If you are stuck for a little light bedtime reading, might I recommend browsing through the decisions of the Medical Practitioners Tribunal (MPT) from the last 12 months? They make for illuminating – albeit bleak and sordid – reading. And if you pay particular attention to decisions marked ‘Erasure’ (meaning the tribunal has decided to strike a medical practitioner’s name from the Medical Register) you will not fail to reflect on the wisdom of Machiavelli in his summary of human nature: “All do wrong.”
My knowledge of the MPT’s decisions is by no means exhaustive, but even a cursory search reveals that almost all instances of Erasure involve some kind of threat to the safety of patients (as one would indeed assume). Most of these concern inappropriate sexual conduct or sexual offences. From the last month or so alone there is, for example, Dr. Cvetkovs, who gave money to a patient so she could buy cocaine and later had a sexual relationship with her; Mr. Baker, a consultant gynaecologist who entered into an inappropriate relationship with a female patient; Dr. Hume, who shared indecent images of children on internet chat rooms and took pictures of a female patient without her consent; Dr. Inthiraraj, who inappropriately contacted a vulnerable female patient and performed examinations on another patient without her consent; Dr. Ali, who intentionally communicated with what he thought were under-16 year old girls for sexual motives without realising they were undercover police officers; Dr. Varnum, who was convicted for possessing large numbers of indecent images of children; Dr. Walker, who did more or less the same thing as Dr. Ali, listed above; I could go on. Occasionally there are cases of outright incompetence (for example, administering the wrong medicine and failing to keep adequate records) or deceit (misrepresenting qualifications). But the basic gist of things is clear: if you get struck off as a doctor, it will basically be because you are likely to put patients at risk.
This puts into perspective the MPT’s decision of September 2023 to ‘Erase’ a certain Mr. Muhammed Adil, who was the subject of my last post. Mr. Adil has apparently been actively uploading YouTube videos and tweeting since early 2020 to express various views about the coronavirus pandemic. The original ‘charge sheet’ (from a hearing now unavailable) listed the views expressed by Mr. Adil between April and October of 2020 as follows:
a. the SARS-CoV-2 virus and/or COVID-19 disease do not exist or words to that effect;
b. the COVID-19 pandemic is a conspiracy brought by the United Kingdom, Israel and America or words to that effect;
c. the COVID-19 pandemic is a multibillion scam which was being manipulated for the benefit of:
- i. Bill Gates;
- ii. pharmaceutical companies;
- iii. the John Hopkins Medical Institute of Massachusetts;
- iv. the World Health Organisation, or words to that effect;
d. the COVID-19 pandemic was being used to impose a new world order or words to that effect;
e. the SARS-CoV-2 virus was made as part of a wider global conspiracy or words to that effect;
f. Bill Gates infected the entire world with SARS-CoV-2 in order to sell vaccines or words to that effect;
g. COVID-19 vaccines:
- i. would be given to everyone, by force if necessary;
- ii. could potentially contain microchips that affect the human body and further the 5G mobile phone technology agenda;
- iii. will transform human psychology and beliefs;
- iv. could be used to control and/or reduce the world’s population, or words to that effect
Now, I should say at the outset that I by no means agree with all of these things. It was my position from the beginning of all of the Covid nonsense that the lockdowns were a really, really stupid thing to do and an overreaction stemming from panic, but I don’t think they were the result of a conspiracy. And I was always of the view that the decision on whether or not to take a vaccine should be rooted only in consent and that personally, since I knew the threat of Covid to be remote, I would not take the jab – but I do not think the vaccine rollout was the result of a plot. I am therefore I suppose a ‘moderate lockdown sceptic’, and I have on occasion since February 2020 found myself being irritated that somebody who holds my views can be bundled in with people like Mr. Adil as a ‘Covid conspiracy theorist’ with crankish ideas about microchips and 5G. In that, I think people like him were not always very helpful to the cause.
But I also believe, even more strongly, that being a crank is in itself not a reason why anybody should be prevented from airing their views. And I don’t believe this because of a highfalutin utilitarian notion about ‘the marketplace of ideas’. I believe it simply because I hold to the corny, but I think ultimately wise, line in Max Ehrmann’s Desiderata: it is important to “listen to others, even the dull and ignorant; [for] they too have their story”. I don’t wish to live in a society in which the great and good are allowed to decide who is and is not worthy of being able to speak, because in the end I don’t really believe that the great and good are particularly great, or good. In fact I think they are as mediocre and bad as the rest of us. Everybody, in short, should be entitled to have their say about the issues of the day because everybody has value as a human being, and nobody intrinsically has greater value than anybody else. Some restraint on speech is necessary, but such restraints should be as minimal as possible and founded in law. Otherwise people should be able to, in modern parlance, ‘speak their truth’ – even cranks.
With all of that said, of course, if the members of the MPT who decided Mr. Adil’s case were here to speak for themselves, they would probably say that they basically agree with me. It’s just that they would add something like: “Mr. Adil’s speech falls under the umbrella of speech that it is necessary to restrain, because it is dangerous.” In their own words:
A finding of impaired fitness to practise was required in order to protect the public and maintain the public confidence in the profession and to promote and maintain proper professional standards and conduct for members of the profession.
That is to say, we can’t have this man going about saying these things and representing himself as a doctor, because people will believe him and not take the vaccine and therefore die. And generally speaking people will lose faith in doctors and therefore that will have an impact on public health in the round. And, what is more, we are entitled to do this as a matter of law, because the General Medical Council has issued guidelines under the Medical Act 1968, which state that medical professionals must act in such a way as to “justify patients’ trust… and the public’s trust in the profession”. The disagreement then is not at the level of principle but at the level of fact: what Mr. Adil was saying just fell outside of the threshold of what it is ‘safe’ and lawful to say.
There are three things to say about this.
The first is that the basic line of reasoning of the MPT is very common these days within the professional managerial establishment, and it goes as follows: ordinary people are presumptively idiots, are totally credulous, and are inclined to believe anything they are told by a figure of purported authority. If they are told by a doctor appearing in a YouTube video that Bill Gates infected everyone with SARS-CoV-2, and so forth, then this will turn them into hardened conspiracy theorists who will then fail to get vaccinated, and this will undermine the campaign to ‘stop the spread’. And therefore any doctor who does such a thing must be cast out of the profession for “undermining public health” (and also undermining “public confidence in the medical profession”, the mainstream of which was advocating lockdowns, mask mandates, vaccines, etc.)
The same pattern plays out again and again in contemporary public life, as I am sure you are well aware. Whenever people do anything which the professional managerial class in general holds to be undesirable (vote to leave the EU; fail to take a vaccine; refuse to buy an electric car or heat pump; watch Andrew Tate videos; etc.) it is immediately cast as a problem of their having the wrong information, which can only be remedied by preventing them getting their hands on such wrong information and replacing it with correct information. Then they will naturally change course and do the right thing.
It is the kind of account of human psychology that only a Martian would find plausible; that our establishment seems to find it explanatory is deeply troubling, but it is plainly evident that it does. It will not be news to readers of this article that this is not actually how things work in the real world, and that in the long-term seeking to control the flow of information in order to control thought in this way can only possibly end in tears. But clearly that is not how most very well-educated people see things, and the MPT obviously comprises members of that strata of society. In their minds, what is ‘dangerous’ is the making of crankish videos that preach to the converted; it simply doesn’t occur to them that attempting to control the way in which the public thinks and speaks has dangers of its own, and that those are indeed much greater. A society in which the elite conceives of the ‘masses’ in this way simply does not have a stable future in the long term, and it is this that is our real danger; but those in positions of power in our society seem almost wilfully blind to it.
The second thing to say is that, reading the MPT’s decision, it becomes clear that while the panel might have been concerned about the ‘dangerous’ effect of Mr. Adil’s videos on public health (failing to take vaccines; failing to ‘socially distance’, and so on), what really annoyed them was the fact that he was thinking the wrong thing.
This is made plain very early on. Mr. Adil was originally suspended for six months as a result of a hearing in 2022 (though it is important to mention that he was de facto suspended from the middle of 2020 due to an interim decision of a MPT, meaning of course that he was not able to work for three years before being formally ‘struck off’). Here is the 2023 MPT’s account of the 2022 MPT’s original suspension decision, with important phrases in bold:
The 2022 tribunal found that there had been a serious breach of Good Medical Practice (‘GMP’) and it had found Mr. Adil’s fitness to practise to be impaired. The 2022 Tribunal found inconsistencies in his evidence and that he showed no proper appreciation of his conduct. The 2022 Tribunal noted that Mr. Adil had continued to challenge the GMC investigative procedures throughout the hearing…
The 2022 tribunal had considered that Mr. Adil’s expressions of regret and apology had come very late in the day and had continued to develop even during the course of the hearing. The tribunal considered that Mr. Adil did not have full insight into the consequences of his actions in relation to paragraphs 2-4 of the allegation, and that he had demonstrated a fundamental lack of appreciation for the impact of his conduct on the public. At times it was considered that he was only telling the tribunal what he believed to be expedient to say.
The 2022 tribunal had considered that although he was starting to genuinely question and reflect upon his conduct, and that he had expressed regret and remorse for what he had said, he still lacked adequate understanding and appreciation of the impact of his actions in relation to these allegations. It was not satisfied that in the face of an opportunity to proclaim his views in such a way again, there was no risk he would not do so.
The 2022 tribunal determined to suspend Mr. Adil’s registration for six months. The length of the suspension would allow Mr. Adil to reflect carefully on the findings of the tribunal in order to be able to demonstrate that he fully understood and appreciated that impact and its consequences. It was suggested that this reviewing tribunal would be assisted if Mr. Adil were to provide [amongst other things] a detailed written reflection about his appreciation and understanding of the gravity of his misconduct and its impact on public health and public confidence in the medical profession.
The petty authoritarianism of this is of course striking – like a stereotype of a bad parent: “Go and sit on the naughty step and think about what you’ve done!!” – but this conceals its more sinister connotations. Imagine being put in the position of having to lie about what you think in order to be allowed to carry out the job which you have been doing for your whole professional life, without ever putting anybody at risk, and without which you have no source of income. Imagine forcing somebody to ‘reflect’ on his views and write a document detailing how he has done so before allowing him to earn a salary again.
One must be careful not to use hyperbole, but it calls to mind an expression used by Michael Oakeshott: it is a moral enormity to behave in that way. It would be one thing for the MPT to have told Mr. Adil to take down his YouTube videos if he wanted to continue to practice as a doctor. That would have been consistent with the idea that the real problem was the ‘dangerous’ effect of his comments, and it would have easily remedied that problem (if we grant that it was such). It is quite another thing for the tribunal to have told him to explicitly renounce his sincerely held opinions in order to keep his job (hidden in the mealy-mouthed language of “assisting” the panel).
Let’s be absolutely clear, then: Mr. Adil was suspended for supposedly undermining public health with his “dangerous” videos in 2020-22. But the 2023 decision on his erasure was chiefly due to his failure to recant:
In his statement to the MPTS dated August 15th 2023, submitted for use in this review hearing, [Mr. Adil] repeated his views. In short, it sets out that his current views are those which he espoused in the videos in 2020… [T]his tribunal should consider this when looking for evidence of insight and remediation.
The problem, to repeat, is not so much saying the wrong thing as thinking the wrong thing. Not the making of the videos. Persisting in holding the ‘wrong’ opinions. This is not an acceptable thing to have happened in a free society. It is happening in ours.
The third thing to say – and I suppose this ought to go without saying – is of course the wonderful and terrible irony of the MPT’s decision. Cast your mind back over the past five years. Would you say that public trust in the medical profession has been undermined during that period? I would say it has been. And what would you attribute that to? Mr. Adil’s YouTube videos? Or, perhaps, off the top of my head:
- Being told that wearing a face mask is not important, but then actually is terribly important and the evidence supporting its importance is overwhelming, but it is only important when you are in a shop or on public transport, and it is definitely not important if you are, say, a world leader at a behind-closed-doors party at Davos
- Being told that it doesn’t matter if children miss a year of school and have no social interactions for months on end, because children are resilient
- Being told that health conditions that aren’t related to Covid don’t particularly matter, and it would be best not to seek medical attention for fear of spreading the virus
- Being told that the vaccine would stop transmission of the virus
- Being told that, although the evidence is overwhelming that the virus is chiefly spread indoors, you should stay at home unless you have a “reasonable excuse” to leave the house
- Being told that, although the evidence that Covid posed little threat to anyone under the age of 60 was overwhelming by February 2020, “we didn’t know anything about the virus” and therefore it was necessary to keep everybody in lockdown on and off for well over 12 months, regardless of their age
- Being told that ‘herd immunity’ means a certain thing one day, but the next day means something totally different
- Being told that it matters whether you are eating a scotch egg or not (or perhaps doesn’t)
I could of course go on, but will stop before I have an aneurysm. You get the point: there was an awful lot of dangerous stuff and nonsense put out into the public domain during the Covid years, much of it spouted by cranks. But those cranks happened to be mainstream medical professionals, and the politicians listening to them. Yet here we are, ‘erasing’ poor Mr. Adil, who seems to have barely put a foot wrong as a surgeon over the course of a 30 year career, because he apparently believes a few things about Covid that could be construed as being a little bit kooky. I know what the ‘dangerous’ thing is here, and I think probably you do too. It’s not the YouTube videos about Bill Gates and microchips.
Where do we go, then, from here? My gut tells me that what happened to Mr. Adil is going to become more common, rather than less. I am anxious not to be misconstrued on this point: we are not waltzing into East Germany or Democratic Kampuchea. But we are heading for a situation in which the horizons of free expression will be increasingly curtailed, and we are going to have to pretend publicly to believe a lot more things which we really don’t. This means our private, internal worlds will take on increasing importance, and indeed we are going to come to cherish them.
In 2017, Victor Davis Hanson wrote an essay for National Review in which he observed that more and more people were retreating into “monasteries of the mind“, enjoying old books, old music and old films, and adopting a “stoical detachment from contemporary life”. In short, we are turning away from public discourse and interesting ourselves chiefly in our imaginations – where we can privately enjoy the things that we like, and think the things that we think, in peace. This phenomenon will become more pronounced as freedom of speech declines; as it becomes increasingly difficult to avoid publicly saying things which you do not believe, and as we are all gradually backed into a corner if we happen to hold opinions that are outside of the mainstream, the monastery of the mind will more seductively beckon. Build yourself a nice one.