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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Health as a private and public responsibility

Government and industry both have a role to play in shaping a healthier world.

Why does health matter? In many ways, answering this question is the central preoccupation of these essays. I have written a number of pieces that attempt to define the meaning of health—why health is something worth pursuing as individuals and collectively. Fundamentally, I see health as mattering because it creates opportunities for us to live rich, full lives. It is a means, not an end, and that end is living a good life, one that is full of time with friends and loved ones, full of the experiences that define what it is to be human. A world where everyone can be healthy is a better world indeed, one worth striving for.

Given the importance of health, given its role in supporting so much of what gives life meaning and value, it makes sense that we should be centrally concerned with asking where the responsibility for promoting health lies. Is it primarily the responsibility of the public sector? Or should the private sector, with its capacity for innovation and scalability, play a larger role? I argue that the achievement of health is both a public and private responsibility, and, as such, we should behave in ways that reflect this. For public health to be most effective in this moment, it should engage with both sectors—finding synergies at the intersection of industry, government, and public health teaching and research—towards shaping approaches that create healthier populations.

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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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