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A License to Practice Medicine Cannot Be a License to Harm

Published:February 27, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.01.051
      Why are physicians who advocate against coronavirus disease 2019 (COVID-19) vaccines allowed to practice medicine? In the United States, everyone has the right to say anything they want, no matter how stupid, hurtful, or even potentially dangerous, but speech is not without consequences. Irresponsible, patently false speech by physicians, given their societal influence, can cause significant harm. Physicians who promote dangerous nonsense about medicine should not be allowed to work as doctors and care for patients, no matter how much access they have to social media, print, or television. Their continued ability to do so threatens not only the lives of patients but also tears at the trust and confidence that the public must have in the honesty and sincerity of the medical profession.
      There are many areas of medicine in which there is no consensus about particular treatments because the definitive studies have not been done, or data are unclear, contradictory, or incomplete. This is not true for the efficacy and importance of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19 illness. For a physician to advocate against vaccination is not just irresponsible, but it essentially defines one as being medically and scientifically incompetent.
      During the COVID pandemic, a relatively small but nonetheless vocal and influential group of physicians whose voices have been greatly amplified by social media and certain news outlets have advocated both for treatments that have been definitively shown to be ineffective and potentially harmful and against vaccination. Such views clearly place individual patients and the public as a whole at great risk of unnecessarily dying of COVID-19 illness. Why then are these doctors still licensed to practice medicine?
      To be eligible to practice medicine in the United States, a person must graduate from an accredited medical school, pass the required series of licensing exams, and complete postgraduate training (in New York State, 1 year of internship or residency). Someone gets the right to add the letters MD after their name just by graduating medical school. To actually practice medicine however—to examine, diagnose, prescribe, and administer medications, or to perform surgery independently—a person must obtain a medical license. Licenses are granted by individual states after certification of the aforementioned requirements. Notably, in New York State, a physician must also be of good moral character.
      Recently, an advertising poster encouraging SARS-CoV-2 vaccination (“Top Ten Reasons To Get Vaccinated Against COVID-19”) that had been placed at a bus stop in New York City by the Department of Health was surreptitiously replaced by one advocating just the opposite (Top Ten Reasons Not To Get Vaccinated Against Covid-19”).
      • Hu W
      • Gold M.
      Anti-vaccination ad mysteriously appears at N.Y.C. bus stop.
      It looked identical in style to the Department of Health's advertisement but was full of misleading statements and outright lies, including “It could kill you,” “The shot promotes the spread of COVID-19,” “Real world data demonstrate vaccine deadliness and inefficacy,” and “COVID-19 infection almost never leads to poor outcomes when treated early and properly.”
      The group that placed the poster listed their web address, www.macabim.org. The website, which carries the tag line, “Doctors and Scientists United to Save Humanity” includes COVID treatment protocols that advocate the use of medications such as hydroxychloroquine that have clearly been shown in randomized controlled trials published in leading journals to be of no benefit. In the “About Us” section of the website, a number of physicians are listed. At least 3 appear to be licensed in New York State, and 1 each in Idaho, California, Florida and Texas.
      In New York State, the Office of Professional Medical Conduct has oversight authority for licensed physicians, and it has responsibility for investigating medical misconduct. (There are similar offices in every state.) As examples of misconduct, it offers “practicing fraudulently [or] practicing with gross incompetence or gross negligence.”

      New York State Department of Health Office of Professional Medical Conduct. Frequently asked questions. Available at: https://www.health.ny.gov/professionals/doctors/conduct/frequently_asked_questions.htm. Accessed January 6, 2022.

      Every relevant professional society, governmental agency, and advisory board endorses and encourages vaccination as the most effective and only real way to save millions of lives and greatly diminish the severity of the pandemic. There is no question about this; in fact, it is pathetic that at the end of 2021 this sentence must still be written. Similarly, groups such as the National Institutes of Health (NIH) Expert Panel and the Infectious Diseases Society of America (IDSA) recommend against the use of hydroxychloroquine for treatment of COVID-19 illness.

      Infectious Diseases Society of America. IDSA Guidelines on the treatment and management of patients with COVID-19. Available at: https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/. Accessed January 6, 2022.

      ,

      National Institutes of Health. Covid treatment guidelines. Available at: https://www.covid19treatmentguidelines.nih.gov/. Accessed January 6, 2022.

      If advocating against vaccination and for therapies such as hydroxychloroquine doesn't constitute practicing with gross incompetence, what does?
      The Federation of State Medical Boards announced earlier this year that physicians who spread misinformation or disinformation about COVID-19 are at risk for suspension or revocation of their medical licenses.

      Federation of State Medical Boards. Spreading Covid-19 vaccine misinformation may put medical license at risk. Available at: https://www.fsmb.org/advocacy/news-releases/fsmb-spreading-covid-19-vaccine-misinformation-may-put-medical-license-at-risk/. Accessed January 3, 2022.

      However, the board is a nonprofit independent organization that has no statutory authority. A recent survey by the organization and additional independent reporting revealed that very few state medical boards have taken any action against physicians for disseminating false or misleading information about COVID,

      Fiore K. Worst COVID liars still have their licenses. MedPage Today. Available at: https://www.medpagetoday.com/special-reports/exclusives/96408. Accessed January 3, 2022.

      ,

      Federation of State Medical Boards. Two-thirds of state medical boards see increase in Covid-19 disinformation complaints. Available at: https://www.fsmb.org/advocacy/news-releases/two-thirds-of-state-medical-boards-see-increase-in-covid-19-disinformation-complaints/. Accessed January 3, 2022.

      despite the fact that complaints have been lodged in more than 30 states. (Astoundingly, early in December, the Tennessee state medical board, under political pressure, removed its recently adopted policy against the spread of COVID misinformation by physicians.

      Kelman B. Tennessee medical board deletes anti-misinformation COVID-19 policy after GOP pressures to dissolve board. USA Today. Available at: https://www.usatoday.com/story/news/nation/2021/12/07/tennessee-medical-board-delete-policy-covid-misinformation/6428734001/. Accessed January 3, 2022.

      )
      In most states, including New York, individuals must file complaints against physicians to begin an investigation that could lead to revocation of a medical license on grounds of incompetent practice. When there is clear evidence in the public arena of physicians’ stating outright medical falsehoods and warning against delusional dangers of COVID vaccination, state medical licensing boards should proactively initiate proceedings that would lead to the suspension or revocation of such physician's ability to practice medicine on the grounds that they are grossly injurious to the public's health. Such a move of course would not prevent unlicensed physicians from continuing to promote dangerous nonsense, but it would prevent them from doing it with the implied imprimatur of the state.
      There is an implicit but nonetheless important social contract between physicians and their individual patients and between the medical profession as a whole and society. It is a great privilege to work as a physician, and physicians are granted high status, respect, and considerable influence in society by the general public because they assume we are acting in their best interests. To allow individuals to continue to work as physicians while they advocate and pursue actions that are so clearly outside the bounds of legitimate medicine and science is to risk losing the respect, trust, and confidence of our patients. Medicine will become just an extension of the culture wars that are tearing at the seams of social cohesion in this country. For the sake of the integrity of the medical profession as a whole, and to protect the public against 21st century snake-oil salesmen, state medical boards must act decisively and quickly.

      References

        • Hu W
        • Gold M.
        Anti-vaccination ad mysteriously appears at N.Y.C. bus stop.
        New York Times. 2021; 18
      1. New York State Department of Health Office of Professional Medical Conduct. Frequently asked questions. Available at: https://www.health.ny.gov/professionals/doctors/conduct/frequently_asked_questions.htm. Accessed January 6, 2022.

      2. Infectious Diseases Society of America. IDSA Guidelines on the treatment and management of patients with COVID-19. Available at: https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/. Accessed January 6, 2022.

      3. National Institutes of Health. Covid treatment guidelines. Available at: https://www.covid19treatmentguidelines.nih.gov/. Accessed January 6, 2022.

      4. Federation of State Medical Boards. Spreading Covid-19 vaccine misinformation may put medical license at risk. Available at: https://www.fsmb.org/advocacy/news-releases/fsmb-spreading-covid-19-vaccine-misinformation-may-put-medical-license-at-risk/. Accessed January 3, 2022.

      5. Fiore K. Worst COVID liars still have their licenses. MedPage Today. Available at: https://www.medpagetoday.com/special-reports/exclusives/96408. Accessed January 3, 2022.

      6. Federation of State Medical Boards. Two-thirds of state medical boards see increase in Covid-19 disinformation complaints. Available at: https://www.fsmb.org/advocacy/news-releases/two-thirds-of-state-medical-boards-see-increase-in-covid-19-disinformation-complaints/. Accessed January 3, 2022.

      7. Kelman B. Tennessee medical board deletes anti-misinformation COVID-19 policy after GOP pressures to dissolve board. USA Today. Available at: https://www.usatoday.com/story/news/nation/2021/12/07/tennessee-medical-board-delete-policy-covid-misinformation/6428734001/. Accessed January 3, 2022.