The debate regarding the “Goldwater rule” has intensified following President Trump’s recent rambling presentation in Pennsylvania (Trump rails on affordability ‘hoax’ and flings racist attacks in rally-style speech, 10 December). As a physician with decades of experience in health policy, I believe the current discourse misses a vital distinction: the difference between prohibited diagnosis and legitimate observation.
The Goldwater rule was designed to prevent irresponsible “armchair diagnosis” based on hearsay. However, Dr Allen Dyer, a psychiatrist instrumental in developing the original rule, clarified in October 2024 that it was never intended to serve as an absolute gag order. It does not preclude responsible discussion of observable public behaviours, particularly when a public figure voluntarily displays these patterns on a national stage.
We must allow medical expertise to inform public discourse. When behaviour that bears on the national welfare is publicly exhibited and extensively documented, discussing it within ethical boundaries is not a violation of professional standards – it is a contribution to the nation’s understanding.
Robert Krasner
New York, US
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