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Slow and Steady Wins the Race; or, How Not To Confuse Efficiency with Expediting

photograph of blurred pedestrians crossing intersection

Efficiency is the credo of a capitalist society. To the average person, “efficient” has a connotation of speed: if something is not getting done imminently, they reason time must be getting wasted. As the capitalist credo, efficiency often seems elevated to the status of a moral value. That is, a thing done efficiently (again, reading as “quickly”) is a positive moral accomplishment.

This confusion—and it is a confusion—is on full display during the COVID-19 pandemic. The race to find successful treatments, and hopefully a vaccine, for COVID-19 have institutions rushing the usual procedures for research and development. Animal tests would usually precede human testing. However pharmaceutical research companies like Moderna have taken the step of running such trials simultaneously. While people living under the pall of this novel coronavirus want a vaccine quickly, many medical expertsincluding newly-minted celebrity Dr. Anthony Fauciurge researchers and policymakers to take the cautious route. These pleas, however, have largely fallen on deaf ears with the advent of initiatives like US President Donald Trump’s Operation Warp Speed.

Nor is the desire for efficiency limited to the development of a vaccine. There is a general desire for the legal and political handling of the COVID-19 pandemic to be efficient. Those who are more cautious and who believe the general public health consensus about COVID-19 want efficiency in the articulation and administration of laws and executive orders. NY Governor Andrew Cuomo enjoys impressive job approval ratings, as do most other states’ governors. Some of the governors with the lowest approval ratings are in states who have moved to reopen more of their states’ non-essential business and to do so more quickly (e.g., Georgia’s Brian Kemp). This is likely because, on the whole, Americans are in favor of many lockdown and social distancing measures, worrying that ending these measures prematurely will negatively impact public health. While apparently more newsworthy, the vocal segment Americans who want the lockdown to end (and believe it never should have started in the first place) is a minority.

Enthusiasm for “efficient” executive authority is not universal and has met substantial legal challenges. The legislature of Wisconsin recently successfully sued to overturn that state’s Department of Health Services stay-at-home orders. The Supreme Court of Wisconsin ruled that the orders were unconstitutional and unenforceable. The court’s decision, which relied largely on a close distinction between a rule and an order as defined by the Wisconsin Constitution, was panned by Wisconsin Governor Tony Evers as creating a state of “total chaos.” Reactions of other Democratic officials throughout the state echoed Evers’ concerns that an efficient response to the COVID-19 emergency would be hamstrung by the courts’ decision.

This illustrates the crux of the matter. Supporters of broad executive authority in the face of COVID-19 take an efficient response to be one which is centralized and univocal. The executive, along with their advisors and adjutants, should be able to do what is necessary to stem the spread of COVID-19. The Wisconsin Supreme Court objected that, even in the face of a crisis, statutory limits on executive power must be observed. This objection is of a kind with those made by Dr. Fauci, among others, concerning expedited vaccine development. Just as the statutory limits of executive power cannot be ignored, neither can the ethical safeguards on clinical research.

What this shows is that what counts as efficient is relative to the goal in question. If all that we want is the development of a vaccine that confers immunity to this novel coronavirus, then some of the standard procedures are inefficient. That is, they require the consumption of resources not necessary to produce the desired effect. However, if what we want is a vaccine that confers immunity and also has a low occurrence of significantly harmful side effects, then it is inefficient to rush the job. Likewise if we simply want to stop the spread of coronavirus, we could empower a single person to create laws by proclamation and enforce those laws by force. That is in effect what declarations of emergency by a governor or president allow, within narrowly-defined limits.

Efficiency then cannot be morally good no matter where it shows up. In the terminology of Immanuel Kant, efficiency is not “good without qualification.” In order for something to be good without qualification, Kant argues, that thing must be good in all conditions and circumstances. He says, for example, that pleasure doesn’t pass this test. After all, a sadist takes pleasure from torturing unwilling victims. Using a similar example, it is easy to see that efficiency fails Kant’s test. A sadist who invents a rack across which he can break multiple victims at once, with the crank of a single handle, is surely being quite efficient. He is also doing something quite repugnant. Just as the ends don’t justify the means, the means do not automatically confer any positive moral value to the ends. In fact, efficiency seems to act simply like a multiplier: if an accomplishment is already good on its own merits, doing it efficiently is even better; but if an accomplishment is bad on its own merits, doing it efficiently is even worse.

We want society to emerge from the COVID-19 pandemic as healthy and whole as possible. However the best ways to do that are likely not fast. Our medical, scientific, and political responses to this crisis cannot be swallowed up by their own sense of urgency. An efficient process is only as good as what it achieves. By casting away failsafes, we set ourselves up to aim unknowingly in the wrong direction.

Hydroxychloroquine and the Problem of Expert Disagreement

photograph of Coronavirus Update Breifing with Dr. Fauci at the podium with Trump behind him

On April 5th, after promoting the use of an anti-malarial drug to (possibly) help stem the tide of the coronavirus outbreak, President Trump commented, “What do I know? I’m not a doctor, but I have common sense.” According to Trump, even though we still lack conclusive evidence that hydroxychloroquine is an effective treatment for COVID-19, there is no reason not to try using it: the medication has been prescribed for other reasons for years and some preliminary results suggest it might also help diminish the effects of the novel coronavirus.

In contrast, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and member of the Coronavirus Task Force assembled by the White House to combat the outbreak, has repeatedly cautioned against counting on a treatment regimen that, based on what we know at this point, may not actually work; speaking to Fox and Friends on April 3rd, Fauci warned “We’ve got to be careful that we don’t make that majestic leap to assume that this is a knockout drug. We still need to do the kinds of studies that definitely prove whether any intervention is truly safe and effective.”

What should the average American (who, presumably, knows next to nothing about hydroxychloroquine) make of this disagreement? In most cases, we have reason to believe that the President of the United States – whoever that person happens to be – is in a position to be well-informed and trustworthy. Similarly, we have good reasons to think that doctors who have been appointed to lead federal research institutes (like the NIAID) – not to mention medical doctors in general – are believable experts about medications and prescription practices, as well as other matters of healthcare. How is a non-expert supposed to know who should be believed when purported experts disagree?

This is what philosophers sometimes call the “problem of expert disagreement” – if a layperson needs the insight of an expert to make a reasonable judgment about a claim, but two potential experts disagree, how can the layperson decide which expert to believe? Although the answer here might initially seem trivially easy – the layperson should just listen to whichever expert has more relevant knowledge about the claim – things aren’t so simple: how can the layperson know what counts as “relevant knowledge” if they are, in fact, just a layperson?

So, instead, we might look to the credentials of the two experts to see what sort of education or experience they might be employing when making their recommendations. If we know that one expert graduated from a well-respected university that specializes in the relevant field while the other received a degree from a university that does not train experts in the specific domain, then we have some reason to trust the first over the second. Ultimately, though, this test might not be much better than the first option: it requires the layperson to be able to judge the relative merit of credentialing institutions rather than credentialed individuals and this also seems unrealistic to expect actual laypersons to be capable of doing.

It’s worth noting, though, that this is exactly what laypersons think they’re doing when they simply assert that someone “went to Cornell” or “is the President” – they’re citing some person as an authority in virtue of credentials that they hold, regardless of whether those credentials are actually relevant to the question up for debate. In the worst cases, this isn’t just some misleading effect of celebrity, it’s actually the fallacious “argument from authority” (or an argumentum ad verecundiam, if you prefer): this example of bad reasoning occurs whenever a bad argument is grounded on the basis of someone’s authority in an irrelevant area of expertise.

Finally, laypersons might judge between two disagreeing experts by investigating which expert agrees with the standard consensus of other experts in their field. By increasing the sample size of experts beyond just the original two, the layperson can feasibly judge whether or not a particular person is an outlier among their peers. Presumably, a majority of experts will hold the most credibly supported position in the field (indeed, it’s not clear what else would constitute such a position). Of course, there are problems with this method too (experts in a field might agree with each other for all sorts of reasons other than a concern for the truth, for example), but it’s worth noting that this technique can be used even by the most ignorant of laypersons: all we need to know to judge between two experts is which expert’s peer group is bigger.

Typically, the problem of expert disagreement is debated among philosophers interested in social epistemology – the study of how knowledge works in group contexts – but when expert testimony bears on moral matters then ethicists should be concerned with it as well. It’s general epistemological doctrine that thinkers should believe what’s true, but (even if you deny this) it’s straightforwardly (or at least pragmatically) clear that people interested in protecting themselves and their loved ones from a pandemic should listen to the best medical experts available.

All of this is to say that, in the case of hydroxychloroquine and its purported role in fighting COVID-19, Fauci’s expertise (if you’ll forgive me for putting it this way) clearly trumps Trump’s. In the case of the first test, Dr. Fauci’s position as a medical expert gives his opinion immediate priority for medical questions over that of President Trump (whose job often entails seeking the expert advice of specialists like Fauci). For the second test, Dr. Fauci’s educational and professional career are clearly more relevant to medical questions than President Trump’s history of making real estate and television deals – and no amount of “common sense” matters here, either. Finally, although Trump has repeatedly referenced a survey of medical professionals in support of his position, Fauci’s insistence on controlled testing is simply the standard vetting process scientists seek to ensure that new treatment regimens are safe; the group Trump appeals to (based on that survey) numbers around 2300 individuals, whereas Fauci’s is something on the order of “most every medical researcher who has practiced in the last century.” United States presidents command many things, but the scientific method is not one of them.

Which might also be why Trump now appears to be actively censoring Fauci during press briefings, but that’s a topic for a different article.

The Moral Quandary of Testing on Animals

Photo of three rats in a cage with a little red house and food and water available

The topic of testing on animals as a form of scientific research has been contentious for quite some time. In most cases, the discussion tends to focus on whether it is morally permissible to test various products and procedures on animals in order to determine whether they would be safe and beneficial for human use. Animal experimentation is not always conducted simply for the benefit of human beings—sometimes the parties that stand to benefit from the research are other non-human animals, often including other members of the same species as the animals being tested.

Defenders of the practice of testing on animals for the benefit of humans argue that the benefits for humans substantially outweigh the harms incurred by animals. Some argue that our moral obligations extend only to other members of the moral community. Among other things, members of the moral community can recognize the nature of rights and obligations and are capable of being motivated to act on the basis of moral reasons. Non-human animals, because they are not capable of these kinds of reflections, are not members of the moral community. As such, defenders of animals testing argue, they don’t have rights. In response, critics argue that if we only have obligations to beings that can recognize the nature of moral obligations, then we don’t have obligations to very young children or to permanently mentally disabled humans, and this idea is morally indefensible.

Other defenders of animal testing argue that it is both natural and proper for human beings to exercise dominion over animals. These arguments take more than one form. Some people who make this argument are motivated by passages from the Bible. Genesis 1:26 reads, “And God said, Let us make man in our image, after our likeness: and let them have dominion over the fish of the sea, and over the fowl of the air, and over the cattle, and over all the earth, and over every creeping thing that creepeth upon the earth.” Some argue that this passage suggests that humans have divine permission to use animals as they see fit. The use of animals for the benefit of humans seems morally defensible to these people for this reason.

Others argue human dominion over other animals is appropriate because human beings have demonstrated their superiority over non-human animals. We are no different from other animals in the sense that we use our natural skills to climb as high on the food chain as our circumstance permit. As rational creatures, our needs extend farther than the needs of non-human animals. As a result, we can use non-human animals to solve a wider range of problems. We can use them not only for protein, but to make our lives longer, better, more beautiful, and more convenient. Critics of such a view argue that might doesn’t make right. What’s more, our enhanced rational capacities also give us the ability to make moral judgments, and these moral judgments should extend to compassion for the suffering of all living creatures.

Arguments against research on animals also come in a variety of forms. One approach focuses on suffering. Famously, Peter Singer argued that what makes a being deserving of moral consideration is their capacity to suffer. If we treat equal amounts of suffering unequally simply because of the species to which the animal happens to belong, our behavior is speciesist—we are taking seriously considerations that are morally irrelevant. Rights based approaches, like the one argued by Tom Regan point out that non-human animals are subjects of lives. There is something it is like for them to experience the world in the unique way that they do. In light of this, we should recognize that non-human animals have intrinsic value and they should not be used as objects to be manipulated for the benefit of human beings.

How should we assess the situation when the research done on non-human animals is done, not for the benefit of human beings, but for the benefit of other non-human animals? In these cases, one major criticism of testing disappears—researchers can’t be accused of failing to take the interests of non-human animals seriously. After all, concern for the interests of non-human animals is what motivates this research to begin with. Vaccines for rabies, canine parvovirus, distemper, and feline leukemia virus have been developed through the use of animal research. These critical procedures improve and even save the lives of non-human animals. When we engage in a consequentialist assessment of the practice, testing on non-human animals for the benefit of other non-human animals seems justified.

On the other hand, it may be that speciesism is rearing its ugly head again in this case. Consider a parallel case in which research was being conducted for the good of human beings. Imagine that a tremendous amount of good could be done for human beings at large if we tested a particular product on a human being. The testing of this product would cause tremendous physical pain to the human being, and may even cause their death. Presumably, we would not think that it is justified to experiment on the human. The ends do not justify the means.  

One might think that one major difference between the case of testing on humans and the case of testing on animals is that humans are capable of giving consent and animals are not. So, on this view, if we kidnap a human for the purposes of experimenting on her to achieve some greater good, what we have done wrong, is, in part, violating the autonomy of the individual. Animals aren’t capable of giving consent, so it is not possible to violate their autonomy in this way.  

Under the microscope, this way of carving up the situation doesn’t track our ordinary discourse about consent. It is, of course, true, that humans are free to use freely (within limits) certain things that are incapable of giving consent. For example, humans can use grain and stone and so on without fear of violating any important moral principle. In other cases in which consent is not possible, we tend to have very different intuitions. Very young children, for example, aren’t capable of consent, and for that very reason we tend to think it is not morally permissible for us to use them as mere means to our own ends. Beings that are conscious but are incapable of giving consent seem worthy of special protection. So it seems wrong to test on them even if it is for the good of their own species. Is it speciesist to think that the ends can’t justify the means in the case of the unwilling human subject but not in the case of the unwilling non-human animal?

Testing on non-human animals for the sake of other non-human animals also raises other sets of unique moral concerns and questions. What is the proper rank ordering of moral obligations when the stakeholders are abstractions? Imagine that we are considering doing an experiment on Coco the chimpanzee. The experiment that we do on Coco might have implications for future chimpanzees with Coco’s condition. The research might, then, have a beneficial impact for Coco’s species—the species “chimpanzee.” Can the moral obligations that we have to concrete, suffering beings ever be outweighed by obligations that we have to abstractions like “future generations” or “survival of the species”?

An APP(le) a Day: Can Smartphones Provide Smart Medical Advice?

I am not going to shock anyone by stating that we live in a time where distrust of government is high, where people believe that they need to ‘take back’ whatever they feel needs taking back. This opinion runs especially strong in matters surrounding healthcare, where people question a range of issues, including: universal insurance, low cost pharmaceuticals, the efficacy of particular medical tests, and autonomy as regards end of life (and other medical) decisions.

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