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 both the statement that science should speak the language of the common people, and that at least some scientists must enter the political and social worlds. All of this is critical to ensuring that all members of our society are enabled to engage in, and benefit from scientific advancements. This, of course, includes biomedical research where inequities in who does the research, what questions are asked, and how the answers are interpreted contributes to persistent health disparities. The perpetuation of these disparities is a social justice issue and the inequities in healthcare that they drive are cruel as voiced by Martin Luther King who stated, “Of all forms of inequality, injustice in healthcare is the most shocking and inhumane.”
Lack of social justice in healthcare is driven by many factors. Perhaps the most important is the lack of understanding among the general public about basic scientific concepts, how science gets done, and how it should be interpreted. This arises, in part, because of the inability of scientists to speak the language of the common people. This is an outcome of “ivory tower” science that fails to value the importance of being able to communicate scientific findings to the average person. Instead the scientific community values publication in high impact journals that are primarily read and only understood by other scientists. This fails to directly benefit the general public.
The general public also fails to benefit from the reluctance of scientists to become advocates/activists in their fields of research. This reluctance is fueled by the underlying assumption that pure science is objective, and that science that is conducted to benefit a political or social cause is tainted and unworthy. First of all, the practice of science by any human cannot be purely objective because when people are involved in any process it is inherently political and social. Consequently, the practice of science by scientists is inherently both political and social. While much of the scientific world fails to openly acknowledge this fact, others accept this “flaw” in science and work to minimize it. I argue that instead of working to minimize the role of science in political and social life, we as a society should work to integrate it more effectively in political decisions and the day-to-day operation of our society. For example, over the years I come to greatly appreciate how the funding of research studies in Cuba are the basis on which political, social, and public health decisions are made.
In Cuba scientists and physicians are expected to engage with their communities and to practice science and medicine for the public good. They are accountable to the general public, and are expected to be advocates in their fields of research. After all, they are the experts and their scientific opinions are arguably the best informed. This fact seems to be lost on the majority of American society. In other words, in the States we want our science and scientists to remain untainted so we expect them to stay in their “ivory tower” and engage in the practice of pure science. Then it is up to policy makers and other members of society to apply their scientific findings to the problems that plague our communities. This unnatural process of keeping the scientist from applying the knowledge that s/he has obtained, and instead relying on others to apply or use it to solve societal problems is inefficient and ineffective.
In my opinion the most efficient and effective way to translate discovery into health (i.e., the NIH’s mission) is to require scientists to be advocates in their fields of NIH-funded research. In this role they should be required to communicate their scientific findings in the language of the common people, and to work collaboratively with relevant stakeholders in the communities their research is meant to serve. Additionally, they should be accountable to the general public for the decisions that they advocate (e.g., the hypotheses they advance). These decisions or hypotheses can be judged by the population-level results that are obtained upon testing of their validity. In my opinion these are the steps that can be taken to balance advocacy with the intended objectivity of the scientific approach.