It’s authoritarianism. Does the scientific and medical community have a duty of care?

The global scientific and medical community finds itself witnessing authoritarian acts in the United States. In the last few weeks, the Trump administration has ordered the United States Centre for Disease Control and Prevention (CDC) to pause publications, recall research, and has moved to censor words including “LGBT” from government publications and research grant applications. 

InSight+ spoke to Australia’s former Chief Scientist, as well as Medical Journal of Australia leadership, about the scientific community’s duty of care in an era of bias, censorship and confusion, with an avian flu outbreak on the horizon. 

Medical Journal of Australia Editor-in-Chief, Professor Virginia Barbour, is an Adjunct Professor in the School of Public Health and Social Work at Queensland University of Technology (QUT). Barbour was named Editor-in-Chief of the MJA in 2023.  

Professor Barbour says the global response to Trump’s actions needs to be loud, aligned and swift. 

“I think people need to be public about what’s happening. What’s happening at the US CDC is an indicator of what’s happening across government in the United States,” said Professor Barbour. 

In the first weeks of his second presidential term, President Trump directed that the United States cut ties with the World Health Organization (WHO), and the CDC to recall all academic papers for review by the administration. President Trump made an executive order “Restoring Biological Truth to the Federal Government”. The administration also removed information from government websites and created a list of terms “forbidden” from government research including “LGBT”, “transgender”, and other gender-related words. In an earlier move, some health officials received a much longer and comprehensive list of words to be avoided, including the words “woman”, “equity” and “gender”. 

Reports of banned word lists and removal of terms have been many and varied. Currently confusion is unavoidable, to the point of seeming deliberate.  

Professor Barbour highlighted the significance of the directives on the science and medicine community. 

“The CDC was one of the first government departments to be affected. They have interfered with the Morbidity and Mortality Weekly Report (MMWR), which the CDC sends out every week highlighting disease outbreaks,” she said. 

“The MMWR was where HIV was first reported on in Los Angeles, well before it was in any other journal. So, it’s a really important tool for surveillance,” said Professor Barbour. 

“The CDC website is absolutely covered in text that says it’s being updated according to Trump’s orders. And in the background, we know they’re taking out any reference to LGBT, or transgender treatment,” she said. 

“They’ve also removed access pages on vaccines – for example, the page for mpox has gone,” said Professor Barbour. 

“The CDC [staff] has also been told they can’t communicate with the World Health Organization (WHO). At every level, they’re trying to change public history, and cutting off the CDC from the rest of the world,” she said. 

“These are the actions of an authoritarian regime,” said Professor Barbour. 

Erasure of LGBTQIA+ information

Professor Barbour said that the censorship is potentially just the beginning. 

“You start by erasing groups like transgender people, then comes an attack on reproductive health care,” said Professor Barbour. 

Professor Barbour says that it is essential to take a stance to protect people from the effects of these actions. 

“We need to shore up our own institutions to make sure that we’re not aligning with policies that Trump wants to push forward. Making sure that journals are not changing anything that we do in response to it,” said Professor Barbour.  

“The MJA will not be changing anything in response to the Trump administration’s actions and will monitor what is happening in the US very closely,” she said. 

International medical journals have responded to the censorship. Last week, Jeremy Faust, MD interviewed Dr Georges C. Benjamin, the Executive Director of the American Public Health Association. 

“We have no interest in following the president’s prohibitions on language. It’s a First Amendment issue for us. It’s a science issue for us. So, we will publish things under our guidelines and under our ethical principles,” said Dr Benjamin. 

Late last week, a United States federal judge ordered the Department of Health and Human Services (which heads the US CDC) to restore public medical information on websites that was removed under one of President Trump’s executive orders aimed at transgender care. 

Preventing the next pandemic 

Health professionals are concerned about access to good information regarding the spread of bird flu.  

On December 18, the CDC announced the first severe case of H5N1 bird flu in the United States.  

“Right now, the United States is not properly communicating about bird flu. What does that mean for global health surveillance?” said Professor Barbour. 

“I’m extremely anxious to know what’s happening with the outbreak surveillance that the CDC would normally do. Can you imagine what it would be if this was happening during COVID, and there was no communication between the US, the WHO, and other international organisations? It would be catastrophic,” said Professor Barbour. 

“Because they are wiping the websites of a lot of historical information, we simply will not have accurate information now about what’s happening within these outbreaks,” she said. 

An uncertain future 

Professor Barbour said that the Trump administration’s actions will affect access to unbiased research.  

“One of the things I’m most worried about is that the American government owns PubMed. PubMed is the single biggest source of this medical information, globally. I would be surprised if they don’t go after it,” said Professor Barbour. 

“Who knows how they’ll do it? Maybe they’ll take out papers that have ‘transgender’ in it, or they’ll say, take out papers that support abortion rights. Then you’ll end up with a distorted evidence space. And then we’re in some big trouble, because we won’t be able to trust what we’re reading,” she said. 

Professor Barbour said that the uncertainty will undoubtedly continue especially now Robert F Kennedy Jr has been confirmed as the top US health official, the US Health and Human Services Secretary. 

“One of the reasons Kennedy is problematic is that he’s so chaotic – like Trump – that it’s hard to know what he’ll do,” said Professor Barbour. 

Spreading to Australia 

Professor Barbour said that there is concern that Trump’s actions will spark similar responses in Australia. 

“There are right wing groups here in Australia who are looking with some interest in what’s happening in the US. And I think that for example, abortion rights in Australia are quite fragile, and only quite recently won,” said Professor Barbour. 

“If people don’t understand that what’s happening over there is not normal, and not okay, we might end up with it happening over here.” 

The progress of uninhibited science 

Dr Cathy Foley is an Australian physicist and was the Chief Scientist of Australia from 2021 to 2024. Dr Foley was previously Chief Scientist for the Commonwealth Scientific and Industrial Research Organisation (CSIRO); Dr Foley now sits on the CSIRO board. 

Dr Foley said that progress in science remains key. 

“Best science comes from being curious, trying to understand things and being evidence-led. What doesn’t work well is when science and beliefs are mixed together. Because science is not about beliefs,” said Dr Foley. 

Dr Foley said she has not seen what is currently happening in the United States, before. 

“Not me personally. I’m sure if you go back in history, there’s been decisions made by elected officials, whether it’s dictators or whomever, to control scientific output,” said Dr Foley. 

“But in recent times, trust in science has been used to progress humanity and its ability to live on the planet, to be healthy, and provide prosperity for nations,” she said. 

“Science … builds on what has gone before, evolves. We learn and try to improve. We keep pushing the boundaries,” said Dr Foley. 

“For example, gender wasn’t taken into account, or sex wasn’t taken into account, in medical research. They might have just looked at male samples of, say, mice studies. And then there’s an evolution of recognising that sex is an important parameter that needs to be differentiated and understood, because it has a big impact on health outcomes,” she said. 

“Saying that we need to pull that variable out, is not the norm for good science,” said Dr Foley. 

Dr Foley said that interdisciplinary work on culture and environment is important. 

“I think that in Australia, we support diversity and inclusion. It’s an important part of Australia’s culture,” she said. 

“We’re seeing interdisciplinary work looking at culture, environment, at health and how it comes together; that is growing all the time in the research world,” she said. 

“Australian researchers are very good at collaborating internationally, and particularly in health and medical, which is our biggest research field,” said Dr Foley. 

“Also, Australia believes in liberal democracies, and the United States is a liberal democracy. You may not like what they’re doing, but then there’s the ballot box next time,” she said. 

When asked about the duty of care that medical science has to people and human rights, Dr Foley highlighted the delicate balance between politics and science. 

“Usually, we take a stand when it comes to things like human rights. And that would be the basis of which people will reach out to another country – especially a like-minded country – just as people might reach out to us about how we are supporting Aboriginal and Torres Strait Islanders, or how we’re dealing with illegal immigrants,” said Dr Foley. 

“I hope that in time it plays out in [that] any changes that are happening in the USA, don’t end up being picked up in Australia.” 

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