Who to Believe? Consequences for Physicians and Nurses Who Spread Misinformation

If you are like many Americans, you may not have heard of the drug Ivermectin until 2021. However, now it is arguably the most talked about drug on the market. Ivermectin, originally developed to treat parasites in animals, was determined to be useful in treating humans with onchocerciasis, a parasitic infection that causes blindness (Aeschlimann, 2021). In fact, the discovery of Ivermectin to treat this condition, commonly referred to as river blindness, has prevented approximately 600,000 cases of blindness (Aeschlimann, 2021). In 2015, William Campbell and Satoshi Omura were awarded the Nobel Prize for their groundbreaking research in repurposing Ivermectin to treat river blindness (Aeschlimann, 2021).

Under this same mindset of repurposing drugs that are readily available, some hoped that Ivermectin could be repurposed to treat COVID-19. This hope was erroneously based on a 2020 study out of Australia (Caly et al., 2020). Many experts believe the study has serious flaws and used concentrations of Ivermectin that could be toxic when taken by a human (Aeschlimann, 2021). In contrast, two large randomized trials found that COVID-19 symptoms did not improve by taking Ivermectin, which is in line with the guidance given by the World Health Organization, the U.S. Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, and the American Medical Association, among others (Aeschlimann, 2021; López-Medina et al., 2021).

However, this has not stopped some physician organizations from spreading the false idea that Ivermectin could help treat COVID-19. For example, the Front Line COVID-19 Critical Care Alliance, a group of healthcare providers, promotes the use of Ivermectin and urges doctors to prescribe Ivermectin to prevent and treat COVID-19, even publishing protocols for the drug’s use (Front Line COVID-19 Critical Care Alliance, n.d., 2022).

Legislation Surrounding Misinformation

In recent legislative sessions across the country, many states have filed legislation to protect healthcare professionals who spread misinformation. In Indiana, Representative Curt Nisly filed House Bill 1372, which permits a prescriber to create a standing order that allows a pharmacist to dispense Ivermectin (Ind. H.B. 1372, 2022). The bill also states that a pharmacist is not allowed to provide information to the patient that discourages using Ivermectin to treat COVID-19 (Ind. H.B. 1372, 2022). According to the sponsor, “The risks [of taking Ivermectin] are low and the potential gains are high” (Rudavsky, 2022). Representative Nisly relied on the advice of Dr. Pierre Kory, a doctor from Madison, Wisconsin, who claimed that “a treatment that includes Ivermectin could reduce COVID-19 deaths by about 75%” (Rudavsky, 2022).

The bill goes on further to protect doctors and advanced practice nurses from discipline if they prescribe Ivermectin as treatment (Ind. H.B. 1372, 2022). The Indiana State Medical Association and the Indiana Pharmacists Association opposed the bill, particularly the provision that forbade providers from discouraging patients from taking Ivermectin (Rudavsky, 2022). Darrin Covington, executive vice president for the Indiana Pharmacists Association, explained, “This bill would set a dangerous precedent by having the government substitute its own medical advice for that of a trained, health care professional” (Rudavsky, 2022).

In Wisconsin, Republican Representative Clint Moses sponsored Assembly Bill 1007, which forbids healthcare entities as well as regulatory boards from taking adverse action, including disciplining a license, against a healthcare professional for expressing professional healthcare opinions, including any statements, policies, studies, publications, or orders (Wisc. A.B. 1007, 2022). The sponsor of the bill dubbed it a “medical freedom” bill to address the prevention of healthcare professionals and pharmacists from recommending alternative COVID-19 treatments such as Ivermectin (Mills, 2022).

While the bill is being messaged as allowing healthcare professionals more freedom to discuss with patients off-label treatments for COVID-19, the Wisconsin Medical Society opposes the bill as unnecessary (Mills, 2022). Dr. Jerry Halverson, Chair of the Wisconsin Medical Society’s board of directors, said there have been no complaints from members that regulatory boards, healthcare entities, or pharmacies are stifling their ability to provide care for their patients (Mills, 2022). Additionally, the Wisconsin Medical Board recognized the threat of COVID-19 misinformation in their state. In the Wisconsin Medical Board’s November newsletter, its Chairperson, Dr. Sheldon Wasserman, included in his column that the Medical Board will “use its authority to act in instances of deliberate, negligent, or reckless misinformation that rise to the level of professional misconduct. … As always the Board’s sole agenda remains the protection of the health and safety of the citizens of Wisconsin” (Wasserman, 2021).

In California, Assemblyman Evan Low filed Assembly Bill 2098, which specifies that the dissemination of COVID-19 misinformation constitutes unprofessional conduct and lists factors that the medical board must consider before issuing such discipline (Cal. A.B. 2098, 2022). In contrast to the bills filed in Indiana, Wisconsin, Kansas (Kan. H.B. 2280, 2022), and many other states, the California bill would make it easier to discipline a doctor for spreading misinformation.

Grounds for Discipline

Healthcare workers have a fiduciary duty to act in the best interests of their patients due to the healthcare professional’s superior knowledge of medicine or nursing (Bard, 2021). Although state practice acts do not specifically identify the spread of COVID-19 misinformation as grounds for disciplinary action, disseminating misinformation typically falls under “unprofessional conduct.”

Dr. Nick Sawyer, an emergency physician and the director of No License for Disinformation, a physician advocacy group that strives to address the harmful effects of medical disinformation, believes bills that prohibit misinformation related to COVID-19 are important because misinformation is putting lives at risk (Gardiner, 2022). No License for Disinformation urges state boards to intervene to protect the public (No License for Disinformation, 2022). Furthermore, Sawyer, in collaboration with his colleagues, wrote an opinion piece in The Washington Post urging regulatory boards to discipline healthcare professionals, including revocation of a license, for those who spread COVID-19 misinformation (Sawyer et al., 2021). As Sawyer stated, “Heath-care workers are tired of battling on two fronts—fighting the SARS-CoV-2 virus in our hospitals, and fighting the onslaught of disinformation in the public mind” (Sawyer et al., 2021).

National Associations of Regulatory Boards Weigh in

In July 2021, the Federation of State Medical Boards (FSMB) issued a news release stating the following:

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. … Spreading inaccurate COVID-19 information contradicts [a doctor’s] responsibility, threatens to further erode public trust in the medical profession and puts all patients at risk (FSMB, 2021a).

According to the FSMB, 67% of medical boards have received an increase in complaints related to dissemination of false information, and 21% have taken a disciplinary action against a licensee for disseminating such misinformation (FSMB, 2021b).

While several state’s medical boards adopted FSMB’s guidance, it was not without blowback from some state legislators. In September 2021, when Tennessee’s Board of Medical Examiners posted the FSMB guidance onto their board’s website—before any physicians could be disciplined for spreading misinformation—some legislators threatened to disband the medical board (Farmer, 2022). According to the FSMB, at least 14 states have filed legislation limiting the board’s ability to discipline physicians for their COVID-19–specific medical advice (Farmer, 2022).

Nursing organizations have been equally concerned with the spread of misinformation. In December 2021, the National Council of State Boards of Nursing, along with 15 additional nursing organizations, urged nurses to “recognize that dissemination of misinformation not only jeopardizes the health and well-being of the public, but may place their license and career in jeopardy as well” (National Council of State Boards of Nursing, 2021).

Conclusion

COVID-19 has taken a heavy toll on everyone’s lives, but particularly on those of the frontline physicians and nurses who work endlessly to save the lives of patients with COVID-19. Misinformation spread by healthcare professionals puts patients at risk and makes healthcare providers’ jobs even more difficult.