Not all science is plausible!
Harvey Risch has been a consistent voice for sanity and rationality during the COVID pandemic. Though he may have been largely ignored or pilloried by the political class, I have no doubt that his analyses will continue to withstand the test of time.
His latest piece, Plausibility But Not Science Has Dominated Public Discussions of the Covid Pandemic [1], does a great job of supporting what used to be one of the pillars of science: the scientist must review data and analyses objectively and without favor. It does not matter who thinks what … it matters what they can support. As Einstein supposedly responded to the hundred (or so) authors who publicly denounced his theory of relativity:
“It would not have required one hundred authors to prove me wrong; one would have been enough.”
Main points
The main points of the article are, in order of appearance:
Plausibility motivates but does not dictate science. Many plausible statements are wrong. Many true statements initially seem implausible. Careful, learned analysis and experimentation is needed to properly distinguish the two.
Evidence-based medicine is a term of hubris. Medicine has always been based on evidence, not in whole but in part. It remains that way, and the moniker “evidence-based” is used as a crutch to prop up bad science.
Randomized Controlled Trials can be woefully wrong. It is extremely important that they be run with sophistication, instead of being provided immediate prominence solely on the basis that they are “randomized”.
Empirical evidence can (and often is) as powerful as poorly run RCTs. As a result, every study must be judged carefully and on its own merits.
Criticisms of hydroxychloroquine (HCQ) for early COVID treatment are not well founded. The papers attacking this medication were hopelessly flawed.
My Criticisms
Although I feel that the articles is excellently written and conceived, I do have some criticisms for the author (as I do for any work I review!):
Prof. Risch is too easily offended. He is insulted by the “evidence-based medicine” crowd, a flawed paper on randomization, publication of bad papers in medical journals, etc. I understand the offense and even empathize with it … but I do not feel that it does anything to strengthen the paper. Au contraire, it injects unnecessary emotion into a rational debunking of popular irrationality.
The argument about the plausibility of the heliocentric orbit of Earth, due to 335 years of observational data, is a red herring (see “The Copernican Revolution” in my piece, Climate Science and other religions).
Given a choice between a generic politicized observational trial and a confounded randomized trial, I would still generally prefer the latter because it reduces the risk of error. The reality is that there will be bad science out there … and probably even that it will be the vast majority of what is published. We cannot eliminate it, but we can try to guide it with best practices, caveats, and, most importantly, humility.
Quotes
“Dr. Fauci has not reported accurately on scientific questions throughout the Covid-19 pandemic … the essential dialectic of science is arguing, questioning, debating. Without debate, science is nothing more than propaganda.”
“… we hardly think about the plausibility of elliptic heliocentric solar system orbits… But we might balk at thinking it plausible that light travels simultaneously as both particles and waves … and we can choose to observe either particles or waves, but not both at the same time. Nature is not necessarily plausible.”
“Historically, pharma control and manipulation of RCT evidence in the regulation process provided an enormous boost in the ability to push products through regulatory approval into the marketplace, and the motivation to do this still continues today.”
‘A bigger failure of evidential reasoning is Sackett’s statement that one should use “the best available external evidence” rather than all valid external evidence.(Hartling et al., 2013; Bae, 2016).’
“The problem is, RCT studies essentially never explicitly demonstrate adequate randomization of their outcome subjects, and what they purport to show of randomization for their total treatment groups is almost always scientifically irrelevant.”
“Censorship is the tool of the undefendable, since valid science inherently defends itself. Until the public begins to understand the difference between plausibility and science and … [the] science “product” that looks like science but is not … leaders seeking authoritarian power will continue to rely on it for fake justification.”
[1] Harvey Risch, Plausibility But Not Science Has Dominated Public Discussions of the Covid Pandemic, Brownstone Institute, November 26, 2022: https://brownstone.org/articles/plausibility-but-not-science-has-dominated-public-discussions-of-the-covid-pandemic/