor shrank nearly completely after just one infusion of the CAR-T cells.
The results of the INCIPIENT trial were unexpected and astonishing—but unfortunately, they were also temporary. For all three patients, the tumors eventually began to grow back regardless of the CAR-T cell infusions. According to the press release from MGH, the medical team is now considering treating each patient with multiple infusions or prefacing each treatment with chemotherapy to prolong the response.
While there is still “more to do,” says co-author of the study neuro-oncologist Dr. Elizabeth Gerstner, the results are still promising. If nothing else, these second-generation CAR-T cell infusions may someday be able to give patients more time than traditional treatments would allow.
“These results are exciting but they are also just the beginning,” says Dr. Marcela Maus, a doctor and professor of medicine at Mass General who was involved in the clinical trial. “They tell us that we are on the right track in pursuing a therapy that has the potential to change the outlook for this intractable disease.”
Since the early 2000s, AI systems have eliminated more than 1.7 million jobs, and that number will only increase as AI improves. Some research estimates that by 2025, AI will eliminate more than 85 million jobs.
But for all the talk about job security, AI is also proving to be a powerful tool in healthcare—specifically, cancer detection. One recently published study has shown that, remarkably, artificial intelligence was able to detect 20 percent more cancers in imaging scans than radiologists alone.
Published in The Lancet Oncology, the study analyzed the scans of 80,000 Swedish women with a moderate hereditary risk of breast cancer who had undergone a mammogram between April 2021 and July 2022. Half of these scans were read by AI and then a radiologist to double-check the findings. The second group of scans was read by two researchers without the help of AI. (Currently, the standard of care across Europe is to have two radiologists analyze a scan before diagnosing a patient with breast cancer.)
The study showed that the AI group detected cancer in 6 out of every 1,000 scans, while the radiologists detected cancer in 5 per 1,000 scans. In other words, AI found 20 percent more cancers than the highly-trained radiologists.
Scientists have been using MRI images (like the ones pictured here) to train artificial intelligence to detect cancers earlier and with more accuracy. Here, MIT's AI system, MIRAI, looks for patterns in a patient's mammograms to detect breast cancer earlier than ever before. news.mit.edu
But even though the AI was better able to pinpoint cancer on an image, it doesn’t mean radiologists will soon be out of a job. Dr. Laura Heacock, a breast radiologist at NYU, said in an interview with CNN that radiologists do much more than simply screening mammograms, and that even well-trained technology can make errors. “These tools work best when paired with highly-trained radiologists who make the final call on your mammogram. Think of it as a tool like a stethoscope for a cardiologist.”
AI is still an emerging technology, but more and more doctors are using them to detect different cancers. For example, researchers at MIT have developed a program called MIRAI, which looks at patterns in patient mammograms across a series of scans and uses an algorithm to model a patient's risk of developing breast cancer over time. The program was "trained" with more than 200,000 breast imaging scans from Massachusetts General Hospital and has been tested on over 100,000 women in different hospitals across the world. According to MIT, MIRAI "has been shown to be more accurate in predicting the risk for developing breast cancer in the short term (over a 3-year period) compared to traditional tools." It has also been able to detect breast cancer up to five years before a patient receives a diagnosis.
The challenges for cancer-detecting AI tools now is not just accuracy. AI tools are also being challenged to perform consistently well across different ages, races, and breast density profiles, particularly given the increased risks that different women face. For example, Black women are 42 percent more likely than white women to die from breast cancer, despite having nearly the same rates of breast cancer as white women. Recently, an FDA-approved AI device for screening breast cancer has come under fire for wrongly detecting cancer in Black patients significantly more often than white patients.
As AI technology improves, radiologists will be able to accurately scan a more diverse set of patients at a larger volume than ever before, potentially saving more lives than ever.