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 think it is not only permissible but imperative that scientists become advocates in their areas of research. It is surprising for me to say this because if you had asked me in college, I think I would have said that scientists should remain unbiased by not advocating for their own work. Over the last few years in medical school, residency, and training in public health and in this year’s master’s courses, I have learned that remaining unbiased and advocating for your work are not mutually exclusive. Given our level of training and experience, I think it is important for us to share the findings of our work, whether the results are positive or negative, and be advocates for our patients. We know probably better than most, what the limitations of our work are and the best way to share those results in a way that is fair and objective. However, I think as scientists, we need to be mindful of the questions we ask and the way in which we present the results, because the way we present the results can have negative ramifications if presented incorrectly. I think having an open mind and being willing to hear other perspectives is an important way to remain objective. Being aware of both our conscious and unconscious biases will help us remain objective as well.
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 think an area of controversy for health disparities research that we discussed in this class was about how best to engage communities in doing health disparities research. Not all communities are the same; depending on which community you are working with, there will be different ways to actively have members of the community participate. But because of the heterogeneity of these communities, this can lead to challenges for best practices of trying to engage the community in research. However, it is very important to have members of the community give feedback and be involved in the design, implementation, and report/publication of your research to ensure that it aligns with the interests and values/goals of the community in order not to worsen health disparities.
Another area of controversy is which measure of association to report: relative vs. absolute. Prior to this year, I thought that odds ratios were the default. I have learned that the measure of association you choose should be carefully considered, and depends on what you are trying to convey. But I think this can also lead to “massaging” of the data to get a result that is statistically significant, so we definitely need to be mindful that when running statistical analyses and deciding on what measure of association to report, it is pre-determined by our analytical plan that is also clinically meaningful (or meaningful for policy, education, etc.) and not just to get a statistically significant result.