In a surprising move, the Italian government fired all 30 members of its Higher Health Council on Monday. This is a council of scientific experts, typically with 3-year terms, whose job it is to advise the government on science and health issues. As an isolated incident this is concerning enough, but unfortunately this is part of a deeper trend we need to confront.
The firing has some context. The Health minister, Giulia Grillo, is part of the Five Star Movement (M5S), which is now the senior member of Italy’s ruling coalition. M5S is a populist movement who has outspoken anti-vaccine views, and supports dubious alternative medical practices. When an anti-vaccine government suddenly fires all their health experts, there is reason for concern.
Defenders of this move argue that the council members were appointed by the previous “left wing” government, but that is not a defense, it actually just adds to the concern. Some components of government are supposed to be expert-based and apolitical. These are usually components that act in an advisory role, provide intelligence or information, or manage technical areas.
Nonpartisan expertise is critical to running a complex society, and medicine certainly qualified as an area where we should collectively be making decision based upon logic, science, and the best evidence available. Medical decisions should not devolve into a partisan or ideological fight.
That is the bigger issue here. Obviously it is concerning that Italy’s government is effectively anti-vaccine. They have already moved to remove the need for parents to have a doctor certify that their children are vaccinated, in favor of “self certification.” This essentially makes vaccines voluntary.
Not by coincidence, Europe, and especially Italy, are in the grips of a massive measles outbreak. This does provide some natural push back against the antivaccine movement, as fear of infectious disease does tend to affect public opinion. We saw this happen in the US after the Disneyland outbreak. But we shouldn’t require disease outbreaks before we get serious about a preventive measure. It’s like getting serious about fire safety after your house burns down.
But again – this affair is just a symptom of a deeper problem. There is mostly argument and little consensus about the complex causes, with many people pointing to the disruption caused by social media. But regardless of the cause(s) we seem to be in an era of backlash against “elites”, which includes scientific and health experts. Political and social movements have been successful in selling the idea that everyone’s opinion is equal, that facts don’t even really exist. They are whatever you want them to be.
Experts and institutions are seen, not as a mechanism for quality control and professional standards, but of oppression. This of course is one step away from metaphorical torches and pitch forks, which is essentially what we are now seeing in Italy and elsewhere.
There are always going to be abuses and failures to point to in order to justify opposition to the experts. No one and no institution is perfect. The optimal answer is to make the institutions better, not to burn them down in favor of anything goes.
All of this dovetails with the alternative medicine movement. At its core, alternative medicine is about an attack on medical expertise. Proponents use conspiracy theories to attack the institutions of medicine. They attack mainstream medicine as not being evidence-based, as being in the pocket of industry, and of being protectionist. Meanwhile they argue that the rules of science should be weakened, watered down, or even ignored in favor of medical populism (usually marketed as health care freedom). Alternative medicine is an attack on the very concept of expertise and professionalism, on reality-based medicine.
As an example of the connection between political populism and alternative medicine, both of which attack facts and experts, the M5S party early on championed a fake cure known as Stamina:
“The great risk of the current situation is highlighted by the case of Vannoni in Italy, in which the Stamina Foundation initially succeeded in obtaining direct authorisation from the Italian government to administer an unproven therapy to patients, thus bypassing the country’s regulatory authorities,” says the report.
In March 2015, David Vannoni was convicted of conspiracy and fraud for administering unproven stem cell therapies to patients at his Stamina Foundation. Vannoni, who was not trained as a scientist or doctor, claimed that bone marrow cells could be converted to neural cells to cure diseases such as Parkinson’s disease, muscular dystrophy and spinal muscular atrophy.
Stamina was nothing but a fraud, typical of the fake stem cell clinics that have popped up over the last 20 years to capitalize on the stem cell hype. This highlights the reasons why we have standard procedures for testing new potential therapies – primarily to protect patients. There are objective, transparent, and tested methods for determining the safety and effectiveness of a treatment. There is no legitimate reason to bypass those methods.
Charlatans claim that those methods (which one might refer to as science-based medicine) are there only as a barrier, but that is false. When you bypass the system, you don’t end up with miracle cures, which is what the con-artists want you to believe. You end up with fake cures exploiting sick people and their families.
M5S championed this fake cure, because it was in line with their populist anti-expertise agenda. Now we can only wait to see who they will appoint in place of the experts that formerly made up the Health Council.
We are also long past time for the medical profession to wake up and notice how their core values are being hollowed out by the infiltration of alternative pseudoscience. The problem is that incidents like this one are often viewed as isolated and on the fringe. Wrong. This is now mainstream. The charlatans have already won, and now we have to undo the damage that has been done.