It is perhaps a conservative attitude we should draw from this catastrophe’s lessons on our imperfect nature and inevitable fallibility. Ross Douthat does exactly that in a splendid op-ed for the New York Times, which I cannot recommend highly enough. But Douthat does something more. He points out to the inevitable cognitive problems we are facing, in struggling with an unknown virus such as Covid19.
Expert knowledge is limited too, and it is contingent upon the particular situation the expert himself is facing. “…you should ignore experts and just take random posts and Twitter rants as gospel”, yet
under conditions of fog and uncertainty, armchair epidemiology will sometimes reach truths sooner than officialdom. If one Medium post foolishly lowballs the disease’s contagiousness, another will make a cogent case for masking long before the C.D.C. did. If one nonscientist offers some dubious casualty projections, another may tease out a high-profile model’s crucial faults. And if a certain line of argument is bad — as I think, and argued last week, that the right-wing anti-lockdown argument is bad — then it has to be judged on its own merits, not just dismissed because it lacks the C.D.C.’s patina.
The official experts, under such conditions, are most trustworthy insofar as their admonitions track with nonexpert common sense. The approach that most experts are currently urging, for instance, is not some complicated high-science approach to disease management, but the most basic pre-modern method of disease control, as obvious to 15th-century Florentines as to 21st-century New Yorkers — shut things down, quarantine the sick and hope for the best.
Whereas the more specific and granular the experts get, the more the fluidity and chaos of the situation make their pronouncements dubious. It’s good that we’re modeling the arc of the pandemic, but that doesn’t make any of the models trustworthy. It’s good that we’re trying to figure out how the disease spreads, but none of the claims so far about how you’re most likely to get it (from air, surfaces or otherwise) or who is most at risk (whether from viral load or pre-existing conditions) can be considered at all definitive. It’s good that we’re practicing social distancing, but all of the rules we’re implementing are just rough and ready guesstimates.
And you don’t want to overweight the pronouncements of official science in a situation that requires experimentation and adaptation and a certain amount of gambling. Yes, you should trust Anthony Fauci more than Donald Trump when it comes to the potential benefits of hydroxychloroquine. But the exigencies of the crisis require that experiments outrun the confidence of expert conclusions and the pace of bureaucratic certainty. So if you’re a doctor on the front lines trying to keep your patients from ending up on a ventilator, Dr. Fauci’s level of caution can’t be yours, and you shouldn’t be waiting for the double-blind control trial to experiment with off-label drugs that Spanish and Chinese doctors claim are helping patients
Douthat’s op-ed is valuable and reminds us of the fallible and provisional nature of our knowledge, particularly in times of crisis. It nicely complements Roger Koppl’s posts, which build on his remarkable book, Expert Failure.
One point I am not that persuaded by in Douthat’s narrative is in the quote above, and concerns the trustworthiness of experts insofar “as their admonitions track with nonexpert common sense”. If experts are valuable as their prescriptions coincide with common sense, why do we need them? I do not see as a point of strength in the current reaction against Covid19 the fact that experts are urging “not some complicated high-science approach to disease management, but the most basic pre-modern method of disease control”. Would you trust an MD recommending the same kind of therapy his forerunners practices even only one century ago? Even political scientists and economists have learned something since 15th century Florence, not to mention sciences such as biology, that have completely changed the way in which they understand sickness (and, of course, discovered the existence of viruses, in the meanwhile). It may well be that shutdowns are the only weapons we have against the epidemic, that no other option was truly viable in such a short time, that it is not technology but rather this sort of collective action which can protect us now. But I do not see that as reinforcing the position of experts, nor our trust in them.
READER COMMENTS
Thomas Hutcheson
Apr 8 2020 at 12:07pm
Why is the front line doctor not sharing “official” caution about chloraquine be called “conservative?” Is the Swedish approach to social distancing more “liberal”or more “conservative?”
Dylan
Apr 8 2020 at 12:31pm
I’m of two minds about this> It seems obvious that we don’t want to accept the word of experts completely unconditionally, there should be some checks, and just because someone is not an expert in a field, doesn’t mean they don’t have the right to question the evidence. However, we’re specialized for a reason. No one can know everything, even about their own field, let alone for areas outside of their specialty. That means we should at least have a pretty strong bias towards the opinion of experts, and if we’re the ones doing the questioning, we need to listen pretty hard and try to understand whatever objections the experts raise to our own points. Chances are, anything a lay person thinks of, the expert has already considered and either integrated into their model, or rejected for some reason. Not always of course, plenty of insights can be made by people outside of an area, but often enough that we need to be careful.
The hydroxychloroquine example is a pretty good one I think. I’m far from an expert in this area, but a read of the data coming in from a number of clinical trials points to no benefit. The one’s that have shown a benefit have some pretty clear problems with them, like excluding the people that couldn’t finish treatment because they died or got worse. The trials have all been small, so there’s still a chance that it might help in some cases, or in combination with other therapies…but we really don’t know that yet. And, the fact that a bunch of physicians are now giving this to patients outside of clinical trials actually makes it harder for us to know if it works. It can also make it harder to enroll clinical trials. Harder to test other potential treatments. Harder for people who need hydroxychloroquine for indications where we know it works to get their supply. And, more likely that the people who get it will suffer adverse effects for no purpose, not too much of a problem if you’re about to be put on a ventilator and only have a 20% chance of survival, but potentially much bigger if you have large numbers of people taking it prophylacticly.
That’s not to say that doctors shouldn’t be able to give the drug off label if they think it is the best course, but everyone else should be pretty clear about what the data is saying (and not saying) before recommending it as a cure.
Mark Bahner
Apr 9 2020 at 8:37pm
To see if this is so, it’s useful to do a thought experiment, ala Albert Einstein.
Suppose we all wore spacesuits everywhere, with HEPA filters that caught 99.9+% of the particles (including viruses) for both inhalation and exhalation. Would anyone infect anyone else? No, there would be no one sneezing or coughing into the air. No viruses left on surfaces (and even if there were, people couldn’t touch those surfaces, because they’d be behind the gloves and body of the space suit).
Now, just start walking that back. If everyone wore: 1) some sort of washable filter mask, 2) a balaclava/head sock over that washable filter, which would provide an additional layer over the washable filter, and also cover the hair and everything on the face but the eyes, 3) A hat with a face shield (or simply glasses) to cover the eyes, and 4) washable gloves, preferably even up to the elbow (if wearing short sleeves)…there would be so little viral transmission, the odds of an infected person infecting another person would be far less than one. So there wouldn’t even be a chance to have a pandemic. And all four of those things could be provided to every person in the world for less than $50 each.
Instead, we’re spending literally hundreds of thousands of dollars for every person who is on a ventilator…and two-thirds of them die anyway.
And the “experts,” rather then telling everyone right away to use a washable filter, a balaclava or head sock, gloves, and some eye protection, told the public that filters were useless unless they were N95 filters (which they didn’t want the public to buy) and have sold hand washing rather than washable gloves (plus hand washing).
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