“Sheltering at home” for the past nine weeks here in Silicon Valley with no definitive end date reinforces that these are difficult and unusual times. As engineers and scientists, we have an obligation to separate reality from wishful thinking. The Scottish philosopher Hume said a guillotine is necessary to separate what is, from what it ought to be. Or in other words do not tailor your experiments to fit a preordained result. Just because man is a social animal does not disprove or reduce the value of “social distancing”.
Science must lead. While “politics may be the art of the possible…” as phrased by Otto von Bismarck, politicians must base their decisions based upon science. Following personal whimsy or party ideology contrary to the science is not only immoral but extremely dangerous. Yes, science may be messy or inconclusive but done properly it is our best understanding of reality. Declaring gravity non-existent, believing the world is flat, or other attempts to argue with reality are counterproductive. Yes, it is easy to float ideas that offer hope, but reality requires stringent proof and testing. Some elements we need to consider as we navigate challenges especially those of the COVID-19 pandemic:
TIME: It may take years to prove a hypothesis and even longer to change the mind of non -scientists. Nicolaus Copernicus’ astronomical model of heliocentrism, published shortly after his death in 1543, challenged 1500 years of acceptance of Ptolemy’s model in which the sun and planets were thought to revolve around the earth. Even though his intent was to help improve the accuracy of the calendar, he was branded as a heretic. It was not until the 17th century when Sir Isaac Newton and contemporaries proved the fundamental correctness of Copernican heliocentrism. Over time common acceptance spread to the majority.
Copernicus’ work laid the foundation on which others could refine and build. The planetary model we use today by Johannes Kepler refined Copernicus’ orbits from circles to the familiar elliptical ones. This is how science works: understanding the physical world by building data-validated models. And in turn, the models are updated when we discover more, especially when we determine the data no longer fits.
ART EVOLVING INTO A SCIENCE: Medicine may have started as an art, but it has evolved into an applied science. The majority of conditions, once properly diagnosed, have clinical treatment protocols that are tested and refined over time. There are still opportunities for creativity and new approaches (the “art”) when patients don’t respond to standard treatments or new conditions are identified. In general, clinical outcomes are better for those treated in the standard method versus when ad-hoc treatments are the first approach tried.
Of course, with medicine there are many challenges that cause re-evaluation of whether the best possible treatment protocols are being used. For example, the specific causes of illnesses may change over time: viruses mutate, individual genetics may play a role, environment factors may change. But just like ‘hardcore’ science a medical hypothesis is formed, research is done, and data is collected to test that hypothesis. Everything from large scale drug trials to small groups testing therapeutic changes are tested for safety and efficacy.
CONTROLLED TESTING: Since medical testing involves people, several aspects including the design of experiment (DOE) are different than in other fields. In medicine the gold standard is double-blind testing where neither participant nor administrators know if the participant is receiving the experimental treatment or a placebo. This is designed to remove any chance of the administrator doing something different or inadvertently tipping the participant off as to their expected outcome. There is also some testing that is simply not possible due to ethical implications or potential harm to the test subjects.
Under normal circumstances, testing starts with surrogates (computer simulations and animals), progresses to very small studies (i.e. a very low sample size), and gradually builds to larger scale testing (large sample sizes to provide sufficient statistical confidence in the results and to identify issues and side effects on the one in ten thousand to one in a million scale). This is done to ensure the safety and health of those in the test protocol since the treatment may be stopped or adjusted based upon preliminary results. It also gives an understanding of how larger populations will respond to the treatment. And this work is done under the watchful eyes of clinical advisory boards, medical conferences, and vetted in peer reviewed journals.
EMERGENCY ALTERNATIVES: So how should/does/did the medical community respond to crises like the current COVID-19 pandemic? They started with standard protocols and shared best practices. Only until they lacked the needed resources or patients did not respond to the treatments did they start to innovate and investigate alternatives. Splitting a ventilator to serve four patients? An act of ingenious desperation that was a better choice than having three patients die due to a lack of equipment. In time the data will show how well this worked as a “second choice” along with the overall protocol of intubation. Preliminary data indicates using other approaches like using continuous positive airway pressure (CPAP) machines – available in greater supply than ventilators – earlier may be a better option than intubation for many in distress.
How about new drug therapies or applying existing ones to COVID-19? Done right they are studied for clinical efficacy and safety in very small trials before being scaled up to larger trials. In an emergency these trials can be “fast tracked” but they still need to be done in a controlled fashion with the proper data collected and analyzed. Even if a new drug is shown to improve outcomes in the short term the long-term effects may not be known for many years. Science takes time, resources, and data. Yes, administrative and bureaucratic aspects (especially the regulatory process) can be reduced but corners cannot be cut in the actual work of science.
BEST OPTION: Sometimes there is no perfect solution and sometimes there are external variables. Getting back to the current situation with many different “social experiments“ on large population groups such as the lock down in Spain vs. voluntary social distancing in Sweden, one must ask is this a controlled experiment? Engineers and scientists can only outline and state the facts based upon the data collected.
And what of elected officials and bureaucrats? Many have earned disdain by ignoring science and/or putting their own self-interest above those of their constituents. Perhaps politicians need a stronger version of an oath of office along the lines of the Hippocratic Oath? At the same time there have been many examples of excellent leadership where politicians head the advice of the medical and scientific communities. These politicians are not shying away from the facts and are making the difficult choices required in this time of crisis. When the ‘dust settles’ the most important task will be to collect and analyze the data as to what can be learned and improved upon in all spheres – medical, scientific, and government.
We will also likely see a wide variation between governments that listened to science and acted quickly versus those that denied the need for immediate action. Similarly, there is a large disparity between governments caught unprepared in terms of resources and action plans versus those who had prepared. At the positive extreme is Taiwan where their Vice President Chen Chien-jen is an epidemiologist by training and was a top health official during the SARS crisis in 2003. Years of preparation and rapid response significantly blunted the impact of the coronavirus in Taiwan. We are all too familiar with the failings here in the US and elsewhere. There will be yet another set of distinctions between those who attempted to return to ‘normal’ too soon or waited until the data was clear.
COVID-19 was arguably not a “Black Swan” event – an unpredictable event with dire consequences – even though many are claiming it is since it had been predicted. Politicians simply chose to ignore the predictions. Bill Gates delivered a very prescient and compelling argument in a 2015 TED talk, the year after the Ebola outbreak, about the need to prepare for the next epidemic. Unfortunately, even using his wealth, his and others’ influence, and the abundance of data this preparation did not remain an ongoing concern for the United States and other governments.
Science even when it is messy and complex – like reality – shouldn’t be ignored just because it is inconvenient, complicated, or does not serve one’s political aspirations. As a society, we ignore science at our peril. As scientists and engineers, we need to advocate for stronger science technology engineering and math (STEM) education to increase the scientific literacy of the electorate.
We would all do well to “remember, if you fail to prepare you are preparing to fail”. (Reverend H.K. Williams, 1919) The COVID-19 pandemic is another reminder that disruptive events occur regularly. We need to be prepared for man-made disruptions such as technology innovation, financial crises, acts of war, etc. and natural events such as earthquakes, floods, famine, disease, etc. No, we do not all have to build bunkers in New Zealand “just in case”. But we should think through the downside risks of these predictable – even if very low probability – events and take reasonable, often small steps, to avoid or mitigate these disruptions to keep them from being full-on disasters.
Corporate bureaucracy can be as bad as government. Protecting continuing operations and infrastructure may block essential changes and destroy future profitability. In addition to having processes to make data driven decisions, professional preparedness requires knowledge of the technology, the markets, and industry history. This is where unbiased outside expertise, such as a consultant, with a wider perspective can guide your team to ensure choices that will yield long-term profitability.
As always, I look forward to hearing your comments directly. Please contact me to discuss your thoughts or if I can be of any assistance.