Our Duty to the Truth

Two months ago, on 29th November 2022, I wrote a Rapid Response to an opinion piece at the British Medical Journal entitled "Understanding and neutralising covid-19 misinformation and disinformation". My reply was longer than the article and the editors chose not to run it (quite possibly for reasons other than length, though). I include it here, unedited, since the points it makes are salient. You do not need to read the original opinion piece for context - it will all be quite clear from my response.

The Worst Thing About CensorshipDear Editors,
This is surely a timely topic, with California having recently passed the controversial legislation Assembly Bill 2098 that the authors refer to in passing. This is a law that allows doctors who express views that depart from 'consensus' to be struck off, and prevented from practicing as doctors. The authors' argument revolves around the claim that that since misinformation and disinformation are by definition a harmful distortion of the facts, such laws are desirable and ought to be pursued. Yet as scientists, we are obligated to remain open to new evidence as to what the facts might be - otherwise, we foreclose investigation and can no longer claim to be acting as scientists.

To a great degree, the authors conclusions rest on a series of presumptions that are not well-supported by any of their chosen citations. For example, it is apparent from the text that the authors have reached the following conclusions about non-pharmaceutical interventions:

a) That 'lockdowns' and other disruption of assembly measures are effective at halting transmission of respiratory viruses and/or SARS-CoV-2 specifically
b) That community masking is effective at halting transmission of respiratory viruses and/or SARS-CoV-2 specifically

The authors do not provide any evidence in support of these assumptions. Instead, they provide a link to evidence that "long covid has risen substantially in children and young people". This is a tangential question, and one that is also a matter of ongoing scientific research and debate. The decision not to provide evidence in support of the implicit claim that non-pharmaceutical interventions are effective constitutes a substantial flaw in this text. Having followed the research on these topics closely for two years, I would personally judge that the balance of evidence was currently against both of these hypotheses, but as a scientist I am always open to hearing new evidence, and would readily acknowledge that the scientific discussion is far from being concluded in these matters.

Because the success of non-pharmaceutical interventions is assumed, and not evidenced, the authors' discussion of mis- and disinformation takes an odd turn. The authors imply UsForThem, HART, UK Medical Freedom Alliance and Children's Health Defence are propagating mis- and disinformation about these and other interventions. Are the authors correct? It's not possible to tell this from their text and its citations. Perhaps more importantly: how could we possibly know if they are correct while these matters are still live research topics...?

It is worth noting that the organisations named are of very different kinds. Conflating a parental activist group (UsForThem) with a research coalition (HART) is a dubious proposition, although it can be acknowledged that there is some political commonality in the groups mentioned, just as there is a political commonality between the authors of this paper and the sponsors of Assembly Bill 2098. This political dimension may be considerably more important than the authors allow.

In the implied denouncement of the previously mentioned organisations, the first two articles cited by the authors are from the Byline Times. One of these pieces claims HART is "a COVID-19 disinformation group which harbours a range of conspiratorial views about the pandemic." This claim is unsubstantiated in this citation and appears quite implausible on the basis of a brief review of HARTs published commentaries. The Byline Times' view is one that could only be reached by pre-supposing the outcome of ongoing scientific research topics. The same article later terms the Great Barrington Declaration (a statement reinforcing what was the standard view on pandemic response up to 2019) a "pandemic disinformation network" - which is an odd and implausible claim, although one that goes beyond the scope of this rapid response to explore. The inclusion of these Byline Times articles as cited evidence significantly weakens the authors claims to speak in a scientific register, as this cited article is a deeply politicised perspective with negligible scientific relevance.

Their third citation is a BBC article that itself contains a factual error: it claims that all the groups mentioned by the authors are engaged in putting out a message 'against vaccines'. But the matter being discussed in the article cited is specifically the mRNA vaccinations for use in the context of SARS-CoV-2, and even then in the specific context of administering these to children. As new drugs, and treatments that received approximately 90 days of safety testing (versus, say, 5 or 10 years of assessment as was expected prior to 2020), conflating doubts about these specific new medical treatments with opposition to vaccination in general (as both the authors and the cited-BBC article engage in) is questionable and misleading. It might even qualify as misinformation - or even, if either party purposefully intends to mislead on this matter, disinformation.

I certainly condemn those who mislead parents by falsifying an NHS Consent Checklist and circulating it, as the BBC article reports. This is certainly not the action of a reputable scientist. But the BBC article does not provide any prima facie evidence against any of the groups the authors mention. Instead, it expressly admits the difficulty in drawing such a connection. Rather, the BBC article assumes that because certain scientists are questioning the mRNA treatments, all such individuals can be grouped together in the vilified category of mis- and dis-information. As scientists, we must take much greater care on these issues, especially given the fact that - as the BMJ reported in November 2021, Pfizer's trial for their mRNA treatment entailed serious data integrity issues.

It is noteworthy that the BBC did not report this story, a point I will return to below.

I would venture to suggest it is implausible to assume any scientific misconduct on behalf of HART et al with respect to what is, after all, a treatment with incomplete safety and efficacy data. It is far from clear to me, frankly, that "contrarian messages" (as the authors put it) are where our concerns regarding mis- and disinformation ought to lie, especially since the engine of scientific discovery is precisely the engagement of contrarian interpretations with our prior assumptions. To be opposed to contrarian messages is to be opposed to the very possibility of new scientific discoveries.

However, the authors are surely correct to draw a parallel with the way that alcohol and tobacco industries distorted the research and media landscape in connection with the health risks of their products. It is plausible to assume that similar interference has occurred in connection with the mRNA treatments, especially given the tremendous advertising expenditure provided by Pfizer and Moderna in the United States via all major television news services, which have played a substantial role in framing debate around these issues.

As BMJ editor Peter Doshi has repeatedly stressed, what is required at this point to restore trust is for Pfizer to release anonymised data of its original trial in order to see where it's "95% effective" figure came from. It is now quite clear from the data on the ground that these treatments were not in any way 95% effective, and it is apparent from the BMJ's whistle-blower story that fraud is one possible explanation for how the now-falsified figure was obtained. In the question of mRNA vaccines and mis- and dis-information, this aspect of the situation ought to be a far more significant area of investigation than "the extent to which groups promoting contrarian messages were able to influence policy" that the authors judge of particular importance.

In this regard, it is worth noting that on 10th December 2020, the BBC announced an alliance dubbed 'the Trusted News Initiative', which included AP, AFP; BBC, CBC/Radio-Canada, European Broadcasting Union (EBU), Facebook, Financial Times, First Draft, Google/YouTube, The Hindu, Microsoft, Reuters, Reuters Institute for the Study of Journalism, Twitter, and the Washington Post. The stated purpose of this media group was to:

...ensure legitimate concerns about future vaccinations are heard whilst harmful disinformation myths are stopped in their tracks.

The implication was that this group would report all factual issues about vaccines. Yet as far as I can ascertain, not one of these sources reported the whistle-blower story covered by the BMJ, which certainly constituted "legitimate concerns". As such, we have reasons to doubt that this media group was able to follow-through on its original commitment, with the inevitable implication that its attempt to prevent mis- and disinformation might ironically have ended up operating as a source of mis- or disinformation in at least some cases.

When we act as scientists, our duty is towards the patient assembling of the truth. This is not something that happens quickly or easily. Prior to 2019, we spent five to ten years establishing the safety of vaccinations before green lighting them for population-level distribution. As such, the earliest we could realistically expect to be able to make assessments of mis- or disinformation with respect to these new mRNA vaccines would be in the 2030s, when there has been sufficient data gathered, and time for adequate debate. Unless that time has passed and that discussion has occurred, it is impossible to ascertain with any certainty whether groups like HART will have their concerns vindicated or disproven. Certainly, it is premature to assume on the basis of a single BBC article that HART is a greater risk of mis- and disinformation that, say, Pfizer, for whom the BMJ has already confirmed malfeasance.

Ultimately, the authors suggestion that the inquiries into the response to SARS-CoV-2 ought to be widened to examine the extent to which "groups promoting contrarian messages" feels terribly misguided, even on the logic of their own discussion. If it were reasonable to expand the inquiry into such areas, the priority ought to be establishing the extent to which news organisations such as those who joined the 'Trusted News Initiative' were unduly influenced by pharmaceutical companies in a manner parallel to the author's references to alcohol and tobacco companies. The question of importance here ought to be the degree to which scientific investigations have been disrupted by pre-empting the dissemination of facts and the withdrawal of support for open debate in public channels on the topics of both non-pharmaceutical interventions and mRNA vaccines.

It is hard to avoid the conclusion that what should be topics of open scientific enquiry and debate have become politicised, and therefore distorted. If we are acting as scientists, this concern ought to be of far graver importance than attempting to police singular interpretations of the facts by smearing alternative interpretations as mis- or disinformation. The authors consider Assembly Bill 2098 in California an "appropriate course of action". Contrary to this opinion, I would call it a shameful betrayal of the ideals of scientific discourse, and a potentially unlawful attempt to supress both free speech and open scientific enquiry.

If we are scientists, our first duty is to the truth, no matter how elusive it may be. When we pre-empt the ongoing search for that truth, as every attempt to assert the categories of mis- and disinformation on an active research topic must necessarily entail, we are no longer acting as scientists. We have let our political beliefs blind us, and we have betrayed the very ideals upon which scientific investigation rests.

Dr Chris Bateman

Open Data

Alma Thomas - The EclipseOpen source began a cultural movement back towards the commons that for the first time established a form of solidarity within technology. At its heart, the open source movement argues that the computer code behind software ought to be publicly available, for both ethical and pragmatic reasons. But open source isn't enough. What we may need to complete this transition is open data.

The recent news that Elon Musk's bid to takeover Twitter is back on the table has created the usual stir. The new left, committed to a censorship it deems entirely necessary, is up in arms about how this will allow the right back onto Twitter, which is apparently a disastrous proposition. But the suggestion that censorship is 'necessary for democracy' is laughable if all this means is "I don't want to have to listen to what my political opponents have to say". Democracy requires the free exchange of ideas, and the moment one faction is given the power to decide what speech is or isn't permitted, we are deep into the territory that Orwell's 1984 warned about.

This sudden zealotry for censorship has collapsed scientific discourse in the last two years, not because research has ceased to function, but because dissemination has faltered. It has been surreal to find open scientific discourse driven underground where, oddly, it thrives, although while it is trapped there practitioners have to interact with folks holding fringe beliefs who I imagine have been excluded from polite society for quite some time. Meanwhile, it seems far too many people (including and especially doctors) trust the media to accurately inform them, which reporters have shamefully ceased to do, preferring one-sided phantasmal narratives over authentic investigation. Alas, if the behaviour of the Vatican in the Middle Ages didn't sufficiently warn of the dangers of allowing institutions to control thought, then the surreality of these past two years will presumably also fail to teach us the lesson we neglected to learn from history. The substitution of enforced consensus for scientific discourse is not a path to truth, it is the utter denial of it.

When Musk declared that Twitter was the "de facto public square", I believe he was absolutely right. Don't let the smaller number of users deceive you - Facebook has many more people sharing cat photos, but the political snowball effect that led to censorship and thus enormous global harm originated on Twitter, where a grim consensus formed over speculative health care interventions that was pure fabulism, having no basis in the existing scientific data or practices. Our first step to restoring democracy must be the restoration of civic discourse. Thus when Musk revealed his intentions for Twitter, I could not help but feel a glimmer of hope that a 'third accord' to replace the fallen Old Republic of human rights (and the Rights of Man that preceded it) might yet be achievable. This third accord may not even need the actions of the nation states to bring it about.

It is fascinating to dig through the private messages that Musk disclosed for the lawsuit between him and Twitter. Two exchanges leap out at me in particular. Firstly, one with former Twitter CEO Jack Dorsey, who suggested on 26th March 2022:

I believe it must be an open source protocol, funded by a foundation of sorts that doesn't own the protocol, only advanced it. A bit like what Signal has done. It can't have an advertising model. Otherwise you have surface area that governments and advertisers will try to influence and control. If it has a centralized entity behind it, it will be attacked. This isn't complicated work, it just has to be done right so it's resilient to what has happened to twitter.

And secondly, on 9th April 2022, an exchange with Musk's brother, Kimball:

I have an idea for a blockchain social media system that does both payments and short text messages/links like twitter. You have to pay a tiny amount to register your message on the chain, which will cut out the vast majority of spam and bots. There is no throat to choke, so free speech is guaranteed.

This is not just open source we are talking about here, it is open data. Right now, social media messages belong to the company that provides the tools - who are then both tempted and empowered to censor, as both Facebook and Twitter did to reckless degrees in recent years. This alternate path would see these messages shared as part of a public protocol. You could choose who you want to curate messages for you, because anyone could mount a tool on top of the protocol. Musk also appears to be considering a "marketplace of algorithms" (suggested to him by Matthias Dopfner in an exchange on 6th April 2022), such that those who require personalised censorship for the benefit of their delicate sensibilities might indulge in it without cutting of public conversation at its roots.

It is well worth pondering the case of Alex Berenson, a former journalist for the New York Times who was banned from Twitter in August 2021 for posting alleged 'misinformation'. In fact, Berenson had not posted anything that was not factual, and it was apparent to anyone who had kept their ear to the research literature that Berenson was both in the know and in the right. So convinced was Berenson of the justice of his cause that he took Twitter to court - and won. On 6th July 2022, Twitter was forced to reinstate him. (Although they banned him again on the 8th October 2022...) However, Twitter clearly knew they had no legitimate basis to ban him, as this internal discussion inside Twitter shows:

Twitter discussing BerensonAs Berenson makes clear, this legal ruling against Twitter was technical and concerned violation of terms of service (the court did not, as far as I can tell, explore any of the  specifics of the claims Berenson was making). What's especially interesting about the Berenson case, however, is what the legal disclosure revealed. The Biden administration leaned on Twitter to silence Berenson, because he was challenging (with legitimate cause) the behaviour of the CDC and the FDA, and by extension undermining the authority of the White House. In this regard, Twitter was behaving as a 'state actor', and therefore violated the First Amendment. This is yet another huge and explosive story that is not permitted to be told, but in my view this approaches the Watergate scandal in its despicable audacity.

Those that are committed to supporting Biden because they have been polarised into one of the two major kinds of useful idiot will struggle to accept the evident wrong-doing entailed in this debacle. For such people I am delighted to report that what President Biden allowed to happen on his watch through apparent senility is matched in shamefulness by what President Trump permitted to happen on his watch through incompetence. Apparently distracted by someone in the audience metaphorically jangling some keys, Mr Trump allowed a positively jubilant Deborah Birx and Anthony Fauci to throw away the right to free association that by legal precedent is also ascribed to the First Amendment. You are free to support whichever useful idiot you like, but please don't try to convince me that either of these Presidents has in any sense of the word been 'good'.

Open data would have prevented the White House from pressuring Twitter to silence Berenson, because his messages would have been irrevocably available for everyone to see - as they always should have been. The integrity of the public square matters greatly if we truly believe in free expression, in democracy, in free speech, or for that matter in the value of the sciences, which always rests upon the freedom to discuss all the possible interpretations of the evidence. Trust in 'The Science' is blind faith in magical science, and this is nothing but idolatry, a corruption of everything scientific investigation stands for. This graven image is one that far too many people have been fooled into worshipping by the New Empire, whose primary tool has become the silencing of those who break with doctrine. A shiny new oligarchical cyber-Vatican for the 21st century!

Nor should we think about open data as applying solely to our social media messages. An intriguing suggestion has been made repeatedly by 'El Gato Malo', a retired pharmaceuticals executive and well-known figure in the scientific underground. He was also banned from Twitter, in his case simply because President Trump shared one of his tweets (strange but apparently true!). I am far from convinced by everything the 'Bad Cat' says, and he is clearly politically to the right of anywhere I might choose to sit down. However, I am in complete agreement with him when he suggests that "public health must be made public", and proposes using open data to share anonymized health records publicly. Such an approach would remove, to name just one benefit, Pfizer's ability to hide their trial data and prevent third parties from adequately investigating its veracity, as British Medical Journal editor Peter Doshi has repeatedly called for as necessary. Open data would ensure adequate scrutiny on all public health claims, rather than permitting the tyranny of unelected agencies we have endured for the past two years. It would represent a radical step toward finally decolonising public health.

As I wrote in The Paradox of Conviction, we would rather be certain than know the truth, and this is the underlying psychology that drives sci-dolatry, self-righteous calls for censorship of contrary opinions, and a great many of our contemporary 'culture war' ills besides. If we want to recover the will to discover what might be true, we must be prepared to endure the collision of disagreements. Censorship, 'fact checkers', disinformation committees - these are not means to protect the truth, they are methods of preventing its discovery. Lies require such authoritarian mechanisms to sustain themselves, because they cannot withstand open discourse. The truth never requires us to silence those who have made mistakes, for the truth itself is strong enough to withstand whatever we might say about it.

It is this sensitivity to the dangers of allowing the institutions with power to control public discourse that Musk, and other like him, appear to share. If Musk is an unlikely ally against the New Empire, we can at least be grateful that anyone is still willing to take a principled stand in these dark and wretched times. When I argued at the beginning of the year against the colonial philanthropy of someone such as Bill Gates, whose institute has been a major player in exacerbating the disaster that was the last two years, I proposed that the only legitimate philanthropy was that which restores or expands the commons. Musk's takeover of Twitter certainly entails enormous commercial benefits for him, but then, Gates too has made extraordinary sums of money from his colonial philanthropy. Elites, it seems, do nothing for free. Yet in so much as Musk's motivation in this affair might also include principled goals, it leans towards a philanthropy of the only kind we should be willing to accept from wealthy power elites: that which restores the commons.

The public square is indeed a commons, one that forms the hub of political, cultural, and scientific discourse. The closing of this space through censorship lies at the heart of everything that has gone wrong in the past few years. We will struggle to get beyond the impasse, however, if we do not take the opportunity to reveal and confess all the myriad mistakes that contributed to the global catastrophe that was our response to the SARS-CoV-2 virus. If the Republicans gain the advantage in the coming US midterm elections, we will likely get little more than recriminatory witch-hunts that will intensify the fractures. What we may need to restore both public and scientific discourse is something more like truth and reconciliation, and if I rather doubt we will get it, I remain hopeful there is still a path forward provided at least some of us remain committed to the inevitable ambiguity of truth.

Truth may be elusive, but it is not fragile: it survives the battle of disagreements that it attracts. Truths are like dark matter, exerting an inexorable gravitational pull that we can witness, even though the truth itself remains forever hidden. If we wish to recover our openness to unveiling these intangible truths, all we need is our willingness to talk to one another, to disagree, to debate. That alone has the power to restore scientific discourse, and perhaps to get us beyond this horrific disaster we have recklessly enacted together in a deadly convergence of cultivated fear and misguided ignorance. This restoration of the global public square requires open data, and with it the power to place all discourse beyond the reach of any individual, any corporation, or any government to silence.

The opening image is The Eclipse by Alma Thomas, which I found at the website for the Smithsonian, here. As ever, no copyright infringement is intended and I will take the image down if asked.

The Paradox of Conviction

Topographical3-1200The 1992 movie A Few Good Men gave us the memorable phrase "You can't handle the truth!", beloved by internet memesters. Yet it is just so: we cannot handle the truth, and indeed we would far rather have certainty than know the truth uncertainly. Certainty brings with it a contentment that we long for, even while we profess that our longing is for the truth. We want to know, we say... but what we desire is the certainty we call 'knowledge', or 'science', which we then falsely conflate with truth. We are not committed to the truth at all. We are desperately seeking certainty - and will sacrifice anything - even and especially the truth - to get at it.

Here is a paradox: certainty (a mental state) seems to rest upon alignment with the truth. We think that if we know the truth, then we are certain. Therein lies precisely the pitfall - we feel certain, and this feeling has nothing at all to do with whether what we are feeling certain about is true. Yet beyond doubt, the only thing our feelings can offer certainty upon is how we feel - and even then, we can be deceived. We can persuade ourselves that we hate someone we love, or vice versa. As Wittgenstein realised, our mental state of conviction is in no way dependent upon any associated truth.

In the grab-bag of half-developed ideas that is contemporary psychology, it is accepted that we are uncomfortable with uncertainty. One experiment conducted in 2016, based upon the ever-popular delivery of electric shocks, suggested people would rather be given a shock immediately than suffer one at an indeterminate point in the future. The amygdala, which mediates fear and anxiety, can be activated by incomplete information - consider a simple example of having said something that you worry might have caused offence. Not knowing is, in itself, a significant cause of anxiety. Certainty alleviates fear.

It is therefore not surprising that we have made an idol out of this thing we call 'Science', which no longer means (as it once did) 'knowledge'. Two centuries ago, many and varied were the things that could be called a science. Today, this term denotes the exclusive authority of those experts upon whose say-so we attain certainty. Yet the history of the sciences is not just theories being replaced with later theories that explain situations with greater accuracy. It is also the history of plausible-sounding gobbledegook that was accepted as knowledge by humans who placed more value on certainty than on truth.

The psychological description of this kind of certainty is nothing of the kind: it is literally faith. Never mind the mismatch between belief and certainty we ascribe to the religious - this has little to do with religion and everything to do with human nature. Our desire for certainty is such that we will take claims on faith as long as in so doing we can feel certain. The truth, on the other hand, is always uncertain. It is only in logic and mathematics that a system admits of truth by 'proofs', which is to say, reliable inferences from foundations that are secured by definition. Once we depart from the artifice of constructed systems, truth lies distant from us and requires tremendous effort to uncover - and even when it is uncovered, it is still uncertain.

And here we are today, still just as human as we ever were. We hide from the truth because it is too challenging - too exhausting! - to seek it, and also because that very search is neither guaranteed nor likely to end in certainty. Instead, we choose certainty, by whatever means it is offered to us. A hypothesis dressed up in theoretical clothing. A non-binding referendum that becomes binding. A fallacious argument from authority. Any escape at all to avoid dealing with the inevitable uncertainty of the truth.

This is the paradox of conviction: we are certain that certainty is truth, and that only the truth deserves our certainty. Thus, we fail to accept that uncovering the path towards truth requires a commitment to uncertainty. The most essential skill for any scientist to cultivate is the one we don't want from them: an openness to the inevitable uncertainties of scientific practice. Certainty and truth are not one and the same, but the exact opposite of one another. Knowing this, we still gladly choose certainty over truth, without hesitation. We must know, and we must know with certainty... and so the truth is forever barred to us.

The opening image is Conviction by Dan Sisken, which I found at his art blog. As ever, no copyright infringement is intended and I will take the image down if asked.

Scientific Truth and Political Reconciliation

Contains ideas some readers may find offensive.


Between 1948 and 1994, South Africa suffered under apartheid, which treated 'whites' as superior to 'blacks', and maintained a state of segregation by force for decades. Under this brutal regime, South Africa's police force routinely tortured political dissidents and caused the violent deaths of a distressing number of black people. When this repressive government fell after the release and election of Nelson Mandela, the country faced an immense challenge: how could it rebuild trust between its citizens? Their solution was a 'truth and reconciliation' commission, which listened to the tragedies suffered and invited those who had endured the worst human rights abuses to testify. The commission offered amnesty from prosecution to all who came forth to speak the truth about what had happened under apartheid. South Africa rebuilt trust between its citizenry through pursuit of the truth, which fostered reconciliation between those who had once been enemies.

We too now stand in need of truth and reconciliation. Throughout 2020 and 2021, the world experienced its greatest catastrophe since the Second World War. Like that dreadful conflict, this disaster flowed forth from human technological advancement. The war in the 1940s was facilitated by the creation of tanks, planes, bombs, and advanced weaponry, culminating in the detonation of nuclear bombs. In one version of the many stories being told about the ruinous events we just endured, they were initiated by genetic tinkering with a bat virus and accelerated by a rash attempt to deny that a research lab was responsible. Whatever the truth about its origins, the crisis reached its calamitous apex through a witch's brew of psychological 'nudging', the polarising effects of social media, and the negligent substitution of computer modelling for empirical evidence. Citizens were turned against one another, segregation and subjugation was maintained by force in nations who had previously sworn to uphold the rights of their citizens, and a great many people died who need not have died - from both the disease and the measures deployed against it.

It will do no good to simply shrug and mutter 'public health', as if this abject failure of scientific process, medical safeguarding, human rights law, international aid, academic credibility, and journalistic integrity could simply be waved away by invoking this phrase. Public health, in the sense this term has traditionally been used, represents an alliance between medical research and political goodwill. Its effectiveness rests upon the trust that citizens have in the agencies which pursue collective health benefits for its citizens. When that trust fails, public health falls with it, as I argued last week in Decolonising Public Health. By choosing to align public health goals with political partisanship, rather than scientific evidence, we shattered the very conditions for good public health policy.

When the measures justified by those in charge of public health messaging are based upon political allegiance rather than due scientific process, we are no longer dealing with medicine as we have traditionally understood it. 'First do no harm' is an impossible principle when definitions of 'harm' fall out along partisan lines, for what one faction declares as essential will appear to their opponents as a cause of great harm, a situation we have already faced for half a century over abortion. Once this factional state of affairs infects medical discourse, 'public health' ceases to be either scientifically or ethically justified, and becomes instead an excuse for the anxious fears of the citizenry to manifest in authoritarian repression against those who do not share that terror.

As with South Africa, truth and reconciliation offers a possible path out of this disaster. Yet this route is blocked until we can admit the extent of our failure. This is something political partisans are largely incapable of doing, for at all times the origin of every problem belongs to the others, and it is their refusal to accept our arguments that we blame for everything that goes wrong as a consequence. We are blameless, because our politics defend the good whereas their politics are confused, ignorant, even barbaric... Not only public health, but scientific truth itself is endangered by this chasm of self-valorisation. Far from the twentieth first century becoming the golden age of achievement imagined by the science fiction writers, we have instead driven into the shadows the open debate that is central to good science.

This did not, however, begin with the SARS-CoV-2 debacle... On 17th January 2003, the best-selling author of Jurassic Park and The Andromeda Strain, Michael Crichton, delivered a blistering address at Caltech attacking the relatively new trend of declaring 'scientific consensus'. Crichton considered this development "pernicious", and all such claims of consensus as "the first refuge of scoundrels... a way to avoid debate by claiming the matter is already settled." He made his argument forcefully and coherently:

Let’s be clear: the work of science has nothing whatever to do with consensus. Consensus is the business of politics. Science, on the contrary, requires only one investigator who happens to be right, which means that he or she has results that are verifiable by reference to the real world. In science consensus is irrelevant. What is relevant is reproducible results. The greatest scientists in history are great precisely because they broke with the consensus. There is no such thing as consensus science. If it’s consensus, it isn’t science. If it’s science, it isn’t consensus. Period.

Crichton observed that whenever consensus is evoked, it is a sign of weakness. Nobody says that the consensus of scientists agrees that E=mc2 or that the sun is 93 million miles away - it does not even occur to anyone to make such assertions. Rather, consensus is claimed solely in those situations where 'bad' science is deployed to support 'good' policy - Crichton's chosen examples are nuclear winter and second-hand smoke. He included in this accusation global warming - the old name for climate change - drawing attention to the way that this subject relies far more upon computer models than empirical evidence. He noted that the renowned theoretical physicist Richard Feynman suggested to him that this obsession with computer modelling was a disease. Crichton offers a stark warning: "Our models just carry the present into the future. They’re bound to be wrong. Everybody who gives a moment’s thought knows it."

The concerns raised by Crichton in 2003 depressingly foreshadow the crisis that followed within a few scant decades. He presciently pointed a finger of blame at journalists, remarking that when even the most distinguished news providers cease to differentiate between factual content and editorial opinion, who is left that can hold anyone to any standard of truth...? Neither was Crichton's talk merely a diagnosis of the problem - on the contrary, he provided quite practical suggestions for how to defend research processes from political influence by pooling funding, thus reducing incentives to produce pre-specified conclusions. He also suggested separating decisions concerning how to gather data from the acquisition of that data, while ensuring that independent verification of evidence is always a priority.

We did not listen, and disaster followed as inexorably as the plot of one of Crichton's sci-fi disaster novels. The monsters would not remain inside their pens.

Now the very fact that climate change (in its old branding as 'global warming') is mentioned by Crichton in his speech is likely to raise some hackles. The fact I will extend this accusation to include community masking, lockdown policies, and blanket vaccination with incompletely-tested mRNA treatments will only make this resistance more ardent. Yet everybody who has a kneejerk emotional reaction here will almost certainly belong to just one side of the political spectrum. Let's call them the 'blue team', after the colour representing this faction in the United States. I note that in the UK, the corresponding party uses red as its colour, and elsewhere perhaps there may be countries sufficiently civilised to support more than two primary colours for its factions. But for simplicity, let's treat these divisions as 'blue versus red'.

Let's look at two competing hypotheses. The 'blue science is the best' hypothesis is that on climate change, face masks, lockdowns, and speculative vaccination, the blue team got all the correct answers because they had the best science. That's why they didn't need to gather evidence in support of community masking, why it was unnecessary to complete vaccine safety trials, and why climate change is indisputable, debate on the topic is forbidden, and Google is justified in demonetizing websites reporting inconvenient satellite data. This hypothesis is self defeating, as it claims that the best science is achieved neither by gathering evidence nor by debating the meaning of that evidence, and these activities are undeniably the quintessential elements of good scientific practice.

The competing 'red science must be silenced' hypothesis is that because universities in the United States gradually veered ever further into a political bias for hiring blue researchers, the research communities steadily became more and more polarised, thus disrupting effective pushback on live research topics. As a result, criticisms began to come mainly from red scientists who were largely outside of these universities. Frustration with these clashes led to the blue-aligned universities refusing discussion on scientific matters, justified all-too-conveniently by claiming that the science was beyond dispute, exactly as Crichton accused. The research community became so one-sided as to fail to pursue good scientific practice since no disagreements could be tolerated.

I note, as is so rarely admitted, that the fact that the 'blue science is best' hypothesis is internally self-defeating provides no evidence whatsoever as to the status of the 'red science must be silenced' hypothesis. This mistake, 'you're wrong and therefore I am right' appears to have been the main way that support for community masking went from being justified as a precautionary measure on weak evidence, to being self-evidently true, despite so few high-quality studies being commissioned. Worse, even among those that were commissioned, such as the DANMASK-19 study, results were simply ignored if they did not reach the desired result. The CDC website expressly informs readers that it doesn't count this key study, while accepting anecdotal studies of much lower quality that happen to align with its prior conclusions. The CDC neglects to provide an explanation for why it was not capable of commissioning its own random-controlled studies, something that it is inconceivable to claim a well-funded federal agency could not have done.

In other words, on all these topics from climate change onwards, a pre-existing political division infected scientific discourse and drove it into the state of pseudoscience where debate about the evidence could not happen - or more accurately, was not permitted. In the case of climate change, a valid (but difficult to quantify) claim about humanity's effect on the atmosphere was ludicrously inflated into undeniable certainty in a hopelessly ineffective attempt to strong-arm the red team into caring about the environment. In the case of community masking and lockdowns, anger that the red team wasn't willing to do anything and everything proposed to save lives obscured the fact that the actions being proposed were only ever hypothetically capable of saving lives. The actual scientific work to determine what was or was not effective at reducing the mortality burden of SARS-CoV-2 was, for the most part, never on the table - and even when it was, results were ignored if they did not support the 'correct' team, which is to say, the blue team.

If this argument is accepted - and obviously this will prove difficult for those on the blue team - it reveals that the state of pseudoscience has become a self-inflicted wound on scientific discourse, a wilful refusal to engage in the debate that has always played the most crucial role in the process of determining scientific truth. Experiments are never self-explanatory. They require interpretation, and this requires discussion. Seeing this, it becomes clearer why we are encountering more and more outbreaks of the state of pseudoscience, why media corporations like the BBC, Facebook, and Google could turn so swiftly and unwisely to censorship to defend positions that they rashly claimed were beyond dispute, and why the worst respiratory epidemic since 1968 turned into the worst cybernetic disaster since World War II - killing a great many people who did not need to die, bankrupting vast numbers of small businesses for no good reason at all, disrupting education for an entire generation of children, and destroying democracy and health care in Africa in the worst incident of colonial medicine the world has yet endured.

It has been over a year now since my wife and I began writing to our representatives to put forth the case for truth and reconciliation. We see this as a vital step towards repairing the social damage unleashed by the mishandling of SARS-CoV-2. But we are not surprised we have never truly been heard, since it is unthinkable that political parties will give up the leverage that springs from blame. The US midterm elections roll around later this year, and knives are already being sharpened for the 'enquiries' (inquisitions?) that will arrive in its wake. But this quest for retribution is as futile as it would have been for South Africa in the wake of apartheid. Mandela and his allies understood that what was required to rebuild the fabric of their nation was restorative justice, an attempt to make right what went wrong by assembling the truth of the horrors that had been inflicted, and thus reconciling the opposing factions such that they might share a future together.

Our own need for truth and reconciliation goes beyond trying to restore peace in the wake of our insane overreaction to the genuine harms of the SARS-CoV-2 virus. While it might be desirable to seek restorative justice in this regard, the greater issue is that legitimate public health policies have been rendered unobtainable by the state of pseudoscience. Even the possibility of establishing scientific truth has been blocked. The equivalent issue in climate science is arguably less serious by comparison, since while this fiasco might have driven us into this miserable corner, we still have time to address these particular problems by renewing scientific debate on environmental topics. The damage from making scientifically-informed public health impossible is far more immediate and too often irreversible. People have already been negligently killed, and many more will die if we cannot fix this problem.

What is the alternative to truth and reconciliation in public health? Shall we lurch between 'blue science' and 'red science' as the election cycle progresses...? Mandatory injection of incompletely tested vaccines while the blue team is in charge, then the collapse of vaccination programmes when the elected seats turn red? This is not a public health policy anyone could consider sensible, regardless of where you stand on vaccination or human rights, although I note that (contrary to the beliefs of the blue team), the red team is not against vaccination, they're just not as fanatical about it as the blues. What makes public health even conceivable as a policy is that scientific truth is supposed to transcend political divisions. The moment we begin making health laws on partisan grounds, the cause of public health itself becomes mortally wounded, if it is not already a rotting corpse. This is the madness of 'consensus science', which is Crichton's name for the state of pseudoscience, the abandonment of scientific discourse. We might just as well talk of consensus pseudoscience, for it is the truth of the matter.

Recovering scientific truth will require some degree of political reconciliation. It is quite unthinkable that we shall reconcile every issue that divides the red and blue teams... some of these political differences are fundamental, and will remain that way for decades, maybe even centuries. But on both public health and climate change, sustaining the limbo of consensus pseudoscience is beyond hopeless. It is to willingly choose catastrophe simply because we are too stubborn, too belligerent, and too unforgiving to engage in the cultural disarmament necessary to restore the trust required for collective public health and practical environmental policies.

Consensus pseudoscience ought to be unacceptable to anyone, but because far too many of us have faith in magical science, we accept ideology in place of methodology, and dogma over discourse. Gladly do we lay blame at the feet of our political opponents for everything that went wrong over the last two years. After all we did the right thing... even though nobody could possibly have ever known what the right thing was, because there was never any open scientific discourse to establish whatever that might have been! Yet still we cheered on as the media corporations censored every disagreement, championing pseudoscience as if it were something noble rather than an abject and murderous nonsense.

Many on the blue team, including former US President Barack Obama, seem to believe we still don't have enough censorship, effectively demanding further intensification of consensus pseudoscience. Obama is at least proposing greater scrutiny of social media algorithms, albeit solely by government... Forgive my inevitable concern about who is to watch the watchers watching the watchers. Further suppression of discourse will just lead to greater partisanship, making our situation even worse. The red and blue teams may have marched into this scientific disaster as bitter enemies, but if we are to escape from it, we will need to do it together. Let no-one take pride in having fought under the banner of public health while recklessly abandoning any legitimate scientific basis for what was demanded. Instead, let us collectively accept the shame of our mutual failure, and somehow commit to a reconciliation that might make collective public health a viable possibility once again.

There is much to be done if we are to rediscover our gift for scientific investigation, and recover the conditions that make public health something other than colonial oppression. We cannot afford to let corporations claim safety and efficacy on data they will not share openly, much less can we permit regulatory bodies to cherry-pick what counts as evidence. Neither can we afford to hinder collective plans for sustainability by substituting ideological certainty for open debate of climate data, as if the mark of good science was deciding what to censor. We need to bring an end to sheltering our muddled faith in magical science, and abandon the mistaken belief that unequivocal support for scientific salvation is beneficial. Our slender comprehension of the mysteries of the universe will be entirely undone by anything that fosters the state of pseudoscience - regardless of whether this disruption emerges from partisanship or censorship. Every attempt to silence debate is a betrayal of knowledge itself.

There are futures that may yet come to pass where our love of scientific knowledge is secured by a resolute commitment to transparency and debate. We must cultivate a far greater appreciation of the unavoidable fact that every science is a discourse where diversity and disagreement is a gift to treasure, not a curse to strike down in anger. The truth is something we can assemble together, but first we must remember how to talk to those who disagree with us. For that to happen, our sole hope is rebuilding the labyrinthine pathways that flow towards scientific truth through an unprecedented act of cultural disarmament and political reconciliation. It is my hope that, like the South Africans of 1994, we are worthy of seeking this future together.

The opening image is Reconciliation 2 by Lloyd Hornsby. As ever, no copyright infringement is intended and I will take the image down if asked.

Decolonising Public Health

Contains discussion of death statistics some may find distressing.

Colour Colonisation

Is the proposition 'vaccines are safe and effective' a scientific claim or a political statement? Some contend that because this claim is scientific it is not a political matter at all. But this is a mistake, and a dangerous one at that, for it mistakenly presumes scientific truths circumvent debate, rather than depending upon it. If 'vaccines are safe and effective' is a scientific claim then it rests at all times upon methodically reviewing the evidence for each and every vaccine. The moment this process is disrupted, no scientific statement of this kind is possible, and the political battle between 'anti-vaxxers' and their opponents ceases to entail anything that can legitimately be called science.

To have a breakdown of scientific debate in a time of crisis is distressing. Yet this is the third such collapse in medical discourse in just two years. Institutions who were tasked with ensuring the good health of their citizens have failed in at least one undeniable sense: significant numbers of people no longer trust them. As a result, the very concept of public health is now in danger of collapsing, ironically because a zealous enthusiasm for this cause severed the balance between scientific discourse and political action. Medicine now faces as great an ethical crisis as the creation of the atomic bomb posed for physics. Now as then, our technical power outstrips our moral reasoning about it in troubling ways. As strange as it sounds, we must seriously consider whether the time has come to decolonise public health.

Wherever there is a power differential between cultures, there is a risk of some form of colonialism. Even the most generous gestures may hide this kind of inequity. Consider the Gates Foundation's mission to bring an end to polio. To our minds, this seems like a no-brainer: why wouldn't we want to get rid of a truly horrible disease like polio...? But entirely eliminating a disease is never as simple as distributing an appropriate vaccine - and even getting suitable vaccines is never easy. We still know of no way to create a vaccine capable of eradicating any strain of influenza or coronavirus, for instance. Even when appropriate vaccines can be developed, eradication requires enormous co-operation between countries, and substantial diversion of local medical networks. There are severe costs to the polio eradication project we never even paused to consider.

Eradicating a disease is something we desire disproportionately to its health benefits. After all, we have already eliminated polio from our own countries, yet still we are unsatisfied ('what if it comes back from over there?', we say, in this most colonial way of thinking about other people's countries - as a source of contagion). Committing charitable funds to the eradication of polio seems a lot less magical when we recognise that this objective is in competition with the provision of regional health services. Pursuing this agenda inadvertently usurped primary care in many poorer nations. The same money could have been used to help these nations with their own urgent health problems... but as Dr William Muraskin remarked of this vastly expensive crusade: "Nobody ever erects a statue for those who build primary care systems".

Worse, we pursued polio eradication recklessly. In our own countries, we vaccinate against polio using an injection based upon an inactivated or 'dead' virus. In the eradication crusade, however, we used the cheaper and easier-to-distribute oral polio vaccine, which contains live virus. Although this will inoculate against the disease, it does so by causing a mild infection of the poliovirus, and it is possible for this to mutate and spread. This dreadful risk manifested in 2019 when outbreaks of a new vaccine-originating polio strain struck several African nations, as NPR reported. The following year, these new polio strains had spread to more than a dozen African nations. Nobody is saying we shouldn't aim towards ending polio, but prioritising speed of eradication was a 'luxury' health project driven by the whims and egos of colonial philanthropy. We did not adequately safeguard the people in poorer nations whose safety we compromised to reach our chosen goals. And this is only one small aspect of our medical empire.

When we talk about 'colonial history' we are referring to what was called in French mission civilisatrice, the civilising mission. This is the darker side of the philosophical achievements of the 17th and 18th century. Having determined that our empires had become enlightened, colonial rhetoric inferred that it was only logical to share the triumph of reason everywhere. This swiftly became self-justifying propaganda for occupying land that was rich in natural resources that could be exported for enormous profit by the mercantile classes of the great seafaring empires (France, Great Britain, Spain, and Portugal). Then as now, colonial rhetoric conceals commercial motives.

The French chose admirable-sounding metaphors for their actions. They spoke of how the Algerians or the Vietnamese became évolué (evolved) by being forced to adopt French culture, and also of the moral duty to make this happen, since they were elevating the ignorant foreigners, bringing them 'up' to their level. Race (as in: skin colour) was undeniably a factor in this, but even if those abroad had been white-skinned the differences in culture would still have produced an equivalent prejudice (racism is never solely about skin colour). That the colonised people looked different just made it easier to look down upon them.

Today we do not even bother to make arguments to defend our colonialism. We simply know we are right, and therefore we are entitled to bully the world towards the health goals we happen to desire. Thus we push towards eradicating polio, with its majestic air of permanence. It feels like a titanic achievement to us, a self-evidently worthwhile project. Yet consider that in 2020 there were only 800 cases of polio anywhere in the world, 200 of the wild virus and 600 - three times as many - of the vaccine-derived strain we are responsible for. By comparison, in the same year there were 241 million malaria cases and 627,000 malaria deaths, while 800,000 children under the age of five died of pneumonia, and 1.6 million people died of diarrhoea, most of them infants and young children. These are just three of the causes of death we don't face 'at home' and therefore ignore, despite 3 million people dying each year from these diseases. Eradicating polio could have been pursued in tandem with strengthening primary care in every country, achieving the same goal far more safely while helping to prevent vastly greater numbers of deaths from other causes. But we do not help other nations in the ways they want, because we are still colonialists at heart.

If you doubt you are a medical colonialist, here is a simple test: did you ever invoke the 5.6 million deaths over two years attributed globally to COVID-19 to make a point, or nod approvingly while someone else did so...? Although it is forbidden to say so, those who tragically died from this respiratory infection were overwhelmingly the elderly citizens of the formerly imperial nations and their allies. For the UK, 90% of COVID-19 fatalities were older than 65, with a median age of 83 based on ONS data, while global data suggests an average age of death of 72.9. Every death is sorrowful, but those who died from this specific cause have been given a macabre hallowed status in our politics, despite these deaths representing just 5% of global mortality over this period. What's more, a great many of those that died after infection with SARS-CoV-2 were already in a precarious state, and would still have succumbed to their failing health within these two years, irrespective of this disease. There was never truly a question of saving those particular lives, which is in no way an argument for doing nothing.

Conversely, the six million largely young and overwhelmingly black and brown people who died of malaria, pneumonia, and diarrhoea over those two years could have been saved from death - and had their life expectancy more than doubled - with just a small fraction of the money we squandered on largely ineffective interventions against COVID-19. While it is reasonable to focus on public health problems 'at home', the extreme and ill-considered actions of the last two years that we deemed absolutely necessary achieved almost nothing except exacerbating health harms by disrupting primary care. Saving the lives of those others in Africa and South Asia was entirely achievable but never even considered, let alone considered necessary.

Not only is this politicisation of one cause of death above all others inherently unethical, it is deeply colonial in its spirit. When we invoke 5.6 million dead from COVID-19, we claim to care about global mortality yet deceitfully frame this around the one disease we have chosen for political importance, while wilfully ignoring all those other causes of death that have far greater impact in many of the nations whose dead we are ghoulishly 'borrowing' to make our chosen big number. Even the name 'pandemic' reveals our imperialism once we accept that this was not a disease that threatened all global countries equally. 'No-one is safe unless everybody is safe' certainly sounds humanitarian, yet this policy entails forcing our politically-motivated medical agenda onto other nations, all for a vaccination that cannot ever result in the desired eradication that this motto falsely invokes for its moral impact. Less than one hundredth of a percent of the African population died of COVID-19, so tell me this: why did anyone argue there was an urgent need to vaccinate Africans against this disease, if it was not because we never gave up being colonialists...?

Our public health empire operates globally, but is primarily an export of the United States of America, aided and abetted by European nations and the United Kingdom. Through the enormous influence federal agencies such as the FDA and CDC have upon the World Health Organisation (the US being by far their biggest donor), colonial health policies decided in the United States inexorably spread around the globe. Likewise, colonial philanthropy is dominated by the United States, because wealth disparity is greater there than almost anywhere else on the planet. Just as the empires of sail justified their colonial ambitions in terms of the benefits they brought to the occupied, so the medical empire has strong rhetoric supporting its colonisation of global health. And much like imperial colonisation, there are indeed significant potential benefits entailed. Nonetheless, for historical colonialism, we came to realise that this kind of cultural imperialism was horrifically racist. We have yet to awaken to this horror when it comes to colonial public health.

The bigotry of colonial occupation has become such an embarrassment today that enthusiastic protestors gleefully topple statues representing that era. Iconoclasm is far easier than owning up to our continuing commitments to colonialism, after all. In both cases - colonial invasion and medical empire - the fact that both positive and negative stories can be told clouds the issues through the familiar distorting effects of political factionalism. Yet in both cases, it is the negative consequences we need to pay the closest attention to, since the positive benefits (by definition) don't entail concerns. When we trumpet the gains and brush the loses under the carpets, we are being very human. When we do this to defend our ongoing colonialism, we are being all too human.

Our politicisation of science, the eruption of the state of pseudoscience into one topic after another, means that everyone who took up a banner on unresolved medical questions was blinded. Yet we do not need to get into the specifics of these scientific controversies to acknowledge colonial tendencies in the US health agencies. We can start by accepting that first lockdowns, then community masking, and finally COVID-19 vaccination all entered the state of pseudoscience, where rational debate of the evidence was no longer persuasive. We can admit our failure here without having to settle the truth of these matters, because even if we believe 'we know' while those terrible others 'spread disinformation', we can still see that at least one faction ('them') is clearly not open to rational debate. This acknowledgement opens the door to confronting the errors of colonial medicine.

We are currently prevented from establishing a scientific answer to the question 'are these new vaccines safe and effective?', but the question itself is revealing. Both the CDC and the FDA are committed to claiming that all vaccines are indeed safe and effective. Yet this is evidently a conflict of interests: is the purpose of the FDA to defend the idea that vaccines are safe and effective, or is it to determine which vaccines are safe and effective...? An organisation cannot pursue both agendas without tying itself into ideological knots. The former is a political goal while the latter is a scientific investigation - and as has become increasingly clear, these are not compatible forms of thought, even though they can and must intersect. Whenever a scientific institution seizes upon political goals, it can no longer openly pursue the ambiguities of research, and it risks falling into the state of pseudoscience whereby nothing can be determined scientifically for there is no longer any free discussion of the evidence.

The FDA's decision to grant full authorisation to COVID-19 vaccines in 2021 was a choice to bypass the long-term trials that were previously deemed essential to establishing vaccine efficacy and safety. It is no good claiming that the urgency justified skipping this step: the vaccines already had emergency authorisations. Neither the ethical nor the scientific requirement to complete all the relevant safety trials can be bypassed by a state of crisis - indeed, the emergency conditions make such trial data all the more vital. Yet because critics of these vaccines levelled accusations that they were experimental treatments, the US health agencies rushed to provide full authorisation in order to cry out 'look, they're not experimental anymore!'. This leapfrogging over the established protocols cannot be justified solely in scientific terms. It was clearly politically motivated.

Ironically, the FDA were so insanely desperate to defend the claim that 'vaccines are safe and effective', that they made vaccines less safe in order to more loudly shout 'safe and effective'! They intentionally lowered the bar of what constitutes 'safety', out of fear that people might otherwise distrust vaccination. In so doing, they counter-productively increased the very vaccine hesitancy they hoped to prevent, and made their own agency appear far less trustworthy. Neither is this problem constrained to the health agencies: as the journal Science reported, researchers are now wary of investigating COVID-19 vaccines for fear of driving up vaccine hesitancy. This medical negligence is compounded by the fact that the original trials upon which these vaccines were declared 'safe and effective' are still not fully available for independent review, as British Medical Journal editor Peter Doshi has repeatedly raised concerns about.

We find ourselves in a bizarre world where media corporations can censor anyone who breaks ranks with the mantra of 'safe and effective', despite the fact that those responsible for determining the conditions of safety and efficacy have undermined their own scientific procedures for establishing this. Journalists are now so politicised on these issues that they turn a blind eye to the FDA having torn up the rulebook while still dogmatically insisting that the agency can still act as referee. Neither is safety data the only place where the rules of the game were rewritten on the fly. Moderna's application to the US government asking for reclassification of its mRNA treatments in August 2020 makes it clear this request happened precisely because gene therapy had acquired a bad reputation:

...the classification of some of our mRNA investigational medicines as gene therapies in the United States, the European Union, and potentially other countries could adversely impact our ability to develop our investigational medicines, and could negatively impact our platform and our business.

No doubt Moderna is correct that having to market these treatments as gene therapy would have robbed them of the lustre of the word 'vaccine', borrowing the aura of eradication and community benefit that vaccines like the MMR invoke. But perhaps this would have meant fewer ill-informed colonial health vigilantes strong-arming young people into taking drugs that neither they nor those around them could plausibly benefit from. A disease whose mortality is overwhelmingly skewed towards the elderly will not be impacted by vaccinating those too young to be at significant risk with a treatment never designed to prevent spread. God forbid the long-term trials (if they even happen now) reveal some unpleasant consequences that the FDA, in its zeal to defend the pharmaceutical companies, neglected to investigate...

Critics of the FDA call its lamentable situation 'regulatory capture': an organisation that was expressly intended to establish the safety and efficacy of manufactured drugs has become an advocate on behalf of the very corporations it is supposed to regulate. This is not just a conflict of interest, it is an invitation to collapse medical discourse into the state of pseudoscience. Likewise, on the question of community masking, we do not have to resolve the truth of the matter to see that the CDC's actions were compromised: over the space of two years they commissioned zero random-controlled trials to investigate these interventions, despite the original argument for their adoption depending upon inconclusive evidence. Errors like this make the federal health agencies look either incompetent or duplicitous - and either way, trust in their ability to fulfil public health goals inevitably suffers.

Yet it is not solely the US federal health agencies at fault. They have been spurred on by the anxious political desires of the citizenry. As with the colonial philanthropy of polio eradication, so with the draconian enforcement of community face masking and the mandatory injection of COVID-19 vaccines - our naïve assumptions pre-empted scientific investigations that were absolutely necessary. Still, while the state of pseudoscience blocks debate of the evidence, it does not stop it accumulating. These forbidden zones now include evidence on the predicted poor performance of these vaccines against spread, confirmation of the superiority of natural immunity against reinfection, disturbing side effect data from Israel and Germany, risks of Original Antigenic Sin that might mean these vaccines made some situations worse, and unexplained actuarial data in the US indicating an unprecedented 40% spike in young adult deaths not attributable to COVID-19.

What does it all mean...? Who knows! How can anyone claim to have answers when we are not permitted to even discuss these topics in any public forum! Even pointing out ambiguities in the available data now invites accusations and censorship, and anyone with concerns can be pre-emptively denounced as an 'anti-vaxxer'. Indeed, these dreaded 'anti-vaxxers' now seem to be lurking everywhere, much like those dastardly communists of the 1950s... even once-respectable researchers, doctors, and Nobel prize winners seem to have turned to the dark side. Rather than assessing whether or not these new treatments are indeed as safe and effective as their manufacturers claim, we have been reduced to a blind imperialism where our medical desires are the only ones that matter because 'we know' and those who disagree with us merely 'spread misinformation'. What a catastrophic failure of public health!

Despite the prevalent dogma, it is not unreasonable to ask the question 'are vaccines safe and effective?' There are two essential approaches. Firstly, we can take this as an axiom, or indisputable claim, as those who favour colonial public health tend to do. But if it is our axiom that vaccines are safe and effective, then to qualify as a vaccine a candidate treatment must pass rigorous tests on safety and efficacy, as they used to do back in 2019. As soon as this painstakingly careful process was disrupted, we were at an impasse. For it might well be that 'vaccines are safe and effective' - but we can no longer tell whether any particular treatment is or is not a vaccine. The state of pseudoscience blocks us from establishing the truth.

Alternately, we can admit that some treatments called vaccines are not safe and effective, which is why they always require rigorous scientific testing. This approach is more grounded in fact: some treatments bearing this name did not pass their trials, and were consequently withdrawn, and vaccines previously distributed widely have later come into question, as happened for both smallpox and rotavirus vaccines - not to mention the disastrous backfiring of polio eradication. The difference between this pragmatic approach and the axiomatic path is a willingness to use the name 'vaccine' for something that is later demonstrated to be either unsafe or inadequately effective. Since we have never withdrawn the name 'vaccine' from treatments that failed in testing, this pragmatic account reflects established practices while the axiom 'vaccines are safe and effective' is a new proposition, one entailing severe risks of falling into the premature certainty behind all colonial endeavours.

The political battle between 'anti-vaxxers' and their opponents was always claimed to be about scientific truth, even as both sides devolved into a factionalism that disrupted anyone's ability to determine what that truth might be. In fact, despite the fervour of the zealots, the key question with respect to vaccines is arguably ethical and not scientific. On the one hand is the maxim that one life is too many to lose to a medicine, no matter how many lives it might save. On the other is the maxim that if a medicine saves more people than it kills, everyone must take it. There is a legitimate political debate to be had between these two positions, no matter how much we detest confronting it. Tragically, the entire issue risks becoming meaningless without scientific research capable of assessing the safety and efficacy of each and every vaccine, which our arrogant imperialism has now circumvented.

Resolution of the world's health problems cannot be achieved by the methods of empire without repeating the moral crimes of colonialism. If we want to take advantage of the collective health benefits that responsible vaccination offers, then we cannot afford to undermine trust in those treatments whose safety can be proven. But such proof depends upon rigorous scientific investigations, without which vaccine safety is simply unknown - to dogmatically mandate vaccines about which such ambiguities persist is to demand medical negligence. We not only enacted this shocking policy globally, we then condemned anyone who dared express their horror at what we were doing. Yet to be a public good at all, health topics must be open to debate by everyone, because such questions are always both scientific and political. Alas, because the political destabilises the scientific, we have descended into a grotesque medical empire, where the name 'vaccine' has become something to swear fealty to, and those with doubts are cursed as infidels. Our neurotic fear of our viral cousins has been weaponised to divide us.

I believe in the great people of the United States of America, but my trust in their health agencies is strained to the point of breaking. They have spectacularly failed to uphold the ideals of the medical profession, and if their officers will not now admit their mistakes, they should expect to be held accountable for their tragic errors. Public health depends upon trust in scientific institutions, and the last two years have savaged that trust, reducing nearly everyone to either cynic or zealot, pitting us against one other. Public health cannot be conducted as a war, and when it becomes a battlefield it abandons the claim to be medicine, since the doctor's highest ideal is 'first, do no harm'. If you care about the health of everyone in our world, as I do, if you believe that every cause of death matters, then we have an unavoidable duty to confess this failure, and commit to the greatest medical challenge the world has ever faced: decolonising public health.

The opening image is Color Colonisation by Terry Smith, which I found here. As ever, no copyright infringement is intended and I will take the image down if asked.

Virus: A Love Story

Uncoiling StrandsIn the beginning were the replicators... we know very little about them and we never will. Our windows on the past are limited, and for the ancient past they are reduced to mere speculation. What we do know is that our cells are based upon the intricate relationship between our DNA and our RNA. DNA provides the library of all the protein recipes we have inherited from our ancestral forms. RNA does the labour of building proteins and communicating between cells. We have deduced that RNA preceded DNA, and that there was, therefore, a time in aeons past when there was an "RNA world", although we do not know (and may never know) if there were other replicating molecules that preceded RNA. Even if there was, it remains true that the replicators precede life as we know it.

The replicators were here first. And we owe them our lives.

The first cellular organisms developed out of these primordial replicators. Right from those very first cells it seems that we had both the DNA library and the RNA messengers, astonishing organic technology that may actually deserve the adjective 'miraculous' that we prefer to reserve for our own crude tampering with genetic codes. Replicators begat single celled life forms about a billion years after our planet formed, some 3.5 billion years ago. We did not arrive until 300,000 years ago. That's quite a home field advantage right there.

These unfathomably immense time scales are rather difficult for us humans to grasp, so I sometimes like to index the past using logarithmic time, which is a fancy way of saying "count the zeroes". After writer John McPhee's memorable phrase for geologic time, we can call log time the 'deep time' index of an event, and this number is just a matter of 'counting the zeroes' in a fancy mathematical way. One billion years in the 'short scale' we have come to prefer is written as 1,000,000,000, which is nine zeroes, and the base 10 logarithm of a billion is indeed 9. Last year would be 0 in deep time. Ten years ago was deep time 1. A century ago was deep time 2 (again, count the zeroes!). So each increment in logarithmic deep time is ten times further away than the previous one. The large dinosaurs went extinct at deep time 7.8, whereas the universe is believed to have kicked off about 13.7 billion years ago, at deep time 10.1. The origin of bacteria lies at 3.5 billion years ago, which is deep time 9.5.

Our single cell ancestors at deep time 9.5 are just as amazing as the replicators that preceded them and gave birth to them. They are the archeobacteria, which is to say, the old bacteria, indeed the oldest bacteria. Then as now, patterns in the DNA library were transcribed by the labour of RNA into the complex biochemical building blocks - proteins - that can do all manner of amazing things. These ancient single-celled creatures swam, fed, reproduced through division, and formed protective outer shells to ward off catastrophic conditions such as great heat or high acidity. What's more, they traded. Unlike later life forms, bacteria don't keep a very strict DNA library. On the contrary, through what has been called lateral gene transfer, bacteria (even today) trade genes with each other. That means that rather than their parental heritage determining the entirety of their biology, bacteria can swap genes to make up new patterns all the time - which also means that bacteria develop new forms far faster than the more complex life forms that were eventually to descend from them.

But life was only just getting warmed up. Swapping genes like trading cards seems like child's play next to what the bacteria were to achieve around deep time 9.3. They started co-operating. As Lyn Margulis described in 1966, the differentiated components of plant and animal cells - the energy-making mitochondria of animals, the light-farming chloroplasts of plants and algae, and much more besides - originated through a unique process of symbiotic co-operation. Margulis suggested this was probably the result of a failed attempt at digestion, but no matter how it happened the bacteria discovered they could become more than the sum of their parts. It was yet another miraculous occurrence - and it was directly responsible for the conditions that would eventually lead to our own existence. The separate genetic libraries of these cellular allies would eventually come to be pooled into a single DNA archive (the nucleus of a cell), so that different 'bacteria' were being made by the same gene library.

Now admittedly, for quite a long period of deep time our multicellular ancestors were basically little more than slime moulds. But deep time is full of miracles, and another one occurred at 8.7: the notorious Cambrian 'explosion'. Up to this point, the new superbacteria had no way of maintaining a differentiated form. Yet 'suddenly' (in the deep time perspective, at least), new patterns made it into the library, those encoding shape. We still do not adequately understand all the mechanisms entailed, but what is clear is that the superbacteria continued their billions of years of co-operation with the ancestral replicators that had formed them in entirely novel ways. By expressing certain proteins at specific points in a cycle of cell division, organisms with a profusion of different shapes and forms emerged.

And what an emergence! The Cambrian explosion is wild and marvellous, full of strange and incredible creatures. Many show body plans that we can still recognise today - the radial symmetry of the starfish; the multi-limbed creepiness of the arthropods that would become insects, spiders, and scorpions; the molluscs that would give rise to squid and cuttlefish; an immense diversity of worms; polyps that would become corals; and of course those plucky little chordates, the little skeletons who could, from which all the fish, reptiles, dinosaurs/birds, and eventually even the humble little mammals would descend.

All in the water, to begin with, where life had begun, but you can't keep a good life-form down. We were onto the land by deep time 8.6 (a clock tick in the logarithmic index, but more than a hundred million years as humans reckon time). We were into the sky soon after. Live birth by around 8.4. Social colonies of the kind we associate with termites and bees by 8.2. Social packs of larger animals by 7.9. The direct ancestors to humans arrive around 6.3. The first humans at 5.4, some 300,000 years ago. Those first five numerals of deep time belong to life in all its diversity. Human history begins at 3.7, our 52 centuries of writing occupying just the shallow end in the immense scope of the time of life.

Now the danger in thinking about these developments in terms of 'progress', as a certain way of thinking invites us to do, is to misunderstand that new life doesn't replace the old. Contrary to the lazy competitive thinking we've been led into believing, bacteria were not invalidated by the arrival of multicellular life. On the contrary, bacteria adapted to live in, on, and around their incomprehensibly larger descendants. Your stomach is a great place for a bacterium that thrives in acidic environments to hang out, and it is quite comfortable there, for all that you might prefer not to think about all your tiny passengers. Likewise, the bacteria did not force the free replicators out of business. Quite the contrary, in fact. Those replicators are still among us. We call them viruses now.

And oh how we have turned upon our ancestors in the last two centuries, after about deep time 2.3. The arrival of scientists in the Victorian era, who supplant and assimilate the natural philosophers around 3.4, brought more of what we like to call 'progress', which is half ignorance and half arrogance. The sciences brought to us an understanding of contagion, of the role of bacteria and replicators in causing disease... but they brought with it a prejudice against germs, our germophobia, if you will. We have all sadly adopted this general inability to distinguish between those scary situations where our ancestral forms are fatal to human life, and the great many circumstances where we depend upon them.

Never forget in the first place that you have some hundred trillion bacteria living in your digestive tract, without whom we would struggle to break down carbohydrates to feed your mitochondria, the bacteria-within-bacteria that power your whole body. For your body is a colony of cells, and each of those cells is analogous to the single-celled bacteria that preceded them. We are not only home to bacteria, we are made of bacteria, our bodies are the most successful and most cosmopolitan bacterial colonies that ever existed.

Ah, but you might say, I'm willing to make peace with the bacteria (or at least to say that my bacteria are good but yours are evil). But not the viruses. They are truly evil... they bring only disease and death. We must exterminate them all. How quickly we turn upon our ancestral forms! We refuse to accept just how essential the replicators were to our even having the chance to come about in the way we have. Just as your body is made of bacteria, those bacteria are made from replicators - we are, at root, beings sustained by the replicators. We are thus the impossibly distant cousins of every virus.

There is a brutal truth to the process of mutation we have not yet accepted. Far from the romantic image of the X-Men, whose freak mutations bring about superpowers, mutations are deadly. Our genetic library encodes all the proteins the many different denizens of our hyperbacterial colony bodies need to live, and when one of them is corrupted - by radiation, by pollutants, by a great many things, the vast majority of which at this point in time have been made in human factories - it causes disease and death. You cannot simply scribble all over our genetic library and expect to shoot force beams, regenerate, or control the weather. When our DNA library is corrupted, we die.

But if this is so, if mutation is death, then how did our ancestors acquire new traits, new proteins, new biological capabilities? The answer is that the replicators role in the story of life did not end at deep time 9.5 with the arrival of bacteria. They kept doing what they had always done... copying themselves. Even as the younger forms of life built the genetic libraries and deployed them to unfold the story of life as we know it, the replicators kept copying, making changes, hacking life by accident, and even becoming domesticated by the replicators in our cells to serve new purposes. Beneficial mutations (by far the least common kind) happen either because our own replicators 'slip' and make transcription mistakes, or because the other replicators - the viruses - give them a nudge in a new direction.

In 1982, Stephen Jay Gould and Elizabeth Vrba proposed exaptation (ex-ap-tation) as a description for the taking on of new functions for which a certain aspect of an organism was not originally adapted. This was an important turning point in our thinking about the development of biological capabilities, since the tendency to treat every feature as having developed for its apparent purpose severely limited the range of explanations available, sometimes to the point of absurdity. Back-projecting the role that feathers now serve in flight effectively limited the explanations considered for how they might actually have developed. Gould and Vrba proposed seeing feathers instead as an exaptation: a feature which originated with a role in temperature regulation that only later opened up possibilities for flight.

Since then, researchers have repeatedly discovered new kinds of exaptations, perhaps most amazingly in the context of viruses. Far from the image of the virus as 'them' to the human 'us', ancestral viruses inserted themselves into our genetic library, and in so doing opened up remarkable new capabilities for humanity. Consider as just one example the syncytins (sin-sigh-tins), genes originating in retroviruses that were captured and domesticated by a variety of mammal species in parallel. These genes opened up all the amazing possibilities of placental mammals from ancestors that were egg-layers - and they did so not once, but apparently multiple times. Primates, mice, cats, and dogs all have different genes domesticated from varying ancestral viruses that are essential to the placenta that sustains life in the womb. Lateral gene transfer - the trading of genes - isn't just something that bacteria do... viruses have brought this genetic marketplace to the multicellular life forms too.

What's more, even our immune system - the means by which we fight off unwelcome viral intrusion - owes its effectiveness to viral co-operation. Around deep time 7.7, we seem to have acquired a viral stowaway in our genetic library (an endogenous retrovirus) that now plays a pivotal role in our immune system. A gene that has been named AIM2 can become activated in response to viral infection, triggering immune responses that include instructing infected cells to effectively 'self-destruct' to prevent further viral spread. As Kat Arney put the matter, these ancestral viruses which are now part of our own DNA act as 'double agents', protecting us from hostile viral intrusion. A reminder that not all viruses are 'the enemy'.

The replicators were here first, and they are still here now. They enabled the bacteria to exist. They empowered multi-cellular life to specialise and diversify. They maintained genetic libraries through untold millennia, such that even now we owe our very lives to the tireless and unfathomably ancient workings of these chemically-inscribed forms of proto-life. Even the viruses, those rogue replicators that nomadically pass between our gigantic colonies of intricately co-relating cells are not merely our enemies. We have incorporated them into our library, and they have opened up new biological possibilities for our species and so many others.

There are times when we fight with our viral neighbours. This is nothing new... our genetic library demonstrates that this has been going on throughout deep time. There are times when we need to take steps to defend ourselves. But still, we should not fool ourselves. The viruses are never solely our enemies... we are dependent upon them, upon the replicators in our cells and the domesticated viruses that have joined them, for everything we are as living beings. That we must sometimes take steps to defend against that minority of viruses that disrupt the elegant workings of cellular life is inevitable. Yet this is merely the biological analogue to the rule of law, and in medicine - just as with law - we do not always make wise choices.

The replicators were here first, and they will likely be here long after we are gone. If we want to continue accompanying them for some tiny fraction of the great journey they have been on - a voyage that is nothing less than the tale of life itself - we might consider paying them the respect they are due.

Doctor Multiverse, Episode 3: Sci-fi and Censorship

What does it mean to 'stop harmful disinformation myths in their tracks', as the BBC, Google, and Facebook have vouched to do...? Join renegade philosopher Doctor Multiverse in an adventure through the last century of media censorship. At stake is scientific truth itself, for when it comes to the sciences the only way to find out what's true is by having a frank discussion about the evidence. If we prevent that debate, all we're left with is science fiction.


Five Choices (5): The Experts vs the People

Part five of Five Choices, a Philosophical Reflection on Scientific Knowledge

5 - Encaustic VioletWho can we trust to make the important decisions? We have a choice. One approach is to stand by the ideals of democracy and, one way or another, let the people decide for themselves. But what if they make the wrong choice? We could be committed to a terrible course of action causing immense harm to public health, political stability, or the ideals of civilisation. Can we afford to let that happen?

The alternative is clear - we can let the important decisions be made by whomever has the relevant expertise. The experts, having had the necessary training, are ideally suited to make decisions, and to abandon expertise would be reckless - especially in a time of crisis. But the nature of every emergency is that the facts are not always evident and prior training is no guarantee of insight into a novel situation. So we face the exact same risks here as in giving the decision to the people - what if the experts make the wrong choice? The risks here are no less grave than with the people, since a terrible mistake is just as disastrous when it is made the well-educated - and it may even be far worse, if only because of the tremendous difficulty experts have in admitting they made a mistake.

But it is here that all this construction of idealised choices as a rhetorical device comes to an end. As every pollster knows, we can mount options deceptively because every time a situation is simplified to a binary choice, we have necessarily abstracted away the context which gives that decision its true meanings. If we come at the question of who we can trust to make important decisions as a choice between either the experts or the people, it looks as if we have to side with the experts. But this is not in fact a choice we should ever face, for the way to get the people to make good decisions is necessarily to share with them the perspectives of all the experts, all of whom are also part of the people. There is no need to nominate a set of 'the experts' to replace the decisions of the people. We are all 'the people', no matter what expertise we possess.

When it comes to the important decisions, the only viable way forward is to discover ways to combine expertise with democracy - because we need expertise to help make difficult decisions, but we also need democracy to ensure accountability and legitimacy, for otherwise there can only be thinly disguised tyranny. Once we realise this, we might begin to appreciate that a crisis is not a time to abandon the people for a tiny subset of experts, no matter how comforting we may find the artificial certainty this provides. On the contrary, when the people cannot question expertise, the experts become as blind to the truth as any other despotic ruler, while the people robbed of discourse with expertise become a danger to themselves and everyone else.

Good decisions do not flow from limiting the availability of expertise, but from ensuring that everyone with relevant experience is allowed to speak. This requires that we not give in to the temptation of premature certainty (the risk of 'The Science'), that we never ignore the harms inherent to our tools and methods (the risk of 'technology'), that we do not eviscerate the immense complexity of good health (the risk of 'disease'), and most certainly that we do not undermine both scientific knowledge and civil rights by saying that anyone who disagrees must be silenced (the risk of 'censorship').

These five choices do not offer different visions of good scientific practice. They offer an understanding of what good scientific practice entails, and of the risks we face when we undermine the work of the sciences through our politics or our fears (if indeed those names refer to different things...). The attempt to make experts into a caste, a priesthood, robs expertise of the democratic foundation that alone can legitimise it. The experts and the people are not opposites at all, but one and the same thing. Only when we accept this paradox can we begin to discover how me might live together.

The opening image is a detail from an encaustic artwork of unknown providence. As ever, no copyright infringement is intended and I will take the image down if asked by the rightful owner of the artwork.

Five Choices (4): Censorship vs Disagreement

Part four of Five Choices, a Philosophical Reflection on Scientific Knowledge

4 - Encaustic BlueHow should we deal with misinformation? We have a choice. One approach is to accept disagreement, to let people share their perspectives even if they are wrong, and thus to tolerate arguments as an essential part of democracy and free speech. But if we do this, we run risks. People may be misled into doing things that put them at grave risk, or even that put everyone in danger. People may be incited into extreme acts that undermine democratic institutions. People might even be lured into hating their neighbours for their differences. Can we bear to undertake such risks?

We have a clear alternative: censorship. We can say that whenever the consequences are sufficiently severe, we are obligated to draw a line in the sand against disinformation and prevent it from being disseminated. We could form a media power bloc - say, a Trusted News Initiative - and get all the tech companies controlling social media, and all the major players in the journalistic media to agree to prevent the dissemination of misinformation. In short, we can unite the most powerful forces in communications technology to enforce censorship in order to prevent misinformation from being spread.

But this too carries risks. The nature of scientific process is built upon disagreements. Despite the simplistic orthodoxy of 'hypothesis, experiment, theory', the production of scientific knowledge is not a sausage machine that you simply crank the handle to reach conclusions. On the contrary, a fairer caricature of the process would be 'competing hypotheses, triangulation of evidence, validation of theories' - and in all three stages, disagreement is essential to success. In the absence of disagreement, we are in danger of drawing premature conclusions based on incomplete evidence, and thus treating provisional hypotheses as robust theories without the painstaking work required to assemble an accurate picture.

Applying censorship to active scientific research topics is not a way of defending scientific knowledge, it is a method of completely preventing its production. You simply cannot stop the spread of misinformation without knowing what the true state of affairs is, and you cannot know this without permitting the disagreements that allow the sciences to conduct effective research programmes. And given that every theory in the sciences is provisional until all objections are eventually resolved (a process that typically takes decades), there is never a viable point at which censorship could plausibly be in the service of scientific truth.

If you resort to censorship, you make it impossible to know the true state of affairs. As a result, people may be misled into doing things that put them at grave risk, even that put everyone in danger, such as prolonging widespread panic. People may be incited into extreme acts that undermine democratic institutions, such as reneging on civil rights agreements. People may be lured into hating their neighbours for their differences, such as whether or not they have taken a vaccine. Can we bear to undertake such risks?

Next week, the final part: The Experts vs the People

The opening image is a detail from an encaustic artwork of unknown providence. As ever, no copyright infringement is intended and I will take the image down if asked by the rightful owner of the artwork.

Five Choices (3): Health vs Disease

Part three of Five Choices, a Philosophical Reflection on Scientific Knowledge

3 - Encaustic GreenHow should we try to look after ourselves? We have a choice. On the one hand, we can choose health, and therefore try to find ways to maintain and encourage good health in all those we share the world with. This is the difficult process of finding ways to balance whatever gives us pleasure and enjoyment with whatever harms are associated with it. It is not a one-size-fits-all situation; even if I know that I need exercise, companionship, and sustenance, what works for me in this regard need not work as well for someone else. Living for good health means wrestling with situations as complex as humanity itself.

Fortunately, there is a far simpler approach to the problem of living: we can declare war on disease instead. If we call 'disease' whatever causes harm, the problem of how we should live becomes far simpler, since all we have to do now is minimise disease. Unlike good health, which requires us to think about humans in the context of their minds and lives, minimising disease seems amenable to a simple calculation - does this cause more disease, or less? If it causes less, that is the option we must choose. All other considerations can be rescinded, or at least brushed under the carpet - even the impact of this choice on other diseases is all too frequently ignored once the order to charge is given.

But this negative policy of disease is a chimera. Disease is always hiding in shadows, and it is never as clearly defined as when it is painted by those who insist we are obligated to wage war against the invisible enemy. 'Disease' is a book of names that is always open for additions, but the naming is not the problem. It is the presupposition of disease that we might question, for once we commit to replacing the problem of good health with the Sisyphean task of fighting diseases, every problem becomes deceptively simple. Here is another disease, what can we manufacture to fight this disease...?

Alas for proponents of this infinite medical crusade, good health is not merely the absence of disease. At best, limiting disease is a component of good health - and how great a contribution it might make we certainly shall not discover by treating disease as a war we are obligated to fight on all fronts. For unless a battle, a disaster, or an accident claims your life you will eventually die of disease - to think otherwise is merely to deceive yourself. As long as you approach the problem of life from the presumption of arresting disease, failure is inevitable.

There is another way: to choose to pursue good health and thus enter a strange and ambiguous world whereby your physical and mental well-being are yours to claim and discover. Paradoxically, committing to fighting disease is not a path to good health at all, but merely a means of escaping thinking about it. For as we always knew, disease is not another name for health, but rather its diametric opposite.

Next week: Censorship vs Disagreement

The opening image is a detail from an encaustic artwork of unknown providence. As ever, no copyright infringement is intended and I will take the image down if asked by the rightful owner of the artwork.