“We must disenthrall ourselves”

On letting go of habits and ideas that do not serve us in this moment.

In his second annual message to Congress, Abraham Lincoln wrote:

“The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew and act anew. We must disenthrall ourselves, and then we shall save our country.”

I have been reflecting on these words lately. This moment, for all its challenges, is not the same as the one with which Lincoln contended — we do not face a crisis of slavery and civil war, though the legacy of both continues to echo through history. However, our occasion is “piled high with difficulty,” and our case is indeed new. We face a range of intersecting, novel challenges that has made this an era unlike any other. Political disruptions, climate change, technological developments such as AI, and global conflict have made this a time of difficulty, a stormy present. These challenges beg important questions: How should we respond in this moment? What should we — can we — do to build a better world when the one we have seems to be so much in extremis?

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Can Science Be Done More Efficiently?

Sir Francis Crick and James Watson are towering figures in science for identifying the double helical structure of DNA. But they perhaps loom even larger in the public imagination for their race to be the first to identify this structure, a science thriller immortalized in Watson’s book The Double Helix. The book became a bestseller and remains to this day a gripping account of what seemed to be feverishly fast science, a competition racing towards an Eureka-moment of discovery. 

This is a very partial picture of what science looks like, though. Science is generally slow, plodding even, with discovery after discovery unfolding systematically over many years. Even the story of DNA is nowhere near as dramatic and fast-paced as our memory of the headline-grabbing identification of the double helix would suggest.

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What is the worst that could happen (for U.S. health)?

Thinking about the potential consequences of a policy landscape in flux

This piece was co-authored by Dr. Nason Maani.

The U.S. stands at a moment of uncertainty regarding its future health and well-being. The current administration has now sought to act on a range of fronts in advancing its policy agenda. These early actions have affected almost all levels of government, many of which will have an attendant impact on health. What this impact might be in the long term remains to be seen, a view that is complicated by both the speed and breadth of the federal actions, and the extent to which these actions are directly affecting our capacity to measure their effects — as in the case, for example, of enforced pauses on health agencies’ communication.

With this in mind, we ask, considering what we know, what is the worst that could happen to U.S. health, what challenges should we be most aware of and anticipating? In asking this question, it is important to note the importance of adjusting for our biases and avoiding a reflexive engagement with the emotions of the moment. It is on us to make an effort to be dispassionate, because dispassion supports the reasoned, fair-minded perspective that helps us to do and say only what is constructive at a time that calls for approaches that build, not break. We have written before about the importance of maintaining this perspective, recognizing that we have just had an election in which the American people chose a particular vision for the US and—while they could not have foreseen all of what has happened since and may well not support much of it—we need to recognize that many of the policy changes of the moment would likely be considered at least directionally correct by roughly fifty percent of the country.

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What we owe, and do not owe, the past, Part 2 of 2

We owe the past much, but do we owe it everything?

In last week’s essay, I engaged with the question, “What do we owe the past?” I began by accepting that the past matters for the present, that we have a responsibility to remember the past both for moral reasons and from a recognition that we cannot fully understand the present without understanding what came before and why. We owe the past, and those who lived in the past, our remembrance of the history that shapes all we do, and are, in the moment. In remembering the past, we should also be learning from the past, recalling the wisdom of our forebearers and trying to avoid their mistakes as we work to build a better world in the present.

We should also try, to the extent we can, to rectify the injustices of the past. While it is true that there is much about the legacy of the past that cannot be changed, there are still ways we can reckon with the past to address some measure of the injustices we inherit, and, where we can do so, we should. These all reflect obligations we owe to the past that should inform all we do in the present, so that even what is bad about the past can in some way — through a process of remembering, learning, and informing the work of rectifying historical injustice — help to create a better present and future.

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Unreliable Science

Scientists know that we should rarely draw conclusions about any scientific issue based on any single publication—the scientific process depends on replication and is iterative by design. To get to an “answer,” we have to look at the overall literature on a subject. Our understanding changes as knowledge accrues. We keep in mind that we do not know which findings will be replicated and which will, in the long run, prove to be cumulatively correct. 

How, therefore, do we distinguish, in the moment, the science we should believe? What evidence should we trust?

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What we owe, and do not owe, the past, Part 1 of 2

Reckoning with the history that shapes health in the present.

My recent writing has been centrally concerned with the moment— the daily disruptions caused by the changing political winds in the U.S. and their effect on the work of health. This focus seems appropriate given the challenges we are seeing to the structures that support health in this country, and I will remain engaged with unfolding events as the tides of this sea change continue to shift. However, I have always tried to make The Healthiest Goldfish a place for sometimes stepping back from the immediacy of the moment to reflect on the deeper forces driving events, to pay attention to the important, beyond the urgent. This includes the history that shapes health in the present and that is at the heart of so much of what we see in our daily view. With this in mind, I wanted today to reflect on history, its implications for the present, and what we owe history as we work to build a better future.

These reflections are grounded in my reading, over the past couple of months, of two books. First was Robert Caro’s The Power Broker: Robert Moses and the Fall of New York, and second was Walter Johnson’s The Broken Heart of America: St. Louis and the Violent History of the United States. I was reading both books for different reasons. Last year was the 50th anniversary of Caro’s book, and while I had read much of it when I was working in New York City, now more than a decade ago, I had never read it cover to cover and thought it was high time I did. The second book was recommended by many colleagues ahead of my move to WashU in St. Louis, and the recommendations turned out to be just right — it was a perfect history of the city I am now living in, and of how the city today is shaped by its history over centuries.

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The input problem

The challenge of disagreeing on issues when we cannot agree on facts.

Readers of these essays will know that, as a new administration has made significant changes to the country, I have tried to be open to the spirit of accepting new ideas about the reorganization/rethinking of what should be, mindful that the actions we are seeing reflect the wishes of millions of Americans who chose this course with open eyes in the last election. Our criticisms, then, of the changes we are seeing should not be knee-jerk, but, rather, considered and thoughtful, reflecting an awareness of the complex cultural and political forces driving this moment. However, I did want to comment on this week’s announcements about layoffs at the Department of Health and Human Services, the Centers for Disease Control and Prevention, and other health agencies. I have written before about the underfunding of public health, and how it contributed to the disaster of COVID, among many other diseases. This new disinvestment in health agencies is clearly going to make this worse. Leaving aside — but acknowledging — the cruelty of these moves happening quickly and unexpectedly, the threat that they pose to the country’s health cannot be underestimated. I worry, as do many others, that this is setting us on a path to perdition, to an escalation of public health challenges that are going to manifest in the years to come. And that is a worrisome thought indeed.

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A new global order, for better or worse

Learning from a changing world.

The past two months have brought dizzying changes to many aspects of the world, disrupting much that we may have once believed were largely settled, stable. We have seen changes come to “the post-war global order,” where the US is a core part of NATO, closely aligned in its interests with Europe, forming a unified bloc that pushed back on Russian expansionism. This unity is now in doubt as the US appears—in the rhetoric of President Trump at least, and in that of some members of his administration—to have changed how it thinks about both Russia and about its commitments to long-held European allies. Moving domestically, assumptions about the solidity of federal employment have been upended, as have the country’s investments in, among other areas, global aid, a belief in scientific research as a national asset, and, potentially, an understanding of a social safety net that reflects a shared social compact.

These few sentences do not fully capture the scope of the changes we are seeing or the likely consequences of these shifts in the “order of things.” I have written before that we should aspire to give space for alternative visions of what the country, and the world, might look like even as we have a responsibility to call out the cruelty of intemperate action. But today, I wanted to reflect on the fundamental shift in the global and domestic order, and, centrally, what it means that we are going through such a moment, and how we might respond to it.

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