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Bad Medicine

A Doctor’s War Against the Right-Wing Medical-Freedom Movement

As alternative medicine infiltrates mainstream health care, one physician is fighting back with everything he has.

Hulda Clark was at the convention, of course. At 76, the dark-haired Canadian naturopath was still going strong, attending natural health expos like this one to publicize and sell her “Zapper,” a unit that looked and operated like a scaled-down version of a car battery with jumper cables and was supposed to cleanse the body of cancer-causing parasites. Charlotte Gerson was there, too, talking about “Gerson Therapy,” a diet-based cancer treatment that can cost more than $15,000. Then there was Kurt Donsbach, an unlicensed chiropractor whose legal troubles had pushed him to locate his alternative cancer hospital in Mexico.

Plenty of healers of lesser reputation were also in attendance, hawking vitamins, minerals, energy bars, and healing crystals. The event seemed like classic L.A.—a consumerist expression of the region’s dedication to holistic approaches to health, wellness, and spirituality. But this gathering, the brainchild of Indiana-based supplements manufacturer Wendell W. Whitman, was different. It was 2005, and the expo was—arguably—the moment when alternative healers began to find a potent political voice.

Whitman and his lobbying group, the HealthKeepers Alliance, had come to California in an effort to harmonize the disparate worldviews of the leftist alternative practitioners celebrating mindfulness and the right-wing free-market libertarians celebrating mind-your-own-businessness. The result was this event, which Whitman branded America’s first “Health Freedom Expo.”

A schedule of presentations from the usual suspects—including Clark, Gerson, and Donsbach—was peppered with talks by right-wing activists such as Diane Miller, a Minnesota lawyer who founded the National Health Freedom Coalition. The freedom activists wanted to recruit alternative practitioners everywhere to a simple if ambitious mission: to change the legal definition of medicine. At the time, most states employed a broad definition that applied to anyone who “diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition.” The capacious category allowed the state to jail unlicensed quacks for failing to conform to the exacting rules and regulations of licensing boards. (Clark and Donsbach were among the many who’d faced criminal charges for practicing medicine without a license.)

The activists argued that the alternative practitioners at the Health Freedom Expo would be much better off if they could enjoy the privilege of treating patients without being held accountable to traditional standards of practice. This could be done by narrowing the definition of medicine and creating a marginal zone of “wellness” where naturopaths, aromatherapists, and others could treat patients without being accused of illegally practicing. To achieve such a coup, the whole industry had to unite behind a new message. Previously, such practitioners had, in their efforts to gain legitimacy, tended to emphasize the science (invariably poor) underpinning the (completely contradictory) theories of people like Clark, Gerson, and Donsbach. The activists urged the practitioners to drum up public support by focusing instead on a fundamental American principle: the right of citizens to freely make (and to spend money on) their own health decisions. This message proved to be a potent seed. The Health Freedom Expo spawned dozens of similar events across the country, and soon, buoyed by the efforts of lobbyist groups, including the National Health Freedom Coalition and HealthKeepers, alternative practitioners from around the nation were united in a political push for health freedom.

One hallmark of the health-freedom movement as it has evolved has been a vibrant conspiracy theory: a belief that the entire medical ecosystem—doctors, the government, academic researchers, the World Health Organization—is populated by pharmaceutical shills, colluding in a plot that keeps people sick to maintain profits. Over the past two decades, the motivating force of this conspiracy theory, together with the organizing efforts of the medical-freedom movement, has allowed alternative practitioners to triumph beyond their wildest imaginings. The right-wing medical-freedom campaigners have carried their unscientific beliefs deep into universities, hospitals, legislatures, and the pocket of the American consumer. For the public, the dividends have been dramatic and tragic: billions of wasted dollars, countless assaults on the concept of science, and untold deaths.

America’s health care landscape, meanwhile, has undergone a quiet sea change. According to surveys from the American Hospital Association, in 1998, just 8 percent of hospitals offered complementary and alternative-medicine services. By 2010, according to a Samueli Institute survey, that number had grown to 42 percent. Since 2000, more than 70 medical and nursing schools have established integrative care programs. Between 2005 and 2015, the proportion of doctors who provided alternative medical services directly out of their offices quadrupled, from 2 percent to 8 percent.

Alternative medicine’s inroads into the medical establishment have not just made it easier to get Medicare to cover your acupuncture treatments (possible as of 2020). They have allowed a dangerous political juggernaut to emerge from the shadows. The medical-freedom movement takes dollars spent by sick and desperate people on long-shot, unproven treatments and converts that money into a powerful lobby that leads more sick and desperate people into early graves. In their drive to legitimize junk science, activists are ripping at the foundation of medical institutions at a rate that could soon make it impossible for the average consumer to know where to turn for reliable advice on an evidence-based treatment plan for anything from cancer to a Covid infection.

The best line of defense against this threat may be America’s existing stock of medical doctors, most of whom were trained in a tradition that predated the maturation of the medical-freedom movement. Multiple surveys show that the number one reason hospitals want to offer alternative medical services is patient demand. And the number one reason they don’t is physician resistance. However, the number of doctors who continue to resist what they see as the co-optation of their field has shrunk to a small but vocal minority. Perhaps even too vocal.

Consider David Gorski, M.D.

By nature shy and deeply nerdy, Gorski encountered the case that impelled him into the public sphere in the 1990s, when he was a surgical chief resident learning colorectal surgery. He and his attending physician were working on a patient suspended in the lithotomy position, stirrups spreading legs above the surgical table to allow them as much access as possible to the man’s slightly paunchy abdomen and anus.

The attending requested suture and scissors. Nurses counted and recounted stitches and instruments to ensure nothing went missing. No one in the operating room mentioned the patient’s skin tone, which was a striking orange.

According to the medical records, his skin had been an unremarkable cream color more than a year before. At the time, the attending offered a Stage 1 colorectal cancer diagnosis and recommended surgery to remove the tumor. But the patient, who was in his fifties, had declined. Instead, he pursued a treatment that involved megadoses of vitamins, a strict diet protocol, coffee enemas, and enough carrot juice to cause carotenemia, the bloodstream oversaturation of beta-carotenes.

Today, Gorski believes the patient’s New York City–based alternative provider was offering some variation of a treatment method pioneered in the 1940s by Charlotte Gerson’s father, Max Gerson, who argued that pancreatic enzymes could cure cancer. Carotenemia is basically harmless, but leaving a tumor to fester in the colon isn’t. After at least a year of carrots and coffee, the patient returned to the hospital in pain, and experiencing BRBPR—bright red bleeding per rectum.

Because the man’s cancer had advanced to Stage 3, the relatively straightforward surgery previously recommended was no longer possible. His best chance to live was now an abdominoperineal resection, a riskier procedure that involves removing the rectum, sphincter, and anus.

As chief resident, Gorski ordinarily would have done much of the work, but the cancer was so advanced that most of it fell to the attending. Afterward, they sewed together the hole where the anus used to be, drew the end of the colon through the abdominal wall, and hooked it up to a plastic bag. The patient was lowered onto the table, re-gowned, and wheeled out of the operating room. The surgery had been a success, but not the sort one feels good about. There was a good chance the cancer would recur, and the surgery often caused permanent impotence. The orange would eventually fade from the patient’s skin. The colostomy bag was permanent.

Though this was Gorski’s first experience with the dangers of choosing alternative over conventional medicine, the orange man’s story was by no means unique. In 2017, a group of Yale researchers compared outcomes for 560 cancer patients who chose chemo, radiation, or surgery against 280 demographically similar patients who chose alternative therapies. The difference was stark—in fewer than six years, twice as many lung cancer patients who’d chosen alternative treatments were dead. Those with colon cancer died at four times the rate; those with breast cancer, almost six times. When Gorski went on to specialize in breast cancer, he saw those differences in his own patient pool. Sometimes, he said, “all you can offer is palliation.”

Given the relative deadliness of many alternative practices, it would be natural for the medical establishment to be locked into a pitched battle with quackery, but in fact, prominent sources of medical advice tend to soft-sell their warnings against alternative therapies for cancer patients. “The choice to use alternative methods is yours,” the American Cancer Society announces. The Centers for Disease Control and Prevention simply recommends that cancer patients talk to their doctor before trying any alternative therapy. The discouragement is tepid because, with an estimated 39 million Americans using some form of complementary or alternative therapy to treat a specific illness, many conventional health care providers are seeking to capitalize on the market by bringing these therapies into hospitals.

Before the abdominoperineal resection of the patient with carotenemia, Gorski believed the carrot juice fraud had a right to ply his worthless treatments. Gorski had graduated from his Roman Catholic high school with an ingrained appreciation of the black-and-white moral views of the Republican Party. He believed the pseudoscience spouted by medical quacks was protected free speech that would be best combated in the free market of ideas. But he also believed that the market only worked if the public heard strong, forceful cases for the truth. When it became clear that leading hospitals and medical institutions were failing to make those arguments, he decided to do it himself.

The physician David Gorski has been on a mission since the 2000s to expose medical misinformation.
Photograph by Sarah Rice for The New Republic

By the time of the first Health Freedom Expo in 2005, Gorski, who had honed his rhetorical skills demolishing Holocaust deniers in the early internet digital message boards of Usenet, was settling in on a target that seemed more actively dangerous than those conspiracists: practitioners of alternative medicine. To Gorski, the very idea of alternative medicine is a logical fallacy. If a practice works, he says, it develops a body of supporting scientific evidence and becomes simply “medicine.” If a practice doesn’t work, it is pure bunkum, and therefore not an alternative at all.

The typical definition of alternative medicine describes any health treatment not supported by science, which, of course, described all medicine before the Scientific Revolution of the 1500s. Establishing an effective body of practical, evidence-based medical procedures took hundreds of years; evidence-based medicine only outstripped homeopathy and other unproven treatments around 1910, when, according to Harvard professor Lawrence Henderson, “for the first time in human history, a random patient with a random disease consulting a doctor chosen at random stood better than a 50-50 chance of benefiting from the encounter.”

In the 113 years since, evidence-based medicine has racked up a staggering number of wins. And yet alternative healing methods—such as Reiki, whose practitioners direct energy into patients’ bodies by touching them, or iridology, whose diagnoses depend on reading the irises of patients’ eyes—that have failed to clear the scientific bar have not simply evaporated. Despite the lack of evidence for homeopathy—whose remedies include an often undetectably small amount of their so-called active ingredients—by 2012, an estimated six million Americans were turning to it. Vulnerable Americans have long been sold a steady stream of quasi-medical services that include cancer-killing magnets, leechings, all-purpose lasers, homeopathic treatments for syphilis, polio-destroying prayers, and herbal remedies for measles. And in the early 1990s, proponents of alternative medicine scored a massive win at the highest levels of government.

A bee-pollen infomercial magnate named Royden Brown (in the process of being fined for making false health claims about bee pollen) convinced Democratic Senator Tom Harkin to take 250 bee-pollen capsules over a five-day period. Believing the pollen cured his allergies, Harkin used a multibillion-dollar U.S. Senate Appropriations Committee bill to set aside $2 million for the National Institutes of Health to explore what the senator called “unconventional” medicine. Harkin’s maneuver mandated the NIH to establish the Office of Alternative Medicine, which would “facilitate study and evaluation of complementary and alternative medical practices.” Eventually, the office became the National Center for Complementary and Integrative Health, or NCCIH.

Few disagree that some alternative healers make outlandish claims—for example, Jillian Mai Thi Epperly, who has claimed that her Jilly Juice, made from fermented and salted cabbage, can not only eliminate disease but regrow limbs, dramatically lengthen life spans, and “cure” homosexuality. But the National Center for Complementary and Integrative Health and its allies within the medical community argue that the alternative-medicine landscape is primarily made up of good-faith actors—including many herbalists, yoga masters, massage therapists, and Indigenous healers—whose arguments about health should not be summarily dismissed.

Such proponents suggest that even treatments based on sham mysticism might be beneficial because the practices themselves could have merit. Alternative approaches often recommend lifestyle changes that include diet, exercise, and meditative techniques that can reduce stress, mitigate pain, and improve levels of happiness or satisfaction. Supporters of an integrative approach say that, as long as an alternative therapy is not actively harmful, it’s best to withhold judgment on spiritual matters, and to accommodate by creating a best-of-both-worlds system in which cancer patients can pursue chemo and, say, aromatherapy—the practice of using essential oils for therapeutic benefit—simultaneously.

However, this argument is tenuous at best, and dangerous at worst. While it is true that accommodating phony treatments might convince a doctor-averse cancer patient to come in for that chemo treatment, the tacit endorsement is just as likely to convince another patient that chemo is unnecessary because alternative therapies are effective. The accommodation also undermines the reputation of the provider, whose dedication to evidence-based practices can no longer be seen as pure. Mandating public-funded research of, say, anthroposophy (whose practitioners recently treated Covid patients with pellets made of “the dust of shooting stars”) is not simply wasteful—federal research grants become a key cog in a system designed to force unfounded theories into the annals of proven scientific knowledge. Alternative approaches typically emphasize a holistic framework that runs counter to scientific evidence—invoking something explicitly mystical, like a universal life force, or a thoroughly discredited theory of disease, such as terrain theory, which posits that germs are actually human cells that mutate and cause sickness due to changes in the body’s internal “terrain.” Gorski argues that the only way to determine whether acupuncture has merit would be to separate the physical processes from their spiritual inspirations and study them alongside conventional practices. “There are discussions to be had,” Gorski acknowledged. But “human beings don’t have energy fields that healers can manipulate.”

Gorski began tackling these issues in late 2004, when he launched a blog called Respectful Insolence, using the pseudonym Orac. In his posts, he drew a line at the question of evidence, and treated everyone propping up pseudoscience with the same scorn he had heaped on Holocaust deniers.

His targets were legion. After Gwyneth Paltrow unveiled her Goop brand, Gorski called her “so ‘open minded’ that her brains fell out.” The Journal of American Physicians and Surgeons was “useless as a source of valid scientific articles.” Mark and David Geier, who argued that vaccines can cause autism, made Gorski feel “dirty after having had to dive into the bowels of the Geiers’ bad science.” Gorski’s alma mater, the University of Michigan School of Medicine, had “become too accommodating of woo.” Rashid Buttar, a doctor who used discredited practices to treat cancer, was a “‘rabid dog’ that needs to be neutralized so that it can’t endanger anyone else.” The newsletter subscription service Substack was a “wretched hive of scum and quackery,” Reiki was “the wooiest of woo,” and talk-show host Bill Maher was a “full-fledged fruitloop.”

Gorski transcended other acerbic bloggers by blending his snark with extensive medical knowledge. As his hard-edged views rippled through cyberspace, he made contact with like-minded science aficionados, many of whom were identifying with an emerging movement that seemed as if it might provide a counterweight to the growing acceptance of alternative-medicine: skepticism.

American skeptics of the late aughts spanned the political spectrum, but what bound them together (other than overwhelmingly being white men) was the belief that they could wield critical thinking as a weapon against people who were, well, wrong. Atheists attacked the pious, debunkers attacked psychics, and scientists like Gorski attacked medical misinformationists, all ostensibly to protect the public from various flavors of fraud.

As his blog began racking up views, Gorski bought subscriptions to Skeptical Inquirer and Skeptic magazines, and corresponded with members of the James Randi Educational Foundation, the Committee for Skeptical Inquiry, and the New England Skeptical Society. With others, Dr. Steven Novella, a clinical neurologist at Yale University, and Gorski co-founded a website, Science-Based Medicine. Novella, who also hosts the podcast The Skeptics’ Guide to the Universe, is like an extroverted version of Gorski—he identifies as a nerd, and holds many of the same anti-quack positions, but speaks much more smoothly and comfortably.

“The pseudoscientists say, ‘Can’t we all be respectful?’ No,” Novella told me. “You are not on the playing field with people who are honest brokers of information. No, you don’t get the respect.”

Science-Based Medicine was meant to counter medical misinformation with essays from doctors and scientists. Under Novella as executive editor and Gorski as managing editor, it took a strictly nonpartisan approach, meaning that it lobbed grenades at both sides. The website debunked the right’s positions on climate change and gender-affirming surgeries and the left’s positions on genetically modified organisms. Its writers also explained the value of vaccinations, which were distrusted by small numbers of both conservatives and liberals in the 2000s.

Alternative healers had their Health Freedom Expo; skeptics, Gorski learned, had the Amaz!ng Meeting, a skeptic conference overseen by James “the Amazing” Randi. A natural showman, Randi rose to national prominence in 1972, when he appeared on Johnny Carson’s The Tonight Show to debunk the spoon-bending psychic Uri Geller. Randi’s organization became the bedrock for the modern skeptic community, and in 2003 the James Randi Educational Foundation drew 150 attendees to its inaugural conference. By the time Gorski attended, in 2009, the event’s buzzing, rowdy energy attracted more than 1,000 attendees to the Nevada casino where it was held that year. Speakers presented on exorcism, poker, and woo in martial arts. Skeptics folded origami flying pigs (the Pigasus) and used mock dowsing rods, then gathered at Del Mar, an in-casino bar, to tipple and talk. Gorski met the stage magician Penn Jillette, Adam Savage of the MythBusters TV series, and bloggers like Rebecca “Skepchick” Watson and biologist PZ “Pharyngula” Myers.

Over the years, Gorski’s blogging took on a near-obsessive pace. Some months, while working full-time as a doctor, he averaged three posts per day, often meaty diatribes of more than 3,000 words. Most weeknights, he sat in the living room with his wife, writing scathing attacks on his laptop while Wheel of Fortune and Jeopardy! played in the background.

Soon, Gorski and other evidence-based medicine advocates were targeted by members of the growing medical-freedom movement. Gorski was doxxed as the man behind Orac; some years later, he was subjected to a letter-writing campaign that sought to get him fired. He received harassing emails, was sued unsuccessfully for libel and defamation, and found his Google reputation poisoned by a website.

He was having the time of his life.

Twenty years ago, the stereotype of the anti-vaxxer was, as Gorski put it, “the hippie dippy granola crunching sixties leftover.” But as the medical skeptics labored to be nonpartisan adherents of scientific truth, alternative healers were abandoning their roots and consolidating into a vibrant, populist voting bloc that fit neatly on the right end of the political spectrum.

If alternative healers were happy to rally around the idea of medical freedom, imagine how jazzed it made libertarians, who were already using the term to advance their goal of “a complete separation of medicine from the state.” This was a much bigger idea than the right of a naturopath to sell sham detoxifying candles. In an article for the Future of Freedom Foundation, the writer Laurence Vance called for the freedom to sell human organs and a free market for ambulance services, meaning that if you live in an area that can’t financially support ambulance coverage, you should pack your sorry, heart attack–having ass into the car and drive to the hospital yourself (where, since emergency rooms would also have the right to refuse service for nonpayment, you’d better be ready with your wallet). Libertarians want no medical licensing laws, no Medicaid or Medicare, no federally funded medical research or programs to combat HIV/AIDS and Covid-19. They would forever abolish the Food and Drug Administration, the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the National Institutes of Health.

The alliance of alternative healers and libertarians also gave fresh life to what had been a tiny, fringe anti-vax movement. Indeed, around 2010, the health-freedom surge began transforming anti-vax views into a core right-wing value. By 2015, anti-vax messages cloaked within anti-governmental calls for health freedom had deeply penetrated the Republican voting base, causing large numbers of Americans to reject routine vaccines. It was an ideological bait and switch for millions of conservatives. As Gorski put it, “Come for the freedom, stay for the anti-vax.”

But the successful assimilation came with a price to alternative health practitioners, who were swallowed by the greater right-wing populist movement. Herbal supplements became a staple of conservative media outlet sponsorships and offerings; a rash of news stories reported on the presence of right-wing conspiracy theories in the yoga community.

At the same time, some libertarians were unhappy to find that their vision of a sweeping health-freedom movement had been largely reduced to a single idea: resistance to vaccination. Anti-vax views were central for quack practitioners whose livelihoods depended on a distrust of establishment medicine, but principled libertarian academics—those most likely to identify as skeptics—were less enthralled. Journal articles by libertarian philosophers like Jason Brennan and Jessica Flanigan argued that “vaccine refusal harms and risks harming innocent bystanders.” Even Gary Johnson, Libertarian presidential nominee in 2012 and 2016, came to believe that a scientific understanding of herd immunity required libertarians to support vaccine mandates.

Gorski had by then seen too many cancer victims who could only be offered palliation. After enumerating the sins of a thousand quacks with ties to the science-scorning medical-freedom movement, he relinquished his conservative ideals. Now, he jokes about his libertarian roots. “You’ve heard the quote about Lord of the Rings and Atlas Shrugged?” Gorski said, paraphrasing blogger John Rogers: “One is a book that appeals to juvenile minds with unrealistic fantasies of power and freedom, and the other one has orcs.”

One important check on medical misinformation is the vibrant ecosystem of journals and universities that act as the main repository for scientific thought. But there are signs that alternative practitioners are compromising the entire system. This often begins at the National Center for Complementary and Integrative Health, where the once–$2 million budget had grown to $159.4 million by fiscal year 2022. The center has funded research on homeopathy, acupuncture, and craniosacral therapy (lightly touching the cranium to relieve putative blockages).

Merely being investigated at the center can lend a practice credibility, regardless of what the research actually finds. A double-blinded study of acupuncture found, for example, that inserting needles into the skin (intended to relieve obstacles to the flow of life energy, or qi) did reduce pain, but with a big caveat. As Novella pointed out, the data “pretty much universally show no difference between real acupuncture and placebo acupuncture.” Nevertheless, the study authors mischaracterize the results in press releases summarizing their research findings to credulous media outlets and the public, arguing that both the placebo and acupuncture work. “If the treatment is no better than the placebo, then it didn’t work,” Novella noted. “They’re trying to rewrite the rules of science.”

Between 1999 and 2017, NCCIH had spent a total of about $2.2 billion “for clinical trials [that] produced no sound, consistent evidence for the efficacy of any alternative therapies,” Dr. Donald Marcus of the Baylor College of Medicine pointed out in a 2020 article in The Journal of Clinical Investigation. The National Library of Medicine lists 49 different NCCIH-funded studies that reference homeopathy; some of the study authors lack medical degrees, and yet have associations with top-tier medical institutions—for instance, Ted Kaptchuk, an acupuncturist who went on to direct an alternative-medicine program at Harvard Medical School; or Gary Schwartz, whose research at the University of Arizona is focused primarily on mediums and energy healing.

The alternative-health industry also influences academia through overt lobbying. And even as it enjoys the financial benefits that come with being embraced by the political right (Americans spent $34 billion on products and services in 2007), it has aggressively wooed the academic circles that are usually dominated by the political left. For example, in 2017, after receiving a $200 million gift from the Henry and Susan Samueli Foundation, the University of California Irvine earmarked funds for up to 15 faculty chairs supporting a curricular focus on integrative health in its College of Health Sciences. Deep-pocketed alternative-medicine groups have also funded partnerships with University of California San Francisco, Harvard Medical School, Brigham and Women’s Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, and Vanderbilt University School of Medicine. As of 2017, 15 research medical schools had begun offering alternative medicine to the public, according to Marcus. Johns Hopkins offers Reiki “to transmit Universal Life Energy to the client”; Duke University offers acupuncture for stroke victims.

Infiltration of government and academia by alternative medicine left the skeptics championing evidence-based medicine on the outs. And the skeptic community, meanwhile, had its own problems. In 2011, Rebecca “Skepchick” Watson posted a video describing her experiences at a male-dominated skeptic conference in Ireland. In the wee hours of the morning, she parted from friends in a hotel bar. A man who had not spoken to her previously got into an elevator with her, then asked her back to his hotel room for coffee. It made Watson uncomfortable. “Just a word to the wise here, guys,” Watson said. “Don’t do that.”

The gentle rebuke is only a small section of the video, but it sparked a huge outcry, dubbed Elevatorgate. Many skeptics rushed to defend the anonymous man, while others saw Watson as the latest victim of a systemic misogyny permeating the skeptic community. The disagreement made it impossible to ignore the group’s deep political divisions. Watson’s critics were mainly conservatives, the old guard who believed skeptics were best-served poking holes in reports of UFOs. Her supporters constituted a new coterie of young progressives who wanted to tackle political falsehoods and champion social justice issues.

Gorski, who had just begun to relax into the comfort of skeptic camaraderie, was uncharacteristically silent on Elevatorgate. But his brand of skepticism was suddenly attracting new criticism. Kavin Senapathy, a science writer, social justice advocate, and friend of Gorski, whom she got to know when they were both speakers at skeptic gatherings, called him self-important, a buck-passer, and “uninterested in examining the role he plays in upholding the status quo.” (She also described him as “thoughtful, caring, funny, witty, and nerdy.”) Senapathy feels that Gorski’s focus on quackery glosses over “the most insidious forms of pseudoscience in medicine.” For example, false assumptions about biology underpin racism in medicine that Senapathy called dehumanizing and “far more harmful than, say, homeopathy.”

Gorski describes himself as an aspiring ally of marginalized communities, and has in recent years begun to identify as a center-left Democrat with progressive views on social justice issues. Though the once-shy blogger has gotten more comfortable speaking to audiences within the skeptic community, it’s clear that his efforts aren’t nearly enough to stem the tide of junk science. Over 18 years of his fighting, the world has tipped against him. Everywhere he casts his eyes, he sees quackery flourishing. Since 2010, public suspicions about medical science have grown. Every year, crazier beliefs emerge—that injecting baking soda into the veins can prevent cancer, that drinking a bleach solution can cure Covid, that the government can remotely control the vaccinated.

Meanwhile, potential allies have drifted away. According to Senapathy, progressives have lost patience for the skeptic movement’s “almost willful immaturity.” Many of the people doing excellent skepticism, she said, have never even heard of the skeptic movement, let alone identified with it. “It’s probably a bit too late for this generation,” Gorski reflected. “I think the teaching of critical thinking needs to begin in kindergarten.” But teaching kindergartners would be difficult, because “you would have to have adults to teach it. And large swaths of our adults do not have those tools.”

Even his ruminations include insults.

The medical skeptics have also lost ground with their colleagues. A 2011 academic analysis by the National Center for Health Statistics found that 63 percent of people who did not work in health care had personally used some form of complementary and alternative medicine over the past year; shockingly, among health care workers, the number was significantly higher, at 76 percent; and within those workers the category with the highest usage was providers, including doctors and nurses, at 83 percent. An NCCIH-funded survey found that a slight majority of doctors were recommending complementary health alternatives such as guided imagery, massage therapy, chiropractic, homeopathy, supplements, acupuncture, hypnosis, naturopathy, and yoga to patients.

The medical skeptics were rising above partisan politics, getting every fact right, winning every argument, and still losing the war.

Even as the skeptic movement has, in its pursuit of truth, failed to gain political traction, the medical-freedom movement has been flexing its muscles in a sustained legislative push with local, state, and federal lawmakers. If the goal of alternative-medicine proponents is to maintain the practices while minimizing the risk of harm, one solution might be found in Nevada, where roughly 50 homeopathic practitioners are licensed or certified under the state-sanctioned Nevada Board of Homeopathic Medical Examiners. The board, which is made up of a mixture of homeopathic practitioners and members of the public, imposes standards of practice, hears complaints, conducts investigations, and imposes disciplinary actions on its licensees.

But in 2016 Diane Miller (who spoke at the Health Freedom Expo of 2005) argued that such oversight meant “professional, lay homeopaths cannot practice freely there.” Miller says regulations and oversight are unnecessary in a practice that carries little risk of harm. Instead, she and the National Health Freedom Coalition advocate for Safe Harbor Exemption Laws that narrow the legal definition of medicine and ensure bogus medical treatments can be sold to the public without typical state oversight or regulation.

For example, in 2019, Maine passed “An Act to Establish the Right to Practice Complementary and Alternative Health Care Act,” which seeks to establish a trade-off by allowing alternative practitioners to operate legally, as long as they don’t perform surgery, represent themselves as doctors, or advise their customers to discontinue medications or drugs that have been prescribed by actual medical professionals, among other restrictions. The medical-freedom movement has passed similar Safe Harbor laws in 11 states, mostly in the last 20 years; many specifically sanction such practices as energetic healing, Gerson therapy, and Reiki.

More recently, the onset of the Covid-19 pandemic accelerated the progress of the health-freedom movement, but also narrowed its focus to public health recommendations like masking, social distancing, and, of course, vaccinations. In 2021, National Health Freedom Action, which has tracked the passage of health-freedom bills in 18 states, noted that 46 states were considering medical-freedom proposals; many of these bills involved the right to refuse vaccinations or to refuse Covid diagnostics. In 2021, California debated a bill that would have explicitly forbidden the state to “restrict a person’s constitutional right to make health decisions for themselves … or place conditions on a person’s ability to receive public benefits based on their decision to decline” treatments, including diagnostic tests or vaccinations. Since July 2021, New Hampshire has passed no fewer than seven right-to-refuse laws, all of them preventing the government, employers, or public facilities, including hospitals, from pressuring people to get vaccinated. And in May 2022, Arizona, which already prevented schools from screening out unvaccinated students from their grounds, adopted language specifying that kids who weren’t vaccinated against HPV could also attend.

The 2022 midterms also suggested that the movement remains vibrant and ready to strike on multiple issues. The activist group Stand for Health Freedom endorsed 642 candidates that it found to be health-freedom friendly, and the group also took credit for momentum behind a federal bill to defund the World Health Organization, saying that it motivated 137,000 constituents to reach out to their representatives, paving the way for 46 lawmakers to sign on to the bill in just one month. Three people who held anti-vaccine views were even elected to the nine-member board of the Sarasota Memorial Hospital in Florida.

In the face of these powerful forces, Gorski, motivated by his inner moral compass, had the courage to keep throwing stones. In April 2021, when celebrity doctor Drew Pinsky argued that vaccine passports “segregate people and strip them of their freedom to travel internationally,” his claim sparked a Gorski-Pinsky Twitter tiff. Gorski said that Pinsky was the latest of a growing number of M.D.s who were playing into the hands of the anti-vaccine movement. “These once-respected doctors,” he wrote, “are pathetic shells of their former selves, scientifically speaking.” Pinsky made an effort to reach out to Gorski, but Gorski refused to get on the phone with Pinsky.

To Gorski, the stakes seemed too high for him to be forgiving. In July and August 2021 alone, the health-freedom movement’s success in spreading vaccine hesitance resulted in an estimate of at least 16,000 unnecessary American deaths due to undervaccination in communities. Dr. Peter Hotez, a vaccine researcher and medical doctor, said in a video for the World Health Organization that 200,000 Americans had died in the last half of 2021 and early 2022 because they refused a Covid vaccine. In this context, anything less than full-throated support for vaccines from a person of influence is potentially deadly.

Some leaders in the public health sphere have been working to understand how to prevent those deaths, and have rolled out public health education campaigns, such as those encouraging indoor mask use, that try to cultivate a tone that will be palatable to their target audience. Gorski’s far more bristling approach, birthed in the baptismal fires of Usenet flame wars, is a good representation of skeptic culture, where the quality of the information is far more important than civility.

That attitude might be counterproductive.

Pinsky said he’s “an absolute fan” of website Science-Based Medicine’s goals and overall efforts, but also sees in them “a hubristic attitude that bugs” him. The magician (and skeptic) Penn Jillette called skeptics “one of the most entitled communities ever.” And when philosopher (and blogger) Massimo Pigliucci left the movement, he described “an ugly undertone of in-your-face confrontation … a willingness to engage in public shaming and other vicious social networking practices.”

If the point of medical skepticism is to humiliate quacks in front of a small but appreciative choir, tone doesn’t matter. But if the goal is to expand a movement, the marketing of the message is as important as the message itself.

Gorski is unlikely to overhaul his tone at this point, but his recent reflections on 18 years spent battling misinformation have led him to explore a new tactic of his own. Quacks, he now realizes, “are not a legion of independent frauds.… The more time goes on, the more I appreciate that it’s not enough to debunk various claims. I think it’s necessary to do pre-bunking.”

Pre-bunking? The idea is a sort of Grand Unified Theory of anti-quackery.

“All anti-vaccine claims are based in conspiracy theory. All science denial is a conspiracy theory,” Gorski explained. These quacks rely on the same rotten framework: that a massive network of compromised individuals is working to prop up the medical-governmental industrial complex.

This idea is difficult to debunk, largely because there is a kernel of truth to it. An analysis of public data, published in JAMA Internal Medicine, showed that, between 1999 and 2018, the pharmaceutical and health product industry spent more than $6 billion on campaign contributions, outside groups such as super PACs, and lobbying. And the Center for Public Integrity cited examples of drug companies influencing the committees that advised states on Medicaid by buying members dinners, hiring them for consulting gigs, convincing speakers to give favorable testimony without disclosing financial ties, and even filling out the doctors’ paperwork needed to get costly drugs approved by state Medicaid programs.

But there’s a difference between understanding that corporate lobbying subverts the public interest, and a conspiracy theory, touted by medical-freedom advocates, that the entire system—including a robust network of media and patient advocacy groups—is controlled by shadowy figures that impose harmful vaccines and drugs on the public.

Unlocking the key to exposing that falsehood could help Gorski debunk a thousand quacks in one fell swoop. But for now, the Trojan Horse was admitted, the ghost is in the machine, and the patients are running the asylum. Gorski said that the influence of the health-freedom movement winds up politicizing the decisions of public health officials and M.D.s.

The politics interfere with “doctors and physicians doing their job,” he said. “The misinformation gets into the government, which starts to meddle with what the scientists do based on the misinformation.”

This understanding, shared by many medical science skeptics, creates an odd sort of rhyme with their ideological foes. In their argument, the entire medical ecosystem—doctors, the government, academic researchers, the World Health Organization—is in thrall to alternative-medicine shills, colluding in a plot that keeps people sick to maintain profits.

Gorski persists in his quack-bashing passion, now buttressing his blog posts with a relentless stream of sharp-elbowed tweets. He used to enjoy contradicting a wrong for the sake of it. Now, the project sometimes feels hopeless. A 2018 survey found that 39 percent of Americans incorrectly believe alternative medicine alone can cure cancer; among young adults aged 18 to 37, the number was even higher, 47 percent. And research shows that people who feel positively about alternative health are more susceptible to medical misinformation.

Though he thinks victory may be a generation away, Gorski continues, attacking mountains with a mallet, bailing the tide with a teaspoon. If current trends continue, the standard of truth he is upholding will soon be so out of sync with accepted medical practice that he himself will be fighting for the alternative point of view.