Against Scientific Gatekeeping

Didier Raoult (an iconoclastic French microbiologist) announced, in March 2020, that anti-malaria drug hydrochloroquine had successfully treated all 36 COVID-19 participants. Raoult’s coworkers argued that Raoult’s trial was too small, and that it wasn’t randomized or controlled. As the coronavirus became more widespread, governments responded swiftly with harsh lockdowns. Public attention quickly turned to the possibility of a cheaper and safer drug that could eliminate this threat.

Donald Trump proclaimed hydroxychloroquine a “game-changer,” drawing the fury of medical and public health professionals. The experts complained that it was dangerous to give the drug to patients with HIV without conducting randomized controlled studies. Trump and other Republican politicians and conservative pundits pressured the Food and Drug Administration to issue an Emergency Use Authorization (EUA), allowing hydroxychloroquine additions to the national strategic stockpile for COVID-19 treatment.

The FDA withdrew the EUA after numerous controlled, randomized trials that failed to show the effectiveness of the drug. This left the stockpile in the USA with 63,000,000 unused doses hydroxychloroquine. Ron DeSantis (the Republican Governor of Florida) had bought 1,000,000 doses to stock the state’s stockpile. These also remained unutilized.

It is important to distinguish between claims that drugs are not useful and weaker claims that they have not. Many Americans believed that hydroxychloroquine had more benefits than its risks, even though Raoult was unable to prove his claims. Some coronavirus infected people continued taking the drug, exercising their right to self-medicate.

The conflict between scientists and their uncredentialed rivals is illustrated by the hydroxychloroquine brouhaha. The internet has made science more accessible to everyone. This means that the academy is no longer the only source of specialized information. Laity can make their own assessment of the information and contribute to shaping scientific discourses, whether they are good or not.

The internet has its own gatekeepers. The people who manage the most popular social media platforms have the ability to filter and control information. While their reputation with the elites is enhanced by flattering the priesthood, it can also protect them against criticisms and calls for regulatory intervention. However, they could be captured.

New ideas are being rejected by the religious priesthoods who claim to be representing the “scientific consensus”. However, academic scientists need to face the truth that search engines as well as digitization have permanently undermined their authority and knowledge gatekeepers. This is a situation that has both advantages as it presents dangers.

Experts: Yes, Priesthoods: No

People prefer to see experts when it comes down to their health care. This is something I find acceptable as a surgeon. However, there is a problem when experts have a large influence on the opinions of others and establish a priesthood-imposed orthodoxy. Any expert who questions this orthodoxy is guilty of heresy. This leads to groupthink that undermines scientific progress.

There were many other examples in the COVID-19 outbreak. Most medical scientists, for instance, uncritically accepted the epidemiological pronouncements of government-affiliated physicians who were not epidemiologists. They dismissed epidemiologists, however, as being “fringe”, when they challenged the accepted wisdom.

Emily Oster was criticized for her extensive data analysis and statistical experience. 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. Sarah Bowen was a sociologist but not an epidemiologist who was among her harshest critics.

It is likely that funding plays a role in the deference shown to government-endorsed positions. 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.” Both of these problems are present today.

The Orthodox Faith in the Earlier Times

Medical science priesthoods have a history of harshly treating people who think outside the box. Toward the end of the 18th century, 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. Jenner’s medical friends considered it dangerous. A Royal College of Physicians member even suggested that this technique might make some people look like cows.

Variolation was a method of preventing smallpox. It involved infecting mild-case patients with the pus of others. Some considered vaccination a threat to their livelihood. Jenner’s plan was appreciated by Parliament, who appropriated funds to fund a London vaccine clinic. The technique was adopted by American physicians in the 1800s. Napoleon issued smallpox vaccinations to all his troops in 1805.

Ignaz Semmelweis was fired by the Vienna General Hospital half a century later. He demanded that his junior doctors and medical students wash their hands prior to examining pregnant patients. Semmelweis connected puerperal sepsis—a.k.a. “childbed fever,” then a common cause of postnatal death—to unclean hands. Semmelweis was published ten years after he returned to Budapest. Childbed Fever: Concept, Etiology, and Treatment. He was driven insane by the vitriol he received from his medical staff. Or so it seems. Some believe that Semmelweis was suffering from bipolar disorder. Semmelweis, who was 47 years old, died in an asylum on 1865.

Semmelweis’ “germ theory”, which he had hoped for, didn’t take root until the 1880s. It is this that the doctor John Snow, who traced the London cholera epidemic back to the Broad Street water pump, was rebuffed by the public health institution in 1854. Snow rightly suspected that the water coming from that pump contained a pathogen which caused cholera.

Instead, public health officials believed that the illness was caused by “bad air.” British medical journal The Lancet published a brutal critique of Snow’s theory, and the General Board of Health determined that his idea was “scientifically unsound.” After another outbreak ofcholera in 1866 the public health system recognized the truthfulness of Snow’s explanation. Herbert Spencer (19th century classic liberal philosopher) warned that public health institutions had grown to serve political ends, which distorted science and prolonged the cholera epidemic. He wrote that “there is an obvious inclination by the medical profession get itself organized according to the fashion of the clergy” in 1851. Social Statistics. Doctors and surgeons work tirelessly to create a comparable medical facility to our religious. The public is unaware of how active professional publications lobby for the appointment of state-appointed health officials.

A Welcome Environment for Heterodoxy

This was due to medical advances that made heterodoxy more acceptable. New knowledge in 20th century science opened scientists up to new ideas.

For example, as a 1970s surgical resident, I was trained to excision melanomas within a 5-centimeter margin. The theory is that it’s important not to give dangerous skin cancer a large margin. For a defect of this size, you will need a skin transplant. Although this approach is not evidence-based, it has been accepted by all since the beginning of the 20th century. In the late ’70s several medical researchers challenged the belief. Numerous studies showed that the margin of five centimeters was not better than a margin of two centimeter. The old rule of five centimeters is gone.

Over the years, doctors believed that hyperacidity (often stress-related) was the primary cause of pepticulosis. Barry Marshall (a gastroenterology resident) noticed the presence of a bacterium in the stomach every day during the 1980s. Helicobacter PyloriHe also included the slide of stomach biopsy samples he submitted to the lab. He believed the bacteria was the cause of the ulcers. He did indeed ingest the bacteria which caused him to develop ulcers. The bacteria gave him ulcers, which he was able to treat with antibiotics. Marshall’s findings were confirmed by several studies in the 1990s. Helicobacter Pylori is recognized as the cause of most peptic ulcers.

Another avenue to medical innovation is “off-label” usage of FDA-approved drugs. The FDA will approve a drug if it addresses a specific condition. However, it’s legal to use the drug for other conditions. About 20% of drugs prescribed in America are off-label. This practice often relies on anecdotal and clinical intuitions. The use of off-label drugs eventually leads to clinical trials.

As with hydroxychloroquine sometimes, studies don’t always confirm the initial hypothesis. Sometimes, however, clinical trials support off-label use. Postoperative stomach cramping is treated with the antibiotic erythromycin by surgeons. The original use of lithium was to treat bladder stones and gout. Now, it’s used to treat bipolar illnesses. Thalidomide was created to cure “morning sick” in pregnant women. It is not recommended for this purpose as it can cause severe birth defects. The treatment of leprosy, multiple myeloma, and other conditions with thalidomide proved to be very effective. Tamoxifen (an anti-fertility medication) is being used for breast cancer treatment.

These are only a few of the many examples of rapid progress in understanding and treating health conditions that I have seen during my career as a physician. This was possible because of an environment that embraces heterodoxism. However, even those health care providers who understand the importance of unconventional thinking are not able to resist challenges from experts.

The internet allows everyone to access information previously only available to medical professionals. The COVID-19 epidemic has accelerated the growth of freelance theorizing and hypothesizing among laypeople. Patients who have asked questions about what they read online can be shared by every physician. These questions can sometimes be misguided. For example, patients may ask about superfoods and special diets that could replace surgery to remove cancer. Patients’ Internet-inspiring concerns can sometimes be valid. They may ask if using surgical mesh for hernia repair could cause serious complications.

According to American fantasy and science fiction writer Theodore Sturgeon, it may be true. “90% of all things are crap.” The remaining 10% can still be very important. The backlash is fueled by the perception that health professionals see this as a threat against the scientific order. They risk throwing away the baby with the bathwater.

The Return of Intolerance

It is clear to see why scientists view the democraticization of opinions in health care as a threat and threat to their authority. Medical experts respond by claiming credentialism. They suggest that you shut down and follow the instructions. Credentials aren’t always a guarantee of competence and can cause you to be denied valuable insight.

For example, economists criticizing COVID-19 research are frequently dismissed because they’re not epidemiologists. However, they may offer an interesting perspective on the pandemic.

Ryan Bourne, Cato Institute economist, notes that many epidemiological models focus on the spread of disease and assumes certain behaviors by the population. Economics as One Virus. They don’t allow us to weigh the costs and benefits associated with decisions made to reduce disease spread. [or] to consider how these broader costs and benefits themselves influence people’s decisions to interact….Economic insights are therefore hugely important both in making broader evaluations of decisions and highlighting where the simplism of the modeling can lead us astray.”

Scott Atlas was formerly the chief of neuroradiology for Stanford Medical School. He is an author and has critically reviewed many medical research papers. As a member, he is a member the Nominating Committee to the Nobel Prize in Medicine and Physiology. Yet when Atlas commented on COVID-19 issues, the priesthood and its journalistic entourage derided him because he is “not an infectious disease expert”—as if a 30-year career in academic medicine does not provide enough background to understand and analyze public health data. Why? It was because the physician dared to question the public’s health. Ashish Jha (dean of Brown University’s School of Public Health), told NPR that he is an MRI man. “He doesn’t know anything about any of these things.”

Other fields also face the dangers associated with credentialism. David Friedman received a Ph.D. from physics, but he never took any credit for either economics or law courses. He did however spend part of his academic career at Santa Clara Law School teaching economics and law. George H. Smith published, even though he never graduated from high school. The System of Liberty. Themes from the History of Classical Liberalism through Cambridge University Press. Roy A. Childs Jr. (deceased), was an important intellectual contributor to libertarian movements in the second decade of the 20th Century.

We physicians love to question “What is the name of the student who finishes last in medical school?” Answer: Doctor.

However, it’s true that lack of knowledge in one discipline can make laypeople less able to analyze scientific studies critically, which makes them more susceptible to being misled by charlatans or quacks. The discipline’s training can help you spot “cherry-picking” and to anticipate other interpretations. Experts have a purpose. It is up to us to maximize the benefits and minimize costs of scientific dedemocratization.

Politics and Science Priesthood

The Trump administration responded in an erratic fashion to COVID-19’s attack in 2020. Trump’s response was to defer policy making to federal officials in public health, while questioning and criticizing them from the sidelines. It almost felt like the chief executive were watching rather than participating.

Trump’s public health team consisted of Deborah Birx, an infectious disease specialist who was in charge of the White House Coronavirus Task Force; Anthony Fauci, an immunologist who directed (and still directs) the National Institute of Allergy and Infectious Diseases; Robert Redfield, an infectious disease specialist and research virologist who headed the Centers for Disease Control and Prevention (CDC); and then–Surgeon General Jerome Adams, an anesthesiologist. The group supported broad restrictions on social and economic activity in order to decrease virus transmission. However, this was despite the fact that the science has not yet proven that massive lockdowns can prevent the spread of respiratory diseases.

Trump openly expressed his doubts about the approach. Trump’s open skepticism about this approach was a result of the stark polarized debate between him and his team in public health.

Trump’s desire to quickly resolve the crisis in public health suddenly made hydroxychloroquine a popular therapeutic option. This was despite the fact that the medical community had been open to using off-label medications for years. Everyone who entertained the notion was seen as an associate of the White House medical ignoramus. Trump supporters that shared his wish to end the pandemic restrictions seemed to instinctively support the drug. It was a waste of time and money to address the problem in a chaotic manner.

Talks about ivermectin are also affected by politics and tribalism. There are limited evidences that the drug could be useful in the prevention and/or treatment of COVID-19. Trump supporters and others opposed to vaccination have praised ivermectin. However, the drug has been incorrectly called a “horse-dewormer” by many. This debate should be resolved by a large, randomized controlled trial currently underway in the United Kingdom.

In the response to prominent lockdown skeptics, it was evident that COVID-19 science had been politicized. John P.A. Ioannidis is a Stanford Professor of Epidemiology and Biostatistics, who was an iconic figure in the movement for evidence-based Medicine. STAT titled “A Fiasco in the Making?” It warned us that, as coronavirus spreads, it is making difficult decisions without any reliable data.

Ioannidis claimed that lockdowns, school closings and similar measures can cause great harm. He said that public health officials need to wait until more information is available before imposing new restrictions.

Ioannidis has not yet stated his political views. His essay was in line with the skeptical views of the president and his many supporters. Therefore, both the medical science clergy and its media supporters made fun of the revered epidemiologist. The Nation Published an article calling Ioannidis’ work “black mark” at Stanford, and suggesting that it was influenced in part by corporate sponsors.

Vinay Prasad is an epidemiologist and oncologist from the University of California in San Francisco. He has been a prominent critic of mandates for face masks. He has opined on the subject for popular medical websites, and he co-authored a Cato Institute review of the relevant literature, which found no evidence that cloth masks are effective in reducing transmission of the virus—a position that even the CDC has at least partly accepted. Peers made personal attacks on Prasad for this. Others disseminated his tweets, including screenshots taken out of context. They also tagged his employer and accused him of being indifferent.

You can also look at the response to the Great Barrington Declaration. It was published October 4, 2020 by Martin Kulldorff who was then a Harvard professor and Sunetra Gopta at Oxford, who is a professor and author of epidemiology. Jay Bhattacharya at Stanford, an economist and Stanford professor, wrote the statement. It was finally endorsed in large part by thousands of public and medical health professionals, including the Nobel Prize winner for Chemistry 2013; Sunetra Gupta, a professor of epidemiology at Oxford, and Jay Bhattacharya, whose Stanford doctor of medicine has authored specialized statements that allow those most vulnerable to COVID-19 to resume their normal lives.

There are many political views represented by the Great Barrington Declaration authors. They were mocked for opposing the policies of the public health establishment, and they received applause by Trump supporters. The journal published an editorial. Science-based Medicine said they were “following the path laid down by creationists, HIV/AIDS denialists, and climate science deniers.”

A year later, medical priesthood was still fuming when Gavin Yamey, a Duke University public-health professor and surgical oncologist Gavin Gorski published a vicious ad hominem attack upon Kulldorff and others. In BMJ OpinionThe Great Barrington Declaration was referred to as a well-funded, sophisticated science denialist campaign that is based on corporate and ideological interests. Kulldorff immediately responded to the accusation with an aggressive rebuttal. Spectator WorldThe following is a list of the BMJ attack “urges people to use ‘political and legal strategies’ rather than scientific argument to counter our views on the pandemic.”

The American Institute for Economic Research, where the Great Barrington Declaration was written and signed, published some emails it obtained via a Freedom of Information Act request in December. “This is the proposal of three fringe epidemiologists who met. [Secretary of Health and Human Services Alex Azar] seems to be getting a lot of attention—and even a co-signature from Nobel Prize winner Mike Leavitt at Stanford,” then–National Institutes of Health Director Francis Collins wrote to Fauci on October 8, 2020. It is urgent that the premises be taken down and published in a devastating manner. I don’t see anything like that online yet—is it underway?”

Atlas was attacked by Trump in his attack. Trump invited Atlas to join the coronavirus task force. Because Atlas has repeatedly condemned lockdowns, this decision appeared to be a mockery of Redfield, Fauci, Birx and Fauci. The email campaign was designed to discredit Atlas and make him look “dangerous” and a real threat to the comprehensive, critical response to this pandemic. He resigned after the public and private attacks on Atlas.

“The fact that the acceptance or rejection of science is increasingly determined by political affiliations threatens the autonomy of scientists,” the Harvard science historian Liv Grjebine noted in a May 2021 essay for The Conversation. “Once a theory is labeled ‘conservative’ or ‘liberal’ it becomes difficult for scientists to challenge it. Thus, some scientists are less prone to question hypotheses for fear of political and social pressures.”

While “science cannot thrive under an administration that ignores scientific expertise as a whole,” Grjebine wrote, “neither can it thrive if scientists are told which political and moral values they must embrace. It could stop or slow down the development of new scientific theories. Indeed, when scientists align themselves with or against political power, science can easily lose its most important asset: the ability to encourage disagreement and to raise new hypotheses that may go against common sense.”

Misinformation and its Role

It is important to recognize the importance of social media in this whole process. Facebook, Twitter, YouTube and other platforms are owned by the owners. They can choose what content they allow. The major media platforms like mainstream news media tend to be aligned with science priesthoods. They therefore are inclined to suppress scientific heterodoxy—a tendency encouraged by the Biden administration’s explicit demands that they eliminate COVID-19 “misinformation,” including content that is deemed “misleading” even if it is not verifiably false.

This alignment may partly be explained by cultural and ideological affinity to the priesthood. Although many tech entrepreneurs don’t have academic degrees, they consider themselves to be new members of an elite intellectual group. Both Republicans and Democrats have referred to the digital media “the wild west” as they seek to control it for their advantage. Tech entrepreneurs may be able to strengthen their resistance against political attacks by forging alliances with academic and scientific elites.

Facebook employed “fact-checkers” to verify the authenticity of its posts. Twitter also applied warning labels and YouTube deleted any comments that challenged the use of lockdown policy by the public healthcare establishment during the early stages. In recent months, it’s become commonplace in society to critique school closures or other lockdown measures.

Twitter pulled down Atlas’ October 2020 post, which he had written while serving as a member Trump’s coronavirus taskforce. Atlas was accused of citing scientific literature that challenged the efficacy masks. Twitter claimed Atlas had violated their policy and shared misleading information about COVID-19. This could have caused harm. CNN’s Jeremy Diamond wrote that Paul LeBlanc, a CNN reporter, described the incident. “The message pushed to us by the controversial neuroradiologist [i.e., not an epidemiologist]This goes against the U.S. Centers for Disease Control and Prevention’s guidance. Although studies regarding the health benefits of masking are still inconclusive at this point, it has become clear that cloth masks, according to CNN’s medical analyst Leana Shen, are “little more than facial ornaments.”

The most outrageous example of digital media doing dirty work for priesthood is suppression of discussion about the source of COVID-19. Pundits rejected any suggestion that the source of the COVID-19 virus was a water leak from the Wuhan Institute of Virology and they suppressed them by the social media gatekeepers. After The Wall Street Journal reported in May 2021 that intelligence sources believed a lab leak is a plausible explanation that deserves further investigation, Facebook lifted its ban on posts that mentioned the theory. Twitter on the other side refused to make a commitment to what they would censor. In summer 2021 scientists from the academy and media had reached a consensus that the laboratory leak theory was plausible. This should have been explored.

The Public Health Priesthood’s Mistakes

The public health authorities made many mistakes in the last two-years. However, it is yet to be confirmed if any of them will actually admit it. Numerous studies have shown that COVID-19 deaths and COVID-19 infection rates were not affected by shelter-in-place or other lockdown tactics. Similar research also shows that these restrictions are detrimental to the most vulnerable groups, such as the elderly and those with low incomes.

Kuldorff, et. al. were criticised by health professionals. Kuldorff et al. were criticised for underscoring natural immunity’s protective role against infection. The CDC acknowledged publicly on January 19, 2022 that natural immunity was more effective than vaccination during the Delta wave. The Great Barrington Declaration was largely accurate.

The policy makers placed a high priority on vaccine development and vaccination, at the expense or therapeutics. The emergence of the Omicron variant meant that vaccines had less effectiveness in stopping virus spread. However, they were very effective in controlling severe diseases. Given the endemic and highly contagious nature of this virus, therapeutic medicines could be very useful. With a new appreciation for therapeutics, it’s puzzling that public officials are so focused on Merck and Pfizer antivirals when fluvoxamine (a 1994 approved antidepressant) is not mentioned. Fluvoxamine has been shown to be as effective in reducing depression than antivirals according to random controlled trials.

It was wrong for public health officials to recommend vaccines that are universally applicable. The public now has the same access to information as scientists and professionals, so they understand the significance of infected-induced immunity. Officials see similar hospitalization and death rates. They are able to identify which group is most at risk for serious illnesses and which are more vulnerable to complications such as vaccine-induced myocarditis. It is possible and desirable to be more specific in vaccine recommendations.

It is important to be clear. As a physician I believe the mRNA vaccines, particularly for high-risk age groups, are highly safe and extremely effective. They undermine trust when the intelligence and public health officials portray those with valid questions about vaccines as “antivaxxers” and “COVID deniers”.

You can have a lot of tolerance.

Public health officials need to abandon their “zero COVID strategy” and admit that the virus is endemic. Science priesthood needs to adapt to an environment where specialist knowledge has been made freely available. Scientists must come to terms with those who are not credentialed in order for scientific knowledge and advancement to occur. They cannot dismiss observations or hypotheses of laymen outright. It is understandable that they would like to keep any hypotheses from being rejected by the health bureaucrats, who have billions in research grants dollars. Long-held beliefs and dogmas can be challenged and revised. It is possible for people from outside the field to offer invaluable perspectives which can’t be overlooked by those who work in that area.

Unconventional ideas are not for everyone. Flat-earthers should not be taken seriously. We shouldn’t give credence to the outrageous claims that COVID-19 vaccinations can cause infertility or implant microchips into people, and/or change their DNA. You don’t have enough time to answer every question. However, a bit of kindness and tolerance can help. If these habits are accepted as the norm, then people will see the rejection of conventional wisdom not only as an objective evaluation of experts but also as a defensive response of elites. Science shouldn’t be considered a religion, but a profession.