Antivaccine nonsense Bad science Medicine Politics Pseudoscience

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

A surgeon attacks “scientific gatekeeping” over COVID-19 in Reason. It goes so poorly that I might have to resurrect an old shtick that I used to use with creationist surgeons.

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.

Sylvester Junior reacts to Dr. Singer's take on "scientific gatekeeping"
Sylvester Junior reacts to Dr. Singer’s take on “scientific gatekeeping.”

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!

Gatekeeping priesthood
Maybe this is the kind of “priesthood” to which Dr. Singer is referring. Probably not. Ghost is an excellent rock band. Also, these masks are a lot cooler than a 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.

Shill card
Scientists and physicians are all apparently government shills.

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.

Great Barrington Declaration authors Martin Kulldorff, Sunetra Gupta, and Jay Bhattacharya
The Great Barrington Declaration authors in front of the American Institute for Economic Research in Great Barrington, MA. (Left to right: Martin Kulldorff, Sunetra Gupta, and Jay Bhattarcharya.)

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:

Quoting someone like Dr. Makary on COVID-19 vaccines for children is not a good look.

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.

Sylvester Junior reacts to Dr. Singer's gatekeeping
“Oh, father…”

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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

Reason has long been the most incorrectly named publication (incorrectly because its content completely lacks any reason) in existence.

I found this comment of his hilarious

“Most people prefer experts, of course, especially when it comes to health care. ”

since it’s a safe bet that a majority of the people who read reason dismissed the opinions on covid 19 given by medical experts.

He also seems to feel that ‘Government‐​imposed prescription requirements violate the rights of individuals to access the medicines they want’. So, no gatekeepers of any kind?

If there is a reaction proximate to the vax, it’s caused by anything but. If there is a death with covid, it’s certainly caused by covid. Fauci is one true science; peace be upon him. This is the word of the priesthood.

Give us this day our daily vax; lead us not into freedom; but deliver us from Covid; lockdown and mask us all as all are still capable of transmitting the virus. This is the word of Fauci; he is the one true science. Peace be upon him.

We the People of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.

Personally, I think the evidence shows these vaccines defend us against being hospitalized or dying from a SARS-CoV-2 infection. They also promote our welfare by making it much more likely that we will not suffer long term symptoms like brain fog, chronic fatigue, etc.

@john labarge There were/are masks and lockdowns outside US. Do you think China takes orders from Fauci ?

You have not commented CICP: You can claim compensation if you have a vaccine injury, but medical records must be supplied:
There are 141 death claims, one of them claims that myocarditis caused the death,
So indeed lots of deaths after vaccination are not caused by vaccines

So vax causes myocarditis and myocarditis causes death, but vax didn’t cause the death?


So [the COVID-19] vax [may] causes myocarditis and myocarditis causes might end in death, but vax didn’t cause the death?



To add to Julian’s comment, which death are you referring to?

You also ignore relevant factors like how often does the effect occur and how severe it is.

Please provide published research on the frequency and severity of myocarditis following SARS-CoV-2 infection and after vaccination.

Then we might be able to have a discussion.

And Covid-19 causes a lot of other nasty effects that aren’t seen with the vaccines.

@john labarge Actually issue was that there is only one claim.
Do you accept that there is only one possible myocarditis death caused by COVID vaccines ?


Autopsy Histopathologic Cardiac Findings in Two Adolescents Following the Second COVID-19 Vaccine Dose

Results.– The microscopic examination revealed features resembling a catecholamine-induced injury, not typical myocarditis pathology.

Conclusions.– The myocardial injury seen in these post-vaccine hearts is different from typical myocarditis and has an appearance most closely resembling a catecholamine-mediated stress (toxic) cardiomyopathy.

Did you ever figure out whether scurvy was understood before or after germ theory was invented. Asking for a friend who thinks (against all odds) that you are capable of learning something if given a weeks to think it over.

P.S. Is the imaginary Fauci you’re fantasizing about in the room with you right now? If so, the Haldol dose may be a little too low, yet.

PPS: Real priesthoods tend to execute unbelievers; Orac lets you post here, so normal people can get a giggle You might want to check the calibration on that brain of yours. The hamster seems to have fallen off the wheel.

Scurvy was understood before the mainstream medical establishment at the time admitted it and it took 100s of years for the medical scholars of the time to acknowledge it. See the parallels yet?

@john labarge Cause of scurvy was established 1927, when Szent Györgyi isolated ascorbic acid, 95 years since. He got Nobel 1937, so recognition was fast indeed. Competive theory was not a germ, but food poisoning.
Lime juice cure is another thing.


Autopsy Histopathologic Cardiac Findings in Two Adolescents Following the Second COVID-19 Vaccine Dose

Results.– The microscopic examination revealed features resembling a catecholamine-induced injury, not typical myocarditis pathology.

Conclusions.– The myocardial injury seen in these post-vaccine hearts is different from typical myocarditis and has an appearance most closely resembling a catecholamine-mediated stress (toxic) cardiomyopathy.

We shouldn’t be so hard on Michael Egnor. After all, he gave us egnorance (= ignorance + arrogance).

Singer cut and pasted from a lot of the anti-vax “priesthood” schtick out there, though disappointingly left out the “they laughed at Galileo” bit.

Singer notes ‘It may be true that, as American science fiction and fantasy writer Theodore Sturgeon said, “90 percent of everything is crap.” ‘. We should all commend Dr. Singer for his article which pinnacles at 100% pure, undulterated crap.

Not only did Singer miss the Galileo gambit, he inexplicably left out 1940s-vintage cigarette ads featuring doctor figures in white coats.

No appeal to pseudoscience is complete without them.

Damn if you’re not right about this! Where’s the cigarette ad featuring the “T”-spot and four out of five doctors recommending the cigarette?

Bozo was upset by this. He pointed out that laughing is wonderful and Bozo is good at his job.

Of course he doesn’t preach junk science either.

(Bozo is a franchised character.)

People that oppose ideas that will be eventually be accepted are useful. Claims would be properly tested. Many new ideas are actually wrong, but nobody remembers wrong ideas.
Semmelweis was opposed by traditional Western medicine, whch was another thing entirely. He could not give any explanation either.

Very good. Solid. Please keep us from the likes of former Pfizer chief science officer Mike Yeadon (who is against the C19 injections) and Dr. Robert Malone, pivotal in inventing the mRNA technology underlying the C19 injections. And DR. Peter McCullough, served on dozens of safety review boards for vaxes and other meds, 600 peer-reviewed pubs.
Oh, right – you didn’t mention any of these horrible, so-called ‘experts’ with their ‘credentials’ who are attacking the narrative. So, good, wouldn’t want anyone to hear from the likes of such doctors. Must agree with the institutions, because there is no conflict of interest or monetary possibility of pfraud, is there?

k. Bobbers:

Before you make more of a fool of yourself, I suggest that you use the search function at the top of this page.

No need to thank me, just doing my duty.

Nobody is stopping you from reading what they have to say online or watching them on YouTube. But I am more interested in relevant published research than in the opinions they share with the media.

Aside from an indirect argument from authority, which of their statements would you like to discuss? What research supports it?

k. Bobbers:
There are COVID vaccines made by companies other than Pfizer. If you don’t like Pfizer, fine (but do remember to throw out your Chapstick). But that doesn’t mean that the other COVID vaccines are somehow tainted.

Liars all.

Yeadon was not their chief science officer.
Malone was not pivotal for discovering anything, he was one of many with a minor role at best. Jealousy is toxic.
McCullough is also a member of the John Birch Society’s medical group that claims abortion causes breast cancer, global warming doesn’t exist and HIV doesn’t exist.

“Facts are stupid things.” – Ronald Reagan

when I encountered an article in Reason

Diagnosis complete.

And you know what? There bloody well should be gatekeeping in medicine! Rigorous gatekeeping, consistently applied, following the best available evidence of safety and efficacy. Because people’s lives are on the lines, and those other lives should not be mere playthings to grandiose narcs. And these fucking quacks project like IMAX. Fuck them all, and strike them off. Ideally with a broadsword.

So we will know all these horrible secrets. Have you any to report? Previous attempts are quite underwhelming,

So, johnlabarf, now that the judge has forced the FDA to spend the next 6 months ignoring all other FOIA requests, what things are the FDA going to be able to hide away for years?

If all 10 clerks spend every minute of the workday, they only have 2 minutes per page to process, redact, and record the redaction in order to meet the 55,000 page per month deadline. Unless they put in overtime, then they get a little bit more time per page. It normally takes 8 minutes to process each page. Two things are going to happen. First, exempt information is going to get released, and people are going to sue. Second, non-exempt information will get redacted, and data that ought to be released won’t be.

True enough about Reason, but Orac could have led with “Goldwater Institute fellow” as Goldwater is so much more thoroughly putrid, and the info that Singer “opposed government vaccine mandates, even for schools, five years before the pandemic”. But then, more readers might have skipped the rest of the OP…

From the length of the reply, it would appear a nerve was hit. Brevity appears not to be the soul of wit in this instance.

One notes that my post has only a slightly higher word count than Dr. Singer’s article. Just sayin’.

You must be new here.
Welcome to Respectful Insolence, where the posts are very long.

C’mon, Orac. You can’t really imagine it’s “worse” for a surgeon to spout wackadoodle than any other physician, not with the evidence of Ben Carson, Mehmet Oz and others. Isn’t surgery generally about fine motor skills, knowledge of anatomy, etc. with epistemology playing little or no role? May i suggest that you reserve any professional shame for your other role as a PhD cancer biology researcher — which I take would make for a LOT fewer occasions to put a bag over your head (which is good since most of the bags these days are plastic, not paper…)

May I also observe that Dr. Singer appears to have a problem with the truth? The authors of the libertarian-think-tank generated astroturf GBD “represent a range of political ideologies.”? Srsly? He claims, “Ioannidis’ political views are unknown.” Uh huh. He claims the GBD authors were vilified over at SBM because “they opposed the policies favored by the public health establishment and received applause from people aligned with Trump.” when the SBM critique was based on problems with the ‘science’ of the “focused protection” proposal, not who was for or agin it. To stuff that critique into the ‘elite gatekeeper priesthood’ model, he calls SBM a “journal”, rather than a blog. Typical for right-wing blowhards, he labors mightily to conflate criticism with censorship, completely ignoring the fact that SBM and RI have open largely unmoderated comment threads where the “uncredentialed” and “outside-the-box thinkers” can post pretty much anything they like. He repeats the lie again and again, that the contrarians have been attacked only because they are contrarian. Here, he defends Scott Atlas (yes, of course he goes there, I’m sure they’re buds from that Hoover/cato/Goldwater/Stanford nexus):


blockquote>Scott Atlas, a former chief of neuroradiology at Stanford Medical School, has published and critically reviewed hundreds of medical research papers. He is a member of the Nominating Committee for 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? Because this physician had the temerity to contradict the public health establishment. “He’s an MRI guy,” Ashish Jha, dean of Brown University’s School of Public Health, told NPR. “He has no expertise in any of this stuff.”


blockquote>No, Atlas was derided because 1) he was full of sh!t, and 2) he was full of sh!t in ways resulting in 10s of thousands of unnecessary deaths.

I will acknowledge that Singer has a semi-valid point about “credentialism”. While I’m sure the quote from Dr. Jha is cherry-picked, the “not an epidemiologist” or not-whatever retort that may be expressed in a Tweet-length hot take does indeed smack of a sort of gatekeeping that goes against the way science presents itself and its method. However, for the most part the critics of the contrarians only raise the matter of their credentials after demonstrating why their claims are unsupported or just downright wrong, as a possible explanation. Which is probably wrong. Singer seems blind to the fact that he is defending Atlas exactly through “credentialism”: Stanford, publications, Nobel… Oh, not to mention that Atlas was credentialed by the frikkin White House to be the actual gatekeeper of COVID policy. (Yes, irony is dead.) Jha was no doubt responding to this version of credentialism with his own, but IMHO this misses the point. Atlas’s “30-year career in academic medicine” probably should enable him to “understand and analyze public health data.” If he wasn’t subverting his ‘science’ to his ideology. That’s the problem, as it is with the credentialed contrarian epidemiologists like Kulldorff and Gupta.

Speaking of ideology… Singer writes:

[Gorski and 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.”

Note first that what Kulldorff has offered is a ‘non-denial-denial’. He doesn’t claim he’s NOT part of a well-funded ideological campaign, he just claims that politics has no relevance to judging scientific argument. As if the so-called priests haven’t offered multiple powerful scientific arguments countering the GBD’s views on the pandemic. So a Cato/Goldwater guy with the Twitter handle “dr4liberty” pretends to be holding to scientific argument over politics in an essay that is all about the supposed institutional politics of medical science and doesn’t even acknowledge, must less address the scientific arguments of the those he labels as priests… just another day in the reality inversion of the American right.

C’mon, Orac. You can’t really imagine it’s “worse” for a surgeon to spout wackadoodle than any other physician, not with the evidence of Ben Carson, Mehmet Oz and others. Isn’t surgery generally about fine motor skills, knowledge of anatomy, etc. with epistemology playing little or no role? May i suggest that you reserve any professional shame for your other role as a PhD cancer biology researcher — which I take would make for a LOT fewer occasions to put a bag over your head (which is good since most of the bags these days are plastic, not paper…)

To quote our President: C’mon, man. It’s a shtick, one that I used to use back fairly frequently between 2005-2011 or so whenever physicians or surgeons used to spout creationist nonsense. It was fun back then, but, as I so often did with my stock routines back in the day (e.g., the Hitler Zombie), I went to the well a few too many times and ran out of ideas. So sue me if Dr. Singer gave me a chance to revive an oldie just this one time.

BTW, as far as your other comments go, have you been following the discourse on Twitter? Dr. Singer really doesn’t react to criticism very well at all. He called my whole post “ad hominem” without pointing out a single thing in it that is in error and even though I never actually insulted him or called him anything. (Apparently my shtick about being really embarrassed that a fellow surgeon would write something so fractally wrong really irritated him.) As for that bit about Atlas, I didn’t even really address that. It’s hilarious, though. Dr. Atlas is a neuroradiologist, a highly specialized area of medicine. His field of practice most definitely does not qualify him to analyze public health data. Personally, I could be down with a criticism of “credentialism,” but that’s clearly not what Dr. Singer is about. He’s about such criticisms only when directed at COVID-19 contrarians. It’s a tool in his armamentarium to characterize public health scientists and physicians as a “priesthood” who are a bunch of “gatekeepers.”

Also, regarding the politics of the GBD authors, I suspect he’s taking advantage of the fact that they all seem to view themselves as “progressive.” I will admit, though, that his bit about John Ioannidis’ politics not being known is utterly hilarious.

I’m pro shtick, as I’d hope my “c’mon” paragraph would demonstrate. Can’t I play, too?

No, I don’t do Twitter. 280 character limits are not right for my idiom.

I stand by my conclusion that Atlas’s problem is
The fact he’s an arrogant right-wing ideologue, not his academic background. It’s not like he was off doing some analysis of public health data all by his lonesome and just futzed the conclusion by some newbie error. All the contrarians were working together, including those like Gupta and Kulldorff with epidemiology credentials. If these folks were just incompetent, I’d expect their errors to be randomly distributed, instead of all falling in line with the ideology of their sponsors. And if someone like me with no medical science training can follow your critiques of the (alleged) science advanced by the GBD, yes I suspect any competent actual scientist should be able to do better, especially given the prods
of warning about their missteps circulating around them.

Dr. Singer really doesn’t react to criticism very well at all. He called my whole post “ad hominem” without pointing out a single thing in it that is in error and even though I never actually insulted him or called him anything.

Grandstanding and insecure—thin-skinned narcissist, much? ISTR reading that K12 and medicine are particularly attractive professions to narcs, due to the power it gives them over pliable others. (N=1: My aunt, a nurse, was definitely on that spectrum.)

There is certainly a lot of similarity between the patterns of behavior employed by the titular Right and those of narcissistic abusers. Some are just plain old psychopaths, of course, but many demonstrate a powerful emotional component. They need, like an addict. Definitely worth reading up on how their minds work, although when it comes to dealing with it most advice is written for victims extricating themselves from under an abusive partner, not how to take down a grifter in public. Still, know your enemy and that. An addiction to adulation makes them vulnerable, as does fear of having it cut off.

The cleverer ones can be effusively charming and very good at faking caring and decency in front of others, unless that mask slips. And they have two particular weaknesses: that enormous friable insatiable ego and the complementary tendency to underestimate everyone else. And narcs cannot handle humiliation; so bonus if you can maneuver them into making fools out of themselves (the “extinction burst” event).

@ has :

” .. particularly attractive professions to narcs, due to the power it gives them over pliable others.”

Yes, yes. exactly.
Common amongst the alties I survey who cosplay as doctors and teachers which they are not educated for being at all, dictating ‘protocols’ and ‘lesson plans’ to ‘save’ followers from the machinations of evil physicians and educators (i.e. the real ones).
You’ll notice that trolls come to RI to ‘lecture’ Orac and Co and frequently refuse to identify their occupation/ education unless of course if it is totally unrelated or low level paraprofessional.

Obviously, the worst ones even go further and instruct their thralls about how / where to live, how to invest, improve relationships and educate kids/ themselves. Also, their rampant sociopathy and grandiosity reveal themselves in every sentence.
See Mike’s guides for surviving/ prepping (NN) and Gary’s Self Empowerment(PRN)

I have a good friend who is a neuroradiologist. His comment/joke is always: “If they asked for a doctor on a plane, I’d hide in the John.” He busies himself sitting in a dark basement clicking the up and down arrows on a keyboard staring at MRI images. I’m certain he would agree that he knows less about epidemiology than your average public health undergrad.

Anything affiliated with American Libertarians is suspect to me.
Everything they do is to push an agenda of turning the US over to capitalist oligarchs.
For years I wondered a little why “libertarian” blowhard Niel Boortz was on the GOP media insiders list and was often a part of the crowd of Republican talking heads. Then nne day he slipped up and admitted on his show (which I’d occasionally briefly listen to) that the purpose of the Libertarian Party was to drive the GOP further to the right.
If the general population is poor, has only enough education to be useful, and is burdened with too many problems to have the time or energy to oppose the Randian overlords then a few excess fatalities are no big deal.

I came across an excellent description of what it means to be a libertarian the other day.

Libertarians are like cats, they think they are independent and self reliant while having no understanding or appreciation of the system that sustains them.

Libertarians display all the behaviors and attitudes of spoiled five year olds: “I deserve everything you have, you don’t get anything.”

No one expects the Respectful Inquisition.

Our chief weapon is surprise…and fear.

And an almost fanatical devotion to the Priesthood of Scientific Gatekeeping…THREE things!

And highly detailed and lengthy posts… four things! …I’ll come in again.

I’m always taken by those saying the issue is that there is no democratization of knowledge, when really there is, peer review being the most obvious, however there is also a headachy of knowledge and expertise, I mean I doubt Dr Singer would most certainly not be taking advice from Walmart greeters on how he performs his surgeries even if a majority of them said he needs to things differently.

“Scurvy was understood before the mainstream medical establishment at the time admitted it and it took 100s of years for the medical scholars of the time to acknowledge it. See the parallels yet?”

Yes. Scurvy was cured by scientific investigation of the issue; Orac is the inheritor of that lesson, while you want to go back to the theories that were overthrown by the scientific method. It’s a perfect parallel. You miss the days when science wasn’t upsetting your ideas about the world, but they’re gone.

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