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Opinion | Seven Cognitive Distortions Poisoning COVID Debates
Our society is more and more incapable of debating real issues
www.medpagetoday.com
COVID-19 cases are climbing and sanity is declining. Here are seven cognitive distortions I routinely see when it comes to talking about SARS-CoV-2.
1. Misusing Both-Sidesing
Both-sidesing occurs when the media present two sides as equally valid, when one in fact is wrong. It gives false equivalence to a flawed idea. For instance, a debate on whether the earth is round or flat would be both-sidesing.
However, if you introduce pandemic restrictions that have never or rarely been implemented before -- travel bans, school and business closures, mask mandates, and military enforced lockdowns (as in Australia) -- it is inevitable some smart people will feel the harms outweigh the benefits, and equally inevitable that other smart people will feel we aren't doing enough. In these cases, having a forum to debate the ideas is not both-sidesing, but rather the legitimate purpose of media and universities.
Recently, dueling editorials -- one by MedPage Today Editor-in-Chief Marty Makary, MD, and Cody Meissner, MD, which argued against masking children in schools, and one by Kanecia Zimmerman, MD, and Danny Benjamin, MD, which argued in favor -- came out in the Wall Street Journal and New York Times, respectively. CNNcovered both sides in a brief television debate, interviewing Meissner and Benjamin. Bring popcorn!
Some commenters labeled the coverage "both-sidesing" -- because they felt Meissner's position was demonstrably wrong. Yet Meissner's view is the current position of the U.K., which despite various mitigation strategies has never mandated masking for kids younger than 12, and where only some secondary schools have reintroduced masking after mandates were lifted in May. Benjamin's position, meanwhile, is consistent with the CDC's in recommending masking kids as young as 2 years old.
I've written on this topic elsewhere, but my point here is about the misuse of "both-sidesing."
Our society is more and more incapable of debating real issues. We are not only certain of our positions, we view the clash of ideas as a threat. More than any specific issue, I am worried about people who are so fragile they cannot bear to hear opinions that conflict with their own. Calling real debates both-sidesing is a cognitive distortion.
2. Doing It for Fame and Clicks
No matter what the topic or issue, and no matter what position someone holds, I have seen someone allege that person A is only saying this or that for the clicks or likes or fame.
Really?
This allegation gets levied all the time, and I pity people who genuinely believe the world can be divided into people who share your views, and who reached them through pure reasoning, and those who disagree with you, who must have ulterior motives or are out for some secondary gain.
I would venture to say that it is almost pathological to think like this. The truth is human beings are motivated by many things, and it is impossible on any issue that all who think one way are good, and all who think another way are bad. The real problematic bias -- the one that can be dealt with -- is financial conflict of interest.
When it comes to COVID-19, there are real conflicts -- being paid by testing companies is just one example. The companies that make COVID tests want to sell those tests, naturally, so one might wonder if an epidemiologist who recommends that vaccinated, asymptomatic, masked students get tested weekly -- as they are doing at Stanford -- is affected by money they receive for consulting for testing companies. No conflict exists if someone holds those very same views while working for a local department of public health (that department has no financial skin in the game).
Clicks and likes can certainly influence anyone, and have probably led everyone to hold slightly more extreme positions than they otherwise would, but largely this pushes in all directions, and does not work as a net vector of bias, as financial conflicts do.
The bottom line is this: the idea that your motivations are pure but those who disagree with you are tainted is a cognitive distortion. Revisit it.
3. The Burden of Proof
Last week, generating controversy, the American Academy of Pediatrics (AAP) tweeted this: "Babies and young children study faces, so you may worry that having masked caregivers would harm children's language development. There are no studies to support this concern."
Like many, I found the claim odd.
It would be one thing to argue that on balance the potential benefits of masking outweigh the harms for baby caregivers, but to discount the concern entirely -- citing "no studies" -- seems hard to defend. In the history of humanity, I am aware of no careful study of babies sent to day care for 8-10 hours, who do not see the bottom portion of caregivers' faces and the long-term outcomes for such babies. Such data would be needed to confidently assert there are no downsides with respect to speech or language development. (A prior MedPage Today essay discusses this notion of confirmation bias beautifully.)
In fact, this idea: to whom does the burden of proof fall -- is a recurring blunder throughout the pandemic. There are two principles worth articulating. One, in emergency circumstances, states and other actors can institute untested interventions in the face of novel threats. But two, if these interventions continue or repeat, year after year, at some point, it is incumbent on the entity or person asserting the intervention to prove that the net benefits outweigh the harms.
The person who repeatedly asks you to disrupt your life -- at some point -- has to show that a given disruption has some net benefit. When it comes to babies and language development, I think in year 2 of mask-wearing at day cares, careful studies must be launched to rule out a modest decrement from caregiver use, and the list goes on and on.
4. Look What Happened to Tom or Jane
Anecdotes are powerful in shaping human minds, but they are prone to emotional response. An anecdote without a sober and methodical appraisal of data can lead to erroneous thinking. Social media abuses anecdotes in all directions: on issues I agree with and vehemently disagree with. But in both cases, I often think that emotional appeal of anecdotes is unfair -- even if it furthers a cause I like. We must make our case solely on the merits of the argument or policy.
5. Ideas Are dangerous
Many commentators on twitter are quick to label factual ideas or predictions dangerous if those ideas are seen to support policy choices they disagree with. Recently, Andy Slavitt wrote that many experts believe it is now inevitable that everyone will someday acquire SARS-CoV-2, and this was labeled a dangerous view.
If you think vaccinated people should isolate to avoid spreading SARS-CoV-2, then any idea that suggests they will get the virus eventually runs counter to your narrative. A person may wonder: Why should I continue to deprive myself if getting the virus is inevitable? (Note: this does not apply to an unvaccinated person who has a high risk of severe outcomes or death that would markedly fall if they were vaccinated.) The idea is only dangerous if you already assume that vaccinated people staying home is a good thing.
If instead, you think that vaccinated people should take reasonable precautions, but have to try to get back to life as much as possible because -- as they say, time's a-wasting -- then the idea that they may someday acquire SARS-CoV-2 and thankfully not get as sick as they otherwise would (after all they have been vaccinated) is not that dangerous. It is just a statement of what many experts believe.
A dangerous idea is too often used to describe an idea that erodes support for your policy recommendation. But using it in this way is a cognitive distortion.
6. 'My Colleagues All Agree With Me'
There is an old saying: If your friends share all your ideas, they aren't your ideas. Nowhere is this more true than with SARS-CoV-2. It is fascinating how we have created party platforms out of COVID policy, with partisan splits over lockdowns, school closures, masks, hydroxychloroquine, ivermectin, and the origins of the virus.
Why can't there be a mixing and matching of our pandemic views? Lockdowns require far more study, and we have no idea under what circumstances they may work. School closure is the most disruptive policy choice and should only be considered when approaching health systems failure. Masking is reasonable in some settings, but we need to run randomized studies to know exactly at what ages and in what scenarios. Ivermectin is being tested in several large ongoing randomized trials, but probably doesn't work. That's nothing against it specifically, just a statement of fact that most drug trials are negative. And, yes, let's put it to bed: hydroxychloroquine doesn't work for COVID. Finally, I have no idea if lab leak did or did not happen, but I do know that censoring debate on the topic was awful.
Being able to hold views that sometimes dovetail with your peers and colleagues, but not always, is the hallmark of independent thinking and appraisal of evidence. Instead I worry that even the professional classes -- folks with doctorates -- have devolved into tribal creatures lusting for blood when they see a view that falls outside their preferred platform.
7. Punishing People for Holding Ideas
It's tiring to go online and read the repeated calls for someone to be fired for something they may have said. Amazingly, often it is the first time I am learning that this person even exists!
I only hear the name of some popular radio, television, or podcast personalities when they say something that results in calls for their expungement. Then I can only find a fractured 15-second clip, and before it plays an ad comes up, and next thing I know I'm closing my browser.
I learned about boycotts in history class, and I don't doubt that they are a reasonable way to achieve change. But, I doubt our ancestors imagined that social media would result in the age of perpetual boycotts, where someone or some brand would be boycotted for a 280-character text. But here we are. It is probably fair to say that we have overused this little trick. Next time you hear something you dislike, just silently move on.
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Missy, if I believe everything you posted about Covid I should be dead by now, but you know I still love ya!
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