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Advice To “Follow The Science” Described As Misleading Approach To
COVID Response
Tradeoffs In
Risk/Benefit Decisions Also Require Consideration Of Values
Epidemiologists,
scientists, and policymakers committed to evidence-based decision
making can often be heard or quoted saying “follow the science” in
making public health policy decisions. The implication is that the
facts will speak for themselves and that an objectively correct and
defensible decision can be arrived at by relying on scientific data.
As the COVID-19
pandemic has evolved and public health decisions have been challenged
by different segments of society, the appropriateness of urging a
"just follow the science” approach is being found wanting.
Shortcomings
In a clear exposition
of the shortcomings of this approach, David Leonhardt writing
in the New York Times suggests the public (and presumably the
scientists too) misunderstand science by imagining it “… almost as a
god—Science—which can solve our dilemmas if only we listened.”
Tradeoffs
In fact, public health
requires values trade-offs in making risk benefit decisions. Such
decisions require facts but also weighing of the risks and benefits of
different courses of action, and the right choice is not often
clearcut. Leonhardt quotes a Georgetown University political
scientist who tweeted “Don’t trust substantive experts to make policy
decisions that balance competing values or stakeholder interests.” If
you should not trust experts, who do you trust and how do you decide?
Best Approach
Given that there is
not one correct answer to public health dilemmas such as mask
mandates, school closures during outbreaks and other topics, and given
that decisions should change as realities change, what is the best
approach to policymaking that involves both the consideration of facts
and values?
One answer comes from
Janet Baseman, an epidemiologist at the University of
Washington who states "we need to be having this conversation." And as
she told the EpiMonitor, it should be within the public health
community itself and between public health and the general public.
Leonhardt points out “The answer will not spring forth from Science.
It really is a conversation.”
Ultimate Goal
In a podcast interview
on Just Serious with Josh Barro, Leonhardt argues further for
having a clear goal when facing public health dilemmas. He believes we
should not be solving these problems by making the impact on COVID the
ultimate success indicator. We should be solving dilemmas by seeking
to identify what is best for the “total well-being of society”.
By that measure, the
right answer might be different for the period of time before COVID
vaccines were available than what it might be now. We have a better
appreciation for the negative impacts on school learning, drug abuse,
murders, and suicides than we did at the outset.
Public Input
The right approach
cannot be geared towards finding the ultimate expert but rather in
relying more on aggretating public judgments and opinions. According
to Leonhardt, in a democracy, the collective wisdom that can be
garnerd from the public has to be an important input in making values
trade-off decisions. The mechanisms to convene and host these crucial
public conversations have not been put in place but could become a
higher priority in post-pandemic public health when the lessons
learned from the pandemic become more widely known and accepted.
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