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Political Enough For Government Work
The science doesn't drive health policy. The policy drives the science.
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Most academic scientists spend a lot of time writing grants that have very little chance of being funded. Because the funding environment is so competitive, many scientists feel pressure to emphasize the most positive, sensational results they can produce. Some academic scientists take this too far, by ignoring conflicting results or even fabricating data. Research fraud that goes unreported can upset decades of research, which happened recently in the field of Alzheimer’s research.
What happens if you take away scientific competition? There is indeed a way to do this, and that’s by working in a government agency. Being a government scientist is not a bad deal for a lot of people. The pay is good, the job is secure, and the expectations aren’t high. Securing funding is pretty easy and completely backwards from academia—you often get the funding first and justify it with a “grant” later. The perceived impact of your publications doesn’t matter, any journal is sufficient. In the case of my position at CDC-NIOSH, mechanistic science wasn’t encouraged. Instead, there was a lot of emphasis on toxicology, which simply involves exposing an animal or tissue to a compound or microbe and determining if there is an adverse effect. If there was, going further steps to determine why there was an adverse effect wasn’t necessary. It was a simple exposure, assess, report, rinse and repeat process.
I wasn’t in my government post-doc position long before I realized that government work wasn’t my calling. It’s not that it wasn’t challenging, it was just challenging in the wrong way. Government scientists often spend more of their time fighting government bureaucracy than scientific problems. In such a red tape-clogged system, self-motivated people eventually get discouraged, while unmotivated people get to coast.
There were many examples of bureaucratic dysfunction and waste. In one department, staff members came across a storage room filled with brand new boxes of obsolete computers that had never been opened. No one seemed to know how they got there. Similarly, it wasn’t a rare occurrence to encounter large stores of expensive reagents in a freezer or storage room that had expired without being opened. These examples were simply a function of shifting funding and priorities. Congress would periodically throw money at the agency so everyone could claim they were doing something about a highly visible health problem. If you didn’t spend it, it went away.
In another instance, government officials decided they needed an online travel booking program for employees similar to Orbitz for Business. The result was underwhelming--millions of dollars and years later, there were still serious problems with it that resulted in travel delays. Everyone complained about having to use it. They could’ve just used Orbitz for Business, if only it had been allowed.
At one point, traveling to a foreign country to give a research seminar required giving notice one year in advance. This included the title of the talk. Who knows what they are going to talk about one year in advance?
One of my favorite horror stories about government bureaucracy was about a CDC employee that got fired accidentally by an unnamed bureaucrat. He didn’t even realize he had been fired until one day his paycheck wasn’t deposited and his security badge stopped working. It took months to get him rehired. The great irony of that story is that it’s nearly impossible to fire someone intentionally. I’m not sure how anyone could do it accidentally. But apparently, it happened.
At the CDC branch where I worked, we had a histology core run by a technician that didn’t like his job, and knew he couldn’t get fired. I would send tissue samples and they’d take months to get processed and stained. When I did get them back, there were some curious things about the slides I would notice. Some of the different samples would appear identical on the cut slides. The histology tech was just cutting the same block over and over to make slides and labeling them differently. When I brought up this behavior to my boss, it didn’t surprise him. He told me that the guy was bitter and intended to metaphorically give us all a big middle finger, and there was no way we could stop him. We ended up contracting the nearby university core to do the same work. Meanwhile, worthless histology tech continued to get paid for doing even less.
Once, a CDC pathologist tried to report him for “destruction of government property”. She was one of those self-motivated people who took her job seriously and could be relied upon by others, and at the same time was naïve enough to expect the same. What happened when she raised a stink about lazy histology tech guy? She was reprimanded and labeled a “troublemaker”. Probably because the bureaucrats recognized that her attempt at whistleblowing would just create work for them, and would not actually result in any meaningful change.
Once I got reprimanded by my boss for a reason that I cannot clearly recall. Much like the honorable yet naive pathologist, I was calling BS on something and thus not endearing myself to the front office. Although I can’t recall much of the dressing down I received, one thing he said stuck with me: “You can’t change the system from outside the system,.” He meant it was pointless for someone in my lowly contract position to fight anything, it would do nothing and only hurt me and annoy everyone else. Later, I realized that something he didn’t mention was also true--it’s impossible to advance within the system by promising to change it. If you wanted to advance within the CDC or another government agency, you have to demonstrate your dedication to the status quo. That powerful incentive ensures the system is preserved, with perverse incentives fully intact.
This dynamic was painfully obvious as I watched the government pandemic response unfold. At the beginning, when uncertainty was the greatest, many leaders seemed reasonable and cautioned against panic, because they knew there was a potential for severe collateral damage. Once more particulars about the virus were known, especially the steep age-stratified risk of severe disease, competing political interests emerged, and as a result messaging and decision-making became distorted.
In normal times, large bureaucratic health agencies driven by political interests do not directly affect the daily lives of most Americans. During a natural disaster, however, these agencies will continue to be driven by politics, not public health, because they are not capable of adapting to a crisis. That’s when the cracks begin to show, and everyone is affected.
A prime example is the CDC’s flagship journal Morbidity and Mortality Weekly Report (MMWR). According to the CDC, MMWR exists "...to report events of public health interest and importance to CDC's major constituents---state and local health departments---and as quickly as possible", and to distribute "... objective scientific information, albeit often preliminary, to the public at large".
The key word here is “objective”, which is apparently used unironically. Here are MMWR editors describing how they determine what content is suitable for publication:
Several other differences [between the MMWR and medical journals] exist. A major one is that, unlike medical journals (with a few exceptions, i.e., certain special supplements such as this one), the content published in MMWR constitutes the official voice of its parent, CDC. One sign of this is the absence in MMWR of any official disclaimers. Although most articles that appear in MMWR are not "peer-reviewed" in the way that submissions to medical journals are, to ensure that the content of MMWR comports with CDC policy, every submission to MMWR undergoes a rigorous multilevel clearance process before publication. This includes review by the CDC Director or designate, top scientific directors at all CDC organizational levels, and an exacting review by MMWR editors. Articles submitted to MMWR from non-CDC authors undergo the same kind of review by subject-matter experts within CDC. By the time a report appears in MMWR, it reflects, or is consistent with, CDC policy.
Did you catch all that? There is nothing “objective” about how the CDC determines what is published in their flagship journal. They choose to publish only results that support their policy, and are completely open about it.
This is backwards from how health policy should be determined. Science should drive policy recommendations, yet at the CDC, the policy recommendations drive the science.
Once this fact is acknowledged, much of the more controversial “studies” published in MMWR begin to make complete sense. For example, many mask studies claiming significant universal or school masking efficacy published by the CDC (some that I have previously discussed) were poorly designed and executed and easily debunked by outside observers. That’s because the “rigorous multilevel clearance process” involved no concern with the actual methodology of those studies. There was simply a set of predetermined conclusions from CDC directors in search of supporting data. Nothing objective about it.
Politically driven science at the CDC and other government health agencies was not limited to mask studies. Risks of severe or long COVID and benefits of COVID vaccines in children and healthy adults were also greatly exaggerated. Worst of all, basic tenets of immunology (e.g. infection-acquired immunity) were denied. Immunologists were expected to go along with it. Many did.
Science is a perfect process complicated by flawed human practitioners. Wherever there are people, there will be politics, and wherever there are government health agencies, their political interests will trample any conflicting science. As with any big problem, the first step is admitting there is a problem. After accepting the fact that health agencies are political organizations, the next steps should explore ways to ensure bipartisan administration and remove perverse incentives. Separating research and policy arms of each agency, term limits for administrative positions, and approval of directors by congress might be a good start.
Obviously, no meaningful change in government health agencies is going to happen without overcoming massive bureaucratic opposition. But a meaningful change is the only outcome we should accept, or we can expect more of the same when the next pandemic comes.