Science Isn’t Meant To Be Followed

President Trump has taken a pointedly anti-scientific approach to the Covid-19 pandemic. When he is not hiding data, gagging public health experts, or touting unproven cures, he is downplaying the toll the virus is taking on people’s lives.

In the face of such indifference to facts, it is understandable that many people, including both Republican and Democratic governors, contend that politics should stand aside while science leads us out of this mess. For instance, a pact among Eastern states promises to coordinate their pandemic response in a manner “driven by data and experts, not opinion and politics.” A pact of western states put it even more tersely, vowing that “health outcomes and science – not politics – will guide these decisions.”

Unfortunately, that belief reveals a deep misunderstanding of the proper role of science in guiding public policy-making. Science cannot lead us out of the pandemic. Whatever paths we take to navigate COVID-19 need to be chosen through political processes. The true role of science is to illuminate these pathways, guiding our policy choices by showing us what’s at stake.

As an analogy, consider the role of science in helping a person newly diagnosed with advanced cancer. As a physician who studies medical decision-making, I would never recommend this patient choose a treatment without help from medical science. But science alone doesn’t always point to an obvious choice. Perhaps one chemotherapy has a small chance of curing the cancer but a risk of serious side effects, while another, gentler chemotherapy will slow down, but not cure, the cancer. This patient faces a difficult trade-off between chance of cure and likelihood of experiencing miserable side effects. In this situation, the best choice isn’t a matter of science, but instead hinges on a value judgment: on how an individual patient weighs the pros and cons of the alternatives.

Like a patient stricken with illness, the United States needs to decide how to treat the COVID-19 pandemic, with every pathway forward confronting us with tragic trade-offs. What can science do to help us navigate these trade-offs?

Sometimes science can help us by developing new solutions that minimize just how tragic our trade-offs need to be. If a new chemotherapy emerges that extends life with few side effects, a patient’s choice becomes much easier. In the case of COVID-19, if scientists develop safe and effective treatments or vaccines, we will be able to scale up social activity with less fear of catastrophic health consequences. Even in that best-case scenario, however, we will face difficult choices beyond the scope of science to answer, such as how much companies should be able to charge for medicines and vaccines, and who should have early access to those interventions when they come to market.

In the absence of virus-thwarting treatments or vaccines, science can help us by illuminating the likely impact of competing mitigation strategies on general public health. This kind of predictive science is quite different from the clean and precise science of a beaker-filled laboratory. It involves complex mathematical models, with estimates changing based both on the assumptions underlying any given model and on rapidly evolving information available to plug into the models. Such models give us an educated estimate of, say, future COVID-related deaths, and how death rates change if we pursue one mitigation strategy versus another. However, predictive modeling cannot tell us which strategy is best. The choice of mitigation strategies will depend on societal value judgments about the risk of infection we are willing to tolerate to resume specific activities.

Science can also help us navigate the pandemic by shining an empirical light on the broader effects of COVID-19, and the strategies we use to fight it, on our lives. Infectious disease experts understandably focus on how various mitigation strategies influence rates of infection and death from COVID-19. These are incredibly important scientific facts to have at hand when we make policy choices. But our national response to the pandemic should also take account of other scientific facts and estimates. We need medical scientists to help us predict how various mitigation approaches influence illnesses not related to COVID-19. We need education experts to help us understand how online education affects our children. We need social scientists to help us understand how unemployment affects mental and physical well-being.

Even if scientists accurately lay out these effects, navigating this pandemic will force us to make difficult choices. Opening up schools will make children better off educationally, emotionally, and socially, but will also create health risks that will largely be borne by adults. Science can help us understand these competing risks and benefits, but only political processes can determine how we weigh them.

It is a tragedy to disparage the role of science in navigating this pandemic. The cost of this disparagement will be paid for with American lives. It is inspiring to see governors from both sides of the aisle committing themselves to a more scientific approach. In doing so, however, they shouldn’t pass the political buck by saying they are “following the science.” They need to explain to their constituents the possible paths they are considering to lead us out of this crisis. And then they should show us what science tells us about the likely consequences of choosing any given path over another.

Peter Ubel is a professor at Duke University and author of Sick to Debt: How Smarter Markets Lead to Better Care (Yale, 2019).