Can Public Health Scientists and Stakeholders Perform Their Professional Duties Effectively and Advocate?

 by Daniel S. Goldberg, JD, PhD

Daniel S. Goldberg, JD, PhD

Daniel S. Goldberg, JD, PhD

The New York Times Magazine recently ran an extensive feature on Mark Edwards, “The Troublemaker Scientist,” and explored a number of questions related to his activities, one of which was the extent to which a public health scientist can produce good quality work at the same time the scientist advocates forcefully in the public and political spheres.

The article quotes a report authored by the American Association for the Advancement of Science on the propriety of advocacy. The prestigious body warned of the risks of scientists engaging in such, as The NYT Magazine article quoted:

“When scientists become advocates, they become ‘partisans’ and are no longer neutral conveyors of scientific information,” the report stated. “While the line between neutral and partisan, between dispassionate and passionate, is not easily drawn, it nonetheless exists.” Scientists who transgress that line tend to have their credibility impugned. Just ask the climatologists. Or think of Rachel Carson, who was a scientist with the United States Fish and Wildlife Service before she became an author. Upon the publication of “Silent Spring” in 1962, critics accused her of hysteria and Communism.

I personally do not find this line of reasoning persuasive as to scientific practice in general, and I find it even less so when it comes to public health science.

As to the general idea, the AAAS’s admonition depends almost entirely on a vision of scientific practice as neutral, impartial, and virtually free from values that might influence the production of scientific knowledge. These ideals are not new but are traceable to a model of objectivity that began its ascent in the middle decades of the 19th century. Historians of science Lorraine Daston and Peter Galison term this framework “mechanical objectivity,” and note its two essential features: first, that any ensuing depiction of the object under analysis maintain perfect fidelity to the object as it appears in nature, and second, that as much human influence as possible be excised from the investigation itself.

However, the idea of a purely or even mostly objective, neutral, and impartial scientific practice is extremely dubious. Generations of scholars working in fields such as the philosophy of science, the sociology of science, and science and technology studies have documented repeatedly that scientific practice, like anything else, is a human endeavor. And like all human endeavors, it is messy, subjective, relies on immense amounts of human judgment and interpretation, is often overtly political and politicized, and can never fully be separated from the values of the scientists and stakeholders involved in the production of scientific knowledge.

Human activity, as some prominent scholars have noted, is fundamentally value-laden. Evidence never speaks for itself. It always demands interpretation, which is part of the reason why disagreement over the “same facts” is so common within almost every human endeavor, science being no exception.

We can try, if we choose, to minimize the effect of our value commitments on the production of scientific knowledge, but it is not convincing to assert that scientists should refrain from advocacy because it risks some dusty notion of “neutrality” that the vast majority of scholars of science have in fact long since jettisoned as a poor descriptor of how science actually operates and how scientists actually behave.

But even if this is not correct, arguing that advocacy is misplaced in the arena of public health is an even further stretch given that the genesis of organized public health in the modern West are firmly and unquestionably rooted in social reform. Historians of public health have documented repeatedly that early public health actors were reformers and advocates to the bone.

For example, Jacob Riis’ stunning photos of NYC tenements in the 1890s were absolutely crucial to sparking municipal public health action. Riis undoubtedly saw himself as an advocate and an activist, and there is no doubt public health was the better for it. In 2010, a group of historians and scholars at Columbia University’s Center for the History & Ethics of Public Health explicitly argued that public health in the US has essentially taken an exodus from its roots in social reform and public advocacy, and that this departure has had and will continue to have grave effects on population health and health inequalities.

So, to return to the original question: can public health scientists and stakeholders perform their professional duties effectively and advocate? Of course; doing so is literally what it meant to do public health historically, and there is no inherent reason to think this is any less possible at the present.

All that said, it does not follow that there is no danger in zealous advocacy. To be sure, science and policy driven solely by the aim to reach preordained conclusions is poor science and poor policy. But that is precisely the point — the issue here is that the actual production of knowledge is substandard and inferior. The history of public health shows beyond all doubt that robust public health science and robust public advocacy can be integrated. Arguably, they should be, although fleshing out that argument is a task for another blog post!

Daniel S. Goldberg, JD, PhD is trained as an attorney, a historian of medicine, and a public health ethicist. [Full Bio]

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