Moses Doubted God's Promise

COVID-19: Critical Thinking Versus Unreasonable Doubt

What is the line that separates critical thinking from unreasonable doubt? A contrarian can save us from making grievous errors by failing to question false assumptions. But sometimes a contrarian view and insistent bias are nearly impossible to distinguish. COVID-19 is offering us many such examples. One of them comes at intersection of COVID-19 with obesity.

Much to Learn

We are in the midst of a chaotic pandemic. Thus, the information about this totally new disease is a mess. It’s full of noise and false signals. But with all that noise comes a flood of new information. With more information and analysis, patterns emerge. And over time the evidence becomes clearer.

It is abundantly clear, for example, that older patients face more difficulties with this disease. In addition, we are seeing reports that people with obesity are an important risk group that may require more intensive care. In one analysis, not yet fully peer reviewed, researchers concluded that obesity was the most important risk for hospitalization, except for age.

The picture is far from complete. Risk factors are different in different populations. And right now, we have limited data from a few, very specific populations.

Doubt and Misinformation

In the face of this limited information, once again, we see examples of unreasonable doubt and misinformation. On one hand, we hear Aseem Malhotra, a cardiologist with a popular diet book. He is writing about “the elephant in the room” and COVID-19. His recommendation:

To reduce morbidity and mortality from COVID-19 people need to be getting the message right now to be cutting out the ultra-processed junk food.

Of course, we have no evidence that this recommendation would actually be effective, even if people could follow it under the conditions of a lockdown. But it plays well with people who believe that obesity is a simple, easily corrected problem resulting from bad choices.

On the other hand, we have people from the HAES® movement selling the idea that obesity has nothing to do with risk for severe symptoms with COVID-19. It lines up with the HAES narrative that obesity isn’t really a medical condition. Just a tool for promoting weight bias.

Both of these extremes seem to be guided more by bias than by an objective review of available evidence.

Never Give Up on the Virtue of Doubt

Clearly, we do not have a complete picture of how COVID-19 and obesity interact to produce bad outcomes. Perhaps diet is an important factor, as Malhotra suggests. It’s a reasonable conjecture. But it’s far from being a scientific fact with the certainty he projects.

Also it’s possible that obesity is a merely marker for some other risk factor we will better understand when we have a more complete picture. We have much to learn. But for now, it seems wise to pay attention to the risks of obesity and COVID-19. Attention to those risks can help providers give better care and help people at risk take extra precautions.

Disparate views about difficult subjects are ultimately helpful for discovering the truth. Overheated rhetoric is not. David Allison, Gregory Pavela, and Ivan Oransky recently explained this well:

There truly are people – some of them in positions of authority – who are promoting disingenuous and unreasonable expressions of doubt. However, if we slip and rely on nonscientific rhetorical devices to argue against them, then we invite others to use these rhetorical devices to dismiss cases in which scientific doubt is reasonable and even essential. As scientists and scholars, we need to rise above that, stick to the science, and never give up the virtue of doubt.

For more on how conjecture and bias are coming into discussions about obesity and COVID-19, click here.

Moses Doubted God’s Promise, painting by Alexander Ivanov / WikiArt

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April 27, 2020