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The FSMB against physicians promoting COVID-19 misinformation

The Federation of State Medical Boards issued a statement that doctors spreading COVID-19 misinformation should be disciplined. It’s toothless, of course, as evidenced by the rarity of a state medical board taking action against such doctors.

My first post for 2021 was a retrospective on the year 2020 entitled Looking back on 2020: Too many physicians behaving badly. The reason was simple. The COVID-19 pandemic, which first hit Wuhan, China in December 2019, was declared a pandemic by the World Health Organization in March 2020, and shortly thereafter caused mass shutdowns and travel restrictions led some physicians to reveal themselves to be very bad actors indeed in terms of spreading misinformation, advocating quackery, and outright grifting. Sure, the usual suspects (several of whom were ultimately dubbed the “Disinformation Dozen” a few months ago) were involved, which is exactly what one would expect. After all, what were doctors like Joseph Mercola, Sherri Tenpenny, Kelly Brogan, and the like going to do during a pandemic except switch their grift to the coronavirus and COVID-19 vaccines? This was utterly expected. Years—even decades—before, I had wondered how doctors like these could keep their state medical licenses. Last month the Federation of State Medical Boards (FSMB) entered the fray, which is the topic of this post. Before I get to that, though, let’s look back briefly.

I will admit, however, to being surprised at just how many doctors who had previously demonstrated no history of this sort of activity took the opportunity to dive head first into the COVID-19 misinformation pool. Even worse, as has been documented here, even some highly respected doctors and academics have become “COVID contrarians,” minimizing the risk of harm from the coronavirus (particularly in children), making risibly off-base predictions (e.g., “we’ll have herd immunity by April“) and advocating against mask mandates (particularly in schools) and vaccinating children—or even erroneously claiming that respiratory syncytial virus (RSV) is being misdiagnosed in children as COVID-19 and that hospitalizations of children are being exaggerated. Worse, when corrected for their mistakes, they almost never seem to have the humility to admit error and move on; often they double down and act as though their statements were never refuted.

I review all this because there’s a topic I’ve been meaning to write about (and have written about a bit at my not-so-super-secret other blog) regarding the lack of professional sanctions against physicians who spread health misinformation, be about vaccines, masks, COVID-19, or anything else. Going back to the case of cancer quacks like Dr. Stanislaw Burzynski, Dr. Rashid Buttar, and beyond, I’ve long lamented how even the most obvious quacks seem to be able to keep their medical licenses and antivaccine doctors (e.g., Dr. Bob Sears) get off with a slap on the wrist, even when their medical board actually investigates. True, there are occasional exceptions, such as Dr. Paul Thomas, a rising star in the antivaccine movement whose license was suspended because the Oregon Medical Board deemed his antivaccine practices a danger to his patients, Dr. Mark Geier, who subjected autistic children to a hormone blocker usually used in children to treat central precocious puberty, based on the belief that decreasing testosterone levels would allow the mercury from vaccines to be chelated easier with his chelation therapy, and “Lyme literate” Dr John Lentz. Basically, state medical boards seem to be (mostly) toothless when it comes to intervening to stop such dangerous doctors. This is a topic that I’ve been meaning to write about, and a few weeks ago the Federation of State Medical Boards (FSMB) gave me an excuse, and then last week the American Board of Emergency Medicine echoed the same sort of sentiment.

The Federation of State Medical Boards enters the fray

Historically, state medical boards seem to have problems going after outright quacks, much less physicians spreading dangerous misinformation during a global pandemic that has killed more than 600,000 people so far in the US alone, which is why I was so heartened a few weeks ago to see this statement from the Federation of State Medical Boards (FSMB), the organization that represents state medical boards:

Physicians who generate and spread COVID-19 vaccine misinformation or disinformation are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license. Due to their specialized knowledge and training, licensed physicians possess a high degree of public trust and therefore have a powerful platform in society, whether they recognize it or not. They also have an ethical and professional responsibility to practice medicine in the best interests of their patients and must share information that is factual, scientifically grounded and consensus-driven for the betterment of public health. Spreading inaccurate COVID-19 vaccine information contradicts that responsibility, threatens to further erode public trust in the medical profession and puts all patients at risk.

The fact that the FSMB issued such a statement stating that physicians spreading misinformation and disinformation about COVID-19 risk disciplinary action was a big deal, at least to me. However, my enthusiasm and approval were tempered by my knowledge of how state medical boards actually operate. They are, in general, underfunded, have inadequate resources, and can only act when they receive a complaints about specific instances of poor practice or patient injury. Indeed, when a state medical board actually does act against an antivaccine physician (for instance), its penalties are often minimal, as was the case for Dr. Bob Zajac in Minnesota.

Indeed, I’ve long lamented how rare it is for a state medical board to suspend or revoke the medical license of outright quacks and how difficult it has been on the occasions when a state has tried, having written more posts over the years about this problem, both here and elsewhere. One good example that I like to cite (and did cite above but repeat here because I can’t emphasize his example enough and feel it’s worth expanding on briefly) is cancer quack Stanislaw Burzynski, who has been practicing his cancer quackery in Houston since the late 1970s and, despite the occasional attempt of the Texas Medical Board to put a stop to his activities, has managed to prevail, with only minor impediments placed on his ability to practice, leading me to lament, How is it that in 2018 cancer Stanislaw Burzynski is still preying on desperate cancer patients? I even lumped him together with correspondence school naturopath and “pH Miracle Living” quack Robert O. Young as examples of how poorly many states regulate medical practice. (Of course, Burzynski practices in Texas, and Young used to ply his quackery in Florida, two of the worst states for this problem.)

Elsewhere, I’ve discussed the problem before a number of times. The problem is that state medical boards tend to be reluctant to go after doctors who use unscientific treatments like “detoxification” and colon cleanses because it forces them to enforce a standard of care, because such cases are harder to prove, and because there is so much pushback. State medical boards are generally good at going after doctors who commit easily identified, clear-cut breaches in trust, such as substance abuse, defrauding insurance companies, or diddling patients. When it comes to making judgment calls about doctors practicing outside of the standard of care, they’re a lot more reluctant to do so. 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 tend to be loathe to make value judgments about medical practice, and proving quackery is way harder and more resource-intensive than proving that a doctor is an addict who has been practicing while impaired or has sexually abused patients.

Even horrible surgeons like Dr. Christopher Duntsch, whose epic incompetence in the operating room coupled with alcohol abuse resulted in multiple “clean kills” and paralyzed patients. He was rare in that his bungled operations so alarmed colleagues that they actually took the even rarer action of complaining about him to the Texas Medical Board. Even so, all too often it took a long time to take down. Ultimately, Dr. Duntsch, who had major substance abuse problems in addition to his epic incompetence in the operating room, finally did lose his medical license and is now serving a life sentence in a Texas prison for multiple counts of aggravated assault relating to 33 botched surgeries over two years, including two that resulted in patient death. Indeed, Dr. Duntsch’s case was so remarkable that he is now the subject of an eight part series on Peacock entitled Dr. Death: The Undoctored Story, which I’ve been meaning to watch:

The good thing about the case of Dr. Duntsch is that doctors as sociopathic as he was are rare. The bad thing about the case is that it took a really long time for his colleagues (who knew his reputation and had had to try to salvage his disastrous complications) and the Texas Medical Board to act.

Which brings us to COVID-19 misinformation, which can kill. Are state medical boards actually doing anything? While it’s true that it has only been less than a month since the FSMB issued its statement, I thought I’d look into this.

“No physicians disciplined for COVID falsehoods”

Earlier this week, a reader made me aware of a story published in MedPage Today that looked into the question of whether state medical boards have been investigating physicians making false COVID-19 claims. Its findings were not reassuring:

Despite a national call to sanction doctors who spread COVID-19 misinformation, a MedPage Today investigation found that not one of 20 physicians who’ve peddled such falsehoods has been disciplined by their state licensing agency for doing so.

That’s not to say that complaints haven’t been filed, or that investigations haven’t been launched. These elements are confidential in most states, including the 10 contacted by MedPage Today who license the physicians.

But that means physicians who have advanced false COVID information — including Simone Gold, MD, JD; Scott Atlas, MD; Joseph Mercola, DO; Lee Merritt, MD; Sherri Tenpenny, DO; and Stella Immanuel, MD — are free to continue to misinform their patients and the public, even as the Delta variant surges.

“Our statement is a reminder to physicians that words have consequences and during a public health emergency like COVID-19, those words can mean life or death for patients,” Joe Knickrehm, vice president of communications for the Federation of State Medical Boards (FSMB), told MedPage Today via email.

Obviously, Dr. Joe Mercola is well-known to readers of this blog, my having featured him in a post earlier this month describing his copious spreading of online COVID-19 misinformation. He is what I have long referred to as a quack tycoon, given that his net worth is north of $100 million, thanks to his online supplement and quackery sales supported by his website, which has spread antivaccine misinformation for close to 25 years. As I mentioned before, of course he pivoted to COVID-19 misinformation and antivaccine fear mongering targeting the COVID-19 vaccines, including false claims that the flu vaccine makes you more susceptible to COVID-19, that mRNA-based COVID-19 vaccine is “gene therapy” that can “permanently alter your DNA,” that the vaccines will cause global depopulation, and that ivermectin is a miracle cure for COVID-19 whose “suppression” is the “crime of the century.”

I also can’t help but note that the reporters seem not to be aware that Mercola recently moved from Illinois to Florida and appears not to be licensed in Florida. Also, he hasn’t practiced medicine for over a decade, which makes asking the Illinois Department of Financial and Professional Regulation strike me as a bit off-target, given that the only thing Mercola would lose if he lost his medical license would be prestige. (His ability to grift would remain inatact.) Still, here’s the statement from the story:

In a statement, the Illinois Department of Financial and Professional Regulation said that if the agency “determines a licensee committed violations against the Act that regulates their profession, an appropriate course of action will be taken. Complaints filed with and investigations undertaken by IDFPR are confidential, unless and until a public complaint or discipline is issued by the Department.”

The largest number by far of doctors featured in this story hold medical licenses in California: Simone Gold, MD, JD; Scott Atlas, MD; Dan Erickson, DO; Artin Massihi, MD; Jeffrey Barke, MD; Jennings Ryan Staley, MD; Brian Tyson, MD. Several of these doctors are familiar. For example, Simone Gold is a prominent member of the Frontline COVID-19 Critical Care (FLCCC) Alliance, which has been promoting ivermectin as the miracle cure for COVID-19 that “they” don’t want you to know about. Unsurprisingly, last summer she was promoting hydroxychloroquine as the miracle cure for COVID-19 that “they” don’t want you to know about.

As for the rest of the doctors in the list, last year around this time Hoover Institution hack Scott Atlas, a radiologist with no expertise in infectious disease or epidemiology, rose to become one of Donald Trump’s most trusted medical advisors regarding the pandemic, even though he was very much for “natural herd immunity.” Early in the pandemic Dan Erickson and Artin Massihi published a highly dubious study that tried to estimate the prevalence of COVID-19. Jeffrey Barke, whom I had never heard of before, has a concierge practice in Newport Beach and appears to be an antimasker, having published a book a year ago entitled Covid-19 A Physician’s Take on the Exaggerated Fear of the Coronavirus. And then there was this last September:

His medically unorthodox opinions have become familiar among the voices claiming that the coronavirus has been politicized in an effort to damage President Donald Trump’s reelection campaign.

Even despite Barke’s proactive omnipresence on social media, a video he posted Sept. 17 managed to create new shock waves – to the point that Hoag Hospital, with which Barke has a business relationship, publicly distanced itself from him.

In last week’s video, Barke shares a split-screen with fellow anti-masking media star Peggy Hall. “What I do, Peggy, to protect you and to protect others when I’m in public – I think better than a mask – this is what I do,” Barke asserts, suddenly brandishing a 9-millimeter handgun.

“You know, I live in Orange County so I carry this wherever I go,” Barke continues, adding that he works for “a local sheriff’s department agency as a reserve deputy.”

The next day, Hoag tweeted that Barke’s “radical views on COVID, masking and hydroxychloroquine” are “diametrically opposite” from the hospital’s.

Well alrighty, then.

Then there’s Jennings Ryan Staley, who has his own mention on the US Department of Justice website:

Dr. Jennings Ryan Staley, previously charged with one count of mail fraud, was indicted by a federal grand jury yesterday for additional crimes arising from his business venture selling COVID-19 “treatment kits,” which he advertised to one potential customer as a “miracle cure.” Staley is a licensed physician and the former operator of Skinny Beach Med Spas in and around San Diego.

According to the new charges, which became publicly available today, Staley agreed with a Chinese supplier to smuggle hydroxychloroquine powder into the U.S., lying to U.S. Customs by mislabeling a shipment as “yam extract.” Staley is also charged with stealing the name and identifying information of one of his employees in order to create and submit a bogus prescription for hydroxychloroquine on the employee’s behalf, in order to sell the drugs at a markup to his customers.

In late March and early April 2020, Staley marketed and sold his treatment kits to Skinny Beach customers. He described his product as a “concierge medicine experience,” which included hydroxychloroquine—an anti-malarial drug that Staley described to one potential customer as a “guaranteed” cure for COVID-19. Staley’s kits were priced as high as $3,995 for a family of four, while Staley himself paid roughly $1 per tablet of hydroxychloroquine. Staley’s marketing materials, per the indictment, stressed that recipients should “NOT BELIEVE THE REPORTS THAT HYDROXYCHLOROQUINE DOESN’T WORK!”

During a phone call with a prospective customer, in reality an undercover FBI agent, Staley repeatedly promised that the drugs he was selling would cure COVID-19.

If he’s convicted, this should be a slam dunk, given that most states automatically revoke the medical license of any physician convicted of a felony, and another notice states that he pleaded guilty to “one count of importation contrary to law, admitting that he worked with a Chinese supplier to try to smuggle into the United States a barrel that he believed contained over 26 pounds of hydroxychloroquine powder by mislabeling it as ‘yam extract.'”” (As a side note, hilariously, this scammer got scammed, given that the shipment turned out only to contain baking soda.)

Meanwhile, Dr. Brian Tyson appears to be a run-of-the-mill hydroxychloroquine quack with an outsized social media presence, who is now promoting ivermectin as part of a “multidrug therapy” for COVID-19:

Personally, I appreciated the FDA’s snark on this. Those of us who have criticized ivermectin believers acknowledge that, when used for its intended purpose, it’s a great drug. We just recognize that there’s no good evidence that it is as much of a “miracle” drug for COVID-19 as it is for river blindness.

I could go on and on through the list, but why bother? Instead, let’s just sample some of the responses from various state medical boards, starting with California, given the number of offenders in that state:

Carlos Villatoro, public information officer for the Medical Board of California, said in an email to MedPage Today that “publicly spreading false COVID-19 information may be considered unprofessional conduct and could be grounds for disciplinary action. The Board will review complaints it receives about its licensees on this topic, as it does with all complaints. To date, no accusation has been filed against a licensee regarding this issue.”

Let’s move on to nearby Idaho:

Yvonne Dunbar, counsel for the Idaho State Medical Board, told MedPage Today in an email, “Neither the Idaho Medical Practice Act nor the applicable administrative rules provide a basis for the Board to discipline licensees for statements made during a conference, to the media, or in any other public setting.”

However, she said the board “does have authority to investigate and possibly discipline its licensees for statements or behaviors which transpire in a health care setting … if it is established that they: ‘Engag[ed] in a pattern of unprofessional or disruptive behavior or interaction in a health care setting that interferes with patient care or could reasonably be expected to adversely impact the quality of care rendered to a patient. Such behavior does not have to have caused actual patient harm to be considered unprofessional or disruptive.'”

Unsurprisingly, many of the docs who promote COVID-19 misinformation on social media and old school media (TV, newspapers, etc.) often also practice according to that misinformation, discouraging masking, demonizing vaccines, promoting “miracle cures” such as ivermectin and hydroxychloroquine (with zinc, and other drugs and supplements, of course!) as part of their treatment protocols.

I can’t resist quoting North Carolina (about, appropriately enough, Rashid Buttar, who once famously referred to the North Carolina Medical Board as a “rabid dog“):

If the North Carolina Medical Board has information that a licensee may be spreading false or misleading information about COVID-19, it would investigate, said communications director Jean Fisher Brinkley. “Decisions about possible regulatory action would be based on the evidence gathered and, specifically, whether the Board has evidence that a violation of law or professional ethics occurred, a process that is consistent with the FSMB’s statement.”

There is a depressing similarity to all the responses, namely either that medical board of the state where the physician in question practices hasn’t received any complaints as of yet, that speech alone can’t be penalized, or that they will “investigate” if there are complaints. When a bunch of readers sent me a link to the FSMB complaint, I generally responded that I don’t expect much to come of it. More recently, I responded to those sending me this MedPage Today article, “I hate to say I told you so, but I told you so.” But why? Why is nothing happening?

So the FSMB’s call for state medical boards to discipline doctors has been ineffective. Indeed, I rather suspect that it was always more performative than anything else, given that the FSMB does not have any actual power over state medical boards. Still, emphasizing the powerlessness of the FSMB was an article the New York Times on Friday:

Now there is a growing call among medical groups to discipline physicians spreading incorrect information. The Federation of State Medical Boards, which represents the groups that license and discipline doctors, recommended last month that states consider action against doctors who share false medical claims, including suspending or revoking medical licenses. The American Medical Association says spreading misinformation violates the code of ethics that licensed doctors agree to follow.

“When a doctor speaks, people pay attention,” said Dr. Humayun Chaudhry, president of the Federation of State Medical Boards. “The title of being a physician lends credibility to what people say to the general public. That’s why it is so important that these doctors don’t spread misinformation.”

OK, so the AMA also says that spreading misinformation is unprofessional and unethical, too, but the AMA,which functions as a trade association designed to protect doctors’ financial interests more than anything else these days, has even less power over this than the FSMB. As for Dr. Chaudhry, I’m sure he means well, but I predict that FSMB will do just what it’s been doing, nothing. Well, nothing other than making statements that can’t be enforced. Indeed, the NYT article is very similar to the MedPage Today article in that it features a bunch of quotes from representatives of state medical boards that say basically nothing.

I will give the NYT credit for citing Rachel Moran, a researcher at the University of Washington who studies online misinformation, including about the Covid-19 vaccines:

“What’s most frustrating about this is how anti-vaccination advocates typically spread mistrust in medical professionals until it’s no longer a useful strategy for them,” Ms. Moran said, noting how they regularly cast doubt on Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases.

“Then a ‘doctor’ comes along that aligns with their values,” Ms. Moran said, “and suddenly that institutional expertise is credible.”

Of course, those of us who have been following the antivaccine movement for two decades knew this all along, in particular how antivaxxers just love the narrative of a “brave maverick doctor” being “persecuted” for his antivaccine views, hence our longstanding frustration dating back to years before the pandemic with state medical boards failing not just to discipline doctors spreading misinformation but to act against outright quacks. Granted, the latter isn’t always the individual state medical board’s fault. As the examples of Stanislaw Burzynski and Rashid Buttar show, sometimes these quacks are politically powerful and popular, and individual state laws often don’t give the medical boards the power that they need.

The First Amendment vs. professional speech

To get an idea of why nothing is happening, I can’t help but point to the reaction of some physicians to the FSMB statement, starting with the Association of American Physicians and Surgeons (AAPS), a far right wing medical John Birch Society camouflaged as a legitimate medical professional society. I’ve written about the AAPS a number of times, relating how it’s promoted antivaccine pseudoscience blaming vaccines for autism, including a view that is extreme even among antivaccine activists, namely that the “shaken baby syndrome” is a “misdiagnosis” for vaccine injury. It’s worse than that, though. AAPS has promoted HIV/AIDS denialism, blamed immigrants for crime and disease, promoted the pseudoscience claiming that abortion causes breast cancer using some of the most execrable “science” ever, and not only rejected evidence-based guidelines as an unacceptable affront on the godlike autonomy of physicians; the very concept of a scientific consensus about anything. Let’s just put it this way. The AAPS has featured publications by antivaccine mercury militia “scientists” Mark and David Geier and many others. Unsurprisingly, in the age of COVID-19, the AAPS has seamlessly pivoted to COVID-19 denial, antimask nonsense, and antivaccine conspiracy theories.

The title of its protest of the FSMB statement? As you might expect, Dr. Tamzin Rosenwasser’s article is entitled The Federation of State Medical Boards Channels the Soviet NKVD. (I suppose I should be grateful that Nazis weren’t mentioned, at least in the title.) After quoting the FSMB statement, Dr. Rosenwasser goes all anti-Communist, consistent with the AAPS’s similarity to a medical John Birch Society:

The FSMB has been described as a “private lobbying organization that represents the state’s attorneys who work for medical boards.” It does not by itself have the legal authority to take a doctor’s license but is highly influential.

The NKVD, the People’s Commissariat for Internal Affairs, was the Soviet secret police agency, the precursor to the KGB.

Unsurprisingly, the editorial goes on to parrot antivaccine misinformation about the COVID-19 vaccine and COVID-19 in general, continue the author’s confusion on whether the FSMB are Communists or Nazis, and appeal to “free speech,” portraying any effort to “censor” misinformation as an unconscionable assault on free speech. It’s a very appealing argument, at least in the US, where free speech protections are embedded in the Constitution. Doctors who are antivaccine and/or promote COVID-19 misinformation often appeal to free speech (and, in the US, the First Amendment) and portray any attempts by medical licensing bodies, whatever the state or country, to discipline them for their activities as fascistic (or Communist) assaults of “free speech.”

Although there are certainly gray areas, these attacks are deceptive, for the simple reason that professional speech by a physician licensed by the state is not the same as some random fool on social media saying the same thing. When physicians use the imprimatur of authority that society has bestowed on them to add the authority of their profession to their misinformation, that is arguably an abuse their status as a physician. These physicians spreading COVID-19 misinformation disingenuously ignore the simple fact that, if they were not physicians, their misleading pontificating about how the vaccine doesn’t work or is dangerous, how we’ll have “herd immunity by April,” or touting drugs that don’t work as “miracle cures” for COVID-19 that are being “suppressed” by The Man would not be taken nearly as seriously by the public.

As physicians and surgeons, as part of our professional role we are granted privileges unknown to non-physicians, including being allowed to ask patients about their deepest and darkest personal matters, administering potentially toxic drugs (such as chemotherapy for cancer), or, in the case of surgeons, removing or rearranging body parts for therapeutic effect using sharp instruments in a way that would be considered assault and battery if attempted by a non-surgeon. We are granted these incredible privileges because society has deemed us worthy after our having completed four years of rigorous training in medical school followed by anywhere from three years to a decade or more of additional training in residency and fellowship. In the age of COVID-19, the entire right-wing COVID-19 disinformation ecosystem, of which the AAPS is a small but influential part on medical matters, will treat any physician whose license is sanctioned by a state medical board as a free speech martyr. This is propaganda, however, not reality, because our professional status makes our utterances on COVID-19 professional speech that is arguably part of our profession as physicians, not just an exercise of free speech, and if we abuse our professional speech, state medical boards should certainly be empowered to investigate and discipline us.

After all, as a result of the privileges granted us, society also accords our words on medical matters (and, let’s face it as ridiculous as it might seem, on many nonmedical matters too) much more weight than those coming from nonphysicians. Physicians, in my experience, often both forget about that and take advantage of it. Again, I like to emphasize that, were these physicians not physicians, a lot fewer people would give a rodent’s posterior what their latest take on COVID-19 or vaccines is. In other words, professional speech misused can have deadly consequences, particularly during a pandemic. Contrary to Dr. Rowenwasser’s ridiculous comparison to the repression carried out by the NKVD and appeal to the Nuremberg Code, it is entirely appropriate for the FSMB to recommend going after the medical license of—or otherwise disciplining—any physician promoting obvious COVID-19 and antivaccine misinformation and conspiracy theories. That is not suppression of free speech. That is professional oversight.

Advocates for science- and evidence-based medicine cannot help but be appalled at how easily physicians practicing modalities that are clearly so far outside the standard of care that they might as well be in another galaxy can continue to do so with little or no oversight or even interference by state medical boards. In essence, it takes mind-numbingly egregious offenses to motivate a board to act, such it substance abuse by a physician resulting in obvious impairment, non-science-based treatments resulting in the death or severe injury of a patient, or blatantly illegal behavior, such as running a narcotic prescription mill. Part of the problem is that the attitude among doctors seems to be that a medical license is a right, rather than what it really is: an incredible privilege bestowed upon us physicians and surgeons by society that takes an equally incredible commitment and skill to be allowed to continue to keep. That same attitude among physicians also seems to lead them to think that they should be able to say anything they want about the pandemic, even though their words are arguably professional speech (particularly given how many “COVID contrarian” doctors use their status either to sell a product or to sell themselves as “experts”).

Our patients deserve better. The vast majority of physicians are competent and try their best to deliver the best evidence-based care they can to their patients. However, doctors who consistently do not practice according to the standard of care, be it because they are incompetent, dishonest, impaired by substance abuse, or because they have come to believe in blatantly unscientific treatments that do not help and not infrequently harm patients, do not deserve to be physicians. The same is true of physicians who abuse their status in order to peddle misinformation about a virus causing a pandemic that has killed over 600,000 in the US alone and millions worldwide—and is still sickening and killing people at unacceptably high rates. I’m glad the FSMB said something about revoking the licenses of physicians who spread misinformation, but I fear that in practice implementing such a policy will be well nigh impossible.

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]

43 replies on “The FSMB against physicians promoting COVID-19 misinformation”

re ” ..mislabeling a shipment as ‘ yam extract’ ..”

which could then be touted as a remedy for the symptoms of menopause amongst other conditions according to alt med

From the AAPS statement: “The FSMB has been described as a “private lobbying organization that represents the state’s attorneys who work for medical boards.”

You could describe it that way if facts are not your strong point.

All of the members of the FSMB Board of Directors are MDs or DOs. The same goes for most of the at-large directors and staff fellows. Every single president/chair of the FSMB has been a physician.
All of the 71 medical boards in the U.S. and its territories are members of the FSMB. The FSMB also co-sponsors the USMLE (licensing exam).

An accurate statement about the AAPS could read: “The AAPS has been described as a fringe organization representing a tiny minority of far-right practitioners who resent regulatory oversight and regularly promote harmful medical misinformation.:”

I had to rotate with a doc who was a vociferous AAPS member and supporter once upon a time. He was really angry that I didn’t want to join. Last I checked, he’d switched to direct pay only and was doing mostly OMT. Ugh.

Did you give anyone remdesivir?
Did you tell anyone remdesivir cures covid?

Boom, there goes your license.

@Scientism Dave Remdesivir has a FDA approval for COVID 19. Remember Mark Twain citation ?

@ Scientism Dave
And what is wrong with that?
If you carmechanic uses the wrong parts for your car, or put water instead of oil in it, thus damaging your car, I suppose you want him punished.

I never told anyone remdesivir “cured” anything. Yeah-it had approval so we gave it out. It was one of the few drugs studied that seemed to do anything to affect mortality and hospital stay. It came with a massive price tag. I was never a fan.

What people like you don’t get is that I became a doctor to help others. This was a novel pathogen and we were running out of hospital beds (Sort of like now.) you were never in those wards or units doing the best you could. You were at home. On your computer. Making things worse (Sort of like now.)

The ivermectin cranks seem to conflate saying that something has a modest therapeutic effect based on a clinical trial with saying that it’s a “cure.”

@Scientism Dave As for Mark Twain, you were right. I would use Wikiquote next time.
As for remdesivir, It is FDA approved for COVID. You seems to believe WHO, expect when you do not believe it. However, NIH has more jurisdiction in US:–therapeutic-management/
Remdesivir is not recommended to everybody, thoughl. It is not cure for COVID, after all.

For example, Simone Gold is a prominent member of the Frontline COVID-19 Critical Care (FLCCC) Alliance, which has been promoting ivermectin as the miracle cure for COVID-19 that “they” don’t want you to know about.

I guess one can add Fred Wagshul to that list.

You have to ask if this lady was vaccinated! It would seem NOT as she ended up on a ventilator. If that’s the case, I then question any of the rest of this as reported.

Wagshul’s promotion of ivermectin is just a wee bit problematic, beyond the drug’s lack of proven efficacy against Covid-19.

“Ivermectin is so safe,” said Dr. Fred Wagshul, medical director at Lung Center of America in Centerville. “It essentially has no drug interactions and no side effects.”

Ivermectin has 76 listed drug interactions (source: and while it isn’t regarded as an especially toxic drug, there are common side effects including headache, dizziness and nausea, as well as more serious ones like confusion, loss of balance, tachycardia and visual disturbance.

Re: Ivermectin common side effects

And this is for the regular dose of ivermectin.

At the big doses/with the formulation the Ivermectin fans are using, going by some tweeter or FB threads, we can add uncontrolled bowel movements to the list.

Seems there is a downside in ingesting daily 10 times a dose which was meant to be taken weekly.

Of course, people rationalize it as just being “parasites” being expelled. Who knew the average American is so full of helminthes?

Who knew the average American is so full of helminthes?

Roundworms specifically.

So Gorski is arguing that any doctor who prescribed or said that Remdesivir cures covid should have their license revoked…
Let’s do it.

You are very silly and not even very good at this. No one ever said that remdesivir “cures” COVID-19, not in the way ivermectin and hydroxychloroquine cranks claimed that the drugs “cure” COVID-19.

Our Old Friend Paracelsus has something to say on the Matter of Ivermectin too, as while it’s generally well tolerated at the correct dose, many of these cranks are telling people to take vetinary Ivermectin, and there is a distinct difference between the average human adult, Obese though they may be, and, say, a Ton of Clydesdale or Holstein…

there is a distinct difference between the average human adult, Obese though they may be, and, say, a Ton of Clydesdale or Holstein

On another blog, a commenter pointed, tongue-in-check, that ivermectin is not to be taken on an empty stomach. Before taking one’s dose, chew 10-20 pounds of hay.

Precisely. And the clear implication, as I very much recall, was you better use it if you have it or risk court. It was the “Standard of Care” at that time for better or for worse. Dave wouldn’t know anything about any of that because it doesn’t fit whatever narrative he’s running with today…

Hello Doctor,
I have read your 5 articles as well as this one, searching for the answer of a very simple question: Why should Ivermectin NOT be part of therapeutic protocols in patients suffering from Covid-19?
It is a simple question, indeed.
Is it dangerous? Well there is a public database that has been put in place by the WHO. Anyone can search for the records of adverse effects for any existing drug, including Ivermectin.
Type Ivermectin and you’ll get 5657 reports of side effects for this molecule since 1992.
Is Ivermectin a magic drug? Nope, there are none and probably never be since we are dealing with a virus.
Is Ivermectin a substitute for vaccination? Nope, since it has no effect in anti-bodies creation.
Nevertheless, there are now well over 100 studies from around the world that have suggested that Ivermectin could have some effects on covid-19 patients, at least in some specific cases.
So my question, Dr Orac, is this: How many of these studies did you read? And if you did, what was the one that convinced you that this molecule was a piece of shit that should be banned?

I have read your 5 articles as well as this one, searching for the answer of a very simple question: Why should Ivermectin NOT be part of therapeutic protocols in patients suffering from Covid-19?
It is a simple question, indeed.

So I’ll give you a simple answer: There’s no good evidence that it works. In fact, it almost certainly doesn’t.

“Coronavirus drug remdesivir to cost $3,120 per patient with private insurance”


What do you think four days in the hospital costs?

Right…its the people who recommend ivermectin who are “quacks” and “grifters”.

Another radio host discovers that ivermectin doesn’t work too late.

“Before he fell ill with the virus, Valentine had spoken out against mask mandates and written a parody of The Beatles’ song ‘Taxman’ called ‘Vaxman’ mocking the preventative. He sang it on the air.

“‘Let me tell you how it will be, and I don’t care if you agree, ‘Cause I’m the Vaxman, yeah I’m the Vaxman,’ he sang. ‘If you don’t like me coming round, be thankful I don’t hold you down.'”

Maybe his audience will take it as a lesson. Maybe.

P.S. Right before I hit “post,” I noticed that there’s a third radio host gone, Marc “Mr. Anti-Vax” Bernier. That’s two for Florida. I doubt that Bernier’s audience will take heed.

In April, he said young and healthy people don’t need to get vaccinated. After an outcry, he told his audience not to take his advice seriously, saying he’s not “an anti-vax person” or a doctor, but rather “a moron.”


Another radio host discovers that ivermectin doesn’t work

Somebody put up a website to track this –

A list of “influencers” against masks or vaccination who have died or are critically ill due to covid.

Earnest seekers after truth will be glad to know that Ending Plague, the latest in the Plague series (Plague, Plague of Corruption, The Many Plagues of Kent Heckenlively) has now gone on sale at finer booksellers.

From the meager excerpts available online, it appears that the book (the lead author is ex-virologist Francis Ruscetti; the book is co-authored by his protege Judy Mikovits with assistance from Kent) follows a pattern set by earlier books featuring Mikovits. It incorporates utterly fascinating (not) autobiographical details, gripes against Those Who Done Me Wrong (in Ruscetti’s case, mostly Robert Gallo) and engages in generalized ranting against the powers that are corrupting Science, in other words failing to recognize the greatness of the authors. Ruscetti lumps the FDA, CDC, NIAID and other organizations into a corrupt influence category, with the Rich Elite pulling the strings. How else to explain the “forced” ending of his scientific career in 2013?

It might make an acceptable bedtime story if our local library decides to carry it.*

*if it doesn’t, we’ll all know why.

[…] Contrary to the “persecution” narrative promoted by astroturf think tanks like AIER and its ilk, in which supposedly those holding its position are “canceled” and “persecuted,” GBD “luminaries” and fellow travelers are actually very influential. It’s easy to laugh at AIER fellow Naomi Wolf for her antivaccine and wacky COVID-19 conspiracy theories, but it’s harder to laugh at someone like AIER contributor Dr. Scott Atlas, a radiologist with no expertise in infectious disease or epidemiology and a fellow at the conservative Hoover Institution at Stanford University (also known for promoting climate science denial), given that he was for a time the chief advisor to then-President Trump on the pandemic, and the advice he gave cribbed heavily from the GBD in his push for “natural herd immunity.” […]

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