Q&A: Diverging Guidelines Undermine Confidence in Medicine, Health-Related News

Growing concerns over shifting federal health guidance, particularly when changes are not grounded in robust scientific evidence, have been causing a divergence among federal agencies such as the CDC and professional associations like the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG), leading to confusion for both patients and health care providers, according to Morgan McSweeney, PhD, social media and health influencer Dr. Noc. These inconsistencies, often fueled by selective use of data, contribute to widespread uncertainty and a decline in public trust, with potentially damaging consequences for public health. Moreover, modifications in official recommendations can have tangible effects, particularly for vulnerable populations, by limiting access to vital vaccines and treatments. McSweeney explores how these developments threaten the integrity and credibility of American health authorities and what it may take to restore that trust.

Drug Topics®: What are the consequences when federal public health guidance is unclear, frequently changing, or conflicting? How does this ambiguity impact health care professionals and patient safety?

Morgan McSweeney, PhD: There's 2 parts here. One is it's actually okay if federal guidance is changing if those changes are based on the development of new data or new analyses of data. There's some evidence underlying those changes. You expect that to happen over time. Certainly we're not going to get everything right initially. You're going to have to update your views over time as new data emerges. The problem arises when you start updating your positions based on not very rigorous scientific interpretations of data or cherry-picked data points. When you start using data as a tool, kind of like as a weapon, to support your previously conceived opinions or viewpoints, that's where you run into trouble, and of course, if you have some people doing that, like some pages on the CDC or other federal health officials are diverging from groups like the American Academy of Pediatrics or the ACOG—American College of Obstetricians and Gynecologists—it quickly becomes very confusing, particularly for patients, right? You're saying, "You're seeing the CDC is telling me one thing, [and] my OBGYN is telling me another that's reflected by the ACOG guidelines. Who am I supposed to believe here?" And I mean, for health care providers too, right? It can quickly become an unnecessary burden to try to figure out which of these were previously aligned authorities that are now diverging. Which one's telling me the true story? What is truly capturing the evidence? So it introduces a lot of chaos. I think there's going to be what could be avoidable harms as a result when people say, "I'm not sure what's true. I'm just going to decide to do nothing at all." Maybe they're pregnant, and they choose not to get a vaccine or some other medical intervention just because of all the chaos, but doing nothing, as you know, is a choice, and that can have implications for your health, for your baby, or for your child if it's a question about pediatrics. So I think the net result is nothing but negative.

Drug Topics: What are the potential long-term consequences for public trust in science and medicine when top government officials appear to actively discredit established scientific consensus and groundbreaking discoveries?

McSweeney: I think this will have very damaging impacts long term on sort of our understanding of the institutions of science and medicine from a public standpoint. If you don't spend a lot of time thinking about the FDA or clinical trials or medical data, and your only concern is figuring out what is true and best for the health of me and my family, you probably don't care a lot about what may seem like bickering between the CDC or the American Medical Association, and you may start to become a little bit jaded to the process of the institution of expertise. It'll start to seem like even the experts can't agree on what is true or what is not true, which is not the case, right? We know that the vast majority of experts are fine with the rigorous interpretations of science and evidence, and it's a very small but vocal minority who have unfortunately risen to some places of extreme power who are giving the illusion of disagreement among experts on various topics in health, but the end result, I think, is fragmenting trust in the broader institutions in science and medicine, which will just be damaging to people's health in the long term.

Drug Topics: How important is it for the Department of Health and Human Services (HHS) to base major policy decisions on the consensus of medical and scientific experts?

McSweeney: This answer is actually not too obvious if you don't know how it works. There's 2 ways that it's really damaging. One big one, and this is the part that people don't think about often, is that HHS recommendations can directly inform programs like who's going to get discounted access to vaccines based on which vaccines they do or don't recommend, and so when they're voicing their opinions on medical topics that aren't rooted in evidence, and they're saying, "Oh no, actually, we're not sure about our recommendation for XYZ medical intervention," changing that statement could directly impact many people's access to those medical interventions. It's not as simple as saying, "Oh well, we're not sure whether [they're] going to recommend it or not anymore. We're going to downgrade the level of evidence Go talk to your [physician]." Talking to your [physician], that part is fine. The part that's not fine is that them changing that level of recommendation actually structurally impacts access to medicine for people who are lower-income families. So that's a very direct financial harm, where even people who may still want to get whatever medical intervention it may be, vaccine or otherwise, and believe their [physician] and believe the American Academy of Pediatrics may not be able to access it anymore if HHS is changing these statements in ways that impact other programs for access.

Drug Topics: How does this affect trust in federal guidance?

McSweeney: It very obviously damages the trust in the CDC, and this is actually pretty odd. Even before [Robert F. Kennedy] RFK Jr. and everything started to happen at the CDC, back when the CDC was truly science led and reputable, I did a poll on my Instagram at one point just to gauge people's level of trust in me as an individual versus the CDC, which obviously the CDC should have won. Actually the numbers were a little bit higher for me, which even back then, should not have been the case, but it was. So the institutions of health in this country have already been facing sort of a crisis of trust and relatability and building personal connections with people even prior to all of this. Now, general people who are on the fence about what to believe or not believe are kind of aware of all the chaos that's going on at the CDC because of these headlines and because of clips you'll see on social media, and so it's just got to be taking a nosedive among that segment of the population ever since.

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