A Candle in the Dark
The struggle between reason and superstition has raged for centuries. Since the Age of Enlightenment, the proponents of science have mainly carried the day. The byproduct of these victories is a world replete with material abundance, technological wonders, and healthy children. Unfortunately, the rise of political regimes promoting misinformation and quackery presents a unique threat to the public good. As experts in healthcare and guardians of patient well-being, physicians have a crucial role in combating this dangerous trend.
Nearly three decades ago, astronomer Carl Sagan published The Demon-Haunted World, a book dedicated to educating the public about the scientific method and the importance of critical thinking. In general, Sagan was hopeful that science would prevail by serving as a “candle in the dark.” Despite his optimism, a sense of dread permeated his writing. He took note of the explosive growth of the Internet in the 1990s and observed that pre-millennial America was ripe for manipulation by charlatans peddling conspiracy theories. He warned that pseudoscience and superstition might grow ever more tempting if society was confronted with a severe social, political, or economic disruption:
I have a foreboding of an America in my children's or grandchildren's time … when awesome technological powers are in the hands of a very few, and no one representing the public interest can even grasp the issues; when the people have lost the ability to set their own agendas or knowledgeably question those in authority; when, clutching our crystals and nervously consulting our horoscopes, our critical faculties in decline, unable to distinguish between what feels good and what's true, we slide, almost without noticing, back into superstition and darkness.1
Carl Sagan passed away in 1996, shortly after the publication of The Demon-Haunted World. He did not live to see the 9/11 attacks, the protracted wars that followed, the Great Recession, or the global coronavirus pandemic. He also did not experience the rise of 24/7 cable news, the proliferation of social media, or the decline of independent journalism—all of which have accelerated the erosion of critical thinking and the spread of misinformation. As Sagan's metaphorical children, we've endured these disruptions and now must navigate a post-millennial America at serious risk of descending into darkness.
Am I overreacting? Perhaps, but consider the incoming administration’s picks to lead our federal healthcare agencies. Several nominees have engaged in the dissemination of harmful COVID-19 misinformation. The man tapped to run the Department of Health and Human Services is an infamous purveyor of pseudoscience who wants to suspend CDC research on infectious diseases and threatens to persecute FDA employees who correctly discouraged the misuse of ivermectin and hydroxychloroquine for treating COVID-19. Based on other public statements, his tenure portends a three-ring circus of anti-fluoridation, raw milk, and chemtrail conspiracies.2
A common thread unites these nominations: a radical disregard for expertise and a desire to settle scores over pandemic controversies. These appointments underscore the politicization of science, particularly public health, which threatens both scientific inquiry and effective governance.
The coronavirus pandemic was an unprecedented global crisis. Working under immense pressure, public health experts provided the best scientific guidance available to policymakers. Science, however, is inherently complex, and pandemics are constantly evolving. While no expert had all the right answers, those who downplayed the virus and advocated for herd immunity strategies were consistently and recklessly wrong. Now, some of these individuals are being entrusted with positions of power.
In his book The Death of Expertise, Tom Nichols highlighted the frustration with pandemic mitigation measures. As an ill-informed public sought scapegoats for these disruptions, many politicians opted for the easy way out. Rather than educating the public on the science behind mitigation strategies, they turned to “pseudo-experts”—charismatic figures willing to pander to base desires and offer simplistic, often misleading, solutions. As Nichols puts it, "This is the worst of all worlds, in which democracy and expertise are corrupted because neither democratic leaders nor their expert advisers want to tangle with an ignorant electorate."3
This state of affairs is not inevitable. Ignorance can be overcome. The solution isn't flawless experts or superior politicians, though those would certainly help. Instead, the answer lies in an informed citizenry. Just as a candle dispels darkness, vigorous civic engagement can illuminate the way forward and safeguard our nation as we grapple with climate change, emerging diseases, and the unintended consequences of artificial intelligence.
Educating the public and the polity is a physician’s solemn duty. One of the most effective ways physicians can exercise this duty is by promoting scientific literacy and critical thinking. By engaging in public discourse, physicians can educate the public about the dangers of misinformation. We can remind the public that everyone is entitled to their own opinion but not their own facts, and we can chastise the media for its lazy insistence on striking a false balance between science and pseudoscience.
Furthermore, physicians can join with other like-minded professionals to advocate for policies that support evidence-based care and regulate the practice of medicine for the public's benefit. This includes lobbying for legislation that protects patients from harmful practices, unproven treatments, and unqualified practitioners. By working with policymakers and regulatory bodies, physicians can help ensure that healthcare decisions are based on sound scientific principles.
In addition to public advocacy, physicians can be crucial in educating their patients one-on-one by providing clear and concise information, answering questions thoughtfully, and addressing concerns with empathy. We should take time to help them see through the latest social media or cable news scams, highlight the limitations of anecdotal evidence, and encourage them to rely on credible sources of information.
Another essential strategy is to be an active member of our professional associations. By working together through organized medicine, we can amplify our voices, share resources, and develop effective political strategies. Democracy is built from the ground up by civic engagement in organizations like the AAFP and AMA. As Alexis de Tocqueville observed, “What political power could ever substitute for the countless small enterprises which American citizens carry out daily with the help of associations?”
As physicians, we have a moral imperative to champion science-based public policy. By educating the public, advocating for evidence-based policies, and embodying compassionate care, we can safeguard our healthcare system from the encroaching shadow of misinformation.
The elevation of charlatans to positions of power is a calculated attempt to erode our trust in science and expertise. We must not succumb to the cacophony of misinformation. Instead, let us keep the candle of science burning brightly. By staying informed, engaged, and resilient, we can dispel the darkness and guide our nation toward a rational healthcare system that serves the common good.
- Sagan, Carl. The Demon-Haunted World: Science as a Candle in the Dark. Ballantine Books, 1997.
- “7 Noteworthy Falsehoods Robert F. Kennedy Jr. Has Promoted.” The New York Times, 22 Nov. 2024.
- Nichols, Tom. The Death of Expertise: The Campaign Against Established Knowledge and Why It Matters (2nd ed.). Oxford University Press, 2024.