The Review Interviews Dr. Scott Atlas

The Review Interviews Dr. Scott Atlas

We need good people to step forward. In life, there are very few opportunities where you are that important, where you have a chance to help your country, your fellow citizens. When it comes up, you have to be bold enough to step forward and rise up against the criticism.”

-Dr. Scott Atlas

The Review recently sat down with Dr. Scott Atlas to discuss his work in health policy and his time serving at the highest level of pandemic leadership in the United States. Dr. Atlas is the Robert Wesson Senior Fellow in health care policy at the Hoover Institution. He served as a senior advisor for health care in 2008, 2012, and 2016 presidential campaigns and as a special advisor to the President on the White House Coronavirus Task Force in 2020. From 1998 to 2012, he was a professor and chief of neuroradiology at Stanford University Medical Center.

Dr. Atlas was attacked over his early opposition to lockdowns and his advocating for “focused protection” as the primary pandemic management strategy. This resulted in heavy backlash from the academic community, the media, and Stanford itself. Since his time on the task force, he has become an inspiration for those seeking academic freedom on increasingly censored campuses.

The Stanford Review: Let’s start with a bit of background. You initially studied to become a physician, you practiced for quite some time, and you eventually chaired the neuroradiology department at Stanford. What got you into medicine and can you tell us a bit about your transition to health policy?

Dr. Atlas: Being raised in a home of immigrants as a first-generation college student, the highest aspiration or accomplishment was to become a doctor. I went to UChicago for medical school, which was an eye-opener to the world of academic medicine. It was a very formal environment with white coats presenting from memory, amazing research, and a great student body. The level of scholarship was extremely high. That was a huge surprise; until then, I had never had any real thought about going into academic medicine. The environment I got to be a part of was the main initiator.

I then went on to do my residency at Northwestern and my fellowship in neuroradiology at the University of Pennsylvania—the number one neuroradiology group in the country, partially because they had just installed the state-of-the-art MRI scanner. At the time, MRI was brand new; no one knew anything about it. Even though I was a trainee, I became the main advisor to GE for MRIs. As I was finishing my training, I was asked to write a textbook on neuroradiology, specifically, on MRI of the brain and spine. The book is now in its fifth edition and is a standard textbook for neuroradiology and MRI.

My entire career for 30 years was in academic medicine at some of the top medical centers in the country. I came to Stanford in 1998 as Professor and Chief of Neuroradiology. I was primarily interested in Stanford because there were other fields that worked closely with the core departments of medicine (such as health policy). This was an interesting time for health policy, as there was a lot of discussion about single-payer healthcare, and subsequently, Obamacare. As such, in the early 2000s, I started working in health policy. Being a data-driven scientist, I quickly realized that strong opinions, not based on data, seem to be the loudest opinions. This was particularly true about single-payer healthcare and measurements of the quality of US healthcare.

In 2004-2005, I became friends with Michael Spence, a Nobel laureate in Economics, while running alongside him at the YMCA in Palo Alto. He asked to see if his prize-winning work had any bearing in the health policy work I was doing. The work was brought to the director of the Hoover Institution, who invited me to give a seminar and eventually gave me a position at Hoover in health policy. For the next 5-7 years, I worked extremely hard to do both jobs. I found it very difficult to devote my full attention to both my health policy work (which had been expanding) and my neuroradiology work. So, in 2012, I resigned from the medical school and accepted a full-time senior fellow position at Hoover.

Health policy integrates many different fields, but my advantage was that I understood the delivery of healthcare, the value of new technology, and the importance of data-driven approaches—as opposed to surveys, a pseudoscience, which are often incorrectly used to evaluate policy and care. I was asked to lead health policy for presidential candidates because of my emphasis on data-driven approaches as well as my ability to present data and conclusions succinctly.

The Stanford Review: Your academic work, both in medicine and health policy, put you in the spotlight when you were selected to be part of the White House Coronavirus Taskforce in 2020. Could you walk us through your experience?

Dr. Atlas: I was asked to be an advisor to the President and to join the task force in late July 2020. In early 2020, I was writing my book about reforming the healthcare system, but I saw early in March that logic, common sense, and fundamental understanding of medical science were being thrown by the wayside. Instead of protecting the people who were at high risk, the government was locking down everyone and doing an inadequate job protecting the high-risk people. This was not only against common sense or logic, but there was a fundamental absence of critical thinking at the WHO-level about what the risk of mortality was.

I thought that this was too important; people were dying, people were being killed by lockdowns. The implementation of the lockdowns themselves was going to cause massive destruction including harming our children by closing schools, disproportionately hurting poorer and single-parent families, and killing older people in nursing homes due to lack of adequate testing and care. So, in March, I started writing based on the data. There was a lot of data being ignored. For example, healthy children had a minuscule risk of serious illness or death and there was a huge age gradient to COVID-19 mortality, meaning that older people were at far higher risk of death than young people. The harms from closing schools, which were known just a few months after the first spring school closures, were enormous. They included 1 in 4 college students considering killing themselves, an explosion of mental illness, suicides, drug abuse, and self-harm visits from slashing wrists or self-burning with cigarettes. Moreover, there were hundreds of thousands of unreported child abuse cases during the spring school closures alone (as schools are the number one reporting agency).

The learning losses from online learning were well-documented, and it wasn’t a consequence of lack of broadband access, as many said it was. Countries like the Netherlands, with the highest penetration of broadband, still had massive drops in learning. All of these harms of lockdowns were far worse for poorer children. Affluent children did not suffer, but the affluent were the ones to dictate the policies. I found this to be morally reprehensible and deeply unethical. I kept writing and doing interviews about these ignored data points until the summer, when it became clear that the United States was going to keep schools closed at the recommendation of Deborah Birx and Anthony Fauci, as we denied the data, while the Europeans understood it and re-opened.

In late July, the Office of Personnel Management of the White House asked me if I’d be willing to speak with the President, which of course, I agreed to. I’m an American. We had Americans dying unnecessarily because grossly incompetent bureaucrats were administering counterproductive lockdowns and universities like Stanford were spewing out irrational information that was at odds with medical knowledge and common sense.

I want to highlight that lockdowns were not the standard pandemic prescription (neither in 2006, nor in earlier pandemics). It was known that they were extremely harmful. Also, I want to highlight that the university-side of science became highly politicized, possibly because it was an election year. I was warned by Stanford professors that I should not help the President. This was morally repugnant: to let people die simply because you didn’t like the current administration.

The Stanford Review: Could you speak more about your thesis regarding the effectiveness of masks and social distancing?

Dr. Atlas: My position was to look at the data. The data showed many things: that healthy children were not at risk and that old people (who had a much higher risk of death) needed to be protected more. Among the things that were false were things that were repeatedly said by infectious disease experts and bureaucrats in the government, such as there was no immunological protection after getting the virus—which was contrary to foundational principles of virology—and that masks were effective against the coronavirus. Masks (surgical and cloth) were known to be ineffectual against many similar viruses. The danger of believing that masks somehow stop the spread of infection was that it gave high-risk people a false sense of safety. Also, it was young people who bore the harms of masking. It was known at the beginning, but it has been repeatedly validated in literature all over the world.

The Stanford Review: Stanford, until very recently, still required masking in classrooms. This mirrors a trend in our locality of still holding on to pandemic-era restrictions while the rest of the world has opened up. What do you think is driving the decision to keep such policies in place today, despite a primarily young population and an extremely high (90+%) vaccination rate?

Dr. Atlas: It’s hard to assess people’s motives. However, we have two pieces of data: the extremely high proportion of people who are vaccinated and the extremely high proportion of people who have had and recovered from COVID. As the data shows, the immunologic protection of having COVID is far superior to that of vaccination. When you then look at a statistic like 80% of Americans have had COVID, you wonder why it’s ignored. It’s a separate level of ignorance to claim that masks work when the data is clearly against it. Any doctor or medical scientist who claims otherwise is a disgrace.

Why would people say it? You could postulate that they’re grossly incompetent and ignorant, or that their own fear of the virus prevents them from seeing the truth, or that their fear of liability prevents them from admitting fault in the past. These people were all in on maneuvers that have been proven to be ineffective. For them to admit that they’ve been wrong all along is a very high hurdle, particularly for people who have low moral standards to begin with (as has been seen through their attempts to de-platform and censor people who disagree with them).

The Stanford Review: Can you speak about some of the criticisms you received, whether at Stanford and/or the broader academic community? What problems in the current system did this reveal?

Dr. Atlas: At Stanford, some professors at the medical school wrote a letter with no scientific data or claims about what I was saying. It was an ad hominem attack that had no basis whatsoever. There was also a faculty senate censure voted on. These people violated Stanford's own published code of ethics. Worse than that, the long-lasting impact of what they did is that they destroyed trust in experts. Some of these people, who have credentials, showed that they can’t truly be experts because they resorted to emotional, ad hominem attacks rather than challenges based on data. This is very harmful to the public because the era of trusting people based solely on their credentials is over. Also, they aggressively tried to intimidate people they disagreed with, at Stanford and elsewhere, which is not an acceptable way for them to do their jobs. The purpose of a university is to be a free market of ideas, without which we cannot find scientific truths. The free exchange of ideas is most necessary to train students in critical thinking, the most important skill you learn in school.

They have failed in their jobs and notably, as role models for students. Now, students think that it’s acceptable to use distortions, misrepresentation, and frank lies to delegitimize people that they don’t agree with. That’s very dangerous, a sinful tragedy brought about by what these Stanford professors did.

The Stanford Review: How do we rebuild trust in institutions such as the public health establishment and institutions like Stanford?

Dr. Atlas: The “experts” and professors politicized science. We know that people of different political parties have different levels of trust in science. This is incredibly dangerous; we must have a society where science is not only the result of the free exchange of ideas, but is also viewed as objective.

Fundamentally, we must reinstate ethical principles in public health. This involves a few key changes:

  • The public health establishment must consider total health, not just the effects of a single disease, when making their recommendations.
  • The public health establishment is supposed to make sure that the most vulnerable, the poor, the elderly, are taken care of, rather than shift the burden of disease from the most vulnerable to the affluent (as they did during this pandemic).
  • The public health establishment has evolved into rules/laws setting. This is unacceptable; they are supposed to advise. Legislators are supposed to take responsibility for policy rather than just defer to public health officials.
  • We need to demand accountability, which means that we must demand admissions of error from these academic “experts”, public health agencies, and government officials because the data shows, unequivocally, that the lockdowns failed to stop the spread of infection, they failed to reduce the number of deaths, and that they in fact added death and destruction. If these people don’t admit that, society will never trust public health again.
  • We need to better define “public health emergency”. It is not supposed to last forever; it’s a short-term state. If it needs to be extended, it needs to be with the consideration of the public, open debates, legislators, etc.
  • Decentralize research funding: there is a strict control on science because there is a strict, centralized control on the supply of research funding. This controls every academic job promotion, the journal publications, etc. When a small group of people control the money, they control what science can and can’t do. This is especially true of the NIH. Institutions like Stanford receive over $500 million annually in research funding from the NIH, so it’s no surprise that Stanford doesn't speak out against what the NIH says. It’s no surprise that an assistant professor who needs a promotion (and needs NIH grant money to do so) would be reluctant to speak out.
  • We need to bring in more outside experts to work in government, which, ironically, is much harder now because people now see the personal costs of serving in an administration that is not liked by their employers. To me, this is very harmful to the public good. If you think that the people in charge are incompetent, there’s more of a reason to step in and help, not less.
  • Scientific publication needs reform. We saw how the journals became editorialized, they became weapons of intimidation. This is the opposite of what science is supposed to be.

But, I think that the most important thing to restore trust is individual behavior. Individuals must rise up and lead. We cannot have cowards occupy leadership positions. This includes presidents of universities, heads of research organizations, and heads of academic departments. When people do not have courage, society is harmed tremendously, and that is what we saw during the pandemic, at Stanford and elsewhere.

The Stanford Review: You’ve more recently started a new project, the Academy for Science and Freedom. Can you give us some background on that? What is it, what is its purpose, what will be its function, and how will it operate?

Dr. Atlas: Hillsdale College asked me, Dr. Jay Bhattacharya, and Dr. Martin Kuldorff to co-found this academy. What we saw during the pandemic was widespread violation of individual and academic freedom in the name of “science”. The purpose of our academy is to educate the American people about the free exchange of scientific ideas and the proper relationship between the freedom of science and the pursuit of truth. This extends far beyond the pandemic; I have colleagues in many other fields who report similar phenomena of violation of academic freedom. We have a lot of ideas on how to change the peer review process, decentralize research funding, and improve public accountability. We aim to reinstate the desire to have a free exchange of ideas, because without that, there is no science.

I believe that most people agree with all these things, even in science, even at Stanford. However, the cost, the pressure, the “cancel culture” in science and at universities, has caused a great deal of self-censorship. I’ve had hundreds of emails from scientists from all over the country begging me to keep speaking out as they couldn’t step forward out of fear for their own families and jobs. This happened at Stanford too; there are people on my block who are professors at the medical school who say that they all knew I was right, but they were afraid to say anything.

We need good people to step forward. In life, there are very few opportunities where you are that important, where you have a chance to help your country, your fellow citizens. When it comes up, you have to be bold enough to step forward and rise up against the criticism.

The Stanford Review: What advice do you have for students, particularly students of science, who may have serious doubts, questions, and bold ideas in today’s sociopolitical climate?

Dr. Atlas: I’m very empathetic to the plight of students, particularly because young people are more influenced by their social milieu than older people. That being said, the first thing is to maintain your moral and ethical compass. I can’t emphasize this enough. Number two is to be informed; know the data. First, learn the information, think critically, and then form your opinion; it doesn’t work going the other way.

Number three is to realize that you’re not alone, that many people who agree with you are silent because they are afraid, and in fact, realize (number 4) that your value in speaking up is not just to add your perspective on the issue, but it’s to embolden others who just need someone else to go first.

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