The limits of “THE” science of public health

January 17, 2022

By Yves Gingras

Historian and sociologist of science, UQAM

Le Devoir, January 17th, 2022

The announcement of Horacio Arruda’s resignation as Quebec’s National Director of Public Health provides an opportunity to revisit the many criticisms of “THE” science to highlight alleged mistakes made at various times over the past two years.

While it is to be welcomed that the appeal to “THE” science and “evidence” has become a kind of reflex to demand justification for any decision, the erroneous tendency to believe that “THE” science is unambiguous and can always dictate the “true” and only right decision must be criticised. The field of public health is not an exact science, given the very large number of variables that must be taken into account. And there is no “algorithm” for weighing them and deciding on the relative importance of these variables.

Even more problematic is the fact that this simplistic conception of ‘THE’ science brings with it the equally simplistic idea that ‘false’ science can be easily eradicated by creating ‘detectors’ to erase ‘erroneous’ opinions from the public arena. Anyone observing the many public speeches made by the various experts in the media will have noticed that they are rarely unanimous.

Risks and benefits

Consider the debate about vaccinating people who have recently been infected with COVID-19. Some say they are immune because the virus has allowed them to create antibodies to defend themselves, while others say that not everyone reacts in the same way and that a third dose, even shortly after the illness, may be useful to boost the immune system further! What should we do? Are we going to wait months for the results of scientific studies comparing the rate of antibody production in the vaccinated with that seen in people with the Omicron variant? Obviously not. So we need to assess the benefits and risks to the best of our knowledge, and this requires experience, and above all judgement, not just science. And those who point to certain studies to cry “wrong decision” often forget to take into account other studies with contradictory results.

Direct empirical observation no longer exists in most sciences, any study can be criticised in principle and one can always find an “expert” and even an “ex-peer” (think of Didier Raoult) to question the method used by a research. The question is therefore to assess whether the hypotheses are plausible or not, which again requires a certain amount of practice in critical thinking and especially in statistical thinking. This is the job of public health teams. Unlike the impromptu critics who offer their opinions of the moment, Dr Arruda was never the only one to decide, even if he was the public face of the announced decisions.

Science progresses by overcoming disagreements, and that takes time. We must therefore learn to live with uncertainties, which will only become clearer in the weeks and months to come and may lead to changes in previous decisions, but which do not become “mistakes”. In the context of an unprecedented pandemic with, among other things, the emergence of different variants, each with its own unforeseen characteristics, requiring irrefutable scientific evidence for any decision therefore makes no practical sense when the situation requires rapid decisions.

The simplistic belief in the existence of irrefutable evidence is also the basis for demands for censorship of supposedly erroneous claims. An extreme, but very instructive, example of this trend is provided by the censorship, at the beginning of November, of the Instagram account of the scientific collaboration group Cochrane, which is internationally recognised for its literature reviews aimed precisely at establishing “evidence” on public health issues. Without knowing by what “scientific” method this was done, the Instagram managers announced that the information published by this group could not be disseminated on their site, “because it had repeatedly posted content that went against our community’s rules on false information concerning the COVID-19 vaccine”! This blunder shows that nuanced thinking is made difficult in times of crisis – not to say collective hysteria – which do not tolerate ambiguity and uncertainty.

The sciences are collective and even fairly anonymous undertakings, and this seems difficult to reconcile with the media, which thrives on personalization, which facilitates the search for scapegoats, which, as the philosopher René Girard puts it, makes it possible to quench “collective anguish and frustrations” by designating “victims who can easily unite against them. The same phenomenon is underway with the fixation on the “non-vaccinated”, a group that is heterogeneous among all of them, but whose grouping under the same term gives the illusion of an easily identifiable unity as responsible for the evil that must be eradicated. This kind of behaviour is, alas, far from any truly scientific thinking, which is always sensitive to the complexity of social phenomena.

In Quebec, Yves Gingras is a well-known historian of sciences. He has published numerous books and has received numerous honours, the latest being knight of the National Order of Quebec, in 2019. He is a regular lecturer at the Centre humaniste du Québec.

Translated by DeepL and validated by Michel Virard.

Michel Virard