Final week, SBM blogger Dr. Jonathan Howard took notice of a submit on (not-so) Smart Drugs by Edward H. Livingston, MD, FACS entitled The Semmelweis Impact and The Nice Barrington Declaration. Dr. Howard identified, fairly appropriately, that Dr. Livingston seems to not have had clue one about what the Nice Barrington Declaration really stated and proposed. Why do we are saying this? In his submit, Dr. Livingston by no means even talked about that the central idea behind the GBD was to cease all these nonpharmaceutical interventions (NPIs), similar to college and enterprise closures, getting used to gradual the unfold of the virus in favor of “opening up” society and permitting mass an infection of the “younger and wholesome,” who have been presumably at low danger for extreme illness and loss of life from COVID-19. The rationale was, in response to the GBD authors, that doing so would enable us to achieve “pure herd immunity” extra quickly; certainly, they promised “pure herd immunity” in 3-6 months if their suggestions have been adopted. However what about those that have been at excessive danger of extreme illness and loss of life from COVID-19, such because the aged and people with varied persistent illnesses that made them excessive danger for issues and loss of life? The GBD proposed “centered safety” for them with out ever really proposing any distinctive, concrete, sensible strategies to really shield the weak. Keep in mind, additionally, that the GBD was printed in early October 2020, which was greater than two months earlier than the mRNA vaccines turned out there to healthcare employees beneath an emergency use authorization in December 2020. (I bought my first dose on December 18, 2020, the primary week the brand new vaccines have been out there in my space.) Actually, the GBD was profoundly social Darwinist at its core.
In fact, the GBD was by no means a critical coverage proposal. Quite, it was propaganda, an inventory of calls for, custom-designed to present a scapegoat for failures of pandemic coverage. Moreover violating primary rules of public well being in a pandemic, the GBD additionally by no means would have labored, as a flack on the Brownstone Institute (the “non secular youngster of the GBD”) tacitly admitted three years in the past, and it arguably did nice hurt to public well being in quite a few international locations. Sadly, one of many three authors of the GBD, Stanford well being economist Dr. Jay Bhattacharya, is now poised to develop into the Director of the Nationwide Institutes of Well being, because of his being nominated by President-Elect Donald Trump, possible on the behest of Robert F. Kennedy, Jr. Because of this, his apologists are frantically attempting to gaslight you about his historical past, similar to when he and fellow GBD co-author Martin Kulldorff appeared at an antivax convention in 2022 organized by some of the ridiculously foolish and deranged antivaxxers of all, Steve Kirsch.
As you may think, it’s not simply sufficient to gaslight. No. Bhattacharya’s defenders at the moment are going out of their strategy to symbolize him as a courageous maverick, as somebody whose concepts have been “confirmed proper” (as evidenced by his nomination), as a rejected, ostracized genius on par with—you guessed it!—Ignaz Semmelweis, and Dr. Livingston embraces this comparability whole-heartedly. Despite the fact that Dr. Howard has mentioned the most important evident error in Dr. Livingston’s submit, particularly his apparently ignorance about what the GBD really stated in favor of declaring the GBD (and thus Dr. Bhattacharya) as having been “vindicated” after supposedly small-minded assaults by dogmatists who have been threatened by his concept, I believed I’d talk about this as nicely, however from (hopefully) an angle sufficiently totally different that you simply don’t view my dialogue as a retread. Mainly, I wish to talk about this as a part of the seemingly determined want that cranks need to be seen as “Semmelweis” or a “persecuted genius” who at some point will likely be vindicated.
Let’s begin with Dr. Livingston’s comparability.
Invoking Ignaz Semmelweis
Dr. Livingston units the stage by explicitly likening Semmelweis’ discovery to the GBD. Refined, he isn’t:
The story is usually informed in medical college about Ignaz Semmelweis, the Hungarian obstetrician who found that hand washing with chlorine diminished maternal mortality from puerperal fever. An intervention seemingly so easy and apparent however when first proposed within the 1840s, the consultants of the day not solely rejected it, however condemned Semmelweis as a heretic. The parallels between Semmelweis’s story and the Nice Barrington Declaration (GBD) authors recall the adage that historical past might not repeat itself, but it surely positive rhymes.
Right here’s the factor that’s typically forgotten about this story, particularly that it was not so apparent on the time that this intervention ought to work. I’ll elaborate, however first let’s see the place Livingston goes with this comparability:
Within the 1840’s, Semmelweis was the equal of a modern-day Chief Resident (sans work hours limitations) on an obstetric ward at Vienna Basic Hospital. Doctor-led wards had a lot larger puerperal fever charges than did the adjoining wards staffed by midwives.
Autopsies have been frequent again then. Physicians, not midwives, attended autopsies and rotated incessantly all through the day between the post-mortem and supply rooms. A pal of Semmelweis minimize his finger throughout an post-mortem. He developed sepsis similar to puerperal fever and died. Given the similarities between the best way his pal died and loss of life from puerperal fever, Semmelweis thought that there should be some pathogen transmitted by lifeless tissue inflicting sepsis. He famous the odor of loss of life was on his arms after performing an post-mortem and that this odor didn’t put off standard hand washing with cleaning soap and water. The odor could possibly be eradicated with chlorine. Semmelweis then adopted a chorine-based hand washing routine leading to a marked lower in puerperal fever on his ward.
Semmelweis spent the following 20 years attempting to persuade the obstetric group of the advantages of chlorinated water washing. He was ignored. Luminaries of his time similar to Virchow, of node fame, chastised Semmelweis believing that puerperal fever was a manifestation of venous thrombosis brought on by irregular uterine contractions. It’s stated that Semmelweis went insane as a result of his life-saving discovery was rejected by the tutorial group. He died in an asylum.
That’s the standard mythology of Ignaz Semmelweis. Nonetheless, as is normally the case, historical past is not as clear, not as cut-and-dried, as represented by Dr. Livingston. At any time when “courageous mavericks” attempt to declare that their concepts are being unfairly rejected by dogmatic scientists and physicians by invoking the story of how Ignaz Semmelweis’ outcomes have been rejected and he was ostracized by some physicians, I wish to level out that his work preceded Louis Pasteur’s seminal work that led to the acceptance of germ idea by practically 20 years and Joseph Lister’s work by even longer. In different phrases, on the time Semmelweis did his preliminary examine there was no theoretical mechanistic framework to clarify why failure to scrub one’s after doing autopsies after which going to ship infants might lead to a a lot larger danger of puerperal fever, a lot much less why washing with chlorine labored. (It’s not as if medical doctors didn’t wash their arms after doing autopsies again then.) In 2025, such an evidence appears brain-meltingly apparent. Not a lot in 1847, when Semmelweis printed his preliminary outcomes), and, opposite to Dr. Livingston’s telling, Semmelweis didn’t suggest a “pathogen.” Quite, he needed to posit that unspecified “cadaverous particles” have been accountable. He fortuitously did select an answer of chlorinated lime (calcium hypochlorite, a type of bleach) for laundry arms between post-mortem work and the examination of sufferers primarily as a result of it removed the odor from the cadavers, and luckily it additionally was a sufficiently good disinfectant to get rid of a lot of the microorganisms inflicting puerperal fever. He had no manner of understanding that that’s what it did, although.
Furthermore, Semmelweis wasn’t precisely right; actually he was fallacious about lots of issues. Whereas he was right that washing with chlorine earlier than attending childbirth would vastly lower the chance of puerperal fever, he was fallacious when he tried to clarify why. For instance, when it was noticed that, even with essentially the most meticulous chlorine handwashing, there was nonetheless a mortality fee from puerperal fever of about 1%, which Semmelweis defined by suggesting that self-infection passed off, particularly that internally generated cadaveric particles have been accountable, similar to from tissue crushed within the delivery course of and finally turning gangrenous. Semmelweis additionally thought that “cadaveric particles” have been the first reason behind puerperal fever, though it was (and is) micro organism, similar to streptococcus infections, both kind A, which is usually discovered within the throat and nasopharynx of in any other case wholesome carriers, or kind B, which lives on the pores and skin. Semmelweis additionally didn’t assist himself by not publishing straight away, though he and his college students did write letters to administrators of a number of outstanding maternity clinics describing their current observations. He helped himself even much less later in his profession by writing open offended letters to outstanding European obstetricians, at instances denouncing them as irresponsible murderers.
Curiously, Semmelweis was not rejected all over the place. For instance, after his lecture to the Medical Society of Vienna in 1850, documented by Dr. Heinrich Herzfelder, the First Secretary of the society:
Herzfelder additionally famous that Semmelweis’ views have been opposed by Lumpe and Zipl, who argued that the info supported a miasmatic reason behind childbed fever, however was supported by Chiari, Arneth, Helm, and Hayne.1,2 He concluded by saying that the place taken by Lumpe and Zipl, in addition to by Scanzoni and Seyfert, have been adequately refuted by Semmelweis’ resolution to the issue, which, he stated, “will be thought of a triumph of medical analysis.”
As I’ve identified quite a few instances, although, none of that is to say that the story of Semmelweis is actually that he introduced all of the criticism and ostracism on himself, revisionist historical past documented within the similar article above however. He did go towards the prevailing scientific concepts of the day and did obtain lots of pushback, on condition that germ idea, which might have defined his outcomes, was nonetheless no less than a few many years away from widespread acceptance. His is certainly a cautionary story of of how medical dogma can react to unexplained findings, main some to name him, not Joseph Lister, the true father of asepsis and to take a position that if Semmelweis hadn’t died so younger he would have lived to see his findings vindicated by means of the work of Louis Pasteur, Joseph Lister, and others.
In fact, the easy model of Semmelweis’ historical past suits Dr. Livingston’s narrative much better, main him predictably (given my previous expertise with invocations of Semmelweis) to start out recounting examples of what he considers the “Semmelweis impact” (extra generally often called the Semmelweis reflex), which includes the reflexive dismissal of concepts and proof that go towards present consensus. Nor would I low cost the Semmelweis reflex as a serious drawback within the psychology of scientists. That being stated, a few of his examples are…questionable. As an illustration:
The issue of recent concepts being rejected by consultants is so pervasive it ought to have its personal time period, one thing just like the Semmelweis Impact. The Semmelweis Impact originated in Vienna however about 100 years later in close by Germany, historical past repeated itself. A German surgeon, Eric Muhe, developed a brand new method for gall bladder elimination in 1985 utilizing telescopic devices launched into the stomach by means of a collection of small incisions – the primary laparoscopic cholecystectomies. Muhe reported his first 100 instances to varied German medical societies. Not solely was his new method to cholecystectomy rejected by his colleagues, however he was charged with homicide in 1987 when certainly one of his sufferers died of a complication unrelated to the laparoscopic method process.
For a few years, the French surgeon, Phillipe Mouret, was credited for inventing laparoscopic cholecystectomy a full two years after Muhe. As a result of Muhe was so completely discredited by his colleagues for performing what the Germans on the time thought of harmful and irresponsible surgical procedure, Muhe’s achievement went unrecognized for a few years.
I lived by means of the transition from open cholecystectomy to laparoscopy cholecystectomy. Certainly, I used to be a resident on the time. Once I went into the lab to do my PhD in Nineties, old style open cholecystectomy nonetheless reigned. Once I got here out of the lab in 1993, laparoscopic cholecystectomy had taken over, and I discovered myself embarrassed that, in contrast to different third 12 months residents, I had no expertise with the laparoscope and even simply “driving the digital camera,” which is what the assistant does, preserving tings in view by shifting the digital camera round as wanted. If something, laparoscopic cholecystectomy is a cautionary story in regards to the widespread adoption of a process earlier than its security was correctly vetted in medical trials. When you learn in regards to the historical past of laparoscopic cholecystectomy, you’ll discover that its reputation far preceded the proof for it. Its adoption was the very epitome of hype earlier than proof, with established surgeons frantically studying the process as a result of, in the event that they didn’t, their sufferers would go to surgeons who might do the process. Thankfully, proof did finally justify the prevalence of the process, particularly after the adoption of the vital view of security, which vastly decreased the incidence of frequent bile duct accidents related to the process, but it surely might have gone the opposite manner. Odd, then, that Dr. Livingston compares Muhe to Semmelweis.
Dr. Livingston then rattles off some extra questionable examples:
The Semmelweis Impact stays stubbornly frequent. The Impact was in play with PCR’s invention by Kary Mullis, discovery of the ldl cholesterol receptor by Brown and Goldstein, with accepting that H. Pylori causes gastroduodenal ulcer illness (Barry Marshall), and figuring out dietary deficiencies as inflicting pellagra (Joseph Goldberger). The notion that tobacco smoking causes lung most cancers was vigorously opposed by Sir Ronald Fisher, maybe essentially the most well-known statistician, due to inconsistencies within the knowledge supporting that speculation.
I’m undecided what the heck he’s speaking about concerning Kary Mullis; he was awarded a Nobel Prize with co-inventor Michael Smith for his invention of PCR. Barry Marshall is a generally cited instance as nicely, but it surely seems that his “rejection” was very a lot overblown. (Humorous that Dr. Livingston doesn’t point out Robin Warren, who labored with Marshall.) It’s true that Barry Marshall and Robin Warren first reported a curious discovering of what they described as “unidentified curved bacilli on gastric epithelium in energetic persistent gastritis” (not an ulcer) in two letters to The Lancet, printed on June 4, 1983. They reported that it wasn’t seen utilizing conventional staining strategies and urged that they may be related to gastritis. By 1992, a number of research had been printed establishing the causative function of H. pylori in peptic ulcer illness, and medical follow quickly modified. That’s lower than ten years, which, given how lengthy it takes to prepare and perform medical trials, is amazingly quick. But someway a favourite denialist fable is that “dogmatic,” “close-minded” scientists refused to just accept Marshall and Warren’s findings. It’s an instance of a scientific consensus that deserved to be questioned, was questioned in the correct manner, and was overthrown—and quickly, too. Though there was preliminary skepticism of their outcomes, if truth be told Marshall and Warren primarily received the day inside a decade, by which era the usual of take care of treating duodenal ulcers had developed to utilizing antibiotics. That’s really an extremely quick about-face for drugs, given how lengthy it usually takes to deliver an concept from bench to bedside.
As for Sir Ronald Fisher, WTF? Fisher was one of many few scientists by the late Nineteen Fifties who had not but been satisfied that tobacco smoking performed a serious function in inflicting lung most cancers, and, as described on this article, his work would possibly nicely have been “influenced by private {and professional} conflicts, by his work as a guide to the tobacco business, and by the truth that he was himself a smoker” however was additionally a part of a extra basic methodological debate in statistics on the time concerning attributing causation. Ditto Joseph Goldberger, whose discovery that dietary deficiencies triggered pellagra got here because of an experiment of extremely questionable ethics, involving providing prisoners on the Rankin Jail Farm in Mississippi pardons for collaborating in a medical trial testing a poor eating regimen, in addition to one other experiment involving the intentional try and infect volunteers with out moral overview.
This brings me to the most important “WTF?” a part of Dr. Livingston’s invocation of Semmelweis, however first he can’t resist this metaphor:
Regardless of the wealthy historical past of the hazards of rejecting new or alternate concepts about illness, the medical institution has not discovered its lesson. With COVID, the Semmelweis Impact was in full pressure. This time, it was the GBD authors who have been the witches burned on the stake.
“Courageous mavericks” positive do love evaluating science-based critics to superstition or faith, don’t they? Virtually as a lot as they like to match their “courageous maverick” heroes to Semmelweis:
Jay Bhattacharya, who authored the declaration with Dr. Martin Kulldorff and Dr. Sunetra Gupta, is the face of the GBD and a modern-day Semmelweis. 2 Bhattacharya and his colleagues issued the Nice Barrington Declaration on October 4, 2020, the pandemic was raging and the response to it was chaotic, calling for a reasoned method to COVID.
Significantly. I’m bored. Now right here’s the “WTF?” comparability:
Early within the AIDS epidemic, CDC case officers realized that AIDS unfold the identical manner as hepatitis. As a result of AIDS was not transmitted by means of the air, they knew it was secure to be in shut proximity with the sufferers. All that was wanted was the implementation of what we now know as common precautions to keep away from contact with blood or secretions. That AIDS sufferers didn’t should be locked away was a part of the message public well being officers communicated. This was not straightforward given the public’s panic about AIDS within the Eighties. By the 1990’s, sufferers dying with AIDS have been surrounded by family members.
An irony is why among the similar public well being consultants similar to Dr. Anthony Fauci would reverse course in the course of the COVID pandemic.
The fundamental method that labored for AIDS ought to have been applied for COVID. Perceive its primary biology after which decide how to reply to the pandemic.
By no means does it appear to happen to Dr. Livingston that AIDS and COVID-19 are very totally different illnesses and that very totally different approaches to slowing their unfold are indicated. He even acknowledges that AIDS is unfold by bodily fluids. That ought to have nixed any comparability to COVID-19, which is unfold by aerosolized respiratory secretions within the air. Certainly, if there’s a actual “Semmelweis reflex” second concerning COVID-19, it’s how lengthy it was insisted that COVID-19 was unfold by massive droplets, which don’t journey very far, quite than aerosols. Furthermore, opposite to what Dr. Livingston would have you ever imagine, scientists did craft suggestions based mostly on present understanding of coronaviruses, of which SARS-CoV-2, the coronavirus that causes COVID-19. Significantly, Dr. Livingston’s analogy doesn’t even make any sense.
Nor does this little bit of misdirection:
COVID is brought on by the SARS CoV-2 virus, a coronavirus, the identical household of viruses accountable for the frequent chilly. What was identified about illness brought on by these viruses earlier than the pandemic? From the 18th version of Harrison’s Ideas of Inner Drugs printed in 2012 referring to the 2003 SARS :
“…The illness seemed to be considerably milder in instances in the US and was clearly much less extreme amongst youngsters,” “…unfold might happen by each massive and small aerosols and maybe by the fecal-oral route as nicely.” “…environmental sources, similar to sewage or water, may additionally play a job in transmission.” “Some unwell people (“superspreaders”) seemed to be hyper infectious and have been able to transmitting an infection to 10-20 contacts…”
“…danger components for extreme illness embrace age>50 years and comorbidities similar to cardiovascular illnesses, diabetes, or hepatitis. Sickness in pregnant ladies could also be notably extreme, however SARS-CoV an infection seems to be milder in youngsters than in adults.”
One might copy these statements written about SARS in 2012 and apply them to the SARS-CoV-2 virus in 2024. The method to COVID, proposed by the GBD, ought to have adopted the identical play ebook utilized by public well being officers within the Eighties for AIDS. Take what is understood in regards to the virus, craft public coverage from that data after which educate the general public in regards to the illness in a manner as to sooth their fears.
Humorous, however Dr. Livingston doesn’t point out what well being officers did to cease the unfold of the unique SARS. One notes that it’s broadly accepted that SARS was an instance of an epidemic that was contained largely by means of conventional public well being interventions, similar to index case identification, quarantines, and the like, not something resembling what the GBD proposed. It’s onerous for me to not counsel right here that, had the unique SARS been dealt with the best way the GBD authors proposed dealing with the pandemic, SARS would by no means have been contained and would have itself develop into a pandemic. Certainly, preliminary interventions for COVID-19 have been explicitly based mostly on what appeared to work for SARS, as described in an article from Could 2020 in The Lancet entitled Can we comprise the COVID-19 outbreak with the identical measures as for SARS? The authors concluded:
Though there are hanging similarities between SARS and COVID-19, the variations within the virus traits will finally decide whether or not the identical measures for SARS may also achieve success for COVID-19. COVID-19 differs from SARS by way of infectious interval, transmissibility, medical severity, and extent of group unfold. Even when conventional public well being measures aren’t capable of totally comprise the outbreak of COVID-19, they may nonetheless be efficient in lowering peak incidence and world deaths. Exportations to different international locations needn’t lead to speedy large-scale outbreaks, if international locations have the political will to quickly implement countermeasures.
Sadly, as we now know, most international locations didn’t have this political will, and right here we’re.
Mainly, the GBD went towards every little thing discovered from earlier expertise with respiratory viruses, together with the 2002-2003 SARS outbreak, however Dr. Livingston would have you ever suppose that the GBD was The Actual Science, with Jay Bhattacharya and his co-authors akin to a modern-day Semmelweis and Anthony Fauci and all of the others who criticized the GBD being akin to Semmelweis’s critics, when in actual fact the GBD violated many rules of public well being science and what was identified then about coronaviruses.
Once more, Dr. Livingston not noted the core concept behind the GBD, as Dr. Howard identified on X, the hellsite previously often called Twitter:
Significantly, notice how Dr. Livingston pivots to “lockdowns have been dangerous”:
The extra essential subject isn’t the immunity argument. The lockdowns have been tremendously damaging to society, and the medical group has paid little or no consideration to that injury. Companies have been ruined, the training system was impaired, and we nonetheless don’t know the total ramifications of lockdowns.
Humorous, that. Not so humorous is how, ignoring the sustained marketing campaign of disinformation on the a part of GBD proponents and different COVID-19 minimizers and, later, antivaxxers, Dr. Livingston writes:
We now know that Dr. Bhattacharya and the opposite GBD authors have been right, and the consultants have been very fallacious. The Semmelweis Impact. Going ahead, consultants needs to be cautious earlier than discrediting new concepts. The extra passionate the consultants are about countering one thing, the extra skeptical the general public will likely be in regards to the consultants.
We “know” nothing of the kind. That is an assertion with out proof, if truth be told an assertion that contradicts out there proof. It was even identified on the time that chasing “pure herd immunity” for COVID-19 was a pipe dream, as described by authors of the John Snow Memorandum. “Pure herd immunity” requires life-long—or no less than long-lasting—postinfection immunity, and it’s lengthy been identified that postinfection immunity is comparatively transient for coronaviruses, as a result of coronaviruses are good at mutating to evade postinfection immunity as a result of prior variants. We noticed this with the Delta and Omicron variants. Once more, the GBD was not in step with what we knew about coronaviruses, immunity, or public well being, irrespective of how mightily Dr. Livingston strains to say in any other case.
Significantly, I’m stunned that Dr. Livingston didn’t quote Arthur Schopenhauer’s well-known (and fallacious) adage, “All fact passes by means of three phases. First, it’s ridiculed. Second, it’s violently opposed. Third, it’s accepted as being self-evident.” (Of notice, Schopenhauer nearly actually by no means really wrote or stated this.) Moreover being risibly fallacious (such “truths” by no means get to the third stage as a result of they’re not “fact”), Schopenhauer’s saying is a favourite of defenders of dangerous science all over the place. I’ll give Dr. Livingston credit score for having restrained himself.
The enchantment of the Semmelweis gambit
A few years in the past I coined a time period—no less than, I believe I used to be the primary to coin it nearly 20 years in the past, though I can by no means by completely positive—the Galileo Gambit. The time period was supposed to explain the propensity of cranks, quacks, and advocates of pseudoscience like creationism to say the mantle of Galileo (or Semmelweis), who have been at first rejected by the scientific orthodoxy of the time and needed to struggle to get their concepts accepted. The implication, after all, is that their concepts, no matter they could be (various drugs, clever design, psychic talents, and so forth.), are on the identical airplane as these of Galileo or Semmelweis and are being unfairly rejected by dogmatic scientists who’re close-minded and unable to just accept their genius. Sound acquainted? I additionally stated on the time that, incessantly, such cranks will add an inventory of well-known scientists or consultants whose views have been rejected by mainstream science however finally prevailed (similar to Galileo or Semmelweis). Sound acquainted? Provided that Galileo is a quite poor instance of this phenomenon on condition that the objection to Galileo’s heliocentric mannequin have been primarily non secular and from the Catholic Church and that different astronomers have been replicating his outcomes, more and more I’ve been considering that I ought to cease calling this the Galileo gambit and begin calling this the Semmelweis gambit.
As I identified on the time (and have identified many instances since), clearly, this method seeks to denigrate the consultants who reject the crank claims as not understanding what they’re speaking about or as close-minded, unable to have the imaginative and prescient that they do. It additionally deceptively tries to affiliate the quack, crank, pseudoscientist, or pseudohistorian with the theories and findings of nice visionaries that went towards standard knowledge and have been thus rejected by the consultants of the day–after which later proven to be right. Though Michael Shermer has of late taken a heel flip, he was right when he stated, “Heresy doesn’t equal correctness.” Too dangerous he appears to have forgotten the knowledge of his earlier phrases, which is why I have a tendency to love to quote Carl Sagan extra typically as of late:
However the truth that some geniuses have been laughed at doesn’t suggest that every one who’re laughed at are geniuses. They laughed at Columbus, they laughed at Fulton, they laughed on the Wright brothers. However additionally they laughed at Bozo the Clown.
Come to consider it, Columbus wasn’t the best instance both. I may need to reformulate the concept. Be that as it might, Dr. Livingston is much from the primary to invoke Galileo or Semmelweis when saying that the GBD was right. Certainly, certainly one of its authors, Martin Kulldorff invoked not simply Galileo however Tycho Brahe, Johannes Kepler, and René Descartes. Again in November 2020, Barry Brownstein invoked Semmelweis defending the GBD and Sunetra Gupta (its third co-author). It’s a standard—and misleading—theme that’s been used many instances by GBD defenders, certainly one of whom much more deceptively argued that “crushing scientific dissenters, as Fauci urges, would kill medical progress.” The frequent narrative is that the GBD’s authors are the “trendy Semmelweis” and that “scientific dissent” is being crushed.
I’m not saying that if you see comparisons like Dr. Livingston’s to Semmelweis (or Galileo) that it’s all the time an indication that you simply’re dealing crankery, pseudoscience, quackery, or simply plain dangerous science. In any case, the oft-ignored complexities of his story however, it’s true that Semmelweis’s concepts have been (largely) rejected by his fellow physicians and scientists however then later proven to be true, no less than true that washing arms with chlorine did dramatically lower the chance of puerperal fever. It’s true that, human nature being what it’s, the Semmelweis reflex generally is a actual phenomenon that hinders the acceptance of recent science and new medical therapies. Nonetheless, typically forgotten is that it may be very tough to guage the place the road between what can be cheap skepticism given the data of the time ended and the Semmelweis reflex begins. In any case, science is about questioning and falsifying hypotheses, and on the time a brand new concept is being proposed it’s not all the time straightforward to inform when questioning passes from cheap to unreasonable. Furthermore, as I wish to level out, the overwhelming majority of “heterodox” concepts are rejected exactly as a result of they’re fallacious! Most such concepts fail the take a look at of science, whereas solely a comparatively few stand the challenges of experimentation and proof. Defenders of crank hypotheses or ideologically motivated dangerous science (just like the GBD) cherry decide the few examples of actual mavericks who have been finally vindicated and ignore the a lot bigger variety of “courageous mavericks” misplaced to the mists of historical past as a result of their concepts by no means panned out.
Mainly, it’s what I wish to name the fallacy of future vindication, besides that the proponents of the GBD, like Dr. Livingston, have leapt to declaring vindication now. By no means as soon as does the thought enter the minds of individuals just like the authors of the GBD (or, incessantly, their defenders like Dr. Livingston) that they may be fallacious, that the rationale they’re seen as cranks or handled with disdain is as a result of they’re so clearly fallacious. That’s what separates them from actual scientists. Certain, actual scientists who imagine unpopular issues additionally imagine that some day they are going to be vindicated, however additionally they rigorously contemplate the chance that they may really be fallacious and are ready to alter course if the proof calls for it. The authors of the GBD and their defenders fail that take a look at.
Depressingly, Dr. Livingston Professor of Surgical procedure at UCLA—it all the time depresses me when a fellow surgeon makes arguments this dangerous—and former Deputy Editor at JAMA. In a manner, that’s a cautionary remark as nicely. Anybody will be susceptible to the Semmelweis gambit, in the event that they imagine in a foul concept strongly sufficient. On the danger of self-aggrandizement, I wish to suppose that the distinction between me and somebody just like the GBD authors is that I all the time ask myself each time I assert one thing whether or not I may be fallacious and take a look at onerous to stay open to the chance that I may be. I additionally know that my readers will disabuse me of such a notion, ought to I ever stumble as badly as Dr. Livingston has stumbled right here. Dr. Jay Bhattacharya shouldn’t be akin to Ignaz Semmelweis. He sat on the similar desk as Steve Kirsch and different antivax cranks.