Teaching Scientific Inquiry

Should we do a better job of teaching scientific inquiry?

Michael E Trigg MD

We wake up one day and see that our driving route to work has been changed, but we had anticipated the change. We had been seeing newspaper articles about the impending change and understood for years the rationale about the required changes due to traffic bottlenecks that occur from time-to-time, particularly during rush hour. We adjust to the new route and to the new traffic patterns because we figured that traffic engineers, with years of experience in this area, devised a new way to limit or remove the bottlenecks. We seem to have faith in their science.?We can’t go back to the old routing regardless, since it has been blocked off or eliminated. We are forced to accept the new routing and over time, we come to realize that it has actually improved the flow of traffic.

These same patterns of change and acceptance have occurred over time for many societal norms that are now accepted. We put on a seat belt when we are in a car, reluctantly by some particularly those sitting in the back seat of a vehicle, but we’ve learned over a long period of time that seat belts save lives. Yet, even with this information, some view this as a violation of their freedom to drive as they please and to sit in their vehicles as they like. I pass each day the roadside memorial to several teens speeding down a neighborhood road on which they lost control of their vehicle and were ejected from the car while not wearing any seatbelts. One died, one is paralyzed from the waist down and the third suffered ongoing concussive brain injuries. Seat belts have been mandated for years, yet still we have some reluctance to accept the known facts. We have various regulations that differ by state to state or even within locales of the same state as to whether school busses will be equipped with seat belts and if so, who will monitor if the students riding on the busses actually put on their seat belts.

How many of us choose our friends or sport playing partners on the basis of whether they smoke or not, as we don’t want to enter into discussions of secondhand smoke inhalation or the dangers of smoking. Despite the package warnings on all tobacco materials and extra taxes on these easy to produce products to fund the societal health and environmental damages from smoking and the limitations that smokers now have, some still protest about where they can smoke.?We persist with a hard-core portion of the society that still buy all manner of tobacco products. Smoke shops are found in most cities and towns across the country. From the days when free cigarettes were distributed in promotional campaigns to the availability of cigarette vending machines, accessible to anyone with the required coins for insertion into the machine as we currently have for candy and snack vending machines, we now have major pharmacy and food store chains that no longer stock any tobacco related products. Yet, such products are still available to those who for whatever reasons do not believe the health-related warnings or that the warnings do not apply to them.

As we come close to the end of the third year of the pandemic that shook the world with closings, illness and prolonged hospitalizations, and the expenditure of massive amounts of money and resources to develop vaccines that are clearly not providing the kinds of long-lasting immunity that we had seen with other vaccines in the past, we begin to assess whether we may be able to categorize the responses of the public to the pandemic. Will such assessments perhaps permit us to focus on one group or another going forward, not only to continue to meet the challenges of this ever-present viral threat, but where to begin if another pandemic should develop in the future. Clearly millions around the world died from the pandemic thus far, leaving behind friends and loved ones and family members, who had to deal with the aftermath, such as children who lost their parents and then had to make their own way in the world without the guidance of their mentoring parents. We saw medical personnel burned out with the hardships they endured and the daily mental anguish of caring for those when no monoclonal antibodies or anti-viral drugs were available and when even the course of the underlying disease was poorly understood, and which individuals were more vulnerable than others. These and other personal and financial losses over time cannot ever be replaced. But there may be a few lessons to be learned if we try and look at the responses that people had initially and over time to the pandemic and relate these responses back to what we have seen with other changes in our lives.

When examining the population of those affected by the pandemic and the recommendations/rules that were initiated, it is possible to divide the entire population into 4 groups.?By congregating a number of different individuals with different behaviors together, as much as possible, this permits the identification of the groups on which the focus must be set for the next public health emergency.

As shown in the attached diagram, group 1 are those individuals, usually non-medical personnel but with exceptions and usually non-governmental leaders but with remarkable exceptions, who do not tolerate any infringement on their personal freedoms. Such individuals of all ages do not like any infringement on smoking, do not like wearing seatbelts, do not like the screening at airports, do not like adhering to vaccination requirements and attempt to use religion or “personal choice” to circumvent these requirements, and certainly do not like any of the mask mandates. The confusion initially over whether to wear a mask and then the confusion over the type of mask to wear caused considerable grief to this group of individuals who did not believe in the science, particularly when the scientific community changed their posture and recommendations week-to-week. Some in this group are the hard-core anti-vaxxers, for whom and with whom change is very difficult. Some from their hospital beds suffering from COVID during the recent pandemic called out for others to wear masks and take precautions or asked for vaccinations when they became available (it was already too late in their COVID course for the vaccinations to provide any benefit). Sometimes they would appeal to their friends and/or relatives to get vaccinated. This sizable group is difficult to convincingly reach and this group, in a public health emergency, may continue to serve as a reservoir of infection to others who have hesitated to follow public health guidelines and to those who for a variety of reasons are immune compromised or unable physically to follow through on the public health guidelines, even though they would like to follow them.

Group 2 are the government leaders, from whom we would expect a reasonably educated response. Unfortunately, that was not uniformly seen in this past pandemic. We had some leaders who were actually members of Group 1 and even with medical or scientific degrees, disagreed with the health experts. We had health experts who waffled in their advice from week-to-week, and this added to the general confusion related to the messages that were given out. Oftentimes new warnings and recommendations were posted onto the CDC and public health sites often not visited by many of the general public, including those in the government. In addition, there were frequent “peddlers” of fake news, erroneous advice and occasional unfounded medication recommendations with no or minimal scientific credible data to back up their recommendations. The general public were often confused as to the behaviors to model when leaders flaunted their own agency advice. For example, large gatherings were not recommended, and some leaders continued to hold unmasked gatherings. Parties were held by government leaders when these were discouraged for the general public. Leaders who were potentially or actually infected refused to isolate and took seemingly active steps to expose others. It is with this group that best efforts need to target for precise, ever-changing public health recommendations. But this is a widely disparate group at the federal, state and local level. In the absence of newspaper readership and the confounding advice from different media channels and considering the number of hours that the general public are viewing cable transmissions, the best source might potentially be a CDC channel that is updated once per week and available on all the cable networks at no cost. If leaders could count on an update on a weekly basis, with documentation as to why certain recommendations were changing or updated, then it would be possible for a reliable source of information to be widely available and disseminated. There would be no excuse for anyone in a position of leadership to not have access to the latest information simply stated and to the written public health guidelines.

Group 3 belongs to those in the medical and scientific community who by-and-large were amendable to following the public health guidelines. However, this group like all the others were often confused by the ever-changing recommendations and how the media interpreted the data from new scientific and epidemiologic studies that were reviewed and analyzed and the recommendations from quasi-anti-science physicians and scientists. In general, this group has a mission to communicate the best medical advice to their contacts and their patients, but they need to have a reliable source updated at least once weekly with the latest information.?During the pandemic this group was overwhelmed with patient care responsibilities to the extent that they could not keep up with reading the scientific literature themselves.

Group 4 is the largest of the 4 groups and includes those who either are accepting of the changing scientific and investigational data and/or have a good understanding of the intention of careful public health measures. This group is willing to change and adapt upon hearing good explanations for any recommendations and/or changes. They strive to be free of confusion, which unfortunately was rampant during the current pandemic. When one school mandates virtual learning and another mandates in-person classroom teaching, when one area or state mandates mask wearing only indoors and another mandates mask wearing outdoors as well, when one state has no vaccine mandates or refuses to publish the daily infection or death figures and others publish them daily all tend to lead to massive confusion, even for this large group of the general public. A CDC lead program limited to no more than 20 minutes per week of new information, with a follow-up time period for call-in questions that examine further nuances of the recommendations, would help to alleviate much of the infusion during the past year.

Although it may seem clear from this separation of individuals into groups that the target groups should be #2 and #4, what seems clear from what occurred over the past two years is a lack of understanding of scientific inquiry and of scientific investigation and how subsequent accumulation of new data might lead to different conclusions. As part of a history or science course required for all middle and/or high school students, should there be material presented as to how scientists over many centuries made erroneous conclusions about data and had to change their approach? The history books and science books are replete with excellent examples. The world was thought to be flat and no one in their right mind would sail off into the horizon centuries ago. Yet over time, with increasing scientific developments, there was an acceptance of new data that the world was not actually flat. It took centuries for surgeons and physicians to accept the notion that infections came from microbes that could not be seen with the naked eye and thus as a result, more sanitary measures were taken with surgical procedures and/or treating wounds. Initial attempts at vaccines for common childhood illnesses and prior plagues failed but with further data accumulation, particularly epidemiologic data, different conclusions were developed. Just in the past pandemic beginning in early 2020, there were initial recommendations that masking was not necessary, and this was accepted as gospel by those in group #1 and never wavered in their approach, even though accumulating data eventually pointed to the mask approach as quite relevant and then to the revisions as to which masks were effective and which were not. Each student in each class could present on a week-to-week basis an example of how further accumulation of knowledge over months, years or even centuries discounted prior conclusions and lead to new ways to do things and new thoughts on human behavior. Having exposed students early in their schooling to the methods and foibles of scientific inquiry could better prepare them for the uncertainties that often come with pandemics as infectious diseases specialists work feverishly to announce new public health recommendations that have been re-formulated. Clearly, there has to be uniformity in terms of the public health information that is communicated and a reliable source of credible information that is updated frequently. Nothing will ever stop the naysayers and others with fake information from attempting to spread such information in whatever format possible as widely as possible. But one of the key ways to combat this effort to disseminate fake and unreliable information is to have a credible source that the public and those in Groups #2, #3 and #4 can access and know that this will be a good source as more data are developed. However, it will help to have educated our population as to how recommendations are generated and why facts may change when additional data are accumulated and analyzed.

As I began this article, it took years of study and acceptance to deal with the issues of smoking and seat belts. In a pandemic, we don’t have the luxury of time to take years to understand the risks of certain behaviors and certain actions or inactions. Recommendations have to be developed and put forward in “real time”, and this requires an attention to detail, a reliable source of information and an understanding of how scientific inquiry actually proceeds and develops. This should become a focus going forward, to assist others in understanding the scientific process and provide a reliable and dependable source of information, that provides easily comprehensible rationales for the recommendations and explains the differences that may be found locally or regionally in terms of those recommendations.?Even understanding simple recommendations, such as why masks were required on airplanes but not in schools or in airports or shopping centers can go a long way to assisting all the groups, particularly those in Groups #2, #3 and #4 to understand how the data were generated and why recommendations may differ from one locale to another.

Michael E Trigg MD

MET Development LLC; www.metdevelop.com

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