The Illusion of Consensus: An Interview with Professor Jeffrey Flier, M.D.
Professor Jeffrey Flier, M.D. is the Higginson Professor of Medicine and Physiology at Harvard Medical School. From 2007-2016, Professor Flier served as the 21st Dean at HMS and he holds the title of Harvard University Distinguished Service Professor. I recently interviewed the esteemed medical scholar to get his thoughts about the AFA and current academic freedom concerns in schools of medicine.
Howard Muncy: Professor Flier, you were among the 217 Founding Members who formed the Academic Freedom Alliance two years ago. What attracted you to join the organization?
Jeffrey Flier: I have long been committed to academic freedom as a bedrock element of a liberal society, and as threats to academic freedom have intensified over the past decade, so has the urgency of dealing directly with this topic. This led to my decision 6 or 7 years ago to join the board of directors of Heterodox Academy. In that role, I have had the opportunity to assess the issue from a national perspective and was honored to chair the search for its current president, John Tomasi, who is refining the strategy of the organization to enhance its visibility and impact. It is clear that many organizations with distinct but overlapping missions and approaches will be needed to address this issue, and when AFA was formed, I was delighted to join as a founding member.
HM: In August 2022, the AFA released its position that called for an end to mandatory diversity statements. You published an article critical of the practice and you served on the subcommittee that helped draft the language of the AFA’s position. What was that experience like and have you received any feedback on the statement?
JF: My earlier article opposing mandatory diversity statements in the academy was published in 2019 in The Chronicle of Higher Education and generated quite a buzz. The great majority of direct feedback was positive, with many people thanking me privately for “saying something that needed to be said,” but the public feedback was minimal. I was pleased and honored when AFA asked me to work with Professor Randall Kennedy of Harvard Law School, whose work I greatly admire, to help draft a statement on this topic for the AFA. The new statement went beyond my earlier piece in a number of respects, sharpening several key points, and I’m delighted this statement now stands as the AFA’s position on the matter. The statement concludes that “compelled diversity statements” threaten academic freedom by “demanding pledges of allegiance to an array of policies that are often vague, frequently ambiguous, and invariably controversial.” I strongly suspect this statement will be increasingly cited as this issue plays out in the academy over the coming years.
HM: As a former dean of Harvard Medical School and as a professor of medicine and physiology what, in your view, are some of the biggest concerns surrounding academic freedom in schools of medicine today?
JF: I have been engaged in academic medicine at Harvard for 45 years, and for most of that time I didn’t see important threats to academic freedom in our vibrant community. More recently, several distinct issues have arisen. One relates to the state of biomedical research, a pursuit in which I have long been directly engaged and have recently been writing about with a focus on policy (here, here, and here). At the heart of scientific research is the unfettered ability to pose questions, generate and publish data, and discuss the results, eventually judged by accepted standards of scientific rigor. When disagreements over data and interpretation arise, as they inevitably do, these must be resolved by additional research, analysis, and vigorous debate. A worrying trend is the interposition of a gatekeeping function linked to politics and ideology carried out by officials within and external to the academy.
One recent example involves problems related to COVID-19 research. Issues such as, for example, the benefits of mask mandates in specific settings and for specific ages, and the benefits and harms of prolonged school closures, became rapidly politicized. As a consequence, the views of many scientists on these issues appeared to be more closely linked to the perceived political valence of the issues than to the underlying science. In some cases, legitimate ideas were erroneously labeled as “misinformation” by government, academic institutions, and/or major elements of the media, with some faculty being subject to mistreatment. If not resisted, I fear the excessive mixing of research and politics will become more prevalent, to the detriment of scientific progress and the integrity of the scientific community.
A second problem relates to the increasingly overt intrusion of politics and ideology into the fields of medicine, medical education, and health care. This intrusion takes a variety of forms, but issues around race and racism, and gender and sex, are especially prominent and troubling in this regard. There are many unresolved medical and ethical issues to be addressed in these important domains. But the approaches now taken by many schools and hospitals embed viewpoints and ideologies that – while deserving attention and discussion – are clearly contestable; many high integrity faculty from across the political spectrum oppose one or more elements. Nevertheless, administrators and activists with potent institutional influence often create the appearance of agreement or consensus that doesn’t exist. Highly visible (if uncommon) instances of faculty whose reputations are besmirched by false and largely uncontested accusations – of racism (or insufficient anti-racism), or transphobia, for example – have effects that ripple far beyond the direct victims. After witnessing such attacks, many faculty and students choose to self-censor, rather than voice concerns on these topics. The illusion of consensus promotes a degraded academic environment in which, influenced by fear, productive resolution of complex issues is less likely to occur.
HM: Why is academic freedom vital in the preparation of students who will enter the health profession?
JF: A fundamental precept of the physician-patient relationship is the expectation that physicians will act in what they believe to be the best interests of their patients. This requires them to acquire and maintain appropriate knowledge about health, disease, and therapies, and to incorporate into their practice the precepts of ethical provision of health care, often linked to the broader term professionalism. Often unstated is the expectation that physicians keep their political views from influencing the care they deliver to individual patients. A few among many possible examples of how these principles are being challenged today are worth mentioning.
In an ideal world, physicians will seek to deeply understand their patients, incorporating knowledge of their diverse life experiences, family and work histories, personal values, and where appropriate aspects of their racial and ethnic backgrounds that might be relevant to their medical risks and subsequent diagnostic and therapeutic decisions. All competent and ethical physicians should understand the importance of these requirements. Likewise, physicians should be willing and able to care for patients despite differing from their patients across any of these dimensions. In an effort to stress the importance of racism in medicine, many professional societies and medical schools have adopted views about the centrality of race and how best to counter racism that – whatever their good intentions – may be intellectually flawed and beset by unintended adverse consequences. A plan adopted by the American Medical Association in 2021 aiming to dismantle racism in medicine incorporates contentious and ideologically charged positions on many issues . Likewise, an influential paper by several leaders in medical education describes a racism and bias initiative among whose elements are a call to fundamentally transform all institutional processes to counter racism in a manner still undescribed, and calls for white physicians to accept that their accomplishments have resulted from white privilege and are therefore meaningless and unearned . Such ideologically centered positions will evoke understandable resistance from well-meaning individuals who oppose racism, and induce many others to self-censor, neither outcome promoting the anti-racist progress they claim to seek. We need an environment in which faculty and students alike are encouraged to engage on such issues without fear of ad hominem attacks by members of the community, including those in positions of professional or institutional power. If physicians lose the habits of mind that enable critical and independent thinking in the face of dominant but contestable government or institutional policies, they will be ineffective stewards of critical professional values going forward.
A second example now frequently in the news involves medical issues related to the status of sex and gender, and in particular, approaches to diagnosing and treating the rapidly rising prevalence of gender dysphoria in adolescent girls. This issue sits at the interface of medical science and medical ethics, and many key questions regarding causation, diagnosis, therapeutics, and medical ethics are subject to uncertainty and require discussion and debate. A cursory examination of evolving approaches to this issue in the U.S. and around the world reveals that promoting a single definitive approach to “gender affirmation” and early therapeutics with medications and sometimes surgery is no longer defensible. But once again, many activists in schools, hospitals and professional societies suppress rather than encourage much needed academic discussion and debate within these venues. Health professionals must be able to recognize areas of contested science and respond in ways that support the integrity of the profession and the interests of their patients. It is critical to note that assaults against academic freedom in the health professions arise from both left and right of the political spectrum. Though these take different forms and respond to distinct issues, such assaults must be resisted whenever and from whomever they arise.
HM: Throughout this interview series, we have identified a number of major problems and serious threats to academic freedom across a variety of disciplines and institutions. I want to depart from that for a moment and ask this optimistic question instead: what has been a positive development that you have observed or read about regarding academic freedom that gives you hope that things are getting better?
JF: It is critical for the community to become more intellectually engaged in domains of the academy, including medicine and medical science, where self-silencing now enables questionable and potentially harmful practices to gain ground without sufficient interrogation. A critical mass of individuals in diverse settings must transition from self-censoring to active engagement; the number required to set this change in motion need not be especially large at first. Two recent events, one at MIT and one at Harvard, have begun to provide hope that beneficial change is on the way.
The disinvitation/cancellation of astrophysicist Dorian Abbott from a scientific lecture at MIT -because he expressed critical views on diversity programs in an opinion piece – produced a local and national firestorm. One consequence was the decision of University leadership to empanel a diverse and independent faculty committee to examine the state of academic freedom at MIT. The committee produced a report and recommendations that strongly supported the essentiality of academic freedom, and the report was subsequently endorsed by the full faculty. One outcome was to launch a new public series to focus upon these issues, and for the first of these, John Tomasi of Heterodox Academy was invited by university leadership to speak, a quite remarkable outcome. A group named MIT Free Speech Alliance has also been formed and is quite active.
A prominent group of Harvard faculty from across multiple schools and disciplines has also been taking form recently, adopting a statement of principles that reflect many features of organizations like HxA and AFA. I have enthusiastically joined this rapidly growing group of lawyers, philosophers, psychologists, sociologists, economists, political scientists, physicians, and others. A public announcement of this new group and its mission is expected over the next month.
HM: Any final thoughts on the future of the AFA or academic freedom?
JF: The concept of academic freedom is so foundational to the modern academy in a liberal society that I still find it disorienting at times to feel the need to publicly defend it. But the threats are real and increasing, and the time for action is now. My most fervent hope is that we reach a point before too long where AFA no longer needs to exist, because the concept of academic freedom becomes safely embedded as a bedrock value of the academy, on which our society so deeply relies for generation of new knowledge and communication of knowledge more broadly to students and society at large.
- The AMA’s strategic plan to embed racial justice and advance health equity.2021; Available from: https://www.ama-assn.org/about/leadership/ama-s-strategic-plan-embed-racial-justice-and-advance-health-equity.
- Hess, L., A.G. Palermo, and D. Muller, Addressing and Undoing Racism and Bias in the Medical School Learning and Work Environment. Acad Med, 2020. 95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments): p. S44-S50.