Public pieces.
In February 1953, one of the world’s pre-eminent scientists, Linus Pauling (who went on to win two Nobel Prizes) published, with Robert Corey, a paper in the Proceedings of the National Academy of Sciences called “A proposed structure for nucleic acids,” suggesting a triple helix as the foundation for what we now call DNA. He was, of course, wrong.
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These essays aim to tackle what is most fundamental to the pursuit of health. Centrally, this means addressing ideas, recognizing that all we do in pursuit of health fundamentally starts with the ideas we embrace. However, these ideas are shaped by a broad range of forces, including, perhaps centrally, our history. Our history shapes our health. Where we come from, our family circumstances, our access to education and safe neighborhoods, the conditions of our past all influence our health in the present.
Just as we have a history as individuals, we also have a past collectively, as members of a society, as citizens of a country. Just as our past as individuals profoundly affects our health in the present, our health as a people cannot be understood without consideration of our common history. Our present is shaped by a range of intersecting legacies. These include the legacies of various philosophical systems, such as the Enlightenment, the legacies of wars, of colonialism, of technological progress, of movements for social justice.
And, in the US, they include—centrally, tragically—the legacy of slavery.
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In this series of Healthiest Goldfish essays, which started more or less at the beginning of 2023, I have been aiming to articulate a practical philosophy of health. In so doing, I have intermittently mentioned the importance of humility and compassion as values that should inform what we do and how we do it. However, I have never focused on the former as a central thought in a full essay. I thought I would do so here, coupled with compassion, which I think emerges from the former.
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The work of science can at times be abstract, ideas and experiments emerge from labs and are published in academic journals. But science leads to technological innovation, and the many products of science reach the general public and become part of daily life. The regulatory agencies that ensure safety of these products play a critical role then in the business of science.
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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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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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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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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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This is the personal website of Sandro Galea. All photos are taken by Sandro Galea.
