If you happened to look up from your turkey over Thanksgiving weekend—and if you happen to be a member of the world of science and medical Twitter—you may have sensed a disturbance. It technically started on Tuesday, when Scientific American’s blog published a story—under the category of Observations/Opinion—titled “Doctors Are Not Gods,” by Jennifer Block. As soon as the article went live, it was clear that it would cause a stir. But the ultimate size of the storm—which led to the eventual removal of the piece from the magazine’s website—has been truly surprising. It’s a strange storm, one that might reveal something about the state of science journalism and the echo chamber effect of social media, particularly when it comes to resolving highly fraught issues of who has a right to expertise and how we, as a society, evaluate scientific evidence.
But to start, let’s just consider the SciAm piece. Its argument was muddled. The most generous read is that it was trying to make what should be a noncontroversial point: Doctors don’t know everything, and they ought to have a little humility about that. This is particularly true when it comes to women’s health, given how recently women were excluded from the field of medicine and how their concerns about their own bodies have historically been minimized and understudied.
To demonstrate this point, though, Block focused on Gwyneth Paltrow’s Goop and the OB-GYN Jennifer Gunter, who is as close to a celebrity as a doctor can get on Twitter. Gunter uses her Twitter platform (she has more than 270,000 followers) to, among other things, debunk misinformation about abortion and criticize alternative medicine. She is a famous Goop critic: In 2017, when Goop started selling $66 nonreturnable jade eggs women were supposed to place in their vaginas to help them orgasm, she posted an open letter to Paltrow that went viral, debunking jade eggs as “the biggest load of garbage I have read on your site since vaginal steaming.” Gunter continued debunking Goop, and Paltrow specifically, on her blog, often with the same exasperated tone. In the Scientific American article, Block criticized what she considered Gunter’s rejection of alternative treatments, arguing that it undermines women’s authority as experts of their own bodies.
The piece had some serious flaws. For instance, Block criticizes Gunter for warning that vaginal steaming could cause burns, which seems like prudent advice, honestly. She implies that Gunter, who has dismissed yogurt as a treatment for yeast infections, missed “credible research” supporting the idea. Block points to a small study that could theoretically, maybe, be defended as credible but is certainly not game-changing to our current biological understanding of yogurt’s (non)role in eliminating yeast infections. Block approvingly cited, as a foil to Gunter, the seminal text (and continuously updated book and now nonprofit) Our Bodies, Ourselves, for the way it validates women’s experiences—but she doesn’t prominently disclose that she’s previously edited sections of the work. (The disclosure was included in her author bio, but this was at the end of the long piece, and it was easy to miss.)
Block concluded the piece by arguing that Gunter’s crusade against Goop is misguided partly because there are so many other, larger issues affecting women’s health, like obstetric violence or the rising maternal death rate. Beyond being useless whataboutism, this is simply incorrect: Gunter has written about obstetric violence and many of the issues Block shames her for ignoring. Gunter may have become a (relative) household name based on her criticisms of Goop, but she’s an OB-GYN who specializes in chronic pain and provides abortion care. She mostly devotes her New York Times column to writing about the serious issues that show up in her exam room (including this great, Gunter-led Times feature on birth control, sex, myths, and women’s biology), and she’s penned stunning personal essays on her own experiences as a patient.
As a result, Block’s argument ended up being much sloppier than it should have been. Which is a shame, because I think that she was trying to get at an important problem: that the ways doctors wield their authority can occasionally, even if inadvertently, end up dismissing and diminishing people. The reaction to the piece might be the best demonstration of its thesis.
About 24 hours after the piece came out, it started to blow up on a certain corner of medical Twitter—a corner occupied by Gunter’s compatriots in the war against pseudoscience. One round of discourse focused on debunking what Block had called “credible research” on yogurt to cure yeast infections. People pointed out that the Iranian midwives who had published the study had done so in what appeared to be a predatory journal, had used small sample sizes, had messed up their p-values, etc. This contributed to another, broader line of criticism, in the vein of “if you are going to come at our evidence, you had better beat us at that game,” along with a number of “the plural of anecdotes is not data”–type debunkings. These are all reasonable points, but Block was not attempting to argue that Gunter is wrong on the merits. If we’re talking about jade eggs or whether drinking small amounts of alcohol while pregnant is OK—another idea raised in Block’s piece—these are complicated questions that depend on how one interprets evidence and what sort of risk one is willing to tolerate. Which is to say they are not necessarily objective—there’s subjectivity involved. Block was mainly trying to argue that focusing only on what is “proven” by the current body of research might miss certain things that still have value in certain circumstances, to certain people. In other words, she was arguing for the inclusion of more subjectivity in the medical sphere.
Some pointed out that in her columns and work, Gunter does defend women’s right to make their own choices once they’ve been informed of the facts. Some defended Gunter by saying that she would not be the subject of such criticism if she were a man and that her no-nonsense, clap-back Twitter attitude would in fact be celebrated if she weren’t a woman. (I empathize with this concern. I’d also suggest that “a man wouldn’t be criticized for this” is not necessarily a convincing defense of the underlying action.) There were correctives over whether Gunter regularly deploys lines like “I’m the fucking expert,” with people noting that she had used it only in response to toxic anti–abortion rights activists who push inaccurate information. And then there were correctives to that, with critics digging into Gunter’s extensive Twitter history.
Then there were the concerns about journalistic integrity. People were justifiably mad about the lack of clear disclosure of Block’s involvement with Our Bodies, Ourselves, which she holds up as an ideal balance of the empathetic and scientific. They were mad that Block quoted Jennifer Lang, an OB-GYN who has also been critical of Gunter, because they thought, incorrectly, that Lang was on the advisory board of an anti-vaccine organization, the Alliance for Human Research Protection. (Lang has clarified that the organization had used her name and image without permission and that as soon as she was made aware of this, she asked the organization to remove it, which it did.) And there was a lot of lamenting over the fact that Block had not asked Gunter for an interview, as if not doing so negated the piece’s entire right to exist. This one is strange to me—suggesting that not asking for an interview was a grave ethical oversight misunderstands opinion journalism. This point was further complicated by the criticism that marking a piece as opinion or commentary wasn’t good enough because readers wouldn’t notice.
As this was unspooling on Twitter, Gunter was encouraging her followers to email Scientific American to express their displeasure at the piece. She retweeted those who screenshotted their protest unfollows of the magazine, and detailed her attempts to convince the editors there to take the piece down.
Meanwhile, Michael Lemonick, the chief opinion editor of the site, was in touch with Block. First, on Friday, he told her via email that they would be taking the piece down temporarily so that they could do their due diligence in fact-checking it. Block got on the phone with Lemonick to discuss a couple of times on Friday and Saturday, and as she recalls, he explained to her that one part of the problem was that SciAm had heard from many people who had complained that the piece was “anti-science” and was too critical of medical authority—which was a problem, Block recalls him saying, because the magazine stands for science.
By Saturday evening, Scientific American had pulled it for good, but it’s been inconsistent about the exact reason. The page that once hosted the article first read, “Editor’s note. The post that originally appeared here has been removed because we’ve determined that it doesn’t meet our editorial standards.” But by Tuesday, the publication had adjusted the editor’s note. It now blames “lapses in Scientific American’s review and fact-checking process,” states that the piece was “removed due to problems with sourcing and citations” and apologizes to the author (Block) and SciAm’s readers. (When I reached out to SciAm, which is between editors in chief, on Sunday, I was sent a statement with language similar to that now on the article page. Scientific American declined to comment further on what the specific problems of sourcing and citations were.)
Taking down pieces is a last resort in journalism because transparency is the entire point. I wouldn’t have published the piece, and I think that SciAm did Block a great disservice by not providing more rigorous fact-checking and editing. But once the piece was published, it was SciAm’s job to correct the record, not delete the record. In one email she shared with me, Block told Lemonick “the archived link is being shared on social anyway. So the work is still out there. It could be out there with the proper correction(s) along with some editorial integrity.” Lemonick told her the conversation was over.
Over email, I asked Gunter why she felt it was preferable that the piece be retracted instead of corrected. She replied, “The piece is poorly researched and so full of inaccuracies that it didn’t deserve a rebuttal, it deserved a retraction. This is Scientific American, not a tabloid.” (I understand why Gunter wouldn’t want to write a rebuttal to the piece, which, per her Twitter, SciAm offered her; that’s an absurd way to correct inaccuracies.) Gunter further wrote me:
When multiple false assertions are presented as fact, when the subject (me) is quoted out of context, when one of the interviews is obtained by claiming the piece was about jade eggs or something other than the actual subject, when a predatory journal is cited and when anecdotes are offered as scientific proof, we are beyond bad science and are now at anti-science.
Scientific American should not be supporting fake news. I work every day against medical misinformation, so the irony of seeing myself characterized by misinformation was horrifying and was not lost on me.
This hits on a particular strain of thought that was also repeated in doctors’ tweets criticizing the piece, a kind of specific horror at the idea that of all possible journalism outlets to have done this, it was Scientific American. This horror is familiar to me, and I think it represents something broader: People in the science and medical community often seem to think science journalism is primarily a venue by which science is explained and communicated to the masses. But the point of all journalism, including science journalism, is not merely to communicate or explain. It’s to ask tough questions, particularly of powerful institutions. And science is an institution that demands interrogation, just like any other. The implication that Lemonick and Gunter seem to make is that Scientific American should be an advocate for science, not that its journalism should also hold science accountable.
I feel for Gunter and the other members of medical Twitter who are constantly exasperated with what they see as pseudoscience. I cannot really imagine what it must feel like to watch people suffer or even die, particularly when modern medicine could prevent or treat their pain. They do a true service in helping debunk things and providing better information, and I know how essential their expertise, knowledge, and participation in this process is. I also know, from experience, that sometimes journalists and doctors have different goals, and that can sometimes mean things get complicated.
It would have taken an enormous amount of generosity for Gunter to engage with the piece. I recognized that asking her to do so is calling for her to be more generous with Block than Block was with her. But I also think that the way we engage with our critics is important. It’s true that there was a storm of experts defending Gunter. In her email to me, Gunter wrote about this outpouring: “What I have learned is that almost everyone who follows me on Twitter, Instagram and Facebook gets what I do. They understand that I am passionate about facts and choice. They know that I am working to fix the gaps in medicine through education and demanding medicine do better as well as calling out those who would use pseudoscience to harm women.” But there was also a smaller, quieter group of women thanking Block for her piece, for putting something into words that they had felt but had been too afraid to state, women speaking up about having felt bullied in the past by the online mob that comes wielding evidence as a cudgel rather than a starting point.
It is boring now to comment on how resoundingly social media can distort realities, by virtue of how everyone can craft their own experience of the world by picking who they follow, who they engage with, what they see. If there is no other lesson from this, it’s just the same one we should have learned by now: Yelling at each other on the internet is no way to resolve problems that require a much more human touch.
When I talked to Block, she said that she regrets not reaching out to Gunter—though that, she said, was a strategic error, not an ethical one. Block also noted that she felt her other large error was focusing so specifically on Gunter herself. “What I’m talking about is much bigger than Gunter,” she said.
There are extensive problems with the idea of tone policing. But it doesn’t strike me as unreasonable to suggest that this community of the internet, which is at once sprawling and intimate, might benefit from actually having the conversation I think Block was attempting to start about how expertise is wielded online and what the ultimate impact of it is. As I was writing this story, I spoke to a physician friend who also spends a good deal of his own time on the exhausting task of debunking. He reminded me that the other side—the full pseudoscience, anti-vaccine side—is showing up armed, and Gunter is one of the few doctors willing to authoritatively fire back. We need people willing to do what she does, he told me. Again, this reflects primarily on problems inherent to how Twitter works more than on what Gunter is doing. Even if you are shooting down one person, even a person you think is a troll, everyone else can still see you, and they may not see the person you are shouting at.
Also—yes, I do feel sort of dumb for how many words I have now spent on what could be characterized as a Twitter dispute. But I think part of the reason we’ve gotten into this mess is because we’ve dismissed Twitter as stupid and something we can just log off of even when it increasingly takes up time in our brains and lives, dictates how we interact with each other, and colors our understanding of the world.
When I decided to write this piece, I started out thinking that basically everyone was wrong. Reporting, as it is supposed to, helped me change my mind. I still think Scientific American was wrong to unpublish the piece—it should have corrected it, in public. But everything else has become significantly murkier in my mind. I actually do think everyone was trying to act in good faith. I think Block and Gunter have a few important things in common: I think they both want to help women better understand and care for their bodies. I think they both want women to feel empowered to make choices that work for them. I think they both do understand problems with the medical hierarchy, and I think they both are working on those problems, albeit from different sides.
Science and medicine are premised on uncertainty and evidence, on testing and revising claims. They are driven, perhaps primarily, by curiosity. Journalism is, too. Unfortunately, curiosity is also one of the first casualties of polarization. I hope the fractures this sent through this corner of the internet don’t end up pushing us further apart.
Update, Dec. 4, 2019: This story has been updated to make clear that Jennifer Lang was never on the board of the Alliance for Human Research Protection.