The cause of public health represents an alliance between medical knowledge and political goodwill. Yet, if the measures justified by those in charge of public health policy are based upon political allegiance rather than due scientific process, we are no longer dealing with medicine as we have traditionally understood it. ‘First do no harm’ becomes an impossible principle when definitions of ‘harm’ fall out along partisan lines, for what one side declares as essential will appear to their opponents as a cause of great harm, a situation we have already faced for half a century over abortion. With our failed attempts to mitigate COVID-19, we aligned public health with political partisanship rather than scientific evidence, and shattered the fundamental conditions for good public health policy.
This lamentable state of affairs did not, however, begin with the disagreements over the response to the SARS-CoV-2 virus. On the 17th of January, 2003, the best-selling author of Jurassic Park and The Andromeda Strain, Michael Crichton, delivered a blistering address at Caltech attacking the relatively new trend of declaring ‘scientific consensus.’ Crichton considered this development “pernicious,” and all such claims of consensus as “the first refuge of scoundrels… a way to avoid debate by claiming the matter is already settled.” He made his argument forcefully and coherently:
Let’s be clear: the work of science has nothing whatever to do with consensus. Consensus is the business of politics. Science, on the contrary, requires only one investigator who happens to be right, which means that he or she has results that are verifiable by reference to the real world. In science consensus is irrelevant. What is relevant is reproducible results. The greatest scientists in history are great precisely because they broke with the consensus. There is no such thing as consensus science. If it’s consensus, it isn’t science. If it’s science, it isn’t consensus. Period.
Crichton observed that whenever consensus is evoked, it is a sign of weakness. Nobody says that the consensus of scientists agrees that E=mc2 or that the sun is 93 million miles away – it does not even occur to anyone to make such assertions. Rather, consensus is claimed solely in those situations where ‘bad’ science is deployed to support ‘good’ policy – Crichton’s chosen examples are nuclear winter and second-hand smoke. He included in this accusation global warming – the old name for climate change – drawing attention to the way that this subject relies far more upon computer models than empirical evidence. He noted that the renowned theoretical physicist Richard Feynman had suggested to him that this obsession with computer modeling was a disease. Crichton offers a stark warning: “Our models just carry the present into the future. They’re bound to be wrong. Everybody who gives a moment’s thought knows it.”
The concerns raised by Crichton in 2003 depressingly foreshadow the crisis that followed within a few scant decades. He presciently pointed a finger of blame at journalists, remarking that when even the most distinguished news providers cease to differentiate between factual content and editorial opinion, who is left that can hold anyone to any standard of truth?
We did not listen, and disaster followed as inexorably as the plot of one of Crichton’s sci-fi disaster novels. The monsters would not remain inside their pens.
Now the very fact that climate change (in its old branding as ‘global warming’) is mentioned by Crichton in his speech is likely to raise some hackles. The fact I will extend this accusation to include community masking, lockdown policies, and blanket vaccination with mRNA treatments will only make this resistance more ardent. Yet everybody who has a knee-jerk emotional reaction here will almost certainly belong to just one side of the political spectrum. Let’s call them the ‘blue team,’ since this is the color representing this side in the United States. The issues entailed show up more clearly if we avoid describing them by the name of the associated political party, since it is the voters we are talking about, not the party. Against the blue team, the ‘red team’ holds different political commitments, likely to make them more receptive to some of the concerns I am raising. But as I hope to demonstrate, the conflict between these opposing camps risks making good scientific process unobtainable, and this is a problem that goes beyond partisan politics. It renders good public health policy impossible.
As an illustrative example, consider just one especially salient example: COVID-19 vaccination. While both the red team and the blue team have supported vaccination policies with sufficiently tested vaccines, the blue team has been adamant about deploying the mRNA vaccines developed by Pfizer and Moderna, irrespective of their state of testing. The blue team’s position in this regard has been stridently worded, and echoed back by both public health agencies and journalists. Indeed, if you drive around the United States right now, you will occasionally pass billboards announcing ‘Vaccines are safe and effective’ – which is an interesting claim, since it is certainly not the case that everything ever called a vaccine transpired to be safe and effective. Both rotavirus and smallpox vaccines, for instance, turned out to be problematic – the latter representing something of a quandary for US law, since it was this vaccine that established the 1905 precedent that states can ‘reasonably’ infringe upon liberty during a public health crisis.
Despite the fervor of the blue team, the proposition ‘Vaccines are safe and effective’ is strictly false unless we opt to withdraw the name ‘vaccine’ from those treatments that fail to reach that benchmark. This isn’t something we have ever done. What, then, are we to make of the apparent commitment of both the CDC and the FDA to asserting that vaccines are necessarily safe and effective? It seems like a conflict of interests. Is the purpose of the FDA to defend the idea that vaccines are safe and effective, or is it to determine which vaccines are safe and effective? An organization cannot pursue both agendas without tying itself into ideological knots. The former is a political goal while the latter is a scientific investigation – and as Crichton warned, these are not compatible forms of thought, even though they can and must intersect.
Ironically, the FDA was so insanely desperate to defend the claim that ‘Vaccines are safe and effective,’ that they made vaccines less safe in order to shout ‘Safe and effective!’ more often. They intentionally lowered the bar of what constitutes ‘safety’ out of fear that people might otherwise distrust vaccination. In so doing, they counterproductively increased the very vaccine hesitancy they hoped to prevent, and made their own agency appear far less trustworthy. Neither is this problem constrained to the health agencies. As the journal Science reported, researchers are now wary of investigating COVID-19 vaccines for fear of driving up vaccine hesitancy. This medical negligence is compounded by the fact that the original trials upon which these vaccines were declared ‘safe and effective’ are still not fully available for independent review, as British Medical Journal editor Peter Doshi has repeatedly pointed out.
We find ourselves in a bizarre world where media corporations can censor anyone who breaks ranks with the mantra of ‘safe and effective,’ despite the fact that those responsible for determining the conditions of safety and efficacy have undermined their own scientific procedures for establishing this. Journalists are now so politicized on these issues that they turn a blind eye to the FDA’s having torn up the rulebook while dogmatically insisting the agency can still act as referee. Neither is safety data the only place where the rules of the game were rewritten on the fly. Moderna’s application to the US government asking for reclassification of its mRNA treatments in August 2020 makes it clear this request happened precisely because gene therapy had acquired a bad reputation:
…the classification of some of our mRNA investigational medicines as gene therapies in the United States, the European Union, and potentially other countries could adversely impact our ability to develop our investigational medicines, and could negatively impact our platform and our business.
No doubt Moderna is correct that having to market these treatments as gene therapy would have robbed them of the luster of the word ‘vaccine,’ borrowing the aura of eradication and community benefit that well-established vaccines, like the MMR, invoke. But perhaps this would have meant fewer ill-informed public health vigilantes strong-arming young people into taking drugs that neither they nor those around them really needed. A disease whose mortality is overwhelmingly skewed towards the elderly will not be significantly impacted by vaccinating those too young to be at risk with a treatment never designed to prevent spread. God forbid the long-term trials (if they even happen now) reveal some unpleasant consequences that the FDA, in its zeal to defend the pharmaceutical companies, neglected to investigate.
Critics of the FDA call its lamentable situation ‘regulatory capture.’ An organization that was expressly intended to establish the safety and efficacy of manufactured drugs has become an advocate on behalf of the very corporations it is supposed to regulate. Likewise, on the question of community masking, we do not have to resolve the truth of the matter to see that the CDC’s actions were compromised. Over the space of two years they commissioned zero random-controlled trials to investigate these measures, despite the original argument for their adoption depending upon inconclusive evidence. Errors like this make the federal health agencies look either incompetent or duplicitous – and either way, trust in their ability to fulfill public health goals inevitably suffers.
Yet it is not solely the federal health agencies at fault. They have been spurred on by the anxious political desires of the citizenry, who had already declared a battlefield over vaccines thanks to ongoing skirmishes between the blue team and so-called ‘anti-vaxxers.’ This conflict was always claimed to be about scientific truth, but despite the fervor of the zealots the key question with respect to vaccines is arguably ethical and not scientific. On one hand is the maxim that one life is too many to lose to a medicine, no matter how many lives it might save. On the other is the maxim that if a medicine saves more people than it kills, everyone must take it. There is a legitimate political debate to be had between these two positions, no matter how much we detest confronting it. But like climate change before it, and community masking after it, the partisanship of the red and blue teams drove this issue far beyond rational debate.
How did this happen? Consider two competing hypotheses. The ‘blue science is the best’ hypothesis is that on climate change, face masks, lockdowns, and vaccinations, the blue team got all the correct answers because they had the best science. That’s why they didn’t need to gather evidence in support of community masking, why it was unnecessary to complete vaccine safety trials, and why climate change is indisputable. Debate on these topics is unnecessary, and Google is justified in demonetizing websites reporting inconvenient satellite data. This hypothesis is self-defeating, as it claims that the best science is achieved neither by gathering evidence nor by debating the meaning of that evidence, and these activities are undeniably the quintessential elements of good scientific practice.
The competing ‘red science must be silenced’ hypothesis is that because universities in the United States gradually veered ever further into a political bias for hiring blue researchers, the academic communities steadily became more and more polarized, thus disrupting effective pushback on live research topics. As a result, criticisms began to come mainly from red scientists outside of these universities. Frustration with these clashes led to the blue-aligned universities refusing discussion on scientific matters, justified all-too-conveniently by claiming that the science was beyond dispute, exactly as Crichton accused. The research community became so one-sided as to fail to pursue good scientific practice since no disagreements could be tolerated.
In fact, neither of these hypotheses might be true. It is the nature of the scientific process that debate over the evidence and its possible interpretations is never guaranteed to entail any correct explanations. Thus, despite the tendency for political partisans on both the red and blue teams to assume that one side must be right and the other wrong, it is perfectly possible for both sides to be mistaken. This represents the greatest danger of letting political factionalism substitute for scientific process. The ambiguities and uncertainties of genuine research problems are treated as if they not only had definite answers, but that these answers are already known, and known with certainty.
In the case of climate change, a reasonable claim concerning humanity’s effect on the atmosphere was ludicrously inflated into undeniable certainty in a hopelessly ineffective attempt to strong-arm the red team into adopting the blue team’s concerns about the environment. In the case of community masking and lockdowns, anger that the red team wasn’t willing to do anything and everything proposed to save lives obscured the fact that the actions being proposed were only ever hypothetically capable of saving lives. The actual scientific work to determine what was or was not effective was, for the most part, never on the table – and even when it was, results were ignored if they did not support the ‘correct’ team, which is to say, the blue team.
If this argument is accepted – and obviously this presents difficulties for those on the blue team – it reveals a willful refusal to engage in the debate that has always played the most crucial role in the process of determining scientific truth. Experiments are never self-explanatory. They require interpretation, and this requires discussion. Seeing this, it becomes clearer why we are encountering breakdowns in scientific discourse, why media corporations like Reuters, the Associated Press, Twitter, Facebook, and Google could turn so swiftly and unwisely to censorship to defend positions that they rashly claimed were beyond dispute, and why the worst respiratory epidemic since 1968 turned into the worst technological disaster since World War II – killing a great many people who did not need to die, bankrupting vast numbers of small businesses, and disrupting the education of an entire generation of children.
The US midterm elections roll around later this year, and knives are already being sharpened for the inquiries that will be unleashed in its wake. But if all that happens is that the red team tries to punish those at the federal health agencies who were derelict in their duties, this will not address the greater issue. The very possibility of establishing scientific truth remains blocked while partisan politics are substituted for legitimate debate of the evidence. To recover the methods of the sciences, we might consider something more unorthodox – perhaps something akin to the Truth and Reconciliation Commissions that South Africa deployed after apartheid. Then as now, trust between citizens was savaged by the appalling behavior of those empowered by the state. The South Africans managed to recover from their political disaster. It is far from certain that we will be able to.
What is the alternative to truth and reconciliation in public health? Shall we lurch between ‘blue science’ and ‘red science’ as the election cycle progresses? Mandatory injection of incompletely tested vaccines while the blue team is in charge, then the collapse of vaccination programs when the elected seats turn red? This is not a public health policy anyone could consider sensible, regardless of where you stand on vaccination, although I note that (contrary to the beliefs of the blue team), the red team is not against vaccination, they’re just not as fanatical about it as the blues. What makes public health even conceivable as a policy is that scientific truth is supposed to transcend political divisions. The moment we begin making health laws on partisan grounds, the cause of public health itself is mortally wounded. This is the madness of ‘consensus science,’ which is Crichton’s name for the abandonment of scientific discourse. We might just as well talk of consensus pseudoscience, for it is the truth of the matter.
Recovering scientific truth will require some degree of political reconciliation. It is quite unthinkable that we shall reconcile every issue that divides the red and blue teams… some of these political differences are fundamental, and will remain that way for the foreseeable future. But on both public health and climate change, sustaining the limbo of consensus pseudoscience is beyond hopeless. It is to willingly abandon scientific truth simply because we are too stubborn, too belligerent, and too unforgiving to restore the trust required for collective public health and practical environmental policies. Our slender comprehension of the mysteries of the universe will be entirely undone by anything that prevents open debate about scientific evidence – regardless of whether this disruption emerges from partisanship or censorship. Every attempt to silence debate is a betrayal of knowledge itself, as Crichton tried to warn us.