Mistaking Politics for Science
Terry H. Schwadron
May 19, 2023
Overlapping news reports poured in this week to confirm that, as a society, we have replaced scientific, medical thinking with outright partisan politics — even as the proponents of doing so exclaim that it was partisan politics that forced the medical messes in the first place.
For openers, we are looking for medical findings in court filings and legislative bills rather than to doctors, practitioners, and regulators of clinical test information. And, if some of us are not getting the answers we want not only for ourselves but for everyone, we take it all to the next court and the next legislature.
It is a spiraling mess that suggests we consider daily life too complicated, and it seems apparent that a good chunk of the country wants someone to reset rules to match our biases.
In New Orleans, the federal appeals court hearing an appeal from that single Texas federal judge who decided he knew better than the Federal Drug Administration what kind of clinical tests were necessary 20 years ago to approve user of medical abortion pills was busily taking apart Biden administration arguments to keep the drug as a safe medication. The three judges showed what reporters heard as discernible sympathy for the arguments that the FDA had erred in judging safety, despite the two decades of use.
Of note was the argument of Judge James Ho, a Donald Trump appointee, that courts have every right to revisit FDA decision-making as they do with any agency. “We are allowed to look at the FDA just like we’re allowed to look at any agency. That’s the role of the courts,” he said from the bench.
Actually, the questions before the court in this case involve determination of fact — as determined by medical clinical information rather than by attitude toward the use of the drug mifepristone to allow abortion by pills available in person or through the mails. The main legal issue surfacing in the case — whether the ad hoc anti-abortion group that had formed only to file this challenge to the drug has “standing” before the court — is a question these judges seemed to waive away.
The scientific certainty for safety argued by Danco, the manufacturer, and the FDA, has been backed by teaching hospitals, medical associations, health experts and studies.
The whole case is certain to go the U.S. Supreme Court on appeal, regardless of the circuit court findings.
The point is the balance among law, medicine and scientific fact-finding is clearly giving way to political overlay of government-imposed values.
Growing Number of Examples
In Texas, meanwhile, a bill passed by the Republican-dominated state legislature became the 18th state and the most populous to bar hormone and puberty blocking treatments and surgeries for transgender minors.
With exceptions for those already in treatment — ordered by this legislation to switch medications to wean themselves over an unspecified time — the bill would halt all medical help or procedures performing mastectomies or surgeries that would sterilize a child or remove otherwise healthy tissue or body parts, or from prescribing drugs that would induce transient or permanent infertility.
Again, stepping back from the moral or even values questions here, we see legislators telling doctors their business.
A similar bill in Florida that just passed another Republican-controlled legislature not only barred treatments for transgender minors but established a new set of felony criminal charges for those who offer services. Indeed, State Bill 1580 allows doctors, nurses, pharmacies, hospitals, mental health providers, medical transport services, clinical lab personnel, nursing homes, and other licensed health care professionals and providers to discriminate and deny coverage or care based on any moral, religious, or philosophical differences.
The American Counseling Assn. notified members that this statement contradicts the professional association’s code of ethics to offer counseling services to anyone requesting them,
The irony of this law coming as there are national concerns about our mental health crisis are astounding, But the hypocrisy of the law coming from legislators whom one would think would want to encourage more counseling over gender fluidity questions rather than less is striking.
The zeal to replace political positioning for medical consideration has become a runaway train.
Abortion as a Values Yardstick
In South Carolina, that Republican-majority state House again has voted to limit legal abortion — this time to six weeks, as in Florida, a time period in which many women don’t even recognize pregnancy. There are exceptions for incest and rape only if a police report or restraining order can be shown,
But here’s the weirder part. The state’s top court ruled in January that the state Constitution guarantees a right to abortion and struck down a previous six-week ban. Then, the state’s only woman justice retired, and was replaced by a male judge supported by the House’s Freedom Caucus.
So, the inevitable court battle here will serve as a direct test of whether it is the law or politics — to say nothing of medicine — that will dictate the outcome.
Indeed, to preserve the independence of the judiciary, we allow judicial candidates to avoid having to say where they stand on issues facing their respective courts all while recruiting and politicking like crazy to get a bench majority of people willing to look at precedent, law, agency power or medicine in ways that match our predisposed values.
These legal and legislative skirmishes in our continuing culture wars are a direct result of flaws in our democracy that increasingly are creating partisan gerrymandering, district line-drawing, a widening rural-urban split and so forth. The continuing polling that shows overwhelming support for abortion rights and the number of tangible election outcomes in Kansas, Wisconsin, Michigan, and other states where the question comes to voters mock the insularity of these Republican-dominant legislatures.
It is crazy that abortion, transgender treatment, or other medical procedures should vary from state to state, and crazier yet that politicians beholden to anti-abortion forces should use every legal excuse to eliminate reliance on scientific or medical information for decision-making.
It’s no wonder why artificial intelligence software is drawing such interest.
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