This transcript has been edited for clarity.
Eric J. Topol, MD: Hello. This is Eric Topol, editor-in-chief of Medscape. I'm here with my co-host, Dr Abraham Verghese, for the Medicine and the Machine podcast. Today we welcome Dr Robert Harrington, the chair of the department of medicine at Stanford. Welcome, Bob.
Robert A. Harrington, MD: Eric, thanks to you and Abraham for having me.
Topol: We have had a lot of discussions about the pandemic over the past few years, but the one that seems to be missing is how academic centers deal with — for lack of a better term — rogue faculty members. That's what we want to get into today, among other things. I wonder if you could give us an overview of your thoughts about this.
Harrington: First, thanks for entertaining the question, because it's something that is talked about more quietly than it ought to be. I say that because I believe most of us who are in the academy cherish the open discussion of ideas and debate. We like to go to conferences and ask questions and even argue as we look at different sides of an issue. So, the natural instinct of academics, including myself, is to be solicitous of new ideas, to be open to new ideas, and even to tolerate what I'll call extreme ideas, with the notion that those kinds of debates and discussions ultimately are the best of what goes on in the university.
But COVID brought out a different issue. We had, unprecedented in our lifetimes, a truly global public health emergency. The science was moving incredibly fast. What we knew changed, sometimes day by day, as new pieces of information became known. And there were voices in our communities, including on our own campus, that were really "out there" and latched onto by a variety of forces in society, sometimes out of naivety, and sometimes out of, I believe, malicious intent.
We ended up in this situation where the public was confused, where even well-intended people weren't sure what to do. Over the past couple of years, as I've thought about it a lot, I believe it's left us in a very difficult situation. In an environment that's dedicated to open and free discourse, how do you have the difficult conversation about what is truth and what is not truth, and what is fair to talk about and what is unfair to the broader public health?
This raises questions of individual freedom vs societal good. When does one have to suppress, potentially, one's individual freedom for the greater good? I would love your thoughts and would love to probe deeper into the dialogue. I certainly have other things I'd like to say about it.
Abraham Verghese, MD: Bob, it's great to see you in this format. I have to share with the listeners that my office is right next to Dr Harrington's, so I get to see him on a regular basis. But the COVID times were poignant for both of us, and for me, especially, to watch Bob as chair of medicine show up every single day, which was a powerful message, given that the rest of the office was pretty much empty.
It was interesting to see, on top of everything else we had to deal with — bed situations and changing directives — what seemed like voices that were working against the theme, so to speak, and not helping. I found myself looking up the definition of academic freedom; of course, it goes back a long, long way. One of the tenets of it is that, within your discipline, you should be fairly free to speak about what you know about. And you should be free to construct the curriculum in any fashion you want to. Much of the time, there is a distinction made between that and free speech.
Free speech, as in the First Amendment, is available to every citizen, but free speech in an academic environment is different; for example, the student doesn't have a right to get up in class and disrupt the professor's lecture, because that's not the place for free speech. Academic freedom doesn't cover them in that sense. It covers them in other senses. So, this was a time of great learning for all of us. Bob, was the issue that people outside disciplines of their expertise were weighing in on things that they didn't necessarily know much about? They didn't have a body of work that allowed them to weigh in on those things, correct?
Harrington: Abraham, having made bedside rounds with you, I know that you like to employ the Socratic method. In this case, I think you're asking me the proverbial rhetorical question.
People ventured out of their area of expertise all the time. Why did people do that? I tend to think the best of the situation. I tend to not think that there's a nefarious opportunity that people are trying to exploit, but in this case, I do believe that some of our colleagues got caught up in the bright lights of the moment. They liked being on the news. They liked being quoted in the newspaper.
They liked being contrarians, and sometimes being a contrarian is helpful. It makes you think of the other possibilities and maybe challenges your decisions. I say, "You know what, maybe I'm wrong." But there were times during this when I said, "I'm not wrong. I've done this for 30-something years, and I know what's right in human subjects research. I know what's right when we're thinking about some of the public health issues." I worried that the intent was not always to find the truth but rather to promote one's own ideas, and there's a difference there.
Topol: And it wasn't even just that. It was characterized by all sorts of ad hominem attacks. Your point was a good one — about becoming popular on Fox News, for example, which has been responsible for a lot of COVID mis- and disinformation. But also taking on — in not collegial ways by any means — people who were trying to stand up for facts and truths.
Getting to the clinical trials point that you mentioned, which is central, Bob, you and I have done a lot of clinical trials. We think we know how to interpret a clinical trial and what a rigorous trial is. But then we have these people who have never done a clinical trial, coming up with a not just skewed but extraordinarily off-base interpretation and then attacking others.
One thing that gave these individuals power is social media. I discussed this with our mutual friend, Bob Wachter, because he has one particularly difficult character at UCSF. I asked, did you ever meet with him to discuss the things we're talking about? And he said, first, he's not in my department. But we did meet with him, and we told him what he's doing, what he's writing, what he's saying is completely false, and it's bad for the reputation of the institution. He admitted that they were concerned not only about muting him or somehow restricting his ability to speak out, but also about the fear of being attacked on social media. Could you comment about this dynamic?
Harrington: It's a great question, Eric, and you framed it at the beginning of the podcast — the ad hominem attack. As you know, I'm active on social media, have been for a long time, and I also have a Medscape podcast.
Approximately 10 years ago, Clyde Yancy and I had a conversation on civility in social media. Clyde, for the listeners, is the chief of cardiology at Northwestern University and a well-known person in cardiovascular medicine. This was in the early days of social media, and we commented that we can debate, discuss, and disagree with each other, but we should do it with a sense of civility, a sense of professional behavior. Don't do something online that you wouldn't do looking somebody in the eye.
In human relations, civility means a lot. I don't think it's an old-fashioned term. We updated it 3 or 4 years later on a second podcast.
First, don't hide behind a name or a picture so that people don't know who you are. My view has always been that if you want to say something, say it out loud with your own name and picture attached. Put it out there. That's what good academics do. They say, hey, I did this study. This is what I found, and this is what I'm putting forward.
Second, treat people as you would like to be treated. Don't make fun of people. Don't pile on if a lot of other people are piling on. Treat people respectfully. Treat people with civility. Treat them with a sense of professionalism.
The individual you're referring to makes fun of people all the time, says things sarcastically, says things that are mean and not respectful. To me, that lowers the quality of that person's remarks, because one tends to attack when one doesn't have meaningful things to say. That happens all over the web. It's one of the things that often discourages me and makes me think, I'm going to give up this Twitter stuff. I don't want to be out there. As you both know well, it's a reflection of the greater society. The total lack of civility in public discourse is depressing.
I've been told by my own superiors that we don't want to be responsible for muting people's speech, and I've said in retort, what if what they're doing is harmful? What about this notion that you can't yell "fire" in a crowded movie theater? Isn't that the same, if you're saying that vaccines aren't helpful, or that there's no myocarditis occurring with COVID infection? Isn't that akin to yelling "fire" in a crowded movie theater, that you're spewing falsehoods and possibly causing people to be hurt, intentionally or inadvertently?
Verghese: Bob, as you know, things came to a head at Stanford, and about 80 of us were signatories on a document that basically said that we felt that this individual on our faculty was poorly representing the university and that he had his facts wrong. And of course, he threatened to sue all of us, which would have been a delight if he'd ever carried it out, but he never did. Many of us felt that we shouldn't have had to write that letter, that it was really the function of the university, of its governance, to rein in someone who clearly — even though he had the president's ear at the time — was not basing his remarks on scientific facts. So, the question is, what is the role of the person leading the department, the dean, the president? What is the administrator's role here?
Harrington: I remember the episode well. I also remember that in all of these tragedies, sometimes a good thing happens, and in that particular case, law school professors and others were able to acquire the services of a large law firm, pro bono, for the 80-plus faculty members, and wrote a powerful letter in retort that said, "Go ahead; come after us and we'll come after you." It's unfortunate that the whole thing happened, but there was some powerful good news that some people on our campus were willing to stand up and take a perspective.
At the administrative level, people feel this sense of a real tension between violating one group's rights to support another group's rights. And do we actually know what's right and wrong here? In that particular case that you made reference to, I would say we did know what was right and wrong. One group of people, and one person in particular, was spewing all sorts of untruthful and inaccurate information, which might have ultimately been harmful to the public health. To me, that is when it crosses a line. What's the old saying? "I vehemently disagree with what you say, but I'll fight to the death for your right to say it." That's not what this is.
This is somebody who, based on education and training, should know better, but for whatever reason, political beliefs or otherwise, was taking a different position. At some point, when it's harmful to an individual's health or the public health, which was the situation, that needs to be dealt with. That needs to be addressed. And universities have a variety of ways to do that.
I think that people tread lightly because they're uncertain where those boundaries are. There were some very prominent people on our campus who felt that any critique at all was wrong, that all sorts of tolerance of these things should be allowed. I don't agree with that.
Topol: It's happened in several leading universities — Stanford, UCSF, Johns Hopkins, and others — where particular faculty members are incessantly saying and writing things that are wrong, that are not backed up by data. They're fostering conspiracy theories — for example, saying that myocarditis after vaccines is far worse than the benefit, or that absolutely, no question, masks don't work.
Here you had the main advisor to the Trump administration, a radiologist who wasn't part of your department, but who, as part of the Hoover Institute, was active in saying and writing things that were completely off the wall.
Thinking about freedom of speech vs academic freedom, when do you cross the line in the middle of a public health emergency? Some of this took place during the true existential threat phase before we had any vaccines or treatments. How do you tolerate these individuals detracting from great universities' reputations? Is this a fuzzy line or should there be a protocol for universities to be able to defend themselves against individuals who are crossing whatever you want to call this line?
Harrington: I like the way you said that, Eric, that we were in the existential threat phase, because you can look back and see that things went in a certain direction, but at that point, we didn't know. I came to work every day and I was frightened many days because I didn't know what was going to happen. Were we going to have enough beds in the hospital? Were we going to have doctors to take care of the patients? Was our whole faculty going to get sick?
We had some crisis moments. God bless our orthopedic chair. When we were running out of medicine doctors, I asked at a chair meeting, "Who can help?" The first person who raised his hand was the chair of orthopedics. "What do you need, Bob?" And I told him. He said, "Well, you know my guys aren't operating anywhere. When do you need them?" And he sent us orthopedic residents to help on the medicine service.
But then we had people who were on our campus saying, "Oh, it's going to be no worse than flu. Oh, you're overexaggerating. Oh, there's not going to be more than 10,000 deaths."
Topol: A Nobel laureate, no less.
Harrington: Stuff that would make you say, are you kidding me? I'm worried that we're going to need to have refrigerated trucks as morgues, and you're telling me that you don't believe this, that it's not true?
I believe the universities have a great social responsibility that goes along with the great social entitlements we have. Leaders need to be willing to stand up sometimes and say difficult things. Like Abraham, I disagreed with the way things were handled, and that's tough to say. I believe you're right. We're a great university with way more good being done than anything else, but I don't think this will be looked back upon as one of our better chapters.
Verghese: That's well said, Bob. It's necessary to acknowledge that not only was social media amplifying good and bad messages, but this was an extremely politically divisive time. It was an extremely divisive time racially within the country. The irony was that we had a conference here on free speech and academic freedom, and many of the more liberal folks who wanted to attend were scared to attend because of how they would be labeled for the very fact of attending.
That is a shame. It's a shame that political divisiveness has entered the campus in that fashion. I think we would be remiss in not bringing up that the biggest threat to academic freedom right now is governors wanting to make changes in our curriculum. That is the one area that no one has ever debated, that we have the right to set the curriculum. But when you have the governor saying this is what you can and can't teach, that is when it really becomes absolutely necessary to define academic freedom, what its parameters are, and how far you will go to fight that.
Harrington The governance of the university is supposed to be its faculty, as you said, Abraham. A faculty is supposed to have responsibility for the curriculum. Eric, at your alma mater, the University of Virginia (UVA), a far-right governor is appointing Board of Visitors members to maintain the Jeffersonian values of the university, a dog whistle for a lot of bad parts of our history regarding slavery and other things.
How is this happening? How is a great university like UVA or a great university like Stanford withstanding this? We're a little bit lucky here, Abraham, in that we're a private university. We don't have to deal with some of the things that the University of Florida and UVA deal with, but these are frightening times. I'm not prone to exaggeration, but I look at this and wonder, where is this going? Because politicians at different ends of the spectrum definitely want to use the academy for their own political means, which are not necessarily in line with what the data show.
Topol: The politics that Abraham has mentioned, what's happening at UVA and the University of Florida and throughout the state of Florida, with the surgeon general there and the governor, these are scary things to see. This is the use of politics to detract from clear-cut unequivocal advances in science and well beyond that in terms of civil rights. But I go back to a point you made earlier about civility, because we have a serious lack of that.
Back in December 2021, I had a debate with Martin Kulldorff about the pandemic. I didn't know Martin. He's one of the trio from the Great Barrington Declaration who had a lot of objections to how the pandemic was being managed. Jay Bhattacharya from Stanford is one of them as well. This debate was remarkable. It was civil. We both made our points, and you could come away from it thinking, These people know their data and they have their views. But we don't see that.
When Dr Ladapo, the surgeon general of Florida, puts out a white paper — not even a preprint — that says vaccines shouldn't be used in men and boosters should be outlawed, and then the governor gets behind that, there are no data to support it. Not only that, it was killing people. This is scary stuff because the public doesn't understand, no one reins it in, and there's no civil discourse about it. If you happen to put something on Twitter, let's say to the Florida surgeon general, watch out because the mob will go after you — literally a mob.
We have a divisiveness that is scary, and now we also know that the governance of some institutions is afraid because of this issue of the politics and the potency of social media. Do you see any remedy? How do we get back to civility? How do we get back to balanced discourse where you hear both sides?
Harrington: I wish I could answer that, Eric. I'm troubled by the lack of civility. I like a good debate, a good argument, but you see lawsuits being filed. You see the mob piling on. The bots are out there stirring up trouble. Our mutual friend Rob Califf at the US Food and Drug Administration has spent much of the past year talking about the public health threat of disinformation — intentionally putting out information to cause harm, misinformation that is being put out there with the intention to mislead and misinform.
Rob spent much of the past year talking about this. And he's talked publicly about getting the universities to step up and help with this. What is disinformation? Why is it a threat to the public health? What is misinformation? How does it affect the public health? And as you probably know, Eric, he's been skewered in multiple places, particularly online, by people with a certain political agenda, to try to lessen his point.
Topol: I've seen that. Basically, he's saying that universities that don't articulate their position and how it differs from the rogue person are complicit. That's his base, and I couldn't agree more. The university needs to separate itself from the disinformation early on. It doesn't mean that the faculty member is fired. It just makes clear that this is not the opinion of the mainstream faculty or university. I've watched Rob take lots of hits, and it seems that what he's gone through is not at all fair because what he's advocating is sensible, don't you agree?
Harrington: It's completely sensible. It made me think about the comments of the Hoover Institution faculty member who was spewing all sorts of misinformation. Stanford did put out a statement that said these are not the views of the university; the university is in favor of masks; the university is for social distancing and good public health behavior. But it's gotten even worse.
One of our faculty members, a leader in one of the departments, is married to a local public health official in one of our surrounding counties. And they had to have a police car sitting outside their house to protect his wife and the family. She's been sued, named in lawsuits multiple times, supported with depositions from faculty members against her. This is where we are.
Verghese: One thing that strikes me listening to both of you is that we use the term "academic freedom" with such imprecision. It means different things to everybody. Even though we can't control the world or politics, I think we need to protect the reputation of our universities. And before we have another episode like this, it begins with defining academic freedom. We need a course on academic freedom, what things the courts have and have not defended, so that people understand. For me, the takeaway in preparing for this podcast was the idea that expertise in your own discipline doesn't give you the license to speak out about another. Not that you shouldn't necessarily speak out, but it's clearly a warning bell. Having a Nobel Prize in something completely different doesn't automatically give you the right to make pronouncements, especially as time goes on and they're wrong.
Harrington: I call that intellectual arrogance. Because you're so good in one area, you think that automatically makes you good in another. And we all know that doesn't happen.
Topol:. I believe Abraham's distinction between academic freedom and freedom of speech is central here. Twitter is still a major platform for disseminating medical information, but the platform is doing just the opposite. Nobody's banned now, and Twitter isn't suppressing disinformation. It's even harder than ever before to get out the facts and the evidence.
We may be hitting a worse time than ever because of this line about academic freedom and the sense of powerlessness at institutions. They want this to be positioned as freedom of speech, and they don't want to be accused of muzzling a faculty member because that could be even worse. I know we don't have a solution here today. I didn't expect that we would, but it's been a helpful discussion.
Harrington: Something I spend a lot of time thinking about is the notion of science in health literacy. We may be at a low point in the country's history of people who not only understand science but accept scientific truths as truth. Some things are true. The way gravity works is a truism. I could list a whole bunch of others. Some things are facts. They've moved beyond hypothesis to facts.
But a whole segment of the population, for whatever reason, refuses to accept facts. What was this notion that Kellyanne Conway created? The alternative fact. Talk about BS. Some things are not true, and some things are true. To create smoke and mirrors around something is BS. Whether it's the failure of our educational system or the failure of our democracy, the inability of some people to accept that some things are true is a big problem, because it's hard to have a democracy if you don't have a central core set of facts and beliefs and principles that we all adhere to.
Wrapped around all of that, I'll go back to the word "civility." We have a responsibility to keep talking about it. I read Abraham's books. Eric, I read your articles. I read your tweets. They are among the best sources of information about many things. What I always say about you, Eric, is that one of the reasons I followed you for years is that you have great taste in science.
You understand science and you highlight things that are important for the rest of us. I follow a few people exclusively for their taste in science. I would ask our listeners to go into fields that you're not familiar with. Try to latch on to some folks who have a voice in that field, getting back to Abraham's point about content matters and academic freedom, and learn from them. We're not all experts on everything.
Verghese: I'm optimistic because, amidst all that noise, both of you have a wonderful way of tweeting. And it's not just opinion tweets. With Eric, you have papers highlighted in yellow. It's so helpful and manages to rise above the noise. You guys have an obligation to keep doing what you're doing. You may not realize how important that is to counter the negative discourse out there.
Topol: Maybe it will get better as we emerge to a more stable time than the current pandemic, maybe a time that is not quite as emotionally charged as it has been. Thanks so much for joining us, Bob. I enjoyed this discussion and hope our listeners enjoyed it as well.
Follow Medscape on Facebook, Twitter, Instagram, and YouTube
Medscape © 2023 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Rogue Faculty and Academic Freedom in the Age of Misinformation - Medscape - Mar 15, 2023.