COVID-19 medical misinformation prompts much hand-wringing, but little hand-slapping for docs

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The spread of medical misinformation during the COVID-19 pandemic resulted in much hand-wringing by physicians, patients, public health experts and policymakers.

But there was little hand-slapping by state medical boards when doctors made unsubstantiated claims about that disease, vaccines or other medical treatments, and their health effects, according to a new study.

“Medical Board Discipline of Physicians for Spreading Medical Misinformation” analyzed 3,128 publicly reported disciplinary actions in the five most populous states – California, Florida, New York, Pennsylvania and Texas. The result: “The frequency of misinformation conduct was exponentially lower than more common reasons for discipline,” such as physician negligence, problematic record keeping, and inappropriate prescribing.

“The results of this study suggest that limited discipline of physicians for spreading medical misinformation occurred,” said author Richard S. Saver, JD, of the University of North Carolina School of Law and that university’s Gillings School of Global Public Health.

Yet, licensed physicians have freedom of expression under the First Amendment of the U.S. Constitution, said Megan L. Ranney, MD, MPH, and Lawrence O. Gostin, JD, in a commentary on the findings.

“Saver posits, based on this low absolute and relative frequency of sanctions, that there are too few health professionals being sanctioned by medical boards for conveying false or harmful information to their patients. We caution against this conclusion,” they said.

Possible offenses

Saver said he selected the period starting Jan. 1, 2020, when the nation turned considerable attention to COVID-19, to May 30, 2023; the study period ended March 30, 2022, for Texas due to incomplete files. He created 11 codes to categorize possible offenses, and noted each action could have more than one code, based on medical boards imposing discipline for more than one reason.

The most common offenses were:

• Physician negligence – 1,911 actions, or 28.7%
• Problematic record-keeping – 990 actions, or 14.9%
• Inappropriate prescribing – 901 actions, or 13.5%

“The frequency of disciplinary actions for any reasons related to COVID-19 care, even if not about misinformation, was also quite low,” with just 10 actions, or 0.2%. “Sanctions in misinformation actions tended to be relatively light.”

Measuring misinformation

Saver noted there is no single formal tracking entity, measure, or definition for “medical misinformation.” Doctors’ First Amendment free speech rights protect even false communications. Meanwhile, medical boards are underfunded and may prioritize easier-to-prove cases. For example, Simone Gold, MD, JD, founded the controversial antivaccine group America’s Frontline Doctors, which widely promoted discrediting COVID-19 treatments, but California’s medical board put her license on inactive status due to her plea of guilty to a federal misdemeanor for participating in the U.S. Capitol riot of Jan. 6, 2021, the study said.

‘Infodemic’

Ranney and Gostin titled their commentary “State Medical Board Sanctions for Misinformation Should Be Rare.” Even in an “infodemic” age, state physician licensing boards cannot discriminate based on content or viewpoint, and it may be difficult to differentiate between official communications and personal social media posts that are protected free speech, even for licensed professionals, they said.

At the same time, “scientific knowledge is often evolving,” and it is in society’s best interest to encourage good faith medical and scientific debate, they said. Physicians should not be sanctioned for opining on topics that are medically beneficial but politically debated, such as abortion, gender-affirming care, or counseling on gun safety or substance abuse, the commentary said.

‘Other’ offenses

In Saver’s study, there were 1,102 “other” offenses, generally involving reciprocal discipline in one state when a state medical board disciplined a physician in a different state.

Incidentally, alcohol and substance abuse accounted for 320 actions, or 4.8%, while inappropriate relations with patients spurred 198 actions, or 3%. They were not among the top reasons for physician discipline, although previous research and commentary suggested they were part of the majority of physician disciplinary cases, according to the study.

The study and invited commentary were published in JAMA Network Open.