Boosting Josh Marshall

Josh Marshall has a good post about Covid 19 boosters. His site is the other site for which I pay actual money. Unfortunately, I see the good post is for subscribers (like me) only, so I will just have to show my respect by free using the hell out of it.

Josh wants a Covid 19 booster shot and he doesn’t think that the experts who won’t let him have one are basing their decision on actual expertise as opposed to shared customs, norms, and standard operating procedures which are typical of all organizations including the FDA and the CDC and which are not science.

I agree so so much. I will now free use three paragraphs

“In the public conversation about boosters, it’s been clear from the start that there’s a big chunk of the population that was and is super ready to get a booster once it was clear that COVID vaccinations weren’t as effective against infection as initially believed. As we’ve all learned, they remain highly effective against severe illness and death. But for infection and mild or moderate illness (which can still really suck) the effectiveness declines significantly over six months.

For many people, they don’t need to hear any more: here’s my shoulder, give me the booster. The reaction from many public health officials, doctors and epidemiologists however has been something like this: No, that’s not what the vaccines are for. They’re really to prevent severe disease, hospitalization and death”


 … who gets to say whether we should give booster doses even if people already have strong protection against severe disease? My sense is that’s more a public question than a technical and expertise-based question. That’s one that ordinary people – if not individually, then at least collectively – deserve to have their say on. I think many people have a different view: The point of the vaccine is to stop you from getting COVID. Period.

[skip] My point here isn’t to say who’s right or wrong. It’s that some of these questions are value decisions, properly ones for public decision-making, rather than simply narrowly technical ones. One of the most important questions about expertise in a democratic society is drawing this line. There is usually a penumbra of belief and opinion which stretches out past expertise per se. It is an artifact of the community of expertise. And we should definitely hear it out. But here you’re looking at the opinions and beliefs of the experts rather than their expertise per se. That’s the ground on which the public is equally entitled to an opinion and in most cases the final say.

I agree entirely that we should and must distinguish between actual expertise and the “penumbra” around expertise. Like all communities, communities of scientific experts develop customs, norms and traditions. Those are not science — here the question is “what are vaccines for?” Exactly as Marshall explains, proposed answers to that question are not scientific hypotheses with testable predictions. They are value judgments on which no one is or can be more expert than anyone else (and that goes for you too Pope Francis, and at least you seem to accept it unlike Benedict may he continue to be benedetto with no self awareness at all).

I do have one quibble (of course). Marshall does not quote any “public health officials, doctors and epidemiologists” . He also doesn’t distinguish between public health officials on the one hand and doctors and epidemiologists on the other. I want to distinguish between legal authority and expertise. Fortunately, since January 20 2021, the people with authority to judge vaccines are actual medical experts who are not improperly over-ruled by political appointees. However, they are not the whole scientific community and their decisions are not necessarily the scientific consensus. “Respect the science” and “respect the FDA and the CDC” are different statements . I agree with both, but respect for law in general and the belief that the Pure Food and Drug Act is a good law do not add up to making the decisions of the FDA identical to the science.

Here I think one of the habits of thought of biomedical researchers include “Never mess with the FDA. Ever. If you do, they will shut you down.” This is recognition of the power of the FDA, and the fact that there is no higher court of appeal if they say no. I don’t know all that many biomedical researchers, but I have never ever heard one take the name of the FDA in vain. This is a rational response to the power relationships, but it is not science.

Another issue is that having followed the “standard of care” is a valid defence against medical malpractice suits. As a result, written standards were established in the 1970s during the first wave of medical malpractice lawsuits. Establish an official standard and follow it is a rational response to the risk of malpractice liability. It is not science and it is not even arguably in the interests of patients who are doomed to horrible deaths if provided with standard care (note I am not thinking of Covid 19). There is no scientific or ethical defence of the extreme (small c) conservative bias of MDs.

This helps explain why they are reluctant to change their advice due to the delta variant and also unwilling to say that they don’t know what non doctors should choose to do. An agreement on a standard of care is a legal defence — their admitting that they don’t know enables juries to decide that they know better and impose damages.