One of the many lessons from the covid-19 pandemic is that misinformation can be deadly. It can lead people to forgo lifesaving precautions and turn instead to potentially harmful therapies. If it’s egregious for politicians and celebrities to purvey misinformation, it’s far worse when the lie peddler is a physician. Surely, such an individual would be in violation of their oath and should be stripped of their medical license.
That’s the thinking behind AB 2098, a bill that passed the California legislature and is waiting to be signed into law by Gov. Gavin Newsom (D). The measure would make California the first state that could take legal action against health-care professionals for conveying false information about covid-19 and its treatments.
While well-intentioned, this legislation will have a chilling effect on medical practice, with widespread repercussions that could paradoxically worsen patient care.
The bill focuses on physicians accused of disseminating misinformation to patients under their care. (It does not extend to comments in the public domain, such as social media.) On a surface level, this is defensible: The expectation should be that doctors always abide by the gold standard of care. Therefore, those who deliberately give patients advice that counter established guidelines should lose their medical license.
The problem is that medical practice is rarely black and white. Much of the time, broad recommendations are intended to be tailored to the individual patient.
Take the recent guidelines on booster shots. The Centers for Disease Control and Prevention has recommended that everyone 12 and older receive updated boosters. Most doctors would probably agree that elderly individuals should get the new booster right away. But many might advise — as I would — that it’s fine for some patients to hold off and time the booster closer to winter holidays. Some providers might not recommend boosters for children and adolescents, especially if they have already had the coronavirus.
These actions go against federal guidelines. AB 2098, taken to the extreme, could put many practitioners at risk. But is it really right for physicians to be threatened with suspension or revocation of their license for offering nuanced guidance on a complex issue that is hardly settled by existing science?
Indeed, another lesson from covid is that science is constantly evolving. In a public health emergency, official guidance often lags cutting-edge research. Consider how long it took the CDC to acknowledge that the coronavirus is airborne. Should doctors have been censured for recommending N95 masks before they were accepted as an effective method for reducing virus transmission?
Moreover, recovery from infection in combination with vaccination conveys strong protection, but the CDC still does not consider infection to take the place of a booster. If a young patient didn’t want a booster for this reason and their doctor agreed, should this be a punishable violation?
Medical practice is nuanced even when there is clear evidence. For example, studies have shown that steroids are not helpful in outpatient treatment of patients with covid-19. But certain patients, such as individuals with chronic obstructive pulmonary disease and asthma, might benefit from them, and physicians need to use their best clinical judgment for their patients’ unique circumstances.
There could also be rare situations in which treatments that definitively do not work might still be prescribed. A colleague told me he prescribed ivermectin to treat covid-19, even though the antiparasitic drug isn’t effective against the disease. If he didn’t, his misinformed patients would have ignored his advice and obtained it anyway from a livestock shop, where the dosages intended for cows and horses could be deadly to humans. This action certainly deviated from what the California bill calls “contemporary scientific consensus,” but that physician shouldn’t have to fear for his license because he tried to reduce harm to his patients.
In a way, though the California bill was introduced by Democratic legislators, it is not unlike the Trump administration’s Title X “gag rule,” which barred health-care providers who worked in clinics that received federal funding from referring patients for abortion care. I strongly opposed the Title X gag rule for the same reason I oppose AB 2098: Both censor what doctors can say to our patients. Both represent political interference with the practice of medicine.
Both measures could also set a precedent with downstream repercussions. Imagine if anti-vaccine legislators introduced a bill that forbids pediatricians from offering parents information on routine childhood immunizations. Imagine if states that already limit reproductive health services or transgender care prohibit health-care providers from discussing options with their patients.
California’s bill is a recipe for medical practice to be subject to the whims of partisan politics. And it challenges the basis of the doctor-patient relationship. At a time of deep division, when trust in health officials has already been eroded, bills that threaten doctors should be reconsidered before unintended consequences create far more problems than the legislation tries to solve.
