The absorption of conflicting and changing medical information about COVID-19 into political agendas presented people with two contradictory pronouncements: currently available vaccines prevent infection and transmission of the disease through neutralizing antibodies, even if immunity does not last long because antibody titers decay, or they do not work at all. In fact, vaccines induce enduring humoral and cellular immunity carried in memory B- and T-cells, with cellular immunity being more important in halting viral infection [1, 2], and they do not reliably prevent transmission of disease because the incubation period is shorter than the time it takes to mount an immune response and because only a small number of mutations in the spike protein against which the vaccine is directed permit immune escape of the virus, allowing people to become infectious before they have a sufficient immune response to contain the virus [3-5]. Instead of synthesizing opposing findings and informing patients of the complexity of evolving data, California politicians and the California Medical Association propose that physicians’ licenses be sanctioned if they provide “false or misleading information” about COVID-19 [6], leaving it up to whoever is in power to decide what is false. It is a short trip from intolerance of conflicting data about an emerging pandemic to the suppression of debate in areas of established medical practice such as the prescription of benzodiazepines. In the same manner as incomplete directives about vaccines, directives about benzodiazepines like the one in California have been derived from superficial readings of the data.

Why should anyone outside of California who is not interested in movie stars care about what happens there? The answer is that initiatives in California often spread throughout the Western world. We should be concerned that California’s ideological limitations on clinical practice will spread. Throughout the world, if clinicians do not fully inform patients about alternative COVID data, patients’ options are restricted. If clinicians accept uncritically the assertion that benzodiazepine prescriptions should always be short-term, the options of patients who could benefit from longer treatment will be limited. If thought leaders around the world are not fully informed about the rich body of data on benzodiazepines, they will discourage clinicians who depend on their opinions from developing the most robust armamentarium of treatments.

The review [7] that prompted Dr. Fogelson’s letter was meant to be a balanced discussion of the potential benefits and risks of these medications in diverse conditions. Anyone who “agrees” that benzodiazepines are always the right choice in treating anxiety and mood disorders, or who, conversely, insists that these medications are outmoded, is choosing sides in an ideological debate, not engaging in medical decision-making. As scientific clinicians, we should resist the temptation to identify uncritically with the assertions of whichever expert with whom we identify. As leaders in our community, we should resist efforts of politicians (including physician-politicians) to excessively simplify complex clinical decision making, as well as all efforts to restrict the open exchange of ideas, experience, data and hypotheses in any aspect of daily life. To do otherwise exposes us to the continued erosion by ideology and politics of our ability to learn and grow.

Research support: Allergan, Boehringer Ingelheim, Seelos, Janssen, Neurocrine, and Sunovion. Membership: International Task Force on Benzodiazepines.

No financial support was provided for the manuscript.

Steven L. Dubovsky researched and wrote the entire manuscript.

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