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 completely agree! Given the impact of social determinants on health, we cannot fully address a patient’s health without considering the social circumstances of our patients. Just as we learn about physiology, pharmacology and pharmacology, we should also learn about health-related social needs. Similarly, just as we learn research methods, so too should we learn about advocacy to help translate research into action. There has long been tension surrounding advocacy and medicine, highlighted in Huddle’s article “Perspective: Medical professionalism and medical education should not involve commitments to political advocacy” and the numerous comments to the article “Do Medical professionalism and medical education involve commitments to political advocacy?” As commentators Palfrey and Chamberlain note,” Clinical advocacy in medicine is a direct response to the needs of patients.” Most of the commentators also brought up the fact that advocacy does not need to be partisan, and not acting/advocating can be not only harmful to patients but its own political statement.
Scientists have an obligation to disseminate their research (both positive and negative results), and to balance advocacy with objectivity, as with anything in medicine, we should be evidence based. Steps to take include having rigorous research methods/designs, anticipating arguments against one’s findings and taking steps to analyze dissenter’s findings, and being transparent in research methods/results. One can be objective through presenting all current research and detailing how one’s own work fits into the broader landscape. It can be frustrating to continually have to defend and demonstrate a clinical/medical basis for social change but such defense can bolster support and make it more difficult to ignore the needs of our most vulnerable patients and appears necessary in our society.