Be rigorous, but don't be fair

Last week I was one of about 13,000 people attending the annual meeting of the American Public Health Association. Despite the thousands of scientific, programmatic and policy presentations, mine was one of few addressing the general area of corporate social responsibilities, conflicts of interest, and business ethics. My presentation applied these lenses to the pharmaceutical industry, and just like it was last year, the response was enthusiastic, with organizers requesting more for next year. (I'll discuss some of my paper findings in an upcoming posting.) It seems that the very topics that fuel Justmeans are in great demand in the world of public health.

As in any scientific setting, the role of advocacy can sometimes become strained. There is often a perception that rigorous science is an objective activity steeped in fairness that takes no sides in political or policy battles. This is a misconception in my book. Tam Ormiston, a wonderful man and the chief deputy attorney general for the state of Iowa, once admonished a room of colleagues at a public health meeting that "we must be rigorous, but not fair." Trained as a lawyer, he has advocacy in his veins, and that belief that rigor does not necessarily equal fairness has become one of my central professional beliefs every since I heard Mr. Ormiston utter those words. When objectivity puts arrows in your opponents quiver, its best avoided.

The scientific method is an important process for answering technical questions. But once even-handed inquiry begins to identify worrisome trends, at what point do we stop waiting for more evidence, and instead take action? The answer is closely tied to potential trade-offs. If a treatment formerly thought to be lifesaving suddenly reveals dangerous side effects, then the decision to stop treatment should be backed with very solid evidence, multiple studies, peer review and balanced consideration. In cases of corporate responsibility, marketing, and potential conflicts of interest--practices where the enrichment of a few endanger the health of many, then the threshold for action should be considerably lower. Instead of an even-handed "fair" presentation of data and its limitations, you can favor the evidence that proves your point. Just as reasonable doubt can set the accused free, reasonable suspicion, informed by scientific inquiry that is as rigorous as a timely review of evidence allows, should be sufficient to support actions to end practices that otherwise serve no greater health producing purpose.

I'm a lover of knowledge, and a collector of trivial and often useless information. But I still believe that science for its own sake is something of a waste of time. Knowledge should inform change. Science should guide improvement of health and human kind. And in a world where private corporations can hide harmful acts behind privacy laws, it should be the duty of public health professionals to us science as an advocacy tool to bring some sunshine behind the heavy blindfolds of justice. Rigor is necessary when speaking truth to power, but fairness is not.