When "Health Equity" Means Exposing Infants to Methadone
The dangerous deformation of medical research
Laura Helmuth, the editor of Scientific American, resigned yesterday. On election night, Helmuth published a since-deleted, profanity-laden screed on the social-media platform Bluesky—taking particular aim at Gen X and her home state of Indiana for helping to secure Trump’s victory. Days later, she apologized—but calls for her firing or resignation continued.
Helmuth announced her departure via a separate thread on Bluesky, which only served to underscore why her tenure at Scientific American had been so contentious. She posted a long list of articles meant to represent some of the work she had been most “proud to support,” nearly all of them involving politically loaded buzzwords— “racial justice,” “environmental justice,” “reproductive justice.”
The practice of science, long understood as a means to uncover truths, was too often presented by Helmuth as a means to prove her own predetermined conclusions. Science in this view is not a process, informed by epistemological humility, with mistakes and corrections to be expected along the way, but a cudgel.
Of course, Helmuth is not alone. Prestigious scientific journals have increasingly become mired in partisan politics. In 2020, Nature, Scientific American, and the Lancet each issued a first-ever presidential endorsement, for Joe Biden; the unprecedented move seems to have resulted mostly in a loss of the magazines’ perceived credibility among the general public. It has been especially deflating to see the decline of Scientific American, though, given that it was created to celebrate American ingenuity; an invention by Abraham Lincoln was featured in an early issue.
Putting aside the credibility of any given magazine, however, it’s worth examining how this approach deforms scientific endeavor— and our shared understanding of the aims of science itself. The latest issue of the New England Journal of Medicine provides an alarming example.
On November 9th, NEJM published four opinion articles under the umbrella heading “Efforts toward Equity.” The premise of each piece is that the pursuit of equity in medicine is inherently good, whatever that might mean in practice. In one of the articles, we are told, “equity” means allowing fetuses and newborns to be exposed to dangerous levels of drugs, legal or illegal, including opioids.
Drs. Katherine Nash, Joanna Perdomo, and Heather Hsu begin the piece by describing the Health Equity Rounds (HER) conference series, which was launched in the pediatric department of Boston Medical Center in 2016 and has since been implemented at over 65 institutions.
They describe the HER program using vague, familiar pablum: It “has helped normalize conversations about medical racism, giving the community a vocabulary and framework for identifying problems.” It has “catalyzed important conversations and efforts toward care transformation.” HER leaders have worked to “incorporate brief, case-based discussions of HER concepts into busy inpatient workflows.” “As a result of expertise gained from HER, some resident alumni have been hired as faculty into leadership positions in equity, diversity, inclusion, and accessibility.” The circular explanations obscure more than they reveal.
The one case study that the authors do offer is unsettling. They describe an HER series in 2018-19 that focused “on caring for families affected by parental substance use.” This led Boston Medical Center to adopt a new set of clinical guidelines in 2021; doctors are now advised not to report parents to child protective services in many cases in which newborns are found to have been exposed to harmful or illegal drugs.
For context, clinicians are mandated reporters of suspected child abuse or neglect, including cases of prenatal substance exposure, or PSE. Federal law requires states to track data on all newborns exposed to harmful substances during pregnancy, and to ensure a plan of “safe care” is created for each family.
Boston Medical Center acknowledges this on their website, noting that Massachusetts requires doctors to report cases in which “a baby was exposed to substances designated as ‘addictive drugs’ prenatally.” But, BMC contends, this is unjust, as the addictive substances include “methadone and buprenorphine, FDA-approved treatments for opioid use disorder (OUD), meaning that healthcare providers are required to report pregnant mothers who are actively participating in evidence-based, physician-recommended treatment for OUD.” In 2023, Massachusetts General Hospital issued a press release demanding changes to the state law for this reason.
Meanwhile, the NEJM proudly features physicians who are flouting the law—and at the direction of a major medical center. The authors of the NEJM article explain that, today, BMC doctors report parents who have exposed their newborns to substances like methadone “only when tangible concerns arise about a parent’s ability to care for a child.” They do not explain what these “tangible concerns” might be. To be clear, both methadone and buprenorphine are narcotics; the latest research available on prenatal exposure to either substance indicates increased risks of fetal death, reduced fetal growth, persistent psychometric deficits, and sudden infant death syndrome, among other symptoms or adverse events.
Further, the article does not distinguish between babies exposed to methadone because their mothers were taking physician-recommended OUD treatments, and those who may have been exposed to other opioids, including drugs purchased on the black market. The authors do not suggest that doctors ought to attempt to discern the difference.
Is there any meaningful proof that HER has improved anything? The authors conclude by citing “a statewide analysis that showed that the guideline change reduced child protective services reporting for opioid-exposed newborns at BMC by nearly half without influencing newborn length of stay or custody at discharge.” Note that this reveals nothing about the health or welfare of the infants involved.
This report reveals a number of things, which I plan to explore further in future posts. For one thing, it demonstrates the authors’ condescending view of “equity”; pregnant women on opioid medications are assumed to be from marginalized communities of the sort that BMC policymakers have taken upon themselves to help. It also reveals a warped idea of what such help ought to look like. The authors do not cite research indicating that exposure to OUD medicine is safe for babies; they do not even appear interested in the question. The ordinary goals of medicine are nowhere evident in this report by the New England Journal of Medicine, much as the ordinary ends of science are ignored in much of the work championed by Helmuth.