Open Mike: The Science of Moving Mountains

Public health is not always easy. It is not always popular or met with unanimous agreement. In seeking to preserve human health, it touches on the more intimate parts of individual lives and the thorniest of societal issues.

As we were preparing this issue of Johns Hopkins Public Health magazine, I knew its subject—sexual and reproductive health—might cause controversy and provoke strong responses from different perspectives. Then I received some practical education in how emotionally and politically charged these issues can be.

In early April, I learned that the administrators of the POPLINE family planning database at our School had blocked the term "abortion" as a key word, making it difficult for users of the database to find information on the topic. (The POPLINE database, which is funded by USAID and administered by the Bloomberg School's Center for Communication Programs, provides evidence-based information on reproductive health and family planning. It is the world's largest database on these issues, and it contains about 400,000 records.)

When I learned of their decision, I immediately reversed it. Full access to the database was restored within hours. (For my full statement on the issue, click here.)

The incident and my response provoked national media coverage, a congressional inquiry, and unbridled criticism and passionate support. One person charged me with having "caved to the librarians" (who initially reported the database's block on "abortion"). Others applauded my "courageous decision" and my "intellectual integrity." And still others demanded to know my personal views on abortion.

My action was not courageous. Nor did it have anything to do with abortion. And, despite the mass media frenzy and the consequences, it was actually a very easy decision.

I based it on the core principles of the Johns Hopkins Bloomberg School of Public Health. Our mission is to create and disseminate knowledge. We do that by generating evidence.

With the right evidence, we can move mountains. We can change the policies governments formulate, the priorities global leaders set, the advice physicians give patients and the choices people make—all with the goal of improving health.

Our School has a public trust to create new knowledge and disseminate it. Anything that impugns our position as a trusted partner in society hurts us and makes us less effective.

Without integrity, we don't have a soul. Restricting the free flow of knowledge violates both our core principles and our professional ethics.

Generating knowledge means having access to evidence, summarizing the evidence and looking for patterns in the totality of the evidence. This is what we do: provide uncensored information to improve health.

Sex is a difficult topic. And abortion is a very difficult topic because of the strong religious and moral beliefs that people bring to it. But we are not going to advance that debate unless we have information such that people can understand what the evidence is on both sides. And that is what we are about. We are not an NGO dedicated to service or representing a particular ideology. Though we provide service to people around the world, it is a byproduct of our research and educational missions. The major way we improve the world is through discovering knowledge and educating the next generation of leaders to make informed decisions.

In the case of abortion, or abstinence education, or condom use, or any other issue that sparks controversy in matters of public health, information and evidence are necessary for dialogue. Otherwise, you are just arguing from beliefs that may or may not be true. In fact, the more difficult the issue, the more emotionally charged the debate, the more polarized society is ... the more important it is to have knowledge. Then you can make decisions from a solid foundation of evidence.

So, it is our duty, our responsibility, to illuminate society's most difficult issues, to wade into issues tangled by controversy, strongly held beliefs and preconceptions, and, hopefully, bring back knowledge that will serve human health.

As a school of public health, we cannot afford not to talk about sex and its related controversial subjects. Whether the topic is unpleasant or makes some people uncomfortable, it is knowledge that we need. It is essential to our mission of protecting health and saving lives.