When the president announced that Tylenol caused autism (it does not), he commented that leucovorin, a cancer medication, treated the condition. His remark had an outsized impact on the public, despite counter-statements by autism specialists. I can understand the response. What mother-to-be would take the chance, even if untrue, that Tylenol may cause autism? Or if parents have a child with this condition, would they not be willing to try anything, no matter how bizarre, that may aid their child?

I can also see the clinician’s perspective. Given the minimal study of leucovorin in children, its use, especially long-term, perhaps even lifelong, could entail significant risk. What is known about its use in treating cancer is irrelevant to treating autism. It would be an uncontrolled experiment, and I can envision upset parents, if their child were harmed, suing the physician. As is typical in such actions, the fact that they asked for the treatment would bear no weight with a jury.

This could set a troubling precedent: Clinicians might be pressured to provide any treatment a patient requests. Lawmakers, eager to satisfy public opinion and improve their reelection prospects, could bypass expert guidance and pass laws compelling physicians to prescribe medications on demand. That scenario is not far-fetched. Some state legislatures have already passed laws requiring physicians to administer ivermectin for COVID-19 if a patient requests it, and other states are intent on passing laws to eliminate some or all vaccine requirements for school entry to appease a few parents who believe vaccination should be optional.

This type of thinking is not unique but has occurred many times in the past and in various parts of the world. It arises when enough people fear they are losing control of their lives and the world around them. These people idolize a fantasized, simpler past. They seek uncomplicated answers to complex situations and distrust those who do not provide them.

Although it is commonly thought that these odd beliefs are limited to certain fringe groups and, recently, a political party, this is a myth. There are those on the left who have been and are equally as addled. The present, unreasoning fixation on using ambiguous referents for individuals to avoid offending trans-individuals is an example of left illogic. The euphemism “pregnant person” is an example, as biologically, only female humans have the organs necessary for gestation, making the term “person” incorrect as it conflates gender preference with reproduction. The person may identify as male and deserves to be treated as one, but for pregnancy and childbirth, femaleness is immutable.

Equally troubling is the fervor with which formerly colonized countries, now independent, reject nearly all influences of their former colonizers, including modern medicine, in favor of indigenous practices they regard as equivalent to science-based care. For example, medical schools in India no longer teach anatomy because it is considered unnecessary for Ayurvedic medicine. Likewise, the New Zealand pharmacist licensing examination includes questions on Maori treatments.

I support cultural uniqueness over the “melting pot” concept, where everyone is supposed to adopt the same, homogenous culture, at least to a point. The resistance to adapting to French culture in any form by Muslim immigrants is wrong, but so too is France’s insistence on absolute adaptation. I also believe that people should have freedom of choice regarding their personal health. Yet, only to the extent that no one else is harmed, and/or the community becomes responsible for the costs and damages resulting from their choice.

The Indian Health Service melds modern and indigenous practices, as this provides comfort to patients and encourages them to seek modern treatment rather than relying solely on traditional cures. Talismans, chanting, drumming, and visits by traditional healers for hospitalized patients are acceptable unless they conflict with medical treatments or could otherwise harm the patient. But even with questionable practices, staff will work with the patient and healers to seek a compromise. This practice could be used with others with strong cultural backgrounds or as a means of working with those who prefer alternative treatments, at least in limited situations.

I doubt, however, that if one is convinced that the COVID-19 vaccine is poisonous, they would agree to take it, even if they could use ivermectin concurrently. If they reject the vaccine, become seriously ill, and seek medical care, it should only be provided if they pay for it themselves. Even if they have health insurance, ultimately, the cost is passed to the community as higher premiums or taxes.

Society depends on reciprocity. People who benefit from the protections and services it provides also bear responsibilities to others. Personal choice matters, but it should be paired with accountability, especially when someone rejects a proven preventive measure for a communicable disease or relies on an unproven treatment.

If someone declines vaccination, they could be required to post a bond or carry supplemental insurance. That coverage would help pay for treatment costs for the individual, their child, and others who may be infected as a result. It could also help cover long-term harm if the illness leads to lasting impairment. This approach aims to preserve freedom of choice while limiting the burden that those choices can place on the wider community.

M. Bennet Broner is a medical ethicist.