Health, not all about the molecules

How population health science and biomedical science together can create a healthier world.

I recently had the privilege of interviewing Dr. Arati Prabhakar, the current Director of the White House Office of Science and Technology Policy. Our conversation was wide-ranging and I much enjoyed it (it can be viewed here on the White House website). At one point in the discussion, Dr. Prabhakar said, “Health is not all about the molecules.” I thought this was a terrific encapsulation of much of what we do in our engagement with health, a succinct distillation from someone who serves as the chief science and technology advisor to the president. Because, fundamentally of course, when we think of science and technology and health, we do often think about the molecules, about the “hard” sciences and the technological developments they yield. We are accustomed to measuring scientific advances in health as the emergence of new pills, potential genetic modifications, and biological enhancements. This perspective is understandable. Such innovations are important, and we would likely all agree that, when we get sick, we want to do so in a world with the best drugs and treatments. Yet it is also true indeed that “Health is not all about the molecules.” Drugs and treatments can help us when we are ill, but they are far less decisive in shaping the health of populations. Health, at its core, is a product of the conditions in which we live. Do we have clean air and water? Can we access nutritious food? Can we get a good education? Do we face racism, misogyny, and xenophobia? Are we financially afloat or do we lack the material resources to live economically secure lives? Such questions are at the heart of population health. They determine whether we live healthy lives or remain vulnerable to disease and preventable harm.

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What is being asked of public health leadership in this moment?

On exercising leadership in pursuit of a healthier world.

I recently had the privilege of speaking at a European Public Health Leadership Course. I very much enjoyed being among the next generation that will lead public health in future. Most importantly, the event pushed me to pause, to note, through conversations with many in the group, that there is a universality of questions that public health is currently asking, questions like: what is leadership in public health? What are priorities for future leadership in public health? How does public health lead in a way that creates confidence in what we do? These questions are resonant worldwide, and even more so in the US in the aftermath of the national election where these very questions were of central importance to the national conversation and to the forward march of history. We are indeed in a time when leadership in health matters perhaps more than ever. Public health, along with science generally, faces a crisis of trust in the post-COVID moment. Challenges like chronic disease, addiction, gun violence, and persistent inequities continue to hold health back nationally and globally. We are seeing a rethinking of the institutions and social structures which, depending on their alignment, can help the health of the public or hinder it. Our capacity to address these challenges, to engage with this moment, is complicated by shifting political winds and voices from both within and outside the field calling for radical changes to how we do what we do. In such times, it is on all of us to rise to the occasion by showing the leadership the moment demands.

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Science as Art?

Art and science exist in the popular imagination at different ends of the spectrum of human achievement. Science rests on the systematic study of the world around us, its orderly permissions move us toward generalizable conclusions. Science requires the application of rigorous methods, in a way that is replicable by others, incrementally building on what has been discovered in previous decades. Art is our paradigm of human imagination and creativity. The best shatters convention with work that pushes us to look at the world in altered and distinctive ways. Science relies on the old virtues of austerity, sobriety, logic, and intellectual complexity. On the other hand, we think of art as spontaneous and impulsive, valuable when what it produces is beautiful, daring. Scientists are trained to weigh in on the truth or falseness of believers’ claims; artists sidestep facts for the emotionally compelling. We divide the academy into arts and sciences, and we imagine little archetypal overlap between scientists and artists. The scientist is the methodical thinker, while the artist thinks outside the box. 

But perhaps there is more to the intersection of art and science, and a consideration of their similarities may lead to new observations about science, the subject of this series of essays. We suggest four instructive areas of commonality.

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Scientific Sentences of Certainty

Scientists value certainty; after all, we are in the business of knowing. But all scientists know that there is enormous uncertainty in much of what we do, that what may seem clear cut is often not, and that there remain open questions for every one that we close and move on from.

Yet, our hankering for certainty is such that our writing often sidesteps uncertainty. We have developed linguistic mannerisms that convey certainty when we introduce the topic under study, in the way we describe our methodology and its limitations, and again when we present our conclusions.

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Certainty as the great enemy of tolerance, part 2 of 2

Are we still sure about that?

In last week’s note, I introduced the idea that the certainty we adopt about issues can lead, not infrequently, to us being very wrong, and that this is true for ideas that emerge across the political spectrum. I highlight this perhaps as a caution to all of us, including those who may feel particularly certain of the rightness of their approaches in moments of electoral triumph or defeat. Today I want to build on that and return to Robert Harris’s line that “Certainty is the great enemy of unity. Certainty is the deadly enemy of tolerance.” Why did this grab me, why do I think it matters?

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Certainty as the great enemy of tolerance, part 1 of 2

Are we sure about that?

As the days post-election turn into weeks and months, there is much that is emerging that is alarming for health. There is also much that is speculative, with little clarity about the real implications of particular proposed actions by the new, emerging, federal administration. Trying to heed my own words, I am refraining from over-investing in comment or dispositive certainty about any of this, aiming to keep an open mind, and to think carefully about how I can be most effective, towards hope. If anyone is interested in comment on the more acute contemporary swirl, I offer thoughts on LinkedIN, and a brief note to our internal Boston University School of Public Health community is here.

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The Power of Culture

What causes a change in scientific interest? A new theory can produce a paradigm shift. Funders from the public sector have great influence in driving research teams down particular tracks. Researchers are sometimes also influenced by what has commercial potential. One other driver of scientific interest, much less discussed, is culture itself. We can think of two important examples, one related to brain science, the other related to reproductive health, where culture shifted and with it shifted the focus of science.

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Challenging the Challenges to Science

The 2024 election has made clear that public health will need to continue its outreach, its defense of important health values, and its ongoing commitment to translating science fairly, humbly, and without partisanship. Not only engaging in conversations, but also trying to influence them is now, more than ever, part of our mission. Given this, we are re-sharing a recent essay on combatting misinformation and restoring trust in 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. 

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