Prof. Peter Hotez, MD, PhD and The Dreadful Rise of Advocacy Science

The Anatomy of a Travesty

Dr. Peter Hotez is an outspoken physician-scientist and a familiar face to cable news viewers during the pandemic. His latest book—The Deadly Rise of Anti-Science: A Scientist’s Warning—came out in late 2023.

By itself, a bombastic rant from a single writer and TV personality would not be particularly noteworthy in our age of political polarization and circus. The book was bound to receive its lavish, momentary praise from the bombast-loving ABC, LA Times, USA Today, MSN, CBC, and other mass media outlets, and then pass into obscurity after a few weeks.

Its value lies not in its intended value but in its delightful caricature of the authoritarian scientist as portrayed by Dr. Hotez himself. It is a gripping story of how the thinking of a smart man can wend its way from expert to hubris, from earnest to authoritarian, from scientific to clownish. The intellectual journey from science to advocacy is perilous. Dr. Hotez seems to have a special talent for falling into every pitfall. He repeatedly undermines his noble cause “to restore the American people’s trust in science” when he enthusiastically adopts the very attitudes that give rise to skepticism of advocacy science in the first place. It’s a cautionary tale about the easy corruption of science when it aims to serve politics.

Dr. Hotez makes a clean break with the traditional approaches to countering "anti-science"—approaches such as improving science education, scientific practices, and science communication—and instead advocates an aggressive censorship against what he deems contrary to "mainstream scientific views" (p. 9). He also suggests building an incentive structure to break scientists out of "the old-fashioned idea that scientists should keep their heads down and stick to their experiments, published papers, and grants" (p. 130) and to train and encourage them to make more frequent appearances in the popular media like he does.

It’s a remarkable tale of errors that a scientist can make when he falls into the abyss of politics and motivated reasoning. Even more remarkable is that the book—and the tragic fall that it documents—was warmly promoted in premier scientific journals, such as The Lancet, Nature, and Science, and the aggressive censorship that it advocates has been enthusiastically endorsed by the US government, the European Union, the World Health Organization, and other governing institutions.

The fervor to censor scientists who disagree with officially-approved narratives is a relatively new phenomenon in Western culture. Dr. Hotez is one of its most prominent voices in the USA. He poses as a noble defender of science against the dark forces of anti-science ignorance. Ultimately, though, he weds a muddled incoherence with an aggressive authoritarianism, epitomizing the dangers of infecting science with politics.

And he's far from alone.

Symptoms

The problems with the book are legion, beginning with the general premise of a "rise of anti-science." Dr. Hotez never questions whether there actually is a rising anti-science sentiment in Western culture. He takes it on faith that there is, that it is deadly, and that it needs to be forcefully suppressed.

What he diagnoses as "anti-science" is almost entirely directed not against science itself but the scientific institutions, or The Science with a capital S to distinguish the institutions from the disciplines of science. In other words, his "anti-science" is really more of an anti-corruption sentiment, which objects to the peddling of non-science as science and to the exaggeration, misrepresentation, or outright fabrication of data, results, inferences, predictions, or degrees of certitude.

The errors are not unique to Dr. Hotez. Taking Science as "science"—or, its corollary, taking objections to the corruptions of Science as "anti-science"—is a common error.

A 2022 ABC News story perfectly illustrates the confusion. The headline breathlessly announces: “Americans' trust in science now deeply polarized, poll shows,” and "Republicans' faith in science is falling as Democrats rely on it even more…”

The headline is false. The poll was not about science per se—the curiosity, the experiments, the devotion to truth, the bend-over-backwards honest evaluation of evidence. Instead, it asked respondents to grade scientists on their stewardship of the institutions of science.

I am going to name some institutions in this country. As far as the people running these institutions are concerned, would you say that you have a great deal of confidence, only some confidence, or hardly any confidence at all in them? …Scientific community.

The distinction is critical. Skepticism about how well scientists live up to the ideals of science is entirely different from rejection of those ideals. What is so often mistakenly tagged as “anti-science” is more akin to "anti-corruption," defending the disciplines of science against a corrosion of scientific standards by its stewards.

Note the stark partisan gap in the figure. Between 1973 and 1989, both Democrats and Republicans were fairly consistent in their grading, but with a substantially higher fraction of Republicans (48.1%) expressing "a great deal of confidence" in scientists than Democrats (40.6%).

Beginning in about 1990, something changed. Republicans' confidence in scientists began a long, gradual decline, while Democrats' increased. In 2000, the lines crossed. In every year that we have data for in the 20th century, Republicans expressed greater confidence in scientists than did Democrats. In the 21st century, it is Democrats with the greater confidence every year. By 2022 an enormous gap had opened up as scientists like Dr. Hotez took center stage in the media and in public consciousness during the pandemic years.

Democrats see scientists leaning more and more toward advocacy for left-leaning politics, and they cheer the powerful new voices on the team. Republicans see scientists increasingly tilting away from the disciplined epistemic humility and vigorous intellectual integrity that science demands. They mourn the looting of scientific credibility for political gain, and they feel targeted by aggressive fanatics like Dr. Hotez.

Etiology

The root cause of the declining cultural trust in the scientific institutions is not the treatises of anti-vax charlatans or in the misinformed rants of cable news pundits and political demagogues but in the corrosion of scientific integrity when it is exposed to the acid of politics.

Schneider's Allochironomy

Epistemic humility and accurate, honest assessments of uncertainty are so central to science that Richard Feynman¹ went so far as to define science as "the belief in the ignorance of experts” His point is not that experts don't know anything—they know a lot!—but that doubts and caveats are an essential part of science, and when experts disregard uncertainties and confidently express opinions or desires as fact, they abandon science.

Stephen Schneider, a Stanford professor and outspoken pioneer in the science of anthropogenic climate change, expanded on the indispensability of a proper assessment of uncertainty. In an interview with Discover magazine in 1989, he famously said:

On the one hand, as scientists we are ethically bound to the scientific method in effect promising to tell the truth, the whole truth, and nothing but—which means that we must include all the doubts, the caveats, the ifs, ands, and buts. [emph. added]

That's all well and good, but he continues:

On the other hand...

There is no other hand!

It almost doesn't matter what comes in the ellipses. The credibility of science rests squarely on its core principle of honest and careful evaluation of the evidence, the inferences, and the uncertainties.

In a stunning betrayal of core scientific principles, he counsels scientists to dismiss uncertainties and portray an unscientific, faux assurance when they want to promote a social or political agenda. He explicitly suggests compromising science's demand for Feynman’s bend-over backwards devotion to truth in exchange for media coverage and leverage in pushing a political agenda.

On the other hand, we are not just scientists but human beings as well. And like most people we'd like to see the world a better place, which in this context translates into our working to reduce the risk of potentially disastrous climatic change. To do that we need to get some broad-based support, to capture the public's imagination. That, of course, entails getting loads of media coverage. So we have to offer up scary scenarios, make simplified, dramatic statements, and make little mention of any doubts we might have. This 'double ethical bind' we frequently find ourselves in cannot be solved by any formula. Each of us has to decide what the right balance is between being effective and being honest. I hope that means being both. [emph. added]

Appalling as his "other hand" sounds, he does get one thing (almost) right. Getting loads of media coverage (virtually) requires² compromising the epistemic humility of scientific integrity for scary, dramatic statements and a hearty, if insincere, confidence. After all, TV audiences love a good fight, and the news and opinion media select for opinionated, self-sure guests who bristle with impatience at those who disagree.

So, yeah. Epistemic humility does not make for popular TV. What he misses is that sacrificing the integrity of science is an extremely high price to pay.

Such compromises have gone from rare and tsk-tsked prior to the 1990s to mainstream and celebrated in the 2020s. It's common now to fall to Schneider's "other hand." I call it Schneider's allochironomy, or simply

al·lo·chi·ro·no·my (a-lō-kī-rah-nə-mē), n. a form of corruption which compromises intellectual integrity for political effectiveness. [from Greek: αλλω other + χαιρ hand + νομος norm].

In science, allochironomy is commonly manifested in the peddling of non-science as science in service to an agenda, aggressive demonization and suppression of rival scientists, fraud, etc.

Severe cases involve deliberate misrepresentation, fraud, or aggressive attempts to demonize and forcibly suppress dissenting voices, which the infected might argue is justified and necessary because the political cause is oh-so-important. Such severe cases can severely damage the credibility of Science when the infection spreads widely within a given field. However, historically, severe cases have been relatively rare and mostly confined to small numbers of fringe scientists, who have been generally recognized as aberrant and considered abhorrent, and the damage has been limited. Recently, though, there seems to be a pandemic of severe allochironomy.

Slightly more subtle but substantially more common are cases that do not involve demonstrable fraud but are manifested in exaggeration or overblown confidence in data, results, or predictions. This threat to science is greater than it may seem at first glance. The corruption goes to the very core of science.

Epistemic Hazards of Allochironomy

A fox knows many things, but a hedgehog knows one big thing.—Archilochus

By definition, experts know a lot in their domain of expertise, which is fantastic and even indispensable. However, in general, expertise provides surprisingly little guarantee of being correct about predictions or speculations about complex systems. It's easy for the mind to get locked into narrow channels, overlooking the broader context and not imagining that the answer could lie outside those channels.

Errors in data, analysis, conclusions, and predictions are particular easy to make in the difficult sciences, like economics and medicine and pretty much any that end in -ology—epidemiology, virology, climatology, biology, psychology, ecology, geology, etc.—where the systems and questions are so complex that they defy reliable mathematical characterization. There is an inherent mismatch between reality and our models. The gap is impressive in the more complex systems.

That's why epistemic humility is an essential virtue of science.

In his monumental, multi-decade study, Expert Political Judgment,³ Philip Tetlock found that reliability in prediction was a more function of thinking style than of degree of expertise. Dilettante epistemic trespassers (i.e., experts making predictions outside their areas of expertise) tended to fare just as well as experts. Those who didn't fare well were the "hedgehogs," the confident experts who saw little reason to doubt their conclusions and predictions. They had difficulty looking beyond their field of expertise and fared substantially worse than the more circumspect "foxes," whether experts or epistemic trespassers. Leon Hadar succinctly summarized the phenomenon as: "knowing too much about a subject and having strong personal commitment to the issue could be a major obstacle to getting it right."

Tetlock found that the media strongly favored these notably unreliable but cocksure experts to amplify preferred narratives and for the entertainment value. Appearing "daily on major news networks such as MSNBC, NPR, the BBC, and others," as Dr. Hotez did during the pandemic (inside cover), would be a severe test for any scientist. To be interested in regularly making such appearances (a la Schneider) and be invited to do so (a la Tetlock)? Let's just say it raises a huge, red flag.

Ebbing Uncertainty in Science

A recent study showed an alarming trend toward fewer hedging qualifiers such as "seems," "could," "approximately," etc. in conclusions in research articles in the premier science journal, Science, between 1997 and 2021. Other studies have demonstrated corresponding increases in superlatives such as “groundbreaking” and “unprecedented” in other journals. Similarly, in a study of over 700,000 psychology journal abstracts published between 1970 and 2016, Wheeler et al. (2021) found markedly greater degrees of "expressive confidence" in recent psychology papers than in older papers. They suggest that the changes in language are intended to persuade rather than just report and inform, and to "influence the likelihood of a particular theory or set of evidence being accepted and acted upon," marking a shift in emphasis from persuasion by evidence and honest appraisal to persuasion by rhetoric, confidence, and appeal to authority in order to have the results be "acted upon" in service to politics or career advancement.

Fewer expressions of doubts and caveats. Fewer ifs, ands, and buts. More simplified, dramatic statements. It's just what the doctor ordered in his 1989 interview with Discover.

Schneider has been progressively replacing Feynman.

Prof. Hotez, MD, PhD: To Allochironomy and Beyond!

Dr. Hotez is in the next generation, after Mr. Schneider. He boldly takes allochironomy two steps beyond Mr. Schneider's vision.

On the one hand, Dr. Hotez is a genuine scientist and medical researcher. He's a professor at Baylor Medical College and co-author of >200 scholarly and semi-scholarly papers. He is smart and fully capable of carefully evaluating evidence and of tempering his preferred conclusions with an honest evaluation of uncertainties and prudent caveats.

On the other hand, he is a TV doctor, who revels in loads of media attention and demonstrates a strong devotion to Schneider's "other hand." Indeed, in the Preface to his book, Dr. Hotez echoes Schneider's formula but with two key extensions.

Our training as physician-scientists say that we...are supposed to be above politics, intently focused on finding the truth, understanding the natural world, and applying our discoveries to improve people's lives. However... (p. xiii) [emph. added]

Sigh.

Like Schneider, he sets up an urgency or earnestness exception to science's demand for intellectual integrity. Unlike Schneider, he moves the "improve lives" clause out of "the other hand" of politics and squarely into "the one hand" of science itself.

For his part, Schneider properly tucks "[desire] to see the world a better place" safely into the "other hand." Asking science to define "better" would be a radical and absurd expansion of the realm of science, placing it firmly in the political realm. Let Karl Marx and Milton Friedman, or Machiavelli and St. Augustine, or Ibram X Kendi and Martin Luther King Jr. argue amongst themselves about visions of "better," and let's not squander the credibility and authority of Science by asking it to arbitrate between social visions, judging one as True Science to be exalted and promoted and the other as Anti-Science to be banned as anathema and uncoupled from public discourse.

Dr. Hotez's call to improve lives is a call to action. Effective action requires putting aside doubts, firmly fixing a direction, laying out a path, and confidently forging ahead. Science, though, is driven by passionate curiosity, always looking for deeper and better descriptions and explanations of the natural world. Curiosity turns the wheel, so to speak, raising questions and driving investigation and analyses. Curiosity is attracted to doubts and animated by a passion to resolve them. Science ends when the curiosity stops, or, as Richard Feynman is reported to have so eloquently put it, "I'd rather have questions that can't be answered than answers that can't be questioned."

Even the science side of Hotez's chironomics is corrupting.

Then, in moving "improve lives" into the one hand, Dr. Hotez creates a void in the other hand, which he promptly fills with an aggressive call to censorship.

...However, the loss of life to politicized anti-science is a circumstance that we, as physician-scientists, cannot ignore. We must do our best to uncouple the anti-science from political discourse in order to save lives.

His call to "uncouple the anti-science" from public discourse sounds a lot like Newspeak for "censor," creepy and ominous in its attempt to sound anodyne. On the one hand, a liberal democracy can and must tolerate a good deal of goofy ideas, including some genuine skepticism or even rejection of science itself. On the other hand, almost all of what Dr. Hotez identifies as "anti-science" is nothing of the sort...unless you identify particular scientists or public policy choices as "science."

Misdiagnosis

Dr. Hotez gets it almost right in the opening pages, where he writes, "something abhorrent has taken shape to...cause millions of Americans to distrust biomedical science" (p. 4). A simple change of case in one letter in the final word corrects the error. The disease is not a mistrust of science but of The Science.

His misdiagnosis is rooted in a misperception that scrutiny or criticism of scientists, the administration of science, or policies favored by scientists is somehow "anti-science." Rather, the skepticism of The Science stems from the relentless politicization of Science by scientists who present non-science as science to push a social or political agenda. Since he misidentifies the disease and is oblivious to its causes, it is no surprise that his prescribed treatment regime would be malpractice, exacerbating the disease and likely causing additional, even more serious conditions. He proposes to intensify the politicization of science and aggressively "dismantle" any dissent.

Dr. Hotez is in the vanguard of the "something abhorrent" that is damaging the credibility of The Science.

He routinely characterizes criticism or scrutiny of scientists or the policies they favor as "anti-science." As he does so, he puts scientists high on a pedestal, above criticism—scientists he agrees with, that is. Others are to be silenced by force.

Conflating Policy with Science

The masks, school closures, prohibition of public and even private meetings, vaccine mandates, standing on little stickers on the floor at grocery stores, being forced to wear masks in a restaurant while standing but not sitting, dumping tons of sand on a skateboard park, arresting lone surfers for violating stay-at-home orders, etc. are policy choices, not science. They were typically based on a simplistic calculus like

1. This policy might reduce the rate of spread of covid;

2. Therefore it is a good idea.

In theory, science can address the potential efficacy of various interventions in a rudimentary way. For example, vaccine trials showed a convincing reduction in rates of moderate or severe covid cases in some populations over the short term. Masks may offer modest protection against respiratory viruses under certain conditions, but the evidence for the efficacy of mask mandates is weak. Most policy choices had no science whatsoever to back their efficacy. That does not mean they are wrong, only that they are not supported by science.

As hard as it is to measure efficacy of an intervention, it is much more difficult to anticipate and reliably predict the potential economic, social, and cultural costs of aggressive interventions like mask mandates and school closures. Indeed, the potential costs are typically well beyond the ability of science to evaluate or even to identify properly.

The final step of weighing potential costs against benefits requires value judgments that are wholly outside the realm of science, even in theory.

And yet, Dr. Hotez views lockdowns and mask mandates as "essential" (p. 14) and calls opposition to such policies "anti-science activities" (pp. 16, 19, 38, 40, 128) that reveal an "open contempt of science." Confusing policy preferences with science is a category error. When scientists make such errors, they damage the credibility of Science.

Dr. Hotez frequently makes such errors.

Reading of resistance to half-baked—or quarter-baked or even thoroughly raw—policies as "open contempt of science" (p. 4) is clownish. Science is not policy. Science does not dictate policy. Resistance to policies with scant scientific evidence of efficacy, which do not seriously consider potential costs and do not even attempt to balance benefits against costs is not "anti-science." In most cases, the charge is patently absurd.

The covid vaccine mandates were different. They were at least half baked. They plausibly promised substantial benefits, which were backed by promising vaccine trials showing clear efficacy. No severe side effects were detected in the trials, and risks appeared to be minimal. Nonetheless, a substantial minority of people refused to be vaccinated. Dr. Hotez labels their resistance as "defiance of science" (p. 4). That's too simplistic. His analysis lacks nuance.

COVID Vaccine Hesitancy: Defiance of Science?

In fall 2020, the covid vaccines were rightly introduced with great fanfare. From identification of the pathogen to the development of effective vaccines to successful testing and Emergency Use Authorization in the US—all within a matter of months—was an astounding win for science.

However, covid risks vary dramatically with age and the general health and habits of individuals, and the science supporting vaccination was not uniform. Where the science was clear, there was near-universal assent and compliance. Where the science was muddled, there was substantial resistance.

For the elderly, the science was fairly clear. With an infection fatality rate (IFR) of around 1% or even higher for people over 65 years old, covid is a serious threat. With no comparable vaccination risks in the vaccine trials and ~90% reduction in symptomatic covid cases, it is no surprise that the vaccination rate among the elderly was close to 100%. They followed the science.

For the young, the science was lacking. The IFR for the unvaccinated was on the order of 1 in 100,000 for people younger than 25. The vaccine trials were much too small to detect any short-term vaccination risks of comparable magnitude and too short to measure long-term risks at all. The mRNA vaccines were a brand new technology, and, unlike Dr. Hotez, the young (or their parents) recognized that the science was sparse. Accordingly, only around 50% of Americans under 25 were vaccinated despite enormous pressure to get the jab. Opting not to take the vaccine was less about defiance of the largely silent science and more about personal risk assessments that differed from Dr. Hotez's. In other words, there was some defiance of Dr. Hotez, but he's not the science.

For the mature adult population between 25 and 65 years old, the physical risk-benefit analysis seemed to favor the vaccine. Accordingly, a strong majority of that population (around 80%) opted for vaccination—a rate well above Mr. Fauci's initial prediction of 60-70% that would be required for "herd immunity", but admittedly short of the 85-90% or so that he actually believed but wouldn't say publicly until the vaccination rates breezed past his initial targets.

In the 25-65 year old age group, the vaccination rate could have and probably should have been higher. However, a palpable degree of distrust of public health authorities drove vaccine hesitancy. The distrust began early, as authorities' pronouncements were frequently science-free but uttered with supreme confidence, commonly as the voice of science itself, but were often arbitrary, absurdly oppressive, exaggerated or deliberately deceptive. The betrayals of trust spawned a spirited "health freedom" movement—skeptical of authority and feisty, defiant toward mandates, disinclined to trust experts when the science is not crystal clear.

Conflating Scientists with Science

Dr. Hotez frequently confuses criticism or questioning of the opinions or behavior of individual scientists or scientific organizations with an attack on science itself, which he promptly labels "anti-science."

He found it "especially shocking" (p. 96) that the US government asked scientists Anthony Fauci and Peter Daszak to answer questions about how they administered government grants for research conducted in collaboration with Chinese virology labs in Wuhan. Mr. Fauci was called before Congress multiple times to account for his peddling of non-science as science and for his agency's lax oversight of research conducted by EcoHealth Alliance (EHA) with substantial financial support from the US government. Mr. Daszak, the president of EHA, was often asked to provide documents under the Freedom of Information Act (FOIA), which was passed in 1967 to provide a measure of transparency and openness for government-funded work.

The cynic might say, "It is indeed shocking when government and investigative journalists actually do their jobs and demand accountability," but I doubt that's what Dr. Hotez had in mind. Rather, the title of the chapter provides a clue to his thinking: "A Tough Time to Be a Scientist." FOIAs are inconvenient and annoying, and it must be uncomfortable to be asked by Congress to answer for "deficiencies" in the way your organization manages government grants. Maybe it's shocking to him that many people do not think scientists are above scrutiny or accountability.

Even the work and motives of Dr. Hotez himself were questioned online by "hurtful" critics, who were disinclined to give him a free pass as a physician-scientist, even though he went into medicine with the best of motives.

"I Am The Science"

Questioning a particular scientist's social policy preferences and the rationale for the preferences is not anti-science—unless that particular scientist is somehow viewed as science itself. That view might explain why Dr. Hotez found government scrutiny of Mr. Fauci "especially shocking." It's an error Mr. Fauci himself made when he famously said, "I am somebody who only cares about science and health...it's easy to criticize, but they're really criticizing the science because I represent the science. That’s dangerous." His statement was widely paraphrased as "I am the science" and rightly mocked.

In a tacit endorsement of the caricature of Mr. Fauci as "I am the science," Dr. Hotez takes criticisms of Fauci as "attacks against science" (p. 96). In short, Congress objected to Mr. Fauci's policy preferences for mask mandates, lockdown measures, and vaccine mandates. The covid policy prescriptions that Mr. Fauci advocated were so strict that, as Dr. Hotez notes, the governor of Florida, Ron DeSantis, called Mr. Fauci "Covid authoritarian," and Senator Ted Cruz said he was "the most dangerous bureaucrat in the history of the country." Some Senators questioned Mr. Fauci about his agency's funding of coronavirus research at the Wuhan Institute of Virology (WIV) and asked for information via FOIA and subpoena. A few Representatives even tried to pass the "Fire Fauci Act" to remove him from power.

Dr. Hotez stood up against these "attacks against science" that went so far as "taking specific aim...against American biomedical scientists" (p. 95). Again, no scientist or policy preference is above criticism. Mr. Fauci's science credentials do not make him infallible or his opinions beyond questioning. His policy preferences are squarely in the political realm, and questioning his policy prescriptions is in no way anti-science.

"EcoHealth Violated Federal Law for Five Years"

Peter Daszak is the President of EcoHealth Alliance (EHA), a non-governmental organization that conducts research on identifying and enhancing potential pandemic pathogens. EHA worked closely with the Wuhan Institute of Virology (WIV), bringing hundreds of novel bat coronaviruses from southern China and southeast Asia to biolabs in Wuhan, screening them for possible infectivity to humans, manipulating the viral genomes to make them more virulent, and testing the infectivity of the engineered viruses.

The US National Institutes of Health (NIH) funded a multi-million dollar grant to EHA for work which included engineering novel coronaviruses (chimeras) in Wuhan and testing them on "humanized" mice. The mice were genetically engineered with human lung cell membrane receptors where coronaviruses attach to the cell exterior and penetrate to the interior. The chimeras had a 10,000-fold increase in viral growth compared to the natural virus and 3 times the lethality. In failing to report these results, EHA violated the terms of their grant. Because of this and other deficiencies, EHA came under scrutiny from Congress and the [US Department of Health and Human Services in 2022.

Although the research was dangerous, much of the lab work was done under biosafety level 2 (BSL-2) conditions, which microbiologist Richard Ebright compares to that of a dentist's office. When Columbia University Epidemiologist and "master virus hunter," Ian Lipkin—who was a co-author on one of the most influential papers arguing against a lab origin for the pandemic—learned the kinds of research that WIV/EHA had done at BSL-2 labs, he changed his mind: "That’s screwed up...my view has changed," concluding that a lab accident may well have initiated the pandemic. Francis Collins, the director of the US Center for Disease Control (CDC), was incredulous that such research would be conducted at BSL-2, and Jeremy Farrar, the Director of Wellcome Trust at the time, tacitly agreed, responding to Collins' email with a simple "Wild West..."

So the federal government had been funding Daszak's EHA to perform highly risky bat coronavirus research under substandard safety conditions. After learning of EHA's failures to abide by the reporting conditions of their research grant, Congress issued Freedom of Information Act (FOIA) requests and launched an investigation into EHA funding and research.

Dr. Hotez was appalled. In his eyes, Congressional oversight of government-funded research represented "attacks against science" (p. 95), “harassment” (p. 96), and “abuses of power” which "unfairly target biomedical scientists" (p. 97).

Should biomedical scientists be granted immunity from scrutiny and from Congressional oversight solely by virtue of their profession? As Dr. Hotez surely must understand, an immunity conceit conjures in people's minds an image of a medieval Priesthood of Science that cannot be questioned. Rather than consider whether it is appropriate for scientists to cultivate a such a conceit, he advises scientists to forge ahead and not to worry about "accusations that we are priests" (p. 140) and to consider scrutiny of individual scientists as attacks on science itself.

"Hurtful and Jarring"

In 2019 things took a terrible turn for for Dr. Hotez. Anti-vaccine protestors escalated their criticisms beyond rude emails and Twitter comments to the point of "some very unpleasant and even menacing face-to-face confrontations" (p. 12). One day, two people taunted him at a conference. The next day, protesters gathered outside the hotel where he was giving a talk in a conference room. His response was surprising: "instead of receiving public adulation, my work...was an object of derision or vilification by extremist groups. I found this extremely demoralizing, given that I had devoted my life's work to science for the benefit of society" (p. 13).

It's not clear why his good intentions should put him above criticism, or how criticism of his policy preferences (like vaccine mandates) would be "anti-science," or why he should be so offended by a handful of goofy randos expressing disagreement with him, but he emphasizes the point again in the opening pages with an anecdote that he finds especially poignant.

In spring 2021, Dr. Hotez received two rude emails from anonymous trolls objecting to his strong advocacy for the new covid vaccines. He found these "anti-science" attacks "hurtful" because he "never imagined a segment of society turning against me or my scientific colleagues" (p. 2). After all, he had good intentions "to use scientific knowledge to make the world better" (p. 2).

Curiously, he never accuses himself of hurtful, demoralizing, anti-science aggression when he criticizes scientists who happen to disagree with him. The label appears to apply only to those who criticize Dr. Hotez himself or his friends.

To end the scrutiny of scientists and suppress resistance to policies that (certain) scientists prefer, Dr. Hotez would uncouple anti-science from public discourse. His vague blueprint for accomplishing that uncoupling is chilling.

The Great Uncoupling

The most important problem does not lie in understanding the laws of the objective world and thus being able to explain it, but in applying the knowledge of these laws actively to change the world.—Mao Zedong

Reactionaries must be deprived of the right to voice their opinions.—Mao Zedong

The aim of rectification is to guide the struggle in such a way as to set right the political orientation, raise the ideological level,...and isolate and split the bourgeois Rightists and all other anti-socialist elements.—Mao Zedong

Dr. Hotez is on a mission. His goal is to

1. expand the vision of science beyond understanding and explaining the laws of the objective world to improving lives by changing the world (p. 9);

2. uncouple anti-science dissenters from public discourse (p. xiv) and dismantle their activities (p. 128);

3. train young, right-thinking scientists to inject themselves more forcefully into political discourse to advocate for their preferred policies (ch. 7).

He doesn't use the words "censorship" or "politicize science" or "authoritarian" to describe his own plans. Instead, he projects those nefarious labels onto his political enemies.

For himself, rather than "censor," he says things like "uncouple...from political discourse" and "dismantle" the cultural infrastructure of those who disagree with his pet causes. The ones he would uncouple from public discourse include scientists who disagree with him or have questions about, say, the origins of covid, the effectiveness of mask mandates, or the ability of the covid vaccines to prevent transmission. They are not referred to as "scientists who disagree" or "dissenting scientists" but as "anti-science," "extremist," or "conspiracy theorists."

He never refers to his call to train young scientists to inject liberal doses of their science-adjacent political views into the media, bureaucracies, and politics as "politicizing science." Instead, he accuses those who argue against a policy or mandate as the ones "politicizing science." That is, calling on the federal government to implement and enforce your policy preferences is somehow not political while objecting to a policy initiative is.

In other words, the authoritarians are not the ones calling for mask mandates, vaccine mandates, and lockdowns, but the ones who resist government coercion, advocating for "health freedom" and "bodily autonomy" instead.

Self-awareness is not one of Dr. Hotez's strong points.

Defining "Anti-Science"

There are still anti-socialist elements hiding among the people.—Mao Zedong

It is essential to begin the uncoupling at the beginning, showing where the anti-science "elements"⁴ (e.g., p. 72) are hiding. Once their habitat has been located, the specific elements can be rooted out for uncoupling and dismantling.

In the opening pages, Dr. Hotez lays out their habitat. "Anti-science [is] the scary new normal across conservative America" [emph. added]. This is followed by a flood of similar labels throughout the book: far-right, extreme/extremist, fringe, White nationalist, Republican, anti-Semitic, right wing, GOP, red (as in "red = Republican = bad"), QAnon, less-educated, etc.—around three such labels per page on average, well over 400 in all. These deplorables abound at Fox News, the Conservative Political Action Conference, and in social media. They are also found in Congress, state houses, and courts.

For those who might feel a sense of alarm at his relentless anti-conservative invectives and his incessant calls for censorship, he offers reassurance that he has no intention of outlawing all dissent. "[E]veryone is entitled to their conservative views" (p. 61); it's only "health freedom propaganda," resistance to covid prevention measures, and other "anti-science" sentiments that are to be disallowed in public discourse.

It's not always easy to identify which particular ideas qualify as anti-science enough to warrant suppression. The task is made more difficult by "contrarian intellectuals," who may even be credentialed doctors, professors, and scientists at Johns Hopkins University, Stanford, Harvard, Brownstone Institute, and elsewhere. They are particularly dangerous because know how to engage in scientific discourse. Their arguments are "extremely clever, using real facts woven together in devious ways" (p. 84) to raise questions about policies or the claims of other scientists.

It’s also not easy to suppress all anti-science elements and only anti-science elements, and a clear definition of "anti-science" is needed. As we might expect in light of Dr. Hotez's expansive view of the realm of science, his definition of "anti-science" is loose enough that he can neatly cast his own views as science and opposing views as anti-science.

Anti-science is the rejection of mainstream scientific views and methods or their replacement with unproven or deliberately misleading theories, often for nefarious and political gains. It targets prominent scientists and attempts to discredit them (p. 9).

Thus, the heart of anti-science would be "the rejection of mainstream scientific views." He never explicitly defines what he means by "mainstream," but, curiously, his personal opinions on policy (e.g., gender ideology, abortion, advocacy for various covid mandates, investigating the origin of the covid pandemic) and science (e.g., efficacy of masking and lockdowns, safety and effectiveness of covid vaccines) seem to coincide perfectly with "mainstream scientific views" as he would define them. By implication, then, scientists and others who disagree with him reject the Hotezian mainstream and are ipso facto anti-science. The pattern is repeated over and over, page after page.

I presume it would take a scientist of Dr. Hotez’s caliber to reliably identify which facts should be suppressed, and a scientist who’s sufficiently mainstream to determine which scientists qualify as “contrarian” and targeted for censorship and dismantling.

The Ouroborus

Ouroboros, an ancient mythological serpent…hungry to make itself stronger, it consumes its tail and ends up consuming itself.

ouroboric (ōr-ə-bōr-ik), adj. self-referring, self-consuming.

His definition of anti-science is deliciously ouroboric. Scientific discovery often requires rejecting mainstream scientific views, proposing to replace them with unproven theories, and then rigorously testing them. In taking direct aim at science, his definition of anti-science becomes anti-science itself.

Thus, like the mythic ouroboros, Dr. Hotez's definition devours itself.

It doesn't work as a serious definition of anti-science, but it is perfect as a definition of anti-Science. When The Science pronounces its orthodoxy, opposition becomes anti-Science. When The Science supports a public policy, arguments against it are triply anti-Science. First, they oppose The Science. Second, they can never prove that costs (including both the unanticipated and intangible costs as well as the easily foreseeable) will outweigh the benefits, so, their theories are bound to remain "unproven," while The Science, by virtue of being "mainstream" is presumed True and does not need its own theories to be proven. Third, since they are raising objections about public policy, the motivation is certain to be at least in part political. For its part, The Science is unencumbered by these considerations because it defines the terms of discussion, asserting its own correctness by virtue of it being mainstream.

Like the ouroboros, Hotez's term "anti-science" is regenerated after devouring itself, but it takes on an entirely new meaning as "anti-Science," an inherently political term, which Dr. Hotez deploys in his mission to uncouple and dismantle dissent.

Identify and Uncover the Anti-Science Elements

...uncover these rebellious elements. —Mao Zedong

Because the issues are complex and the conspiracy[^eco] vast, uncovering the anti-science elements is not a trivial task, but it is a necessary one if they are to be successfully dismantled.

A key element of the plan would be for the federal government to carefully monitor communications to identify what it deems "anti-science" or "disinformation."

Dr. Hotez was encouraged when the Biden administration created a new Disinformation Governance Board (DGB) to keep a close, government eye on opposition voices in the media. Not surprisingly, the DGB received intense public backlash when it was publicly announced on April 27, 2022. The DGB was promptly paused and then disbanded on August 24. Blatant censorship is still a hard sell for most Americans. Dr. Hotez mourned the official demise of the DGB because now, in his eyes, "the anti-science political eco-system continues largely unchallenged" (p. 86).

While the government tests its options for either making its speech-policing efforts both legal and politically palatable or expanding its efforts while keeping them under the public radar (or both), it may be necessary to fill the void with hard-charging, reliably left-leaning private organizations like Media Matters (MM), Center for Countering Digital Hate (CCDH), and a new organization modeled after the Southern Poverty Law Center (SPLC). They specialize in sophisticated smear campaigns against organizations or individuals they disapprove of, with the aim to "deplatform" or "demonetize" them, by hook or by crook.

The policing would extend beyond just criticisms of The Science to the questioning of "mainstream research" or "rais[ing] doubts about the integrity of prominent US scientists" (p. 136). Those who question The Science are "purveyors of uncertainty" (p. 136) and are dangerous because they exploit the natural unsettledness of science to promote doubts about those true, acceptable narratives which are spun into "mainstream scientific views" (p. 9) in presumably non-devious ways (p. 84).

Uncouple and Dismantle the Anti-Science Elements

Suppress the reactionary classes and elements and those exploiters who resist the socialist revolution.—Mao Zedong

Although surprisingly successful in the past, policing by entities like MM, CCDH, and SPLC is ultimately too limited to effectively suppress the anti-science elements. Private organizations lack the extensive experience, deep pockets, and coercive power of the federal government, so Dr. Hotez calls on the "Departments of Homeland Security, Commerce, and Justice—and even State" bring their expertise in combatting "global terrorism, cyberattacks, and nuclear proliferation" (p. 159) to bear on those who criticize the scientists or science-adjacent narratives and policies that he champions. Even more, he would look to the United Nations (UN) and the North Atlantic Treaty Organization (NATO) to expand their missions and join with US government agencies in Interagency Task Forces (p. 160) to address "anti-science aggression." He asserts that the seriousness of threat "now warrants this level of engagement" (p. 160) and backs his assertion with an appeal to authority: "As someone who personally endures attacks from conservative news outlets and US elected officials, I speak from experience..." (p. 160). Specifically, what's urgently needed is to "halt the anti-science aggression emanating from Fox News and elected officials" and to "demonetize...the disinformation dozen"⁵ (p. 159).

Mobilizing the full force of the US federal government, working in concert with the UN and NATO, in an effort to dismantle scientific dissent and uncouple it from public discourse is no longer unthinkable in America. After all, Dr. Hotez just published a book calling for precisely that, and the Biden administration has been testing the legal and political limits of government censorship and extralegal coercion. However, significant obstacles remain.

Censorship

The censorship regime may require "new institutions or organizations to respond to a widening assault on biomedical science, while working in parallel with the US federal government to identify legal mechanisms to dismantle an organized and well-funded anti-science ecosystem" (p. 6).

As part of that dismantling, "social media companies must...become more transparent in sharing their data on anti-vaccine activities with researchers and government agencies" [emph. added] (p. 70). It is no surprise that Dr. Hotez applauded recent efforts of the US government to coerce Facebook and other social media companies to censor scientists who were critical of government policies. He calls the efforts "helpful" (p. 145) but concludes that ultimately they were too "modest" and did "very little to stop the far-right from generating dangerous internet content" (p. 145).

A more challenging difficulty is that those censorship dreams run afoul of the US Constitution, which guarantees freedom of speech and press. The US 5th Circuit Court of Appeals ruled that the efforts to “coerce” the media into censoring scientists were "in violation of the First Amendment," giving scientists and doctors at Stanford, Harvard, and elsewhere injunctive relief from the incipient, Hotez-endorsed US government aggression against dissenting scientists.

Because the targeted scientists were "contrarian intellectuals" (p. 84) by virtue of disagreeing with Dr. Hotez, he was appalled that a court would even consider their case against government censorship and mourned the "political damage" (p. 79) that legal challenges to government overreach could cause.

Extra-Legal Diktats

The inclination that science dictates policy easily expands into an authoritarian, scientistic science trumps law, which asserts that in questions of science versus law, science must prevail.

In that view, if The Science declares that some policy is necessary, then the courts, the law, and the Constitution would have no legitimate power to check the State's claim to authority. It's a remarkable sentiment, oft-repeated in the book.

In November 2021, the Occupational Safety and Health Administration (OSHA) announced a covid vaccine mandate for employees of large companies. The 4th Circuit Court of Appeals promptly blocked enforcement, ruling that the OSHA's diktat exceeded their authority and thus represented an extra-legal, administrative power grab. Later, the Supreme Court agreed, rendering the mandate null and void.

Dr. Hotez's response is astonishing: "This set a dangerous precedent in which courts sympathetic to health freedom plaintiffs might routinely challenge public health recommendations intended to save lives" (p. 28).

A jurisprudence that hinges decisively on discerning the good intentions of bureaucrats is not compatible with a liberal republic.

In a similar case in 2022, a US district judge in Florida struck down the federal mask mandate for public transportation, determining that the Center for Disease Control (CDC) did not have authority to issue such a mandate and bypassed the legally-binding process for administrative rule-making.

Again, Dr. Hotez's response is astonishing. He does not question the legal rationale. Rather, he objects to the very legitimacy of the court's power to review policies advocated by The Science: "This sets a dangerous precedent in which federal judges without qualifications in medicine or public health can reverse the decisions made by experts" (p. 79). He might well prefer a world where he can issue mandates and policies that cannot be questioned, altered, or nixed by anyone beyond his narrow clique of like-minded, public health cadres. The checks and balances of a liberal, constitutional republic appear as "political damage" (p. 79) in the eyes of public health bureaucrats who would prefer their power unchecked by the law and their decisions not balanced against competing interests.

Because "GOP extremism" and its "anti-science" appendage "cannot be appeased or compromised with [but] can only be defeated" (p. 146), so the argument goes, government must considerably step up its censorship efforts and its aggressive assertions of power. This looks a lot like a totalitarian power grab to most Americans and even to many of Dr. Hotez's readers. Accordingly, he adds a disclaimer. The uncoupling and dismantling should be done only "in ways that do not violate the Bill of Rights or the US Constitution" (p 159). His applause for serial Constitutional violations and his expressed abhorrence for Constitutional constraints do not inspire confidence in his disclaimer.

Politicization

We must criticize the apolitical attitude...Politics and technology must be combined together.—Mao Zedong

Dr. Hotez criticizes the scientific professions because, in his view, they "remain committed to political neutrality" (p. 140). He suggests that it may be time "to discard outdated conventions that say scientists should stick to their lab meetings, grant applications, and journal publications, while maintaining political neutrality" (p. 6) and appeals to his comrades in science and medicine to "start feeling comfortable in the political realm" (p. 141). Politics must be combined with science and medicine because "success in combating anti-science aggression requires...battle on multiple fronts" (p. 140).

There's a problem, though. Many people naturally distrust a Science that seems to be politicized, and it is not easy to politicize science without appearing to politicize science. It's a conundrum for Dr. Hotez because, as he suggests, combatting anti-science does "require engaging in an uncomfortable dialogue about Republicans and far-right extremist groups" and "there is no clear road map for advancing a discussion without giving the appearance of playing politics" (pp. 135-136).

There's a reason that scientists are uncomfortable in the political realm. Science is characterized by an insatiable curiosity, continually driven to explore, understand, and explain natural phenomena.

The political realm begins where the curiosity stops. The time for exploration is over. The understanding is sufficient. There's nothing left to explain. It's time to act. Political effectiveness requires too many simplified, dramatic statements. Too many exaggerated, scary scenarios. Too much suppression of doubts. Too much temptation to compromise epistemic humility and intellectual integrity for loads of media attention.

Movement away from the curiosity of science toward the action of politics "requires a fundamental shift in our academic culture" (p. 130). That shift might involve "science communication training" for young scientists, "incentivizing young faculty...to speak out and engage," (p. 130) and shaping new "evaluation metrics" to reward media appearances and prioritize "public engagement" (p. 131). This would require overcoming some institutional inertia because most scientific institutions traditionally favored the one hand of science hand over the other hand of politics "as risk mitigation to protect the institution" (p. 131).

Because the boring facts, detachment, and uncertainties of science are not particularly captivating to the general population compared to the snappy conclusions and emotional appeals of the anti-science (p. 71), he cries out to scientists that we "urgently need to communicate with emotion and appeals to core human values rather than just present facts" (p. 129) and suggests "targeting personal identities and ideologies" (p. 129) and, of course, "not being afraid to take a political stand" (p. 155).

While "health freedom" and other anti-science voices talked, the biomedical scientific community "lacked the drive and capacity to work aggressively and strategically to dismantle anti-vaccine and anti-science activities." To raise the political profile of science in the public imagination and energize scientists to take up the fight, political rallies can be helpful. For example, an impressively large "March for Science" in Washington, DC, in spring 2017 and smaller marches in 2018 and 2019 helped mobilize biomedical scientists. Although some scientific societies "held side events" in conjunction with the political rallies, Dr. Hotez argues that more "could have and should have" been done to increase the "visibility, volume, and heft" (p. 128) of the participation of The Science (p. 128).

Because not enough has been done to politicize science, the public "too often disregards the science or questions the integrity, motivation, and sincerity of our professional activities...[and] scientific communication and public engagement represent key areas for expansion" (p. 128).

If the goal is "to begin to restore the American people's trust in science and scientists" (p. xiii), a plan to intensify the politicization and crack down on dissent is bound to backfire.

Prognosis

Perhaps the most shocking thing about the book is the infatuation with totalitarian thought. A drop of politics poisons a whole vat of science. Politicization gives free rein to a power lust. And to a habit of undisciplined thinking. As the thought turns to political effectiveness and TV success, the temptation is to become ever more bombastic. Success in the political realm requires defeating alternative voices. In politicized science, one of the most effective tactics is a bastardization of the bedrock scientific principles of epistemic humility and intellectual integrity, replacing them with a fixation on uncoupling and dismantling dissent.

Necessarily, a universally accepted public health message must be both truthful and delivered by trustworthy people. That means foregoing the scary scenarios, exaggerations, and faux certainty, which may well work for gaining enough support to enact a political agenda, or even win a majority of people, but are bound to leave substantial resistance and resentment in their wake—not at all a safe and effective prescription for a pandemic or for long-term credibility of The Science (see, for example, Fig. 1 above).

A scientist selling non-science as science does more damage to the credibility of Science than kooks and cretins can ever do. If you are a scientist or doctor and care about, say, vaccination rates or the credibility of science, I'd suggest the following:

• never refer to a public policy preference as "science" and opposition as "anti-science"

• avoid asserting or implying that any scientist or group of scientists is "science" and opposing views are "anti-science"

• do not present any current, complex, active, science or science-adjacent question as "settled science" or "consensus" unless it really is (e.g. special relativity, the periodic table)

• avoid expressing certainty when there is real uncertainty

• do not exaggerate dangers or effects or safety or efficacy in order to manipulate public behavior

• do not attempt to demonize, demonetize, destroy, or decouple from the public discourse scientists who disagree with you

• do not publish or promote false or flimsy or disingenuous or fraudulent work even if you really want it to be true

• be especially on guard against the urge to Become the Science to dictate policy, prohibit dissent, define permissible opinions.

You are the public face of science. Reflect carefully and frequently whether your presentation of science is faithful to the necessary virtues of epistemic humility and intellectual integrity. In short, when you get in front of the cameras, don't abandon science in favor of making a splash or furthering a political agenda. Otherwise, you fuel the flames of skepticism about Science and build a robust foundation of an anti-Science culture.

This is not a skepticism of science qua science, but a skepticism of the stewardship of the institutions of Science by politically-motivated scientists who peddle a false conception of science as certain and coercive. It is not against science per se, but against the corruption of the institutions of Science—a corruption that offers up scary scenarios, makes simplified dramatic statements, and makes little mention of doubts; a corruption that pushes an agenda as "science" and paints opposition as "anti-science."

If you can't manage that, first "do no harm." Instead of looking for ways to politicize science, look for ways to advance actual science—in the lab, in the field, at the computer. When you emerge, honestly evaluate the uncertainties, scrupulously weigh whether your data address the question and whether the scope of your inferences are too grand.

1. Richard Feynman won the Nobel Prize for physics in 1965. He is well-know for his staunch advocacy of scientific rigor, intellectual integrity, and epistemic humility (i.e., being clear about uncertainties in scientific finding and cautious about inferences from experiments and models). He gave his "definition" of science in an epic talk at a National Science Teachers Association meeting in 1966: "What is Science?", published in The Physics Teacher 7(6):313-320.

2. As a scientist, I bristle at the assertion that success in the media requires Schneider's litany of compromises. The litany certainly may be helpful for getting media exposure, but I’m hoping against hope that it is not obligatory.

3. Tetlock, Philip E. 2005. _Expert Political Judgment_. Princeton University Press, Princeton, NJ. 321 pp.

4. Dr. Hotez often refers to his political opponents as "elements," e.g. anti-science elements, anti-vaccine elements, far-right elements, fringe elements, extremist elements, etc. The language is eerily evocative of Mao Zedong.

5. The "disinformation dozen" is a small group of mostly independent, contrarian internet activists, who are prolific purveyors of anti-vaccine propaganda in a sensationalized mix of information of varying veracity, rumors, and conspiracy theories. Many are physicians (5) or natural products marketers (2) who are skeptical of modern medicine and advocate for "holistic health," "true health," "alternative health," "natural medicine" and the like. Several are political organizers (5)—Health Freedom, Nation of Islam, Urban Global Health Alliance, and Robert F. Kennedy, Jr.