Public pieces.
How we engage with our communities in challenging times
This is a challenging moment in the public conversation. Across the country, there has been heated debate about issues of central importance to the health of populations and to the safety and stability of our world. These conversations have intersected with an election year which is unfolding in what is arguably a uniquely polarizing moment in our history.
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In a 2015 paper, “Does science advance one funeral at a time?” Pierre Azouley and colleagues show that when a star scientist dies, those in their network publish less, but those who had not previously collaborated with the dead scientist publish more. Dramatically, these new papers were, in this analysis, more likely to be highly cited. The authors suggest—plausibly enough—that the field, with the passing of an eminent scientist, becomes more hospitable to different ideas proposed by those who think differently than the deceased. In a subsequent publication of this paper, the same authors suggest that “the loss of a luminary provides an opportunity for fields to evolve in new directions that advance the frontier of knowledge.”
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In 2017, I wrote an essay, published in The Milbank Quarterly, arguing that the then-new administration would be harmful for Americans’ health for two reasons—by representing a disinvestment in the resources that shape heath, and by sowing a language of division that would rend the fabric of trust that we need to create a healthier world. I was not alone in these concerns, and subsequent years have shown that they were not without cause. In many ways, this period of American history will perhaps inevitably be remembered as a time characterized by enormous public distrust and divisions that are unprecedented in the past century.
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In February 2003, a new severe respiratory illness emerged in Guangdong Province, China. The World Health Organization global surveillance system alerted travelers to a new disease. The search began for the cause and eleven research labs from countries around the world began to work together to find and analyze what became known as SARS. This “collaborative multicenter research project” proceeded through daily teleconferences, shared electron microscopy photos, and viral genome sequences. Scientists traded samples, debated results, made decisions about experimental dead ends, and in one week a candidate virus was isolated nearly simultaneously in two labs. Three weeks later, confirmatory studies permitted the announcement of a novel coronavirus as the cause of SARS. This model of health science collaboration at a global scale was unique, the results remarkable, speedy and effective. The virus was, according to WHO, “collectively… discovered.”
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The COVID-19 pandemic was, in many ways, a triumph of science. The world, through collaboration by scientists across countries, sequenced a novel coronavirus almost immediately. We then, building on a novel mRNA platform, developed several highly effective vaccines faster than any vaccines had ever been developed in human history. These vaccines went on to save millions of lives and allow the restoration of social and economic function faster than anyone might have imagined. This was all the work of science. And yet, there was much that the COVID-19 pandemic did to illuminate challenges in science, and it is helpful to contemplate what the pandemic taught us that we can carry forward in the coming decades.
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Part of the aim of these essays is to engage with topics which may be challenging, reflecting the importance of having difficult conversations that advance progress. If we find that nothing we say causes us to feel a bit uncomfortable, it is hard to think we are truly having the kinds of conversations that make us better at holding a mirror up to ourselves towards a more effective pursuit of health. With this in mind, I will today address a topic that is certainly touchy, challenging, while at the same time being essential to the work we do to generate a healthier world. That topic is paternalism.
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FThe world at times feels like it is on fire, with highly visible forms of injustice challenging our collective moral conscience. Scientists live in this world, and it comes up, time and again, whether scientists should put pressure in our particular ways on those who are committing atrocities, who are waging war, or who are oppressive to their people, in order to encourage a change in such (usually national) behavior.
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Regular readers of these essays will recognize that a core theme of much of my writing is that the business of health is the business of being concerned about the world around us. The air we breathe, the water we drink, the food we eat, the places where we live, work, and play, politics, the economy, the environment, and the broader geopolitical issues of war and peace—these forces are fundamental to whether we can live healthy lives. They are, to return to the central metaphor of The Healthiest Goldfish, the water in which we swim. Creating a healthy world means attending to these forces, optimizing them for health, to ensure our water is “clean.” This work requires an intellectual and practical commitment to engaging with a “big picture” vision of health. A healthier world is a world where we tackle forces as foundational as climate change, structural racism, and individual behavioral choices, all of which affect health.
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This is the personal website of Sandro Galea. All photos are taken by Sandro Galea.
