On Avoiding Bad Faith and Ad Hominem Arguments

An instructive recent exchange on social media with two other physicians

Yesterday, two physicians on Twitter posted the following:

💉Josh Rubin, MD 🩺 @DrSandman11

I don’t know who *still* needs to hear this but advocating for “natural immunity” over vaccination would result in millions of dead Americans. I’m really glad I’m immune to measles without having had gotten it first.

Liz @mdlizs

@DrSandman11 @akheriaty still needs to hear this. Take a scroll through his page. I am also tired of the argument “vaccine does not protect against getting covid” while my vaccinated colleagues are safely at home with covid, and my unvaccinated patients are overwhelming our ICU. 😞

Here is the response I posted (note: the numbering here has to do with the Twitter word count limit: a long thread of Tweets is often necessary to say anything substantive on Twitter):

1/ @mdlizs and @DrSandman11, I have never encountered someone who is “advocating for 'natural immunity' over vaccination.” I certainly have never done so. This is a straw-man argument, but a telling one. I advocate for those who have *already recovered* from Covid.

2/ I have never suggested anyone deliberately try to get infected with the virus. This mischaracterization is telling, for it reveals one of the key reasons that so many public health officials and physicians refuse to acknowledge what research shows about natural immunity.

3/ Scientific findings are ignored not because they are false, but because people worry that if the public knows, it might impede behavioral outcomes (getting vaccinated) that public health officials want. But this just reveals a condescending contempt for the intelligence...

4/ ...and judgement of most ordinary people. Yes, perhaps some people will behave recklessly, but we physicians encounter people who make misguided health decisions routinely. This has never justified withholding relevant scientific information or bypassing informed consent.

5/ As I have said *repeatedly* on this platform and in my legal documents regarding vaccine efficacy: vaccines lower one's risk of moderate to severe symptoms and hospitalization; they may might lower one's risk of mild or asymptomatic infection...

6/...though all of these protective effects are waning with time and new variants, especially the latter. Covid vaccines do not prevent transmission--an inconvenient truth, perhaps, but true nonetheless. Deliberately ignoring these truths only increases hesitancy and mistrust.

7/ Ordinary people can and do read the primary literature. They can see through half-truths that contribute to public health behavioral propaganda. (The group in the U.S. with the highest rates of vaccine hesitancy are PhDs, not low-information folks).

8/ One-size-fits all policies, and especially coercive mandates, *increase hesitancy* and mistrust. People can readily see that the risks/benefits of vaccines and risks/benefits of Covid are *very different* between those who recovered from Covid already and those who have not yet been infected.

9/ Like you, I have consulted on countless Covid cases in our ICU and on the wards. Serving as our lead ethics consultant, I have had more anguishing conversations than I can count with families explaining to them that their loved one in our ICU is irretrievably dying of Covid.

10/ I suffered with Covid, as did my wife and five children. I don't need a lecture from another physician on how bad this illness can be. I have never dissuaded anyone--whether they have natural immunity or not--from getting vaccinated. I simply advocate for informed consent.

11/ But informed consent requires accurate information and the freedom to consent or refuse the intervention. So yes, please do "take a scroll through my page" or any of my legal documents before you mischaracterize my position on vaccines or mandates.

12/ And before you accuse a fellow physician (who has suffered just like you through the difficulties of this pandemic) of advocating for something that “would result in millions of dead Americans,” please make sure you understand what he has actually said.

13/ Finally, @mdlizs and @DrSandman11, I am happy to engage in a respectful and civil debate with either or both of you, either live-streamed or in writing, on the topic of vaccine mandates for Covid-recovered individuals. I will publish anything you write on this topic...

14/... on my blog, along with my response of equal word-count. You can write a rejoinder to my response and we can go as many rounds as you'd like. My only rules are that we avoid ad hominem attacks and straw-man arguments.

15/ We can respectfully disagree on public health policy without accusing the other either of bad faith or a callous disregard for those who have lost their lives during this pandemic. Let me know if you would like to engage in a respectful dialogue/debate.

The end.

To her credit, @mdlizs reached out to me on Twitter via direct message saying, “I appreciate your thread and have read the whole thing. There are many points I appreciate.” She also apologized, indicating she should have engaged with me directly from the beginning rather than tagging me in the tweet. She then raised some thoughtful concerns about a few of my posts, and we had a fruitful and civil exchange. Perhaps this is an example of how civility and respect on social media advances the pursuit of truth more than snark or sarcasm. This requires patience, nuance, and a willingness to engage directly with our interlocutors. It’s more time consuming and difficult, but it is worthwhile.

I concluded my response to her with this:

Finally, thank you for all your tireless work treating Covid patients in the ICU. You are a true hero, and I do mean that with complete sincerity. It's been a very hard year and a half for all of us, and I commend you for everything you've done to treat the sick during this pandemic.