The Problem with Using Medical Boards to Regulate Misinformation

Abstract

Some stakeholders called on medical boards to sanction physicians for spreading misinformation during COVID-19 and discussing off-label medications. In 2022, California passed AB 2098, which classifies physician dissemination of misinformation as unprofessional conduct subject to discipline by the state medical board. This article describes the purpose and function of state medical boards, the law relating to off-label prescribing, and why using medical boards to discipline physicians for discussing controversial opinions exceeds the traditional role of state medical boards. Though physicians do have a duty to provide accurate information to the public, defining misinformation is difficult and poses five distinct problems. Although California’s law was repealed, this article asserts that disciplining physicians for disseminating misinformation could pose Constitutional concerns, hinder physicians’ ability to practice medicine, or suppress information that is important to the public interest.

Keywords:

• state medical boards
• unprofessional conduct
• misinformation
• physician discipline
• physician licensing
• off-label prescribing
• Constitutional law

Notes

1 Johnny Edwards, Georgia Medical Board Mum as Doctors Spread COVID-19 Misinformation, Atlanta J. Const. (Oct. 28, 2021), https://www.ajc.com/news/coronavirus/georgias-medical-board-mum-as-doctors-spread-covid-19-misinformation/CRWP7IZFBBEBPFSAVIW7AGD7CM/; Brian Castrucci & Nick Sawyer, COVID Vaccine and Treatment Misinformation is Medical Malpractice. It Should Be Punished, NBC News (Jan. 8, 2022, 12:47 P.M.), https://www.nbcnews.com/think/opinion/covid-vaccine-treatment-misinformation-medical-malpractice-it-should-be-punished-ncna1287180; Zeeshan Aleem, DeSantis’ Surgeon General, Joseph Ladapo, Is Spreading COVID Vaccine Misinfo, MSNBC (Oct. 22, 2021, 5:46 P.M.), https://www.msnbc.com/opinion/desantis-surgeon-general-joseph-ladapo-spreading-covid-vaccine-misinfo-n1282191; Jeffrey Schweers, Florida Department of Health Rejects Complaint against Surgeon General Joseph Ladapo, Tallahassee Democrat (Dec.13, 2021, 8:06 A.M.), https://www.tallahassee.com/story/news/local/state/2021/12/13/florida-department-health-wont-investigate-complaint-against-surgeon-general-joe-ladapo-any-further/6460851001/.

2 Edwards, supra note 1.

3 Castrucci & Sawyer, supra note 1.

4 Edwards, supra note 1; Castrucci & Sawyer, supra note 1; Aleem, supra note 1; Schweers, supra note 1.

5 Bethany Lindsay, B.C. Doctors Warned They Could Face Discipline for Spreading COVID-19 Misinformation, Canadian Broad. Co. News (May 11, 2021, 8:00 A.M.), https://www.cbc.ca/news/canada/british-columbia/bc-doctors-misinformation-covid-19-1.6021489; Kate Aubusson, Doctors, Healthcare Workers to Be Punished for Anti-Vax COVID Claims, Sydney Morning Herald (Mar. 10, 2021, 1:11 P.M.), https://www.smh.com.au/national/doctors-healthcare-workers-to-be-punished-for-anti-vax-covid-claims-20210310-p579dk.html; White v. Gen. Med. Council [2021] EWHC 3286 (Admin).

6 Physicians and Surgeons: Unprofessional Conduct, A.B. 2098, 2022 Legis., Reg. Sess. (Cal. 2022); Jacob Sullum, California’s COVID-19 “Misinformation” Law Chills Constitutionally Protected Speech, Reason (Nov. 23, 2022, 12:01 A.M.), https://reason.com/2022/11/23/californias-covid-19-misinformation-law-chills-constitutionally-protected-speech/; Ed. Bd., California to Doctors: Agree with Us or Shut Up, Wall St. J. (Oct. 11, 2022, 6:43 P.M.), https://www.wsj.com/articles/california-to-doctors-agree-or-shut-up-medical-misinformation-covid-vaccines-gavin-newsom-joseph-ladapo-11665520691.

7 FSMB: Spreading COVID-19 Vaccine Misinformation May Put Medical License at Risk, Fed’n of State Med. Bds. (July 29, 2021), https://www.fsmb.org/advocacy/news-releases/fsmb-spreading-covid-19-vaccine-misinformation-may-put-medical-license-at-risk/; Two-Thirds of State Medical Boards See Increase in COVID-19 Disinformation Complaints, Fed’n of State Med. Bds. (Dec. 9, 2021), https://www.fsmb.org/advocacy/news-releases/two-thirds-of-state-medical-boards-see-increase-in-covid-19-disinformation-complaints/.

8 Blake Farmer, Medical Boards Pressured to Let It Slide When Doctors Spread COVID Misinformation, Kaiser Health News (Feb. 15, 2022), https://khn.org/news/article/medical-boards-pressured-to-let-it-slide-when-doctors-spread-covid-misinformation/.

9 Two-Thirds of State Medical Boards See Increase in COVID-19 Disinformation Complaints, supra note 7.

10 Id.; Farmer, supra note 8.

11 Physicians and Surgeons: Unprofessional Conduct, supra note 6.

12 Id.

13 Aleem, supra note 1; Schweers, supra note 1.

14 Id.

15 Id.

16 Aleem, supra note 1.

17 Schweers, supra note 1.

18 Exploring the Relationship between All-Cause and Cardiac-Related Mortality Following COVID-19 Vaccination or Infection in Florida Residents: A Self-Controlled Case Series Study, Fla. Dep’t of Health (2022), https://floridahealthcovid19.gov/wp-content/uploads/2022/10/20221007-guidance-mrna-covid19-vaccines-analysis.pdf.

19 Press Release, Fla. Dep’t of Health, State Surgeon General Joseph A. Ladapo Issues New mRNA COVID-19 Vaccine Guidance (Oct. 7, 2022), https://www.floridahealth.gov/_documents/newsroom/press-releases/2022/10/20221007-guidance-mrna-covid19-vaccines.pr.pdf.

20 Arek Sarkissian, Florida Surgeon General Altered Key Findings in Study on COVID-19 Vaccine Safety, Politico (Apr. 24, 2023, 1:59 PM), https://www.politico.com/news/2023/04/24/florida-surgeon-general-covid-vaccine-00093510.

21 Id.

22 Drew Carlson & James Thompson, The Role of State Medical Boards, 7(4) AMA J. Ethics 311, 311 (2005).

23 Nadia Sawicki, Character, Competence, and the Principles of Medical Discipline, 13 J. Health Care L. Pol’y 285, 290 (2010); Gregory Dolin, Licensing Health Care Professionals: Has the United States Outlived the Need for Medical Licensure?, 2 Geo. J. L. Pub. Pol’y 315, 321 (2004).

24 Sawicki, supra note 23, at 321.

25 Cal. Bus. & Prof. Code §§ 725-733 (West 2022); Brief for American Civil Liberties Union of California as Amici Curiae Supporting Plaintiffs, McDonald v. Lawson, No. 8:22-cv-01805-FWS-ADS (C.D. Cal. 2022), https://www.aclunc.org/sites/default/files/60-1%20-%20Proposed%20ACLU%20Amici%20Brief.pdf.

26 Sawicki, supra note 23; Dolan, supra note 23.

27 Id.

28 Regenerative and Stem Cell Therapy Practices, Fed’n of State Med. Bds. (Apr. 2018), https://www.fsmb.org/siteassets/advocacy/policies/fsmb-stem-cell-workgroup-report.pdf; FDA Warns about Stem Cell Therapies, FDA (Sept. 3, 2019), https://www.fda.gov/consumers/consumer-updates/fda-warns-about-stem-cell-therapies; Leigh Turner et al., Businesses Marketing Purported Stem Cell Treatments and Exosome Therapies for COVID-19: An Analysis of Direct-to-Consumer Online Advertising Claims, 8(11) Stem Cell Reps. 2010 (2023); Patrick Foong & Alan Leung, Consumers Should Beware of Stem Cell Treatments for COVID-19, BioEdge (Jan. 4, 2024), https://bioedge.org/stem-cells/consumers-should-beware-of-stem-cell-treatments-for-covid-19/.

29 Cong. Rsch. Serv., The First Amendment: Categories of Speech (Jan. 16, 2019), https://sgp.fas.org/crs/misc/IF11072.pdf.

30 Michelle Mello, Vaccine Misinformation and the First Amendment—The Price of Free Speech, 3(3) JAMA Health Forum 1 (2022); Carl Coleman, License Revocation as a Response to Physician Misinformation: Proceed with Caution, Health Affs. Forefront (Jan. 5, 2022), https://www.healthaffairs.org/do/10.1377/forefront.20211227.966736.

31 Id.

32 Complaint, Hoeg v. Newsom, No. 2:22-cv-01980 WBS AC (E.D. Cal. 2022); Complaint, McDonald v. Lawson, Case No. 8:22-cv-01805-FWS-ADS (C.D. Cal. 2022); Greg Piper, Doctors Sue California for COVID “Misinformation” Law That Enforces Amorphous Consensus, Just the News (Nov. 3, 2022), https://justthenews.com/nation/free-speech/doctors-sue-california-covid-misinformation-law-enforces-amorphous-consensus; Bob Egelko, ACLU Weighs In against New California Law to Punish Doctors Who Spread COVID Misinformation, S.F. Chron. (Nov. 9, 2022, 4:49 P.M.), https://www.sfchronicle.com/politics/article/ACLU-weighs-in-against-new-California-law-to-17572042.php.

33 Complaint, Hoeg v. Newsom, supra note 32; Complaint, McDonald v. Lawson, supra note 2.

34 Egelko, supra note 32.

35 Memorandum and Order re: Plaintiff’s Motion for Preliminary Injunction, Hoeg v. Newsom, No. 2:22-cv-01980 WBS AC (E.D. Cal. Jan. 25, 2023); Jacob Sullum, California Quietly Repeals Restrictions on Doctors’ COVID-19 Advice, Reason (Oct. 11, 2023, 11:00 A.M.), https://reason.com/2023/10/11/california-quietly-repeals-restrictions-on-doctors-covid-19-advice/.

36 Christopher Wittich et al., Ten Common Questions (and Their Answers) about Off-Label Drug Use, 87 Mayo Clinic Procs. 982, 982-90 (2010).

37 Id.

38 Id.; Katrina Furey &Kirsten Wilkins, Prescribing “Off-Label”: What Should a Physician Disclose?, 18 AMA J. Ethics, 587, 587-93 (2016).

39 Furey & Wilkins, supra note 38, at 587-93.

40 Id.

41 Furey & Wilkins, supra note 38, at 587-93.

42 Coronavirus Disease (COVID-19) Treatment Guidelines, Nat’l Inst. of Health, https://files.covid19treatmentguidelines.nih.gov/guidelines/covid19treatmentguidelines.pdf.

43 Wittich et al., supra note 36, at 982-90; Furey & Wilkins, supra note 38, at 587-93.

44 Edwards, supra note 1.

45 Id.

46 COVID-19 Early Treatment: Real-Time Analysis of 3,575 Studies, c19 early, https://c19early.org/; Ivermectin for COVID-19: Real-Time Analysis of All 236 Studies, c19ivm, https://c19ivm.org/; HCQ for COVID-19: Real-Time Meta Analysis of 414 Studies, c19hcq, https://c19hcq.org/meta.html.

47 Id.

48 Lance de Haven-Smith & Matthew Witt, Conspiracy Theory Reconsidered: Responding to Mass Suspicion of Political Criminality in High Office, 45(3) Admin.& Soc’y 267, 267-95 (2012).

49 Mello, supra note 30; Katherine Drabiak, Sacrificing the Public’s Health: Conspiracies and Trust in the Scientific Enterprise, 15(2) Univ. St. Thomas J. L. Pub. Pol’y 689, 689-755 (2022).

50 Early Outpatient Treatment: An Essential Part of a COVID-19 Solution: Hearing Before S. Comm. on Homeland Sec. and Governmental Affs., 116th Cong. (2020), https://www.hsgac.senate.gov/hearings/early-outpatient-treatment-an-essential-part-of-a-covid-19-solution; Early Outpatient Treatment: An Essential Part of a COVID-19 Solution: Part II: Hearing Before S. Comm. on Homeland Sec. and Governmental Affs., 116th Cong. (2020), https://www.hsgac.senate.gov/early-outpatient-treatment-an-essential-part-of-a-covid-19-solution-part-ii.

51 Early Outpatient Treatment: An Essential Part of a COVID-19 Solution, supra note 50.

52 Early Outpatient Treatment: An Essential Part of a COVID-19 Solution: Part II, supra note 50; see also COVID-19 Early Treatment: Real-Time Analysis of 3,575 Studies, supra note 46.

53 Early Outpatient Treatment: An Essential Part of a COVID-19 Solution, supra note 50.

54 Catie Edmonson & Nicholas Fandos, Elevating Fringe Theories, Ron Johnson Questions Virus Science, N.Y. Times (Mar. 21, 2021), https://www.nytimes.com/2020/12/07/us/politics/ron-johnson-coronavirus.html.

55 Jeffrey Schweers, “Grave Concerns”: Florida Surgeon General Joseph Ladapo’s Medical License OK’d in Two Days, Tallahassee Democrat (Apr. 5, 2022, 12:43 P.M.), https://www.tallahassee.com/story/news/local/state/2021/11/10/joseph-ladapo-florida-surgeon-general-medical-license-approved-two-days-ron-desantis-mask-vaccines/6288880001/.

56 Yair Goldberg et al., Waning Immunity after the BNT162b2 Vaccine in Israel, 385 New Eng. J. Med. 1 (2021); Michael Klompas, Understanding Breakthrough Infections following mRNA SARS-CoV-2 Vaccination, 326(20) JAMA 2018, 2018-20 (2021); Natasha Altman et al., Vaccination-Associated Myocarditis and Myocardial Injury, 132 Circulation Rsch. 1338,1338–57 (2023); Jennifer Pillay et al., Incidence, Risk Factors, Natural History, and Hypothesised Mechanisms of Myocarditis and Pericarditis following COVID-19 Vaccination: Living Evidence Syntheses and Review, 378 British Med. J. 1 (2022).

57 Id.; see also Ruth Koepke et al. Estimating the Effectiveness of Tetanus-Diphtheria-Acellular Pertussis Vaccine (Tdap) for Preventing Pertussis: Evidence of Rapidly Waning Immunity and Difference in Effectiveness by Tdap Brand, 210 J. Infect. Dis. 942, 942-53 (2014).

58 Advisory: Hospital Discharges and Admissions to Nursing Homes, N.Y. State Dep’t of Health (Mar. 25, 2020), https://skillednursingnews.com/wp-content/uploads/sites/4/2020/03/DOH_COVID19__NHAdmissionsReadmissions__032520_1585166684475_0.pdf.

59 Suzy Khimm, Coronavirus Spreads in a New York Nursing Home Forced to Take Recovering Patients, NBC News (Apr. 25, 2020, 4:00 A.M.), https://www.nbcnews.com/news/us-news/coronavirus-spreads-new-york-nursing-home-forced-take-recovering-patients-n1191811.

60 Id.

61 Joint Public Health: Residential Healthcare Facilities and COVID-19: Hearing Before the N.Y. State Legislature, 203rd Legis. Sess. (N.Y. 2020), https://www.nysenate.gov/sites/default/files/08-03-2020_senate_health-care_facilities_and_covid-19_final.pdf.

62 Id.

63 Nursing Home Response to the COVID-19 Pandemic, N.Y. State Off. of the Att’y Gen. Letitia James (Jan. 31, 2021), https://ag.ny.gov/sites/default/files/2021-nursinghomesreport.pdf.

64 Id.

65 Id.; Joe Palazzolo et al., Cuomo Advisers Altered Report on COVID-19 Nursing-Home Deaths, Wall St. J. (Mar. 4, 2021), https://www.wsj.com/articles/cuomo-advisers-altered-report-on-covid-19-nursing-home-deaths-11614910855.

66 Nursing Home Response to the COVID-19 Pandemic, supra note 63.

67 George J. Annas et al., Pandemic Preparedness: The Need for a Public Health, Not a Law Enforcement/National Security Approach, Am. Civ. Liberties Union (Jan. 2008), https://www.aclu.org/sites/default/files/pdfs/privacy/pemic_report.pdf; Fear, Politics and Ebola, Am. Civ. Liberties Union (Dec. 2015), https://www.aclu.org/sites/default/files/field_document/aclu-ebolareport.pdf; Lawrence Gostin & Eric Friedman, Private: State Quarantine Powers Under the Constitution: Fear in an Age of Ebola, Am. Const. Soc’y (Nov. 4, 2014), https://www.acslaw.org/?post_type=acsblog&p=10552.

68 Annas et al., supra note 67.

69 Id.

70 The Doctor Is In: Scott Atlas and the Efficacy of Lockdowns, Social Distancing, and Closings, Hoover Inst. (June 23, 2020), https://www.hoover.org/research/doctor-scott-atlas-and-efficacy-lockdowns-social-distancing-and-closings-1.

71 Victoria Knight, Will Doctors Who Are Spreading COVID-19 Misinformation Ever Face Penalty?, Time (Sept. 20, 2021, 3:10 P.M.), https://time.com/6099700/covid-doctors-misinformation/.

72 Martin Kulldorff et al., The Great Barrington Declaration (Oct. 4, 2020), https://gbdeclaration.org/.

73 Id.; Jeanne Lenzer, COVID-19: Experts Debate Merits of Lockdowns Versus “Focused Protection,” British Med. J. News (Nov. 3, 2020), https://www.bmj.com/content/371/bmj.m4263.

74 Knight, supra note 71; Letters to the Ed., Opinion: Don’t Just Fire Scott Atlas. Revoke His Medical License, Wash. Post (Nov. 20, 2020, 4:32 P.M.), https://www.washingtonpost.com/opinions/letters-to-the-editor/dont-just-fire-scott-atlas-revoke-his-medical-license/2020/11/20/cfbb73c2-29cd-11eb-9c21-3cc501d0981f_story.html.

75 Joel Achenbach, Proposal to Hasten Herd Immunity to the Coronavirus Grabs White House Attention but Appalls Top Scientists, Wash. Post (Oct. 14, 2020, 6:47 P.M.), https://www.washingtonpost.com/health/covid-herd-immunity/2020/10/10/3910251c-0a60-11eb-859b-f9c27abe638d_story.html.

76 Jay Battacharya & Martin Kulldorff, The Collins and Fauci Attack on Traditional Public Health, Indep. Inst. (Jan. 4, 2022), https://www.independent.org/news/article.asp?id=13941; Ed. Bd., How Fauci and Collins Shut Down COVID Debate, Wall St. J. (Dec. 21, 2021, 6:47 P.M.), https://www.wsj.com/articles/fauci-collins-emails-great-barrington-declaration-covid-pandemic-lockdown-11640129116.

77 Missouri v. Biden, 83 F.4th 350, 359 (5th Cir. 2023).

78 Id. at 373.

79 Id. at 373-74.

80 Id. at 367.

81 Biden, 83 F.4th at 381.

82 Id. at 382.

83 Id.

84 Id. at 373.

85 Matal v. Tam, 582 U.S. 218, 235 (2020).

86 Murthy v. Missouri, SCOTUSBlog, https://www.scotusblog.com/case-files/cases/murthy-v-missouri-2/(last visited Jan. 21, 2024).

87 Merriam-Webster defines “misconduct” to include “intentional wrongdoing, specifically: deliberate violation of a law or standard especially by a government official.” Misconduct, Merriam-Webster, https://www.merriam-webster.com/dictionary/misconduct (last visited Jan. 21, 2024).

88 Missouri v. Biden, supra note 77.

89 Police Dep’t of the City of Chi. v. Mosley, 408 U.S. 92 (1972).