Vinay Prasad might well have made his contrarian points without invoking the specter of the Third Reich. He didn’t have to go there—but he did. Voluntarily.
Prasad, an oncologist and associate professor in the Department of Epidemiology and Biostatistics at UCSF, likes a good Twitter fight. He has incited brawls over FDA’s accelerated approval of cancer drugs, efficacy of checkpoint inhibitors, usefulness of next-gen sequencing, and—in recent months—the restrictions aimed at curbing the spread of COVID-19.
In an Oct. 2 Substack blog post, Prasad argues that public health measures may have laid the groundwork for the onset of fascism in the U.S.
The comparison set off a deluge of Twitter controversy, including accusations of anti-Semitism and ignorance of the circumstances that led to the rise of German fascism.
In the blog post and an accompanying video titled “How Democracy Ends,” Prasad speculates that in the name of public health and safety, an unscrupulous U.S. government could turn dictatorial and fascist.
“When democratically elected systems transform into totalitarian regimes, the transition is subtle, stepwise, and involves a combination of pre-planned as well as serendipitous events,” Prasad wrote. “Indeed, this was the case with Germany in the years 1929-1939, where Hitler was given a chance at governing, the president subsequently died, a key general resigned after a scandal and the pathway to the Fuhrer was inevitable.”
Also on Oct. 2, Prasad posted a link to his blog post and video on Twitter, sharing it again the next day. The Twitterverse exploded, with Prasad’s detractors battling his defenders while Prasad stood by his original point. Prasad didn’t respond to questions from The Cancer Letter, and at this writing, the post is still up.
Arthur L. Caplan, a bioethicist at the New York University and an expert on the bioethical implications of fascism, said Prasad’s argument is specious and ignorant.
“The notion that public health will lead us to fascism due to efforts to control COVID is ludicrous, dangerous, and offensive,” Caplan said to The Cancer Letter. “It’s anti-Semitic, anti-gay, anti-Romani people. It cheapens the deaths of those who died in camps for political objections, or in the case of Jehovah’s Witnesses, religious objections.
“I have to say, rarely will I claim to be the world’s expert on much, but I’m up there on the Nazis. I’ve studied it for decades and I did it, just so you know, because my dad was in the troops that liberated Dachau.
“I have written one of the first books about Nazi medical experiments and the ethics thereof, and early on, I have argued that Trump’s rhetoric and his divisiveness, his racism, his homophobia, and his appeals to white nationalism were somewhat analogous to what was going on in Germany in the 1930’s.
“I haven’t changed my opinion since he became president, nor since his more public looney followers attacked the Capitol,” Caplan said.
“But to mix the two—the public health effort to fight a plague with political forces that we ought to be watching carefully—is imbecilic.”
Caplan, the Drs. William F. and Virginia Connolly Mitty Professor and founding head of the Division of Medical Ethics at NYU Grossman School of Medicine, is the editor of When Medicine Went Mad: Bioethics and the Holocaust, the authoritative text on Nazi medicine.
Caplan’s guest editorial on Prasad’s invocation of fascism is published here.
Robert Proctor, professor of the history of science at Stanford University and author of The Nazi War on Cancer, another classic book on Hitler’s view of public health, said he, too, finds Prasad’s words unconvincing.
But to mix the two—the public health effort to fight a plague with political forces that we ought to be watching carefully—is imbecilic.
Art Caplan
“Dr. Prasad clearly likes to be provocative, and, given all of the problems of modern medicine, I can see where he is coming from,” Proctor said to The Cancer Letter. “Comparing a mask or vaccine mandate to the steps taken by Hitler to restrict liberties in 1930s Germany is a misrepresentation of what went on in the Third Reich.
“If you’re going to play the Nazi card, you’d better have something to back it up. And in this case, Dr. Prasad is overplaying the dangers of vaccination mandates and trivializing the genuine harms to liberty posed by 1930s fascism.
“I’m not too worried about COVID policies leading us onto the path of fascism; the restriction of liberties is nowhere near that great. It goes without saying that a more dramatic epidemic might well lead us to take to more draconian steps, but we are very far from that.”
Prasad: “All these people *pointing emoji* are lying”
With 110.8K followers on Twitter and 23.7K Tweets under the handle @VPrasadMDMPH, Prasad is a veteran of countless Twitter debates.
A following this large means Prasad can easily disseminate and amplify his publications when they appear in peer-reviewed journals, turning obscure papers into social media hits.
Three years ago, The Cancer Letter talked to Prasad about his vocal criticism of new directions in oncology and his rise to Twitter stardom (The Cancer Letter, June 22, 2018).
“Let’s be honest, why do I use Twitter? Number one, I find it fun. I find it fun to use Twitter, it’s enjoyable, it’s interactive, you get to hear from interesting people,” Prasad said of his activity on the site (The Cancer Letter, June 22, 2018).
Following his comments on fascism, Prasad has doubled down. In an Oct. 3 tweet, he said his critics were “lying about the content of my piece” and clarified, “Its [sic] not a Holocaust analogy.”
Prasad attached to this an image of several responses from physicians —all of whom condemned his Hitler reference—including Ryan Radecki, Mark Shapiro, Avital O’Glasser, and Jennifer Gunter.
“This isn’t a think piece, it’s an audition to be the Surgeon General of QAnon,” Gunter, a San Francisco OB/GYN, tweeted.
Yet some Twitter users are stepping up to defend Prasad’s remarks, including Daniel Goldstein, an oncologist at the Davidoff Cancer Center of Rabin Medical Center in Israel. Goldstein posted a tweet on Oct. 4 rejecting the notion that “How Democracy Ends” is anti-Semitic.
“I’m a Jew and an Israeli,” Goldstein wrote. “Say what you want about @VPrasadMDMPH’s most recent piece, but it’s not antisemitic. Can agree or disagree with what he’s saying – that’s fine. But there’s no antisemitism there. Just Sayin.”
Prasad re-tweeted this cautiously worded exculpation from his own account.
As his original tweet backfired, Prasad, in an Oct. 3 tweet, invoked cancel culture. He said his critics have misinterpreted his statements and are attacking him personally.
This familiar claim of cancel culture victimhood was, according to Caplan, entirely predictable—and represents a shirking of personal responsibility on Prasad’s part.
“I’m sure there are going to be complaints by his admirers that this is another instance of cancel culture,” Caplan said to The Cancer Letter. “But sometimes self-cancellation has to be taken seriously.”
Thought experiments
“How Democracy Ends” is just one of many recent attacks Prasad has lobbed at COVID-19 public health measures.
The oncologist has published and re-tweeted several posts critiquing COVID-19 mask and vaccine mandates for school-aged children. Recent op-ed headlines attributed to Prasad include “Scientists Who Express Different Views on COVID-19 Should Be Heard, Not Demonized” and “Why Are Highly Vaxxed Colleges Implementing Strict COVID Policies?” (STAT News, April 27, 2020; MedPage Today, Sept. 30, 2021).
On Sept. 29, in a blog post titled “Progressivism is Dead,” Prasad argued that the Left has become “increasingly frenzied and disinhibited” during the COVID-19 pandemic—censoring misinformation, shaming individuals, infringing on personal rights, and instituting policies like school closures, which, according to Prasad, disadvantaged the poor.
“That was the original sin,” Prasad wrote. “Closing schools for so long in Democratic stronghold cities, strong union cities, precisely after the President that many disliked pushed for it. But no matter how wrong he was about other matters, he was right on that issue. We should have reopened schools. And the net result has been devastation so catastrophic it will shape this country for the next 100 years, if we survive it.”
I’m not too worried about COVID policies leading us onto the path of fascism; the restriction of liberties is nowhere near that great. It goes without saying that a more dramatic epidemic might well lead us to take to more draconian steps, but we are very far from that.
Robert Proctor
Prasad is the author of Ending Medical Reversal: Improving Outcomes, Saving Lives (2015) and Malignant: How Bad Policy and Bad Evidence Harm People with Cancer (2020). He hosts the Plenary Session Podcast (@Plenary_Session), where he discusses medicine, oncology, and health policy.
Prasad has also published over 300 academic articles, according to his website. In 2018, The Cancer Letter shared three reviews of a Prasad “thought experiment” paper on drug prices (The Cancer Letter, June 22, 2018). These experts pointed out inaccuracies in the assumptions and methodology used in the paper. Soon after the publication of the three reviews, Prasad retired the Twitter account he was using at the time (The Cancer Letter, Sept. 7, 2018).
Also in 2018, Prasad chaired an evidence review committee that recommended denying Medicaid coverage of next-gen sequencing tests for vulnerable patients in Oregon. The effort was unsuccessful (The Cancer Letter, Sept. 28, 2018).
“Inflammatory, unhelpful”
Prasad isn’t a member of the UCSF Cancer Center and doesn’t see patients at UCSF Health facilities. Officials at Zuckerberg San Francisco General Hospital, where Prasad practices medicine, didn’t respond to The Cancer Letter’s request for comment.
UCSF Executive Director of Public Affairs Kristen Bole said her institution believes in academic freedom, but condemns misinformation.
“COVID-19 public health measures have saved innumerable lives and minimized suffering for millions of people,” Bole said to The Cancer Letter. “UCSF is proud to play its part in the public health response to this global pandemic.
“As a university, we celebrate academic freedom and respect the right of our faculty to express their individual opinions. In some cases, however, we must respectfully disagree. We understand that some may seize upon any opinion to foster misinformation. As an institution, UCSF will continue to advocate for evidence-based public health measures.”
Prasad holds a faculty appointment with UCSF’s Department of Epidemiology & Biostatistics.
Kirsten Bibbins-Domingo, chair of that department, said that the department and university protect his academic freedoms.
“That doesn’t mean, necessarily, that we all agree with him, but I think that people are free to voice their opinions,” Bibbins-Domingo said to The Cancer Letter.
Bibbins-Domingo is the vice dean for Population Health and Health Equity, the Lee Goldman, MD, Endowed Professor of Medicine, leader of the UCSF COVID Community Public Health Initiative, and co-founder of the UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital.
“I think we are always trying to balance the importance of free exchange of ideas, which is sort of the lifeblood of a university, as well as the ability to speak out on those ideas with which we disagree,” Bibbins-Domingo said.
If her Oct. 3 tweet is any indication, Bibbins-Domingo disagrees with Prasad—strongly, openly, poetically even:
“As an MD & epidemiologist who closely follows COVID, knows & has contributed to COVID literature
As a daughter in a family who has known Nazi horrors
I’m appalled by comparisons of this regime with pandemic response
Inflammatory, unhelpful to the discourse, ultimately harmful.”
