Medical Boards Barely Acted Amid Flood of COVID Misinformation

Only a handful of physicians in the five most populous states faced medical board discipline over spreading misinformation to the community during the height of the COVID-19 pandemic, a new study found.

In California, Texas, Florida, New York, and Pennsylvania, only six physicians were disciplined for disseminating medical misinformation in the first years of the pandemic, reported Richard S. Saver, JD, University of North Carolina School of Law and School of Medicine, Chapel Hill, in JAMA Network Open.

While the Federation of State Medical Boards had warned physicians that sharing misinformation could risk their licenses, “the study found extremely limited discipline for physicians spreading misinformation,” Saver told Medscape Medical News. “There does seem to be a very serious disconnect.”

The COVID-19 pandemic spawned an avalanche of medical misinformation about topics such as disease severity, prevention methods, treatments, and vaccines.

Physicians were often sources of false claims: An analysis published last year identified 52 US physicians who spread misinformation about COVID-19 via online platforms from 2021 to 2022. However, a Washington Post investigation of all state medical board records in 2023 found that few physicians who’d spread COVID-19 misinformation were disciplined.

Misinformation: A Tiny Proportion of Offenses 

Saver said his analysis was inspired by news about alleged misinformation purveyors such as California physician Simone Gold, MD, JD, a leading anti-vaccine activist and promoter of discredited COVID-19 treatments.

Gold was eventually disciplined by the state medical board but not because of her statements. Instead, the board acted because she was convicted of taking part in the US Capitol riot of January 6, 2021.

“There are several other examples of Simone Gold–type behavior in the news,” Saver said. “It led to people asking, ‘Why are medical boards not cracking down on this behavior and these physicians?’”

Saver identified 3128 medical board disciplinary proceedings — regarding 6655 offenses — in the states from January 1, 2020, through May 30, 2023 (California, Florida, Pennsylvania, and New York) or March 30, 2022 (Texas only).

The most common offenses were negligence (28.7%), other (16.6%), problematic record-keeping (14.9%), inappropriate prescribing (13.5%), and criminal activity (9.0%). According to Saver, the “other” category includes rare offenses that don’t fit into other categories such as failing to report child abuse or giving orders without proper hospital privileges.

Six cases (0.1% of offenses) addressed misinformation that physicians spread to the community.

‘Troubling Regulatory Inaction’

In just 21 cases, physicians were disciplined over misinformation directed at patients, not the public. In one case, Saver said, a Pennsylvania physician was disciplined for spreading misinformation to patients about the prescribing of ivermectin and hydroxychloroquine, non-approved but popular treatments for COVID-19.

“The low number of misinformation sanctions in this study suggests troubling regulatory inaction because it occurred against a backdrop of apparently increasing complaints to medical boards about misinformation, heightened salience about the problem, and medical board guidance and research indicating serious concerns,” Saver wrote in the study.

Joe Knickrehm, spokesman for the Federation of State Medical Boards, declined to answer questions from Medscape Medical News about the study’s findings.

Instead, he provided a general statement that noted that state medical boards can be affected by inadequate resources.

“State medical boards can also send warnings or have conversations with licensees to encourage them to change a concerning behavior,” the statement said. “These efforts are not always seen by the public or media, but they do occur.”

Where Does First Amendment Fit in?

In an adjoining commentary, Megan L. Ranney, MD, MPH, of Yale School of Public Health, New Haven, Connecticut, and Lawrence O. Gostin, JD, of Georgetown University Law Center, Washington DC, express skepticism about tackling misinformation via medical boards.

The First Amendment limits how government agencies, including medical boards, can curtail free speech, they noted.

“Licensing boards cannot impose sanctions without clear and compelling reasons,” they wrote. “Board sanctions should be rare and used only if physicians consistently spread verifiably false information, in their professional capacity, that has demonstrated potential for harm.”

The commentary authors added that “although there are many verifiable truths (for example, vaccines are overall safe), scientific knowledge is often evolving. It is also in society’s interests to encourage good faith medical and scientific debate.”

Today’s ‘Facts’ May Be Misinformation Tomorrow

A 2024 Medscape survey of physicians about state medical boards turned up similar concerns about crackdowns on medical speech.

“Who decides what is misinformation? I think the history of cigarettes, beta blockers, aspirin, and statins says it all,” said a 63-year-old male anesthesiologist in Indiana. “Misinformation is a slippery slope.”

Misinformation “today is a fact tomorrow or vice versa,” agreed a male pediatrician, age 55, in Arkansas. “Many of the things I learned in medical school have now been proven wrong and were expounded as fact for ages.”

Still, “there are certainly exceptional cases of disinformation that undoubtedly violate medicine’s precepts of honesty, integrity, and ‘do no harm,’” the JAMA Open Network commentary authors wrote.

“Punitive measures, whether by federal or state agencies or the criminal justice system, can certainly be justified. But sanctions should be reserved for the clearest and most egregious cases.”

The study noted limitations such as the lack of information about other forms of discipline other than sanctions: “Many complaints to medical boards remain confidential. Further, informal nudging of physicians by medical boards is also not publicly reported.”

Saver, Ranney, and Gostin had no disclosures.

Randy Dotinga is an independent writer and board member of the Association of Health Care Journalists.