What we owe, and do not owe, the past, Part 2 of 2

We owe the past much, but do we owe it everything?

In last week’s essay, I engaged with the question, “What do we owe the past?” I began by accepting that the past matters for the present, that we have a responsibility to remember the past both for moral reasons and from a recognition that we cannot fully understand the present without understanding what came before and why. We owe the past, and those who lived in the past, our remembrance of the history that shapes all we do, and are, in the moment. In remembering the past, we should also be learning from the past, recalling the wisdom of our forebearers and trying to avoid their mistakes as we work to build a better world in the present.

We should also try, to the extent we can, to rectify the injustices of the past. While it is true that there is much about the legacy of the past that cannot be changed, there are still ways we can reckon with the past to address some measure of the injustices we inherit, and, where we can do so, we should. These all reflect obligations we owe to the past that should inform all we do in the present, so that even what is bad about the past can in some way — through a process of remembering, learning, and informing the work of rectifying historical injustice — help to create a better present and future.

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Unreliable Science

Scientists know that we should rarely draw conclusions about any scientific issue based on any single publication—the scientific process depends on replication and is iterative by design. To get to an “answer,” we have to look at the overall literature on a subject. Our understanding changes as knowledge accrues. We keep in mind that we do not know which findings will be replicated and which will, in the long run, prove to be cumulatively correct. 

How, therefore, do we distinguish, in the moment, the science we should believe? What evidence should we trust?

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What we owe, and do not owe, the past, Part 1 of 2

Reckoning with the history that shapes health in the present.

My recent writing has been centrally concerned with the moment— the daily disruptions caused by the changing political winds in the U.S. and their effect on the work of health. This focus seems appropriate given the challenges we are seeing to the structures that support health in this country, and I will remain engaged with unfolding events as the tides of this sea change continue to shift. However, I have always tried to make The Healthiest Goldfish a place for sometimes stepping back from the immediacy of the moment to reflect on the deeper forces driving events, to pay attention to the important, beyond the urgent. This includes the history that shapes health in the present and that is at the heart of so much of what we see in our daily view. With this in mind, I wanted today to reflect on history, its implications for the present, and what we owe history as we work to build a better future.

These reflections are grounded in my reading, over the past couple of months, of two books. First was Robert Caro’s The Power Broker: Robert Moses and the Fall of New York, and second was Walter Johnson’s The Broken Heart of America: St. Louis and the Violent History of the United States. I was reading both books for different reasons. Last year was the 50th anniversary of Caro’s book, and while I had read much of it when I was working in New York City, now more than a decade ago, I had never read it cover to cover and thought it was high time I did. The second book was recommended by many colleagues ahead of my move to WashU in St. Louis, and the recommendations turned out to be just right — it was a perfect history of the city I am now living in, and of how the city today is shaped by its history over centuries.

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The input problem

The challenge of disagreeing on issues when we cannot agree on facts.

Readers of these essays will know that, as a new administration has made significant changes to the country, I have tried to be open to the spirit of accepting new ideas about the reorganization/rethinking of what should be, mindful that the actions we are seeing reflect the wishes of millions of Americans who chose this course with open eyes in the last election. Our criticisms, then, of the changes we are seeing should not be knee-jerk, but, rather, considered and thoughtful, reflecting an awareness of the complex cultural and political forces driving this moment. However, I did want to comment on this week’s announcements about layoffs at the Department of Health and Human Services, the Centers for Disease Control and Prevention, and other health agencies. I have written before about the underfunding of public health, and how it contributed to the disaster of COVID, among many other diseases. This new disinvestment in health agencies is clearly going to make this worse. Leaving aside — but acknowledging — the cruelty of these moves happening quickly and unexpectedly, the threat that they pose to the country’s health cannot be underestimated. I worry, as do many others, that this is setting us on a path to perdition, to an escalation of public health challenges that are going to manifest in the years to come. And that is a worrisome thought indeed.

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A new global order, for better or worse

Learning from a changing world.

The past two months have brought dizzying changes to many aspects of the world, disrupting much that we may have once believed were largely settled, stable. We have seen changes come to “the post-war global order,” where the US is a core part of NATO, closely aligned in its interests with Europe, forming a unified bloc that pushed back on Russian expansionism. This unity is now in doubt as the US appears—in the rhetoric of President Trump at least, and in that of some members of his administration—to have changed how it thinks about both Russia and about its commitments to long-held European allies. Moving domestically, assumptions about the solidity of federal employment have been upended, as have the country’s investments in, among other areas, global aid, a belief in scientific research as a national asset, and, potentially, an understanding of a social safety net that reflects a shared social compact.

These few sentences do not fully capture the scope of the changes we are seeing or the likely consequences of these shifts in the “order of things.” I have written before that we should aspire to give space for alternative visions of what the country, and the world, might look like even as we have a responsibility to call out the cruelty of intemperate action. But today, I wanted to reflect on the fundamental shift in the global and domestic order, and, centrally, what it means that we are going through such a moment, and how we might respond to it.

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Null (And Void?)

Scientists like good news: positive and significant findings impress the public and funders of the work. As a corollary, science tends to downplay studies with null or negative results — those that fail to confirm a preconceived hypothesis (usually in the form of being unable to find an expected relationship between variables or groups) or that demonstrate a new medication or behavioral intervention does not improve health. Negative or null findings are far less likely to be published than positive results. Unfortunately, this publication bias can mislead other researchers or the public.

Put this into the context of how scientists think of their work: how might one interpret a null finding, the failure in finding a predicted difference between two treatments or proposed causes? There are four possibilities. First, the researchers did not find what they and many others thought they had good reason to find. Second, the researchers did not find what only they thought they had good reason to find. Third, the researchers did not find what they only had a hunch they would find. Or, fourth, the researchers did not find what they had no good reason to expect but hoped they would anyway.

We make these distinctions because they can teach us a lot about science, how science is practiced, and how it can be better.

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On balancing complex, competing ideas

How can we be a constructive influence in the midst of challenge and uncertainty?

We are in a complex, challenging moment. The country remains deeply polarized, with no end in sight to the partisan rancor that has characterized the last decade. Technological changes have deepened these divides, even as they also help connect the world in the digital space. In the case of AI, these approaches have the potential to radically improve the lives of populations, although this potential carries many uncertainties. We continue to argue amongst ourselves about what all this means, about who is to blame for the challenges we face, and about what is to be done to seize the opportunities of this moment and mitigate its risks. There is much about this moment that lends itself to easy outrage, with no shortage of voices reflecting this sentiment in the public debate. In this context, it is worth asking: what is our job in this moment? How can we be a constructive influence in the midst of challenge and complexity?

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Women in Science

Have women had the same opportunities and options to participate in the work of science, either as scientists or as participants, as men? The evidence suggests not. Although inequities may be decreasing over time, men continue to hold about 70 percent of all research positions in science worldwide.

Why is this the case? There are undoubtedly a broad range of reasons. Gender inequities seem to be embedded in the processes that influence the conduct of research, including what is prioritized, as well as who does research, who is promoted, who becomes leaders, and whose contributions are valued. There has been considerable research on sex-based disparities in the health sciences focusing on how explicit or implicit bias differentially affects investigators. Women may also have a harder time getting hired in science than men. In an experiment, when sex was randomly assigned to curricula vitae, a hiring committee was more likely to choose male candidates. Once settled into scientific jobs, mobility and advancement remain uneven. Women have fewer publications, and as research shows, women on scientific teams are significantly less likely than men to be credited with authorship; both of these contribute to slower career trajectories. Women also have fewer collaborators and less research funding. And more than forty percent of female scientists in the United States leave full-time work in science after their first child.

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