Thinking about the Hard Stuff

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It is a new year and we are heading into revitalized science policy territory. Like me, you might be heartened to ponder ways the public interest and confidence in science will be better served by enhancing innovative research, promoting more inclusive involvement and equitable advancement of researchers’ careers, and supporting the translation of basic research into application. Further encouragement comes with the appointment of the distinguished sociologist, Alondra Nelson, to the new position of deputy director of science and society in the White House Office of Science and Technology Policy.

Nelson’s book, The Social Life of DNA, should be a “further reading” choice for anyone reading this genetics-themed issue of Anthropology News.

It is an inescapable fact that science is socially situated, and the high-ranking post is well suited for a moment when people and societal institutions must be featured prominently in the science policy equation. Relatedly, I recently had a conversation with a colleague who used the term “hard” science to set the natural and physical sciences apart from anthropology. I grimaced at this usage, since it implies that anthropology and other social sciences are squishy soft, riddled with uncertainty, and devoid of predictive value.

That is not the case! In view of this issue’s theme, in my career as an energy and environmental health policy researcher, I have had a chance to collaborate with geneticists on projects involving subjects as varied as the elevated risk of congestive heart failure among women with an X-linked recessive genetic condition that often leads to Duchenne or Becker Muscular Dystrophy (DBMD) in their sons, and the genetic basis for increased susceptibility to environmental triggers that cause childhood asthma.

Women who are DBMD genetic carriers have an increased chance of specific cardiac problems. Awareness of the potential link between carrier status and cardiac risk appeared to be low among carriers, and limited among their health care providers as well. Our work showed that providers identified an ambiguous evidence base, lack of clear health education messages and behavior recommendations, and inadequate referral mechanisms as limiting factors in communicating cardiac risk and recommendations to carriers. The women identified a lack of awareness and caregiving as the primary barriers in seeking cardiac care, with insurance coverage, limited provider awareness, and inadequate referral mechanisms as secondary barriers. Effective, patient-centered communication approaches were developed with geneticists, counselors, carriers (identified and potential), and providers serving DBMD families to motivate women to seek screening.

In the case of asthma, exploratory investigations on the genetic basis for increased susceptibility to environmental triggers have helped sharpen the focus of work on specific cytokines, interleukin-4 and -13, that help regulate adaptive immunity to allergens and other asthma triggers. This research, coupled with work on technology developments, environmental impacts, health and social impacts, and observations about such institutional measures as the licensure restrictions of school nurses, can combine to yield interventions that reduce emergency room visits and missed school days, and improve child health.

Is it necessary, or even productive, to label some of this work “hard” and some of it “soft”?

The geneticists’ work on X-linked recessive inheritance is important, but only accounts for about two-thirds of DBMD cases. The other one-third are due to a mutation. The uncertainty is important, because of implications for medical decision-making. The same with asthma susceptibility. Research targeted up to 70 promising genetic loci, narrowed it down to five, and has generally found these five to have decent positive predictive value, but still enshrouded in uncertainty.

To me, dealing effectively with the uncertainty is the hard part. The distinction between risk and uncertainty is important here, as Mary Douglas pointed out. When we are concerned with known probabilities of alternative outcomes, conditions of risk obtain. We are operating under conditions of uncertainty when the range of alternative outcomes may not be known, nor their likelihood of occurrence.

Uncertainty is present even in the most tightly constructed models. Our distinction between the so-called hard and soft sciences discounts this uncertainty in the one example and over-emphasizes it in the other. Discounting uncertainty lends a false sense of precision to findings—having identified the likely genetic source, a safe and effective drug can’t be too far away. Over-emphasizing uncertainty diverts attention from real-world problem-solving—this is merely anecdotal evidence in support the idea that licensed school nurses can reduce the severity of student asthma attacks.

I’ve come to believe that new knowledge production is always hard, because the findings are always contingent, and self-correction is built into our work. We wouldn’t want it any other way.

Cite as: Liebow, Ed. 2021. “Thinking about the Hard Stuff.” Anthropology News website, March 12, 2021. DOI: 10.14506/AN.1599