Hematology... Literally and Seriously

As we settle in for a Trump presidency, numerous political pundits are still trying to explain his unprecedented victory, and must conclude that the experts’ polling was as useful as shoe umbrellas. We’ve heard the parade of explanations: Hillary’s server and bleached emails, the James Comey effect, the revenge of the forgotten rust-belt worker, Trump as a swamp-draining agent of change, and failure to mobilize sufficient numbers of Democrats to the polls.

For voters banking on a Hillary win, including individuals tagged as “coastal liberal elites,” this postelection period is being used to claw through denial, anger, bargaining, depression, and acceptance. Incredulity persists regarding how the Oval Office will be turned over to a man who whipped up a salad of xenophobic populist fervor, misogyny, and racism, and dressed it with winks and nods to the self-described "alt-right." However, our democracy rests on free and willing adults having every right to choose their political diet and make as many return trips to the buffet as they’d like. Trump voters would argue, and they may be right, that coastal elites live in a bubble, disconnected from the heartland and from the hearts and minds of those who live outside of New York, Washington, and San Francisco. Of course, it’s a lot more complicated than this.

As a guest on MSNBC’s “Meet the Press Daily,” republican strategist Brad Todd offered a snappy idiom to both explain Trump’s traction amongst voters as well as journalists’ inability to pin him down on issues: “The voters take Donald Trump seriously as a candidate but they don’t take him literally; the press takes Donald Trump literally but they don’t take him seriously…” Todd’s rubric was widely disseminated among media outlets that latched on to this as both an epiphany and perhaps the prologue to a user’s manual on how to adapt to Trump as a new breed of politician. Todd aptly pointed out that both politicians and journalists are wordsmiths devoted to ensuring that the tone and meaning of words are parsed over countless times by seasoned political operatives in the case of politicians, and by a hierarchy of editors and fact-checkers in the case of journalists. We hematologists — physicians and scientists — share many similarities with journalists. We use facts every day to guide decision-making about patients and to generate scientific arguments that ultimately require verification by our colleagues. We double- and triple-check our data (as journalists do with their sources) and take the meaning of words literally and seriously. In most instances, the scientific (and journalism) community has been able to sniff out troublesome actors — the debacle with Theranos last year is just one example where science (among many other principles) was betrayed, and a course correction was instituted.

Whether one wishes to refer to the President-elect’s library of demonstrably false statements as "lies," "untruths," "bullshit," or "truthful hyperbole" as Trump prefers to label them, they of course have nothing to do with the truth. With Trump taking the oath of office, we physicians and scientists should be self-righteous about assuming the mantle of “truth squad." As part of his psychological grab bag of tools to dismiss opponents, he uses clever distraction and gaslighting techniques to either ignore or undermine facts, shift blame, question motives, or accuse his naysayers of a hysterical over-reaction. Sooner or later, this has the effect of making some of us re-examine our reality and facts, allowing lies to share oxygen with the truth as part of the normal discourse of our lives. The burgeoning industry of fake news exemplifies this trend.

Since our Society and the broader scientific community will have to play in the same sandbox as Trump, we will, at a minimum, need to acknowledge his aforementioned tactics and strategize how best to immunize ourselves against them. To be fair, before we scream the house is on fire, we should give our new president and his cabinet picks a chance to declare their intentions. We’ll know rather quickly whether our 70-year-old President will be changing his stripes.

This is the time to double-down on advocating for ASH’s missions of education, research, and patient care. We should at least acknowledge the possibility that Trump’s tactics may also be adopted by increasing numbers of legislators who are trying to secure or maintain downballot offices. In this regard, I see ASH’s advocacy efforts as more important than ever in advancing agendas and funding for our patients and our physician-scientists who are researching and treating blood diseases. Increased recruiting of passionate foot soldiers through the ASH Advocacy Leadership Institute, the ASH Congressional Fellowship Program, and Grassroots Network will help embolden our causes, including the federal Precision Medicine and Cancer Moonshot initiatives.

The clinical and scientific breakthroughs highlighted in this third Year’s Best edition of The Hematologist truly speak to the groundbreaking progress in our profession. In particular, we highlighted sickle cell disease (SCD) as the Year’s Best in Hematology in 2016 because of the increasing number of high-quality trials, such as TWiTCH and SUSTAIN, which anticipate enormous dividends for SCD patients, as well as much-needed re-examination of universal precautions against sudden death in U.S. army soldiers with sickle cell trait. SCD is a major research priority for ASH, and its leadership (with a particular nod to the efforts of Drs. Charles Abrams and Alexis Thompson) has inaugurated a series of initiatives to tackle the disease. These include the exploration of activities to encourage the study of unaddressed research questions that could greatly impact the field, the development of a newborn screening and early intervention consortium in Africa, and an education strategy that empowers patients and diverse health-care providers (e.g., hospitalists, advanced care practitioners, and primary care clinicians) to be able to provide high-quality, evidence-based care. Toward these efforts, ASH has founded a Sickle Cell Disease Coalition that includes 35 members — three patient groups; 18 public health, research, and provider organizations; three federal agencies; nine industry partners; and two foundations.

This is exactly the type of army we need to navigate Trump’s shape-shifting world and to show how much we take hematology both literally and seriously.