On our responsibilities when faced with moral atrocities | The Healthiest Goldfish

Choosing what to do, how far to go, in a suffering world. Part three of three.

In my last two essays, I engaged with the question of how our morals might constructively guide the arguments we advance and the science we generate in pursuit of health. I did so as part of a broader, ongoing, conversation about our values and how they inform all we think and do in our efforts to build a healthier world. The challenge is that in engaging with the world we are regularly faced with events and ideas that are truly terrible, that lead to much suffering, destruction, and death. These events pose a challenge to a values-driven field like public health. When we see moral atrocities, there is an implicit challenge to us to act on what we are seeing, to put our values into practice by saying or doing something, anything, to address the suffering of the world. I have lately found myself thinking about these moments and their implications for how we should or should not act.

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Patent Rights and Wrongs | Observing Science

Article One of the U.S. Constitution includes the intellectual property clause. Congress can “promote the Progress of Science and useful Arts, by securing for a limited time to Authors and Inventors the exclusive Right to their respective Writings and Discoveries.” Two years later, in 1790, the U.S. Patent Office opened, rewarding the creation of new technologies, inventions, and ideas with government-granted monopolies, protected from competitors. After more than two centuries of practice, we are still struggling with this reward system, asking ourselves whether it is sufficiently and correctly motivating or skewed to produce problematic pricing and ruin our chances for health equity.

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Population health science as a prerequisite for moral argument in health | The Healthiest Goldfish

On the consequential, rigorous, and inquisitive inquiry that should be at the heart of our moral argumentation; part two of three.

I recently read with interest a piece by Michael Schulson in Undark which compared and contrasted the methodological norms of evidence-based medicine (EBM) with those of public health. The piece, which I encourage everyone to read in full, sketches areas of tension between some in public health and in the EBM space, focusing on how these tensions shaped the pandemic moment and our subsequent reflections on that time. The piece was interesting on several fronts, offering insights into the limitations of data science in guiding the work of public health.

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Commercializing Science | Observing Science

During the COVID-19 pandemic, pharmaceutical companies—keeping to World Trade Organization policy—limited the international roll-out of free or low-priced vaccines, placing billions of citizens of low-income nations at risk for severe illness. When Canada was rolling out its third booster, fewer than 10% of Africans had been vaccinated. Drug companies defended their patents, and wealthy nations, where those companies had headquarters, vaccinated widely. The 1994 Agreement on Trade-Related Aspects of Intellectual Property Rights had created a near-uniform global system of glut and deprivation once manufacturing was in place. Lifting patents would have required a waiver of intellectual property protection and resulted in less profit, so market-driven economies relentlessly commercialized science even in a pandemic. Pfizer earned $37 billion for its COVID shot in the first year of roll-out, one of the most lucrative products ever. In the best instances, financial incentives spur innovation. Is the COVID-19 pandemic the largest scale case study of over-commercialization to the detriment of global health?

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Making a moral argument without moral bullying | The Healthiest Goldfish

The first of a three-part series on what we think, believe, and do, and the moral imperatives that shape our work.

I have long felt that the work of health does not rest only on surfacing the data that explain what causes health, but also on making a moral argument about why we should act on those data. We make our case for approaches we think will support health by communicating both the science and the moral imperative to create a better world. This reflects writing I have done about the intersection of our knowledge and our values: how we should aspire to strike a balance between what we know—what our data tell us—and our commitment to shaping a healthier world based on principles of justice, equity, inclusion, and respect for the dignity and autonomy of all. To my mind, the work of public health is achieved when the data point to a particular course of action and when there is strong acceptance, informed by our values, for taking that course of action. For example, the data are clear about the importance of childhood vaccination, and it seems inarguable that, as a basic value, we should do all we can to ensure children do not acquire deadly diseases like polio or measles. Ideally, then, we should aim to achieve this balance between what the data suggest is correct and what our values tells us is right. The work of health therefore builds on data from population health science, combined with making a moral argument. In some ways, this aligns with our work to move the Overton window and to change what we regard as acceptable. These are all examples of goals that can best be accomplished by making a moral argument, marshaling the facts to make the case for policies that support a healthier world.

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The Public Trust Problem | Observing Science

Public opinion polling shows a remarkable drop in confidence in science over the past few years, with only about half of all Americans saying that science has a mostly positive effect on society. Only about a third of Americans now trust the National Institutes of Health and the Centers for Disease Control and Prevention, the two most prominent organizations whose work is based on the health sciences. Given that scientists—perhaps particularly those working in the health sciences—need to engage the world around them to ensure that our work has impact, these votes of non-confidence suggest that something is being lost in translation.

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Science and the Phantasies of Our Time | Observing Science

“Every age has its particular folly; some scheme, project, or phantasy into which it plunges, spurred on by the love of gain, the necessity of excitement, or the mere force of imitation.” From Charles Mackay: Memoirs of Extraordinary Popular Delusions and the Madness of Crowds. London: Richard Bentley. 2 vols 1841.

In the year since ChatGPT stunned the world with a compelling, easily available, and user-friendly large language model, there has been an extraordinary boom in interest in Artificial Intelligence (AI). Fortunes have been made by companies that trade in goods that are related to AI, and the number of column inches dedicated to AI in public media have soared.

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With Gratitude | Dean's Note

On stepping down as Dean of Boston University School of Public Health at the end of 2024, paving the way for the next generation of leadership at the school who can lead the school into its 50th anniversary and the future.

This week, I let the school community know that I shall be stepping down as Dean of Boston University School of Public Health at the end of 2024, paving the way for the next generation of leadership at the school who can lead the school into its 50th anniversary and the future. Starting in 2025, I shall be taking on the position of inaugural Dean of a new School of Public Health at Washington University.I wanted here to follow up my earlier communication with a note of gratitude.  I have had the enormous privilege of serving as Dean of this school for 10 years. I have had the good fortune of working with wonderful colleagues and friends, contributing to a school I care deeply about, and shepherding a new generation of scholars and scientists who are going to be the future of this school, and of public health, in coming decades.  For all this I am so very grateful.

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