Three weeks ago, we learned that the Credentials and Certification Committee of the American Board of Internal Medicine (ABIM) had voted strip two COVID-19 quacks, Drs. Pierre Kory and Paul Marik, of their board certifications. In my discussion a couple of weeks ago I noted that there appeared to be less than met the eye to this decision; first, because this decision was announced not by the ABIM but rather by the antivax quack organization founded by Kory and Marik, the the ivermectin-promoting Frontline Covid-19 Critical Care Alliance, or FLCC (apparently after the two quacks had received letters from the ABIM) and, second, because a perusal of the ABIM website demonstrated that Dr. Kory was still board-certified in internal medicine and pulmonary and critical care medicine (which he still is as of early this morning), while Dr. Marik’s certification status was listed as “inactive” (which it also still is as of early this morning). As a reminder, the reason that Dr. Marik’s status was listed as “inactive” is because you need a valid state medical license to be board-certified, and Dr. Marik had let his license lapse in 2022, leading to his inactive status.
In my original post, I had considerable fun with some of the merch being sold by FLCCC that portrayed Drs. Marik and Kory as some sort of superheroes, which I republish below, because they are truly cringe and suggest the self-image held by Drs. Marik and Kory:
As I said, totally cringe.
Given this background and the FLCCC’s relentless promotion of antivaccine misinformation as well as repurposed drugs that were demonstrated to be ineffective against COVID-19 by early 2021 at the latest (making them quackery in 2023), perhaps you might have wondered what the FLCCC’s response would be after its initial response, in which the FLCCC decried the ABIM for “censorship” and “persecution,” even as they openly admitted that loss of board certificate will have no effect whatsoever on their ability to
grift practice grift.
Lest you think that I am exaggerating when I refer to Dr. Kory as an antivaxxer, I’ll just leave this Tweet right here from last December:
So what does Dr. Kory do for a followup? He takes to his Substack, of course—where else?—to launch a rather lengthy attack on the ABIM entitled The American Board of Internal Medicine’s Longstanding War On Doctors Is Escalating, for which he adds the blurb:
The ABIM’s history proves their present actions are political/financial and not scientific. They are making examples of us “dissenters” to scare the rest of the country’s docs to keep quiet.
Because, to conspiracy theorists, the ABIM’s decision, even as long-delated as it is—seriously, the ABIM should have stripped these two of their board certifications in 2021!—can’t possibly be a principled one. Indeed, I can’t help but suggest that the very fact that this decision took three years, given that the FLCCC first started promoting hydroxychloroquine and ivermectin, along with its “COVID-19 early treatment” protocols mere months after the pandemic first hit, suggests an organization struggling with what its role should be in enforcing professional standards among physicians holding certificates and too cowardly to anything about any but the most egregious promoters of COVID-19 misinformation and quackery, like Drs. Kory and Marik.
Drs. Kory and Marik, of course, are clever, though. They take a common complaint about the ABIM that has at least some validity and then repurpose it to portray the ABIM’s action against them as totally corrupt, much as the FLCCC repurposed ivermectin and hydroxychloroquine from treating roundworm infestations and malaria, respectively, into miracle cures for COVID-19. I’ll quote Kory’s Substack to show you what I mean, starting with his introductory rant:
The unholy alliance of industry captured high-impact medical journals, federal public health agencies, professional societies (ABIM, AMA, APHa etc), and most importantly, the state medical licensing boards directed by the Federation of State Medical Boards (FSMB) are still going hard after us “dissenting” doctors. You know, those of us that very publicly called out the unscientific policies implemented by corrupted policymakers in a directed pursuit of profits and power. Their actions trying to silence us (and to scare other doctors from speaking out) are escalating.
In essence, this is the pharma shill gambit aimed at the ABIM and state medical boards. Personally, I find the pharma shill gambit aimed at state medical boards to be incredibly ridiculous even for fools like Dr. Kory, given that state medical boards are funded by taxpayers out of state budgets and are chronically underfunded and understaffed. One might think that if big pharma had such pull, financial and political, state medical boards would be far better funded, more powerful, and more willing to take action disciplinary against quacks. The real situation, of course, is quite the contrary, with state medical boards having long been toothless in the face of misinformation-spewing quacks, a problem that I’ve been lamenting for close to two decades. (In other words, it’s nothing new since the pandemic.) As I put it three weeks ago, state medical boards have always been toothless. The more interesting gambit comes in Dr. Kory’s attack on the ABIM for its maintenance of certification program.
Dr. Kory starts with a complaint about ABIM that many physicians have made. Indeed, peruse doctors’ websites for “maintenance of certification,” and you will find many harsh criticisms of the ABIM’s requirements for physicians to maintain certification, as well as the expense and effort required to do so. It’s not just the ABIM, either. Here’s a rant against the American Board of Pediatrics’ maintenance of certification program published on KevinMD in 2014:
Up until 1988, being board certified in pediatrics was a voluntary process of passing the board exam once in a career. The American Board of Pediatrics (ABP) apparently realized this process didn’t make them much money, so in 1989, they abruptly ended “lifetime certification” and required an open book test and the associated fee every seven years. I was in pediatric residency during this maintenance of certification (MOC) stage, the mandate was an annoying and costly change from lifetime certification, but an open book test seemed manageable for a busy pediatrician to complete. I watched my attendings work on their open book tests over the lunch hour. It was collegial and almost fun.
The ABP apparently realized this process didn’t make them enough money either, because in 2003, they abruptly required a secure exam every seven years. This was a bigger deal, requiring participation in expensive $1,000 board review courses, offered conveniently by the same academic doctors who established this new requirement. Secure exams, in addition to costing more to administer and prepare for, also require taking time away from the office and patient care for the actual test.
Then out of the blue, just seven years later, the rules changed yet again. Passing the boards once in a career wasn’t enough, an open book exam every seven years wasn’t enough, a secure exam every seven years wasn’t enough: Pediatricians needed to remit $990 and enroll in a continuous MOC program. Because pediatricians are a compliant lot, I did as I was told.
Now, here’s Dr. Kory about the ABIM:
At the end of my training, I became Board Certified by the ABIM in three specialties (Internal Medicine, Pulmonary Diseases, and Critical Care Medicine).What is the ABIM? Well, from this devastating article by Kurt Eichenwald, an accomplished corporate investigative journalist who did a devastating takedown of the ABIM and its officers in a Newsweek piece in 2015:The ABIM is a purported nonprofit that certifies new physicians as meeting standards of practice. Beginning in the early 1990s, the ABIM ordered certified doctors to be recertified, again and again. Without the ABIM seal of approval, lots of internists and subspecialists can’t get jobs and can’t admit patients to hospitals. So by taking advantage of that monopolistic power, the ABIM has forced hundreds of thousands of physicians to follow recertification processes that doctors complain cost them tons of money (paid to the ABIM), require tons of time (taken from families and medical practices) and accomplish nothing.In many doctor’s opinion, this cash grab of the ABIM by selling “certifications” is a corrupt farce. There is no evidence that certifying doctors in this highly costly way does anything to improve the quality of care delivered. The ABIM has not only refused to produce data showing the program improves patient care but also hasn’t conducted any studies on that matter. In fact, the ABIM and its related organizations are:harming American medicine and diminishing the quality of scientific research, pushing physicians to close practices rather than wasting time on expensive and frustrating busywork, and forcing specialists to play a game of medical trivial pursuit. (Even Baron has admitted that he was tested for recertification on topics he never used in his practice.)But it sure does generate cash for ABIM executives. Note that Board Certification used to simply be a sort of “honor” denoting that the member passed a more rigorous examination in their specialty. That “honor” comes at a price though…
So, yes, my colleagues in internal medicine and pediatrics and their subspecialties do have legitimate complaints about the ABIM’s onerous maintenance of certification requirements, which have only become more and more onerous with each passing decade. I like to compare these requirements to the much more reasonable requirements mandated by the American Board of Surgery for maintaining my certification in surgery, which was to submit a case list, continuing medical education credits, and some other documentation every ten years and pass a written secure test. (My board certification expires at the end of 2028, as anyone who wants to can verify.)
More recently, the ABS has created a different track for maintaining board certification for subspecialists who are board certified in general surgery but have sub specialized. We have to submit the same CME and other documentation about our practice, but instead of a massive test on all of general surgery, including the parts that I haven’t had to deal with since residency (like vascular surgery) or early in my career as an attending (like trauma) every decade we can now elect to take smaller, more specialty-focused open book tests every three years that don’t require, for example, me (a breast cancer surgeon) to review vascular surgery and trauma (kinds of surgery I never do anymore) every ten years. That is certainly the option that I plan to take in 2028, my having recertified a year early for the “old school” full ten year term in 2017, right as this newer maintenance of certification program was coming into being and its form was still uncertain. Indeed, the existence of this program eliminates a dilemma that I had feared, namely whether it would be worth going to all the effort to certify for another decade when I hope and plan to retire several years before 2038. (Yeah, I’m that old.)
But back to Dr. Kory. In his rant, he cleverly weaponizes legitimate criticisms of the ABIM to imply that the real reason he and Dr. Marik are being “singled out” (along with another COVID-19 quack, Dr. Peter McCullough) for “special treatment” by the ABIM. To do that, he attacks Dr. Richard Baron, president and CEO of ABIM using a bogeyman, a PR firm called Weber Shandwick. Why? Because one of Weber Shandwick’s specialties is crisis and reputation management, which involves combatting disinformation and announced two years ago its new Weber Shandwick Media Security Center, described by the company as “an industry leading, cross-disciplinary team with AI-driven technology at its core, built to address what the overwhelming majority of executives say is one of the leading reputation issues businesses faces today – the spread of disinformation.”
The company website continues:
The Weber Shandwick Media Security Center is powered by insights from some of the leading institutions combating misinformation and disinformation and an exclusive partnership with threat detection platform, Blackbird.AI. The Media Security Center is designed to help clients navigate a volatile media landscape with bespoke solutions that protect reputations and commercial interests.
Manipulated media is no longer just a reputational concern – it is now a financial, employee and organizational security concern, notes Peter Duda, head of Weber Shandwick’s Global Crisis and Issues Management Practice. “We are currently working with clients in healthcare, government, technology and CPG as they battle a potentially harmful information landscape littered with bot created content, artificial distribution and erroneous stories that often spread undetected until they’re unmanageable.”
AI…of course, it had to be…AI.
My sarcasm aside and also leaving aside for the moment the question of whether Weber Shandwick actually delivers what it promises or not, you can see why a group like the FLCCC and doctors like Drs. Kory and Marik would hate a company like Weber Shandwick. Indeed, Dr. Kory makes it a point to quote a passage from his book on Weber Shandwick because he is convinced that the company was behind the “Horse Dewormer PR campaign,” that portrayed ivermectin as a horse dewormer. (Never mind that ivermectin’s most common use in the US is in fact, is as a veterinary deworming drug.) Moreover, as I’ve discussed elsewhere, the promotion of ivermectin by quacks like Dr. Kory did lead people to use veterinarian formulations designed for large animals like horses and cows. As I like to point out (and will do again), equine ivermectin comes packaged in syringes with “1.87% ivermectin paste. 6.08 g syringe treats up to 1,250 lbs. Safe for horses of all ages, pregnant mares, breeding stallions.” Another formulation comes as a 1% solution to be given 1 ml/110 lbs of weight. Basically, in horses the dose of ivermectin can be up to 1.200 mg, while the human dose recommended is only around 3 mg. In other words, even if Weber Shandwick was the originator of the “horse dewormer” anti-ivermectin campaign, so what? It was effective countermessaging against quackery and not anywhere near as deceptive as FLCCC’s ivermectin messaging has always been.
After a long rant that mixed legitimate criticisms of the ABIM’s imperiousness and ever-increasing “mission creep” with respect to board certification with conspiracy mongering claiming that because Dr. Baron engaged a PR firm like Weber Shandwick, whose clients also include pharma companies and describing how they and their lawyers had written a 76-page “rebuttal” to the ABIM’s findings about their spreading misinformation, Dr. Kory writes:
We sent that letter over 6 months ago… and finally got an answer a few weeks ago. To understand the misinformation committee’s response, note this statement from an editorial written by Baron where he tries to give examples of misinformation:A whole range of statements with which many — or even most —physicians might disagree would therefore not trigger our disciplinary process. On the other hand, when someone certified by the ABIM says something like “the origin of all coronary heart disease is a clearly reversible arterial scurvy” or “children can’t spread Covid” or “vaccines don’t prevent Covid deaths or hospitalizations,” we are not dealing with valid professional disagreement; we are dealing with wrong answers.That last sentence is critical as Baron literally is saying that the ABIM gets to determine what is a valid professional disagreement versus a “wrong answer.” Good to know, especially in regards to the fact that the narrative that “vaccines prevent Covid deaths or hospitalizations” was strongly refuted in our initial response letter.
Well, yes. That’s basically what boards responsible for board certification do. They decide, based on evidence and expert input, on a standard of care consensus for their specialty in order to design test questions to test physicians on that standard of care. You can disagree with the standard of care (and certainly boards aren’t 100% correct, nor are they anywhere near infallible), but to attack ABIM for doing what medical boards have done for decades is like attacking university for teaching students. I would criticize the ABIM for not being a bit more clear here, however. If I were writing the response, I might cite the same examples, but I would point out that, to qualify as misinformation, what is being said has to be so far outside the realm of reasonable scientific disagreement as to constitute medical error so gross that believing or spreading it should disqualify a physician from treating patients. As I like to say, this is not about “censorship.” It’s about quality control.
Just like medical cranks of all stripes, Dr. Kory really, really hates the concept of scientific consensus. He even cites Michael Crichton’s infamously bad paragraph about scientific consensus, the same one quoted by quacks, cranks, and antivaxxers since time immemorial (or at least since Crichton, who famously was a climate science denier, first said it), the one that says that the “work of science has nothing whatever to do with consensus” and concludes, “If it’s consensus, it isn’t science. If it’s science, it isn’t consensus. Period.” It is a quote that is so full of bullshit and misunderstanding of science that I must paraphrase my usual response to it for Dr. Kory’s benefit, given how he is so impressed by the paragraph that he adds:
I love that last line so much it bears repeating, “If it’s consensus, it isn’t science. If it’s science, it isn’t consensus. Period.”
Wrong. Crichton was wrong then about scientific consensus, and Dr. Kory is wrong now. Crichton’s sentiment was, of course, always utter bullshit, a complete misrepresentation of how science works. No wonder Dr. Kory is so enamored of Crichton’s two decade old take. Science has always been about seeking a tentative consensus understanding about the real world based on evidence and systematic experimentation designed to reduce observer bias. It’s a consensus that can be changed—occasionally even by brave mavericks like Dr. Kory!—but that change requires evidence. Also, anyone can question a scientific consensus. Many scientists do just that but get no further. Why? Because it takes a lot more than mere “questioning” to overturn one. I would go further and say that, when a scientific consensus involves a discipline like medicine, which is more akin to applied sciences like engineering than to pure science in that it involves the application of scientific understandings and principles to achieve a specific end, consensus is even more important because lives are on the line. When doctors wander too far from existing consensus without damned good data to justify it, people die unnecessarily. Worse, in my not-so-humble opinion, doctors like Drs. Kory and Marik who peddle misinformation in support of their quack medical protocols profit off of people dying unnecessarily.
Dr. Kory in essence admits that he profits from what I consider to be his quacker all while invoking the very common excuse of quacks going back to Stanislaw Burzynski and earlier, that he needs “autonomy” to do his brave maverick doctor thing:
There is only one silver lining here. One – the impending loss of my certifications does not affect me materially because I have a private fee-based practice due to my need for complete autonomy and lack of restrictions in empirically treating the vaccine injured with various repurposed and alternative therapeutics. I thus cannot and will not accept insurance, and secondly, my academic career is over – no longer will I ever enter back into the system of medicine.
About the only opportunity this whole attack has created is one where I get to defend myself on appeal in a debate with three academic white coats of their choosing. Bring. It. On.
Oh, goody. Dr. Kory is a “debate me, bro” doc too. In other words, as I have been emphasizing all along, even if Dr. Kory does end up losing his board certifications (which in my opinion he most definitely should), it won’t affect his grift one iota. Nor will it affect Dr. Marik’s FLCCC grift. It will, however, give Dr. Kory a perfect opportunity to do what he now does best, play the persecuted victim in order to attract that sweet, sweet cash for his “early treatment protocols” for COVID-19, all while spinning conspiracy theories:
I will then toss in a little lecture about how RCT’s have long ceased to be a credible means of proving anything in science given that in modern medicine only “Big RCT’s” count and that all “Big RCT’s” require such massive funding that the bias of the funders outweighs any objectivity such trials can profess to attain. I will also remind them that throughout modern medial history, the findings of RCT’s and retrospective observational trials are identical, yet academia has been taught to systematically ignore observational trials. Reason: only massively funded entities can conduct a “Big RCT” while any committed clinician willing to give up nights and weekends can conduct an observational trial. Pharma cannot allow research to be conducted that they have no control over – so they took over the journals and medical school curriculums which now literally teach that observational controlled trials can only be considered “hypothesis generating” and thus their results should not be acted on. Nonsense.
No, the findings of observational studies and RCTs have not been “identical,” although I know why he said this given that a lot of ivermectin studies cited by ivermectin hawkers like Dr. Kory are low-quality observational studies. If such were the case, randomized controlled clinical trials would never have been developed because they wouldn’t have been necessary. Basically, what Dr. Kory is doing here is what all promoters of disinformation like this do: Sow fear, uncertainty, and doubt.
That, and sell beach towels with himself portrayed as a superhero on them:
Basically, Dr. Kory is trying to confuse you and thereby convince you that you can’t know anything for certain. He’s attacking expertise, knowledge, and science themselves. To do that, he is co-opting reasonable criticisms of the ABIM’s maintenance of certification program and how the organization is run to imply that the only reason ABIM is coming after Dr. Marik and him is because it is in bed with big pharma, as well as casting the usual doubt that cranks try to cast on the very concepts of expertise, deep subject knowledge, and scientific consensus.