Update: Presidential Candidates' Answers to 20 Science Questions

Campaign for Cures

The Campaign for Cures Election 2016 blog features news, analysis, commentary and data about the presidential candidates and congressional races in key states on issues relevant to medical progress. Janice Lloyd, former USA Today senior editor and health reporter, manages The Campaign for Cures blog. You can reach Janice at campaignforcures@gmail.com.   Follow Campaign for Cures, a national voter education initiative, on Twitter and Facebook and visit www.campaignforcures.org

Update: Presidential Candidates' Answers to 20 Science Questions

By: 
Janice Lloyd

(Editor's note: This item was been updated after ScienceDebate.org received answers from Jill Stein and Gary Johnson.)

Hillary Clinton has been clear about her support for vaccines, but Donald Trump appears to be revising his views on immunizations. While supporting vaccination laws established by the states, Gary Johnson thinks the federal government should be allowed to intervene if there is a national or regional health concern. Jill Stein is concerned about declining vaccinations rates and has a plan to reverse it.

The presidential candidates’ thoughts on vaccinations and 19 other science-related questions were released last Tuesday by ScienceDebate.org.

Trump suggested a year ago at a GOP debate there’s a link between vaccinations and autism, giving an example of a 2 ½ year old child who developed a fever and autism shortly after getting a vaccine.

His response, when asked by ScienceDebate.org about vaccine science, seems to have shifted. “We should educate the public on the values of a comprehensive vaccination program. We have been successful with other public service programs and this seems to be of enough importance that we should put resources against this task.”

Other fresh viewpoints focus on an emerging public health crisis brought on by the Zika virus and a stalemate in Congress over whether to grant additional funds to fight it. Clinton vows to create a “Public Health Rapid Response Fund, with consistent, year-to-year budgets, to better enable the Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, the Federal Emergency Management Agency, state and local public health departments, hospital systems, and other federal agencies to quickly and aggressively respond to major public health crises and pandemics.”

Trump’s response, “We cannot simply throw money at these institutions and assume that the nation will be well served. What we ought to focus on is assessing where we need to be as a nation and then applying resources to those areas where we need the most work.”

The 20 questions were developed by dozens of scientific organizations including Research!America representing more than 10 million scientists.

In this blog item, we’ll show Clinton’s, Trump’s, Johnson’s and Stein’s answers to important questions on science and innovation.

Having a basic understanding of the science forming public policy issues is an important thing for presidential and congressional candidates to have, according to a large majority (87%) of Americans in a 2015 nationwide survey commissioned by Research!America and ScienceDebate.org.

"Science is central to policies that protect public health, safety and the environment, from climate change to diet related diseases," said Andrew Rosenberg, Director of the Center for Science and Democracy at the Union of Concerned Scientists, a consortium member of ScienceDebate.org.

Responses below were edited for brevity.

INNOVATION: Science and engineering have been responsible for over half of the growth of the U.S. economy since WWII. But some reports question America’s continued leadership in these areas. What policies will best ensure that America remains at the forefront of innovation? 

Clinton: Since World War II, America’s leadership in science- and engineering-based innovation has provided economic benefits along with major advances in health, safety, security, and quality of life. Education, research, and commercialization are all key to America’s success.  As President, I will work to strengthen each of these core elements of the ecosystem and facilitate public-private partnerships between them to ensure that America remains at the forefront of innovation.

Both basic and applied research are major drivers of innovation. As President, I will work with Congress to ensure that government funding of research is sufficient to allow for multi-year planning, exploration of emerging research areas, and inflation-adjusted costs. Funding is needed not only for the basic science research agencies and the large science and engineering mission agencies but also for the broader universe of agencies that are increasingly dependent on STEM for their missions.

Trump:  Innovation has always been one of the great by-products of free market systems. Entrepreneurs have always found entries into markets by giving consumers more options for the products they desire. The government should do all it can to reduce barriers to entry into markets and should work at creating a business environment where fair trade is as important as free trade. …Though there are increasing demands to curtail spending and to balance the federal budget, we must make the commitment to invest in science, engineering, healthcare and other areas that will make the lives of Americans better, safer and more prosperous. 

Johnson: First, true leadership in science and engineering cannot happen without a robust economy that allows the private sector to invest and innovate. Conversely, in times of slow or nonexistent growth and economic uncertainty, basic research and higher-risk development are among the first items to be cut. Thus, the most important policies for science and engineering are those that reduce the burdens on the economy of deficit spending and debt, and which reduce a tax burden that siphons dollars away from investment and into government coffers.

Likewise, government has an important role to play in creating a level playing field. Innovation works best when government doesn’t pick winners and losers. Manufacturers and consumers best understand the necessary applications required, not government funding offices. Innovation happens when the prevailing narratives and paradigms are questioned - not when government imposes political priorities on the scientific, engineering, business, and hobbyist communities.

Stein: Virtually every component of our 2016 Platform contains elements likely to have positive effects on innovation. These include our climate action plan, our free public education and cancellation of student debt proposals, and our Medicare for All plank. Vast resources will be freed for investment in public R&D by reduced Pentagon spending. Millions of people currently hobbled by poverty and underperforming schools will be able for the first time in American history to bring their talents to bear on the problems of the 21st century. A just economy, with living wages and paid sick leave, can be far more innovative than one where innovation is determined by a relative handful of corporate executives and Pentagon planners.

RESEARCH: Many scientific advances require long-term investment to fund research over a period of longer than the two, four, or six year terms that govern political cycles. In the current climate of budgetary constraints, what are your science and engineering research priorities and how will you balance short-term versus long-term funding?

Clinton:  Advancing science and technology will be among my highest priorities as President. Historically, federally funded basic research–often done without a particular application in mind and intrinsically long term–has yielded breakthrough discoveries of new knowledge and technologies. This knowledge and these technologies have, through the power of innovation, transformed entire sectors of industry, fueled economic growth, and created high-paying jobs.

I share the concerns of the science and technology community, including many in the industry, that the United States is underinvesting in research. Federal funding of basic research amounts to less than one percent of annual federal spending, yet it is an investment that pays big dividends. I believe it is essential that we strengthen our research capacity, by funding talented young investigators, looking for ways to prioritize “high-risk, high-reward” projects that have the potential to transform entire fields, and enhancing partnerships between government, universities, and the private sector. 

Trump: The premise of this question is exactly correct—scientific advances do require long term investment.  This is why we must have programs such as a viable space program and institutional research that serve as incubators to innovation and the advancement of science and engineering in a number of fields.  We should also bring together stakeholders and examine what the priorities ought to be for the nation.  Conservation of resources and finding ways to feed the world beg our strong commitment as do dedicated investment in making the world a healthier place.  The nation is best served by a President and administration that have a vision for a greater, better America.

Johnson: We have made clear our commitment to reducing federal spending significantly. To do so, we plan to subject every program to close and fresh scrutiny. Our basic priorities will bend towards funding for basic science and limiting funding for applied science to that which has clear public benefit, but isn’t feasible in the private sector. The Johnson-Weld administration defines basic science as research that works towards understanding of fundamental issues at the core of scientific disciplines. We believe that in the case where applied science can produce a profit, the best thing that government can do is get out of the way, while providing safety regulations that cannot be covered by the investigating organizations’ Institutional Review Boards, Ethical Review Boards, or Research Ethics Boards. We believe that science is best regulated by scientists, not regulators.

 

With regard to basic science, private companies are often willing to invest funds, and that should be encouraged - not discouraged. And when the government gets involved, the scientific discourse can be squelched. Frequently, public scientific funding has the effect of quashing private investment in certain research. Why would a private company invest in research, either basic or applied, if the government will do that for them?

Stein: The greatest challenge currently before us is climate change. We will place innovative breakthroughs in the science and technology associated with mitigation of greenhouse gases and the building of a resilient society that can withstand current and future climate change at the very top of our research priorities.

Presidents are able to affect long term R&D priorities by creating institutions focused on research like the National Science Foundation and the National Institutes of Health that are to some extent insulated from short-term political cycles. We will revisit these institutions--their charge, focus, and operations--to ensure that they're performing as expected. We will look for opportunities and mechanisms whereby science policy can be made more democratic, and more responsive to the preferences and needs of average citizens.

PUBLIC HEALTH: Public health efforts like smoking cessation, drunk driving laws, vaccination, and water fluoridation have improved health and productivity and save millions of lives. How would you improve federal research and our public health system to better protect Americans from emerging diseases and other public health threats, such as antibiotic resistant superbugs?

Clinton: America has witnessed enormous successes with some of its major public health initiatives, such as smoking cessation and water fluoridation. Yet, we have a long way to go to strengthen the public health system to provide adequate protection for our communities. Recent events like lead contamination in drinking water in Flint, Michigan, development of antibiotic resistant microbes, uncontrolled spread of Aedes mosquitos that spread tropical diseases like Zika, Dengue and Chikungunya, the growth of opiate addiction, and the continuing need to address HIV make clear the shortcomings of our public health system and the urgent need for improvements.

But despite these threats, we are not investing in public health preparedness and emergency response the way we should to keep our families and communities safe. A 2015 study found that spending on public health had fallen more than nine percent since 2008. And uncertain long-term budgets leave our public health agencies dependent on emergency appropriations—meaning that when Congress fails to step up, communities are left without the resources they need, vaccines languish in development, and more people get sick. … That is why as President, I will create a Public Health Rapid Response Fund, with consistent, year-to-year budgets, to better enable the Centers for Disease Control, the U.S. Department of Health and Human Services, the Federal Emergency Management Agency, state and local public health departments, hospital systems, and other federal agencies to quickly and aggressively respond to major public health crises and pandemics...

Trump: The implication of the question is that one must provide more resources to research and public health enterprises to make sure we stay ahead of potential health risks.  In a time of limited resources, one must ensure that the nation is getting the greatest bang for the buck.  We cannot simply throw money at these institutions and assume that the nation will be well served.  What we ought to focus on is assessing where we need to be as a nation and then applying resources to those areas where we need the most work.  Our efforts to support research and public health initiatives will have to be balanced with other demands for scarce resources...

Johnson: Most public health laws and programs are appropriately under the jurisdiction of the states, given that state and local governments are closer to the specific needs and challenges of their populations and regions. However, we have made clear our belief that, when a public health threat spreads beyond state lines or is clearly beyond the capacity of individual states to handle, there is a role for the federal government to step in, consistent with the federal responsibility to protect citizens from harm.

That same guiding principle will dictate our response to such challenges as “superbugs”, possible epidemics, and other threats that extend across the entire nation.

Stein: A Medicare For All single payer healthcare system would place health as the bottom line rather than industry profits, which is fundamental for improving public health.

A Medicare For All system would:

  • Allow health data to be aggregated on a population-wide scale (much of it is currently held in secret as proprietary information by private companies like health insurers) so that trends and outbreaks could be monitored.
  • Permit assessment of the health needs of the entire population to be determined so that priorities could be set based on areas of need and funds could be given to institutions that would focus on solutions to priority areas.
  • Drive public policy to pursue a greater public health and preventative approach because having a healthier population would save money.
  • Cover every person living in the United States and would remove financial barriers to care. This means that people with infectious diseases and other conditions that impact the population would have access to care when they need it.

REGULATIONS: Science is essential to many of the laws and policies that keep Americans safe and secure. How would science inform your administration's decisions to add, modify, or remove federal regulations, and how would you encourage a thriving business sector while protecting Americans vulnerable to public health and environmental threats?

Clinton: It is essential that environmental, health, and energy regulations, among other areas, use the best available science to guide decision-making, and I am committed to making sure that continues...

Trump: This is about balance. We must balance a thriving economy with conserving our resources and protecting our citizens from threats.  Science will inform our decisions on what regulations to keep, rescind or add. A vibrant, robust free market system will regulate the private sector.

Johnson: We believe in reducing federal regulations where possible. One way we would reduce regulation is to investigate and execute a national Right to Try for medicines and procedures aimed at chronic and terminal patients. Right to use experimental medicine when hope is deemed lost - in a purely voluntary basis should be allowed with proper oversight…We would prefer the FDA take a more holistic approach to relative risk. We would turn the FDA more towards informing the public of possible effects and away from regulation whereby important therapies are kept from or removed from the market. Patients and doctors must be kept informed of the relative risks involved, but patients and doctors are more aware of the stakes than regulators in Washington D.C.

Stein: We will rely on evidence-based approaches to regulation. Science advisors will play a central role in our administration. We will appoint scientific review panels and committees. Some guiding principles for our approach to regulation:

  • Protect the rights of future generations. Adopt the Precautionary Principle. When an activity poses threats of harm to human health or the environment, in the absence of objective scientific consensus that it is safe, precautionary measures should be taken. The proponent of an activity, rather than the public, should bear the burden of proof.
  • Redirect research funds from fossil fuels into renewable energy and conservation, as well as other technologies that promote the transition to a sustainable civilization.
  • Enact stronger environmental justice laws and measures to ensure that low-income and communities of color are not disproportionately impacted by harmful pollution and other negative environmental and health effects.

VACCINATION: Public health officials warn that we need to take more steps to prevent international epidemics from viruses such as Ebola and Zika. Meanwhile, measles is resurgent due to decreasing vaccination rates. How will your administration support vaccine science?

Clinton: Through vaccinations and vaccine science, I am committed to protecting our nation’s children, as well as populations worldwide, from infectious disease threats. … As president, I will work closely with the talented physicians, nurses, and scientists in our US Public Health Service to speak out and educate parents about vaccines, focusing on their extraordinary track record in saving lives and pointing out the dangers of not vaccinating our children.  

Trump: We should educate the public on the values of a comprehensive vaccination program.  We have been successful with other public service programs and this seems to be of enough importance that we should put resources against this task.

Johnson: We believe the current legal infrastructure regarding vaccination is basically sound. There are currently no federal vaccination requirements, leaving those requirements largely to the states and school districts, consistent with the legal requirement that children attend school. However, if a national or regional outbreak of disease presents a threat to the general population, the Federal Government has the obligation to assist, and if necessary, impose science and medically - based requirements.

We also need better and greater international engagement in dealing with international outbreaks. Viruses don’t yield to customs officials, and as we’ve seen with the recent Ebola crisis, a dangerous pandemic is often one international flight ticket away from our country.

Stein: Vaccines are a critical part of our public health system. Vaccines prevent serious epidemics that would cause harm to many people and that is why they are a foundation to a strong public health system…Experts like Douglas Diekema, MD MPH say that the best way to overcome resistance to vaccination is to acknowledge and address concerns and build trust with hesitant parents. To reverse the problem of declining vaccination rates, we need to increase trust in our public health authorities and all scientific agencies. We can do that by removing corporate influence from our regulatory agencies to eliminate apparent conflicts of interest and show skeptics, in this case vaccine-resistant parents, that the motive behind vaccination is protecting their children’s health, not increasing profits for pharmaceutical companies.

 

OPIOIDS: There is a growing opioid problem in the United States, with tragic costs to lives, families and society. How would your administration enlist researchers, medical doctors and pharmaceutical companies in addressing this issue?

Clinton: …We must work with medical doctors and nurses across the country to treat this issue on the ground, from how patients are accessing these medications to how we are supporting them in recovery. To combat America’s deadly epidemic of drug and alcohol addiction, I have proposed a $10 billion initiative, and laid out a series of goals to help communities across the country. We need to expand the Substance Abuse Prevention and Treatment block grant and support new federal-state partnerships targeting prevention, treatment, recovery, and other areas of reform. 

Trump: We first should stop the inflow of opioids into the United States.  We can do that and we will in the Trump administration.  As this is a national problem that costs America billions of dollars in productivity, we should apply the resources necessary to mitigate this problem.  Dollars invested in taking care of this problem will be more than paid for with recovered lives and productivity that adds to the wealth and health of the nation.

Johnson: Opioid addiction is, indeed, a crisis, and one that can largely be attributed to the insanity of our drug laws. A major reason opioids are overprescribed is that patients don’t have access to other safer pain management alternatives - such as cannabis. It is absurd that thousands of people are dying each year from ‘legal’ opioids, while the Federal Government still treats medical cannabis as criminal. One of my first acts as President would be to direct the rescheduling of cannabis to allow more research and prescription.

And in all due respect, with regard to doctors and pharmaceutical companies, the reality is that opioid prescription and subsequent abuse is a product of crony capitalism. In state after state, legislation to allow the prescription of medical cannabis and related products has been stymied largely by doctors, pharmacists and those who profit from the sale of legal opioids.

Stein: We will end the "war on drugs” and redirect funds presently budgeted for the "war on drugs" toward expanded research, education, counseling and treatment.

​For a full report on the questions, including Mental Health, Climate Change and Scientific Integrity, click here.

 

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Presidential Candidates Should Participate in Debate on Science

 
Source: A Research!America and ScienceDebate.org poll of U.S. adults conducted in partnership with Zogby Analytics in September 2015.

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