Holding Docs Accountable for Spreading Misinformation

In this exclusive video, Richard J. Baron, MD, president and CEO of the American Board of Internal Medicine (ABIM) and the ABIM Foundation, discusses the current problem of medical misinformation and proposes ways organizations can hold doctors who spread misinformation accountable.

The following is a transcript of his remarks:

I think we're in a really challenging time dealing with the problem of misinformation as a society overall. In healthcare, that kind of misinformation can lead to lethal outcomes, to the point where if patients believe things that aren't true, they can forgo treatments that might save their lives, they can take treatments that can injure them.

We've over time had a broad regulatory apparatus to try to protect the public. That's everything from the FDA reviewing the safety of drugs, to state licensing boards saying who has demonstrated the ability to practice medicine, to certifying boards like ours.

But it's a really challenging problem. And it seems to bleed over into free speech issues and people say, "Oh, what do you mean you're going to regulate speech?"

We're not regulating speech. People can say whatever they want, but as the American Board of Internal Medicine, we have an interest in being sure that our credential means something and that people who hold it are differentiated from people who don't hold it. So, it's not a freedom of speech issue.

We certainly don't want to overreach. We're not interested in beginning disciplinary actions against doctors for good faith differences of opinion, especially in areas where there really is controversy. But there are areas where there is not controversy, and we do have doctors, some of them board certified, who are feeding misinformation to the public in a way that's damaging.

ABIM hopes to, first of all, demonstrate to other medical institutions that it is possible to draw a line. It is possible to take action. That's one thing we want to do. We want to make it clear to the public that the ABIM credential means something, that it distinguishes doctors who hold it, that doctors who hold it can be trusted by the public to be current in their field and not to be deceptive and misleading and not to behave in blatantly unprofessional ways.

One of the challenges in misinformation, and one of the questions we get asked is: How do you know what's true? How do you know what's right? Especially in areas of evolving knowledge, aren't you just going to shut down doctors who are trying to do their best?

Well, one of the things we realized was that ABIM has a process for creating our exams, and it's actually a process that very few people understand or know about. It turns out that, in the art of putting together multiple-choice tests, the easy part is coming up with the right answer; the art is when you come up with answers that are definitely wrong, but plausible. They could be right; you're not really sure.

It turns out that the way ABIM does this is we bring together expert, practicing clinicians – it's a mix of people in the academic world doing research and people in the community doing practice – and that group sits down. Somebody has written the question and they believe answer C is the wrong answer, and somebody else at the table says, "Well, you think that's the wrong answer, but I can come up with this paper in an authentic peer-reviewed journal that suggests that it might actually be a right answer." At that point, they have to take option C off the table because it's not demonstrably wrong, and somebody could pick it and say, "But it really is right."

What we realized as we thought about the challenge of deciding whether we are really dealing with misinformation is that ABIM does have access to experts around the country who are in the field, and those folks are very familiar with the literature and they are guided by the literature when they have those kinds of conversations. The thought was: could we use those [experts] to help us decide if people are putting out misinformation?

Now, all that would do is say, "No, I'm sorry; what they said was really wrong." But that's not the only thing that matters. We're especially concerned about people who are using platforms that reach millions of people, or are using fora like state legislative hearings or federal court proceedings to put out information that is known to be false.

So we thought we could use our process at least to identify some of the more egregious, clear, crossing-the-line type statements, like "children can't transmit COVID." Those kinds of things are simply not true. There is no evidence to support them.

We can't use this tool across the whole spectrum of social media -- Twitter, YouTube, Facebook, there are millions, billions, of entries created. We're not putting ourselves out there to police all communication in all settings. We can't do that. We don't want to do that. It's not our role to do that. But it is our role, for people who hold our credential, if they are making completely demonstrably false statements in public settings, it's on us to call that out and say, "I'm sorry, if you're going to do that, you can't be certified by the American Board of Internal Medicine."

I think certifying boards are part of the promise that the profession makes to the public that we will self-regulate, and self-regulation is about us acting together as a community. It's not about individual freedoms and liberty. It's not about getting to do whatever you want. It's about having the humility as an individual to recognize that your insight, your reading, your thinking, your scholarship, only goes so far.

That testing it against groups of people who are doing the same work and engaging in conversations with that community, that kind of humility on the part of individual practitioners and a willingness to subject their intuition and instinct to a larger community of people to recognize that they're in good faith with you.

I think that's a really important place for us as a profession to be right now, where we stand together as a community and recognize that our collective authority derives from the trust patients place in us, which is based on the integrity with which we operate individually and the integrity with which our institutions operate.

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