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Doctors struggle to stay true to science but not cross Trump

Dr. Deborah Brix, White House coronavirus response coordinator, speaks as President Donald Trump listens during the daily coronavirus briefing at the White House on April 20, 2020, in Washington, DC. (Alex Wong/Getty Images)

WASHINGTON (AP) — It’s becoming a kind of daily ritual: President Donald Trump and a phalanx of doctors file into the White House briefing room each evening to discuss the coronavirus, producing a display of rhetorical contortions as the medical officials try to stay true to the science without crossing the president.

The result can be a bewildering scene for Americans trying to understand how best to protect themselves from the virus.

On Tuesday, for example, Dr. Deborah Birx aligned herself with Trump’s positive comments about plans to reopen businesses in Georgia and suggested that beauty salons and tattoo parlors there might be able to safely operate by using “creative” forms of social distancing.

But Birx, the White House coronavirus task force coordinator, later told Trump privately that Georgia’s reopening plan was too hasty. And the next day, Trump publicly denounced Georgia’s plans to start to reopen the state as coming “too soon.”

On Wednesday, Trump opened his daily briefing by inviting Dr. Robert Redfield, the head of the Centers for Disease Control and Prevention, to “say a couple words just to straighten” out the doctor’s earlier comments that the virus’s return in the fall could be even more difficult than the current outbreak.

then tried to “clarify” his remarks by saying the return of the virus
during flu season would be a difficult combination — while allowing that
his earlier comments had been accurately reported.

Wednesday, a top government doctor said he’d been ousted from his
position for opposing politically connected efforts to promote a malaria
drug that Trump touted without proof as a remedy for COVID-19.

Rick Bright “was sidelined for one reason only — because he resisted
efforts to provide unfettered access to potentially dangerous drugs,”
his lawyers said. Trump said he knew nothing about the matter.

experts worry that it hinders the ability of medical professionals to
provide frank advice to the president and the public.

doctors on the task force and the scientists more generally responding
to the pandemic are constantly looking over their shoulders,” said
Lawrence Gostin, a public health expert at Georgetown University. “There
is a tug of war between the politicians and the public health
officials. It’s a very unhealthy dynamic.”

Besides being asked to
provide updates on the spread of the virus and best practices for
combating it, the doctors find themselves drawn into Trump’s efforts to
provide a positive take on his handling of the pandemic.

keenly aware that the president has a record of bringing respected
officials into his fold, talking up their credentials and then
ultimately undercutting them or moving them aside. That happened with
former Secretary of State Rex Tillerson, former White House chief of
staff John Kelly and former Defense Secretary James Mattis.

Even Fauci hasn’t escaped the need to massage his message after the fact to soothe a volatile president.

this month, Fauci set off Trump when he told CNN that more lives could
have been saved if the U.S. government had acted more quickly.

we had right from the very beginning shut everything down, it may have
been a little different,” he said. “But there was a lot of pushback
about shutting things down back then.”

Later that day, Trump retweeted a call to #FireFauci, raising questions about whether Fauci’s job was in jeopardy.

following day, Fauci took the podium at the briefing to say he had used
the “wrong choice of words.” He added that the “first and only time”
that he and Birx had talked to Trump about a national shutdown to
mitigate the spread of virus, the president “listened to the
recommendation and went to the mitigation.”

Trump has largely
listened to his team of medical experts. But he also sees them as his
subordinates and doesn’t want to be crossed. At Thursday’s briefing,
Birx was the only one of the medical experts advising the president in
attendance. She spoke only briefly.

Instead, Trump invited
William Bryan, a senior Department of Homeland Security official, to
detail ongoing research his agency is conducting on the impact warm
temperatures and sunlight might have on killing the virus.

has kept an eye on the doctors’ media appearances and has told
confidants that he is impressed with Birx’s demeanor, according to three
White House officials and Republicans close to the White House. The
three spoke on condition of anonymity because they were not authorized
to speak publicly about private conversations.

Birx has generally
tried to avoid splitting with Trump in public, generating some
criticism for not speaking out more forcefully. Fauci, for his part, has
been more blunt in diverging from the president’s message at times.

and some in his inner circle have grown frustrated at Fauci’s
willingness to break with the president both in interviews and during
the briefings. Although Trump has not discussed firing Fauci, despite a
clamor from some on the right, he has expressed annoyance at Fauci’s
positive press coverage — and word was sent from the White House that
the doctor should not participate in any more personal profile stories.

president also seethed over Redfield’s comments about the virus’s
potential threat this fall, though he later agreed with aides who said
the CDC chief’s comments had been overblown.

Because of his
clashes with Trump, rumors about Fauci’s fate take off whenever he
misses a briefing because of his other duties. Trump has denied there is
any conflict.

Birx, a political appointee from the Obama
administration, has encouraged Trump to let the data inform his response
to the crisis. At moments, she’s also conspicuously heaped praise on
the president.

As the Trump administration’s original 15-day
guidelines promoting social distancing were set to expire at the end of
March, she told a Christian TV network popular with Trump’s evangelical
base that she was confident that the president, like her, was a student
of data.

“I think his ability to analyze and integrate data that
comes out of his long history in business has really been a real benefit
during these discussions about medical issues,” Birx told CBN.

said he’s sympathetic of Birx’s difficult position. But he said her
public sidestepping of questions about how the Georgia governor wants to
reopen businesses was problematic.

“It matters because in an ideal world, her only loyalty would be to science and public health,” Gostin said.

Weinstein, who heads the AIDS Healthcare Foundation and got to know
Birx professionally after she was named the global AIDS coordinator in
2014, said Birx is driven by her concerns for patients and public
health. She knows that she cannot be an effective advocate for science
if she doesn’t have the president’s ear, Weinstein added.

glad she’s there,” Weinstein said. “It’s very obvious that she’s made a
calculation what she must do to remain there, and that’s, on balance,

Dr. Kavita Patel, an adult medicine physician and
health policy expert who served in the Obama White House, said
scientists who advise any president have to be thick-skinned. But he
said the situation is particularly fraught under Trump, who has
sometimes followed his own instincts over the factual information given
to him by experts.

“It is clear he is only picking and choosing from that information,” Patel said.

“There seems to be a revolving door of people in science and medicine placed in an uncomfortable position,” said Patel. “It feels a little bit like you put all the scientists on a Russian roulette board, and depending on where it lands, an individual could be pitted very publicly against the president.”

Lemire reported from New York and Madhani reported from Chicago. Associated Press writers Mike Stobbe in New York and Ricardo Alonso-Zaldivar in Washington contributed to this report.