Truth, Science, and the American Dream

America’s finest moments have been driven by dual commitments to science and ethics.
Dr. Darrell Kirch at Learn Serve Lead 2017
Darrell G. Kirch, MD, addresses attendees from the nation’s medical schools and teaching hospitals at Learn Serve Lead 2017: The AAMC Annual Meeting.
 
The following are abridged remarks delivered to more than 4,500 participants at Learn Serve Lead 2017:  The AAMC Annual Meeting, in Boston on Nov. 5.
 
Recently, one particular issue has been weighing heavily on my mind. That issue is the threat to truth. The kind of threat that comes from opinion masquerading as fact, especially on the web and in social media. The threat of confusing “fake news” with real news. The threat that exists when bias and fear distract and distort a debate. For us, this threat to truth represents a fundamental challenge to science—the science we depend on to reveal truth in medicine. Our patients depend on that truth. 
 
Each time I visit one of our member institutions, I witness the power of science in action. A few months ago, I spent a day at the Joslin Diabetes Center in Boston. For most of history, diabetes meant an early death. But a century ago, medicine found the scientific basis for the disease, leading to the discovery of therapeutic insulin in the early 1920s. Dr. Elliott Joslin, a Boston physician with a deep commitment to patients with diabetes, was a pioneer in the use of insulin and in care models that finally allowed patients to manage their diabetes effectively. 
 
During my visit I learned that, as survival rates for diabetes improved, the center established the Joslin Medalist Program to recognize those rare patients who successfully managed diabetes for 25 years—something that once seemed impossible. Then, as science progressed, the Joslin Medalist Program expanded, giving 50-year medals and 75-year medals. In 2013, Joslin recognized the first 80-year Medalist, a man diagnosed when he was eight years old. In just a few decades, the truth revealed by science enabled people with diabetes to live their lifelong dreams. 
 

Sunday, November 05, 2017

Truth, Science, and the American Dream

Darrell G. Kirch, MD, delivers his Leadership Plenary address at Learn Serve Lead 2017: The AAMC Annual Meeting.
But building scientific evidence is not enough. We need to match our science with an ethical commitment to ensure that all patients benefit from that research. When we fail to translate our science—when society reacts with neglect or with bias and fear—we lose the power of science to help our patients. 
 
Bias and fear are the enemies of the truth revealed by science. And worse, they make it difficult, if not impossible, for patients to achieve their dreams. We know bias leads to significant disparities in care for minority populations. Research shows that physicians’ conscious and unconscious biases affect how they treat patients of different races. For minority patients, these biases result in worse health outcomes. The message is clear. We need to match our growing base of scientific evidence with an equally compelling ethical commitment to apply that evidence fairly and equally to all our patients. 
 
I am concerned that today we face a growing threat to science, to truth, and to our ethics. In 2016, the Oxford English Dictionary selected “post-truth” as its word of the year, defining the term as “relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief.” When we fail to embrace the truth of science and we let bias influence patient care, we contribute to an environment in which important decisions are based on emotion and personal belief, rather than on evidence and facts. When this becomes widespread in our culture, across our media landscape, and in our policy discussions, our patients suffer.
 
In the name of those hopeful patients and their families who so courageously participate in our research studies, I refuse to live in a post-truth world. I believe in truth. I believe science reveals the truth in medicine. I believe our ethical foundation gives us the compass to apply that truth wisely for the good of our patients. 
 
We have seen the damage that a post-truth attitude causes. The Centers for Disease Control and Prevention (CDC) has been barred from researching the public health effects of firearms since 1996. The anti-vaccine movement has been putting lives at risk since 1998, when our community let down its guard and allowed junk science to pass through our peer-review system and be published in a highly respected journal. And more recently, this year’s divisive showdown over the Affordable Care Act was based more on the emotion-laden, partisan politics of “repeal and replace” than on evidence about ways to improve the health of the American people. 
 
“I refuse to live in a post-truth world. I believe in truth. I believe science reveals the truth in medicine.”
To see our national conversation descend to a place where facts are in question and “fake news” creates a fog concerns me for another reason. For us as individuals and for our nation, our American dream—and the dreams of countries around the globe—were realized through science and innovation. Science has propelled us to incredible achievements—from walking on the moon to being on the cusp of eliminating polio from the planet. We will always have political differences in our nation. But America’s finest moments have been driven not by politics; they have been driven by relying on science to reveal the truth. 
 
But I see encouraging signs that we are reasserting the authority of science in our national debates. Last April, more than one million people in 600 cities around the world marched for science. In September, hundreds of you walked the halls of the Capitol in Washington as part of the “Rally for Medical Research Hill Day” to support NIH funding. And 60,000 of our students and residents have spoken out on key health care policy issues through our AAMC Action grassroots network. It is that kind of passionate defense of science and evidence that will carry the day. Think how far we have come in science. Think how much farther we can go. Someday soon, someone with diabetes will receive their 100-year Joslin Medal.
 
As the late Senator Daniel Patrick Moynihan once said, “Everyone is entitled to his own opinion, but not his own facts.” We need to rise above that and occupy the high ground of evidence and ethics. That is when truth prevails. And that is how each of us—and each of our patients—can realize our dreams.