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 with the statement by Rudolph Virchow that we have a duty to carry out scientific investigation with an eye and ear to public needs, including those that are social. We have learned a great deal in this class surrounding the ways in which social life affects comprehensive health, so any attention to public health should incorporate attention to one’s overall social wellbeing.
There is always a risk of bias in scientific research with regards to what one believes, both from a social and medical context (mechanisms of disease, disease behaviors, treatment effects), however this should not deter one from using their beliefs as a method for hypothesis generation. It is important, however, during the design of any study, to understand where the potential weaknesses lie with regards to bias, and to address these weaknesses as best as possible. This includes both careful consideration of the variables involved, how those are defined, how patients are selected, how other variables may affect your results (through confounding, for example), and how the model is designed in order to minimize results due to chance. In the event that some of this is not possible, it is important to address these limitations in the manuscript. Additionally, one should always question their results, be prepared to find outcomes that differ from any preconceived hypothesis, and be prepared to publish those, if valid, even if it differs from their initial belief.
With specific attention to health disparities, the lessons learned in this course should be applied to ensure that the results that are found help to narrow disparities, rather than inadvertently widen them. This can be done with thoughtful consideration of the variables, including the way in which they’re defined, the patients selected for investigation, as well as how confounding may contribute to the overall findings.
Please describe a 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.
Access to care is an area of research in health disparities that should be prioritized, and this has many layers and levels to it. This includes geographic access to care/clinic/trials, access to affordable medications and those that are clearly superior to other treatments with fewer side effects (though they may be more costly), access to specialty care, access to different mechanisms of care (such as telehealth or home care for those that are remote or cannot take off work), and access to diagnostic testing that is medically necessary and affordable, to name a few. In order for this make a difference, changes must be instituted at the systems level. I find this type of work important to improve health equity for all no matter where they live or the circumstances that make prioritizing their health challenging or not possible. It is important to outline what quality care looks like as well, so that we can draw attention to those who are not receiving it, in order to intervene and improve care and equity for all.