For Academic Institutions, Silence is Golden

Joseph Marine responds to a problematic perspective in the New England Journal of Medicine

Editors note: a shortened version of this post was originally submitted to the New England Journal, but it was rejected. Refusing to host debates is why journals will die.

By Joseph Marine, MD

In a recent NEJM Perspective piece, Drs. Mullen, Topol, and Verghese argue “in support of institutional voices” to take public positions on matters of public controversy “when it concludes that a faculty member’s opinion could cause public harm.” Their essay (ironically published on July 4) effectively supports institutional suppression of community members’ speech under the guise of exercise of free speech. The essay contains a number of flawed ideas and troubling statements.

When a university or academic medical center speaks as an institution, especially when targeting an individual voicing unpopular or contrarian views, the effect will be to intimidate and silence diverse voices, particularly those that do not enjoy tenure or other protections. Furthermore, the low threshold of potential to “cause public harm” could apply to any medical or public policy controversy and would place an impossible burden on institutions to police faculty speech.

The perspective piece demonstrates a corporatist mindset which places the values and importance of the corporation above those of its members. This is backwards. The purpose of the academic institution is to support the human beings that comprise its faculty, trainees, and students. An “institution” is not a human entity. It cannot have an opinion or a voice on any matter. As such, it’s “voice” will necessarily be that of its leaders.

The authors acknowledge a major weakness of their own thesis when they pose the question “Who speaks for the institution?” They answer with a serious of tenuous suggestions before settling on an amorphous “advisory group” which would “build consensus” and [more irony] “consult relevant experts.”

This is a formula for decision making that only a university administrator could love and sounds a lot like the White House Coronavirus Task Force that produced so many failures in the US covid response.

Further weakening the author’s arguments is that they were plainly targeted toward a single individual: Dr. Scott Atlas. A neuroradiologist and public policy expert at Stanford’s Hoover Institution, Atlas was brought into the White House in August 2020 to provide badly needed counterpoint to the groupthink-dominated authoritarian lockdown approach championed by Birx and Fauci. However, rather than engage with his ideas (that children were at little risk from covid, that schools should be opened with minimal restrictions, that there was little evidence to support public mask mandates, and that lockdowns were doing more harm than good), Atlas’s opponents inside and outside government relentlessly undermined and marginalized him until his resignation in late November.

The one bright of the NEJM Perspective is that it brings to light a 1967 statement known as the Kalven Report. Written by a University of Chicago faculty committee in response to growing pressure from students for the University to take public positions on controversial political and social matters, the report concisely and brilliantly refutes the NEJM authors’ main ideas. It is only two pages and well worth a read.

A key pearl: “To perform its mission in the society, a university must sustain an extraordinary environment of freedom of inquiry and maintain an independence from political fashions, passions, and pressures. A university, if it is to be true to its faith in intellectual inquiry, must embrace, be hospitable to, and encourage the widest diversity of views within its own community.” We should all agree and encourage our universities and academic medical centers to speak less as institutions and to do more to foster faculty debate on controversial medical and health policy issues.