When should scientists debate?

Happy to go on Joe Rogan for self aggrandizement, but unwilling to take a chance in dialog

Scientists are debating when, and under what conditions, scientists should participate in public debate and dialog. Peter Hotez— a Texas doctor— has previously appeared on Joe Rogan. During the pandemic, he pushed for prolonged school closures, masking young kids, and mandating a vaccine that does not halt transmission. Recently, he said he did not want to debate RFK b/c that would legitimize RFK. I disagree with RFK on many issues, detailed in the Free Press, but Hotez acts as if he is holier than thou. On twitter I put it this way:

So when should scientist debate? And when it is ridiculous?

First, scientists do have a professional obligation to explain their views and educate the public. To the extent that public dialogs and debates do this, they should be considered. While it is reasonable to stick to what you know well, it is natural to expect questions from the public that you don’t anticipate. Scientists should be willing to talk about issues that they did not prepare in advance.

Second, some argue that some ideas are so ludicrous— debate is not needed. For instance, should a scientist debate whether a hearing aid actually contains a little human being who repeats what he hears more loudly? or whether the earth is flat? What about something that I consider just as ludicrous: the idea that a 2 year old (2 years old!) should be forced to wear a useless, cloth mask in daycare or head-start?

Now, you start to see the complexity. Merely because an idea is crazy does not mean it is unworthy of discussion. If an idea is gaining prominence rapidly, and actually changing policy— then a scientist needs to descend from the ivory tower and debate it.

When I saw that public health & the CDC had actually forced toddlers to mask— despite no data, and despite salient concerns about downsides—I wrote and spoke about it extensively. I personally think making a toddler mask is a special kind of stupid. Put a dozen 2 year olds in cloth masks and watch them for 10 mins. Even a grade school drop out would conclude: hmmm, this doesn’t look very effective. And yet, ‘experts’ endorsed this sheer lunacy— with zero credible data and no ongoing attempts at remedy. It was mass, expert, hysteria.

Where does that leave Hotez and RFK Jr? Both have some erroneous beliefs. Hotez’s COVID policy views strike me as nakedly partisan, and deeply harmful. RFK has good ideas about regulatory capture, and also wrong ideas on childhood immunization and other environmental risks. I detail them here and here.

Should a scientist engage with a dialog with RFK Jr? Absolutely, yes. For several reasons. One, many of his arguments about political corruption within FDA are correct, and one should validate good ideas when possible, no matter who offers them. Second, his claims on vaccines are gaining traction and his poll numbers are rising, ergo, they do warrant rebuttal. Third, I truly believe we can reach a conclusion that everyone agrees with.

In a recent letter in Vaccine, Fraiman and colleagues make the good point that current vaccine surveillance systems cannot find harms of COVID vaccines that are small, but important, for instance an increased risk of 1.2 OR for heart attacks.

The US failed to detect VITT and myocarditis BEFORE other nations alerted us to these adverse events of COVID vaccines. A scientists talking to RFK Jr should ask what his policy would be towards vaccines, and whether he would be amenable to an ongoing, prospective study to put this issue to rest. Ultimately, the compromise I see is that— while his specific claims are incorrect— his general view that vaccine safety could be better is true. I would acknowledge this, and seek a policy solution we can agree on. Even Hotez may agree with such an improved system.

A new Phase IV surveillance system for all drugs and devices— which is not beholden to Pharma— is the policy solution to concerns about vaccine safety. Dialog has potential to highlight the nuances here. When a patient comes to a doctor with a false belief, often exploring that belief can find the kernel of anxiety and suggest another way to ameliorate it.

Finally, some argue that debates need live fact checking. This is completely wrong. That is what the audience is there for. Your job is to persuade them. Treat them like adults and not infantilize them. Moreover, I am confident your fact checker is not going to be up to snuff. Once again, Zaid Jilani says it best.