From time to time, I catch myself thinking some pretty stupid stuff for entirely dumb reasons. A piece of information finds a way to bypass any critical thinking faculties I proudly think I possess and worms its way into my belief web. Almost like a virus, which is a great segue.
A perfect example of this happened last week in relation to the COVID-19 news, and I thought it important to share here, both as an exercise in humility to remind myself that I should not think myself above falling for false information, and as my contribution to correcting misinformation floating around the web.
Through a friend’s Stories on Instagram, I saw the following screencap from Twitter:
My immediate thought was to nod my head in approval and take some smug satisfaction that of course I’m smart enough to already know this is true.
Thankfully, some small part at the back of my brain immediately raised a red flag and called for a timeout to review the facts. I’m so glad that unconscious part was there.
It said to me “Hang on… is hand-sanitizer ‘anti-bacterial’?”
I mean, yes, technically it is. But is it “anti-bacterial” in the same way that it is getting implied in this tweet? The way the information is framed, it treats the hand-sanitizer’s anti-bacterial properties as being exclusively what it was designed for, like antibiotics. For example, you can’t take antibiotics for the cold or flu, because those are not bacterial infections but viral infections.
According to the author on the topic of alcohol-based hand sanitizers (ABHS),
There are some special cases where ABHS are not effective against some kinds of non-enveloped viruses (e.g. norovirus), but for the purposes of what is happening around the world, ABHS are effective. It is also the case that the main precaution to protect yourself is to thoroughly wash your hands with soap and water, and follow other safety precautions as prescribed.
The tweet, while right about the need for us to wash our hands and not overly rely on hand-sanitizers, is factually wrong generally. Thanks to a mix of accurate information (bacteria =/= virus) and inaccurate information(“hand sanitizer is not anti-bacterial”), and a packaging that appeals to my “I’m smarter than you” personality, I nearly fell for its memetic misinformation.
There are a number of lessons I’ve taken from this experience:
My network is not immune to false beliefs, so I must still guard against accepting information based on in-group status.
Misinformation that closely resembles true facts will tap into my confirmation bias.
I’m more likely to agree with statements that are coded with smarmy or condescending tonality because it carries greater transmission weight in online discourse.
Appeals to authority (science) resonate with me – because this was coming from a scientist who is tired of misinformation (I, too, am tired of misinformation), I’m more likely to agree with something that sounds like something I believe.
Just because someone says they are a scientist, doesn’t make the status true, nor does it mean what they are saying is automatically right.
Even if the person is factually a scientist, if they are speaking outside of their primary domain, being a scientist does not confer special epistemological status.
In the aftermath, the tweet was pulled and the person tried to correct the misinformation, but the incident highlights that the norms of Twitter (and social media more broadly) are entirely antithetical to nuance and contextual understanding.
It’s interesting how much information spread (memetics) resembles pathogen spreading. If the harmful thing attacking us is sufficiently designed to sidestep our defenses, whether that’s our body’s immune system or our critical thinking faculties, the invading thing can easily integrate within, establish itself within our web, and prepare to spread.
The one thing that really bums me out about this event is the inadvertent harm that comes to scientific authority. We as a society are caught in a period of intense distrust of the establishment that is coinciding with the largest explosion of information our species has ever seen. The result of this is not that good information is scarce, but rather the signal-to-noise ratio is so imbalanced that good information is getting swept away in the tide. If people grow distrustful of the sources of information that will help protect us, then forget worrying about gatekeepers that keep knowledge hidden; there will be no one left to listen.
During a throwaway thought experiment in his 1641 treatise, Meditations on First Philosophy in which the existence of God and the immortality of the soul are demonstrated, René Descartes posited the idea of an evil genius or demon that systematically deceives us to distort our understanding of the world. Contrary to first year philosophy students everywhere (a younger version of myself included), Descartes did not actually believe in the existence of an evil manipulator that was holding us back from understanding the nature of the real world. Instead, he was using it as part of a larger project to radically re-conceive epistemology in an era of rapid advancements in science that was threatening to overturn centuries of our understanding of the world. He felt that knowledge was built upon shaky ground thanks to an over-adherence on the received authorities from Greek antiquity and the Church’s use of Aristotelian scholasticism. Similar to Francis Bacon twenty years earlier, Descartes set out to focus on knowledge that stood independent of received authority.
Through Meditations one and two of his book, Descartes considers the sources of our beliefs and considers how we come to know what we think we know. He wants to find an unshakable truth to build all knowledge from, and through an exercise of radical doubt he calls into question many of the core facts we hold – first that knowledge gained from the senses are often in error, that we often can’t distinguish the real from fantasy, and through the use of the evil genius, that perhaps even our abstract knowledge like mathematics could be an illusion.
When I teach this to first year students, they either don’t take his concerns seriously because of the force of the impressions the real world gives us in providing sense data for knowledge (a stubbed toe in the dark seems to forcefully prove to us that the external world to our senses is very real), or they take Descartes too seriously and think Descartes really thought that a demon was actively deceiving him. Regardless of which side the student falls on, they will then conclude that Descartes’ concerns are not worth worrying about; that this mode of thinking is the product of an earlier, less sophisticated age.
Unless you are a scholar delving into Descartes’ work, the real purpose of teaching the Meditations is to provide students with a framework to understand how one can go about thinking through complex philosophical problems. Descartes starts from a position of epistemic doubt, and decided to run with it in a thought experiment to see where it took him. The thought experiment is a useful exercise to run your students through to get them to think through their received opinions and held-dogmas.
However, in light of my rant a few weeks back about informed consent and vaccines, I’ve discovered a new contemporary use for thinking about Descartes’ evil genius. In some sense, the evil genius is *real* and takes the form of fear that shortcuts our abilities to learn about the world and revise our held beliefs. Descartes posited that the evil demon was able to put ideas into our heads that made us believe things that were completely against logic. The demon was able to strip away the world beyond the senses and even cast doubt on abstract concepts like mathematics.
Much in the same way Descartes’ demon was able to “deceive” him into believing things that were contrary to the nature of reality, our fear of the unknown and of future harm can cause us to hold beliefs that do not map onto facts about the world. Worse yet, the story we tell about those facts can get warped, and new explanations can be given to account for what we are seeing. This becomes the breeding ground for conspiracy thinking, the backfire effect, and entrenched adherence to one’s beliefs. We hate to be wrong, and so we bend over backwards to contort our understanding of the facts to hold-fast to our worldview.
In truth, we are all susceptible to Descartes’ demon, especially those whom believe themselves to be above these kinds of faults of logic. In psychology, it’s called the Dunning-Kruger effect, of which there are all sorts of reasons given why people overestimate their competence. But in the context of an entrenched worldview that is susceptible to fear of the unknown lurks Descartes’ Demon, ready to pounce upon us with false beliefs about the world. Its call is strong, its grip is tight, and the demon is there to lull us into tribalism. We fight against those we see as merchants of un-truth and in a twisted sense of irony, the weapons of truth we yield only affect those already on our side, while those we seek to attack are left unaffected. It becomes a dog-whistle that calls on those who already think and believe as we do.
If we hope to combat this modern Cartesian demon, we’ll need to find a new way of reaching those we see on the other side.
In the ethics of conducting research with human participants, there is the concept of “informed consent.” At its foundation, informed consent is the process of communicating a sufficient amount of information about a research project to a prospective participant so that the prospect is able to decide whether they want to consent to being a participant in a study. There is a lot of nuance that can go into selecting what gets communicated because you have a lot of necessary information that needs be shared but you don’t want to share so much information that the participant is overwhelmed by the volume of information.
When I review research ethics applications, I am privy to a lot of information about the project. In the course of reviewing the project, I have to make judgement calls about what should be included in the informed consent letters that participants read. It would be counter-productive if the participant had to read all the documentation I am required to read when reviewing an application, so we use certain best practices and principles to decide what information gets communicated as a standard, and what is left in the application.
There is, of course, some challenges that we must confront in this process. As I said, when reviewing a research project, you have to balance the needs of the project with the needs of a participant. All research, by virtue of exploring the unknown, carries with it an element of risk. When you involve humans in a research project, you are asking them to shoulder some of the risk in the name of progress. Our job as researchers and reviewers is to anticpate risk and mitigate it where possible. We are stewards of the well-being of the participants, and we use our experience and expertise to protect the particpants.
This means that one challenge is communicating risk to participants and helping them understand the implications of the risks of the research. In many instances, the participants are well aware of risks posed to their normal, every-day lived experiences and how the research intersects with it. The patient living with a medical condition is aware of their pain or suffering, and can appreciate risks associated with medical interventions. A person living in poverty is acutely aware of what it means to live in poverty, and understands that discussing their experiences can be psychologically and emotionally difficult. Our jobs (as reviewers and researchers) is to ensure that the participant is made aware of the risk, mitigate it as much as we can without compromising the integrity of the research program, and to contextualize the risk so that the participant can make choices for themselves without coercion.
The concept of informed consent is hugely important, arguably the most important component of research projects involving humans as participants. It is an acknowledgement that people are ends in themselves, not a means to furthering knowledge or the researcher’s private or professional goals. Indeed, without a respect for the autonomy of the participant, research projects are likely to not be moved into action even when research funds are available.
All of this is a preamble to discuss the anger I felt when I read a recent CBC report on how anti-vaxxer advocates are using the concept of informed consent as a dog-whistle to their adherents, and are using informed consent as a way of both furthering their awareness and raising money with well-meaning politicians and the public.
In fairness, I can see the chain of reasoning at play that tries to connect informed consent with concerns about vaccines. For instance, in the article there is a photo of supporters of a vaccine choice group with a banner that reads “If there is a risk there must be a choice.” This sentiment is entirely consistent with the principles of informed consent. The problem with this application is that the risk is not being communicated and understood properly within context, and instead fear, misinformation, and conspiracies that lead to paternalistic paranoia are short-cutting the conversation. Further, the incentive structures that are borne out of the economics of our medical system are doing little to address these fears. Because so little money is flowing from the government to the medical system, doctors are forced to maximize the number of patients they see in a day just to ensure enough money is coming into the practice to pay for space, equipment, staff, insurance, and supplies. Rather than seeking quality face-to-face time with a patient, doctors have to make a choice to limit patient time to just focus on a chief complaint and address questions as efficiently as they can.
I don’t think it’s all the doctor’s fault either. I think we as patients, or more specifically we as a society, have a terrible grasp of medical and scientific literacy. I don’t have a strong opinion about what the root cause of this is, but some combination of underfunded schooling, rapid technological innovation, growing income disparities, entertainment pacification, a lack of mental health support, increasingly complex life systems, and precarious economic living in the average household are all influencing the poor grasp people have about what makes the world around us work. Rather than being the case that we are hyper-specialized in our worldviews, I think it’s the case that “life” is too complex for the average person to invest time into understanding. Let’s be clear, it is not the case that the average person isn’t smart enough to grasp it (even if sometimes my frustration with people leads me to this conclusion). Instead, I think that people are pulled in so many directions that they don’t have the time or economic freedom to deal with things that don’t immediately pay off for them. People are so fixated on just making it day-to-day and trying not to fall behind that it becomes a luxury to have the leisure time to devote to these kinds of activities.
What this results in, then, is the perfect storm of ignorance and fear that congeals into a tribal call to rebel against the paternalism of a system that is ironically also too cash-strapped to allow the flexibility to educate people on the nature of risk. People don’t have the time and ability to educate themselves, and doctors don’t have the time to share their experiences and knowledge with their patients.
Within this gap, opportunistic charlatans and sophists thrive to capitalize on people’s fears to push their own agendas. This is why bad actors like the disgraced former doctor Andrew Wakefield and movement leader Del Bigtree are able to charge fees to profit from speaking at anti-vaccination events. I’m not saying a person who spreads a message should do it for free. What I am saying is that they are able to turn a personal profit by preying on people’s fears while doing little to investigate the thing they claim to worry about.
We must find a way to communicate two simultaneous truths:
There is an inherent risk in everything; bad stuff happens to good people, and you can do everything right and still lose. Nevertheless, the risks involved when it comes to vaccines are worth shouldering because of the net good that comes from it and the risks themselves are vanishingly small.
In the 22 years since Wakefield published his study and the 16 years since its retraction, there has not been any peer-reviewed credible evidence that supports many of the claims given by the anti-vaxx movement. The movement is predicated on fears people have of the probability of something bad happening to them or their loved ones. The motivation behind the fear is legitimate, but the object of the fear is a bogeyman that hides behind whatever shadows it can find as more and more light is cast on this area.
The anti-vaxx ideology knows it cannot address head-on the mounting scientific evidence that discredits its premise, and so it instead focuses on a different avenue of attack.
This bears repeating: the anti-vaxx ideology cannot debate or refute the scientific evidence about vaccination. We know vaccines work. We know how they work; we know why they work. We understand the probabilities of the risk; we know the type and magnitudes of the risks. These things are known to us. Anti-vaxx belief is a deliberate falsehood when it denies any of what we know.
Because of this, the anti-vaxx ideology is shifting to speak to those deep fears we have of the unknown, and instead of dealing with the facts of medicine, it is sinking its claws into the deep desire we have for freedom and autonomy. It shortcuts our rational experience and appeals to the fears evolution has given us to grapples with the unknown – the knee-jerk rejection of things we don’t understand.
Informed consent as a concept is the latest victim of anti-vaxx’s contagion. It’s seeping in and corrupting it from the inside, turning the very principle of self-directed autonomy against a person’s self-interest. It doesn’t cast doubt by calling the science into question. Instead, it casts doubt precisely because the average person doesn’t understand the science, and so that unknown becomes scary to us and we reject or avoid what brings us fear.
Anti-vaxx ideology is a memetic virus. In our society’s wealth, luxury, and tech-enabled friction-free lives, we have allowed this dangerous idea to gain strength. By ignoring it and ridiculing it until now, we have come to a point where it threatens to disrupt social homeostasis. Unless we do something to change the conditions we find ourselves in – unless we are willing to do the hard work – I fear that this ideology is going to replicate at a rate that we can’t stop. It will reach a critical mass, infect enough people, and threaten to undo all the hard work achieved in the past. We have already seen the evidence of this as once-eradicated diseases are popping up in our communities. The immunity and innoculations have weakened. Let’s hope those walls don’t break.
I finished reading Complications by Atul Gawande last week and really enjoyed it. It was his first book and covered stories from his apprenticeship phase of becoming a surgeon. I thought back to the first book I read from him, The Checklist Manifesto, and realized that while I enjoyed the topic Manifesto covered, I found it lacking a certain charm that Complications had.
Manifesto felt like a good idea that was stretched a bit too thin to fit the book format, and was heavily supplemented with references to studies done by other researchers. This isn’t meant as a criticism – it was a good book! But what I felt Complications (and his other book Better) had is the first hand reflection on one’s professional development. It’s not just a memoir of one’s life, nor is it a tell-all, but instead it’s a focused meditation on the training, learning, failures, achievement, and lessons one gains from devoting themselves to their vocation.
Over the last three and a half years of reading, I’ve found I really enjoyed these kinds of books. I looked over my reading list and pulled a bunch of examples randomly below. Some of them are about medicine, others are of actors, and a few books from the business world. The common thread is that it’s less about the personal biography of the person and more about the development of the professional (for this reason, I didn’t include Elon Musk’s and Enrico Fermi’s biographies, or career retrospectives like the books from James Comey and Hillary Rodham Clinton).
It describes a world bigger than the person telling the story, and their attempt to grapple with the epistemological, ethical, and professional obligations that comes from entering a profession, and where their limits lie. These are not stories about heroes – the stories are about human error and fallibility, and learning to deal with that revelation. It also keeps its eye towards what it means to serve others, and where the profession should go in the future.
Ultimately, these books differ from the animated bibliography in one crucial area. The animated bibliography is often a book that results from a person researching and stitching together the ideas of others. In some cases, these books will require the author to attempt to put the ideas into practice, but in my opinion this is in service of selling the credibility of the book. However, the books I’m discussing here and listing below are different because they are an account of people who are learning by doing. They are applying what they previously learned during formal education, and reflecting on the outcomes to see what lessons can be derived. In some sense, the books are an autopsy that try to tease out causes, or at least serve as a cautionary tales for those who come later.
I wrote my masters thesis in 2012 on the relationship of knowledge, first aid, and the moral requirements of rescue. The thesis argued that 1.) if you have special knowledge or training (first aid), you are morally required to render aid, even if there is no pre-existing legal requirement; and 2.) everyone should be trained in first aid. While it is the case that I have to keep my first aid certificates current in order to work at the bar, I believe that it’s important to keep these skills fresh and sharp regardless of your occupation.
You never know when you’ll need to draw upon the skills, so frequent practice is important if you want to be effective.
There have been two instances while working at the bar where a pedestrian was struck by an automobile while I was working. The first was New Years Eve a few years back, and the second was this past St. Paddy’s Day. Thankfully, in both instances the person did not seem to be critically harmed in the incident, and both were conscious when they were loaded into the ambulance to be taken to the hospital for further attention. I suspect that while both had some degree of recovery ahead of them, they thankfully won’t likely experience prolonged physical suffering.
In both instances, I was working on the door, so I was the first responder on scene to start treatment. In the case of a traffic collision, the most important steps are to protect yourself, and start control of the scene. I can confidently say that I’m terrible at the first thing, and half-decent on the second. This is why consistent practice is important.
I fail on this in two regards. I have a tendency to run out into the street to reach the pedestrian quickly, meaning that I put myself at risk of getting hit by a car while on scene. The other thing I’m bad at is getting to the pedestrian and starting treatment before I finish the scene survey (which includes putting on medical gloves to protect myself). These are big no-no’s. I expose myself to unnecessary risk while trying to be first to the injured, when realistically I should take an additional 15-30 seconds to stop, take in the scene, and put on my gloves.
Control the Scene
I am adequate at this because I tend to default to immobilizing C-Spine and trying to talk to the pedestrian if they are conscious. I could do this better in a number of way, such as having a fellow staff member control the spine while I assess for additional injuries and control the scene (directing people around me, updating EMS, taking notes, etc.). In regards to the staff at the bar, I am probably the most experienced first aider, so removing myself from the decision-making portion of the response has benefits and drawbacks. I am the best person to perform first aid until advanced medical care arrives, but I also have enough experience to understand the dynamics of the scene. At this point, it’s best that I trust my fellow staff to respond appropriately.
Responding to a traffic incident is chaotic, noisy and confusing. On top of this, adrenaline courses through your body, making your hands shake and your limbs jittery. Your brain feels like mush because your thoughts are lightning quick. Time seems to slow down, and that ambulance that is 5-8 minutes away always takes an eternity. You are hyper-focused on your patient, but aware that there is a light din of noise at your periphery. It’s like a bubble is around you, and you are hoping like hell that you don’t mess anything up under the spotlight of the gawking mass of people encircling the scene.
This is all normal. It (sadly) gets easier the more you do it. You become calmer each time you respond; it’s happening to me already.
The lesson to take from this is to always keep your certs current, and find time to meaningfully practice your skills. Someones life may depend on it.
Last week, I announced that I’m shelving the pursuit to be a paramedic. This decision was made on pragmatic grounds: with trying to start a life together with my fiancé, I need to focus on setting down strong roots and establishing financial security. Changing careers while both supporting my partner and building stability is far more risk than I’m willing to tolerate. Good things are happening at work right now, and I enjoy a generous paycheck and benefits. If I hope to continue to pay off my existing student debt in a timely manner, contribute towards the mortgage, etc., my best option is to stay put for now.
Having said that, deciding to not go the paramedic route is not without its share of doubt and heartache. When I started entertaining the idea that I wouldn’t apply off this February, I felt like I was giving up. I had carefully laid out a timeline and a series of objectives that would take me step-by-step to my destination. To give up now would mean I failed in my goals. I felt like I was a failure.
I’m largely over this mindset now. What helped me re-frame this was a passage out of Peter Pan. I stumbled across this quote on a Medium post late last year and jotted it down in my notebook. From time to time, I read the passage to remind myself that I have more important obligations than what I want. Sometimes, you need to re-evaluate your goals to ensure you’re staying true to your priorities.
*Side note, my awesome fiancé, whom I read this quote to, put a copy of Peter Pan (the book) in my stocking for Christmas as a result.*
“There are many different kinds of bravery. There’s the bravery of thinking of others before one’s self. Now, your father has never brandished a sword nor fired a pistol, thank heavens. But he has made many sacrifices for his family, and put away many dreams.”
Michael: “Where did he put them?”
Mrs. Darling: “He put them in a drawer. And sometimes, late at night, we take them out and admire them. But it gets harder and harder to close the drawer… He does. And that is why he is brave.”
It’s important to remind ourselves that there is no shame in letting go when things change. My decision to become a paramedic was made when I was in a different place in my life, but I’m no longer in that place. There is certainly nobility in staying the course, even through uncertainty and change. But it’s important to reflect on your priorities, and act in accordance with what is most important to you.