Editors’ Expressions: Roll With the Changes

You’re one of the world’s top infectious-disease specialists. Your entire career has been defined by a commitment to public health. In 2020 a pandemic emerges, and as per usual, you devote your work to research that will mitigate the threat, find a treatment, a cure, a vaccine.

Like most scientific endeavors, the research isn’t perfect the first time around, and you are obliged to recall and refine some measures, admitting mistakes, while the pandemic continues to rage.

These revisions engender vitriolic reactions in some citizens, who believe for some reason they are being lied to and fed mistruths. They result in threats of violence to you, the scientist, and your family.

Which is why Anthony Fauci, MD, exercising daily with a brisk walk alongside his wife, is now flanked by two beefy federal agents wearing wraparound sunglasses, ready to mitigate any threats to his life.

When I saw news footage of the 79-year-old, 5-foot-7 Fauci and his wife walking along D.C.’s C&O Canal with bodyguards, I was stunned. How have we gotten to a place where a scientist’s life is being threatened?

I recently read a fascinating article in the U.K. newspaper The Guardian that proves this is not a new phenomenon. The author, Ian Leslie, explored another scientific controversy, the one that essentially birthed the low-fat/low-cholesterol diet movement in the 1970s. Turns out the push for a low-fat diet was actually based on shoddy research, which may explain why obesity rates throughout the world have been climbing, not decreasing, since the mid-’80s.

One scientist, John Yudkin, was brave enough to cry foul, postulating that sugar was much more dangerous than fat, but nutritionists and the food industry weren’t having it, and they effectively destroyed his reputation as a scientist. Leslie so aptly observed that “scientific inquiry [is] prone to the eternal rules of human social life: deference to the charismatic, herding towards majority opinion, punishment for deviance, and intense discomfort with admitting to error.”

Do nutritionists now regret this turn of events 40 years ago, or maybe take blame for the obesity epidemic as something they could have turned around? Similarly, are the physicians who were told opioids are not addictive or dangerous fully honest with themselves and their patients, as we now know the truth is the polar opposite?  How does Purdue Pharma feel about their deception?

What will we regret when it comes to how we handled this pandemic? And more broadly, what are EMS’s responsibilities as clinicians, as first responders, as public servants who have a trusted voice when it comes to healthcare?

Physicist Max Planck has been quoted as saying “a new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”

We in EMS have all experienced vehement and stubborn naysayers; sometimes the veterans and more tenured providers need the most convincing to adopt a new protocol, operation, or procedure. But we shouldn’t wait for the old guard to “die”; instead, we must commit to evidence-based medicine. We need to champion the change champions, and we need to support the science. You’ve all seen it firsthand in your own practice, I’m sure: that improvement in EMS is doable, but that it takes work.
When EMS providers have access to the data, when the data is presented and researched properly, it doesn’t lie.

Fauci thinks some of his detractors are angry with him for initially saying masks were not necessary. It is understandable in a global pandemic to want one right answer and not wish to abide any hemming and hawing. But at the beginning Fauci was rightfully worried about surgical and N95 mask shortages for healthcare workers. When science demonstrated cloth masks did indeed help prevent virus transmission, Fauci did what good scientists do: admitted the initial data was not sufficient, that things had changed, and revised his recommendations for the sake of public health and safety.

So, what did you do the last time a protocol or operational change was suggested in your own system? Did you listen with an open mind and request the science behind the change? If you accepted the change and it failed, did you welcome a revision and give it a fair second shot?

We know Fauci’s legacy will be a long one, both revered and reviled, to be sure. When you stop to think about your contributions to EMS, your reaction to change, your willingness to lead and improve patient care, have you also considered: what will be your legacy?

Hilary Gates, MAEd, NRP, is the senior editorial and program director for EMS World.