Science says, “do this.” Science says, “do this.” Science says, “do that.”
This is the confusing moment we find ourselves in. The very phrase, “science says,” invoked over and over by our politicians and public health officials, implies consistency, and it implies that science races ahead of the rest of us and has already answered the questions we now have and already solved the problem we only just realized we had. It implies that science speaks in a univocal way, as though it were a single person. Univocality assumes there is a reasoned consensus, overwhelming agreement, and “the science is settled.”
“Science says, ‘do this’” are the four most reassuring words in the English language.
Until science says, “do that.”
Then, like children playing the game Simon Says, we fumble, to keep up. We’ve been listening very hard to that authority, Simon, trying to be good followers. But that Simon keeps changing his mind. It has become clear these last few weeks that it is not just mercurial politicians (read, one’s favorite political foes) who are responsible for these reverses. It is, “science” so-called.
The clearest illustration was the masks. No masks for the many; then masks for the many. Its wasn’t rogue local physicians doing the reversals, but “official science” doing the about-faces as represented by officials affiliated with WHO (which claims in its “values” statement, “We are guided by the best available science, evidence and technical expertise.”) and the CDC. First they insisted for months that wearing them was pointless, at best wasteful, and possibly an outright public health risk. They insisted masks only stopped people with the virus from spreading it, and didn’t protect the person wearing it (as they, in the next breath, called masks PPE, or personal protective equipment, and said they should be saved for physicians and nurses who were protesting they were being put at risk having to see COVID-19 patients with outdated masks, and who feared for their lives). Were these public health officials even listening to themselves speak?
Such inconsistencies were so unnerving to the public precisely because they were about something so simple, so rudimentary as a mask, and if public health prescriptions guided by the best available science couldn’t be clear about something used in hospitals daily for a century, and which was presumably well understood, how reliable would they be, when it comes to understanding a mutating virus? As the Christian Bible says, “He that is faithful in that which is least is faithful also in much; and he that is unjust in the least is unjust also in much.”
Many flip-flops. We need universal lockdowns, because according to the WHO, there is a 3.4% case-fatality rate for COVID-19 which justifies them, and anyone who says different is undermining measures and in denial—until last week, when the CDC revised its case-fatality rate for Americans, by an order of magnitude downwards, to about 0.4%. New numbers mean new policies. Dr. Anthony Fauci, who had said Americans could be locked down until a vaccine came along in 18 months, told MSNBC this past Friday, “We can’t stay locked down for such a considerable period of time that you might do irreparable damage and have unintended consequences, including consequences for health. … So we are enthusiastic about reopening, I don’t want people to think that any of us feel that staying locked down for a prolonged period of time is the way to go.”
And of course there were the major reversals on travel bans. WHO said, on repeated occasions throughout January and February, that countries should not restrict travel from China, which would only be stigmatizing, and most public health officials say we should listen to the WHO. By March “the science” had almost every country in lockdown, including the proudly open-bordered EU. The issue was completely reframed by those who did the about-face without an explanation … as if to say, after all, what are travel restrictions, but social distancing between countries? The point is not which policies, or numbers are right, and which wrong; the point is all are in the name of something we might call “official science.”
At the outset of the pandemic, “scientific authority” held, meaning, that if someone said that “science said” to do it, most people, and most countries, listened, and obeyed, reassured that—science—something above mere politics, self-interest, and mere opinion—was guiding us. Intellectuals were especially pleased. Historian Yuval Harari pointed out, approvingly, that, for the most part, our churches, mosques and synagogues have closed down, “because the scientists said so. They believe the epidemiologists and the doctors. … Almost everyone everywhere is turning to science as the most reliable source of guidance. … The question on everybody’s lips is when will the vaccine be ready. Not if, but when.” Perhaps nothing in the modern world has more intellectual prestige and capital than science. But there is no amount of trust, authority and capital so immense that it can’t be squandered overnight, with a few bad decisions people can understand. Even children understood that with the mask about-face, something was amiss.
Many educated people claim to not be “religious,” saying instead that they put their “belief” in science, and speak as though science replaces religion, which represents humanity’s mythic and irrational need for certainty. But under psychological stress, the quasi-religiosity of so much of that scientific belief emerges. When we say (as some do) that we are science-trusting, and act as though “science says” some univocal truth, which can be revealed, on demand, we show that we are really only transferring the quest for certainty from religion to science.
After all, what specific scientific discipline are we talking about, in this pandemic? “Public health,” we are told. But public health, as a discipline, based on science, is in ways, the furthest thing possible from a univocal science—it is, rather, by necessity, interdisciplinary, and very broad, for “the public” is very broad, and “health” is very broad, as is the notion of “preventing sickness.” It is composed of a score of disciplines, and specialists, not just epidemiologists but also infectious disease specialists, immunologists, vaccine experts, behavior modification experts, mental-health experts, cultural anthropologists, and often virologists, molecular biologists and chemists (who help develop tests), pharmacologists, sanitation experts, statisticians, contract-tracing AI experts, pediatricians, gerontologists, nutritionists, reproductive-health specialists, occupational-health experts, among others.
Often, these people can’t even read or understand each other’s journals or jargon, or understand the PowerPoint presentation of the person in the office next to them. All these disciplines have serious controversies within them, and, often between each other. For instance, a public health official who is a virologist will emphasize the behavior of the virus, and means to kill it, but one with a background in nutrition and functional medicine, might think we need far more emphasis, and resources, placed on what we can do to support our own immune health.
Despite these conflicts, they are all, struggling together to form a picture of how best to deal with COVID-19. Rather than proclaiming the single truth of “Science,” these many fields participate in a scientific process that is more like an evolving conversation. When I last looked two weeks ago, 7,000 academic papers had been published on the pandemic over the previous three months—many of them contradicting each other within specific fields. Science normally takes years, not months.
When we, or politicians, or the media, in the midst of a plague, ask our scientists for a simple answer to a simple question, like, “when will the lockdown be over?” or “when will we defeat the virus?” we are asking the same question that children throughout the world are asking their parents, “When will corona be over, so I can go out and play with my friends?” We are being like these precious children.
When the science-friendly media asks, “Dr. Fauci, when will we be back to normal—according to science?” they don’t really care about “science,” they care about when.
That is because these questions are the product not of science, but of a fantasy about science, something that masquerades as science. The essence of that fantasy is a wish: I want my “normal life” now, and there is this thing, science, that can give it to me.
We might call that fantasy “consumer science.” We or our elected representatives sense a need, and snap our CEO fingers, and scientists produce the product on cue. Science is powerful, and once in a blue moon it actually happens that scientists “produce” what we want. We are told that happened with AIDS and AIDS drugs, and it did—plus or minus 32 million deaths. Great progress was made in AIDS, but in reality, it took years, not months. We are more than 50 years after President Richard Nixon declared the War on Cancer, and while there has been some definite progress in easing some cancers, it is still a major killer—about 600,000 Americans a year die from it, despite the advances and the best that science has to offer.
The consumer science fantasy is a “top-down” view of science. A prime minister or president turns to his or her “chief scientist,” or the “nation’s chief doctor,” or whomever, and commands scientists to put aside what they are working on now (often matters that are ripe for discovery), and instead work on the problem of the moment, “ripe” or not. It throws a lot of money at problems—no expense is spared, and emphasizes the huge, industrialized scientific machine.
America, despite having been more religious than much of Europe in recent years, in some ways is also the inheritor of Europe’s 18th-century Age of Enlightenment’s cults of reason, science, and progress that argued that science would replace religion, by providing something akin to heaven on earth through scientific progress. One reason Americans of a certain age in particular have this fantasy about science-on-demand is because none of a certain age can forget that President John F. Kennedy promised to land a man on the moon before the end of the 1960s, seemingly snapped his fingers, and America did so. But that leaves out that America did so by using German rocket scientists who had been working on the problem for decades already (and, not to detract from its majesty, but this was a feat of astrophysics and applied engineering—fields that are very different from evolving biology, which is more relevant to our current problems).
While usually ‘the expert’ is the person who, when asked a question, doesn’t miss a beat before giving an answer, the real scientist might just be the one we need: the one who can say, ‘I don’t know.’
The media is currently focused on how different political parties and leaders are increasingly developing different approaches to the pandemic. But seeing everything in political terms obscures what may be an even harder truth to bear, which is that if this is a “war” against the virus, we are still somewhat in that early “fog of war” stage where there is uncertainty about some key issues, and while usually “the expert” is the person who, when asked a question, doesn’t miss a beat before giving an answer, the real scientist might just be the one we need: the one who can say, “I don’t know.”
But no one wants to hear that.
The almost messianic belief in progress through science and technology (and this includes medical progress) is beloved by left and right both in America, educated and uneducated alike. The techno-fetishistic utopian rhetoric, the machine worship, and the tiresome personal quests for immortality by the heads of Big Tech, Apple, Google, Amazon, Tesla, etc., embody it. And of course they each must have their own private space programs, echoing Kennedy.
This blind faith in consumer science causes more harm than good. Here is New York Gov. Andrew Cuomo, on March 2, during a period when he and Mayor Bill de Blasio were encouraging New Yorkers to mingle freely in public:
Excuse our arrogance as New Yorkers—I speak for the mayor also on this one—we think we have the best health care system on the planet right here in New York. So, when you’re saying, what happened in other countries versus what happened here, we don’t even think it’s going to be as bad as it was in other countries. … We have been ahead of this from Day 1.
He knew this was precisely the boast that so many of his constituents love to hear, “Excuse our arrogance …” (but, you see, fellow citizen, it is befitting!). And he sensed, too, that it is the progressive fantasy that is the basis of the new American “secular religion” of the educated, STEM-woke classes in which American science easily outguns nature: “We have been ahead of this from Day 1.” Notice, he doesn’t say, “New Yorkers will be protected because we are healthier, or more physically fit, or somehow more immune, or because we are exercising prudent preventive medicine in dealing with this,” but because our science-based health care system is the peak of human advancement. So, he forged ahead, capitalizing on people’s reflexive belief in science to project confidence. He did this again and again and again—even as he was communicating scenarios and plans that were changing week by week.
On March 17, with 814 coronavirus cases already reported in New York City, de Blasio announced that he was considering a shelter-in-place order for the city. But the same day, Cuomo insisted that the decision was his to make. “No city in the state can quarantine itself without state approval,” Cuomo said. Neither, the science-savvy governor added, was he open to the possibility at that time: “I have no plan whatsoever to quarantine any city.” Five days later, on March 22, Cuomo ordered the state shut down.
Was it risky for Cuomo to promote the fairy tale of New York being ahead of the virus because of its science, only to have to tweak and reverse his policies the following week or month? It was for New York, which has some of the highest COVID-19 death rates in the world. But not for his political career, so far. He is enjoying astronomically high approval ratings. He knows something about America’s secular religion, and he knows to emphasize whatever he recommends is rooted in a confident endorsement of American scientific and medical know-how.
There is the science we want, and the science we need.
It’s not always “Big Science” or “Big Medicine” that makes the biggest difference. I’m especially impressed with some discoveries made around the world by individual nurses and physicians on the frontlines who first noticed COVID-19 patients didn’t have typical respiratory distress, and were having terrible outcomes on ventilators, most dying. For instance, Dr. Cameron Kyle-Sidell from Maimonides Medical Center in Brooklyn, who on March 31, posted a video, a cri de coeur explaining that we seemed to be treating the “wrong disease.” Dr. Richard Levitan wrote about the same issue in The New York Times soon after. It had dawned on frontline physicians that many COVID-19 patients’ lungs didn’t stiffen, as in typical pneumonias, and so they often didn’t feel short of breath, even though their oxygen levels were barely compatible with life. Put on ventilators, they often did worse. In fact, Italian physicians, and others, had already seen the same thing.
Using a technique developed in the 1980s, by the Italian intensive care physician Luciano Gattinoni, it was found that many patients with breathing problems of a certain kind, did better placed on their stomach. (He was, no surprise, initially ridiculed for his discovery, it being so low-tech.) During the pandemic, Gattinoni realized that many COVID-19 patients could avoid ventilators, if they were put on their stomachs, and some other noninvasive changes were made to the standard COVID treatment. By April 14 he published an article showing how we had misunderstood what happens in COVID-19, and why this stomach position was relevant for its treatment. Dr. Nick Caputo in New York has found, in a small study, that these techniques kept about three-quarters of patients off of ventilators, which, when we consider that the majority of patients on ventilators die, was a huge breakthrough. This improved outcome for the sickest of COVID-19 patients, might, if it holds up, have more benefit than the millions of dollars that were spent on ventilators—a classic consumer-science-on-demand project. But this humble maneuver doesn’t fit with the techno-fetishistic, Big Science-Big Medicine narrative, so it’s not received the attention it deserves. Sometimes it is combinations of such modest but elegant techniques, which based on truly understanding the nature of the illness, rather than the equipment we have on hand, that can dramatically change a case-fatality rate.
The one-click shopping consumer-science fantasy is the science we want, provided by experts who don’t miss a beat. The reason they don’t miss a beat when asked a question is because they are often people who deal with already solved problems.
The science and the scientists we need, are those who spend most of their time dealing with hitherto unsolved problems. I’ve met many such scientists and physicians in my travels, including Nobel Prize winners and those who deserved them, and what they generally had in common was that they loved opening questions more than closing them, and lit up at the prospect of exploring barely fathomable problems. They would often miss a beat, in conversation, and ponder. They didn’t mind finding answers and providing solutions; but their lives were organized around exploration, and they were quickly bored by solutions. I found them, in their dealings, quite capable of being courteous enough—when required—but also intellectually disagreeable in a most refreshing and irreverent way. In their chosen endeavors, they didn’t look for the “consensus,” but away from it, almost reflexively. Generally they seemed to believe that the more a scientist (including themselves), ends up on a committee, the greater the chances are he or she is pretty much boxed in, and done for, as a thinker. One of them, Gerald Edelman, M.D., Ph.D., who won the Nobel Prize for describing the chemical structure of antibodies, but now had switched to studying consciousness, disdained even being described as some kind of immunological scientist.
“So, what do you do?” I asked.
“I study problems.”
If you were to say, “science says,” to him, the conversation would be over.
Citizen, beware. Science is an advanced form of critical thinking, not a crisis management technique. Those who present science and themselves as doing the latter are often playing a role, the consumer-science fantasy image of what a scientist is, and in the process undermining the authority of the very science that we need.
Norman Doidge, a contributing writer for Tablet, is a psychiatrist, psychoanalyst, and author of The Brain That Changes Itself and The Brain’s Way of Healing.