[When medicine doesn’t focus on prevention, anti-vaccination
rhetoric flourishes. It’s time to address the system.]
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WHY DON’T AMERICANS BELIEVE IN SCIENCE?  
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Philip Eil
November 30, 2023
The Nation
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_ When medicine doesn’t focus on prevention, anti-vaccination
rhetoric flourishes. It’s time to address the system. _

, Lev Radin / Getty Images

 

Early last month, the scientist and medical researcher Dr. Peter
Hotez shared a photo
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depicting a law enforcement officer leading two bomb-sniffing dogs
through an empty lecture hall. An American flag stood in the corner.
Hotez’s caption read: “Dog sweep prior to my next @Yale lecture
this afternoon. Our/my new normal.”

At the time, he was on tour for his newest book, _The Deadly Rise of
Anti-science: A Scientist’s Warning_
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which attempts to explain how our nation has descended into a Dark Age
in which scientists are cast as enemies and “conspirators with
global elites to acquire vast wealth and power.” In his book, which
Hotez wrote during the Covid-19 pandemic, he explains that while
anti-science forces aren’t new, in recent years they have become
more organized, better funded, and embraced by more high-profile
politicians such as Ron DeSantis and Marjorie Taylor Greene, as well
as pundits who reach millions like Tucker Carlson and Sean Hannity.
“This was no longer small nongovernmental groups monetizing the
internet,” he told me in a recent interview. “This was full-on
adopted as a platform of a major political party in the United
States.”

In _The Deadly Rise of Anti-science_, Hotez focuses most squarely on
the driving force of this era’s anti-science movement: the Covid-19
pandemic. He estimates that 200,000 Americans died preventable deaths
during the Delta-variant surge of 2021 simply because they shunned
vaccination. These lost lives, he writes, were “an orchestrated
product of a networked political ecosystem of anti-science
extremism.”

Hotez is well-positioned to raise alarms about anti-science. He is a
physician scientist who, for both personal and professional reasons,
was publicly defending vaccines long before Covid-19. In 2018, he
published the book _Vaccines Did Not Cause Rachel’s Autism: My
Journey as a Vaccine Scientist, Pediatrician, and Autism Dad_
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Throughout the latest pandemic, he was a tireless source of medical
expertise for print, radio, online, and TV news outlets. As a result
of this visibility and advocacy for vaccines, he “became a new
favorite target for the far-right” he explains. He got menacing
voicemails. He was accosted at home. He received e-mails calling him
an “enemy of the United States Constitution” and vowing, “I will
celebrate the day I see you hanging from the gallows.”

He was not alone. Nearly two in five Covid scientists reported similar
attacks via phone, e-mail, social media or in person, according to
Hotez. As a result, many experienced anxiety, depression, fears for
their safety, and a decline in productivity. What’s worse, Hotez
warns that Covid is not the end of this. “We should expect it will
spill over to other areas,” he writes, “with a resulting drop in
immunization rates for all childhood vaccines and interference with
many other aspects of public health, including global efforts to
combat HIV/AIDS, malaria, tuberculosis, and neglected tropical
diseases.”

_The Deadly Rise of Anti-Science_ foretells a worrisome future for
vaccines in America—but it also opens up larger questions about our
healthcare system. It is hard to list all of the urgent issues. As
a recent _Washington Post_ series explores
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life expectancy in the US has been declining for years. Meanwhile, the
nation’s rates of infant and maternal mortality outpace other
high-income countries
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Americans hold almost $200 billion in medical debt
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and prescription drugs cost so much that people routinely choose not
to take them for financial reasons
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suffering dire health outcomes instead. Physicians are burning
out, trying to unionize
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and leaving the profession altogether, while hospital executives
collect eye-popping salaries
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Amid it all, glaring race-based disparities in health outcomes
persist
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Is anyone fully insulated from this dysfunction? As a longtime adjunct
college instructor, I’m all too aware of how health insurance is
linked to full-time employment. And I, too, am scared and angry about
right-wing anti-science. But what _The Deadly Rise of
Anti-Science_ doesn’t answer is how we might address the rise of
anti-science while also working to fix the bigger, systemic issues
that loom behind the problem Hotez calls a “terrible monster.”

Gillian Mason, director of communications at the advocacy organization
Healthcare-NOW says she’s actually surprised that more people
haven’t been anti-science throughout the country’s history.
From scientific racism
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the Tuskegee Syphilis experiments
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to push OxyContin onto doctors and their patients, “science has
traditionally been used and weaponized against working people and
people of color,” she says.

Dr. Ashish Jha, dean of Brown University’s School of Public Health
and former White House Covid-19 response coordinator, offered a recent
example of how this works: Robert F. Kennedy Jr.—who announced last
month that he’s running as an independent in the 2024 presidential
election—is targeting marginalized groups with his anti-vaccination
message. In 2021, he produced a documentary called _Medical Racism:
The New Apartheid_, which NPR described
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“resurfac[ing] and promot[ing] disproven claims
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the dangers of vaccines…[and] aimed squarely at a specific
demographic: Black Americans.” With this film, Jha says, Kennedy
takes “that mistreatment [and] the mistrust…and drives his
anti-vaccine message through.” And he is not to be dismissed:
A recent Quinnipiac poll
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Kennedy with 22 percent support in a hypothetical three-way race with
Donald Trump and Joe Biden.

One place where doctors may be able to persuade science-hesitant
patients is in primary care, where patients go for regular checkups
and other day-to-day healthcare needs. But according to a recent
report by the National Association of Community Health Centers
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over 100 million Americans face barriers to accessing this care in the
first place, and thus may rarely come face-to-face with a real medical
professional. A 2020 survey by the Commonwealth Fund
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that less than half of American adults have a long-standing
relationship with a primary care provider. Dr. Vineet Arora
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Medical Education at the University of Chicago’s Pritzker School of
Medicine, tells me that when people can’t find or access a doctor,
they seek other sources of info. “They’re gonna go to their
community member or social media or chat GPT, or whatever podcast that
they’re listening to” she says.

The crisis in primary care can’t be easily separated from other
systemic issues. A lack of patient access to primary care also has to
do with a supply issue, as it usually pays less than specialties in
the medical field, which makes it less appealing to medical students,
many of whom are trying to climb out from under mountains of student
debt.

And the crisis in primary care is actually part of a bigger crisis of
preventive care, as our entire healthcare system is geared more toward
fixing problems than preventing them. When medicine doesn’t focus on
preventing problems, anti-science flourishes, which, according to
Arthur Caplan, a professor of bioethics at New York University’s
medical school, is how we ended up with a booming “wellness”
sector that’s often conspicuously lacking in medical rigor and
scientific grounding. When “the money is on the ‘fix-it’ end of
the street,” Caplan says, our system will also inevitably play
catch-up on massive prevention campaigns like Covid vaccines.

Of course, it’s impossible to have this conversation without
discussing the very nature of the US fee-for-service system
itself. Millions of Americans face healthcare debt
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and many are choosing between paying medical bills and buying basic
necessities
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This isn’t a good foundation for a trusting relationship. And when
people seek treatment for themselves or their loved ones, the care
they receive is often disjointed, expensive, and alienating.

Frederick Isasi, executive director of the healthcare consumer
advocacy organization Families USA [[link removed]], tells
me that our system often incentivises profits and high-margin services
over quality and overall health outcomes. The results are predictable:
“Over time, what we’ve seen is that people’s level of
satisfaction, their level of trust, is really eroding,” he says.

And it isn’t just patients who are frustrated. Dr. Arghavan Salles
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professor at Stanford Medical School who spent time treating Covid
patients in emergency wards at the height of the pandemic, described
the current strains on doctors trying to navigate a deeply flawed
system. Well-intentioned physicians are often hamstrung by obligations
and responsibilities in a system where workers at every level are
“overwhelmed and overworked,” she says.

Patients don’t see what Salles describes as the “constant
struggle” that doctors face behind the scenes to meet their various
obligations. All too often, a patient only sees a rushed visit where
they didn’t get all of their questions answered or perhaps felt
brushed off. And this, in turn, leads to more disillusionment and
distrust.

“I think there’s a transference of seeing how deeply flawed our
healthcare system is and needing someone to blame it on and the person
you’re seeing often is the physician,” she says. “So that’s
who you blame.”

Dr. Hotez, for all of his staunch defense of vaccines, is no apologist
for the status quo_ _in American healthcare. We have one of the most
expensive and least efficient of any industrialized nation. “It is a
broken system;_ _there’s no question about it,” he said. In our
interview, he was incredulous that Pfizer and Moderna, after receiving
tens of billions of US taxpayer dollars for development costs and
purchases of their Covid vaccines, had proceeded to jack up the prices
for those jabs. “I mean, do you want people to hate you?” he said.
(Here, too, RFK Jr. has found a point of attack; in a recent
interview [[link removed]], he called the
pharma industry a “criminal enterprise.”)

Hotez’s advice for how we can fight anti-science _and _fix our
healthcare system is to be more intentional and specific in how we
talk about these issues. In particular, we must separate actors that
vaccine opponents are all too eager to conflate.

Vaccines are often developed by medical scientists at the academic
health centers who “are working day and night trying to develop new
cures, new vaccines, and [working] very much with a humanitarian
drive,” Hotez says. Before those vaccines are recommended for the
general public, they must pass through an “advanced monitoring
system” at the CDC and FDA that has been built over decades. “That
shouldn’t be conflated with the greed from the pharma companies,
which is real,” he said.

As Gillian Mason notes, our efforts to build trust in science can’t
just be better and louder explanations of the facts themselves. We
need to reckon with painful histories of harm, bias, and mistreatment.
“The problem isn’t necessarily with the science,” she says.
“It’s with the institutions that have weaponized science in the
past.”

_PHILIP EIL is a freelance journalist based in Rhode Island. He was
the news editor and staff writer at the alt-weekly, the Providence
Phoenix, until the paper closed in 2014. Since then, he's contributed
to VICE, the Atlantic, Men’s Health, The Nation, Boston Magazine,
and Huffington Post, among other outlets. His debut book, Prescription
for Pain: How a Once-Promising Doctor Became the "Pill Mill Killer"
will be released in April 2024._

_Copyright c 2023 THE NATION. Reprinted with permission. May not be
reprinted without permission
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Distributed by PARS International Corp
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_Founded by abolitionists in 1865, The Nation has chronicled the
breadth and depth of political and cultural life, from the debut of
the telegraph to the rise of Twitter, serving as a critical,
independent, and progressive voice in American journalism._

_Please support progressive journalism. Get a digital subscription
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* Science
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* ultra-right
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* COVID-19
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* vaccines
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* Health Care
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* Racism
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* primary care
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* preventive care
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