Thinking Citizen Blog — “Just Trust the Science” is a Сop-Out (Ross Douthat, NYT)

Thinking Citizen Blog — Thursday is Health, Health Care and Global Health Policy Day

Today’s Topic — “Just trust the science” is a cop-out (Ross Douthat, NYT)

Humans avoid tough decisions like the plague. Pointing fingers comes so much more naturally. Pretending that there is an easy answer is so irresistible most of the time. And so it is with Covid, argues Ross Douthat of the New York Times. As if science speaks with one voice. As if the hardest decisions to be made are not essentially ethical and political. As if the only problem in 2020 was Trump. Experts — please chime in. Correct, elaborate, elucidate.

DR. ANTHONY FAUCI VERSUS DONALD TRUMP

1. “To the extent that trust the science just means that Dr. Anthony Fauci is a better guide to epidemiological trends than someone the president liked on cable news, then it’s a sound and unobjectionable idea.”

2. “But for many crucial decisions of the last year, that unobjectionable version of trust the science didn’t get you very far. And when it had more sweeping implications, what the slogan implied was often much more dubious: a deference to the science bureaucracy during a crisis when bureaucratic norms needed to give way; an attempt by para-scientific enterprises to trade on (or trade away) science’s credibility for the sake of political agendas; and an abdication by elected officials of responsibility for decisions that are fundamentally political in nature.”

THE VACCINE DEBATE IS INESCAPABLY POLITICAL

1. “That the vaccines exist at all is an example of science at its purest — a challenge posed, a problem solved, with all the accumulated knowledge of the modern era harnessed to figure out how to defeat a novel pathogen.”

2. “But the further you get from the laboratory work, the more complicated and less clearly scientific the key issues become. The timeline on which vaccines have become available, for instance, reflects an attempt to balance the rules of bureaucratic science, their priority on safety and certainty of knowledge, with the urgency of trying something to halt a disease that’s killing thousands of Americans every day. Many scientific factors weigh in that balance, but so do all kinds of extra-scientific variables: moral assumptions about what kinds of vaccine testing we should pursue (one reason we didn’t get the “challenge trials” that might have delivered a vaccine much earlier); legal assumptions about who should be allowed to experiment with unproven treatments; political assumptions about how much bureaucratic hoop-jumping it takes to persuade Americans that a vaccine is safe.”

3. “And the closer you get to the finish line, the more notable the bureaucratic and political element becomes. The United States approved its first vaccine after Britain but before the European Union, not because Science says something different in D.C. versus London or Berlin but because the timing was fundamentally political — reflecting different choices by different governing entities on how much to disturb their normal processes, a different calculus about lives lost to delay versus credibility lost if anything goes wrong.”

SO WHO SHOULD GET THE VACCINE? SCIENCE VERSUS PARA-SCIENCE

1. “Then there’s the now-pressing question of who actually gets the vaccine first, which has been taken up at the Centers for Disease Control and Prevention in a way that throws the limits of science-trusting into even sharper relief. Last month their Advisory Committee on Immunization Practices produced a working document that’s a masterpiece of para-scientific effort, in which questions that are legitimately medical and scientific (who will the vaccine help the most), questions that are more logistical and sociological (which pattern of distribution will be easier to put in place) and moral questions about who deserves a vaccine are all jumbled up, assessed with a form of pseudo-rigor that resembles someone bluffing the way through a McKinsey job interview and then used to justify the conclusion that we should vaccinate essential workers before seniors … because seniors are more likely to be privileged and white.”

2. “As Matthew Yglesias noted, this (provisional, it should be stressed) recommendation is a remarkable example of how a certain kind of progressive moral thinking ignores the actual needs of racial minorities. Because if you vaccinate working-age people before you vaccinate older people, you will actually end up not vaccinating the most vulnerable minority population, African-American seniors — so more minorities might die for the sake of a racial balance in overall vaccination rates.”

3. “But even if the recommendation didn’t have that kind of perverse implication, even if all things being equal you were just choosing between more minority deaths and more white deaths in two different vaccination plans, it’s still not the kind of question that the C.D.C.’s Advisory Committee on Immunization Practices has any particular competency to address. If policy X leads to racially disparate death rates but policy Y requires overt racial discrimination, then the choice between the two is moral and political, not medical or scientific — as are other important questions like, “Who is actually an essential worker?” or “Should we focus more on slowing the spread or reducing the death rate?” (Or even, “Should we vaccinate men before women given that men are more likely to die of the disease?”)

FINAL WORD

Health policy like national security policy and economic policy is all about painful trade-offs. Good, innocent people will suffer and perhaps die no matter which choice you make. Admitting this to yourself and to others is no easy task. A little sympathy for those who are forced to make these choices would not be out of line this holiday season. Nor a little humility with the respect to our own understanding of the intricacies of the issues involved.

Opinion | When You Can’t Just ‘Trust the Science’

For the last three years of posts organized by theme:

PDF with headlines — Google Drive

YOUR TURN

Please share the most interesting thing you learned in the last week related to health, health care or health care policy — the ethics, economics, politics, history…. Or the coolest, most important thing you learned in your life related to health are or health care policy that the rest of us may have missed. Or just some random health-related fact that blew you away.

This is your chance to make some one’s day. Or to cement in your mind something really important.