Acknowledging challenge, engaging with hope

Some thoughts, inspired by the class of 2025, on the challenges and opportunities of the moment.

Last Monday, I had the privilege of attending the Commencement ceremony at Washington University in St. Louis, where I serve as dean of the School of Public Health. I have long felt that graduation is the happiest day of the academic year, an enduring source of inspiration and joy. Coming together as a community to recognize the achievements of our graduates always ends the academic year on a hopeful note.

That perhaps fits uneasily in times of challenge and disruption, such as the current moment. It has been a disorienting few months. The election of a new administration has led to an array of proposed changes, some countermanded shortly after being introduced, some leading to court challenges and stays that change little but leave a policy Damoclean sword hanging over a lot of the work we do. Some of these actions directly affect what we do both in the academic world and in a world where we are aspiring to promote the health of populations. While I have written about where I see these policies endangering the health of populations, I also have tried hard to keep an open mind about the remit that should be afforded any administration to implement the agenda it feels it was elected to pursue.

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On Apostasy

The movable type printing press was invented in the mid-fifteenth century in Germany by the goldsmith Johannes Gutenberg. The press, which could produce up to 3,600 pages a day, was a dramatic change from previous ways of reproducing texts, which could produce at best a few pages a day. This was transformative for the spread of texts and ideas, and within a few decades, by the start of the sixteenth century, hundreds of printing presses existed throughout Europe.

The printing press heralded changes throughout the Western world, not the least of which was its challenging the hegemony held by the Catholic Church over religious ideas and attendant beliefs. With the advent of the printing press, religious texts could be distributed more readily, giving space to individual interpretations and finding mainstream audiences. Most notable was the spread of the work of Martin Luther, which led to the development of the Protestant Reformation throughout Europe.

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Can Science Lead to Real-World Change More Efficiently?

Lead has been used as a conduit for water for thousands of years. The Roman Empire, in particular, made extensive use of lead—a malleable material—for water transport. Scientific observation about the harms of lead in drinking water goes back at least hundreds of years. Bernardino Ramazzini documented disorders associated with lead exposure among workers in the 1700s. J. Lockhart Gibson documented the consequences of lead poisoning among children in 1904, and at the turn of the twentieth century, there was rapidly growing awareness of the potential harms of lead poisoning, particularly in children.

In the U.S., the Environmental Protection Agency put in place a ban on lead in plumbing materials in 1986, followed by the Lead and Copper Rule as the National Primary Drinking Water Regulation in 1991. Today, about 9.2 million lead service lines continue to deliver water to communities in the U.S. The EPA created a $15 billion fund to eliminate this problem, literally hundreds of years after science first documented the challenge of using lead pipes to deliver water.

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“We must disenthrall ourselves”

On letting go of habits and ideas that do not serve us in this moment.

In his second annual message to Congress, Abraham Lincoln wrote:

“The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew and act anew. We must disenthrall ourselves, and then we shall save our country.”

I have been reflecting on these words lately. This moment, for all its challenges, is not the same as the one with which Lincoln contended — we do not face a crisis of slavery and civil war, though the legacy of both continues to echo through history. However, our occasion is “piled high with difficulty,” and our case is indeed new. We face a range of intersecting, novel challenges that has made this an era unlike any other. Political disruptions, climate change, technological developments such as AI, and global conflict have made this a time of difficulty, a stormy present. These challenges beg important questions: How should we respond in this moment? What should we — can we — do to build a better world when the one we have seems to be so much in extremis?

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Can Science Be Done More Efficiently?

Sir Francis Crick and James Watson are towering figures in science for identifying the double helical structure of DNA. But they perhaps loom even larger in the public imagination for their race to be the first to identify this structure, a science thriller immortalized in Watson’s book The Double Helix. The book became a bestseller and remains to this day a gripping account of what seemed to be feverishly fast science, a competition racing towards an Eureka-moment of discovery. 

This is a very partial picture of what science looks like, though. Science is generally slow, plodding even, with discovery after discovery unfolding systematically over many years. Even the story of DNA is nowhere near as dramatic and fast-paced as our memory of the headline-grabbing identification of the double helix would suggest.

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What is the worst that could happen (for U.S. health)?

Thinking about the potential consequences of a policy landscape in flux

This piece was co-authored by Dr. Nason Maani.

The U.S. stands at a moment of uncertainty regarding its future health and well-being. The current administration has now sought to act on a range of fronts in advancing its policy agenda. These early actions have affected almost all levels of government, many of which will have an attendant impact on health. What this impact might be in the long term remains to be seen, a view that is complicated by both the speed and breadth of the federal actions, and the extent to which these actions are directly affecting our capacity to measure their effects — as in the case, for example, of enforced pauses on health agencies’ communication.

With this in mind, we ask, considering what we know, what is the worst that could happen to U.S. health, what challenges should we be most aware of and anticipating? In asking this question, it is important to note the importance of adjusting for our biases and avoiding a reflexive engagement with the emotions of the moment. It is on us to make an effort to be dispassionate, because dispassion supports the reasoned, fair-minded perspective that helps us to do and say only what is constructive at a time that calls for approaches that build, not break. We have written before about the importance of maintaining this perspective, recognizing that we have just had an election in which the American people chose a particular vision for the US and—while they could not have foreseen all of what has happened since and may well not support much of it—we need to recognize that many of the policy changes of the moment would likely be considered at least directionally correct by roughly fifty percent of the country.

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What we owe, and do not owe, the past, Part 2 of 2

We owe the past much, but do we owe it everything?

In last week’s essay, I engaged with the question, “What do we owe the past?” I began by accepting that the past matters for the present, that we have a responsibility to remember the past both for moral reasons and from a recognition that we cannot fully understand the present without understanding what came before and why. We owe the past, and those who lived in the past, our remembrance of the history that shapes all we do, and are, in the moment. In remembering the past, we should also be learning from the past, recalling the wisdom of our forebearers and trying to avoid their mistakes as we work to build a better world in the present.

We should also try, to the extent we can, to rectify the injustices of the past. While it is true that there is much about the legacy of the past that cannot be changed, there are still ways we can reckon with the past to address some measure of the injustices we inherit, and, where we can do so, we should. These all reflect obligations we owe to the past that should inform all we do in the present, so that even what is bad about the past can in some way — through a process of remembering, learning, and informing the work of rectifying historical injustice — help to create a better present and future.

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Unreliable Science

Scientists know that we should rarely draw conclusions about any scientific issue based on any single publication—the scientific process depends on replication and is iterative by design. To get to an “answer,” we have to look at the overall literature on a subject. Our understanding changes as knowledge accrues. We keep in mind that we do not know which findings will be replicated and which will, in the long run, prove to be cumulatively correct. 

How, therefore, do we distinguish, in the moment, the science we should believe? What evidence should we trust?

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