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Should Clinicians Have Soapboxes?

blurred photograph of busy hospital hallway

Despite the tendency to talk about the pandemic in the past tense, COVID-19 hasn’t gone. Infection rates in multiple countries are swelling, prompting some – like Kenya, Austria, the Netherlands, and Belgium – to employ increasingly stringent measures. Unsurprisingly, alongside increasing infection rates comes an increase in hospital admissions. Yet, there’s one trait that most of those requiring COVID-19 treatment share – they’re unvaccinated.

This trend isn’t surprising given that one of the points of vaccination is to reduce the seriousness of the infection, thus reducing the need for serious medical interventions. Simply put, vaccinated people aren’t ending up in hospitals as often because they’re vaccinated. The people who haven’t been vaccinated, for whatever reason, are more likely to have severe complications if infected, thus needing clinical care. So far, so simple.

This tendency for hospital beds to be occupied by the unvaccinated invites questions regarding the burden on healthcare systems. After all, emergency care services are better placed to respond to emergencies – like bus crashes, heart attacks, or complicated births – when their wards, ambulances, and hallways aren’t preoccupied with patients. If those patients are there because of their choice not to be vaccinated, it’s only natural to wonder whether they are equally deserving of that resource-use.

But is it appropriate for those working in the medical profession to voice such concerns? If you’re in the hospital seriously ill, does it help to know that your nurse, doctor, consultant, or porter may resent your being there?

This question’s been brought to the forefront of the COVID-19 discussion because of a recent Guardian article entitled ICU is full of the unvaccinated – my patience with them is wearing thin. In it, an anonymous NHS respiratory consultant writes, “I am now beaten back, exhausted, worn down by the continuous stream of people that we battle to treat when they have consciously passed up the opportunity to save themselves. It does make me angry.” Similar sentiments come from the Treating the unvaccinated article in The New Yorker, where critical care physician Scott Aberegg recounts:

There’s a big internal conflict… On the one hand, there’s this sense of ‘Play stupid games, win stupid prizes.’ There’s a natural inclination to think not that they got what they deserved, because no one deserves this, but that they have some culpability because of the choices they made… When you have that intuition, you have to try to push it aside. You have to say, [t]hat’s a moral judgment which is outside my role as a doctor. And because it’s a pejorative moral judgment, I need to do everything I can to fight against it. But I’d be lying if I said it didn’t remain somewhere in the recesses of my mind. This sense of, Boy, it doesn’t have to be this way.

It’s not unsurprising that clinicians feel this way. They’ve seen the very worst this pandemic has to offer. The prospect that any of it was avoidable will undoubtedly stir up feelings of anger, betrayal, or even injustice; clinicians are, after all, only human. While expecting clinicians not to have such opinions seems like an impossible demand, should they be voicing them on platforms with such a broad reach?

On the one hand, the answer is yes. Entering the medical professions in no way invalidates one’s right to free speech, be that in person or print. Much like how any other member of the public can pen an article in an internationally respected newspaper if invited, clinicians have the right to share their views. If that view concerns their increasing inability to accept the preventable loss of life, then, at least in terms of that clinician’s rights, there is very little to stop them ethically. To try would be to revoke a privilege which many of us would likely consider to be fundamental and, without a robust justification, unassailable.

However, those experiencing the pandemic’s horrors may have more than just a right to share their opinions; they might have a duty. Those working on the frontlines in the battle against the pandemic know better than most the state of the healthcare services, the experience of watching people die from the illness, and the frustration from having to cope with much of it is seemingly preventable. Given that they have this unique knowledge, both from a medical and personable standpoint, it would seem that clinicians have a responsibility to be as honest with the general public as possible. If that means sharing their woes and frustrations about the reluctance of people to take even the most basic steps to save themselves, then so be it. After all, if they don’t tell us this information, it seems unlikely that anyone else is.

But, such a principled stance may detrimentally affect trust in the healthcare system, and subsequently, that system’s effectiveness.

As The Prindle Post has recently explored, shame is a complex phenomenon. Its use in trying to shape people’s behaviors is far from simple. This complexity has been seen in several previous public health concerns where shame has had the opposite effect intended. As both The Wall Street Journal and NPR have recently reported, shame makes for a terrible public health tool as it deters engagement with clinicians. If you believe that you’re going to be shamed by your doctor, you’re probably less likely to go. For smokers and alcoholics, this chiefly detrimentally affects only a single person’s health. During a global pandemic,however,  it means there’s one more potentially infectious person not receiving medical care. Scaled-up, this can easily result in countless people refusing to visit hospitals when they need to – increasing infection rates and preventing medical assistance from getting to those that need it.

All this is not to say that doctors, nurses, surgeons, and countless others involved in the care of the vulnerable should be automatons, devoid of emotion and opinion about the unvaccinated. Again, they’re human, and they’re going to have thoughts about what they see during the course of their professional careers. But whether those opinions should be broadcast for the entire world to read and see is an entirely different question.

Aesop and the Unvaccinated: On Messaging and Rationality

cartoon image of scorpion on frogs back

Aesop shared a fable once about a scorpion and a frog. The scorpion asked a frog to ferry him across a pond. The frog was reluctant because he feared the scorpion’s sting. But the scorpion appealed to the frog’s intellect and pointed out that if he did sting the frog, the scorpion would surely drown as well. So, the frog agreed to the request. But, as expected, about halfway across the pond, the frog felt an awful pain and before they both died, asked the scorpion why. The scorpion replied that he really couldn’t help it saying, “it’s in my nature to sting.”

Why did the frog make that irrational decision, even though he knew better? Fables typically have a moral for us to learn, and this one is no different; make rational decisions. Unfortunately, we make irrational decisions all of the time, even if, in the animal kingdom, we are known as the rational ones.

As of this writing, about 50% of the U.S. population is vaccinated. Since it is estimated that between 70% and 90 % of the population will need to be vaccinated against the COVID-19 virus to reach herd immunity, we have a long way to go. But the vaccination rate overall has slowed significantly. We watched the vaccination rate begin to plateau in late June and early July, at about the same time that the more deadly Delta variant began to ravage the unvaccinated. Now, with new cases rising each day across the country, one wonders why anyone would put off getting the vaccine.

Explanations for this phenomenon abound; some believe that vaccine hesitancy is to blame. Early on in the rollout of the three major vaccines available in the U.S., many were “hesitant” because they wanted more information about the vaccines. Were the vaccines safe? If so, like most medications, they probably were not safe for everyone, so for whom were the vaccines not safe? Where would people go to get the vaccines? What costs would be involved? These are rational questions the population was asking; they may have been gathering facts to make rational decisions. Or were they?

Humans aren’t really known for our ability to be consistent when it comes to making rational decisions. Some of those same people get flu shots every fall and make sure their children receive needed vaccinations as infants and again prior to the start of school, still don’t want to take the COVID vaccine. All despite the fact approximately 99% of deaths in America due to COVID are found among those unvaccinated. It seems irrational not to avail oneself of this life-saving intervention.

Even some government officials — in those areas where the vaccination rate is low, and the spread of the variant is high — are growing more outspoken about their constituents’ health decisions. Senate minority leader, Mitch McConnell (R-KY), has reiterated in public that for those who can be vaccinated to do so. (His state, Kentucky, has a lower-than-average vaccination rate.) The Governor of Alabama, Kay Ivy, recently said that this is now an epidemic of the unvaccinated in her state, further stating that you just can’t teach “common sense.”

But alongside these pleas are plenty of name-calling, finger-pointing, and blaming — all of which may be smokescreens for the fact that we don’t really know how to message the vaccine’s appeal to remaining holdouts. We continue to assume that humans are consistent in making rational choices, and when we believe they have not done so, we have a tendency to throw up our hands. We think that stupid decisions are made by stupid people. The truth, however, is that we aren’t consistent in making rational choices; irrationality abounds, and it has nothing to do with stupid. The same people who buy lottery tickets also buy insurance. Why? Cognitive science and the felicific calculus of Jeremy Bentham may both give us a peek into why we make decisions as we do, whether they are rational ones or not.

In the 18th century, Bentham formulated the “felicific calculus” which stated that an event can be assigned a value (typically numeric) as to its utility or worth. That worth was measured in terms of the amount of happiness or pleasure the event would bring people; the more happiness, the better the decision that caused it, and the more rational it would be seen. This mathematical algorithm measured pleasure or pain in terms of several facets; among them were the pleasure or pain’s intensity, its duration, the probability of its occurrence (and reoccurrence), and the number of people affected. While being mathematically sound, philosophically appealing in many ways, and rational, for most day-to-day decisions the calculus was impractical. Adapting a thought experiment originally posed by cognitive scientist/mathematician Amos Tversky however, may help us understand from a cognitive perspective why people are so inconsistent when making decisions.

Example 1. Let’s say that your local health department has projected that 600 people will get the Delta variant of COVID-19 in your hometown of 6,000 people.

There is a proposed treatment, A, and if applied it will save 200 people. 

There is another proposed treatment, B, and if applied, there will be 1 chance in 3 that 600 people will be saved, and 2 chances in 3, that no one will be saved.

Which treatment would you choose?

When presented with the original problem, most people chose treatment A where there is a surety that 200 people will live.

Example 2. Now, let’s say that the health department again predicts that 600 people in your hometown of 6,000 will get the Delta variant of COVID-19.

There are 2 treatments, A and B.

If treatment A is applied, 400 people will die.

If treatment B is applied there are 2 chances in 3 that all 600 will be lost, and I chance in 3 that no one will be lost.

Which treatment would you choose?

When presented with the original problem, most people chose treatment B.

Notice, however, that 200 people survive in each case. Despite this, in case one, treatment A was chosen as the better alternative, while in case two, treatment B was chosen. Why, when the probabilities and outcomes are the same, did A get chosen one time and B the other time? It’s the way the cases are presented, or framed. In the first scenario, the probabilities are presented in terms of lives saved (gains), and in scenario two the probabilities are framed in terms of lives lost (losses). We focus on the number of lives saved in either case, whether it’s a “sure bet” or the better probability.

Currently, public messaging regarding vaccinations focuses on lives lost rather than the number of lives saved. If we reframe messaging to focus on lives saved (gains) instead of lives lost (losses), the application of Tversky’s thought experiment might get us over the hump and on our way to achieving herd immunity. The felicific calculus of Bentham applies as well; perhaps a mathematical algorithm makes more sense to us homo sapiens in this case. Think of the number of persons who would experience happiness and pleasure instead of pain over a long period of time, plus the freedom from worry that the Delta could re-infect us. Correctly framing the message seems to be one effective and scientific way to help people manage the inherent irrationality that comes with being human.

Will the Real Anthony Bourdain Please Stand Up?

headshot of Anthony Bourdain

Released earlier this month, Roadrunner: A Film About Anthony Bourdain (hereafter referred to as Roadrunner) documents the life of the globetrotting gastronome and author. Rocketing to fame in the 2000’s thanks to his memoir Kitchen Confidential: Adventures in the Culinary Underbelly and subsequent appearances on series such as Top Chef and No Reservations, Bourdain was (in)famous for his raw, personable, and darkly funny outlook. Through his remarkable show Anthony Bourdain: Parts Unknown, the chef did more than introduce viewers to fascinating, delicious, and occasionally stomach-churning meals from around the globe. He used his gastronomic knowledge to connect with others. He reminded viewers of our common humanity through genuine engagement, curiosity, and passion for the people he met and the cultures in which he fully immersed himself. Bourdain tragically died in 2018 while filming Parts Unknown’s twelfth season. Nevertheless, he still garners admiration for his brutal honesty, inquisitiveness regarding the culinary arts, and eagerness to know people, cultures, and himself better.

To craft Roadrunner’s narrative, director Morgan Neville draws from thousands of hours of video and audio footage of Bourdain. As a result, Bourdain’s distinctive accent and stylistic lashings of profanity can be heard throughout the movie as both dialogue and voice-over. It is the latter of these, and precisely three voice-over lines equating to roughly 45-seconds, that are of particular interest. This is because the audio for these three lines is not drawn from pre-existing footage. An AI-generated version of Bourdain’s voice speaks them. In other words, Bourdain never uttered these lines. Instead, he is being mimicked via artificial means.

It’s unclear which three lines these are, although Neville has confirmed one of them, regarding Bourdain’s contemplation on success, appears in the film’s trailer. However, what is clear is that Neville’s use of deepfakes to give Bourdain’s written words life should give us pause for multiple reasons, three of which we’ll touch on here.

Firstly, one cannot escape the feeling of unease regarding the replication and animation of the likeness of individuals who have died, especially when that likeness is so realistic as to be passable. Whether that is using Audrey Hepburn’s image to sell chocolate, generating a hologram of Tupac Shakur to perform onstage, or indeed, having a Bourdain sound-alike read his emails, the idea that we have less control over our likeness, our speech, and actions in death than we did in life feels ghoulish. It’s common to think that the dead should be left in peace, and it could be argued that this use of technology to replicate the deceased’s voice, face, body, or all of the above somehow disturbs that peace in an unseemly and unethical manner.

However, while such a stance may seem intuitive, we don’t often think in these sorts of terms for other artefacts. We typically have no qualms about giving voice to texts written by people who died hundreds or even thousands of years ago. After all, the vast majority of biographies and biographical movies feature dead people. There is very little concern about the representation of those persons on-screen or the page because they are dead. We may have concerns about how they are being represented or whether that representation is faithful (more on these in a bit). But the mere fact that they are no longer with us is typically not a barrier to their likeness being imitated by others.

Thus, while we may feel uneasy about Bourdain’s voice being a synthetic replication, it is not clear why we should have such a feeling merely because he’s deceased. Does his passing really alter the ethics of AI-facilitated vocal recreation, or are we simply injecting our squeamishness about death into a discussion where it doesn’t belong?

Secondly, even if we find no issue with the representation of the dead through AI-assisted means, we may have concerns about the honesty of such work. Or, to put it another way, the potential for deepfake facilitated deception.

The problem of computer-generated images and their impact on social and political systems are well known. However, the use of deepfake techniques in Roadrunner represents something much more personable. The film does not attempt to destabilize governments or promote conspiracy theories. Rather, it tries to tell a story about a unique individual in their voice. But, how this is achieved feels underhanded.

Neville doesn’t make it clear in the film which parts of the audio are genuine or deepfaked. As a result, our faith in the trustworthiness of the entire project is potentially undermined – if the audio’s authenticity is uncertain, can we be safe in assuming the rest of the film is trustworthy?

Indeed, the fact that this technique had been used to create the audio footage was concealed, or at least obfuscated, until Neville was challenged about it during an interview reinforces such skepticism. That’s not to say that the rest of the film must be called into doubt. However, the nature of the product, especially as it is a documentary, requires a contract between the viewer and the filmmaker built upon honesty. We expect, rightly or wrongly, for documentaries to be faithful representations of those things they’re documenting, and there’s a question of whether an AI-generated version of Bourdain’s voice is faithful or not.

Thirdly, even if we accept that the recreation of the voices of the dead is acceptable, and even if we accept that a lack of clarity about when vocal recreations are being used isn’t an issue, we may still want to ask whether what’s being conveyed is an accurate representation of Bourdain’s views and personality. In essence, would Bourdain have said these things in this way?

You may think this isn’t a particular issue for Roadrunner as the AI-generated voice-over isn’t speaking sentences written by Neville. It speaks text which Bourdain himself wrote. For example, the line regarding success featured in the film’s trailer was taken from emails written by Bourdain. Thus, you may think that this isn’t too much of an issue because Neville simply gives a voice to Bourdain’s unspoken words.

However, to take such a stance overlooks how much information – how much meaning – is derivable not from the specific words we use but how we say them. We may have the words Bourdain wrote on the page, but we have no idea how he would have delivered them. The AI algorithm in Roadrunner may be passable, and the technology will likely continue to develop to the point where distinguishing between ‘real’ voices and synthetic ones becomes all but impossible. But such a faithful re-creation would do little to tell us about how lines would be delivered.

Bourdain may ask his friend the question about happiness in a tone that is playful, angry, melancholic, disgusted, or a myriad of other possibilities. We simply have no way of knowing, nor does Neville. By using the AI-deepfake to voice Bourdain, Neville is imbuing meaning into the chef’s words – a meaning which is derived from Neville’s interpretation and the black-box of AI-algorithmic functioning.

Roadrunner is a poignant example of an increasingly ubiquitous problem – how can we trust the world around us given technology’s increasingly convincing fabrications? If we cannot be sure that the words within a documentary, words that sound like they’re being said by one of the most famous chefs of the past twenty years, are genuine, then what else are we justified in doubting? If we can’t trust our own eyes and ears, what can we trust?

Duties to Vaccinate, Duties to Inform

image of 2021 with vaccine vial and syringe representing two of the numbers

The news these days has been dominated by information about the development of a vaccine for COVID-19, something that has felt like the first really good bit of news pertaining to the pandemic since it started. While there is reason for optimism, however, it is not as though the deployment of a vaccine will end the pandemic overnight: in addition to logistical problems of production and distribution, recent research suggests that it may still be possible that vaccinated individuals could spread the disease, even if they themselves will not contract it. As such, it’s not as though we can all just throw our masks in the garbage and start going to music festivals the day the vaccines start to roll out. This is not to say that things won’t get better, but that it might take a while.

You would think that the development of a vaccine would be universally regarded as good news, and that pretty much everyone would want to get vaccinated. However, when surveyed, large portions of the US population have responded that they would be hesitant to receive a vaccine, or else would outright refuse it. These numbers have varied over the months: according to the PEW research center, in May 27% said they would “probably not” or “definitely not” get the vaccine, while that number increased to 49% in September, before going back down to 39% in November. It’s not clear whether these numbers will change as more information becomes available, however; similarly, when people actually start receiving the vaccine and seeing that it’s not dangerous one might expect these numbers to go down.

Reasons for current levels of skepticism vary: while much has been made about the wildest conspiracy theories floating around Facebook – Bill Gates is trying to mind control you, or something – it seems more likely that the majority of skeptics are driven more by concerns about making the best decisions given limited information, combined perhaps with a distrust of medical experts. The question then becomes how we can best communicate scientific information to those who are skeptical. Indeed, this is a problem that we have been facing since the pandemic started: first it was information regarding the need for social distancing, then for wearing masks, and now for getting vaccinated. While at no point have we found the magic solution, it is worth considering what our roles in this process should be.

I think we have a certain obligation in this regard: beyond getting the vaccine itself, we also ought to try to inform others as best we can.

Here’s why I think this. Part of the problem in communicating information to a lot of skeptical people is that it will be difficult to find sources of information that everyone finds trustworthy. To try to address this concern, former presidents Barack Obama, George W. Bush, and Bill Clinton have stated that they would all receive the vaccine on camera to show that it is safe, with the goal of appealing to as politically diverse a population as possible. Given that a number of issues surrounding COVID-19 have become politicized, this seems like a good strategy: if those on one side of the political spectrum are less likely to trust someone from the other side, then having representatives of both sides together to present a unified message may help convince a larger audience.

(Other campaigns seem less promising: Trump, for instance, reportedly attempted to develop videos to be played on YouTube promoting the vaccine using only celebrities that were not critical of Trump or some of the causes that he does not support, such as having voted for Obama in the past or being in favor of gay rights. The number of people who met these criteria turned out to be very short.)

While trust can be affected by one’s general political position, there are additional divisions that may affect who one deems trustworthy. This can be seen in recent polls measuring Americans’ willingness to receive the vaccines that target more specific demographics. For instance, some have expressed concern that Black Americans may be particularly prone to skepticism regarding the vaccine, prompting members of various Black communities to attempt to communicate the importance of getting vaccinated. In an even more specific study, one recent poll reported that over half of New York City firefighters would refuse a vaccine. Here union leaders seem to be going in the wrong direction, stating that they would not require first respondents to be vaccinated, and that they would respect the decisions of their members.

We can see, then, that while major figures like former U.S. presidents may be seen as trustworthy sources, there is also a role for less prominent individuals to convey information to skeptical individuals. Given the importance of having as many people receive the vaccine as possible, the duty to try to inform others extends, I think, to pretty much everyone: while not everyone is a community leader, one may nevertheless be considered a trustworthy source of information by one’s friends and family, and may be able to communicate such information more effectively than former presidents or celebrities, given that one may share more values with those one is close to. When it comes to the COVID vaccine, then, one’s obligations may extend beyond just getting the vaccine oneself, and may include duties to help inform others.

Anti-Maskers and the Dangers of Collective Endorsement

photograph of group of hands raised

Tensions surrounding the coronavirus pandemic continue to run high, especially in parts of America in which discussions over measures to control spread of the virus have become something of a political issue. Recently, some of these tensions erupted in the form of protests of “anti-maskers”: in Florida, for example, a group of such individuals marched through a Target, telling people to take off their masks, and playing the song “We’re Not Going to Take It.” Presumably the “it” that they were no longer interested in taking pertained to what they perceived to be a violation of personal liberties, as they felt as though they were being forced to wear a mask against their wills. While evidence regarding the effectiveness of masks at keeping oneself and others safe continues to grow, there nevertheless remains a vocal minority that believes otherwise.

A lot of thought has been put into the problem of why it is that people continually ignore good scientific evidence, especially when the consequences of doing so are potentially dire. There is almost certainly no singular, easy answer to the problem. However, there is one potential reason that I think is worth focusing on, namely that anti-maskers, among many others of those who reject the best available scientific evidence on a number of issues, will tend to trust sources that they find on social media instead of through more reputable outlets. For instance, one investigation of why anti-maskers hold their beliefs pointed to the effects of Facebook groups in which such beliefs are discussed and shared. Indeed, despite their efforts to contain the spread of such misinformation, anti-masker Facebook groups remain easy to find.

However, the question remains: why would anyone believe a group of random Facebook users over scientific experts? The answer to this is no doubt multifaceted as well. But one reason may come down to a matter of trust, and that the ways we determine who is trustworthy works differently online than it does in other contexts.

As frequent internet users will no doubt be familiar with already, it can often be difficult to identify trustworthy sources of information online. One reason is that the internet offers varying degrees of anonymity: the consequence is that one will potentially not have much information about the person one’s talking with, especially given the possibility that people can fabricate aspects of their identities in online environments. Furthermore, interacting with others through text boxes on a computer screen is a very different kind of interaction than one that occurs face-to-face. For instance, researchers have shown that there are different “communication cues” that we pick up on when interacting with each other, including verbal cues like tone of voice, volume of speech, and rate at which one is speaking, and visual cues like facial expressions and body language. These kinds of cues are important when we make judgments about whether we should believe what the other person is saying, and are largely absent in a lot of online communication.

With less information about each other to go on when interacting online, we will then tend to look to other sources of information when determining who to trust. One thing internet users tend to appeal to is endorsement. For instance, when reading things on social media or message board sites we tend to put more trust in those posts that have the most hearts, or likes, or upvotes, etc. This is perhaps most apparent when you’re trying to decide what product to buy: we tend to gravitate towards those with not only the highest ratings, but those that have the most high ratings (something with one 5 star review doesn’t mean much, but a product with hundreds of high reviews means a lot more). The same can be the case when it comes to determining which information to believe: if your post has thousands of endorsements then I’m probably going to at least give it a look, whereas if it has very few, I’ll probably pass it by.

There is good reason to trust information that is highly endorsed. As noted above, it can be hard to determine who to trust online because it’s not clear whether someone is really who they say they are. It’s easy for me to join a Facebook group and tell everyone that I’m an epidemiologist, for example, and without having access to any more information about me you’ve got little other than my word to go on. Something that’s much harder to fake, though, is a whole bunch of likes, or hearts, or upvotes. So the thought is that if enough other people endorse something, that’s good reason to trust it. So here’s one reason why people getting their information off social media might trust that information more than that coming from the experts, namely because it is highly endorsed by many other members of their group.

At the same time, people might be more willing to believe those with whom they interact with online in virtue of the fact that they are interacting with them. For instance, when a scientific body like the CDC tells you that you should be wearing a mask, information is traveling in only one direction. When interacting with groups online, though, it can be much easier to trust those that you are interacting with, and not merely deferring to. Again, this is one of the problems raised by online communication: while there is lots of good information available, it can be easier to trust those with whom one can engage with, as opposed to just take orders from them.

Again, given that the problem is complex and multifaceted means that there will not be a one-size-fits-all solution. That said, it is worthwhile to think about how it might be possible for those with the good information to establish relationships of trust with those who need it, given the unique qualities of online environments.

Conspiracy Theories and Emotions in the Time of Coronavirus

image of screen with social media app icons displayed

While it is not unusual in this day and age to come across a conspiracy theory on social media, the coronavirus pandemic seems to be producing far more than its fair share. Here are some recent examples of such theories that have been circulating:

Each theory is backed by its own kind of specious reasoning. Some, like the conspiracy theory that flu shots will result in positive coronavirus test results, are based on posts made by a discredited doctor; others, like the 5G conspiracy, appears to be a holdover from previous conspiracies about the installation of 3G cell towers, just in an updated form. For others, it is not clear whether the conspiracy theorists are motivated by political concerns (were the Dr. Fauci conspiracy true, for example, it would validate Trump’s recommendations) or something else.

Regardless, the spread of these and other conspiracy theories are not inert. For instance, those who believe in the 5G conspiracy theory have been setting 5G towers on fire in the UK. What’s more, the generation of such theories does not seem to be slowing down: in the time of writing these two paragraphs I have been notified of the existence of three conspiracy theories regarding a potential coronavirus vaccine: that the first volunteer in a UK vaccine trial has died (no, she hasn’t); that a vaccine already exists for dogs but is not being used for humans (no and no); and that a vaccine does in fact already exist, and was in fact developed as part of that UK vaccine trial I just mentioned (again, no).

While some of these theories at least purport to be based on scientific information, many just seem so far outside the realm of plausibility that it is difficult to imagine how anyone could believe them, let alone take them seriously enough to light a cellphone tower on fire. So what’s going on? Why are there so many conspiracy theories, and how is it that they’re actually getting some traction?

There are of course many potential explanations for how it is that such theories start and are spread. However, part of the explanation for why it is that coronavirus conspiracy theories in particular are so numerous could be that many people are feeling really stressed out. Consider some recent research that suggests that one’s willingness to accept fake news stories and conspiracy theories peddled online depends in part on how emotionally charged those stories are; in other words, stories that grab your attention with language that are likely to make you feel angry, sad, surprised, etc., are going to be ones that, on average, are shared among one’s friends and followers. You have probably come across this trick by producers of less-than-reputable web content before: when a headline tells you that “you won’t believe ___!” they are counting on your piqued curiosity driving you to their site. While often this is merely annoying, when it comes to fake news and conspiracy theories it can be much more dangerous.

Why it is that emotionally-charged stories are shared more is up for debate. One such theory, however, posits that being in an emotionally-charged state will make it more likely that you won’t be reasoning to the best of your abilities. For instance, I might tell you a sob-story to pull on your heartstrings in an attempt to get you to believe what I’m saying; or, I might present you with a salacious headline designed to make you angry, etc. Having put you in a certain emotional state might then result in you not critically engaging with the content of my message, which might then make it more likely that you’ll believe and/or share my story (after all, there’s no better way to express your anger than to talk about it on the internet).

Part of what might explain how the recent flurry of coronavirus-related conspiracy theories and fake news stories continue to be spread and believed, then, is that they manipulate people who are already feeling a lot of emotional strain. As many people are worried, stressed, and anxious for a multitude of pandemic-related reasons, it is perhaps not surprising that stories and theories that attempt to make one even more worried, or angry, or whatever else, should interfere with one’s ability to think as clearly as possible.

Given that these continue to be stressful times, we should probably not expect to see these conspiracy theories dwindling in numbers any time soon. At the same time, given the connection between emotional manipulation and the spread of fake news, we perhaps have another avenue by which to address the problem, namely via an increased attention on our own mental well-being. It has become a mainstay of pandemic advice that one should pay particular attention to one’s mental health, especially when one is feeling stressed and isolated. While this is good advice in general (and indeed, is good advice regardless of whether there is a pandemic or not) it may have the added benefit of reducing the spread of coronavirus-related fake news and conspiracy theories: managing one’s stress may help manage one’s ability to critically engage with information one receives online to the best of one’s ability.

Swamping, Epistemic Trespassing, and Coronavirus

photograph of newspapers folded on top of laptop keyboard

Every day the media are awash with new information about coronavirus. And with good reason: people are worried and want to know the latest developments, what they should do, and how bad things could get. News is coming in not only locally, but globally: my current news feed, for example, has been providing me with information about the coronavirus in the US, Canada, Italy, South Korea, Australia, Spain, among other places. And not just about the spread of the virus itself, but about the consequences thereof, specifically the many events that have been canceled globally, as well as the financial ramifications. It is on everyone’s mind, and everyone is talking about it.

We are, of course, no exception here. But with one story dominating the headlines, there are two phenomena that we should watch out for: the first is swamping, in which other important news stories are, well, swamped by one story occupying everyone’s attention; and the second is epistemic trespassing, in which people who aren’t experts chime in on issues as if they were. Let’s look at these both in turn.

Consider the first problem: news of the coronavirus is so prevalent that it’s easy to lose track of news of anything else going on. For instance, in the US there are reports that a number of senators are currently trying to get a bill passed that would put limitations on websites and users to encrypt their data, and thus have potentially serious ramifications for data privacy in the US. Reddit users have also compiled a list of news stories that people may have missed because of the deluge of information about coronavirus, some that may have made the physical or virtual front page if there weren’t other matters occupying our attention. Important information can be more easily missed, then, if it is swamped by a singular issue.

This is not to say, of course, that it is a bad thing to get a lot of information about coronavirus. Nor is it to say that it is not an important issue that deserves our attention. We should, however, be vigilant both with regards to other important news stories, as well as the possibility that unscrupulous individuals may be using the pandemic as a distraction.

The second problem is a version of what some philosophers have called “epistemic trespassinga phenomenon in which someone weighs in on an issue outside of their area of expertise. For instance, if I, as a trustworthy and trained philosopher, were to write an op-ed about some matter in astrophysicsa topic I know almost nothing aboutthen I would be epistemically trespassing. It seems that as a general rule that one ought not epistemically trespass: you should know something about a subject before commenting on it, and you should not rely on unrelated expertise to be taken seriously. That is not to say, however, that one should avoid learning about and engaging in discussions concerning topics one is interested in: even though one might not be able to be an expert in everything, one is free to learn about subjects that one is unfamiliar with. The problem, then, is not with going where one doesn’t belong, so to speakwe don’t want to say that chemists can’t learn about or comment on art, or that physicists can’t learn about or comment on philosophy, nor that one cannot be knowledgeable about multiple different kinds of fields. The problem is presenting oneself as an expert in some domain that one is not an expert in.

You have no doubt come across some forms of epistemic trespassing with respect to coronavirus news in the form of friends and relatives suddenly becoming armchair epidemiologists and weighing in on what people should be doing and how concerned people should be. It is easy to find examples of such instances online, even from otherwise reputable sources.

Consider, for example, a recent article on The Verge. This piece by Tomas Pueyo argues persuasively that the United States is currently seeing exponential growth in the number of people contracting the disease, and that hospitals are likely to be overwhelmed. Pueyo’s background is in growth marketing, not in epidemiology. While there may be some similarities between marketing trends and the spread of viruses, there is clearly some amount of epistemic trespassing going on here: it seems like it would be better for someone who specializes in epidemiology to comment on the spread of virus instead of someone who works in marketing.

We have, then, two potential pitfalls when it comes to staying vigilant about knowing what’s going on in the world at this point in time: that a singular focus on coronavirus reporting could swamp other news, news that could also have important ramifications if missed, and with so many people weighing in on the pressing issue of the day that we risk running into epistemic trespassers, namely those people who might speak with the authority of an expert, but really don’t have much of an idea of what they’re talking about. As has been discussed here before, an epidemic can impact not just our physical lives, but our epistemic lives, as well.

The Ethics of Panic Hoarding

photograph of empty shelves at a grocery store

Future historians are going to face a difficult time figuring out whether our current times should be called the coronavirus epidemic of 2020 or the great toilet paper shortage of 2020. Amidst the WHO’s declaration that the COVID-19 outbreak now constitutes a pandemic, border closings, and “self-isolation” in order to prevent the spread of the virus, many have decided that the prudent thing to do is to purchase large amounts of toilet paper in addition to hand sanitizer, and non-perishables. In the United States the run on toilet paper has caused shortages. In Canada, despite attempts to prevent similar outcomes, grocery stores were flooded with consumers buying entire shelves. Marc Fortin of the Retail Council of Canada advised customers that “You don’t need a supply of toilet paper or rice for months,” adding, “Let’s not fall into panic mode.” Certainly, some of what we have seen this week is panic, and an important issue we should consider is when panic regarding the outbreak is morally acceptable and when it is not?

First, we must consider what we mean by the term “panic.” Typically, acting in a panic is contrasted with acting reasonably. As I write, the US government recommends cleaning your hands often, using hand sanitizer, avoiding close contact with people that are sick, and distancing yourself from others if the virus is spreading within a given community. They also recommend staying home if you are sick, covering your coughs and sneezes, and disinfecting touched surfaces daily. The Canadian government recommends similar measures; wash your hands frequently, and cover coughs and sneezes. They also suggest changing routines to help prevent infection; shop during off-peak hours, exercise outdoors rather than indoors. We could assume that recommendations of the government, often made on expert advice, are a reasonable standard. However, the government also specifically recommends purchasing essential materials without “panic buying.” This includes having easy-to-prepare foods like dried pasta, canned soups and vegetables, as well as having extra hygiene products. Unfortunately, they do not explain what is meant by “panic.” How does one know if purchasing that 10th bottle of hand sanitizer or that 5th pack of toilet paper constitutes panic buying?

One way to understand panic is that it is a way of acting without reason. For example, if one is driving and faces an oncoming car that has suddenly swerved towards them and they close their eyes and turn the wheel in any direction hoping to avoid an accident, this could be called panic. In his study of practical reasoning, philosopher John Dewey defined reasonableness or rationality as an affair of understanding the relationship between means and the ends they produce. If one pursues goals, for instance, with no connection to the means available and without reference to the obstacles that will prevent one from meeting said goal, they are acting unreasonably. By contrast, we could define panic as an action that does not consider the relationship between means, goals, and obstacles.

Therefore, if one goes into a grocery store upon hearing about the dangers of COVID-19 and because of this they purchase items at random because they feel they need to, this would constitute panic. Certainly, there are at least some people who chose to purchase large amounts of toilet paper or food they would never eat simply because of sheer panic. Some have suggested that this kind of behavior may be caused by anxiety combined with a desire to copy the behavior of others. Such action, while understandable, is not reasonable. While this definition of panic would preclude the idea that such actions are justified, they aren’t necessarily ethically wrong. According to Michael Baker, a professor of public health, hoarding and bulk purchases may be a way of handling anxiety by establishing a feeling of control. While there is nothing ethically wrong with falling into this pattern, panicked shopping can lead to shortages of important items for others. We can end up purchasing things we do not need and, in the process, make things worse off for others in legitimate need.

However, it is not likely that the vast majority of such cases are sheer mindless panic. After all, if one does purchase excessive accounts of food or toilet paper, they could still be considering how these can serve as means to goals like potentially having to quarantine oneself. One may act with a certain degree of reason and still potentially panic. As mentioned, the Canadian government suggested that one may wish to stock up on certain items, not necessarily because they will need to self-isolate but in order to ensure one doesn’t unnecessarily expose oneself if they are sick. However, there is a difference between making sure that one has a few days of food and toiletries and hoarding. One can “do the math” behind such considerations, establishing a relationship between means and ends, but could still go overboard.

While the concept of “moral panic” is generally tied to cases like the Salem Witch Trial or the panic of Satanism in the 1990s, it was originally defined in the 1970s in a broader way to include reactions to peoples, groups, and events. A common feature to these definitions of panic includes the idea of disproportionality; one may act in a panicked way if their actions are disproportionate to what is needed. Of course this is difficult to measure as well. It certainly requires an adequate idea of the problem, and this can be difficult in the case of the epidemic because of the “overabundance of information” available. Regardless, given that toilet paper is not especially more important than other general household items that governments and other institutions are suggesting that people stock up on, it is still unclear why there is a disproportionate demand for it.

There is also the matter of inductive risk. What if the experts are wrong? What if the outbreak gets unexpectedly worse? What if grocery stores close? As some have pointed out, making sure that one has toilet paper if they have to be confined to their house (in other words, planning for the worst) may not be unreasonable. This, in addition to the unclear relevance of information and inconsistent messaging, has led to calls that we should not mock those who engage in hoarding. While mocking may not be the most helpful or considerate reaction, that doesn’t mean that panicked hoarders should be let off the hook either.

Hoarding, whether understandable or not given the anxiety and stress of the situation, still leads to harmful effects. For example, empty food shelves have made it difficult for charities to get food to the disadvantaged. It has also opened room for price gouging, something that again will hurt those worst off. While things could get worse, purchasing enough cans of tomato soup to last for years is not proportionate to the problem, nor is purchasing food that you would never eat anyways. Worse yet, by purchasing things you do not need while making others worse off, and only to help ensure that you feel more secure against unlikely outcomes, is an act of selfishness. Anxiety, stress, and fear do not absolve people from the moral consequences of their panicked behavior. If you are buying for a potentially long stay in your home, ask yourself questions like “Will this item actually help if I get the virus?” “How much will it help?” “How long should I reasonably expect to have to stay at home and given that, how much food and household items will I need?” And “Can I imagine others need these things more than I do?”

Are We Overreacting? Coronavirus in Context

Perhaps the fear about the novel coronavirus (COVID-19) stems from uncertainty about the future. Or perhaps it stems from confusion about the virus itself. In late January, the number of coronavirus cases was just shy of 600; seven weeks later that number had ballooned to 110,000. Figures such as those can cause panic. But numbers without context or explanation can be meaningless. As psychologist Daniel Kahneman observes, “Human beings cannot comprehend very large or very small numbers.”

Relative to the world’s population, the number of cases is small. Proportionally, if every seat in Gillette Stadium was occupied for a Patriots game, only one of the spectators would have coronavirus. And that spectator would have a 3.4% chance of dying as a result.

But even that percentage, provided by the World Health Organization (WHO), requires context. Depending on the location, the mortality rate varies substantially. Jamie Ducharme and Elijah Wolfson of Time observe that countries with a greater number of tests administered have lower mortality rates. For example, the U.S. has a mortality rate of 5% but has only administered seven tests per million residents, while South Korea has administered 1,100 tests per million residents and registers a mortality rate of 0.6%. Additionally, compared to other once-novel coronaviruses, COVID-19 is more akin to flu.

“Severe Acute Respiratory Syndrome (SARS) killed about 10% of the people who got it, while Middle East Respiratory Syndrome (MERS) was even deadlier,” Ducharme and Wolfson write. “At least so far, COVID-19 does seem to be more lethal than the seasonal flu, but it’s closer to that end of the spectrum.”

Often excluded from the live updates of the number of coronavirus cases is the number of those who have recovered. During an address on March 9, the WHO Director-General noted that of the 80,000 individuals in China who have tested positive for COVID-19, 70 percent have made a full recovery. The 110,000 number does not reflect the number of those currently infected with the virus but rather the total known number of those who have been infected.

Our perception of the risk informs our reaction. Incomprehension about numbers paves the way for overreaction. But does that matter? Is it better to be safe than sorry? Or should we balance preventing the spread of the disease with finding normalcy amidst the prevention?

In reaction to fears about the virus, shoppers in the UK are emptying out grocery stores despite government ministers saying there is “no need for anybody to stockpile.” Grocery chains have begun to limit the purchases of certain goods such as anti-bacterial gels, dry pasta, and canned vegetables. In the U.S. and Canada, shoppers are stockpiling toilet paper. In New York, people are stealing medical masks and other equipment from hospitals. Steven Taylor, a clinical psychologist who studies how people respond to pandemics, called the reaction “excessive.” “When people are told something dangerous is coming, but all you need to do is wash your hands, the action doesn’t seem proportionate to the threat,” he told CNN.

Morgan Housel of the Collaborative Fund echoes Taylor’s observation in his piece about the panic. “[Wash your hands is] too simple for some people to take seriously,” he writes. “The idea that complex problems can benefit from simple solutions isn’t intuitive.”

Abdu Sharkawy, an infectious diseases specialist at the University of Toronto, says that he is not scared of COVID-19. “What I am scared about is the loss of reason and wave of fear that has induced the masses of society into a spellbinding spiral of panic, stockpiling obscene quantities of anything that could fill a bomb shelter adequately in a post-apocalyptic world,” he wrote in a Facebook post.

The risk of contracting COVID-19 remains low. The risk of suffering the most grave consequence is even lower. But you may not know that when hit with a steady stream of numbers on the news and an increasing sense of panic amongst your neighbors. Perhaps the best thing to do is keep calm, heed the most up-to-date advice of your government, and wash your hands. If you have questions about the coronavirus, visit the WHO’s Q&A page.

Infodemics and Good Epistemic Hygiene

3d rendering of bacteria under a microscope

There has been a tremendous amount of news lately about the outbreak and spread of COVID-19, better known as the coronavirus. And while having access to up-to-date information about a global health crisis can certainly be a good thing, there have been worries that the amount of information out there has become something of a problem itself. So much so that the World Health Organization (WHO) has stated that they are concerned that the epidemic has led to an “infodemic”: the worry is that with so much information it will be difficult both for people to process all of it, and to determine what they should trust and which they should ignore.

With so much information swirling about there is already a Wikipedia page dedicated to all the various rumors and conspiracy theories surrounding the virus. For instance, some of the more popular conspiracy theories state that the virus is a human-made biological weapon (it isn’t), and that there are vaccines already available but are just being kept from the public (there aren’t). It shouldn’t be surprising that social media is the most fertile breeding ground for misinformation, with large Facebook groups spreading not only falsehoods but supposed miracle cures, some of which are extremely dangerous.

In response to these problems, sites like Facebook, Google, and Twitter have been urged to take steps to try to help cull the infodemic by employing fact-checking services, providing free advertising for the WHO, and by trying to make sure that when looking for information about coronavirus online that reputable sources are those that dominate the results.

While all of this is of course a good thing, what should the individual person do when faced with such an infodemic? It is, of course, always a good idea to be vigilant when acquiring information online, especially when that information is coming from social media. But perhaps just as we should engage in more conscientious physical hygiene, we should also engage in a more substantial epistemic hygiene, as well. After all, the spreading of rumors and misinformation can itself lead to harms, so it seems that we should make extra sure that we aren’t forming and spreading beliefs in a way that can potentially be damaging to others.

What might good epistemic hygiene look like in the face of an infodemic? Perhaps we can draw some parallels from the suggested practices for good physical hygiene from the WHO. Some of the main suggestions from the WHO include:

  • Washing hands frequently
  • Maintaining social distance
  • Practicing good respiratory hygiene (like covering your mouth when you cough or sneeze)
  • Staying informed

These are all good ways to minimize chances of contracting or spreading diseases. What parallels could we draw from this when it comes to the infodemic? While the physical act of hand-washing is unlikely to stop the spread of misinformation, perhaps a parallel when it comes to forming beliefs would be to make extra careful which sources we’re getting our information from, and to critically reflect upon our beliefs if we do get information from a less than trustworthy source. Just as taking a little extra time to make sure your hands are clean can help control the spread of disease, so could taking some extra time to critically reflect help control the spread of misinformation.

Maintaining a kind of social distance might be a good idea, as well: as we saw above, the majority of misinformation about the epidemic comes from social media. If we are prone to looking up the latest gossip and rumors, it might be best to just stay out of those Facebook groups altogether. Similarly, just as it’s a good idea to try to protect others by coughing or sneezing into your arm, so too is it a good idea to keep misinformed ideas to yourself. If you feel like you want to spread gossip or information you’ve acquired from some other less-than-reputable source, instead of spreading it around further by posting or commenting on social media, the best thing would be to try to stop the spread as much as possible.

Finally, the WHO does suggest that it is a good idea to stay informed. Again, we have seen that there are better and worse ways of doing this. Staying informed does not mean acquiring information from just anywhere, nor does it mean getting as much information as is humanly possible. In the light of an infodemic one needs to be that much more vigilant and responsible when it comes to the potential spread of misinformation.

California’s “Deepfake” Ban

computer image of a 3D face scan

In 2018, actor and filmmaker Jordan Peele partnered with Buzzfeed to create a warning video. The video appears to feature President Barak Obama advising viewers not to trust everything that they see on the Internet. After the President says some things that are out of character for him, Peele reveals that the speaker is not actually President Obama, but is, instead, Peele himself. The video was a “deepfake.” Peele’s face had been altered using digital technology to look and move just like the face of the president.

Deepfake technology is often used for innocuous and even humorous purposes. One popular example is a video that features Jennifer Lawrence discussing her favorite desperate housewife during a press conference at the Golden Globes. The face of actor Steve Buscemi is projected, seamlessly, onto Lawrence’s face. In a more troubling case, Rudy Giuliani tweeted an altered video of Nancy Pelosi in which she appears to be impaired, stuttering and slurring her speech. The appearance of this kind of altered video highlights the dangers that deepfakes can pose to both individual reputations and to our democracy more generally.

In response to this concern, California passed legislation this month that makes it a crime to distribute audio or video that presents a false impression about a candidate standing for an election occurring within sixty days. There are exceptions to the legislation. News media are exempt (clearing the way for them to report on this phenomenon), and it does not apply to deepfakes made for the purposes of satire or parody. The law sunsets in 2023.

This legislation caused controversy. Supporters of the law argue that the harmful effects of deepfake technology can destroy lives. Contemporary “cancel culture,” under which masses of people determine that a public figure is not deserving of time and attention and is even deserving of disdain and social stigma, could potentially amplify the harms. The mere perception of a misstep is often enough to permanently damage a person’s career and reputation. Videos featuring deepfakes have the potential to spread quickly, while the true nature of the video may spread much more slowly, if at all. By the time the truth comes out, it may be too late. People make up their minds quickly and are often reluctant to change their perspectives, even in the face of compelling evidence. Humans are prone to confirmation bias—the tendency to consider only the evidence that supports what the believer was already inclined to believe anyway. Deepfakes deliver fodder for confirmation bias, wrapped in very attractive packaging, to viewers. When deepfakes meet cancel culture in a climate of poor information literacy, the result is a social and political powder keg.

Supporters of the law argue further that deepfake technology threatens to seriously damage our democratic institutions. Citizens regularly rely on videos they see on the Internet to inform them about the temperament, behavioral profile, and political beliefs of candidates. It is likely that deepfakes would present a significant obstacle to becoming a well-informed voter. They would inevitably contribute to the sense that some voters currently have that we exist in a post-truth world—if you find a video in which Elizabeth Warren says one thing, just wait long enough and you’ll see a video of her saying the exact opposite. Who’s to say which is the deepfake? The results of such a worldview would be devastating.

Opponents of the law are concerned that it violates the first amendment. They argue that the legislation invites the government to consider the content of the messages being expressed and to allow or disallow such messages based on that content. This is dangerous precedent to set—it is exactly the type of thing that the first amendment is supposed to prevent.

What’s more, the legislation has the potential to stifle artistic expression. The law contains exemptions for the use of deepfakes that are made for the purposes of parody and satire. There are countless other kinds of statements that people might use deepfakes to make. In fact, in his warning video, artist Jordan Peele used a deepfake to great effect, arguably making his point far more powerfully than he could have using a different method. Peele’s deepfake might have resulted in more cautious and conscientious viewers. Opponents of the legislation argue that this is precisely why the first amendment is so important. It protects the kind of speech and artistic expression that gets people thinking about how their behavior ought to change in light of what they viewed.

In response, supporters of the legislation might argue that when the first amendment was originally drafted, we didn’t have the technology that we have today. It may well be the case that if the constitution were written today, it would be a very different document. Free speech is important, but technology can cause harm now in an utterly unprecedented way. Perhaps we need to balance the value of free speech against the potential harms differently now that those harms have such an extended scope.

A lingering, related question has to do with the role that social media companies play in all of this. False information spreads like wildfire on sites like Facebook and Twitter. Many people use these platforms as their source for news. The policies of these exceptionally powerful platforms are more important for the proper functioning of our democracy than anyone ever could have imagined. Facebook has taken some steps to prevent the spread of fake news, but many are concerned that it has not gone far enough.

In a tremendously short period of time, technology has transformed our perception of what’s possible. In light of this, we have an obligation to future generations to help them learn to navigate the very challenging information literacy circumstances that we’ve created for them. With good reason, people believe that they can trust their senses. Our academic curriculum must change to make future generations more discerning.

Mental Health, Information Literacy and the Slenderman Stabbing Case

A sidewalk chalk drawing of Slenderman.

On May 31, 2014, two 12-year-old girls lured a friend, also 12, into the woods with the promise of a game of hide-and-seek.  Once there, one of the girls pinned their friend down, while the other stabbed her 19 times with a long-bladed kitchen knife, causing serious injuries to major organs and arteries.  The young perpetrators then fled the scene, leaving their young friend to die of her injuries.  Miraculously, the victim survived.  She was able to crawl to a road where a cyclist found her and went for help.  

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