Principles of engagement in a turbulent time | The Healthiest Goldfish

On working to generate light, not just heat, in the coming year.

We are entering the last few months of a year that has been marked by horrors. Around the world, we have seen conflicts that have injured, killed, and displaced many. It has been nearly a year since the October 7 attacks, when Hamas invaded Israel, killed 1,139 people and kidnapped 251. Israel’s retaliatory actions in Gaza remain ongoing, a conflict which has killed over 40,000. Russia’s war on Ukraine also continues, with more than 500,000 dead and creating global tensions which threaten the world with their potential for nuclear escalation. In Sudan, a civil war has killed some 150,000 people and displaced over 8 million, with no end in sight. These conflicts are devastating for the millions of humans caught up in them. This reality has made for appropriately strong feelings, particularly on college campuses, as we have engaged with the challenge of what to do, as individuals and communities, when faced with atrocities that harm many.

The moment is ripe for turbulence and belligerence. These global conflicts are occurring against a backdrop of mistrust and division, with politics and culture increasingly polarized. In the US, we are facing a federal election in November with the potential to surface much of this division. It seems fair to anticipate that many of us will be engaged in the moment, that none of us will emerge without emotionally tangling with some aspect of what is swirling around us. This engagement will require, of all of us, a clear-eyed commitment to our core aspiration—to build a healthier world by creating the structures that generate health. This means working in the space of ideas in a way that is constructive, humane, and supportive of the kind of world we wish to see.

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Scientific Siloes | Observing Science

In a series of papers we published over the past decade, we explored a question that seemed to us interesting: Why were there dramatically different schools of scientific thought about whether reducing population-level salt intake would result in fewer cardiovascular complications? 

The science has long been settled that for people with high blood pressure, salt reduction can be part of the risk reduction armamentarium. However, two competing National Academies of Science, Engineering, and Medicine reports came to rather different conclusions, highlighting the lack of consensus in the field about the utility of reducing salt for everyone. While one report noted that this was an open question for decades, the other report said that “For 40 years we have known about the relationship between sodium and the development of…life threatening diseases.” This leaves consumers confused and policymakers without direction.

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A global health? | The Healthiest Goldfish

Reevaluating the biases that shape how we think about, and engage with, the world.

I am writing from within the country where I live, the United States. Being non-native to this country, I find myself often reflecting on place—what it means to be thinking and writing from within a particular place, and what influence the geographic region with which we identify has on how one thinks.

The more one reflects, the more one realizes that place influences more or less everything. That is not to say that one embraces a nationalist perspective that excludes any consideration of other countries and the people who live in them. But it is to say we should not overlook the degree to which most of us see the world through the lens of where we live. This perspective implies an acknowledgment of the difference between places, that however much we may embrace a universalist outlook—and we should embrace such an outlook—places are different, and this is reflected in the values and attitudes of the people who live in them. For all we share in common, we should remember that not everyone in the world lives the way we live, thinks the way we think, or has the same aspirations we have. Where we live is central to shaping our thinking about all of this, and this has direct applicability to how we think of the role of health within a global lens.

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Challenging the Challenges to Science | Observing Science

In his 1997 book “The Art of the Comeback,” then future President Donald J. Trump said that asbestos was “100% safe” and “got a bad rap.” The science on asbestos as a risk factor for a broad range of cancers has long been settled, with little meaningful dispute about the product’s harms. But Trump’s book, which was a bestseller, had reach, and was part of an effort to sow doubt about a product that seemed to have inconvenienced his efforts in construction projects. 

The world is by now accustomed to former President Trump’s promotion of—at best dubious—claims about particular commercial products. This includes, more recently, his claims about the efficacy of ivermectin during the COVID-19 pandemic, which were in sharp contrast with what the science tells us.  

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Is it OK to stop worrying about COVID? | The Boston Globe

Nearly five years on, it might be time to stop treating COVID as exceptional.

Schools are reopening, and flu season is just around the corner. Parents are facing the prospect of kids sharing germs and bringing them home. COVID cases have been on the rise and an infection can seem inevitable, making some parents particularly nervous.

This summer, it seemed like COVID was once again everywhere. The Centers for Disease Control and Prevention reported a surge of COVID in several states, including Massachusetts. According to wastewater data, COVID levels in Massachusetts were over twice the national average, reflecting the highest level of COVID in the state since last winter. Yet people wearing masks remained the minority and life was largely business as usual. Which raises the question: Is all this normalcy OK?

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Ways of Knowing | Observing Science

We have been writing about science. And yet, sometimes, it seems worth asking ourselves again, what is science. There are any number of definitions, and countless books, but broadly, a simple Oxford Languages definition captures the idea well: science is “the systematic study of the structure and behavior of the physical and natural world through observation, experimentation, and the testing of theories against the evidence obtained.” 

There seems little question that science has played a central role in helping advance our condition as a human species. Science leads directly to vaccination, the reduction of childhood illness, to genetic engineering and CRISPR-based treatment of disease. Science has facilitated automation, creating more time for recreation and self-actualization. And yet, of course, science has contributed to its fair share of challenges. Science has led to nuclear weapons, the atrocities associated with their use in Hiroshima and Nagasaki, and the near constant threat of human extinction. Science has led to polluting technologies and accompanying global climate warming, with its attendant consequences for human living. It is with this in mind—the good and the bad—that we, in some ways, set out to write about science in this Observing Science series.

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On respecting individual autonomy, creating structures that allow all people to live as we choose to | The Healthiest Goldfish

Building a heathier world means letting people be who they are.

These essays are concerned with thoughts that contribute to the health of populations, that can inform science and scholarship and, indirectly perhaps, action. Ultimately, The Healthiest Goldfish aims to be a constructive project. I am interested in building structures that we can all contribute to, that we can create, that generate health. But in talking about building an intellectual architecture that generates health, I fear that sometimes we forget the “why” of our work—the reason we are trying to generate health. This fear has been a reoccurring theme of these essays. As I have written before, we are generating health not for its own sake, but so that people can live, and live fully. Health is a means not an end, and it is important that we leave room for the joy that accompanies living healthy. 

With that point made, though, I think that there remains a different point to emphasize towards a practical philosophy of health. How exactly do these structures support living? Notions of what it means to live optimally have been developed in recent years in a growing literature about human flourishing. All of that is to the good. But the particular part of this goal that I want to address today is people living as they choose to, and the balance we have to strike with how we think about this and how we act to respect it.

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Centering dignity as the ultimate goal of health | The Healthiest Goldfish

Reframing our engagement with a universal human value.

In 2021, I wrote a Viewpoint for JAMA Health Forum arguing that elevating dignity should be a central goal for our pursuit of health in the COVID-19 era and beyond. Most of those who work in the health space would likely say that we value dignity, but it struck me that few have articulated the importance of dignity as an organizing principle for all we do, one which can help guide our efforts in the complexity of this moment. Since writing that piece, I have continued to think about the role of dignity as a core value for our work. In many ways, dignity, despite its importance, remains under-discussed in the health conversation. There have been only a handful of academic articles which have discussed dignity in health, and these tend to focus on patient dignity in healthcare rather than dignity in the broader context of health—as in, for example, Francis Peabody’s classic 1927 article, “The Care of the Patient.” While this article does not actually use the word “dignity,” it in many ways started the conversation about dignity in healthcare by advising clinicians to keep always in view the individual identity of patients, rather than see them as faceless, interchangeable problems to be solved.

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