Medicine is a social science, and politics is nothing more than medicine on a large scale. Those are the words of German physician, and father of social medicine, Rudolf Virchow. Even now, all this time later, his words still resonate. Particularly during the pandemic where stark differences between groups seem to grow ever more obvious – whether it is within countries or between countries and regions. How can we reify the importance of social environment and context in a hyper-biomedical world?
Applying the lens of social medicine seems most obvious and intuitive in infectious diseases and public health. As mentioned before, the pandemic has placed a spotlight on how interconnected we really are. Talk of community transmission, public health and safety measures such as social distancing and masking, but also an increased public spotlight on how infectious diseases spread through marginalised communities and people working low income jobs are all prime examples of how medicine functions as a social science. It has shown us that our communities are more lattice than silo; more multigenerational than age-segregated. But the framework of addressing social causes and their impact on disease can, and should, reach farther – as far as into our world of fundamental and particularly translational science.
I have lamented the blinders that are pervasive in (bio)medical research before. Personally, my interest lies in a type of research called ‘translational research’ which aims to bridge the gap between basic research – that is research that is focused mostly on increasing knowledge about a natural phenomenon – and clinical research. When you’re going to be the bridge between the clinic and the bench, it is imperative that you have a good sense of the community even though that might be a little less intuitive than the connection one has to the bench. Dementia in general, and Alzheimer’s disease in particular, is a good case study for where it is necessary for those at the bench to be in tune with what is happening in the clinic and by extension the community. Alzheimer’s disease is a disease with many social determinants including education, access to health care and social isolation. Research in the United States suggests that African Americans and Hispanic Americans have higher rates of Alzheimer’s disease than their white counterparts, yet have a harder time getting a diagnosis. UK based estimates mimic the delay in getting an Alzheimer’s diagnosis in BAME (Black, Asian and Minority Ethnic) communities. Of course, when factoring in these social and ethnic differences in disease, it is imperative that we do not primarily default to biological determinism and instead take these together in a way that is already common in the social sciences, humanities and public health: it is complex and combines a lower socio-economic status, oppression and structural inequalities with cultural practices and the environment. The reality is that if we are going to translate bench science to the clinic, we need to factor in all of the community-based determinants for health outcomes and give these serious consideration.
In my view, integrating the ‘social’ into social medicine (and social medical research) is two fold: on the one hand the traditional approach of factoring in social determinants of health, on the other being in constant dialogue with the communities most affected by our research. Of course there are ways to keep the scientists at the bench engaged with the clinic and the raison d’être of their medical research. Alzheimer’s Society, a UK based charity that funds research into dementia and aims to improve quality of life for those suffering from dementia and their carers, funds projects and regularly allows volunteers to meet with the researchers to discuss the work. Community engagement is not solely science communication, but genuine interest and cooperation with the people our research most affects.
I think the adage ‘people’s health in people’s hands’, a slogan from the People’s Health Movement, is relevant to translational science as well. If translating science from the bench to the bedside is something we care about, we have to engage with the communities we are supposed to be working to help. That means we have to take a holistic approach; one that takes the social science nature of medicine – lab or clinic – into consideration, and one that is deeply rooted in the community. This will not only make our research more accurate and grounded in on-the-ground reality but will also empower people to be active agents in treatment and research into diseases that affect them and their loved ones. It will mean that people can truly take their health into their own hands.
If translating science from the bench to the bedside is something we care about, we have to engage with the communities we are supposed to be working to help. That means we have to take a holistic approach; one that takes the social science nature of medicine – lab or clinic – into consideration, and one that is deeply rooted in the community.
The Argentine-Cuban revolutionary and doctor Ernesto “Che” Guevara, in an address to fellow doctors, pointed out that it’s important not to approach people and communities from a space of charity, but with a sense of solidarity. He says: “We should not go to the people and say, ‘Here we are. We come to give you the charity of our presence, to teach you our science, to show you your errors, your lack of culture, your ignorance of elementary things.’ We should go instead with an inquiring mind and a humble spirit to learn at that great source of wisdom that is the people”.
I think this is not just an important mindset for the doctors working in the clinic, and not just in factoring in the social determinants of health, but certainly also for us trying to make a difference through translational medical research. An inquiring mind and a humble spirit truly go a long way.