When a scientists of the stature of Dr Anthony Fauci distort the truth to get people to what they want them to do, they are embarking on a dangerous game, writes Dr Vinay Prasad, in MedPageToday.
Prasad, a haematologist-oncologist and associate professor of medicine at the University of California San Francisco, writes:
As a former National Institutes of Health fellow, I have a profound reverence for Dr Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and a towering figure in American medicine. Recently, Fauci told The New York Times that new science had changed his thinking on the herd immunity threshold but he also admitted that his statements were influenced in part by "his gut feeling that the country is finally ready to hear what he really thinks."
Specifically, the fraction of people who would need immunity to SARS-CoV-2 to extinguish the spread of the virus was initially estimated to be 60% to 70%. In recent weeks, Fauci had raised the percentage: from 70% to 75%, and then to 75%, 80%, and 85%.
Allow me to quote verbatim from the article, titled How Much Herd Immunity Is Enough?: "When polls said only about half of all Americans would take a vaccine, I was saying herd immunity would take 70% to 75%," Fauci said. "Then, when newer surveys said 60 percent or more would take it, I thought, 'I can nudge this up a bit,' so I went to 80, 85."
Of course, the herd immunity threshold is just an estimate … Fauci has some wiggle room. But, the two undeniable admissions in the article are 1) Fauci is, to some degree, basing his statements on what he thinks the public will accept, and to what degree his rhetoric might help vaccination efforts, and 2) this is the absolutely stunning part, he is admitting this openly to a reporter!
This is not the first instance when Fauci made a public statement while considering, in part, what he believed people would do with the information. The first instance concerns masks and occurred during an interview on 60 Minutes in March, during which he appeared to say that face masks had no value and should not be worn.
Later, the public messaging would shift in support of universal cloth masks. This occurred in the absence of any substantive new mask studies. Critics would then point to this video as evidence that Fauci was dishonest. However, a full look at the remarks suggests the comments were nuanced. Fauci would later clarify that his words were chosen to prevent a run on masks – so that healthcare workers would get first priority.
Irrespective of your feelings in these specific cases, the core tension in both examples is whether we want scientific advisors and public health experts to report just the facts, as they see them, or do we want them to make the additional calculation of what the public would do with those facts, and use that to shape their comments, aiming to maximise the greater good?
I believe scientists and public health experts can only report the complete, unvarnished truth, as they believe it to be. We cannot and must not attempt to distort our ideas in an effort to generate responses we think might occur. For four reasons.
1. The information gap no longer exists: Experts are not inherently smarter, more analytical, or logical than the lay public. Perhaps in the past, they preferentially had access to certain types of insider information. In the modern world, due to the internet, this information gap no longer exists. This dramatically changes the game.
If an expert seeks to distort their view of the science to further a behavioural change amongst the public, the risk of detection is high — at least by some in the public. As such, it runs the risk of immediate backlash and the ensuing loss of credibility.
2. It is not an easy game to play: Human beings are masterfully complex, and not easily predictable. In this case, Fauci's messaging in March may have been intended to prevent a run on masks, but it also may, to some degree, have contributed to masks becoming one of the most polarised issues of 2020, and, in many quarters, fostered a deep suspicion and distrust of Fauci.
Scientists are not trained to predict what people will do with varying pieces of information, in an effort to optimise outcomes. Scientists, like anyone else, have difficulty knowing what you will do or say if you hear one thing versus another.
3. Loss of trust is incalculable: Once it is revealed that any individual has presented information selectively to get the listener to change their behaviour – that person will forever be viewed through that lens: a calculating person. Is Fauci telling me this because the science supports it, because he believes it, or because he thinks hearing it might motivate a behavioural change on my part?
4. Distortion steals power from the people and gives it to scientists: In a prior column, I argued that "follow the science" is an incoherent message. That's because science can tell you what might happen in varying scenarios, but science cannot tell you what to value. Science is necessary for sound policy, but it is not sufficient. Humans beings voicing their concerns and priorities, in concert with scientific guidance, is required to shape policy, and policy fundamentally belongs in the realm of politics and in the public square.
This means that scientists must not distort their view of a situation to get you to do the right thing because this robs you of your ability to decide what is the right and just and virtuous course. A scientist must always and only and indefatigably tell you the scientific truth, as best they see and understand it, but we all – every last one of us who votes and participates in society – we alone get to decide what the policy should be.
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