Melissa Harris-Perry: Back with The Takeaway, I'm Melissa Harris-Perry. Heading into the holiday season, nearly 60% of the US population is fully vaccinated. Good job folks and almost 70% have received at least one dose, but still, according to the CDC, US COVID infections were up sharply this past week.

While European governments are responding with strict restrictions and new quarantine measures, many American states continue to follow a far more libertarian pathway. For example, Florida Governor Ron DeSantis called a special legislative session to move new rules against COVID-19 vaccine mandates. Now, those who resist vaccine mandates typically site medical choice and freedom. Here at The Takeaway, we were curious about the history of these arguments and the way that they're connected to American identity. So we called up this guy.

Lewis Grossman: My name is Lewis Grossman. I'm the author of Choose Your Medicine: Freedom of therapeutic Choice in America.

Melissa Harris-Perry: Now, I asked Grossman to walk us through the history of therapeutic choice.

Lewis Grossman: When I conceived of this book, I was focusing not so much on freedom from compulsion, which is one of the big issues now obviously with mandatory vaccination, so much as freedom to obtain the treatments that you want without the government interfering in those choices. Now, this impulse has always overlapped significantly organizationally ideologically with freedom from compulsion. This is a broader issue than resistance to mandatory medication but it does include resistance to mandatory medication.

Melissa Harris-Perry: Okay. I feel like I need to back up a little bit maybe to even more foundational concept here of freedom. You write about a version of Jacksonian democracy that lays out four specific freedoms, freedom of conscience, freedom of person, freedom of business, and also a universal equal freedom. Can you walk us through how those ideas of freedom are connected back to this question of therapeutic or medical freedom?

Lewis Grossman: Modern people when they enter into the world of freedom of therapeutic choice tend to focus on bodily freedom. This is largely an outgrowth of the early 1970s when Roe v Wade and the right to choose were the dominant strains of medical freedom discussions in the United States. In fact, even though bodily freedom has always been an important strain of this ideology, there are also other very important ones, including economic freedom, which I can say more about, religious freedom, which I can also say more about, and freedom of inquiries.

Each of those opens up a door into an interesting discussion, but I will mention that if you look at medical freedom rhetoric today in the context of COVID, you hear all four of these freedom themes in connection with freedom of therapeutic choice. What's interesting is that until fairly recently in history, pretty much the mid 20th century, testimonials and anecdotes were the basis upon which everybody decided whether medicines were effective or not.

With the rise of the randomized controlled trial in the mid 20th century, the medical establishment now has an incredibly different approach to assessing efficacy. That approach is in many ways intention with the notion of trial and error, and free unrestricted unregulated choice, because of course in a randomized controlled trial, first of all, you are not even being told which thing you're getting, you might be getting the drug, but you might also be getting a sugar pill and you don't even know which one you're getting.

What's interesting in addition is that the notion of unrestricted societal experimentation with a drug is intention with that mission of doing randomized controlled trials. Any person who's desperately ill who has a choice between either entering a randomly controlled trial, where there's a 50% chance they're going to get a sugar pill, on the other hand to a situation where they know they're getting the drug, which may give them some hope, they're going to turn toward that latter option and not participate in clinical trials.

Melissa Harris-Perry: Let's also talk for just a moment and then I do want to bring it directly to the question of vaccine hesitancy, but I want to connect not only these freedoms but also the question of populism and of trust. I think the trust piece that you begin to articulate even with the notion of the randomized trials and the idea that, "Well, I'd have to trust those who are making the choices, trust that it is randomized, trust that the pharmaceutical companies aren't going to harm me with the active ingredient rate." There's all of these various layers of trust.

As you wrote about the ways that a deterioration of trust had been associated with, for example, getting rid of medical licenses, just in the ramp-up to the civil war. It occurred to me that we are also in this moment of a reduction of trust in so many collective institutions.

Lewis Grossman: Yes. I think that's one of the defining features of our age, is Americans' lack of trust, sometimes feeding over into actual paranoia about our establishment institutions, whether it's the government or establishment science and medicine or big business or the media. A lot of people look at the current state of America with respect to trust and think that we are going off the rails.

One of the basic themes of my book is that we're actually reverting to our norm. America has been distrustful of establishment institutions throughout most of its history. The one striking exception is a time I remember, and in which my parents and grandparents experienced more directly than I did, a time in the mid 20th century when America was flushed with pride in its scientific achievements and in the victory of World War II and with scientific and medical progress such as the polio vaccine. The 1970s really represented a point in time in which this trust disintegrated in a bipartisan way and we've been in this situation ever since.

Melissa Harris-Perry: I think you've in many ways hit on one of the challenging spaces I feel like even I occupy and so many folks who I know, which is the-- It's almost an inversion ideologically around, "Look, just trust the government. Just trust the government and do what the government says to do," by so many folks who are my progressive and liberal friends who typically say, "Hey, don't trust the government. Don't just do what the government tells you to do."

I guess I'm a little surprised by how the pandemic has left us mapping ideologically. Actually, it seems like in reverse to what has typically been how we thought, at least maybe since that 1970s moment about trust in government.

Lewis Grossman: I am a little bit surprised by it too. There have been other times in American history where attitudes toward medical freedom have mapped onto political parties. For example, the early 19th century, which you mentioned when medical freedom activists were associated very much with the Jacksonian Democrats. What we see now is quite different from the '70s as you alluded to because even before the 1970s you had right-wing conspiracy theorists and skepticism about institutions.

What you got in the 1970s was a mainstreaming and a bipartisan aspect to this. The left is not immune at all from distrusting establishment institutions, as you mentioned, and there actually is a surprising level of trust from the progressive side of the political spectrum. Whereas the mistrust from the conservative side of the political spectrum, I don't really find surprising. I find it typical because there has been both a right side and a left side distrust for a long time in American political thought.

Melissa Harris-Perry: The text is largely about political thought, about the ways that we've wrestled with these big questions, but in terms of wrestling with these big questions, there are structures and systems across the American narrative helped us to adjudicate these by literally adjudicating them and determining what constitutes constitutional action on the part of the government and what does not. Based on what you understand about how these debates have played out and also what the jurisprudence is, are the current mandates from the Biden administration constitutional?

Lewis Grossman: The technical question that the courts are confronting now with respect to the Biden mandates are actually more a question of administrative law and statutory interpretation than they got out of constitutional law. Constitutional issues are always hanging out there as a potential issue but especially when we're talking now about the OSHA mandate for workplaces of more than 100 people, the main line of attack on that mandate is that it is exceeding OSHA's authority to issue a mandate of that type. You may see decisions first coming out with respect to that that are actually quite technical rather than really embracing the deep philosophical issues I discuss in my book.

Melissa Harris-Perry: Are we still in an infancy around medicine that maybe we don't realize that we still are in? So I guess I'm asking when we're looking at vaccines, whether it is the COVID vaccine or medical trials for other kinds of medications, I guess I have a pretty robust trust in the scientific process and I'm concerned that maybe that is misplaced and simply socio-historical and that in 50 years it will be obvious that all of this was poorly placed trust in medicine.

Lewis Grossman: It is worth noting that modern medical science has not won the fight if you will. There are whole disease areas where they have not come up with solutions. In addition to that, even when it comes to the most effective therapies, there are invariably risks involved and invariably not perfect efficacy, and anybody who's inclined to be skeptical of modern medicine can look at that unavoidable uncertainty and measure it in a way that reinforces their own skepticism about modern medicine.

Melissa Harris-Perry: Are pandemics different than cancer relative to the limits of our own freedom for making choices about how we're going to intervene.

Lewis Grossman: Contagious diseases raise different issues because if you're talking about a disease that is threatening your own life but not threatening the life of those around you, that is obviously a very different question than a disease where if you acquire the disease, you can also infect other people.

I'd also like to point out by the way that for all the newsprint that the vaccine resistors are getting, we today are in a situation where I forget the exact number, but 70%, 75% of Americans have taken the vaccine. I don't think that the level of vaccine skepticism we're seeing with respect to COVID is necessarily all that different from the level of vaccine skepticism we saw 100 years ago.

Melissa Harris-Perry: I suspect either there was certainly this feeling of, "Surely when it's available everyone will want to take it." It's a little a bit of a misplaced anxiety. I feel like when you look at the map, the global mapping of COVID vaccines, it's pretty clear the US is near the top. There are some nations where one has fewer than the four freedoms where we have higher vaccination levels. The real question is parts of the world where the vaccine is simply unavailable and no matter what choices people want to make they're unable to make those choices.

Lewis Grossman: Now it is interesting to contrast the COVID vaccine with, for example, the polio vaccine. The polio vaccine when it was rolled out and the 1950s invented by Jonas Salk who became a national hero. There was very, very widespread celebration and uptake of that vaccine. Parents around the country willingly rolled up their children's sleeves to participate not just in receiving the approved vaccine but actually participating in clinical trials in the first place.

Now we're obviously in a different place but it's also important to recognize certain differences between the situations. One of them is that the victims of polio were most prominently children whereas many of the victims of COVID are elderly people and people with other conditions that are dying quietly behind closed doors and maybe are not the same poster children literally as the polio poster children were.

Second, I heard somebody interviewed recently who said, "Well, polio was almost completely effective whereas this is only 70% effective," and Americans are really bad at risk assessment. That is a difference that people can grasp onto especially when you add to the fact that everyone knew if they got polio, they were facing dire, dire circumstances whereas in COVID especially the younger population knows that if they get COVID, they may suffer very few personal consequences at all. Therefore what you have to do is appeal to people's altruism and devotion to community health, and America's never been great at that.

Melissa Harris-Perry: Is there a way to engage some of these big issues around populism around trust, around freedom to make us better at exactly that?

Lewis Grossman: I'm sad to say that I'm pretty pessimistic about this issue. Let's start by saying that public health officials themselves have to become better at communicating. Communicating about risk and uncertainty in a way that they can preserve the public's trust rather than invite skepticism every time. Anything they say doesn't turn out to be exactly what happens.

I feel like our media environment today is so divided and people are getting their version of the truth from their own sources. By the way, this isn't new in America either. This was newspapers in 1820, 1830, they were completely partisan. I don't know exactly how this country overcomes this divide based on mistrust when everybody is getting their news from sources that are largely reinforcing their own prior beliefs.

Melissa Harris-Perry: That was Lewis Grossman, author of Choose Your Medicine: Freedom of Therapeutic Choice in America.

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