On the freedom of scientific debate

I receive and distribute the press release of 26 October from the Sustainability and Health Network "on the radiation of doctors for conspiracy offenses" ( here the online text, here the pdf). With this appeal, the professionals and associations that join the Network take a position on the ongoing radiation process against some doctors who would have expressed their own opinion that is not aligned with the political will to promote the dissemination of certain health treatments.

It is good to remember that this is an unprecedented way of operating , even in the darkest years of dictatorship and war. Not even, as the writers of the document recall, "in cases punished by criminal justice with sentences of life imprisonment (!) Or for crimes of corruption and extortion". One way of operating, that of denying health professionals the right to their profession for having honored the requirements of "freedom and independence" enshrined in the Code of Conduct (Article 4), all the more absurd and dangerous in the period we are today crossing. As I write this, the country and much of the world are in fact subject to political measures with an unprecedented impact on the quality of social life due to a declared health emergency. Never before has the right of doctors to operate – I read in the Code – "without subjecting to interests, impositions or conditioning of any kind" represents an invaluable asset to navigate the cacophony of information, interpretations and measures that are often incomprehensible and contradictory, if not really senseless . Attacking at this moment the autonomy of the health personnel for mere ideological indiscipline would have the effect of leaving the field free to narration, to remedies and to the consequences dictated by political and industrial interests alone. Hitting the plurality of the scientific debate would affect the possibility of developing citizens' well-being, knowledge and consciences. Social development would hit the heart.

Those who follow me know that I have made this complaint my own for years, since the first provisions issued by the Provincial Orders against doctors now on trial. In the book Immunity of law , written in 2018 with Pier Paolo Dal Monte , I commented on those facts:

Thus a circular relay was inaugurated between the Ministry of Health – which obliges patients – and the orders – which oblige doctors – where the former justified his acts by citing the unanimous approval of "the doctors", while the latter fulfilled that justification silencing dissenters with the threat of severe disciplinary action. The desired effect thus gave birth to its cause: the legislator boasted the certification of a scientific community nominally free and authoritative, but in fact authorized … to produce nothing but that certification.

It's still:

It is not logically possible to recommend citizens to defer to the evaluation of the treating staff as they are aware, expert, educated etc … and at the same time prevent the latter from freely formulating that evaluation. By subordinating doctors to a directive of merit, they are compressed on the same level as their patients. And since both must only abide by the verdict of a higher authority, the hierarchical presuppositions of custody are lacking.

Even if [the doctor] questioned would firmly adhere to what has been imposed on him, how can the patient know whether it is an adherence in science and conscience or rather a response dictated by the fear of sanctions? That whoever repeats what he has to repeat really believes it, is it in good faith? It cannot, so it cannot be trusted.

Already in the subtitle of the book we suggested the risk, then in a nutshell and now a reality, that the claim to govern by citing the "certainties" of science would have demanded the sacrifice of scientists, their subservience to political messages that aspire to become certainties and therefore their autonomy and their credibility. In a later article I applied this reflection to a controversial "pact for science" and recalled a prophecy by Aldous Huxley on the role of scientific research in totalitarian regimes. Meanwhile, the signs of citizens' growing distrust of health care that was encouraged or forced to say only "the right thing" became irrefutable evidence, as are the numbers on the increase in vaccination mistrust after the introduction of the new obligations, which I commented on in this article .

Among the many important scientific and civil contributions of the Sustainability and Health Network, this last appeal deserves special attention because it is not addressed to a specific theme, but concerns the method underlying the very possibility of doing science and medicine. If the method denounced today were to be confirmed and become the norm, we will only have to resign ourselves to a sanity transformed into its opposite, in a "witch hunt" from which no one, be it doctor or patient, can be said to be safe.

Press release of 26 October 2020

The position of the Sustainability and Health Network on the radiation of doctors for crimes of opinion

( original version )

In these days some doctors are awaiting the verdict of the CCEPS, Central Commission for Health Professions, for confirmation or rejection of their radiation pronounced following the expression of critical opinions on the obligation to vaccinate and the methods of administering vaccines.

According to article 41 of Presidential Decree 221/1950, the cancellation is pronounced against the member who by his conduct has seriously compromised his reputation and the dignity of the health class. Article 42 necessarily correlates the cancellation only to conducts having criminal or similar relevance, according to the canon of proportionality between fact and sanction. Since the alleged facts are devoid of criminal relevance, from an objective point of view, because they are free of offensiveness, as these medical professionals have not caused personal damage to the health of the patients, applying this sanction against them does not appear consistent with the principles of proportionality and reasonableness , especially since the same measure was not adopted in cases punished by criminal justice with life imprisonment, or for corruption and extortion.

The dismissal of doctors for the crime of opinion raises a decisive question: whether or not it is lawful for a doctor to express his or her opinions, whatever they are. The accusation is that he expressed a thought that would have provoked in the population the idea of ​​the uselessness and risks of vaccines, with a consequent reduction in vaccination coverage and a potential damage to individual and collective health. Even if there is no verification of the concrete results of such behaviors, Article 21 of the Constitution states that "everyone has the right to express their thoughts in speech, writing and any other means of dissemination". The manifestation of thought, as an expression of freedom, is therefore a lawful activity for everyone, even for doctors and cannot be compressed by sources inferior to constitutional ones. This freedom and this right belong indiscriminately to every subject, regardless of the qualification that the same has, even if belonging to the Order of doctors.

Article 33 of the Constitution states that "art and science are free and their teaching is free". Therefore, there can be no constraint to a single science of state and order of belonging. Science also has its criteria and even its own truth, but it and scientists act within social, cultural and economic systems that condition their priorities, orientations and results and of which it is important to be aware.

History also shows that this truth is often subject to changes, second thoughts and it is not certain that the one proclaimed today will remain immutable, especially if new and stronger proofs question and lead to change some conclusions, or even current paradigms. But this becomes impossible if, instead of relying on the strength of the evidence to reject arguments that are unfounded, one represses free confrontation with sanctioning instruments not only extraneous to the scientific debate, but intimidating against an entire category.

The independence and autonomy of doctors are precious assets to be preserved, in an anti-dogmatic environment, favorable to free scientific debate, transparent and as free as possible from conflicts of interest. No researcher and no health worker should be put in a position to be afraid of expressing their beliefs on issues relating to medicine and medical practice, it being understood that the practices to be recommended are those that in an ever-changing scientific context make use of the best. evidence of efficacy currently available and safety over time.

The worldwide phenomenon Covid-19, which has allowed an open international debate on clinical experiences in continuous evolution, essential for sharing and reviewing approaches that evolve in real time, is showing the fruitfulness of a comparison without prejudice on the efficacy and safety of medical practice, even between opposing positions.

The other accusation made against doctors was that they presented critical positions to the public, rather than limiting them to a scientific or institutional context. We understand the reference to the opportunity to maintain this conduct and its rationale, but the spaces for debate in the scientific and institutional sphere must be effectively guaranteed. It is equally essential that, always in full compliance with the rules of scientific confrontation, even minority positions are allowed today, without making the dissent subject to discredit, censorship and sanctions, as is unfortunately happening.

We therefore ask in conclusion that, within the appropriate medical and institutional contexts, the possibility of a free and open confrontation (today strongly inhibited) between professionals who share the scientific method and can therefore discuss in a documented way be effectively guaranteed. of important health issues, without censorship or prejudicial prohibitions, much less running the risk of radiation.

The Sustainability and Health Network

Align Health and Health Foundation
No thanks
AsSIS – Association of Health Studies and Information
Mediterranean Network for the Humanization of Medicine
Foundation for Salutogenesis ONLUS
Hands Off Children ONLUS
Democratic Medicine ONLUS
Movement for the Happy Degrowth
Slow Medicine
SIMP Italian Society of Psychosomatic Medicine
Sportello Ti Ascolto – Social Psychotherapy Network

This is a machine translation from Italian language of a post published on Il Pedante at the URL http://ilpedante.org/post/sulla-liberta-di-dibattito-scientifico on Wed, 28 Oct 2020 03:56:17 PDT.