When We Confuse Scientific Solutions With Policy Solutions

By way of Andrew Gelman, we come across a very good question posed by Daniel Lakeland:

I [Lakeland] really do worry about a world in which social and institutional and similar effects keep us plugging away at a certain kind of cargo-cult science that produces lots of publishable papers and makes it easier to get funding for projects that don’t really promise to give us fundamental and predictive models that can drive real improvements in people’s lives.

It’s sort of a “it’s 2014, where’s my flying car?” attitude I know, but I’d be satisfied with a lot of things other than flying cars, such as:

1) real, effective solutions to antibiotic resistant organisms
2) cures for cystic fibrosis
3) reducing the effect of heart disease on people under age 75 by 30%
4) understanding major causes of “the obesity epidemic” in a real detailed way and finding effective ways to reverse it.
5) Being able to regenerate organic replacement joint components instead of titanium hip implants etc
6) Growing replacement kidneys
7) A more significantly more effective and long lasting pertussis vaccine

Is the way we are doing science today going to provide any or all of these things in the next 30 years? What are some similar order of magnitude things that it has provided since 1980 using current “modern” methods and funding priorities, publication priorities, tenure systems, and so forth?

I do share Lakeland’s concern about how funding affects our ability to solve scientific problems: there are too many continuations of preliminary projects, when, for certain areas, we need to, as I’ve so eloquently put it, ‘go all Manhattan Project on its ass’ (a fucking poet, I am). That said, I think we already have solutions to some of the problems on Lakeland’s list (#1, #4, #7*), but our political system is unable to implement them.

Let’s start with #7, “A more significantly more effective and long lasting pertussis vaccine.” Ideally, a ‘better’ pertussis vaccine would exist (we had one that was more effective, but caused rare side effects). But imagine that we had an effective national healthcare system (note that I mean the delivery of healthcare, not the particulars of health insurance and financing), as well as some paid sick leave so doctor’s visits are easier to manage. People would be going to the doctor regularly, the doctor would note that it’s time for your pertussis booster (“Tdap”, and SHAZAM!, we’re doing pretty well. Sure, a one-shot vaccine would be better and easier–I won’t argue that–but we could make this work, if we chose to do so.

Moving on to #1, “real, effective solutions to antibiotic resistant organisms.” There are a lot of things we could currently do to significantly reduce the threat of antibiotic resistant organisms:

1) Stop clinical misuse of antibiotics. Maybe handing out Z-paks like candy shouldn’t be best practice.
2) Improve healthcare-associated infection control.
3) Stop the misuse of antibiotics in agriculture.
4) Make a serious attempt to make the use of phage (bacterial virus) therapy viable (the Soviet Union used this for decades).
5) Improving sanitation in developing countries so antibiotics aren’t used as often (and to lessen the transmission of resistant commensal bacteria).
6) Better combination therapy in the clinic.

None of those are really difficult technological or scientific challenges. But they are regulatory and political challenges–Rep. Louise Slaughter and Sen. Ted Kennedy tried for years to get PAMTA passed (and failed), which was a pretty modest agricultural antibiotic use reform bill. No one has figured out to how commercialize phage therapy–which is, again, not a scientific problem. The only thing that comes close is combination therapy.

Finally, let’s consider obesity. There is plenty we could do today to make our environment less ‘obesogenic’. Many of these are policy-driven, from not massively subsidizing crappy food to improving school lunches. Others are indirect effects of policy, such as the increase in hours worked over the last 35 years, sleep deprivation due to odd schedules, and so on (this is essentially the loss of worker agency–it could be a coincidence).

The point is, while ‘having a pill for that’ would help greatly, some of these problems are tractable today in terms of technology. It’s just that we choose not to make tackling these problems a priority (or, in fact, favor policies that make them worse).

*I’m not sure what #3 means (decreasing incidence by 30% or the long-term effects of various heart diseases, such as cardiac arrest), so I’m removing it from consideration.

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2 Responses to When We Confuse Scientific Solutions With Policy Solutions

  1. dr2chase says:

    #3 — I was going to say, “get 60% of that population to walk or ride a bike for all errands/trips shorter than or equal to 3 miles”.

    But (working from ORNL data): that’s only 90 billion (9e10) miles per year, divided by 300 million people (3e8) yields 300 miles per person per year, which is not enough if you bike (6 miles per week). 4 mile trips gets you to 160 billion, 5 mile trips gets you to 230 billion. 23e10/3e8 = 800 miles/year or 16 per week, which is getting there (that’s over an hour on a bike, assuming the usual hassles with traffic and traffic controls — personal best across Belmont and Cambridge is 14mph door-to-door w/o breaking traffic laws).

    I think you want double that, and I do triple that (and I got move-the-numbers checkup results, too). I keep thinking I have made a glitch in my arithmetic, because a 5-mile commute (times 2 for round trip) 5 days a week gets you to 50 per week, with no other trips required. (No, I did not ride my bike to work today, we had a bit of the home heating circulation system freeze and I was home intermittently tending to that. But 12F, I’ve done without any problems.)

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