Karl Popper, one of the 20th century’s most influential philosophers of science, wrote that “the growth of knowledge depends entirely on disagreements.” Contrary to media portrayals of science, the scientific method depends not on the existence of a mythical consensus, but structured scientific debates. Consensus is the hallmark of dead science.
The other reason consensus can be dangerous is when it intersects with medical ethics. Recently we saw supposed consensus fuel mandates, taking away patient’s personal right to make an informed choice. While there may be a time this is required, it is fraught with danger. We distort medicine into something it’s not. It is reduced into nothing more than a mechanism of control instead of a way to heal.
I fear we are simplifying a relationship and knowledge that is far more complex and uncertain than we think. Medicine is complicated. Rarely is the same answer correct for every person and every situation.
It is time to remember the original intent.
American philosopher Ralph Waldo Emerson wrote, “I distrust the medical facts”. He wasn’t anti-science. He was against those who believed medicine could be reduced to biological functions and that diseases were nothing more than a collection of symptoms. Emerson didn’t think that medicine could be so discretely defined. It requires an air of uncertainty. Some humility.
The progenitor of modern American medicine, Dr. William Osler, asked his medical students to read Emerson. Both Osler and Emerson saw medicine as an experience where knowledge is gleaned through direct interactions with the patient. Osler called it bedside medicine. Emerson described every man as a “sliding scale”, a fluctuating array of symptoms and perceptions.
When we have evidence to support what we perceive to be true, we call it logical truth. When we lack evidence, yet still believe something to be true, we call it transcendental truth. The full truth, therefore, can only be understood through experience because each person decides independently what assumptions to believe and how to interpret the available evidence.
Medicine will always have an element of the unknown. Good physicians recognize this uncertainty and chart the best path forward balancing what they know with what remains ambiguous. There is no one right or wrong decision that fits every patient. The best decision makers respect uncertainty as they weigh the relative benefits for each patient.
The final reason consensus is dangerous is because too often it has been proven wrong. Ambrose Bierce, in his Devils Dictionary, described this state of certainty as “the art of being mistaken at the top of one’s voice”. When perverse interests intersect with this arrogance, the results are tragic.
The illusion of scientific consensus throughout the Covid-19 pandemic led to disastrous policies. Lockdowns are a primary example. It was clear from the onset that the economic dislocation lockdowns caused would throw tens of millions worldwide into food insecurity and deep poverty – all of which have come to pass.
It was also clear that school closures would devastate children’s life opportunities. The emerging picture of catastrophic learning loss, especially among poor and minority children who had fewer resources to replace lost schooling, means that lockdowns will fuel generational poverty and inequality in the coming decades.
Empirical evidence against established consensus comes from places like Sweden, which did not impose severe lockdowns or close schools, yet has among the lowest rate of all-cause death in Europe.
The illusion of consensus around proper use of the Covid vaccine was another major public health disaster. Public health officials everywhere touted the randomized trials on the COVID vaccines as providing protection against getting and spreading COVID.
The vaccines did neither.
In fact, the trials themselves did not have the prevention of infection or transmission as a measured endpoint. Rather, the trials measured protection against symptomatic disease for two months after a two-dose vaccination sequence.
What was ignored, and what was not allowed to be said, was that the primary benefit of the COVID vaccine is to reduce the risk of hospitalization or death upon COVID infection in those at high risk. There is more than a thousand-fold difference in the mortality risk from COVID infection with children or young and health people compared to older people.
So, the maximum potential benefit of the vaccine is meager for the young healthy people or children, while it is a different consideration for elderly people with multiple comorbid conditions. Not the same answer for everybody.
Unvaccinated people around the country, who questioned this wisdom were dealt with severely. The premise was that only the unvaccinated were at risk of spreading COVID. Getting the shots were painted as a required civic duty. “It’s not about you, it’s to protect my grandparents.”
Overstating the necessity of the COVID vaccine for the young and healthy, while downplaying the possibility of severe side effects, by institutional public health and medicine ignored the reality that an increasing number of citizens could see.
Now, reanalysis of the clinical trial data, published in April in Cell journal, demonstrated that Pfizer and Moderna Covid vaccines did not impact overall mortality. The protection against deaths in high-risk individuals was offset by vaccinated trial participants being more likely to die from cardiovascular problems.
The failure of the traditionally well-regarded public health agencies like the FDA and CDC - with perverse influences from pharmaceutical companies, in tandem with the powerful forces of censorship on social media - has destroyed trust in public health institutions. The pandemic has revealed the stunning magnitude of the political and institutional capture of science, controlling consensus.
I don’t know if these institutions will recover. I don’t know if they want to. The road back calls for rigor, humility, and open discussion. I’ve seen little of these qualities displayed.
Tim Powell MD