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Looking back on 2020: Too many physicians behaving badly

Looking back on 2020, if there’s one thing that the COVID-19 pandemic has taught us, it’s that crises reveal character. Unfortunately, even as many doctors bravely risked their lives taking care of COVID-19 patients, the character of too many other physicians was been found wanting, as they spent 2020 denying the pandemic and spreading misinformation. What can be done?

As I sat down yesterday to write this post, it suddenly occurred to me: This will be my first post of 2021. Out of curiosity about the year that just ended, I scrolled back to my very first (substantive) post in 2020 and noticed that it was a about crowdfunding cancer quackery through GoFundMe, with the second post being about the goop lab on Netflix and the third being about a bogus attempt by an antivaxxer to claim that antivax parents could get a medical exemption to school vaccine mandates just by lying about their child having had an anaphylactic reaction to a vaccine. Worthy topics, all, but nonetheless I couldn’t help but think, How quaint. I then realized that it was around that time that what later came to be known as SARS-CoV-2 but then was known just as the novel coronavirus that had first emerged in Wuhan, China was just a blip on the world news. True, by the end of January I had deconstructed the very first conspiracy theory about COVID-19 that I had encountered, namely that a larger-than-usual use of the influenza vaccine in China had led to an increased susceptibility to the novel coronavirus, thus starting the outbreak that was to turn into our current pandemic. It was a strangely precise claim that I ended up revisiting and refuting again and again. Sadly, to this day, the claim that the flu vaccine increases your susceptibility to COVID-19 by 36% remains one of those viral bits of pandemic disinformation that just won’t die, and I still see it popping up from time to time. Worse, it’s a claim that was popularized by a physician.

The point is that, first, beginning in early March, when COVID-19 was officially declared a pandemic by the World Health Organization, this blog (and my not-so-secret other blog) was largely taken over by the all things coronavirus, for the simple reason that the pandemic became the single biggest focus of medical misinformation, science denial, and quackery in the world. Soon, I was writing again and again about the dubious promotion of the antimalarial drug hydroxychloroquine as a “miracle cure” for COVID-19, a topic that I’ve revisited more times than I can remember. Sadly, the disinformation and astroturf propaganda campaigns spawned by the drug’s boosters, including Didier Raoult and Dr. Oz, have since metastasized to other drugs, such as ivermectin (which deserves a post of its own) and that evidence can’t seem to kill the myth that hydroxychloroquine is a cure for COVID-19 that could allow the “reopening” of the economy that “they” are hiding from you—for nefarious purposes, of course. Second, and worse, many of these claims are being spread by physicians, which brings me to my year-end theme: What do we do about physicians behaving badly, particularly in a pandemic? In other words, what do we do about physicians who actively spread antivaccine disinformation, deny or minimize the severity of COVID-19, promote (or even sell) quack (or at least unproven) “cures,” and spread other disinformation designed to discourage people from cooperating and complying with public health authority recommendations to slow the spread of the pandemic?

Antivaccine physicians in 2015: How quaint

Nearly six years ago, there was a post entitled, What do we do about politicians and physicians who promote antivaccine misinformation? It was written at a time when the Disneyland measles outbreak was still in full swing, an outbreak whose toll was minuscule compared to the carnage caused thus far by COVID-19, as of this writing over 19 million cases and 330K deaths and (rapidly) counting in the US alone. Yet that outbreak spawned SB 277, the California law that eliminated nonmedical “personal belief exemptions” to school vaccine mandates, a movement that spread to other states. Basically, I and others, such as Peter Lipson argued that antivaccine physicians should lose their medical licenses, a suggestion that I revisited a mere three weeks ago, when the Oregon Medical Board issued a temporary emergency suspension of the license of antivaccine pediatrician Dr. Paul Thomas, an action that I heartily approved of. At around the same time, the Oregon Medical Board also issued a similar suspension of the license of Dr. Steven LaTulippe, a physician who had given a speech to a pro-Trump, anti-“lockdown” rally in which he bragged that he didn’t wear masks at his medical practice. The suspension was an action that I also heartily approved of. As they year draws to a close, this sort of case was what led me to write this post.

The reason, quite simply, is that, as dangerous as the disinformation being promoted back then by doctors like “Dr. Bob” Sears and a panoply of “integrative” physicians and pediatricians in California who started selling fake “medical exemptions” to school vaccine mandates (and, yes, Dr. Thomas, who was just starting to become famous as an antivax pediatrician back then) was, the disinformation being promoted by physicians now is so much more harmful.

Physicians behaving badly
Too many physicians viewed the COVID-19 pandemic as an opportunity to do this.

2020: The year of (some) physicians behaving very, very badly

Obviously, the one massive overarching event that will forever define 2020 and by which this year will be remembered has been the COVID-19 pandemic, which has nowhere-near run its course yet, even as the first effective vaccines are starting to roll out to healthcare workers and those most vulnerable in nursing homes. In well under a year, SARS-CoV-2, the coronavirus responsible for COVID-19, has already claimed the lives of one in one thousand Americans since the first reported infections in late January and the first reported deaths in February. Not only is that estimate likely a gross undercount, but I haven’t even included the toll the virus has taken in the rest of the world, with nearly 1.8 million dead total as of this writing. Just think of it, though. Currently, COVID-19 is the leading cause of death in the US, having surpassed cancer and heart disease, and the very fact that it’s claimed one in one thousand Americans puts a very hard lower bound on its infection fatality rate of 0.1%, given that it’s killed 0.1% of the population already. Of course, given that it has only taken a small fraction of the people in the US having been infected to reach this grim milestone, that means the true IFR is likely much higher; yet we still see COVID-19 deniers referring to “99%” or even (“99.8%”) survival and saying that the disease is “no more deadly than the flu,” as though even such a “high” survival rate means that the disease is no big deal and that we’re “overreacting”. Pay no attention to all those hospitals whose ICUs are overflowing and that are hitting the point where they are having trouble taking care of the usual emergencies because they’re so busy taking care of critically ill COVID-19 patients.

That’s why I found it so depressing just how easily so many physicians jumped on board the COVID-19 denial train or started chasing shiny miracle cure objects, like hydroxychloroquine. Just out of curiosity, I perused SBM and my not-so-secret other blog for examples, restricting my search to quackery and/or disinformation peddled only by those with an MD or DO after their names. Sadly, the examples were numerous. One good overview comes to us courtesy of Jann Bellamy, who discussed in June an FTC warning about all the quackery being promoted by physicians and, of course, naturopaths, chiropractors, and acupuncturists. One favorite is intravenous high dose vitamin C (because, don’tcha know, to quacks intravenous high dose vitamin C is good for everything, including cancer, the common cold, and, yes, COVID-19):

To give you an idea of the geographic and provider diversity, other clinics nabbed by the FTC for promoting IV Vitamin C for COVID-19 include the Envista Medical Neck & Back Center (California MDs and DCs), Whole Health Chicago (an “integrative” practice which includes an MD, a “chiropractic physician specializing in functional medicine”, a TCM practitioner, and a homeopath), Revive and Rally Health Lounge (Kansas, run by an MD and an RN), Aspire Regenerative Health (California ND), iCRYO (a multi-state cryotherapy-infusion franchise operation with an MD Chief Medical Officer), LotusRain Naturopathic Clinic (California), Naturopathic European Medical Centre (which, despite the name and spelling, is in Wisconsin), Holgistic Personalized Healthcare/Natural Care Institute (Michigan MD and ND partnership), Traditional Chinese Medicine Clinic (Colorado Doctors of Oriental Medicine and Acupuncturists), East Valley Naturopathic (Arizona), Gonino Center for Healing (Texas DO), Hawaii Naturopathic Retreat, Health Associates Medical Group (California MD, DO, DC and LAc combo), Restore Med Clinic (California MDs), Revival Hydration (a “100% mobile” California infusion company using unspecified “medical professionals”), Sage Integrative Medicine Clinic (Washington NDs), and Vero Clinics (Illinois MD).

Then, of course, Joe Mercola was named as a “superspreader” of COVID-19 disinformation, and so he is.

Of course, Mercola and the docs mentioned by Ms. Bellamy are the usual “integrative medicine” grifters selling dubious treatments alongside conventional medicine as the “best of both worlds”. It’s unsurprising that they view the COVID-19 pandemic as a profit opportunity that can be pursued by simply “rebranding” their usual treatments as somehow being able to prevent and/or treat COVID-19. Far more dangerous, in my view, are the physicians promoting misinformation about COVID-19, discouraging people from following public health interventions to slow the spread of the virus, or even fear mongering about new COVID-19 vaccines before they were even ready to be distributed. Inevitably, some of these physicians’ views are reflected in how they practice medicine, thus putting their patients in danger.

Take Dr. LaTulippe, for instance. The Oregon Medical Board quite appropriately suspended his license because he had openly bragged that he didn’t use or require masks at his medical practice which violated an order in Oregon requiring healthcare workers to wear face coverings in healthcare settings, and also because he was giving out dangerous misinformation to his patients. At the time, I didn’t look into just how egregious his violations were. I now rectify that error:

The order of suspension gave some examples of practices at his clinic.

It stated that a patient who contacted the clinic in July to get advice on being tested was told, “asymptomatic persons should not be tested, that wearing masks does not prevent transmission of COVID-19, and was directed not to self-isolate because being around other people would provide [the patient] with immunity to COVID-19.”

On July 23, after questioning the advice, the person was terminated as a patient.

Additionally, the suspension order said that LaTulippe repeatedly told elderly and pediatric patients incorrectly “that it was ‘very dangerous’ to wear masks because masks exacerbate COPD and asthma and cause or contribute to multiple serious health conditions, including but not limited to heart attacks, strokes, collapsed lungs, MRSA, pneumonia, and hypertension.”

The order also notes that Dr. LaTulippe “and the staff in his clinic refuse to wear masks in the clinic and urge persons who enter the clinic wearing masks to remove their masks,” “regularly tells his patients that masks are ineffective in preventing the spread of COVID-19 and should not be worn,” and “further asserts that, because virus particles are so small, they will pass through the recommended N95 masks and most other face coverings people are choosing to wear,” while directing “patients to a YouTube video providing false information about mask wearing.” The order further notes:

On December 2, 2020, a Board investigator visited Licensee’s clinic and observed: neither patients nor health providers were wearing masks; no screening procedures were in place or being conducted (e.g., taking patient temperatures on or before entering the clinic); no hand sanitizer was available in the waiting area; a sign was posted in the public area of the clinic with “warning signs” of CO2 toxicity; an article was posted in the public area of the clinic, with a portion of the article highlighted that claims 94% of the individuals who will experience serious effects of COVID-19 have co-morbidities.

The last bit is a bit of viral COVID-19 disinformation claims that because 94% of COVID-19 fatalities have comorbidities recorded on their death certificates, therefore “only 6%” of those recorded as having died of COVID-19 had actually died of COVID-19, rather than the comorbidities. It’s utter dishonest nonsense, as I explained, that I like to refer to as the “only 6% gambit“. That a physician would so willfully misunderstand how death certificates are filled out and how having comorbidities that might have contributed to one’s death by COVID-19 does not mean that COVID-19 wasn’t the cause of death is shocking, but is an example of a phenomenon that has been all too evident and common this year. Worse, horrible doctor that he is, Dr. LaTulippe even cut a patient loose from his practice for having questioned his disinformation. I also note that the order of suspension also includes a pretty good refutation of Dr. LaTulippe’s nonsense based on science. Let’s just put it this way. Masks are imperfect, but they work (and do not make you sicker), N95 masks the best of all, which is why they are used by those treating COVID-19 patients. Ditto social distancing. Ditto hand washing. Any physician who refuses to follow these practices and encourages his patients not to follow them is practicing medicine so far below the standard of care that it is, in my not-so-humble opinion, malpractice.

2020: The year of physicians spreading disinformation about a pandemic

Doctors like Dr. LaTulippe are just one example of the harm physicians spreading COVID-19 disinformation can do. If Dr. LaTulippe hadn’t drawn attention to himself by speaking at an anti-“lockdown” and antimask rally, he might have been able to go on practicing his substandard, disease-spreading medicine for a lot longer than he did. However, for a doctor to do real damage in a pandemic requires that he become well known and start spreading disinformation that encourages resistance to public health orders, such as mask mandates, the temporary closing of specific businesses where spread of contagion is more likely, and vaccines, when they become available. We’ve seen a sadly large number of examples of this phenomenon this year, starting very early in the pandemic.

I’ve written about the mania over hydroxychloroquine, going all the way back to March. A brief recap is in order. As I discussed in more depth in April, the hypothesis that antimalarial drugs might be effective treatments for COVID-19 originated in Wuhan, China during the early phase of the pandemic in January. There, Chinese physicians reported that none of their 80 patients with lupus erythematosus who were taking hydroxychloroquine went on to become infected with SARS-CoV-2. As a result of that and old in vitro evidence of antiviral activity for the drugs, they became interested in using these antimalarial drugs to treat COVID-19. (Never mind that immunosuppressed patients are exactly the patients most likely to assiduously follow the recommendations of public health authorities during a pandemic.) A number of clinical trials were registered, and, based on anecdotal reports and small clinical trials (nearly all of which are as yet unpublished), in February the Chinese government published an expert consensus recommending CQ or HCQ for patients with COVID-19. Soon after, a number of nations followed suit. By March and April, hydroxychloroquine was part of the protocol used at many hospitals in the US and all over the world, despite the incredible lack of good evidence that it actually worked.

To some extent, this was understandable, even though the abandonment of evidence-based medicine led to an unkillable story about a “miracle cure” that still hasn’t died even though randomized clinical trial evidence has now clearly shown that hydroxychloroquine does not work against COVID-19. The docs in the trenches of the ICUs and ERs were desperate for anything that might work. But then the grifters and quacks jumped on board, encouraged by the horrible “science” on hydroxychloroquine promoted by French researcher Didier Raoult. You’ve probably heard these names: Dr. Vladimir Zelenko, Dr. Mehmet Oz (yes, him!), Dr. Stephen Smith, and many others. Meanwhile, a group of doctors dubbing themselves “America’s Frontline Doctors” (none of whom are actually what I would consider pandemic frontline doctors) started promoting all manner of COVID-19 disinformation, including the claim that hydroxychloroquine is a miracle cure that “they” are keeping from the people.

Among the worst of these doctors, Dr. Stella Immanuel:

Dr. Immanuel had her 15 minutes of fame when it came out that she had been known before the pandemic for believing that gynecological problems like cysts and endometriosis are in fact caused by people having sex in their dreams with demons and witches. It’s how she got the nickname of being the “demon sperm” doctor. Among these “frontline doctors” were other quacks and grifters, such as Dr. Simone Gold, who’s also appeared at QAnon rallies.

It’s not just hydroxychloroquine quacks, though. Early in the pandemic a pair of ER physicians made a brief splash promoting dubious epidemiology to downplay the severity of COVID-19. Other physicians who have spread COVID-19 disinformation include Dr. Carrie Madej, who has promoted the myth that the new mRNA-based COVID-19 vaccines will “reprogram” your DNA and are in fact transhumanism. (I kid you not.) How a physician can make it through medical school without understanding some very basic molecular biology (seriously, this is Biology 101 material, people!) that tells us that mRNA vaccines will not alter your DNA, I don’t know, but there you go. Then there’s Dr. Kelly Victory, an ER doctor who’s a veritable cornucopia of COVID-19 conspiracy theories and disinformation. The list goes on and on.

Perhaps the most despicable propaganda being promoted by some physicians is that, because COVID-19 is known to be much more lethal in older people and people with comorbidities such as type 2 diabetes, we should simply, in essence, let the virus rip through the “young, healthy population” and used “focused protection” to keep it from killing the elderly in nursing homes. Yes, I’m referring to the Great Barrington Declaration, a document produced by an epidemiologist, a biostatistician, and a Stanford physician basically advocates doing just that, never mind that it’s impossible to achieve herd immunity without a vaccine, unless you are willing to accept millions of deaths, and then it’s debatable whether it’s possible at all. Basically, the Great Barrington Declaration is a eugenics declaration, the denials of its authors notwithstanding, and a physician was one of the three authors who collaborated with the American Institute for Economic Research (AIER), a right wing think tank advocating “opening up” the economy. Even more sadly, although it is true that there were a lot of fake signatories to the declaration, spoofs done to demonstrate how lax the website’s procedure for signature verification was, it is also true that a lot of apparently real physicians did sign it. Fortunately, it is also true that a great many also signed the John Snow Memorandum, an excellent refutation to the Great Barrington Declaration. Of note, the physician behind the declaration, Dr. Jay Bhattacharya, later backed off a bit and seemed to be trying to have it both ways.

Arguably the absolute worst example of a physician behaving badly during a pandemic is Dr. Scott Atlas, who rose to prominence advising President Trump on his coronavirus response during the summer. Atlas is a neuroradiologist and, so it seems, a formerly well-respected one, having served as the chief of the neuroradiology section at Stanford University. Unfortunately, later he became a political hack working for the Hoover Institution at Stanford, a conservative think tank that’s been a font of bad takes on COVID-19. The reason Dr. Atlas so quickly gained Trump’s ear even though he had no relevant expertise in infectious disease, epidemiology, or public health, of course, is because told Trump what he wanted to hear, that COVID-19 was not deadly, that we could achieve herd immunity, and that the cost of the “lockdowns” was far worse than the “disease” of COVID-19 being addressed. Perhaps his most infamous moment was when he Tweeted:

Atlas had criticized Michigan’s new Covid-19 restrictions in a tweet shortly after they were announced Sunday evening, writing, “The only way this stops is if people rise up.”

“You get what you accept. #FreedomMatters #StepUp,” he said.

The message — which runs counter to the consensus of public health officials — immediately fueled new tension between the White House and Michigan Democratic Gov. Gretchen Whitmer, whom federal and state officials announced last month was the target of an alleged domestic terrorism kidnapping plot.

Unsurprisingly, Dr. Atlas was entirely on board with the Great Barrington Declaration, and, as a result, in October the Trump administration was seriously considering a herd immunity-based strategy before there was a vaccine. Truly, when the history of the pandemic is finally written with the perspective of a decade or two from now, Dr. Atlas will likely end up being one of the worst of the worst in terms of physicians promoting misinformation, largely because of his outsized influence in the Trump administration before he finally—and mercifully—resigned a few weeks ago, when it finally became absolutely clear that Trump’s legal challenges of the election results would fail and that there would be no second Trump administration, at least not in 2021.

Again, I could go on and on and on and on. The most recent wrinkles that keep surfacing are the promotion of ivermectin as a cure-all using exactly the same arguments and tactics (something I do need to write about in 2021 if it remains relevant) and doctors spreading fear, uncertainty, and doubt about COVID-19 vaccines, a task that physicians who were antivaccine before the pandemic have leapt on with enthusiasm.

What do we do about doctors spreading disinformation during a pandemic?

This post has been a litany of doctors behaving very, very badly in 2020. As the year lurches to a close, that leaves the question: What can be done about these doctors in 2021? As I like to say, crises reveal character. So while this crisis has revealed a whole lot of good character among physicians and other healthcare providers, as evidenced by the number of physicians who’ve worked so hard for so long and sacrificed so much to save lives and try to ease suffering during the pandemic, sometimes at considerable risk to themselves of being infected with coronavirus, it’s also revealed a whole lot of bad character in doctors. You’ve seen it. I and my fellow SBM bloggers have written about it. These are the ideologues who’ve let their personal belief systems override science, the grifters, the science deniers, and the quacks.

Physicians are, of course, humans beings like any other. What that means is that we are just as prone to the errors in thought to which all humans are prone, including logical fallacies, confirmation bias, confusing correlation with causation, etc. Similarly, we as a group are just as prone to letting political, ideological, and/or religious beliefs influence their actions as anyone else is. I wish it were otherwise, but it clearly isn’t.

Finally, although I sometimes get some outraged blowback from my colleagues when I say this, it must be emphasized that most physicians are not scientists, and that’s OK. Most physicians don’t need to be scientists to do their jobs well and take good care of patients. I view our profession as more of an applied science, like engineering, than pure scientific research. Medicine should be, as this blog has long advocated, based in science, even if it isn’t itself a science. Having seen both sides, as an MD and a PhD, I think I can safely say this. Unfortunately, society tends to give a lot of deference to the scientific opinions of physicians, whether that deference is observed. Regular readers might remember that I used to write a lot about physicians who deny evolution; i.e., creationist physicians. So did Steve Novella. One such physician in particular comes to mind, a neurosurgeon named Dr. Michael Egnor, whom I long ago dubbed the Energizer Bunny of antievolution. So epic was his misunderstanding of evolution that a term was coined for it: Egnorance. But it wasn’t just evolution; Dr. Egnor also promoted dualism, much to Steve’s annoyance as a neurologist.

The reason that I’m bringing Dr. Egnor up again after all these years is simple. Not only was he a prime example of how easily even well-respected physicians could fall into pseudoscience when they wandered out of their area of expertise, but he also demonstrated absolute faith that medical practice keeps physicians from being so spectacularly wrong, or, as he once put it, “…medical practice is a very effective check on b.s., because in medicine ideas often have immediately obvious consequences.” My response was:

Actually, those who have been regular readers of this blog almost certainly realize that Dr. Egnor holds far too high an opinion of the utility of medical practice as an “effective check on b.s.” In fact, it is science that serves as a “very effective check on b.s.,” not medical practice. Indeed, I’ve argued that time and time again. Yes, it’s true that science is often wrong, that sometimes it takes a maddenly long time for incorrect paradigms to be overthrown by new experiments and observations, and that the process of correcting accepted scientific dogma with hypotheses that more closely fit the data and make better corrections can be incredibly messy viewed from the outside, but science is inherently self-correcting. Eventually, b.s. is cast out. Not so when it comes to pseudoscience like ID creationism and–yes, you knew I’d mention it eventually–unscientific medical practices.

After all, what is the whole concept of “complementary and alternative medicine” (CAM) but incredibly concentrated b.s.; yet medical practice seems to have no effect preventing so many physicians to believe in a variety of unscientific and ineffective treatments. Indeed, unscientific CAM has infiltrated bastions of scientific medicine, such as Yale, Beth Israel, and others. Medical practice didn’t stop Dr. David Katz or Dr. Andrew Weil from falling into pseudoscientific woo. It certainly didn’t stop Dr. Jay Gordon from deciding that his clinical experience leading him to believe that vaccines cause autism trumps the strong science and epidemiology that say they do not, from making brain-meltingly ridiculous claims that there are “toxins” in vaccines that cause all sorts of terrible complications, or even giving speeches to rallies organized by people and groups who are antivaccine. He even exasperates the normally mild-mannered Steve Novella.) Practicing medicine didn’t stop any of these people from diving headlong into pseudoscience, even in areas directly related to their medical practice.

If anything, the COVID-19 pandemic has reinforced my opinion, first stated 12 years ago, that medical practice itself is a sadly weak check on BS, particularly when the medical system is stressed. Just look at the list of examples that I’ve discussed in this post and realize that there are many more that I could have discussed if I didn’t mind having this post balloon up to 10,000 words or more. The point, of course, is that all too often we physicians view ourselves as relatively immune to being led astray by “BS”, certainly far more so than others. It is that arrogance that leads to doctors like Dr. Scott Atlas pontificating on areas of medicine that he doesn’t understand and then portraying himself as Galileo when criticized for it. Don’t believe me?

Here you go:

Little did I realize 10-15 years ago how dangerous this tendency among some doctors would become, although I should have recognized it given how many times I encountered the Association of American Physicians and Surgeons (AAPS), which, I suspect, has been behind some of the astroturfing of hydroxychloroquine but has definitely been pushing the “casedemic” conspiracy theory that claims that it is false positives due to too-sensitive PCR testing that is giving the appearance of a pandemic, along with other disinformation and conspiracy theories.

Personally, I’m hardening in my opinion that it is appropriate for medical boards to investigate doctors like these, but at the same time I do recognize that there are a lot of problems with taking this course. First, state medical boards are notoriously toothless. Think about it. How many times has the Texas Medical Board gone after Stanislaw Burzynski over the last 40+ years and failed? Or what about the quack whose friendship with the town sheriff led to the identification of the nurses who complained about him and their suffering severe professional and legal consequences as a result? Or what about the neurosurgeon who can’t operate and injured many patients? Or what about the oncologist who administered chemotherapy to patients without cancer and administered medically-unnecessary chemotherapy to patients with cancer? So bad was his behavior that a nurse interviewing for a job noticed that the chemotherapy was being mixed up incorrectly and complained to the state medical board with no result. This oncologist was only brought down when the feds investigated massive Medicare fraud. Given the fusion of pro-Trump, right wing politics with COVID-19 disinformation, it’s not uncommon that doctors like the ones I’ve described align with Trump supporters and are likely to be painted as martyrs (as Dr. LaTulippe was) when medical boards come after them, even more so than Dr. Burzynski’s supporters tried to portray him. The reason is simple. Dr. Burzynski’s supporters were few (albeit vocal). Trump supporters are numerous and supported by a whole media infrastructure to get their message out.

Medical boards also need a concrete complaint, and that concrete complaint usually has to be about the actual practice of medicine. The Arizona Board, for example, might list 49 definitions of unprofessional conduct, but try fitting spreading COVID-19 disinformation into any of them.

The bottom line is that state medical boards tend to be toothless, underfunded, and overwhelmed. That’s why the only physician behaviors very likely to result in strong action consists of running a prescription mill, sexual improprieties with patients, or practicing while impaired due to abuse of alcohol or illicit substances. It’s a matter of resource allocation and prioritization. State medical boards tend to react primarily to what they perceive to be the most immediately and obviously dangerous behaviors. Practicing quackery rarely makes the cut, because medical boards are loathe to make value judgments about medical practice, and proving quackery is way harder and more resource-intensive than proving a doctor is an addict practicing while impaired or that he’s diddling patients. Even horrible surgeons like Dr. Duntsch, whose epic incompetence in the operating room resulted in multiple “clean kills” and so-alarmed colleagues that they actually took the rare action of complaining about him, all too often take a long time to take down. On the other hand, the pandemic might very well change the perception of state medical boards regarding the harm being done by misinformation and disinformation. Also, as was the case with Dr. LaTulippe, any physician who is publicly spewing anti-public health, COVID-19 denying disinformation is almost certainly also not practicing good medicine with respect to infection control practices during a pandemic, just as Dr. Thomas’ public promotion of antivaccine disinformation was accompanied by substandard medical care.

The bottom line is that practicing medicine is a privilege, one of the highest privileges society can grant to any human being. It is not a right. Unfortunately, all too often the law treats it more like a right, with state medical boards being loathe to strip quacks and other doctors practicing inarguably substandard medicine of their privilege to practice. That needs to change, and that change needs to include stopping physicians from abusing the privilege of their profession to spread disinformation that kills, as too many physicians did in 2020 and, sadly, are likely to continue to do in 2021.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

74 replies on “Looking back on 2020: Too many physicians behaving badly”


^^That is a little less tinted over reminiscence of Dr. Demon Semen. It became such an effective retort to some spouting that crap. The funny thing is that they were aware of that bit of inconsistency but still adhered to the information. At least, they soon shut up or changed the subject to just fixing the tractor.

And we why should care about your or some random three year old anonymous blog says?

Oh look…Orac just broke wind! Hurry…go inhale and bask in it before it fades!!

Pretty much the same with your narcissistic host. Maybe you should tell him to do the same while you continue with your bootlicking.

Pretty much the same with your narcissistic host. Maybe you should do the same…that is, when you are not licking his boots.

Quack physician Stella Emmanuel marches moronically into the New Year with a 1/6/2021 “Rally for Our Rights” superspreader event in Hartford Connecticut, speaking along with anti-vaxxer Jennifer Margulis as well as a Pastor Aaron Lewis and attorney Tricia Lindsay.

This failure of physicians to police quack physicians like Mercola, Madej, Kaufman, Orient, etc is maddening but so, too, is the realization that many physicians have litte/no science training yet somehow think they are science experts. I was reading an article on Doximity this weekend about a family physician leaving a small rural town because she and her family were being so severely harassed and threatened by anti-maskers, many of whom had been friendly neighbors up until the pandemic. That was sad enough, but the physician comments section was riddled with supporters of that Barrington Declaration and others stating that masks don’t work and that the physician was a snowflake who needed to stop making waves.

From all that I read, that list of “quacks” is really a list of superb scientists. The real quack is usually the one who does the name-calling, because counterarguments to prove those doctors wrong are patently missing.

They are quacks. Trust me*.

*source: have had sex with a demon and didn’t get vaginal warts.

Maybe you should go back in the blog and read Orac’s discussions of these doctors, some of which are linked in this post? Because he addressed how they were wrong in detail.

@ notelling

A sycophant is someone who get paid by state authorities when publicly accusing someone else. Who fits that description here? Tell me…

Or do you just use greek words because they’re cool?


Or, you know, you could use the actual definition of a sycophant, which is someone who is obsequious, servile or prone to flattery. Also, see boot-licker, toady, flunky, lickspittle.

Who fits that description here? Tell me…

Or do you not understand actual definitions of real words because it makes you look cool?

@ Notelling

“Or, you know, you could use the actual definition of a sycophant, which is someone who is obsequious, servile or prone to flattery.”

Ah… sorry. I indeed checked the french and english definitions and wikipedia pages: french has retained that ancient greek meaning while english has moved on to a more fluid interpretation of the word. Lost in translation.

“Who fits that description here? Tell me…”

Honestly? I do not know… I, for instance, tend to encourage him in his self-imposed task against bullshit (I can’t even bring myself to call everything Orac is writing about “pseudo-science”, that feels too respectful). But I do not see myself as a flatterer, which is quite out of sync with my somewhat thuggish temper.

“Or do you not understand actual definitions of real words because it makes you look cool?”

Hmmhhh… no. I guess it’s because it was a faux-ami. But, anyhow… you’ll have to get used to it: we do not seem to see it eye to eye on medical matters. So let that fact sink into your head, cut your losses, and come back to the table with a cool attitude.

In ancient Greece, sykophantēs meant “slanderer.”…Apparently, the farmers would sometimes try to avoid making the payments, but squealers—fig revealers—would fink on them, and they would be forced to pay. Another possible source is a sense of the word fig meaning “a gesture or sign of contempt” (as thrusting a thumb between two fingers). In any case, Latin retained the “slanderer” sense when it borrowed a version of sykophantēs, but by the time English speakers in the 16th century borrowed it as sycophant, the squealers had become flatterers.

Of course, modern meanings/usage do sometimes shift a little. Did you know that if your ancient mom told you to go out and “fuck the ground” that it meant to “sow a seed with a stick?”

Now, hop to it; that field ain’t gonna fuck itself.

Orac writes,

“What can be done?”

MJD says,

Use RI to crush the placebo effect. Quack medicine and questionable physicians will continue to endure in that the “placebo effect” is nature/nurture infused in human beings. There is an infinitesimal chance of placebo effect with science-based pharma drugs based on their propensity to communicate, in great length, potentially hazardous side effects.

“On September 18, 2007, a few dozen neuroscientists, psychiatrists, and drug-company executives gathered in a hotel conference room in Brussels to hear some startling news. It had to do with a class of drugs known as atypical or second-generation antipsychotics, which came on the market in the early nineties. The drugs, sold under brand names such as Abilify, Seroquel, and Zyprexa, had been tested on schizophrenics in several large clinical trials, all of which had demonstrated a dramatic decrease in the subjects’ psychiatric symptoms. As a result, second-generation antipsychotics had become one of the fastest-growing and most profitable pharmaceutical classes. By 2001, Eli Lilly’s Zyprexa was generating more revenue than Prozac. It remains the company’s top-selling drug.
But the data presented at the Brussels meeting made it clear that something strange was happening: the therapeutic power of the drugs appeared to be steadily waning. A recent study showed an effect that was less than half of that documented in the first trials, in the early nineteen-nineties. Many researchers began to argue that the expensive pharmaceuticals weren’t any better than first-generation antipsychotics, which have been in use since the fifties. “In fact, sometimes they now look even worse,” John Davis, a professor of psychiatry at the University of Illinois at Chicago, told me.

should we also examine John Ioannidis PhD. thesis, maybe get that retracted, because he dared to question medical science “Why Most Published Research Findings Are False.”

@ scott allen

“should we also examine John Ioannidis PhD. thesis, maybe get that retracted, because he dared to question medical science”

Of course not. He did a serious job. This is not “questioning” medical science. This is “criticizing” medical science. A very different thing. And a Very Good Thing. ®

Ioannidis used the words “question” science in his paper.
He did not criticize modern medical science.
“blame, censure, condemn, denounce, dispraise, fault, knock, pan, reprehend”
He “questioned” modern medical science.
“challenge, contest, dispute, impeach, oppugn, query”

so yes two very different words.

And to your point on my second post, the quote was from this very blog, Orac.

If you go to a doctor and get an opinion, do you ever get a second opinion later, if you do, why? Do you doubt the first doctors ability to diagnose your problem, are you questioning his/her medical advice/experience and their ability to give you the most up to date medical advice?

Medical advice from a doctor is called a medical “opinion” for a reason. Every medical expert that testifies in court will state his/her “opinion” based on their training and experience . I am sure that even Orac has changed his medical advice/opinion over the many years (for very valid reasons).

And if you sanctioned every doctor for giving wrong/bad/misleading medical advice, I would guess that there would be very few doctors.

and to quote Martha Stewart, really? Why not quote scientists…..

“Science is more than a body of knowledge, it’s a way of thinking. A way of skeptically interrogation of the universe with a fine understanding of human fallibility. If we are not able to ask skeptical questions, to interrogate those that tell us something is true, to be skeptical of those in authority, then we’re up for grabs of the next charlatan, political or religious leader who comes ambling along”.
Carl Sagan in a interview with Charlie Rose

“If you thought that science was certain- well, that is just an error on your part”
Richard Feynman

that applies to vaxers and anti vaxers. Consensus got us into Viet Nam and Iraq, we lost friends in both wars.

@ scott allen

“Ioannidis used the words “question” science in his paper.”

Nope. Checked the 11 occurences of the word. Doesn’t match your description.

“He did not criticize modern medical science.”

Oh yeah? He sure did. Check pages 126 and 222 to understand what counts as criticism and what does not. (That book is a bit rough, but is the best guide I found through the murky swamps of epistemology).

The work of Ioannidis does not say “throw medical science away, it’s worthless”. It says “we overlooked things and should start double-checking a few things more seriously before confirming the level of credence we give to our results”. It’s a call for revision of the status of knowledge, which is different from “questioning it” in the sense you put forward. It indeed is the distinction between revisionism and denialism, two different constructs, one being legitimate, the other not being legitimate.

That’s precisely the difference between “putting into question” and “making sound criticism”.

“If you go to a doctor and get an opinion…”

I never do that. Do not get me started on my personal relation with medical doctors or medicine as a whole.

“Do you doubt the first doctors ability to diagnose your problem, are you questioning his/her medical advice/experience and their ability to give you the most up to date medical advice?”

Hmmmhhh… yes. 100%.

“Medical advice from a doctor is called a medical “opinion” for a reason.”

Didn’t sound like an “opinion” last time I talked about that to my mother…

“I am sure that even Orac has changed his medical advice/opinion over the many years (for very valid reasons).”

Seems he did on a few occasions. I remember him thinking twice about a Lyme disease case. (Sad not to have seen Orac mention in his post the Perronne/Raoult HCQ vs. Lyme “deal” that Smut Clyde unearthed, BTW… stunned me.)

“And if you sanctioned every doctor for giving wrong/bad/misleading medical advice, I would guess that there would be very few doctors.”

Actions nonetheless need to be taken for gross misconduct. Starting with antivax doctors would indeed send a signal. A good one.

“…that applies to vaxers and anti vaxers.”

Nope. That’s confusing pyrrhonism with skepticism. Or confusing relativism with anti-fideism. So no: “doubting” is a different notion from “criticising”. And this is putting it mildly.

“Consensus got us into Viet Nam and Iraq, we lost friends in both wars.”

Consensus never has been absolute truth. Consensus can be criticised. Once you stop mistaking “questioning” for “criticising”. But consensus is the best we’ve got for consumption by unqualified people. So stop the FUD. (And… N.B.: I am not a “pacifist”).

There you go.

I am not a “pacifist”

As my great used to say between snuffing in a soup can, “bomb them before they bomb us.”

Also, she used to point at rocks hanging over the road and say, “on the day of the Lord, people will cry out for those rocks to fall on them.”

Recently (50 years later), those very rocks did, in fact, fall and block the road for a week. No remains were ever found; probably mashed into a pulp and hid from God by leeching into the local ground water.

Don’t you know that you’re supposed to apply skepticism to everything that anyone says?

Unless it’s from Orac…his word is simply gospel.

At least it is according to his hypocritical lickspittles

@ nottelling

“Don’t you know that you’re supposed to apply skepticism to everything that anyone says?”

More like to any idea than to what anyone says. Not interested in wasting my time.

“Unless it’s from Orac… his word is simply gospel. At least it is according to his hypocritical lickspittles.”

Nope. It’s fine disagreeing with Orac. His hypocritical lickspittles simply enjoy reading someone who dissects things in a way they usually agree with. I’ve had disagreements with Orac. On Gøtzsche, for instance. And on a few other topics. You’re welcome to disagree. Just do not expect us to agree with you, and expect criticism in return, in the same way that you may attempt to criticise science. It’s indeed a fair game, here: it in fact is one of the few places where denialists of all stripes may voice their grievances openly and expect real-time opponents. You should bless this blog.

I’d welcome a sound criticism: one that does not fall into the same eternal pitfalls people have been falling for intellectually for centuries.

(BTW: we may have very different reasons for being lickspittles…)

Just a point of irony

“I’m a bit concerned about a COVID-19 vaccine. It’s not because I doubt that a vaccine is possible, but rather because the incredible rush towards a vaccine is naturally concerning.

Were a vaccine to be approved within that timeline, it would be a world record in terms of speed, and pushing it to be even faster could well be an utter disaster.

Funny, isn’t it, how the original news stories about the trial left out the bit about the significant adverse events.
A couple of days ago, bioethicist Arthur Caplan and colleagues published an article in JAMA warning of the potential adverse consequences of too much speed:

It’s not hard to imagine that when promising vaccine candidates emerge President Trump, hyping “Operation Warp Speed,” in a frenzied effort to demonstrate leadership and produce good news, pressuring the FDA to approve a vaccine that has serious side effects.

Large clinical studies for a new vaccine for a new disease take months or years to carry out, particularly for a vaccine, in which a large population needs to be vaccinated and compared to a population receiving a placebo. One can imagine the disaster that would occur if a vaccine were deployed and then the reports of serious adverse events—or even deaths—started rolling in.”

Should we investigate the doctor that said that as well.

@ scott allen

“Should we investigate the doctor that said that as well.”

Likely not. In fact, the host of this blog has expressed in the past his reluctance to put the vaccine process in overdrive mode.

Funny how antivaxxers where I live are now pushing the European Medical Agency to discard cherry-picking allegations concerning the AstraZeneca vaccine simply because they bought into the mRNA = GMO nonsense. They are the ones wanting less scrutiny of vaccines. When it suits their twisted agenda.

This situation is very different from the antivax doctors that have been sanctioned. Doctors should on the whole be sanctioned much more often, BTW. It’s just complicated to do, and there is heavy reluctance in the face of the prospect of such sanctions.

squirrelelite linked a video some time back wherein it was explaned that much of the “speed” comes from quickly solving the things that money can solve in advance. Also, BioNtech started theirs in January as soon as the genome was released.

Thank-you Orac for continuing to be a reliable source of sound scientific information in these troubling times. Over many years as a lurker, I have relied upon your site as a consistent source of insight and education.

As a Family Doc of over 40 years experience, I face a relentlessly increasing barrage of irrational nonsense on a daily basis which the Covid crisis has only worsened. I hope, as you mentioned early on in your post, that you find time to address the Ivermectin issue too.

Irrational nonsense, afetr 40 years of practice? You mean like “Did they ever, ever, isolate a covid virus?” You mean like, “Can a mask actually stop a virus from spreading?”

Doctors are drug pushers. Take yourself for example. Have you ever let a patient of yours come in the first time and NOT give him a drug? I doubt it. You’re the drug pusher, the one who wants to believe you’ve been doing good for all those wasted 40 years. Get a life, shmuck.

Oops. Sorry, Tony Ford. I thought it was addressing Orac. Which would be weird as that would imply he’s been slicing and dicing since he was ~12. Not unheard of — people do — But still.

@ Tony Ford

Sorry, buddy, there is a drug fetishism problem in the medical world. Can’t deny that.

I do not mind drug dealers. I do mind drug pushers: the one that do not give a fuck what you say might be the issue at hand, and who are keen on beating you up to get drugs down your throat.

That is a reality. Do not deny it.

Apparently, some of those physicians influenced one pharmacist with deleterious effects.

A pharmacist who was arrested on charges that he intentionally sabotaged more than 500 doses of the Covid-19 vaccine at a Wisconsin hospital was “an admitted conspiracy theorist” who believed the vaccine could harm people and “change their DNA,” according to the police in Grafton, Wis., where the man was employed.

The police said Steven Brandenburg, 46, who worked the night shift at the Aurora Medical Center in Grafton, Wis., had twice removed a box of vials of the Moderna vaccine from the refrigerator for periods of 12 hours, rendering them “useless.”

“Brandenburg admitted to doing this intentionally, knowing that it would diminish the effects of the vaccine,” the police said.

Looking back, I’m a little disappointed we didn’t get a conspiracy theories about Dolly Parton funding the Moderna vaccine. Has any recipient reported an increased desire for rhinestones?

The mill can process only finite reams of.. stuff.

It currently is more pressed to vacillate between traitor-to-Trump Pence not being ‘Pence’ because the deep state got him and replaced him with a body double, and the truth:

The Q people were going to throw him under the bridge down by the river anyways because he snubbed their little get together back in September.

Has any recipient reported an increased desire for rhinestones?

I fondly recall a road trip that involved a stop in Pigeon Forge.* I don’t recall the exact route, but I came in from the east and found myself on a fine hill overlooking things. Power substation, as I recall. Beautiful weather.

Once one actually hits the main drag, there must be at least a mile of shops selling all manner of crap and kitsch. I chose a velvet wall hanging of the Last Supper as a gift for one of my friends.

*And a custom-made bong mounted to the driver’s-side door and the best mix tape I’ve ever made.

“overlooking things”

Oh yes. It is (mostly very beautiful there). I ran the portable wind profiler up in Cade’s Cove for a little time. Although a high elevation, you couldn’t really see down but look up the surrounding hills {the radar worked better in a bowl}. There was also a substation and water treatment for the campers.

My companion from a cooperating entity commented how gaudy Dollywood was compared to the pristine site of our setup.

I seem to remember a fire took lots of that ‘main drag’ out. I miss remembered:

“but spared the Dollywood theme park”,_Tennessee#Fire_of_2016

Women don’t get men to pay 10,000 dollars to a doctor for bigger rhinestones.

And so it begins, “It is believed to be among the first cases like it to hit the state’s courts”. the life insurance policies that aren’t paid off, because a ME, listed the probable cause of death was Covid (even if no test was taken).
In other news the state of Washington is facing similar problems on the criminal side, when 6 persons who died from gunshots/stab wounds were listed as having died of Covid.

It just keeps getting weirder and weirder.

Could you provide publicly available links? I don’t want to sign up for a Nebraska newspaper.

If a person’s death certificate claims that Covid is responsible for a death (even as a contributing factor), in a criminal case it makes it extremely hard to charge somebody for Murder 1 (if the ME list covid as a secondary cause murder, 1 is off the table, which is a very big bargaining chip).

In an insurance claim (as cited) Covid being a cause (or supplemental/contributor cause) of death, the insurance can then claim (as was the case here) that the insurer made false claims of the person health, when the policy was taken out (under normal circumstances it would be more difficult for an insurance company to make that claim).

When Dr. Birx, said in april, the government is classifying all deaths of patients with coronavirus as ‘covid 19 deaths regardless of cause’ I wrote on this blog the next day that this would be an issue in court.

Keep an eye on the hospitals, scott. Don’t expect to get let in anytime soon when you slice your toe off or get coral stuck in it {I hear it grows inside the body. Gnarly}.

The escapades of American lawyers are nothing to do with whether Covid is a contributing factor in a death or not. If the ME thinks that the patient would have lived if they were healthy and says so, it’s American law that bears the responsibility for any legal consequences. I’m pretty sure that the ME is not responsible for the letter of the law and the actions of lawyers.

@ NumberWang

“The escapades of American lawyers are nothing to do with whether Covid is a contributing factor in a death or not.”


And on medical matters, I’m the kind of guy to listen with great attention to lawyers. I love my lawyer. He’s a hero.

“A pharmacist who was arrested on charges that he intentionally sabotaged more than 500 doses of the Covid-19 vaccine at a Wisconsin hospital was “an admitted conspiracy theorist” who believed the vaccine could harm people and “change their DNA,” according to the police in Grafton, Wis., where the man was employed.”

Another martyr to the Evil Transhumanists. 🙁

scott, your link says nothing about why the insurance company denied a claim for a reported Covid death in Nebraska. As for Washington State, whatever “problems” it may have had with classifying half a dozen Covid-19 deaths* pales next to the 3,558 who’ve died in the state so far during the pandemic.

*the only relevant story I can find online is from June and mentions 7 Washington deaths for which causes were being revised. A self-professed libertarian running a Seattle radio talk show recently hosted a guest from some “Freedom Foundation” alleging that hundreds more death classifications were being changed, something I suppose we’ll just have to take his word on.

Whole Health Chicago (an “integrative” practice which includes an MD, a “chiropractic physician specializing in functional medicine”, a TCM practitioner, and a homeopath)

Somehow, I don’t think I’ll be checking them out for clinical psychotherapy, even though I’m stuck back in the market.

Or what about the neurosurgeon who can’t operate and injured many patients?

What eventually what got Duntsch busted wasn’t all the dead patients, but shoplifting a pair of trousers.

If you are ever wondering why this country is in the political shape it’s in, this guy was reelected to the House of Representatives by 80% to 19%.
Remember he votes on your taxes and how they are spent, including NIH funding, the Judiciary and transportation Infrastructure and intellectual property aviation, EMERGENCY MANAGEMENT and the INTERNET.

@ scott allen

I absolutely do not get your point. This is just the video of some official making whacky statements about Guam capsizing.

What’s that got to do with a bunch of thugs that should have been shot in cold blood because they threatened a democratic process? (I tend to be a bit brutal when it comes to defending the notion of democracy. After all, we use(d) the guillotine in this country…)

…and you still have politicians who want creationism to be taught as science, groups of people who only pay lip service to democracy when it goes their way and a departing president who’s doing his level best to fuck you all over on the way out.

Here’s a link to an MD on YouTube saying early research on ivermectin for COVID looks promising. Her first YouTube on the topic was taken down so she put up this second one. I wonder what you guys think about her presentation. She’s trying to be careful not to overstate the facts but she’s clearly feeling positive about the drug.

I’m delighted to see that LaTulippe has had his license yanked. I work for the 211 info line in Oregon, answering questions about covid for the general public. Back in the spring & summer I had two callers that complained about LaTulippe (one was the poor letter carrier who brought the mail into the office and was scolded to REMOVE his mask on entry). I am one of dozens of people at 211, so if I had two calls about him there were certainly many more. His patients are lucky to be rid of him, though they probably do not think so being that his practice was mostly elderly people in a rural community.

Zelenko with co-authors actually published a study: “COVID-19 outpatients: early risk-stratified treatment with zinc plus low-dose hydroxychloroquine and azithromycin: a retrospective case series study” in the same old “International Journal of Antimicrobial Agents” (Volume 56, Issue 6, December 2020, 106214 – first appeared as a preprint in summer) – just as Raoult (did not find this one particular study discussed either here or on SBM). This journal seems to become more and more the go-to place for publishing questionable (to put it mildly) HCQ research with the special issues like this: (edited by Raoult himself !)
Zelenko’s study seems to be gaining some traction with HCQ crowd after it has been officially published.

[…] As it became clear from more and more evidence that hydroxychloroquine doesn’t work against COVID-19, the narrative started to—shall we say?—evolve? For instance, Dr. Vladimir Zelenko claimed that you had to use zinc with hydroxychloroquine. Others started coming up with cocktails of drugs, vitamins and supplements willy-nilly, with no evidence for efficacy of any of the individual components except the steroids sometimes included in the mix, with grand claims that the cocktail was the miracle cure. Truly, 2020 was a year of physicians behaving badly. […]

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