When questions became disobedience

Medicine begins with a person who needs an answer. During COVID, too many encounters ended with a slogan. A patient wanted to know why a recommendation applied to him; the answer often concerned what responsible people were expected to do. When I interviewed musician and SteynOnline writer Tal Bachman on March 16, 2022, he kept returning to that failure of explanation.

“I’m just trying to ask the right questions,” Bachman said. He claimed no medical expertise. His objection concerned the conduct of people who did: their impatience with questions, their confidence about unsettled matters, and their tendency to treat disagreement as evidence of defective character. I recognized the problem from my own profession, where credentials sometimes supplied an answer’s authority without supplying its reasoning.

Bachman’s example was the phrase “horse dewormer.” Ivermectin has veterinary uses; identifying those uses does not answer whether a human formulation benefits a particular patient. His comparison was concrete: “we’ve been using antibiotics on horses, your cat, dogs, everything.” A drug’s usefulness for an animal tells us little about its usefulness for a human disease. That requires clinical evidence, with a specified dose, population, and outcome.

The same rule applies to our enthusiasm for proposed treatments. The TOGETHER randomized trial, published after our interview, found that ivermectin did not reduce its primary outcome of hospitalization or prolonged emergency observation. That result belongs in any present account of our claims. Ridicule could not establish that a treatment failed; our distrust of the ridicule could not establish that it worked. See pubmed.ncbi.nlm.nih.gov

Vaccine-injury reports demanded the same discipline. Bachman asked, “How many adverse reactions really are there?” It was a reasonable question, although personal reports could not supply the answer. The Vaccine Adverse Event Reporting System accepts reports of events following vaccination; those reports alone establish neither causation nor an incidence rate. Underreporting matters, but correcting it requires investigation and a denominator. A larger pile of reports still needs careful evaluation. FAQs

My strongest clinical objection concerned the distance between a product’s general merits and an individual’s need for it. I used yellow-fever vaccination as an example. A vaccine can serve an important purpose without being indicated for every person in every setting. COVID recommendations likewise required attention to age, previous infection, exposure, and the outcome being prevented. My later essay, “Why Have Any Covid-19 Vaccines, 2025?”, develops my judgment about that question; it is an argument, not a substitute for patient-specific evidence.

I also described a physician’s shouting at me when I spoke with a mother at a squash club. Bachman interpreted such reactions through cognitive dissonance: a professional who had committed himself publicly might experience a question as a threat to his standing. “This is what I think is going on,” he said. That qualification matters. His explanation was a psychological interpretation, not an established account of another physician’s motives.

Corporate history gave Bachman further grounds for scrutiny. The Justice Department’s 2009 Pfizer settlement documents $2.3 billion in criminal and civil resolutions involving unlawful pharmaceutical promotion. That record supports demanding independent evidence and enforceable disclosure. It does not establish that every subsequent Pfizer product is defective, or that every physician recommending one acts dishonestly. Specific accusations still require specific proof. United States Department of Justice

Mandates raised a separate question. A recommendation can be medically defensible while the penalty for declining it remains unjustified. Bachman objected to the claim that nobody had been forced when employment and travel depended on compliance. I share his objection to treating those consequences as trivial. An employer or government imposing them owes a further explanation: what harm does the restriction prevent, how much does it prevent, and why is that burden warranted? Repeating a product’s benefits does not answer those questions about the use of power.

Bachman’s final hypothetical asked how many loved ones would have to suffer a severe health crisis shortly after vaccination before an advocate hesitated to recommend another dose. The question probes willingness to reconsider; it cannot determine causation, and refusing its premise cannot by itself establish bad faith. I would put the obligation more directly: a physician should state what finding would change his recommendation. His patient’s consent means more when the physician has explained both his reasons and the limits of what he knows.