Looking back on 2020: Too many physicians behaving badly

As I sat down yesterday to write this post, it suddenly occurred to me: This will be my first post of 2021. Out of curiosity about the year that just ended, I scrolled back to my very first (substantive) post in 2020 and noticed that it was a about crowdfunding cancer quackery through GoFundMe, with the second post being about the goop lab on Netflix and the third being about a bogus attempt by an antivaxxer to claim that antivax parents could get a medical exemption to school vaccine mandates just by lying about their child having had an anaphylactic reaction to a vaccine. Worthy topics, all, but nonetheless I couldn’t help but think, How quaint. I then realized that it was around that time that what later came to be known as SARS-CoV-2 but then was known just as the novel coronavirus that had first emerged in Wuhan, China was just a blip on the world news. True, by the end of January I had deconstructed the very first conspiracy theory about COVID-19 that I had encountered, namely that a larger-than-usual use of the influenza vaccine in China had led to an increased susceptibility to the novel coronavirus, thus starting the outbreak that was to turn into our current pandemic. It was a strangely precise claim that I ended up revisiting and refuting again and again. Sadly, to this day, the claim that the flu vaccine increases your susceptibility to COVID-19 by 36% remains one of those viral bits of pandemic disinformation that just won’t die, and I still see it popping up from time to time. Worse, it’s a claim that was popularized by a physician.

The point is that, first, beginning in early March, when COVID-19 was officially declared a pandemic by the World Health Organization, this blog (and my not-so-secret other blog) was largely taken over by the all things coronavirus, for the simple reason that the pandemic became the single biggest focus of medical misinformation, science denial, and quackery in the world. Soon, I was writing again and again about the dubious promotion of the antimalarial drug hydroxychloroquine as a “miracle cure” for COVID-19, a topic that I’ve revisited more times than I can remember. Sadly, the disinformation and astroturf propaganda campaigns spawned by the drug’s boosters, including Didier Raoult and Dr. Oz, have since metastasized to other drugs, such as ivermectin (which deserves a post of its own) and that evidence can’t seem to kill the myth that hydroxychloroquine is a cure for COVID-19 that could allow the “reopening” of the economy that “they” are hiding from you—for nefarious purposes, of course. Second, and worse, many of these claims are being spread by physicians, which brings me to my year-end theme: What do we do about physicians behaving badly, particularly in a pandemic? In other words, what do we do about physicians who actively spread antivaccine disinformation, deny or minimize the severity of COVID-19, promote (or even sell) quack (or at least unproven) “cures,” and spread other disinformation designed to discourage people from cooperating and complying with public health authority recommendations to slow the spread of the pandemic?

Antivaccine physicians in 2015: How quaint

Nearly six years ago, there was a post entitled, What do we do about politicians and physicians who promote antivaccine misinformation? It was written at a time when the Disneyland measles outbreak was still in full swing, an outbreak whose toll was minuscule compared to the carnage caused thus far by COVID-19, as of this writing over 19 million cases and 330K deaths and (rapidly) counting in the US alone. Yet that outbreak spawned SB 277, the California law that eliminated nonmedical “personal belief exemptions” to school vaccine mandates, a movement that spread to other states. Basically, I and others, such as Peter Lipson argued that antivaccine physicians should lose their medical licenses, a suggestion that I revisited a mere three weeks ago, when the Oregon Medical Board issued a temporary emergency suspension of the license of antivaccine pediatrician Dr. Paul Thomas, an action that I heartily approved of. At around the same time, the Oregon Medical Board also issued a similar suspension of the license of Dr. Steven LaTulippe, a physician who had given a speech to a pro-Trump, anti-“lockdown” rally in which he bragged that he didn’t wear masks at his medical practice. The suspension was an action that I also heartily approved of. As they year draws to a close, this sort of case was what led me to write this post.

The reason, quite simply, is that, as dangerous as the disinformation being promoted back then by doctors like “Dr. Bob” Sears and a panoply of “integrative” physicians and pediatricians in California who started selling fake “medical exemptions” to school vaccine mandates (and, yes, Dr. Thomas, who was just starting to become famous as an antivax pediatrician back then) was, the disinformation being promoted by physicians now is so much more harmful.

2020: The year of (some) physicians behaving very, very badly

Obviously, the one massive overarching event that will forever define 2020 and by which this year will be remembered has been the COVID-19 pandemic, which has nowhere-near run its course yet, even as the first effective vaccines are starting to roll out to healthcare workers and those most vulnerable in nursing homes. In well under a year, SARS-CoV-2, the coronavirus responsible for COVID-19, has already claimed the lives of one in one thousand Americans since the first reported infections in late January and the first reported deaths in February. Not only is that estimate likely a gross undercount, but I haven’t even included the toll the virus has taken in the rest of the world, with nearly 1.8 million dead total as of this writing. Just think of it, though. Currently, COVID-19 is the leading cause of death in the US, having surpassed cancer and heart disease, and the very fact that it’s claimed one in one thousand Americans puts a very hard lower bound on its infection fatality rate of 0.1%, given that it’s killed 0.1% of the population already. Of course, given that it has only taken a small fraction of the people in the US having been infected to reach this grim milestone, that means the true IFR is likely much higher; yet we still see COVID-19 deniers referring to “99%” or even (“99.8%”) survival and saying that the disease is “no more deadly than the flu,” as though even such a “high” survival rate means that the disease is no big deal and that we’re “overreacting”. Pay no attention to all those hospitals whose ICUs are overflowing and that are hitting the point where they are having trouble taking care of the usual emergencies because they’re so busy taking care of critically ill COVID-19 patients.

That’s why I found it so depressing just how easily so many physicians jumped on board the COVID-19 denial train or started chasing shiny miracle cure objects, like hydroxychloroquine. Just out of curiosity, I perused SBM and my not-so-secret other blog for examples, restricting my search to quackery and/or disinformation peddled only by those with an MD or DO after their names. Sadly, the examples were numerous. One good overview comes to us courtesy of Jann Bellamy, who discussed in June an FTC warning about all the quackery being promoted by physicians and, of course, naturopaths, chiropractors, and acupuncturists. One favorite is intravenous high dose vitamin C (because, don’tcha know, to quacks intravenous high dose vitamin C is good for everything, including cancer, the common cold, and, yes, COVID-19):

To give you an idea of the geographic and provider diversity, other clinics nabbed by the FTC for promoting IV Vitamin C for COVID-19 include the Envista Medical Neck & Back Center (California MDs and DCs), Whole Health Chicago (an “integrative” practice which includes an MD, a “chiropractic physician specializing in functional medicine”, a TCM practitioner, and a homeopath), Revive and Rally Health Lounge (Kansas, run by an MD and an RN), Aspire Regenerative Health (California ND), iCRYO (a multi-state cryotherapy-infusion franchise operation with an MD Chief Medical Officer), LotusRain Naturopathic Clinic (California), Naturopathic European Medical Centre (which, despite the name and spelling, is in Wisconsin), Holgistic Personalized Healthcare/Natural Care Institute (Michigan MD and ND partnership), Traditional Chinese Medicine Clinic (Colorado Doctors of Oriental Medicine and Acupuncturists), East Valley Naturopathic (Arizona), Gonino Center for Healing (Texas DO), Hawaii Naturopathic Retreat, Health Associates Medical Group (California MD, DO, DC and LAc combo), Restore Med Clinic (California MDs), Revival Hydration (a “100% mobile” California infusion company using unspecified “medical professionals”), Sage Integrative Medicine Clinic (Washington NDs), and Vero Clinics (Illinois MD).

Then, of course, Joe Mercola was named as a “superspreader” of COVID-19 disinformation, and so he is.

Of course, Mercola and the docs mentioned by Ms. Bellamy are the usual “integrative medicine” grifters selling dubious treatments alongside conventional medicine as the “best of both worlds”. It’s unsurprising that they view the COVID-19 pandemic as a profit opportunity that can be pursued by simply “rebranding” their usual treatments as somehow being able to prevent and/or treat COVID-19. Far more dangerous, in my view, are the physicians promoting misinformation about COVID-19, discouraging people from following public health interventions to slow the spread of the virus, or even fear mongering about new COVID-19 vaccines before they were even ready to be distributed. Inevitably, some of these physicians’ views are reflected in how they practice medicine, thus putting their patients in danger.

Take Dr. LaTulippe, for instance. The Oregon Medical Board quite appropriately suspended his license because he had openly bragged that he didn’t use or require masks at his medical practice which violated an order in Oregon requiring healthcare workers to wear face coverings in healthcare settings, and also because he was giving out dangerous misinformation to his patients. At the time, I didn’t look into just how egregious his violations were. I now rectify that error:

The order of suspension gave some examples of practices at his clinic.

It stated that a patient who contacted the clinic in July to get advice on being tested was told, “asymptomatic persons should not be tested, that wearing masks does not prevent transmission of COVID-19, and was directed not to self-isolate because being around other people would provide [the patient] with immunity to COVID-19.”

On July 23, after questioning the advice, the person was terminated as a patient.

Additionally, the suspension order said that LaTulippe repeatedly told elderly and pediatric patients incorrectly “that it was ‘very dangerous’ to wear masks because masks exacerbate COPD and asthma and cause or contribute to multiple serious health conditions, including but not limited to heart attacks, strokes, collapsed lungs, MRSA, pneumonia, and hypertension.”

The order also notes that Dr. LaTulippe “and the staff in his clinic refuse to wear masks in the clinic and urge persons who enter the clinic wearing masks to remove their masks,” “regularly tells his patients that masks are ineffective in preventing the spread of COVID-19 and should not be worn,” and “further asserts that, because virus particles are so small, they will pass through the recommended N95 masks and most other face coverings people are choosing to wear,” while directing “patients to a YouTube video providing false information about mask wearing.” The order further notes:

On December 2, 2020, a Board investigator visited Licensee’s clinic and observed: neither patients nor health providers were wearing masks; no screening procedures were in place or being conducted (e.g., taking patient temperatures on or before entering the clinic); no hand sanitizer was available in the waiting area; a sign was posted in the public area of the clinic with “warning signs” of CO2 toxicity; an article was posted in the public area of the clinic, with a portion of the article highlighted that claims 94% of the individuals who will experience serious effects of COVID-19 have co-morbidities.

The last bit is a bit of viral COVID-19 disinformation claims that because 94% of COVID-19 fatalities have comorbidities recorded on their death certificates, therefore “only 6%” of those recorded as having died of COVID-19 had actually died of COVID-19, rather than the comorbidities. It’s utter dishonest nonsense, as I explained, that I like to refer to as the “only 6% gambit“. That a physician would so willfully misunderstand how death certificates are filled out and how having comorbidities that might have contributed to one’s death by COVID-19 does not mean that COVID-19 wasn’t the cause of death is shocking, but is an example of a phenomenon that has been all too evident and common this year. Worse, horrible doctor that he is, Dr. LaTulippe even cut a patient loose from his practice for having questioned his disinformation. I also note that the order of suspension also includes a pretty good refutation of Dr. LaTulippe’s nonsense based on science. Let’s just put it this way. Masks are imperfect, but they work (and do not make you sicker), N95 masks the best of all, which is why they are used by those treating COVID-19 patients. Ditto social distancing. Ditto hand washing. Any physician who refuses to follow these practices and encourages his patients not to follow them is practicing medicine so far below the standard of care that it is, in my not-so-humble opinion, malpractice.

2020: The year of physicians spreading disinformation about a pandemic

Doctors like Dr. LaTulippe are just one example of the harm physicians spreading COVID-19 disinformation can do. If Dr. LaTulippe hadn’t drawn attention to himself by speaking at an anti-“lockdown” and antimask rally, he might have been able to go on practicing his substandard, disease-spreading medicine for a lot longer than he did. However, for a doctor to do real damage in a pandemic requires that he become well known and start spreading disinformation that encourages resistance to public health orders, such as mask mandates, the temporary closing of specific businesses where spread of contagion is more likely, and vaccines, when they become available. We’ve seen a sadly large number of examples of this phenomenon this year, starting very early in the pandemic.

I’ve written about the mania over hydroxychloroquine, going all the way back to March. A brief recap is in order. As I discussed in more depth in April, the hypothesis that antimalarial drugs might be effective treatments for COVID-19 originated in Wuhan, China during the early phase of the pandemic in January. There, Chinese physicians reported that none of their 80 patients with lupus erythematosus who were taking hydroxychloroquine went on to become infected with SARS-CoV-2. As a result of that and old in vitro evidence of antiviral activity for the drugs, they became interested in using these antimalarial drugs to treat COVID-19. (Never mind that immunosuppressed patients are exactly the patients most likely to assiduously follow the recommendations of public health authorities during a pandemic.) A number of clinical trials were registered, and, based on anecdotal reports and small clinical trials (nearly all of which are as yet unpublished), in February the Chinese government published an expert consensus recommending CQ or HCQ for patients with COVID-19. Soon after, a number of nations followed suit. By March and April, hydroxychloroquine was part of the protocol used at many hospitals in the US and all over the world, despite the incredible lack of good evidence that it actually worked.

To some extent, this was understandable, even though the abandonment of evidence-based medicine led to an unkillable story about a “miracle cure” that still hasn’t died even though randomized clinical trial evidence has now clearly shown that hydroxychloroquine does not work against COVID-19. The docs in the trenches of the ICUs and ERs were desperate for anything that might work. But then the grifters and quacks jumped on board, encouraged by the horrible “science” on hydroxychloroquine promoted by French researcher Didier Raoult. You’ve probably heard these names: Dr. Vladimir Zelenko, Dr. Mehmet Oz (yes, him!), Dr. Stephen Smith, and many others. Meanwhile, a group of doctors dubbing themselves “America’s Frontline Doctors” (none of whom are actually what I would consider pandemic frontline doctors) started promoting all manner of COVID-19 disinformation, including the claim that hydroxychloroquine is a miracle cure that “they” are keeping from the people.

Among the worst of these doctors, Dr. Stella Immanuel:

I refuse to be chained by fake science. I have successfully treated over 250 COVID patients with HCQ, zpack and zinc. No deaths. All these double blinded studies sponsored by big Phama is fake science.@ProcterMd @richardursomd @realDonaldTrump @dbongino @IngrahamAngle

— Dr. Stella Immanuel MD (@stella_immanuel) July 17, 2020

Dr. Immanuel had her 15 minutes of fame when it came out that she had been known before the pandemic for believing that gynecological problems like cysts and endometriosis are in fact caused by people having sex in their dreams with demons and witches. It’s how she got the nickname of being the “demon sperm” doctor. Among these “frontline doctors” were other quacks and grifters, such as Dr. Simone Gold, who’s also appeared at QAnon rallies.

It’s not just hydroxychloroquine quacks, though. Early in the pandemic a pair of ER physicians made a brief splash promoting dubious epidemiology to downplay the severity of COVID-19. Other physicians who have spread COVID-19 disinformation include Dr. Carrie Madej, who has promoted the myth that the new mRNA-based COVID-19 vaccines will “reprogram” your DNA and are in fact transhumanism. (I kid you not.) How a physician can make it through medical school without understanding some very basic molecular biology (seriously, this is Biology 101 material, people!) that tells us that mRNA vaccines will not alter your DNA, I don’t know, but there you go. Then there’s Dr. Kelly Victory, an ER doctor who’s a veritable cornucopia of COVID-19 conspiracy theories and disinformation. The list goes on and on.

Perhaps the most despicable propaganda being promoted by some physicians is that, because COVID-19 is known to be much more lethal in older people and people with comorbidities such as type 2 diabetes, we should simply, in essence, let the virus rip through the “young, healthy population” and used “focused protection” to keep it from killing the elderly in nursing homes. Yes, I’m referring to the Great Barrington Declaration, a document produced by an epidemiologist, a biostatistician, and a Stanford physician basically advocates doing just that, never mind that it’s impossible to achieve herd immunity without a vaccine, unless you are willing to accept millions of deaths, and then it’s debatable whether it’s possible at all. Basically, the Great Barrington Declaration is a eugenics declaration, the denials of its authors notwithstanding, and a physician was one of the three authors who collaborated with the American Institute for Economic Research (AIER), a right wing think tank advocating “opening up” the economy. Even more sadly, although it is true that there were a lot of fake signatories to the declaration, spoofs done to demonstrate how lax the website’s procedure for signature verification was, it is also true that a lot of apparently real physicians did sign it. Fortunately, it is also true that a great many also signed the John Snow Memorandum, an excellent refutation to the Great Barrington Declaration. Of note, the physician behind the declaration, Dr. Jay Bhattacharya, later backed off a bit and seemed to be trying to have it both ways.

Arguably the absolute worst example of a physician behaving badly during a pandemic is Dr. Scott Atlas, who rose to prominence advising President Trump on his coronavirus response during the summer. Atlas is a neuroradiologist and, so it seems, a formerly well-respected one, having served as the chief of the neuroradiology section at Stanford University. Unfortunately, later he became a political hack working for the Hoover Institution at Stanford, a conservative think tank that’s been a font of bad takes on COVID-19. The reason Dr. Atlas so quickly gained Trump’s ear even though he had no relevant expertise in infectious disease, epidemiology, or public health, of course, is because told Trump what he wanted to hear, that COVID-19 was not deadly, that we could achieve herd immunity, and that the cost of the “lockdowns” was far worse than the “disease” of COVID-19 being addressed. Perhaps his most infamous moment was when he Tweeted:

Atlas had criticized Michigan’s new Covid-19 restrictions in a tweet shortly after they were announced Sunday evening, writing, “The only way this stops is if people rise up.”

“You get what you accept. #FreedomMatters #StepUp,” he said.

The message — which runs counter to the consensus of public health officials — immediately fueled new tension between the White House and Michigan Democratic Gov. Gretchen Whitmer, whom federal and state officials announced last month was the target of an alleged domestic terrorism kidnapping plot.

Unsurprisingly, Dr. Atlas was entirely on board with the Great Barrington Declaration, and, as a result, in October the Trump administration was seriously considering a herd immunity-based strategy before there was a vaccine. Truly, when the history of the pandemic is finally written with the perspective of a decade or two from now, Dr. Atlas will likely end up being one of the worst of the worst in terms of physicians promoting misinformation, largely because of his outsized influence in the Trump administration before he finally—and mercifully—resigned a few weeks ago, when it finally became absolutely clear that Trump’s legal challenges of the election results would fail and that there would be no second Trump administration, at least not in 2021.

Again, I could go on and on and on and on. The most recent wrinkles that keep surfacing are the promotion of ivermectin as a cure-all using exactly the same arguments and tactics (something I do need to write about in 2021 if it remains relevant) and doctors spreading fear, uncertainty, and doubt about COVID-19 vaccines, a task that physicians who were antivaccine before the pandemic have leapt on with enthusiasm.

What do we do about doctors spreading disinformation during a pandemic?

This post has been a litany of doctors behaving very, very badly in 2020. As the year lurches to a close, that leaves the question: What can be done about these doctors in 2021? As I like to say, crises reveal character. So while this crisis has revealed a whole lot of good character among physicians and other healthcare providers, as evidenced by the number of physicians who’ve worked so hard for so long and sacrificed so much to save lives and try to ease suffering during the pandemic, sometimes at considerable risk to themselves of being infected with coronavirus, it’s also revealed a whole lot of bad character in doctors. You’ve seen it. I and my fellow SBM bloggers have written about it. These are the ideologues who’ve let their personal belief systems override science, the grifters, the science deniers, and the quacks.

Physicians are, of course, humans beings like any other. What that means is that we are just as prone to the errors in thought to which all humans are prone, including logical fallacies, confirmation bias, confusing correlation with causation, etc. Similarly, we as a group are just as prone to letting political, ideological, and/or religious beliefs influence their actions as anyone else is. I wish it were otherwise, but it clearly isn’t.

Finally, although I sometimes get some outraged blowback from my colleagues when I say this, it must be emphasized that most physicians are not scientists, and that’s OK. Most physicians don’t need to be scientists to do their jobs well and take good care of patients. I view our profession as more of an applied science, like engineering, than pure scientific research. Medicine should be, as this blog has long advocated, based in science, even if it isn’t itself a science. Having seen both sides, as an MD and a PhD, I think I can safely say this. Unfortunately, society tends to give a lot of deference to the scientific opinions of physicians, whether that deference is observed. Regular readers might remember that I used to write a lot about physicians who deny evolution; i.e., creationist physicians. So did Steve Novella. One such physician in particular comes to mind, a neurosurgeon named Dr. Michael Egnor, whom I long ago dubbed the Energizer Bunny of antievolution. So epic was his misunderstanding of evolution that a term was coined for it: Egnorance. But it wasn’t just evolution; Dr. Egnor also promoted dualism, much to Steve’s annoyance as a neurologist.

The reason that I’m bringing Dr. Egnor up again after all these years is simple. Not only was he a prime example of how easily even well-respected physicians could fall into pseudoscience when they wandered out of their area of expertise, but he also demonstrated absolute faith that medical practice keeps physicians from being so spectacularly wrong, or, as he once put it, “…medical practice is a very effective check on b.s., because in medicine ideas often have immediately obvious consequences.” My response was:

Actually, those who have been regular readers of this blog almost certainly realize that Dr. Egnor holds far too high an opinion of the utility of medical practice as an “effective check on b.s.” In fact, it is science that serves as a “very effective check on b.s.,” not medical practice. Indeed, I’ve argued that time and time again. Yes, it’s true that science is often wrong, that sometimes it takes a maddenly long time for incorrect paradigms to be overthrown by new experiments and observations, and that the process of correcting accepted scientific dogma with hypotheses that more closely fit the data and make better corrections can be incredibly messy viewed from the outside, but science is inherently self-correcting. Eventually, b.s. is cast out. Not so when it comes to pseudoscience like ID creationism and–yes, you knew I’d mention it eventually–unscientific medical practices.

After all, what is the whole concept of “complementary and alternative medicine” (CAM) but incredibly concentrated b.s.; yet medical practice seems to have no effect preventing so many physicians to believe in a variety of unscientific and ineffective treatments. Indeed, unscientific CAM has infiltrated bastions of scientific medicine, such as Yale, Beth Israel, and others. Medical practice didn’t stop Dr. David Katz or Dr. Andrew Weil from falling into pseudoscientific woo. It certainly didn’t stop Dr. Jay Gordon from deciding that his clinical experience leading him to believe that vaccines cause autism trumps the strong science and epidemiology that say they do not, from making brain-meltingly ridiculous claims that there are “toxins” in vaccines that cause all sorts of terrible complications, or even giving speeches to rallies organized by people and groups who are antivaccine. He even exasperates the normally mild-mannered Steve Novella.) Practicing medicine didn’t stop any of these people from diving headlong into pseudoscience, even in areas directly related to their medical practice.

If anything, the COVID-19 pandemic has reinforced my opinion, first stated 12 years ago, that medical practice itself is a sadly weak check on BS, particularly when the medical system is stressed. Just look at the list of examples that I’ve discussed in this post and realize that there are many more that I could have discussed if I didn’t mind having this post balloon up to 10,000 words or more. The point, of course, is that all too often we physicians view ourselves as relatively immune to being led astray by “BS”, certainly far more so than others. It is that arrogance that leads to doctors like Dr. Scott Atlas pontificating on areas of medicine that he doesn’t understand and then portraying himself as Galileo when criticized for it. Don’t believe me?

Here you go:

https://twitter.com/ScottWAtlas/status/1308581495959965698

Little did I realize 10-15 years ago how dangerous this tendency among some doctors would become, although I should have recognized it given how many times I encountered the Association of American Physicians and Surgeons (AAPS), which, I suspect, has been behind some of the astroturfing of hydroxychloroquine but has definitely been pushing the “casedemic” conspiracy theory that claims that it is false positives due to too-sensitive PCR testing that is giving the appearance of a pandemic, along with other disinformation and conspiracy theories.

Personally, I’m hardening in my opinion that it is appropriate for medical boards to investigate doctors like these, but at the same time I do recognize that there are a lot of problems with taking this course. First, state medical boards are notoriously toothless. Think about it. How many times has the Texas Medical Board gone after Stanislaw Burzynski over the last 40+ years and failed? Or what about the quack whose friendship with the town sheriff led to the identification of the nurses who complained about him and their suffering severe professional and legal consequences as a result? Or what about the neurosurgeon who can’t operate and injured many patients? Or what about the oncologist who administered chemotherapy to patients without cancer and administered medically-unnecessary chemotherapy to patients with cancer? So bad was his behavior that a nurse interviewing for a job noticed that the chemotherapy was being mixed up incorrectly and complained to the state medical board with no result. This oncologist was only brought down when the feds investigated massive Medicare fraud. Given the fusion of pro-Trump, right wing politics with COVID-19 disinformation, it’s not uncommon that doctors like the ones I’ve described align with Trump supporters and are likely to be painted as martyrs (as Dr. LaTulippe was) when medical boards come after them, even more so than Dr. Burzynski’s supporters tried to portray him. The reason is simple. Dr. Burzynski’s supporters were few (albeit vocal). Trump supporters are numerous and supported by a whole media infrastructure to get their message out.

Medical boards also need a concrete complaint, and that concrete complaint usually has to be about the actual practice of medicine. The Arizona Board, for example, might list 49 definitions of unprofessional conduct, but try fitting spreading COVID-19 disinformation into any of them.

The bottom line is that state medical boards tend to be toothless, underfunded, and overwhelmed. That’s why the only physician behaviors very likely to result in strong action consists of running a prescription mill, sexual improprieties with patients, or practicing while impaired due to abuse of alcohol or illicit substances. It’s a matter of resource allocation and prioritization. State medical boards tend to react primarily to what they perceive to be the most immediately and obviously dangerous behaviors. Practicing quackery rarely makes the cut, because medical boards are loathe to make value judgments about medical practice, and proving quackery is way harder and more resource-intensive than proving a doctor is an addict practicing while impaired or that he’s diddling patients. Even horrible surgeons like Dr. Duntsch, whose epic incompetence in the operating room resulted in multiple “clean kills” and so-alarmed colleagues that they actually took the rare action of complaining about him, all too often take a long time to take down. On the other hand, the pandemic might very well change the perception of state medical boards regarding the harm being done by misinformation and disinformation. Also, as was the case with Dr. LaTulippe, any physician who is publicly spewing anti-public health, COVID-19 denying disinformation is almost certainly also not practicing good medicine with respect to infection control practices during a pandemic, just as Dr. Thomas’ public promotion of antivaccine disinformation was accompanied by substandard medical care.

The bottom line is that practicing medicine is a privilege, one of the highest privileges society can grant to any human being. It is not a right. Unfortunately, all too often the law treats it more like a right, with state medical boards being loathe to strip quacks and other doctors practicing inarguably substandard medicine of their privilege to practice. That needs to change, and that change needs to include stopping physicians from abusing the privilege of their profession to spread disinformation that kills, as too many physicians did in 2020 and, sadly, are likely to continue to do in 2021.