Clinton vs. Trump: A race between a policy wonk and a ‘black box’

WASHINGTON — When Hillary Clinton announced in December that she wanted a big increase in Alzheimer’s research, she did it in typical Clinton fashion — with a major speech and a six-point plan, led by a specific commitment of $2 billion a year in federal funds to find a cure by 2025.

When Donald Trump announced his own support for Alzheimer’s research last summer, he did it because someone asked him a question at a town hall. And his response was typical Trump. He assured the New Hampshire audience that Alzheimer’s was a “total top priority” for him — a bold promise with no specifics and no follow-up.

These are the two paths that US medical research could take now that the lineup for the November presidential election is settled. The fate of the Obama administration’s significant investments in biomedical research will end up in the hands of either a candidate with a long, wonky track record on health and medicine — with mixed results — or the candidate whose views are an almost complete mystery.

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Clinton “really knows what’s going on and is a policy wonk on medical research as well as health care,” said Mary Woolley, president of Research!America, a coalition of groups that promote medical research. Trump, however, has such an “in the moment” approach to medical research — almost never raising the issue unless someone asks him about it — that it will be impossible to know what he’d do until people ask him more questions, she said.

Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia, puts the choice in more stark terms.

“I think it is fair to say that Donald Trump is a black box. He says one thing one day and the opposite the next,” Offit said. “So he certainly scares me far more than Hillary Clinton, who has generally supported public health.”

President Obama has launched three major medical research projects: the Precision Medicine Initiative, which is trying to develop treatments tailored to people’s genetic makeup; the BRAIN Initiative, which is trying to map the human brain; and Vice President Joe Biden’s cancer “moonshot” initiative. All are at critical stages of their development, and all will depend on the support of the next president and Congress to achieve their goals.

Clinton hasn’t said specifically whether she would continue those initiatives, and her campaign didn’t respond to questions about her plans. But among medical experts there is little doubt that she shares the president’s enthusiasm for research.

She has laid out plans to boost Alzheimer’s research, increase treatment and support for people with autism, advance the fight against HIV and AIDS, and reduce opioid addiction and substance abuse.

She has spoken out on the most urgent public health crisis of the moment — the Zika virus — echoing other Democrats’ calls for Congress to approve emergency funding. And she worked to advance medical research as first lady and as a US senator, promoting initiatives to fund breast cancer research and co-chairing the Congressional Task Force on Alzheimer’s Disease.

Trump, on the other hand, has sent mixed messages when it comes to medical science.

He has said supports Alzheimer’s research, and has given financial support to other kinds of disease research. A STAT review of Trump’s record shows he has helped raise money for a variety of cancer groups, including Susan G. Komen, the Prostate Cancer Foundation, and the Lustgarten Foundation for Pancreatic Cancer Research. And the Donald J. Trump Foundation has donated to disease groups fighting everything from cancer to heart disease, epilepsy, Parkinson’s, and childhood diseases.

But some of Trump’s remarks have also alarmed the scientific community. When conservative talk radio host Michael Savage offered himself for the job of National Institutes of Health director in an October 2015, Trump didn’t shoot down the idea — and suggested the agency had major, unspecified problems.

“I think that’s great,” Trump said. “You know you would get common sense if that were the case, that I can tell you. Because I hear so much about the NIH, and it’s terrible.”

Trump has also bought into theories that aren’t grounded in medical science. He has talked and tweeted, many times, about the now-disproven link between vaccines and autism. “If I were President I would push for proper vaccinations but would not allow one time massive shots that a small child cannot take — AUTISM,” he tweeted in March 2014.

And during the height of the Ebola crisis in 2014, he tweeted calls to stop flights from the affected countries, warning that “the plague will start and spread inside our ‘borders’” even as public health experts were trying to assure a nervous public that Ebola wasn’t that easy to catch.

“These are not what most public health people would call responsible statements,” said Research!America’s Woolley. “But he does change his mind,” she added, calling Trump “consistently inconsistent.”

Other public health experts are also worried about Trump’s comments that he’s “not a big believer in man-made climate change,” saying they show a more general skepticism of science. Dr. Georges Benjamin, executive director of the American Public Health Association, called the climate change comments “very concerning.”

And, of course, there was Trump’s vitamin network, a network marketing company that sold supplements on the basis of bad science.

The Trump campaign didn’t respond to questions about his comments and his plans for medical research.

It’s not unusual in presidential elections for the two candidates to have wildly different approaches to health care, or even for the Democratic nominee to talk about it more than the Republican nominee. What’s unusual in this race is how vast the imbalance is between Clinton’s track record — whatever one thinks of it — and Trump’s lack of one.

That imbalance is putting medical research groups, which have a strong interest in currying favor with both candidates, in the awkward position of acknowledging they just don’t know what to expect from Trump.

“Secretary Clinton has promised to support medical research for patients with a variety of diseases, including Alzheimer’s, HIV, and AIDS. We are unaware of a similar commitment from Donald Trump,” said Edward Abrahams, president of the Personalized Medicine Coalition, which supports Obama’s Precision Medicine Initiative and wants to see it continue beyond its presidency.

“No matter who is elected, we hope that the next president will continue to invest in the Precision Medicine Initiative because its potential to improve care while also increasing the efficiency of the health system is so great,” Abrahams said.

Clinton has a broad circle of advisers who are well-versed in health policy and medical science — including Dr. Harold Varmus, the former National Institutes of Health director, who’s now an outside adviser to the campaign.

So far, Trump hasn’t built the kind of network of health and medical advisers that is typical for presidential nominees — at least, none that is known to mainstream conservative health and medical science experts.

Clinton hasn’t always succeeded with her health initiatives. As a senator, she had to settle for a scaled-down version of a bill to promote research into environmental factors that are linked to breast cancer. The failure of her health reform initiative in 1994 came despite an enormous effort.

Still, she has a deep history of interest in medical science. Varmus recalls that Clinton visited the NIH campus for a day of meetings as first lady in early 1994 — when he was NIH director — and said she was interested in retroviruses and AIDS. She told Varmus at the time that Chelsea Clinton was interested too — she was working on a high school report about the life cycle of retroviruses.

Even Clinton’s conservative critics don’t doubt her knowledge — but they object to her proposed solutions, including her plan to crack down on drug prices, which they say fails to appreciate the financial risks biotech investors have to take.

“It’s an ecosystem, and you need both” greater medical research funding and a payoff for the costs of medical innovation, said Paul Howard, director of health policy at the conservative Manhattan Institute.

Former House Speaker Newt Gingrich told the BIO International Convention in San Francisco last week that Clinton is “extraordinarily knowledgeable” about medical research, but that Trump would be “more aggressive” on issues like reforming the Food and Drug Administration and promoting “decentralized, market-oriented proposals” for encouraging medical innovation.

The problem, Howard said, is that the uncertainty over a Clinton vs. Trump race is likely to make the biotech industry nervous about investing in long-term drug development when they have “no idea what the reimbursement climate is going to be.”

“Clinton has some things that you may not like, but at least you know where she’s coming from,” Howard said. “With Trump, you may not know what he’s going to do … until he gets in. It might be the traditional Republican market-oriented approach, or it could be something very different.”

Even medical research groups that have received contributions from Trump say they have little insight into his views. When STAT contacted a dozen groups that have received donations from Trump or help with fundraisers, top officials at all of them said they had never talked with Trump about the reasons for his support or declined to comment.

As a result, Trump hasn’t made an impression with advocates even on disease research he has supported, including breast cancer research.

“I have really never heard his name mentioned in my world,” said Fran Visco of the National Breast Cancer Coalition, who has worked with Clinton in the past on her breast cancer initiatives. One thing she does know: Unlike Clinton and Jeb Bush — his former rival for the Republican nomination — Trump has not signed a pledge to support the group’s goal of ending breast cancer by 2020.

Even on Alzheimer’s, advocates aren’t sure how encouraged to be about his one vague statement of support.

Clinton’s promise to push for $2 billion a year in Alzheimer’s research funding is “truly noteworthy. There’s no other presidential candidate, or even a sitting president, who has laid down a marker like that,” said Rob Egge, executive director of the Alzheimer’s Impact Movement.

With Trump, Egge said, “what he has said is very encouraging.” But by calling Alzheimer’s research a “top priority,” Egge added, “what does he mean by that? We’re eager to hear more details from him.”

The one factor that takes some of the edge off of the presidential race, in the view of some researchers, is that the future of Obama’s initiatives doesn’t depend entirely on the presidential election. Members of Congress from both parties have been giving at least rhetorical support to medical research, too.

“My hope is that this will be important to everyone regardless of who wins the presidency,” said Dr. Elizabeth Jaffee of Johns Hopkins University, one of the cochairs of the “blue ribbon panel” that’s advising Biden’s cancer effort. “Everyone gets cancer. … Everyone wants to see cancer eradicated the way we eradicated smallpox.”

Ike Swetlitz and Rebecca Robbins contributed to this report.

Correction: An earlier version of this story incorrectly identified Dr. Paul Offit as head of infectious diseases at Children’s Hospital of Philadelphia.