The Slop Index

What the h index doesn’t tell you.

Abdul El-Sayed won Michigan's open Senate seat on November 3 by about seven points, and within hours two arguments that had been running for most of the year started up again.¹ The first was whether he is a doctor. The second was whether his academic record is as impressive as his admirers claim, a claim that crystallized into one widely shared number: his h-index on Google Scholar is 37, which, one economist posted, is "higher than that of your average tenured professor at an Ivy League school."² I disagree with the senator-elect on nearly every question of policy that matters to me, and I will say so in this publication for as long as he holds office. But both of these arguments have been conducted badly, by his critics and his defenders alike, because both sides have been arguing about labels when the facts underneath the labels are not in dispute. He is a doctor. He is not a physician. His h-index is real, and it does not mean what the people repeating it think it means. The last of those points is the one I most want to make, because I have spent the past several weeks building a tool to make it with numbers instead of adjectives.

Start with the credentials, because they are the easy part. El-Sayed earned a Doctor of Philosophy in public health at Oxford in 2011 as a Rhodes Scholar, then a Doctor of Medicine from Columbia's College of Physicians and Surgeons in 2014.³ Those are two doctorates from two serious institutions. When his campaign spokesman answered the credential stories in May by saying that he "has earned the right to be called 'doctor' twice over," the spokesman was correct.⁴ Anyone who insists that El-Sayed is "not a doctor" is making a claim that the diplomas refute. The honorific belongs to the degree, and he has the degree.

A physician is something else. In Michigan law the word has a definition, and it has nothing to do with diplomas. The Public Health Code says that a physician "means an individual who is licensed or authorized under this article to engage in the practice of medicine," and it defines the practice of medicine as the diagnosis, treatment, prevention, cure, or relief of human disease.⁵ El-Sayed did not complete a residency, never sat for licensing examinations, and has never held a medical license in Michigan or New York, the two states where he has lived and worked.⁶ Politico's reporting in May found that his hands-on clinical experience amounted to a four-week sub-internship at a small Manhattan hospital at the end of medical school, an experience he described on a podcast in 2022 as being "the, like, worst doctor on the team" and "cosplaying a doctor."⁷ His own account of why he stopped is honest and, as far as it goes, admirable: he decided during medical school that he wanted to work on systems rather than on patients. That is a legitimate career. It is also the career of a person who chose not to become a physician.

The distinction is one that every physician understands in his bones and that almost no layman does, which is exactly why it is worth insisting on. Medical school confers knowledge. Residency confers the thing patients actually rely on, which is supervised responsibility for sick people, thousands of hours of it, with a senior physician checking the work until the day the trainee is judged fit to carry that responsibility alone. The license is the state's attestation that this happened. A person who has the degree but not the training is in the position of a law school graduate who never took the bar: well educated, entitled to the title his diploma confers, and not a lawyer. Nobody would be confused if such a person called himself a doctor of law. People would be confused if he called himself an attorney, and the confusion would be the point.

That is where El-Sayed's defenders lose the argument they could have won. He did not merely accept the honorific. He described himself as a physician in public biographies and on the campaign trail, told a podcast in March that he had "been a doctor my whole career," told a room of Teamsters nurses that he had "been in enough codes to watch who really does the work," and in 2018 ran a gubernatorial advertisement in a white coat.⁸⁹ When Crain's Detroit Business asked about the missing license during that campaign, he answered, "I'm a physician because I have an MD, but I'm also a physician because of the work that I've dedicated my career to," and that sentence is the whole maneuver: the title detached from the license and reattached to a career.¹⁰ Michigan's statute, read literally, restricts not only the word "physician" but the letters "M.D." to individuals licensed under the medicine part of the code, and separately forbids anyone not licensed from using a title "to induce the belief that the person is licensed."¹¹ I am not interested in whether any of this is prosecutable, and I doubt that it is. I am interested in why a man with two doctorates felt the need to borrow the social authority of a third credential he does not hold. The answer, I think, is that in American politics the white coat still signals something the public trusts, and the word "epidemiologist," which is the honest description of what he is, does not. He wanted the trust without the residency. The critics who say he is a fraud are wrong about the degrees. The defenders who say he is a physician are wrong about the law, and about the thing the law is trying to protect.

Now the h-index, which is the more interesting question and the one his defenders think they have won outright. For readers who have not encountered it, the h-index was proposed by the physicist Jorge Hirsch in 2005 as a single number summarizing a researcher's output: a scientist has an index of h if h of his papers have each been cited at least h times.¹² An h-index of 37 means that 37 of El-Sayed's papers have each been cited 37 or more times. Hirsch suggested, for physicists, that an h of about 12 was typical at the point of tenure and about 18 at promotion to full professor, with the explicit caveat that the numbers would differ across fields.¹³ By that yardstick an h of 37 is strong, and the posts celebrating it are not lying. They are, however, repeating a number without asking the only question that matters, which is what was cited.

The h-index does not care. A randomized trial in JAMA and a two-page viewpoint in JAMA count identically. A paper reporting the discovery of a mechanism and a paper reporting that one demographic group answers a survey question differently from another count identically. A field whose every paper cites every other paper in it will produce high h-indexes for everyone in the field, regardless of whether the field has established anything. And the index grows automatically with co-authorship, so that a middle-author slot on a large collaboration counts the same as a paper the researcher conceived, designed, and wrote. None of this is a secret. Hirsch acknowledged most of it in the original paper. But the index has escaped its caveats and is now wielded on social media as a kind of intellectual net worth, a single figure that is supposed to settle whether someone is a serious scientist. It cannot do that, and for public health in particular, where the ratio of commentary to experiment is higher than in almost any other biomedical discipline, it is close to useless.

So I built a companion to it. The Slop Index, which lives at slop.galtmd.com with its full methodology and source code, takes a researcher's PubMed-indexed bibliography and asks three questions the h-index ignores.¹⁴ First, what kind of paper is each one: original empirical work with data, synthesis or modeling without primary data, or commentary. From that comes an empirical h-index, computed only over papers that report original data, and a simple ratio I call the Slop Index proper: one minus the empirical h divided by the total h, which tells you what share of a researcher's citation standing rests on papers with no data in them. Second, what is each paper about, reported transparently so that the reader can see whether a bibliography is concentrated in highly politicized topics. Third, and this is the axis that encodes an editorial position and does not pretend otherwise, does the paper add anything to actionable science: a trial or a mechanism or a strong causal design with a hard endpoint on one end of the scale, a cross-sectional survey of self-reported attitudes about a demographic label followed by a paragraph of cultural speculation on the other. The three axes are combined into a composite called the Total Slop Index, which runs from zero, where every paper is a major trial or discovery, to one, where every paper is identity-topic commentary. A bibliography whose average paper is neutral, neither contributing nor detracting, lands at 0.57. Below about 0.47 is a research record. Above about 0.65 is a commentary record. The space between is mixed.

Every weight in the index is published and adjustable, including a preset that sets the topic penalties to zero, because I would rather have the argument about the weights in the open than pretend the tool has no author. I will say plainly what the author believes. I believe that trials, mechanistic discoveries, and causal designs with hard endpoints are what a scientific bibliography is for. I believe that research on race, discrimination, lived experience, and the social determinants of health has to earn its credit with design, endpoints, and impact in exactly the way every other paper does, because that literature as a whole has a preferred answer before the study starts, and a field with a preferred answer is not doing science until it demonstrates otherwise. Readers who disagree can set the penalties to zero and see how much of any score they account for. That is the honest way to run an index with a point of view.

Here is what it says about the senator-elect.¹⁵ PubMed holds 70 papers by Abdulrahman El-Sayed of Michigan and Columbia, once three name collisions with an Egyptian pharmacologist are removed. His PubMed h-index is 27, lower than the Google Scholar figure because PubMed does not index books, op-eds, policy reports, or most social-science journals, and Scholar indexes nearly everything, including the citations that one blog post pays to another. Of the 70 papers, 47 report original data, 10 are reviews or models, and 12 are commentary. His empirical h-index is 22, and his Slop Index proper is 0.185, which means that about 80 percent of his citation standing rests on papers that contain data. That is a respectable figure. It is better than Nancy Krieger's, better than Arline Geronimus's, better than every one of the critical-race and intersectionality scholars I ran for calibration, and it is the first thing his critics should concede: El-Sayed is not a man who built a career on viewpoints. He generated data. On the first axis of my own index, he does well.

The second and third axes are where the record turns. Seventy percent of his papers fall in highly politicized topics, overwhelmingly race and ethnicity and the social determinants of health, and of those, exactly one clears all three rescue criteria of a cohort-level design, a hard endpoint, and above-average citation impact. Only 30 percent of his papers have positive substantive value. The median paper scores below zero. His Total Slop Index is 0.625, which places him in the mixed band, but at its upper boundary, a few hundredths from the commentary records of Krieger and Geronimus and a long way from the research records of Marty Makary at 0.41 or Jay Bhattacharya at 0.47, two men whose politics are at least as visible as his and whose bibliographies nonetheless consist mostly of surgery outcomes and health economics with hard endpoints. The index describes El-Sayed, in the calibration note I wrote before the election, as landing at the boundary: more empirical than the sociologists, less rescued than the economists.

The individual papers tell the story better than the composite. His best work by the index's lights is work most of his admirers have never heard of. He was senior author on a genuine randomized trial, run on Microsoft's Bing search engine, that showed 710,000 anti-smoking advertisements to users and measured which ones prompted subsequent searches for cessation help.¹⁶ He was a middle author on registry studies of in-hospital mortality in stress cardiomyopathy and on a series of neurosurgical outcome papers examining smoking, hyperglycemia, and the surgical Apgar score as predictors of postoperative death.¹⁷ He was a middle author on a Lancet Public Health analysis of 1,094 counties over 30 years that linked jail incarceration rates to cause-specific mortality, a paper whose conclusions I think are confounded past rescue but whose design, a fixed-effects longitudinal cohort with hard endpoints and a citation ratio four times the field average, clears every bar I set.¹⁸ I penalize incarceration research as a topic because the field has decided in advance that criminality is something that happens to people. That paper earned its credit back anyway. That is what the rescue criteria are for.

Then there is the other half of the bibliography. A dozen papers slice birth-certificate files, most of them Michigan's, for Arab American and immigrant mothers in different directions: before and after September 11, by maternal birthplace, by interethnic marriage, by community context, by acculturation, by marital status, by infant mortality.¹⁹ A 2014 piece in the AMA's ethics journal is titled "Complex systems for a complex issue: race in health research."²⁰ A 2015 commentary in the American Journal of Public Health proposes "calorie offsets," an environmental-policy instrument for the food environment.²¹ A 2015 agent-based model simulates stigma as the cause of depression among the obese.²² These are the papers the h-index counts at face value and the Slop Index counts at minus five or worse, and the reader who wants to know which is the fairer accounting should look at what the papers conclude. Most of them conclude that further research is warranted.

One of them is better than that, and it is the one I keep returning to. In 2008, as a first author still listed with a bachelor's degree, El-Sayed published a study in Ethnicity and Disease testing whether Arab American mothers in Michigan had worse birth outcomes in the six months after September 11, 2001, than in the same six months a year earlier.²³ A University of Chicago demographer had found exactly such an effect in California two years before, and the finding had become a staple of the argument that discrimination has measurable biological consequences.²⁴ El-Sayed's study, with 129,000 births, found no effect. None. His paper said so plainly, noted the contrast with the California finding, and reported that Arab ethnicity was in fact associated with lower risk of preterm and very-low-weight birth. It is the single most intellectually honest paper in his bibliography, and the index scores it positively despite the topic: a quasi-experimental design, a hard endpoint, a null result reported without apology. Four years later, writing on September 11, 2012, for CNN, he argued that post-attack "discrimination and marginalization" had taken a measurable toll on Arab and Muslim health, cited the California study, and did not mention his own.²⁵ In his 2020 memoir he reconciled the two by suggesting that Michigan's Arab enclaves had shielded their residents from prejudice, which is a hypothesis, and a reasonable one, and one that his study did not test.²⁶

I do not think that makes him dishonest. I think it makes him representative. The 2008 paper is what a scientist does: he asks whether a politically convenient finding replicates, and he reports that it does not. The 2012 essay is what an advocate does: he reaches for the finding that supports the argument and leaves the one that complicates it in the drawer. El-Sayed's bibliography is roughly 30 percent the first man and 70 percent the second, and his h-index of 37 cannot tell you which papers belong to which. That is the whole case for a second number.

The honest objections to the Slop Index are the ones I built the tool to invite. The classifier is rule-based and tuned on seventeen records; it will misfile papers, and the per-paper evidence column exists so that anyone can catch it doing so. PubMed undercounts economists and sociologists, which flatters some records and punishes others. The topic penalties are an editorial judgment that a reader may reject, which is why the topic-neutral preset exists and why I would ask anyone quoting a default score to quote the neutral one beside it. What the tool does not do is pretend that a citation is a citation. Readers who want to run El-Sayed, or Makary, or Krieger, or themselves can do it in the browser at slop.galtmd.com, with every weight visible and every paper listed.²⁷

So the senator-elect is a doctor twice over, by the plain meaning of the word and the plain evidence of his diplomas, and those who say otherwise should stop. He is not a physician, by the plain meaning of the Michigan statute and the plain evidence of his career, and he should stop saying otherwise too. His h-index is 37 and that is a real achievement in the field he chose. The field he chose is one in which it is possible to publish a dozen papers on the same birth-certificate files, each confirming the prior, and watch the number climb. When his admirers hold that number up as proof that a serious scientist is going to Washington, they are making the same mistake the critics made about the white coat: they are mistaking a credential for the thing the credential is supposed to certify. The Slop Index is an attempt to look at the thing itself. On that inspection, El-Sayed is a capable epidemiologist who did some real science early, spent most of his career on the kind of work his discipline rewards and mine does not, and has now left both for a career in which the only index that will matter is the one that gets counted every six years.

1. Siwicki D. El-Sayed Wins U.S. Senate Race In Michigan: AP. Patch. November 3, 2026 (updated November 4, 2026). https://patch.com/michigan/across-mi/michigan-u-s-senate-election-results-2026-el-sayed-vs-rogers-live-updates

2. Hauge J (@haugejostein). Post stating that El-Sayed's Google Scholar h-index of 37 is "higher than that of your average tenured professor at an Ivy League school." X. November 2026. https://x.com/haugejostein/status/2118575686080426201

3. Abdul El-Sayed. Wikipedia. Accessed November 7, 2026. https://en.wikipedia.org/wiki/Abdul_El-Sayed

4. Lengel A. Politico: Abdul El-Sayed Says He's a Physician, But Has No Experience as a Licensed Medical Doctor. Deadline Detroit. May 12, 2026. https://lifestyle.deadlinedetroit.com/articles/34569/politico_abdul_el-sayed_says_he_s_a_physician_but_has_no_experience_as_a_licensed_medical_doctor

5. Michigan Compiled Laws § 333.17001(1)(f), (1)(j) (Public Health Code, Part 170, Medicine: Definitions). https://codes.findlaw.com/mi/chapter-333-health/mi-comp-laws-333-17001/

6. Schmad R. Dem Senate hopeful's 'physician' campaign pitch under fire after license records reveal key gaps. Fox News. May 14, 2026. https://www.foxnews.com/politics/dem-senate-hopefuls-physician-campaign-pitch-under-fire-after-license-records-reveal-key-gaps

7. Chapman M. 'Cosplaying a doctor': Senate hopeful's old quote undercuts his 'physician' pitch. Raw Story. May 12, 2026. https://www.rawstory.com/abdul-el-sayed/

8. Schmad R. Dem Senate hopeful's 'physician' campaign pitch under fire after license records reveal key gaps. Fox News. May 14, 2026. https://www.foxnews.com/politics/dem-senate-hopefuls-physician-campaign-pitch-under-fire-after-license-records-reveal-key-gaps

9. Wren A, Lippman D. Michigan Senate hopeful El-Sayed calls himself a 'physician' but has little history treating patients. Politico. May 12, 2026. https://www.politico.com/news/2026/05/12/abdul-el-sayed-doctor-physician-00916389

10. Wren A, Lippman D. Michigan Senate hopeful El-Sayed calls himself a 'physician' but has little history treating patients. Politico. May 12, 2026. https://www.politico.com/news/2026/05/12/abdul-el-sayed-doctor-physician-00916389

11. Michigan Compiled Laws § 333.17011(5) and § 333.16261(1) (Public Health Code). https://codes.findlaw.com/mi/chapter-333-health/mi-comp-laws-333-17011/ and https://codes.findlaw.com/mi/chapter-333-health/mi-comp-laws-333-16261/

12. Hirsch JE. An index to quantify an individual's scientific research output. Proc Natl Acad Sci U S A. 2005;102(46):16569-16572. https://doi.org/10.1073/pnas.0507655102

13. Hirsch JE. An index to quantify an individual's scientific research output. Proc Natl Acad Sci U S A. 2005;102(46):16569-16572. https://doi.org/10.1073/pnas.0507655102

14. Galt J. The Slop Index: methodology and interpretation. slop.galtmd.com. Accessed November 7, 2026. https://slop.galtmd.com/methodology.html and https://slop.galtmd.com/interpretation.html

15. Galt J. Slop Index report: El-Sayed AM (70 PubMed-indexed papers, NIH iCite citations, default weights). slop.galtmd.com. Run November 2026. https://slop.galtmd.com/

16. Yom-Tov E, Muennig P, El-Sayed AM. Web-Based Antismoking Advertising to Promote Smoking Cessation: A Randomized Controlled Trial. J Med Internet Res. 2016;18(11):e306. https://doi.org/10.2196/jmir.6563

17. Galt J. Slop Index report: El-Sayed AM (70 PubMed-indexed papers, NIH iCite citations, default weights). slop.galtmd.com. Run November 2026. https://slop.galtmd.com/

18. Kajeepeta S, Mauro PM, Keyes KM, El-Sayed AM, Rutherford CG, Prins SJ. Association between county jail incarceration and cause-specific county mortality in the USA, 1987-2017: a retrospective, longitudinal study. Lancet Public Health. 2021;6(4):e240-e248. https://doi.org/10.1016/S2468-2667(20)30283-8

19. Galt J. Slop Index report: El-Sayed AM (70 PubMed-indexed papers, NIH iCite citations, default weights). slop.galtmd.com. Run November 2026. https://slop.galtmd.com/

20. Galt J. Slop Index report: El-Sayed AM (70 PubMed-indexed papers, NIH iCite citations, default weights). slop.galtmd.com. Run November 2026. https://slop.galtmd.com/

21. Galt J. Slop Index report: El-Sayed AM (70 PubMed-indexed papers, NIH iCite citations, default weights). slop.galtmd.com. Run November 2026. https://slop.galtmd.com/

22. Galt J. Slop Index report: El-Sayed AM (70 PubMed-indexed papers, NIH iCite citations, default weights). slop.galtmd.com. Run November 2026. https://slop.galtmd.com/

23. El-Sayed A, Hadley C, Galea S. Birth outcomes among Arab Americans in Michigan before and after the terrorist attacks of September 11, 2001. Ethn Dis. 2008;18(3):348-356. https://pubmed.ncbi.nlm.nih.gov/18785451/

24. Lauderdale DS. Birth outcomes for Arabic-named women in California before and after September 11. Demography. 2006;43(1):185-201. https://doi.org/10.1353/dem.2006.0008

25. Ross C. El-Sayed Blamed Post-9/11 'Discrimination and Marginalization' for Muslim Moms Having Premature Babies. He Ignored His Own Scientific Study That Proved It False. Washington Free Beacon. July 15, 2026. https://freebeacon.com/democrats/el-sayed-blamed-post-9-11-discrimination-and-marginalization-for-muslim-moms-having-premature-babies-he-ignored-his-own-scientific-study-that-proved-it-false/

26. Ross C. El-Sayed Blamed Post-9/11 'Discrimination and Marginalization' for Muslim Moms Having Premature Babies. He Ignored His Own Scientific Study That Proved It False. Washington Free Beacon. July 15, 2026. https://freebeacon.com/democrats/el-sayed-blamed-post-9-11-discrimination-and-marginalization-for-muslim-moms-having-premature-babies-he-ignored-his-own-scientific-study-that-proved-it-false/

27. Galt J. The Slop Index: methodology and interpretation. slop.galtmd.com. Accessed November 7, 2026. https://slop.galtmd.com/methodology.html and https://slop.galtmd.com/interpretation.html