On the importance of the opportunity to freely think

Remembering the central importance of clear thinking in challenging times.

The last month has been a time of fear for many working in health. Fear of funding cuts and challenges to public health institutions. Fear of what will come next in an uncertain political moment. Fear of the changes being enforced, of radical disruption of what we do and how we do it. Such fear is understandable. A new administration has pursued cuts to federal funding for science and health, prohibited external communication by federal health agencies, and taken actions that have led to the dismissal or resignation of thousands of federal workers, including many working in science and health. The administration has also made clear that certain forms of research are not welcome at the present time. This has led to some researchers removing their names from publications or pausing their work for fear of retaliation.

These fears are likely, sadly, not unfounded. I have written about the need to give the new administration a chance to pursue the policies it ran on, respecting the fact that the American people voted for much of this, just as they voted for a different administration four years ago, and their preferences merit due consideration, particularly by those of us working in public health, for whom the attitudes of the public should never be disregarded. However, the manner in which the new administration has chosen to pursue what it perceives as its mandate has created unnecessary disruption, uncertainty, and fear, and we should acknowledge this. Fairmindedness, the willingness to give a new administration a chance, does not mean giving a pass to cruelty or staying silent when we see policies enacted that undermine the science and institutions that support a healthier world.

Yet, it is also important to acknowledge the imperative need of finding the right words to speak about this moment. As is often the case in history, it can be hardest to speak at precisely the times when doing so is most necessary. We wish to speak and can find ourselves blocked by fear. It is true that fear can be useful when it reminds us of the importance of caution, of exercising prudence in our words and actions, toward ensuring they are maximally constructive in the moment. However, fear can also have a chilling effect, causing us to take caution too far, to refrain from speech because we fear a confrontation with authority. When this happens, we have entered a climate where it is necessary to remind ourselves of the centrality of free thought and speech to what we do.

Why is it important to freely think?

Let me then take a moment to revisit why the ability to freely think and speak is a nonnegotiable for the work of health and to consider how we can preserve these fundamental principles even in this challenging moment.

Why does health depend on our capacity to freely think? We are accustomed to thinking of health as a product of structures, and it is true that the world around us, the context in which we live, is foundational to whether or not our world is healthy. But at an arguably deeper level, health is a product of ideas. The state of the world starts with the ideas we accept and reject about how it could and should be. Our ideas, then, should be — must be — good ones, which means the integrity of the process through which we formulate and test ideas should be good. When we cannot think freely, when we cannot express ourselves honestly, we cannot properly articulate and test the ideas that are the basis for all we do, running the risk that our ideas will not be fully developed as they travel the pipeline from thought to implementation. This represents a fundamental flaw in our ability to do our work. We need freedom of thought, freedom of speech, to create the healthy climate of ideas that is core to the work of creating a healthy world.

We also value the ability to think freely because it is essential to the maintenance of a free society and the civic and political structures that support it. It is always worth remembering that the framers of the U.S. Constitution made freedom of speech the first amendment, so central did they regard it to the project of building this country. Ensuring the work of health is supported by freedom of thought and expression is deeply in line with the broader work of maintaining the integrity of our society and politics. If we cannot honestly air and debate issues and data in the public square, it could be said that, in some fundamental way, we cannot have a fully functioning society, because that society will be based on untruths, half-truths, and the omission of robust discussion about what is real and what is not.

Telling the truth, then, is a kind of world-building. It helps to maintain the core structures of a reality in which we can live, grow, and thrive. We should not take it lightly when we sense a collective drift away from the principles of free thought and speech. We should resist such a drift in whatever ways we can, mindful that doing so is centrally important to all we do.

What challenges our ability to freely think?

What are the challenges to creating an environment in which we can freely think, particularly in this moment? I suggest that the challenges facing thought and expression are threefold.

First, we have entered a political and cultural ecosystem in which it has become harder to distinguish between what we believe and what we know to be true. Partisanship, cultural division, and the rise of new technologies such as social media and AI have muddied the public debate, casting doubt on the reality of what appears to be true, making facts suspect when they come from outside our “bubbles” and allowing us to cocoon ourselves within spaces where most of the voices we hear are those with which we already agree. This has made it easier than ever to confuse what is true with what feels true and to reject facts that complicate our preferred narratives. In this context, we no longer need to test theories, to determine they are sound, before they gain purchase in the wider world. When everyone has access to an online megaphone, free thought and speech can easily be drowned out by whoever shouts loudest, and bad ideas can overpower good ones simply by going viral. Navigating this ecosystem is an ongoing challenge that is bigger than any political or cultural moment. It is a challenge with no easy solutions, but one with which we must engage if we are to preserve and elevate freedom of thought in our complex era.

Second, we are in a time when, instead of thinking for ourselves, it has become possible, and increasingly commonplace, to let others do our thinking for us. Political and cultural figures, TV hosts and columnists, YouTubers and podcasters — such figures have found wide audiences in this moment. With the siloing of news and information enabled by polarization and social media, thought is often a matter of checking to hear what our preferred “influencer” has to say about a given subject. We also can find ourselves outsourcing our thinking to colleagues and friends, keeping our thoughts quiet when they diverge from the widely held thinking of the group. This can lead to a context of self-censorship that undermines our ability to speak and think in ways that truly reflect how we feel and what we know.

These challenges in many ways inform and exacerbate the third challenge, that of preference falsification, in which what we say in public becomes less likely to reflect what we actually think and believe. Czesław Miłosz referred to this as “Ketman,” a Persian word Miłosz took to mean as a kind of necessary deceit that occurs when people cannot say what they mean. From Jacob Mikanowski writing on Milosz in Aeon:

“In 1953, he published The Captive Mind, a series of essays about the inner lives of intellectuals living under totalitarianism. In it, he took aim at the notion that tyranny crushes thought. Rather, he found that illiberal regimes could provoke their citizens to engage in the most elaborate mental acrobatics. In The Origins of Totalitarianism (1951), Arendt had written that the ideal subjects of totalitarianism are people ‘for whom the distinction between fact and fiction … and the distinction between true and false … no longer exist.’ Miłosz found that the reverse was true. The subjects produced by totalitarianism were not mindless drones, but skillful dissemblers, as capable of self-justification and moral hair-splitting as the best-trained Jesuit. The name Miłosz gave to this new talent was ‘Ketman.’”

While Ketman might be interesting as a concept, it should be deeply unwelcome as an ongoing state of mind and behavior. That certain social and political contexts may seem to necessitate it reflects the importance of doing all we can to forestall the arrival of such contexts and, when they emerge, of making an effort to support each other and the truth in whatever ways we can — in actions big and small.

Reaffirming the need to freely think

I can think of little that is more important, now more than ever, than to maintain our capacity to freely think, to see through the fog of the moment, to have clarity about what is true and untrue, even while we keep an open heart and mind to different approaches and perspectives. It seems also worthwhile to note that many of us can intersect differently with the moment. We are all just trying to navigate these times, to continue being in a position to do the work that makes a healthier world. We do what we can, even when what we can do is limited. But it is important to see a bigger picture, one where thinking clearly may be more important during such a time than ever, and where indeed, as a collective, we need to make sure we create space for — and encourage — rigorous, careful, open thought that analyzes, and discusses, what is happening around us, to the end of ensuring that we emerge from moments of change better.

Thank you to all who are part of the work of health, who keep it going even in moments of challenge, with hope for a better, healthier future for all.

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Perhaps of interest

I would like to draw attention to three convenings the School of Public Health is co-hosting with partners globally.

1. The “Business for health: Finding business and public health convergence towards reducing and managing Noncommunicable Diseases (NCDs)” global dialogue, is being organized in partnership with the World Health Organization and the Olin School of Business at WashU. The event will take place virtually March 27-28, 2025, from 8:30-10:30 a.m. ET; 1:30-3:30 p.m. CET. Registration is here.

2. Coincident with the 78th session of the World Health Assembly, we will be hosting a Washington University Ideas event, “Listening to people to improve health systems: Post-COVID trends in public attitudes on healthcare,” in partnership with the Alliance for Health Policy and Systems Research. The event will be May 22, 2025, in Geneva, Switzerland, 12-1:30 p.m. ET, 6-7:30 p.m. CET, and also will be livestreamed. Registration is here.

3. We are hosting our School of Public Health annual convening, this year on Science for Health Systems, in partnership with the QuEST network. The meeting will take place in St. Louis, MO, October 29-31, 2025. The meeting will focus on new research on the measurement and improvement of health system performance. There are limited spots available for registration, and discounts for early-career professionals. Program details and registration are here.