I posted this thought, before the UK lockdown:
This is really a debate about “preventable” death vs sustainable quality of delayed death IMHO … And population sustainability generally. Which does indeed sound callous, but it’s the heart of the matter.
â” What, Why and How do we Know? (@psybertron) March 15, 2020
I also got into a “dialogue” with Massimo Pigliucci when I posted this in response to Jim Baggott’s piece at IAI “Science in the time of coronavirus
Exploring the tension between scientific reasoning and human irrationality.”
Actually, irrational behaviour is not so … irrational?
â” What, Why and How do we Know? (@psybertron) March 28, 2020
It went nowhere, because Massimo seemed to think I was disagreeing with Jim and the exchange went on to have nothing to do with what I’d actually said, which was in fact a suggested paraphrase of this early paragraph from Jim:
Actually, irrational behaviour is not so difficult to understand. The simple truth is that we have created for ourselves a world that is far more complex than any individual human mind can ever hope to fathom. We have invented extraordinary social structures to help us earn a living, care for us, protect us from harm, and to manage trade among ourselves in an increasingly connected world.
Twitter is a useless medium for actual dialogue, other than sharing links and pithy rhetorical exchanges. Massimo, when he’d lost track of what I’d actually said, simply repeated that since I was disagreeing with Jim (I wasn’t) I needed to provide an example.
I didn’t have in mind any other example than the same one Jim had. That the received wisdom of lockdown might not be as straightforwardly rational as the “science led” rhetoric of the politicians would have us believe. (At which point this is in danger of becoming a debate about narrow and broad definitions of rationality and more to the point, the “quality” of any rationale based on your chosen rationality.) As an example, it’s too complicated for Twitter rhetoric, hence this post (as in, hence Jim’s post too).
The CV19 (UK Lockdown and Social Distancing) strategy is basically about saving lives from premature CV19 death, and protecting the NHS from anything that might reduce their effectiveness in that aim, by minimising spread of CV19 infection in the population in order to minimise the viral-load-over-time on health-care and other key workers. (If you disagree that’s a fair summary, help me with that reality before engaging in any subsequent argument.)
So, back to the “science-led” rationale.
I’m an epistemologist, not claiming anything wrong with the epidemiology science. What I’m claiming is that the strategy is not science-led. Perhaps surprisingly, I’m suggesting it could be a good thing that it’s not, although unfortunately by making that the core of the policy, the politicians have cut actually themselves off from a better, broader rationality.
I’m also not claiming wrong or casting any doubt on diagnoses of death, from or with CV19. Health professionals put contributing factors as well as proximate causes on death certificates. It may be an imperfect science, but it’s sincere and professional – even if overall awareness might put it more in the spotlight as a potential factor to be tested for.
The first irrationality is the idea that lives are “paramount” in the sense that death and risks of death as countable facts must be minimised above all other factors. This is a religious act of faith. It is not science-based. No amount of good science based on that premise produces (good) science-led political advice and rules.
The idea that “saving lives” is paramount. There’s worse things than dying, and quality of life extended in an individual who may have other conditions predicting premature death is essentially subjective, even if objective quantifiers are created in order to assess. Premature is itself subjective in elderly who have achieved a “good” age. Simply replacing all these subjective components with the idea of maximise a where a = greatest possible age, or minimise d where d = any death, is nonsense. If in doubt, ask an elderly loved one.
Anyway any coronavirus management decision is ultimately about the quality (and quantity) of extended lives vs the unintended consequences. And they’re unintended in that they are unpredictable to anything like the same extent – not even precautionary ignorance – as the CV19 death toll as a numerical count.
And they’re not just economic and ecological consequences, but displaced life & death health consequences. Non-referred minor symptoms that turn out to be life-threatening. Psychological causes now of physical ailments later.
Sure the epidemiological science can be as good as the epidemiological knowledge, and statistical predictive knowledge based on uncertainty and a precautionary approach to unknowns. But however good it is it’s still only epidemiological science and single measure of success. No matter how many daily graphs we get shown, a single numerically quantifiable measure. We actually have a choice about what to be precautionary about.
A science-led politics is only as good as that choice.
The reality of all conceivable unintended consequences is not only as complex as the whole human cosmos, but there is no single measure or set of measures about which to be precautionary. Being precautionary about ignorance, of what we could measure and predict with knowledge in principle, is no protection about those factors we cannot even attempt to model at the time we need to make decisions. And, many of the factors are essentially qualitative.
Furthermore none of these possible histories will be repeatable. After the event(s) we will be able to attribute causal whys and wherefores but these will only as good as history written by the survivors. Conclusions will be in no way scientific. 20:20 hindsight at best.
Decisions – eg lockdown strategies including exit strategies – can be science-led in only a very narrow sense. In fact – if acknowledged – they require a much broader from of rationality. A political wisdom. If unacknowledged we are locked into a course of action based on a kind of tunnel-vision. The irrational fetish that “science-led” is the only defensible rationale. Something I’ve been calling Catch-22 for several decades.
Fortunately there are alternative voices being heard. Last weekend it was Jonathon Sumption in the Sunday Times (which I’ve still not actually read in any detail). This morning it was Dr Spiegel on BBC R4 Today
Science can’t tell you what you should do.
To believe it can, is irrational.
I was about to make a joke mixing epidemiology & epistemology, but I didnât know who would get it.
â” Kate Pearce (@secvalve) April 19, 2020