The Journal of the American Medical Association recently published a review of alleged ‘misinformation’ about COVID-19 that physicians were responsible for, either on social media and in other news sources.
In the paper, the corresponding author, Dr. Sarah L. Goff, MD PhD, defined misinformation. She surveyed social media platforms and news sources for anything written by other physicians that fits her selected examples of both. She then proposes that physicians guilty of writing what she judges to be misinformation should be “regulated and disciplined”.
Dr. Goff and her co-authors define misinformation as “false, inaccurate or misleading information according to the best evidence available at the time” and disinformation as “having an intentionally malicious purpose”.
Dr. Goff states: “We conservatively classified inaccurate information as misinformation rather than disinformation because the intent of the propagator cannot be objectively assessed.”
Dr. Goff identified four major themes of alleged misinformation. These included: (1) vaccines were unsafe and/or ineffective; (2) masks and/or social distancing did not decrease risk for contracting COVID-19; (3) other medications for prevention or treatment were effective despite not having completed clinical trials or having been FDA approved, and (4) other misinformation.
Dr. Goff includes a brief discussion of vaccine safety and effectiveness and mask effectiveness, but does not attempt to undertake a full review of the published evidence in these areas. Instead, she seems to assume that her readers will agree that any suggestion that vaccines or masks were ineffective or unsafe are self-evidently false.
Dr. Goff states that the American Medical Association has called for disciplinary action for physicians propagating COVID-19 misinformation. She laments the fact that “few physicians appear to have faced disciplinary action” for alleged sins against Covid orthodoxy.
I am not an expert in analysis of published medical research. I don’t work in a School of Public Health like Dr. Goff. I have worked as a licensed physician in England for over 40 years as a family doctor and an occupational physician and I have over 40 years’ experience reading the medical peer review literature. I retired from full time medical practice in 2017. I have a reasonable understanding of English, maths, logic and critical thinking. I don’t pretend to have read all the published research on masks or vaccinations. However, I continue to read leading medical journals on a regular basis.
I understand the concept of truth and how hard it is to establish an absolute truth in science. I understand the enlightenment principles that any ideas can be discussed, that nobody has a veto on ideas and that it is important to doubt and test all of our ideas continually. There is no indication from her writing that Dr. Goff understands how important it is to doubt, question and test the effectiveness and safety of interventions such as vaccines and masks.
From my reading of the peer review literature, for illustration purposes, I identified the following four publications as examples of publications which should raise concerns and questions about COVID-19 vaccines and masks.
In 2019, the World Health Organisation (WHO) published a report entitled ‘Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza’. The WHO concluded: “There are a number of high-quality randomised controlled trials demonstrating that personal measures (e.g. hand hygiene and face masks) have at best a small effect on transmission.”
In February 2023 a Cochrane review into the effectiveness of masks concluded: “Compared with wearing no mask in the community studies only, wearing a mask may make little to no difference in how many people caught a flu-like illness/Covid-like illness.”
A study from the Department of Infectious Diseases in Cleveland, Ohio, in December 2022 found that “the bivalent COVID-19 vaccine only offered modest effectiveness”.
A study from the University of Queensland in September 2022 concluded: “Never in vaccine history have 57 leading scientists and policy experts released a report questioning the safety and efficacy of a vaccine. They not only questioned the safety of the current COVID-19 injections but were calling for an immediate end to all vaccination. Many doctors and scientists around the world have voiced similar misgivings and warned of consequences due to long-term side effects.”
These four publications are examples which give us a legitimate reason to question the use of masks and the Covid vaccines and to look further for evidence. Are we not allowed to raise questions about these issues without being threatened with disciplinary procedures? Not to ask any questions would be lacking in curiosity in the extreme, especially for practising physicians concerned about the safety of their patients and the integrity of their advice. These publications do not prove anything conclusively, but they should not be ignored. Expressing doubt and asking questions about the safety and effectiveness of vaccines and masks is not false, inaccurate or misleading, to use the definition adopted by Dr. Goff. If questions arise in my mind, why don’t similar questions arise in the minds of Dr. Goff and her co-authors? How did Dr. Goff reach such a degree of certainty about the effectiveness of masks and vaccines against COVID-19 that she can classify any statement to the contrary as misinformation worthy of disciplining a colleague? Why does she conclude that a colleague who disagrees with her does not have the right to be heard? Why would she seek to silence those who disagree with her?
Inaccurate information which is not deliberately intended to deceive is simply inaccurate. In science and medicine there are many inaccurate statements made in good faith by researchers who are presenting their data or their theories as accurately and honestly as possible. It is important that all theories and all research data can be published, even when the data or the theory are wrong. Disciplinary action for any statement which turns out to be inaccurate or false would surely suppress a large proportion of all scientific and medical discourse. Is this what Dr. Goff wants?
It could be argued that the examples of misinformation used by Dr. Goff are themselves misinformation. To suggest that anyone who states that the Covid vaccines were unsafe and/or ineffective is guilty of misinformation is to ignore significant evidence which raises questions about the vaccines. To suggest that anyone who states that masks did not decrease risk for contracting COVID-19 is guilty of misinformation is also to ignore evidence to support this view. It could be argued that Dr. Goff is using false, inaccurate or misleading examples of misinformation in her study in order to suppress dissenting views.
Dr. Goff appears to have very little humility. She does not appear to be in any doubt that she and her co-authors are infallible in relation to masks and vaccines. She seems to think she is the ultimate arbiter of truth, and that she is immune from being regulated or disciplined for her views in the way she promotes for others. I would not propose disciplining or applying regulatory sanctions to Dr. Goff or her colleagues if her publication includes false, inaccurate or misleading statements. Instead, I would propose respectful dialogue with her to debate her proposal, offering arguments to the contrary with a view to educating her and myself.
In England, medical doctors are obliged to respect colleagues’ skills and contributions, and to treat colleagues fairly. We must create a working environment in which it is safe to ask questions and raise concerns. I believe in these principles. Failure to adhere to these standards can lead to disciplinary action against medical doctors. I understand that similar professional obligations apply to medical doctors in the United States. Dr. Goff does not appear to respect the skills and contributions of colleagues who disagree with her. She seems to be promoting a working environment in which it is not safe for those who disagree with whatever the orthodoxy within the medical profession is at any one time to ask questions and raise concerns. Does she not realise that this may make it unsafe for her to raise concerns and ask questions in due course?
Dr. Goff acknowledges in her final sentence that “a coordinated response by federal and state governments and the profession that takes free speech carefully into account is needed”. This tiny nod towards free speech is somewhat undermined by her attempts to censor her colleagues’ right to disagree with her. Free speech is nothing if it is not accorded to those with whom we disagree.
Frederick Douglass, the American social reformer said: “To suppress free speech is a double wrong. It violates the rights of the hearer as well as those of the speaker.” If Dr. Goff persuades those in power to regulate or discipline those who disagree with her, then their right to free speech is violated and our right to hear them is violated. Does Dr. Goff not have a glimmer of doubt about her omniscience? Does she not think there is even a faint possibility that physicians who disagree with her might have something useful to say?
Why do some physicians think that the best response when another physician disagrees with them is to censor their colleague? How could any physicians achieve such unshakeable certainty in their own omniscience? When did they forget the fundamental principles of the enlightenment, that all ideas can be discussed and that nobody has a veto on any ideas? How did the principles of treating colleagues with respect and upholding the free speech of those with whom we disagree become so degraded?
Dr. Goff and her co-authors should be careful what they wish for. They seek to discipline colleagues for daring to disagree with their orthodoxy. If they succeed, the cancel police may be coming for them next.
Dr. Nigel Wilson MRCGP FFOM is a retired consultant occupational physician.
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