Earlier this month, Dr. Jonathan Howard took note of a post on (not-so) Sensible Medicine by Edward H. Livingston, MD, FACS entitled The Semmelweis Effect and The Great Barrington Declaration. Dr. Howard pointed out, quite correctly, that Dr. Livingston appears not to have had clue one about what the Great Barrington Declaration actually said and proposed. Why do we say this? In his post, Dr. Livingston never even mentioned that the central concept behind the GBD was to stop all those nonpharmaceutical interventions (NPIs), such as school and business closures, being used to slow the spread of the virus in favor of “opening up” society and allowing mass infection of the “young and healthy,” who were presumably at low risk for severe disease and death from COVID-19. The reason was, according to the GBD authors, that doing so would allow us to reach “natural herd immunity” more rapidly; indeed, they promised “natural herd immunity” in 3-6 months if their recommendations were followed. But what about those who were at high risk of severe disease and death from COVID-19, such as the elderly and those with various chronic diseases that made them high risk for complications and death? The GBD proposed “focused protection” for them without ever actually proposing any unique, concrete, practical methods to actually protect the vulnerable. Remember, also, that the GBD was published in early October 2020, which was more than two months before the mRNA vaccines became available to healthcare workers under an emergency use authorization in December 2020. (I got my first dose on December 18, 2020, the first week the new vaccines were available in my area.) Truly, the GBD was profoundly social Darwinist at its core.
Of course, the GBD was never a serious policy proposal. Rather, it was propaganda, a list of demands, custom-designed to provide a scapegoat for failures of pandemic policy. Besides violating basic principles of public health in a pandemic, the GBD also never would have worked, as a flack at the Brownstone Institute (the “spiritual child of the GBD”) tacitly admitted three years ago, and it arguably did great harm to public health in a number of countries. Unfortunately, one of the three authors of the GBD, Stanford health economist Dr. Jay Bhattacharya, is now poised to become the Director of the National Institutes of Health, thanks to his being nominated by President-Elect Donald Trump, likely at the behest of Robert F. Kennedy, Jr. As a result, his apologists are frantically trying to gaslight you about his history, such as when he and fellow GBD co-author Martin Kulldorff appeared at an antivax conference in 2022 organized by one of the most ridiculously silly and deranged antivaxxers of all, Steve Kirsch.
As you might imagine, it’s not just enough to gaslight. No. Bhattacharya’s defenders are now going out of their way to represent him as a brave maverick, as someone whose ideas were “proven right” (as evidenced by his nomination), as a rejected, ostracized genius on par with—you guessed it!—Ignaz Semmelweis, and Dr. Livingston embraces this comparison whole-heartedly. Even though Dr. Howard has discussed the largest glaring error in Dr. Livingston’s post, namely his apparently ignorance about what the GBD actually said in favor of declaring the GBD (and thus Dr. Bhattacharya) as having been “vindicated” after supposedly small-minded attacks by dogmatists who were threatened by his idea, I thought I’d discuss this as well, but from (hopefully) an angle sufficiently different that you don’t view my discussion as a retread. Basically, I want to discuss this as part of the seemingly desperate desire that cranks have to be seen as “Semmelweis” or a “persecuted genius” who one day will be vindicated.
Let’s start with Dr. Livingston’s comparison.
Invoking Ignaz Semmelweis
Dr. Livingston sets the stage by explicitly likening Semmelweis’ discovery to the GBD. Subtle, he is not:
The story is often told in medical school about Ignaz Semmelweis, the Hungarian obstetrician who discovered that hand washing with chlorine reduced maternal mortality from puerperal fever. An intervention seemingly so simple and obvious but when first proposed in the 1840s, the experts of the day not only rejected it, but condemned Semmelweis as a heretic. The parallels between Semmelweis’s story and the Great Barrington Declaration (GBD) authors recall the adage that history may not repeat itself, but it sure rhymes.
Here’s the thing that’s often forgotten about this story, namely that it was not so obvious at the time that this intervention should work. I’ll elaborate, but first let’s see where Livingston goes with this comparison:
In the 1840’s, Semmelweis was the equivalent of a modern-day Chief Resident (sans work hours limitations) on an obstetric ward at Vienna General Hospital. Physician-led wards had much higher puerperal fever rates than did the adjacent wards staffed by midwives.
Autopsies were common back then. Physicians, not midwives, attended autopsies and rotated frequently throughout the day between the autopsy and delivery rooms. A friend of Semmelweis cut his finger during an autopsy. He developed sepsis very similar to puerperal fever and died. Given the similarities between the way his friend died and death from puerperal fever, Semmelweis thought that there must be some pathogen transmitted by dead tissue causing sepsis. He noted the smell of death was on his hands after performing an autopsy and that this smell did not do away with conventional hand washing with soap and water. The odor could be eliminated with chlorine. Semmelweis then adopted a chorine-based hand washing regimen resulting in a marked decrease in puerperal fever on his ward.
Semmelweis spent the next 20 years trying to convince the obstetric community of the benefits of chlorinated water washing. He was ignored. Luminaries of his time such as Virchow, of node fame, chastised Semmelweis believing that puerperal fever was a manifestation of venous thrombosis caused by abnormal uterine contractions. It is said that Semmelweis went insane because his life-saving discovery was rejected by the academic community. He died in an asylum.
That is the conventional mythology of Ignaz Semmelweis. However, as is usually the case, history is not as clear, not as cut-and-dried, as represented by Dr. Livingston. Whenever “brave mavericks” try to claim that their ideas are being unfairly rejected by dogmatic scientists and physicians by invoking the story of how Ignaz Semmelweis’ results were rejected and he was ostracized by some physicians, I like to point out that his work preceded Louis Pasteur’s seminal work that led to the acceptance of germ theory by nearly two decades and Joseph Lister’s work by even longer. In other words, at the time Semmelweis did his initial study there was no theoretical mechanistic framework to explain why washing one’s hands with chlorine bleach, but not just soap and water, after doing autopsies could so dramatically decrease the risk of puerperal fever. (It’s not as though doctors didn’t wash their hands after doing autopsies back then.) In 2025, such an explanation seems brain-meltingly obvious. Not so much in 1847, when Semmelweis reported—but didn’t formally publish—his initial results), and, contrary to Dr. Livingston’s telling, Semmelweis did not propose a “pathogen.” Rather, he had to posit that unspecified “cadaverous particles” were responsible. He fortuitously did choose a solution of chlorinated lime (calcium hypochlorite, a form of bleach) for washing hands between autopsy work and the examination of patients mainly because it got rid of the smell from the cadavers, and fortunately it also was a sufficiently good disinfectant to eliminate most of the microorganisms causing puerperal fever. He had no way of knowing that that is what it did, though.
Moreover, Semmelweis wasn’t exactly correct; certainly he was wrong about a lot of things. While he was correct that washing with chlorine before attending childbirth would greatly decrease the risk of puerperal fever, he was wrong when he tried to explain why. For example, when it was observed that, even with the most meticulous chlorine handwashing, there was still a mortality rate from puerperal fever of about 1%, which Semmelweis explained by suggesting that self-infection took place, specifically that internally generated cadaveric particles were responsible, such as from tissue crushed in the birth process and eventually turning gangrenous. (We now know that, most likely, it’s bacteria that normally grow on the skin and in the urogenital tract that can cause this.) Semmelweis also thought that “cadaveric particles” were the primary cause of puerperal fever, even though it was (and is) bacteria, such as streptococcus infections, either type A, which is commonly found in the throat and nasopharynx of otherwise healthy carriers, or type B, which lives on the skin. Semmelweis also didn’t help himself by not publishing right away, although he and his students did write letters to directors of several prominent maternity clinics describing their recent observations. He helped himself even less later in his career by writing open angry letters to prominent European obstetricians, at times denouncing them as irresponsible murderers.
Interestingly, Semmelweis was not rejected everywhere. 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.”
As I’ve pointed out a number of times, though, none of this is 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 at least a couple of decades away from widespread 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.
Of course, the simple version of Semmelweis’ history fits Dr. Livingston’s narrative far better, leading him predictably (given my past experience with invocations of Semmelweis) to start recounting examples of what he considers the “Semmelweis effect” (more commonly known as the Semmelweis reflex), which involves the reflexive dismissal of ideas and evidence that go against current consensus. Nor would I discount the Semmelweis reflex as a major problem in the psychology of scientists. That being said, some of his examples are…questionable. For instance:
The problem of new ideas being rejected by experts is so pervasive it should have its own term, something like the Semmelweis Effect. The Semmelweis Effect originated in Vienna but about 100 years later in nearby Germany, history repeated itself. A German surgeon, Eric Muhe, developed a new technique for gall bladder removal in 1985 using telescopic instruments introduced into the abdomen through a series of small incisions – the first laparoscopic cholecystectomies. Muhe reported his first 100 cases to various German medical societies. Not only was his new approach to cholecystectomy rejected by his colleagues, but he was charged with murder in 1987 when one of his patients died of a complication unrelated to the laparoscopic approach procedure.
For many years, the French surgeon, Phillipe Mouret, was credited for inventing laparoscopic cholecystectomy a full two years after Muhe. Because Muhe was so thoroughly discredited by his colleagues for performing what the Germans at the time considered dangerous and irresponsible surgery, Muhe’s achievement went unrecognized for many years.
I lived through the transition from open cholecystectomy to laparoscopy cholecystectomy. Indeed, I was a resident at the time. When I went into the lab to do my PhD in 1990s, old-fashioned open cholecystectomy still reigned. When I came out of the lab in 1993, laparoscopic cholecystectomy had taken over, and I found myself embarrassed that, unlike other third year residents, I had no experience with the laparoscope or even just “driving the camera,” which is what the assistant does, keeping tings in view by moving the camera around as needed. If anything, laparoscopic cholecystectomy is a cautionary tale about the widespread adoption of a procedure before its safety was properly vetted in clinical trials. If you read about the history of laparoscopic cholecystectomy, you’ll find that its popularity far preceded the evidence for it. Its adoption was the very epitome of hype before evidence, with established surgeons frantically learning the procedure because, if they didn’t, their patients would go to surgeons who could do the procedure. Fortunately, evidence did eventually justify the superiority of the procedure, especially after the adoption of the critical view of safety, which greatly decreased the incidence of common bile duct injuries associated with the procedure, but it could have gone the other way. Odd, then, that Dr. Livingston compares Muhe to Semmelweis.
Dr. Livingston then rattles off some more questionable examples:
The Semmelweis Effect remains stubbornly common. The Effect was in play with PCR’s invention by Kary Mullis, discovery of the cholesterol receptor by Brown and Goldstein, with accepting that H. Pylori causes gastroduodenal ulcer disease (Barry Marshall), and identifying nutritional deficiencies as causing pellagra (Joseph Goldberger). The notion that tobacco smoking causes lung cancer was vigorously opposed by Sir Ronald Fisher, perhaps the most famous statistician, because of inconsistencies in the data supporting that hypothesis.
I’m not sure what the heck he is talking about regarding Kary Mullis; he was awarded a Nobel Prize with co-inventor Michael Smith for his invention of PCR. Barry Marshall is a commonly cited example as well, but it turns out that his “rejection” was very much overblown. (Funny that Dr. Livingston doesn’t mention Robin Warren, who worked with Marshall.) It’s true that 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 an 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 “dogmatic,” “close-minded” scientists refused to accept Marshall and Warren’s findings. It’s an example of a scientific consensus that deserved to be questioned, was questioned in the right way, and was overthrown—and rapidly, too. Although there was initial skepticism of their results, in actuality Marshall and Warren essentially won the day within a decade, by which time the standard of care for treating duodenal ulcers had evolved to using antibiotics. That’s actually an incredibly fast about-face for medicine, given how long it typically takes to bring an idea from bench to bedside.
As for Sir Ronald Fisher, WTF? Fisher was one of the few scientists by the late 1950s who had not yet been convinced that tobacco smoking played a major role in causing lung cancer, and, as described in this article, his work might well have been “influenced by personal and professional conflicts, by his work as a consultant to the tobacco industry, and by the fact that he was himself a smoker” but was also part of a more general methodological debate in statistics at the time regarding attributing causation. Ditto Joseph Goldberger, whose discovery that nutritional deficiencies caused pellagra came as a result of an experiment of highly questionable ethics, involving offering prisoners at the Rankin Prison Farm in Mississippi pardons for participating in a clinical trial testing a deficient diet, as well as another experiment involving the intentional attempt to infect volunteers without ethical review.
This brings me to the biggest “WTF?” part of Dr. Livingston’s invocation of Semmelweis, but first he can’t resist this metaphor:
Despite the rich history of the dangers of rejecting new or alternate ideas about disease, the medical establishment has not learned its lesson. With COVID, the Semmelweis Effect was in full force. This time, it was the GBD authors who were the witches burned at the stake.
“Brave mavericks” sure do love comparing science-based critics to superstition or religion, don’t they? Almost as much as they like to compare their “brave maverick” heroes to Semmelweis:
Jay Bhattacharya, who authored the declaration with Dr. Martin Kulldorff and Dr. Sunetra Gupta, is the face of the GBD and a modern day Semmelweis. 2 Bhattacharya and his colleagues issued the Great Barrington Declaration on October 4, 2020, the pandemic was raging and the response to it was chaotic, calling for a reasoned approach to COVID.
Seriously. I’m bored. Now here’s the “WTF?” comparison:
Early in the AIDS epidemic, CDC case officers realized that AIDS spread the same way as hepatitis. Because AIDS was not transmitted through the air, they knew it was safe to be in close proximity with the patients. All that was needed was the implementation of what we now know as universal precautions to avoid contact with blood or secretions. That AIDS patients did not need to be locked away was part of the message public health officials communicated. This was not easy given the public’s panic about AIDS in the 1980s. By the 1990’s, patients dying with AIDS were surrounded by loved ones.
An irony is why some of the same public health experts such as Dr. Anthony Fauci would reverse course during the COVID pandemic.
The basic approach that worked for AIDS should have been implemented for COVID. Understand its basic biology and then determine how to respond to the pandemic.
Never does it seem to occur to Dr. Livingston that AIDS and COVID-19 are very different viral diseases and that very different approaches to slowing their spread are indicated, while also conveniently ignoring the role of homophobia in contributing to the AIDS panic in the 1980s. He also seems to be asserting that the fear that HIV was spread through the air diminished because the CDC recognized that it was spread by bodily fluids. It didn’t, not for a long time anyway. That leads to my “WTF?” reaction to his comparison to COVID-19, which is spread by aerosolized respiratory secretions in the air. Indeed, if there is a real “Semmelweis reflex” moment regarding COVID-19, it’s how long health authorities continued to insist that COVID-19 was spread by large droplets, which don’t travel very far through the air, rather than aerosols, which can and do. Moreover, contrary to what Dr. Livingston would have you believe, scientists, physicians, and public health officials did craft recommendations based on the existing understanding of coronaviruses in 2020, of which SARS-CoV-2, the coronavirus that causes COVID-19, was but one. Seriously, Dr. Livingston’s analogy doesn’t even make any sense.
Nor does this bit of misdirection:
COVID is caused by the SARS CoV-2 virus, a coronavirus, the same family of viruses responsible for the common cold. What was known about disease caused by these viruses before the pandemic? From the 18th edition of Harrison’s Principles of Internal Medicine published in 2012 referring to the 2003 SARS :One could copy these statements written about SARS in 2012 and apply them to the SARS-CoV-2 virus in 2024. The approach to COVID, proposed by the GBD, should have followed the same play book used by public health officials in the 1980s for AIDS. Take what is known about the virus, craft public policy from that knowledge and then educate the public about the disease in a way as to sooth their fears.“…The disease appeared to be somewhat milder in cases in the United States and was clearly less severe among children,” “…spread may occur by both large and small aerosols and perhaps by the fecal-oral route as well.” “…environmental sources, such as sewage or water, may also play a role in transmission.” “Some ill individuals (“superspreaders”) appeared to be hyper infectious and were capable of transmitting infection to 10-20 contacts…”
“…risk factors for severe disease include age>50 years and comorbidities such as cardiovascular diseases, diabetes, or hepatitis. Illness in pregnant women may be particularly severe, but SARS-CoV infection appears to be milder in children than in adults.”
Funny, but Dr. Livingston doesn’t mention what health officials did to stop the spread of the original SARS. One notes that it’s widely accepted that SARS was an example of an epidemic that was contained largely through traditional public health interventions, such as index case identification, quarantines, and the like, not anything resembling what the GBD proposed. It’s hard for me not to suggest here that, had the original SARS been handled the way the GBD authors proposed handling SARS-CoV-2 and the COVID-19 epidemic, SARS would never have been contained and would have itself become a deadly pandemic, something that almost happened despite the effective public health interventions that ultimately contained it. Indeed, initial interventions for COVID-19 were explicitly based on what appeared to work for SARS, as described in an article from May 2020 in The Lancet entitled Can we contain the COVID-19 outbreak with the same measures as for SARS? The authors concluded:
Although there are striking similarities between SARS and COVID-19, the differences in the virus characteristics will ultimately determine whether the same measures for SARS will also be successful for COVID-19. COVID-19 differs from SARS in terms of infectious period, transmissibility, clinical severity, and extent of community spread. Even if traditional public health measures are not able to fully contain the outbreak of COVID-19, they will still be effective in reducing peak incidence and global deaths. Exportations to other countries need not result in rapid large-scale outbreaks, if countries have the political will to rapidly implement countermeasures.
Unfortunately, as we now know, most countries did not have this political will, and here we are.
Basically, the GBD went against everything learned from previous experience with respiratory viruses, including the 2002-2003 SARS outbreak, but Dr. Livingston would have you think that the GBD was The Real Science, with Jay Bhattacharya and his co-authors akin to a modern day Semmelweis and Anthony Fauci and all the others who criticized the GBD being akin to Semmelweis’s critics, when in fact the GBD violated many principles of public health science and what was known then about coronaviruses. The only reason the GBD seems to have been “vindicated” now is because of a persistent propaganda and misinformation campaign of revisionist history on the part of its advocates that forgets that the GBD was based on mass infection designed to reach “natural herd immunity” within 3-6 months and that it wasn’t just the claim that “lockdowns” do more harm than good.
Again, Dr. Livingston left out the core idea behind the GBD, as Dr. Howard pointed out on X, the hellsite formerly known as Twitter:
Seriously, note how Dr. Livingston pivots to “lockdowns were harmful”:
The more important issue isn’t the immunity argument. The lockdowns were tremendously damaging to society, and the medical community has paid very little attention to that damage. Businesses were ruined, the education system was impaired, and we still don’t know the full ramifications of lockdowns.
Funny, that. Not so funny is how, ignoring the sustained campaign of disinformation on the part of GBD proponents and other COVID-19 minimizers and, later, antivaxxers, Dr. Livingston writes:
We now know that Dr. Bhattacharya and the other GBD authors were correct, and the experts were very wrong. The Semmelweis Effect. Going forward, experts should be careful before discrediting new ideas. The more passionate the experts are about countering something, the more skeptical the public will be about the experts.
We “know” nothing of the sort. This is an assertion without evidence, in actuality an assertion that contradicts available evidence. It was even known at the time that chasing “natural herd immunity” for COVID-19 was a pipe dream, as described by authors of the John Snow Memorandum. “Natural herd immunity” requires life-long—or at least long-lasting—postinfection immunity, and it’s long been known that postinfection immunity is relatively brief for coronaviruses, because coronaviruses are good at mutating to evade postinfection immunity that results from infection with prior variants. We saw this with the Delta and Omicron variants. Again, the GBD was not consistent with what we knew about coronaviruses, immunity, or public health, no matter how mightily Dr. Livingston strains to claim otherwise.
Seriously, I’m surprised that Dr. Livingston didn’t quote Arthur Schopenhauer’s famous (and wrong) adage, “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” (Of note, Schopenhauer almost certainly never actually wrote or said this.) Besides being risibly wrong (such “truths” never get to the third stage because they’re not “truth”), Schopenhauer’s saying is a favorite of defenders of bad science everywhere. I’ll give Dr. Livingston credit for having restrained himself enough not to have used that common chestnut.
The appeal of the Semmelweis gambit
Many years ago I coined a term—at least, I think I was the first to coin it almost 20 years ago, although I can never by totally sure—the Galileo Gambit. The term was intended to describe the propensity of cranks, quacks, and advocates of pseudoscience like creationism to claim the mantle of Galileo (or Semmelweis), scientists who were at first rejected by the scientific orthodoxy of the time and had to fight to get their ideas accepted—or who did not live to see their ideas accepted, like Semmelweis. The implication, of course, is that their “unconventional” or “outside-the-mainstream” ideas, whatever they may be (alternative medicine, intelligent design, psychic abilities, etc.), are on the same plane as those of Galileo or Semmelweis and are being unfairly rejected by dogmatic scientists who are close-minded and unable to accept their genius. Sound familiar? I also said at the time that, frequently, defenders of such crankery will add a list of famous scientists or experts whose views were rejected by mainstream science but ultimately prevailed (just like Galileo or Semmelweis). Sound familiar? Given that Galileo is a rather poor example of this phenomenon given that the objection to Galileo’s heliocentric model were mainly religious and from the Catholic Church and that other astronomers were replicating his results, increasingly I’ve been thinking that I should stop calling this the Galileo gambit and start calling this the Semmelweis gambit.
As I pointed out at the time (and have pointed out many times since), obviously, this technique seeks to denigrate the experts who reject the crank claims as not knowing what they’re talking about or as close-minded, unable to have the vision that they do. It also deceptively tries to associate the quack, crank, pseudoscientist, or pseudohistorian with the theories and findings of great visionaries who went against conventional wisdom, were rejected by the experts of the day, and then later shown to have been correct. Although Michael Shermer has of late taken a heel turn, I have to concede that he was correct two decades ago when he said, “Heresy does not equal correctness.” Too bad he seems to have forgotten the wisdom of his earlier words, which is why I tend to like to quote Carl Sagan more often these days:
But the fact that some geniuses were laughed at does not imply that all who are laughed at are geniuses. They laughed at Columbus, they laughed at Fulton, they laughed at the Wright brothers. But they also laughed at Bozo the Clown.
Come to think of it, Columbus wasn’t the greatest example either. I might have to reformulate the idea that Sagan was expressing. Be that as it may, Dr. Livingston is far from the first defender of crank ideas to invoke Galileo or Semmelweis when he argued that the GBD was correct. Indeed, one of the GBD authors, Martin Kulldorff invoked not just Galileo but Tycho Brahe, Johannes Kepler, and René Descartes, likening the GBD (and the reaction to it) to the theories of those great scientists. Back in November 2020, Barry Brownstein also invoked Semmelweis defending the GBD and likened Sunetra Gupta (its third co-author) to him. It’s a common—and deceptive—theme that’s been used many times by GBD defenders, one of whom even more deceptively argued that “crushing scientific dissenters, as Fauci urges, would kill medical progress.” The common narrative is that the GBD’s authors are the “modern Semmelweis” and that “scientific dissent” is being crushed by modern-day versions of Rudolf Virchow, the most prominent critic of Semmelweis of the era. (Yes, I’ve seen Anthony Fauci likened to Virchow in this context.)
I’m not saying that when you see comparisons like Dr. Livingston’s to Semmelweis (or Galileo) that it’s always a sign that you’re dealing crankery, pseudoscience, quackery, or just plain bad science. After all, the oft-ignored complexities of his story notwithstanding, it is true that Semmelweis’s ideas were (mostly) rejected by his fellow physicians and scientists but then later shown to be true, at least true that washing hands with chlorine did dramatically decrease the risk of puerperal fever. It is true that, human nature being what it is, the Semmelweis reflex can be a real phenomenon that hinders the acceptance of new science and new medical treatments. However, often forgotten is that it can be very difficult to judge where the line between what would be reasonable skepticism given the knowledge of the time ended and the Semmelweis reflex begins. After all, science is about questioning and falsifying hypotheses, and at the time a new idea is being proposed it is not always easy to tell when questioning passes from reasonable to unreasonable. Moreover, as I like to point out, the vast majority of “heterodox” ideas are rejected precisely because they are wrong! Most such ideas fail the test of science, while only a relatively few stand the challenges of experimentation and evidence. Defenders of crank hypotheses or ideologically motivated bad science (like the GBD) cherry pick the few examples of real mavericks who were ultimately vindicated and ignore the much larger number of “brave mavericks” lost to the mists of history because their ideas never panned out.
Basically, it’s what I like to call the fallacy of future vindication, except that the proponents of the GBD, like Dr. Livingston, have leapt to declaring vindication now. Never once does the thought enter the minds of people like the authors of the GBD (or, frequently, their defenders like Dr. Livingston) that they might be wrong, that the reason they are viewed as cranks or treated with disdain is because they are so obviously wrong. That’s what separates them from real scientists. Sure, real scientists who believe unpopular things also believe that some day they will be vindicated, but they also carefully consider the possibility that they might actually be wrong and are prepared to change course if the evidence demands it. The authors of the GBD and their defenders fail that test.
Depressingly, Dr. Livingston Professor of Surgery at UCLA—it always depresses me when a fellow surgeon makes arguments this bad—and former Deputy Editor at JAMA. In a way, that’s a cautionary observation as well. Anyone can be prone to the Semmelweis gambit, if they believe in a bad idea strongly enough. At the risk of self-aggrandizement through humble-bragging, I like to think that the difference between me and someone like the GBD authors is that I always ask myself whenever I assert something whether I might be wrong and try hard to remain open to the possibility that I might be. I also know that my readers will disabuse me of such a notion, should I ever stumble as badly as Dr. Livingston has stumbled here. Drs. Jay Bhattacharya, Martin Kulldorff, and Sunetra Gupta are not akin to Ignaz Semmelweis, nor was the Great Barrington Declaration a discovery on par with antisepsis. Quite the contrary, two of the GBD authors sat at the same table as Steve Kirsch and the worst of the worst antivax cranks, and the GBD was not an idea that was ever vindicated.
