Follow the Science? Only if Good Policy is the Goal

"Follow the science” has become a phrase – much like “death panels,” “critical race theory” and the mask-Nazi nonsense – the demonizes issues not for the sake of discussion, but for the sake of dismissing all the thought that should be invested in evaluating policy on complicated topics like health reform, teaching the history and current impact of racism in the US and, of course, the importance of public health. That this rhetorical sleight-of-hand comes from those who should know better and have influence makes it all the more discouraging.

Should science dictate decisions that legitimately are in the public policy domain? Of course not. But should policymakers consider the best scientific evidence when decisions are made? Absolutely. And when science evolves, should policymakers be smart enough and brave enough to change the policy? Of course.

A case in point is tobacco. The policy of this country for generations wasn’t just to take a hands-off approach to tobacco, but to actively support and promote tobacco. Cigarettes were part of military ration kits, tobacco was a heavily subsidized agricultural crop and smoking was permitted in every public space. The scientific knowledge that cigarette smoking is hazardous is not new. Harper’s Magazine ran a cartoon on the danger of secondhand smoke in the 1850s. Cigarettes have been called “coffin nails” for at least 150 years. And the trove of documents discovered through the tobacco litigation revealed that the tobacco companies themselves had incontrovertible scientific evidence of how addictive and carcinogenic tobacco was for decades before they were forced to release the information.

Policymakers chose not to follow the evidence until many people demanded that we have reasonable and fact-based conversations about the impact of tobacco on people’s health. Bit by bit, public policy did indeed follow the science. Countless millions of lives have been saved as a result.

Following the science does not compel policymakers to make decisions based only on what leading scientific experts in a particular field are advising. Policymakers, though, should be compelled to take into consideration all the evidence. Science can tell us about the impact of certain emissions on human health and the environment. Policymakers may choose to ignore those factors, weighing economic considerations more heavily, for example. But to exclude human and environmental impacts from their calculations, as the Trump Administration sought to do by executive order, is bad science AND bad policymaking.

So that brings us to Covid and vaccines, because it is there that “follow the science” has become the pejorative du jour. Science tells us unequivocally that the vaccines are safe and effective. Yes, the vaccines don’t prevent all infections. No vaccine does. They do prevent almost all serious illnesses and deaths. The vaccines are safe. Billions have been administered and there have been few documented cases of adverse effects. Those who say otherwise typically point to the CDC’s Vaccine Adverse Effect Reporting System (VAERS) without understanding what this file actually is – a collection of self-reported health events – and what it isn’t – validated and documented links between a vaccine and an adverse effect.

Should policy follow the science on vaccines? Absolutely. The role of public policy in fighting the pandemic is to determine how to implement a vaccine policy fairly, effectively and with due consideration of individual rights and liberties. In fact, policy does that all the time with health issues, from requiring people in certain jobs to have routine physical examinations. For example, airline pilots-in-chief are required to take an annual physical exam and be certified based on the exam by a federal agency. The exam is not for the pilot as much as it is for the people around the pilot – people typically called passengers.

There are many examples of actions required to protect the general health and welfare of a larger public. Children are mandated to be vaccinated for MMR, polio and other conditions (and, by the way, many of these vaccines require boosters) before attending school, for example.

In these cases, policymakers wisely “followed the science.” They determined that the rights of children to have a safe and healthy school environment prevailed against the liberty of families to not vaccinate. Today, most states don’t allow smoking in public places because in following the science, public policy acknowledged that not only is smoking harmful to the smoker but the secondhand smoke damages others.

Following the science does not mean that policymakers blindly go down every path proposed by every person with science training. Rather, we look to experts acting on our behalf – the CDC, NIH, etc. – to act as our advocates and intermediaries. Policymakers should demand that evidence of science affecting health, for example, is validated through randomized, peer-review studies conducted by credible organizations. Similar standards should be demanded in other areas of science.

Yes, science has made mistakes. More often, science has evolved. That is the nature of human endeavors. We keep learning. We keep growing. And we ask our leaders to apply the best current knowledge in the most beneficial way. We ask them to follow the science when science points us in a clear direction.