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“Big Pharma” has its flaws, but like all industries, it’s made up of people – some bad, some good

Syngen Grede
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“Big Pharma” has its flaws, but like all industries, it’s made up of people – some bad, some good

Negative feelings about “Big Pharma” have inundated our popular media. The pandemic and its associated medical misinformation, the controversies surrounding “Pharma Bro” Martin Shkreli and the Sackler Family’s Purdue Pharma bankruptcy have led people to believe that for Big Pharma to succeed, it requires people to remain sick.

With these stories and many others, it’s not hard to see why many people feel that “Big Pharma needs sick people to prosper,” and how this refrain could come to affect how people feel about pharmaceutical companies. While the pharmaceutical industry has done unethical and reprehensible things, as Dr Steven Novella writes over on Science-Based medicine:

“It has become fashionable, however, to not only criticize the pharmaceutical industry but to demonize them – and the term “big pharma” has come to represent this demonization. Cynicism is a cheap imitation of skepticism – it is the assumption of the worst, without careful thought or any hint of fairness.”

As a person that has worked in the pharmaceutical industry, I have felt that demonisation even in skeptical spaces. I have worked in the pharma industry for seven years, in positions from sourcing starting materials, sampling and analysing raw materials, and manufacturing and analysing intermediate products, active pharmaceutical ingredients, and finished products. I do not speak for any of the companies that I have worked for, and all views and opinions are solely my own.

While my experience does not cover senior management, sales or marketing, most of my post-college career has been in R&D and in the manufacturing and testing of drug products. Working in the industry, from raw material to finished products, has led me to have some insight into the “big pharma” conspiracy.

When I got my first job at a contract research organisation (CRO), which did specialty testing, our first day was focused on the history of the FDA in America and why it was created.

A timeline of the history of the FDA
Timeline of the historical evolution of Pharmacovigilance *ASA: acetylsalicylic acid; **WHO: World Health Organization; ***EMA: European Medicines Agency

Throughout history, there have been many instances of drug adulteration and bad science that have led to deaths. The number one goal of those who manufacture and test pharmaceutical products is to prevent these incidents. As the world has learned from these tragedies, more tools and regulations have been created to not only catch similar incidents, but also to identify any new issues before a product goes to market. Many of the tools and systems that are put in place are used all the way through the process.

Working at the CRO, whose business was to specialise in analysing many different companies’ pharmaceutical and food raw materials all the way through to their finished products, informed me about many of the regulations and tools the industry uses to keep the end users safe from impurities and contamination. One of the most critical tools is current good manufacturing practice (cGMP) documentation. This takes scientific documentation to the next level, and is codified in the US and audited by the FDA.

As a brief overview, the principles of cGMP documentation are Attributable, Legible, Contemporaneously recorded, Original or true copy, and Accurate, plus complete, consistent, enduring and available (ALCOA+). In simpler terms: read a step, do a step, then document a step, and ensure that data is accessible. These regulations and document system together form a way of organising the manufacturing and testing process. This style of thinking highlights its purpose: everything a person or company does may influence the end user of the product. This might seem counterintuitive, but it is very effective for motivating staff to do the utmost, even on the longest days.

Another important set of tools, that go hand-in-hand with cGMP, are the pharmacopoeias. These include the United States Pharmacopeia-National Formulary (USP-NF), European Pharmacopoeia (EurP or EP), Japanese Pharmacopoeia (JP), British Pharmacopoeia (BP), and Chinese Pharmacopoeia (ChP). These pharmacopoeias include monographs (a list of tests and specifications for a raw material, its active pharmaceutical ingredient or API, and/or inactive ingredients), general chapters (how to perform testing), and general notices (like presenting the basic assumptions, definitions, and default conditions for the interpretation and application of the pharmacopeia). While the pharmacopoeia outlines the minimum quality a material must have, many companies have extra quality checks and specifications. These additional specifications may help ensure that the purity of the final product exceeds the regulatory requirements.

At one point in my career, I was responsible for writing and revising raw material specifications. To create these specifications, I had to work with many people who were responsible for thinking about a unique aspect of the material. This team of people includes, but is not limited to toxicologists, material scientists, engineers, quality control scientists, and quality assurance. Not only did we have to consider the pharmacopoeias as they currently were, but it was our job to also think about what new regulations might come.

In addition to the chemicals that made up the product, we had to consider the reactors, tubing, and any other elements that could touch the process. When I would draft specifications, the documents would be reviewed by at least four people before a final Quality Assurance review, to ensure that all the information complied by each group was accurately documented and would meet or exceed the regulatory requirements. Most companies have this practice to ensure accuracy and accountability.

As time passed in my career, I saw the introduction of another key goal for pharmaceutical companies: creating a sustainable manufacturing and supply chain. This is not just a push from a regulatory body for more sustainable practices, but represents a culture change within the companies themselves. Some of that push is from the public, but most is from the younger generation in the pharmaceutical industry fighting for change. I have been part of the sourcing efforts and supplier grading to evaluate how sustainable a supplier’s manufacturing process is. From the outside, it may look like not much is being done, but more and more companies are starting to really challenge themselves and their supply chain to put such policies in place.

If we look at “big pharma” from a bottom-up approach, we can see that – while far from perfect – there are hardworking people wanting to make a difference in people’s lives. Like many things in the world, pharmaceutical companies must be weighed with nuance. Many of the tools and regulations discussed here continue to evolve through companies – and their employees – wanting to do better.

As we rightly scrutinise the pharma industry, we need to keep in mind that businesses are made up of people, and we need to have an empathetical eye, to avoid demonising everyone within an industry. Over the timeline of licensed and regulated pharmaceuticals, the average worker within the industry is genuinely trying to improve standards, ensure there’s less chance of accidental harm, and improve the safety of their products.

From the archive: S.G. Soal – A statistical master of deception

Chris Scott
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From the archive: S.G. Soal – A statistical master of deception

This article originally appeared in The Skeptic, Volume 2, Issue 2, from 1988.

The philosophical world was startled in 1944 by the publication from the head of the Cambridge philosophy department of an extraordinary paper: a 15-page discussion in the journal Philosophy on “The Experimental Establishment of Telepathic Precognition.”

Of course this was not the first time that a respected thinker had expressed belief in a fringe science. Newton himself was a devotee of alchemy, Alfred Russell Wallace was a firm believer in spiritualism, Sir William Crookes believed in the séance room materialisation of the dead. But this time it really looked different. To begin with, the author had a reputation as a supremely cautious man. Head of a faculty which included Bertrand Russell, Wittgenstein and Moore, his intellectual standing was beyond dispute.

Broad was not writing about his own experiments but about those of another academic, S.G. Soal, a mathematics lecturer at London University. Soal was a sceptic about psychical research. In the mid-1930s he had collected over 120,000 card guesses with no sign of above-chance results. He had become openly scornful of J.B. Rhine’s celebrated card-guessing experiments in America and Rhine’s claim to have demonstrated extrasensory perception (ESP). Yet it was these very results of Soal’s, apparently totally negative, that had led to the new findings. A colleague had urged Soal to look again at those discarded data and try the effect of scoring the guesses, not against the target card at which they were aimed, but against the cards just before and just after. As Soal later recounted, with much reluctance he made the check and found, to his surprise, two persons who had scored indisputably above the chance level on this new criterion. One of these subjects, Basil Shackleton, was then followed up by Soal in a new series of experiments and it was these that yielded the remarkable findings now signalled by Broad.

A black and white photo of Hubert Pearce and J.B. Rhine experimenting with Zener cards. Rhine is holding a pen in his right hand. Both men look serious, wearing suits, staring at the table.
Hubert Pearce with the parapsychologist J. B. Rhine, experimenting with Zener cards. Public domain, via Wikimedia Commons

Soal’s experiments, unlike many others in the new field of “parapsychology”, appeared to be models of scientific rectitude. Extreme precautions were taken to eliminate normal means of communication, recording errors, cheating by the participants, and even fraud by the experimenters. The experiments continued over a total of 40 sessions. A large number of witnesses were brought in. Copies of the score sheets were made by hand at the end of each session, witnessed, and posted in the presence of witnesses to Professor Broad in Cambridge. The originals were stated to have been deposited in the archives of the Society for Psychical Research.

Shackleton scored consistently above chance throughout, but his success was with the card one ahead – the one to be looked at next. When the calling rate was doubled, his scoring shifted to the card two ahead. In some of the experiments the choice of each target card was made only at the moment of guessing, by taking a counter blind from a bag. This condition seemed to require precognition as the only explanation; it also ruled out any possibility of normal communication through some undetected channel. Finally, the statistical significance was overwhelming (over 10 to 1) so that chance as an explanation was clearly ruled out.

Over the years that followed, the Soal-Shackleton series was constantly cited by parapsychologists as a model; they saw in this work the conclusive evidence they had long awaited. Repeatedly it was said that only a person ignorant of the evidence could now rationally deny ESP. This theme was taken up by less committed but more influential writers, notably in England by C.E.M. Joad, the popular philosopher and broadcaster. Many open-minded people must have been led to see ESP as just another of the marvels, along with relativity and quantum theory, which modern science required them to believe in.

The full story of how these uniquely rigorous experiments were reduced to ruins is too complex to relate here. The process took thirty years and involved many independent researchers. We quote only the highlights.

In 1955, G.R. Price showed that several methods of fraud were possible if collusion were assumed between Soal and two other participants.

Between 1955 and 1960, C.E.M. Hansel developed a hypothesis of fraudulent card substitution by the agent (the person whose thoughts were supposedly being read by Shackleton). For this, Soal would need only one fraudulent collaborator in any given session. Over the whole series three different persons had operated as agent, selected by Soal. Some statistical features of the data seemed to lend some support to this hypothesis, though far from conclusively. Soal scornfully rejected Hansel’s reasoning: he successfully showed that the hypothesis could not account for all of the results.

In 1956, pressure from sceptics requesting the records for study obliged Soal to reveal that, contrary to the published report, the original records were not available because he had lost them. The handwritten duplicates that had been mailed to Broad were still in existence, held by the Society for Psychical Research.

In 1960, further pressure from sceptics obliged Soal to publish a more serious admission which had been known to some of them by hearsay. During the experiments one of the participants, Mrs G. Albert, had reported seeing Soal improperly “altering the figures” – specifically, changing ones into fours and fives. A full contemporary report had been kept by his collaborator, Mrs K.M. Goldney, but Soal had up to that point refused to allow publication, using the threat of a libel action.

In 1971, R.G. Medhurst reported a computerized attempt to identify the sequence of target digits that Soal had used. He was unable to trace the sequences in any relevant sources and concluded that Soal’s account of the way in which the targets were prepared must be incorrect.

In 1973, C. Scott and P. Haskell showed that there was strong statistical evidence in the experimental records supporting the allegation that Soal had “altered the figures”, changing ones into fours and fives in such as way as to turn misses into hits. The effects found were both highly significant statistically. They appeared in just three of the 40 sittings, and in particular in the one in which Albert had reported observing the manipulation, and they could account for the whole significant ESP-effect in these three sittings.

This damning evidence seems to have had little effect on the community of parapsychologists. Almost without exception those who commented rejected the fraud interpretation, despite the highly specific confirmation of Albert’s observation, and reaffirmed confidence in Soal.

The coup de grace came in 1978 when B. Markwick published the results of an astonishingly tenacious pursuit of the line opened earlier by Medhurst. She first showed that the target digits contained many runs of consecutive digits that were repetitions of runs used in earlier sessions, and that this could not have arisen by chance. This in itself was not particularly serious. However, she also showed that in many such cases the repetition was not exact but there were intrusions – digits inserted in the sequence – and that these intruded digits were nearly always hits. The implication of improper manipulation seems almost inescapable.

A black and white photograph of five white men, all in suits and appearing to be over ~50 years of age. They are sat around a table that has cards spread out on it, with a projector screen and bookcase behind them.
The mentalist Frederick Marion (back right) being tested at the National Laboratory of Psychical Research in a card experiment by the psychical researchers Samuel Soal (middle) and Harry Price (right). Source: Josef Kraus (Frederick Marion), Public domain, via Wikimedia Commons

After Markwick’s publication parapsychologists generally gave in and admitted that the evidence against Soal’s honesty was overwhelming. Many, however, continued to discuss the possibility that some of the data in the Soal-Shackleton series were still due to ESP. And most said that, despite their new-found belief in Soal’s duplicity, they had been right at the time to reject the Scott-Haskell evidence.

Clearly the views of parapsychologists are highly resistant to infection by unfavourable evidence. The total collapse of the strongest experimental series ever produced has not visibly diminished their belief in ESP. They simply cite different experiments now.

Recently, parapsychologists have argued that frauds have been identified in many branches of science without thereby discrediting the field of knowledge concerned: “why should parapsychology be treated any differently?”, they ask. They overlook a crucial fact: in ESP research, it is the very existence of ESP that is at stake. The only serious evidence for ESP comes from experiments, like Soal’s, in which guesses are aimed at random targets in conditions where normal communication is supposedly ruled out. But every one of these experiments has been less carefully controlled than the Soal-Shackleton series.

The Soal débacle is the clearest possible demonstration that believers in ESP are over-ready to accept defective evidence. To continue to accord the same value to the remaining experiments even after this demonstration implies an unshakeable faith impervious to counter-evidence.

Did we really discover pain in insects? Maybe… but we can’t be sure they feel it like we do

Georgy Kurakin
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Did we really discover pain in insects? Maybe… but we can’t be sure they feel it like we do

Every time you burn your fingers with a hot teapot, your spinal cord rapidly withdraws your hand before you can understand what was the matter – and before you experience an emotionally loaded, unpleasant sense of tissue damage that you call pain.

This example of a simple reflex illustrates a usually omitted fact: nociception, which means the ability to sense the actual damaging stimulus by nerve endings, is not yet pain. Pain is a much more complex experience. In this example, nociception results in a defensive action before pain arises in your brain.

In humans, pain has cognitive and emotional components, but the study of its mechanisms are ongoing. These studies are extremely important – to date, the most potent painkillers are the ones that act on the gatekeeping mechanism of pain regulation. They would be excellent applications of our knowledge about the higher levels of pain formation, if it weren’t for the fact that these medications are opioids – dangerous drugs with the risk of side effects and dependency.

Some intriguing phenomena of human physiology give us some clues of pain mechanisms. First of all, “descending control” remains the most characteristic and most mysterious pain feature. Stories are widely circulated about heavily injured soldiers who continued dispatching a mission and felt no pain until a battle was over. This is an example of the working gatekeeping mechanism mentioned above – a neuronal filter in the spinal cord, regulated from the deepest brain structures located around the brain ventricles. The key mediators of these mechanisms are endogenous opioids, for example endorphins, which determine our perilous sensitivity to exogenous opioids like morphine.

A kind of reverse phenomenon is called “neuropathic sensitisation”, often clinically described as allodynia. In this case, non-noxious stimuli are perceived as painful – very often, the trigger of this condition is real damage.

Drosophila melanogaster — the favorite model insect for scientists. Image credit: André Karwath/Wikimedia Commons/CC BY-SA 2.5

Recently, both phenomena were described in insects: a review from a group led by Lars Chittka (a professor at Queen Mary University of London, and author of the book The Mind of a Bee) highlighted the possible existence of downstream pain control in the fruit fly Drosophila melanogaster and the larva of tobacco hawkmoth Manduca sexta.

Meanwhile, their Australian colleagues managed to induce allodynia in Drosophila via injury. These papers elicited a wave of headlines in science media. “There’s Growing Evidence That Insects Feel Pain, Just Like Us”, ScienceAlert writes. “Put Down That Flyswatter: Insects Feel Pain Too”, Technology Network warns.

In a new research, Chittka’s group found that bumblebees groom their own antennae if injured by hot iron – this might be misinterpreted as evidence of pain in bumblebees, however that conclusion is not quite consistent with the study. “The logic is that there are lots of claims in the literature that such grooming does not exist in insects, and people have taken this as positive evidence that insects cannot possibly feel pain”, Chittka explained, “However, no one bothered to test this. So, while this new observation is not proof of pain, it is proof that one of the key claims against pain in insects is demonstrably incorrect”.

Manduca sexta caterpillar. Image credit: Ben Cappellacci/Flickr/CC BY 2.0

Other pieces of evidence must be also treated with caution. Even if we look at the criteria of pain-perceiving ability, it will appear that insects pass only a subset of them (as far as we know from the currently available papers). The most comprehensive set of criteria was firstly developed by Prof. Jonathan Birch (London School of Economics and Political Science) and subsequently implemented for insects by the same team, led by Lars Chittka.

It specifies:

  1. Presence of nociceptors
  2. Presence of integrative brain regions
  3. Connection between nociceptors and integrative brain regions
  4. Possibility of pharmacological analgesia
  5. Motivational trade-offs of noxious stimuli
  6. Flexible self-protecting behaviour
  7. Associative learning when presented with noxious stimuli
  8. Preference of analgesic drugs.

Downstream pain control and self-grooming after injury could meet, at most, two or three of these criteria, even if we pool the data obtained in different species (strictly speaking, the possibility of insect-to-insect extrapolation requires extra proofs). Moreover, these criteria are only structural and behavioral prerequisites for pain, sine qua non for suffering. But they cannot warrant the presence of pain. Behavioral pain-like reactions like self-grooming can be observed in brainless (spinal) frogs whose pain centers are cut away. They are just simple and rough movements, but such a reflex is technically possible. No one can be sure that self-grooming in insects is not a reflex – just a more complex reflex, involving several structures of their nervous system. Neuroanatomical criteria are much less reliable – wiring between brain centers says nothing about the signals and sensations transmitted by it.

In 1974, philosopher Thomas Nagel wrote an article that created an everlasting basis for skepticism in studying animal perception and cognition. In the article “What Ιs Ιt Like to Βe a Βat?“, he suggests the mental experiment of trying to imagine how a bat perceives echolocation signals. After a long philosophical discussion, he concludes that we have no way to understand or describe it – a bat’s experience is so dissimilar from ours, that we have no terms, words or other references to describe it.

This mental experiment has led to a conclusion that we have no clue what another creature feels and experiences – and this inability includes pain, too. We have no way to objectively measure or prove the level of pain not only in another animal, but even in another human. According to Chittka, “For example, if I say that I had an awful headache last week, you have no way to check this or prove this wrong. It is a problem for insurance companies – for example, if a client said that they were in severe pain from an injury after a car accident, they cannot disprove it”.

Even doctors are forced to rely on patient’s complaints and self-scores in prescribing painkillers (veterinarian doctors use a cat’s grimace in a similar manner). We have no way to precisely diagnose the patient’s pain level – so don’t even ask about insects.

So, what is left for scientists to do? Our fundamental inability to understand the senses of another living thing is not a reason to give up. All of the evidence and criteria, discussed above, enables scientists to draw probabilistic conclusions. For such conclusions, any signs of flexibility in the perception of noxious stimuli are useful – from allodynia to self-grooming. They allow us to evaluate the plausibility of a complex integration of nociceptive information in insects. Maybe, their way of integrating such information is dissimilar from the distressful experience we call “pain” – but the question of its existence is a good research objective itself. 

“We can only discuss this problem in the terms of probability and state that an insect has something more than a simple nociception”, Chittka explains. But we can only guess how this “something more” could look.

In the book “An Immense World: How Animal Senses Reveal the Hidden Realms Around Us“, Ed Yong cites the example of a squid that exhibits defensive reactions but never grooms a damaged tentacle. Yong characterises this behavior in this way: “Injured squid behave as if their entire bodies were sore”. This is an insight into how different this “something more” can be – but there’s a catch: indeed, we cannot understand what it is like to be a squid. Just as we cannot understand what it is like to be a bee.

Do extraordinary claims really require extraordinary evidence?

David Weinberg
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Do extraordinary claims really require extraordinary evidence?

The proclamation “extraordinary claims require extraordinary evidence” was oft spoken by American astronomer and science communicator Carl Sagan. He was not the first to express some version of the sentiment, but definitely popularised that particular phrase.

Is this a mere platitude or is Sagan making a valid point? The answer hinges on what is meant by “extraordinary”. There are many dimensions that could be used to measure the extraordinariness of a claim. It could be the novelty, the utility, or the complexity of a claim that make it extraordinary. None of these features would necessarily alter the strength of evidence needed to affirm that claim.

What Dr Sagan meant by “extraordinary” was a claim that is highly unlikely or implausible. In that context, the essence of Sagan’s statement is valid. If a particular strength of evidence is just persuasive enough to validate a claim, a less plausible claim would require stronger evidence to achieve the same threshold. An extraordinary claim would lie at the far extreme of implausibility.

We apply this principle constantly, but mostly unconsciously, in our daily lives. If a colleague shows up late to work and attributes their delayed arrival to a traffic jam, we would not give it a second thought. If the same coworker attributed their tardiness to an alien abduction, we would be much less charitable. In both examples, our coworker is providing the same quality of evidence, a personal testimonial. Why is this level of evidence sufficient to accept one claim but not the other? Traffic is a mundane, highly plausible event. Based on what we know of the world, alien abduction is much less common and much less plausible than heavy traffic.

Let’s do a thought experiment to understand the interplay between the plausibility of a claim and the persuasiveness of the evidence.

Here are the assumptions for this thought experiment.

  1. Our protagonist is “Homer”. Homer is frequently late for work.
  2. There are only two possible reasons for Homer’s late arrival to work: heavy traffic or alien abduction.
  3. Heavy traffic is responsible for 98% of Homer’s late arrivals and alien abductions are responsible for 2%.
  4. Despite his unreliable arrival, Homer is a pretty honest reporter. He accurately attributes the true cause for his late arrival 95% of the time and inaccurately reports the alternate excuse 5% of the time. In other words, his testimonial is accurate 19 out of 20 times and inaccurate for 1 out of 20 late arrivals. Not perfect, but mostly correct.

You are Homer’s Human Resources manager. Late arrivals due to traffic are not excused, but late arrivals due to alien abduction are excused because they are considered “acts of nature”. Given that he reports the correct excuse 95% of the time, you can accept the fact that 19 out of 20 times he reports alien abduction, he is doing so accurately, right?

Let’s run a simulation of 1,000 late arrivals and see.

For the 1,000 late arrivals, 98% or 980 will be due to traffic and 20 will be due to aliens. For the traffic delays, 95% of the time (931 of 980) Homer will accurately report the cause as “traffic” and 5% (49/980) he will inaccurately report as “aliens.”

For clarity, we can enter the results into a table.

Table: True cause for late arrival (Traffic – 98%) vs Homer’s Excuse (95% accurate); Traffic in 931 (green) cases, Alien in 49 (red) cases, out of a total of 980 lates.

For the 20 alien abductions, Homer will correctly report 95% (19 of 20) as “aliens” and incorrectly report one as “traffic”. Add this as another row to the table. The green cells represent the events for which Homer’s excuse matches reality. The red cells represent the events for which Homer’s excuse does not match reality.

Table as above, with an additional row labelled Alien (2% of true causes), making the Traffic excuse column 1 in red and for Alien, 19 in green, of the total 20 alien abductions.

If we sum the contents of the green cells: 931 + 19 = 950, this confirms that Homer correctly reported the cause of his tardiness 95% of the time. The sum of the green cells is 49 + 1 = 50, confirming that Homer incorrectly reported the cause of his tardiness 5% of the time.

If we sum the columns on the right half of the table, we can determine the number of times Homer reported “Traffic” and the number of times he reported “Aliens.”

Table as above with a new row added, labelled ALL – 1,000 total late arrivals. 932 for the Traffic excuse, 68 for Alien. An additional row below this shows the Traffic excuse is correct in 931/932 reports, while the Alien excuse is correct in 19/68 reports.

On Monday, Homer is late, and reports “traffic” as the excuse. The table tells us that for every 932 times Homer reports traffic, his report is correct 931 times. A traffic excuse accurately reflects reality 99+% of the time.

On Friday, Homer is late again and reports “alien” as his excuse. For every 68 times Homer reports aliens, his excuse is correct only 19 times. A report of alien abduction accurately reflects reality only 28% of the time.

If Homer is 95% reliable overall, why this inconsistency for traffic and alien abductions? The 5% inaccurate reports are not distributed symmetrically. The mundane “traffic” events generate a disproportionate number of false “alien” excuses.

In this model we could consider a report of “traffic” an ordinary claim, and evidence with 95% reliability ordinary evidence. This combination leads to a correct conclusion over 99% of the time.

We could consider “alien abduction” an extraordinary claim. The same ordinary evidence leads to a correct conclusion only 28% of the time. In order to have confidence that Homer’s extraordinary reports of alien abduction we would need some form of evidence with greater than 95% reliability.

Like any model, our thought experiment has limitations. The example used presents a binary choice between two mutually exclusive claims. The frequencies of the two claims are known and are constant: 98% traffic and 2% aliens. We also have a known accuracy of the evidence, and the accuracy is the same for both contingencies; Homer’s excuse is 95% accurate for traffic events and 95% accurate for alien events. These levels of precision and consistency are unrealistic in the real world, but instructive in our model.

We can run variations of the model with different frequencies of the 2 excuses, and different degrees of reliability in Homer’s reporting. If we make alien abductions less than 2% likely (more extraordinary), Homer’s reports of alien abduction become even less reliable reflections of reality.

The only version of this model for which ordinary and extraordinary claims have equal evidentiary value is a model in which Homer is a perfect reporter, accurately attesting the cause of his late arrival 100% of the time. In that universe every claim, no matter how implausible, could be accepted at face value.

Carl Sagan in his classic turtleneck under a dark blazer, gently resting his right hand on his cheek and smiling, in a black and white photo.
Dr Carl Sagan

In the real world, evidence is not perfect. The plausibility of a claim is not accurately known. The relative plausibility of competing claims can be quite contentious. Despite these confounding factors, the principle expressed by Dr Sagan is worth remembering.

If I were to expand to a more nuanced version of Sagan’s dictum, it would go something like this: The strength of the evidence required to accept a claim should be adjusted in proportion to the implausibility of the claim. The more implausible claim, the stronger the evidence required to accept that claim.

Does a prohibition-based approach to drugs and disposable vaping make sense?

Clio Bellenis
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Does a prohibition-based approach to drugs and disposable vaping make sense?

It’s easy to get the impression that the government acts swiftly to ban any substance primarily enjoyed by young people. Nitrous Oxide recently joined this list, along with freshly picked ‘magic’ mushrooms (which were previously only illegal to own if processed, for example by drying). There is now a move to ban disposable vapes. Are any of these reasonable, or are they all knee-jerk, vote-winning fixes?

Legislation of intoxicating substances has been happening for over a century, and has been prompted by some laudable aims, such as protecting people from serious avoidable harm, and also more worrying goals, where racism has been an element. Outright prohibition was first trialled in America from 1920-1933 with alcohol. Although there was an initial drop in consumption and alcohol-related problems, it wasn’t a success. It led to more potent alcoholic drinks, a huge black market, and the rise of the Mafia. Despite this failing, the penchant for simply banning stuff continued into the still-active, US-led “War on Drugs”.

The war on drugs has claimed many casualties: the move from hash to skunk and from cocaine to crack mirrors the prohibition-era move from beer to spirits, as more compact, stronger substances are easier to smuggle, and therefore more profitable. Until very recently, research into therapeutic uses of psychedelics has been almost totally stymied, and probably the most harmful thing about cannabis use is a potential criminal record. But this doesn’t mean that the area should be free from legislation. We have good examples of limiting, but not preventing, access with cigarettes and alcohol.

Mushrooms

It became illegal to pick and possess fresh magic mushrooms in 2005, and it is almost impossible to think of a good reason for this. The reason given by the then Home Office minister, Paul Goggins was:

“By clarifying the law we are making it clear that we will not allow the sale and supply of magic mushrooms … this will benefit people likely to be at risk from the dangerous effects of magic mushrooms and will bring to an end profiteering in fresh mushrooms by growing numbers of vendors.”

But given the very low risk posed by mushrooms, this reason is thin. It’s hard to avoid the conclusion that, in the view of these lawmakers, simply allowing anything psychedelic to be freely enjoyed contravenes the spirit of the Drugs War, and that their open sale was an embarrassment to the government. The relaxed attitude towards the inevitable move to the black market is harder to fathom.

Nitrous Oxide

Possession of Nitrous Oxide was made illegal in 2023. It has many uses, including as a rocket fuel booster and, combined with air, as an anaesthetic agent. When it began to be increasingly used as a culinary frothing agent, small cannisters of it became more easily available, and people began to inhale it recreationally.

Combined with air, it is a very safe, pleasant and short acting anaesthetic. But while the large gas and air bottles aren’t conducive to recreational use, a small cannister released into a balloon for rebreathing, is.

Nitrous Oxide itself poses little risk, but rebreathing an oxygen free gas can lead to hypoxia, which has its own risks, including, at worst, seizures and cardiac arrest. If a person is sitting down and begins to lose consciousness, they will let go of the balloon and quickly restore their oxygen levels, so these outcomes are rare in the absence of other methods of use, or when used alongside other intoxications.

It was interesting that the littering produced by discarded cannisters was cited as something which necessitated the legislation, as littering is already subject to sanctions – especially as cigarettes, a cause of frequent and unpleasant littering, have never been subject to a proposed ban on the same grounds. Again, it seems hard to avoid the conclusion that people are enjoying something which causes altered consciousness, so it must be banned. There is a strong argument that controls, and limits on purchasing would be reasonable, but this is not the same as banning – and doesn’t appear to ever have been suggested.

Disposable vapes

Disposable vapes are next in line for banning, and this one seems entirely reasonable. Vaping started as an alternative to smoking, and the UK has stood apart from many other countries in keeping vaping in our arsenal of smoking-cessation support. The idea is that they deliver nicotine without the tar, and so reduce the risk. There is some evidence that for someone wanting to quit smoking, it is easier to reduce consumption in this way, and that vaping works better than patches or gum.

Unsurprisingly though, with the reduction in cigarette smoking, tobacco companies have found a new lucrative market with brightly-coloured, interestingly-flavoured disposable vapes, which sit in the front of shops along with sweets. If the target market was children, it would be hard to plan it better. Not only does this mean introducing nicotine to people who otherwise may never have become smokers, but it also exposes them to all the substances added as flavourings, which have never been cleared as safe for inhalation.

Vapes aren’t controlled by either food or drug standards. Substances like diacetyl, which causes popcorn lung, is found in some vape flavours, although no cases have been definitively linked to vaping. One final problem of disposable vapes is that it is not possible to reclaim the lithium in the batteries. Lithium is a valuable resource which is becoming scarcer, and consigning huge amounts to landfill in this way is environmentally unsound.

On balance then, making disposable vapes readily and appealingly available to young people doesn’t sound like a good idea. It is encouraging, at least, that the government still wants reusable vapes to be available, and aren’t choosing their usual route of simply banning them altogether. However a simplistic ban on disposable vapes may achieve little, as manufacturers can simply add a USB port for recharging, taking the vape out of the disposable category in terms of technology, even if not in terms of intended use, so nothing is changed. More thought needs to go into achieving the combined objective of protecting children while allowing for help with smoking cessation.

The UK government, in all its iterations, does not have a good record on control of drugs. The Drugs War has claimed far too many victims and needs to be consigned to history, and options for the sensible management of drugs need to be explored. This seems unlikely to happen in the near future, and in the meantime it appears that we will continue to see piecemeal additions to drugs policy, which are simply tinkering around the edges, with mixed harm and benefit, both directly and as a result of unintended consequences.

An anti-vaccine circus takes over the Brazilian Senate’s paediatric vaccinations discussion

Cesar Baima
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An anti-vaccine circus takes over the Brazilian Senate’s paediatric vaccinations discussion

The Senate plenary was transformed into the stage of an anti-vaccine circus Monday 26 February. Requested, chaired and organised by two legislators from the House who gained notoriety in 2021 for their denialist actions during the Senate Parliamentary inquiry into the COVID-19 pandemic, this most recent session was billed as a discussion on the inclusion of the paediatric vaccine in the National Immunization Program (PNI), but was limited to the dissemination of misinformation on the topic that is now, unfortunately, immortalised in the annals of the Brazilian National Congress.

It would be comical, were it not a tragic spectacle, with the convex dome of the Senate acting as the circus tent. Soon after invoking God at the opening of the proceedings, the master of ceremonies – that is, president of the session – gave an idea of ​​what would come with what can only be described, gently, as a half-truth. In a jubilant tone – and in a clear attempt to give legitimacy to the event – he stated that the session was approved “unanimously” by Brazilian senators.

However, as the saying goes, the devil is in the details. The reality is that request 1046/2023 , was inserted as an “extra-agenda item” literally in the final two minutes of the Senate’s agenda on 28 November 2023, by senator Weverton Rocha (PDT-MA), the second secretary of the House table, who was at that time acting as president of that session. Weverton then opened a symbolic vote, which was over in a matter of seconds (as recorded in the Senate Diary of that date):

Voting on the application.
The senators who approve it remain as they are.
(Break)

Application approved.
The requested session will be scheduled by the General Secretariat of the Bureau.
In other words: there was no vote, so it’s impossible to claim or deny that this “thematic debate session” on the vaccine  was “unanimously” approved by the Brazilian senators. 

Still, the “show” must go on. In the session introduction, the senator presiding over the work promised a “scientific” and “technical” debate, which would leave “any type of ideology or political issue aside”. A point he would contradict shortly afterwards, with an open criticism of the inclusion of the paediatric COVID-19 vaccine in the PNI, an inclusion he described as “alarming”. Invited to speak about this serious issue? A litany of exclusively anti-vaccine activists, from Brazil and abroad.

Before the guests entered the scene, however, the president of the session set the “stage” with a video featuring testimonies from alleged victims, and family members of alleged victims, of the COVID-19 vaccines in Brazil. Emotional appeal is a common tactic of misinformation spreaders, and exploiting the tragedy of rare real-life cases of deaths and other severe adverse events possibly associated with vaccination is a frequent weapon of anti-vaccine movements.

The reality, however, is that according to the latest epidemiological bulletin on the subject from the Department of Health and Environmental Surveillance of the Ministry of Health, Brazil registered only 50 deaths that had a “causal relationship considered as consistent with vaccination” (level A), out of almost 385 million doses applied throughout the country between January 2021 and March 2023 (with the exception of the state of São Paulo, which was not part of the analysis). None of these deaths with the highest probability of causality with vaccination were children or adolescents, with only one case of death due to myocarditis classified as “B2: Undetermined”, because “investigational data conflict regarding causality”.

The most recent COVID-19 Special Epidemiological Bulletin published by the Ministry of Health, in December 2023, records 211 deaths from Severe Acute Respiratory Syndrome (SARS) associated with COVID-19 among Brazilians under the age of 19 last year alone. More than half of those cases (112) were in babies under one year old, and another 59 in children aged between 1 and 11 years. With 3,562 deaths recorded between 2020 and 2022, there were almost 4,000 fatalities from COVID-19 in this age group by the end of 2023.

Furthermore, the same bulletin points to the registration of 2,121 cases of Paediatric Inflammatory Multisystem Syndrome (PIMS) associated with the disease throughout the pandemic, causing 144 deaths, with an unspecified number of suspect occurrences still under investigation. It is no coincidence that the number of registered cases of PIMS related to COVID-19 fell drastically once Brazil began to vaccinate children aged 5 to 11, in January 2022, cases fell from 868 in 2021 to 442 in 2022, and just 68 last year.

Among the entire population, there were more than 38.2 million cases of COVID-19, and 708,638 deaths, between February 2020 and December 2023. Again, the numbers show the importance of vaccination: they fell from 424,107 deaths in 2021 – most of them in the first months of the year, when it had barely started – to 74,797 in 2022, and 14,785 last year.

All these numbers confirm that the vaccines against COVID-19 approved and applied in Brazil are safe and effective, and that the possible risks posed by vaccination are much smaller than those suffered by those who decide to face the disease without the protection of the vaccine. The deaths that could perhaps be attributed to the vaccine are no more than 50, while deaths from COVID-19, before vaccines were available, were in the hundreds of thousands – a number that fell drastically after the vaccines were rolled out. 

Lack of science, plenty of misinformation

None of these facts and data, however, were presented in the arena – I mean, plenary – of the Senate. Nor, of course, the science and impartiality that was promised by the senator president at the beginning of the session. Overall, what we saw instead was the repetition and recirculation of typical topics of anti-vaccine disinformation in the form of half-truths, unsubstantiated claims, exaggerated statements, and outright lies.

We heard that children do not suffer serious illness and death from COVID-19, and therefore the risks of vaccination do not outweigh the benefits – which the above illustrates is clearly not true. We were advised that vaccines are unnecessary because there is an “early treatment” of COVID-19 in cocktails that include medicines such as chloroquine or ivermectin – a hypothesis completely debunked by research in 2020. We were told that vaccines are inefficient, and that they do not prevent hospitalisation or deaths – a statement clearly disproven by the data. And we were warned that vaccines, especially those involving the messenger RNA (mRNA) mechanism, are causing a wave of sudden deaths of relatively young people, in what was yet another statement disconnected from the data.

It is saddening and revolting to see public structures, built and maintained with the money of the Brazilian people, being used to host almost eight hours of such a depressing spectacle.

Given his rising influence, the case for debating RFK Jr has never been more urgent

Danny Bradley
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Given his rising influence, the case for debating RFK Jr has never been more urgent

‘Never wrestle with a pig. You both get dirty, and the pig gets 40,000 new followers on Twitter’.

 Mehdi Hasan, ‘The Mehdi Hasan Show’, 19/06/2023

In June of 2023, the most popular podcast in the world gave an uncritical platform to one of the most prolific anti-vaccine activists in modern history, and allowed almost every outlandish, outdated and already–debunked falsehood that flew out of their mouth to go unchecked.

Robert F. Kennedy Jr’s record needs no introduction to readers of this magazine. Neither does Joe Rogan’s. Yet this particular episode marked an important milestone in cementing Rogan’s reputation as a bona fide industry leader in credulous platforming of pseudoscience. Appropriately, the debacle also threw into question the vital issue of ‘debate’ itself. Particularly the public, verbal variety.

After the podcast aired, vaccine scientist Dr Peter Hotez shared an article calling the episode ‘an orgy of unchecked vaccine misinformation’. Rogan then publicly challenged Dr Hotez to appear on his podcast, opposite RFK Jr, and contest the issues in person with Rogan as moderator. Hotez did not accept.

In the weeks that followed, pundits and specialists alike questioned whether such a venture could ever yield useful results. What is the point, they argue, of entering into such a debate when one side is so clearly committed to goalpost shifting, gish galloping, and misrepresenting their opponents? The idea that Rogan would be an impartial moderator is plainly risible. Likewise, his audience appears more entrenched than ever before, more prone to selectively edit the resulting footage, and more likely to declare victory no matter what happens.

Moreover, the idea of asking a medical health professional to debate a vexatious activist with a fringe position – as though they are equal, valid, opposing sides of an argument – is ludicrous. One has spent the last few years working on the frontline of a pandemic, when not conducting life-saving research, and the other has withered on the wild vines of Twitter, with zero professional skin in the game, having never treated a sick patient in their life. 

It has been argued that even the very format of a verbal debate, such as it would stand on the Joe Rogan Experience, would mean that a conversation notionally about communicating scientific truth would inevitably descend into point scoring, linguistic jousting, and the eventual valorisation of whoever happened to bellow the loudest. After all, knowledge overconfidence is worryingly associated with anti-consensus views. At best, such an exchange would serve only as a garish spectacle in the ongoing coarsening of public health discourse.

And finally, perhaps more importantly, many brilliant scientists and well-respected pro-science advocates contend that debating RFK Jr publicly would be not only a profound waste of time and energy, but even counter-productive. Simply entering into a debate with someone considered by many to be a ‘crank’, it has been argued, creates the mirage of a live question where there isn’t one among experts, as well as the false impression that debate is alien to science to begin with. Platforming fringe views on such issues necessarily risks elevating, emboldening, and even legitimising them.

I sympathise with every single concern listed above, and believe that each of them speaks to a very real discursive malaise that the pandemic years have done a terrible job fomenting – but whose origins, of course, predate the pandemic by several decades. However, I do not believe that any of these concerns have anything to do with why it is important to debate RFK Jr. The claim that neither he nor Rogan are interested in the pursuit of truth – and that their most hardcore listeners are unlikely ever to be persuaded – is a misdiagnosis of both the problem and the solution. 

This is not about convincing Rogan, RFK Jr, or even their most dyed-in-the-wool fans. This is about whether we choose to squander one of the best opportunities in living memory to reach a sizable minority of famously politically un-aligned podcast listeners in Rogan’s enormous audience by letting a rhetorically fierce vaccine expert make RFK Jr squirm on camera.

Whether we like it or not, Rogan’s podcast – notorious for its at-least-notional devotion to a detached ‘devil’s-advocate’ centrism – plays host to possibly the single largest tent of fence-sitters in the country, given that the podcast’s oversized reach happens to dwarf cable news‘. Writing off Rogan’s entire listenership as ‘unreachable’ ignores the fact that 55% of them are vaccinated, as well as relatively politically diverse overall, despite the prevalence of a few obvious trends – his listeners are often young and frequently men. Listeners praise the podcast, accurately or otherwise, for its ostensibly ‘flexible, unaligned political agenda’, and Rogan himself for his ‘curiosity’ and willingness to listen to a wide range of perspectives. While we should retain a healthy scepticism over just how open minded Joe Rogan really is, this seems to be the single most repeated reason why his listeners claim they like him. 

A substantial proportion of people who occupy tentatively neutral terrain within a controversial topic can act as a wild card with the power to determine whether a particular view survives in the mainstream, or drifts into obscurity. And, unfortunately, this wild card is up for grabs by both sides. Arguing that some views ought to be beyond the pale for engagement – especially when the issues in question have already been settled by real experts – crucially abandons fence-sitters to a salivating opposition.

Such a forfeiture is made all the worse at a time of pronounced political urgency – a context often overlooked by those who argue against engaging. As political commentator Medhi Hasan argued on MSNBC:

“Why would anyone think that’s a debate worth having? What next? Neil deGrasse Tyson debates Alex Jones on astrophysics? Noam Chomsky debates Lauren Boebert on Cartesian linguistics..? Experts shouldn’t agree to debate cranks. I mean, no serious person would consider having a pre-eminent World War II historian debate a holocaust denier.”

Aside from the fact that reactionary movements against Cartesian linguistics and astrophysics have yet to be spearheaded by Lauren Boebert and Alex Jones – at least at time of writing – it is imperative to point out that a holocaust denier is not currently fronting a rising campaign to be President of the United States. Nor is one currently boasting the highest favorability ratings of any individual candidate in the race, beating both Trump and Biden in the 18-34 age group, successfully peeling away big donors from the GOP and, prior to that, polling at 20% within the Democratic Party itself. 

Should the day come when a holocaust denier is the second most popular candidate in the Democratic Party behind the actual President – and who is making worrying advances as an independent in a notoriously precarious race – I certainly would hope that experts might feel it worthwhile to take notice. 

Any sense of political and contextual urgency – wherein some dangerous ideas happen to be prospering more rapidly than others – is completely absent from Hasan’s argument. Further, I would argue that anti-vaccine advocacy is no less heinous than, say, pro-war apologetics – yet presumably Hasan believes that debating John Bolton was a perfectly worthwhile endeavour, despite Bolton’s predictable evasiveness. The interview was watched by roughly half a million people, and the recording remains on YouTube for posterity. In years to come, anyone sincerely curious about Bolton’s record will have no problem finding and watching it. This, as Hasan himself must realise, is a good thing.

Making a favourable impression in the minds of the uncertain is a very effective way of guaranteeing a future in which we continue to outnumber the vaccine-critical. Far from the absurd task of trying to elicit an admission of defeat from a conspiracy theorist – let alone a change of heart – this is about providing a potentially life-saving off-ramp for those caught temporarily in their tractor beam. And their gut-level suspicions are only being stoked by Hotez’s refusal to engage, and the scientific community’s notional endorsement of this refusal.

I believe that arguing against such a debate is a serious tactical misstep, and one that happens to look away from a mountain of evidence to boot. It ignores the plethora of historical cases in which a rhetorically-equipped activist stepped into ideologically unfriendly territory and succeeded. Noam Chomsky, Rutger Bregmen, Michael Brooks, Krystal Ball, Bernie Sanders, Ross Greer, Mick Lynch, Christopher Hitchens, and Marianne Williamson have all debated ‘cranks’ publicly, often on the ‘crank’s’ own platform. They did so at different times, for different causes, and with differing approaches. They each, in their own way, absolutely nailed it. And, in doing so, helped set forth a marvellous ‘how-to’ of tackling contrarians on their own turf. While such individuals may be rare, that is no reason not to find them, enlist them, and put their talents to good use.

Claims that nobody could possibly survive in such a bad-faith, hostile environment disregards the abilities of today’s many fierce, pro-vaccine advocates who literally train for situations like this every single day by debating professional anti-vaccine contrarians who are far less respectable than RFK Jr. Put simply, these activists eat Kennedys for breakfast.

Dr Peter Hotez owes nobody a debate, and based on his recent public appearances he may not be the best choice for challenging RFK Jr in such a combative context anyway. Hotez comes across as a brilliant, affable, mild-mannered specialist who has far better things to do than engage with an irksome troll on a platform for irksome trolls. The idea of forcing him to debate Kennedy – as opposed to simply enlisting any of the passionate activists above who would be delighted with the opportunity – would be like playing a game of chess by trying to force a knight to behave like a pawn.

If we adopt a big-picture view of the strategic battle against misinformation, we would do well to recognise that everyone has a part to play in the cause. Experts, activists, journalists, public speakers, educators, artists and creators all have varying skill-sets and areas of expertise. Why wouldn’t we want to use our allies by stationing them in the areas in which they can be most effective? Here, we have a legion of skilled and steadfast activists at our disposal, and we refuse to use them at our peril. Just because our task is difficult does not mean that it cannot be done well. Additionally, anybody tentatively sympathetic to Joe Rogan’s covid contrarianism is unlikely to seek out media appearances of a vaccine expert on a mainstream, corporate news channel, let alone read their book. We must meet them where they’re at. Appealing to the vast enclave of fence sitters in Rogan’s audience is too good an opportunity to squander.

The problem is not RFK Jr’s intransigence, and the solution is not trying to convince him. The problem is a coasting middle ground at risk of taking him seriously due to his rising exposure, and the solution is to firmly disabuse them of his nonsense – preferably with wit, verve, and zeal. Ultimately, as much as we may resent it, presentation matters. If we are serious about the task of reducing vaccine hesitancy – and blunting the momentum of a rising anti-vax presidential candidate before it’s too late – we must acknowledge the importance of public debate as just one of many aspects of the fight to get right. And those who bemoan its futility, funnily enough, almost always get it wrong.

Failed attempts

In and amongst the chorus of scientific Skeptics warning against debating RFK Jr, one voice stood out to me in particular. Significant, I felt, due to the direct personal experience from which they spoke. In the New York Times, Farhad Manjoo related an incident in which he engaged a notorious conspiracist publicly, and it did not go well. In this case, the conspiracist happened to be… RFK Jr himself.

Manjoo debated Kennedy on the issue of US election fraud in 2004 on public radio – an encounter Manjoo now believes was ‘a mistake’, and should serve as an example of why such endeavours are doomed by design. In doing so, whether he realises it or not, he has inadvertently provided a near-perfect, textbook model of how not to go about these kinds of confrontations.

He says:

“There’s this basic unfairness when you debate a conspiracy theorist. Your side is bound by evidence. You have to say what has been proven. You have to cite the truth. But they can just make up anything… So when it’s my turn to speak, I have to kind of get into all of the complicated reasons [why RFK Jr was wrong]… I have to say where the numbers come from… It just becomes a very droning recitation of facts, compared to [Kennedy’s] overly simplistic declaration that Republicans stole the election.”

Acknowledging that he had hoped the facts would speak for themselves, Manjoo continues:

“I had expected that the audience would clearly see that the numbers he was peddling were not correct… I don’t think that’s what happened at all.”

Manjoo concludes:

“I don’t think there’s much good that can come from debating a conspiracy theory. I think that you risk making the problem much worse… The best thing to do is kind of ignore it, because ideas that are crazy enough will just kind of go away by themselves perhaps if we don’t fan the flames.”

Incidentally, immediately after making the above statement, Manjoo mentions the fact that conspiracy theories happened to proliferate during the first Donald Trump presidency. The political phenomenon of Donald Trump, I would argue, is not a good example of a problem simply going away by ignoring it.

Curiously, Manjoo appears genuinely surprised that a spouter of nonsense would have the gall to spout nonsense during a debate. Almost as though it caught him off guard – rather like diving into a tank with a hungry shark, and then being flabbergasted that the shark had the audacity to bite you. 

While reflecting on his debate appearance with RFK Jr, Manjoo seems quite unaware of the penetrating critique he gives his own performance. Having listened to the debate myself, I agree with him – it is indeed a ‘droning recitation of facts’. It could certainly do with some energy, some panache, some humour perhaps. Maybe even a creative barb or two. When dealing with a clown, I believe some licence to be colourful is afforded. When you have the facts on your side, irony, charm and a tongue-in-cheek approach can be tremendously fruitful in winning over curious listeners. 

Simply scurrying around behind RFK Jr, correcting each and every little inaccuracy he makes, ensures that you’ll never break free from the confines of his vapour trail. Expecting the facts to speak for themselves does not work when dealing with someone who has forged a career out of obscuring facts. I share Manjoo’s frustration about the asymmetry of evidentiary responsibility, having written about it myself. But claiming that the venture itself is futile, simply because one’s own approach didn’t succeed, is a highly unimaginative conclusion to reach. I agree with a slightly modified version of Manjoo’s verdict; debating a conspiracy theorist may well risk making the matter worse… if you are ill-prepared or ill-equipped. 

The tactics of deflection, evasion and obfuscation have been RFK Jr’s modus operandi for decades now – almost all of which is public record. These are the tricks of the trade, the tools for which he is famed. The idea that a sophist might deploy sophistry during a debate should be the very minimum we expect and, importantly, prepare for. If witnessing a professional conspiracist hurl wild, baseless claims is something that will blindside you, then you may not be ideally suited to challenging them in a public debate.

Not everybody flourishes in a debate environment. It is certainly not incumbent on specialists in a given field to develop such a skill. And such an enterprise is definitely not the be-all and end-all of combating misinformation. I argue simply that we should allow our experts and activists to each play to their strengths. Because when rhetorically equipped activists step into the fray, they can be astonishingly effective. 

Successful attempts

Some have voiced reasonable misgivings along the lines of biased editing – how can we trust that any debate footage will be used and edited fairly? However, when the historian and author Rutger Bregmen appeared on Fox News with Tucker Carlson, he devised and executed an ingenious way around this issue with astounding results.

The interview was civil to begin with, but quickly went off the rails. After challenging Carlson pointedly on his own hypocrisy in discussing elite tax avoidance, something that Carlson clearly had not anticipated, Bregman prompted the following outburst from his host:

“… I just wanna say to you why don’t you go fuck yourself, you tiny brain – I hope this get’s picked up because you’re a moron!”

Bregman handled the incident with humour, nerve and aplomb, responding to Carlson’s tantrum with a wry smile:

“You can’t handle the criticism, can you?”

After the incident, Fox News informed Bregman that the segment would not air at all. However, unbeknownst to them, Bregman had secretly recorded the exchange in its entirety, apparently having anticipated this turn of events. Once it became clear that his appearance would not see the light of day, Bregman leaked it himself. It remains on YouTube with several million views, and even the comments on Fox News’s own subsequent video attempting to explain Carlson’s actions are generally not favourable to the host. It was an audacious stunt that successfully brought the issue of elite tax avoidance hypocrisy to the mass attention of Fox News viewers – some of whom may well have questioned their favourite politico’s motives as a result.

In addition to his pitch-perfect composure in the face of Carlson’s meltdown, Bregman’s example shows us that when it comes to circumventing the biased hand of an editor, we have permission to be creative. Bringing along a confidant to covertly record the exchange allowed Bregman to make two things plainly visible to Fox News viewers – their favourite host attempted to hide something from them, and when accused of being ‘a millionaire funded by billionaires’, he seemed suspiciously rattled. Whyever could this be…?

The combination of a forceful, substantive challenge with a teasing style can go a long way.

In a TV segment that was broadcast on Good Morning Britain in early 2019, contrarian pundit Piers Morgan gave the radical MP Ross Greer a very unflattering introduction. Greer had recently labelled Winston Churchill a ‘white supremacist mass murderer’ in a tweet. After Morgan taunted him for ‘applauding [his] own genius’ on Twitter, he asked Greer to begin the interview by explaining himself. 

The 60 seconds that followed are an absolute masterclass in how to flourish while facing a hostile interlocutor:

“Absolutely… Piers, you’re a sensitive soul; yesterday you accused me of being a racist for pointing out that you look like honey-glazed gammon. If you want an example of real racism, you just have to look to Churchill – he talked about his belief in the “triumph of the Aryan race’. He hated Indians with a passion – he said they were “a beastly people with a beastly religion”. When a famine broke out three million people starved to death… He used poison gas against Kurds, against Afghans. He was a strong supporter of Britain’s concentration camps in the Boer War where 28,000 people died. He’s always advocated the use of… “terror” bombing campaigns. His own cabinet had to stop him… from bombing protesters in Ireland.”

Greer manages to give an opening statement that includes a surfeit of accurate historical events, direct quotations from the political figures involved, as well as a joke – albeit a churlish one – at the expense of the host who antagonised him. He speaks briskly and clearly, as though he is aware he is dealing with a host who might try to interrupt him. When Morgan later attempts to imply that Churchill single-handedly won the Second World War ‘through the power of his rhetoric’, Greer visibly laughs. Outraged, Morgan immediately attempts to chide him for laughing, allowing Greer the opportunity to succinctly dispute the preceding analysis again.

The incident made national news, with many outlets placing particular focus on Morgan’s lack of composure. The incident remains on YouTube having garnered millions of views, and comments were generally favourable to Greer. Passing viewers of the morning news who may well have been unfamiliar with Churchill’s broader record – owing to a near-unanimous idolisation by mainstream press – were given a pocket-sized precis of the former Prime Minister’s murkier side.

Were we to glean any lessons from Greer’s performance, I think they would be:

  1. Come prepared.
  2. Speak briskly and push through interruptions.
  3. Don’t be afraid to laugh if something is ridiculous. 

Although not debating a ‘crank’ as such, similar tactics were deployed quite effectively by Mick Lynch during the UK rail strikes in the summer of 2023. Anyone considering debating RFK Jr might do well to remember that judiciously executed mockery can be lethally effective.

A more recent example that showcases the efficacy of ridicule and sarcasm to an even greater extent occurred when Bassem Youssef appeared on Piers Morgan Uncensored. Although Youssef is indeed a professional satirist, it is valuable to notice how such an approach seems to lend its user a stylistic upper hand in an otherwise precarious environment – the polar opposite of Manjoo’s approach in the aforementioned debate with RFK Jr. One way to let an audience know that an opponent is laughable is to invite an audience to laugh at them.

While adopting a bold, assertive approach certainly can be beneficial, quiet charm and affability can persuade quite powerfully too. Dave Rubin likely did not expect much from Marianne Williamson when he invited her to appear on his show, given her idiosyncratic presence in the political landscape of the US at the time. Over the course of an hour-long interview, their conversation covered mass incarceration, reparations, slavery, open-borders, and myriad culture-war moral panics that constitute the currency of Rubin’s entire brand. Their exchange can be summarised by a single line, delivered gently by Williamson:

“Dave… Have you read up much on slavery?”

Williamson’s tone never deviates from that of a patient school-teacher, gainfully tasked with the thankless duty of educating an errant student. In discussing the case for reparations in the US, she calmly and repeatedly clarifies the difference between Rubin’s tired, specious notion of ‘collective guilt’ and that of ‘taking responsibility’:

“This is not about guilt. There is a difference… If you have a company that takes over another company – you inherit their assets and you inherit their debts”.

The analogies she uses are clear, easy to understand, and delivered elegantly – in stark contrast to Farhad Manjoo’s efforts against RFK Jr in 2006. Despite Rubin’s almost admirable persistence in misunderstanding what she is talking about, she never relents her poise and her lucid exposition. The comments section of the interview yields some interesting results:

  • ‘i was skeptical [sic] at first, but her depth of knowledge and ease of conversation really changed my mind about her.’ – @joe42m13
  • ‘Not gonna lie, this was a lecture for me too. Never thought Marianne Williamson would explain things so plainly and so eloquently. Good stuff’ – @alexg2890
  • ‘Marianne is more impressive than I gave her credit for’ – @MissySqrrr
  • ‘Lmao even Dave’s own audience is dunking on him in the comments section’ – @RaitoYagami88

Lest we forget, these are comments on a video posted by a channel criticised by experts for platforming race and IQ quackery. The sheer fact that Williamson was able to give a basic US history lesson to the viewership of the Rubin Report – and for viewers to actually warm to her – is a remarkable achievement. Charm and personability, it seems, can make quite a durable Trojan horse. We can’t know for sure, but I suspect Williamson understood perfectly the environment she was walking into, and the task at hand. Convincing Rubin was never on the cards. Slowly peeling away some of his viewership was the name of the game.

Williamson herself, it should be said, has an unfortunate history of veering dangerously close to entertaining anti-vaccine narratives, despite committing to funding vaccination programmes fully via a universal healthcare program – one of only a few candidates to do so. Just as we are free to evaluate her to-ing and fro-ing on vaccine messaging, we are similarly at liberty to mine her rhetorical tactics for utility. Vaccine vacillating notwithstanding, she nailed the exchange above.

Audience response can be instructive. One ex-Jordan Peterson fan wrote of how watching the Canadian celebrity psychologist debate the Slovenian philosopher Slavoj Žižek led to his impression of Peterson ‘crumbling’. Witnessing how ill-prepared Peterson was for the debate was not lost on other audience members too:

  • ‘Jordan Peterson’s opening is a first year uni essay done the night before’ – @WanderingSTar5270 (1.4k likes)
  • ‘imagine reading the communist manifesto once and thinking you can take on a post-marxist philosohper [sic] in a debate’ – @jasonkazazis (1.5k likes)

Although this particular debate is mercilessly long and both parties could be said to boast a reputation of sophistry of varying kinds, Žižek plainly disassembles a number of Peterson’s contradictions in a way that resonated with viewers. Peterson’s debate with Matt Dillahunty yielded similar results, having usefully provoked Peterson into admitting that he does not believe that art would exist without belief in God – a claim wild enough to give even Peterson fans pause for thought.

Noam Chomsky famously debated William F. Buckley Jr on his own turf in 1969, during the US invasion of Vietnam, for an episode of Firing Line. Chomsky confidently and persistently challenged his opponent on the wider contextual motivations for US imperial interests abroad, conspicuously highlighting Buckley’s own gaps in historical knowledge. Buckley’s frequent interruptions and shifting of goalposts earned him the title of ‘professional subject changer’. Years later, Chomsky recalled that:

“At the end, he [Buckley] was pretty angry. He said he would invite me back but, of course, I never heard from him again.”

Chomsky’s dogged insistence on factual truth and unflagging perseverance in drawing attention to historical inaccuracies is a valuable precedent. It is echoed in Krystal Ball’s appearance on Real Time with Bill Maher, Michael Brook’s appearances on i24, and James O’Brien’s cross-examination of Nigel Farage on LBC. 

Additionally, Chomsky attempts novelly to resist the framing of the debate as ‘two equally valid opposing sides’ by disclosing at the outset:

“There are certain issues… such that by consenting to discuss them, one degrades oneself and to some degree loses one’s humanity”. 

Readers familiar with Chomsky’s style will note the acerbic humour of beginning an exchange by saying ‘before we go on, this conversation is a fundamental affront to my humanity’. However, I think it is possible to imagine appropriating this tactic against RFK Jr by beginning any debate with a similar verbal frontispiece; ‘Just so we’re clear, for anybody who happens to be listening, this entire conversation is a circus’. As we have seen, audiences appreciate candour and humour. Such devices fare well in conversations at risk of becoming a ‘droning recitation of facts’. 

Admittedly, the examples I have given thus far have all involved either an impartial moderator, or taken the form of a televised interview. However, I believe it is still possible to do well in far more dire circumstances – when your opponent, your moderator, and even a majority of the audience are flatly opposed to you.

In April 2019, Bernie Sanders appeared at a town hall event organised and hosted by Fox News – the first time a Democratic presidential candidate appeared for such an event on the network. The event was chaired by not one but two Fox News hosts, who were asking and fielding questions. The segment was broadcast to 2.6 million Fox News viewers around the country, and Sanders’ stated aim was to bring the issue of universal healthcare to an audience notionally opposed to him.

Only one month prior to this, the DNC declined an invitation from Fox News to moderate a debate amid concerns the network would not be ‘fair and neutral’. It is difficult to imagine a finer example of being outnumbered in enemy territory.

By all accounts, Sanders triumphed. Despite appearing on a network virtually synonymous with contemporary political casuistry, Sanders managed even to earn applause breaks when discussing single-payer healthcare, immigration and climate change. A strong message delivered simply and robustly can make a startling impression, even when the very structure of the format you are operating within appears dead set against you.

Similarly, in the year 2000, Christopher Hitchens debated the President of the Catholic League Bill Donohue at the Union League Club in New York City. The debate predated the cultural phenomenon of ‘New Atheism’ by a number of years, thus rendering Hitchens bereft of the legion of admirers he would soon acquire. The event was sponsored by a Roman Catholic organisation. Hitchens’ opponent was a Roman Catholic layman. The moderator of the debate was a Roman Catholic priest. Hitchens was given measurably less time to speak than his opponent – as well as being frequently cut off by the moderator – and the audience were largely unsympathetic to his side of the aisle. At one point, when Hitchens suggested that homosexuality is an entirely valid form of human love, the room audibly jeered. 

Despite every odd being overwhelmingly stacked against him, Hitchens managed to put his case forward dynamically and unequivocally, as well as calling out in no uncertain terms the stark homophobia proudly on display in the room. By the end of the event, Hitchens was earning a small smattering of increasingly spirited applause. However, even if every single audience member was left somehow unmoved by his efforts, the act of committing to record a clear and damning challenge of the Catholic Right’s positions is valuable, and guards against possible future efforts to backtrack as the institution succumbs to the rising tide of social progress. The debate has enjoyed more than a decade on YouTube, and Donohue’s stale pronouncements on evolution, homosexuality and AIDS are at the mercy of history. 

While much can be said about Hitchen’s broader political activism, his economy of language within a debate format is particularly useful to appraise critically. His deft balance of humour, rhetorical skill and unflinching nerve makes him ideally predisposed to these kinds of public confrontations. Similar tools should be utilised against RFK Jr advisedly.

Let us turn now to examples both recent and germane to the field in question; to pro-science advocates successfully challenging anti-vax campaigners in a public setting. I believe that each of the following activists would flourish while debating RFK Jr and would likely be delighted with the opportunity to do so. Crucially, they each manage to integrate a bold, disputatious style with the ability to be ruthlessly evidence-based and entertaining to a wider audience.

On the 31st of January, geneticist Dr Ian Copeland publicly debated Steve Kirsch, an anti-vax campaigner that even Alex Berenson manages to find fault with. To the uninitiated, Kirsch’s exploits, stunts and low standards of evidence make RFK Jr look almost respectable. The debate took place online, in the setting of a ‘Twitter Space’ – a medium that facilitates live audio conversations. Spaces carries the advantage of being able to support your arguments instantly by posting links to research for listeners to review in real time. 

Thanks to Dr Copeland’s spirited, combative style, and his unrelenting insistence that his opponent support his arguments immediately with adequate evidence, Kirsch floundered in the debate. Upon Kirsch’s claim to have personally accrued a data set that purported to demonstrate vaccine-related harms, Dr Copeland asked him to provide a p-value for his statistics, so as to affirm any statistical significance. Not only had Kirsch not calculated one, he did not appear to know how to do so in the first place. Dr Copeland exposed Kirsch so thoroughly, aided by similarly robust contributions from “The Veg Doc”, and scientist and activist Aysha Mirza MBS – rhetorically gifted in their own rights – that Kirsch lost his composure entirely around the 1:22:50 mark.

Kirsch is no stranger to humiliating debate appearances, having endured a similar experience on the 1st of June 2023. A scientist and activist named Cat Morgan debated the question ‘do vaccines cause autism’ with Kirsch, who had suddenly become enamoured with the topic. Morgan did tremendously well. When listening to the debate, it became clear within the first 30 minutes that Kirsch did not even know what autism was. Kirsch said:

“These children reacted very badly to the measles vaccine… Whether you want to call that autism or not call that autism, I don’t care…”

If we needed further confirmation that Kirsch speaks with great confidence on issues he knows almost nothing about, this debate provided it. Despite being quite outnumbered, Morgan aptly and deftly untangled every tired, Wakefield-adjacent trope that came from Kirsch and his acolytes, all while offering clear and compelling explanations for the phenomena they were attempting to flag. Morgan’s ability to keep her cool in the face of Kirsch’s tone-deaf pronouncements on autism was unimpeachable. As well as being a compassionate expert on the granular details of the vaccine-autism non-link, Morgan herself happens to be autistic. Soon after the debate, Kirsch blocked Morgan.

A pro-vaccine activist who goes by the cunningly deceptive handle The Real Truther (TRT) has demonstrated similar prowess in exposing anti-vaccine chicanery, having debated Ed Dowd on Dr Drew’s show. Dr Drew can hardly be considered an impartial moderator and TRT was given very little time to make his case. Yet TRT effectively and directly challenged Dowd to explain Sweden’s historic negative excess deaths in 2021, 2022, and 2023 despite boasting a significantly higher vaccine uptake than the US, and with less confounding variables such as gun violence. Dowd responded by claiming that excess deaths were in fact going up for 2023, which TRT disputed immediately.

TRT has an enviable talent for squeezing research-laden yet entertaining rebuttals into almost no time at all – a skill that made him a suggested candidate to take Peter Hotez’s place in a debate against RFK Jr on The Joe Rogan Experience. I believe this would be a phenomenally wise idea. Our undertaking is not to convert Kennedy’s most extreme followers, but rather to peel away enough fence-sitters so as to demobilise his outreach and blunt his effect. It creates a public record of trickery being dismantled in real time – available to view permanently to future generations of curious people. 

Insisting that facts ought to speak for themselves is having absolutely no effect on RFK Jr’s polling numbers. Nor is it doing anything to reach the vaccine-hesitant. Concerns about potentially ‘elevating’ dangerous views are rendered moot by the fact that those very views have already enjoyed uncritical airtime on the world’s largest podcast. Spending precious hours bemoaning the cheapening of public discourse is a luxury we cannot afford when a worryingly popular anti-vax contender is challenging an incumbent with favourability ratings at a record low. Decrying public debate as a crass, boorish pursuit simply allows our opponents more scope to appeal to fence-sitters and more time to build momentum unimpeded. 

Every second we spend arguing against ‘fanning the flames’ could be better spent by going about the business of putting out the fire. We must keep Kennedy where he belongs: firmly at the fringe. Debates, done well, can change minds. RFK Jr must be challenged by a formidable vaccine expert. Forcefully. Publicly. Now.

From the archives: Creationism and Noah’s Ark – founders on the facts

Stephen Moreton
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From the archives: Creationism and Noah’s Ark – founders on the facts

This article originally appeared in The Skeptic, Volume 1, Issue 6, from 1987.

People are sometimes surprised to learn that there still exist today individuals who sincerely believe the earth to be flat and to lie at the centre of the universe. Genuine flat-earthers really do exist and are based in California. Also based in American’s most crank-ridden state are the devotees and promoters of a far more popular but equally ludicrous set of beliefs – the self-styled “scientific creationists.”

According to organisations such as the San Diego-based Institute for Creation Research, the earth is only 6000 years old. fossils prove nothing, and the Genesis account of creation is the literal truth. Being fundamentalists, they are compelled to accept every story in the Bible as historical truth, thus Jonah really did get swallowed, the sun really did stop for a day, and the first woman really was formed from Adam’s rib. In their attempts to prove tales which ought to be taken with a pillar of salt, the creationists resort to gross distortions of fact, ignore mountains of contrary evidence, and use the most absurd fallacies and sophisms. Here I shall examine in detail one of their favourite “theories” – Noah’s Flood – which is also one of the easiest to disprove.

As historians and archaeologists have long known, the ancient Sumerians living in the Tigris-Euphrates valley were subject occasionally to disastrous floods, one particularly severe flood giving rise to the flood story in the “Epic of Gilgamesh” and, after centuries of exaggeration, the story in Genesis. The creationists do not want to know. They believe that the flood took place in 2348 B.C., and the fact that Egyptian history carried on through that period is of no consequence: the Egyptologists have got it wrong.

The creationists tell us that prior to the flood the planet was surrounded by a huge water-vapour canopy which maintained a tropical climate over all the earth. In reality, such a canopy would require conditions like those on Venus to maintain it, and the humidity would have been suffocating. One is also left wondering how all the organisms adapted to extreme cold or dryness survived or even why they were so adapted. Imagine polar bears, cacti, and penguins living together in the conditions of a sauna!

A divine meteorite disrupted this impossible canopy and caused massive precipitation. Fortunately, the earth’s topography was not the same then. There were no very high mountains, so the amount of water needed was not too great. The mountains were thrust up later as the ocean basins opened up to allow the water to drain away afterwards. The creationists ought to learn about plate tectonics.

The “evidence” for all this consists of a few fossil graveyards where whole communities of living things have been wiped out suddenly and the fact that flood tales are common around the world. It does not occur to them that sudden burial and fossilisation can be achieved quite simply by local, natural floods. Nor does it occur to them that most ancient civilisations lived in fertile but flood-prone river valleys – hence the preponderance of flood myths.

Naturally, the geological record contains no record of any world-wide flood. The creationists’ answer is that the geological record is itself the record of the flood! All the rocks from Cambrian times onwards and all the fossils within them were laid down during and by Noah’s Flood. This “flood geology” is supposed to explain the ordering of fossils in the strata. Organisms dwelling on the sea-floor were the first to be buried and so appear at the bottom of the record. Fish are next, then slow-moving land animals, then more mobile ones, and finally the birds, as they can fly and so evade the rising waters the longest. Regrettably for the creationists, the fossil record is hopelessly at variance with this. Whales occur above equal-sized marine reptiles; corals should only be present in the lower levels whereas they occur continuously from the Ordovician to the present day; plants, being rooted to the spot, should all occur together, yet giant tree-ferns and mosses clearly precede flowering plants, and so on.

It is not just the order of fossils that contradicts flood geology. The Permian rock-salt beds of Cheshire formed by evaporation of sea-water, the Carboniferous Fossil Grove in Glasgow with its still upright tree-stumps, or the giant fossil coral reefs over a mile across in the Silurian limestones of northern Indiana all occur in the middle of the sequence of rocks that creationists tell us were laid down during and by Noah’s Flood. The mind boggles at how seas can evaporate, trees grow, and huge coral reefs form during a planetary flood.

The creationists are fond of telling us how the Ark would have been big enough to take on board all the animals. and they reckon it was about the size of H.M.S. Invincible. However. they tend to underestimate just how much living matter had to go on board. An article in Nature in December 1986 put the total number of species at between 1 ½ and 30 million, probably over 10 million. One wonders how a family of eight can, for about a year, look after a floating menagerie of several million sea-sick animals, including dinosaurs!

It is not just land animals that would have had to go on board. The mixing of salt and fresh water together with vast amounts of sediment would have made the oceans intolerable for most aquatic organisms. Presumably Noah somehow managed to cram on board the 90 or so species of Cetaceans, though I am not sure how the various pairs of whales were supposed to survive off a single pair of krill, or how the krill managed. Plants, too. pose problems. A large supply of fresh plant material would be required for food. Where it was all kept is not clear. Seeds (in hermetically sealed containers to prevent premature germination or decay due to the damp) of every species would be needed, as plants and their seeds would perish under miles of water just as surely as any animal. Those animals requiring specialised food would have a problem. The single pair of ants would not have lasted the pair of anteaters long, and pandas will eat nothing but fresh bamboo.

It doesn’t end there. How did diseases survive the flood? Did Noah and his family all carry smallpox, diphtheria, malaria, polio, syphilis, and all the other diseases of mankind? If so, then why did they not die, and if not, then how did the diseases survive? Were the bacteria and viruses kept in little phials in the fridge, perhaps? Thousands, possibly millions, of creatures are utterly dependent upon the Amazon rain forest for their survival. As any ecologist knows, such jungles take millennia to grow or to recover from damage. What did all those poor creatures do while waiting thousands of years for their habitats and food-supplies to regenerate?

Finally, I would like to finish with just one more little fact for the creationists to ponder. In some parts of the world, where lakes form around the foot of melting glaciers, one gets a seasonal variation in the sediments deposited in the lake. The sediment deposited in the summer is coarse, being washed in by the meltwater, and is rich in organic matter from the stagnant, algae-rich water of the lake. In the winter the sediment is the very fine clay left in suspension from the summer and is poor in organic remains The result is an alternation of layers, each pair of layers representing one year’s deposition, and they can be counted back just like the rings of a tree. These sediments, called varves, can contain up to 12,000 pairs of summer/winter layers and. because they contain carbon, they can also be dated by the carbon-14 method, which correlates with them as far back as 12.000 years.

Do those varves show any sign of a break at around 2348 B.C.? Not at all. The sequence is completely unbroken. These simple muds, on their own. are better evidence against the Biblical flood than all the creationists’ half-geology, semi-meteorology, and pseudoscience in general can ever counter.

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