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?
My field of interest (injection drug use and opioid use disorder) is particularly socially stigmatizing, as substance users are extremely marginalized in our society. There is a trove of robust, evidence-based medical research identifying sound approaches to managing these issues medically (syringe exchanges, safe injection sites etc.) however there is no political will or social imperative among many politicians to enact these changes because they are either antithetical to their moral values, or they simply lack awareness of these issues altogether. Ham reduction researchers have been forced to advocate and politicize their work because history has proven the science alone will not provide requisite access to adequate health programming for this population. The 2015 HIV outbreak in Scott County, Indiana is a perfect example of the interrelatedness of health, politics and social life and the devastating consequences of being unable to unify these competing interests. Then-Governor Pence implemented “emergency” syringe exchanges in Scott County (it was previously illegal to carry syringes there) to stop the outbreak (thus admitting that he understands the evidence base for this health service). Of course, HIV infection rates were curbed as soon as clean syringes were distributed in the community. In the field of harm reduction, this is no separation between health, advocacy, politics and social life. There is a historical tension that will certainly not fade any time soon (particularly in the next four years). Harm reduction practitioners and researchers have known for some time now that their job as health professionals relies on their ability to enter the political and social sphere in order to enact change. The problem is figuring out how to do it effectively. Luckily, there is incredibly synergy in this field between researchers, practitioners, advocates, and social service providers. While I think it’s imperative to bring medicine into the social and political space, I think it’s equally important to identify who those players are that can successfully bridge these different worlds. Certainly not all researchers make good advocates and vice versa. It’s about knowing who can catalyze change effectively.
I come from the field of anthropology so for me, I learned about the social and structural causal path of disease before learning about the biological mechanisms. I know, however, that this is atypical for most researchers. When you think about how long it has taken our field to include social and economic factors as essential drivers of health, then it’s really not that surprising for it to take those outside the field even longer to understand the essential connections between medicine, politics and social life.