The wisdom of nature and the folly of experts

The global response to Covid 19 has been a teachable moment illustrating the limited boundaries of our knowledge. Not even claims of having developed vaccines in remarkably quick time can gloss over the reality that we still do not know how it originated and spread, what holds for us in terms of future mutations, the timing and nature of a possible third wave etc. In the last eighteen months, expert opinion has vacillated from one idea to another, one moment advocating something to debunking the same a few weeks later. It should have been a sobering reminder about the limitations of experts and expert advice. However, it's unlikely to be the case. 

I had blogged here and here in the early days of Covid 19 cautioning against the folly of relying on expert advice and urged a more nuanced approach that sought to accommodate and co-exist with the virus. 

Ananth points to a very good essay by Norman Doidge who provides a perspective on human beings search for solutions that seek to "eliminate" the virus.

Ancient science was attractively harmless: It saw human beings as inseparable from nature, and tried to describe the web within which we dwell... Nature—as the ancients understood it—was seen as a whole, likened to a vast living organism, meaning something alive and organized... Nature, they believed, could be understood... as in some way, partaking of intelligence. This kind of intelligence, called nous, was not merely the highest human faculty, but also a transcendent principle manifest throughout the cosmos. It was because the human microcosm mirrored that macrocosm that we had the capacity to understand, and resonate with intelligible nature in awe and amazement. This was knowledge for its own sake, a dignified form of contemplation of a cosmic order that inspired the questing feeling that, according to Socrates, underlies the fundamental philosophic attitude: Wonder.

But modern science sees knowledge as power—and science as a means to other, greater, more useful and more practical ends. Since its origins, modern science has emphasized that “nature” is harsh, and often rallies against us, and so, following Francis Bacon (1561-1626), has come to see itself as a method of mastering nature, “for the relief of man’s estate.” Henceforth, “utility” was science’s purpose, not wisdom, and nature was there not to be contemplated, but conquered... Thus, Bacon weaponized the wonder that drove ancient philosophy, and spoke of using the new science to extend “the empire of humanity” over “the universe.” He was to science what Machiavelli —to whom he explicitly said he was beholden—was to politics: He discarded the ancient approach to nature, which took as the primary question of study, how we might understand it better, to live, “the good life,” in accord with nature, and replaced it with the study of the science as a means to acquire power, to master nature.

In the world of Covid 19, this scientism meant that our collective objective was to eliminate the virus. And the consequences of responses motivated by such scientism are often counter-productive.

The officials, blinded by the eradication at all costs mentality, discarded the practical wisdom required to respond to such a crisis, and endorsed an intervention that defies the standard public health practice of taking a holistic approach and always taking into account a measure’s total effects, and not just its immediate effects on the pathogen labeled as “the invisible enemy.” “COVID denial” is real. So is “COVID-management-induced-devastation denial.” The term, in medicine, for the inadvertent harms caused by a medical treatment is “iatrogenic” harm. Because public health exists on a massive scale (compared to individual doctoring), when public health officials make iatrogenic errors, millions suffer. Iatrogenic errors are underestimated for long periods because they are often made with the best of intentions (which is part of the reason they are missed, and repeated), until there is a sudden reckoning. A good rule of thumb is that the more the practitioners are certain of their good intentions (as they define them), the more vigilant we must be about the iatrogenic possibilities.

An alternative and more holistic approach that the essay points to is the work of Janelle Ayres,

She says, “The way we have been thinking about treating infectious diseases is that we have to annihilate the pathogens through vaccines and antimicrobials.” She completely reframes the problem, and challenges our thinking: “Instead of asking how do we fight infections, we should be asking ‘how do we survive infections?’”... The project of developing these new kinds of therapies (which is well underway in Ayres’ lab) requires having a better understanding of the “tolerance defense system,” alluded to above. Not every infection kills us, in part because an innate tolerance system has already evolved to help our bodies coexist in the sea of microbes in which we live, and which dwells within us (the microbiome). It is the product of a cooperative two-way evolutionary process.

To understand this cooperative co-evolution, it’s best to first look at its “opposite,” the traditionally studied antagonistic co-evolution. An organism gets inside us, we evolve ways to kill it, then it evolves ways to resist that, and perhaps we, the host, evolve more aggressive means of attack, but that also leaves us with an overactive immune system, which perhaps then also predisposes us to causing collateral damage to ourselves. This basically describes the traditional immune resistance system, and the collateral “autoimmune” damage it causes. This is not good for us, but, if a pathogen’s host dies it is not necessarily helpful to it either. After all, once the pathogen gets inside us, we are its environment, so, if it kills us (a Baconian specialty) it’s created a disaster for itself (as it were)... In a more cooperative co-evolution, as Ayres calls it, both host and pathogen acquire traits that are not mutually destructive. 

Ayres hypothesized this must exist, and then began demonstrating it did. In cooperative host microbe evolution, cycles occur, in which the host influences the microbe and the microbe influences the host, such that they co-evolve, together, and cause each other to select for traits that maximize their mutual ability to both survive, and replicate. From the point of view of the microbe, for instance, it does well to develop traits that let it acquire nutrients from our bodies to meet its metabolic demands, and to replicate, and get passed on to another host, whom we can meet at a party, because the microbe hasn’t killed us... In this situation, there is an evolutionary pressure on the organism to develop mutations that are less lethal (which happens sometimes) and Ayres and her lab have shown that the host can, in certain cases, trigger these anti-virulence traits in the pathogens, so that while they are present in a host, they don’t trigger a disease. 

In this context, Howard Marks points to two excellent analogies of how systems contain within themselves the mechanisms to treat their problems

In the forestry business, if there's a small fire they let it occur and sometimes they even cause some small fires to burn up the fuel that lies on the forest floor. And if you don't permit any small forest fires, when you finally have one that you can't put out right away, you're going to have a doozy because of all the accumulated fuel on the forest floor.

I believe that if they prevent every recession, that will give rise to such excesses on the high side, it will be, as I say, unsustainable and will cause a recession and that's going to be a doozy. So it just seems to me that if I were running Fed, which I'm absolutely unqualified to do, I would opt for leaving it alone most of the time, the economy, and having it do what it does naturally...We're all in the investment business because we believe in the efficacy of the free market as an allocator of resources. So if you do, then shouldn't you leave the economy and the capital market alone as much as you can so that it can freely allocate resources?

Or on similar lines from John Kay in his book on Obliquity,

From the early twentieth century, the policy of the National Park Service (NPS) was one of zero tolerance. Every outbreak of fire, however small, would be extinguished – the basic-level action. But the incidence of fire did not fall: it increased. Computer simulation of fire control policies suggests the explanation. Most forest fires are small and burn themselves out. In doing so, they remove combustible undergrowth, and create firebreaks that limit the spread of future fires. So the best way to reduce fire is not to extinguish all fires. The Service adopted a different view of the goals that would achieve its higher level objective: controlled burning replaced zero tolerance. But what actions does this goal require? In 1972 the Service decreed a new policy: it would put out man-made fires but allow natural ones to burn.

Sixteen years later, the largest fire in American history swept through Yellowstone National Park. In extremely dry conditions, several fires joined together. Lightning was probably the original cause, though perhaps some fires were lit deliberately by arsonists. By the time the blaze was controlled by a force of 25,000 fire-fighters at a cost of over $100 million, almost half the vegetation of the park had been destroyed. Today’s guidelines allow experienced forest rangers to use their judgement in deciding which fires should be tackled and which left to burn. Experience has shown that too much effort devoted to fire extinction is counter-productive. But some fire-control activity is essential. Time demonstrates, but only slowly, whether policy has gone too far in one direction or the other – whether actions are appropriate to states, whether goals are appropriate to objectives.

However, striking out on your own and opposing the conventional wisdom can be very hard.  

It’s not that modern science doesn’t produce some scientists who urge caution. It’s just that it also creates an appetite, and a climate of opinion, in which those who counsel restraint and moderation (another ancient, but not a modern virtue), just about always lose eventually.

On treading this lonely path, Ananth again points to another essay by Ann Bauer about her personal struggles in fighting the conventional wisdom in treating autism in her son. She describes the sway till the early nineties of the theories by the fraudulently fabricated theories of Bruno Bettelheim over autism diagnosis and treatment.