Science is politics

No, this isn’t some post-modernist rant on the inherent non-objectivity of science. On the contrary—this is a much simpler, grittier point, that science actually is the most accurate way of describing reality, and because of this, politics (the job of manipulating and controlling group’s social reality) and science will always be roommates.

This comes up because we get complaints—regular complaints about science blogging failing to stick to “science”. I gotta say that this complaint always seems to come from those who find reality to be a bit too liberal, but maybe that’s just my bias showing.

This intersection (if you’ll excuse the expression) is crudely obvious to working scientists writing grants—if you write the “wrong” thing (e.g. studying HIV in sex workers, stem cell research, etc.), your grant is history.

Less crudely, science informs political positions, such as how to deal with global warming (or whether or not it’s even a problem).

One such question came up in a comment recently. The question revolved around whether doctors should ask patients about firearms.

It is the policy of my professional organization to inquire about firearm ownership and safety. Is this a valid position, and if so, why?

First, physicians are charged with prevention and treatment of human disease/injury. Prevention encompasses screening for risk factors, and preventative treatments such as vaccination. It also includes counseling regarding important health behaviors, such as seat belt use.

So, we must ask, “are firearms an important, preventable health problem?” Then, “if so, how do we intervene to prevent firearm injury and death?”

The data regarding firearms and preventable injury is unassailable. The CDC and DOJ both track statistics, but as an example, homicide and suicide by firearm are the second and third leading causes of injury-related death in the US in the 15-24 age group. The exact magnitude of the problem can be debated, but its health significance cannot.

The American College of Physicians (in a 1998 position statement) has taken a two-pronged approach: asking patients about gun ownership and safety, and advocating for gun-control legislation. The first should be uncontroversial—who can argue with asking a patient if they own the means to end life rapidly and violently, if they know how to secure it properly, and if they keep it out of the reach of children?

The second point is, needless to say, very controversial, although not so much among physicians, who consistently poll favorably on the issue.

Lets add some science-based medicine to the cauldron. First, is it plausible that doctors’ interactions with patients and legislators can reduce gun violence? Sure, it’s plausible, but not proven. Is it probable? Can this intervention cause harm? There is slightly more evidence supporting the position that gun violence can be reduced by intervening with patients and on a legal level, but the evidence isn’t ironclad. There is no good evidence to suggest that intervening on an individual level is harmful.

Ideologically, and based on my reading of the (very clear) statistics, I agree with the ACP position statement from 1998. Despite lack of conclusive evidence, it is very reasonable to discuss firearm safety with patients, and to let them know that risk of injury and death increases significantly with gun ownership. There is also pretty good evidence to suggest that some gun control laws reduce gun violence in some situations.

There is a push to develop better data. Until then, I’m following a prudent public health course of recommending vaccination, seat belts, safe sex, and firearm safety. If you don’t like it, find a doctor who doesn’t care.