When it comes to navigating the pandemic, many proudly proclaim: "Follow The Science [1]." It's a popular and feel-good message. To me, #FollowTheScience [1] means that science [1] is essential to makinggood and rational decisions and implies that science [1] makes policy decisions clear. The first half of that sentence is right. The second half is dangerously wrong. I think we must address what science [1] isand is not.
Of course, science [1] is necessary to navigate the pandemic. Science [1] --in the form of randomized trials -- allows us to separate therapies that work from those that do not.
At the same time, science [1] will never be sufficient to guide choices and trade-offs. Science [1] cannot make value judgments. Science [1] does not determine policy. Policy is a human endeavor that combinesscience [1] with values and priorities. In other words, science [1] can help quantify the increased risk (or lack thereof) of school reopening on SARS-Cov-2 spread, and help quantify the educational losses fromcontinued closure,but science [1] cannot tell you whether to open or close schools. Making the decision requires values, principles, a vision of the type of society we want to be. How much do we care aboutthe kids that rely on public school? Is it enough to offset a theoretical (but unsubstantiated) risk of viral spread? On this topic, I agree with others that we have chosen poorly.
1. Credentialism is not science [1]. Science [1] is not the degrees someone has or where they trained. Is their view justified or is it unsupported? I joke that when someone disagrees with you about COVID-19 policy, you ask if they have an MD, MPH, PhD, faculty appointment, policy expertise, and infectious disease background. But if they agree with you, none of that matters. They are a self-taught savant, and amateur expert!
2. Science [1] is not dogmatic; it demands testable, falsifiable hypotheses. The hallmark of science [1] is that when there are competing ideas, we can agree on studies that will decide who is correct. Believing in things that cannot be falsified or tested is religion. Science [1] is everything else. I worry we have a lot of religion when it comes to COVID-19.
3. Science [1] is not censoring. Over the course of the pandemic, YouTube removed videos by university professors with unpopular views, and Facebook and Twitter have labeled some posts as false or inaccurate. Even if we disagree with these speakers, this is dangerous. Science [1] is the idea that we must confront, discuss, debate, and refute ideas. Using brute force, the power of the platform, to proclaim the truth is antithetical to our creed.
The simple fact is that most heretical ideas will turn out to be false, but some may be true. Academic freedom is the idea that we allow many people to be wrong, so that some may be right. That doesn't mean we blindly accept everything folks say, in fact, it means the opposite, we must interrogate and challenge them, but we must create an environment where folks can argue their case, even if initially unpopular.
4. Science [1] is not a popularity contest. In an era of petitions, it seems as if science [1] is the belief that most scientists hold. This is incorrect. Science [1] is a process to make sense of the world, and folks in the minority may well be vindicated. In fact, throughout history, there have been many moments in medicine where the majority was wrong.
5. Science [1] is applying criticism impartially, equally, fairly. Let's say there are two studies about masks. One is a randomized trial with a wide confidence interval, the other is a retrospective observational study with myriad deficiencies. It is completely fine to fault the RCT for having results that are compatible with a broad range of outcomes, and I did, but one cannot celebrate the observational study as "proving masks work" simply because its conclusion aligns with one's worldview. In other words, we have to apply critical appraisal fairly. If we try to convince others that weak or faulty evidence proves something works, we are not scientists, but magicians.
