Science isn’t liberal or conservative, red or blue

THE WORLD’S RESPONSE to COVID is the story of medicine and science – and of selfless individuals standing up to do their jobs. I’m lucky enough to be a small part of this team.

Over the last three months, as an emergency physician at Mass General Hospital, I’ve worked to treat the horrors wrought by COVID on my patients and their families. We have saved some lives, but it’s the losses I remember. There was the death of the World War II veteran who was able to tell me about his service in Europe and how he wanted “comfort measures only” before he then died alone but for the nurse holding his hand.

There was also the cooling hand in my own of the previously healthy mother in her mid-40s. She had been walking around her house the night before, and less than 24 hours later, her heart — after every technology and hope had been exhausted — simply quit pumping as the virus reduced it to a quivering standstill. Even as new patients continued to arrive, I felt rooted to the spot, obliged to hold her hand and stand vigil until her family could arrive. Fifty-two years of life experience, over 25 years of hard work learning the art and practice of medicine at one of the world’s great medicine centers, with all the tools of 21^st century medicine spent, all that was left for me to contribute was to hold the woman’s hand and wait — as humans have done since before the plains of Troy.

But care alone isn’t enough. The mission of medicine is to provide new solutions. Over a very rapid week in March, working with world-class collaborators in MGH Anesthesia, we wrote and began enrolling patients in a novel clinical trial using inhaled nitric oxide to treat acute COVID disease. Prescient philanthropists stood up to fund our work. Clinicians, lab researchers, administrators, and investigational review board leadership rapidly came together, looked at the best science, and discerned which study designs would achieve intended outcomes quickly.

It was a simple, data-driven process that reached beyond traditional boundaries to serve our patients and society. Emails traded rapidly at 2 a.m. on the weekend were the norm. Events that would typically occur over weeks were thoughtfully finalized in days. When an institution with a deep bench in clinical care and research steps up, amazing advances occur.  Getting this and other research projects together in such a rapid time – and during a pandemic – was an institutional masterpiece.

Our local institutional successes were similarly playing out on the federal level. An extraordinary array of federal scientists and physicians rose to the challenge. I was especially impressed with the quality of the work being produced at the Biomedical and Advanced Research Development Authority (BARDA) headed by Dr. Rick Bright, who is now in the spotlight for claiming he lost his job because he warned the Trump administration about the potential for the coronavirus pandemic.

I first met Bright last fall. I had flown down to Washington, DC, to participate in an antimicrobial resistance conference bringing together scientists and entrepreneurs, federal regulatory and funding agencies.

I was joining colleagues to propose an innovative ecologic approach to prevent the deadly scourge of MRSA and other multi-drug resistant bacteria. On the flight down I began to wonder about what kind of a reception I would get.

Faced with unknown giant federal bureaucracies ahead, all of the tropes about hazards of interactions with government employees leaped to mind. Certainly, human nature makes it much easier to say no to anything new rather than to take the time to look at the data. What if they were obstructionist or lazy or ill-informed? What if government was the problem? What the hell was I doing? This trip could be a disaster.

Bright’s keynote address on antimicrobial resistance reassured me. He was impressive, expert, authoritative, clear-eyed in assessing danger and how best to deploy limited resources. But smart people can have the most closed minds when their underlying assumptions are challenged. What chance did my team have with a novel approach to such a durable problem?

I met Bright afterwards and, to my surprise, where my bias predicted stasis and work aversion, we were rapidly off to the races. Bright asked a quick series of insightful questions. He listened to the answers – even as they were different from other common approaches. He looked at the early data, and started making introductions to other federal experts.

Uniformly from BARDA to Food and Drug Administration to the National Institutes of Health, the response was skeptical – as it should have been – but open-minded. First and foremost, they were advocates for the average American citizen.  They shared an approach of “that’s a novel claim, which puts you in a deep intellectual hole from the start, but let’s look at the data and if it looks promising, let’s see what next steps might be, and how we can help get this to the American people.” Their actions indicated that they recognized that human lives hang in the balance, that timeliness mattered, and the best way forward was simply to look at the data to best serve the American people as quickly and safely as possible.

I came away from these meetings completely heartened. If NASA’s ability to go from an audacious political proposal in the early 1960s to putting humans on the moon less than 10 years later was evidence of the selfless efforts of the best and brightest scientists and engineers, the same spirit lives in the federal bureaucrats of BARDA and other federal agencies I have worked with since. I was proud of the quality, intellect, integrity, tactical, and strategic brilliance of a cohort of world-class servants who had dedicated their professions to helping to keep Americans safe and well. Bright was one of many, but clearly the epitome of selfless service as he worked to secure the health and safety of the American people.

Early in the pandemic, when I heard Bright’s voice in an interview talking about his growing up on a farm in Kansas, and his description of how we develop vaccines using chickens’ eggs with a matter-of-factness gloriously endemic to the rural Midwest, I turned to my wife and told her about his work. We both appreciated how lucky we were to have this generation’s best and brightest working in the service of our nation.

To follow Bright’s more recent appearance in the news has been painful – and frightening.

I sense and feel the fear behind the lines being drawn across communities in the United States, where science appears to be perceived as a faceless, dichotomous force: either respected as a sacred source of information to guide our civilization’s way forward or treated with suspicion, if not outright disbelief, as a dangerous means of forcing change onto more rural and conservative communities against their wills.

I recognize the latter’s suspicions. I’m a southerner come north to Boston. A man most at home in rural central Virginia come to a busy urban emergency department. I have a reverence for story, and yet make my living and help my patients by using the power of science to shelter and advance our species. I share the sense of a country divided against itself, even as I cherish aspects of both red and blue state America. I increasingly see little difference between them other than a mutual and stubborn unwillingness to extend a charitable view to the other to recognize and start to overcome the durable divides dating back to our country’s founding.

I wish I could communicate to all my fellow Americans the power of science and the benefits we all accrue from public servants of Bright’s caliber as he works to advance science in their interest.

As I experience it, science is simply a means to allow us to discern what physically is happening in the world. It isn’t conservative or liberal, red or blue. It is human, curious, and relentless in pursuit of helping us to determine what is. When facing a viral pandemic, this is its strength.

Bright acted to protect the power and process of science no differently than I would fight to protect my responsibility as physician to best serve my patients. Insisting on this isn’t a point of pride or obstinacy, but a respect for process that ensures best outcomes. The process matters. Narrative drives us as a species, but data matter.  Just as a fighter pilot may explore the outer limits of the possible during a dogfight by respecting the forces of aeronautics, so a rational review of risks and benefits must drive medical decision-making – especially in a pandemic. Guessing at new therapies leads to patients needlessly dying. Yes, we lean hard into accelerating clinical studies of new therapies, but we respect the bounds of the scientific process. Studies removed from this scientific rigor produce answers that are simply mirrors of our biases, darts thrown in the dark and more likely to create harm than good.

Bright fought to protect this process, because it protects the American people. Science’s strength is that it builds safeguards into our clinical trials to protect both subjects and scientists. We all share the inevitable human impulse to discover the world to be not as it is, but as we want it to be. Scientists have skin in the game. We have loved ones at risk.  We too will die. We want our time and hope to be rewarded with positive outcomes – even as we know that chances are against us on any one day.

Science advances understanding and health by trying to protect us all from these universal human biases.  Scientists are blinded to the factors being tested.  If we know the Celtics are our home team, it’s hard to be a non-biased referee. Blinding forces us to simply call the fouls we see, regardless of the players’ jerseys. We follow thoughtful procedures and statistical plans to measure pre-determined outcomes (rather than simply throwing our hat in with whatever random outcome might seem to rise to significance.) Before sharing our work with the world, we know outside experts will independently peer-review our results — and that they are appropriately incentivized to break our precious data and provide additional insights before it is published.

Good science isn’t a great novel – an independent act of genius.  Instead, it demands that other scientists can reproducibly re-create the work we’ve reported.  All of this is the opposite of an ivory tower. It is a furious battle of ideas. Science fully embraces us as we are at our worst, aware of our human failings. The process of science moves us forward by minimizing the risk that we’ll be led into false conclusions simply because that’s what we want to be. Science is both hugely embracing of human imagination and aspiration — and ruthless in making us show the data that support our claims. In the midst of a pandemic, Bright is exactly right in seeing good science as our best way forward.

Bright believes in this process, and appropriately applied it even in the face of a global disaster. This is what great scientific leaders do. Pandemics don’t make placebos productive. Pandemics certainly don’t make dangerous medications for other diseases effective solely because it would be politically expedient. Science requires that good minds stand up for the process, and requires its methods to be followed — even if at great personal sacrifice — if the facts of a disease and its best treatment are to be revealed. This is what we pay people like Bright to do.

Good science requires an ecosystem of bright and well-trained scientists, resources, funding, and a faith by leadership that this process is a critical human and national security priority.

It is.

I’d love to think we could bend the virus to the force of our will.

We can’t.

In this pandemic, our one hope is to use the extraordinary minds and talents of our best scientists and physicians to lead us forward. Bright has lived and acted professionally in a way that transcends politics. As a broken Apollo 13 was hurtling back to earth with three lives, American prestige, and human aspiration in the balance, we wanted the best and brightest minds on the job. From the farms of Kansas to our largest cities, we attract, train, and trust those capable of working as a team to accomplish extraordinary missions that serve a higher good. This talent has never been more important than the present.

When traveling to and from work in remote Alaska, there is a particular bush pilot I’ve been working with for years.  Flying over the tundra, as we weave in between fog-shrouded mountains with a low ceiling, his expertise is the one factor keeping me alive. I trust him completely. I love my work, but know I need to get home. I feel blessed to know he’s on the job. I feel similarly about dedicated civil servants like Bright.

These are dangerous times. Levelheaded expertise driven by data will be the salvation of our citizens and economy. The power of the American intellect, integrity, and professionalism will be squelched only at our mutual peril. As we look ahead to the coming summer, and then beyond to what could be a very dark winter, we need our best and brightest in our service.

As a father, physician, researcher, and citizen, living in a time of COVID, I can tell you that no greater choice could be made than to immediately reinstate Bright to his position as head of BARDA. Our nation cannot afford to fly into a mountain his expertise would have allowed us to avoid.

N. Stuart Harris is the chief of the division of wilderness medicine in the department of emergency medicine at Massachusetts General Hospital. He is also an associate professor of emergency medicine at Harvard Medical School.