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?
It seems that “science should speak the language of the people” can be interpreted in a couple of ways. One interpretation would be that the topics addressed by science should reflect public or popular interest, while another interpretation is that scientific knowledge should be accessible to the general public. I do agree that efforts should be made to make scientific findings accessible to a lay audience, because I believe that part of the purpose of science is to generate knowledge and that, with few exceptions, information and knowledge are public goods. As to the former interpretation, that science should be guided by public or popular interest, it is somewhat more complicated to address. First, the general public may prioritize certain problems or topics that the scientific community knows to be less significant or not feasible. Second, the relative social position and power of certain social groups means that “popular interest” may be a matter of influence, rather than the “actual” significance of a potential topic for science. I think that community-engaged research can begin to address both of these concerns by fostering dialogue between the scientific community and the public community, who are often the participants and supposed beneficiaries of research.
I believe that is not only permissible but sometimes necessary for scientists to become advocates, in the case of evidence or results that demonstrate an actual or potential harm, or when findings have the potential to redress an existing harm. This may especially be the case when a topic or finding has important or controversial implications, or implications that go against a prevailing norm or power structure. I further believe that in the case of healthcare professionals, who operate under ethical principles (e.g., beneficence, nonmaleficence, justice, etc.), there may be an obligation to extend these principles beyond the clinical setting. This may be the “greatest task” of medicine referred to in the quote above. Healthcare professionals’ clinical experience and expertise often afford us unique insight into particular conditions that go beyond the healthcare setting (e.g., SDOH), while our extensive training and often greater access to certain resources (like prestige or cultural capital) position us to be effective advocates—could arguably create an imperative to act as advocates. The evolution of the situation with COVID-19 offers an unfortunately timely example, in which it seems there have been instances where epidemiologic and public health best practice (such as complete and accurate reporting of findings, or best procedures for testing) were at odds with political will. In light of this, as well as failures of the healthcare system that may be contributing to the spread of COVID-19, some scientists have moved into the role of advocate to advance information or call out these shortcomings. More broadly, there is certainly precedent for medicine entering the political arena, as it is now the norm for professional organizations of various healthcare disciplines to release position statements on social and political topics that have health implications, for example, gun violence and gun control.
I take the stance that true objectivity in science is unattainable. Science is itself an epistemological stance, predicated on certain epistemic values, as described by Resnik and Elliot, and is always situated within social, historical, political, and cultural contexts. In enacting science, we are always already advocating for something, whether we acknowledge it or not. There is no “view from nowhere” (Haraway, 1991/2004). That said, as someone entering the field of health research, I obviously recognize the merit of scientific inquiry and subscribe to its norms. Further, in this so-called post-truth era, I believe that science and its legitimacy are especially critical (for timely discussion of this concern, see Kleinman, 2020). So, to balance advocacy and scientific rigor, scientists should engage an ongoing process of reflexivity, examining their starting point for research (e.g., theoretical background or framework, epistemology, relevant preceding scientific findings, etc.) and consider how this forestructure influences and is in turn influenced by all stages of the scientific process. Writing from relevant fields (STS, history of science, philosophy of science) can help with this process. Scientists should then address this background and epistemology as appropriate in presenting their research, as Resnik and Elliot discuss.
Haraway, D.J. (1991/2004). Situated knowledges: the science question in feminism and the privilege of partial perspective. In D. J. Haraway, Simians, Cyborgs and Women, The Reinvention of Nature. Reprinted in S. Harding (Ed). The Feminist Standpoint Theory Reader: Intellectual & Political Controversies, pp.81-102. New York: Routledge
Kleinman, D. L. (2020). From sideline to frontline: STS in the Trump Era. Engaging Science, Technology, and Society, 6, 45-48. doi:10.17351/ests2020.385
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 health disparities research, the questions of whether and how to measure the concept of “race” seem to be sources of ongoing uncertainty, if not controversy. My understanding is that these questions arise out of several concerns. First, there is a concern that research addressing “race” as potential mechanism on a disease pathway may reify race and racial categories as biologically inherent and deterministic, particularly if the research is done without considering the way racial categories have been used in this way. This may furthermore contribute to problematic discourses that attribute health outcomes, health status, or even personal characteristics like intelligence to an outdated definition of race that is not based in current scientific understanding of the construct. This leads to a second concern, where if we understand that racial categories are not biological but are social constructs, we have to consider what we are actually measuring when we include racial categories in our data collection and analyses. If we take a perspective informed by the realities of historical racism and ongoing structural racism in U.S. society, it seems apparent that what we are trying to measure in health disparities research is actually the impact of racism and racist structures, not race/ethnicity as an inherent category. From this perspective, it may then make more sense to measure other variables that more accurately represent the experience and impact of racism in its various forms. However, from what I learned in this class, these questions about measuring race/ethnicity have been inconsistently addressed and applied in health disparities research thus far. Our understandings of and approaches to measuring race/ethnicity are also still evolving, contributing to uncertainty and controversy around the issue.