A centralized system ungrounded in science or epistemology and without consequences is guaranteed to deliver bad answers

Interesting, not wrong, but incomplete.  From Debunkers return to the 'soft targets' by Vinay Prasad.  The subheading is The biggest defenders of science did the most damage to it. 

I know the pandemic is winding down when I see ‘science influencers,’ ‘debunkers’ and the ‘misinformation police’ return to focusing on issues that match their skill set: debunking vitamins, supplements, cupping, homeopathy, electric fields and other clearly unproven and implausible medical interventions.

Previously, John Horigan called these the ‘soft targets’. He drew a distinction between non-mainstream, biologically-implausible interventions promoted by random individuals on the internet (soft targets) and the unproven interventions that pervade traditional medicine, and are sold based on exaggerated or distorted data (e.g. stenting stable coronary disease, or the use of aortic balloon pumps, selenexor in combination with velcade and dex, etc. etc.). These are the hard targets. They constitute the larger, more pervasive and caustic misuse of medical spending, often involving insurers to reallocate society’s resources rather than personal spending choices.

Of course, it is a lot harder to debunk hard targets. You need more technical knowledge of medicine, statistics, clinical trials, and worse, your audience and opponents— largely physicians and professors— are not fringe elements on the internet. You are talking to real scientists— not biology minors who write wikipedia pages— so you have to bring your A-game.

Pre-pandemic, there was a growing chorus of soft-target debunkers— building an audience of disgruntled pro-science people to combat the disgruntled anti-science people. Largely, however, I was sympathetic to these debunkers. After all <insert supplement> probably doesn’t work, and certainly has no good evidence to support its sale. People who purchase it are being conned, and someone has to set the record straight.

Then the pandemic hit, and we faced scientific and policy choices that were unprecedented. Should we close schools in Los Angeles for 18 months? Should we authorize a booster dose to a 16 year old boy who had COVID-19? Should Paxlovid be given to a healthy 40 year old who had 3 boosters?

I like the discussion around hard and soft debunking targets.  It makes sense of some of the nonsense we saw during the Pandemic when people asking for evidence were tarred as anti-vaccine science illiterates.  The mob of half science-literate debunkers who were accustomed to going after soft targets were not effective on the epistemic front against hard targets and resorted to slander, innuendo and ad hominem.

We needed apostles of the scientific method willing to demand the evidence and develop the evidence into rigorously tested policies.  Instead, we got policy cheerleaders who cheered policies which were either questionable or blatantly wrong.  

Prasad goes on to make an argument in broadly political terms.  Science pundits incorrectly endorsed bad public health policies apparently for largely political affiliative reasons rather than based on historical experience or current data.  Historical experience and current data both pointed away from the chosen policies.  Prasad is not wrong about this, political affiliation clearly muddied the epistemic process.  

But I suspect there is something more at work.  Additive.  More to do with incentives.  It is an unhealthy issue which needs to be tackled but is difficult to see how we would address it.  Cleaning out the politics from the epistemic process is a necessary first step, certainly.  Recommitting to and reinforcing the rigor and value of the scientific method would also be helpful.

But I suspect part of the deep hole we got ourselves into is that the funding of scientific research is now highly concentrated and centrally directed.  The government acted along with Pharma and Tech, closely aligned with one another, and with closely aligned Academia.  While there are still real private or independent investments in research, much of it is tainted by regulatory consensus and government driven dictates.  While not all the science research money comes from the taxpayer, all of it is heavily influenced by the government's extraction of taxpayer money.

If all these funds were spent on clearly determined consensus priorities, subject to rigorously adhered to scientific method, and all of it made publicly transparent in near real time, the concentration of science research in the hands of the government and its closely owned regulated subsidiaries in Pharma, Tech and Academia might not be so bad.

As it is, there is no public consensus on priorities, little rigor, and virtually no transparency.  Essentially, it is a system free from consequence and therefore ill-adapted to serving the interests of citizens and science.