The Challenge

Back in March 2020 when the pandemic swept through the West, we as a society were dealing with a series of unknowns:

  • We were unsure of the origins of the virus.
  • We were unsure of the lethality of the virus.
  • We were unsure of the biological mechanisms (pathophysiology) by which Covid-19 caused illness.
  • We were also unsure about the types of medical and non-medical interventions that could be used to help individuals and wider society.

In this context, it is perhaps no wonder that governments around the world instituted lockdowns and mandated different NPI’s (non-pharmaceutical interventions) to try and stop the spread. They had to rely on computer modelling of what the future might look like, rather than rely on the established approach of evidence-based medicine, and the evidence-based medicine hierarchy (which you can see below).

Evidence-based medicine (EBM) is defined as ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients’. Again, this lack of ‘best evidence’ may help to explain decisions by governments back at the start of the pandemic.

However, as we sit here in September 2021, we are in a very different world from a scientific perspective.

There is now an abundance of observable real-world data that have passed the rigorous peer review and contributed to a huge amount of EBM research.

In fact, if you go to PubMed and search “Covid-19”, as of today, there are 164,804 studies available.

Not only that, there is 3,542 meta-analyses and systematic reviews on the topic. As you can see from the EBM hierarchy above, this type of research sits at the top of the EBM hierarchy.

These studies filter through the published research, seek to account for factors that can bias results (sample size, dosage, timing, conflicts of interest, etc.) and synthesise the evidence on a given topic to help our understanding.

With all this published data freely available, a reliance by governments on theoretical computer modelling to shape future public health policy would be deeply unscientific.

We believe it is important for all of us to understand the essentials of EBM.

Every day we are exposed to new studies shared in the news and on social media. Knowing this hierarchy enables you to begin to understand the potential quality of that data based on the EBM hierarchy.

This perspective was summed up well by clinicians in an opinion piece in the British Medical Journal:

The principles of EBM are more important now than at any other time in our careers. We must collectively do all that we can to ensure our response to the pandemic is based on science and not on emotional, political or economic issues that challenge it.

As the evidence base changes, we must too.

"Where we have good, testable explanations, they then have to be tested, and we drop the ones that fail the tests."

- David Deutsch

Embracing Fallibility

This willingness to change our perspective, beliefs and approach as new evidence emerges is vital in the scientific process. Science is about embracing fallibility and using EBM to improve our understanding and knowledge over time through testing hypotheses.

As David Deutsch so elegantly put it in the book, “The Fabric of Reality’:

An entire political, moral, economic and intellectual culture – roughly what is now called ‘the West’ – grew around the values entailed by the quest for good explanations, such as tolerance of dissent, openness to change, distrust of dogmatism and authority, and the aspiration to progress both by individuals and for the culture as a whole.

Indeed, the Enlightenment of the 18th Century was all about rejecting the idea that knowledge required authority: that we should believe what kings, queens and leaders say just because they have authority. This is why the Royal Society in London, one of the earliest scientific academies founded in 1660, embraced its motto as ‘Nullius in verba’, which translated equate to a phrase like ‘Take no one’s word for it.’

In short, progress for the last few hundred years have required fallibility, testability and refutability. As the legendary scientific philosopher Karl Hopper once said, “If observation shows that the predicted effect is definitely absent, then the theory is simply refuted.”

Why is this discussion on the philosophy of science important today? 

It’s perhaps never been so important.

For the last eighteen months, we have all been exposed to public health messaging that so frequently lacked this willingness to embrace fallibility.

We have been told to follow “The Science” as if it is a single identity rather than a process that contains uncertainty, evolution and debate.

The censoring of different opinions serves only to increase cynicism, mistrust in authority and deeper division.

To come out of this together with compassion and wisdom, we must embrace the scientific process and evidence-based medicine and hold those we elect accountable as such.

We write this from a place of love and desire to help everyone collectively move forward with lessons learnt and a positive passion for the future.

Justin Buckthorp, MSc

Justin Buckthorp is the Founder of 360. He has over 20 years of experience in health and wellness and is passionate about improving people's lives.

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