Long before the COVID-19 pandemic hit, I not infrequently went on record arguing that physicians who promote antivaccine misinformation should lose their license to practice medicine. The most recent example I could find occurred nearly a year before things started shutting down due to COVID-19, when I noted the case of Dr. Larry Palevsky, who had recently spoken at a rally opposing vaccine mandates issued in response to measles outbreaks that had been occurring due to low MMR vaccine uptake. (Truly it was a simpler—and far less lethal—time two years ago.) At the time, I argued that antivaccine physicians, particularly antivaccine pediatricians like Dr. Palevsky, should be subject to sanctions by their state medical boards, up to and including losing their license to practice medicine. Before that, I had applauded the Medical Board of California for having suspended the license of Dr. Robert Sears (who like to go by “Dr. Bob”) for deficiencies in practice related to vaccination, among other things), having said at the time action was first taken that “it was about time” and then approving of the sanctions the board finally issued, while lamenting that, not only did Dr. Bob get off easy, with just a suspension of his license, but he was being defended with massive false balance.
What Dr. Bob did wrong and why the Board sanctioned him can be found previous posts by yours truly here and here, Skeptical Raptor, and others. The CliffsNotes version is that there was a case where he handled the complaints of a child with severe headaches after having been hit in the head…poorly. He also granted a nonmedical exemption to school vaccine mandates to a child based on non-science-based reasons and failed to keep adequate records. Personally, at the time, I was surprised that what got Dr. Bob’s license in trouble was mostly the case of the child with head trauma, given that he had started profiting by offering seminars on how to avoid vaccine mandates and providing bogus nonmedical exemptions to school vaccine mandates beginning almost as soon as SB 277, the California law that eliminated nonmedical exemptions, was passed in 2015.
In light of this history, I was happy to see that the Federation of State Medical Boards (FSMB) had issued a statement on physicians who promote COVID-19 misinformation and disinformation:
Physicians who generate and spread COVID-19 vaccine misinformation or disinformation are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license. Due to their specialized knowledge and training, licensed physicians possess a high degree of public trust and therefore have a powerful platform in society, whether they recognize it or not. They also have an ethical and professional responsibility to practice medicine in the best interests of their patients and must share information that is factual, scientifically grounded and consensus-driven for the betterment of public health. Spreading inaccurate COVID-19 vaccine information contradicts that responsibility, threatens to further erode public trust in the medical profession and puts all patients at risk.
The FSMB is, as its name implies, the organization made up of state medical boards, described thusly:
The Federation of State Medical Boards represents the state medical and osteopathic regulatory boards – commonly referred to as state medical boards – within the United States, its territories and the District of Columbia. It supports its member boards as they fulfill their mandate of protecting the public’s health, safety and welfare through the proper licensing, disciplining, and regulation of physicians and, in most jurisdictions, other health care professionals.
With this mission:
The FSMB serves as a national voice for state medical boards, supporting them through education, assessment, data, research and advocacy while providing services and initiatives that promote patient safety, quality health care and regulatory best practices.
The fact that the FSMB issued such a statement stating that physicians spreading misinformation and disinformation about COVID-19 risk disciplinary action is a big deal, at least to me. However, my enthusiasm and approval are tempered by my knowledge of how state medical boards actually operate. They are, in general, underfunded, have inadequate resources, and can only act when they receive a complaints about specific instances of poor practice or patient injury. Indeed, when a state medical board actually does act against an antivaccine physician (for instance), its penalties are often minimal, as was the case for Dr. Bob Zajac in Minnesota.
Indeed, I’ve long lamented how rare it is for a state medical board to suspend or revoke the medical license of outright quacks and how difficult it has been on the occasions when a state has tried. One good example that I like to cite is cancer quack Stanislaw Burzynski, who has been practicing his cancer quackery in Houston since the late 1970s and, despite the occasional attempt of the Texas Medical Board to put a stop to his activities, has managed to prevail, with only minor impediments placed on his ability to practice, leading me to lament, “How is it that in 2018 cancer Stanislaw Burzynski is still preying on desperate cancer patients?“
Elsewhere, I’ve discussed the problem before a number of times. The problem is that state medical boards tend to be reluctant to go after doctors who use unscientific treatments like “detoxification” and colon cleanses because it forces them to enforce a standard of care, because such cases are harder to prove, and because there is so much pushback. State medical boards are generally good at going after doctors who commit easily identified, clear-cut breaches in trust, such as substance abuse, defrauding insurance companies, or diddling patients. When it comes to making judgment calls about doctors practicing outside of the standard of care, they’re a lot more reluctant to do so. 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 tend to be loathe to make value judgments about medical practice, and proving quackery is way harder and more resource-intensive than proving that a doctor is an addict who has been practicing while impaired or has sexually abused patients.
Even horrible surgeons like Dr. Christopher Duntsch, whose epic incompetence in the operating room resulted in multiple “clean kills” and paralyzed patients, to the point that his bungled operations so alarmed colleagues that they actually took the rare action of complaining about him, all too often take a long time to take down. Ultimately, Dr. Duntsch, who had major substance abuse problems in addition to his epic incompetence in the operating room, finally did lose his medical license and is now serving a life sentence in a Texas prison for multiple counts of aggravated assault relating to 33 botched surgeries over two years, including two that resulted in patient death. Indeed, Dr. Duntsch’s case was so remarkable that he is now the subject of an eight part series on Peacock entitled Dr. Death: The Undoctored Story:
The good thing about the case of Dr. Duntsch is that doctors as sociopathic as he was are rare. The bad thing about the case is that it took a really long time for his colleagues (who knew his reputation and had had to try to salvage his disastrous complications) and the Texas Medical Board to act.
Which brings us to COVID-19 misinformation, which can kill.
I previously discussed the case of Dr. Steven LaTulippe, whose license was suspended by the Oregon Medical Board for having 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. The order also noted 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.” At the time, I approved, but didn’t think the order went far enough. Just a suspension of Dr. LaTulippe’s license just didn’t seem to go far enough given his irresponsibility and spreading of COVID-19 misinformation.
The problem, of course, is the sheer number of physicians who have fallen under the spell of COVID-19 and antivaccine conspiracy theories, starting in 2020. It started with hydroxychloroquine and other “miracle cures” for COVID-19 and degenerated from there. 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. Now, many of the same doctors (plus others who, to their initial credit that didn’t last, didn’t jump on the hydroxychloroquine bandwagon last year) are promoting ivermectin.
Also, unsurprisingly, there are physicians who were not at all happy to see the FSMB statement. Even less surprisingly, it’s the Association of American Physicians and Surgeons (AAPS), a far right wing medical John Birch Society camouflaged as a legitimate medical professional society. I’ve written about the AAPS a number of times, relating how it’s promoted antivaccine pseudoscience blaming vaccines for autism, including a view that is extreme even among antivaccine activists, namely that the “shaken baby syndrome” is a “misdiagnosis” for vaccine injury. It’s worse than that, though. AAPS has promoted HIV/AIDS denialism, blamed immigrants for crime and disease, promoted the pseudoscience claiming that abortion causes breast cancer using some of the most execrable “science” ever, and not only rejected evidence-based guidelines as an unacceptable affront on the godlike autonomy of physicians; the very concept of a scientific consensus about anything. Let’s just put it this way. The AAPS has featured publications by antivaccine mercury militia “scientists” Mark and David Geier and many others. Unsurprisingly, in the age of COVID-19, the AAPS has seamlessly pivoted to COVID-19 denial, antimask nonsense, and antivaccine conspiracy theories.
The title of its protest of the FSMB statement? As you might expect, Dr. Tamzin Rosenwasser’s article is entitled The Federation of State Medical Boards Channels the Soviet NKVD. (I suppose I should be grateful that Nazis weren’t mentioned, at least in the title.) After quoting the FSMB statement, Dr. Rosenwasser goes all anti-Communist, consistent with the AAPS’s similarity to a medical John Birch Society:
The FSMB has been described as a “private lobbying organization that represents the state’s attorneys who work for medical boards.” It does not by itself have the legal authority to take a doctor’s license but is highly influential.
The NKVD, the People’s Commissariat for Internal Affairs, was the Soviet secret police agency, the precursor to the KGB.
No subtlety there, is there? It gets even less subtle. Dr. Rosenwasser invokes Ignaz Semmelweis (of course!) and the example of Barry Marshall and Robin Warren, who in the 1980s discovered that most peptic ulcer disease was due to a bacteria, Helicobacter pylori, which went against the prevailing medical consensus of the day. I applaud Dr. Rosenwasser from resisting the urge to invoke Galileo. That shows some major restraint, perhaps more so than not invoking Nazis. Oh, wait, she did go there:
To coerce people to be vaccinated against their will violates the Nuremberg Code. Did we not once have an actual meeting of minds that the things done by doctors in Germany at the direction of that National Socialist government warranted the Nuremberg Code, designed to prevent any recurrence of such medical experiments?
Was there a consensus in Germany in the 1930s and 1940s that Jewish, Romany, and Slavic peoples were a disease on the superior Aryan race? Was that consensus enforced by fear? Was there also a consensus that Jehovah’s Witnesses, Catholic priests, and Lutherans like Dietrich Bonhoeffer who did not agree with that consensus were to be tortured and executed along with the people they defended?
Is there now a consensus among all 50 States that physicians are to be muzzled, silenced, and have their lives destroyed in case they do not agree with the new NKVD?
It always amuses me how the AAPS can’t seem to understand the difference between Communism, socialism, and fascism, but whatever. Also, as I’ve pointed out before, the Nuremberg Code does not apply to vaccine mandates or COVID-19 vaccines, but rather is a thinly veiled Godwin designed to portray vaccine advocates as Nazis.
But back to Semmelweis and Marshall and Warren. The resistance to Marshall and Warren is often vastly exaggerated for effect when they are invoked for this purpose. In reality, their findings were accepted quickly when you come right down to it. In brief, as I’ve discussed before, Marshall and Warren first reported a curious finding of what they described as “unidentified curved bacilli on gastric epithelium in active chronic gastritis” (not ulcer) in two letters to The Lancet, published on June 4, 1983. They reported that it wasn’t seen using traditional staining methods and suggested that they might be associated with gastritis. By 1992, multiple studies had been published establishing the causative role of H. pylori in peptic ulcer disease, and medical practice rapidly changed. That’s less than ten years, which, given how long it takes to organize and carry out clinical trials, is amazingly fast. Yet somehow a favorite AAPS-style myth is that “dogmatic,” “close-minded” scientists refused to accept Marshall and Warren’s findings. In actuality, H. pylori as a major cause of gastric and peptic ulcer disease is, in reality, an example of an old scientific consensus that deserved to be questioned, was questioned in the right way, and was overthrown rather quickly.
As for Semmelweis, whose evidence that the simple act of handwashing before delivering babies was very effective at dramatically lowering the incidence of life-threatening prevent puerperal fever was rejected by most of his fellow physicians in Vienna 160 years ago in one of the most shameful episodes in medical history, I can say one thing with great confidence. Neither Dr. Rosenwasser, the AAPS, nor any of the other quacks promoting COVID-19 misinformation is another Semmelweis, or anything resembling Semmelweis. (I also note that Semmelweis’ story is a bit more complex than the version that is usually recounted by people like Dr. Rosenwasser in that Semmelweis’ findings were more favorably viewed in other countries, such as the UK and his results were long understood because of his reluctance to publish them, leading to their being spread through secondhand reports.)
Unsurprisingly, Dr. Rosenwasser can’t resist including standard antivaccine talking points in her article:
Now, we have an experimental vaccine for a disease with a greater than 99 percent survival rate except in patients who are over 70 years old or have comorbid conditions. Though it is available only under an Emergency Use Authorization, people are under intense pressure to receive it. Severe side effects have occurred in some recipients: myocarditis in more than 3,000; Guillain-Barré syndrome in more than 450; bleeding and clotting disorders in about 2,000; and death in more than 11,000. But mass vaccination is apparently consensus-driven.
If you have any doubt that the AAPS is antivaccine, just look at that paragraph. It recycles all the standard antivax talking points about the COVID-19 vaccine, such as the claim that it is experimental, which conflates a legal definition of a drug or vaccine that hasn’t yet achieved full FDA approval with a scientific definition. (By any reasonable scientific definition, vaccines that have undergone multiple phase 3 clinical trials and been administered to two billion people with an excellent safety record are no longer “experimental.”) Then there’s the dishonest appeal to the Vaccine Adverse Events Reporting System (VAERS) database, which deceptively ignores the baseline rates of such complications.
In the end, even as I support the concept of the FSMB’s statement of suspending or revoking the licenses of physicians who promote COVID-19 disinformation and antivaccine misinformation, I have enormous doubt that it will come to anything. State medical boards are constrained by the laws of their state, some of which (I’m talking to you, Texas) treat a medical license, once obtained, more like a right than a privilege, severe underfunding that only lets them go after a medical license in the most egregious cases, and other constraints. Worse, in the age of COVID-19, the entire right-wing COVID-19 disinformation ecosystem, of which the AAPS is a small but influential part on medical matters, will treat any physician whose license is sanctioned by a state medical board as a free speech martyr. I’m glad the FSMB said something about revoking the licenses of physicians who spread misinformation, but I fear that in practice implementing such a policy will be well nigh impossible.
Doctors who are antivaccine and/or promote COVID-19 misinformation often appeal to free speech and portray any attempts by medical licensing bodies, whatever the state or country, to discipline them for their activities as fascistic (or Communist) assaults of “free speech.” Here’s the thing, though. Professional speech is not the same as some random fool on social media saying the same thing. When physicians use the imprimatur of authority that society bestows on them to add the authority of their profession to their misinformation, that is an abuse their status as a physician that during a pandemic can have potentially deadly consequences. Contrary to Dr. Rowenwasser’s ridiculous comparison to the repression carried out by the NKVD and appeal to the Nuremberg Code, it is entirely appropriate for the FSMB to recommend going after the medical license of any physician promoting obvious COVID-19 and antivaccine misinformation and conspiracy theories. That is not suppression of free speech. That is professional oversight. My fear is that nothing will come of the FSMB’s statement, as much as this statement should guide state medical boards in disciplining quacks.