What's at stake in today's election. (And who got my vote.)

Why endorsements by people matter more than institutions.

The phrase “healthcare is on the ballot” has become a cliché because it is perennially true. Meanwhile, some physicians have called on other physicians to avoid commenting on politics on social media during election season. The half-baked theory behind that is that whiffs of partisanship online weaken trust between doctors and patients, negatively affecting care.

What a sophomoric idea. That view depends on a pretty poor opinion of one’s fellow citizens. The idea that doctors (and patients) would not be able to put their political differences aside when making important medical decisions goes against all of our core values.

I believe we can and we do put these differences aside all the time in medical settings. At the extreme, the Geneva Conventions dictate that as a physician, I would be duty-bound to give the best medical care to even my most hated political enemy. To quote Dr. Joel Zivot, “I have long recognized in myself that the patient I like the most is more often the one I like the least as a person. In that circumstance, the work is pure.”

An important and yet light-hearted anecdote of an exchange between President Reagan and his surgeon in 1981 applies as well. Reagan was about to be sedated for an emergency operation after having been shot in an attempted assassination. "Please tell me you're Republicans," Reagan said. As it happened, the lead surgeon was a Democrat. His answer spoke volumes. "Today, Mr. President, we're all Republicans,” the doctor replied.

The differences on the issues are real.

There’s a belief among some that the difference between Democrats and Republicans are minor, leading to third party “protest.” votes. This baffles me with respect to healthcare. Think of the issues that affect our lives and health:

• Abortion/reproductive care.

• Pandemic preparedness.

• Healthcare access/insurance, costs.

• Improving government agencies (e.g., HHS, CDC, NIH, FDA).

• Climate change.

There are real differences here, and our policies now will affect lives. And it goes beyond these. We know that the Right has taken to undermining vaccines and, now, even fluoride in the water. I was no fan of the anti-vaxxer movement when it was just as likely to come from crunchy liberal enclaves as crusty conservative ones. Today, vaccines are under attack almost exclusively from the Right, not the Left. If that ever changes, you can expect me to raise my voice in horror. Vaccines save lives. Fluoride saves teeth. These are supposed to be nonpartisan issues. But just because they are increasingly treated as such, doesn’t mean public health experts have to retreat or recuse themselves. It’s reasonable for doctors and public health experts to speak on these issues. It’s very reasonable for you to base your vote on them.

Thoughts on endorsements. Or, why the Washington Post should have endorsed Harris and Scientific American should not have. And why Taylor Swift was right to!

Meanwhile, Presidential endorsements—or the absence of them—have made some headlines recently. On one hand, the Washington Post decided at the behest of its owner Jeff Bezos that the paper would break with tradition and not endorse a candidate for President. This led over 250,000 readers to cancel their paid subscriptions to the Post. On the other, Scientific American endorsed Vice President Kamala Harris.

Both choices were wrong because context matters. Historically, the Post has reliably endorsed the Democratic candidate. SciAm, on the other hand, has only endorsed one candidate in its 179-hear history, backing President Biden in 2020, and now Vice President Kamala Harris in 2024.

Now, it’s no secret that my mail-in vote went to Harris (albeit, if asked, I would consider serving a Republican administration if I felt the work in question was important and bipartisan). And yet, I believe the Washington Post’s decision not to endorse Harris and SciAm’s decision to do so were both wrong!

The Post: Jeff Bezos claimed that the Post’s move was designed to enhance reader confidence in its ability to cover politics in a non-biased way. But the existence of an Op-Ed section has always refuted this. It’s understood that the opinion side of the paper is firewalled from the news side. That’s why partisan opinions are not only permitted on the opinion side of the paper, but they are the bread-and-butter of it. None of this undermines the beat reporters’ work in the other sections. But even if an explicit endorsement from the editorial board of the Post were thought of differently, that would not let Bezos off the hook in this instance. Breaking tradition in October of 2024, in an election putting a boilerplate Democrat against a Republican who (at a minimum) wanted his own Vice President to subvert democracy or else be hung seems pointedly wrong—and is just as political as the usual endorsement would have been. If Bezos really cared about this issue—and I suspect he doesn’t—he could have made this choice years ago, before the candidates were known. Or he could tell his editorial board that 2024 will be its last endorsement. It’s one thing to say “starting in 2028, we’ll get out of the endorsement business,” and another to pretend that doing so at the last minute now somehow gets the paper above the fray.

SciAm: An endorsement of Vice President Harris by Scientific American, meanwhile, was ill-advised for two reasons: precedent and influence. Those highlighting that SciAm has only endorsed two candidates in its nine-score history hope to accentuate just how important this deviation from its usual practice is. But since the magazine endorsed Biden in 2020, it looks more like something else; a pivot into the usual endorsement business. Is SciAm going to sit out 2028 and 2032? Or will those elections also be deemed, “the most important of our lifetime” (another cliché that is always true enough to say, and cannot be refuted)?

My problem with SciAm endorsing a presidential candidate is two-fold. First, for any reader of the publication, it ought to be clear enough in any election which candidate is closer to the truth on the important scientific issues of the day. So, why the need to make an explicit binary judgment? Let the readers figure it out. Second, it squanders clout. If the editors of SciAm have an agenda that includes making its readers more likely to support the candidate whose views on the salient issues most closely aligned with science, the best way to achieve that is to educate its readers on those issues, as it does month after month. Then, when it comes time to vote, readers can make the leap. If the SciAm readership has not been convinced by its decades of stories revealing how climate change is both real and driven by humans, I don’t see how endorsing Kamala Harris explicitly is suddenly going to matter now. What it might do, though, is make it less likely for people who today identify as Republicans (but who remain open-minded to science) to shrug SciAm aside as a partisan outlet. In other words, the best way for SciAm to get towards its preferred outcome of electing more pro-science candidates would be to stick to its strength: educating readers.

On top of that, the effect size is likely tiny. Very few people will have changed their vote based on SciAm’s say-so. Will a Harris endorsement have been worth it if a generation of red-state readers dismiss the august magazine as a liberal rag? I want today’s young readers to pick up a copy of SciAm and be curious about the science found within. That may lead to a better-informed electorate down the road. Presidential endorsements, it seems to me, undermine that project.

The endorsement of Vice President Harris by Taylor Swift, on the other hand, made a lot of sense to me. Swift wagered that the only consequence of her endorsement would be her own bottom line as an artist. She took a risk, choosing her convictions over her financials. Plus, her audience is the correct one. Swift’s following is far larger (sizable enough to make a difference) and far more likely to achieve its intended outcome—getting younger people to the polls, which they do less often than older demographics.

People vote. Pixels don’t.

Entities don’t have beliefs. People do. I’m iffy on whether organizations (like unions) should make endorsements, but it makes some sense in many cases. But at this moment, I’m far less convinced that publications (like newspapers or magazines) should be in the endorsement business—though if anyone should be, it would be places like The Post, whose motto is “Democracy Dies in Darkness.”

That’s why I, Jeremy Faust, already voted for Kamala Harris for President. Inside Medicine, however, doesn’t possess a separate opinion, nor a vote. It’s a newsletter, not a person. So, sure, I hope you vote for Vice President Harris. But if you don’t, I’ll still be here, writing about issues that may influence your thinking down the road. Indeed, if Inside Medicine had its own opinion, it would simply want you to read this newsletter, so that when you do go out and cast your vote in a future election, you’re informed on the issues that matter to us.

Here are the results from last week’s Inside Medicine reader poll: