Jeff Singer is a practicing general surgeon in Phoenix, Arizona, and a senior fellow at the Cato Institute, where he studies health policy. He appeared as a guest on The Bob Zadek Show in 2020 to discuss the government’s pandemic response and, later that year, the history of prescription drug regulation in the United States. In both episodes Bob Zadek introduced him as a frequent returning guest and described his work as database-driven rather than motivated by anything other than the truth. Here comes “the spike…” (2020)
Government performance during COVID-19
In the June 2020 episode, Zadek framed the hour as a report card on how elected officials performed when, as he put it, the chips were a bit down and the playbook was not all that clear. He asked Singer to critique executive decision-making at the city, state and federal levels, noting that the legislative branch had ceded power to the executive branch and was largely passive. Here comes “the spike…” (2020)
Singer began by declining to give a blanket opinion, saying that one of the advantages of the federal system is that one size does not fit all, and that conditions on the ground in the New York metropolitan area differed from those in South Dakota or California. He listed population density, demographics and the age of the population as factors that should play into a decision, and said rigid restrictions on movement might make sense in one region depending on what is going on there. Here comes “the spike…” (2020)
His central criticism was that executives deferred decision-making to public health officials, asking them what needed to be done to eradicate the virus and then implementing whatever they were told. Singer said public health officials look through one narrow lens—getting rid of the virus—and do not pretend to be experts on economics or sociology, so they do not consider the economic, social or long-term unintended consequences of the interventions they recommend. He argued that an executive should also consult experts on the unseen economic consequences, discuss the measures with political people to gauge public willingness to go along, and weigh first, second and third best solutions before deciding. Here comes “the spike…” (2020)
Singer illustrated the point with an analogy: hiring a pest control man to eradicate roaches without caring what he does, then returning to find the house burned to the ground. He also recalled that Dr. Fauci, asked by Senator Rand Paul whether he had considered the economic consequences of some measures, replied that he is not an economist and does not pretend to be one, but is a public health expert giving public health insights. Here comes “the spike…” (2020)
Singer stated that the virus is part of the ecosystem and is here to stay, that smallpox is the only virus affecting humans ever to have been eradicated, and that measles and polio have re-emerged when immunization stops. He described herd immunity as the point at which enough people have immunity that the virus cannot find enough hosts and vectors to spread to any significant degree, reached through a combination of vaccination and natural immunity, and noted that no vaccine exists for HIV after twenty years of trying or for hepatitis C. Here comes “the spike…” (2020)
Trade-offs and individual risk
Zadek put the trade-off question in concrete terms, quoting Governor Cuomo’s position that even one life is invaluable and that any degree of economic loss would be accepted to save one life. Zadek called the concept absurd, arguing that government at every level decides to sacrifice American lives for a greater good—sending troops into combat, or permitting driving even though it kills 55,000 Americans every year. Here comes “the spike…” (2020)
Singer answered that decisions of this kind should as much as possible be made at the individual level, because different people are willing to accept different risks; he gave the example of tobacco smokers who judge that the pleasure outweighs the health considerations. He qualified this by saying that when he is contagious and could affect people around him, the decision is not only his, because he would be jeopardizing the life and rights of his neighbors—which is why there is a legitimate role for government in dealing with such externalities. That role, he said, has to be as narrowly defined as possible, requires a compelling reason, and should carry a time limit; it should deal only with a person’s ability to affect the life and safety of others. Here comes “the spike…” (2020)
He listed scuba diving, skiing and skydiving as activities involving accepted trade-offs, and noted that raising speed limits from 55 to 70 in California or 75 in Arizona caused an increase in deaths from automobile accidents, while drivers remain free to drive below the limit. Zadek interrupted him to close the show, thanking him and directing listeners to his writing at Cato. Here comes “the spike…” (2020)
Prescription drug freedom
The November 2020 episode centered on a Cato paper, Drug Reformation: End Government’s Power to Require Prescriptions, which Singer published with Michael Cannon. Zadek introduced the subject by describing prescription drugs as another aspect of a permission-full society in which so much of daily life requires the permission of a government official, and asked whether anyone should be required to seek permission to put something into their body. Dr. Jeff Singer on Prescription Drug Freedom (2020)
Singer opened with the FDA’s emergency use authorization for the first at-home self-administered COVID-19 test, which the agency said could not be obtained without a prescription and which a doctor was not to prescribe unless the patient had symptoms. He noted that no prescription is required for an at-home pregnancy test or an at-home HIV test, and that the FDA’s memo itself stated the doctor is not necessary to provide the test. He pointed out that forty to fifty percent of people have no symptoms and spread the virus unknowingly, so people conscious of that fact could not test themselves because they had to have symptoms to get the permission slip. Dr. Jeff Singer on Prescription Drug Freedom (2020)
On the history, Singer dated the prescription requirement to 1951. Before that, he said, it was widely recognized that every human being has the right to self-medicate, which he described as a corollary of the right to informed consent: just as no procedure or medicine can be imposed without consent, a person should not need another’s consent to medicate or test himself. He cited Thomas Jefferson, who speaking about freedom of speech said it is so sacred it is as sacred as the right to self-medicate—a comparison Singer said has been reversed, so that he now has to explain that the right to self-medicate is as sacred as the right to free speech. Dr. Jeff Singer on Prescription Drug Freedom (2020)
Singer said that before the 1950s the overwhelming majority of people who took medications sought the advice of an expert such as a doctor, and that pharmacists are also experts whom people consulted before ultimately making their own decision. A prescription from a doctor was the doctor’s recommendation, and a pharmacist might suggest something else and make the case for it, with the individual deciding at the end of the day. In that era, he said, the prescription was not a permission slip but a recommendation. Dr. Jeff Singer on Prescription Drug Freedom (2020)
Across episodes
Both episodes turn on the same underlying question—who decides what goes into an individual’s body—but the excerpts show no development between them: the June episode treats it as a matter of executive trade-offs and externalities during a pandemic, and the November episode treats it as a matter of regulatory history and patient autonomy, with Singer advancing the argument in each and Zadek framing it. Here comes “the spike…” (2020) Dr. Jeff Singer on Prescription Drug Freedom (2020)
What the sources do not cover
The excerpts do not give Singer’s age, education, medical training, practice history or any title beyond practicing general surgeon in Phoenix and senior fellow at the Cato Institute. They do not describe the contents of Drug Reformation beyond the arguments Singer states on air, nor the Durham-Humphrey Amendment or any other statute by name. The June episode’s discussion of regulatory hurdles that delayed testing and treatment, certificate of need laws, elective surgery bans and the politicization of medical treatments appears only in the episode’s topic list, not in the quoted transcript. Singer’s remarks on the at-home COVID test are cut off mid-thought in the second episode, and the excerpts contain no closing segment for it.