John Ruffin, former head of the National Institute of Minority Health and Health Disparities wrote:
"The 19th-century scientist and pathologist Rudolph Virchow gave voice to many of our present-day concerns about disparities and went a long way toward defining the task before us. A socially minded man, he believed that science should speak the language of the common people and that medicine should serve the public's health. He wrote, 'If medicine is to fulfill her greatest task, then she must enter the political and social life…'"
Do you agree and why? Is it permissible for scientists to become advocates in the areas of their research? What steps can one take to balance advocacy with the objectivity that is considered the ideal in scientific inquiry?
Ruffin’s works ring true to me. Why else but pursue inquiry if not to learn and then share this knowledge? This is especially true if there is some notable public impact that can be made. As Resnick cautions, though, the importance of maintaining objectivity is key in research. But what does one do when the message indicates that a disparity or inequality exists? It seems unethical to ignore it. I admire that Robert Lustig has used his research to propel an agenda targeting a reduction of sugar consumption (much as the scientists listed in Resnick’s papers advocated for what they believed was the greater good from the work they’d done and seen). It seems that once established data has been captured, and the research has been done, that supporting the evidence makes sense. The need for value-neutrality, while important – especially when needing to persuade others of its legitimacy (as in climate change as described, or perhaps in other controversial areas like childhood vaccinations) – may be outweighed by other benefits, like the need for social responsibility. As Resnick describes, it would be irresponsible to overlook the “implications of one’s research.” In order to overcome potential public distrust, though, the steps of first performing as unbiased and objective research as possible is important. It may be prudent to achieve (as a collective) several studies supporting and reinforcing these concepts to reach a social threshold of acceptance before beginning advocacy work. In addition, avoiding funding that present or bring into question certain biases would be important when conducting this work. As Resnick references, once one begins advocacy work, it may be difficult to return to a position of objectivity or be perceived as objective.
To some degree there is an almost anti-science/anti-intellectual undercurrent in society. The trust of the layperson for knowledge and advice outweighs that of one’s medical provider in some situations. I feel that advocacy now must fall to researchers as well to continue to support the field. Politicians and the public may not have the ability to interpret the information, and journalists may be limited in their scope to be able to appropriately interpret and disseminate. Some of the work falls to the researchers themselves to advocate for the field and their work.
In the setting of all this, I was disheartened to read the Gollust paper. The idealistic part of me would have thought that by sharing more about the contribution of social determinants of health to disparities that this would encourage change. Instead, it polarized the groups and caused decreased support in the Republicans, which was disheartening. Although I think it is important to introduce social responsibility to research, it is alarming to think about the potential ways for it to backfire in its intent.
Please describe an of controversy for health disparities research that you learned about in this course, or alternatively an area of research that should be prioritized in health disparities. Include why you find this area interesting or controversial.
I am embarrassed to admit that prior to this class, I had not viewed genetic
difference-based research to be one of controversy. Having less of an eye toward
basic science literature, I did not recognize that the attempt to determine
some of these differences had its core the ability to generate a sense of
racial/ethnic difference that may not truly be there (given the genetic
heterogeneity found within each group). It is certainly an interesting idea,
though, as seek to know more about how our genome (and epigenome and proteome)
can provide such huge variation given the seemingly subtle differences that do
exist. It seems worth continuing to provide some investigation to better
understand these areas even as we also pursue other means of explaining our
differences (namely that in our lived environments) if for no other reason that
to be thorough in our approach. I will be curious to see how these areas develop
in conjunction, and what ties we may end up seeing between the two, especially
as our understanding of epigenetics, proteomics, and other more reactive responses
evolve.