What does it really mean “to follow science”?

Sad to acknowledge but necessary to recognize, even the political discourse surrounding the continuous management of the COVID-19 virus has in the U.S. become a political football. Considering the upcoming presidential and congressional elections in November, this may not surprise but is, nevertheless, deplorable if one looks back on how, even in politically contentious times, the two major parties in the past usually presented unified positions in national emergencies of similar extent and significance; yet, they, this time, are failing miserably. 

Trying to be as non-partisan as possible, one at the current point in time must conclude that distinct policy differences have arisen between the two parties on how current stages of the COVID-19 pandemic should be managed: The Democratic party clearly favors as slower and the Republican party a quicker pace in reopening the U.S. economy, with both parties claiming to follow science.”Our intent here is notto imply motivations for their respective positions, nor do we consider this the appropriate forum to support one or the other approach. Because to “follow science,” has become the, likely, most widely used cliché in the ongoing political debate, with both parties attempting to wrap themselves into the mantle of science, while attacking the other side for “ignoring science,” we here will attempt to clarify what “following science” really means.

Largely deserted Grand Central Station with signs advising that passengers wear masks at all times. Image by Yucel Moran via Unsplash.

We already last month in these pages questioned whether any politician using this phrase really could define what “following science” means. We here are ready to expand on this thought by arguing that neither do representatives of the media and/or pundits addressing these issues in the media. We, indeed, would argues that a large part of society, including many health providers, have either no or a wrong understanding of the meaning of this phrase.

What does it mean to “follow science?”

One cannot define the meaning of “following science,” without, first, defining science in itself. Merriam-Webster defines science in 4 ways:

  • The state of knowing; knowledge as distinguished from ignorance or misunderstanding.
  • A department of systemized knowledge as an object of study.
  • Knowledge or a system of knowledge covering general truth or the operation of general laws, especially as obtained and tested through scientific methods.
  • A system or a method reconciling practical ends with scientific laws.

Google defines it as:

  • The intellectual and practical activity encompassing the systematic study of the structure and behavior of the physical and natural world through observation and experiment.

Albert Einstein (1879-1955), in turn, described it as follows:

  • It is the fundamental emotion which stands at the cradle of true art and true science.

As these examples clearly demonstrate, a universally accepted definition of science does notreally exist. If CHR had to give it a try, we would define it as:

  • The systematic and unbiased pursuit of objective evidence-based truth in the moment

Most scientists understand that there is no permanent truth in science, since scientific truth constantly changes? This is the reason why over the last three decades scientific textbooks on paper have become largely obsolete. By the time they are published, most of their content is usually out of date. Because science never can offer a “last word,” scientists who have absolutely no doubts left regarding a scientific observation, or even their own work, therefore, must be viewed with a level of suspicion. True scientists know that every scientific result only asks for more investigations and even deeper truth. Those investigators who fail to understand that scientific truth never can be absolute and, therefore, become enamored with their own truth, consequently, reveal themselves as believers rather than scientists. Believers practice a religion and, even if widely admired for their allegedly scientific achievements, they in reality practice religiosity rather than science.

Science in general, but especially the various specialty areas in medical sciences, are, unfortunately, heavily populated by believers pretending to be scientists. They often, indeed, represent a heavy presence among so-called “leading experts” who, regretfully, often become opinion leaders, charged with establishing the directions of scientific endeavors. These pages of the VOICE have repeatedly pointed out how strongly the behavioral science literature warns against unchallenged advice from “experts.” Precisely because of their longstanding involvement in subjects relating to their areas of expertise, they are strongly predisposed to biases. The more secure we, as scientists, become in our opinions, the more we practice religiosity rather than science

That governments all over the world resorted to “expert-opinions” once the extend of the COVID-19 pandemic became apparent, can and should not surprise. Public health experts, of course, must have a seat at the table when new policies are to be developed to fight a worldwide pandemic. Because pandemics are usually only caused by highly infectious viruses, experts in infectious diseases must, obviously, be listened to. But experts are meant to offer opinions, not to determine national policy. To determine policy is under the U.S. constitution exclusively privilege and right of elected officials.  

This is, however, not the sequence of events in decision-making processes surrounding the COVID-19 virus her in the U.S. and in most countries of the world. Being politicians and, therefore, rather automatically seeking the politically most expedient decision (for reelection) rather than “best” decisions, politicians almost everywhere came to an amazingly similar conclusion (opinion polls may also have contributed): By following conveniently available “experts,” they could claim that they were “following science.” Being the clearly politically most expedient approach, politicians, unfortunately, however were unqualified to judge who among their advisors were “believers” and who were real scientists. Unsurprisingly, many (if not most) turned out to be “believers,” following the “conventional wisdom” of the moment of the public health community. Politicians, therefore, in a large majority ended up receiving only the typical myopic view of “experts” in one field.

This is how the slogan of “following science” was born and became the worthless cliché it really represents. One, of course, cannot “follow science” because science is never represented by only one opinion. Nobody should understand that better than physicians who know how discrepant treatments can be for the same condition between different physicians. If one wishes to pretend to “follow science,” one, at minimum, must listen to divergent opinions and, even then, one is not “following science” but one reaches a final conclusion after listening to different subjective opinions. In other words, the concept of “following science” really does not exist. Our politicians, therefore, did not “follow science” but followed their own personal gurus!

This is the only explanation why New York’s, New Jersey’s and other governors made the same fateful decision of sending COVID-19 infected older nursing home patients back to their nursing homes and virtually forced those nursing homes to accommodate them under the threat of loss of licensure. The result was a catastrophic death rate, representing up to 40% of all deaths in those two states. We can state with absolute certainty that the idea for this executive order was not the governors’; it must have come from public health “experts” (as a further example of how politicized management of COVID-19 has become in the U.S., it appears that Republicans and Democrats had, both, their own “experts,” leading to similar decisions in states where governors were members of the same party but quite different policies where governors belonged to opposing parties). Is there a better example why “experts” should not be allowed to determine policy?

Focused on their small kingdom of expertise, their biases and inability to consider unintended consequences outside of their small areas of direct expertise render them unable, and really unqualified, to make policy. But this is exactly the corner they found themselves in because politicians all over the world were unwilling to make difficult decisions and found it politically much more opportune to hide behind famous, in the media popular experts. In the U.S., nobody fits that picture better than Dr. Anthony Fauci, per Wikipedia, “America’s Man on Infectious Diseases.”

For over 36 years, since 1984 Director of the National Institute of Allergy and Infectious Diseases (NIAID), he was not only an expert; he was the expert, – the world’s greatest infectious disease expert, as many media outlets described him in most glowing terms. It did not matter that the opinions he initially dispensed to the public regarding COVID-19 were all wrong: In early January, he publicly declared that COVID-19 was no significant threat to the U.S. At roughly the same time-point, he also suggested in televised interviews that medical information received from China and the World Health Organization (WHO), in his opinion, could be trusted. He especially pointed out the sincerity and qualifications of Tedros Adhanom, Director General of the WHO, as, coincidentally, he had just co-chaired a telephone conference with him (the MD after Adhanom’s name is not missing by accident; he, indeed, is the first non-physician at the head of the WHO).

It apparently also did not matter that Fauci’s opinions went from one extreme to the next, when, after declaring COVID-19 not to be a threat, he became the most outspoken proponent of mitigation and separation and, therefore, the economic shutdown of the nation. He now also advocates the wearing of face masks by everybody, even outdoors, while, before, he advised the public that facemask were not only useless but could actually increase infection risks.

In his aggressive advocation of mitigation to “flatten the death curve,” Fauci (and other public health “experts”) also did not hesitate to quote even some of the most absurd mathematical models. Likely the most extreme in infamy was earned by the British Royal College model, predicting ca. 2.5 million deaths from COVID-19 in the U.S. without mitigation. The model’s principal intellectual father was Fauci’s British counterpart who advised the British government as, supposedly, the country’s premier public health official, like Fauci, blessed by special expertise in taming infectious disease epidemics.

The, at times, rather ridiculous pronouncements of both of these “leading experts” should have served as warning signs; but they, unfortunately, did not! It is, of course, almost impossible to remain in the same leadership position for almost four decades, as Fauci did, without becoming affected by the religiosity of the field. At the same time, such long-term involvement in only one area of public health, has, of course, additional consequences: it isolates the person from what else is happening in medicine. Unsurprisingly, Fauci, therefore, appears to have had shutters in front of his eyes when it came to unintended health consequences in other medical domains: How else can one understand that he never even once (at least in public) raised the question of unintended consequence on national health that his recommendations regarding the COVID-19 pandemic might cause?

He apparently found it irrelevant, how many people would avoid getting emergency room care for other medical conditions they urgently needed, – if hospitals were shut down for non-COVID-19 care? He also never asked how many patients would have their urgent surgeries cancelled? How many children would not get their timely immunizations? How closing down the economy would reduce timely cancer diagnoses, and how suicide rates, women and child abuse in homes and even traffic fatalities would spike? He was rightly concerned about “flattening the curve” to prevent hospitals from being overrun; yet, he, obviously, never considered the devastating economic impact on hospitals the policies he propagated would have.  

It is, of course, difficult to blame Fauci for the religiosity he developed over 36 years as head of the NIAID. Almost anybody in that position would have become a believer of what evolved as the common wisdom of the field over those years, especially if oneself contributed as much to this common wisdom as Fauci did. One, however, must blame him for having become a politician: One cannot survive for 36 years as head on a major institute at NIH (and over multiple Democrat as well as Republican administrations) without, indeed, also being an excellent politician. Being a good politician, however, unfortunately also extends to advice he has been giving to the administration as well as public: Within this context, we noted earlier how Fauci swayed from minimizing COVID-19 risk in January to, instantly, becoming a mitigation hawk, once the severity of the pandemic became obvious. More aggressively than most other scientists he then promoted radical distancing between all and, thereby, leaving no choice but an almost complete shutdown of the U.S. economy, without ever mentioning (or considering) potential unintended consequences from such a policy.

Interestingly, now that increasing criticism is voiced against the wisdom of shutting down the economy as over 40 million unemployed starkly demonstrate, he in a recent TV interview, suddenly, again, veered back, for the first time suggesting in public that “unintended medical consequences” from closing of the U.S. economy could be significant. Why haven’t we heard this argument before?  The politician Fauci, therefore, vey obviously is at least as much driven by political correctness of the moment as by interpretation of science. We do not wish to question his integrity, and the mistakes made, were, ultimately, not his; they were made by those who, unfortunately, chose to listen to him and follow his advice in the name of “following science!”

We will probably never know for certain whether Fauci, indeed, simply, was foolishly ignorant of potential serious adverse health outcomes from 40 million suddenly newly unemployed U.S. citizens or simply hid this news. But, as behavioral sciences taught us, this is exactly how “experts” are expected to behave and why recommendations experts make must be viewed with the understanding that they come with built-in biases of their field of expertise and, often, without any considerations for consequences that do not relate to their field of expertise. Fauci, indeed, said so-much, when confronted in a recent Senate hearing by Senator Paul (Kentucky), and reaffirmed “that he could testify only regarding his expertise and not, for example, regarding any possible impact on the national economy.” He concurred with Senator Paul that his opinions, therefore, should not be “the end’s all.”  

Yet, when criticizing each other’s positions and claiming that they, but not their opponents, “follow science.” both Democrats as well as Republicans used Fauci’s public declarations in support of their allegedly scientific approach to the COVID-19 crisis. To this day, neither side, indeed, understands what science really is and, therefore, what it really means to, “follow science.” Had they understood what it means, “to do science,” they would immediately have known that Fauci, for quite some time, no longer was a scientist or, for that matter, a practicing physician because every physician, of course, before prescribing a treatment not only asks how good are the chances of this treatment to work but, also, what may go wrong if I order this treatment?

Dr. Fauci, unquestionably, deserves praise for a highly distinguished career but, regarding the COVID-19 pandemic, he was, and is, the wrong person at the wrong time and place to determine national policy. Like so many distinguished experts before him, he has fallen victim to his obvious religiosity toward what the public health community currently considers best care. That, however, has absolutely nothing to do with science because the first responsibility of science, well reflected in various medial oaths, is that all agree “to do no harm.” 

Fauci’s sudden stardom is, thus, a very appropriate reflection of how little intellectual clarity is nowadays remaining in national and state politics in both major parties and, unfortunately, also in most media. Intellectual clarity has been diminishing for some time, giving way to hyperbole, exaggeration and, yes, a constant assault of “fake-news.” Fake news is not only a characteristic of how media these days cover government and how government retorts. Fake new are equally present in medicine and in all of sciences, with believers, like in politics, being the most radical perpetrators of falsehoods. The more we believe, the more religious we become in viewing pertinent subjects, whether on a genetic, historical or truly religious background, on which we conduct what we consider purposeful and honorable experiments. 

We are not alone in our criticism of how the federal government allowed Fauci to influence U.S. policy. Yuval Levin, editor of National Affairs, expressed similar opinions on Fauci’s 36-year reign at NIAID in a recent article in The Wall Street Journal (May 16-17, 2020, page C3). There are highly reputable scientists out there who have not fallen into religiosity. They are uniformly characterized by an understanding of relativity of truth in science and the need to think (and analyze) in multifactorial ways. We previously have described the exceptional work of Stanford professor, John P.A. IoannidisAllysia Finley recently profiled Aaron Ginn, who is not a physician but a Silicon Valley technologist and, therefore, was not encumbered by professional preconception and biases when analyzing publicly available research data on COVID-19 (The Wall Street Journal, May 16-17, 2020, page A13). Others are Stanford professor Jay Bhattacharya, University of Southern California professors Joel Hay and Neeray Sood.

They and a good number of other scientists (including CHR) have almost since the very beginning of the COVID-19 pandemic been trying to present more unbiased insights but, unfortunately, apparently have not yet received the deserved attention of the U.S. government and the international press core.Our conclusion in attempting to answer what it means, “to follow science,” therefore, is a very simple one. It is impossible “to follow science” because science constantly changes. To argue that one politician follows science more than another, therefore, makes absolutely no sense. Not being experts themselves, most politicians must in knowledge areas where they lack appropriate personal insights, in most of their decisions rely on “expert opinions.” It is, however, the politicians’ responsibility to select experts carefully and with clear understanding of which aspects of their expertise can or cannot be integrated into their final decisions, which must be untainted by personal believes and formulated based on the hard facts of the moment. Considering the multifactorial nature of most complex decision-making processes, it, contemporaneously, is also the politicians’ responsibility to be as comprehensive as possible in obtaining expert advice from different viewpoints. Politicians can, however, not, simply, pass on the decision-making-power to one (or more) alleged “expert.” 

This is a part of the June 2020 CHR VOICE.

CHR’s COVID-19 Bulletins

  1. What it means to follow science (Published on June 3, 2020)
  2. What we now know about COVID-19 and what it means for mitigation strategies (Published on May 22, 2020)
  3. COVID-19 response in retrospect, as well as going forward (Published on May 7, 2020)
  4. The essence of the COVID-19 pandemic (Published on May 7, 2020)
  5. Practical consequences of COVID-19 for CHR’s fertility patients (Published May 7, 2020)
  6. IVF after COVID-19: ASRM and SART release reopening guidelines for IVF centers (Published on 4/29/2020)
  7. One medical expert, missing from all COVID-19 task forces, who should be listened to (Published on 4/29/2020)
  8. Governments worldwide should have let herd immunity develop rather than cause one of the worst recessions on wild guesses of “experts” (Published 4/27/2020)
  9. Reciprocal collaboration among IVF centers for cycle monitoring may be on the wane (Published 4/22/2020)
  10. Is embryo freezing better than IVF during COVID-19 outbreak? (Published on 4/17/2020)
  11. When to restart fertility treatments after COVID-19 (Published on 4/17/2020)
  12. “Reopening” of fertility centers after COVID-19: How that may look like (Published on 4/17/2020)
  13. Some IVF centers may never reopen (Published on 4/17/2020)
  14. Skepticism warranted for “expert opinions” on COVID-19 (Published on 4/13/2020)
  15. Fertility Providers’ Alliance tries to reframe ASRM’s reaffirmation of COVID-19 guidelines as FPA victory (Published on 4/6/2020)
  16. States in the Northeast may see first signs of “flattening the curve” (Published on 4/6/2020)
  17. Reported death rate exaggerated by the media, shelter in place or herd immunity, first COVID-19 antibody test approved, and more (Published on 4/3/2020)
  18. What can I do to continue on my fertility journey? [VIDEO] (Filmed on 3/26/2020, published on 4/2/2020)
  19. “Controversy” over ASRM recommendation hints at investor interest’s power grab amid COVID-19 pandemic (Published on 4/2/2020)
  20. Pregnant women concerned over delivery and babies during COVID-19 pandemic (Published 4/1/2020)
  21. ASRM’s COVID-19 Task Force reaffirms previous recommendations (Published 4/1/2020)
  22. To stay open or not: IVF centers argue over ASRM guidelines on COVID-19 and fertility treatments (Published 3/27/2020)
  23. Concerning news on COVID-19’s effects on pregnancy and newborn (Published 3/27/2020)
  24. What’s urgent is urgent and what’s not urgent isn’t: Explaining ASRM recommendations on fertility treatments during COVID-19 pandemic (Published 3/26/2020)
  25. Patient autonomy and “do no harm” principles mean CHR continues to offer fertility diagnosis and treatments during COVID-19 crisis (Published 3/23/2020)
  26. ASRM and SART’s recommendations on fertility treatment during COVID-19 outbreak (Published 3/18/2020)
  27. CHR’s response to the COVID-19 outbreak: What we are doing to protect our patients, staff and community (Published 3/13/2020)
  28. Does COVID-19 have an effect on fertility? (Published 3/13/2020) 
  29. What happens if I get quarantined during an IVF cycle? (Published 3/13/2020)
  30. What happens if CHR is closed for quarantine during my IVF cycle? (Published 3/13/2020) 
  31. What should fertility patients do during the coronavirus outbreak? (Published 3/13/2020) 
  32. Should international patients of IVF do anything differently during the outbreak? (Published 3/13/2020) 
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.