11.3 Censorship in Medicine: Politics in Science

These proceedings summarize the educational activity of the 16th Biennial Meeting of the International Andreas Gruentzig Society held January 31-February 3, 2022 in Punta Cana, Dominican Republic

Faculty Disclosures     Vendor Acknowledgments

2022 IAGS Summary Document

Statement of the problem or issue

Censorship in science and medicine is not new. In the 15th Century, the Catholic Church prevented certain medical books from being placed on library shelves, and had published periodically a list called “The Index” of the banned medical volumes. In the 21st Century, medical censorship has become much more complex due to improved methods of communication through increased numbers of medical journals, the internet, instantaneous television, printed news, and print or digital forms of social media. Censorship is defined as the suppression of words, images or ideas deemed as “offensive” or “absurd.” A close cousin of censorship is bias, defined as prejudice in favor of or against one idea compared with another in a manner considered unfair. Interestingly, different types of social media have been helpful as well as harmful in combatting scientific bias and censorship. Bias and censorship are antithetical to the scientific method which attempts to advance science through open dialogue, argument, and eventual proof or rejection of an hypothesis. Worse still, in today’s highly polarized world, politically motivated censorship is now even more prevalent, and was particularly evident during the recent pandemic.

One can view the spectrum of censorship in science and medicine as: (1) bias or censorship against new ideas; (2) bias or censorship against individual papers, procedures, or concepts; (3) bias or censorship against entire journals and communication channels; and (4) bias or censorship that is politically motivated in general.

An illustrative example of bias/censorship of a new idea is the saga of Dr Barry ­Marshall, a gastroenterologist (GI) in Australia who theorized that the bacterium H. Pylori was an etiologic agent causing gastric ulcer disease. The prevailing dogma at the time was that ulcer disease was due to cigarette smoking, stress, and alcohol consumption. Marshall’s hypothesis was considered “absurd” by prominent GI physician-scientists of the time, and his work gained no traction. He could not develop an animal model of ulcer disease to test his hypothesis, so after undergoing an upper endoscopy demonstrating no H. Pylori in his own gastric biopsies, Marshall then drank a slurry of broth containing H. Pylori bacteria. Very soon afterwards he developed biopsy-proven ulcer disease. It was only through a highly salacious form of social media at the time, Star Magazine, that would publish his story, as the “Human Guinea Pig Doctor.” This article in Star helped break through the censorship of his ideas and provide an outlet for his work. Ultimately, Marshall and his research partner, Dr Robin Warren, won the Nobel Prize in Medicine in 2005 for their seminal work on H. Pylori in gastric ulcer disease.

Likewise, the story of Dr Andreas Gruentzig is very similar to Dr Marshall, and much more recognizable in the cardiovascular field. However, some details of early bias against percutaneous transluminal coronary angioplasty (PTCA) are not as well known. While Dr Gruentzig’s successes in peripheral and even renal angioplasty were applauded and fairly well recognized, many of the prevailing cardiologists and angiologists believed the dogma that percutaneous angioplasty could never work in the heart. Gruentzig’s hypothesis that PTCA was safe and effective was felt by many to be “absurd.” His own Chief of Medicine hindered admission of patients to the hospital for the procedure, and his scientific papers were overly scrutinized—some would say reviewers were biased against his theory. Again, a highly sensational German publication, Schweizer Illustriete, with a cover page using a partially clad female model with body paint depicting a PTCA, highlighted the new procedure in paparazzi-type fashion. This article helped publicize the technique and Dr Gruentzig eventually overcame the bias and censorship against his novel procedure.

Another form of bias is levied against entire journals. In today’s world, the scientific method of discussion, with reasoned argument and evidence proving or refuting a proposed hypothesis, frequently occurs in an online forum facilitated through scientific journals. MedLine, the well-known medical search engine, has a literature selection committee that has the power to allow or prevent entry of any specific scientific journal into the MedLine registry. Certain general-interest periodicals like Time Magazine, which have very little or no original scientific content, are present on MedLine, while other serious scientific journals are excluded. One such excluded periodical is the Journal of Nutritional and Environmental Medicine, the official journal of the British, Australian, and American Societies for Ecological Medicine. This form of censorship is rather blatant, and it prevents new ideas in nutritional and environmental medicine from being discussed, referenced, or easily accessed by other physician-scientists.

During the COVID-19 pandemic, political polarization has resulted in outright bias and censorship regarding multiple scientific and medical issues. One example from Great Britain involved the scientific advisory group for emergencies (SAGE). The SAGE group had very few under-represented minorities involved in medical policy decisions. The SAGE group was aware that minorities and women had higher mortality rates from COVID-19, and yet these groups were not represented on the committee. Once again, social media, via a newspaper article, brought a shining light on this bias and the SAGE group was reconstituted with a more representative membership. In the United States, Senate hearings uncovered private emails of one government-employed epidemiologist who was attempting to discredit another “nonconforming” epidemiologist regarding interpretation of COVID-19 data. This type of government employee-based bias is quite concerning, due to inherent power gradients, and can be harmful to the scientific method and medicine.

Gaps in knowledge

First, censorship and bias are detrimental to application of the scientific method in medicine. However, how do we define scientific-medical bias and censorship for the purpose of combating them? In some instances, censorship and bias may operate quietly to suppress novel ideas. In the worst cases, novel ideas may be blatantly discouraged and it may even be professionally dangerous to support unconventional minority views on certain clinical topics or therapeutic procedures. With regard to politically based biases and censorship, totalitarian states have controlled their official narratives during the pandemic rather easily, but how should open democracies manage real or apparent biases without suppressing freedom of speech? Social media can be a powerful force in either direction, possibly protecting against biases and censorship, or alternatively, used as a weapon against “unfavored” minority opinions. How do scientists, countries, and societies in general monitor this powerful tool? Finally, and perhaps rhetorically, how can we keep politics out of science and medicine?

Possible solutions and future directions

Solutions likely will be very difficult, but we should not wait until the next pandemic or medical catastrophe before we begin attempts to solve the adverse influences of bias and censorship in science and medicine. We will not be able to keep politics from trying to enter medicine; therefore, we must change science and medicine so they can rise above bias and censorship. Medical societies are currently developing anti-bullying policies. Should they also develop anticensorship/antibias policies? In the examples cited above, social media was able to expose and change bias and censorship that was occurring in science and medicine by exposing it directly to the public. Finally, should peer-reviewed medical journals get into the business of communicating directly to the public in a manner similar to the direct-to-consumer medical advertising that we all experience daily in the media?