Why are physicians threatened by efforts to report doctors to their state medical board for COVID-19 misinformation?

State medical boards rarely do anything to stop physicians from practicing quackery and spreading medical conspiracy theories. It's rare for a state medical board to suspend or revocation the license of even the worst quacks, and we tend to write about it here. The revocation of a doctor's license in Florida was one example of the fake diagnosis that is "chronicLyme disease." One of the New York doctors sued Jann Bellamy and the editors of SBM, naming some of the people who had written about him. It is noteworthy when doctors who are leaders of the antivaccine movement are disciplined by their state medical boards, like the example of Dr. Bob Sears and Dr. Paul Thomas.

Counterexamples include Dr. Buttar, who referred to the North Carolina Medical Board as a "rabid dog" for treating patients with cancer. After signing a consent decree with the Board that reprimanded him and ordered him to give informed consent to his patients as dictated by the Board, he was free to practice again. The Texas Medical Board has tried at least three times to stop Dr. Stanislaw Burzynski from treating patients with his ineffective antineoplastons. The doctors are selling COVID-19 misinformation. Tenpenny has long referred to vaccines as a method of mass destruction and "depopulation" and more recently claimed that COVID-19 vaccines make you magnetic. Legislators are trying to limit state medical boards.

Many of my colleagues were shocked to see the number of physicians promoting misinformation and antivaccine quackery after the first Pandemic hit in 2020. They should not have been. If only they had been paying attention, this would not have happened. The shock that colleagues expressed was that America's Frontline Doctors didn't suffer any consequences for pushing ivermectin and hydroxychloroquine. Quite the opposite. Dr. Joseph Ladapo was nominated to take charge of the public health bureaucracy in Florida, where he is now implementing all manner of unscientific and dangerous COVID-19 policies. The formation of No License for Disinformation, founded by Dr. Nick Sawyer and his colleagues, is a sign that colleagues are waking up to the threat of misinformation and the promotion of quackery. I have argued that NLFD doesn't go far enough and that this effort shouldn't be restricted to just COVID-19 misinformation and quackery, but I welcome the baby steps towards a more general effort to hold quacks accountable.

The vast majority of doctors would approve of a renewed effort to purge our profession of dangerous doctors. I like to hope that you are right, but I have been seeing a number of doctors who are very disturbed by NLFD and have been expressing their unease in op-eds and on social media. There are doctors who agree with me, but I have been seeing more and more of this after a Maine physician had her license suspended for promoting COVID-19 disinformation.

There are regulatory actions for physicians who spread misinformation.
Maine is correct. This needs to be standard. When people are victims of misinformation and scientific untruths, the routine ruining of lives and families occurs.
Boundaries must protect.
January 13, 2022.

There were other people who were less enthusiastic about this development. Why is this happening? Why are some doctors against the idea of state medical boards disciplining doctors who promote COVID-19 disinformation? Doctors hold a high status in society. When physicians promote pseudoscience and quackery, their assumed expertise is trusted by a lot of the public.

Quality control andCancel culture.

I don't know what I mean by doctors who come across as threatened by the effort to hold doctors accountable. It was easy to dismiss this response from non-physicians.

Maine has a medical licensing board. How much was paid to do this? They are a disgrace. America is dead because of free speech. Wake up.
M.a. January 13, 2022.

You don't seem to know that a lot of the things written off as a conspiracy theory have been proven correct.
Maybe a little less righteous indignation and more critical thinking would be a good thing for you.
January 13, 2022.

Conspiracy theorists love to claim that every conspiracy was a conspiracy theory that was later proven to be correct. There is a difference between a conspiracy theory and a real conspiracy.

There were reactions from doctors.

I was not sure what Dr. Jha was talking about. If they use pseudoscience, conspiracy theories, and quackery, moral arguments can be just as misleading. In any event, Dr. Jonathan Howard and I responded.

Quality control is what Dr. Daly calls it, and cancellation culture is what he calls it.
David Gorski, MD, PhD, is on January 13, 2022.

The First Amendment and free speech have been hidden by doctors who promote misinformation. The Association of American Physicians and Surgeons (AAPS) is a medical John Birch Society camouflaged as a legitimate medical professional society. I have written about how the AAPS promotes antivaccine pseudoscience, including a view that is extreme even among antivaccine activists, namely that the "shaken baby syndrome" is a "misdiagnosis" for vaccine. It is worse than that. 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 In August, an AAPS member likened the recent statement by the Federation of State Medical Boards (FSMB) endorsing disciplining doctors for spreading COVID-19 misinformation to the Soviet NKVD, which led me to quip that at least he didn't invoke Nazis.

I mention the AAPS because I think it makes sense to contrast it with the doctors expressing extreme reserve about NLFD and to disabuse readers of the idea that there aren't a lot of cranks and DOs. It is easy to make fun of the AAPS because it is a home for little but medical conspiracy theorists who don't follow the herd even when they are correct. The doctors expressing reservations are not cranks. I don't recall ever having spoken to Dr. Daly, but I do like Dr. Jha.

It is interesting that doctors who practice science-based medicine would react negatively to the idea of a "cancel culture", leading to a continuation of the conversation.

Maybe they are the echo chamber of the social media site. It is a challenge to fight quackery and censorship.
Ryan P. Daly, MD is a doctor.

Mr. Bond makes an excellent point that echoes what we have been saying for a long time.

Then there was this.

Who decides what is mis-information?
Terry Maratos-Flier is on January 13, 2022.

If state medical boards can't determine what is fake news, who can? If you think about it, the response isn't so bad, particularly in the context of my periodic moans over how state medical boards rarely discipline quacks like Dr. Buttar or Burzynski. If state medical boards can't enforce even a minimal standard of professional behavior, what good are they? Getting rid of doctors who are impaired due to substance abuse disorders, who assault patients, or who defraud third party payers is good and necessary, but it is not enough, nor is it cancellation of the medical board culture.

Let's take a look at some of the common concerns of non-quack physicians.

Start with an easy example.

In considering the whole issue of cancellation culture and physicians' reactions to Dr. Nass' suspension by Maine, let's start with the article that Dr. Jha cited. There are two categories, Yes, Those Doctors Are Doing Wrong and No, Those Physicians Have a Right to Speak Their Beliefs, in the article. I will be focusing more on the arguments for the second since I am arguing the first point, which is that science and controversial thought are being muzzled. These sorts of arguments came from different perspectives. Here is a person who is against distrust of big pharma.

The truth is hard to discern from less-than-truth in a country with a profit-oriented economic ideology.

From the other side.

Another clinician asked who could determine what truth was. The Federal Government, who is here to help you, is not qualified to make such determinations, and who are you to suggest removing someone's license because they disagree with you? Give me a break!

What is truth? How deep! Most doctors are pretty bad at philosophy.

Big pharma doesn't have the greatest track record in terms of its messaging, but it doesn't follow from that history that it is impossible to discern good science from bad or quackery from science-based medical care. No one is saying that the federal government should take away a doctor's license because it is the state governments who set up state medical boards.

This is where my "easy example" comes in, specifically physicians who deny germ theory and use that denial to spread antivax misinformation, something I did last week.

I can give you a number of examples of doctors who deny germ theory, along with the receipts, if you want to know. I've been writing about this for nearly two decades.
David Gorski, MD, PhD, is on January 13, 2022.

If you don't overthink it, this is an easy example. I am not talking about the contribution of host susceptibility to the development and severity of disease. I am talking about the basic concept of whether or not Germs cause disease, which is a longstanding belief in large swaths of alternative medicine and the antivaccine pseudoscience spawned by it. I am talking about people like Dr. Kelly Brogan.

There are many more like her. State medical boards don't do anything about them.
David Gorski, MD, PhD, is on January 13, 2022.

We have written about Dr. Brogan before. She denied germ theory years before the outbreak. She continues to deny germ theory. If there is one thing that those of us who have been struggling to counter medical misinformation, quackery, and antivaccine pseudoscience often encounter, it is medical professionals and scientists who have a hard time believing us. They seem to think that there is no way anyone could believe that in 2022. Germ theory denial is one of the alternative medicine beliefs that causes the most disbelief among my colleagues. Few doctors believe me when I say there are people who don't believe in germ theory. I have to show them the evidence.

Most physicians agree that a physician like Kelly Brogan who denies basic germ theory should face sanctions from her state medical board. Certainly Dr. Daly did. There is a trap. The naysayers concede my main point, that state medical boards should have the power to sanction physicians who promote misinformation, by acknowledging that promoting one very obvious sort of medical misinformation should be sanctionable by a state medical board. To echo a famous joke, the rest is justggling over the price.

Doctors complain that "dogma will prevail" if they are disciplined for spreading misinformation. Even though they concede that misinformation from doctors can be dangerous, they won't take a stand on where to draw the line.

What misinformation is worth pulling a license for?
When 5g comes online, will the vaccines be full of hydra and graphene?
January 14, 2022.

Dr. Ryan never answered Mr. Bedell's question about real world examples. Maybe he doesn't support sanctioning speech that promotes conspiracy theories, but maybe I'm wrong. He didn't answer the question. Those of us who are trying to fight misinformation do not have the right to not speak up. Sometimes these questions are easy, but not always. Kelly Brogan and physicians who deny germ theory are not difficult cases. It is not easy to implement standards for misinformation that is dangerous.

Settled science, or what about scientific debate?

The move to sanction doctors for promoting misinformation is a common complaint by physicians. Here is an example from the Medscape article.

Many physicians were concerned that science and controversial thought were being muzzled.
A doctor said no. What is misinformation in this age? Science advances with challenge and it is not about an authority.

Again, I quote Dr. Daly, who asks the questions.

Clearly. That is a black and white example. The slope is not slippery. What theories can be challenged? Is all science settled?
Ryan P. Daly, MD is a doctor.

And appeals to the art of medicine.

You think that is not the case. I have been writing about this topic for nearly two decades. I am the manager of a blog that is devoted to these sorts of discussions.
David Gorski, MD, PhD, is on January 13, 2022.

This is a very common straw man fallacy that is often used when professional and scientific sanctions against physicians are advocated. There are more examples from the Medscape article.

A specialist warned that if doctors are held responsible, a lot of them will be gone because almost anything that is written or said about COVID can be challenged.
A physician warned his colleagues about suppressing new ideas because they didn't agree with their opinion.

This time we are talking about what is truth.

My response is very simple. No one is suggesting that state medical boards should strip doctors of their licenses if they take medical or scientific positions that are questionable from a scientific standpoint. I have never made that claim or argued against it. I argue that there are certain scientific conclusions in medicine that are close to being settled, and that not accepting them is unscientific. The basic germ theory is one. It's not physically impossible to use homeopathy. It would take a huge swath of well-established theory in physics and chemistry being wrong to have a chance of working with homeopathy. It is possible to provide enough evidence to make it physically plausible, but only if there is a level of evidence that can topple major theories undergirding our current understanding of chemistry and physics. I generally conclude by saying that all theories can be challenged, but that denying them based on no evidence is not a challenge that professional societies and medical boards are obligated to take seriously.

The science of COVID1-19 is rapidly evolving, having started out with us knowing little about the coronaviruses, its mechanism of activity, its transmissibility, and the like, contrary to the claim that "almost anything that is written or said about COVID can be." The coronaviruses that cause COVID-19 were novel in the early days of the epidemic. As early as January 2020, I could say with a lot of confidence that the flu vaccine was not to blame for the outbreak of the disease.

A lack of knowledge does not mean that we can't know what is true and what isn't when we see it. It doesn't mean we can't know about it. The Pandemic hit the US almost two years ago. The argument about the lack of scientific knowledge about COVID-19 and the other diseases is less compelling now than it was in March 2020.

Doctors fear that sanctions will shut down nuance.

There is a lot of hype and misinterpretations in medicine, and just watch the poop-show of nutrition science. I am pro-nuance and my comments are not anti-vax. And Pro-vax.
Ryan P. Daly, MD is a doctor.

The problem is here. We are not dealing with nuance, and the fallacy we are talking about is not a scientific debate. It is denialism. It is the same as the denial of climate science, evolution, or that HIV causes AIDS. Germ theory denial is a form of denialism. Mark and Chris Hoofnagle warned about the dangers of denyingism a long time ago, and they are still doing it today. It is exactly the trap that the peddlers want you to fall into. Conspiracy theories, fake experts, cherry picked evidence, impossible expectations, and logical fallacies are all part of denialism.

Speaking of logic...

It is a slippery slope.

If state medical boards start sanctioning doctors for promoting COVID-19 misinformation, it will be a slippery slope to sanctioning other things. They are afraid that the gray areas will end up being sanctioned. I don't mean to keep picking on Dr. Daly, who seems sincere and dedicated to evidence-based medicine, but he sums up the common arguments rather succinctly). Another invocation of the slippery slope.

Yes, clearly. Not my main point. There is a role for quality control. There is a grey zone one for each egregious example. We are just frankly wrong about something as a profession. Blackswans.
Ryan P. Daly, MD is a doctor.


We are not sure if we are arguing the same thing. And likely agree on a lot of things. Discussing dual.
It's difficult to balance quackery and censorship with a slippery slope. Not an argument.