Good evening, sickos. I am preparing to record an episode of Death Panel duck-hunting Sandro's new-ish book, Within Reason: A Liberal Public Health for an Illiberal Time. It's a doozy, not in the sense of being packed with ideas but in the sense of being one of the worst books I have ever read in my life. It fails on every level as a book (at the level of idea, the level of argument, the level of prose). Big ups to the University of Chicago press for binding a bunch of this man's toilet paper scribbles (blog posts) into a book and selling it to rubes and bitter bitches like me. Anyway, I wrote some rambling notes on the first parts of the book as a way to get back into it and jog my memory for recording. These are just notes, please don't hate me because they're sketchy and full of block quotes. I'm trying to synthesize the common threads that make this so shitty and so of a piece with what passes for thinking about the pandemic in my cursed field... but this is not that. Proceed with the knowledge that this is raw process!
Big thoughts
He managed to write an entire book about “liberalism” and “public health” without once advancing a serious definition (let alone a serious thought) about either
… Because UChicago Press paid him to print out and bind some of his ice cream brain blog posts. I guess this is the level of COVID analysis that publishers (the public??) are looking for.
The unifying theme is how hackneyed and fucking irritating he is while saying absolutely nothing at all.
He loves to talk about “marginalizing forces” and “disparities” and “structural determinants” but doesn’t ever complicate the narrative – that liberalism itself is one of these marginalizing forces and structural determinants. (I’ve skipped several grade levels over Sandro here)
He doesn’t even aspire to internal consistency.
“Narratives” – are they good or bad?
Overidentifies public health with “Enlightenment science” which is just wrong. The techniques of public health were not developed in the enlightenment. Public health itself developed during the industrial revolution. Was this a time of flourishing liberalism? No. This was a time when the contradictions and weaknesses of liberalism were exposed.
Does liberalism transcend time and place? According to Sandro, both yes and no. (Because he’s too fucking dense to be bothered sorting it out.) He takes pains to let us know that racial justice and other forms of social justice are important to liberalism – which is decidedly not true of many, many episodes in the history of liberalism. The liberalism of the Enlightenment is not the same thing in any way as the liberalism of today. But public health is failing because we’ve forgotten our “liberal roots” and Enlightenment values (reason?? Whose reason and who decides?).
It’s crazy this book got published because the basic thesis of it is so fucking confused.
He wants the nice parts of liberalism but none of the nasty parts. He doesn’t even know there are nasty parts. He’s allowed to do this because he’s a Spreadsheets Doctor, nobody expects him to know anything.
Phenomenology of reading this book: despair. This is what passes for serious scholarly discourse in my field. It makes me want to KMS.
By sections (picking and choosing which ones I think are the most interesting/telling):
Introduction
The “problematic” of the book: people don’t trust public health anymore. This Primal Scene of seeing a coffee shop in Brookline, MA posting a sign clarifying that they were still requiring masking in the winter of 2022. He simply can’t believe this, sees it as a sign of public health’s major failure.
Why might the public think that public health leaders are dishonest and incompetent? Maybe because… they are. This has never occurred to Sandro even for a second, but it’s the most obvious explanation in the world.
“If we are believed, yet our advice is ignored because the extreme embrace of restrictive public health measures – going beyond even the advice of epidemiologists – has become, above all, a political and cultural signifier akin to the red hats worn by some supporters of former president Donald Trump, we should likewise ask ourselves what role we might have played in bringing this about.” (p. 2) Record scratch – masks are the same as MAGA hats? You sure about this one king?
The examples he marshals in the introduction:
CDC seeking input from the NEA on indoor masking guidance in spring 2021
The “vitriolic” response to the Great Barrington Declaration (not vitriolic like the CDC working with teachers’ unions, he’s confused about this but it’s clear what the differences are between the two scenarios)
Whether to vaccinate kids. (“Fundamentally, we wanted to vaccinate children because it protected us as adults.” p. 4)
He claims the “common thread linking the anecdotes I’ve shared is that each reflects a challenge to the liberalism that has long been the animating principle of our field.”
Has no empirical basis
Has no historical basis
Does not establish either what liberalism is or how it is “the animating principle of our field”
Fascinating section on page 5 about the Great Barrington Declaration. “Indeed, the concept of herd immunity could be said to be Epidemiology 101.” (He doesn’t even have the fucking juice to state the plain fact that herd immunity is a basic epi concept.) But the issue here, vis-à-vis the Great Barrington Declaration, isn’t whether “herd immunity” is a concept you can find in epi textbooks, but rather whether the public health strategy propounded in the GBD, which claimed to have “herd immunity” as its goal, was a good one. “While the sum total of the declaration may have been problematic, the response to the document was, I would argue, much worse for what it reflected about the intersection of public health and the hyperpartisan era in which COVID emerged.” (also p. 5.)
“During the pandemic, discussion of mitigation measures based on relative risk rather than indefinite, societywide lockdowns was often met by a tone of opposition that those of us who were used to sober, evidence-based discussion found striking. Such a tone is not consistent with the way public health has long conducted itself. But it is consistent with the behavior of a political interest group engaged in partisan conflict. And that’s a problem.” (p. 5) The very next sentence is: “It’s likewise a problem to see a chilling of free and open debate about something as important as vaccinating children during a pandemic.”
So… do free and open debate, but do it the right way. And watch your tone. Liberalism, indeed!
“And that’s a problem.” How, or why, is it a problem? He doesn’t bother to say.
“The conversation about vaccinating children also reflects our unwillingness to grapple with the trade-offs inherent in choices about health policy. All of this raises ethical questions: were we pushing to vaccinate children for their sake or ours? Were we doing it to support health or make a political point?” (p. 5.) Earlier in the chapter, he claims that the free and open debate should have been had, because we don’t know about the long term effects of the vaccine. We don’t know about the long term effects of COVID in children, either.
According to Sandro, the “core values” of liberalism are: freedom of speech and debate, adherence to the scientific method, and an embrace of diversity.” Here’s some more ice cream brain, p. 6:
“We in the United States have inherited a system with roots in the European Enlightenment, a time when societies began to organize around reason, free speech, the pursuit of truth, and the preservation of liberty. Out of these values emerged liberal democracy and modern science. I am aware that liberalism in its wider sense can mean many things to many people. I use the word “liberal” to mean the core values I have described, leaving it to others to apply different uses to the word in the context of different arguments.”
He does this throughout the book: treats various systems with a kind of transhistorical reality and reverence.
Thesis statement: through COVID, “we” (public health) “forgot the liberal values that used to be the basis of all we did.” I’d be sad if I were Sandro, too – he’s mourning a past that literally never existed (p. 6)
“Public health faces five key obstacles to a full restoration [RETVRN] of its liberal ideals.” (p. 7). 1) Science and public health institutions have become politicized; 2) we have forgotten our roots; 3) we have become poor at weighing trade-offs; 4) media feedback loops have become the new peer review; 5) we have prioritized the cultivation of influence over the pursuit of truth
What stories will we tell about COVID-19?
“The narrative of scientific excellence did not come out of nowhere. The methodologies that generated the advances we have seen are the product of a tradition with roots in the Enlightenment and the Scientific Revolution. These historical periods both informed and were informed by the principles that birthed our present liberal system. When we celebrate science, then, we also celebrate the small-l liberal principles that allow scientific reasoning to flourish.” (p. 18)
This is literally just fucking wrong. I dunno what else to say!
Liberty and health?
This is the one where he compares COVID shutdowns to the Patriot Act.
Vague fumbling about the importance of “motivation” – “Are we acting based on fear? Are our priorities guided by reason?” (p. 25) – How do you tell? Sandro never tells us.
Fear
Interesting abortive argument here – he cites research showing that “legal restrictions” accounted for just 7% of declines in economic activity during early 2020 (causally interpreting R-square, classic) and that “individual choices” were more important, particularly individual “fears of infection.” Keeping up the 9/11 vibes with the “get out there and fucking SHOP” mentality but this is just one of many examples of the internal incoherence of his viewpoint, even of each fucking paragraph of this thing. Which was it? Were lockdowns incredibly draconian and generative of immense economic harm, or was it that people were unreasonably afraid of getting COVID?
He thinks anti-vaxxers are anti-vax because they don’t believe the data about the efficacy and risk profile of vaccines. This is wrong, and there’s a lot of research to show it. Sandro hasn’t read any of it.
Amazing line: “throughout the pandemic, the data were clear that schools were not hubs of transmission, and that the virus itself posed little risk to children.” (p. 29) Inexcusably wrong!
Shortlist this man for the Booker prize: “Given public health’s missteps in the context of crisis, it is clear that fear played a role in causing us to forget our liberal roots. This is notable, since it was precisely the Enlightenment era that helped society navigate the fears that emerge from a lack of reason. During the Enlightenment, science helped show a way through fear by helping us better understand the unknown.” This is like a Disney cartoon about the Enlightenment.
How to get healthier and wealthier during a crisis
This is nominally about “inequality” during COVID but is really about how bad lockdowns were. He claims that lockdowns happened because poor people aren’t represented in Congress and in the upper echelons of public health policy making.
“Well, the pandemic hit, we were afraid, and that fear caused us to bungle testing and early response, leading us to adopt widespread shutdowns as a way of minimizing viral spread. We then continued to bungle our response, and the shutdown efforts affected sectors that were overpopulated by those with lower levels of education and income: retail, service, hospitality, leisure, mining.” Mining! What a curveball! (p. 38)
This is, it barely even needs to be said, not an accurate read of what happened! It wasn’t “fear” that cause us to “bungle testing and early response,” it was underinvestment, incompetence, political interference.
Amazing: “Was what happened during COVID avoidable? Were indefinite lockdowns the only way we could have addressed the disease?” Doll… please.
“Reason is but choosing” – John Milton