Darin Brown“HIV/AIDS” is one of those “hard cases” that illustrate how disastrous can be the scientific illiteracy that is so widespread among science journalists (and among general journalists even more so), among self-appointed science pundits, among the science advisors to governments, among policy makers, and — last but far from least — within the scientific community itself.
Scientists often like to say that no one can understand science without actually having done some. There’s important truth to that. However, it’s also importantly true that you can’t understand science if all you know about it comes from having done some science. Working scientists learn a great deal about the leaves, roots, warts and microscopic components of the particular tree they happen to get fascinated by, but there’s nothing about doing science that automatically brings insight into the whole tree, let alone the forest of scientific activity, let alone the wider societal context with which that forest interacts.
A growing sense of the need for a comprehensive and contextual understanding of the proper place of science and technology in a modern society stimulated the emergence, during the last half century or so, of what has become the almost established yet little known field of “science studies” or “science and technology studies” (STS) — almost unknown outside academe, and within academe about as little known, understood, or appreciated as are, say, departments of religion or theology or religious studies. Two streams of endeavor are at the foundations of STS. One came from technologists, scientists, political scientists, and others concerned that inventions like the atomic bomb, with incalculable potential impact on humanity, could be handled sensibly only by a polity and governance that understands science and technology in all their aspects and implications. The second stream emerged from a recognition among philosophers of science, historians of science, and sociologists of science that their disciplinary insights were inadequate to grasp the totality of scientific activity and scientific knowledge and scientific theories. Thus STS is an inescapably interdisciplinary endeavor, fraught with all the extreme difficulties that attend attempts to bring coherence to a multidisciplinary collection of biases, cultures, and ideologies. Still, despite the lack of a consensual governing paradigm within STS, a few insights are shared across the spectrum of differing approaches, for example:
1. Science and technology are not the same thing. Advances in science will not necessarily lead to important technology.
2. Future knowledge is unforeseeable; future science is unforeseeable. It is paradoxical and counterproductive to aim to support potential breakthroughs by awarding funds to ‘projects’ assessed in the light of the current conventional wisdom.
3. Specific technologies can sometimes be foreseen, but the implications of technology are unforeseeable; and it is virtually certain that any new technology will have unforeseen, unforeseeable, and unwished-for consequences.
4. Because living systems, including human societies, harbor complex interrelationships, even apparently simple individual factors have a multitude of consequences. There is no such feasible thing as ‘only’ wiping out mosquitoes, for example — other living species will be affected; nor can one ‘only’ clean up the environment — the standard of living measured in conventional economic terms will be affected; nor will there be a miracle drug to lower blood cholesterol and leave the rest of a human organism working as before; nor will it make sense to transplant organs until the immune system is understood rather than seen as an enemy to be immobilized.
5. Some of the most worrisome social questions cannot be answered unequivocally. The best available evidence in social matters will always be statistical, and statistical inferences always have a residual uncertainty. Above all: correlations do not signify causation.
6. Science is fallible — individual psychology, social forces, and historical influences affect the direction and performance of science. Nevertheless, science is enormously reliable under normal circumstances.
7. The distinction is vital between frontier science, where much is uncertain, and textbook science, where relatively little is uncertain (within the boundary conditions under which the knowledge was gained). Humanists and social scientists tend to understand the fallibility and contingency of science at the frontier, but tend also to have little if any feel for the enormous reliability of thoroughly tested science; by contrast, engineers and scientists know the enormous reliability of what’s in their texts and reference works without realizing that the same reliability does not pertain to recent discoveries, let alone to extrapolations from them. (For a survey of viewpoints within STS, see A Consumer’s Guide to Science Punditry.)
8. Science is a social activity. As such, it is inherently conservative. Breakthroughs occur despite scientists, not because of them: they occur when reality refuses to have itself molded to current theories. At the same time, the reliability of science depends on the conservatism of science.
It should be evident that at least some of this understanding contradicts directly what “everyone knows” about science — “everyone” including people who imagine themselves competent to hold forth about matters scientific.
Perhaps most pertinent to HIV/AIDS is the little-recognized distinction between frontier science and textbook science. Everything in HIV/AIDS theory is as uncertain and fallible as anything that has been newly observed in a laboratory or in a doctor’s office. “AIDS” was without precedent, and even the now-unquestioned interpretation that it represents a general “immune deficiency” was never established by differential diagnosis, let alone by continued assessment of evidence. Understanding of the immune system at the cellular level was barely beginning in the early 1980s, and the now-unquestioned interpretation that a deficiency of CD4+ cells is crucial has never been established by continued assessment of evidence. Retrovirology was a new specialty. “HIV” is credited with a whole range of unique characteristics for which independent evidence has never been produced. Antiretroviral drugs are introduced with the barest nod to testing their safety and efficacy, and the only valid approach — blinded clinical trials against placebo — is not used.
Despite how tentative remains the basis for much of HIV/AIDS activity, that researchers treat their results as definite until proven otherwise is not particular to HIV/AIDS, it’s in the nature of scientific activity; as also is the fact that researchers treat new publications by others as to-be-relied-upon until proven otherwise. In science, the kudos go to those who push ahead, not to skeptics who try to clean up behind the ground-breakers, who question and quibble and try to prove others wrong in the endeavor to bring genuine reliability to the whole enterprise. What happened with HIV/AIDS is not, on the whole, particularly atypical in principle, it stands out “only” in magnitude and the terrible harm done to many people. All the incentives in science point to going with the herd, and for every maverick who is responsible for an eventual scientific revolution there are untold would-be mavericks whose careers get nowhere. Most scientists, as in most other professions, choose to follow a low-risk path that guarantees a respectably successful career. All budding researchers know that the grants go to those who base their proposals on the prevailing mainstream consensus. Whistleblowers are no more welcome in science than elsewhere. As Sharon Begley noted in a recent article, even when scientists write about having changed their minds, it’s rare that they changed them significantly — the typical “changes” are modifications that overturn no apple-carts. That overall approach, that routine functioning of the scientific system, has served science and society well in most cases, and it’s whistling in the wind to suggest otherwise. STS understands that the big advances come from the headstrong, ambitious, creative bulls-in-the-china-shops among researchers, not from the scholarly, carefully appraising, skeptical scientists who think before they leap. Science is not done by “the scientific method”, even if it might seem like that by long superficial hindsight that overlooks all the trial-and-error mis-steps along the way — see Scientific Literacy and the Myth of the Scientific Method .
The basic problem with HIV/AIDS is that the scientific system that works so well on routine tasks is wide open to catastrophe when something quite new crops up. It’s somewhat analogous to the trade-offs between freedom and security in a democratic society. To ensure that no terrorist events could ever happen, society would have to be as controlled as in the Soviet Union, Nazi Germany, or the dictatorships envisaged by George Orwell; but to allow complete freedom to all would mean little or no safety for anyone.
So one cannot blame the scientific system as such for the tragic mistake of HIV/AIDS and thereupon conclude that the system needs to be changed in some fundamental way. What went wrong is owing only in part to the virologists and their cohorts and the official institutions. There have certainly been rather spectacular displays of incompetence, sloppiness, apparently willful ignoring of evidence, and the like, on the part of a few identifiable individuals. Such institutions as NIH and CDC have displayed bureaucratic deficiencies much more than accountability, competence, efficiency, or due diligence in exercising oversight. Nevertheless, I think a great part of the blame can justifiably be laid at the feet of hordes of ignorant science pundits and science administrators. If there’s one thing that those who manage science and grants should know, the very same thing that every science journalist and science writer should know, it’s the difference between relatively reliable textbook science and utterly unreliable frontier science. REAL SCIENCE ISN’T NEWS. A fundamental problem is that reporting science in a responsible way is incompatible with the media concentration on what’s new and remarkable. No “scientific breakthrough” announced by an individual researcher, a laboratory, an official agency, or a corporation should be accepted with more trust than should be granted to the promises made by campaigning politicians. Even when an announcement is made in relatively good faith, with subjective belief in its essential accuracy, it’s at least partly self-serving and, most important, not informed by the understanding that no new “discovery” can be relied on until it’s been re-discovered and re-re-discovered and has served to guide, successfully, a certain amount of further research that depends on the validity of that claimed discovery.
That’s not difficult to understand. The reasons for it are not difficult to understand. Indeed, every science pundit is likely to hold forth at length about the necessity of peer review. Yet that’s lip service only, not applied in practice. Routinely, press releases from drug companies, directors of federal laboratories, individual researchers and laboratories, are treated as reliable and worthy of disseminating to the general public without further ado. Press releases from politicians and political parties are treated with well-deserved skepticism, but not anything that has to do with “science” or “medicine”; in those connections, our media swallow and regurgitate conscientiously what in better days most people would have recognized immediately as snake oil — say, a vaccine to safeguard against cervical cancer, peddled on the basis that a small number of strains of a particular virus are often associated with cervical cancers. Where’s the understanding that association doesn’t prove causation? Where’s the skepticism that an association with a small percentage of something makes causation even a plausible interpretation? Where is the collective memory of the “gene for breast cancer”, that’s associated with a small percentage of breast cancers but whose detection makes women contemplate disfiguring major surgery as prophylactic?
Illiteracy about the nature of scientific activity is a clear and present danger in this self-styled “scientific” and “modern” age, and innumerable “science bloggers” and science pundits illustrate that daily in their uninformed herd-like comments about HIV/AIDS. Scientific illiteracy isn’t about knowing what a molecule is, or a retrovirus; it’s not realizing that science isn’t done by a “scientific method” ; it’s about knowing that science can’t be guaranteed to deliver what it promises any more than a politician can; it’s about realizing that scientists are super-specialists blinkered to anything outside their immediate interest, and that the best people to consult about science policy and the assessment of a scientific consensus are historians of science, sociologists of science, ethicists and philosophers of science, especially those who have also done some science themselves at one time or another. Presidential science advisors and congressional advisors about science and technology should be drawn to a major extent from the young community of STS — as was indeed the case with the congressional Office of Technology Assessment, which was disbanded out of nothing short of political spite after partisan disputes over access to it.
HIV/AIDS Skepticism 