To question the biomedical consensus is not to lack moral accountability

Publications must always permit debate on the quality and relevance of research – plus the efficacy and costs of derived policy, says Robert Dingwall

September 30, 2020
Illustration of coronavirus casting a shadow, with people standing around the virus.
Source: Getty/iStock montage

“While academic sparring can keep a few sociologists amused during lockdown, we need to remember our moral accountability to a society in crisis.”

The medical professor who wrote those words in an early pre-print advocating the use of face coverings deleted them from subsequent versions. It is, however, one of the more forthright expressions of an attitude that has become increasingly problematic as the Covid-19 pandemic has developed.

Researchers who are sceptical of hastily produced and poorly designed studies, or critical of the policy overreach in the conclusions of others, report increasing difficulty in getting their voices heard or their work published.

These are not people who claim that Covid-19 is a hoax, a conspiracy or caused by 5G phone masts. They are respected scientists who question assumptions about population immunity, suggest that the explanation of the elevated risk among ethnic minority groups may be more complicated than structural racism, or point to the problems in using PCR testing for screening rather than diagnosis. They accept that there was a serious issue in early 2020, when a novel virus might have been an existential threat to humanity. They also endorse the rigorous use of scientific method in understanding and responding to that threat and agree there is a proper role for evidence-based clinical and public health interventions. They simply draw different conclusions from the same data.

As myself and more than 30 colleagues asked in an open letter to the UK prime minister on 21 September, if we now understand that the risk from Sars-CoV-2 is concentrated in specific and well-defined population groups, should we focus our efforts on those, rather than locking down the whole society and economy? 

It would be easy to represent the exclusion of such questioning from the published literature as another kind of conspiracy. As a sociologist, however, I recognise that it is an unintended consequence of deference to a professional culture that has come to dominate science policy in the UK and elsewhere.

It is a privilege to observe biomedical and public health researchers close up; they are clever and committed people doing outstanding science of great benefit to humanity. However, observation also identifies their unexamined assumptions: the knowledge silos that have been created and the failure of policy communities to question the supposed implications of the science.

In particular, we need to understand the differences between biological and biomedical sciences, precisely in terms of their moral accountability. Biologists use neutral language like “mutualism” or “parasitism” or “commensalism” to describe close relationships between species. Biomedicine, however, is founded on the value judgement that certain physical and biological states of humanity should be prevented, corrected, managed. When we use a word such as “infection” or “disease”, we are declaring that some natural process is undesirable and that medicine is the proper institution to correct it.

In practice, the scale and complexity of that enterprise now reaches well beyond people with a medical degree to embrace large numbers of PhD scientists. Nevertheless, this community remains united around the shared goal of remedying nature’s failings, rather than simply observing nature’s workings.

In the present instance, the community is focused on the impact of a novel virus. Once a virus is defined as an “infection”, though, it becomes a moral problem as much as a scientific one. Sars-CoV-2 is not just another microorganism that offers an interesting topic for study. Scientific effort is to be directed towards controlling, suppressing or, if possible, eliminating it.

In such a circumstance, it is easy to slide from a disinterested scientific observation of nature to a commitment to act, even where evidence is poor or imperfectly assimilated by the community. Scepticism about evidence or questions about the policy inferences to be drawn from it can be taken as indicative of a lack of adherence to community values. Voices from outside the community can be dismissed as lacking in moral accountability. In either case, the result can be barriers to publication in the channels recognised by biomedicine.

The institution of biomedicine is very important for the organisation of contemporary societies, contributing to defining the boundary between what is normal and what is deviant. Such institutions make everyday life sufficiently certain, stable and predictable for us to sustain the interactions and relationships that make up our society. But biomedicine is only one among those institutions. Excessive deference to it risks the creation of an “iatocracy”, a society governed by physicians and devoted solely to the pursuit of health, in terms defined by that profession.

Real societies must balance a variety of goals – life and liberty and the pursuit of happiness. There must always be space for publications to debate the quality and relevance of research, the effectiveness of the measures derived from it and the wider social costs of control strategies.

Moral accountability goes well beyond conformity to the values of a particular institution and community of practice.

Robert Dingwall is professor of sociology at Nottingham Trent University and a member of various government advisory groups. These views are strictly personal.

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