Executive Summary

A small but vocal minority of physicians are intentionally and publicly spreading disinformation about COVID-19 and vaccines. In doing so, they are putting lives at risk and violating their professional oath.

State medical boards have the authority and responsibility to take disciplinary action against doctors who violate state laws and regulations governing the practice of medicine.

A recent poll shows that a majority of American adults – nine in 10 – believe that doctors who intentionally spread misinformation about COVID-19 should be held accountable [1].

The Federation of State Medical Boards, the national organization representing all U.S. state medical boards, issued a statement in July 2021 making it exceedingly clear that dissemination of COVID-19related disinformation by doctors will not be tolerated [2].

Despite boards’ legal mandate to investigate patient and consumer complaints, discipline doctors who violate the public’s trust, and ensure that the public can expect to receive the highest standard of care, state medical boards have taken little to no action against doctors who deliberately spread disinformation.

The failure of state medical boards to act – and worse, to rubber-stamp the medical license renewal of doctors actively spreading dangerous and unfounded conspiracy theories – creates a COVID-19 force multiplier, leading to overwhelmed and understaffed hospitals and unnecessary suffering and death. Just as doctors have a duty to act in their patients’ best interest, state medical boards have a duty to act in the public’s best interest.

Foreword

Most members of the public assume that any licensed doctor will provide them with appropriate, up-to-date, and evidence-based medical care.

To wear the white coat, physicians take an oath to do no harm and to practice medicine in accordance with the highest ethical standards. In adhering to that oath, physicians have worked for years to earn and maintain the public’s trust – a level of trust rated higher than most other professionals. An AP-NORC poll revealed that seven in 10 Americans trust their doctors “to do what’s right for them and their families [3].” During the COVID-19 pandemic, polling has consistently found that Americans consider their doctors the most credible source of information about the virus.

However, during this ongoing public health emergency that has claimed more than 5 million lives globally, a small minority of physicians have exploited the credibility that comes with their medical licenses to disseminate disinformation to the public. Their lies, distortions, and baseless conspiracy theories have caused unnecessary suffering and death and are prolonging the pandemic.

Throughout the country, state medical boards have the responsibility to uphold medical standards and the authority to issue, renew, suspend, or revoke medical licenses. With severe consequences, state medical boards have failed to uphold that trust. Not only have most boards failed to suspend or revoke licenses, but many have rubber-stamped renewals for doctors who are in clear violation of medical standards, which allows them to do more harm with no questions asked.

Misinformation is a public health crisis, and ‘disinformation doctors’ are making it worse.

Misinformation, or the propagation of false rumors, represents one dimension of the problem. Its subset, deliberately deceptive disinformation, is another. Misinformation is a public health crisis, and “disinformation doctors” are making it worse. Physicians and other medical professionals who spread disinformation are violating their professional oath, tarnishing the reputation of the medical field, and putting lives at risk.

This impacts not only patients with COVID-19, but all who seek care [4]. Nationwide, COVID-19 hotspots have overwhelmed hospital capacity, which in some cases has led to rationing of care [5]. Under these demanding conditions, there have been unprecedented levels of burnout among healthcare workers [6] and hospitals are facing critical nursing shortages [7].

This report documents the urgent need for state medical boards to investigate physicians who are publicly and intentionally spreading false information. The examples in this report are just a small sample, but they have an outsized impact in distorting public perceptions of the pandemic.

State medical boards and other governing bodies must step in to protect patients, the public, and healthcare workers, and to help end the pandemic.

Brian C. Castrucci, DrPH            Nick Sawyer, MD, MBA, FACEP

President and Chief Executive Officer Board Certified Emergency Medicine Physician de Beaumont Foundation        Executive Director

@BrianCCastrucci      No License for Disinformation

@deBeaumontFndtn                            @NickSawyerMD

@NLFD_org

Introduction

State medical boards, whose members are appointed by state governors, are statesanctioned government agencies with the legislative authority to license, investigate, discipline, and regulate medical doctors [8]. Each state’s medical board is granted its authority by legislation, the Medical Practice Act, which includes legal provisions that set boundaries around the limits of acceptable behavior. While these legal provisions vary from state to state, every state’s Medical Practice Act begins with a statement of purpose: “To protect the public from the unprofessional, improper, incompetent, unlawful, fraudulent, and/or deceptive practice of medicine.”

In the midst of an ongoing pandemic, caused by a highly transmissible, airborne, novel coronavirus, which has claimed nearly 800,000 U.S. lives [9] and taken a caregiver from more than 140,000 U.S. children [10], a group of contrarian doctors began generating and spreading false, fabricated, distorted, and potentially life-threatening “medical advice.”

These efforts are amplified through social media, television appearances, websites, podcasts, blogs, congressional testimony [11], public appearances and nationwide “tours [12].”

Many of their statements regarding the epidemiology, the most appropriate public health mitigation measures, and prevention and treatment of COVID-19 are based on poor-quality studies that do not meet the rigors of peer review, contain inaccurate or fabricated data, or misrepresent the most current medical literature [13].

   Doctors who spread COVID-19 disinformation know better.

They are creating unnecessary suffering, death and unmitigated strain to the health care system. This raises the question, where are state medical boards during this crisis?

Even worse, many of their claims are not supported by any scientific evidence at all, particularly as it pertains to the safety and efficacy of the COVID-19 vaccines [14].

Doctors who spread COVID-19 disinformation know better. They are creating unnecessary suffering, death and unmitigated strain to the health care system. This raises the question, where are state medical boards during this crisis?

Earlier this year, the Federation of State Medical Boards issued a rare public statement in response to a “dramatic increase in the dissemination of COVID-19 vaccine misinformation and disinformation by physicians and other health care professionals on social media platforms, online, and in the media.” The statement outlined the risk of disciplinary action against physicians who spread COVID-19-related misinformation, including suspension or revocation of their medical license.

But despite the Federation’s warnings, in the five months since the statement was issued, only a handful of doctors have faced such consequences.

In a survey of the Federation’s 70 state medical board members, more than two-thirds reported an uptick in complaints, and yet just 12 medical boards reported taking any disciplinary action against a doctor for spreading “false or misleading information” (though the Federation has not clarified the level of discipline and whether the disinformation was related to COVID) [15].

Public health officials have blamed COVID disinformation for prolonging the pandemic; 50% of the Americans who refuse to get vaccinated cite a piece of disinformation as their reason [16].

A study conducted by the Associated Press in

May reported that 98% to 99% of American COVID-19 deaths were among the unvaccinated [17].

Data released by the Centers for Disease Control and Prevention (CDC) in November showed that unvaccinated adults were five times more likely to test positive and 14 times more likely to die from COVID-19. State medical boards must recognize the gravity of this crisis and act now to protect the public from the dangers of misinformation.

Disinformation spread by physicians has been widely reported throughout the pandemic. Disinformation generated by such doctors is reaching an audience that numbers in the hundreds of millions. The following represent just a few examples that demonstrate their reach:

A viral video of a licensed Indiana physician spreading disinformation at a school board meeting received over 100 million likes and shares on Facebook and more than 10 million views on other mainstream social media platforms [18].

The website for America’s Frontline Doctors, an organization with which many disinformation-disseminating doctors associate, has received 6.8 million visits from May to October 2021, according to data compiled on Dec. 2, 2021, using the online tool Semrush.com.

Disinformation-riddled testimony [19] from a licensed Ohio physician went viral and appeared on late-night television [20. While this coverage was unfavorable, her audience grew significantly and Google searches related to one of her most spurious claims spiked to its highest level over the pandemic, according to data from Google Trends.

The need to act is clear, and Americans agree. A recent poll conducted by Morning Consult for the de Beaumont Foundation revealed that nine in 10 American adults believe that doctors who intentionally spread misinformation about COVID-19 should be held accountable [1].

Barriers to Enforcement

Given the rampant and dangerous disinformation that licensed doctors are generating on podcasts, websites, and social media, it is clear that state medical boards have the grounds to take disciplinary action based on state Medical Practice Acts [8]. But almost two years into the pandemic, the boards have largely failed to take action against these doctors. This problem has three primary causes.

The first step in most states’ complaint process is an evaluation of whether the complaint should be authorized for investigation. Because complaints that are under investigation are confidential and complaints that are closed without action are not public records, most state medical boards have no public accountability for the number or validity of decisions around complaints that they close without taking action. Placing the burden for this accountability on a complainant is irresponsible.

In an interview for an August 2021 article on WebMD, Dr. Humayun Chaudry, president of the Federation of State Medical Boards, stated that in some cases, boards have contacted physicians and have persuaded them to voluntarily refrain from making false public statements, without taking disciplinary action [21]. Such action does nothing to repair prior harms or undo the real-world impact of doctor-disseminated disinformation. And while physicians contacted in this way may change their public behavior, one cannot assume that they’ll also modify their practice to uphold standards of care.

In an October interview given to CNN, Dr. Chaudry acknowledged that while boards have received “a lot” of complaints about physicians spreading misinformation about COVID-19, “state boards simply do not have the resources…to monitor what’s happening on the internet or what’s going on even in an individual patient encounter [22].”

As the sampling of examples in this report demonstrates, this burden on the complainant, combined with a cumbersome complaint process, means that the current system is failing to address clear violations of state Medical Practice Acts.

The fraction of complaints to state medical boards that are referred for investigation generally take months – and sometimes years – to reach a conclusion. And because complaints under active investigation are confidential, doctors who are disseminating disinformation are free to continue touting their medical credentials as a reason to believe their pseudoscience, half-truths, or flat-out lies over the period of the investigation.

Rebuilding Trust: Recommendations for Enforcement

To rebuild trust and better enable state medical boards to hold doctors accountable for their roles in disseminating lies relating to COVID-19, the following actions should be taken immediately to protect the public. In all cases, boards can and should enforce their state’s Medical Practice Act.

Boards have a tremendous amount of discretion over whether complaints are referred for investigation and what level of action is taken as a result of investigations. In many states, there is no accountability or visibility for complaints filed if they’re not referred for investigation or if they don’t result in action against the licensee. In addition to aggregate reporting, there needs to be more granular oversight where questionable decisions or disproportionate levels of inaction can be reviewed and referred to the entity that oversees the state medical boards for review. State legislatures, inspectors general or attorneys general could play this role.

The mission of state medical boards includes an obligation to protect the public. Protection requires a proactive capability, and state medical boards currently exist in a statutory framework that only allows them to consider action in response to a direct complaint. This is an outdated framework that must be updated for the digital age.

Across the states, there are 15 different types of entities, ranging from federal agencies and courts to professional societies and peers, that are required to report possible violations to state medical boards. However, there are inconsistent reporting requirements in every state, and not all states require physician misconduct to be reported to the licensing state’s medical board.

There is an urgent need to establish standardized reporting for any of these entities that encounter physician behavior that should be referred for potential investigation. This will ensure that state medical boards can respond in cases where doctors’ potentially violating behaviors have been identified outside of the context of a direct complaint to a board. Some, if not all of these entities’ reporting requirements should be standardized across all states.

Medical misinformation and disinformation directly impact public health in a matter of days. Complaint review processes that take months or years are completely insufficient.

Consumer protection agencies have already established that information that could be perceived as medical advice must be disclaimed as opinion, but the same requirement currently does not appear to extend to content on social networks.

 Establish a requirement for disclaimers from doctors who are taking positions that they don’t want to be considered medical advice. This will serve to protect both doctors and consumers.

 Enhance the requirement for visibility of these disclaimers – buried at the bottom of websites or at the end of long posts or videos is not protecting the consumer.

 Enforce the presence and visibility of these disclaimers with substantive, license-based action that is under the purview of state medical boards.

The Federation of State Medical Boards has stated that boards are not staffed to be “out there looking” for misinformation and disinformation online [22]. There are plenty of organizations that are out there doing exactly that, but boards aren’t currently willing or able to utilize that data or information.

In recent years, many state medical boards have reduced the number of metrics they report on annually, removing visibility to the number of complaints filed as well as more granular views on what happens to complaints that are referred for investigation. These metrics need to be standard requirements that state medical boards report to the public and the state.

Disinformation Doctors: Licensed to Mislead

Disinformation Doctors and the Boards that License

Them

Through a review of social media posts, websites, live and virtual conferences, podcasts, interviews, and testimony, No License for Disinformation collected the following examples of statements by doctors intentionally and publicly spreading disinformation about COVID-19. These doctors are able to point to their medical license for credibility, while continuing to spread COVID-19 lies with no repercussions.

These doctors’ role in spreading misinformation is well documented, but even with the Federation of State Medical Boards’ statement, little action has been taken, and none of these doctors have had their licenses suspended or revoked. With this lack of accountability, they’ve become further emboldened, and their disinformation continues to prolong the pandemic and put more lives at risk.

While the lack of transparency and glacial pace of the investigatory process leave researchers and the public unable to assess the specific reasons for inaction, this section of the report is intended to highlight the need for this capacity with examples of COVID-19 disinformation and misinformation that state medical boards have allowed licensed physicians to spread throughout the pandemic. While we do not take a position here on any specific instance, these are the kind of statements that illustrate the need for stronger investigation and accountability from medical boards.

COVID-19 Virus Disinformation

Almost two years and millions of deaths into this pandemic, there are licensed doctors who still make public claims that SARS-CoV-2 or its variants are a hoax or simply do not exist. For example:

One Florida-licensed physician featured prominently as a guest on mainstream podcasts has gone even further to claim  that through her own research she has “come to question whether viruses exist

[23].”                                                        Source: www.agatheringofstories.com

More common are statements that intentionally and falsely downplay the severity of COVID-19 without evidence. For example:

COVID-19 Vaccine Disinformation

There is no scientific evidence to support the claim that any COVID-19 vaccine is capable of causing COVID-19 or other diseases. This claim, however, is particularly popular among disinformation-spreading doctors. For example:

Another popular thread of COVID-19 vaccine disinformation centers around the side                                                                                             ^{Source: CNN}

effects of the various vaccines. In its most extreme form, doctors have represented this disinformation with claims that COVID-19 vaccines cause death. A sample of these claims include:

Conclusion

This report documents the urgent need for state medical boards to investigate physicians
who are publicly and intentionally spreading false information. Physicians and other
medical professionals who intentionally spread disinformation are violating their
professional oath, tarnishing the reputation of the medical field, and putting lives at risk.
State medical boards have the authority to hold these doctors accountable but have
largely failed to do so.

Disinformation generated by these doctors is reaching an audience that numbers in the
hundreds of millions. The examples in this report are just a small sample, but they have an
outsized impact in distorting public perceptions of the pandemic. The need to act is clear.
State medical boards have the opportunity to protect patients and the public – and to
save lives.

To learn more or to report a doctor who has spread COVID-19 disinformation,
visit nolicensefordisinformation.org/report.

Disinformation Doctors: Licensed to Mislead
December 2021 19
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