Is Medicine a Natural or Social Science? (complete)

Note: This fuller treatment replaces an earlier version I posted on this site late last week.

In his Nicomachean Ethics, Aristotle points to the difference between the natural and social sciences, when he says one cannot use the language of mathematics in discussing politics. And what is the essence of that difference? In the former, we are talking about matters of certainty; in the latter, matters of probability.

Where, then, does medicine fall in this little schema? In most younger and even middle-aged patients, it is closer to being a natural science. Generally one has an illness or injury, visits the doctor, and is treated for that illness or injury. End of story.

For us oldsters, though, it’s usually more complicated. Even when we see the doctor about a specific condition, we need to take into account the possible side effects of any medicines prescribed, as well as the interaction effects between those drugs and the ones we’re already taking. And often we need to take into account the relationship between the condition we’re seeing the doctor about and other, pre-existing conditions, or (for want of a better term) structural weaknesses. Not infrequently, treating one condition runs the risk of worsening another. In deciding what to do about a particular condition, both the doctor and we as patients must often engage in a balancing act–a balance of probabilities. This puts us squarely in the domain of the social sciences. Indeed, a dash of humanities (as well as humanity) can also be helpful, as that scribbling neurologist, Oliver Sacks, would not have hesitated to tell us.

Finally, where does the ongoing COVID-19 pandemic fall within our little schema? Certainly there’s a good deal of hard science involved, particularly when it comes to matters such as understanding how the virus is transmitted or how to develop vaccines against it. But hard science takes us only a small part of the way toward understanding how the pandemic has played out, is playing out, and will play out in practice.

Consider, for instance, the huge variation in case and death rates in different countries. Hard geographic fact–in particular, the fact that some countries are islands–helps explain some of that variations. Almost without exception, the countries (or states or provinces) that have fared best in the pandemic are islands. New Zealand and Iceland and, within Canada, Newfoundland and Prince Edward Island come quickly to mind here. The explanation for this isn’t rocket science. It’s much easier to control and if need be block entry to an island, which normally can be entered only by sea or air, than to a jurisdiction which can be entered by road. By blocking or otherwise restricting entry, or by imposing strict quarantine conditions on those it does to allow to enter, the island jurisdiction has gone a long way toward preventing the virus from being transmitted from outside.

At the same time, even within the very limited domain of island jurisdictions, we find a few significant variations. Australia and New Zealand are both islands, yet the latter has had a better COVID record than the former. The hard facts of geography don’t explain this. To get such an explanation, we need to rely on “squishier” facts having to do with the jurisdiction’s social and political arrangements, legal system, and so on. These facts, in turn, will often have a good deal to do in determining, for example, how strictly travel into the island will be controlled, as well as the extent to which the government in question is willing to restrict its citizens’ behaviour in order to control the virus.

These “squishier” variables play an even bigger role when we start looking at all jurisdictions–particularly when we compare jurisdictions which on the surface appear to be similar. Take, for example, Sweden, as compared to its Nordic neighbours, Norway and Denmark. Geography certainly doesn’t explain Sweden’s far higher rate of COVID cases and deaths. Neither do the relatively “hard” facts of socio-economic development. The three countries have generally similar economies and are roughly at the same state of economic development. What is key here are the countries’ differing attitudes toward restrictions on their citizens’ freedom. Norway and Denmark moved to fairly strict lockdowns early on, and as a result had many fewer cases and deaths than Sweden, which was notably and notoriously reluctant to do so, even in the face of early evidence suggesting it was taking the wrong approach.

Such political and cultural factors play an even bigger role in understanding interstate and interprovincial COVID case and death rate differences in the U.S. and Canada. Between the lowest and highest COVID rates among American states, (e.g. Vermont and North Dakota),there is a per capita difference of the order of about 10:1. Between the lowest and highest COVID rates among Canadian provinces (e.g. P.E.I. and Quebec or Alberta), the per capita difference is more like 50:1. Granted, as noted above, P.E.I. does benefit from being an island and thus being able to restrict entry quite easily. But even if we substitute the non-island Atlantic province of Nova Scotia for P.E.I., the per capita difference is still of the order of nearly 20:1.

In attempting to account for such huge interstate and interprovincial differences, the two critical factors are politicians’ willingness to impose tough restrictions on their citizens’ freedom, and citizens’ willingness to accept those restrictions. Like the other Atlantic provinces, Nova Scotia went into strict lockdown mode, with restaurants, beauty parlours, gyms, and even public libraries and public parks closed before it had even a handful of cases. In contrast, Western provinces like Alberta didn’t impose such restrictions until well after all of Atlantic Canada had. Even at their strictest, these provinces tended to be not as strict as the Atlantic ones were, both with respect to the restrictions themselves and to enforcement. And when they did impose those restrictions, they were far more often greeted with strong resistance than were provincial governments in the Atlantic region.

Even hard-hit central Canadian provinces such as Quebec, which would experience the highest case and death rates in the country, didn’t impose restrictions until later than Atlantic Canada did.  Quebec Premier Legault brought in restrictions closing schools and most businesses on March 23, nearly a week after such restrictions had been imposed in Nova Scotia, despite the fact that Quebec had reported cases some time before any of the Atlantic provinces had.  Interestingly, the Atlantic provinces have reported the highest satisfaction rates in Canada with the way provincial governments have handled the pandemic, a fact which suggests a good deal of social consensus among the citizenry.  Again, such social consensus is much harder to find in Western provinces (particularly Alberta, whose Premier is the staunchly pro-business Jason Kenney) and in Quebec.

The differences between and even among states are greater yet in the U.S.  In Maine and Vermont, it would appear that most citizens are prepared to comply, albeit grudgingly, with state-imposed mask requirements and other restrictions.  Elsewhere in the country, the closing of business and mask requirements have resulted in loud and not infrequently violent protests.  In some states, municipal sheriffs have refused to enforce state restrictions.  In others, state officials have overridden municipal restrictions imposed by city mayors and other local officials.  In Michigan, a sharply divided state politically, things reached such a point that armed men stormed the state capitol, threatening to kidnap Gov. Gretchen Whitmer, a Democrat who had imposed (by American standards) tough restrictions on businesses.[1]And many disputes in stores between mask-wearing and non-mask-wearing customers have turned ugly, even violent, and assaults on store employees who’ve insisted on enforcing their stores’ mask policies have become far from infrequent.  While one would not want to push this generalization too far, it would appear that by and large, Americans are more insistent than Canadians or Europeans on retaining their personal freedom to do what they want when they want.  And American politicians, wishing like most politicians to be re-elected, have responded by being slower than most Canadian or European politicians to impose lockdowns or shut down businesses, and quicker to remove lockdowns and re-open businesses.  (This was carried to extremes in Florida during the spring of 2020, when pictures of half-naked Floridians packing newly-reopened beaches went viral on the Internet at the same time as case rates were still rising both there and in the rest of the U.S., as well as in Canada). In the name of generating income from business, some American states (e.g. South Dakota) not only condoned but encouraged enormous “super-spreader” gatherings such as the annual motorcycle rally in Sturgis, S.D. which drew six-digit crowds to the small town.  Not surprisingly, perhaps, South Dakota and its adjoining states rank at or near the top of the pack in COVID cases.  One could not even imagine such a gathering or anything remotely close to it being condoned in Canada, where even during the mid-summer “lull” public events such as worship services, concerts, and theatrical performances continued to be significantly restricted.

Much of the higher COVID incidence in “red” Republican states is due to what former President Donald Trump did or, more precisely, didn’t do about the pandemic through his largely laissez-faire approach to the disease.  Though I haven’t yet completed my tabulations, it appears that for the most part, states that supported Trump in the 2020 presidential election had higher COVID rates than those that didn’t.  Vermont, with just about the lowest COVID rates in the country, had just about the highest rate of support for Joe Biden and the Democrats, and thus lowest rate of support for Trump.  On the other hand, South Dakota, whose ultra-right-wing Governor was practically a Trump clone in her approach to COVID, and where, as noted, a “super-spreader” event was held during the summer, ranked near the top in support for Trump, along with other neighbouring high-COVID states like Nebraska and North Dakota.  In the latter state, as well as in South Dakota, well over one resident in ten has had COVID—officially.  This compares with a national American rate of something over 6%, and the national Canadian rates of something over 2%.  The Canadian province with the highest COVID rate is Quebec, where just over 3% of the residents have had the disease.[2]

It isn’t going too far to suggest that in some American states, particularly in the South and West, the virulent disputes over COVID restrictions are not just disputes about tactics; they are disputes over the existence of COVID as such, as a disease whose defeat will only be achieved through a marshalling of societal resources comparable to what we have hitherto seen only in wartime.  Indeed, they are in many cases even more fundamental disputes about the scientific method as such, and its use, along with that of factual evidence, in solving society’s problems (including those caused by pandemic diseases).  Between those who do and those who don’t believe in the scientific method and the solution of problems through evidence, there can be no middle ground.  Either you believe in the scientific method or you don’t; it isn’t, for example, possible to use science on Mondays, Wednesdays, and Fridays but revert to medieval-style theocracy on the remaining days of the week. 

While Americans have had many bitter political disputes in their country’s tumultuous history, few, with the possible exception of the Civil War, have been over issues so fundamental in nature.  To find the equivalent of the ongoing American battle between those believing in science and those not believing in it, you would need to go to the Middle East, where such battles between theocratic “traditionalists” and scientific “modernizers” have made up a large part of the political landscape over the past several decades.

You might think that in this discussion of COVID, I’ve strayed a long way from my original topic.  But nothing could be further from the truth.  Science itself can hardly be expected to explain why some citizens believe in it while others do not.  To even attempt to come up with such an explanation, we must draw on all manner of  “squishier” factors, ranging from historical and cultural ones to socio-economic and religious ones—including even some that would normally fall within the domain of abnormal psychology.  In closing, I shall attempt another, admittedly broad but not, I think, unreasonable generalization.  Based on the very ample international, interstate, and interprovincial evidence provided by the ongoing COVID pandemic, it would appear that societies fare best when their scientists and doctors are allowed to operate in relatively unfettered fashion, free from political interference and certainly from the threat of bodily harm regrettably experienced by the eminent American disease expert, Dr. Anthony Fauci.  In other words, we’re likely to do best when medicine is allowed to operate as something approaching a natural science, with of course reasonable allowance made for specific cultural circumstances.

Thankfully, the new U.S. President, Joe Biden, seems to agree with me. Let’s hope he will be able, during his time in office, to overcome the forces of darkness and medieval theocracy sufficiently to be able to bring science fully to bear on the herculean task of defeating COVID, and the equally herculean task of rebuilding an economy shattered by COVID. Returning to the Aristotelian note on which this piece began: the past four years have provided ample, even overwhelming evidence that politics itself does best when its domain is rather closely circumscribed, and it is not freighted down with all sorts of other things, such as religion, science, and matters of personal morality. The less that enters the political arena, the better the political system will work.

[1] It should be noted that by any Canadian standards except perhaps those of Alberta, Whitmer’s restrictions were relatively lax.  For example, houses of worship were allowed to conduct services with few limits on gathering size.

[2] Data used for these statements are as of Feb. 1, 2021.

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