Fighting Infections from COVID-19 Misinformation

Ethics Committee report

FSMB followed up in April 2022 (3) when its House of Delegates adopted a report from its Ethics Committee, entitled “Professional expectations regarding medical misinformation and disinformation.” The report noted that “Honesty, truthfulness[,] and transparency are virtues that society expects of all health professionals.” It defined medical misinformation as “Health-related information or claims that are false, inaccurate[,] or misleading, according to the best available scientific evidence at the time.” It defined disinformation as “Misinformation that is spread intentionally to serve a malicious purpose, such as financial gain or political advantage.”

Cautions from ABIM

On the heels of the FSMB action, The New England Journal of Medicine published a “perspective” article on May 18, 2022, on “Physicians spreading misinformation on social media…” by Richard J. Baron, MD, CEO of ABIM, and Yul D. Ejnes, MD, chair of the ABIM Board of Directors (4). “ABIM has long had a policy that unprofessional or unethical behavior can lead to revocation of an ABIM certificate,” Baron and Ejnes wrote. They said ABIM issued a policy statement in October “making clear that ‘providing false or inaccurate information to patients or the public is unprofessional and unethical and … constitutes grounds for disciplinary sanctions.’”

The authors wrote that many areas of medicine are not settled and are subject to disagreement, but when “Someone certified by the ABIM says something like … ‘children can't spread COVID’ or ‘vaccines don't prevent COVID deaths or hospitalizations,’ we are not dealing with professional disagreement; we are dealing with wrong answers. We physicians need to use the institutions we’ve created for professional self-regulation to maintain public trust by establishing some recognizable boundaries.”

Legislative pushback

However, even what FSMB and ABIM consider an obvious principle—to not disseminate misinformation—has received pushback from those claiming that patients should have the “freedom” to access treatments, such as ivermectin and hydroxychloroquine, even though the vast majority of physicians accept the evidence that they are ineffective treatments for COVID-19.

At a meeting in September 2021, the Tennessee Board of Medical Examiners endorsed the FSMB statement and posted a version on its website. When a powerful Republican member of the Tennessee Senate learned of the action, he notified the board that it had exceeded its legal authority and threatened to introduce legislation to dissolve the board. The board had a special meeting at which it voted to remove the statement from the website but did not necessarily abandon its efforts against misinformation.

The FSMB's Robin said that “The board chair pushed back. She publicly stated that the board would continue to investigate instances of physicians spreading disinformation.”

But this pattern of state legislatures challenging boards’ independence has become common, with more than 83 bills introduced in 31 states in 2021 to restrict boards’ disciplinary authority or to explicitly protect off-label uses of drugs to treat COVID-19 (5). A few of the bills have passed. North Dakota enacted a law that prohibits its Board of Medicine from disciplining a licensee solely because the licensee dispensed ivermectin for off-label treatments, such as for COVID-19. Tennessee and Missouri enacted similar legislation prohibiting disciplinary action against physicians for their approach to treating COVID-19.

FSMB opposes such legislation to limit a board's work because “It sets a dangerous precedent and puts the public at risk.” Robin said, “It is something that we have not seen before.... It is concerning…” to see a legislature override the authority of the professionals and public members who are appointed for their expertise.

Most of these bills are being considered in red states, and in contrast, California is the only state with a bill moving through its legislature that defines misinformation and specifically empowers the state medical board to act against physicians who spread it. On June 13, 2022, the American Medical Association adopted a policy aimed at combating public health disinformation, with one of its priorities to ensure that “…licensing boards have the authority to take disciplinary action against health professionals for spreading health-related disinformation…” (6).

Nephrology angle

Despite the increase in complaints about misinformation to medical boards, several prominent nephrologists interviewed by Kidney News agreed that the problem is less visible in nephrology.

“Fortunately, it seems that spreading misinformation is not a widespread problem in the nephrology physician community,” said Rudolph A. Rodriguez, MD, director of hospital and specialty medicine at the Veterans Affairs (VA) Puget Sound Medical Center in Seattle, WA, and chair of the ABIM Nephrology Board. “Health systems and professional societies need to step up and find ways to ensure patients know how to find good information.”

“The ABIM Nephrology Board will not be taking any action independent of the general ABIM actions,” Rodriguez said, but a top-level administrator at the VA sent a link to The New England Journal of Medicine article to a list that included all the VA chief medical officers “reminding our staff that sharing and condoning medical misinformation is an issue that we continue to address nationally.”

As part of its campaign, ABIM emailed medical society leaders and others a “communications toolkit” encouraging them to become active in its campaign against misinformation. The toolkit includes sample emails to send colleagues with a link to The New England Journal of Medicine article, a draft copy to use in a newsletter, a sample Letter to the Editor to send to mainstream media, and sample social media posts.

Deidra Crews, MD, a former ABIM Nephrology Board member and professor of medicine at Johns Hopkins University in Baltimore, MD, said that she has encountered some disinformation in the kidney community, but it is “rare.” She said that some “safeguards” in place to prevent the spread of misinformation at forums, such as conferences, are the presence of gatekeepers to “guard against those who may be known for spreading misinformation” and to request slides ahead of time to review what a person plans to say. “There can be times when what is said during a conference could be something that many may find to be offensive or to be misinformation, and then you [may have to] make a counter statement,” Crews said.

Matthew Sparks, a current ABIM Nephrology Board member and assistant professor of medicine at Duke University in Durham, NC, said that “It is becoming increasingly important to have a presence online to whatever capacity you feel comfortable. That can be just a website,” or it could involve finding ways for greater advocacy to combat misinformation. Sparks is the program director for the Nephrology Social Media Collective Internship, a yearlong curriculum that teaches how to use social media effectively “to be part of the solution.” Information on the program, which began in 2015, is available at www.nsmc.blog (7). “There is no way to eliminate misinformation, so it is imperative that all of us take it upon ourselves to call it out and also put out information that is not only accurate but [is also] backed up by data,” Sparks said.