Innovation

Where do new scientific hypotheses come from? Pasteur’s nugget, “Chance favors only the prepared mind,” suggests that scientific breakthroughs—ones that are groundbreaking and impactful—do not occur idiosyncratically. Rather, the scientific mind needs to contain a reserve of information, but also be open to anomaly and surprise, to recognition when something novel comes into view, and to accepting that something new is not impossible. This could happen for an individual scientist long-experienced in her field who remains persistent: one who has assembled enough evidence over time to make a new claim. Or it could happen when a scientist crosses fields and solves a problem far from her home domain, who steps over a line to speak to a new audience. It turns out that breakthroughs in content (papers, methods, concepts, patents) are indeed prodded by new context (input from a faraway technological discipline).

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On the importance of the opportunity to freely think

Remembering the central importance of clear thinking in challenging times.

The last month has been a time of fear for many working in health. Fear of funding cuts and challenges to public health institutions. Fear of what will come next in an uncertain political moment. Fear of the changes being enforced, of radical disruption of what we do and how we do it. Such fear is understandable. A new administration has pursued cuts to federal funding for science and health, prohibited external communication by federal health agencies, and taken actions that have led to the dismissal or resignation of thousands of federal workers, including many working in science and health. The administration has also made clear that certain forms of research are not welcome at the present time. This has led to some researchers removing their names from publications or pausing their work for fear of retaliation.

These fears are likely, sadly, not unfounded. I have written about the need to give the new administration a chance to pursue the policies it ran on, respecting the fact that the American people voted for much of this, just as they voted for a different administration four years ago, and their preferences merit due consideration, particularly by those of us working in public health, for whom the attitudes of the public should never be disregarded. However, the manner in which the new administration has chosen to pursue what it perceives as its mandate has created unnecessary disruption, uncertainty, and fear, and we should acknowledge this. Fairmindedness, the willingness to give a new administration a chance, does not mean giving a pass to cruelty or staying silent when we see policies enacted that undermine the science and institutions that support a healthier world.

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Science and Technology

The authors of its 1861 charter named the university the Massachusetts Institute of Technology, not the Massachusetts Institute of Science. It was a moment of increasing industrialization in the United States, and the school’s founders believed that the word technology suggested a vocational emphasis, a hands-on approach to industrial engineering and applied science, with less concern for theoretical science. Engineering technology was about processes and operations, it was meant to be practical. The university’s principal founding donor was the inventor of film production methods. Over the following decades, MIT’s academic leaders have continued to nurture a balance between the basic science work of physics, chemistry, and molecular biology, and the technological practice of product development.

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What would it take to ‘Make America healthy again?’ Part 2 of 2

How improving our healthcare system can support a healthier country

This piece was co-written with Dr Nason Maani.

In last week’s piece, we started to address the question of “What would it take to Make America healthy again?”— discussing what it would mean to hold a new administration accountable to its word to do just that, and offering some specific ideas building on its stated goals toward this aspiration. We started by outlining the scope of the challenge of poor health in this country and then discussed how we might center prevention to improve health. Here we will talk about addressing how we might tackle the challenges and shortcomings of treatment, and specifically of the healthcare industry itself, to the end of improving health.

When considering how we might improve healthcare, an industry that accounts for more than 17% of the country’s GDP, it might be worth recognizing that there is much about healthcare that is not working well. For example, there is the sheer opacity of the system. In his first term, President Trump called for more transparency in healthcare. That seems worthwhile and we could start by honestly acknowledging the long-term challenges that have plagued how we deliver healthcare in the U.S. Although the U.S. spends more on healthcare than any other country in the world, it has been by many metrics the sickest high-income country for many decades. While this is, in large part, because of a lack of focus on preventing disease in this country, it also reflects the need to improve our healthcare system to secure a better return on our massive investment in it.

It is therefore reasonable to say that we do indeed need to improve how we deliver healthcare, and that, to date, successive administrations have failed to do so, at great fiscal and human cost, and this is far from a recent consequence of COVID-19 alone but reflects both acute and chronic failures. How, then, might we go about improving the healthcare industry?

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Facts?

Science is in the business of drawing generalizations to better understand nature. In science, there is little we pride ourselves on more than the fact that we are all about the facts, that we are able to strip away confounding conditions so that we can reveal greater truths about the world. This reliance on empiricism has stood science well and has been a canonical element of the workings of science for more than a thousand years. Islamic scholars who were some of the earliest scientists—about five hundred years before the Renaissance— did work predicated on a scientific method that urged experimentation, proving hypotheses through observation and data, correction of error, and the documentation of fact.  

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What would it take to ‘Make America healthy again?’ Part 1 of 2

Thinking through the realities facing such a commitment

This piece was co-written with Dr. Nason Maani.

This week Robert F. Kennedy Jr. was confirmed as Department of Health and Human Services. The possibility of his appointment has not been without controversy, with his positions on a range of issues, notably his skepticism of some vaccines, facing justifiable scrutiny. This scrutiny reflects a reasonable response to Kennedy’s nomination, given his positions and statements. At the same time, it is worth trying to engage with the health policy goals of a new administration in good faith as it implements the policies that the president ran on, even as we call out bad policy when we see it. This reflects an acknowledgement that elections are a contest of ideas, and the American people have just unambiguously endorsed a particular vision for the country, revealing an appetite for widespread changes, including to the U.S. public health system.

Before taking office, President Trump publicly stated that his goal with respect to health and science agencies is to “restore these agencies to the traditions of Gold Standard Scientific Research, and beacons of Transparency, to end the Chronic Disease epidemic, and to Make America Great and Healthy Again!” This slogan is both welcome and somewhat perplexing, given the prior positions of both the president and his Republican party on a range of health-related issues, positions that, at first glance, do not seem to bode well for health in the U.S. This includes the efforts of the first Trump administration to repeal the Affordable Care Act, the administration’s recent actions in the area of global health, and its moves to cut NIH research funding, all of which raise concerns over the consequences of its actions around health. Early announcements and executive orders by the new administration, such as ceasing reviews and external communications at the National Institutes of Health, withdrawing the U.S. from the WHO, withdrawing the U.S. from the Paris Agreement and changing the rules governing civil servants have evoked serious concerns and merit scrutiny. Ultimately, health expertise and scientific evidence should not be partisan issues, and each policy choice involves long-tail consequences for all Americans, particularly the most vulnerable. It seems imperative, then, that the administration’s intentions be treated with the respect, caution and objectivity that administrative responsibility demands. The administration says it wants to make America healthy again. So, in this piece, we will try to take this sentiment at face value and ask:

What would it take to truly make America healthy again?

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Creating the Next Generation of Scientists

Science, as with all fields, needs the next generation in order to grow and evolve. Even more, it needs the next generation to be better than the current generation, and subsequent generations to be better still. That is how fields continue to flourish. Given the importance of science to the human enterprise, it should be of paramount importance for all of us that science continues to thrive by investing in training the next generation.

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“Not as a matter of charity”

Building a healthier world as a matter of social duty.

Recently, I have been writing some reflections that are spurred by the moment, focusing on how we need to make health a priority in our politics, and on my concerns about ensuring our politics are informed by an appreciation of their effect on people’s lives and health. Today, I want to reflect on perhaps some of the genesis of the current actions we are seeing at the federal level, actions with deep implications for national and global health. As the new US federal administration has begun making sweeping cuts to federal programs, one cannot help but feel that these programs are being cut, in part, because they are seen as being “charitable” and that charity, when times are tough, or when ideology shifts, is no longer regarded as a tenable motivation for large-scale federal expenditure. This matters for public health because much of what we do can indeed be interpretated as, at core, charitable in intent, with all the baggage this can carry in the national political debate.

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