Does Science Make a Difference?

 

The voice of science has been remarkably faint over the past four years, raising the age-old question and challenge -- does science make a difference? Sir Paul Nurse, president of Rockefeller University and Nobel prize winner for medicine in 2001, thinks it does, and he says, "The most important question facing the scientific community in the coming 25 years is: How can it maintain its contact with society to ensure that it has a continued license to operate?"1

A variety of environmental factors over the past few years have conspired to separate scientists from society and dampen enthusiasm and support for scientific progress. These include the bursting of the technology bubble in the late 90's, the mixing of religion and science in modern politics, the movement toward holistic and homeopathic care, and the explosion of information - some good and some bad - in traditional and electronic media.

We live in an age of health consumer empowerment. Over the past two decades, patients have made considerable progress, largely supported by their physicians, toward educational empowerment.2 Yet, clearly, scientific enlightenment remains a work in progress. Two-thirds of the American public believes that alternative theories to Darwin's theory of evolution should be taught in public schools.3

As a counterbalance, mainstream science has clearly made a positive and undeniable contribution to the human condition. Years of life have been expanded, moving in one century from an average lifespan of approximately 50 years to nearly 80. Between 1950 and 1990, the world's population has nearly doubled and now tops 6 billion. In the last half-century we've made enormous strides in understanding organ function or physiology, and disease processes or pathophysiology. This knowledge, along with a scientific lexicon, is rapidly being transferred to patients, placing them in a position to more actively partner with their caregivers.

As we have gained understanding of disease processes, we have gradually conquered many of them, including infectious diseases, peptic ulcer disease and increasingly, heart disease. For others, like many forms of cancer, behavioral insights, such as the harmful effects of cigarette smoking and cancer screening and prevention, have made a real difference. Lives have been saved, disability lessened, and all of this has occurred in a moment of time when new worlds have been explored for the first time -- ranging from the genome to the outer cosmos, with the help of the Hubble space telescope.

And yet, at the same time, science manages to raise a wide variety of troubling questions. Issues of concern include genetic engineering of foods, global warming, human cloning, germ warfare, nuclear power and the use of nuclear weapons. The one underlying, common theme: Will we control science or will it control us? Dr. John Gibbons, Science Adviser in the Clinton Administration, has noted: "People thought of science as a cornucopia of goodies. Now they have to choose between good and bad."3

Being a scientist remains a highly prestigious career choice, however, the number of individuals pursuing a career as a scientist is somewhat in decline. A recent Harris poll showed that 57 percent agreed that being a scientist carried very great prestige, above doctors, teachers, nurses, and certainly above lawyers, athletes and actors. And science remains intriguing to the young and bright and inquisitive. Solving riddles, taking pleasure in the craft, craving unique insights all contribute to the allure. When Einstein had the original insight that would underlie his theory of relativity, he said it was the "happiest thought of my life." So, in its simplest terms, science makes scientists happy.

In the global environment however, science is becoming less U.S. centric. Some of this may reflect a downward trend in prestige in the U.S. While still at the top at 57 percent, the prestige level for scientists is down from 66 percent in 1977. At the same time, interest in science beyond America's boundaries is increasing. For example, by 1999, the number of foreign students in full-time engineering programs in the U.S. exceeded the number of U.S. students, according to the National Science Foundation. And more than 25 percent of the U.S. industrial patents are now held by Japan, Taiwan and South Korea.3 While spending of late has increased in both public and private science sectors in the U.S., there is a great need to expand cross-sector cooperation to enhance effectiveness and competitiveness.

Clearly, science is in transition but experts are optimistic. Dr. Gerald Holton, a Harvard professor specializing in the history of science, says: "Science is one of the charismatic activities. This keeps our interest in science at some level even if we are deeply troubled by some aspects of its technical misuse." Noble laureate Dean Lederman adds, "You can smell discovery in the air."

What then are the major challenges for science and scientists up ahead? The most dramatic opportunities lie at the intersection of human, environmental and population science. Those science issues in the news include breakthroughs in cancer, AIDS and immunologic diseases, acid rain, environmental toxins, global warming, genetically modified food, sustainable energy and urban city management.

This last item will grow in urgency as we move from 3 billion urban dwellers in 2000 to 5 billion in 2005. The only way to manage the predictable issues of waste, water use, congestion, pollution, transportation, and energy are by creating a new science of cities. 4

Dr. John Gibbons comments, "The urgency is to re-establish the fundamental position that science plays in helping devise uses of knowledge to resolve social ills."3

Will science make a difference in tomorrow's world? Probably more than we can even begin to imagine.

Until next week, for Health Politics, I'm Mike Magee.

References

1.Wilford JN. Will we ever find Atlantis? New York Times, November 11, 2003

2.Nash.DB. Connecting with the New Healthcare Consumer. Aspen Publishers, Gaithersberg, MD 2001

3.Broad WJ and Glanz J. Does science Matter. New York Times. November 11, 2003

4.Heiken, G. " Earth Science in the City." American Geophysicial Union, Washington, DC 2002.