Tag: Opinion

On Medical Research.

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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.

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The shakiness of our foundations.

Tyara Uiterloo3 Comments
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Karl Marx wrote that ‘the history of all hitherto existing society is the history of class struggle’. To many people the idea of class struggle seems archaic and belonging firmly to the 20th century. An equally 20th century idea is that of living through a deadly pandemic – a scenario that has for most of us only been conveyed through history books, and a scenario in which we have collectively been thrust by the once-in-a-century unprecedented COVID-19 pandemic. This current pandemic is exposing the problems within our current economic and social systems, and most importantly exposes the fragility of the human right to health. It turns out that the emperor is naked.

Inequalities in access to healthcare between Global North and Global South countries have, rightfully, long been the focus of conversation surrounding global health. Soon after the WHO declared a public health emergency of international concern (PHEIC), the Director General, Dr Tedros, pointed out that this virus could be most lethal and dangerous for countries with weaker health systems, largely (though not uniquely) corresponding to the Global South. Beyond ‘developing’ and conflict-heavy countries with weaker health systems, the current pandemic has exposed the health inequalities that exist within the Global North as well. In many Global North countries, in the years after the crashing down of the neoliberal order, austerity (to varying degrees) has been the go-to policy with public sector jobs being cut, and many people being thrust into unemployment and even poverty. This has had many consequences on health (both mental and physical) and has caused many of our countries to be woefully underprepared for something as catastrophic as a pandemic.

In recent weeks, governments have been calling on ‘essential workers’ and their skills. Many people across the world have been applauding their healthcare staff from their windows, balconies, living rooms and their palaces. We have, rightfully, been supporting ‘essential workers’, but what does that mean when essential workers have been devalued for years within our societies? When many of the people we have elected have been the ones to systematically cut funding for healthcare and the minimum wage is still not necessarily a living one. Many essential workers are in low-paying jobs, and additionally many essential jobs are traditionally feminised roles such as caring professions and domestic and service jobs. This exacerbates already exiting inequalities where they exist.

One of the most effective ways to slow the spread of infectious disease is through social – also called physical – distancing measures such as working from home, staying at home as much as possible, and avoiding close physical contact with other people not part of one’s household. However, for many people, many of whom economically disadvantaged and/or marginalised, this is nearly impossible, increasing the burden of mortality for this group. For many these people working from home is impossible because of the nature of their jobs, staying at home would mean a loss of income and livelihood, and there is a lack of paid sick leave and no (affordable) available childcare.

But beyond income inequality and depletion of resources for many of our health services and the low-wage nature of many essential jobs,, there are other vulnerable groups who will be suffering from increased difficulty in accessing healthcare during the pandemic. An example of this are the homeless who will not have the opportunity to social distance in the same way those with a home do, and who will often not be able to access quality healthcare as easily. Another example of a vulnerable group who might experience more difficulty are prisoners. Prisons are often not adept at containing major infectious disease epidemics. Thirdly, immigrants and refugees who are currently living in dire conditions in camps and settlements, particularly as these people will likely live in crowded places with poor sanitation and more difficulty to access healthcare. Beyond the elderly and those with underlying conditions, there are so many other people who might be particularly at risk in this time. Many of whom have been neglected by society, but all of whom are particularly at risk of having their human rights abused.

This global pandemic has shown us that, even though health is a human right, it is only as viable and attainable as the strength of our health systems and our care for the most vulnerable in society are.

Health is a human right as recognised in the Universal Declaration of Human Rights. The decade of systematic cuts to our health systems and the secondary effects of austerity of thousands of people working in precarity and dealing with failing living standards have caused us to be woefully unprepared for a catastrophic event like this. This global pandemic has shown us that, even though health is a human right, it is only as viable and attainable as the strength of our health systems and our care for the most vulnerable in society are. In a world where the rich are able to self-isolate in mansions or second homes, and get access to tests even when others can’t, it seems difficult not to imagine there might be an aspect of class strife involved. It seems clear that we won’t be able to return to normal after the pandemic is over. The shaky foundations our systems are built on are not likely to survive in tact after this. It is then up to us to decide what’s next and to prepare for the next pandemic – which will come – in more comprehensive ways such as defending the right to healthcare, increasing its access, funding our health systems, implementing fairer labour policies, and redistributing wealth. We must applaud our essential workers, but we must also not forget them when this pandemic is over and they ask for more than just verbal appreciation. We, after all, are only as strong as the weakest link and at the moment the tower is crumbling.

On the (possible) return of community.

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The world has been under the spell of the novel coronavirus (COVID-19) first discovered in Wuhan in 2019, which has quickly transformed from a semi-local epidemic to an unprecedented global pandemic. The disease’s epicentre has rapidly shifted from China to Europe, with Italy being the first domino to fall on the continent and many countries following swiftly. At this point Spain and France are (almost) in complete lockdown, and other European countries are contemplating the best course of action.

Public health officials have advised a measure called ‘social distancing‘ – perhaps better called physical distancing – where we are encouraged (or mandated) to avoid large gatherings, work from home, stay home as much as possible, and in many cases are closing schools and businesses altogether. Social distancing has as its main goal the reduction of the spread of disease, and ‘flattening the curve’. ‘Flattening the curve’ is, not unlike ‘social distancing’, a term that has got more attention in the media and popular culture (the graph has gone viral…pun not intended) lately. It refers to how the social distancing measures we take – in particular staying at home – can effectively spread out and slow down the number of infected cases so our health systems can still operate at capacity rather than overburdening the already fragile systems.

These unusual and drastic measures have in many cases, for example in Wuhan, Italy and Spain, brought out the best in people, with neighbours singing and chanting in unison, and neighbourhoods applauding their brave healthcare workers. At the same time, this pandemic has also brought out the internalised hyper-individualisation many Western societies have been experiencing for a long time. Many countries are experiencing empty shelves in supermarkets as people are hoarding products, and people across Europe and the United States are still not quite taking the pandemic seriously and are still going to bars, cafés and other events with a large number of people around.

Indeed, it seems like we are at a juncture where we can either increase our sense of community and solidarity and turn a new leaf, or we can get more entrenched in our internalising of the neoliberal lie that it is every man for himself. In a pandemic situation where community solidarity is essential to our mutual survival, it seems to me clear what the best course of action is. This means, perhaps ironically, to limit physical contact with other people as much as possible. This means checking in on our loved ones and the most vulnerable in our communities (that is: the elderly and those with underlying conditions). The current circumstances can, and in some cases already do, bring us together. In a world of constant distraction, it is perhaps an uncomfortable but nonetheless perfect time to return to the heart of what matters to us as human beings: love and community.

For many Christians around the world, the pandemic coincides with the Lenten season where we deny the flesh, contemplate our fleeting mortality, and try to give alms and care for those in our communities. Contemplation is an essential facet of the Lenten fast. However, beyond the religious, many people have a longing for something more; people long for the knowledge that there is more to life than can be found amidst the hectic and distracting nature of our societies and constant competition within our hyper capitalist contexts. In that moment, a pandemic that asks of us to isolate ourselves and return to our core out of community solidarity, might cruelly be the thing that can bring us back to ourselves and our communities. This is the best possible time to do some shopping for your infirm or elderly neighbours, to spend more time reading, with family, or alone in silence. Now is the time for self-reflection and for deciding how it is we can bring back our connection to our local communities and our central humanity.

Even though it might seem easier, or more pleasant, to be amongst each other in bars, pubs, shops, clubs and cafés instead of at home at a physical distance from our friends, there is little to despair. The act of isolating as much as possible at this time is an act of profound love and care for the least of these, for our neighbours, for those who are working in healthcare and are trying their best to save as many people’s lives as possible.

Within the Latin Church there is an antiphon that is chanted during Holy Thursday which proclaims: ubi caritas et amor, Deus ibi est – where charity and love are, there God is. Even though it might seem easier, or more pleasant, to be amongst each other in bars, pubs, shops, clubs and cafés instead of at home at a physical distance from our friends, there is little to despair. The act of isolating as much as possible at this time is an act of profound love and care for the least of these, for our neighbours, for those who are working in healthcare and are trying their best to save as many people’s lives as possible. Even if you are alone, remembering that where charity and love are, there God is, should bring a sense of profound peace, whatever ‘God’ means to you. So, please, stay at home whenever possible – binge your favourite Netflix shows, read, sit in silence, spend quality time with your loved ones if they live with you. But also check in on your elderly relatives and neighbours, help your chronically ill family, friends and neighbours out with groceries. Help and care for each other. Fight against the voice in your head that says it’s every man for himself. Stand in solidarity…from a sensible distance and without shaking hands!

You can’t eat money.

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Greta Thunberg, the 16-year-old climate activist that I have talked about on this blog before, seems to bring out the worst in a (mostly) male cohort across Europe. In The Netherlands, Britain and Italy, mocking the teenager and her autism seems to be a national sport. Grown men being threatened by a child who has been speaking truth to power is baffling to many of us, but let those voices not deter us from her message that is still incredibly pertinent.

When we talk about climate change, we often think about middle-class environmentalists and we focus intently on individual sins: your carbon footprint is too high, you should be vegan, you you should not take long showers, you should not use plastic bags or bottles and ideally you really ought to drive an electrical car and not have more than two children (or even better: have no children at all!). Individual acts to counter climate change are always welcome, but I am afraid the focus on personal sinfulness does little to challenge the systemic sins of large corporations, the current economic system, and the collective “climate delaying” by our governments. In addition, the narrative surrounding climate change seems to easily point the finger at the Global South, who are historically far from the worst polluters, rather than confront the West’s longstanding intransigence. This has to change.

Just to be clear, individual choices to live a sustainable lifestyle are absolutely necessary. We are all responsible for the planet because this is, to quote Pope Francis, Our Common Home after all. However, the scale of the change needed to avert climate catastrophe far exceeds what can be done by simple individual changes in lifestyle. As 70% of the green house emissions since 1988 is produced by just 100 companies it seems clear that our individual changes alone are not going to cut it. What is needed is radical, systemic, change that comes from the top. Like Vox reporter David Roberts said (and I’m paraphrasing): we will have to stop signing resolutions and producing reports at one point, and actually start implementing policy changes.

Leaving it up to the market to solve seems to be, to some, a rational response to the climate catastrophe that awaits us. But in a globalised world full of consumers where companies are the main polluters, and where the fossil fuel lobby still holds sway over decisions made by our government, it seems to me that the problem might be with the unsustainable capitalistic system we have now. If we want to steer clear from the absolute worst case scenario, we will have to do something drastic and possibly eschew capitalism altogether. Saying that, understandably, evokes memories of the 20th century’s brutal dictatorships, but there is very little preventing us from creating a system that is both democratic and does not worship the market and place it above human dignity or the survival of our planet and species. What is needed is the will and the vision of (young) ambitious policymakers and politicians who are not in the pocket of the industries that are commodifying our human experiences and ‘our common home’. We need to think beyond the current frameworks, and that includes looking beyond an unsustainable economic system that we have grown so accustomed to.

Alanis Obomsawin, the Abenaki filmmaker, once said that:

When the last tree is cut, the last fish is caught, and the last river is polluted; when to breathe the air is sickening, you will realize, too late, that wealth is not in bank accounts and that you can’t eat money.

To effect actual change that is needed on a large scale we need to move beyond the highly atomised perspective of personal sins and individual carbon footprints. The sheer scale of the task ahead of us, the task we, as stewards of the earth, are burdened with, requires a radical approach. It requires the fundamental, and collective, overhaul of our current economic and political system. It needs to go beyond good will, treaties and pledges and towards radical policy changes. This will mean that we will all have to chip in, and more than anything that the largest fossil fuel and transport corporations will need to be taxed heavily. The fact of the matter is that we can’t eat money. Our common home is more than a commodity to be passed between hands, or a resource to be continually exploited at the expense of the worlds poorest, sickest and youngest. When children are dying because of air pollution induced asthma and when people around the world are dying because of extreme weather, it is clear we have to do something. It means listening to the scientists, to the young and ambitious politicians, and to the young activists like Greta (who deserves more than mockery for her passion for the planet and her autism). Right now it is not yet too late. But how much longer can we say that?

Healthcare as a human right.

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Any discussion of universal healthcare is seemingly conducted as if it is a solely partisan issue. The left wants universal healthcare, the right doesn’t — so goes the argument. However, the fact of the matter is that the United Nations’ Universal Declaration of Human rights, article 25, states that:

(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The countries that have signed up to this declaration have implicitly or explicitly accepted healthcare as a human right. Most countries provide free or affordable healthcare to its citizens, but how it manifests for non-citizens seems to differ between countries. We can do better.

War and natural disasters seem common and omnipresent, and will likely increase with climate change. Unsurprisingly, these calamitous events will also leave the most vulnerable exposed to health risks — particularly women, children, the elderly, and the chronically ill. Particularly in war and conflict areas, getting healthcare to the most vulnerable populations can be an arduous task, made more difficult by various state actors and disparate political motivations. Attacks on humanitarian aid workers make it difficult for vital medical care to arrive to the people who need it most. The World Health Organisation’s (WHO) 2017 report estimates that 14.8 million people in Yemen have no access to healthcare, and the International Medical Corps has said that delivering healthcare to affected populations in the country is difficult with major infrastructure destroyed, and the lack of a government that could support them. In addition, Amnesty International reports that the Saudi-led coalition has restricted the access to essential goods such as medical supplies from entering Yemen. The situation in Syria is equally dire, with the WHO reporting calamitous conditions in Syrian refugee camps, and additionally refugee camps housing former members of ISIS and their children have also not received adequate medical assistance. Chatham House experts recently wrote that many people with chronic illnesses end up being under-treated in war and conflict as the nature of chronic illnesses and the nature of war make it logistically very difficult to help them. In many instances, these local makeshift hospitals end up being in rebel-held territories with Western aid organisations fearing a loss of funds if they were to support these hospitals. From a security and counterterrorism point of view this might make sense, but the fact of the matter is that vulnerable people will see their right to medical assistance denied. It is clear that healthcare as a right is often a casualty of war, with deliberate attacks on hospitals, as well as restrictions on humanitarian aid depending on whose side the territory is held by, creating more issues for the local population and constituting continuous violations of international humanitarian law and human rights.

Closer to home, it is often the case that refugees and immigrants do not get to enjoy free healthcare in the same way citizens of a country can. A report by the Equality and Human Rights Commission published in 2018, showed that asylum seekers in Britain are often afraid of seeking medical care for fear of high costs, or being tracked by the Home Office. Ambiguities and an increasingly hostile environment for migrants, refugees, and asylum seekers, create inaccessibility to healthcare for an already vulnerable group of people. Guaranteeing that everybody, regardless of background and citizenship status, gets access to healthcare that respects human rights, requires political will and leadership. Moreover, people with mental health issues are still often subject to violations of human rights in mental health care where they are often stripped of agency and dignity — this has been the observation of the UK’s parliamentary and health service ombudsman as well. In the United States, many black women are dying in childbirth because they are not listened to in health settings and their human rights are systematically violated. Worldwide, people with dementia are still fighting for their human rights to be respected. There is still a lot to be done.

So, how do we make sure that human rights are respected and guaranteed, even in disaster and conflict zones, even when someone is an asylum seeker or a refugee, and even when the patient is disabled, mentally ill or cognitively impaired? There is no simple answer, but political leadership that sees beyond manoeuvring and posturing to behold the human cost of war, conflicts, health disparities locally and globally, and the victims it makes, would go a long way. In an international setting the countries with vetos in the UN security council have a particular responsibility to look beyond political expediency and geopolitics when the stakes are so high and there are no winners. The WHO has a prime position as an intergovernmental organisation to coordinate medical response and epidemiological research, and assist local governments after a disaster or in conflict zones. Human rights organisations monitoring, researching, and advocating for human rights to be respected, in conflict and in peacetime, play a vital part in holding the powers that be to account. Academic research in how to best coordinate humanitarian aid, particularly medical aid, in disaster and conflict zones is imperative. Non-governmental aid organisations and their local partners on the ground need continued support to take care of affected citizens regardless of their affiliations in war. Disability and mental health advocates need to be listened to. And finally, as citizens we have a duty to be aware and cognisant of our human rights, the inalienability of it, and that by respecting them we are doing not only the other, but our selves, a great service. By being informed and educated on the role human rights play in our day to day lives, we can lobby and advocate our local governments, and in turn politicians of good will can effect change. Eleanor Roosevelt, the mother of the UN Declaration of Human Rights, said it best:

Where, after all, do universal human rights begin? In small places, close to home – so close and so small that they cannot be seen on any maps of the world. Yet they are the world of the individual person; the neighbourhood he lives in; the school or college he attends; the factory, farm, or office where he works. Such are the places where every man, woman, and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.

Climate change, anti-vaxxers, and ‘alternative facts’.

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The last days of February were somewhat of a shock to the system of humans and nature alike, as temperatures rose to 21 degrees celsius in Kew, and many parts of Northwestern Europe saw April-like weather conditions. Whilst most people were enjoying the sun by lunching in parks, eating ice cream, and chatting on terraces, something about these scenes were equally unsettling. Clearly these temperatures are far from normal, and enjoying it felt an awful lot like the famous meme where Jay-Z bobs his head to music with an anxious expression on his face.

The Intergovernmental Panel on Climate Change (IPCC) recently released a report detailing what will happen if the Earth warms by 1.5 degrees celsius or by 2 degrees, and issued stark warnings. The World Health Organisation (WHO) warned of the health risks associated with climate change and an increased air pollution, and unsurprisingly the poorest people in low income countries who are far from the biggest polluters, will bear the brunt of the detrimental effects of climate change. In August 2018, 16 year old Greta Thunberg became somewhat of a celebrity when she started the school strikes for climate action that have become a phenomenon across Europe as of late. Expected petulance from the adults in the room aside, climate change has been firmly on the table. Whether through Greta and her age cohort’s school strikes, the IPCC’s reports, or Alexandria Ocasio-Cortez’s “Green New Deal“, climate change is something finally talked about in earnest. The interesting phenomenons that come with this increased attention for climate change, are both climate change deniers and climate delayers.

Climate delayers (thanks for coining the term, AOC) are the climate change deniers more respectable cousins. These are people who are aware of the devastation of climate change, but are reluctant to support or enact drastic reform of laws and regulations to make a meaningful difference to reverse, or more realistically lessen, the devastation that awaits us and our progeny. These are often politicians who will say that they are already doing more than they should, and expediently postpone any major changes for long enough so the next administration can not deal with the issue. Climate change deniers are the people (like the US president) who have an absolute commitment to denying all the scientific evidence for global warming and climate change, and are hostile to any measures taken to mitigate the effects of climate change. This outright denial of the evidence is an interesting phenomenon. As we all know, countering climate change denial with facts or insults do not help change people’s minds — in fact, they might even get more entrenched and double down on their views even more (this is called cognitive dissonance). It is easy to believe that many of the climate change denying politicians have some kind of vested interest in maintaining the status quo, but the reasons why the general public might not believe in climate change are less obvious and more disparate. These reasons range from misinformation (‘alternative facts’ if you’re Kellyanne Conway), to a lack of knowledge on what global warming entails or what the consensus really is.

This brings me on to anti-vaxxers. Anti-vaxxers are often young, middle-class parents who have chosen not to vaccinate their children because vaccines cause autism. Let me make it absolutely crystal clear: vaccines DO NOT cause autism. There is no evidence for this, and Andrew Wakefield is a disgraced physician who lost his license because of his shoddy and unethical study. Those are the facts based on countless scientific studies, but relaying those facts will probably cause cognitive dissonance if it is someone’s strongly held belief that vaccines are a Big Pharma conspiracy that will endanger their child.

Recently, there have been countless measles outbreaks across the world, with, for example the European Centre for Disease Prevention and Control identifying a suboptimal vaccination coverage to create herd immunity as the culprit. Many of the people who fell victim from this outbreak were young children who were too young to be vaccinated (and who, just like the immunocompromised, herd immunity is meant to protect). Just like with climate change, there seem to be people who are aware of the function and effectivity of vaccines, but think parents’ right to choose trumps public health. An argument can be made that if we are proponents of liberalism, individual liberty is of prime importance. Even so, John Stuart Mill, the father of liberalism, proposed that “The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others”. Indeed, I would argue that governments being more diligent about getting at least 95% of the population vaccinated — perhaps even making them mandatory for those who aren’t immunocompromised — fits perfectly within Mill’s harm principle. Particularly when there are so many people who suffer without any choice in the matter, because of somebody else’s parent’s decision not to vaccinate their children. The most vulnerable in society bear the brunt of this, again, not unlike with climate change. Indeed, the WHO has named a lack of vaccination as one of the biggest threats to global health. Whilst low- and middle income countries, despite challenges, do their best to get vaccinations to the most vulnerable populations, there are instances where Westerners reintroduce preventable diseases to countries that had finally put a handle on them, and even export the fearsome stories of what might happen to vaccinated children. A recent example of exported disease it that of the French family who reintroduced measles to a measles-free Costa Rica. Situations like this give an eerily colonialist feel to the case. But I digress…

Whether it is climate scepticism, or anti-vaxxers, how we change people’s minds is a difficult question to answer. It is clear that questioning parents’ love for their children, or insulting climate sceptics is not working. Perhaps, in the case of climate change deniers, Greta and her peers’ strategy of striking until the grownups finally listen is a good idea. Maybe we should all be lobbying politicians, striking, signing petitions, at least so the policymakers end up doing something — the rest of the population might follow. When it comes to those firmly believing in the anti-vaccination movement it is important that we try to tackle these harmful untruths with evidence and understanding. Moreover, public health officials ought to do a better job at educating the population, the government ought to be more diligent in tackling misinformation, and journalists should stop inviting ‘both sides’ to create a sense of false balance. Scepticism is not a bad trait. Indeed, even a dose of scepticism towards established science is not necessarily a bad thing. But it is up to critical citizens to find factual and truthful answers to their questions based on research and scientific evidence, and why it is that scientists have reach consensus over something. I promise you, scientists do not reach consensus easily. So, I leave you with some sage advice: please, don’t believe everything you read on Facebook.

Brains have bodies.

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I’m a neuroscientist. Or, well, an aspiring one (let’s not get into the philosophical discussion of when it is that someone can call themselves a scientist. That’s a whole other post for another day). When I mention that people automatically assume a lot of things, with the most common assumptions being an incredible intelligence, and perhaps a lack of social life. However, to some people science also carries with it a connotation of distance; of the ivory tower; of something experts do over ‘there’ that has no bearing on the average person’s life in the ‘real world’. In the very worst case scenario, people might assume malevolence — that you’re in the hands of Big Pharma to propagate vaccinations, or part of China’s elaborate plot to make US manufacturing non-competitive by creating (and apparently recruiting the scientific community to proselytise) the concept of ‘global warming’. The musings of the Leader of the Free World aside, I think there is some merit to the claim that science is at times far removed from the ‘real world’. Sometimes that is a good thing, and sometimes that can cloud our judgment.

In February 2017 The Atlantic published an article about advances in technologies used in neuroscience, and the criticism some scientists have when it comes to using these techniques. These critics warn of the spectre of reductionism looming over our quest to understand the brain. John Krakauer and colleagues (2017) published an article in Neuron discussing the problem of reductionism in neuroscience. They postulate that the advances in technology have created a class of researchers who are well-versed in the novel techniques, but have a tendency to disregard the organism: behaviour, development and evolution are treated as secondary to the neural circuits and the exciting new technologies. As mentioned in the The Atlantic article, wanting to include behavioural research is at times looked at with scepticism in the neuroscientific community, with the idea that behavioural research is the sole domain of psychology as an underlying apprehension. However, it disregards the fact that the lines between psychology and neuroscience are often much blurrier than people give it credit for (not to mention the fact that inferring behaviour from circuits seems to be the wrong order to go at it). Basic biomedical research into disorders such as autism spectrum disorder (ASD) can at times run the risk of disregarding the voices of the autistic community who have called for conditions such as ASD, previously simply classed as ‘disorders’, to be seen as variants of normal human behaviour instead (see more on neurodiversity here).

Neuroscience is hardly the only life science that runs the risk of forgetting the human component of research or treatment. Medicine is famously known for occasionally treating patients as their illnesses and conditions rather than human beings. One reason for this, it is suggested, is caused by the need to distance oneself from the patient and consequently individual responsibility for what happens to the patients. In his book Do No Harm, Mr Henry Marsh hypothesised that a practice as common in neurosurgery as shaving a patient’s head might have its origin in dehumanising the patient in order to make it easier for the surgeon to operate. However understandable it may be to distance oneself, and prevent oneself from getting emotionally attached to patients, it is surely possible to do that without veering into the territory of dehumanisation.

Recently, Ed Yong in The Atlantic, looked at the ethics of a virus study that resurrected a dead horsepox virus. It is more important, the argument goes, to push the boundaries and expand knowledge, even if it is at times at the expense of ethics or concern for global consequences. The scientific quest for knowledge is an honourable one, however, in my opinion, scientists cannot disregard ethics or consequences to humans and the environment in pursuit of it.

I doubt anybody expects scientists to make these ethical decisions on their own, or to constantly think of all the possible consequences of their research. However, I believe all of the aforementioned cases highlight the importance of communication outside of the (biomedical and/or scientific) community with ethicists, psychologists, government, and importantly the public. If we want government, the public, and our colleagues in the humanities to respect science and its place in society, then we have to be more responsible as a community. In the life sciences in particular it is important to avoid reductionism and to remember that most of the research we do will affect people. We cannot recklessly sacrifice our humanity in the quest for knowledge consequences be damned. Science is not removed from society, and if we want the public to believe us when we say that we will have to act as if we believe it ourselves.