Thursday, February 27, 2014

On rights and public health

In an interesting article, Mark Bittman, food writer for the New York Times, discusses a new book Nicholas Freudenberg, “Lethal but Legal: Corporations, Consumption, and Protecting Public Health.” 

The article (and presumably the book, though I haven't read it yet) lumps together several major industries that use a similar framework to justify behaviors that inevitably result in worse public health outcomes. The industries - tobacco, food and beverage, alcohol, guns, pharma, and automotive - use a paradigm of "rights" to counter any assertions that they share responsibility in the widespread adoption of behaviors that are unhealthy (such as smoking).

It's an interesting article and one that I find particularly interesting in light of some conversations about ethics I've recently had with my students. We have been talking about which people might be most likely to be turned off by various public health promotion messages. For example, in discussing campaigns to get people to eat healthier, we have been talking about how shaming tactics may galvanize some people to change their behaviors, but that for others, particularly those who already experience marginalization based on multiple aspects of their identity, shaming tactics are unlikely to prompt behavior change and perhaps more likely to increase dysphoria and a sense of hopelessness.

Bittman's take on this book is centered on the food industry (which makes sense as he's a food writer) and the efforts that food and beverage corporations take to manufacture and market highly addictive and unhealthful food. In a NYT magazine article from about a year ago, The Extraordinary Science of Addictive Junk Food, the back room discussions that have led to some of these decisions were compellingly described. What I am concerned about from a public health standpoint is this pervasive use of "rights" language, when human rights can never be divorced from social protection and status.

In my work with former child soldiers, recently discussed in this beautiful article by Jean Friedman-Rudovsky in the Telegraph, it was clear that women did not feel entitled to access structures to protect their human rights until they felt social acceptance. For example, one woman shared how she had been beaten badly by her boyfriend. While the law protected her, she felt that she could not go to the police because the police would target her because of her past history. It was only after she had gained social acceptance in her community that when another incident occurred, she felt able to speak not yet to the police, but to the local chief who listened to her story and negotiated a settlement between her and her partner. Years later, perhaps she would go to the police. But change like this was incremental. So the "rights" may have been legally endowed, but because of her status and relationship with those who share the obligation to protect rights, she was unable to exercise her rights.

So when corporations that make guns or that sell cookies and soda talk about rights, I always wonder whose rights they are talking about? They say the rights of the consumers, but they mean corporate rights to sell what they want and earn as much money as they can. And whether those who are already likely to suffer worse health in our society because of our unjust history or because of continued social exclusion evident in all domains of our society are the ones most likely to consume these unhealthful products, who has the obligation to protect them? I guess that's where public health comes in.....

Monday, February 17, 2014

Do we need professors?

An interesting debate is taking place in the op-ed pages of the New York Times about the role of professors. Most recent contribution was by Nicholas Kristof arguing for professors to be more vocal and active public intellectuals.

And in another perspective, Adam Grant proposes that we restructure tenure to separately allow for excellence in teaching and in research.

Ethics in Epidemiology and Public Health

A recent spate of investigations into conflicts of interest among academics have left me both saddened at the examples of poor decision-making exhibited by certain individuals in the field of public health, and hopeful that there may be an opportunity for leadership by universities and professional organizations about how to better advise and regulate faculty in dealings with conflicts of interest.

In the wake of the article published by the Center for Public Integrity exposing Patricia Buffler's role on the board of a chemical company, Lauded public health researcher also worked for industry, revealing entanglements of science, the Epidemiology Monitor had a nice issue discussing the case and others.

Pat Buffler was a professor of mine - and actually was the instructor for my doctoral seminar where we covered professional and research ethics. I vividly remember a class session where we discussed disclosures in a scenario she gave us around a potential conflict of interest when a corporation had funded research into its product. I was shocked to read about her undisclosed conflicts of interest.

While I don't personally know what to make of her story - she conducted such important research over so many years and was an incredible mentor to may people I know and care about - I do believe that universities need to take a systematic approach to understanding and ridding themselves of conflicts of interest in research. In order for research to have an impact in the world, it needs to be perceived as credible. Scandals like this one threaten not just an individual's reputation, but an entire field's. We must confront these sorts of instances not by denying the problem, but by understanding where the gaps in oversight or cultures of complacency exist in order to change them.

I was recently reading a children's book about Rachel Carson. There is a line that forces me to acknowledge that these scandals are very old. In discussing how Rachel began research into the effects of DDT in 1958, the authors write, "No one had taken a stand against big business, federal agencies that approved chemical use, or universities that performed shoddy research about the effects of chemicals. She knew she was walking into dangerous territory. However, because she had no connection with industry, government, or any university, she felt she could gather facts more freely." Since when did affiliation with a university make conducting unbiased, high quality research harder? Yikes.

Two excellent antidotes to the nihilism that this could inspire are in recent issues of the New Yorker. One, a Shouts and Murmurs piece, describes an experiment to investigate the relations between obesity and soda consumption. The other documents the chemical company Syngenta's attacks on Tyrone Hayes, a savvy, dedicated professor who exposed the harmful effects of one of Syngenta's products. Another full disclosure: I audited Hayes' undergraduate endocrinology course at U.C. Berkeley and thought he was an excellent professor.