Scott Atlas, MD, the radiologist selected by President Trump to advise him on the COVID-19 pandemic, has now resigned from the administration. His tenure had been mired in controversy. Atlas, an accomplished physician and health policy scholar, challenged the analysis given by many experts in the fields of infectious disease and epidemiology. While some felt passionately that he was a voice of reason, others viewed him as a danger to the public's health. What will be the legacy of his time in the White House?
The presidential advisory team, including Anthony Fauci, MD, of the National Institute of Allergy & Infectious Diseases (NIAID), suggested multiple restrictions to limit the spread of COVID-19, including mask-wearing. The president sought out a noted physician who would agree that many restrictions aimed at limiting and delaying the spread of the infection were not worth the infringement on personal liberty, economic losses, and stresses on the public's mental health.
Like Fauci, is an accomplished physician-scientist, as well as a health policy expert. He was a professor of radiology at Stanford University and chief of their neuroradiology section for over a decade. He was the editor of a leading neuroradiology textbook, a widely published scholar, and a globally respected physician (he served on the nominating committee for the Nobel Prize in Medicine and Physiology). His subsequent work as a senior fellow at the Hoover Institution of Stanford University, a respected conservative think tank, focused on health policy, and he advised prior Republican presidential candidates on healthcare issues.
His tenure in the White House became controversial. In September 2020, dozens of Stanford physicians and researchers critical of Atlas and his public comments. In mid-November, the university itself distancing itself from him. Also in November, the Stanford faculty senate passed a condemning Atlas' comments, including his statement that Michigan residents should "rise up," which many took as a promotion of violence (despite his subsequent denial). Was such controversy the inevitable result of his challenges to the prevailing wisdom? It is an important question since science has often benefited from those that challenged the accepted thinking.
Take the .
Patterson had an interesting career. He worked on the Manhattan Project, helping build the first atom bomb, and then went on to help calculate the age of the earth. Initially confused by the data from his work determining the age of the earth, he realized that lead, added to gasoline, was being spread widely throughout the environment. Importantly, he also recognized that this dangerous substance was showing up in humans. After careful research, Patterson helped sound the alarm about this environmental threat.
Patterson studied chemistry and geology. He was not a physician, nor an expert in toxicology. Nonetheless, it was Patterson that stood up against the prevailing wisdom of the day. It would take many years until his words were heeded, and in the interval, his reputation was attacked. In the end, the evidence won out and lead is no longer added to gasoline. The have been dramatic, with a marked reduction in environmental lead, a profound decrease in human lead levels, and improvements in IQ and even economic gains.
Both Patterson and Atlas received criticism as non-expert outsiders and were advised to "stay in their lane." Patterson was told that he should focus on geologic analysis and leave the toxicology to the experts. Many suggested that Atlas, a radiologist with health policy (but not public health) experience, should not be commenting on COVID-19; he should leave epidemiology and infectious disease guidelines to those with greater experience.
While there are similarities between Atlas and Patterson, with both gentlemen receiving criticism for speaking outside their perceived areas of expertise, there are fundamental differences in their use of data. Patterson came to support his position after analysis of the data. In contrast, Atlas began with an ideological position, and then used data to support those beliefs.
To his credit, Atlas made many important observations based on data that support his philosophy. For example, he noted that cancer does not pause for COVID-19, and if we curtail non-emergent exams (like screening tests and biopsies), we will be trading one disaster for another. But he also made that lacked nuance and seemed to downplay the severity of infection. For example, "We know that 98, 99% of people that get the virus have no serious problem with the infection. Half are asymptomatic." In fact, we do not know that. We know older adults are at , but even young adults have small but meaningful risks of serious disease and chronic illness.
A found that even among healthy young adults (18-34 years old) with no chronic medical conditions that tested positive, 26% reported that they had not returned to their usual state of health 2-3 weeks after testing positive. For those 50 and older, close to half had not returned to their usual health. And this is among outpatients, people not requiring hospitalization. Among young adults (again, ages 18 to 34 years) hospitalized with COVID-19, 21% required intensive care and 2.7% died. The mortality rate of young adults hospitalized with is about twice that of young adults that have a heart attack.
The has become controversial, with most experts agreeing that they are not a panacea but are beneficial and an important part of a broader program to limit the spread of infection. While the data on their exact efficacy can be reasonably questioned, they represent a low-cost/high-benefit option to help limit the spread of disease. Atlas, however, muddied the waters on mask-wearing. In October, by Atlas, which said: "Masks work? NO." There was additional information on the selective use of mask-wearing versus widespread mandates, but the implied message of the tweet along with images of Atlas and the President without masks helped politicize what should have been an apolitical issue of public safety, not unlike seat belt wearing.
Will the legacy of Atlas be that physicians and scientists, witnessing the slings and arrows hurled at such an accomplished physician, think twice before speaking against the establishment? Maybe. But maybe that's OK. Maybe they should think twice. Or even three times. In an age of "fake news," QAnon, and other conspiracy theories, and attacks on science itself, the importance of strong data has never been greater.
Let that be the lesson that we take from the saga of Atlas: science before agenda. Do not fear questioning the prevailing wisdom, but ask yourself: Am I following the data or an ideology? Am I overstating the data to advance an agenda?
When said, "Science is the belief in the ignorance of experts," he was not encouraging the voice of the passionately opinionated. Rather, he was championing the ideals of the scientific method. No matter how respected the individual making the claim, whether they are the long-time head of the NIAID or the former chief of neuroradiology at Stanford, no one is beyond questioning. In the end, let the data be our guide. To again quote Feynman, "It doesn't matter how smart you are, who made the guess, or what his name is. If it disagrees with experiment, it's wrong. That's all there is to it."
Richard Heller, MD, MBA, is a pediatric radiologist in Chicago..