Science and the Embrace of Ambiguity
Trust - assured reliance on the character, ability, strength, or truth of someone or something.
Public trust in science has eroded dramatically, fractured by polarization, misinformation, and the collapse of shared information sources. The COVID-19 pandemic starkly illustrated this crisis—and revealed how professional societies might help rebuild that trust.
Professional societies, such as the American Society for Clinical Pharmacology and Therapeutics (ASCPT), have an opportunity to play a crucial role in leading efforts to provide insight and feedback on the creation of new knowledge commons that embrace scientific ambiguity while offering principled frameworks for evaluating complex issues.
Lessons of Ivermectin and the COVID-19 Pandemic
When laboratory studies suggested ivermectin's activity against SARS-CoV-2, widespread off-label use followed. Shortly thereafter, a clinical pharmacologist's analysis, published in ASCPT's journal, made a strong argument that ivermectin doses required to achieve effective concentrations far exceeded safe human doses.
Clinical pharmacologists understand the concepts of the risk and benefit of a drug based on dose, disease, and patient characteristics. The principled argument against the use of ivermectin in SARS-CoV-2 was a welcome message to the clinical pharmacology community. The paper was one of the top-cited publications in the journal for 2020 and served as a strong rejoinder to the ill-informed public voices calling for widespread use of the drug.
If you are not a member of this community, you probably didn’t know about the publication or its well-reasoned argument against the use of ivermectin in treating COVID-19 infection. What you are likely familiar with are people lined up on either side of this controversy, calling the other side ignorant and holding them responsible for irreparable harm.
The Revolt of the Public
Martin Gurri's book, The Revolt of the Public, argues that the internet and social media have provided society with unprecedented access to information and platforms for voicing dissent. The widespread dissemination of half-truths, rumors, and deliberate ignorance of contrary information has eroded the authority and credibility of traditional institutions, including government, media, and academia. At the same time, the public has become increasingly fragmented and is more likely to reject the advice of experts.
Unfortunately, the abundance and obscurity of sources of ‘facts’, manipulative attempts by malevolent actors, and the publication of fake news and half-truths as ‘clickbait’ are all features of our current environment. These features speak to the social and emotional aspects of communication and the challenge of distinguishing between deceptive, sensationalized, or otherwise misleading information sources.
As pointed out by the media scholar Andrey Mir, the real solution lies in developing tolerance for the ambiguity of truth. Attempts to suppress what has been labeled disinformation by punishing individuals who don’t adhere to the preferred narrative have caused more harm than the information being suppressed.
Immunity to disinformation does not come from censorship but from cultural literacy.
The Embrace of Ambiguity
The principles of pharmacology provide a valuable framework for considering the off-label use of a drug when incessant voices make ill-considered proclamations.
The core principles of pharmacology arise from the study of how drugs interact with biological systems. These principles include pharmacokinetics, pharmacodynamics, dose-response relationships, drug selectivity, individual variation, and tolerance and dependence. These principles guide the risk-benefit considerations that determine the value, or lack thereof, of a drug in different contexts.
The inescapable trade-off between these risks and benefits for any therapeutic agent in any context often leads to an ambiguity over the decision to use a drug. We live in a time where this ambiguity doesn’t seem to have a place in our conversations.
I still see signs on the lawns in my neighborhood extolling the virtues of science. But what is science? Indeed, it is more than a collection of facts.
In science, facts may line up on all sides of an argument. Decisions rely on an intuition that takes in the facts and, on balance, finds a sort of détente in the embrace of ambiguity that arises from assembling coherent facts while accounting for discordant ones. Trust in first principles, and their proper use, plays a significant role in interpretating and assessing the rationality of an idea, decision, or plan of action.
Society at large encompasses a diverse range of perspectives and can easily fragment into groups with opposing notions. And what we call science has evolved into preferred narratives that often fail to acknowledge the underlying ambiguity in a proposed solution.
Rebuilding the trust that was lost as a result of insistence on preferred narratives is an imperative for our age.
Shaping the Knowledge Commons of the Future
Legacy media had represented our 'knowledge commons' and the place we relied on for balanced insights into complex questions.
There was a particular dynamic in the conversational flow with legacy media that sought to emphasize balance in the presentation of controversy, the interviews with experts who can speak to all sides of a debate, and the careful drawing of conclusions.
As the legacy media succumbed to ideology and suffered the ‘revolt of the public’ phenomenon, we retreated into groups of like-minded people who shared a similar, if incomplete, framing of a problem. While this led to a comfortable feeling of understanding the situation and brought with it a certainty in proposed solutions, in truth, it provided only a partial picture of the challenge. It made it easier for groups who share a different framing of the problem to embrace conspiracy theories.
Google had served to support the knowledge commons. The search engine initially focused on discriminating between ‘good’ and ‘bad’ sources of information based on the structure of links going to and from the site of interest. Crawling the web costs money, and over time, strategies for search engine optimization and the ubiquity of advertisements added noise to the system. The quality of search results deteriorated, and clickbait became more prevalent, drawing us into narratives that confirmed our biases.
But Google has been losing its search engine monopoly, and the artificial intelligence platforms are becoming the 'knowledge commons' of the future.
These new knowledge commons must be infused with appropriate values and principles to address complex problems. Each controversy must become an opportunity to test these values and principles as a systemic application of science rather than a wack-a-mole strategy of preferred narratives when controversies surface in the public consciousness.
Role of Professional Societies
Professional societies possess unique advantages: multidisciplinary expertise, established credibility, and platforms for sustained dialogue.
However, the professional societies themselves face trust deficits. They must navigate tensions between members who support ideology-based initiatives aimed at achieving cultural progress and those who view them as inappropriate political activism. These debates reflect broader cultural divisions about how professional organizations should address social issues while maintaining their scientific and professional credibility.
In the face of these tensions, professional societies, with their diverse range of disciplines and expertise, have the advantage of becoming advocates for the creation of a new knowledge commons.
This knowledge commons can be a structured space for sharing perspectives; one that doesn't try to silence dissenters, or suffers from deference to elites, but welcomes all to engage on their merits. We need as many sources of information as possible to reveal those who are trying to dominate the space from a narrow perspective, while respecting the voices that carry weight and foster the inclusion of sources of ambiguity as well.
Most professional societies hold annual meetings of their membership. The annual meeting of the American Society for Clinical Pharmacology and Therapeutics, for example, brings together scientists and clinicians from numerous disciplines in medicine, pharmacy, pharmacology, nursing, and pharmaceutics. The meeting serves as a forum to discuss current research, topics of interest, innovative ideas, and controversies in medicine and therapeutics.
These meetings can serve as the basis for a community-based effort in defining the values and principles required to embed pharmacological reasoning into the artificial intelligence-based knowledge commons of the future.
Reestablishing Trust and Respect for Rationality
In a recent publication in the ASCPT journal, Brian Corrigan reviewed the history of ivermectin in the context of the COVID-19 pandemic. He emphasized the importance of rapid follow-up publications that directly engage with controversies to combat the dysfunctional information-sharing environment and rebuild public trust.
A key aspect of this engagement is collaboration with journalists and media outlets to establish and apply proposed clinical pharmacology frameworks as a framework for therapeutic-related controversy, and to improve transparency and reach through the routine adoption and dissemination of lay summaries of scientific manuscripts.
These are essential activities for the scientific establishment to rebuild the trust that has been lost. Still, we must acknowledge the true nature of this challenge and the evolving information-sharing environment.
The public is conditioned to expect that a narrative broadcast by the legacy media is coming from a distant elite supporting an ideology rather than a principled consideration of risk and benefit.
We have a critical responsibility to reverse this conditioning and provide all members of society, regardless of their educational level, status, or employment, with a clear set of principles that can strengthen immunity to misinformation.
This will require developing AI training protocols that embed pharmacological reasoning, creating public-facing educational frameworks, and establishing cross-society collaborations to scale these efforts.
Whatever else the effort requires, it is not an advertising campaign extolling the virtues of yet another source of expertise.
The question isn't whether professional societies should act, but how quickly and systematically they can respond.
Coming Soon:
Building [mis)Information Immunity: A Clinical Pharmacology Framework for Public Engagement