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?
Medicine is unique in that it demands that doctors be scientists, sociologists, and fellow human beings at the same time. For most who go into medicine, sitting at this nexus galvanizes a deep concern for the well-being of others. It is difficult to care for patients without realizing that society drives illness as much as biology. Though doctors have clearly been thinking about these issues since the days of Virchow or before, only relatively recently has health disparities research taken a more prominent role in academic medicine. This line of study is promising and urgent, but comes with unique risks. Because social medicine naturally leads into policy, the lines between science and advocacy can blur. Science is the endeavor to discover truth in the universe, a process which is inherently amoral (at least by the standard of human society). Advocacy, however, makes normative conclusions, all of which are based on guiding ethical principles for how society should run. In the ideal world, these two systems can harmonize. But even the most well-meaning researchers may end up letting the goals of their advocacy threaten the objectivity of their work. This is a significant hazard, even when the goals are pure. Practicing science without objectivity is in some ways akin to running an underpowered clinical trial—it risks generating conclusions that don’t represent reality and may mislead more than inform. To avoid this trap, we must maintain skepticism, for our own work and that of our peers. A diverse scientific community, with multiple contrasting viewpoints, will maintain skepticism, rigor, and encourage the constant questioning of our assumptions. In this way, the system keeps itself in check. Finally, this is a two-way street: just as science empowers advocacy, advocacy should prompt new and important avenues of scientific inquiry, which can go on to shape policy and ultimately improve society.
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 the field of nephrology, the relationship between ApoL1 and kidney disease has been one of the most lauded discoveries of the last generation. There is little argument that ApoL1 plays an important role in kidney disease for many people and may someday offer a therapeutic target; however, learning more about the complexities of the genesXenvironment interactions has brought me look at this literature in a new light. The idea that ApoL1 risk alleles may explain only a minority of illness compared to social determinants of health is a paradigm shift. Though genetic and epigenetic factors are crucial to many disease processes, the insidiousness of social determinants makes them uniquely power and difficult to nail down. Because social determinants and environmental factors are more abstract, they can get overshadowed by seemingly simple genetic explanations. This underscores the fact that when we observe disparities in health outcomes (especially along racial, ethnic, or gender boundaries), we need to work hard through the socioecological model to find explanations that may lurk behind the readily observable biology.