The purpose of scientific research in public health is to provide evidence-informed, context-relevant, resource optimising, culturally compatible and equity promoting recommendations
“He listens to scientists!” is the insult President Trump decided to direct at Joe Biden in a recent round of attacks intended to show how weak his electoral opponent is. The explicit barb was that Biden did not have a mind of his own and the implicit message was that scientists generally give bad advice that politicians should not pay heed to. Biden tweeted back a ‘Yes’ indicating that he would indeed listen to the scientists as that was the right thing to do. This raises several questions. Why should politicians listen to scientists? Are scientists always right? What happens when scientists disagree among themselves?
In an ideal world, an intimate relationship between science and public policy should be regarded as integral to the advancement of society to higher planes of development. This has generally been true since the start of human civilisation, even when science was not formally defined as a rigorous discipline which combines observation, experimentation, deduction, invention and application. Science became the accepted method for analysing natural as well as anthropogenic phenomena, as it progressively dispelled superstition and advanced civilisation. This rewarding relationship is even more true of the modern world, as science and public policy have become closely intertwined. Science is sterile if it lacks social relevance and policies will collapse on clay feet if they are not firmly embedded on the foundations of sound science.
This, of course, assumes that both public policy and scientific enquiry are pursuing the paths of unbiased objectivity and intellectual integrity. While these are the essential requirements of a healthy relationship between science and public policy in any domain, they become all the more necessary in the exposition and application of knowledge in the arena of public health. Pandemics like Covid-19 highlight the importance of both, science and public policy, rising above the mire of dogma, prejudice and sectarian interests that entrap political decision making in many spheres.
The purpose of scientific research in public health is to provide evidence-informed, context-relevant, resource optimising, culturally compatible and equity promoting recommendations for policy and practice. These recommendations must have scientific credibility, financial feasibility, operational steerability and political viability. The last calls for acceptance by the wider community. This effort requires multi-disciplinary research, conducted on a knowledge platform that brings together bio-medical and other life sciences, a broad array of social sciences ranging from sociology and economics to anthropology and ethics, quantitative sciences like epidemiology, statistics and demography as well as other supportive disciplines like management, engineering, communications and law.
What happens when science reaches an incorrect conclusion, makes a wrong recommendation or advocates a harmful product? It does happen, not infrequently, as scientific research is not infallible. However, the strength of science lies in its ability to self-correct. Thomas Midgley, a brilliant chemist, became famous in the last century for developing two products which were widely used and highly praised. These were leaded petrol and chlorofluorocarbons (CFCs). One directly caused harm to human health, and the other created holes in the ozone layer. It was again the strength of science which led to the recognition of the harm caused, resulting in bans on both products. The scientific method weds enthusiastic quest for new knowledge and critical scepticism that demands constant verification. As long as objectivity remains its credo, science can pursue its unrelenting quest for better understanding with honesty in purpose and integrity in its positions. It will devotedly search for truth unburdened by orthodoxy or obscurantism.
The demanding method of science also means that scientists may disagree with each other till incontrovertible proof emerges. This has happened in all eras, in all sciences and all countries. However, consensus crystallises on the strength of evidence as it accumulates. Orthodoxy could not maintain the geocentric theory of our universe nor does eugenics stand today as a respectable scientific position. Peer review, replication of studies and more insightful experimentation are methods by which proffered evidence is tested. Consensus positions may change over time, as the community of scientists review fresh evidence, but the synthesis of evidence available at any given time offers the best guide to the policy at that time.
However, scientists cannot be the sole arbiters of the public good. The excitement of scientific discovery and the exuberance of new technologies may blind scientists to potential dangers, be it developing nuclear weapons or gene-edited babies. What may affect all of society must be debated by all of society, whether it is evidence on genetically modified crops or the safety and efficacy of a new vaccine, for acceptance or rejection on the strength of evidence provided. For this to be meaningful, scientists must frequently engage with the wider community and communicate with clarity and conviction.
Thomas Jefferson wisely observed, “I know no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise that control with a wholesome discretion, the remedy is not to take it from them but to inform their discretion.” Yes indeed, good politicians must listen to scientists as Biden said but good scientists too must speak with the people, as honest communicators of undistorted facts. Because ultimately the people should decide in a true democracy.
The writer is President, PHFI. Author of “Make Health in India: Reaching a Billion Plus”. Views are personal