A Science of Values

In the public realm, our values are thought to reflect our personal tastes, arbitrary and unverifiable—a matter of will and subjectivity. This subjectivity may seem to put values at odds with science and claims that can be objectively verified. A strong strain in science argues that we should remain “value-free” and even “ethics-free.” This perspective argues that we value the appearance of not having values, or at least having them well-managed through the use of objective methods.

Yet this fact-value distinction ignores a cultural and political reality: policymakers create policy that may include evidence but always has value commitments in mind. And various efforts in science are catching on, attempting to study values as an intrinsic part of science.

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What is next for health in 2025, part 1 of 2

On the trends and ideas that will shape health in the coming year.

This is the first Healthiest Goldfish essay of 2025. I hope all the readers of this newsletter had a happy, restorative holiday season with family and friends. For my part, I spent much of the season moving with my family from Boston to St. Louis, to join the new School of Public Health at Washington University. It is an exciting time, one of transition, of engaging with the possibilities of the moment and looking ahead to the future. Thank you to the many who have participated in this process—those at WashU, those in the wider world of public health, and you, the reader of The Healthiest Goldfish. It takes the proverbial village to build a healthier world, and, in this time of change, it is just such a village that we are building around the ideas that generate better health for all.

The start of a new year is a time for looking ahead, for thinking about the challenges and opportunities of the moment and how they might shape the next twelve months and beyond. In today’s essay, I would like to reflect a bit on what is next for health in 2025. What are the key trends that will likely define the pursuit of healthier populations in the coming year? What should our priorities be as we aspire to do the most good in this moment? We are in a time of social and political churn, with a range of influential forces shaping the present and, potentially, the future. However, it seems to me that the following four trends will be of special salience to health in the coming year, reflecting the ongoing work of shaping a forward-looking vision for health and suggesting our engagement with these forces should be at the heart of our collective priorities.

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Censoring Ourselves

One of the central tenets of science is that its work be allowed to follow the data, to publish the facts wherever they lead us, to the end of advancing knowledge and understanding. Scientists bridle, correctly, at any efforts aimed at stifling or censoring science. For example, recent efforts to censor science around climate change have been met with widespread opprobrium in the scientific community. Similarly, a few years ago, there was substantial pushback against efforts by federal funding agencies to align with a more conservative agenda that was being promoted by the then-president. In the main, countries such as the U.S. with a robust tradition of research have been able to maintain the progress of science, pushing back occasional politically motivated efforts to impose ideological agendas that censor the work of science.

But what happens when science starts censoring itself? It is no secret that science, the bulk of which happens in universities, is predominantly being carried out by scientists who have a particular ideological bias themselves. Fewer than 10% of U.S. academics, in one study, identified as being on the “right” of the political spectrum. In and of itself, there is nothing wrong with scientists having perspectives on the world around them, nor that those may cluster similarly, as do perspectives in all workplaces. But in the context of science, where the purpose is to dispassionately evaluate data, does such homogeneity of perspective affect the work of science? 

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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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