I have always thought public health was one of the most impressive things human beings ever invented. Medicine asks a question I have spent most of my professional life asking: How can I help this person? Public health changes one word: How can we help everybody?
Maybe that’s why I studied it. Clean water, sewers, vaccination, food safety, lead-free paint, clean air, washing our hands. There is something almost audacious about organizing a society around the health of people we will never meet. I remember studying infectious diseases during internal medicine and learning a wonderfully simple principle: germs don’t understand boundaries. They don’t recognize property lines, state lines, political parties or constitutional rights. A virus leaving my respiratory tract doesn’t pause in midair to ask whether the person inhaling it consented to my medical choices.
Somewhere along the way, though, we became very interested in me: my body, my choice, my taxes, my money, my freedom, my health. All perfectly reasonable concepts, but what happened to we?
Someone Else Lives Here Too
When I was younger, people smoked everywhere: restaurants, offices, airplanes, hotels, even hospitals. Then we learned what secondhand smoke did. Laws mattered, but something larger happened. We changed. Lighting a cigarette beside someone eating dinner went from perfectly ordinary to almost unimaginable because we absorbed a fairly sophisticated moral idea: you have considerable freedom to make choices about your own health, but that freedom becomes more complicated when I have to breathe it.
We understand the same principle when we go camping. Leave nothing but footprints. Pack out the beer can. Don’t dump garbage into the stream. Nobody has to introduce me to the child hiking there fifty years from now before I decide that child deserves a trail I haven’t ruined. Jerry Garcia, of all people, put it beautifully when talking about freedom: “For any scene to work, along with that freedom there’s implicit responsibility.”¹ He wasn’t talking about public health, but he could have been.
Then COVID arrived and I began hearing another phrase constantly: I’m healthy. Aaron Rodgers said versions of it. Joe Rogan said versions of it. I’m young, I exercise, I take care of myself, my immune system works. Why should I worry?
And every time I heard it, my public-health brain had almost exactly the same response: That’s great. But IT’S NOT ABOUT YOU.
I’m worried about the little old lady you breathe on at Safeway. Maybe she’s 91, receiving chemotherapy or taking an immunosuppressant. Maybe she’s an infant who hasn’t yet been vaccinated. You don’t know her, which is precisely the point. Public health asks us to care about people we don’t know.
Anthony Fauci described vaccination during COVID as part of our “communal responsibility” to contain the outbreak.² This doesn’t mean every mandate was wise or every COVID policy correct. Some weren’t. It means infectious disease cannot be reduced to the question What are my chances of getting very sick? Your infection doesn’t necessarily stop with you.
Why Would Anyone Want Measles?
The same problem appears in the romance with “natural immunity.” Yes, infection can produce immunity. Humanity had a remarkably effective method of acquiring natural immunity to measles before vaccination: you got measles.
Most people recovered. Some developed pneumonia or encephalitis; some died. Rarely, people who seemed to recover later developed a progressive and fatal neurological disorder called subacute sclerosing panencephalitis. Measles is also among the most contagious infectious diseases humans know, with the traditional estimate suggesting that one infected person in a susceptible population may infect roughly 12 to 18 others.³
So when someone celebrates natural infection because it produces natural immunity, I get stuck on an obvious question: why do you want the disease? Vaccination is an attempt to obtain the useful part of the immune response without requiring everyone to run the disease obstacle course first.
Polio makes the nostalgia even harder for me to understand. Most people infected with poliovirus didn’t become paralyzed, but some did, and sometimes the virus damaged the motor neurons controlling the muscles required for breathing. That’s where the iron lung came in. The patient’s body went inside a huge metal cylinder while the head remained outside, and changing air pressure around the chest mechanically drew air into the lungs.
The machine breathed because the patient couldn’t.
When I first worked at Children’s Hospital, one of my superiors still walked with a limp from polio he’d contracted as a child. This was roughly sixty years later. Polio was still walking with him.
Nature isn’t benevolent or malevolent. Nature doesn’t care. Polio is natural. Measles is natural. Smallpox was natural. So are rattlesnakes. “Natural” is not a synonym for “good.”
How Did Anthony Fauci Become the Criminal?
I take the transformation of Fauci into a political villain somewhat personally. When I studied internal medicine, his name meant something entirely different. He was a longtime editor of Harrison’s Principles of Internal Medicine, the enormous two-volume textbook that was essentially our bible. Harrison’s wasn’t something you casually read at the beach. It was where you went when you wanted to know what the hell you were talking about.
Fauci entered the NIH in 1968, became director of the National Institute of Allergy and Infectious Diseases in 1984 and remained there for 38 years. His career encompassed HIV/AIDS, influenza, Ebola, Zika and COVID. He was also deeply involved in the development of PEPFAR, George W. Bush’s global AIDS initiative, one of the most consequential public-health programs of the modern era.
Yet now I can say “Fauci” and occasionally hear something like, Oh, him. The criminal.
Huh?
There are legitimate questions about COVID policy, Wuhan research, NIH funding, government transparency and Fauci’s congressional testimony. Investigate them. Ask difficult questions. But somehow a public official whose decisions can be questioned became the architect of all our suffering. Fauci became a character representing lockdowns, vaccines, masks, China, pharmaceutical companies and apparently everything unpleasant that happened between March 2020 and the day we finally stopped wiping down our groceries.
The irony is that successful public health tends to erase the evidence of its own success. There is no photograph of the child who wasn’t paralyzed. Nobody builds a memorial to the measles encephalitis that never occurred or wakes up thinking, Thank God the sewage system worked again. The outbreak didn’t happen. The water didn’t transmit cholera. The child didn’t get polio.
Eventually people mistake nothing happening for evidence that nothing was ever going to happen. The disease disappears, but the vaccine remains. The vaccine is visible; the disease isn’t. The intervention begins looking more frightening than the catastrophe we’ve forgotten.
That’s not natural immunity. It’s cultural amnesia.
Apparently Doctors Are Supposed to Know Everything
This brings me to Bill Maher. I used to admire him. I still think he’s funny and can be excellent at identifying bullshit, but his longstanding skepticism toward medicine fascinates me because it contains much of our current distrust of expertise in miniature.
Maher has repeatedly made some version of the argument that doctors don’t know his body; he does. There’s an important truth buried in there. A patient knows things about his own experience that I don’t. If someone tells me a medication makes him feel terrible, I don’t get to say, No it doesn’t. Look, I have a medical degree.
But I know my experience isn’t the same claim as I understand how my body works better than people who have spent their careers studying human bodies.
For most of human history, distrust of doctors wasn’t entirely irrational. We bled people, purged them, administered mercury and recommended treatments that were useless and sometimes spectacularly harmful. The remarkable thing is that distrust of medicine has intensified during the relatively brief period when medicine became extraordinarily good at actually doing things.
The same skepticism has spread beyond medicine. We’ve entered a cultural moment in which expert can almost sound like an insult. Experts said this. Experts were wrong about that. Experts told us masks. Experts told us vaccines. Therefore, experts don’t know anything.
That’s an extraordinary leap. An expert isn’t somebody who possesses absolute truth. An expert is somebody who has spent an unreasonable amount of time learning about one narrow part of reality. Of course experts are sometimes wrong. The relevant question isn’t whether your infectious-disease specialist has ever been wrong. It’s whether you’re more likely to be right.
Put Neil deGrasse Tyson in front of us and ask what dark matter actually is or what happened before the Big Bang. Eventually we arrive at a sophisticated version of we don’t know, and everybody leans forward. Fascinating. A physician says, We don’t completely understand why this treatment works, but controlled trials show that people receiving it improve more often, and suddenly the medical establishment knows nothing.
Apparently the universe is allowed to be complicated. My pancreas is not.
Richard Feynman said, “I can live with doubt and uncertainty and not knowing.”⁴ That’s not an embarrassing admission from a scientist. It’s practically the job description. The alternative to uncertain expertise isn’t certainty. It’s often someone who knows considerably less being absolutely certain.
Actually, I Was Wrong About That Too
I remember learning during medical training that Victorian physicians treated “hysterical” women by bringing them to orgasm, eventually adopting mechanical vibrators because doing it manually became tedious. It’s an irresistible story.
It also appears not to be true.
The idea became famous after Rachel Maines’s 1999 book The Technology of Orgasm. Later historians Hallie Lieberman and Eric Schatzberg went back through the primary sources and found that the evidence did not support its central claim.⁵ Doctors really did use mechanical vibrators therapeutically, but the familiar image of exhausted Victorian physicians spending their afternoons producing therapeutic orgasms appears largely to be mythology.
I believed it too. So what am I supposed to do now, insist it’s true because somebody taught it to me?
The history underneath the myth remains disturbing. “Hysteria” became an elastic diagnosis applied disproportionately to women, and medicine spent centuries confidently interpreting women’s physical and emotional lives through overwhelmingly male assumptions. The therapeutic-orgasm story may be mythology; medicine’s spectacular confidence while misunderstanding women isn’t.
But the correction itself matters. Somebody checked the sources and discovered that a wonderfully memorable story didn’t survive scrutiny. That’s not evidence that scholarship doesn’t work. That’s what scholarship working looks like.
Psychiatry May Be the Best Example
I see the same tension especially clearly because I’m a psychiatrist. For most of human history, if somebody became psychotic, profoundly depressed, manic, suicidal or incapacitated by anxiety, we didn’t know what was happening. We had explanations: demons, sin, weakness, bad character, masturbation, bad parenting. Eventually Freud gave us mothers.
But explanations aren’t treatments.
We still don’t completely understand the human psyche or brain, and we haven’t discovered a final theory of consciousness, personality or emotion. But something fundamental has changed: we can help now. Not everybody, perfectly or every time, but the difference between psychiatry today and psychiatry a century ago is extraordinary.
People also misunderstand what we’re trying to accomplish. My job isn’t to make somebody happy. Happiness isn’t a medical condition. You may get it falling in love, eating a great meal, hearing Jerry Garcia play an extraordinary solo, or taking acid in the woods at a concert, although I am not recommending that as a treatment plan.
My job is less glamorous. I help people function. I try to reduce suffering enough that somebody can get out of bed, attend school, hold a job, maintain a relationship, sleep, concentrate, stop wanting to die or simply get through Tuesday without existence feeling unbearable. Contentment is a reasonable ambition. The absence of relentless suffering is an extraordinary achievement.
Happiness belongs to life.
Science Is Supposed to Change
Maybe medicine became so effective that we started expecting omniscience. If my oncologist can cure my lymphoma, why can’t she predict with certainty whether it will recur? If my psychiatrist treats depression, why can’t he know beforehand which medicine will work? Because biology is complicated. There are probabilities, individual differences and mechanisms we haven’t discovered, and sometimes we’re wrong.
Good.
I remember what I learned in medical school. Some remains true, some has been refined and some has been replaced. I hope today’s medical students can say the same thing forty years from now. Imagine opening a medical textbook from 1926 and discovering everything in it was still accepted in 2026. That wouldn’t demonstrate medicine’s wisdom. It would mean we’d learned nothing.
• Childhood leukemia in 1926: overwhelmingly fatal.
• Insulin before 1922: unavailable.
• Effective combination HIV treatment in 1985: not yet available.
• Antibiotics before the twentieth century: mostly nonexistent.
• Amount left to learn about the human body: an impressive amount.
I want somebody challenging my doctor. I want the larger study, the better imaging technique and the researcher discovering a mechanism nobody knew existed. I want the textbook rewritten.
Science isn’t a warehouse where facts sit after somebody stamps TRUE on them. It’s a method for becoming progressively less wrong.
We Became Me
This brings me back to public health. I don’t think Ronald Reagan invented selfishness; humanity had mastered it long before 1981. But his presidency gave modern American individualism an extraordinarily successful vocabulary. In his first inaugural address, Ronald Reagan famously said, “government is not the solution to our problem; government is the problem.”⁶ The sentence had a context more complicated than its later use, but the cultural message endured: my money, my taxes, my property, my responsibility.
Individual liberty matters, and skepticism of government matters. Governments can be spectacularly wrong. But a society composed entirely of individuals eventually runs into a sewer problem.
I cannot have my own herd immunity, atmosphere or electrical grid. I cannot individually prevent an epidemic or have clean drinking water if everyone upstream believes the river is exclusively their personal property. Civilization is the stuff we have to do together.
Maybe that helps explain why some younger Americans are attracted to democratic socialism. Perhaps they’ve all become dedicated students of Marx. I suspect many simply want a functioning bus, affordable housing, health care, schools and public spaces that work. Maybe what attracts them isn’t collectivization so much as the collective.
Maybe the radical word isn’t socialism. Maybe it’s we.
Someone Else Lives Here Too
Which brings me back to the hiking trail. I don’t throw my garbage into the stream because somebody drinks downstream. I don’t smoke beside you because you have lungs. I vaccinate partly because somebody else’s immune system may not work as well as mine. None of this requires me to love you, agree with you or even like you. It requires me to acknowledge that you exist.
It’s not about you.
That’s not an insult to individual freedom. As Jerry Garcia understood, freedom comes with “implicit responsibility.” That’s how the scene works.
Everybody wants to go back these days. Fine. I’d like to go back too, but not to iron lungs, measles or smoke-filled restaurants. I’d like to go back to something much older: we.
Science says I don’t know everything. Democracy says I don’t decide everything. Public health says I’m not the only person who matters. We don’t know everything, which is why we need science. We don’t agree about everything, which is why we need democracy. And we can’t survive everything alone, which is why we need each other.
Someone else lives here too.
Notes and Sources
Jerry Garcia, interview with Charles Reich, Rolling Stone, 1972.
Anthony S. Fauci, interviews on vaccination as individual protection and a “communal responsibility,” PBS NewsHour, June 29, 2021; CBS News, December 19, 2021.
Centers for Disease Control and Prevention, MMWR, “Real-Time Use of a Dynamic Model to Measure the Impact of Public Health Interventions on Measles Outbreak Size and Duration,” 2024; CDC measles epidemiology and complications materials.
Richard P. Feynman, “The Pleasure of Finding Things Out,” BBC Horizon, 1981; later collected in The Pleasure of Finding Things Out.
Hallie Lieberman and Eric Schatzberg, “A Failure of Academic Quality Control: The Technology of Orgasm,” Journal of Positive Sexuality, Vol. 4, No. 2, 2018; Rachel P. Maines, The Technology of Orgasm, Johns Hopkins University Press, 1999.
Ronald Reagan, First Inaugural Address, January 20, 1981.
Fauci AS et al., eds., Harrison’s Principles of Internal Medicine, multiple editions, McGraw-Hill.
National Institutes of Health, biographical and historical materials on Anthony S. Fauci and the National Institute of Allergy and Infectious Diseases.
U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), U.S. Department of State, historical and program-impact materials.
Centers for Disease Control and Prevention, “About Polio” and historical materials on poliomyelitis and vaccination.
Smithsonian National Museum of American History, historical materials on the iron lung and negative-pressure ventilation.
Centers for Disease Control and Prevention, measles transmission, complications and vaccination materials.
National Cancer Institute, historical materials on childhood acute lymphoblastic leukemia treatment and survival.
University of Toronto, Banting & Best Diabetes Centre, historical materials on the discovery and clinical introduction of insulin, 1921–1922.
National Institutes of Health, Office of NIH History and Stetten Museum, HIV/AIDS treatment history and the development of combination antiretroviral therapy.
Centers for Disease Control and Prevention and U.S. Environmental Protection Agency, historical materials on secondhand tobacco smoke and smoke-free public-health policy.
World Health Organization, measles and poliomyelitis fact sheets and vaccination materials.
PBS FRONTLINE, interview with Anthony Fauci, The Vaccine War, 2010, on vaccination, herd immunity and protection of people who cannot be adequately immunized.
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