Any science-based physician or skeptic who dips their toe into the waters of countering quackery, antivaccine activism, and anti-(conventional) medicine propaganda will very soon run into a concept known as “medical freedom” or “health freedom.” (The two terms tend to be used more or less interchangeably, and I will probably do the same.) The concept basically argues that personal autonomy to do what one wishes with their own body trumps science and, as a result, a person should be able to choose any treatment desired, regardless of whether it’s based in science or not or even whether there’s any evidence that it works or not.
While I have been, to some extent, sympathetic to this sort of view, having frequently said that a competent adult can choose no treatment or ineffective treatment, I always included a caveat, namely that the person had to be properly informed of the evidence showing that their chosen treatment doesn’t work and what the consequences of choosing no treatment or quack treatment are likely to be. From my perspective, much of the problem with the “medical freedom” movement is that in practice it often provides a license to hucksters and quacks to ply their trade selling snake oil in that it opposes regulation that would prevent quacks from defrauding people by claiming that their quackery works and then profiting. There’s a reason why I frequently say that “health freedom” in practice means freedom for quacks from any sort of pesky regulation that would keep them from selling ineffective “cures” by falsely claiming that they work—and work miraculously.
This brings me to a post that I saw the other day at the Brownstone Institute, the “free market” and “medical freedom” think tank founded by Neo-Confederate hack Jeffrey Tucker (discussed the other day for his contribution to the Great Barrington Declaration, which promoted “natural herd immunity” and thereby did massive damage to public health). It’s written by someone named Dr. Clayton J. Baker and entitled What is Medical Freedom, Exactly? Naturally, faced with such an article, I can’t resist comparing and contrasting what a Brownstone flack thinks medical freedom is compared to what it really is in practice. As you will see, Dr. Baker pontificates using a whole bunch of unobjectionable bromides about “freedom” and “personal autonomy” that are at odds with what advocates of “health freedom” actually do in practice.
First, I was amused at how much umbrage Dr. Baker took at how “medical freedom” or “health freedom” has been characterized:
For what it’s worth, Wikipedia does not have an entry for “medical freedom” as of this writing. However, it defines “health freedom” as follows: “The health freedom movement is a libertarian coalition that opposes regulation of health practices , and advocates for increased access to “non-traditional” health care.”
It goes on to associate said movement with such luminaries as former Congressman Ron Paul, former Beatle Paul McCartney, and yes, the John Birch Society.
In the mainstream media, starting about 2 years ago – soon after the onset of the Covid-19 vaccine mandates – published articles appeared that characterized “medical freedom,” at least in part, as a sort of rallying cry for right-wing militia initiatives.
All of this is, of course, inarguably true. “health freedom” and “medical freedom” have become a rallying cry for libertarians, far right wingers, and even outright fascists. Indeed, the Republican Party has become a bastion of antivaccine and anti-public health hostility, a process that actually predates the pandemic by at least several years. “Health freedom” and “medical freedom” have always been code words for dismantling public health infrastructure, anything resembling a vaccine mandate (even in schools), and dismantling the FDA. That latter goal is justified in the name of “getting cures to the people faster” because, supposedly, the FDA kills more people than it saves through its overweening regulation and particularly pesky regulations requiring that manufacturers demonstrate efficacy and safety before they can market a drug or device. Some even think that a “Yelp for drugs” would be better than large phase three clinical trials. I also can’t help but note that right wing militias had already started marching with antivaxxers several months before the COVID-19 pandemic actually arrived in the US. Of course, the optics of this association are embarrassing to Dr. Baker (and Brownstone), even though they appear to share these beliefs; so Dr. Baker has to try to claim that “medical freedom” doesn’t mean these things.
He also doesn’t like another clearly factual aspect of “medical freedom” and “health freedom”:
More recently, with public distrust in vaccines reaching historic highs, the media has shifted its characterization of medical freedom from a domestic terror threat to a cabal of ingenious and industrious hucksters. (After all, how can a few crackpot far-right militiamen sway mass public opinion so successfully?)
In a March 24, 2023 article, the far-left magazine the Nation described “The Medical Freedom Hustle” as follows:Under the great dispensation of our new age of medical freedom, these disparate forces—ambitious Republican politicians, self-interested medical professionals, profiteering quacks, and nihilist visionaries—have melded.It would be a subject for another day and another essay to unpack all the psychological projection concentrated in that quote. Suffice it to say that the traditional far-left – insofar as outlets like The Nation represent it – has come to characterize “medical freedom” largely as a kind of scam or confidence game, allegedly designed to draw the population away from legitimate mainstream medicine and toward the folly of snake-oil and naturopathic quackery.
Amusingly, I couldn’t have put it better myself than how Matt Hongoltz-Hetling put it in that article. You really should read the article yourself. It’s basically what I’ve been saying for 20 years about the “health freedom” movement, that it in reality, rather than meaning freedom to choose how one treats one’s body, in practice it really means freedom for quacks to defraud people. Indeed, before moving on to how Dr. Baker defines “medical freedom,” I can’t resist quoting this passage from Hongoltz-Hetling’s article:
Medical freedom wasn’t an entirely new idea, of course, but the proliferation of One True Cures in the Internet age gave rise to a whole class of American entrepreneurs who had a vested financial interest in beating back the regulations that were designed to protect the public. Fueled by their raw energy, the Health Freedom Expo was an enormous success for all involved, spawning dozens of similar events across the country. In evolutionary terms, if the Internet caused the medical quack to become so immensely prolific that regulatory predators couldn’t keep pace, the medical-freedom activists now invited them to herd up and act as one for mutual protection and benefit.
Thanks to these sorts of grassroots actions, diverse sellers of One True Cures began speaking in a single voice. When the disgraced pH Miracle Diet guru Robert Young had a chance to meet President Barack Obama at an event, he didn’t start talking about the science of acid and alkaline diets. “Freedom is a God-given right,” he told the president. “It’s about the right to choose between complementary or alternative or conventional treatment.” Other alt-health entrepreneurs enthusiastically joined the chorus. Toby McAdam said he merely wanted to exercise his rights to sell supplements that he said could treat various cancers and prevent radiation poisoning ; Larry Lytle argued that the ability to purchase lasers to heal virtually any disease of the mind or body was “a private right”; and Pentecostals like Dale and Leilani Neumann began defending faith healing as an exercise of their constitutional religious rights.
As sellers of One True Cures were converted into medical-freedom advocates, a side effect was the creation of a political space that welcomed the fringe actors remaining in the anti-vaccine movement. They were, like alternative healers, eager to move on from scientific debates and instead talk about the rights of Americans to choose. And they were happy to point to One True Cures as solutions to the communicable diseases that vaccines were designed to prevent.
As I like to say, every accusation from people like Dr. Baker and groups like the Brownstone Institute is actually an admission. As if to contrast what “medical freedom” really is compared to what the “far left” claims it is, Dr. Baker cites Florida Governor Ron DeSantis’ legislation that prevents businesses from requiring proof of vaccination of customers or employees, thus gutting one major component of public health during a pandemic. He also cites additional Florida legislation banning “gain of function” research, which isn’t really related to “medical freedom” per se, but rather to conspiracy theories about SARS-CoV-2 supposedly having come from a “lab leak.” Ditto his citing medical “freedom of speech,” given that quacks have always wielded “freedom of speech” as a defense whenever the law or medical societies have tried to enforce professionalism and quality control on quacks or whenever quacks face criticism for advocating, well, quackery. Dr. Baker approves of such measures based their supposedly addressing what he sees as three big problems:
These are 1) the medical and public health infringement on citizens’ fundamental civil liberties, 2) the systematic and oppressive control and silencing of physicians during the pandemic, and 3) the apparently out-of-control, dangerous, and unethical research that spawned the pandemic in the first place.
One can argue what the proper balance is between civil liberties and public health during a public health emergency in the form of a pandemic, but that’s not what Dr. Baker is doing. Rather, he is arguing that personal liberties should be, in essence, absolute, public health be damned. As for #2, quality control and enforcing professional standards do not equal “censorship” or “silencing.” And, of course, #3 is a conspiracy theory that evidence does not support.
So let’s see how Dr. Baker defines “medical freedom.” Predictably, he refers to the Bill of Rights and everything “American” to justify what he calls the “three-legged stool” of “medical freedom”:
Medical freedom is a moral, ethical, and legal concept, essential to the just and proper practice of medicine, that asserts the following:
- The individual patient’s autonomy over his or her own body with regard to any and all medical treatment is absolute and inalienable.
- Physicians and public health officials do not possess the authority to deprive any citizen of their fundamental civil rights, including during a declared medical emergency.
- The four fundamental pillars of medical ethics – autonomy, beneficence, non-maleficence, and justice – are essential to medical practice and must be observed at all times by all physicians, nurses, public health officials, researchers, manufacturers, and all others involved in health care.
Let’s unpack these “legs” on the “three-legged stool” or central “pillars” of “medical freedom” one at a time. The first principle sounds perfectly reasonable on the surface, but what Dr. Baker fails to mention is that there are two things often glossed over. Before I get to that, though, if one’s autonomy over one’s body is “absolute and inalienable,” then I would assume that Dr. Baker would also argue that the right to abortion or suicide falls under this principle. (Somehow, I bet that he wouldn’t.) Or that transgender people should have an absolute right to gender-affirming care. (Somehow, I doubt that he supports transgender people having full and unfettered access “any and all medical treatment.”)
What’s glossed over are a couple of other things. First is true informed consent. Antivaxxers frequently warp the concept of informed consent into what I like to refer to as “misinformed refusal” of vaccines based on misinformation portraying vaccines as ineffective and dangerous. That is one element that Dr. Baker has no doubt contributed to by promoting disinformation of the Brownstone variety on vaccines and masks. (Just peruse his articles at Brownstone if you don’t believe me. Vaccines as “depopulation” through sterilization, anyone?) Another element is the consideration, often ignored by antivaxxers, of children as autonomous beings with their own rights who deserve protection when their parents decide that their “medical freedom” includes the “freedom” to medically neglect their children by denying them vaccines or effective treatment for diabetes, both serious and easily treatable infections, and even cancer.. Also, no right is absolute, as Hongoltz-Hetling pointed out in the “far left” article that Dr. Baker hates:
The guiding principle of medical freedom is that a person’s health and safety are the sole concern of the individual, not the government—a bit of ideological boilerplate that pretty much refutes the whole modern history of disease treatment and eradication. All you have to do is Google “Typhoid Mary” to grasp the real-world limitations of this fancy—it’s a simple fact of life that society has a significant stake in an individual’s health. In 1980, Massachusetts court stoutly affirmed this principle in a case involving mandatory helmet laws for motorcycle riders. “From the moment of the injury, society picks the person up off the highway; delivers him to a municipal hospital and municipal doctors; provides him with unemployment compensation if, after recovery, he cannot replace his lost job; and if the injury causes permanent disability may assume the responsibility for his and his family’s continued sustenance. We do not understand a state of mind that permits a plaintiff to think that only he himself is concerned.”
I suspect that targeted surveying would reveal that 100 percent of healthy libertarians proclaim their intentions to do without all these luxuries, while 100 percent of libertarians lying injured on the pavement admit that, yes, such societal services are kind of necessary, now that they think of it.
I forgot to mention mandatory auto seatbelt and motorcycle helmet laws. In any event, the idea that any individual right is absolute is a key fantasy of libertarian “thinking,” which is no doubt why Dr. Baker’s second principle comes into play, his assertion that no one possesses the “authority to deprive any citizen of their fundamental civil rights, including during a declared medical emergency.” Contrary to the Brownstone’s frequent depiction of public health officials as jack-booted fascists advocating endless “lockdowns” akin to what the authoritarian Chinese government imposed, here in the US there was always a debate about personal liberty versus public health. Moreover, “lockdowns” (such as they were, given that governments were doing everything they could to open back up by late summer/early fall of 2020 and the mask mandates—and later vaccine mandates—instituted in their place were hardly the horrific affronts to liberty portrayed by Brownstone) were always weighed against the cost to personal freedom and the economy. Also, again, no right is absolute, and personal rights have always been weighed against public health and interest as in, for example, laws against indoor smoking. Dr. Baker’s argument boils down to arguing that someone carrying an infectious disease should be allowed to spread it because that person’s personal rights override the rights of everyone else around him, regardless of the harm that is caused.
Let’s just say that there’s a lot of “lockdown” revisionism going around, thanks to people like Dr. Baker.
As for Dr. Baker’s third leg of his “medical freedom” stool, that the
“four fundamental pillars of medical ethics – autonomy, beneficence, non-maleficence, and justice – are essential to medical practice and must be observed at all times by all physicians,” no one is arguing that they should not be observed. Because I have been involved in clinical research and clinical trials throughout my career, I immediately recognized where two of those four principles of medical ethics came from and that two of them (beneficence and non-maleficence, were basically two sides of the same principle.
In case you’re wondering where these pillars come from, Dr. Baker is basically paraphrasing the principles laid down in the 1970s in the Belmont Report, a document that discusses ethical principles as applied to medical experimentation using human subjects, not accepted medical practice. I can’t help but wonder whether Dr. Baker had intentionally done this in order to imply, not-so-subtly, that nonpharmaceutical interventions (NPIs), treatment, and vaccines as applied to the pandemic were medical experimentation. I acknowledge that this could just be my overthinking it, with Dr. Baker just latching onto these principles because they sounded good to him. I also can’t help but wonder why he didn’t cite the much more up-to-date and current “state of the art” with respect to medical ethics governing human subjects experimentation, the Helsinki Declaration, which is periodically updated as ethical principles evolve and become more stringent. The Belmont Report was definitely a landmark in medical ethics, but it is certainly not the be-all and end-all anymore.
Whatever Dr. Baker’s intent in paraphrasing it, the Belmont Report lists three basic ethical principles that must govern human subjects research:
- Respect for persons. This includes autonomy but the Belmont Report also states that “persons with diminished autonomy are entitled to protection.” Leaving aside that the Belmont Report is about research more than it is about practice, those with diminished autonomy include children. Also, arguably, in a pandemic, this principle could easily be used to argue that people who cannot avoid being out and about—and therefore frequently exposed to the virus—deserve some protection in the form of measures that can decrease the transmission of the pandemic virus, like…oh, you know…masking, social distancing, good ventilation and air filters, vaccine mandates for workers, and the like, all measures that Brownstone has vehemently opposed. Dr. Baker’s idea of “autonomy” above all is not true “respect for persons,” which is probably why he wrote “autonomy” rather than “respect for persons” and didn’t quote the Belmont Report directly.
- Beneficence. Let’s quote the Belmont Report here: “Persons are treated in an ethical manner not only by respecting their decisions and protecting them from harm, but also by making efforts to secure their well-being. Such treatment falls under the principle of beneficence. The term “beneficence” is often understood to cover acts of kindness or charity that go beyond strict obligation. In this document, beneficence is understood in a stronger sense, as an obligation. Two general rules have been formulated as complementary expressions of beneficent actions in this sense: (1) do not harm and (2) maximize possible benefits and minimize possible harms.” I would argue that Dr. Baker’s definition of “beneficence” for purposes of his argument is, as his invocation of “autonomy,” quite incomplete in a manner that ignores society at large and in particular the vulnerable.
- Justice. Let’s quote the Belmont Report again: “Who ought to receive the benefits of research and bear its burdens? This is a question of justice, in the sense of ‘fairness in distribution’ or ‘what is deserved.’ An injustice occurs when some benefit to which a person is entitled is denied without good reason or when some burden is imposed unduly.” I can’t help but point out that the “autonomy über alles” approach advocated by Brownstone and Dr. Baker clearly violates the principle of justice in that it requires those at the bottom of society’s ladder (such as workers who cannot do their jobs remotely and have to deal with the public) to bear the burdens unequally in the form of greater exposure to the virus, without even minimal efforts to decrease their exposure through mask mandates, social distancing, ventilation, and other NPIs designed to decrease the spread of the virus.
In light of these principles, a number of Dr. Baker’s formulations are basically straw men, or at least deceptive. For example:
Truth-telling. Physicians and health officials are duty-bound to tell the truth. Willful deviation from this violates patient autonomy, and must result in professional discipline.
I totally agree with this principle, actually. After all, who can argue against truth-telling with respect to disease and medicine? However, Dr. Baker is being deceptive here in that he means “truth telling” in a specific way that excludes what he and Brownstone (and many quacks) do. What I don’t agree with is the libertarian interpretation of this principle to mean that quacks can promote quackery and antivaxxers can promote dangerous pseudoscience and misinformation because they are “truth telling.” In fact, I would argue that quacks violate patient autonomy all the time by telling them incorrect medical information and should therefore be subject to the very professional discipline that Dr. Baker advocates for physicians who don’t tell the truth about diseases and medical interventions. Indeed, I would go even farther and argue that this very principle demands that quacks—such as Dr. Peter McCullough, for example—lose their medical licenses and professional certifications. Again, this is quality control, not censorship.
Dr. Baker’s take on beneficence is a bit…slanted as well:
Beneficence requires that all treatments given to a patient should be done only when the prospect, intention, and likelihood of providing genuine benefit to that patient exists. There must be no “taking one for the team.”
This is an obvious straw man about vaccines, and, of course, vaccines were recommended (and sometimes mandated) with the intent that they would benefit the patient, as well as those whom the patient interacts with. I also can’t help but point out that the entire idea behind the Great Barrington Declaration that, if we just let COVID-19 run through the population in order to achieve “natural herd immunity”—in six months, yet!—was to require young (and presumably healthy) people to “take one for the team” and get infected, the better to speed up the process of “natural herd immunity” for society. The rationale behind this approach was that these people were at very low risk for complications and death.
However, “low risk” does not mean zero risk. The GBD, at its heart, advocated that large numbers of “young and healthy” people endure an illness that could range from asymptomatic to mild to so severe that it would threaten their lives, with the knowledge that some of them would die, all in order to reach “natural herd immunity” that would benefit society and protect the “vulnerable.” If that isn’t “taking one for the team,” I don’t know what is. Remember, “We want them infected” was the slogan of “natural herd immunity” advocates. Dr. Baker is thus very selective in how he views what constitutes forcing people or patients to “take one for the team” so that it’s fine if society does it the Brownstone way but not fine to do it through vaccine mandates.
It’s not for nothing that I am reminded of a famous scene from the movie Shrek:
Dr. Baker’s concept of “justice” with respect to pandemic interventions is also rather…slanted:
Justice requires that both the benefits and burdens of medical care must be distributed equally throughout the population. A new emphasis on the protection of vulnerable populations, especially children, is essential.
Funny, but GBD-inspired “natural herd immunity” also demanded that children, always considered a vulnerable population under medical ethics principles, be infected in order to achieve “natural herd immunity” so that schools could be reopened faster, as Dr. Jerome Adams, Surgeon-General under President Trump, recently railed against.
Again, I note that, yes, the risk to children from COVID-19 is relatively low, but nowhere near zero. Children can and do die of the disease, even previously healthy children, to the point that COVID-19 is now a major killer of children.
Then, of course, there is this:
Protocols. The mandated or coerced use of strict or inflexible protocols in medical practice must be prohibited. Variation from protocols, to allow for individualized patient care decisions, must be allowed.
In actuality, this was always true. Early in the pandemic, there was no playbook, and doctors tried protocols that seemed reasonable based on existing knowledge. Heck, it’s why hydroxychloroquine was part of the standard of care in some hospitals (including one where I practiced) in March 2020 but was abandoned by summer 2020 as evidence increasingly showed that it didn’t work. Basically, once clinical trials and further epidemiological evidence was accumulated, medicine—as medicine does—became less tolerant of “informed experimentation” by brave maverick doctors and started insisting on science- and evidence-based protocols that had developed as a result of experimentation and clinical trials with the actual SARs-CoV-2 virus and patients with COVID-19. Basically, an appeal to “individualized patient care” has long been a favorite trope used by quacks and cranks to attack conventional science-based medicine and advocate for their quackery.
In fact, that’s exactly what Dr. Baker is doing with his definition of “medical freedom,” recycling very old quack tropes about patient autonomy, “freedom of speech,” and the “individualization” of treatments used by quacks. He thinks he’s saying something new, but in reality he’s just saying the sorts of things that antivaxxers like Andrew Wakefield and cancer quacks like Stanislaw Burzynski have been deceptively arguing for decades.
Same as it ever was.
Does Dr. Baker know that? Who knows? Even if he does, he probably doesn’t care because his infantile version of “freedom” matters more to him than the messy, complicated discussion of how to balance individual freedom with that of others and the good of society.