At medical rounds, the lecturer gathered his students together after a formal presentation and I overheard him asking the students how they knew something to be true. He was referring to a new medication, had seen the possibility of a “teachable moment” and was asking his group about the nature of evidence.
The students had been down this road before and offered up what they’d heard or read. There was, for instance, direct observation, as in the account of seeing a man on a horse. But observation is fallible and often wrong, the argument ensued, though much of what we regard as justice relies on citizens and their experience. Much better, the learned students and lecturer agreed, is to know something based on research, particularly with well-planned, randomized and observer-blinded trials or experiments – and the Holy Grail of the search for truth in science.
The problem is, however, that even clinical trials can still be wrong and much of our existence isn’t appropriate or covered by randomized trials. Or, as a politician of some renown noted recently: “You can’t believe everything you see.”
I’ve thought of this exchange often and am relieved that there is a pathway to truth given the welter of voices telling us all manner of things about our lives. Things have gotten complicated. The burden of human illness, for example, was pretty well covered by the metaphor in the New Testament referring to the Four Horsemen of the Apocalypse: War, Conquest, Famine and Death. Add in pestilence, for good measure, and the things that could go awry in life were pretty well covered.
Apocalyptic horsemen may have been a reasonable metaphor then, but no longer. Our therapies and even our diagnostic manuals run to hundreds of pages now, in keeping with our burgeoning technologies. Key to understanding our new perils has been the recognition that our general health depends on the way we live. Accordingly, we now know that most of the transmissible diseases of our time have figured so prominently in our lives because 10 or 15 thousand years ago, we converted from hunter-gatherers and nomads to farmers. Our lives changed forever with settlements; with the elaboration of money and commercial enterprises, we became members of communities, with livestock and cattle. Along came the diseases associated with plentiful food, our built-in tendency to forego exercise, and to eat too much processed food and, voila, the way we live now. We’d like to think we’re getting things under control now, with dietary regimens and new pharmaceuticals.
The biggest news, however, relates to the problems we face thanks in part to our technologies. Our most pressing concerns relate to our numbers, all 8.2 billion of us. Our over-burdened planet received much more attention several decades ago, when visionaries such as Paul and Ann Ehrlich warned of mass shortages of foodstuffs that didn’t occur due to new fertilizers and crop management techniques. The stage was set, however, for population numbers we hadn’t seen before.
As well, population scientists tell us that the news may not be as bad as imagined, since birth rates are falling in the most industrialized countries. Helpful as this may be, birth rates in the underdeveloped world are high and are likely to stay that way. Nigeria, as one example, has somewhere in the order of 230 million people right now, but will exceed 400 million people mid-century. Without belabouring the point, how much more tractable the world would be with fewer of us struggling to live. I bring this up not to blame any country or nation, or to promote matricide, infanticide or any of the other “cides” but as a matter of helpful public policy.
More immediately concerning is the present global state of affairs at the moment: the world seems to be in more of a tangle now than ever before. We’ve endured a pandemic that was bad enough, but it likely wouldn’t compare well to other more murderous plagues; nonetheless, we’re faced with the reality that we did not comport ourselves well in recent times.
We’re on the far side of COVID-19 now, or at least we hope we are. Cases are still occurring but in manageable numbers, and it would appear that for most of us, seasonal or yearly flu shots and updated COVID boosters will suffice.
It would be a mistake, though, to think that this news is rosy or even upbeat. Our general mood most everywhere is gloomy. Governments everywhere spent cash they didn’t have and are having a hard time refilling their larders. Restaurants, bookstores and small businesses have cut back their hours of business hoping that things will improve. Background to all this, however, has been the fractious and even rogue behaviour of social groupings who variously ignored quarantine and vaccine measures, half-heartedly went along with others or embraced other crackpot measures such as industrial cleaners and pharmaceuticals meant for veterinary use. We persist in large measure to go along with bizarre and outlandish theories of dark forces at work behind the scenes.
The amount of disinformation is unparalleled and has culminated in a crisis of both trust and truth in institutions and fellow citizens. Growing numbers believe that climate change is a hoax, that forest fires are due to arsonists, that governments have hidden the facts about vaccines and deaths due to coronavirus. Indeed, people seem to rely on their own particular sources of information in lieu of newspapers and other more reliable sources of information.
Why we’ve given up on traditional sources of information so readily remains unknown, but it has been divisive, and we’re frozen in our inactivity. Experts warned that more rather than fewer plagues might be on their way, but there’s little said about this possibility, and a new outbreak would find us as unprepared as ever.
In the same way that turning from nomadic hunters to farmers millennia ago has led us this far, our digital environment is germane to our present circumstances. Our abundant social media and our online experiences were expected to lead to a new golden age of communication but have instead gone awry.
I’m reminded of grade school and the noisy bedlam that would occur if the teacher left the room unattended. The strong suggestion is that our digital media can’t be left unregulated, that it’s not a matter of truth, but that bullies and blowhards and the unhinged can’t be left to plunder and run amok in our digital worlds.
On the same basis, the digital world has offered up enormous riches associated with online commerce. Well and good, except to note that the citizens left behind must have access to reasonable levels of wealth if they are to be counted on as members of the body politic.
We haven’t touched on climate change, and we’ll put off talking about the next big thing – artificial intelligence – until we know more about it. But rumors persist that this new technology is going to make our jobs redundant.
We’d better get used to looking out for one another again.
Like we used to …
Editor’s note: The views, perspectives and opinions in this article are solely the author’s and do not necessarily represent those of the AMA.