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WASHINGTON There were a whole host of candidates and issues on the 2020 ballot beyond Joe Biden and Donald Trump, and many of those races will have dramatic implications for health and science policy in America.

Will Democrats keep or even grow their majority in the House? Can they take back enough seats to claim control in the Senate? Health care and science cropped up in several of the congressional races were watching, too, from a House campaign on Long Island to Senate contests in Kansas and North Carolina. Plus, voters in some states were also weighing in on issues like abortion access and marijuana legalization.

Throughout the week, STAT reporters in D.C., Boston, and beyond will keep track of the results that will have the biggest implications for health policy. Check back here for live updates.

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In Floridas 27th Congressional District, Democratic Rep. Donna Shalala, the former health secretary during the Clinton administration, lost her seat amid a Republican surge in Miami and its suburbs.

Democrats didnt take advantage of Shalalas health policy expertise during her single term in Congress: She wasnt assigned to any committees with health care jurisdiction, and she didnt play much of a role in Democrats signature health policy initiatives, including H.R. 3, their aggressive drug pricing bill. Still, Shalala was seen as an elder statesperson on health care issues. Shell be succeeded by her Republican challenger, the former television journalist Maria Elvira Salazar.

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Rep. Roger Marshall (R-Kan.) defeated his Democratic opponent, Barbara Bollier, in a Senate race hyper-focused on health care. Bollier kept things surprisingly competitive in deep-red Kansas, but fell short despite a campaign focused on issues like Medicaid expansion, surprise billing, and Covid-19.

Marshall is a deeply conservative OB-GYN who becomes the Senates fourth Republican doctor, joining John Barrasso (Wyo.), Bill Cassidy (La.), and Rand Paul (Ky.). He made health care central to his own campaign, and has volunteered at Kansas hospitals helping to treat Covid-19 patients throughout the pandemic. Hes generated controversy, though, for past comments on Medicaid beneficiaries and for his advocacy for physician-owned hospitals. And on health policy, he was a bit of a 2020 anomaly: He campaigned on a pledge to repeal the Affordable Care Act a position many Republicans now view as a liability.

Republican Ronny Jackson, the former White House physician, won a Texas panhandle congressional seat Tuesday to represent one of the most conservative districts in the country.

Jackson became White House physician under former President Obama, but rose to national prominence when he said President Trump has incredible genes, I just assume during a 2018 press briefing about the presidents health. Trump then nominated Jackson to serve as Veterans Affairs secretary, but Jackson withdrew from the process amid allegations about his management of the White House medical unit and about his personal and professional conduct.

Jackson won the Republican primary for the congressional seat in part by aligning himself closely with Trump.

States around the country eased drug laws on Tuesday, with a handful legalizing different forms of marijuana and some jurisdictions taking the first steps to decriminalize possession of other drugs.

Voters in New Jersey, Montana, and Arizona opted to legalize the recreational use of marijuana for people 21 and over, joining the dozen other states that have embraced the policy (and typically tax marijuana sales) despite it remaining illegal at the federal level. In Mississippi, voters approved a medical marijuana program. And in South Dakota, voters approved separate ballot measures that will legalize recreational and medical marijuana.

Residents in Oregon voted to legalize psilocybin, the active compound in certain hallucinogenic mushrooms, for use in mental health treatments. The state also voted to decriminalize the possession of small amounts of drugs, including cocaine and heroin, while greenlighting new funding for addiction treatment and harm reduction programs. And in the District of Columbia, residents approved a measure to decriminalize the possession of some psychedelic plants, including magic mushrooms.

Days before the Supreme Court will decide whether or not it will take up a case that could far more strictly limit abortion, voters in Louisiana have decided to specifically prevent the states constitution from being used to mount challenges to abortion restrictions in the future.

Voters in Colorado, however, decided against barring abortions after 22 gestational weeks; the state is one of the few where people who need the procedure done during their third trimester of pregnancy can find physicians who are willing to provide it.

Voters in Oregon and Colorado both voted resoundingly to establish new taxes on vapor products like Juul. The initiatives in both states would also drastically increase existing taxes on cigarettes and other smokable tobacco products.

Voters in Oklahoma also rejected an initiative that would have diverted tens of millions from the states tobacco trust fund to fund expansion of the states Medicaid program. The initiative was opposed by tobacco control advocates including the American Cancer Society Cancer Action Network and the Campaign for Tobacco-Free Kids.

Cameron Webb, a physician running as a Democrat in Virginias 5th Congressional District, conceded his race early Wednesday to Bob Good, a Republican. Webb ran a health care-focused campaign in the largely rural district, but didnt endorse Medicare for All, a hallmark of many more progressive Democrats 2020 campaigns. Had Webb won, he would have become the first Black doctor to serve in Congress (other than non-voting delegates).

Democratic upstart Quinn Nystrom was unsuccessful in her bid to unseat Republican Rep. Pete Stauber in Minnesotas 8th District.

Nystroms race, which was laser-focused on the issue of high drug prices, did not attract the national attention of other drug pricing-heavy races, like the effort to unseat Republican Sen. Thom Tillis in North Carolina, which is still too close to call. But Nystroms defeat is an early, albeit small, sign that drug pricing was not the animating issue activists had hoped it would be this election cycle.

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The 2020 election results that will impact health and science policy - STAT

As inother periods in our history, ours is a battleground between two basic views of statecraft: 1) the liberal view of social change for the good of the people and 2) the conservative belief that any social engineering is doomed to failure at best and is tyrannical at worst.

Our present-day heated, even venomous arguments, are nothing new. Abraham Lincoln, not a rabid Socialist, had to contend with the reactionary Democratic Party of his time. It was called the know nothing party. It was true to its name.

Teddy Roosevelt (TR) fought the big money interests of his time. He also planted the seeds of the progressive movement. His fifth cousin Franklin Delano (FDR) gave us the New Deal, a social experiment of profound dimensions. And Lyndon Johnson completed the work of Lincoln, TR, and FDR with his much underappreciated War on Poverty.

This seemingly inexorable process of progressivism was punctuated with conservative backlash. The most profound was initiated by Ronald Reagan whose worldview could be summed up by his own pithy phrase from his 1981 Inaugural address:

Government is the problem, not the solution.

This conservative trend continued during George Bushs two terms and assumed its most extreme form in the Libertarian ideology of Ron Paul. A stance that is perpetuated by his son, Senator Rand Paul.

This was followed by two terms of the progressive, Barack Obama. In addition to digging us out of the economic mess left by the preceding president, he also was able to get the Affordable Care Act signed into law. Although it fell short of the universal coverage that many progressives hoped for, it did significantly increase coverage, particularly in the left-leaning states that expanded Medicaid.

And, then came Republican Donald Trump who has spent his first term trying to undo everything that Obama had put into place. True to his promise, he slashed taxes primarily benefiting corporations and the rich. He also implemented severely restrictive immigration policies.

Other articles by this author:The Unfortunate Consequences of Disbelieving in Free WillWhat is the Science Behind the Spread of Fake News?

However, His biggest coup when it comes to conservative social policy may come on November 10, 2020. This is when the newly lopsided Supreme Court votes on whether The ACA is constitutional or not.

So, whos right?

An important book by Timothy Wilson, Redirect: The Surprising New Science of Psychological Change, reviews the track record of social change through policy.

Wilson is a social psychologist at the University of Virginia who has made groundbreaking discoveries in the study of intuition and introspection. Who better to judge whether intuition and ideology are sufficient? Although written in 2011, it is still quite relevant today. In fact, it is an eye-opener.

Equally important to read is a review of Wilsons book in Science Magazine that was written by Geoffrey L. Cohen of Stanford Universitys Departments of Education and Psychology. It appeared shortly after the book was published.

Here is what he said,

When the father of the field, German refugee Kurt Lewin, conducted his seminal studies, the problems of World War II preoccupied him:

At the heart of Lewins approach rested a novel idea: social problems are amenable to experimentation. The best way to understand something is to try to change it, he was fond of saying. Beyond descriptive and correlational studies, Lewin championed experimental manipulation: Introduce an exogenous shock to the system and see how it responds.

Cohen goes on to say,

Lewin also advocated a diagnosis stage in what he dubbed action research. First, assess the relationships among variables in a system. In doing so, one could identify the pressure points where a small nudge might have large consequences.

For example, to encourage families to eat cheap-cut meats like sweetbreads during the war (because the finer cuts had limited supply),Lewin showed the importance of the gatekeeper, the person who controls the behavioral channelin this case, the housewife.

He also demonstrated the impotence of persuasion and the power of the small group. Bring housewives together into a new groupsupportive of change, freeing them from the grip of their old familial norms, and they would try the novel foods far more frequently than if they were lectured to.

Time and again, Lewin showed that what often seem problems of bad attitudes, lack of information or economic incentives were instead problems of group influence, identity, and social perception.

But most revolutionary was Lewins method. There was a combination of optimism and folly in the idea that researchers could, through the experimental method, change reality, and improve social conditions for the better.

In Redirect: The Surprising New Science of Psychological Change, Timothy Wilson reviews much of this history and revisits the field of social psychology 70 years after Lewins pioneering work.

To summarize his findings from this extensive review, it becomes clear that policies based on ideology and intuition are almost always doomed to failure. On the other hand, policies based on controlled studiesemploying the best techniques science provideshave an infinitely better chance to succeed.

Such studies start with a limited population sample. Once proven effective, they are scaled up to larger and larger populations. Fortunately, our thousands of municipalities, tens of thousands of school districts, and 50 culturally-diverse states offer an enormous laboratory for such social experiments.

Interventions that defuse blacks and whites fear of interracial rejection increase their likelihood of becoming friends. And reminiscent of Lewin, there are studies that cleverly manipulate social norms to reduce teen alcohol use and encourage energy conservation.

Now lets consider the ideologically-based policies, such as, for instance,the ownership society ofGeorgeBush. The ideawas basically quintessential conservative:

Give people property and theyll become conservative. This is because they now have something to lose. Hopefully, they start voting Republicana not-so-fringe benefit of the policys advocates.

The catastrophic failure of this policy is still reverberating through our economy today and will, I believe, continue to do so for many years to come.

Cohen, the Stanford scientist, concludes:

Wilson wants society to adopt more of an experimental approach to solving social problemsputting interventions to the test with randomized controlled trials. This is a good idea, at least when the ambition is to disseminate the interventions widely. However, one problem that Redirect does not explicitly address concerns limitations in the experimental method itself.

There is nothing better than an experimentfor testing causality, whether an intervention A affects a social problem B. However, a positive experimental result risks deluding us into believing that A is both necessary and sufficientto solve B.

But as Lewin taught us, the effect of A will depend on the context into which it is introducedthe preexisting system of variables. Encourage students to see their academic fates as within their own control and they will thrive., provided on inhabiting a classroom that provides them with opportunities for growth, such as committed teachers and quality instruction.

Many of the interventions Wilson reviews act like catalysts. They will not teach a student who cannot spell to spell, butthey will encourage the student to seize opportunities to learn how. Because the effects of interventions are context-dependent,there will be no silver bullets.

Wilson compellingly argues that effective interventions validated by social-science research are rarely implemented. This is a problem. Why are such interventions ignored in favor of ideology and intuition? What can we do to prevent this? What interventions should we be implementing today?

Richard Thaler is an economist at the University of Chicago and Cass Sunstein is a professor of law at Harvard Law School. These professors, both with an unimpeachable conservative (in the academic sense of the word) track record, did something unique in our ideology-soaked political environment: They looked at the science.

Specifically, they examined the field of behavioral economics as developed by Daniel Kahneman and his colleagues. And in doing so, they arrived at a surprising conclusion:

When based on science, both a conservative and a liberal approach to social policy can be married.

In their book, Nudge: Improving Decisions About Health, Wealth, and Happiness, Thaler and Sunstein state:

The libertarian aspect of our strategies lies in the straightforward insistence that, in general, people should be free to do what they like and to opt-out of undesirable arrangements if they want to do so. On the other hand, it is legitimate for choice architects to try to influence peoples behavior in order to make their lives longer, healthier, and better.'

They dubbed this theoryLibertarian Paternalism, somewhat of a dissonant contradiction to my ears. Their argument is that you dont have to compel people to do whats good for them, rather you can nudge them toward it. For example:

You get the picture.

How such an approach would fare with anti-maskers and anti-vaxxers who detest wearing their facial covering or getting their children vaccinated against deadly diseases, is left unanswered.

I suspect that part of the answer will not be wholly acceptable to libertarian paternalists a la Thaler and Sunstein; lets call it soft coercion.

Take, as an example, smoking cessation. The science is unequivocal: smoking cigarettes is deadly!

But libertarian ideology says that as a free society we should be free to smoke and if it kills us, well, that was our choice. This argument totally ignores the societal harm done by smoking, such as:

So how did we, as a society that lives in reality rather than in an ideological ivory tower, deal with it? We followed the science and banished smokers from all spaces where people congregate. Further, we limited them smoking to circumscribed spaces (smoking rooms, outside of their office building) that were not always very inviting.

We raised the prices of cigarettes to make them less affordable. We forced cigarette manufacturers to label their products with prominently warning labels. We even made them pay the cost of anti-smoking public service announcements.

This approach did not outright ban smoking, acknowledging our societys libertarian streak, rather it nudged smokers into quitting this harmful habit.

So when it comes to dealing with the ideological anti-vaxxers school districts may face funding penalties for not mandating childrens immunization. To deal with the anti-maskers, companies could become legally liable if they do not mandate wearing a mask at work.

Does this tactic sound too coercive? I suggest it is a middle ground between mandates and laissez-faire, between liberal and conservative approaches. And, it was demonstrated to be successful in dealing with the man-made cigarette pandemic that afflicted the world.

I believe that, just as with the smoking problem, at the end of the day we will be forced to acknowledge science and abandon intuition and ideology.

It gives me hope that examined dispassionately through the lens of scientific evidence such seemingly irreconcilable ideologies as Libertarianism and Liberalism can rise above the ideological cacophony and give us enlightened policymaking.

Is it too much to ask?

In the current environment, probably.

Published 12/28/11. Updated and republished 6/16/17. Updated and republished again 11/2/20 because of the remarkable relevance of the arguments to todays political environment. We hope it adds to the much-needed conversation about U.S. policy approaches.

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Conservative vs. Liberal Views of Social Change: Who's Right? - The Doctor Weighs In

Rand Paul was confronted by a rowdy group of Black Lives Matter protesters in Washington, DC, early Friday after leaving the White House for the Republican National Convention.

Paul was walking to the Hotel Washington with his wife when a crowd descended upon him while shouting Say Her Name and Breonna Taylor.

The senator from Kentucky where Taylor was fatally shot and killed by police was being escorted by D.C.s Metropolitan Police.

In one of the videos, a protester pushes a Metro DC police officer who trips and brushes into Paul.

The officer briefly stumbles and regains his footing.

A woman can be heard shouting at Paul: Her name is Breonna Taylor!

Just got attacked by an angry mob of over 100, one block away from the White House, Paul said in a tweet.

Thank you to @DCPoliceDept for literally saving our lives from a crazed mob.

The senator and his wife did not appear to be injured.

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Rand Paul assaulted by Black Lives Matter protesters after RNC

As you know by now, Senator Rand Paul and his wife were attacked by a Black Lives Matter moboutside the White House last night after leaving the RNC convention. Paul credits the police for his survival.

"I can't tell you how I'm not sure we would have made it. They were attempting to push the police over to get to me...you've seen the pictures of what they do to you. If the police are not there, if you defund the police, if we become Portland, if America becomes Portland, what's going to happen is people are going to be pummeled and kicked in the head and left senseless on the curb. That would have happened to us I promise you, had we not had the D.C. police to support us...Thank God for the police. Had we not gotten to the police I truly believe that the police saved our lives and we would not be here today or we would be in a hospital today if the police had not been there," Paul told Fox and Friends Friday morning.

But this isn't the first time Paul has experienced violence from the left. It's his third time.

Paul was on the baseball field where Bernie Sanders supporter James Hodgkinson opened fire in an effort to kill as many Republicans as possible. Congressman Steve Scalise nearly died after being shot.

"One of the things that's really fortunate and probably why, everybody probably would have died expect for the fact that the Capitol Hill police were there," Paul said during a June 2017 interview with MSNBC.

Earlier that same year, Paul was violently attacked from behind by a leftist neighbor. Six of his ribs were broken, his lung was punctured and his injuries required surgery.

The man who violently attacked Senator Rand Paul while he was mowing his lawn in Kentucky, leaving him severely injured, has been ordered by a jury to pay $580,000 in damages. Paul filed a lawsuit against Rene Boucher after suffering a number of broken ribs and long term damage to his body in 2017.

"A Kentucky jury on Wednesday awarded $375,000 in punitive damages and $200,000 for pain and suffering, plus $7,834 for medical expenses," the Associated Press reported Wednesday. "Paul said afterward that he hopes the jury's verdict sends a "clear message that violence is not the answer."

Paul's attacker is reportedly a socialist and registered Democrat. His attorney argued the attack came after a dispute "between neighbors."

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Rand Paul Survives His Third Attack From the Violent Left

Sen. Rand Paul (R-Ky,), questions Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, as he testifies during a U.S. Senate hearing last month.

Sen. Rand Paul (R-Ky,), questions Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, as he testifies during a U.S. Senate hearing last

Sen. Rand Paul (R-Ky,), questions Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, as he testifies during a U.S. Senate hearing last month.

Sen. Rand Paul (R-Ky,), questions Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, as he testifies during a U.S. Senate hearing last

Opinion: How flattening the curve saves lives

While the recent heated exchange between Sen. Rand Paul and Dr. Anthony Fauci about pandemic response strategies received considerable attention, Ive seen no scrutiny of Pauls false claim that flattening the curve only saves lives if it prevents the health care system from being overwhelmed. This thinking assumes that the area under the curve (i.e., total deaths) will be the same regardless of the measures taken, so long as we dont overburden the medical system. This belief has been stated often this year as if it were a fact, yet its patently false.

The claim rests on the absurd assumption that treatments for patients infected by this novel virus havent improved and will never improve. Expressed another way, Pauls claim about flattening the curve only holds water if health care professionals are no better at treating infected patients today than they were in March.

Of course, months of research and clinical experience have improved our understanding of how to treat patients with COVID-19. For example, research on the use of corticosteroids to treat severe cases of COVID-19 has yielded promising results, including one study that found dexamethasone decreased mortality by approximately one-third among patients who were on ventilators. Additionally, a recent editorial from JAMA encourages placing some patients on ventilators in the prone position, a strategy rarely used at the start of the pandemic.

These advances in medical care mean that people who are infected today are more likely to survive than people who were infected at the beginning of the pandemic, and this trend will likely continue. Consequently, delaying the time at which a person is infected by flattening the curve increases their chances of surviving and having an easier course of illness.

Many critical questions about the virus remain unanswered, such as the optimal dose of dexamethasone for various patient demographics, and these gaps in knowledge further highlight the value of flattening curve. It takes time to research these issues and to discover more effective treatments, and flattening the curve allows these advances to help more people. Perhaps the most obvious example is the development and distribution of an effective vaccine. If an effective vaccine is distributed widely in the coming year, then the number of lives the vaccine saves will be directly related to how aggressively weve flattened the curve.

To be fair, Paul also claimed that public health interventions have no effect on the rate of transmission of the virus and therefore attempts to flatten the curve only cause economic and psychological damage rather than save lives. This claim is in stark opposition to the guidelines of the CDC and WHO and ignores the contradicting results of New Zealands approach. Whats more, while Paul cited the results of Swedens relatively lax approach to support his argument, Fauci noted that the countrys results may argue against his position: Sweden has death and case rates that are several-fold higher than those of other Scandinavian countries that more aggressively tried to curb transmission. While effectively flattening the curve may be more complicated than enforcing public health measures, it doesnt mean that were better off disregarding such measures.

Though there may be compelling reasons to adjust pandemic response strategies, the falsely claiming that flattening the curve doesnt save lives from COVID-19 infection isnt one of them. If anything, promoting this falsehood likely endangers American lives. People need to stop repeating and spreading this lie. Sen. Paul, I hope youre listening.

Rob Palmer is a fourth-year medical student at the Yale School of Medicine and co-president of the schools Preventative Medicine Interest Group.

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Opinion: How flattening the curve saves lives - CT Post