A little over a month ago, I wrote about how the Federation of State Medical Boards (FSMB) had recently issued a statement asserting that physicians who spread COVID-19 misinformation should be subject to disciplinary measures by their state medical boards up to and including revocation of their medical licenses. Given that there have been some developments on that front since then, I thought that now would be a good time for an update and a bit more discussion on the general issue of what should be done about physicians who promote misinformation not just about COVID-19 and COVID-19 vaccines, but medical misinformation, antivaccine conspiracy theories, and pseudoscience in general. At the time of my original post, I expressed major skepticism that the FSMB’s statement would result in any action. The situation is perhaps not as bad as I had predicted then, but it’s also not so great, either.
In that post a month ago, I started by pointing out how many physicians had been behaving badly since the pandemic began 18 months ago. That was just in 2020. In 2021, the prominence (and, I fear, number) of physicians promoting health misinformation has only continued to increase—and not slowly, either. In addition to the usual suspects jumping onto the COVID-19 misinformation grift train (several of whom were ultimately dubbed the “Disinformation Dozen“), there were academics who really should know better downplaying the pandemic and doubting the effectiveness of vaccines. Dr. Jonathan Howard even went so far as to point out how some of them have gotten to the point where, even though we know they are not antivaccine, their bloviations need to be fact-checked as though they were antivaccine. Again, it was no surprise that the usual suspects have been promoting COVID-19 misinformation. Grifters gonna grift, as I like to say, and COVID-19 was an unprecedented opportunity for physicians like Joseph Mercola, Sherri Tenpenny, Kelly Brogan, and the other usual quacks to pivot and switch their grift to the coronavirus and COVID-19 vaccines.
If it had only been the usual quacks and grifters who had jumped on the COVID-19 misinformation fraud train, possibly the situation now with respect to COVID-19 misinformation wouldn’t have deteriorated so much. After all, in contrast to the academics who have turned COVID-19 contrarian, the usual quacks and grifters are at best fringe figures with little influence outside their usual echo chambers. So let’s briefly review some of the messages being promoted by physicians who were once respected doctors and academics who have become what Dr. Howard and I like to call “COVID contrarians”. They minimize the risk of harm from the coronavirus (particularly in children), make risibly off-base predictions (e.g., “we’ll have herd immunity by April“) and advocate against mask mandates (particularly in schools) and vaccinating children—or even erroneously claim that respiratory syncytial virus (RSV) is being misdiagnosed in children as COVID-19 and that hospitalizations of children are being exaggerated. During the recent discussion over myocarditis in children associated with COVID-19 vaccination, none of them seem to be able to acknowledge that COVID-19 actually harms children, while one physician whom I used to respect whose results I used to write about on a regular basis has gone down the rabbit hole of conspiracy theories, repeating a particularly pernicious one dating back to early in the pandemic that early intubation of COVID-19 patients was killing them. That physician, Dr. John Ioannidis, even went to far as to say that doctors, “not knowing how to use mechanical ventilation, just going crazy, and intubating people who did not have to be intubated”. (Spoken like a doc who has never taken care of critically ill patients in an ICU!) And don’t even get me started on the physicians who wrote and signed on to the Great Barrington Declaration, the pre-vaccine statement that advocated letting COVID-19 rip through the “healthy” young community and using “focused protection” to keep the elderly and those at high risk of severe disease and death safe from the coronavirus.
Worse, when corrected for their mistakes, these “COVID contrarians” almost never seem to have the humility to admit error and move on; often they double down and act as though their statements were never refuted. Indeed, they often characterize criticism as “cancel culture” and loudly claim victim status whenever their efforts encounter serious pushback. We’ve recently seen an excellent example of just that from recent discussions of the VAERS analysis looking at myocarditis after COVID-19 vaccination in teens by Tracy Beth Høeg, John Mandrola, Josh Stevenson, and Allison Krug that utterly misused the VAERS database and didn’t put the findings into context. Predictably, they and their defenders are crying “Persecution!” and blaming the blowback on “medical tribalism“. So what’s new?
The medical boards in Mississippi and Washington weigh in
A week and a half ago, I was made aware of this news story out of Washington, which reported that the Washington Medical Commission can now discipline doctors who spread COVID-19 misinformation:
Doctors and physician’s assistants who spread misinformation about COVID-19 in Washington could face disciplinary measures. That’s after action taken this week by the Washington Medical Commission, which monitors and enforces licenses of about 34,000 physicians and physician assistants here.
During a special meeting, the commission formally adopted a position statement to that effect. The commissioners agreed unanimously that the treatment of COVID-19 must meet the same standard of care as other diseases.
That’s after reports of a surge in unsafe alternative treatments such as ivermectin, an anti-parasitic drug often used in animals. It has off-label approval for human use in limited circumstances, but both the CDC and the FDA say there’s no convincing evidence it works to prevent or treat COVID-19.
The State of Mississippi has also made a move in the same direction:
Physicians who spread misinformation about the COVID-19 vaccine could now have their license to practice medicine suspended or completely revoked, according to a new policy adopted by the Mississippi State Board of Medical Licensure.
The policy, adopted on Sept. 7, says that doctors have an “ethical and professional responsibility” to practice medicine in the best interest of their patients and share factual and scientifically-grounded information with them.
“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 policy reads.
The policy says whether physicians “recognize it or not” they possess a high degree of public trust due to their specialized knowledge and training. That gives them “a powerful platform in society.”
The policy specifically warns doctors against spreading misinformation on social media and strongly recommends physicians separate their personal and professional content online.
“Physicians must understand that actions online and content posted can affect their reputation, have consequences for their medical careers, and undermine public trust in the medical profession,” it reads.
This is a step in the right direction, although I do wonder how these new policies in Washington and Mississippi will be operationalized. Why do I wonder this? The article about the Washington Medical Commission alludes to it, but doesn’t quite get to the point where we at SBM have been for a while:
Dr. Yanling Yu, a research scientist from Lake Forest Park, serves as a public member of the commission. She expressed initial concern about following state law that protects alternative medicine, but then spoke in favor of the position statement on misinformation.
“There is no valid science at all. … Like, ivermectin, there have been patients that have been harmed by it. So that is not scientific practice of medicine. And that needs to be stopped,” Yu said.
And there you have it, the exact issue that I’ve been writing about for well over a decade, the powerlessness of state medical boards in the face of quackery. Let’s take a trip down memory lane to explain what I mean.
COVID-19 misinformation and alternative medicine
Out of curiosity, I perused this blog to search for the first instance when I wrote at length about the problem with state medical boards and found that it was in 2008, when the North Carolina Board of Medical Examiners finally disciplined cancer and autism quack Dr. Rashid Buttar (who, unsurprisingly, is today one of the usual quacks and grifters promoting COVID-19 and COVID-19 misinformation). Unsurprisingly, all Dr. Buttar got was the proverbial slap on the wrist, even after having called the Board a “rabid dog“. All the Board did was to restrict Dr. Buttar’s practice so that he was no longer permitted to treat children or cancer patients. Why children and cancer patients specifically? Simple. Dr. Buttar had been known for his antivaccine views that blamed mercury in the thimerosal preservative in vaccines caused autism, and his treatment was a “transdermal chelation therapy” that we disparagingly called “Buttar’s butter“, and he was a cancer quack, to boot.
Two years later, Dr. Buttar was free to practice medicine again mostly unencumbered. Basically, he signed a consent decree with the Board that reprimanded him and ordered him (1) to provide informed consent to his patients as dictated by the Board; (2) to obey all laws, as well as rules and regulations governing the practice of medicine in North Carolina; (3) to notify the Board if he changes his address; and (4) to meet with the board periodically. The informed consent forms were utterly worthless, as well. Basically, they stated that Dr. Buttar made no claims for the efficacy of anything that he was doing. It also pointed out that serious complications can occur from IV treatments. As I noted at the time, if I were to use an informed consent like this for surgery, for example, in which I “make no specific claims” that the proposed surgery will do anything therapeutic for the patient, sane practitioners would demand to know why I was allowed to do this operation in the first place!
Of course, Dr. Buttar was one of many examples of the failure of state medical boards to discipline outright quacks and antivaxxers. Worse, in one state, whistleblowers who have reported dubious practices of physicians have even been prosecuted by law enforcement, as I described in depth in 2009. The state was Texas, the same state whose medical board has been unable to shut down the practice of Houston cancer quack Dr. Stanislaw Burzynski, who has been plying his cancer quackery there since the late 1970s. Then there’s the case of Dr. Christopher Duntsch, the substance abuse-impaired neurosurgeon who was so incompetent that his fellow surgeons had seen nothing like it before. As I’ve mentioned recently Duntsch is now the subject of a Peacock series Dr. Death. My own state is not immune. This might have nothing to do with alternative medicine, but it took the FBI, not my state medical board, to finally stop Dr. Farid Fata, the oncologist who gave chemotherapy to patients who didn’t even have cancer. How did they stop him? They busted him for Medicare and Medicaid fraud for having billed over $30 million for unnecessary treatments.
You get the picture.
It’s worse than that, though. As Jann Bellamy and others at a favorite blog of mine have been documenting, quacks like naturopaths, chiropractors, and other alternative medicine practitioners have been playing the long game of pushing to change state laws to legitimize their “professions.” She even has a term for it: legislative alchemy, the process in which quacks try to turn the lead of their professions into gold. She’s long documented the process for chiropractors, naturopaths (among the most persistent and successful of the legislative alchemists), acupuncturists, reflexologists, and practitioners of “integrative medicine” who “integrate” quackery with their medicine. These bills take the form of promoting bills mandating formal state licensure, expanding quacks’ scope of practice, and requiring Medicare and insurance companies to reimburse quacks for their “services”. In Florida, a new law even forces doctors who don’t support alternative treatments for pain to endorse acupuncture and other quackery as “non-opioid treatments” for pain.
This brings me back to the State of Washington. Remember how that one quote expressed concern about how the state could police physicians promoting COVID-19 misinformation when it has a law on the books that protects “integrative” (and therefore alternative) medicine practitioners? Remember how I discussed how North Carolina handled the case of Dr. Buttar? One thing I didn’t mention then but will mention now is this, quoted from a story that is no longer on the web (and not in the almighty Wayback Machine at Archive.org), although the relevant parts are preserved in my post:
The consent order, signed Friday, marks the end of a battle that Buttar had vowed to take to the U.S. Supreme Court. He said he has spent “hundreds of thousands of dollars” defending himself against the board’s allegations that he exploited patients by charging exorbitant fees for unproven therapies that didn’t work and by arbitrarily ordering expensive tests to make more money.
In recent years, Buttar led a successful effort by the N.C. Integrative Medical Society to get legislators to change state law to make it friendlier to practitioners of alternative medicine.
This is another example of “legislative alchemy”, in which influential quacks manage to persuade state legislatures to pass laws protecting “alternative medicine” practices. So what is the relevance to the ability of, for instance, the Washington Medical Commission? Simple. As we’ve documented here time and time again, if there’s one consistent aspect of alternative medicine (besides its lack of science), it’s antivaccine views. Naturopaths, chiropractors, and acupuncturists, for example, tend to be overwhelmingly antivaccine, and many even deny germ theory. If their views are “protected” somehow by state law, that would put these new directives allowing state medical boards to discipline physicians for spreading COVID-19 misinformation into direct conflict with the laws protecting “alternative and traditional” medical practices.
So here’s what I mean when I ask: How will, for example, the Washington Medical Commission operationalize this new policy, particularly if it conflicts with a law that protects alternative medicine practice? For example, if a doctor promotes germ theory denial and antivaccine views about COVID-19 under the guise of “integrative medicine” citing acupuncture (licensed) and naturopathy (also licensed), how can the Washington Medical Commission do anything about it? The state of North Carolina has also suggested that it might discipline doctors who promote COVID-19 misinformation, but how will it do so when its own law privileges alternative medicine (hidden in “integrative medicine”) almost as much as science-based medicine, thanks to the efforts of Dr. Buttar and his fellow quacks? This is a general principle that applies to any state that has legalized forms of “alternative medicine,” not just Washington or North Carolina.
That’s aside even from the consideration of where to draw the line in terms of professional speech. While it’s obvious that saying, for example, that COVID-19 vaccines don’t work is misinformation or disinformation, what about physicians who not-so-subtly raise doubts about the vaccines that rely on leaving out key pieces of information? One way has been proposed in an op-ed by doctors, a couple of whom should be familiar to regular readers here:
It’s important to understand that the wrongdoing involved is not misinformation — that is, something that a person incorrectly but innocently believes to be true. It is disinformation, which is information created and shared with the intent to deceive. For many months a well-coordinated network of disinformation doctors has been working to undermine mask-wearing and lockdowns, spread anti-vaccine conspiracy theories, and promote phony covid “cures” such as hydroxychloroquine and the horse-deworming drug ivermectin.
The best known of these groups calls itself “America’s Frontline Doctors” — though many physicians in this group have never practiced emergency medicine, and some haven’t practiced any form of medicine for years. Amid the Trump administration’s disastrous handling of the pandemic, this group was ushered into the public arena to discredit medical science. They began by trying to convince Americans that the potential for severe illness from covid-10 was a hoax, in the interest of keeping the U.S. economy open and thus fueling Donald Trump’s reelection campaign. Through their social media platforms and rallies, they continue to sow distrust of the Centers for Disease Control and Prevention and dissuade their audiences from following public health guidelines. In January, the group published a white paper denouncing vaccines. Its members have held rallies to spread their message in states including Florida, Texas and California — all of which are now experiencing covid spikes. Now, with the delta variant, those cases include a large number of very sick children.
They further note:
But these physicians will not be dissuaded by strongly worded statements. Consider Simone Gold — a California physician and noted advocate of the hydroxychloroquine “cure.” In 2020 she was one of the founders of America’s Frontline Doctors; today, as NPR reported, Gold continues to spread disinformation, discourage vaccination and promote unproven treatments for covid (for which, NPR noted, she was offering to prescribe via a $90 telehealth appointment). She was arrested after Jan. 6, when she participated in the incursion into U.S. Capitol, having come to Washington that day to speak at a “rally for health freedom.” Simone Gold is still licensed to practice medicine in the state of California.
The pessimist in me wonders if even losing their licenses would dissuade some of these doctors, many of whom seem not to be in medical practice any more, having gone into full time COVID-19 grifting. On the other hand, if their state medical boards were to yank their licenses to practice, then at least they wouldn’t be able to function as ivermectin prescription mills any more. The doctors behind the op-ed cited above have gone beyond an op-ed and set up a website for reporting the worst disinformation peddlers, No License for Disinformation.
Let me finish on a more optimistic note. I’ve long said that professional speech is not the same thing as free speech. Specifically, we as physicians have a privileged status that is highly respected when it comes to our statements on medical matters (and, oddly enough, even on nonmedical matters, as nonsensical as that may seem). As a result, we have a particular professional responsibility not to spread misinformation, and professional ethics demands that we do not publicly promote quackery or disinformation. State medical boards should be enforcing this, but traditionally have not, just as they have been very reluctant to discipline outright quacks. They are understaffed and underfunded, which tends to disincentivize going after any but the most straightforward cases, such as doctors running prescription mills, sexually abusing patients, or suffering from substance abuse problems that impair their ability to practice medicine safely. Traditionally, they’ve been reluctant to engage in judgment calls on anything other than the rankest of quackery, and even then, as in the case of Dr. Burzynski, their track record is uneven at best. Policing professional speech about COVID-19 will be even more difficult.
Even so, given the harm that physicians promoting misinformation cause, this is something that state medical boards need to undertake. If there could be one good outcome from the pandemic, it would be enhanced power of state medical boards to discipline physicians promoting medical misinformation and disinformation of all kinds, not just about COVID-19 or COVID-19 vaccines. As No License for Disinformation puts it, “Everyone has the right to an opinion. Doctors, however, are bound by an ethical and legal obligation to do no harm”. Physicians promoting misinformation and disinformation betray that obligation.