June 12, 2021 · medicine opinion

Paradoxical Effect of Enforcing Authority

A paradoxical effect is defined as an effect of a chemical substance, typically a medical drug, that is opposite to what would usually be expected. An example of a paradoxical effect is pain caused by a pain relief medication.

Health organizations have a duty to protect their citizens from harm through measures such as infectious disease control, workplace safety, effective laws, and good healthcare infrastructure. When things are going smoothly (no pandemics occurring), health organizations do not have much pressure to move quickly and citizens give them a passing glance. They are able to use evidence-based methods and long-term deliberation to modify laws, practices, and recommendations based on the citizens' needs. But in times of crises, when citizens are flocking to them for answers and they are under scrutiny, health organizations by their very existence are compelled to enforce their authority. This means that they have a duty to legitimize themselves by any means necessary, show a unified and single narrative, and discourage any dissenting opinion. From the health organization's perspective, they are saving citizens by spreading knowledge, reducing fear, and fighting misinformation. Naturally, since they are a health authority, all actions are justified.

In reality, it gets a bit more complicated. Our Western society is defined by individualism, freedom-of-thought, and freedom-of-speech. Questioning authority here is okay! Another problem arises from entrusting public figures to competently represent scientific truth. The job itself selects for people who want to appear in the media, not those who want to publish accurate research. There's an interesting article about whether experts are real on Hacker News, that explores this issue further.

This ultimately leads to two things: health organizations that are wrong at times, and an eventual splitting of society. Take a look at the WHO, who spectacularly denied that COVID-19 could be airborne and denied the efficacy of masks, as detailed by a WIRED article. Unfortunately, all it takes is one "lie" to push citizens onto fringe paths, giving rise to anti-maskers, anti-vaxxers, and batshit-crazy conspiracy theorists. In their eyes, "if an authority lied to me about this one thing, why not others?".

By nature of a health authority's need for a unified narrative, it sets up an irreconcilable divide where if a citizen or member is to have an outspoken opinion, they are immediately cast into the "out-group". In January 2021, an Ontario medical doctor was outspoken and critical of his provincial government for not being proactive about the B117 variant. He was subsequently fired from his position, arguably to protect the health authority's credibility to the public (Source). Within a few months, the B117 variant became the most prevalent variant in Ontario, with a terrifying 60% increased risk of death and 60% increased risk of hospitalization (Source). It's possible that if his criticisms were addressed and more discussions were allowed, fewer Ontarians would have died during the third wave. Sometimes, you can observe the more bizarre side-effects of maintaining a unified front, where a worried WHO spokesperson fakes network connection issues when asked about Taiwan. All this did was generate public distrust in the WHO.

This is the paradoxical effect of enforcing authority, how an effort to gain public cohesion can sometimes cause the opposite effect. As a medical student, I try to support actions taken by health authorities to protect public health, but I wonder if their actions can be presented in a way that doesn't cause public mistrust or stigmatize the people who criticize them. I think that we as citizens should recognize that health authorities are not perfect, and encourage health authorities to embrace their own limitations and fallibility.

As a final note, this is what the top result currently is when you search for ivermectin on Google:

Why You Should Not Use Ivermectin to Treat or Prevent COVID-19 (FDA)

Not exactly a nuanced title, is it? Nowhere in the article does it say that the FDA is unsure about the actual effects of Ivermectin on COVID-19, or that there is ongoing research with interesting (positive) results. A better title would be "FDA Does Not Recommend Ivermectin for Treating or Preventing COVID-19 as of March 2021". Time will tell if this will be another trigger for public division.