A risible attack on the “priesthood” of “scientific gatekeeping”

Longtime readers might remember a humorous (I hope) shtick that I used to employ from time to time when I encountered a fellow physician—or, worse, a fellow surgeon—spewing science denial. The vast majority of the time, back in those early heady days of this blog, what provoked this shtick was seeing a surgeon spew creationist nonsense denying the theory of evolution. So what was this shtick? In brief, I had a running gag that involved highly extravagant descriptions (based on old Looney Tunes) of how I wanted to hide my face behind a paper bag in sheer embarrassment over the antiscience antics of fellow physicians, particularly fellow surgeons. Over time, the gag evolved to my expressing a mock desire to hide my visage behind a metal Doctor Doom-style mask, again, over sheer embarrassment over the antiscience stylings of one of my colleagues. In most cases, it was evolution, because there are a depressingly large number of creationist physicians out there. (Anyone remember the creationist neurosurgeon Dr. Michael Egnor?) I retired the shtick many years ago, but every so often a physician or surgeon seriously tempts me to resurrect it. Thus far, I’ve resisted, but I failed when I encountered an article in Reason by a fellow general surgeon entitled Against Scientific Gatekeeping. As if to goad me further into resurrecting the paper bag, its subtitle read: Science should be a profession, not a priesthood.

I didn’t have to read any more before I became Sylvester Junior.

Of course, I did read more about the take of this general surgeon, Dr. Jeffrey A. Singer, on “scientific gatekeeping,” the better to discuss the libertarian COVID-19 propaganda that flowed after a very old favorite among antiscience cranks, comparing science to a religion and scientists to a “priesthood.” The more I read, the more I thought that a paper bag probably isn’t enough. It might well be time to get out the Doctor Doom mask again. On the other hand, thinking about it all these years later perhaps the paper bag will suffice. Doctor Doom, after all, wore the mask because his own face had been hideously disfigured in a lab accident that occurred during a particularly dangerous experiment of his; he was not ashamed of himself or his profession. So Sylvester Junior it is. Even though Dr. Singer is not my father, he is a senior member of my profession, and that’s enough to bring out the paper bag!

Are we “gatekeeping” or a “priesthood”?

Why am I getting out the paper bag? Let’s take a look at how Dr. Singer starts:

In March 2020, the iconoclastic French microbiologist Didier Raoult announced that the anti-malaria drug hydroxychloroquine had cured all 36 COVID-19 patients enrolled in his clinical trial. Many of Raoult’s colleagues rejected his conclusions, arguing that the trial was too small and noting that it was not randomized and controlled. But as the deadly coronavirus spread rapidly throughout the world and governments responded with draconian lockdowns, public attention was quickly drawn to the chance that a common and inexpensive drug might rid the world of the danger.

That’s right! He leads with Didier Raoult, whose absolutely awful study using the repurposed antimalarial drug hydroxychloroquine plus the antibiotic azithromycin to treat COVID-19 combined with his conspiracy mongering basically threw gasoline on the spark that the Chinese government had lit with its recommendation to use hydroxychloroquine in February 2020, which led to President Trump, Dr. Mehmet Oz, and a whole panoply of grifters and conspiracy theorists to jump on the hydroxychloroquine bandwagon and promote it as a miracle cure. The rest, of course, is history. A drip-drip-drip of negative clinical trials finally killed the drug in the legitimate scientific and medical community by late summer that first pandemic year.

In fairness, it is true that Dr. Singer does go on to point out that, after the FDA had issued an emergency use authorization (EUA) for the drug (a horrible mistake), science ultimately showed that hydroxychloroquine was not effective in treating COVID-19, but he does use the uproar over the drug early in the pandemic to pivot to his rant against “scientific gatekeeping.” First, he notes (correctly) that the scientific “academy no longer has a monopoly on specialized information,” which is true as far as it goes, but is apparently not enough for him. He notes that, based “on their own assessments of that information, lay people can chime in and may even end up driving the scientific narrative, for good or ill.” Those of us who’ve long countered the antivaccine movement know that these self-proclaimed scientific “experts” without specialized training who now have access to specialized scientific information that used to be the province of university libraries know that in general such people tend to drive the scientific narrative more for ill than for good, but let’s for the moment assume that this development is neutral. What really sticks in Dr. Singer’s craw appears to be this:

Meanwhile, the internet is developing its own would-be gatekeepers. Those who oversee the major social media platforms can filter information and discourse on their platforms. Pleasing the priesthood enhances their credibility with elites and might protect them from criticism and calls for regulatory intervention, but they risk being captured in the process.

Challenges to the priesthoods that claim to represent the “scientific consensus” have made them increasingly intolerant of new ideas. But academic scientists must come to terms with the fact that search engines and the digitization of scientific literature have forever eroded their authority as gatekeepers of knowledge, a development that presents opportunities as well as dangers.

And there you have it: The longstanding trope that science is a religion (a cult, actually) and scientists are its “priesthood,” with people like Dr. Singer, apparently, the Enlightenment. Just for my own amusement, I looked up how many times I’ve discussed or alluded to this trope over the years, which was harder to do than I thought. I’ve only used the term “priesthood” around a dozen times, starting with, hilariously enough, Dr. Egnor ranting against a “medical priesthood” in 2008—his article was even entitled Advice to an Arrogant Medical Priesthood: Wash Your Hands!— and going up to Great Barrington Declaration (GBD) authors Martin Kulldorff and Jay Bhattacharya both echoing Dr. Singer’s rant about a scientific “high priesthood” a month and a half ago. Of course, this is very much like the rhetoric coming from aligned groups (like the Brownstone Institute) that liken masks to magic, religion, and slavery and vaccine advocates to fanatics.

Lest you get the wrong impression, Dr. Singer doesn’t think all gatekeeping is bad. For instance, being a surgeon himself, he naturally thinks that surgeons are cool. He just doesn’t like experts with “outsized influence,” who according to him promote “groupthink”:

Most people prefer experts, of course, especially when it comes to health care. As a surgeon myself, I can hardly object to that tendency. But a problem arises when some of those experts exert outsized influence over the opinions of other experts and thereby establish an orthodoxy enforced by a priesthood. If anyone, expert or otherwise, questions the orthodoxy, they commit heresy. The result is groupthink, which undermines the scientific process.

The COVID-19 pandemic provided many examples. Most medical scientists, for instance, uncritically accepted the epidemiological pronouncements of government-affiliated physicians who were not epidemiologists. At the same time, they dismissed epidemiologists as “fringe” when those specialists dared to question the conventional wisdom.

One wonders which “epidemiologists” who were dismissed as “fringe” Dr. Singer is thinking about here. He does mention Emily Oster, an economist whose “don’t worry, be happy” (obviously not Dr. Singer’s characterization) pronouncements about the pandemic were roundly criticized. (It also turns out that her takes on parenting before the pandemic weren’t too great, either.) To Dr. Singer, this criticism largely came about because Oster is not an epidemiologist, claiming that many “dismissed her findings—that children had a low risk of catching or spreading the virus, an even lower risk of getting seriously ill, and should be allowed to normally socialize during the pandemic—because she wasn’t an epidemiologist.” Actually, many dismissed her findings because they were based on questionable data and analyses, The fact that she wasn’t an epidemiologist was just icing on the cake—and probably, combined with her previous positions against “paternalism” and the precautionary principle, a likely explanation for how she went so wrong, particularly in her use of economic, rather than epidemiological, methods to make her point.

We’re all shills, apparently

Naturally, Dr. Singer can’t resist a variation of the shill gambit, in which one argues that the only reason an argument with which you disagree is being made is because the person making it is being paid to do so. Usually, this takes the form of the “pharma shill gambit,” in which it is implied (or outright stated) that those arguing against antiscience conspiracy theories are only taking their position because big pharma is paying them. In this case, though, it’s not big pharma. It is—surprise!—the government:

The deference to government-endorsed positions is probably related to funding. While “the free university” is “historically the fountainhead of free ideas and scientific discovery,” President Dwight Eisenhower observed in his farewell address, “a government contract becomes virtually a substitute for intellectual curiosity.” He also warned that “we should be alert to the…danger that public policy could itself become captive of a scientific ​technological elite.” Today we face both problems.

Near the end of his article, Dr. Singer even argues:

They must fight against the understandable desire to avoid any hypothesis that might upset the health bureaucrats who control billions of research grant dollars. It is always useful to challenge and reassess long-held premises and dogmas. People outside of a field might provide valuable perspectives that can be missed by those within it.

While it is true that sometimes people outside of a field can “provide valuable perspectives that can be missed by those within it,” more commonly they make simple mistakes based on superficial and incomplete knowledge of the field that members of the field spot immediately. My favorite examples are astrophysicists Paul Davies and Charley Lineweaver, who proposed that cancer is atavistic; that is, a “an evolutionary throwback to the dawn of multicellular life, when single cells began cooperating and forming rudimentary aggregations.” Unfortunately, their “atavistic hypothesis” was itself a throwback to at least as far back as the ideas of Theodore Boveri, who 120 years ago published a fascinating article on the origin of cancer that, in part, discussed “interesting parallels” between malignant tumors and embryos produced by multiple divisions in the doubly fertilized sea urchin egg, as a suggestion of how tumors can resemble cells from early stages of embryogenesis. No wonder some likened the atavistic hypothesis of cancer from two astrophysicists to a doctor who reinvented calculus, and evolutionary biologists were even more scathing as was I, being a cancer biologist in addition to a surgeon. So, yes, it’s possible that outsiders can contribute valuable context, but one has to be careful about embracing them uncritically because far more often they just contribute ill-informed speculation.

Let me also take a moment to correct Dr. Singer, who, being a private practice general surgeon, has likely never actually tried to win a government science grant and clearly has no idea how NIH grants work. Contrary to his seeming assumption that grants are only doled out based on ideological fealty to the “government-endorsed position,” the grant application process at the NIH, NSF, and other government agencies that fund scientific research is actually about as close to a meritocracy as there is in funding. I’m not saying that it’s perfect—not by a long stretch!—but the process does involve rigorous peer review by scientific review panels called study sections that results in a priority score, with funding directed at applications with the lowest (low numbers are better) priority scores that the budget will allow.

Indeed, the epitome of this process is the NIH R01 grant, which can be about virtually anything health-related. This doesn’t mean that the NIH can’t set priorities for the areas of science and medicine for which it solicits applications. It also doesn’t mean that there haven’t been periodic complaints that the grant evaluation process is too cautious and “conservative” and that it doesn’t tend to favor “safe” science. As I’ve argued, those complaints tend to be overstated for ideological reasons, but they’re not entirely without merit. That being said, Dr. Singer’s portrayal of scientists being in the thrall of “government-endorsed” science, lest they fail to obtain grant funding, is a massive exaggeration. At the risk of going too far into “whataboutism,” I also can’t help but conclude this point by reminding Dr. Singer that Republicans have periodically tried to do exactly what he seems to think that the “priesthood” is doing now about COVID-19. One example from 2009 springs to mind, when Representative Darrell Issa (R-CA) offered an amendment to rescind funding for three then currently funded, peer-reviewed NIH grants that that focused on HIV/AIDS prevention because he didn’t like the studies funded by them. I’ll conclude by arguing that what makes less “whataboutism” than a valid question about hypocrisy is that Dr. Singer is insinuating suppression of research funding that never happened while being apparently blissfully unaware (or aware but approving of) attempts by those on “his side” to do exactly what he decries, use government funding for research to enforce conformity.

COVID-19 contrarians: Barry Marshall, Ignaz Semmelweis, John Snow, or all three rolled up into one?

No article of this type is complete without a mention of Ignaz Semmelweis. (I knew it was coming, and Dr. Singer didn’t disappoint, any more than Dr. Egnor did all those years ago.) For reasons that escape me, Dr. Singer introduces his appeal to Semmelweis by first discussing how “Britain’s Royal Society refused to publish Edward Jenner’s discovery that inoculating people with material from cowpox pustules—a technique he called ‘vaccination,’ from the Latin word for cow, vacca—prevented them from getting the corresponding human disease, smallpox.” Unsurprisingly, although it is true that some physicians “were making a good living by performing variolation, which aimed to prevent smallpox by infecting patients with pus from people with mild cases” and “saw vaccination as a threat to their income,” the history of Jenner’s discovery turns out to be a bit more complicated than Dr. Singer describes. For example, as the practice of vaccination spread, it was reported that two-thirds of recipients developed general eruptions. Jenner attributed this to contamination of the lymph used with actual smallpox. In any event, it is true that the House of Commons did indeed fund Jenner to continue his research, but it is also true that science won out, as Dr. Singer himself even admits:

By the early 1800s, American doctors had adopted the technique. In 1805, Napoleon ordered smallpox vaccination for all of his troops.

A few years? (Jenner first published his discovery in 1796.) That’s actually fairly quick for a medical innovation to be widely adopted, even now, much less in the late 18th and early 19th centuries, when communication was much slower. Indeed, later Dr. Singer brings up the example of Barry Marshall and Robin Warren’s discovery that peptic ulcers were mostly caused by a bacterium, H. pylori, and that antibiotic therapy could resolve most of them. This example is a favorite of cranks everywhere, who often portray extreme resistance to the idea from the medical establishment, as misguided and ill-intentioned “gatekeeping.” Indeed, a prominent creationist named William Dembski once invoked Marshall and Warren in 2008. Not a good look.

I like to cite how Marshall and Warren’s work was summarized very well by Kimball Atwood IV, MD. Barry Marshall and Robin Warren first reported a curious finding of what they described as “unidentified curved bacilli on gastric epithelium in active chronic gastritis” (not ulcer) in two letters to The Lancet, published on June 4, 1983. They reported that it wasn’t seen using traditional staining methods and suggested that they might be associated with gastritis. By 1992, multiple studies had been published establishing the causative role of H. pylori in peptic ulcer disease, and medical practice rapidly changed. That’s less than ten years, which, given how long it takes to organize and carry out clinical trials, is amazingly fast. Yet somehow a favorite denialist myth is that gatekeeping “dogmatic,” “close-minded” scientists refused to accept Marshall and Warren’s findings. In fact, their findings went from a basic science observation provoking a reaction of “Hmmm, that’s odd” to standard-of-care within a decade, which is incredibly fast.

If Dr. Singer thinks that scientists don’t value questioning the prevailing dogma, he should read the Nobel Prize Committee’s comments about Warren and Marshall, in which the Committee praised their tenacity and willingness to challenge existing prevailing dogmas. Scientists—including COVID-19 scientists—do value those who challenge existing dogma, but only if they can deliver the evidence to support the challenge convincingly. In fact, it was for questioning scientific dogma and proving to be correct that Warren and Marshall won the Nobel Prize! The same can’t be said of COVID-19 contrarians.

Back to Semmelweis, though. You can guess what Dr. Singer says about him:

Half a century later, the prestigious Vienna General Hospital fired Ignaz Semmelweis from its faculty because he required his medical students and junior physicians to wash their hands before examining obstetrical patients. Semmelweis connected puerperal sepsis—a.k.a. “childbed fever,” then a common cause of postnatal death—to unclean hands. Ten years after Semmelweis returned to his native Budapest, he published The Etiology, Concept and Prophylaxis of Childbed Fever. The medical establishment rained so much vitriol on him that it drove him insane. (Or so the story goes: Some think, in retrospect, that Semmelweis suffered from bipolar disorder.) He died in an asylum in 1865 at the age of 47.

At least Dr. Singer inserted a parenthetical admission that the story might be more complex than he’s relating. Whenever discussing Semmelweis, I like to note that his story is indeed a bit more complex than the version that is usually recounted in that Semmelweis’ findings were more favorably viewed in other countries, such as England, and his results were long misunderstood because of a seeming reluctance to publish them promptly, leading to their being spread through secondhand reports. It’s not as though he had, as is often related, no support in the medical profession. For example, after his lecture to the Medical Society of Vienna in 1850, documented by Dr. Heinrich Herzfelder, the First Secretary of the society:

Herzfelder also noted that Semmelweis’ views were opposed by Lumpe and Zipl, who argued that the data supported a miasmatic cause of childbed fever, but was supported by Chiari, Arneth, Helm, and Hayne.1,2 He concluded by saying that the position taken by Lumpe and Zipl, as well as by Scanzoni and Seyfert, were adequately refuted by Semmelweis’ solution to the problem, which, he said, “can be considered a triumph of medical research.”

This is not to say that the story of Semmelweis is really that he brought all the criticism and ostracism on himself, revisionist history documented in the same article above notwithstanding. He did go against the prevailing scientific ideas of the day and did receive a lot of pushback, given that germ theory, which could have explained his results, was still a couple of decades away from widespread experimentation and acceptance. His is indeed a cautionary tale of of how medical dogma can react to unexplained findings, leading some to call him, not Joseph Lister, the true father of asepsis and to speculate that if Semmelweis hadn’t died so young he would have lived to see his findings vindicated through the work of Louis Pasteur, Joseph Lister, and others. That being said, whenever someone like Dr. Singer invokes the name of Ignaz Semmelweis and the reaction of the medical establishment to his findings to imply that the contrarian take on science that he is promoting is being unjustly maligned (in this case as misinformation, which it largely is), I like to co-opt an old quote about Galileo and respond that to wear the mantle of Semmelweis it is not enough that you be persecuted by an unkind establishment, you must also be right. Oops! (Also, I will express a small degree of gratitude to Dr. Singer for resisting the temptation to invoke Galileo himself.)

There are, of course, many examples during the COVID-19 pandemic of “gatekeeping” and “gatekeepers” that Dr. Singer tries to compare to Ignaz Semmelweis, Barry Marshall, and Robin Warren (and also, ironically enough, to John Snow). He laments the “gatekeeping” over ivermectin, because of course he does:

Politics and tribalism also contaminate discussions of ivermectin. Several limited studies suggest the drug might be effective in preventing and/or treating COVID-19. But since ivermectin has been touted by Trump supporters, including people opposed to vaccination, it has been unfairly and inaccurately mocked as nothing more than a “horse dewormer.” A large randomized controlled trial underway in the United Kingdom should help resolve this debate.

Of course, numerous trials have already shown that ivermectin doesn’t work against COVID-19. One wonders if Dr. Singer will mention the TOGETHER trial, which was recently published in the New England Journal of Medicine and turned out to be resoundingly negative.

Gatekeeping against the Great Barrington Declaration (of course)

What really burns Dr. Singer in terms of “gatekeeping” is the reaction to the GBD, which, as I pointed out when it was first published in October 2020, advocated in essence a “let ‘er rip” strategy for the pandemic—remember, effective vaccines were still thought to be months away—with “focused protection” of the “vulnerable”; i.e., the elderly and those with medical conditions that predisposed them to severe disease and death from COVID-19. It was a highly eugenicist exercise in “magnified minority,” in which fringe scientists try to present their ideas as legitimate alternatives to prevailing science by getting as many scientists as they can to sign on. I also pointed out how the GBD originated at a weekend conference held by the libertarian “free market” think tank America Institute for Economic Research (AIER) and, unsurprisingly, reflected its beliefs that government-mandated COVID-19 mitigation measures were more harmful than SARS-CoV-2, the coronavirus that causes the disease. Moreover, far from being ignored (thanks to “gatekeepers”), the GBD has been highly influential, with its adherents having had access to the highest levels of government in the US and Europe.

But Dr. Singer is still angry, even though the GBD has arguably “won” over those trying to exercise “gatekeeping”:

Or consider the reaction to the Great Barrington Declaration, published on October 4, 2020, by Martin Kulldorff, then a professor of epidemiology at Harvard; Sunetra Gupta, a professor of epidemiology and immunology at Oxford; and Jay Bhattacharya, a Stanford professor of medicine with a Ph.D. in economics. The statement, which was eventually endorsed by thousands of medical and public health scientists, including the recipient of the 2013 Nobel Prize in chemistry, noted that broad lockdowns entail large costs and advocated a more focused approach that would let those least vulnerable to COVID-19 resume normal life as much as possible.

I have to stop right here for a moment. See that part about the GBD being “endorsed by thousands of medical and public health scientists”? That’s exactly what I meant by “magnified minority.” As was the case with similar statements, for example, denying climate science showing that the earth is warming or denying that HIV causes AIDS, the vast majority of the signatories have no expertise in the relevant sciences. Like such documents used as propaganda for climate science denial and HIV/AIDS denial, the GBD was an ideological document far more than a scientific document.

But pray continue, Dr. Singer:

The authors of the Great Barrington Declaration represent a range of political ideologies. But because they opposed the policies favored by the public health establishment and received applause from people aligned with Trump, they were vilified. An editorial in the journal Science-Based Medicine said they were “following the path laid down by creationists, HIV/AIDS denialists, and climate science deniers.”

The medical priesthood was still seething a year later, when the surgical oncologist David Gorski and the Duke University public health professor Gavin Yamey published a scathing ad hominem attack on Kulldorff et al. in BMJ Opinion, calling the Great Barrington Declaration a “well-funded sophisticated science denialist campaign based on ideological and corporate interests.” Kulldorff promptly responded with a fierce rebuttal in Spectator World, stating the BMJ attack “urges people to use ‘political and legal strategies’ rather than scientific argument to counter our views on the pandemic.”

The article to which Dr. Singer refers is Covid-19 and the new merchants of doubt, and it really set the COVID-19 contrarians and GBD supporters off because it likened the GBD to the sorts of activities that tobacco and fossil fuel companies have long been documented to have undertaken to undermine the science showing that smoking kills and our use of fossil fuels is catastrophically affecting the climate. I am, however happy to be considered part of the “priesthood,” given that Dr. Singer cited me twice. (Yes, I did write that article in my not-so-secret other blog that he cited.)

Back to the priesthood

Unsurprisingly, Dr. Singer erroneously argues that there are a number of things that the gatekeeping “public health priesthood”—am I a member?—got wrong, including “natural immunity.” Of course, no one—and I mean no one—in public health has denied postinfection immunity (the more correct term for immunity that occurs after infection). Dr. Singer claims that the CDC agreed that “natural immunity” was better than vaccines against the Delta wave of COVID-19 infections, a common talking point that is, as I’ve discussed, misleading at best, misinformation—yes, I said it!—at worst. Indeed, as I’ve also discussed, it’s better not to get COVID-19 in the first place, but if one has had it “hybrid immunity” is stronger than vaccine- or infection-induced immunity alone. Moreover, contrary to the mystical magical characteristics attributed to “natural immunity,” postinfection immunity appears to be, at best, only slightly more long-lasting than vaccine-induced immunity, as the Omicron variant has shown us. Other things that Dr. Singer seems to think that the “public health priesthood” got wrong include—surprise! surprise!—lab leak conspiracy theories, “lockdowns,” treatments over vaccines, and “one-size-fits-all” vaccine recommendations.

Then there’s this:

To be clear: As a physician, I have no doubt that the mRNA vaccines are both safe and highly effective, especially for the age group most at risk. But when public health officials and the intelligentsia portray people with legitimate questions and concerns about the vaccines as “anti-vaxxers” or “COVID deniers,” they undermine public trust.

Note the careful phrasing of “age groups most at risk.” That’s a “tell” that Dr. Singer likely doesn’t think we should be routinely recommending vaccinating children against COVID-19. I could be wrong, but I doubt it:

Dr. Marty Makary of Johns Hopkins reports similar findings in tomorrow's Wall Street Journal. It really raises justifiable questions about the need to vaccinate very young children. https://t.co/LJgzJDPkj8

— Jeffrey A. Singer (@dr4liberty) July 20, 2021

Also note the false statement that people with legitimate questions were being tarred as “antivaxxers” or “COVID deniers” by “gatekeepers,” public health officials, and scientists. Although some intemperate social media influencers might have made that mistake (people I’d hardly call the “intelligentsia”), the public health establishment, if anything, bent over backwards not to label the vaccine hesitant “antivax,” arguably to the point of bending too far over backwards not to do so, even when certain people promoting COVID-19 misinformation are clearly antivax.

Gatekeeping versus “tolerance”?

Dr. Singer finishes by invoking, unsurprisingly, “tolerance.” He starts with the curious claim that just “as public health officials must abandon a “zero COVID” strategy and accept that the virus will be endemic, the science priesthood must adapt to a world where specialized knowledge has been democratized” (I guess he couldn’t help himself. There’s that reference to “priesthood” again!), trying to seem so very, very reasonable in his final paragraph:

Openness to unconventional ideas has its limits. We don’t take flat-earthers seriously. Nor should we lend credence to outlandish claims that COVID-19 vaccines cause infertility, implant people with microchips, or change their DNA. There are not enough hours in the day to fully address every question or hypothesis. But a little tolerance and respect for outsiders can go a long way. If those habits become the new norm, people will be more likely to see rejection of challenges to the conventional wisdom as the objective assessment of specialists rather than the defensive reaction of self-interested elites. Science should be a profession, not a priesthood.

Imagine my relief that Dr. Singer doesn’t think that we should take flat-earthers or claims that COVID-19 vaccines cause infertility, implant people with microchips, or change their DNA seriously! That’s good, but I’m puzzled. Would Dr. Singer consider these ideas about COVID-19 “misinformation” that deserves some—dare I say—gatekeeping from scientists and social media companies? It isn’t clear. What does “not taking these ideas seriously” even mean when so many people mistakenly do take them very, very seriously, to the point where they resist vaccination and COVID-19 mitigation measures and thereby prolong the pandemic and the harm it is causing? I suppose to Dr. Singer it means just ignoring them as not worth responding to, as doctors whom we called “shruggies” over a decade ago ignored the malign effects of quackery, medical misinformation, and yes, antivaccine conspiracy theories. Then, we might have had that luxury. (We actually didn’t). Now, we no longer do. Also, how did all that ignoring misinformation for all those years work out? The pandemic is showing us.

Moreover, most scientists are more than happy to explain to people with genuine questions and confusion why COVID-19 vaccines don’t infertility, implant people with microchips, or change their DNA. Certainly, I have been. However, that’s not what we’re dealing with here. What we’re dealing with are people who promote such messages for an ideological purpose, either knowing the claims are false or not caring whether they’re true or not. When such messages come from networks who use them to promote fear, uncertainty, and doubt (FUD) about public health, including COVID-19 interventions and vaccines and when social media algorithms are custom-designed to amplify such messages, does Dr. Singer think that nothing should be done? Particularly given that such misinformation is arguably

Unsurprisingly, Dr. Singer is a senior fellow of the Cato Institute, a visiting fellow at the Goldwater Institute, and member of the Board of Scientific Advisors of the American Council on Science and Health. He opposed government vaccine mandates, even for schools, five years before the pandemic, although he did support mandatory quarantine for those exposed to Ebola, which he characterizes as “self-defense” and recommended the same for the unvaccinated in schools as a reasonable response that avoids mandates. It is thus not surprising that he would characterize public health physicians and scientists as a “priesthood” and, by inference, their science a religion, while touting the “democratization” of scientific knowledge.

So I’ll conclude by pointing out that that physicians and scientists have already mostly adapted to a world where scientific knowledge has been democratized. The problem is physicians like Dr. Singer, who don’t see the problem in how that democratization has been weaponized by ideologues to oppose science-based policies against the pandemic. It’s not just the pandemic, either. A similar dynamic is at work in climate science, evolution, “integrative medicine,” and the war against women’s reproductive health and the rights of LGBTQIA individuals, which science is misrepresented and misused to justify.

In the meantime, seeing a fellow surgeon lay down such an obvious line of COVID-19 minimizing propaganda about “gatekeeping,” I think I’ll go looking for that paper bag again.