Again: Never reason from a fatality change

The future isn’t written yet

Last week Richard Epstein predicted around 500 fatalities in the United States (I originally misread his estimate to be 50,000 for the US, not the whole world). His estimate was tragically falsified within days and he has now revised his estimate to 5,000. I still think that’s optimistic but I am hopeful for less than 50,000 deaths in the United States given the social distancing measures currently in place.

Today, several US peers have become excited about a Daily Wire article on comments by a British epidemiologist, Neil Ferguson. He has lowered his UK projections from 500,000 to 20,000 Coronavirus fatalities. The article omits the context of the change. The original New Scientist article (from which the Daily Wire is derivative with little original reporting) explains that the new fatality rate is partly due to a shift in our understanding of existing infections, but also a result of the social distancing measures introduced.

The simple point is:

Policy interventions will change infection rates, alter future stresses on the health system, and (when they work) lower future projections of fatalities. When projections are lower, it is not necessarily because the Coranavirus is intrinsically less deadly than believed but because appropriate responses have made it less deadly.

Life

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No matter how old, frail or vulnerable it may be, a life isn’t something to take or risk at another’s discretion. Nor does it undermine culpability when someone dies as a result of negligence. The common law ‘eggshell skull’ rule reflects this moral principle.

During the Coronavirus pandemic, some erstwhile defenders of the famous Non-Aggression Principle (NAP) appear to have forgotten that natural rights are conceived to protect life as well as liberty and property. They seem to think that the liberties we ordinarily enjoy have priority over the right to life of others. The environment has changed and, for the time being, many activities that we previously knew to be safe for others are not. They are not part of our set of liberties until a reformed set of rules, norms and habits establishes a sufficiently hygienic public environment. To say that bans on public gatherings violate natural rights a priori is as untenable as G.A. Cohen’s claim that a prohibition on walking onto a train without a valid ticket is a violation of one’s freedom.

The clue for anarcho-capitalist state-sceptics that this is a genuine shift in social priorities is that even organized criminal gangs are willing to enforce social distancing. You do not have to believe that the state itself is legitimate to see that the need for social distancing is sufficiently morally compelling that it can be enforced absent free agreement, just as one does not need free agreement to exercise a right to self-defense.

Not every restriction is going to be justified, although erring on the restrictive side makes sense while uncertainty about the spread of infection persists. Ultimately, restrictions have to balance genuine costs with plausible benefits. But rejecting restrictions on a priori grounds does not cohere with libertarian principles. Right now, our absolute liberties extend to the right to be alone. Everything else must be negotiated under uncertainty. Someone else’s life, even two-weeks or so in the future, is a valid side-constraint on liberty. People can rightfully be made to stay at home if they are fortunate enough to have one. When people have to travel out of necessity, they can be temporarily exempted, compensated or offered an alternative reasonable means of satisfying their immediate needs.

Pandemic responses are beyond Evidence-based Medicine

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John Ioannidis, a professor of medicine at Stanford University, fears that the draconian measures to enforce social distancing across Europe and United States could end up causing more harm than the pandemic itself. He believes that governments are acting on exaggerated claims and incomplete data and that a priority must be getting a more representative sample of populations currently suffering corona infections. I agree additional data would be enormously valuable but, following Saloni Dattani, I think we have more warrant for strong measures than Ioannidis implies.

Like Ioannidis’ Stanford colleague Richard Epstein, I agree that estimates of a relatively small overall fatality rate are plausible projections for most of the developed world and especially the United States. Unlike Epstein, I think those estimates are conditional on the radical social distancing (and self-isolation) measures that are currently being pushed rather than something that can be assumed. I am not in a position to challenge Ioannidis’ understanding of epidemiology. Others have used his piece as an opportunity to test and defend the assumptions of the worst-case scenarios.

Nevertheless, I can highlight the epistemic assumptions underlying Ioannidis’ pessimism about social distancing interventions. Ioannidis is a famous proponent (occasionally critic) of Evidence-based Medicine (EBM). Although open to refinement, at its core EBM argues that strict experimental methods (especially randomized controlled trials) and systematic reviews of published experimental studies with sound protocols are required to provide firm evidence for the success of a medical intervention.

The EBM movement was born out of a deep concern of its founder, Archie Cochrane, that clinicians wasted scarce resources on treatments that were often actively harmful for patients. Cochrane was particularly concerned that doctors could be dazzled or manipulated into using a treatment based on some theorized mechanism that had not been subject to rigorous testing. Only randomized controlled trials supposedly prove that an intervention works because only they minimize the possibility of a biased result (where characteristics of a patient or treatment path other than the intervention itself have influenced the result).

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So when Ioannidis looks for evidence that social distancing interventions work, he reaches for a Cochrane Review that emphasizes experimental studies over other research designs. As is often the case for a Cochrane review, many of the results point to uncertainty or relatively small effects from the existing literature. But is this because social distancing doesn’t work, or because RCTs are bad at measuring their effectiveness under pandemic circumstances (the circumstances where they might actually count)? The classic rejoinder to EBM proponents is that we know that parachutes can save lives but we can never subject them to RCT. Effective pandemic interventions could suffer similar problems.

Nancy Cartwright and I have argued that there are flaws in the methodology underlying EBM. A positive result for treatment against control in a randomized controlled trial shows you that an intervention worked in one place, at one time for one set of patients but not why and whether to expect it to work again in a different context. EBM proponents try to solve this problem by synthesizing the results of RCTs from many different contexts, often to derive some average effect size that makes a treatment expected to work overall or typically. The problem is that, without background knowledge of what determined the effect of an intervention, there is little warrant to be confident that this average effect will apply in new circumstances. Without understanding the mechanism of action, or what we call a theory of change, such inferences rely purely on induction.

The opposite problem is also present. An intervention that works for some specific people or in some specific circumstances might look unpromising when it is tested in a variety of cases where it does not work. It might not work ‘on average’. But that does not mean it is ineffective when the mechanism is fit to solve a particular problem such as a pandemic situation. Insistence on a narrow notion of evidence will mean missing these interventions in favor of ones that work marginally in a broad range of cases where the answer is not as important or relevant.

Thus even high-quality experimental evidence needs to be combined with strong background scientific and social scientific knowledge established using a variety of research approaches. Sometimes an RCT is useful to clinch the case for a particular intervention. But sometimes, other sources of information (especially when time is of the essence), can make the case more strongly than a putative RCT can.

In the case of pandemics, there are several reasons to hold back from making RCTs (and study designs that try to imitate them) decisive or required for testing social policy:

  1. There is no clear boundary between treatment and control groups since, by definition, an infectious disease can spread between and influence groups unless they are artificially segregated (rendering the experiment less useful for making broader inferences).
  2. The outcome of interest is not for an individual patient but the communal spread of a disease that is fatal to some. The worst-case outcome is not one death, but potentially very many deaths caused by the chain of infection. A marginal intervention at the individual level might be dramatically effective in terms of community outcomes.
  3. At least some people will behave differently, and be more willing to alter their conduct, during a widely publicized pandemic compared to hygienic interventions during ordinary times. Although this principle might be testable in different circumstances, the actual intervention won’t be known until it is tried in the reality of pandemic.

This means that rather than narrowly focusing on evidence from EBM and behavioral psychologists (or ‘nudge’), policymakers responding to pandemics must look to insights from political economy and social psychology, especially how to shift norms towards greater hygiene and social distancing. Without any bright ideas, traditional public health methods of clear guidance and occasionally enforced sanctions are having some effect.

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What evidence do we have at the moment? Right now, there is an increasing body of defeasible knowledge of the mechanisms with which the Coronavirus spreads. Our knowledge of existing viruses with comparable characteristics indicates that effectively implemented social distancing is expected to slow its spread and that things like face masks might slow the spread when physical distancing isn’t possible.

We also have some country and city-level policy studies. We saw an exponential growth of cases in China before extreme measures brought the virus under control. We saw immediate quarantine and contact tracing of cases in Singapore and South Korea that was effective without further draconian measures but required excellent public health infrastructure.

We have now also seen what looks like exponential growth in Italy, followed by a lockdown that appears to have slowed the growth of cases though not yet deaths. Some commentators do not believe that Italy is a relevant case for forecasting other countries. Was exponential growth a normal feature of the virus, or something specific to Italy and its aging population that might not be repeated in other parts of Europe? This seems like an odd claim at this stage given China’s similar experience. The nature of case studies is that we do not know with certainty what all the factors are while they are in progress. We are about to learn more as some countries have chosen a more relaxed policy.

Is there an ‘evidence-based’ approach to fighting the Coronavirus? As it is so new: no. This means policymakers must rely on epistemic practices that are more defeasible than the scientific evidence that we are used to hearing. But that does not mean a default to light-touch intervention is prudent during a pandemic response. Instead, the approaches that use models with reasonable assumptions based on evidence from unfolding case-studies are the best we can do. Right now, they suggest we should err on the side of caution, physical distancing, and isolation while medical treatments are tested.

Never reason from a fatality rate

 

Richard Epstein has produced several posts and a video interview arguing that the mainstream media is overreacting to the Coronavirus pandemic. Richard understands the potential seriousness of this situation and the proper role of government. He recognises the value of the Roman maxim Salus populi suprema lex esto – let the health of the people be the highest law. In public health emergencies, many moral and legal claims resulting from individual rights and contracts are vitiated, and some civil liberties suspended.

Nevertheless, along with Cass Sunstein, Richard claims that this particular emergency is likely to be overblown. His justification for this is based on data for infection and fatality rates emerging from South Korea and Singapore that appear (currently) under control with only a relatively small proportion of their population infected. This was achieved without the country-wide lockdowns now being rolled out across Europe. Extrapolating from this experience, Richard suggests that the Coronavirus is not too contagious outside particular clusters of vulnerable individuals in situations like cruise ships and nursing homes.

The line of argument is vulnerable to the same criticism that one should never reason from a price change. The classic case of reasoning from a price change is reading oil prices as a measure of economic health. When oil prices drop, it could herald an economic boom or, paradoxically, a recession. If the price dropped because supply increased, when OPEC fails to enforce a price floor, then that lower price should stimulate the rest of the economy as transport and travel become cheaper. But if the price drops because economic activity is already dropping, and oil suppliers are struggling to sell at high prices, then the economy is heading towards a recession. The same measure can mean the opposite depending on the underlying mechanism.

The same logic applies to epidemics. The transmission rate is a combination of the (potentially changing) qualities of the virus and the social environment in which it spreads. The social environment is determined, among other things, by social distancing and tracking. Substantial changes in lifestyle can have initially marginal, but day after day very large, impacts on the infection rate. When combined with the medium-term fixed capacity of existing health systems, those rates translate into the difference between 50,000 and 500,000 deaths. You can’t look at relatively low fatality rates in some specific cases to project rates elsewhere without understanding what caused them to be the rate they are.

Right now, we don’t know for sure if the infection is controllable in the long run. However, we now know that South Korea and Singapore controlled the spread so far and also had systems in place to test, track and quarantine carriers of the virus. We also now know that Italy, without such a system, has been overrun with serious cases and a tragic increase in deaths. We know that China, having suppressed knowledge and interventions to contain the virus for several months, got the virus under control only through aggressive lockdowns.

So the case studies, for the moment, suggest social distancing and contact tracing can reduce cases if applied very early on. But more draconian measures are the only response if testing isn’t immediately available and contact tracing fails. Now is sadly not the time for half-measures or complacency.

I believe that Richard’s estimated fatality rates (less than 50,000 fatalities in the US) are ultimately plausible, but optimistic at this stage. Perversely, they are only plausible at all insofar as people project a much higher future fatality rate now. People must act with counter-intuitively strong measures before there is clear and obvious evidence it is needed. Like steering a large ship, temporally distant sources of danger must prompt radical action now. We will be lucky if we feel like we did too much in a few months’ time. Richard believes people are more worried than warranted right now. I think that’s exactly how worried people need to be to adopt the kind of adaptive behaviors that Richard relies on to explain how the spread of infection will stabilise.

Joker: an evidence-based criminology review (spoilers)

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Last Friday, Joker hit cinemas to much acclaim and some anxiety. Hot takes claim it glamorizes violence while the Slate pitch is that it’s boring. Having seen it over the weekend, I don’t see anything more transgressive about it than the various Batman films to which Joker is a sort of prequel, but it is more entertaining.

 

The film uses both narrative and moral ambiguity driven by the theme of mental illness. We are not quite sure what’s real and what’s not. And what (if anything) is responsible for catastrophic events that turn wannabe standup-comedian Arthur Fleck into the Clown Prince of Crime. This ambiguity is in league with contemporary criminology. Many researchers now suspect that crimes are typically the result of multiple, incremental causes (little things going wrong) that together add up to sometimes catastrophic outcomes.


So with spoilers already skulking in the alleyways over the fold, let’s review some of 
Joker’s overlapping narrative alongside some theories of crime (some of which I draw from my forthcoming book chapter on evidence-based policing).

 

Continue reading

Atomistic? Moi?

I have written a brief paper entitled ‘Hayek: Postatomic Liberal’ intended for a collection on anti-rationalist thinkers. For the time being, the draft is available from SSRN and academia.edu. Here are a couple of snippets:

Hayek offers a way of fighting the monster of Rationalism while avoiding becoming an inscrutable monster oneself. The crucial move, and in this he follows Hume, is to recognize the non-rational origins of most social institutions, but treating this neither as grounds for dismissal of those institutions as unsound, nor an excuse to retreat from reason altogether. Indeed, reason itself has non-rational, emergent origins but is nevertheless a marvelous feature of humanity. Anti-rationalist themes that appear throughout Hayek’s work include: an emphasis on learning by processes of discovery, trial and error, feedback and adaptation rather than knowing by abstract theorizing; and the notion that the internal processes by which we come to a particular belief or decision is more complex than either a scientific experimenter or our own selves in introspection can know. We are always, on some level, a mystery even to ourselves…

Departing from Cartesian assumptions of atomistic individualism, this account can seem solipsistic. When we are in the mode of thinking of ourselves essentially as separate minds that relate to others through interactions in a material world, then it feels important that we share that world and are capable of clear communication about it and ourselves in order to share a genuine connection with others. Otherwise, we are each in our separate worlds of illusion. From a Hayekian skeptical standpoint, the mind’s eye can seem to be a narrow slit through which shadows of an external world make shallow, distorted impressions on a remote psyche. Fortunately, this is not the implication once we dispose of the supposedly foundational subject/object distinction. We can recognize subjecthood as an abstract category, a product of a philosophy laden with abstruse theological baggage… During most of our everyday experience, when we are not primed to be so self-conscious and self-centered, the phenomenal experience of ourselves and the environment is more continuous, flowing and irreducibly social in the sense that the categories that we use for interacting with the world are constituted and remade through interactions with many other minds.

Is Dominic Cummings a hypocrite, or does the EU’s Common Agricultural Policy just suck?

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On Saturday, The Observer revealed that Prime Minister Boris Johnson’s recently appointed chief of staff received around £235,000 of EU farm subsidies over the course of two decades in relation that his family owns. Dominic Cummings is often portrayed as the mastermind behind the successful referendum campaign to Leave the European Union. So he is currently enemy no.1 among remain-supporters.

I am unconvinced this latest line of attack plays in Remainers’ favor (I was a marginal Remain voter in the referendum and still hold out some hope for an eventual EEA/EFTA arrangement). Instead, this story serves as a reminder of probably the worst feature of the current EU: the Common Agricultural Policy.

The CAP spends more than a third of the total EU budget (for a population of half a billion people) on agricultural policies that support around 22 million people, most of them neither poor nor disadvantaged as Cummings himself illustrates. Food is chiefly a private good and both the interests of consumers, producers and the environment (at least in the long-term, as suggested by the example of New Zealand) are best served through an unsubsidized market. But the CAP, developed on faulty dirigiste economic doctrines, has artificially raised food prices throughout the European Union, led to massive over-production of some food commodities, and denied farmers in the developing world access to European markets (the US, of course, has its equivalent system of agricultural protectionism).

These economic distortions make an appearance in my new paper with Charles Delmotte, ‘Cost and Choice in the Commons: Ostrom and the Case of British Flood Management’. In the final section, we discuss the role that farming subsidies have historically played in encouraging inappropriately aggressive floodplain drainage strategies and uneconomic use of marginal farming land that might well be better left to nature:

British farmers currently receive substantial subsidies through the European Union’s Common Agricultural Policy. This means that both land-use decisions and farm incomes are de-coupled from underlying farm productivity. Without the ordinarily presumed interest in maintaining intrinsic profitability, farmers may fail to contribute effectively to flood prevention or other environmental goals that impacts their output unless specifically incentivized by subsidy rules. If the farms were operating unsubsidized, the costs of flooding would figure more plainly in economic calculations when deciding where it is efficient to farm in a floodplain and what contributions to make to common flood defense. Indeed, European governments are currently in the perverse position of subsidizing relatively unproductive agriculture with one policy, while attempting to curb the resulting harm to the natural environment with another. These various schemes of regulation and subsidy plausibly combine to attenuate the capacity of the market process to furnish both private individuals and local communities with the appropriate knowledge and incentives to engage in common flood prevention without state support.

Our overall argument is that it is not just the direct costs of subsidies we should worry about, but the dynamics of intervention. In this case, they have led not only farmers but homeowners and entire towns to become reliant on public flood defenses with significant costs to the natural environment. There is limited scope for the government to withdraw provision (at least in a politically palatable way).

Turning back to The Observer’s gotcha story, it isn’t clear to me that Cummings is a hypocrite. I think the best theoretical work on hypocrisy in one’s personal politics comes from Adam Swift’s How Not To be Hypocrite: School Choice for the Morally Perplexed. In it Swift argues that the scope to complain about supposed hypocritical behavior, especially taking advantage of policies that you personally disagree with, can be narrower than intuitively imagined, mainly because of the nature of collective action problems. Swift’s conclusion is that, in some circumstances, leftwing critics of private schools are entitled to send their own children to private schools so long as others continue to do so and burden of doing otherwise is too strong. Presumably, this also means that strident libertarians are not hypocritical to use public roads so long as a reasonable private alternative is unavailable.

In an environment where every farmer receives an EU subsidy, it might be asking too much of EU-skeptic farmers to deny it to themselves. Instead, it seems legitimate and plausible to take the subsidy while campaigning sincerely to abolish it.