Tuesday, October 20, 2020

Maintaining a Sense of Perspective and Proportionality During the COVID-19 Pandemic (Post #2- 6 months later)

 

It has now been over 10 months since the onset of the current pandemic and many important empirical insights concerning how infectious and lethal COVID-19 is have been established in that time.  This post is the second installment on my earlier post from late March.

 Despite the transition from being a completely “unknown” virus to a “somewhat known but still largely unknown” virus over the past 8 months, parts of Canada and the UK are returning to the lockdown measures of March so I think it is time to put these issues in a broader public health perspective.

I will focus on recent data from the US, since the US remains one of the countries hardiest hit from the virus and it has easily accessible mortality data.  My usual disclaimer applies- this pandemic is very serious (though not close to the most serious public health predicament of the past century). 

There are many serious public health predicaments (e.g. obesity, cancer, mental illness, etc.) and so the response to any specific health risk (e.g. severe COVID-19) must consider both the costs and benefits of the efforts to mitigate those risks AND ensure they are a proportionate response given the other health challenges facing a population.

Two particular types of recent data are helpful for putting this pandemic in the health context of the United States- (1) the total number of Americans who have died to date vs the number of deaths in non-pandemic years, and (2) the percentage of deaths involved with COVID-19 in different age groups across the lifespan.

Now of course mortality does not tell us everything about the severity of a disease, but it is a vivid illustration of the heavy toll it can have on a population.  Cancer, for example, kills about 600 000 people in the United States every year.  But the number of people who survive cancer is estimated to be about 18 million people a year (
https://www.cdc.gov/cancer/dcpc/research/articles/cancer_2020.htm). 

Cancer survivors can carry the toll of their cancer diagnosis for years- financial, emotional and health-related.  To fixate solely on cancer deaths as exhausting the “burden” of the disease would be an understatement.  The same is true of COVID-19 and influenza.  But the number of deaths a specific disease causes is a very significant factor, it is an essential element in determining the story of the severity of different health challenges.

From January through to mid-October the CDC has reported 2,203,637 deaths in the United States.  Is that number unusually high?  There are still 10 weeks left to go in 2020, but the reported deaths in 2018 was 2,839,205 deaths,  2017 was 2,813,503 deaths, in 2016 it was 2,744,248.

So far 2020 does not stand out as having an unusually higher than normal number of deaths.  If the numbers of death for the remaining 10 weeks approximate the average of the last 40 weeks, then 2020 will have an average death toll.  (Aside- Of course some public health officials warn that the weeks to come will be “the darkest yet” of the pandemic, but that has been the headline rolled out for almost every month of the last 8 months now, so take it with a large dash of salt!)

The fact that 2020 is not an exceptional year for total deaths will strike most of us as surprising, even shocking, given that when you turn on the evening news you could easily form the impression that unprecedented numbers of Americans will die this year, and most from COVID-19.  Both of those assumptions are not based on the facts, they are perceptions skewed by hearing daily news updates on COVID-19 infections and mortality.

Now I know what the critic might will retort-- that it is possible that the reported deaths underestimate COVID-19 deaths- see here.  But when such cases fixate so much on the numbers when COVID-19 deaths were at their highest in April (because the virus spread among the elderly (e.g. in nursing homes)) I think some healthy scepticism is warranted.  Significantly higher rates of COVID-19 infection are reported daily now (and have for the past 4 months!) in the United States compared to April, and yet the deaths have remained much lower than in that peak month of reported deaths.  Assuming there are not massive outbreaks of the virus in nursing homes again, I think it is reasonable to assume we will not see higher death tolls than what occurred in April (which was before the vulnerable were shielded).  

I will admit it is still too early to come to any definitive conclusion about COVID-19 mortality this year.  It may take another 2 years before we really get a sense of what is going on.  But even still, I think it is imperative we assess the data we have to date, and modulate our approach to mitigating the risks from the virus accordingly.

When you look at the mortality data from the CDC you see there are 3 categories of deaths, deaths involving pneumonia (with or without COVID), deaths involving COVID-19 and pneumonia but excluding influenza, and deaths from influenza with or without COVID-19 or pneumonia.  So it is a complicated business and will take some time to sort out!  

But based on the data now in hand, it is clear, at least to me, that this is not an exceptional year for death in the United States.  That message contravenes everything you will likely read in the news headlines.  (Aside- perhaps I will write another post later on why the media has become some fixated on this story).

What is also important to keep in mind, from a public health perspective, is that COVID-19 is not the only cause of death.  The CDC helpfully provides the overall deaths and COVID-19 “involved” deaths for different age categories.  I attach the image here:


Let’s compare the mortality numbers at three stages of the lifespan- childhood (age <15), middle age (age 35-54) and late life (age > 65).

For children ages 0-15, approximately 18, 446 children have died in the United States this year.  Of those deaths, only 74 deaths, or 0.4% of the deaths, involved COVID-19.  This means that the cause of over 99% of the childhood deaths this year in the United States did not involve COVID-19.  What did they involve?  In my last point I noted this graph, (source): 


 COVID-19 will not make the top 10 causes of death for children and adolescents (ages 0-19) this year.  That is really good news!  But at the same time it is also rather disturbing news.  Why don’t the top causes of deaths among the young ever make such an impact on the evening news, if they are ever reported on.  We hear a lot more about COVID-19 deaths, but we ignore 99% of the childhood deaths, like the 3000+ childhood and adolescent deaths from firearms, or 1100+ suicides among  the same age cohort. 

OK, let us move on to consider the mortality risks to the parents of these children and adolescents, adults ages 35-54.  For this age cohort, 195, 211 people have died this year. And 14,956 of those deaths, or 7.6%, have involved COVID-19.  The risk of death to these parents is considerably higher than to their children, but still over 90% of their deaths come from things that are not COVID-19. 

Finally let’s look at the grandparent’s mortality risks, those age > 65.  This year 1, 628, 625 people age > 65 have died in the US, and COVID-19 was involved in 160, 080, or 9.8%, of those deaths.  For even the age group most at risk of COVID-19 mortality 90% of those that died were killed by something other than COVID-19.  And yet how many news stories do we hear each night about the deaths from cancer, heart disease, suicide or accidents?  We do not hear about those other causes of death, many of which could be prevented by changes to behaviour and public health policies and priorities. 

I emphasize the above points, concerning the normal death toll in the US, and the fact that COVID-19 accounts for a relatively small portion of deaths this year, not to minimize the seriousness of the pandemic.  It is a big problem, just not the biggest health problem.  Our response to mitigating the risks from this pandemic, like any other risk, should be proportionate and backed by sound empirical evidence.  I don’t think we have a good track record of that to date.

Cheers, 

Colin

Wednesday, July 29, 2020

Geroscience and COVID-19



For over a decade most of my academic research has been devoted to establishing the case for the following two theses:

(1) the aspiration to promote health in late life for humans is one of the most pressing societal predicaments of the 21st century, and

(2) achieving (1) will require altering the aging process itself vs simply extending the number of years humans survive by managing multimorbidity, disability, frailty and postponing death.

I believe it is accurate to say that neither of the two theses I identify above is currently a prominent position in the humanities and social sciences. Undergraduate students coming out of University with a degree in the humanities and social sciences will have taken many courses exposing them to the importance of topics like patriarchy, economic inequality, racism, colonialism, multiculturalism, global poverty, and climate change. All important topics. But these same students will receive little, if any, exposure to the realities of population aging. Nor are they likely to have taken any courses which will help them perceive the empirical realities of today through the explanatory lens of evolutionary biology. Instead most will receive a steady dose of insights from paradigms like "ideal theory" or, conversely, identity politics. And finally what will be absent from the discussions of those research paradigms will be any engagement (outside of perhaps climate science) with the significant of science, and science policy, for addressing the future of humanity. Ideal theory and identity politics are not well equipped for addressing the societal predicaments raised by population aging, artificial intelligence, climate change, or infectious diseases like COVID-19.

The COVID-19 pandemic ought to serve as a "slap in the face" wake-up call to scholars in the humanities and social sciences. We are ill equipped for addressing the societal predicaments this virus, and our response to this virus, has thrown us into because our theorizing about the world's problems is often detached from the complex realities like the fact that there are nearly 1500 different species of infectious organisms have been identified as causing disease in humans. Students in first and second year courses in philosophy, politics, sociology, and history (perhaps an exception will be a history of pandemics course) are unlikely to even learn about this reality of the human predicament. And by the time these students finish their degree they still might not, and thus they can be forgiven for forming the impression that human beings go through life disease-free till the day they die. For that is the impression of the world they receive from what they learn in University. They will learn about combating the threats of global capitalism, racism, patriarchy, colonialism, etc. but it is unlikely they learn much about the things that will actually cause the most disease and death in the world today. And I think this is deeply problematic for many reasons. We are failing the mission of higher education when this happens.

One consequence of the COVID-19 pandemic is that this might change things, and hopefully for the better.
The pandemic ought to compel scholars in the in the humanities and social sciences to re-think their neglect of population aging and the importance of scientific innovation. The pandemic has compelled me to think very deeply about how we are responding to this virus (i.e. has it been proportionate and evidence-based?), and what the pandemic’s impact is likely to mean for aging research in the future. I believe these questions will fuel my research over the coming decade.

For those who haven’t followed this blog or my academic career, my list of publications on the importance of aging research includes the following (just to make it clear that I am not jumping on the "hey, disease and science is now important" bandwagon! It has been the primary focus of my research for 20 years):

Genetic Ethics: An Introduction
Biologically Modified Justice
Aging, Geroscience and FreedomRejuvenation Research 22(2) 2019: 163-170.
Justice and Life Extension” in End-of-Life Ethics (edited by John Davis) (New York, NY: Routledge Publishing, 2016).
Empirical Ethics and the Duty to Extend the Biological Warranty PeriodSocial Philosophy and Policy 30 (2013): 480-503.
Why the NIH Should Create an Institute of Positive BiologyJournal of the Royal Society of Medicine 105 (2012): 412-15.
Biogerontology and the Intellectual VirtuesJournal of Gerontology: Biological Sciences 67(7) (2012): 734-46.
"Positive Biology” as a New Paradigm for the Medical SciencesNature’s EMBO Reports 13(2) (2012): 186-88.
Global Aging, Well-Ordered Science and ProspectionRejuvenation Research 13(5) (2010):607-12.
Equality and the Duty to Retard Human AgingBioethics 24(8) (2010): 384-94.
“Why Aging Research?Annals of the New York Academy of Sciences 1197 (2010): 1–8.
Mind the Gap: Senescence and BeneficencePublic Affairs Quarterly 24(2) (2010): 115- 30.
Framing the Inborn Aging Process and Longevity ScienceBiogerontology 11(3) (2010): 377-85.
Has the Time Come to Take on Time Itself?British Medical Journal 337 (2008):147-48.
A Tale of Two Strategies: The Moral Imperative to Tackle AgeingNature’s EMBO Reports 9(7) (2008): 592-95.

The COVID-19 pandemic of the past 6 months has revealed a number of interesting things about the popular attitudes people, the media and policy advisors have towards disease, aging and death. In what we might call the “pre-pandemic” era, say the decade preceding the outbreak of COVID-19 in 2020, I would commonly encounter the following attitudes from students, scholars and the general public when discussing the prospect of extending the human lifespan via modifying biological aging:

Aging and death are natural.
There are too many people on the planet already so why would we want to extend the lifespan!?!
It is unfair to extend the lifespan when there are other pressing problems, like poverty, malaria, climate change, unemployment, etc.
Altering aging is science fiction.

Now contrast those sentiments with the following sentiments which have quickly become more mainstream among the public, media and policy experts and advisers in just the past 6 months:

COVID-19 is the worst public health threat in over a century!
Spend whatever needs to be spent on preventing the spread of the virus.
Spend whatever needs to be spent developing a COVID-19 vaccine and expediate the trials to get the vaccine within the next year.
Enforce prolonged lock down measures (limiting work, public transport, friendships and romantic intimacy; closing schools for children; banning travel, etc.) to prevent the spread of the virus and minimize the risk of dying from COVID-19.
Mandate compliance with the wearing of face masks if there is any chance doing so could help prevent the spread of the virus and reduce the risk of death from COVID-19.

The COVID-19 pandemic has really brought to the fore a number of inconsistencies and fallacies in the way people think about the aspiration to prevent disease and death. The complacency many have for the most common causes of death- the chronic diseases of late life like cancer, heart disease and stroke- stands in sharp contrast to the vigilant (even militant) attitude many take to preventing death from this new virus. I have found this both surprising and puzzling.

Just to be clear, I am among the most staunch defenders of promoting the health of the elderly, and yet I have been a critic of many of the strict (and unsubstantiated, in terms of the evidence for effectiveness) measures taken by developed countries in responding to the virus (the one exception being Sweden, the country I think has responded the most rationally and proportionately to the virus). My main opposition to most strict lock down measures is that little to no care was given to consider the adverse side effects of the lock down measures themselves- the harms to children, victims of domestic abuse, the newly unemployed, those at risk of addiction, suicide, and anxiety disorders, not to mention the delays in diagnosing and treating medical conditions unrelated to COVID-19 (which is the VAST majority of health problems plaguing the Canadian population). There are also substantial harms to the economy and liberty.
If the lock downs had been a drug, we never would have pursued them on grounds of both safety and efficacy. At a minimum we ought to have at least required "informed consent" before locking people up indefinitely. But fear, uncertainty and a rush to action won the day.

All of the risks and harms I just mentioned, risks and harms which have been incurred by the lock down measures themselves, were inflicted for the benefit of (mostly) reducing the mortality risks of older persons who already suffer multi-morbidity and would most likely pass within a few months, maybe years, in their nursing home. In other words, had we prevented most of the COVID-19 deaths doing so would still not have scored high in terms of what is called "QALYs"- quality-adjusted life years saved. An 87 year-old who is in the final stages of cancer progression and develops COVID-19 in their nursing home while undergoing chemotherapy would not survive many months even if a cure had been discovered for COVID-19. This is why aging researchers argue that tackling aging itself, and not simply the diseases of aging, is so important. Because of the reality of co-morbidity in late life. COVID-19 is not the only fatal disease among the elderly, nor is it the most fatal.

The data on COVID-19 deaths in Canada make vivid the role aging has played in our susceptibility to COVID-19.

To date Canadians over age 80 account for only 16.2% of our positive infection numbers, this is roughly equal to the percentage of Canadians who tested positive between the ages of 20-29 (14.9%), 30-39 (14.2%), 40-49 (15.1%) and 50-59 (15%).

And yet the percentage of Canadians who died from the virus between the ages of 20-29 was only 0.1% (9 people), for those ages 30-39 the deaths account for 0.2% (15 people), the 49 people between the ages of 40-49 who have died account for 0.6% of the total COVID deaths. And finally 2.3% of deaths have occurred among those age 50-59. These 4 younger age categories account for a total of 59.2% of the known positive COVID-19 cases and yet they only account for just over 3% of the total deaths.

By contrast, the 16.2% of known positive cases for those over age 80+ account for 71.5% of the total deaths from the virus. Canadians over age 70 account for roughly 90% of all our COVID-19 deaths.
Like cancer, COVID-19 is much more lethal for the elderly than it is for the young. But the death toll from cancer will be much more significant than that from COVID-19, and for Canadians at all stages of the lifespan. Cancer will kill an estimated 83,300 Canadians this year alone, nearly 10 times the current total deaths from COVID-19 to date. Every day cancer kills 228 Canadians. This number never makes the evening news. I suspect it rarely ever gets “tweeted” or mentioned on social media.

150 Canadian children under the age of 15 die every year from cancer. To date there are no reports of any COVID-19 deaths among children in Canada (under the age of 15). One person under the age of 19 does appear on the data for COVID-19 deaths in Canada. But there has not been any disclosure of the age, nor any more details on the cause of death for Canada’s youngest COVID-19 death (e.g. were there other contributing factors?).

It is also worth noting that the country now has 115,000 documented positive cases of the virus, which means there has probably been around 1,000,000 people infected in Canada if we assume the findings from this study in the US also apply to Canada.

If only a fraction of the popular support for prioritizing the effort to reduce COVID deaths among the elderly could also be harnessed towards support for aging research itself (which would help us prevent ALL the diseases of aging, including COVID-19 and any new future viruses) we would reap a much bigger health and economic dividend than simply slowing the spread of one virus. But of course aging is not a virus, nor did it originate in a foreign country, and its health and economic toll is not reported everyday in the news. Framing and exposure to information is everything when it comes to our collective priority setting.

But there is some reason for optimism that reason, evidence and a sense of proportionality will, in the end, prevail! Some of the leading aging researchers in the world have a forthcoming editorial in the journal Aging and Disease highlighting one of the biggest lessons the medical sciences can learn from the COVID-19 pandemic—we ought to target the aging process itself to help protect today’s aging populations from the multimorbidities of late life. A COVID-19 vaccine will not, by itself, be a panacea when the chronic diseases of aging are so prevalent among the elderly. A sample from the policy implications section of the editorial:

“The COVID-19 global emergency has emphasized to vast masses of people the vital need to prevent old-age multimorbidity, protect the elderly and improve their health span. Proponents of geroscience have argued for the importance of such preventive measures for many years. Now we see in front of our own eyes the disastrous consequences of the deficit in such preventive measures, and the portent this gap in our approach represents for the future. We are witnessing how this new infectious disease is wreaking havoc among individuals, the healthcare system and the entire social fabric around the world, while the rapid aging of the population represents the main risk factor and aggravating condition. Therefore, arguably, one of the most important lessons to be learned from this pandemic, is the need to therapeutically address degenerative aging processes to prevent aging-related ill health as a whole.

…. Conquering the current pandemic will require a multipronged approach, including primarily an ‘offensive’ approach represented by the development of vaccines and treatments, as well as a ‘defensive’ approach focused on strengthening the resilience of affected individuals. Importantly, the offensive part of our arsenal requires the urgent development of a new vaccine, curative and palliative treatments for each successive pandemic and epidemic confronting the world. This aspect of our approach is unfortunately both slow and specific to the currently relevant virus or pathogen. In contrast, the defensive arm proposed here is pathogen-blind insofar as the interventions are pathogen independent. Therefore, a geroscience-focused response to the COVID-19 pandemic can be deployed not only against the current emergency, but the same approach will certainly be relevant to future infections, be them pandemic, epidemic, endemic, or even those affecting any one individual."


I hope the COVID-19 pandemic will put aging and aging research on the “global radar” as an important priority for global health. Many of the ageist and irrational objections to promoting health in late life I have encountered for over a decade in my research and teaching will be much harder for people to raise as a result of the outbreak of this pandemic and people seeing (a small reality of) of the impact global aging has on our health prospects.

Cheers,
Colin

Wednesday, July 22, 2020

Human Arrival in North America



Naturenews has the scoop on new findings which suggest that humans arrived in North America more than 15 000 years earlier than previously thought. A sample from the news item:

The first humans in the Americas came from East Asia, but when they began to arrive is hotly debated. Some researchers think that it could have been as early as 130,000 years ago, although most of the archaeological evidence supporting this theory is disputed. For instance, some of the stone artefacts are so simple that sceptics say they were probably produced by natural geological processes rather than by people. The mainstream view is that the peopling of the Americas began about 15,000 or 16,000 years ago — based on genetic evidence and artefacts found at sites including the 14,000-year-old Monte Verde II in Chile.

The latest discoveries, published on 22 July in Nature1, question that consensus. Since 2012, a team led by Ciprian Ardelean at the Autonomous University of Zacatecas in Mexico has been excavating Chiquihuite Cave, which is 2,740 metres above sea level in the country’s Astillero Mountains. The researchers found almost 2,000 stone tools, 239 of which were embedded in layers of gravel that have been carbon dated to between 25,000 and 32,000 years old.
Cheers,
Colin

Tuesday, July 21, 2020

What is Political Theory? (updated for 2020)



Over 14 years I wrote this brief post on what I thought political theory is. This remains one of the most read posts on my blog. Today's post is an extended, and long overdue, update on that theme.

This summer I am undertaking a major revamp of the full year history of political theory course I have taught here at Queen's for the past 11 years to approximately 275 students. In the past this course was a standard Plato to Marx course. It will still cover major thinkers from the canon, but with a new mix of theorists and the themes will be juxtaposed with more contemporary issues and concerns. This is the new course outline for this coming year:

This course will survey and examine historical thinkers, and socio-political events, that have helped shape Western political thought. Ideas can be powerful catalysts for progressive change, but they can also be utilized to maintain and perpetuate oppression and exclusion. The study of the ideas and ideals of Western political thought reveal a diversity of assumptions (e.g. what is human nature?) and societal aspirations which invoke values like stability, individualism, community, equality, freedom and justice. Students will exam the writings of a diverse range of thinkers, ranging from Plato, Thomas Hobbes and John Locke, to Emma Goldman, Martin Luther King, Jr., Mary Wollstonecraft, Anna Cooper, W.E.B. Du Bois, JS Mill, Karl Marx and Frantz Fanon. These thinkers wrote about, and lived during, significant historical events in the development of Western democracies. From Athenian democracy and slavery, to the English Civil War, the French Revolution, colonialism, and industrialization and patriarchy, the history of political thought is ripe with examples of theorists diagnosing pressing societal predicaments, as well as exercising the intellectual skill of imagining collective solutions to these problems. Students will be expected to demonstrate both a comprehension of the material covered in the course and the ability to critically evaluate that material.


The impetus for these substantive changes to the course are three-fold:

(1) for my own interest and intellectual growth and development I had planned on revamping the course, and already started making substantive changes last year.

(2) Because of the COVID-19 pandemic the plan is, for at least the first term of the course, for the lecture material will be delivered online. This entailed a re-think of how the course is delivered, and it's aims and objectives. So I decided to do the complete overhaul at the same time.

(3) The recent events of the BLM movement and global protests against racism and police violence have helped give me the further push needed to update and invigorate my course with new content, to address ( more substantively) diversity concerns and better equip my students with an understanding of the political ideas and ideals needed to meet the challenges of the 21st century.

In order for a political theory course to be part of the solution to the problems of today (vs being part of the problem), it must be something an instructor constantly attends to and modifies vs simply hitting the "cruise control" button and teaching the same content in the same manner indefinitely.

Over the last two years I had removed Hume and Hegel from the course to provide space for addressing MLK and the civil rights movement. And this year I will also remove Aristotle and Kant to create space for a more extensive discussion of the BLM movement, Emma Goldman and anarchism, Charles Mills on the racial contract, WEB Du Bois and some Frantz Fanon in the final section of the course on Marx and Marxism.

I am working on the introduction lecture to the course and I would like to detail my thoughts for that introduction here.

Let us start with two important questions:

(1) What is political theory?
AND
(2) Why should we study and teach the history of Western political thought?

Both questions are hotly debated and contentious topics in the field. If you had 5 political theorists together in a room to answer these 2 questions you might actually get 10 different answers in total!

As the professor for the course I will give my answers to these questions, but students and readers of the blog should take my answers with a grain of salt. Having taught and published on these topics for over 20 years now I think my answers are plausible and defensible answers, but they are not the only answers. Nor do they have to become YOUR answers.

You might discover, as you engage with the course readings and topics for yourself, that you come to your own conclusions and answers to these questions. And that is a good thing. Higher education should facilitate insight and debate rather work towards a predetermined consensus on complex and important questions.

Whatever one says about the field of political theory, it certainly is a unique area of study in politics. Its main focus is on the realm of ideas and ideals vs specific institutions or the election outcomes of a particular country. Rather than focusing on empirical questions like “Why do voters vote for the candidates they vote for?” or “What causes war?”, political theory addresses moral, evaluative concerns. “What is justice?” “Are freedom and equality compatible political ideals?” “Why, and how, should we redress the inequalities persistent in today’s societies?” These are just a few of the concerns theorists address.

At it’s most general level, I like to think of political theory as the exercise of two distinct, but related, intellectual skills. In my earlier post from 14 years ago I referred to the 3 skills John Dunn notes, but for brevity I am reducing these 3 down to just 2 skills (merging his second two skills into one).

And to explain these skills I would like to make an analogy with the medical sciences. In oncology, which is the study of the pathology of cancer, there are two important aspects of cancer research- the diagnostic dimension AND the treatment dimension.

The first thing an oncologist must do is confirm if a patient actually has a cancer tumour vs a (harmless) benign growth. Cancerous tumours are not typically visible to the naked eye, which is why it is so important to catch cancer early on versus waiting for more serious symptoms to be manifest after the cancer has metastasized (that is, spread to other parts of the body). Thus some imaging scans like a CT scan, coupled with a biopsy of the suspicious mass, takes place to confirm if the tissue is cancerous or noncancerous.

If a cancer diagnosis is confirmed, then a treatment plan for this specific type (and stage) of cancer will need to be developed. This might involve chemotherapy and/or radiation and surgery, or a combination of different types of treatment. Even when a cancer turmour has been removed, there must be periodic followup exams to make sure it doesn’t return or grow.

Political theorists are kind of like oncologists for the cancers of politics and our collective lives. And like oncology, political theory has both a diagnostic and prescriptive function:

1. The diagnostic dimension: identifying pressing societal problems by developing the conceptual tools to identify, and quantify, societal problems. Political theory helps put on our “radar” things that we might not realize are significant problems. These problems can range from economic inequality and patriarchy, to climate change, racism, intolerance and unjustified government interference in our liberty.

2. The prescriptive dimension: showing us how best to confront these societal problems. Like a skilled cancer surgeon, a skilled political theorist will help us develop the insights needed to determine "what needs to be done” to improve our collective future. The prescription might be democratic reform, imposing clear limits on governmental power and authority, tackling inequality within the family or engaging in civil disobedience to raise awareness to persistent injustice. This second skill engages our capacity for political imagination (going beyond what is currently feasible), but is tempered by a pragmatic disposition to keep prescribed political actions and ambitions within the realm of "potential" vs "the impossible".

This last point is of course subject to much debate and disagreement. What seemed impossible only yesterday is often taken as "a given" today (e.g. universal suffrage, industrialization, peace, economic prosperity, etc.). But on the flip side, appealing to overly idealized "pie-in-the-sky" aspirations is one sure way to ensure no change ever comes. Incremental meaningful progress is still progress. Admittedly determining what the optimal point is between prioritizing "the feasible" and the "truly transformative" will be rife with disagreements over the magnitude of the shortcomings of the status quo vs the magnitude of the potential benefits (and possible harms) of more radical change. Such debates are the essence of what politics is about.

Now let us turn to question #2: (2) Why should we study and teach the history of Western political thought?

There are a variety of different perspectives to take on answering this question, sometimes these perspectives are driven by disagreement over which thinkers and themes to cover, sometimes the disagreement tracks different ideological convictions concerning the pros and cons of the ideas developed in Western political theory (and Western civilization more generally).

Perhaps the most contentious and divisive topic in academia today (at least in North America) are the pros and cons of Western civilization. Countries like Canada, England, Scotland, the United States, Australia, France, Germany, Sweden, Norway, etc. are among the most free, equal and democratic countries in the world. The citizens of such societies enjoy legal and political rights that would have been unimaginable just a few centuries ago, and remain the envy of people living in authoritarian regimes in the world today. Citizens in such countries also enjoy high levels of economic development and prosperity, as well as democratic governance, freedom of the press and religion, and access to quality education and healthcare. These countries have the highest life expectancy for human populations in the world.

These positive features of Western liberal democracies are the envy of persons living in societies where they have no substantive voice in their political futures, and little or no access to the benefits of gender equality, freedom of religion or the press, or access to quality education and healthcare. And yet, ironically, many people living in developed democracies take for granted the benefits they enjoy (benefits they have access to merely as a consequence of their being born when, and where, they were born). It is easy to watch social media and the news about the political dysfunction of one's society and mistakenly equate those shortcomings with a condemnation of the system as a whole. The "twitterverse" amplifies this ahistorical, non-comparative understanding of the virtues and vices of the status quo within today's most affluent, free and tolerant societies.

But having said all of the above, concerning the successes of Western civilizations, this does not negative the reality that there still are significant injustices and problems facing all such societies. A history of colonialism and slavery, coupled with the persistence of institutional racism, intolerance, climate change and socio-economic inequality all pose formidable challenges for even the most successful societies of today. It can be true that a society like Canada fares (comparatively) very well on many indexes of justice (e.g. freedom, equality between the sexes, tolerance, affluence, treatment of minorities, etc.) and yet it can also be true to argue that Canada comes up well short on other important dimensions of justice (e.g. treatment of Indigenous persons and addressing concerns of transitional justice, the health and inclusion of its democratic practices and institutions, etc.)

Western civilization has had a dramatic impact (both positive and negative) on the life prospects of humanity. Rather than reduce these impacts to the simplistic narratives of "all good" or "all bad", an engagement with the history of political theory encourages us to do an extensive inventory of the mistakes we have made in the past, and continue to make today, as well as acknowledge the successes we have made in overcoming many of the exclusionary, intolerant, authoritarian, and shortsighted ways the collective fate of human societies have been decided in the past (and still are in many parts of the world).

I believe the study of the history of political thought in the 21st century is as important today as it ever has been. Sadly I fear my perspective is becoming more and more of a minority position within the discipline of political science. This is why I continue to passionately teach the large service course in the history of political thought. Each new generation must make its own reckoning with our past, for today's present will be tomorrow's past. And yesterday's past was once a potential future humans could have altered and changed. By learning how the ideas of past, and those of today, help shape our collective futures students can gain an awareness of the importance of attending to their own political beliefs, assumptions and aspirations. By doing so we will be better positioned for redressing the injustices that persist today, and improve the odds that the societies of the future will flourish vs flounder/perish.

Cheers,
Colin




Thursday, June 04, 2020

BMJ Debate on Extending the Lockdown



The BMJ has this interesting exchange on the issue of extending the COVID-19 lockdowns. I have posted a "rapid reply" to the article, which I reproduce here:

Dear Editor,

The case for lockdown was predicated upon the assumption, noted by Melnick, that a population is naïve to COVID-19. But in the months since the initial outbreak we have now gathered much more nuanced insight than this. We can say with some confidence, based on the data of who is most at risk of infection and death, that COVID-19 mortality afflicts a population much more like the chronic diseases associated with late life than the 1918-19 flu pandemic. In the latter nearly half of those who died were young adults between the ages of 20-40 years of age.

Like cancer, it is the elderly that are most at risk of developing, and dying from, COVID-19. There appears to be protection factors that make children more resistant to the virus. In making the case for prolonged lockdown Melnick argues that “even the most conservative predictions show that COVID-19 deaths may exceed those from any other infectious diseases in our lifetimes”. But if this turns out to be true that is only because of the significant progress we have made in reducing deaths from infectious disease. It would not establish the case that the health threat posed by COVID-19 is very severe. Not all deaths are equally comparable. The number of healthy years of life lost when a 10 year-old child dies prematurely from malaria is very different than what is lost when an 84 year-old with multimorbidities dies from COVID-19 during the final stages of life.

Given COVID-19 is much more severe for aging populations, rather than compare its death toll to other infectious diseases it should be compared to the chronic diseases associated with late life, such as cancer. The CDC estimates that 630,000 people will die from cancer this year alone in the United States. Globally that number will be closer to 10 million deaths. The pandemic of chronic diseases like cancer, heart disease and stroke will be exacerbated by prolonged lockdowns and yet they dwarf the severity of the COVID-19 pandemic. Prolonged lockdowns are a disproportionate response to an infectious disease that kills less children and less elderly persons than a chronic disease like cancer. I think that point strengthens the case for Ioannidis’ argument against prolonging the lockdowns. The harms now exceed, by a significant margin, the likely benefits.


Cheers,
Colin

PS- the image above is from the local park in my neighbourhood. It is the image that my son and I have seen for the past 3 months of the lockdown (with still no signs of it lifting in Ontario) when we go for our daily walk.

Wednesday, May 27, 2020

New Paper Out on the Ethics of Memory Modification



My latest publication titled "Insulating Soldiers from the Emotional Costs of War: An Ethical Analysis" is now published as a book chapter of this book. The chapter grew out of a workshop presented a few years ago in Kingston on enhancing soldiers. Many thanks to the editors for seeing this project through to completion! The abstract from my chapter is:


Would it be ethical to enhance the emotional resilience of soldiers by developing memory-altering drugs to help reduce the emotional toll they suffer from witnessing the traumas of conflict? One common objection to such technologies is that any such enhancement is “unnatural”, and as such threatens to rob soldiers of the opportunity to live an “authentic” human life. In this chapter I argue that this line of objection to memory-altering drugs is weak and problematic. The stressors of modern warfare are “unnatural”. Furthermore, memory modification is an integral element of the “psychological immune system”. Memory modifications can be both adaptive and maladaptive. An ethical analysis of memory-altering drugs should focus on the specifics of the impact such cognitive modifications will likely have on the welfare of soldiers rather than invoking the complaint that such interventions are “unnatural”.

Cheers,
Colin

Tuesday, May 26, 2020

Pandemic Justice post #2- The Social Contract (contemporary ideal theory)



This post continues my previous post, on the social contract tradition and an account of pandemic justice.

In the previous post I drew inspiration from the historical examples of non-ideal theorizing the social contract (Hobbes, Locke and Rousseau), and this post details the deficiencies of contemporary ideal theorizing of the social contract (esp John Rawls).

In the twentieth century the social contract tradition was revived. This was due, in large part, to new social contract philosophers like John Rawls, David Gauthier, Jurgen Habermas, and Thomas Scanlon, each of whom derived their own distinctive account of the social contract. But unlike the earlier social contact theorists, that were primarily focused on theorizing the non-ideal realities of the 17th and 18th centuries, 20th century social contract theorists were academic scholars who focused primarily on articulating justice as an “ideal”. As such justice was characterized as “fairness”, “mutual advantage”, or whatever consensus would emerge among participants in an ideal speech situation or the principles that no one could reasonably reject.

In John Rawls’s A Theory of Justice, arguably the most important work in political philosophy in the 20th century, Rawls sought to offer a moral theory to rival what was the dominant position in ethics at the time- utilitarianism. According to utilitarianism, a mode of ethical thinking going back to Jeremy Bentham and John Stuart Mill, the morally right act is that which produces “the greatest happiness of the greatest numbers”. The problem with utilitarianism, argued Rawls, is that it failed to recognize the “separateness of persons”, and as such it was a public ethic that permitted individual rights to be violated in the interests of the public good. To counter against utilitarianism, Rawls developed an account of what he called “pure procedural justice”. That is, Rawls attempted to describe a fair choice situation (his “original position”- where the social contract parties are all free, equal and impartial) and whatever the outcome was of this fair decision procedure must itself be a fair agreement.

Rather than endorsing the principle of utility, which would leave the contracting parties’ basic rights and freedoms and socio-economic needs (if they are the least advantaged) vulnerable, Rawls concluded that the contracting parties would agree to a social contract that prioritizes the principles of equal basic liberties for all, fair equality of opportunity and the difference principle (e.g. arranging socio-economic inequalities so they are to the greatest benefit of the least advantaged).

In Morals by Agreement David Gauthier advanced a neo-Hobbesian contract theory. Like Hobbes, Gauthier believed that rational self-interest was the foundation of morality and a theory of government. A rational social contract, he maintained, was one that improved all the contracting parties’ positions relative to their initial bargaining position of non-agreement. And this initial bargaining position was determined by a Lockean impartial standard, to ensure the effects of taking advantage of others was removed from the initial bargaining position. The “Lockean proviso” permitted Gauthier to champion a moralized Hobbesian state of nature. Rather than starting from a “war of all against all” baseline, the Lockean proviso started from the moralized baseline of rights to life, liberty and property. Rights, argued Gauthier, “provide the starting point for, and not the outcome of, agreement. They are what each person brings to the bargaining table, not what she takes from it” (Gauthier, 1986: 222).

Gauthier’s contactualism utilized complex concepts and theorems from rational choice theory and the substantive conclusion it reached was that a society that protected these Lockean rights with a free-market economy approximated this ideal contract.

Jurgen Habermas and Thomas Scanlon also derived social contract theories that closely resembled the spirit of John Rawls’s broadly neo-Kantian contract theory. Habermas’s theory of communicative action (see Moral Consciousness and Communicative Action) stipulates the conditions of an “ideal speech situation” (e.g. every subject with the competence to speak and act is allowed to take part in a discourse, everyone is allowed to question any assertion whatever, etc.) and the content of morality would be the consensus conclusions reached in such an ideal speech situation.

In What We Owe To Each Other Thomas Scanlon defends a similar version of contractualism, one that “holds that thinking about right or wrong is, at the most basic level, thinking about what could be justified to others on grounds that they, if properly motivated, could not reasonably reject” (page 5).

While these four 20th century social contract theorists invoke different aspects of ideas from Hobbes, Locke and Kant when deriving their versions of the social contract, what they share is that their primary focus is on elucidating an account of either ideal justice or the ideal circumstances (e.g. speech situation) for moral theorizing vs theorizing non-ideal circumstances or predicaments (which inspired the 17th and 18th century social contract thinkers). Reading A Theory of Justice, Morals by Agreement, Moral Consciousness and Communicative Action, and What We Owe to Each Other one wouldn’t get a clear sense that what the most pressing practical predicaments of the late 20th century actually were.

The Many Complaints Launched Against Rawlsian Ideal Theory

The social contract theorist John Rawls takes ideal theory to be the fundamental part of his account of justice, for it illuminates the “nature and aims of a perfectly just society”. Non-ideal theory, according to Rawls and his defenders , plays a secondary role, and concerns itself with the question of how the goals articulated by ideal theory might be realized. Rawls believes that, without an account of the perfectly just society, non-ideal theory lacks an aim.

But to theorize about “ideal” pandemic justice would be pointless as such an ideal would simply be a world with no disease! So outside of the obvious prescription of “eradicate and prevent all disease”, I do not think an ideal theory of pandemic justice is likely to yield important normative insights. While the ideal circumstances of “disease-free” existence would obviously be desirable, that will never be a reality for the mortal and vulnerable beings we are, existing on a planet that is hostile for all forms of life. And so I believe ideal theorizing is a distraction from the concerns of pandemic justice and, as such, threatens to perpetuate pandemic injustice by creating the false impression that justice is not concerned with protecting human populations from the known and unknown threats of infectious disease.

Charles Mills argues that what distinguishes ideal theory from non-ideal theory is that ideal theory “relies on idealization to the exclusion, or at least marginalization, of the actual”. Idealizations involve making claims that are actually false (e.g. like society being closed) in order to simplify an argument. By contrast non-ideal theory theorizes the actual and the non-ideal- like the fact that the world contains harmful viruses, and that we have inherited an evolutionary biology that makes us prone to infectious and chronic diseases as our populations age, and that the development of novel vaccines and treatments will be expensive and risky. Or the reality that stay-at-home orders will impose significant (and unequal) psychological and economic burdens, burdens on children, the unemployed and the elderly. The COVID-19 pandemic effectively illustrates why the time is ripe for developing a non-ideal theory of pandemic justice.

Critics of ideal theory have raised a plurality of objections to Rawls’s account of “justice as fairness” that stem from the myopic lens his ideal theorizing imposes. For example, feminists aspire to eliminate patriarchy and create a world with greater inclusion and substantive equality between the sexes. In order to achieve these aspirations it is important to develop an understanding of why patriarchy exists, why it persists, and how it might be abated. Why, for example, does the world have the pattern of patriarchy it currently possesses? And why do patriarchal practices and institutions evolve and modify the way they have tended to over time in human societies? These are important and complex issues that a theory of justice applicable to a patriarchal world should take seriously. And yet Rawls ignores such concerns when he assumes that, in his construction of the choice situation of the original position, the parties are “heads of families”.

Carole Pateman develops a feminist critique of Rawls in her book The Sexual Contract. The “representative” in the original position is, Pateman argues, “sexless”, “their bodies can be dispensed with”. By trying to ensure the choice situation of the original position is impartial, Rawls ignores the empirical reality that biological characteristics such as sex, and the sexual relationships between men and women, do dramatically impact the life prospects of males and females. By drawing our attention to a hypothetical “sexless” choice situation, we ignore the historical injustices of patriarchy.

Similarly Charles Mills critiques the neglect of race in Rawls’s idealized account of justice. Mills argues that ideal theory is a form of ideology that contributes to perpetuating illicit group privilege because it ignores the realities of racial injustice. Critiquing Rawls for his neglect of the actual history of injustice in the United States, in The Racial Contract Mills remarks: “So John Rawls, an American working in the late twentieth century, writes a book on justice widely credited with reviving postwar political philosophy in which not a single reference to American slavery and its legacy can be found”. And in “”Ideal Theory” as Ideology” Mills claims that such an omission perpetuates group privilege.

Rawls’s “simplifying assumption” that society is closed, and thus the focus of the deliberating parties is solely on distributing wealth, income and rights domestically, has lead to cosmopolitan critiques that this distorts the global scope of justice. In The Idea of Justice Amartya Sen argues that this limiting feature of Rawlsian contractualism has three distinct problems. Firstly, because justice is, at least in part, a relation in which obligations to each other are important, confining membership to the borders of a sovereign state skews the idea that we have duties that are owed to others, qua human beings. Secondly, ‘the actions of one country can seriously influence lives elsewhere’ (Sen 2009: 129). Countries are interconnected in diverse and complex ways. This is most evident when we consider the non-ideal realities of a pandemic. A country that does not attempt to contain, or mitigate, or test for the presence of the COVID-19 virus, for example, will, if it keeps its borders open, facilitate the global spread of the virus. There would not be any pandemics (only epidemics) in the world if the world’s countries were Rawlsian closed societies. This “simplifying assumption” distorts our moral deliberations because it brackets the importance of containment and mitigation measures to prevent the spread of legal viruses that can profoundly impact the health and wellbeing of people living in different parts of the world (as well as domestically).

Sen’s third concern with Rawls’s idealization that societies are closed is that neglecting all voices from elsewhere increases the risk of parochialism. He argues:
The point here is not that voices and views elsewhere have to be taken into account just because they exist- they may be there but entirely uncompelling and irrelevant- but that objectivity demands serious scrutiny and taking note of different viewpoints from elsewhere, reflecting the influence of other empirical experiences… If we live in a local world of fixed beliefs and specific practices, parochialism may be an unrecognized and unquestioned result. (Sen 2009: 30)

The perspectives of different geographies and histories are ignored by the closed impartiality of the Rawlisan original position. Increases in global warming (due to our reliance on fossil fuels), for example, could increase the transmission of malaria in tropical highland regions because it would increase the transmission season (as malaria is transmitted to humans via mosquito bites). The importance of science and innovation to societies with different geographies and histories ought to be at the forefront of our deliberations about pandemic justice. The fact that different regions of the world face different risks for infectious disease is a non-ideal reality that makes vivid the need for having the globally disadvantaged (and not just domestically disadvantaged) factor into our deliberations concerning the social contract for pandemic justice.

By looking through the “eyes of mankind”, Sen believes a theory of justice can better transcend the parochial distortion of government priorities that arises from closed impartiality. The domestic decisions countries like the United States make concerning a COVID-19 vaccine or treatment, travel bans, and economic policies during a pandemic (e.g. impacting manufacturing production) can have a profound impact, positive or negative, on the most vulnerable living in distant lands. Such consequences are ignored if the focus of a theory of justice is limited to the membership entitlements of those living in a closed and affluent society.

In my own research (here, here, here and here) I have critiqued the Rawlsian assumptions that all contracting parties are healthy, productive members of society, and that the “least advantaged” should be conceived of solely in terms of their social primary goods (like wealth and income) vs natural primary goods (e.g. health and vigor). In the Rawlsian ideal society, there is no illness, disease, disability or aging. It is a social contract for young, healthy adults living in a closed society insulated from infectious and chronic disease. I do not believe such a social contract offers much normative guidance to the real, aging and global societies of today. Societies with growing burdens of chronic disease, persistent threats from infectious disease and societies where the public policies governing science and innovation (not just the distribution of wealth and income) are among the most significant collective decisions being made. Pandemic justice aspires to take all the latter seriously. Theorizing the non-ideal is the real challenging and significant work that political philosophers must address today, vs bracketing or ignoring such considerations by starting with idealizations that make them superfluous.

Cheers,
Colin