Brooke: One of the things you mentioned about the independent SAGE is that it’s highly iterative. And in my own experience, working in those iterative contexts, one of the things that I’ve seen is that those rapid cycles allow for problem framing to evolve very quickly. So you mentioned with the main SAGE group, the downstream impacts of the sides, how it’s taken up, what decisions are made on that basis, et cetera,. is a bit opaque and it’s hard to see how things are flowing through the system.
What about further upstream? Do you feel that there’s opportunity for the main SAGE group to actually engage in discussions around problem framing? Or is it very much kind of that a formal request comes in and the problem is already cut up for you, and you must remain within the boundaries of that box?
Susan: That’s an interesting question. And no, I think what you’re alluding to is right, that we are able to shape up the question. So the question may come in a form that doesn’t really make sense to us, or that we think could be improved on. And so that’s really a negotiation to say, I think what you mean to ask us or I think what would be more useful for us to address is this. And so that is the first bit of work, is actually translating what comes to us into something that we think would be addressable and useful within that arena.
Brooke: That touches so nicely on the second dimension that I’d like to explore, kind of the institutional changes that COVID-19 is bringing about. Maybe the easiest way to sum that up is around this value free ideal that all that the researchers are doing is feeding evidence into the system, it’s not politicized, there’s no kind of bleed of politics or ideology into research, it remains pure and kind of on its own on one side. And on the other side, you have policy and political discussions. And those two things are supposed to remain somehow separate and unique with this extremely thick frontier between them, with all of the research going on in academia, and no discussions of values or ideology.
And on the other side, you’ve got this extremely naked power discussion, which is going on in the political and policy realm. How do you see that kind of ideal, which of course is not real to begin with, right, it’s a caricature, even to start. But how do you see it breaking down even further now in the COVID situation?
Susan: I think this is a really interesting question. And it’s a question that I’ve been thinking long and hard during this last year. And my final views: I don’t have final views. I want to be involved in all discussions about this. It’s a very complex and a very important question. What I do think is the mantras that are being used are too simplistic. So on the one hand, we’ve had the UK government, the Prime Minister, Boris Johnson, repeatedly saying, “We follow the science, we follow the science.”
And it almost became a repetitive mantra, people saying, “What’s going on here?” I mean, I’ve worked with policymakers in government for many decades. And anybody who’s worked with policy makers knows that policy makers don’t follow the science, we hope they’re informed by the science, we hope that science is a really important part of what feeds into decision making. So it’s very odd, this determination to keep saying, “follow the science, follow the science.”
And myself and many colleagues began to get a bit suspicious. Is this setting science up to be blamed if and when things go wrong? So there’s really quite a concern about that. And also, what became evident was that there was a mismatch between what was being said and what was being done. So, for example, the methods for communication, the methods for optimizing adherence to the population that has come through our committee were not being followed. We advocated consultation and engagement of communities, working with communities in a co-production co-creation kind of way. That’s not happened.
We’ve advocated all the way along about support and enablement for those communities who find it most challenging to adhere. But instead, there’s been much more of a blame and punishment culture. So it’s been very obvious that there’s a big chasm in many cases between the behavioral and social science that was being advised via SAGE and what we saw happening with the government.
And then there were some very blatant occasions where this wasn’t true. So for example, we, like several other countries, had a rule about keeping two meters apart, in order to reduce the droplet transmission of COVID. And that was instituted in organizations, in public spaces, all very well, using markings on pavements, et cetera.
And then I think it appeared that this was getting in the way of short term profitability. And so I think it was quite a business lobby to drop it. And SAGE didn’t shift its advice, because the scientific advice is very clear: two meters is much, much safer than people staying one meter apart. I mean, you just need to look at trajectories when people cough or sneeze or shout or laugh, to know that, it’s not up to interpretation.
And so what then happened was the Prime Minister set up his own Downing Street Review by a body he called of scientists and economists to give him different advice. And that advice was what ended up as ‘one meter plus,’ which actually ended up as one meter, which is actually the space that is a normal social space between people who aren’t intimate with each other. So basically, the whole idea of distancing just went.
And now, this group, the membership was never published, the deliberations were never published, the science on which the ‘one meter plus’ was based was never published. So, that’s an example of how following the science kind of idea was, I think, being politically used. However, that’s a different question than the more interesting one you raise about what should be the relationship between scientists and policymakers, those who make policy decisions?
And there are a group of scientists who very much say, “scientists advise, policymakers decide.” Try and make use of hermeneutically sealed two boxes. And this is kind of a one way trip. Now, my experience working effectively with policymakers and governments, is that you make relationships with people, and they trust you. And there’s a lot of joint discussion. And yes, at the end of the day, you’re not making the policy. But you’re involved in a lot of discussion about the science, its interpretation, and also its implementation.
Because you have scientific advice, but it has to be implemented into the real world. And that itself is a subject of scientific inquiry. I was one of the founding editors of a journal called Implementation Science. So there’s a whole pathway from science coming together, multidisciplinary science, different kinds of advice. And then how is that communicated? And not just communicated, but how is it translated so that it is maximally implementable?
Because, from my perspective, science needs to be useful and usable. And that means not just saying, “I’m a pure scientist out here. I will publish my papers, I will tell you about my findings. End of story.” It’s about being involved in relationships, we are part of society. And to think about the whole translational pathway, it’s not just science, and then there’s a bridge, and then you’ve got policy. There’s a much more nuanced, much more iterative type of relationship and pathway that I think should be understood.
And the whole process of decision making, again, is the stuff of social science. It’s not that science is divorced from society. If you’re a social or behavioral scientist, it is part of society. And indeed, for all sciences, there’s a question of, what questions do you ask? What methods do you use to address those questions? How do you interpret those findings? These are all shaped by people’s experiences of society. And people’s experiences of society engender certain values in them.
So for example, many scientists, many social behavioral scientists, now think — and probably this wasn’t so explicit a few decades ago — that working towards a more equal society is a good thing. For many, many reasons, we could have a whole hour on that, that’s the value. And there are other values too. And I think the important thing is to be explicit about what the values you’re drawing on are. And that should be true of everyone. That when you discuss things, there are frameworks in which you’re thinking about things. And I would say that’s very different from the government SAGE body from independent SAGE, because independent SAGE is much more upfront that we do have beliefs about the kind of society that we think there should be.
Now we can say, “this is for public health, for physical and mental public health, this is the kind of society.” And a vision of that, quite explicitly, would drive up what we are saying and doing. So I think there’s not such a demarcation between, ‘we are the scientists, we will advise you, the policymakers.’ And this is why we have this very much consultation documents, we have our weekly press and public conferences, not just to talk and to answer questions, but to listen, and to learn. So a two way nuanced process.
But as I say, I think this is a really fundamental, a very deep, a very complex question. And I would love to be part of future discussions. I’m sure it will be because I think there’ll be many discussions about quite what’s the best way to think about this in order to make the process as transparent, and also as effective as possible.
Brooke: I like that, that we need to have our priorities kind of clear and upfront, not just about the types of solutions that we would propose as a government science advice body, but also about the purpose of government science advice, it’s to help the government to find that meeting point of being a policy solution that is both good management and good leadership. We think it will effectively get us going in the direction we want to be headed. And a lot of that comes down to problem framing. And I really like the way that these two examples, the kind of contrast classes of the main SAGE and the independent SAGE really illustrate two very different approaches to that.
And I’m, on a personal note, very glad to hear that the kind of early stage work with SAGE is really a good chunk of mileage on problem framing, because that can so often be the place where science advice falls down. That the way that a problem is communicated from a government body has a bunch of assumptions implicitly baked into it. And those get stripped out when a group of researchers who have kind of decided that they will put themselves behind a wall, read a question and interpret it in a very, very different way than it was intended. And at the end of a very long, arduous process, they come back with something that ultimately is not answering the right question, and therefore it doesn’t have the kind of impact that we hoped it would have.
Susan: Absolutely, I totally agree. I mean, in science and in life, you get the question right, and you’re halfway there to solving it. You get the question wrong, and you can’t solve it. Having said that, I do think there is a very dialectical process of formulating the question in the best possible way to begin with, but also, as one begins to address it, as one begins to gather the evidence to address it, as one begins to interact and talk with people from other disciplines, other perspectives, other experiences to address it, that formulation of the problem can change.
Just as I said, it’s not necessarily that science is a static thing that is plonked onto the desk of the politician. So we don’t have a problem as a static thing, that then has a solution plunked on the desk of whoever wants the problem solved. And I really learned this in my many years working as a clinical psychologist. Because there, somebody comes to you, in distress with a problem to solve and a huge bit of that work is helping them and jointly formulating the problem.
But as often as not, as the strategy for addressing the problem begins to be played out, so they and you learn more about the nature of the problem. And so, often, it’s very explicit that this is part of the process, that as you try things out in real life, you learn, you’re collecting data, whether it’s formally or informally, and using that data to update your understanding of yourself, of the situation around you, the interaction between you and the situation. And so problems don’t stand still.
And as often as not, the problem that we end up working with is actually not the one that the person comes when they come to see. Now, obviously, clinical psychology and advising policymakers are two very different processes. But I just use this as an example of the fact that, I mean, it’s very much in line with Bayes’ thinking, that you come with your priors based on what you know, but then as you go forward, those are continually being updated. That’s what we’re doing the whole time in our lives as we go on with our lives. It’s not explicit, it’s so automatic, that we’re not aware of it. And I think one of the arts of that whole science policy communication is the ability to do that in a constructive and alternate partnership way.