Leading Academics: "Stop Epidemiologists From Giving Public Health Advice"
Top researchers at the world's leading universities say most epidemiologists haven't got the proper background to give public health advice
In 2015, noted Cambridge statistician David Spiegelhalter made a striking comment at a Royal Statistical Society event about how scientists could better communicate statistics to the public. His advice:
“Stop epidemiologists (from) giving public health advice. Epidemiology has nothing to do with what people should do,” said Spiegelhalter, who is chair of the Winton Centre for Risk and Evidence Communication.
But epidemiologists can’t help themselves. “They can’t resist. At the end of their paper—and they might be doing some decent epidemiology—they can’t resist,” he said. They add in suggestions, guidelines.
“This is what we should be doing.… No, It’s not your job. Shut up. Shut up. And journal editors, don’t let them say it.”
The moderator asked Spiegelhalter—“Who should give public health advice?”
His response: “Preferably people who work in public health—and take into account the totality of evidence and the totality of impact of any advice that’s given, including whether people are like to take any notice of it.”
Spiegelhalter’s comments were especially attention grabbing because I watched his lecture on YouTube in January 2021, during the height of the coronavirus pandemic, when epidemiologists had suddenly become the masters of the universe.
So I emailed Spiegelhalter, “Do you still think epidemiologists shouldn’t give public health advice advice?”
He responded quickly:
“…I had forgotten my comments about epidemiologists not giving public health advice, but I believe it even more now. They can give estimates of the potential impact of different policies, but it's not their job to say what should be done--need a rounded public health viewpoint for this.”
I told a friend of mine who is a noted psychologist what Spiegelhalter said. She agreed:
"What continues to amaze me is that the ‘scientists’ who were consulted for public health advice about the pandemic did not include any economists or psychologists. It was as if the concept of unintended consequences was never considered.”
I asked Spiegelhalter if this is the sort of expertise he had in mind.
“All of those, and more. Epidemiology studies causes and occurrences of disease--important but only part of the story when it comes to policy,” he said.
Did he think most local and state public health officials were qualified to give public health advice?
“No, of course they need advice. But in the end, the policy is decided by the person who carries the can.”
Spiegelhalter’s remarks made me very curious, so I reached out to John Ioannidis, a professor of medicine and health research and policy at Stanford. I asked him what he thought about Spiegelhalter’s comments. Should epidemiologists be stopped from giving public health advice?
Ioannidis responded rather enthusiastically: “David Spiegelhalter is one of the most thoughtful people on the planet. I fully agree with his statement. Epidemiology is a wonderful scientific discipline, but epidemiologists alone making policy inferences can be a recipe for disaster. We can destroy the world more efficiently than nuclear warfare!"
I got more intrigued and emailed Katherine Baicker, dean of the Harris School of Public Policy at the University of Chicago. I asked her what she thought of Spiegelhalter’s and Ioannidis’ remarks. She tended to agree:
“Assessment of health policy options has to be based on solid causal connections: if we change policy X, we would expect Y to happen as a result. This is a strength of economics, but not of (most) epidemiology. I think that's the valid basis of the comments you're citing. Epidemiology has enormous strengths in surveillance, hypothesis generation, and trend identification, but often not in evaluating the effects of different public health policy options—which is what's needed to make good policy choices.”
While the media has relentlessly pushed epidemiologists as experts on all aspects of the coronavirus throughout the pandemic, most journalists are completely unaware of the criticism that topflight academics have of epidemiologists’ giving public health advice. Reporters are blissfully oblivious of the rather constrained role that epidemiologists should play.
Keeping in mind this criticism, I asked the Los Angeles County Public Health Department how it set its public health policies during the pandemic. I asked if the agency consulted outside experts. A spokesperson acknowledged the agency did not:
“Dr. (Barbara) Ferrer has discussed, and we stated in press releases, how Public Health works with the Board of Supervisors on safety measures to reduce transmission of the virus.”
That is, the LA County Department of Public Health never consulted with any outside public health experts—just the LA County Board of Supervisors, a group of elected politicians. And while Ferrer claimed to follow state and federal CDC guidelines throughout the pandemic, there were plenty of times when she either enacted more draconian measures before the state and federal government recommended them for Los Angeles based on its COVID levels—or kept them after they were no longer recommended. At present, the LA City Council still refuses to drop mask mandates for its libraries and museums, even though the county, state, and federal government dropped the requirements more than six weeks ago (by March 4, 2022.) The City of Los Angeles has not got its own public health department, but instead uses the LA County Public Health Department, whose advice it is now disregarding. The City of LA seems determined to outdo the County in restrictiveness—no small feat since LA County was one of the most restrictive in the country throughout the pandemic—whether or not their policies were really made keeping in mind the full public health viewpoint that experts say is needed.
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