Life involves many risk-benefit trade-offs and you can’t always ‘follow the science’
By David Leonhardt
The C.D.C. describes medium-rare hamburgers as “undercooked” and dangerous. The agency also directs Americans to avoid raw cookie dough and not to eat more than a teaspoon or so of salt every day. And the C.D.C. tells sexually active women of childbearing age not to drink alcohol unless they are on birth control.
If you happen to be somebody who engages in any of these risky activities, I have some bad news for you this morning: You apparently do not believe in following the science.
The misery of the Covid-19 pandemic — with its death, illness, isolation and frustration — has left many Americans desperate for clear guidance on how to live safely. People want to protect themselves, their family and their communities, especially the most medically vulnerable members of it. This instinct is both understandable and profoundly decent.
But it has led to a widespread misunderstanding. Many people have come to believe that expert opinion is a unitary, omniscient force. That’s the assumption behind the phrases “follow the science” and “what the science says.” It imagines science almost as a god — Science — who could solve our dilemmas if we only listened.
When Donald Trump was president and making false statements to downplay Covid, “follow the science” began to gain popularity. Now, it also serves as a response to the many allegedly incorrect statements that vaccine opponents make. President Biden likes to promise that he will follow the science, to signal his difference from Trump and deference to the C.D.C.
The phrase does have its uses. It’s a rejection of myth and a recognition that some aspects of the pandemic are unambiguous: Covid is more deadly for the unvaccinated than almost any virus in decades, and the vaccines are remarkably effective at preventing serious illness.
Many other Covid questions, however, are complicated. What does the science say about them? It says many things. Above all, science makes clear that public health, like the rest of life, usually involves trade-offs.
If you want to minimize your risk of getting sick from food, you probably need to eat less tasty food than you now do. If you want to minimize your chance of dying today, you should not get inside a vehicle. If you want to minimize your children’s chance of going to an emergency room, don’t allow them to ride a bike or play sports.
Unfortunately, none of these statements provide answers about what to do. People have to weigh the risks and benefits. They let their kids play sports, but maybe not violent ones. They don’t drive in a snowstorm. They ignore the C.D.C.’s advice about medium-rare burgers and heed its warnings about medium-rare chicken.
The current stage of the pandemic presents its own set of hard choices and trade-offs. If you wade into the angry, polarized Covid debates on social media and cable television, you will find people who try to wish away these trade-offs. They pretend that science offers an unambiguous answer, and it happens to be the answer they favor.
Proponents of an immediate return to normalcy claim, implausibly, that masks and social distancing do nothing to reduce the spread of Covid and that anyone who says otherwise doesn’t care about schoolchildren. Proponents of rigorous Covid mitigation claim, just as implausibly, that isolation and masking have no real downsides and that anyone who says otherwise doesn’t care about the immunocompromised.
The truth is that Covid restrictions — mask mandates, extended quarantines, restrictions on gatherings, school closures during outbreaks — can both slow the virus’s spread and have harmful side effects. These restrictions can reduce serious Covid illness and death among the immunocompromised, elderly and unvaccinated. They can also lead to mental-health problems, lost learning for children, child-care hardships for lower-income families, and isolation and frustration that have fueled suicides, drug overdoses and violent crime.
Balancing the two is unavoidably vexing. “We need to be better at quantifying risk, and not discussing it in a binary way,” Dr. Aaron Carroll, the chief health officer at Indiana University, told me. (This essay by Carroll made me aware of the C.D.C.’s advice on cookie dough and salt, and I also recommend this Times essay of his.)
As you think about your own Covid views, I encourage you to remember that C.D.C. officials and other scientists cannot make these dilemmas go away. They can provide deep expertise and vital perspective. They are also fallible and have their own biases.
C.D.C. officials tend to react slowly to changing conditions and to view questions narrowly rather than holistically. They often urge caution in the service of reducing a specific risk — be it food-borne illness, fetal alcohol syndrome or the Covid virus — and sometimes miss the big picture. The C.D.C. was initially too slow to urge mask use — and then too slow to admit that outdoor masking has little benefit.
As Matt Glassman, a political scientist at Georgetown University, wrote this week, “Don’t trust substantive experts to make policy decisions that balance competing values or stakeholder interests.”
There is no one correct answer to our Covid dilemmas. People are going to disagree passionately, and that’s frequently how it should be. Most policy options have both benefits and drawbacks. The same applies to other areas of public health: We could also reduce flu deaths with permanent mask mandates, but this fact doesn’t mean that mandates would be wise.
One of the few Covid truisms is that policies should change as reality changes. A world without vaccines calls for more restrictions than a world with vaccines. When cases are surging and hospitals are overwhelmed, as was the case last month, more restrictions make sense. If hospitalizations and deaths keep falling, continued steps toward normalcy will make sense.
“We have to be able to act differently when the situation changes,” Carroll said. Or as Janet Baseman, a University of Washington epidemiologist, told me, “We need to be having this conversation.”
It really is a conversation. The answer will not spring forth from Science.
Credit: New York Times Morning Letter