The appeal of being a medical “apostate”

Recently, I was taking my turn supervising the surgical skills lab for the interns in the residency program in which I’m faculty. It was a practice session for knot tying, suturing, and using the simulators to practice basic laparoscopic skills, as the course was nearing its end, and the final examinations are coming up. I happened to be talking with some of the interns as they practiced or took breaks, and somehow the topic of medical misinformation and antivaccine physicians came up. As I’ve noted a number of times among my colleagues and trainees, one intern was surprised at how many physicians have been promoting antivax disinformation and COVID-19 quackery since the pandemic hit. As I am wont to do, I pointed out that we’ve always had these “contrarian” doctors in our profession’s midst; it’s just that most of our colleagues didn’t notice or pay attention to them. Many didn’t believe they existed—or thought our complaints about them were exaggerated—and as a result there has been little impetus in our profession to do anything about them, a task that specialty boards and state medical boards have historically been depressingly lax about. Indeed, it’s topic that I’ve written about almost as long as I’ve been blogging, and way back in 2008 Dr. Val Jones even coined a term for doctors who didn’t pay much attention to medical pseudoscience, the “shruggie.” I noted that no one who paid attention to these issues before the pandemic has been particularly surprised to see how many quacks and antivaxxers are in our midst. Indeed, some of these interactions are why of late I’ve been stepping back a bit and writing more and more about my views regarding why and how physicians ostensibly trained in science-based medicine break bad and use their credentials to attack the science-based regulation of medicine, viewing it as “thoughtcrime” and “censorship.”

In 2009, I laid down some of my thoughts on why doctors become quacks and updated those thoughts a couple of weeks ago, but I now realize that even that update was incomplete. Although I did discuss hubris, arrogance, and ego gratifications as some of the traits that fuel the conversion of a physician into a quack and antivaxxer, an article in the New York Times by Andy Kroll published a week ago led me to realize that I forgot one other important trait: Apostasy. So, even though there are a number of pieces of misinformation and disinformation that I could have written about, such as the resurrection of the SARS-CoV-2 “lab leak” conspiracy theory by Vanity Fair and ProPublica (the latter of which made me think that Kroll, who is a reporter for ProPublica, should turn his gaze on his fellow reporters), Robert F. Kennedy Jr.’s new conspiracy “documentary” based on his book on Anthony Fauci, or Emily Oster’s risible suggestion of “amnesty” for public health officials who “got it wrong” early in the pandemic that ignores the disinformation promoted by her allies and her, I kept coming back to apostasy for this week’s topic. Kroll’s article isn’t just about medicine, of course; it’s about an entire right-wing narrative about the pandemic. While it’s impossible for me to completely avoid mentioning politics, I’m going to try to deemphasize that aspect of this discussion, because the appeal of “apostasy” in medicine long predates the capture of the anti-public health movement including the antivaccine movement by the right. It’s a more general phenomenon than the politics of today might lead one to believe.

Kroll starts out with the example of a physician, one whom I have as yet not written about but one who is running as the Republican nominee to become governor of Minnesota, Scott Jensen:

On Apr. 8, 2020, in the chaotic early days of the Covid pandemic, the Fox News host Laura Ingraham welcomed a little-known state senator onto her prime time show. With his unmistakable Minnesota accent and an aw-shucks bearing, Scott Jensen, a Republican, was the furthest thing from the typical fire-breathing cable news guest. But the message that he wanted to share was nothing short of explosive.

He told Ms. Ingraham that he believed doctors and hospitals might be manipulating the data about Covid-19. He took aim at new guidelines issued by the Centers for Disease Control and Prevention, warning that they could lead medical institutions to inflate their fees‌. “The idea that we are going to allow people to massage and sort of game the numbers is a real issue because we are going to undermine the trust” of the public, he said.

Ms. Ingraham’s guest offered no evidence or data to back up this serious allegation. Coming from a random state senator, the claim might have been easily dismissed as partisan politics. What gave it the sheen of credibility was his other job: He is a medical doctor.

If there’s one thing that the pandemic has taught us, it’s that there is much hubris among my colleagues, in which physicians in specialties unrelated to public health, epidemiology, and pandemics come to think that they know better than experts in those fields. Dr. Jensen is no different. He is a family practice doctor who’s run a practice in Watertown, Minnesota, since 1986. He shows no evidence of possessing the knowledge, skills, and expertise relevant to making pronouncements about COVID-19, such as the ones that he made on Fox News and antivaccine outlets such as Del Bigtree’s vlog, such as the claim that people died “with COVID, not of COVID” and death certificates were being rigged to exaggerate the number of COVID-19 deaths. For instance, here he is in a Q&A with Minnesota Public Radio in March 2022:

Do you dispute that more than 12,000 Minnesotans have died as a result of COVID-19? Or that COVID-19 has killed more than 960,000 Americans?
Yes, I do. I think that what we have, when you say killed, I would say that COVID-19 may well have played a part. I would say that if this is a person who’s dying of stage 4 colon cancer, and COVID was diagnosed in the last 48 to 72 hours and it was put down as a COVID death I think that’s problematic. And I think the only way to solve the problem rather than call one another names or accuse someone of misinformation or disinformation, why don’t we just do an audit?

When questioned about his expertise, he responded:

I studied epidemiology in 1976 and ‘77 when I was in dental school. My wife was an immunology researcher, prior to veterinary school. My family is very medically oriented. I went back and did advanced studies as a part of a Bush Fellowship and epidemiology and leadership and communication were part of that. But I don’t think that’s really the issue. I think that you’ll find people a lot more credentials than me on both sides of this argument. And I don’t think that it necessarily does anything to constructively move forward to simply denigrate this group of people’s credentials and elevate someone else’s.

So he studied epidemiology 45 years ago as an undergraduate, and was awarded a Bush Fellowship in Leadership and Policy Studies in 1999. I note that it wasn’t difficult just to search the Bush Foundation website and find Dr. Jensen’s name. What did he study? According to the Bush Foundation, he studied “dermatology, allergy, computer applications, leadership, and ethics.” No doubt that’s why he moves on to a “both sides” fallacy:

I mean, you’ve got people like Jayanta Bhattacharya, Harvey Risch, Scott Atlas, John Ioannidis, Peter McCullough, these people are all highly regarded giants in their field. And then you’ve got other people like Tony Fauci and Mike Osterholm, and others that are respected on another side.

Of couse, many of those names are quite familiar to regular readers of this blog, as we have written about them and how they have promoted COVID-19 contrarianism and minimization going back to very early in the pandemic. (Just use the Search Box for this blog if you’re interested in the details.) I’m not going to dwell on that or relitigate past discussions. Rather, I want to move on to this part of Kroll’s article.

My first experience with medical apostasy: Dr. Robert S. Mendelsohn

I’ve frequently made allusions to the religious language that antivaccine doctors and doctors who have come to believe in alternative medicine quackery use. They love to dismiss conventional science-based medicine as “dogma,” as though it were simply another competing religious belief to theirs. Indeed, a number of physicians with views outside the mainstream who are not quacks and antivaxxers sometimes like to invoke the very same language, although rarely as aggressively as doctors like Dr. Jensen.

The apostate evokes images of a distinctly religious variety. The fourth-century Roman emperor Julian, who pushed to abandon Christianity and return to paganism. Freethinkers tortured and burned at the stake for daring to question the official orthodoxy of their era. And yet for as long as the word “apostate” has existed, it has possessed a certain allure.

To become one requires undertaking a journey of the mind, if not the soul, a wrenching transformation that eventually leads one to reject what was once believed to be true, certain, sacred. It’s a journey that often results in glorious righteousness. They’ve experienced an awakening that few others have, suffered for their awakening and now believe they see the world for what it is.

Although Kroll points to examples of politicians such as Ronald Reagan, who was famously a dedicated New Deal Democrat before he became a Republican, in particular:

“I didn’t leave the Democratic Party,” Reagan liked to say. “The Democratic Party left me.”

This was a clever bit of sloganeering by the future president. It was also the testimony of an apostate.

My first experience with medical “apostasy” dates back to medical school. My girlfriend at the time gave me a book by a Dr. Robert S. Mendelsohn, Confessions of a Medical Heretic, which had been first published in 1979. Note the language: Heresy and apostasy often exist in the same person, if that person is someone who was once a member of a religion who embraced beliefs considered heresy by that religion to the point of leaving and becoming an apostate.

Indeed, in the introduction to Confessions, Dr. Mendelsohn declared:

I do not believe in Modern Medicine. I am a medical heretic. My aim in this book is to persuade you to become a heretic, too. I haven’t always been a medical heretic. I once believed in Modern Medicine.

And there you have it. Dr. Mendelsohn was not just a “medical heretic.” He was a medical apostate, too, having renounced his “belief” in Modern Medicine for another belief system, while portraying patients in starkly religious terms:

Without the ritual of the checkup, internists would have trouble paying the office rent. How else can the doctor ensure a steady supply of sacrificial victims for the Church’s other sacraments without the examination? The Gospel said many were called and few were chosen, but the Church of Modern Medicine has gone that one better: All are called and most are chosen.

I remembered my shock at reading Dr. Mendelsohn’s jeremiad against modern medicine, particularly its religious language that cast Dr. Mendelsohn as the “heretic” who had discovered The Truth and medicine as a religion with doctors as its high priests. As these books frequently do, Confessions of a Medical Heretic mixed reasonable criticisms of how modern medicine operated with over-the-top rants that portrayed surgeons as bloodthirsty butchers who didn’t care if operations were therapeutic and necessary or not but did them anyway because they were greed-heads who just loved to cut. He was particularly harsh on obstetricians and gynecologists, whom he characterized as sacrificing women on the altar of surgery during childbirth. Not surprisingly, it turns out that Dr. Mendelsohn was antivax to the core as well, writing in a chapter in his 1984 book How To Raise a Healthy Child In Spite of Your Doctor that there was “no convincing scientific evidence that mass inoculations can be credited with eliminating any childhood disease”; “while the myriad short-term hazards of most immunizations are known (but rarely explained), no one knows the long term consequences of injecting foreign proteins into the body of your child”; and “there is growing suspicion that immunization against relatively harm-less childhood diseases may be responsible for the dramatic increase in auto-immune diseases since mass inoculations were introduced.” He even asked, “Have we traded mumps and measles for cancer and leukemia?”

If you read the article, you’ll find a number of antivax tropes that antivaxxers co-opt against COVID-19 vaccines today. Forty years ago, Dr. Mendelsohn portrayed measles and mumps as basically harmless diseases, with the vaccines being more dangerous. He pointed to outbreaks of pertussis among vaccinated children in much the same way that COVID-19 antivaxxers point to transmission of COVID-19 among the vaccinated, leading him to call mass vaccination against pertussis “indefensible.” (The pertussis vaccine is not a sterilizing vaccine and only partially inhibits transmission, even as it is good at preventing serious disease. Sound familiar?) He fear mongered about unknown “long term” effects of vaccines. He blamed the DPT vaccine for sudden infant death syndrome. He wrote this about the polio vaccine:

Meanwhile, there is an ongoing debate among the immunologists regarding the relative risks of killed virus vs. live virus vaccine. Supporters of the killed virus vaccine maintain that it is the presence of live virus organisms in the other product that is responsible for the polio cases that occasionally appear. Supporters of the live virus type argue that the killed virus vaccine offers inadequate protections and actually increases the susceptibility of those vaccinated.

This offers me a rare opportunity to be comfortably neutral. .I believe that both factions are right and that use of either of the vaccines will increase, not diminish, the possibility that your child will contract the disease.

In short, it appears that the most effective way to protect your child from polio is to make sure that he doesn’t get the vaccine!

Everything old is new again. I know, I know, I write that too often, but it really is true.

Dr. Mendelsohn’s rhetoric was full of explicitly religious imagery, too. For instance, there’s a chapter in Confessions of a Medical Heretic called Ritual Mutilations (Chapter 3, about appendectomies, tonsillectomies, hysterectomy, cancer surgery, and more). While it was a reasonable argument regarding how many tonsillectomies and hysterectomies were truly necessary, that was not what Dr. Mendelsohn was about, as he referred to the “millions of mutilations which are ceremoniously carried out every year in operating rooms.” He also dismissed most cancer surgery as useless, predicting that most cancer surgery “will be regarded with the same kind of horror that we now regard the use of leeches in George Washington’s time.” Religious imagery is everywhere in the book, for instance, in Chapter 7, The Devil’s Priests—in the “Church of Modern Medicine,” yet! If that’s not enough, he described hospitals as The Temples of Doom. Again, for every reasonable criticism about hospitals (e.g., the oversuse of laboratory and diagnostic tests of dubious value and fee-for-service reimbursement models that incentivize doing more procedures), there are several overblown ones that portray hospitals as abattoirs. (I exaggerate only slightly.)

Other chapters have titles like:

• Miraculous Mayhem (Chapter 2)
• Holy War on the Family (Chapter 5)

The religious language of “heresy” versus religion is overwhelming in the book, and it wasn’t just there either. In 1984, during an address to the the “health freedom” group, the National Health Federation, Dr. Mendelsohn said something that really drilled home what I mean by how the view of medicine as a religion leads to quackery:

Doctors complain that quacks keep patients away from orthodox medicine. I cheer! Since all the treatments, both orthodox and alternative, for cancer, coronary heart disease, hypertension, stroke, and arthritis, are equally unproven, why would a sane person choose treatment that can kill the patient?

Both sides! Alternative or science-based medicine, they’re just two different belief systems that are “equally unproven”! Got it? Elsewhere, in the foreword to Immunisation: The Reality Behind The Myth by Walene James, he wrote:

Elegance of style is an additional bonus. For example, James compares modern vaccines—laden with formaldehyde, mercury, dog kidney tissue—with the “eye of newt and toe of frog” added to the brew of Macbeth’s witches. She wisely comments: “Is it too impudent to suggest that man has long had a love affair with decomposing animal proteins, noxious potions that ward off the demons of ill fortune?”

Immunization: The Reality Behind the Myth will open the eyes of those who still believe in the religion of modern medicine. It will strengthen those who have left that religion. And to protect every human being right from the start— this book is the most valuable gift you can present to the mother of a newborn baby.

Again, note the narrative of the apostate.

Also, note how Dr. Mendelsohn sounded rather New Age-y before Oprah Winfrey ever became popular, describing his alternative “new medicine” thusly:

Our New Medicine cuts across all political and ideological lines and touches the core of every person’s relationship with life: How long and how well will I live? The New Medicine, too, takes on some of the trappings of a religion.

And:

Faith is the first requirement for a religion, and you still need faith to practice the New Medicine. But you won’t need faith in technology or doctors, or drugs, or professionals.

You need faith in life.

By faithfully, religiously if you will, regarding life — and loving it — the New Medicine immediately will discredit Modern Medicine. The New Medicine need not come between a person and whatever traditional religion he or she chooses, because the religions that have survived all support life.

And:

Since life is the central mystery of our New Medicine, our “sacraments” acknowledge and celebrate the life of the universe. The “sins” of the New Medicine, in many cases, turn out to be the virtues of the Church of Modern Medicine: any practice that promotes or condones violence against life. The New Medicine says it’s a “sin” to restrict weight gain during pregnancy, to use the Pill freely on the theory that it’s safer than pregnancy, to submit to routine annual physicals, to put silver nitrate in babies’ eyes, to immunize children routinely, to be ignorant of nutrition, and a host of other activities that Modern Medicine promotes as “healthy.” These activities are sins not because they offend anybody’s idea of correct or polite behavior, but because they present a clear and present danger to life. They are offenses against biology. Since the life in our bodies seems to have an incredible capacity to heal itself, if given the proper conditions the corrective activities of the New Medicine — guilt and penance — will aim at producing those proper conditions. Imbalance is often as difficult to avoid in human life as balance is desirable. Since this is a human medicine, not one bound to the deathly formality of machines, hope is one thing that is never taken away from even the worst “sinner.”

The New Medicine doesn’t have any empty [260] rituals. You fulfill the “commandments” and celebrate the sacraments by doing real things. Naturally, we have priests in this religion, too. But the New Doctor is not the prime mediator between the faithful and the object of faith. The authority of the doctor is severely limited by the individual taking the responsibility upon himself. Still, a system of ethics needs a mediator, a supporter of the faithful in their quest, a lifeguard when the quest runs into trouble.

I could go on and on, but you can read the entire book for free for yourself if you want, as a PDF of it is hosted at—where else?—Whale.to, which was a good thing for me writing this post, as I no longer possess the original copy of the book that I’d received in the mid-1980s. I really don’t know what happened to it.

I also can’t help but note that Dr. Mendelsohn was as underqualified to make such sweeping indictments of many areas of medicine as Dr. Jensen is to make sweeping indictments of public health responses to COVID-19.

Why is medical apostasy so attractive?

There’s no doubt that medical apostasy is very attractive to certain physicians. Nor is apostasy attractive only to the doctor who embraces “heresy” and becomes an “apostate” opposed to the “church of medicine,” as Dr. Mendelsohn so famously described himself, although maybe not using exactly those words. The idea of an apostate is attractive to those who would follow the apostate. In this concluding segment, I’ll look at both sides of this coin. After all, it doesn’t take much to think of a list of physicians who used the language of medical heresy/apostasy in describing their “conversion” to quackery; e.g., Andrew Wakefield, Paul Thomas, Stanislaw Burzynski, and many other physicians turned quacks have railed against the “dogma” of medicine that has left them on the outside.

In my last article on the making of COVID-19 contrarians specifically and quacks more generally, I noted that hubris was a key trait in physicians that lead them to believe that they know better than the assembled experts in their fields, that they alone have found some fatal flaw in the understanding of science missed by experts far more qualified than they are. In fairness, one has to recognize that it is always theoretically possible that a doctor such as Dr. Mendelsohn, Dr. Jensen, or any of the other panoply of “apostates” to see something that the experts didn’t. It’s just incredibly unlikely. Moreover, if such “apostates” brought home the evidence to prove their point, chances are good that eventually they could persuade the experts. I won’t claim that it would be easy or fast, but in general over time science does win out.

It takes a lot of self-confidence to believe that you have what it takes to be entrusted with people’s lives and most private information, as physicians are. This is even more true if you think you have what it takes to become a surgeon, the only profession to which society explicitly gives permission to remove or rearrange parts of people’s anatomy for therapeutic intent, to plunge into places in the body that even the person possessing that body can never see. Also, as I point out a lot, most physicians are not scientists. Many go into medicine and surgery because it’s a calling; they want to help people. Many go into medicine for religious reasons; indeed, unlike the case among scientists the level of religious belief among physicians is similar to that of the general public, at least in the US. It is therefore unsurprising (to me, at least) that many would view medicine and its practices in a religious light.

There is also a tendency among physicians to believe that they are the “best and the brightest,”” because in large part many of us are, at least if you define “best and brightest” as academic achievement. After all, high academic achievement and strong work ethic are basically prerequisites to be accepted to medical school. As a result, when physicians find that the reality of medicine as a service, even an assembly line seeing patients if you will, there is often disappointment. For physicians who have always seen themselves as brilliant and creative (even if medicine itself tends to disincentivize too much creativity), as “brave mavericks,” as I like to call them, something “different” becomes very attractive. There’s a reason why there are medical pseudoacademic pseudoprofessional societies like the Association of American Physicians and Surgeons (AAPS), whose members seem to think they’re all even better than the children at Lake Wobegon, where all of the children were “above average,” as in unappreciated geniuses who are all “ahead of the herd.” Moreover, like the apostate, they are “persecuted,” as this old editorial entitled Medical Herdology by a former AAPS president described:

Inescapably, the herd is a force to be reckoned with in all of our professional lives. We must be prepared to travel with it or alongside it, to one degree or another, without being trampled or singled out for extermination. And, for those few physicians who still believe in individual-based medicine practiced according to the principles of Hippocrates, and in watching out for one another when one of our own is attacked, fortunately we have the AAPS. We are a fellowship of “different doctors,” and the distinction is apparent.

It’s also very satisfying to be able to tell yourself that you were once deluded, but saw through the delusion and embraced The Truth, whether that narrative is accurate or not.

Going back to Kroll’s description of apostasy, these brave maverick physicians, in their own self-image, have “experienced an awakening that few others have, suffered for their awakening and now believe they see the world for what it is.” Of course, being an apostate can be good or bad. If you reject one harmful non-science-based belief system in favor of one that is science-based (as Jim Laidler did when he rejected antivax beliefs and “autism biomed” quackery), then being an apostate can be a good thing, and the good feelings about oneself the conversion engendered can encourage the apostate to continue to do good. However, when, as Dr. Mendelsohn and Dr. Jensen did, the “apostate” embraces a set of harmful beliefs after rejecting science-based medical conclusions, then being an apostate is not something to be applauded, even as that apostasy leads such doctors to view themselves as possessors of secret knowledge that their colleagues do not possess, refuse to understand, or even reject outright. Indeed, they become susceptible to conspiracy theory, because if everyone rejects what you believe to be knowledge that you possess that the vast majority of experts characterize as nonsense, then you have to explain why our knowledge is rejected. Enter conspiracy theory and characterization of a belief systeme as “dogma.” It never occurs to this type of apostate that their new beliefs are rejected because they are not supported by evidence; to them, it’s because of religious differences, with science-based medicine being cast as just another belief system, a sort of religion or dogma whose adherents are trying to cast “heresy” against their belief as “thought crime.”

Apostasy also provides a testimonial message that people tend to find very appealing. Kroll sums it up well in his NYT article:

There are few more powerful messages in human psychology than that of the apostate: “Believe me. I used to be one of them.”

I would add that there are also few narratives more powerful in reinforcing a change in belief system for the person who’s made that change. There’s a reason why an antivaxxer named J.B. Handley once likened Andrew Wakefield to “Nelson Mandela and Jesus Christ rolled up into one.” Particularly powerful to them was Wakefields narrative of “unjust persecution” for his views, just as the stories of martyrs are particularly powerful in religion. Moreover, apostates, because they have rejected beliefs that they used to hold dear, can be particularly strong in their new beliefs and persuasive in converting others. It’s very similar to how converts to a new religion are often the most devout.

As I like to say, it’s not the pure grifters who know they’re grifting who are the most dangerous. It’s the true believers whose belief leads them to grift.