The Scary Implications of U.S. Government Attacks on Medical Journals

Scientific American

01-05-2025

In April, I decided to make public a leaked letter from the acting U.S. attorney for the District of Columbia to the editor-in-chief of CHEST, a leading pulmonology and critical care journal. I did so because the letter represents an authoritarian threat to science, and I knew it wasn't an isolated, bizarre incident. It is a warning sign, another move in a broader campaign to exert control over research, medicine and media.
The letter asserts that 'publications like CHEST Journal are conceding that they are partisans in various scientific debates.' It was written by recently appointed acting U.S. attorney Edward R. Martin, Jr., who gives no examples that might demonstrate partisanship; nor does he cite any laws or legal principles to indicate a matter that should concern the U.S. government. Instead, without justification or jurisdiction over a private medical journal based in Illinois, he simply invokes his federal office to demand that CHEST explain if it accepts 'competing viewpoints,' and how it is now developing 'new norms' to adjust its editorial methods in view of its alleged—by Martin—biases.
Since I publicly shared this, at least four additional journals, including the New England Journal of Medicine, have confirmed receipt of similar letters, according to MedPage Today, STAT News, the New York Times and Science. Aside from Eric Rubin at the NEJM, none of the targeted editors have been willing to go on record, fearing retribution from the Trump administration. It's likely that letters were sent to many more journals; CHEST 's was simply the first to leak.
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Why CHEST? It's a specialty outlet—not even among the top 50 medical journals. Is this a keyword-driven campaign like those we've seen at the CDC and NIH? Under Robert F. Kennedy, Jr., terms like 'diversity,' 'minority' and 'equity' have been systematically flagged. This has led to elimination of federal positions and programs, cancellation of research grants, and scrubbing of government websites and statistics —all related to these words.
A search of CHEST 's archive for 'transgender,' for example, returns 33 hits—articles acknowledging the clinical implications of caring for trans patients (e.g., ventilator settings may need to be adjusted). Add in other Trump-targeted terms like race, disparity, female and disability, and we can see the outlines of a new DOJ-led front in the administration's campaign to target minorities for denial of care, legalized discrimination and bureaucratic erasure.
Kennedy has also previously objected to medical journals not publishing studies that support his debunked and baseless theories, such as false claims that vaccines cause autism, declaring a plan to 'create our own journals' to publish such studies. Last year, while running his own presidential campaign, he stated he would take legal action against editors in response: 'I'm going to litigate against you under the racketeering laws, under the general tort laws. I'm going to find a way to sue you unless you come up with a plan right now to show how you're going to start publishing real science.' Kennedy is not a scientist and has no training in medicine. He has not volunteered to submit his claims to the types of critical, anonymized expert reviews that are designed to support scientific rigor at scientific journals.
Kennedy frequently makes evidence-free claims on podcasts and television shows and now in government press conferences, regardless of the consequences. However, peer-reviewed journals like CHEST require extensive scrutiny as part of their evaluation process. Outside scientists examine submitted studies for biases, errors, and unsupported claims or conclusions, and authors are required to include statements about conflicts of interest—including reasons for even just the appearance of bias in the eyes of others—and to disclose their funding sources. This is routine procedure at journals, about which Martin's letter indicates he knows strikingly little.
We don't know Martin's, Kennedy's or Trump's specific motivations in sending a letter to CHEST, but it is clear that Martin's threat to journals is not a one-off stunt. Like Trump's actions that cut off or threaten federal research funding at Columbia, Harvard and other universities, it appears to be part of a calculated strategy to identify, isolate and intimidate researchers who, and institutions that, acknowledge realities like inequality, social differences and structural violence.
American health institutions have long been entangled with state violence: forced sterilizations of Black and Indigenous women, repression of civil rights protesters, collaboration with anti-immigrant policing, the push to categorize queer people as pathological and dangerous, and denial of reproductive and gender-affirming care.
These alliances are enabled by a professional culture that rewards compliance and punishes dissent. In that respect, the Trump administration's mounting ideological control over medicine represents not a historical rupture but rather a continuation of sordid legacies.
To understand what is now transpiring, it is important to note that Martin has never before been a prosecutor. He has no experience in criminal litigation, appointed to his post to serve political ends. Since taking office, he has hired Michael Caputo —Trump's disgraced first-term COVID spokesman who then infamously accused government scientists of ' sedition '—as an advisor at the U.S. Attorney's Office. The message is clear: this is not about law enforcement. It is about using state power to intimidate scientists and suppress dissent.
Against this backdrop, if journal editors refuse to speak out and organize to defend academic freedom, they will not only ultimately fail to protect themselves and their journals. They will also sacrifice targeted communities.
When confronted by government intimidation driven by personal ideological agendas instead of the public good, silence is complicity—not neutrality. We must refuse to compromise when the Trump administration comes first for stigmatized and vulnerable groups—such as trans individuals, disabled people, or immigrants they label as 'criminals' —as a means of normalizing state violence and expanding its unconstitutional reach.
This is not the time to issue hollow statements condemning the supposed ' politicization of science '—a line that conflates partisan interests with what should be bipartisan political principles upon which rigorous scientific practice, ethical clinical care and genuine public health depend. Science is always already political, and we must organize politically to defend it against authoritarian threats. That requires calling out the Trump administration's intimidation campaign for what it is: a McCarthyite attempt to purge science of inconvenient truths and ethical foundations.
The production of knowledge, the allocation of care, and the very questions we ask and answer, are all shaped by systems of power. When medical professionals pretend otherwise, we create a vacuum. And that vacuum is quickly filled by the loudest ideologues and most craven opportunists.
To fight back, we need coordinated action and solidarity with those most targeted. And we need to stop pretending that defending science means staying above politics. Provoked by the revelation of Martin's letter, The Lancet —a world-leading, London-based medical journal—has taken on this public responsibility and done what its American counterparts have so far declined to do: published a clear and forceful editorial stance condemning the Trump administration's assault on science, medicine, and public health, and calling for Kennedy's resignation. Other journal editors and health leaders should now join in taking such principled political stands. To do so, they must give up on the naïve fantasy that, if they just keep their heads low enough, they can avoid becoming targets and simply wait out the Trump administration as it destroys essential scientific infrastructure.
Martin's letter is a declaration that scientific inquiry is no longer safe unless it aligns with state ideology. If we let that stand, we don't just lose our journals. We lose the right to ask questions that matter—and the ability to care for those most in need.