August 09, 2020

Andrew Harrison

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pass the hydroxychloroquine

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        On Monday, July 27, my week started by opening my computer and learning the news that a cure had been discovered for COVID-19.  Further, the drug was found to be effective at the prevention level as well.  This, of course, was fantastic news.  By week’s end, however, my ventures out into public still presented a sea of covered faces, surrounded by instructions plastered on every available surface, advising social distancing and other pre-apocalyptic behaviors.  What had happened to that promised cure?  Who was that confident group of doctors on the steps of the Supreme Court touting a cure?


~~~good for what ails you~~~
        That group of physicians was America’s Frontline Doctors (AFD).  And if both that name and that acronym fail to ring a bell, this is due likely to the fact that they are (were?) a newly formed band of experts, presumably, based on their name, the boots on the ground in the frontline facing the COVID crisis.  But alas, either the conclusions that they boasted that sunny day were somewhere south of accurate, or the good news that they were disseminating had inexplicably fallen on mostly deaf ears.  In the meantime, consensus among the rest of the world’s experts, at least all of the mainstream sources that we are accustomed to hearing from--the CDC, FDA, NIH, WHO--, had remained unchanged: While there had been early hope that hydroxychloroquine might be of use in preventing or treating coronavirus, all recent studies and trials had failed to indicate a discernible benefit from the drug, compared with the normal “standard of care.”  Anytime a potential treatment for some disease turns out to be ineffective, the result is disappointment.  But now we were forced to endure frustration stacked on top of disappointment with the multitude of conflicting advice, often from the same source, and all from supposed ‘experts.'  (Sadly, conflicting instruction has appeared to be the norm with COVID-19 since its arrival.)

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We're left with the question of whether we should listen to any experts at all who come bearing news about the pandemic.  And really this applies not only to the current pandemic, but more generally to a whole range of questions for which we are accustomed to looking to the experts for guidance.  Is there any way to tell up from down?  For that question we must put on our epistemology hats.  And for what it’s worth, my epistemology hat is my favorite hat.  I wear it all the time, even when I’m sleeping, and when it must be taken off for need of a wash, it’s my least favorite half hour of the week.  

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~~~direct evidence and indirect evidence~~~
        Epistemology is the branch of philosophy (and life for that matter) that has to do with what it means for someone to ‘know’ something, and more importantly, *how* it is we come to know things.  So this week, epistemology is the branch of philosophy that has to do with whether to listen to Dr. Stella Immanuel or Dr. Fauci (or neither).  People have beliefs and opinions about all kinds of things, and generally these beliefs are supported by two types of evidence.  The first of these is what I tend to think of as ‘direct’ evidence.  Direct evidence is anything that bears...well...*directly* on a given question.  For tomorrow’s weather, for example, barometric readings and radar directly indicate the state of the weather; for whether hydroxychloroquine is impactful when treating COVID, one would look at case studies, drug trials, and pharmacological data.  But if you are like me, which is to say not an expert in medicine or pharmacology or anything even in the neighborhood of those areas of study, then when it comes to having opinions about the current pandemic (at least the sciency, infectious disease side of it), the ‘direct’ evidence is largely inaccessible.  One cannot spend an hour on the Internet and come away with a mastery of virology.

Fortunately, one need not gain such a mastery to form reasonable beliefs on questions like these.  Instead, we can lean on ‘indirect’ evidence, which largely has to do with things like expert testimony.  Drop all of that indecipherable scientific data on the desk of a trained professional, and let them tell us what it means.  The trouble is, you can never know for sure that what they report back is the unblemished truth.  Maybe the expert forgot to carry the 1, or maybe the expert was bankrolled by some villainous international conspiracy, or maybe the CDC is saying one thing while the Norwegian Institute of Public Health is saying the opposite.  These things happen, and unfortunately there is no shortcut solution. 


~~~so, who do you trust?~~~
        Well...‘whom do you trust?'  But that sometimes-lonely objective form of the pronoun notwithstanding, this is a vexing question.    Herewith a handful of criteria that can help.  Take note, though, that these are general rules.  There is no foolproof method here.  Our eye is on the long game.

expert opinion
        An important starting place is the acknowledgement that there really is such a thing as an expert.  To believe that a layperson’s opinion is just as valuable as someone who has spent years of their lives in a particular area of study seems like a pretty indefensible claim.  But granted the legitimacy of expert opinion, a next step might be to note that not all experts are created equal.  Drs. Stella Immanuel and Simone Gold of AFD are real doctors, but their area of focus is not infectious disease.  Ideally there is close alignment between the specific question at hand and an authority’s area of expertise.

safety in numbers
        This can be tricky, and numbers aren’t everything, but when there is a consensus view on some question, especially across diverse groups of experts, this should generally be taken as a strong indicator of its accuracy.  Add ‘staying power’ to that consensus, where the same conclusions persist over a long period of time, and that indication is stronger still.  Yet these days it is not very uncommon to find people who believe that if something is the official or mainstream view, then that is the view that should be considered the most suspect.  Healthy critique of the mainstream media aside, such a view is a gross overstep.  To give no weight whatsoever to the consensus view, especially when it comes to questions of *fact*, one must hold the assumption about the majority that they are either fools or that they have hidden motives.  Interestingly, it is this very attitude--I think 'attitude' overrides 'thinking' here--that is at or near the core of most conspiracy theorists’ mode of operation.  But it is worth observing the dangers present in the opposite disposition as well.  Expert opinion is usually a powerful indicator of the truth, but it is reckless and naive to accept indiscriminately anything that the authorities or experts claim.  That’s like an open mouth ready to be fed by any spoon that wants to feed it.

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attitude toward dissenting views
        When AFD released their video, they didn’t just present their evidence and conclusions, they claimed that their point of view had been “silenced” and “censored.”  And while we know that such censorship and marginalizing of certain perspectives does happen, especially when politics are involved, ‘politics’ is not the only potential explanation.  Sometimes views are marginalized for reasons of politics, power, and bias, but sometimes views are marginalized because they are unfounded and false.  If the CDC, FDA, NIH, and WHO are covering up a known cure for the novel coronavirus, that's one heck of a conspiracy.  I'm not sure the odds that Las Vegas would put on the requisite combination of villainy and cover-up needed to keep that going.

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modesty of claims
        If someone acknowledges the legitimacy of other points of view or the ambiguity of the evidence, this is a sign of trustworthiness.  They dare to consider the possibility that their conclusions may not be perfect.  Also, clear and careful language alongside qualifiers about one's claims can be taken as signs of acting in good faith.  Here the AFD sounded all the wrong notes.  Hydroxychloroquine hadn't just proven effective in some limited instances, it was a *cure*, plain and simple.  Everyone toss your masks out and get the party started.  Their imprecise and conclusive language was a red flag.

bias
        Everyone has interests that influence his or her handling of evidence and the conclusions they reach.  For this reason some level of healthy suspicion can safeguard us from politically driven messaging.  I like to think that even when politics has invaded some public discussion to one degree or another, that a commitment by the majority to an objective handling of the facts can overcome politics, and truth still win the day.  I am confident that this is generally where we are with COVID-19.  Other times, I'm afraid it becomes impossible to tell the difference.  Global warming, to me, has become such an issue.  Climate change discussions have become so politicized and propagandized, that the free exchange of ideas and hardcore scientific analysis have been mostly crowded out.
 

~~~just say 'no'~~~
        So, society’s response to America’s Frontline Doctors was just what it should have been, mostly comprising either dismissing their claims or explaining why they deserve dismissal.  This is the way it’s supposed to work with bad information and even ‘fake news.’  I’m a fan of Mr. Bill Gates, but he along with many, many others are looking to the wrong solution when we look to social media to police the content for us.  But more on that another time perhaps. ■