The Importance of Free Speech in the Medical Profession, and the Dangers of Censorship

by Theodore Dalrymple

“More than ever, society needs all clinicians to step up and speak up. Furthermore, professional organizations and state medical boards must make more robust use of their powers to take appropriate disciplinary action against clinicians who violate professional standards by spreading health misinformation,” wrote Allison M. Whelan in an article published by the AMA Journal of Ethics on March 1, 2023.

These two sentences seem to me to be in contradiction to one another. In essence, they require physicians to voice their opinions but also to face disciplinary action if their opinions happen not to coincide with the received opinions of their time. This is a very odd way of going about stimulating medical debate, which is so necessary to progress, to say nothing of freedom itself.

The two sentences would be compatible only if true science were a body of doctrine and all that lay beyond it were false, which is to say heretical. But as anyone who has ever been to a medical meeting knows, this isn’t the case. It has been said that where there are two economists, there are three opinions; the same might be said of doctors.

Controversy over many subjects remains vigorous among doctors, and in my own career, going back several decades, I have seen medical consensus on many things change. Differences of opinion are always possible, and while they may sometimes be attributable to personal antagonisms, vanity, pride, financial interest, and so forth, often they aren’t. People can disagree without any of them being ill-intentioned.

The medical profession isn’t, and has never been, without its dishonest or fraudulent practitioners: Indeed, whole histories of medicine have been written as if the profession had been composed exclusively of fools and frauds. In my experience, though, persons with bees in their bonnet (I’ve had a few myself) are more common in the profession than outright frauds, and sometimes they have been right, against the opinion of the massed ranks of their colleagues. Ignaz Semmelweis, for example, believed that the puerperal sepsis that more than decimated the mothers of Vienna in the maternity hospital there was spread by the unwashed hands of the doctors who attended them, and he ended up driven into a lunatic asylum by his colleagues who weren’t grateful for his absurd, though actually correct, idea.

What counts as misinformation isn’t straightforward, as the author of the paper I have quoted acknowledges, but she’s especially concerned that those doctors connected in some way with politics or government shouldn’t pass on misinformation, as they’re likely to be seen as being in authority. The examples of misinformation that she gives are unfortunate, however.

For example, she quotes Dr. Scott Atlas, a radiologist, who wrote in a tweet that masks didn’t work in protecting against or preventing the spread of COVID-19, this going against “guidance from the Centers for Disease Control and Prevention (CDC).”

But guidance from the CDC isn’t in itself evidence of the justification of that guidance, and a recent Cochrane review (the nearest to a disinterested and objective review of medical evidence as is to be found in this wicked world) came to the conclusion that evidence in favor of masks was lacking. The review itself has been criticized by scientists who came to an opposite conclusion, but the point here is not that one side or the other is right, but that Atlas’s view could hardly in the circumstances be called misinformation, though his views were removed from Twitter as having been such. Being censored by Twitter, however, is also not evidence in itself of having spread misinformation.

The paper in AMA Ethics continues:

“Atlas espoused many controversial and questionable positions about COVID-19, clashing frequently with public health officials. Among other things, he promoted a disputed and potentially dangerous approach to herd immunity, suggesting it could be achieved by allowing the virus among healthy Americans. Many public health experts believed such an approach could result in the deaths of hundreds of thousands, if not millions, of Americans. Officials from the World Health Organization (WHO) called such a strategy ‘very dangerous.’”

This passage suggests a touching faith in the knowledge and wisdom of “public health experts” and the WHO. In fact, in many countries, the wisdom of the drastic lockdowns that were imposed, with almost medieval severity, is now being questioned. I came to the conclusion that selective protection of the vulnerable (of whom, by virtue of my age, I would have been one) would have been better. But again, the question here isn’t who was right, but whether Atlas should have found himself censored for having uttered an unorthodox view—even if that view were mistaken.

John Stuart Mill, in his great philosophical polemic “On Liberty,” argued that no opinion, no matter how wrong, should be suppressed, because it’s from the clash of opinion that truth, or something more approximating to it, emerges. This is a utilitarian argument for freedom, and a slightly dangerous one, because there are surely some opinions that are so absurd that they aren’t worth refuting, and might be suppressed without any loss of utility. If I were to propose that the Pacific Ocean were made of melted blue cheese, no one would bother to investigate in order to refute it, and humanity would lose nothing if I were shut up and prevented from expressing my opinion on that subject. Mill might retort that overall humanity would suffer if it weren’t made a rule that opinions weren’t to be suppressed, since if you start by suppressing the fatuous you will end by suppressing the useful, but I know of no way either to prove or refute this.

What most alarmed me about the paper in AMA Ethics was that there was expressed in it no attachment to freedom of opinion as a good or desirable thing in itself, independent of its effects: in other words, that freedom is an end in itself, an extremely important value. Even if the CDC, the WHO, or the majority of expert medical opinion were invariably right, it would not be a reason for suppressing dissent by resort “to robust use of [licensing authorities’] powers to take appropriate disciplinary action” by, for example, depriving dissidents of their livelihood. The Soviet Union, it sometimes seems, won the Cold War.