Keith Humphreys recently published a reflection on the social roles of public health professionals. in response to a recently published memoir by Griffith Edwards, the former editor of the journal Addiction for 25 years.
The contract to which I refer, roughly speaking, ran as follows. Researchers’ fundamental duty was to systematically and accurately describe the addiction-related problems of the day as well as what programs and policies made those problems better or worse. Scholars of course had political opinions and policy preferences about how the evidence they gathered should be used, but appreciated that scientific expertise conveyed no expertise in governance (if you don’t believe me, attend a faculty meeting, Humphreys & Piot, 2012). Further, it was not scientists’ place to tell the citizenry how to live because they did not have the democratic warrant to do so.
Policymakers in contrast did have such a warrant, either because they were elected by voters or appointed by people who had been elected. It was therefore appropriate for them to decide how any evidence scholars provided should be used or indeed whether it should be used at all. Policymakers at the same time should defer to scientists on what the evidence about addiction actually was and not discount it based on anecdotes, ideological priors, or political expediency.
Humphreys K. (2026). Can the Contract Between Addiction Scientists and Policymakers Be Restored to What It Was in Griffith Edwards’ Time?. Journal of studies on alcohol and drugs, 10.15288/jsad.26-00236. Advance online publication. https://doi.org/10.15288/jsad.26-00236
His commentary is important and timely, given the recent public flogging of Anthony Fauci and the ascendance of public health and academic research in the addiction/recovery space over the past decade.
Politicians, influencers, and their followers are accusing public health of dishonesty, misjudgment, and hubris. We’re also seeing calls for more participatory approaches to public health. More often, we’re seeing influencers and others create their own health and wellness information ecosystems, and some of what we’re watching play out is the competition for ownership of public health and the social power that is believed to accompany it.
To me, the most salient questions relate to that power. What should we expect from public health professionals and systems? What power do public health professionals have? What powers should they have? How do their roles interact with other roles?
Our expectations for public health determine the power dynamics. Discussing expectations gets complicated because there are the expectations from the public, clinicians, government, business, schools, health care delivery systems, etc., and then there are public health’s expectations for its own social role (and the roles of others in public health). This opens the door to all sorts of chicken/egg questions.
If one believes that public health wields too much power, is that because it is trying to meet public expectations, because it is filling gaps left by other groups failing to fulfill their roles (e.g., politicians), or because of hubris?
Public health has many important functions and roles, but with respect to policy development, I’d say that public health’s role is to provide information and make recommendations to the public and the people making governmental and institutional policy (legislators, mayors, governors, etc.). Unfortunately, health and wellness information can generally only be provided as estimates and probabilities with varying confidence levels. I say “unfortunately” because estimates and probabilities with varying confidence levels generally aren’t satisfying for the people giving or receiving the information. There’s often a hunger for certainty from everyone involved. In these circumstances, expertise includes knowledge (including respecting what you don’t know), restraint, and humility.
Further, making policy decisions based on estimates and probabilities with varying confidence levels is unappealing, especially for ambitious people who do not have specialized knowledge. As a result, responsibility for policy decisions at micro and macro levels can end up resembling a hot potato. In those moments, it’s tempting for policymakers to abdicate responsibility to public health officials. Much is lost when this happens. Public health officials bring expertise in diseases, disorders, and population health. Scientists and content experts of all sorts can be prone to scientism. Policymakers are responsible for integrating that expertise with the expertise of other stakeholders and an appreciation for the unknowable. When this process—akin to checks and balances—breaks down, it contributes to a crisis of faith in experts and institutions, and a tendency to question everything we believe.
Public trust is earned slowly, often with difficulty, and is easily lost.
As someone who works extensively in public policy, I have witnessed scholars who declare themselves activists be for some reason surprised when policymakers start seeing them not as sources of carefully gathered evidence but as, well, activists, i.e., just another self-interested party in the sea of lobbyists, special interest groups, and spin doctors who populate the corridors of government. Griffith could have told such colleagues that this decline in trust was inevitable if they chose to tear up the old contract.
Humphreys K. (2026). Can the Contract Between Addiction Scientists and Policymakers Be Restored to What It Was in Griffith Edwards’ Time?. Journal of studies on alcohol and drugs, 10.15288/jsad.26-00236. Advance online publication. https://doi.org/10.15288/jsad.26-00236
All of this emphasizes the risks at the intersection of science, public trust, and activism. Personally, I don’t think this forbids activism, but it does require transparency and clarity about what hat we’re wearing when we speak and respect for knowledge, values, and priorities of other systems and stakeholders.
I addressed some of this in a previous post on polarization, our fractured information environment, scientism, and institutional mistrust:
One of the refrains I heard frequently was “follow the science!”
I hear this a lot in addiction treatment and recovery too. I find it frustrating. Not because I don’t value science, but I find that a useless statement.
My response is, “follow the science to what?”
Science can help us understand what is and what is possible, but it can’t tell us what endpoint to want. And, the trends above will shape our understanding of the problem(s), the solution(s), the good, etc.
For example, with COVID-19, the question may be, “what course of action would result in the fewest deaths and is medically, socially, and economically sustainable for up to 18 months?” or “how open can we be without pushing hospitals past a breaking point?”
In the case of addiction treatment, the question may be which treatment will “get me back to the way I used to be” or “help me have a normal life with a job, a house, kids, friends, and family” or “what’s the most effective death prevention?”
Those questions will have very different answers and it would be wrong to characterize one set of answers as “science” and the other set of answers as “unscientific.”
Science can provide valuable data and clues to help us achieve our goals, but it can’t tell us which questions to ask and it can’t answer many of the questions that are most important to us.
