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Should doctors who spread disinformation lose their medical licenses?
Phony cures and/or resistance to public health messaging is nothing new, and during the COVID-19 pandemic, we've seen it all -- from patients suing their doctors or hospital systems to allow for use of the deworming medication ivermectin to treat COVID-19, to healthcare providers echoing conspiracy theories that the virus is a hoax.
The Federation of State Medical Boards put out a statement in early August saying that they support disciplinary action, including suspension or revocation of medical licenses, for those who "generate and spread COVID-19 vaccine misinformation or disinformation."
When we inquired if any such actions had been taken and what the numbers looked like, we were told they are currently surveying their member boards to find out just how widespread of an issue this has become.
On this week's episode, Eve Bloomgarden, MD, of Northwestern University Feinberg School of Medicine in Chicago, who is a member of No License for Disinformation, a non-partisan grassroots coalition taking on disinformation by healthcare providers, joins us to explain how they plan to push for action against those who spread false information.
The following is an abridged transcript of her interview with "Track the Vax" host, Serena Marshall:
Marshall: Taking on disinformation from healthcare providers -- that's a pretty big lofty goal you have there.
Bloomgarden: It sure is. It is a lofty goal, but I think it's just a very important goal as well. Because we are seeing the harmful effects of misinformation and really disinformation playing out with our patients all day, every day. And it's really heartbreaking. So I think while it is a lofty goal, I think it's something that we really feel strongly that needs to be addressed and needs to be addressed with some urgency.
Marshall: Before we dive into how you're going to address some of those issues and some of the misinformation or disinformation you are hearing from your patients, let's define "disinformation." Because we are talking more about disinformation than misinformation or unintentional inaccurate information?
Bloomgarden: That's right. The difference between misinformation and disinformation is really that disinformation is information that's created and shared with the intent to deceive. So disinformation that is generated that can then be shared as misinformation. But it's the intent that really separates or distinguishes one from the other.
Marshall: But how do you distinguish between somebody who actually thinks one of these drugs works and isn't just misinformed and somebody who does actually know in their heart that it's inaccurate, that the science isn't there, and still pushing it?
Bloomgarden: I mean, that's a fantastic question and you can't always know what somebody really truly believes, but when someone is coming out into the public arena, in particular someone that has a medical license and holds this trusted space in our country or in the community and goes completely against the scientific consensus in a way that directly leads to harm and has significant impacts on the welfare of the public, you need to go back and question what's going on with this person and what is their reasoning for sharing this.
And what we're seeing, is over and over again, a small number of people, including a small number of medical professionals, are doing this throughout the pandemic and continue to make statements and offer "cures" that really are not founded in science and truly are kind of leading people away from what we know is safe and what we know is effective for COVID prevention. I think the difference is really just in the magnitude of the effect and the fact that it really challenges the scientific consensus.
These people truly stand out in their going against what we do in medicine, which is, we do have to follow evidence in science and you can't just make it up and make claims. We don't typically say we're going to cure something and offer something that has no medical or no science behind it. And that's essentially what's happening.
Marshall: Let's talk about some of those disinformation campaigns that we've seen or heard. I mentioned a couple of them at the start, but when you're talking to your patients, what are they coming in with and what are you hearing from them?
Bloomgarden: We hear a lot of what initially we're seeing on social media. So I hear a lot of questions and concerns initially about the vaccine. Was it too rushed? Was it rolled out too quickly? There was a lot of concern about the vaccines altering DNA. There were concerns about fertility -- all of these things that we hear on the news or that we've all seen on Twitter, on Facebook, on Instagram.
These are all things that are echoed day in and day out in the office with my patients and are interfering with my patients' ability to take care of themselves and to be well and to stay safe, and also my ability to care for them.
We see it tearing apart family dynamics, and a lot of people actually will say that they got this information on social media. Before the vaccines, we heard very similar kinds of tropes or characterizations of what people were seeing on social media, when it came to masks or social distancing.
I think that also is heartbreaking when we see this play out in schools or when we see areas of the country that we're not masking and how many cases of COVID were showing up in the ER, or in the hospitals, all related to information that you can trace back to social media, but also trace back to, unfortunately, the small group of licensed healthcare professionals.
Marshall: Is there one disinformation campaign or issue that sort of stands out to you as worse than the others? Is that ivermectin? Is it hydroxychloroquine? Is it masking or just the general push back against vaccination?
Bloomgarden: Yeah. I mean ...
Marshall: Is that hard to quantify?
Bloomgarden: It's very hard to quantify because it all depends on where we are in the pandemic, and what's happening hyper-locally and to my patients or the people that I care about, my community. I think one of the biggest challenges really has been the anti-vaccine movement. If I had to rank these in order of awfulness, which certainly I don't have to do that, but because we are seeing just so many cases, so many hospitalizations, we're still seeing deaths in the thousands every day in this country. But the difference between now and a year ago is that we actually have vaccines now, which we know will prevent that.
So, the tragedy of having people hospitalized or having people die, or developing long COVID or any long-term sequelae of COVID that was all preventable is really, is really tragic. And I think it's on a different level in terms of how much harm has been caused by this disinformation.
Marshall: In what magnitude is this about personal freedoms and personal choice? I mean, every individual has a different perspective and we can't think all doctors would have the same perspective. Science changes, you know, routinely. What we learn and what we know changes routinely. So at what level does it become: this doctor is peddling misinformation, disinformation, and this doctor is just trying to understand the perspective of hesitant patients?
Bloomgarden: Absolutely. No, that's a great question. And, you know, we certainly over the last 2 years have seen how science evolves and how recommendations change as more evidence comes in. And that's truly the nature of science. And in particular, in a global health crisis, things are expected to change.
But once there is a medical consensus, and I would say with the vaccines, for example, we've now given hundreds of thousands of doses and enough time has gone by that the safety and efficacy is really from a medical and evidenced standpoint, is really is not up for debate anymore as to whether this is the right thing to do.
And I think it is when despite all of this evidence and despite the time that's gone by, despite the medical consensus, despite the clear data showing a prevention of hospitalizations and deaths, that we continue to hear people questioning vaccines or recommending to their patients not to get it, for example, I mean, that is a different kind of statement as opposed to early on when we're still all learning the facts.
In terms of the culture of medicine, the field of medicine is certainly conservative. We do not want to set up a precedent where anyone who is expressing their opinion or practicing medicine and using their own creativity and their own expertise to potentially prescribe something that is off-label or to do something a little bit outside the box, that's not the same as what we're saying here, which is in the face of very clear recommendations and guidance in a public health emergency, to defy that and to take this to social media and truly encourage people to act against their own safety and health interests is really distinct.
Marshall: What's the threshold? You have an op-ed in the Washington Post on this issue. What's the threshold for saying, that doctor continues to push disinformation, they should lose their license. I mean, there's ongoing licensing for medical professionals, but is there, they've been dinged so many times to the medical board for pushing the idea that you don't need a vaccine ... they should get their license revoked.
Bloomgarden: Sure. Yeah, no, I think that's a good question. And that's not really, I don't know that I'm qualified to say that there's a threshold there.
I think there is, certainly, we encourage anybody to report to the medical board, which is what the medical boards are designed to do, where anyone in the community or anyone in the public can report something to the medical boards.
And then it's really up to the medical boards and the state medical boards to investigate to see if there's any unethical or unprofessional conduct, and whether that warrants disciplinary action. I am not, we are not calling for a threshold and I don't think it is an objective measurement.
It's really nuanced. And I think it's case by case, but when there's a clear kind of intent to deceive and there's clear harm that is happening that we can trace back to the actions of a licensed professional, I think that is really something that is above and beyond what we expect and what is appropriate and what is ethical.
Marshall: Dr. Bloomgarden, I have a feeling people are listening to this and thinking, well, wait a minute, aren't doctors reviewed all the time? Aren't they having to maintain their credentials? Don't they already have these bodies making sure that they aren't providing inaccurate information or harming their patients? So, explain for us what currently happens in a situation where a patient's being harmed by a physician.
Bloomgarden: Well, I mean, fortunately, this is not something that happens that often. In general, yes, there are certainly processes in place when this is happening. But the medical boards don't know what's happening unless something is reported. It's a report-based system that's set up.
And so, what we're really just not seeing ... we saw the FSMB [Federation of State Medical Boards] and we saw ABIM [American Board of Internal Medicine] and ABEM [American Board of Emergency Medicine] come out with statements, kind of supporting ...
Marshall: And those are medical board licensing?
Bloomgarden: Yeah, those are medical societies and the FSMB is the federal state medical boards, they're the umbrella kind of overseeing licensing, but it's really up to each state's medical board to take action.
And so the process is really, the medical boards, they provide the initial legal right to practice medicine. And then they're also responsible for disciplining physicians, but they need to be aware of it first. And then it's a notoriously slow, kind of drawn out, process that has not really been, I would say, it has not really come to ... we haven't needed it in this way, on this scale.
In my opinion, nothing has compared to this, but we also, I think, tend to not want to police our own in the same way, you know? So we're not talking ... the distinction from the medical boards and licensing is we're really not talking about us asking for criminal action. We're saying this is a privilege to have a medical license. And if somebody is actively, if we're concerned that someone is spreading disinformation that is causing direct harm and going against scientific consensus in a way that is out in the public light, which is what's happening here, we expect our medical boards to investigate this further and that is not really happening yet to anyone's satisfaction.
Marshall: We know vaccine disinformation, there was a report that came out not too long ago that called it "the dirty dozen." That most of disinformation was coming from a dozen key individuals and/or groups. So is it just going after the doctors associated with those groups? And de-licensing them? And even if you took their license away, would it change public opinion for those who already listen, trust, and follow them?
Bloomgarden: I'm not sure that I know the answer to how it would influence public opinion. But, I can say, it lends them credibility. And it gives, you know, people with a large platform and influence when they have a medical license, which again is not an easy thing to obtain, and it is something that is held to a very high standard, it can, it really gives this person with this platform a lot of credibility that, you know, actively is now working, I think, against getting us out of this pandemic.
And, whether or not they would still have the same influence is hard to measure and hard to know, but for us, I mean, we consider having a medical license as a privilege and something that we really take it very seriously. We don't think that it's appropriate for people to be using that as a way to kind of push an agenda through that is directly harming the public.
Marshall: Do you know how often doctors get their licenses revoked? I'm assuming it's not very often.
Bloomgarden: I do not know how often, but I know it is not common. It is certainly not common. I mean, a lot of times there's, if there's somebody who's being investigated, there's typically a chat with the medical board and potentially a threat or even a threat of a threat.
For the most part, obviously, we went into this, or many of us, the majority of us, went into medicine to take care of people and to help people. We take an oath to do no harm. And ... it's not common, it's not something that's common.
But, certainly, there are bad seeds everywhere. And to be clear, disinformation is not only coming from physicians. I mean, we've seen this coming from politicians. We see this coming from other healthcare workers. We see this coming from celebrities. With absolutely no medical background. And I think this is a small piece of the puzzle, but it is a piece that really, I think, gets to us because over the last 20 months, this is something that we are seeing the direct repercussions of in our patients, and in some ways, the tragedy that's been playing out that we're witnesses to.
And I think that is the rationale for us kind of calling out from where we stand and what we know. I think awareness of this issue is a first step, and hopefully encouraging some action to help us get through the pandemic.
Marshall: What is the role of the federal government? I mean, we know the Justice Department has prosecuted pharmacists for giving the COVID vaccine to those it wasn't approved for, kids that were too young. The FTC [Federal Trade Commission] sent hundreds of warning letters to those pushing false COVID-19 treatments. So, what role is this the responsibility of the federal government? And at what level is it the responsibility of the medical boards to ensure these doctors aren't pushing disinformation that could harm their patient?
Bloomgarden: So, again, I'm not a lawyer. And I'm not on the medical board, but in talking with, or in going and kind of getting involved in this more and more, it really does seem that the medical licensing piece of this really is state by state.
Marshall: So it'd be the state individual [boards] and, so far, no one for peddling disinformation has lost their license and that's something you guys really want to see changed then?
Bloomgarden: Correct ... the FSMB and others have come out with statements saying that if you are pushing disinformation and prolonging the pandemic and promising cures from medications or from therapies or interventions that don't have any scientific backing and making a profit on that and taking advantage of people like that, you should not hold a medical license. And we want to see some action behind that.
Because the ultimate goal is we would like to make sure that no more of our patients or our families or our communities are harmed by this information that is, you know, very hard to contain once it's out, and that continues to really slow our ability to end this pandemic. I think if we don't have any disciplinary action or any threat, then I think it calls into question our licensing process. I think that is an unsettling thought for those of us who take our license very seriously.
Marshall: So what's the next step for you guys and for this movement?
Bloomgarden: That's a great question. I think the first step was awareness. Second, the next step is really, there's a website that we have that is basically just a way for people to figure out how to report to the medical boards, if they see something, to say something. We are trying to make sure that the urgency of the situation is clear ... and hopefully this will be a continued discussion.
We did not want to take this on as a problem. But it's something that truly, if you take care of patients, you can't ignore. I mean, the stories day in and day out, I'm in the ambulatory outpatient ward, but colleagues of mine who work in the ER, it really, at this point with an available vaccine that really works to prevent severe illness and death, I mean, to not have to see people coming in really sick and to hear my patients tell me the stories about family members who died or who didn't believe that COVID was real and who didn't believe in vaccines, who wound up in the hospital and now they have their entire life trajectory altered by this.
I mean, it's just, it's heartbreaking. And so we really felt we couldn't not say something. We felt strongly that we had to mention that this was playing out in all of our office visits and all of our ER visits for physicians -- thousands of physicians are experiencing this daily.
So, I think the next step kind of depends on the next step taken by the medical boards and by the community. And we don't necessarily want to be involved in the point of, like, we're not lawyers. We don't want to be regulating and policing our physicians. We just want our systems and the checks and balances that exist already to take what are threats and then have action behind them.
We would also really like to have some of these social media platforms take some responsibility here. Because these platforms are really not pulling their weight and we know that misinformation, disinformation is shared more so than the facts. We see that some of the algorithms favor kind of showing people what they want to hear and that de-platforming some of these players, both physicians and non-physicians, would have a big impact. And we've been promised that over and over by various social media companies, and so far we have not seen it. So, I mean, I think that is another thing -- they need to go hand in hand.