The Covid-19 pandemic was an “existential moment” for the use and abuse of knowledge, with complex issues often falsely framed as black-and-white, according to one of the main architects of the Government’s response.
Critics of Covid policy “wilfully misconstrued” science and tried to shut down debate with over-simplifications, former deputy chief medical officer Dr Ronan Glynn said.
Dr Glynn was delivering the annual Doolin memorial lecture hosted by the Irish Medical Organisation on Saturday, speaking “In Defence of Uncertainty” in medicine.
Dr Glynn, who has left the Department of Health to work for consultants EY, described the start of Covid as a classic “wicked problem”.
“It had no clear definition, the situation was constantly changing and every attempt to solve one problem inevitably led to another. There was very little information on the virus itself, how it spreads, who is most vulnerable, how to treat it, and especially how it would evolve over time.”
Because everyone had different circumstances, they experienced the pandemic differently, he said. Yet people had to work together because each of their actions had the potential to impact on everyone.
Covid was also the first pandemic of its kind in the era of social media: “It was effectively live streamed with developments reported in real time, and masses of often contradictory information coming out day after day after day. It was challenging for people to know where they should look up the most accurate information.”
Science “stood up like never before” with the rapid sequencing of the Covid genome, the publications of tens of thousands of research articles and the quick development of vaccines.
Science does not exist in a vacuum and is not “some monolithic body” of agreed opinion, he said. “It rarely provides a clear indisputable course of action. Uncertainty, and changing views among scientists and doctors are enormously important and constructive part of scientific debate on the scientific process.”
“During the pandemic, these uncertainties, the necessity of working with imperfect and incomplete and changing information and the need to change course regularly, were exposed to the public like never previously.”
“Unfortunately, as part of that, there were many who sought to take the normal parts of scientific process and to wilfully misconstrue them and the evidence that the science is producing. This in turn had the potential to create doubt and amplify uncertainty.”
“Added to this were attempts by some to frame issues as either black or white, when the reality was what all of us were dealing with on a day-to-day basis could best be described as a shade of grey.”
“Such framing was often used to polarise or to shut down debate, to oversimplify really complex issues and ignore or obscure nuance,” he said.
Dr Glynn said the last few years have been a time of great uncertainty for everybody. Doctors need to communicate that uncertainty does not equate with failure, that it is ubiquitous and an inevitable component of science and medicine and that doctors do not and cannot know everything, he said.
“We need to communicate to the media and wider society that scientific and medical research is rarely conclusive, that no test is 100 per cent accurate and that many diagnostics are not easily circumscribed entities.”
“The right decision is usually about much more than the empirical evidence, while a prognosis is an informed estimate rather than an outcome set in stone. We need to explain that sometimes not taking action is in fact, if based on reasoned judgment, the best course of action.”
Faced with uncertainty, doctors tend to err on the side of caution, he pointed out, resulting in excessive health costs, unnecessary procedures and overuse of antibiotics.
Given a world of ever accumulating information and research, where uncertainty is a “routine inevitability of our working lives”, acknowledging its presence and learning how to deal with it is more crucial than ever.
