The accelerating war on science-based medical regulation

Add this as another chapter to a series that I really should have called “Everything Old Is New Again”, even if the title grates a bit, coming across as, “I told you so”. I’ve long written about how there’s a war against science-based regulation of doctors’ practice by the states, just as there’s a war against science-based policies regarding drug approval, vaccine mandates, and public health. This war predates the pandemic, and not by a little. For example, previously I wrote about how autism and cancer quack Dr. Rashid Buttar had mobilized public support to neuter the North Carolina Medical Board and prevent it from disciplining doctors who practice quackery associated with “integrative medicine”. This happened 13 years ago. Since then, this war on the regulation of medicine has only accelerated, as I’ve described before a number of times. Unfortunately, last week it became increasingly clear that this war is only accelerating, and it involves old school antivax physicians who have taken advantage of the rise of what I like to refer to as the “new school” antivaxxers who only started promoting antivaccine propaganda after the introduction of COVID-19 vaccines nearly two years ago. It’s gotten to the point where “new school” antivaxxers are becoming increasingly indistinguishable from “old school” antivaxxers.

What reminded me of this is a story published late last month in Vice by Anna Merlan, “Crank Doctors and Their Allies Are Ready for War With the Medical Establishment“. Think of it as Dr. Rashid Buttar calling the North Carolina Board a “rabid dog” 15 years ago when it tried to discipline his “unprofessional conduct” related to his cancer and antivaccine autism quackery, but nationalized and backed by political organizations dedicated to the weakening of government regulation. Before I discuss Anna Merlan’s story and put it into context in my inimitable fashion, let me just go back and quote what Dr. Buttar said in 2007, quoted by The Charlotte Observer and other newspapers:

Armed with complaints from Kenny and three others, the state board accuses Buttar of unprofessional conduct for departing from prevailing medical practice by treating patients with experimental, ineffective therapies and charging “exorbitant” fees. A public hearing is set for Feb. 20, after which the board could reprimand the doctor or revoke, suspend or put limits on his license. Buttar, 41, who has tangled with the board before, denies wrongdoing and vows to retaliate. “I’ve been itching for a fight,” he said. “I’m going to make this into a huge thing. … I told the (state) legislature that the medical board was a rabid dog, and they needed to put it down.”

Also, I’ll remind you of the sort of quackery that Dr. Buttar practiced—and still practices:

But Buttar believes most patients with cancer also have high levels of heavy metals, such as mercury, and other toxins, such as pesticides, because of environmental exposure. “Chelation works for the right things,” he said. “It’s not a panacea. But it works phenomenally well for chronic disease.” Buttar’s practice also has two hyperbaric oxygen chambers — and more on the way. The treatment, which floods the body with oxygen, is commonly used to accelerate wound healing. But Buttar uses it to fight cancer because, he says, cancer cells can’t thrive in an oxygen-rich environment. He acknowledges most of his treatments have not been proven by standard means, such as controlled clinical trials. But he said they have been effective in his practice over 10 years.

The story notes that Dr. Buttar’s therapy for cancer patients ranged from $40,000-60,000 for two months, and, of course, he didn’t take insurance. (Sound familiar? The grift continues, and Buttar is now one of the “Disinformation Dozen“.) Unfortunately, Dr. Buttar’s practice and his war against the North Carolina Medical Board (which he mostly won) was a precursor of what we are seeing today. Basically, he got a slap on the wrist, being temporarily restricted from treating cancer patients and children. The medical board did not do what was really warranted, strip him of his medical license, or, as I described what I thought that he deserved at the time in 2008, “having his medical license stripped from him, cut up in front of his face, and then the fragments ritually burned”.

“You really think it’s all new”

“You really think it’s all new,

“You really think about it too,”

The old man scoffed as he spoke to me,

“I’ll tell you a thing or two.”

The Clash, Something About England

In her article, Merlan reports about two state medical boards, the ones in Ohio and Maine, that are attempting to rein in two different “old school” antivax quacks, Drs. Sherri Tenpenny (who referred to vaccines as “transhumanism” two years before the pandemic and now characterized COVID-19 vaccines as a “method of mass destruction” while claiming that they could magnetize recipients to the point where silverware would stick to them) and Meryl Nass, who used to spread antivax nonsense about Ebola but has pivoted to fear-mongering about COVID-19 vaccines.

As Merlan notes:

“Once I realized I was being used as a poster child in a national fear campaign designed to purge doctors who think independently, I decided to fight back,” Nass wrote in a recent blog on Substack. “Fortunately, Children’s Health Defense is helping with my legal expenses, which is what allows me to mount a strong defense against the bulldozing of free speech, patient autonomy and choice, and the doctor-patient relationship. There is a lot riding on the outcome.” In one sense, Nass is correct: What’s happening to her and Tenpenny is part of a much larger trend, and a brewing, culture-wide showdown. State medical boards and certification bodies face growing pressure to take action against crank doctors, and more and more often, they’re heeding that call. This summer, Kory and Peter McCullough, who have both loudly advocated for discredited COVID treatments, said they were at risk of losing their board certification from the American Board of Internal Medicine. California governor Gavin Newsom recently signed a new law that will make doctors subject to professional discipline if they repeat “false or misleading” medical information to their patients. And the Federation of State Medical Boards recently issued a strongly worded statement and a position paper on the problem of physicians spreading medical misinformation, and the consequences they should face.

It is, of course, nothing new that “brave maverick doctors” (a.k.a. quacks) always portray attempts to discipline them, stop them from committing fraud by misrepresenting ineffective treatments as miracle cures, or otherwise prevent them from endangering patients and others as “tyranny”, “persecution”, and “attacks on free speech”, all while portraying themselves as victims in order to rally support from their supporters (and, of course, raise money). Examples are legion and include the aforementioned Rashid Buttar, as well as cancer quack Stanislaw Burzynski and antivax pediatricians “Dr. Bob” Sears and Dr. Paul Thomas. Indeed, among antivaxxers it’s a strategy pioneered by the godfather of the modern antivaccine movement, Andrew Wakefield when he was struck off (delicensed) in the UK.

So what’s different now? Before the pandemic, quacks and antivaxxers did indeed use investigations and disciplinary actions by state medical boards and the FDA as a tool for fundraising and firing up their supporters. Dr. Buttar even managed to use the disciplinary actions against him in order to rally support to get the law in North Carolina changed to make it far more friendly to quacks. In retrospect, Buttar’s success against the “rabid dog” of the North Carolina Medical Board was a harbinger of things to come. All that was needed was a global pandemic that anti-regulation and anti-government political forces were able to successfully weaponize against laws that empower state medical boards and other regulatory bodies to regulate the practice of medicine, resulting in this:

Anti-vaccine organizations and public figures have proclaimed that they’re outraged by these actions, saying they infringe on free speech and the privacy of the doctor-patient relationship. But they also quite clearly see an opportunity, taking this moment as a chance to grandstand, promote more COVID misinformation, turn the reprimanded doctors into martyrs for free speech, and, above all, fundraise. And they have powerful allies, like Wisconsin senator Ron Johnson, who recently told an anti-vaccine audience he’s in a “guerilla war” against the medical establishment and what he called “woke doctors.” (Johnson complained those doctors “will not question authority, don’t have the courage and compassion to practice medicine. They just follow orders.”) There are also clear signs that medical boards trying to sanction crank doctors is becoming the next major culture war fight. In several states, legislation has been introduced that is aimed at limiting medical board power or explicitly allowing “off-label” treatments—that is, things like ivermectin and hydroxychloroquine— for COVID. (The prescription of drugs outside their intended use, it should be noted, is incredibly common. It’s difficult to imagine what a regulatory regime that would still permit it while barring discredited COVID treatments would look like.) Meanwhile, some medical experts say what medical bodies are doing to respond to the problem of crank doctors isn’t enough. “At this point, I’m disappointed and I’m just pissed,” Nick Sawyer told Motherboard. He’s a co-founder of No License for Disinformation, which was founded to respond to the problem of doctors promoting COVID and vaccine misinformation.

Dr. Sawyer is a mensch, and I commend him for taking this fight on, given the threats and abuse that have been aimed at him since he started trying to shame state medical boards into actually protecting the public from quacks promoting COVID-19 misinformation, quackery, and antivaccine views under their MDs and DOs.

It’s also interesting that Sen. Ron Johnson figures so prominently. Actually, it isn’t.

From “right-to-try” to COVID-19 quackery

Sen. Ron Johnson is actually a key figure here, but not because over the last three years he has become fully antivaccine. Before the pandemic, I used to write about him in the context of promoting a federal “right-to-try” law. I used to write fairly frequently about “right-to-try” laws, which were passed in many states (including, unfortunately, my own), before Sen. Johnson spearheaded a federal right-to-try law, which ultimately passed. In brief, “right-to-try” promises to help patients by allowing patients with terminal illnesses access to experimental therapeutics that have only passed phase 1 clinical trials. I long described these bills and laws as a sham, because (1) phase 1 trials are the barest minimum of safety trials that usually only include less than 50 patients; (2) the federal government (through the FDA) regulates drug approval, not states; (3) there was nothing in these laws that helps patients actually pay for what are often very expensive treatments; and (4) there was nothing to help drug companies actually comply with such requests, given that often experimental drugs are made in small batches just large enough for the clinical trials needed to gain FDA approval. Between Sen. Ron Johnson and then-Vice President Mike Pence, unfortunately, a federal version of “right-to-try” did become law. It has been a miserable failure so far, even at achieving its stated goals, although it has been a success at letting the unscrupulous take advantage of desperate patients.

Along with other things, right-to-try did, however, lay the groundwork for laws being proposed to protect COVID-19 quacks for promoting antivaccine disinformation and prescribing ineffective treatments like ivermectin and hydroxychloroquine, which I’ve likened to acupuncture. Moreover, right-to-try comes from the same DNA as efforts by quacks before right-to-try was ever a glimmer in the eye of the political flacks at the Goldwater Institute. Its purpose was to defang the FDA and greatly weaken its ability to regulate drug approval and to create legal uncertainty.

State medical boards, old school antivaxxers, and new school antivaxxers

Sherri Tenpenny and Meryl Nass are, without a doubt, what I would refer to as “old school” antivaxxers in that they had been antivax quacks for a long time before the pandemic. Indeed, Merlan notes as much about Tenpenny in this hilarious passage:

Nor are vaccines, by any measure, a new preoccupation for [Tenpenny]: During remarks made aboard a 2016 cruise for conspiracy theorists, which I attended, Tenpenny downplayed the risks of measles—a disease that can be deadly—to young children while advocating against MMR vaccines. She also told her audience that, in general, they shouldn’t need to be vaccinated as long as they avoided “filth countries,” a phrase that has lodged immovably in my memory.

At the time, I referred to it as the “Woo Boat,” and it featured a veritable rogues’ gallery of cranks, quacks, and antivaxxers, including not just Tenpenny but Andrew Wakefield, who held forth in various lectures and panels on topics like:

GMOs, Monsanto, bee colony collapse, ecology, global warming, climate change, fracking, HIV, autism, big pharma, medical suppression, vaccinations, flouridation, political corruption, government corruption, forbidden archeology, forbidden religion, Federal Reserve, truth about money, World Bank, IRS, strawman, property title, admiralty law, martial law, Bohemian Grove, Skull and Bones, JFK, cover-ups, September 11, Star Wars agenda, nuclear plants, chemtrails, HAARP, crop circles, IRS, MK-Ultra, Fukashima, NASA, NSA, Bilderbergs, sustainability, military industrial complex, pentagon, Waco, Malaysia 370, Pan Am 103, TWA 800, Gulf Oil Spill, Halliburton, Obama, Ruby Ridge, OK City, Vatican, New World Order, false flags, Montauk, privacy, surveillance, Area 51, Dulce, Project Rainbow, Nazi Bell, Vrill, U.S.S. Eldridge, Iron Mountain, psyops, population mangement, subliminal ads, Nibiru / Planet X, Cointel Pro, technology suppression, entity possession, electoral fraud, identity chips, 2nd amendment, and so much more.

It was therefore no surprise that, when COVID-19 vaccines received emergency use approval (EUA) by the FDA in December 2020, antivaxxers like Tenpenny and Nass repurposed their old antivaccine narratives to the task of demonizing the new vaccines and spreading as much fear and distrust about them as they could. It’s also not surprising that they immediately embraced unproven treatments for COVID-19 over vaccines, such as ivermectin:

The medical board began investigating [Nass] after she prescribed hydroxychloroquine and ivermectin to a COVID-positive family of three – two parents and their adult son– charging that she failed to follow proper standards of care. All three people ultimately ended up in the hospital; a concerned doctor who treated one of them made a report to the medical board. Separately, a midwife reported Nass’ conduct to the board in December, saying that earlier in the year, one of her pregnant clients tested positive for COVID and said she was prescribed hydroxychloroquine by Nass. A progress note that Nass wrote on September 21 for the patient contained, according to the board, “no patient history, no physical examination, no medical decision-making, no patient informed consent, no coordination of care, and no recommended follow-up.”

We in the medical profession have it drilled into our heads from the first day we set foot on the hospital wards as bright-eyed and bushy-tailed young medical students that if it isn’t documented in the chart it is assumed not to have been done. Even if you don’t think that Nass did anything wrong in the latter case described above (obviously, my assessment is that she practiced grossly under the standard of care to the point of medical malpractice), I can’t help but note how she shares something I see in a lot of quacks: A sheer sloppiness in her approach to medical documentation that would be, in and of itself, a danger to patients even she were practicing perfectly defensible science-based medicine. I noted that sort of sloppiness from Dr. Bob Sears in his clinic notes when the California Board of Medicine disciplined him. As a physician myself, I see passages like the one above and wonder: Doesn’t Nass ever worry about getting sued? After all, the best protection against a malpractice suit is rigorous documentation of everything you do treating patients. Apparently malpractice suits aren’t a concern.

But I digress.

Let’s look at a “new school” antivax physician who is mentioned in this article as well, Dr. Peter McCullough, along with Peter Kory and Robert Malone. The reason I mention this is because, soon after Merlan’s article was published I started noticing a lot of Substack posts and social media outrage from antivaxxers about the Texas Medical Board trying to discipline Dr. McCullough. For instance, Steve Kirsch wrote a Substack yesterday titled “Dr. Peter McCullough is being progressively stripped of his medical credentials“, ranting:

Peter McCullough is an author of 677 articles published in the scientific peer-reviewed journals. He’s one of the most respected cardiologists in the world. He’s been right about everything throughout the pandemic. He has an encyclopedic memory of every paper he’s ever read. And he’s just a wonderful, nice person to boot. You really never met a nicer guy. He’s sacrificed everything so he can speak the truth about the COVID policies. If there was one COVID advisor that the government should be listening to, Dr. Peter McCullough would be at the top of every list.

Personally, I like to mention McCullough as an example of a doctor who might have seemed legitimate taking a sudden crank turn, and indeed he’s been featured here for his conspiracy theories and misinformation, including parroting of old antivax tropes like “depopulation” by vaccines and weaponizing the medical literature to attack COVID-19 vaccines.

What brought him into the narrative (again) of antivaxxers this week is that he was apparently fired as a journal editor, as Dr. Paul Alexander rants in a Substack titled “Dr. Peter McCullough, leader of freedom movement, top global cardiologist, stripped of medical licenses & credentials by Texas medical boards; why? he spoke of early treatment & danger of the vaccine“:

I know Peter personally and know what he has gone through. He is being attacked and smeared and slandered because he stood against the fraud COVID vaccines and he pioneered early treatment with Zelenko. He was the senior author on many of the early treatment papers and algorithms we wrote and he was very gracious asking me to write a follow-up paper as senior author, but always he led with Dr. Risch and Dr. Oskoui, Dr. Fareed, and Dr. Zev Zelenko was senior scientist…

And:

Dr. McCullough is a cardiologist and was vice chief of internal medicine at Baylor University Medical Center and a professor at Texas A&M University. McCullough is editor-in-chief of the journals Reviews in Cardiovascular Medicine and Cardiorenal Medicine. He was and is an advocate for early COVID-19 treatment that included hydroxychloroquine. “I was terminated as the Editor-In-Chief of Cardiorenal Medicine and Reviews in Cardiovascular Medicine after years of service and rising impact factors. There was no phone call, no board meeting, no due process. Just e-mails or certified letters. Powerful dark forces are working in academic medicine to expunge any resistance to the vax.

I can only say: Good! Why any journal that wished to remain even the least bit reputable would keep someone like McCullough on as its editor after his promotion of ivermectin and the idea that COVID-19 vaccines are causing a “holocaust”, I don’t know. The odd thing is that he was apparently terminated in March; it’s interesting how these narratives keep resurfacing at “convenient” times, such as now, when the Texas Medical Board is investigating him.

The Wheel of Time

“The Wheel of Time turns, and Ages come and pass, leaving memories that become legend. Legend fades to myth, and even myth is long forgotten when the Age that gave it birth comes again.”

Robert Jordan, The Wheel of Time novels

I’ve long written about the battle between those who want to weaken the scientific standards behind medical practice and hamstring federal and state regulatory bodies that try to protect the public from quackery and dangerous medical misinformation. It used to be that we would argue against moves to make “integrative medicine” quackery respectable and off-limits to such bodies or to weaken the FDA with ideologically-inspired laws like “right-to-try”. Before “right-to-try”, I would argue that, although these efforts were dangerous to patients, it was still a relatively small group of doctors and ideologues pushing them. Then came right-to-try, which rallied libertarian-leaning anti-regulation advocates in many states to bring pressure on the federal government. Ultimately, as ideology “right-to-try” succeeded because of its message, even if as policy it has failed utterly. State after state passed right-to-try laws, and ultimately, when Republicans controlled the Presidency and both houses of Congress, a federal “right-to-try” law passed. However, policy was never the interest of those promoting right-to-try. Weakening the FDA’s drug approval regulatory apparatus was, which is where right-to-try succeeded in its intended purpose.

Now, as Anna Merlan notes:

This is, of course, of a piece with the politics of the moment: The states trying to legalize or formalize the use of drugs like ivermectin are largely conservative-leaning ones, where denying the reality that Donald Trump lost the last election brings political advantage. If Republican politicians get the sense that standing up for quackery and against the basic processes of the administrative state is a useful wedge issue, there’s no reason to think more of them won’t join in. And in the meantime, the ivermectin and hydroxychloroquine discourse is leading to increasingly weird, bizarre and [sic] worrying real-world encounters. Last December, the president of the California medical board said she was followed and harassed by people belonging to America’s Frontline Doctors, four of whom confronted her in a dark parking garage and followed her to her home. (The incident ended without physical violence.)

Back when I first started writing about the antivaccine movement, roughly 20 years ago, the stereotype of the typical antivaxxer was that of a hippy-dippy granola-crunching lefty. That stereotype was never really accurate, as there has always been a right-wing presence in the antivaccine movement and evidence from a decade ago strongly suggested that antivaccine beliefs were roughly equally prevalent among conservatives and liberals. However, over the last decade, there has been a strong political shift in the antivaccine movement to the right, and it is no longer even possible to argue rationally that the antivaccine movement hasn’t aligned itself with conservative/libertarian, even far-right, political movements. It’s a process that picked up steam in 2015 when, during the fight to pass California SB 277, a law that banned nonmedical exemptions to school vaccine mandates, antivaxxers hit on a message that attracted conservatives who distrusted government and, especially, government regulation, namely resistance to vaccine “mandates”, which were characterized as an unacceptable assault on “freedom” and “parental rights”.

As I like to say, “Come for the ‘freedom’; stay for the antivaccine conspiracy theories and pseudoscience”. The end result is that conservatives who had allied with antivaxxers to oppose the “government overreach” of vaccine mandates were steeped in antivaccine conspiracy theories and pseudoscience, and many of these new recruits started to believe them. Then came the pandemic.

Now, as Merlan observes:

There’s a strong reason to think that all of this is just beginning, and that the endgame here is not just to question reality, but to bend it into a shape more favorable to the COVID deniers and the broader pseudomedical universe they’re part of. Part of the strategy for getting there is to force loud, public showdowns between these two versions of the world. Medical boards records show that after Nass prescribed hydroxychloroquine to her COVID patient and lied to a pharmacist to get it, she reported what she’d done herself.

I would add this twist. I now tend to characterize the antivaccine movement as the dog who actually caught the car. It won over a large segment of the right that now includes much of the GOP and pundits like Tucker Carlson, who was lying about the CDC Advisory Committee on Immunization Practices (ACIP) just a couple of weeks ago. As a result, however, it’s no longer running the antivax show. Rather, the antivaccine movement appears to have been absorbed by a much larger enterprise, one that opposes public health interventions, including vaccines, but also wants to weaken or eliminate all the systems in place to regulate physicians and the practice of medicine.

Unfortunately, this is not a new movement. We as a nation have been here before. The first medical licensure law in the US, the Medical Practices Act, was passed by the state legislature of New York in 1806. The act empowered the state to license practitioners, meaning that only licensed physicians could recover their fees in courts. The act also fined unlicensed practitioners $25.00 for practicing without a license. Other states soon passed similar laws, which immediately ran into serious resistance from practitioners of Thomsonian medicine, a kind of herbalism founded by Samuel Thomson.

The history of Samuel Thomson and Thomsonian medicine is quite interesting. In brief, it was the death of one of Thomson’s patients that led many states to pass laws to restrict the practice of unconventional medicine, much of it having been long practiced by enslaved Black people. As a result of the efforts of Thomson and his Thomsonians, by the 1850s most states had seriously weakened or even repealed their medical licensure laws or had never had such laws to begin with.

Although the situation in the first half of the 19^th century was different in that at the time “conventional” medicine was still largely based on the four humors and unscientific practices, which makes it harder from today’s perspective to defend them, the situation is much different in that now medicine has a strong scientific basis. Sure, there are areas where the science is less certain and the evidentiary base for standard-of-care not as strong as for others, but we are nowhere near the situation in medicine 200 years ago. Even so, I fear that science is not enough and that history is repeating itself. Just as Thomsonians invoked “freedom” and reflected the Jacksonian zeitgeist of the time, so, too, are the ideologues using the pandemic as an excuse to gut state and federal regulations of medicine reflecting the zeitgeist of our current time. One notes that once the Thomsonians had succeeded, it wasn’t until the Flexner Report in 1911 that conventional science-based medicine truly reasserted itself.

I also note that Thomson, despite claiming that every person could be their own physician and heal themselves, still claimed that only he alone had unlocked the secrets of healing and health. Even as he chastised conventional physicians for their hubris, he himself was full of hubris and jealously guarded his own patent rights. Not coincidentally, he became very wealthy. Sound familiar? (I really should do a more detailed post just about Samuel Thomson.)

History repeats itself, indeed, I fear. The pandemic was just a very effective accelerant, along with social media.