This transcript has been edited for clarity.
Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU's Grossman School of Medicine.
Quite a controversy has ensued as a result of a decision by the American Board of Internal Medicine (ABIM) to decertify two doctors for spreading false information and misinformation about ivermectin. Some of you may remember that that was a drug initially used in animals — horses, I believe — to control worms, and it had some application in human beings for diseases involving worms as well.
Some people felt, for reasons that I'm still not clear about, that it might be useful for helping people infected with COVID-19 to kill the virus. Merck, the manufacturer of that drug, issued many statements saying that ivermectin was not intended for that use, had no effect on COVID-19, and should not be prescribed.
Some doctors wrote papers saying that they had seen impact in terms of morbidity and lessening of death rates and symptoms in people with COVID-19 who had taken ivermectin. Ivermectin had many fans, including some who were in the federal government in the White House. We heard about that during the outbreak, and many people were recommending it and using it. There was even a bit of an underground market for ivermectin on social media.
Mainstream medicine never accepted the utility of ivermectin. Just like the manufacturer, mainstream medicine said anti-worming medicine is not going to have an effect on this virus. The small number of studies that indicated they'd seen an impact pretty quickly got denounced as inadequate, and subsequent to the first round of COVID-19 in 2019, 2020, those papers have been withdrawn as fraudulent. Nonetheless, two physicians who were board certified continued to promote ivermectin and defend its use.
Some would say that you can't take away someone's board certification because of their promoting a drug that is legal to prescribe, has been approved, and has a pretty good safety profile when it comes to battling worms, both in animals and humans. This is just wrong, some argue, because it really infringes on the free speech of doctors to dissent and to try to argue for alternative views to what the mainstream says.
There is something of a point here. You shouldn't just throw someone's board certification away or drum them out of a medical professional association just because they somehow are deviating from what the standard of care might be. Obviously, dissent and disagreement are a part of any science. Obviously, medicine has to tolerate disagreement with what mainstream experts are going to say.
When you're in the middle of a pandemic that's lethal; when you have a public health emergency; when the manufacturer insists not to use the drug to fight the agent — in this case, COVID-19 — that is causing all the trouble; when groups like the WHO, the [Infectious Diseases Society of America], and all kinds of groups come out to say not only is this not something you should do, but you're risking people's lives because they don't pursue standard of care and accepted, proven things that might actually help them, then at some point, the medical group has to step in, after debate and after warning the dissenters that what they're doing is putting people's lives at risk.
That's very different from having a dissenting opinion when there's controversy about what drug might be best. It's very different from being in a situation where somebody asks if a risk factor is big enough to act upon— say, for measuring problems around the prostate.
This is not the same. This is touting nonsense and dangerous, life-threatening information in the middle of a horrible worldwide pandemic. Mainstream medicine can't, shouldn't, and mustn't tolerate that.
I'm not saying you have a kangaroo court and just withdraw people's boarding and certification, but you collect evidence, you do an examination, you debate, much like you might on a trial. You warn people about what they're risking if they continue to put their patients’ lives in danger, and then and only then do you act.
It's clear to me, and I hope clear to you, that actions like taking someone's board status away have to be justified, deliberate, and done in the context of real harm to patients — and rare, but it's not never. I think the ABIM acted appropriately in finally coming to the conclusion that these two doctors couldn't retain board certification because of the harm that they did, and the harm that they would continue to do if they invoke their status as board certified as part of misinforming their patients and the public.
I'm Art Caplan. I'm at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for watching.
COMMENTARY
Sanctions for COVID Misinformation: Rare, Not Never, Says Ethicist
Arthur L. Caplan, PhD
DISCLOSURES
| October 23, 2024This transcript has been edited for clarity.
Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU's Grossman School of Medicine.
Quite a controversy has ensued as a result of a decision by the American Board of Internal Medicine (ABIM) to decertify two doctors for spreading false information and misinformation about ivermectin. Some of you may remember that that was a drug initially used in animals — horses, I believe — to control worms, and it had some application in human beings for diseases involving worms as well.
Some people felt, for reasons that I'm still not clear about, that it might be useful for helping people infected with COVID-19 to kill the virus. Merck, the manufacturer of that drug, issued many statements saying that ivermectin was not intended for that use, had no effect on COVID-19, and should not be prescribed.
Some doctors wrote papers saying that they had seen impact in terms of morbidity and lessening of death rates and symptoms in people with COVID-19 who had taken ivermectin. Ivermectin had many fans, including some who were in the federal government in the White House. We heard about that during the outbreak, and many people were recommending it and using it. There was even a bit of an underground market for ivermectin on social media.
Mainstream medicine never accepted the utility of ivermectin. Just like the manufacturer, mainstream medicine said anti-worming medicine is not going to have an effect on this virus. The small number of studies that indicated they'd seen an impact pretty quickly got denounced as inadequate, and subsequent to the first round of COVID-19 in 2019, 2020, those papers have been withdrawn as fraudulent. Nonetheless, two physicians who were board certified continued to promote ivermectin and defend its use.
Some would say that you can't take away someone's board certification because of their promoting a drug that is legal to prescribe, has been approved, and has a pretty good safety profile when it comes to battling worms, both in animals and humans. This is just wrong, some argue, because it really infringes on the free speech of doctors to dissent and to try to argue for alternative views to what the mainstream says.
There is something of a point here. You shouldn't just throw someone's board certification away or drum them out of a medical professional association just because they somehow are deviating from what the standard of care might be. Obviously, dissent and disagreement are a part of any science. Obviously, medicine has to tolerate disagreement with what mainstream experts are going to say.
When you're in the middle of a pandemic that's lethal; when you have a public health emergency; when the manufacturer insists not to use the drug to fight the agent — in this case, COVID-19 — that is causing all the trouble; when groups like the WHO, the [Infectious Diseases Society of America], and all kinds of groups come out to say not only is this not something you should do, but you're risking people's lives because they don't pursue standard of care and accepted, proven things that might actually help them, then at some point, the medical group has to step in, after debate and after warning the dissenters that what they're doing is putting people's lives at risk.
That's very different from having a dissenting opinion when there's controversy about what drug might be best. It's very different from being in a situation where somebody asks if a risk factor is big enough to act upon— say, for measuring problems around the prostate.
This is not the same. This is touting nonsense and dangerous, life-threatening information in the middle of a horrible worldwide pandemic. Mainstream medicine can't, shouldn't, and mustn't tolerate that.
I'm not saying you have a kangaroo court and just withdraw people's boarding and certification, but you collect evidence, you do an examination, you debate, much like you might on a trial. You warn people about what they're risking if they continue to put their patients’ lives in danger, and then and only then do you act.
It's clear to me, and I hope clear to you, that actions like taking someone's board status away have to be justified, deliberate, and done in the context of real harm to patients — and rare, but it's not never. I think the ABIM acted appropriately in finally coming to the conclusion that these two doctors couldn't retain board certification because of the harm that they did, and the harm that they would continue to do if they invoke their status as board certified as part of misinforming their patients and the public.
I'm Art Caplan. I'm at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for watching.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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