The Hedgehog Review

The Hedgehog Review: Vol. 18 No. 3 (Fall 2016)

Science Anxiety

Ari N. Schulman

The Hedgehog Review

The Hedgehog Review: Fall 2016

(Volume 18 | Issue 3)

There is a classic psychological experiment, known as the Strange Situation Protocol, in which children become unwitting stars in a piece of abstract theater. An infant is brought into a playroom with one parent. A stranger enters; soon the parent leaves; then the stranger departs, leaving the baby alone; then the parent returns; and so on in varying combinations. Some babies play unbothered in the presence of the stranger and show affection to the parent when he or she returns. Others are wary of the stranger, reluctant to play in his presence, and alternate between clinginess and defiance when the parent returns.1

Psychologists who conduct the experiment describe these respective behavioral patterns as secure and anxious-ambivalent attachment. The latter is the product of inconsistent parenting, neglect mixed with intrusive attention. The child’s inability to depend reliably on its parent prevents the growth of the child’s independence. The vacillating parent creates a vacillating child, pulled one moment by neediness and the next by wariness, in a simple harmonic motion of dysfunction.

Whatever the merits of this tidy theory on its own, it’s a useful metaphor for thinking about the relationship today between the public and that vast body of knowledge, work, and authority we monolithically call “science.” Our conversations about science are dominated on one side by those who reflexively distrust broad swathes of it as corrupted by groupthink, corporatism, or global governance conspiracy, and on the other by those keen to distance themselves as far as possible from the first group, to label any deviation from scientists’ opinions as paranoia, “denialism,” “anti-science.”

We seem to be facing a slow-brewing crisis of scientific authority even as we hear ever-more-eager paeans to science. Though these attitudes of defiance and deference might seem at odds, they are each dysfunctional stances toward scientific authority, mutually reinforcing and commonly opposed to the empowering independence science is supposed to sustain. Both attitudes suggest a kind of infantilization. That our science popularizers are heaped with the greatest praise when they “destroy” some crank or declare that they “F***ing Love Science” speaks to the peculiar exaggerations of our emotional involvement. Seldom do our conversations resemble the dispassionate, evidence-based discourse science is said to perfect.

One common story is that this conflict is a societal one, between factions with sharply divergent affinities for science—left versus right, secular versus religious, technocratic versus traditionalist. But there is little stability as to which side proclaims itself pro-science and which the bold challenger to an ideologically exhausted establishment. The capitalist conservative who is skeptical about climate change may have no trouble tarring his environmentalist foes as anti-science for opposing nuclear power. The coastal bobo who sees creationism in Texas classrooms as a harbinger of a new Dark Age may be contributing to keeping childhood vaccination rates in his city below those of Third World countries, owing to beliefs the Texas parent regards as voodoo.2

But the notions of anti-science and pro-science attitudes do seem to gesture, however problematically, toward something unsettling about the interminability of these debates. When we carefully lay out the seemingly definitive conclusions of a decades-long research program and our opponent just shrugs, we are left genuinely baffled, and the indignant charge of “anti-science” does not seem unreasonable. The bafflement only doubles if we find ourselves on the receiving end of such an argument, at odds with the apparent scientific orthodoxy on some matter and on the defensive against the charge of crankery. The counsel that science decides matters of fact instead of value does not adequately account for this disquiet—for disputes about value still end up being fought largely on the battleground of facts. Sometimes it really does seem that we are all entitled to our own facts, although we know this can’t be.

In his commencement address to the 2016 graduating class of the California Institute of Technology, the physician and New Yorker writer Atul Gawande wisely identified the social resistance to science as a matter of mistrust.3 This mistrust, Gawande argued, is not of science itself but of the scientific community. In practice, the ostensible cranks advance their own alternative explanations, studies, and interpretations, meant to seem equally scientific. They dispute not the authority of science itself but the question of who rightly bears it.

In his Caltech speech, Gawande went on to locate the problem in various cognitive errors: Science defies intuitively appealing explanations; refuting bad ideas tends to spread and entrench them, and so on. Like many others, Gawande turns to cognitive biases out of frustrated recognition that resistance to science persists even among the highly educated. But his cognitive explanations account for neither the elaborateness nor the particularity of the various anti-science camps. Why, out of the infinitely many unfounded beliefs available, is it the same few—denial of climate change, fear of vaccines and genetically modified organisms (GMOs)—that are so stubbornly persistent today? And why, if our faulty cognitive architecture is unchanged, are we not still mired in the alchemies and phrenologies of yesterday? Most significantly, Gawande does not consider whether scientific authorities might occasionally earn some of this mistrust.

Doubling Down on Mutual Mistrust

Last February, a few months before Gawande’s speech, the Centers for Disease Control and Prevention (CDC) issued a bullheaded recommendation: Any woman of childbearing age who is not using birth control should abstain completely from drinking alcohol in case, unbeknownst to herself, she is pregnant.4 Given that this recommendation applied to millions of American women5 and touched on thorny debates around sexuality, gender equality, substance abuse, campus sexual assault, alcohol-fueled hookup culture, and mommy policing, the many-splendored criticisms lobbed its way fell out just as one might have predicted. And one wonders why the CDC somehow didn’t see what was coming.

This is just one of several recent recommendations or regulations by public health agencies that have been criticized as excessive. Recently, the Food and Drug Administration came under fire, especially from libertarians, for zealously regulating sodium levels in food—“Food Marxists at the FDA,” said Julie Gunlock in National Review Online.6 The FDA also sought to expand its existing tobacco regulations to include e-cigarettes, a move interpreted by both supporters and critics as an aggressive stance against treating the new technology as a preferable alternative to traditional tobacco products.7 Other such examples abound, but the running theme is that agencies tasked with guarding the public’s health seem gripped of late by a risk aversion that strikes people of many political backgrounds as paternalistic.

The prevailing view among researchers seems to be that because vaping eliminates most of the carcinogens produced by smoking, it’s probably less harmful than cigarettes, possibly much less harmful.8 Consequently, many advocates argue that the public health establishment should embrace vaping as a safer alternative. But skeptics warn that the fluids used in e-cigarettes contain additional chemicals whose toxicity is not yet sufficiently established, and that the products are too new for comparisons to be made with the well-researched long-term effects of cigarettes. These skeptics also warn that the strategies used to market e-cigarettes, and their reputation as being relatively safe, might attract new customers who would not otherwise have become nicotine users. The available studies on this question are limited and conflicting.

Among the FDA’s proposed new regulations is one that would require companies seeking to sell new e-cigarette products to conduct population-based studies to demonstrate the likelihood that the product would serve as a substitute for existing smokers who might otherwise quit tobacco. Critics such as the American Enterprise Institute’s Sally Satel argue that these regulations unreasonably assume that vaping is no safer than smoking, and create a burden of proof that effectively scuttles the industry by regulatory fiat.9

What’s interesting about the FDA’s stance is not so much its severity, for which there is certainly a reasonable case, as the pretense that its position is a neutral extension of its existing regulatory regime. To the extent that our public health agencies engage in any moral reasoning at all, we might expect it to be hard-nosed consequentialism. But with the consequences simply not well known, the FDA had numerous choices available in its approach, each with a justification to be found in the available evidence, each with its own interpretation of the uncertainties. It’s hard to avoid the impression that the posture the FDA in fact adopted is a rather stringently moralistic one—treating smoking-like behavior as a vice, or even an intrinsic evil, to be opposed along the same lines as, for example, the Catholic Church’s opposition to distributing condoms to prevent AIDS.

On the one hand, there’s something perversely refreshing about witnessing this organic rebirth of public moralism in, of all places, our doggedly utilitarian bureaucracies. On the other hand, the bureaucrats would surely insist that their posture was nothing but scientific. And this is a problem. Take the CDC’s recommendation that women of childbearing age abstain from alcohol—it is difficult to criticize fairly because its rationale is so opaque. But this opacity is the strongest reason to criticize it. The problem was not that the logic itself was so difficult to suss out: There is no “proven safe” level of alcohol consumption, and so, in the succinct explanation of CDC deputy director Anne Schuchat, “Why take the chance?”10 But why alcohol? And why now? What standards dictate adequate levels of certainty for such a recommendation, and appropriate levels of caution?

As Slate contributor Ruth Graham has pointed out, citing Brown University economist Emily Oster, there are also no “proven” safe levels of Tylenol or caffeine consumption during pregnancy, and so a similar case could have been constructed for recommending abstention from these. Or the agency could just as well have urged that women refrain entirely not from alcohol but from sex—a stance that would have been equally backed by the same science, and equally heedless of the lived realities of the women nominally targeted by the recommendation. The even greater firestorm such a ruling would surely (and rightly) have created gestures at the wide array of cultural and normative views the CDC endorsed with its alcohol recommendation without wanting to say so explicitly.

The result of rulings of this kind is a loss of credibility by public health agencies. This loss of credibility gives license to members of the public to dismiss as politicized whatever other recommendations they don’t like. And the result of this increased public intransigence is, one might infer—again, a core problem here is that the agencies’ decision processes and criteria are opaque—that the agencies sense their authority slipping and decide to double down with overreaching recommendations like these. The upshot is a vicious cycle of mutual mistrust, a microcosm of the public relationship with science generally.

Airborne Hysteria

This problem of mistrust becomes clearer when agencies are tasked with handling crisis situations, particularly disease outbreaks. These cases are also striking because the agencies tend to overreach in the opposite direction—not overly precautious, but overly reassuring. There is a long series of instances in which public health agencies have responded to disease outbreaks with dangerous Pollyannaism, seemingly violating their core mission.

The most notable recent example is the widely criticized handling by the CDC and the World Health Organization (WHO) of the 2014 outbreak of the Ebola virus. But the criticisms have largely framed the problems as failures of communication—that the organizations were too sanguine in their public statements—or as failures of foresight—that they were underfunded and caught off guard.11 These assessments actually have let the CDC and WHO off too easily.12

From early in the outbreak, there was a near-consensus among political and public health leadership that America was in the grip of what Time magazine called “Our Collective Ebola Freak-Out.”13 At the time, WHO director Margaret Chan warned that “rumors and panic are spreading faster than the virus.”14 Journalists mocked public concerns about the disease, latching on to the clumsy portmanteau “Ebolanoia,” coined by a science writer for Wired.15 For political officials and public health agency heads alike, the addled ramblings of full-time conspiracy theorist Alex Jones were adequate synecdoche for Ebola anxiety per se.16

The need to quell public panic was not simply a rhetorical concern; it also influenced the practical response by the agencies and the broader medical community. Most notably, the CDC and WHO repeatedly insisted that Ebola could not be transmitted through the air, despite the limited evidence available on this question. As a consequence, the agencies not only insisted that doctors and nurses treating Ebola patients need not wear air-filtering respirator masks, but also discouraged health-care workers from doing so. Three physicians writing in The Lancet explained the rationale: Ebola workers who used “excessive precautions” like hazmat suits and respirators “might contribute to the panic in some communities.”17 Also responding to suggestions that the CDC and WHO protective guidelines were incautious, the authors of an article in the Annals of Internal Medicine scolded that “as health-care professionals, we strive to provide evidence-based care driven by science rather than by the media or mass hysteria.”18

In the event, two Dallas nurses who had reportedly adhered to the CDC guidelines contracted Ebola from their patient. Within days the CDC reversed its stance, requiring the use of respirators by all health-care workers treating Ebola patients.19 In early 2015, after the US crisis had passed and attention turned to other matters, twenty reputable researchers concluded in a literature review that “it is very likely that at least some degree of Ebola virus transmission currently occurs via infectious aerosols.”20 After publication, the one author who worked for WHO—which has yet to change its position that Ebola cannot be transmitted through the air—was forced under pressure from the organization’s leadership to remove his name from the paper.

Researchers suggest that there is a pattern to this type of mishandling on the part of government agencies that manage public health crises. In her book Who’s in Charge?, Laura H. Kahn, a physician and public health scholar at Princeton University, describes a number of similar examples from around the world stretching back over decades. Particularly notable is the 2003 outbreak of the SARS virus in Ontario, which, like Ebola, prompted warnings from political leaders and journalists that hysteria posed a greater danger than the disease itself.21 Amid this climate, and with a lack of evidence that SARS was transmitted through the air, doctors and nurses reported being pressured to avoid wearing respirator masks so as to project a sense of calm.22 A Canadian government commission later concluded that the early relaxation of protective guidelines played a key role in a resurgence of the disease.23 A year after the outbreak, epidemiological evidence demonstrated that many SARS infections had indeed been contracted through the air.24

Scientizing Political Debates

Taken together, these cases offer no coherent story about our public health agencies as either overly cautious or insufficiently concerned. Rather, they depict an abiding anxiety among public health authorities about the exercise of individual agency—the legitimacy of the public’s concerns about disease threats; the capacity of members of the public to make lifestyle decisions based on health information. And this anxiety stems from a pervasive view that science is a neutral authority for resolving political and moral questions. The institutional legitimacy of public health agencies, in turn, is widely viewed as deriving from this authority.

In an indispensable article bearing the meek title “How Science Makes Environmental Controversies Worse,” Daniel Sarewitz, a geologist and the director of Arizona State University’s Consortium for Science, Policy & Outcomes, notes that scientific questions significant enough to breach the realm of public debate typically land at the intersections of scientific disciplines. Sarewitz argues that what are commonly regarded as scientific questions, resolvable by some singular methodology of science per se, in fact arise from conflicts among different scientific disciplines, with their rival methodologies, outlooks, and interests.25

Sarewitz notes the case of an experiment in which climate scientists used long-range oceanic acoustic waves to measure average global temperatures. Biologists warned that the experiment posed a hazard to whales. The National Research Council conducted a study and found no conclusive evidence that the experiment would harm whales—or that it wouldn’t. Each side saw in this uncertainty the vindication of its case for or against the experiment. “These positions are not reconcilable,” Sarewitz writes, “because there is nothing to reconcile—they recognize and respond to different problems.”26
This problem only scales with the complexity of a question and the number of disciplines brought to bear. Consider the debate over GMO foods:

The two sides of the debate represent two contrasting scientific views of nature—one concerned about complexity, interconnectedness, and lack of predictability, and the other concerned with controlling the attributes of specific organisms for human benefit. In disciplinary terms, these competing views map onto two distinctive intellectual schools in life science—ecology and molecular genetics.27

So the seemingly unitary conflict over the risks and benefits of GMOs is actually a conflict between broad disciplinary approaches and their conflicting ethical priorities, political valences, and even metaphysics. As public interest in a question increases, the bodies of evidence available to support each of the contrasting positions grows. Our tendency to expect science to adjudicate normative questions—as Sarewitz puts it, our tendency to “scientize” debates—only entrenches the rival positions.

If supposedly scientific disputes are in fact normative even when carried out among scientists, then surely the same will be true of debates in the public sphere. This normative work is clear enough when it comes to the FDA’s regulation of e-cigarettes and the CDC’s recommendation that women not drink.

But that explanation only goes so far once debates move outside the scientific community. To start, most political actors aren’t affiliated with any scientific discipline. And more to the point, political interests are too expansive to be mapped down to disciplinary disputes. What sort of protection does a woman owe her unborn child? What about a potential unborn child she isn’t yet aware of? How are the answers to these questions changed when hazards are poorly understood? The CDC’s alcohol recommendation didn’t simply bypass these ethical questions; it also did an end-run around equally fraught political questions concerning the role of various parties—federal and state health agencies, elected officials who create laws related to fetal harm, a woman’s physician, community health clinics, parents of sexually active teenagers, male partners of women, and, lest we forget, the woman herself—in deciding these questions.

These are conflicts that arise not only out of the current incompleteness of science but also out of the inherent nature of political life. What is required is an account like Sarewitz’s that, while encompassing the disciplinary plurality within science, also acknowledges the plurality of norms and interests that characterize political life generally. In the absence of that account, the problem we face is a refusal to reckon with the political nature of our disputes.

Science Shaming

For Sarewitz, our inability to recognize our disputes as political means that we get sidetracked into debates about uncertainty. But this does not seem to be the case in the public sphere, where our debates often focus on why disagreement persists in the absence of scientific uncertainty. Atul Gawande speaks for the mainstream in framing the question around resistance to settled science. And the psychologized answers Gawande offers are indicative of the underlying problem.

The response to the Ebola outbreak illustrates how essentially political disputes devolve into rhetorical attempts to weaponize science. Political leadership, echoed by many scientists, described the public’s concerns as hysterical, and cast mass psychological management as one of its main objectives. Major national publications joined in by dismissing the public’s concerns as irrational, even devoting coverage to explaining these anxieties as holdovers from our frightened caveman ancestors.28

This type of rhetoric, which might in the parlance of our times be called science shaming, has become pervasive. It can be seen in the reams of books, articles, and speeches in which progressives have smeared conservatives as “anti-science,” and in the various nakedly cynical attempts by conservatives to co-opt this label for use against progressives.29 As in the Ebola outbreak, these arguments are frequently backed by further-scientized explanations for science denialism: Conservatives have a closed-minded cognitive style; progressives are in the grip of tribalistic moral signaling, as described by moral foundations theory.

What we are witnessing in these cases are political struggles that are being miscast as disputes not even over scientific questions but over who is failing to adhere to scientific authority. Not only does this rhetoric divert us from seeing clearly the nature of our disputes, it does so in a way that’s self-reinforcing, entrenching us ever more deeply in our particular camps.

Science, as we are often told, has its special authority precisely because it is ruthlessly indifferent to the dictates of politics, religion, and brute preference. Paradoxically, this makes science a powerful political ally. But its power depends on public trust, and this trust is poisoned by the way science has become weaponized in political debates.

A key feature of these debates is that they invoke science not just to bolster the political legitimacy of one side but also to deny the political legitimacy of the other. Succeed in attaching one of the labels anti-science, denialism, paranoid, irrational, or culture of fear to your opponent, and you elevate yourself as calm and rational while tarring your foe as a troglodyte whose opinions do not even deserve a hearing in enlightened company. This invocation of science reduces it to an instrument of political power—the very abuse this rhetoric claims to combat.

More significant than the erosion of scientific trust, the weaponization of science is profoundly illiberal, and so undermines the political process itself. It betrays a cynicism about the capacity of open debate to secure proper resolution of political disputes. What gradually takes the place of open debate is a power play to exclude our opponents as legitimate participants in the political process, usually by labeling them foes of reason.

If appeals to illiberality are not a convincing enough complaint against this mess, notice that the weaponization of science has not just failed but backfired: Despite being labeled “denialists” for decades, climate change skeptics, anti-vaxxers, and the like have only dug in further and gained political traction. Ideas persist when there is something some people find persuasive about them. Whatever that is will not go away just because adherents are marginalized from mainstream conversation. This will only strengthen the power of the margins, the Alex Joneses of the world, now puffed up by a story about how the corrupt establishment can’t handle the hard truths they’re selling.

Resisting the Scientization of Politics

Finding our way out of this morass will require shifting the way we think and talk about the relationship between science and politics. To use Sarewitz’s language, we are immersed in worry about the politicization of science when we should be worried about the scientization of politics.

The mission creep of public health agencies, for example, is hardly confined to the agencies themselves. In the last few years we have seen the phrase “public health crisis” applied to issues as diverse as gun violence,30 mass shootings,31 loneliness,32 car seat failures,33 drowsy driving,34 pornography,35 and homophobia.36 It’s not that there is nothing to this: All of these are legitimate public concerns, some matters not of health but of safety, others with implications for longevity and happiness and various social indicators. But as long as we’re at it, nuclear war might be deemed a significant public health risk; yet we wouldn’t expect this classification to add clarity to geostrategic policy debates, and might indeed expect it to muddy the waters if people really started believing it. We fool no one when we claim that disputes over violence or sex can be settled independently of culture, and damage our ability to think clearly about the role science still must play in these debates.

What we need is not a depoliticized science but a more political science—that is, a science unembarrassed about the legitimate role of politics in resolving what we now call scientific disputes. Public health agencies like the CDC and the FDA are never going to become apolitical, and we shouldn’t expect them to. But we ought to be able to reckon honestly with their political purposes. Their primary purpose is to effect steady improvements in public health outcomes. As an adjunct to this purpose, the agencies have an interest in maintaining their own political legitimacy, and may seek to do so in ways that actually undermine their credibility, as we’ve seen.

If the agencies and their defenders were to more forthrightly characterize their actions as deriving from a political mandate separate from scientific authority, they might wind up in a better position to assert both their political legitimacy and their credibility as public interpreters of health research. Federal and state agencies, for example, might more fully defer decisions about quarantines during disease outbreaks to elected leaders, who have a clear mandate to balance the economic and other non-health factors that inevitably go into making such decisions.37

One out-of-the-box approach would be for health agencies to start including confidence levels in their statements about scientific research. These are simple qualitative measures—low, medium, high, very high—that provide a quick relative sense of how well founded in evidence a conclusion or recommendation is. And they have the advantage of already being commonly used internally by the medical community, in, for instance, some CDC and WHO documents.

The adoption of even this prosaic measure would require the agencies to delineate a more robust role for individuals in making their own health decisions. The aggregated, statistical way in which the agencies conceive of public health outcomes does not clearly articulate at all any role for the individual. It’s only to be expected, then, that as the agencies seek steady improvement in those outcomes they will creep up against individual discretion. To some extent, the public health mandate will always be in tension with personal liberty, which requires the freedom to choose unhealthy behaviors, or to adopt definitions of health at odds with the medical mainstream. But dropping the pretense that the public health mandate is strictly scientific would actually be a step toward improving the credibility of public health agencies’ advice and regulations.

Toward a More Political Science

A shift in our approach to scientific debates will also require admitting a role for individual psychology. Behind the use of psychology to explain away people’s beliefs as irrational is a denial that psychology might serve a legitimate purpose. Take the inevitable hand-wringing about “the real epidemic—fear” that accompanies any prominent disease outbreak. The risk communications researcher Peter Sandman describes the anxious response to a novel threat as the “adjustment reaction,” whose purpose is to direct our attention toward gathering information about the new threat and taking protective actions.38

As Columbia University sociologist Duncan Watts has argued, public anxieties contributed to a (for the most part) robust response to the SARS outbreak.39 Moreover, the absence of such anxieties could be blamed for the severity of some past epidemics—Watts points to the lack of widespread concern in the early years of the AIDS epidemic as a contributing factor in the spread of the disease. From this perspective, the tinfoil-hat wearers are the fringe of an inherently desirable overall response, and if they are not to be defended, neither are they worth quite the degree of exasperation they so reliably provoke.

The broader premise of the psychologization of scientific disputes is that psychology does not bear content. It assumes, in other words, that psychology is a substitute for rather than a complement to articulated political debate. But rival political outlooks are not only a matter of differing answers to a given set of normative questions, but also of differing priorities for which questions are relevant. It is to be expected that these differences will be embodied in rival cognitive orientations.

Consider vaccine skepticism. Misguided as it is, we ought to be able to recognize in it an ethical reluctance, an almost Hippocratic intuition that we bear a different kind of responsibility for harms we inflict than for natural harms we might have averted. This sensibility finds some justification in the early centuries of vaccine history, when vaccine precursors produced high mortality rates and were often tested and applied in violation of modern standards of medical ethics. Vaccination does involve the introduction of a host of foreign substances into the bloodstream, and even in recent history it has occurred that the manufacturing process was tainted or that previously unused substances caused unforeseen harm to patients.40 Parents’ resistance to the practice should not be forgiven as sound, but neither should it be sneered at as simply irrational.

Vaccines also serve as a proxy for concerns about the nature of Western medicine—its reductiveness, its invasiveness, its emphasis on disease over health, the influence of pharmaceutical corporations in crafting therapeutic techniques. These are not only political but also philosophical, even metaphysical, disputes far larger than the particular question of vaccines. It’s comprehensible that those who subscribe to these criticisms, pending the better articulation of some coherent holistic scheme, might defer their doubts on this issue and remain stuck on it even in the presence of disproof.

It seems that what are required are pluralisms not only of norms, interests, psychological orientations, and scientific views of nature, but, much more crucially, an understanding that each of these is intertwined with the other. I am suggesting, in other words, that some revival of the classical understanding of science as natural philosophy is urgently required if we are to extricate ourselves from our current morass. There is little hope that our scientific debates will become coherent so long as we labor under the illusion that our stances can be cleanly partitioned up, made other than the wholes they are.

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Endnotes

  1. Inge Bretherton, “The Origins of Attachment Theory: John Bowlby and Mary Ainsworth,” Developmental Psychology 28 (1992), 759–775.
  2. Zack Kopplin, “Texas Public Schools Are Teaching Creationism,” Slate, January 16, 2014, http://www.slate.com/articles/health_and_science/science/2014/01/creationism_in_texas_public_schools_undermining_the_charter_movement.html; Tasneem Raja and Chris Mooney, “How Many People Aren’t Vaccinating Their Kids in Your State?,” Mother Jones, February 17, 2014, http://www.motherjones.com/environment/2014/02/vaccine-exemptions-states-pertussis-map.
  3. Atul Gawande, “The Mistrust of Science” (speech, Pasadena, California, June 10, 2016), http://www.newyorker.com/news/news-desk/the-mistrust-of-science.
  4. Centers for Disease Control, “More than 3 million US women at risk for alcohol-exposed pregnancy” (press release, February 2, 2016), http://www.cdc.gov/media/releases/2016/p0202-alcohol-exposed-pregnancy.html.
  5. About 3.3 million, by the CDC’s estimate. Even factoring in prevalence of sexual activity, alcohol use, and birth control use, this seems a conservative estimate given the more than 60 million American women of childbearing age. (See Kimberly Daniels, Jill Daugherty, Jo Jones, and William Mosher, “Current Contraceptive Use and Variation by Selected Characteristics among Women Aged 15–44: United States. 2011–2013,” National Health Statistics Reports 86, November 10, 2015, http://www.cdc.gov/nchs/data/nhsr/nhsr086.pdf.) The number seems to represent women “at risk” in any given month, and not to take into consideration what the total might be over the span of, say, a year, or over the entirety of a woman’s childbearing years.
  6. U.S. Food and Drug Administration, “Draft Guidance for Industry: Voluntary Sodium Reduction Goals: Target Mean and Upper Bound Concentrations for Sodium in Commercially Processed, Packaged, and Prepared Foods,” June 2016, last modified July 11, 2016, http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/ucm494732.htm; Julie Gunlock, “The Food Marxists at the FDA,” National Review Online, June 6, 2016, http://www.nationalreview.com/article/436221/new-low-salt-regulations-bad-science-government-overreach.
  7. U.S. Food and Drug Administration, “FDA takes significant steps to protect Americans from dangers of tobacco through new regulation” (press release, May 5, 2016), http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm499234.htm; Sabrina Tavernese, “FDA Imposes Rules for E-Cigarettes in a Landmark Move,” New York Times, May 5, 2016, http://www.nytimes.com/2016/05/06/science/fda-rules-electronic-cigarettes.html.
  8. Ibid.
  9. Sally Satel, “Congress, Save E-Cigarettes from the FDA,” Forbes, April 11, 2016, http://www.forbes.com/sites/sallysatel/2016/04/11/congress-save-e-cigarettes-from-the-fda/.
  10. Liz Szabo, “CDC: Young women should avoid alcohol unless using birth control,” USA Today, February 3, 2016, http://www.usatoday.com/story/news/2016/02/02/cdc-urges-young-women-avoid-all-alcohol-unless-theyre-using-contraception/79701890/.
  11. David Nather and Brett Norman, “CDC chief survives trial by fire on Hill,” Politico, October 16, 2014, http://www.politico.com/story/2014/10/cdc-ebola-tom-frieden-congress-111962; Michael Hiltzik, “More on why the U.S. was unprepared for Ebola,” Los Angeles Times, October 13, 2014, http://www.latimes.com/business/hiltzik/la-fi-mh-unprepared-for-ebola-20141013-column.html.
  12. Ari N. Schulman, “The Ebola Gamble,” The New Atlantis 45 (2015), 3–42, http://www.thenewatlantis.com/publications/the-ebola-gamble.
  13. Josh Sanburn, “The Psychology Behind Our Collective Ebola Freak-Out,” Time, October 20, 2014, http://time.com/3525666/ebola-psychology-fear-symptoms/.
  14. Margaret Chan, “WHO Director-General’s speech to the Regional Committee for the Western Pacific” (speech, Manila, Philippines, October 13, 2014 [delivered in her absence by Ian Smith, Executive Director of the Director-General’s Office]), available at http://www.who.int/dg/speeches/2014/regional-committee-western-pacific/en/.
  15. Maryn McKenna, “Ebolanoia: The Only Thing We Have to Fear is Ebola Fear Itself,” Wired, October 22, 2014, http://www.wired.com/2014/10/ebolanoia/.
  16. Alex Jones, “Why Obama Brought Ebola to US Exposed: Special Report,” YouTube video, 4:24, August 2, 2014, posted by “The Alex Jones Channel,” https://www.youtube.com/watch?v=gRNlxI9OpyU.
  17. Jose M. Martin-Moreno, Gilberto Llinás, and Juan Martínez Hernández, “Is respiratory protection appropriate in the Ebola response?,” The Lancet 384 (2014), 856, doi: 10.1016/S0140-6736(14)61343-X.
  18. Michael Klompas, Daniel J. Diekema, Neil O. Fishman, and Deborah S. Yokoe, “Ebola Fever: Reconciling Planning With Risk in US Hospitals,” Annals of Internal Medicine 161 (2014), 751–752, doi:10.7326/M14-1918.
  19. Centers for Disease Control, “CDC Tightened Guidance for US Healthcare Workers on Personal Protective Equipment for Ebola” (press release, October 20, 2014), http://www.cdc.gov/media/releases/2014/fs1020-ebola-personal-protective-equipment.html.
  20. Michael T. Osterholm et al., “Transmission of Ebola Viruses: What We Know and What We Do Not Know,” mBio 6 (2015), doi: 10.1128/mBio.00137-15.
  21. Dean E. Murphy, “In US, Fear Is Spreading Faster Than SARS,” New York Times, April 17, 2003, http://www.nytimes.com/2003/04/17/health/17SARS.html.
  22. Archie Campbell, Spring of Fear: The SARS Commission Final Report (Toronto, Ontario, 2006), 600–605, http://www.archives.gov.on.ca/en/e_records/sars/report/v2-pdf/Vol2Chp4v.pdf.
  23. Ibid., 590.
  24. Ignatius T.S. Yu, et al., “Evidence of Airborne Transmission of the Severe Acute Respiratory Syndrome Virus,” New England Journal of Medicine 350 (2004), 1731–1739, doi:10.1056/NEJMoa032867.
  25. Daniel Sarewitz, “How science makes environmental controversies worse,” Environmental Science & Policy 7 (2004), 385–403, doi:10.1016/j.envsci.2004.06.001.
  26. Ibid., 390.
  27. Ibid., 391.
  28. Alice Robb, “Fear of Ebola Could Make People More Likely to Vote Conservative,” New Republic, October 19, 2014, https://newrepublic.com/article/119895/psychology-fear-increases-conservatism; Deborah Kotz, “Why Americans have irrational Ebola fears,” Boston Globe, October 23, 2014, https://www.bostonglobe.com/lifestyle/health-wellness/2014/10/23/why-americans-have-irrational-ebola-fears/38DRvAtA5sF3KTUCQYPcPP/story.html.
  29. For progressive examples, see Chris Mooney, The Republican War on Science (New York, NY: Basic Books, 2005), and Chris Mooney, The Republican Brain: The Science of Why They Deny Science—and Reality (Hoboken, NJ: Wiley, 2012). For a conservative example, see Alex B. Berezow and Hank Campbell, Science Left Behind: Feel-Good Fallacies and the Rise of the Anti-Scientific Left (New York, NY: PublicAffairs, 2012).
  30. American Medical Association, “AMA Calls Gun Violence ‘A Public Health Crisis’; Will Actively Lobby Congress to Lift Ban on CDC Gun Violence Research” (press release, June 14, 2016), http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-gun-violence-lobby-congress.page.
  31. Vincent J. Bove, “Mass Shootings: America’s Public Health Crisis,” Epoch Times, December 10, 2015, http://www.theepochtimes.com/n3/1916854-mass-shootings-americas-public-health-crisis/.
  32. Amy Ellis Nutt, “Loneliness grows from individual ache to public health hazard,” Washington Post, January 31, 2016, https://www.washingtonpost.com/national/health-science/loneliness-grows-from-individual-ache-to-public-health-hazard/2016/01/31/cf246c56-ba20-11e5-99f3-184bc379b12d_story.html; Julienne Roman, “Loneliness A Public Health Crisis As Damaging As Poverty And Poor Housing: Report,” Tech Times, October 30, 2015, http://www.techtimes.com/articles/100954/20151030/loneliness-a-public-health-crisis-as-damaging-as-poverty-and-poor-housing-report.htm.
  33. “Safety Advocates Say Fatal Car Seat Failures Are ‘Public Health Crisis’,” CBS Los Angeles, May 16, 2016, http://losangeles.cbslocal.com/2016/05/16/safety-advocates-say-fatal-car-seat-failures-are-public-health-crisis/.
  34. Richard Knox, “Asleep at the Wheel: Drowsy Driving as a Public Health Crisis,” Huffington Post, May 18, 2016, http://www.huffingtonpost.com/entry/asleep-at-the-wheel-drowsy-driving-as-a-public-health_us_573c8360e4b008447494569b.
  35. Jacqueline Howard, “Republicans are calling porn a ‘public health crisis,’ but is it really?,” CNN, July 15, 2016, http://www.cnn.com/2016/07/15/health/porn-public-health-crisis/; Amber Phillips, “Porn has been declared a ‘public health crisis’ in Utah. Here’s why,” Washington Post, April 22, 2016, https://www.washingtonpost.com/news/the-fix/wp/2016/04/22/anti-porn-advocates-are-changing-the-game-and-it-starts-with-utah-declaring-it-a-public-health-crisis/.
  36. United Nations, “Secretary-General, in Message to Event on Ending Sexuality-based Violence, Bias, Calls Homophobic Bullying ‘a Moral Outrage, a Grave Violation of Human Rights’” (press release, December 8, 2011), http://www.un.org/press/en/2011/sgsm14008.doc.htm.
  37. At the federal level, statutory authority to implement quarantines at ports of entry rests with the secretary of the Department of Health and Human Services (HHS). This authority is delegated to the CDC, a division of HHS. As a practical matter, quarantine decisions during major outbreaks can be directed by the president and his advisers to be implemented by the CDC. Indeed, news reports during the Ebola outbreak confirmed that federal pressure to override the strict quarantines implemented by New Jersey and other states was initiated by the Obama administration. But the public impression is often, mistakenly, that the president acts strictly on the advice of the CDC, or that the CDC acts independently of the presidential administration and its broader interests. See Centers for Disease Control, “Legal Authorities for Isolation and Quarantine,” last modified October 8, 2014, http://www.cdc.gov/quarantine/aboutlawsregulationsquarantineisolation.html; Matt Flegenheimer, Michael D. Shear, and Michael Barbaro, “Under Pressure, Cuomo Says Ebola Quarantines Can Be Spent at Home,” New York Times, October 26, 2014, http://www.nytimes.com/2014/10/27/nyregion/ebola-quarantine.html; Russell Berman, “Standing Up for Ebola Health Workers,” The Atlantic, October 28, 2014, http://www.theatlantic.com/politics/archive/2014/10/obama-ebola-response/382033/.
  38. Peter M. Sandman, “Adjustment Reactions: The Teachable Moment in Crisis Communication,” January 17, 2005, http://www.psandman.com/col/teachable.htm.
  39. Duncan Watts, “Outbreak,” Slate, April 30, 2003, http://www.slate.com/articles/arts/culturebox/2003/04/outbreak.html.
  40. Aaron Rothstein, “Vaccines and Their Critics, Then and Now,” The New Atlantis 44 (2015), 3–27, http://www.thenewatlantis.com/publications/vaccines-and-their-critics-then-and-now.

Ari N. Schulman is a senior editor of The New Atlantis and has written for The Atlantic, The Wall Street Journal, First Things, and Time.

Reprinted from The Hedgehog Review 18.3 (Fall 2016). This essay may not be resold, reprinted, or redistributed for compensation of any kind without prior written permission. Please contact The Hedgehog Review for further details.

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