Responding to fear and magical thinking in the US
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r311 (Published 13 February 2025) Cite this as: BMJ 2025;388:r311
“I am a researcher within the federal system, and I hope that you will forgive me and understand why I am publishing this piece anonymously. The very fact that I am having to publish this anonymously in a country that has the right to free speech written into our Constitution is an indictment of what is happening.”
You will find these chilling sentences in an opinion piece published by The BMJ about the impact of the Trump administration on the US federal research system (doi:10.1136/bmj.r294).1 The article describes the censorship, bullying, and fear that are suddenly the day-to-day experience of US researchers who took an oath to the constitution and “not to a president or political party.” The researcher describes the removal of data relevant to vulnerable communities as “digital genocide,” painting a picture of a dystopian world or a totalitarian regime where official publications that share information on diseases are mothballed and epidemiological surveillance systems no longer function, allowing infectious diseases to flourish unmonitored and unchecked.
Why don’t more scientists speak up? The answer is sobering: “You have not heard from us because we are terrified of the response—not just having our research cancelled and being summarily dismissed, but also set upon by the 250 million followers of Elon Musk on X. Our homes, salaries, families, and even our lives are at risk.”
The BMJ publishes anonymous articles only in extraordinary circumstances. We will consider anonymity when a clinical scenario is particularly important to share and learn from, or to protect an author’s safety—for example, if they are a whistleblower. In all such circumstances we satisfy ourselves that the author and the article are both genuine.
In a separate piece, Esther Choo expands on the long term harm of blocking access to key scientific data (doi:10.1136/bmj.r288).2 The purpose of this war on information, says Choo, is to purge the “dangerous ideology” of tackling health and workforce inequities. The World Inequality Report 2022 describes how wealth inequalities in the US narrowed after the second world war as average incomes increased, but they began widening from the 1980s and are once again close to those “observed at the beginning of the 20th century, with a top 10% wealth share above 70%.”3 In lockstep with this are widening health inequalities, and the Commonwealth Fund neatly described US healthcare as “accelerating spending, worsening outcomes.” The US is an outlier for health spending and health outcomes among rich countries.4
The difficulty is how to respond to a regime that has disregard for health and wellbeing (doi:10.1136/bmj.r304),5 ignores the central role of inequalities in poor health outcomes, and believes science and scholarship to be the enemies of progress. Kathleen Bachynski and Martin McKee detail the alarming effect of sudden US funding cuts on ongoing research around the world (doi:10.1136/bmj.r289),6 how this betrays the fundamental principles of the Declaration of Helsinki, and how “Trump has placed many thousands of people across the world at risk of some of the most profound violations of their fundamental rights as research participants.”
Bachynski and McKee suggest a five point plan: seeking guidance from research ethics committees; scientific and professional bodies speaking up; appreciating that rational argument won’t succeed and using the literature on denialism to inform a response; turning to the law as 22 US states have done, winning a restraining order on cuts to National Institutes of Health funding (doi:10.1136/bmj.r303)7; and avoiding “anticipatory compliance,” such as by self-censorship, while maintaining ethical standards. Why, for example, does Musk remain a fellow of the UK’s Royal Society? If that isn’t mystery enough, when looking at the Top Trumps set to lead US healthcare—such as Robert F Kennedy Jr (doi:10.1136/bmj.r267)8—the notion that they will fix the health system’s hardwired problems is an exercise in magical and high risk thinking.