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 we have a moral obligation to advocate for policies and social causes that are relevant to our research. As clinicians and/or scientists, we have an extensive amount of training and expertise that places us in a uniquely powerful position from which we can offer opinions and guidance. However, the dissemination of this information often derives from just a handful or physicians/scientists who are well-versed in politics or media. I think if we all assumed additional responsibility for advocating for the research we perform, the information that the public receives would be more nuanced and well-rounded.
One thing that I find particularly interesting in this discussion is the statistical analysis. A critical part of every research question is the hypothesis, and because investigators initiate a project based on a hypothesis, I think we all have an inherent bias from the outset. As we have learned in Biostat208 this quarter, model building and variable selection/transformation can be subjective, so I think a real challenge is for us remain objective when we are analyzing our data and framing our results.
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.
The content of this course focused largely on the health disparities that are experienced as a result of racism in this country, which is critically important to all areas of research. I think another area that received less of a focus, but is also critical, is disparities by sex. Beginning at the level of basic science, sex disparities are regularly ignored. Experiments are frequently performed with animals of a single sex or the sex of the animals is not reported, which leads to a fundamental bias in our understanding of basic biology and the differences (or lack thereof) by sex.
On the other far end of the spectrum in clinical research and practice, we also see this. In my area of interest, liver transplantation, female patients are disadvantaged by the current organ allocation scheme in two major ways. First, the Model for End Stage Liver Disease (MELD) is used as the marker of disease severity and patients with higher MELD scores receive priority for liver transplant. One component of MELD is the creatinine, which is routinely lower in females because they have less muscle compared to males. As a result, their MELD scores underestimate the severity of their liver disease and disadvantage them in the competition for deceased donor organs. Second, organ size matters. If a liver is too big for a recipient, even one who may be at the top of the waiting list, it will be turned down and the offer will be moved to the next person in line. And as you can imagine, this disproportionately disadvantages female patients waiting for liver transplant, who tend to be smaller in stature compared with their male counterparts.
In thinking about our socioecological model, I am confident that the experiences of males and females differ in all aspects: economic and social opportunities/resources, living/working conditions, behavior, medical care, and interaction with biologic factors. It’s imperative that we remember to account for sex, and its intersectionality with race, in health disparities research.