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?
I agree that physicians, clinical researchers, and scientists have a collective responsibility to advocate for policies that improve health. This is the ultimate goal of the research we undertake. There are several arguments for researchers as advocates: 1) Researchers may have specialized expertise and can speak knowledgeably on certain policy-relevant topics, 2) Research is often publicly funded by taxpayers, who should be the beneficiaries of the research, and 3) Without advocacy, policy makers may remain uninformed about key issues and perpetuate unjust policies.
Advocacy and scientific objectivity are not always in conflict. However, scientific objectivity could be compromised in several ways: 1) Researchers turned advocates may narrowly represent the views of an interest group, and blur the lines of scientific objectivity to advance the interest group's goals, 2) Effective advocacy may require story-telling and embellishment, rather than solely statistics, 3) Researchers may be asked to use their position to advocate for issues that they are not truly informed about.
Academic researchers face many priorities and responsibilities, some of which may conflict with scientific objectivity. For example, conflicts of interest or incentives for publication and promotion are often not aligned with scientific objectivity. Managing all these conflicts of interest, including ones that arise in advocacy, is essential to maintain the integrity of scientific research.
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.
In our class, we touched upon race-based reporting of estimated glomerular filtration rate (eGFR). Several institutions across the country, including San Francisco General Hospital, are eliminating the race-based reporting. The attached JAMA editorial discusses the issue:Eneanya ND, Yang W, Reese PP. Reconsidering the consequences of using race to estimate kidney function. Jama. 2019 Jul 9;322(2):113-4.
I agree with the authors that race-based eGFR reporting has negative consequences for kidney transplant listing, and probably a negative impact on kidney health equity. However, in the absence of a current better approach, eliminating race-based reporting will make eGFRs less accurate for *on average* for black individuals. However, for a substantial percentage of black individuals, eGFRs without the "race adjustment" will become more accurate. Importantly, the eGFR equation was derived in a population with only white and black individuals. Deriving a new equation with more racial categories would be one step forward, but still have the limitations that come with race-based estimates. Ideally, equations would rely on objectively determined inputs.