The article was the first case series in the medical literature to describe the syndrome that we now call AIDS. It was extremely important — both clinically, in that it alerted doctors to think about Pneumocystis carinii when evaluating pneumonia in men who have sex with men, and scientifically, in that it spurred researchers to investigate why these otherwise healthy men were suddenly dying.
In the early 1980s, there was significant stigma attached to homosexuality. President Ronald Reagan had won power in part by mobilizing religious conservatives, many of whom were hostile to gay people. But it’s unlikely the MMWR report’s authors were thinking much about politics when they published their findings. If anything, they were going against the political headwinds of the moment, not bowing to them. They were instead rightly focused on public health.
This is characteristic of the MMWR, known as a trustworthy scientific publication. Its high standards of evidence and its reliability have made it an important source of data for clinicians and public health researchers for decades.
That reputation is now at risk. According to recent news reports, the spokesman for the Department of Health and Human Services, Michael Caputo — a political appointee and protege of Roger Stone who worked as a consultant for President Trump — has tried to force the CDC to delay the MMWRs and coerce the CDC into altering wording on its findings. He has also demanded that the CDC retract published MMWR articles. Caputo’s rationale has been that CDC scientists are part of a “deep state” opposed to Trump’s reelection and that the reports contradict Trump’s statements about covid-19 and make him look bad.
Caputo’s manipulation is appalling. If left unchecked, it could have disastrous consequences for the reputation and reliability of the CDC, which has already been battered by the U.S. response to covid-19. It could also prove devastating for medical practice in the United States more broadly.
Physicians need clear, scientifically reliable information in order to provide our patients with the best possible medical care and maintain their trust. One of the articles Caputo and his team reportedly delayed concerned children who contracted the coronavirus while at summer camp in Georgia — essential information for pediatricians advising parents on group activities.
Another article concerned the lack of benefit of hydroxychloroquine in treating covid-19. Following Trump’s repeated claims that the drug is a promising option for fighting the novel coronavirus, many Americans demanded hydroxychloroquine prescriptions, and the U.S. government stockpiled 63 million doses. The result was a shortage for people who needed the drug for autoimmune conditions such as lupus and rheumatoid arthritis. There are real-life consequences to these political shenanigans: I recently saw a lupus patient whose inability to refill her hydroxychloroquine prescription led to an emergency-room visit for intractable pain.
Caputo’s interference with the MMWR’s covid-19 reporting sets a dangerous precedent for other conditions as well. I frequently consult the MMWR to stay up-to-date on my ongoing research into seafood-related illnesses. What if a future restaurant-industry lobbyist exerts pressure on HHS to suppress unfavorable information about seafood-related outbreaks? If sympathetic political appointees comply, the result could be a series of incorrect diagnoses as doctors fail to recognize patients’ symptoms as seafood-related. Others in the seafood industry would be harmed, too: Transparency and trust in the CDC’s medical literature allow consumers to feel confident that the fish they eat is safe, and that if there is an outbreak, they or their doctors will know about it.
The same applies to covid-19. At a time when there is so much mistrust of government authorities surrounding the pandemic — when one-third of people surveyed said they would not get a vaccine even if it were made available for free — tainting one of the few remaining credible sources of medical information is a recipe for disaster.
Of course, no scientist is infallible — which is why the MMWR has a thorough process for vetting its reports. This rigor is one of many reasons that past presidential administrations have remained hands-off with the CDC’s findings. While Reagan has been criticized for acting too slowly to address AIDS, his Department of Health and Human Services knew better than to undercut the credibility of the MMWR. Imagine how many more lives would have been needlessly cut short if it hadn’t.
Just as doctors in the Reagan era did, those of us in the trenches of clinical practice today need assurance that political hacks aren’t meddling with the MMWR’s guidance. If anything, that confidence has become all the more essential amid the unfolding disaster of covid-19 — and our government’s ongoing bungled response.
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