Trump and the tech bros: demagogues of harm to human and planetary health
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r196 (Published 30 January 2025) Cite this as: BMJ 2025;388:r196
A US medical society has written to tell us that some of its members will be unable to contribute to journal activities. This followed a government mandate that initially seemed to prohibit US federal employees, such as those working directly for the National Institutes of Health, from publishing or participating in external communications (doi:10.1136/bmj.r172).1 A subsequent clarification confirmed that submitting papers to and corresponding with journals was allowable. However, “posting preprints, or unreviewed manuscripts, online is on hold,” with more guidance to follow.2 The restriction is heavy handed and censorious—a sign of the times.
It’s hard to understand what danger preprints and unreviewed manuscripts pose to the US—or how a partial gagging order on scientists puts the health and wellbeing of people and the planet first. How does it even put “America First”? Every inch that the US withdraws from international collaboration opens up an inch for Donald Trump’s avowed enemies such as China to exploit, as is the case with artificial intelligence and medical research. Saner voices in the US argue that America First shouldn’t mean America Alone, but sanity isn’t the order of the day. Gagging scientists or punishing them for doing their work comes with sinister historical echoes (doi:10.1136/bmj.r170).3
America’s 47th president signed executive orders to withdraw the US from the World Health Organization (doi:10.1136/bmj.r140 doi:10.1136/bmj.r116)45 and the Paris Agreement (doi:10.1136/bmj.r185).6 WHO is a UN agency “dedicated to the wellbeing of all people and guided by science.”7 The Paris Agreement, a legally binding international treaty on climate change, seeks to combat climate change and adapt to its effects.8 These manifestations of America First, as the law professor Larry Gostin explains, harm the US and the world.9 Other policies will end foreign aid, damage women’s health (doi:10.1136/bmj.r173),10 cut health insurance (doi:10.1136/bmj.q2402),11 abandon equity initiatives (doi:10.1136/bmj.r134),12 and further marginalise vulnerable communities (doi:10.1136/bmj.r150).13 These are historic mistakes.
The day after Trump’s bombastic inauguration in Washington an understated event in London marking the 75th anniversary of George Orwell’s death deliberated on the meaning of “Orwellian.” The best definition I heard was that it is the denial of objective truth. DJ Taylor, Orwell’s biographer, proposed that the central message of Orwell’s work was to “behave decently.” Unfortunately, for many modern politicians the denial of objective truth comes easily; behaving decently, less so.
That criticism applies equally to the tech bro demagogues seeking untold wealth and political influence. The business of science is to seek objective truth. The business of healthcare is to behave decently towards patients and the public. Only days before Holocaust Remembrance Day, Elon Musk fired up a rally of Germany’s extreme right wing party, urging it to move on from the past to build momentum and public support. Jeff Bezos damaged the Washington Post’s reputation by tampering with its editorial independence. Mark Zuckerberg’s principles are blowing in the political wind.
Social media platforms—the empire of these “broligarchs”—are now a primary source of health information. Much of that information is either misinformation or disinformation and is therefore harmful to health and wellbeing (doi:10.1136/bmj.q2617 doi:10.1136/bmj.q2485).1415 One answer is to counter disinformation with trusted information. But how can the public decide which is which? It’s clear that the owners of social media platforms can’t be relied on to moderate their moneyspinning businesses to protect the public. This is the ultimate manifestation of power without responsibility. Society’s challenge is how to rein in social media, now that the naive notion that an unmoderated dialogue will be self-regulating is thoroughly debunked.
Facts and integrity
Another response to misinformation and disinformation is fact checking and content moderation, but these interventions are only as good as the motivation that drives them. Is your fact checking seeking objective truth, seeking it selectively, or seeking to deny it? Both fact checking and content moderation add to costs—it’s an investment we expect of trusted sources of information—but the tech billionaires seem unwilling to eat into their obscene profits by properly funding these activities, whatever the negative impact on society.
The BMJ has firsthand experience of the failures of social media fact checking. At the height of the covid pandemic, Facebook’s fact checkers blocked a BMJ article (doi:10.1136/bmj.n2635).16 The article was a thoroughly worked up and substantiated investigation into data integrity issues related to a specific vaccine trial in the US. The BMJ is not anti-vaccine—quite the opposite—but it’s certainly sceptical of the drug industry’s motivations and considers any problems in the conduct of a clinical trial to be a matter of public interest. We should surely be sophisticated enough to support evidence based interventions but at the same time demand better conduct of clinical trials and transparency around harms.
Regrettably, Facebook’s third party fact checkers weren’t just fact checking: they sought to control the message, to quash any reasonable questioning of a trial’s data integrity. Zuckerberg now claims that he was being pressured by Joe Biden’s administration to support the US pandemic response. Whether that directly affected Facebook’s behaviour towards The BMJ’s investigation is hard to know, but our appeal to Facebook’s oversight committee17 fell on deaf ears (doi:10.1136/bmj.o95).18
What, then, did Facebook’s flawed fact checking achieve? The article that Facebook aimed to censor is now one of the best read and most widely discussed in the history of the scientific record. Mission unaccomplished, from Facebook’s perspective. In our view, no intervention is a free good or free of harm. The role of science in seeking objective truth is to establish, honestly and fairly, the balance of benefits and harms and to communicate those to professionals and the public. This is how to behave decently.
The answer to flawed or politically loaded fact checking and content moderation is not to abandon them and replace them with gimmicks such as “community notes” but to improve them, to focus on proving or disproving facts rather than allowing ideological censorship, to moderate content while being mindful of extremism and harms, and to develop appeal mechanisms that are genuine and fair. However, social media platforms continue to demonstrate their inability to restrict misinformation, disinformation, and harmful or extreme content. Combine the power of social media with the power of artificial intelligence and we face a risk that ranks alongside climate change, conflict, obesity, and antimicrobial resistance in its potential to harm people and the planet. The responsibility to regulate social media, given the failures of the tech companies themselves and of self-regulation across many different industries, must inevitably fall to governments.
Some people will ask why Trump’s political policies matter to a medical journal. They matter because the US is powerful and influential. They matter because many of those policies will harm health in the US and everywhere else. This is a time for global solidarity in the face of the climate crisis and the assault on rights; for fresh international resolve to end the spiral of regional conflicts; for a concerted effort to drive the public benefits of social media and artificial intelligence, without people’s wellbeing and lives being destroyed by disinformation; for a crash course for Trump and the tech bros on the societal benefits of a strong democracy, ethical artificial intelligence, and responsible social media; and, fundamentally, for an unequivocal commitment to objective truth and behaving decently.
Footnotes
Competing interests: Kamran Abbasi is a trustee of the Orwell Foundation.