Public Trust in Science and the Future of Cancer Care Is Crucial

Maurie Markman, MD

Few would disagree with the statement that we live in complex times. Although there is no intent here to further discuss the continuing effect of the COVID-19 pandemic, the scientifically undeniable current and future effects of climate change, or the ever-expanding misinformation regularly reaching all members of our society through interactions with social media platforms, it would be an error of great consequence to ignore these factors in the future. Finally, although it is difficult to assign any one cause to disturbing results of population-based public health outcomes, the trends must be considered worrisome.

Consider, for example, a 2023 report from the National Vital Statistics System that in 2021 maternal mortality in the United States (32.9 deaths per 100,000 births) was at its highest level in more than 50 years. The US topped the list for risk of such deaths, higher than any other “high-income country.”¹ In addition, recent CDC data revealed a 3% increase in infant mortality from 2021 to 2022, the first such increase in decades.²

Also, consider the recent report from the CDC that noted that “exemptions” from the requirement to receive essential childhood vaccinations increased in 40 states for the 2022-2023 school year compared with the previous reporting period. In addition, 10 states permit an exemption for at least 1 vaccine in more than 5% of kindergarten students.³ Although the overall national rate of vaccination in this critical age group (nearly 93%) remains high, it is the trend that is concerning.

With this in mind, this commentary focuses on the role the scientific and public health communities must play in this evolving societal environment, specifically in the cancer arena.

It is difficult to overstate the relevance of the degree of trust the public has for national and local public health representatives in ensuring critical health-related messages will be heard, understood, and appropriately acted upon. Unfortunately, our society is at a critical juncture where this expertise and leadership are both regularly and often vigorously challenged.

Of course, factors outside the direct control of the scientific and public health communities have contributed to the current state of affairs, including the effect of pandemic-related continually evolving events as well as national/local decisions with major economic and societal consequences (school and business closures, mask mandates). In addition, the rapid expansion and ease of use of a variety of artificial intelligence programs have made it much easier for a limited number of individuals or groups who desire to spread health-related misinformation to succeed.⁴

However, it must also be acknowledged that the current source of tension between a substantial segment of society (including many local and national elected officials) and the scientific and public health communities is the result of specific actions that have only served to heighten the disagreements. For example, meaningful questions have been raised regarding the effectiveness of continued mandates for COVID-19 vaccination on public or even individual health.⁵ Equally relevant issues are events that simply challenge and raise questions within the public’s mind for the basic integrity of the scientific process, including claims of objectivity for the often vigorously lauded peer-reviewed process. The newsworthy retractions of high-profile publications, as well as reports highlighting the increasing overall number of withdrawn papers, can only increase the public’s concern for the validity of scientific claims.⁶

Further, it is relevant to note the historically opaque scientific literature and the rather rigid approach to defining the quality of evidence. As a result of greater public access to this literature, less-than-optimal or poorly considered scientific communication and commentary can lead to the rapid spread on a variety of social media platforms of misleading interpretations of what has been stated in even high-impact peer-reviewed publications.

Consider a report published recently in the highly regarded Cochrane Database of Systematic Reviews that examined evidence supporting the clinical utility of mask mandates.⁷ When reaching their conclusions regarding the overall impact, the authors found very limited randomized trial data that documented the benefit of this public health strategy, and they chose to ignore other evidence that solidly supported this strategy.

As noted by Naomi Oreskes, PhD, the Henry Charles Lea Professor of the History of Science at Harvard University in Boston, Massachusetts, in her blistering commentary on the topic, “Cochrane ignored this epidemiological evidence because it didn’t meet its rigid standard. I have called this approach ‘methodological fetishism,” when scientists fixate on a preferred methodology and dismiss studies that don’t follow it. Sadly, it’s not unique to Cochrane. By dogmatically insisting on a particular definition of rigor, scientists in the past have landed on wrong answers more than once.”⁷

Tremendous success has been documented in our efforts to improve cancer outcomes, notably a recently reported 33% reduction in cancer related death rates in the United States since 1991, which translates into an estimated 3.8 million deaths averted.⁸ Despite this widely acknowledged impressive past success, the issue being raised in this commentary is for the future of cancer care, early detection, and critically important prevention.

A recently published JAMA editorial related to the future of artificial intelligence in health care noted the “total administrative spending in the US is estimated to be up to 1 trillion dollars a year, more than the spending for the entire health care systems in Germany, France, and Italy combined.”⁹ Add to this profound dysfunction and enormous financial strain on the US, the rapidly rising costs of new antineoplastic agents, as well as the impact of an aging population with an anticipated higher cancer incidence, and it is not difficult to conclude our society must somehow discover alternative approaches to influence malignancy-associated outcomes.¹⁰

Effective communication to the public regarding the known benefits of well-established screening strategies and other approaches to prevent or reduce the risk of cancer or its recurrence, such as smoking cessation, human papillomavirus vaccination, or even regular exercise, may offer the realistic potential to produce a highly cost-effective impact on both cancer incidence and outcomes.

But in the face of the tsunami of misinformation as well as the current state of trust of the scientific and public health communities, is the public going to listen to what they have to say?¹¹ And what might be done to favorably change the situation?

References

1. Declercq E, Thoma M. Measuring US maternal mortality. JAMA. 2023;330(18):1731-1732. doi:10.001/jama.2023.19945
2. Whyte LE. Jump in infant mortality rate reverses long decline. November 1, 2023:A2.
3. Seither R, Yusuf OB, Dramann D, Calhoun K, Mugerwa-Kasujja A, Knighton CL. Coverage with selected vaccines and exemption from school vaccine requirements among children in kindergarten – United States, 2022-23 school year. MMWR Morb Mortal Wkly Rep. 2023;72(45):1217-1224. doi:10.15585/mmwr.mm7245a2
4. Mims C. The rise of artificial intelligence is causing the decline of truth. Wall Street Journal November 11, 2023:B2.
5. Vogel G. Do COVID-19 vaccine mandates still make sense? Science. 2023;379(6637):1072-1073. doi:10.1126/science.adh7971
6. Subbaraman N. What’s wrong with peer review? November 11, 2023:C5.
7. Oreskes N. Masked confusion. Scientific American.2023;329(4):90. doi:10.1038/scientificamerican1123-90
8. Siegel R, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. doi:10.3322/caac.21763
9. Schulman KA, Nielsen Jr PK, Patel K. AI alone will not reduce the administrative burden of health care. JAMA. Published online November 16, 2023. doi:10.1001/jama.2023.23809
10. Chen S, Cao Z, Prettner K, et al. Estimates and projections of the global economic cost of 29 cancers in 204 countries and territories from 2020 to 2050. JAMA Oncol. 2023;9(4):465-472. doi:10.1001/jamaoncol.2022.7826
11. Schillinger D, Baron RJ.Health communication science in the balance. JAMA. Published online July 31, 2023. doi:10.1001/jama.2023.14763