Fie on your experiments!

The title is a (mis)quote I used back in 2011, here. I’m reminded of it by a typical headline in the Telegraph today: “Watch: Will Sweden’s coronavirus gamble pay off?”. But as a spokesman from Sweden said not too long ago, the real gamble – or unevidenced experiment, to be more precise – is being conducted by the other nations, including America and Britain. Sweden has just based its response on universal precedent.

I’m still not sure how the same novel idea of “shutdown” came simultaneously to so many nations as the way to manage this pandemic. From the start, it was never expected to match the severity of the 1918-19 “Spanish Flu,” and it pretty soon revealed itself to be even less lethal than some of the forgotten pandemics in my lifetime, such as Asian and Hong-Kong flu. Nobody in the history of the world, as I pointed out back in mid-March, has ever attempted to control a disease by shutting down society. But now everybody – except Sweden – has done so, and the inevitable mission-creep from “flatten the curve so health services can keep pace” to “Stop this spreading until we find a cure” has caught the politicians in a PR trap of their own making. By using “Save Lives” as a propaganda slogan, they have made every inevitable death seem a policy failure.

I say “a trap of their own making,” but it would seem that they genuinely have “followed the science,” but only in the sense that they have exposed themselves to a particular type of scientist, who adhere (it appears) to a particular view of epidemiology. It is an open secret (surprisingly uninteresting to both media and public) that from the start Imperial College’s gloomy predictions of half a million UK deaths were based on models with guessed parameters, that were forcefully rejected by its rivals at Oxford. Why was Imperial’s model adopted?

Oxford’s Centre for Evidence-based Medicine argues that the data shows not that lockdown is working, but that the disease peaked naturally even before the locks went on, so that we are now seeing the natural slowing of the disease more than the success of a draconian experiment. And they predicted that from the beginning. Sweden’s close match to America, and its significantly better record than Britain, appears to confirm their assessment. As does even Italy’s obedient compliance to the general pattern of improvement.

Another medical scientist, obviously not a member of the inexplicably anonymous SAGE scientific advisory group, was discussing the costs of lockdown on the BBC yesterday. He introduced the dreaded concept of “QUALYs,” “Quality Added Life Years” – an idea I hated as a hands-on clinician for its implicit suggestion that one could put a monetary value on human life. Still, my objection was that this economic value should not impinge on my care of individuals: in planning national resources centrally for the NHS, such rationing measures are necessary. QUALYs are used to determine whether the NHS will provide treatments of high cost and limited benefits.

Yesterday’s spokesman made one very startling point: if QUALYs had been properly assessed, lockdown would never have been imposed in the first place. In essence, as the interviewer correctly inferred, the life of a SARS-Covid-2 patient has been assigned a value far higher than that of cancer patients, the mentally ill, and so on. And certainly far, far higher than that usually assigned to very elderly patients with co-morbidities each winter.

Another interview on BBC news this morning suggests one reason this has been allowed to happen. Although the anonymity of SAGE’s membership makes it impossible to judge the bias of its scientific advice accurately, this professional, a social scientist, is pretty sure that SAGE lacks adequate sociological input. He says that its behavioural psychologists, much cited by Boris Johnson at briefings before the lockdown, are aware of only a very limited field of study – ie, how much the public will put up with removal of their civil liberties. This, of course, leaves the question of the harmful sociological effects of such drastic measures inadequately addressed, not to mention the more politically familiar, but perhaps epidemiologically less interesting, economic effects.

I’m not sure how much sociological advice the Swedish epidemiologists took, but there is a level at which certain things are “bleedin’ obvious.” Even someone like me immediately saw that shutting down the economy and society was a pretty risky experiment to combat what is, in historical perspective, a run-of-the-mill pandemic. I suspect that the Swedish authorities (before they realised they were the only ones in step) simply saw no more of a sensible solution in total lockdown than they would in nuking all the centres of infection.

In fact the more I think about it, the more bizarre and dangerous an experiment the world’s reaction appears. Given the high stakes involved – the livelihoods of every nation and individual on the planet – the advice for the world to switch off normal life, in the vague hope that it would switch back on afterwards without too much damage, makes cold-war atmospheric nuclear testing seem like primary school science.

It almost seems parallel to those experiments under fascist science establishments in wartime Germany and Japan, where in the spirit of objective intellectual inquiry prisoners’ hearts were artificially stopped to see if they could be successfully restarted afterwards. The suffering was scientifically irrelevant. The failures became part of the data to be explained. The brain-damage was the price of progress.

It is, of course, unfair to compare the policies of our democratic governments under the guidance of well-meaning scientists with the experiments of a corrupt Nazi medical establishment. After all, the latter only performed their crazy experiments on individuals.