Censorship is bad for Medicine
- Dr. Stephen Smith
- Oct 10, 2021
- 7 min read
This morning I read an article Healio News, an online medical news journal. Healio News has several different issues, one for each subspecialty. In fact, I am a contributor and member of Healio Infectious Disease News editorial board. Today’s article was in the Primary Care version and written by Janel Miller, an experienced medical author. The title is “Medical boards threaten action against physicians who spread COVID-19 misinformation”.
In this article, Ms. Miller began -
“Several medical boards have announced that physicians who engage in “unethical or unprofessional conduct” regarding COVID-19 may be subject to disciplinary action.
The announcement from the ABIM, American Board of Family Medicine and American Board of Pediatrics follows a similar announcement from the Federation of State Medical Boards that “physicians who generate or spread misinformation or disinformation about COVID-19 are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license.”
Here is the URL for the article -
Ms. Miller did not condone nor criticize these attempts to silence doctors just doing their jobs or stating their opinions. Essentially, medical boards are calling for a centralization of the practice of Medicine, meaning doctors will have to follow some organizations guidelines on disease treatment. That’s even worse than socialized Medicine. It’s totalitarianism Medicine. Guidelines in any field are for the uninformed. If I am looking to the Guidelines for all of my treatment decisions, then I am not even close to doing my job.
I cannot overstate the threat this movement is to the practice of good Medicine. Several reputable physicians have found that ivermectin works against Covid. Several other reputable and irreputable physicians, such as this one, found that HCQ/AZM works well against Covid. Yet, for the first time in American Medicine history hospitals have banned the use of FDA-approved drugs by use. HCQ and IVM are banned by many hospital for the treatment of Covid. Safety is not an issue. It is unclear why this has been done. Regardless, these bans are widespread and represent a real and present danger to the practice of independent Medicine. But these drugs are approved by the FDA for Covid, so why should a doctor be able to use them? Because well over ½ of first line treatments of infectious diseases are off-label, or for uses not approved by the FDA.
Below is a copy of the letter I sent to Healio News today. BTW, if any of y’all still “believe” in masks. Stop Believing and start proving. The three main studies, the CDC’s September 2020, the Dutch Annals of Internal Medicine in December 2020 and the more recent Bangladesh study from last month prove that masks have no effect on Covid-19 transmission.
Thomas Payne
October 10, 2021
Janel Miller
Editor, Healio Primary Care
Dear Ms. Miller:
I read your article today on medical boards, including the ABIM, threatening action against physicians, who spread COVID-19 misinformation. I am bothered by several aspects of your report. Broadly and obviously, any attempt to restrict freedom of speech, however well-meaning, is dangerous and, most likely, unconstitutional. As your article was a news article and not an editorial, perhaps, it's understandable that errors of others were propagated or left unchallenged.
You cited an article from the Oregonian, which reported that a physician had his license revoked for not following Covid-19 guidelines and spreading misinformation. You did not, however, comment on the legitimacy or lack thereof of this action. Guidelines are guidelines and are not meant to define standard of care. Not following guidelines hardly means a physician is not practicing standard of care medicine. Although guidelines are updated at varying intervals, the cannot keep up with the literature. For instance, the DHHS publishes guidelines on the HIV treatment in adults and adolescents.. Therefore, when a new treatment becomes available or compelling data on a new approach become available, clinicians do not and should not wait for an update to change their practice and the standard of care. IDSA puts out many guidelines. Some of these guidelines contradict each other. All guidelines make one or more recommendations, which are admittedly based upon very limited or poor quality evidence. Similarly, IDSA’s guidelines are updated many years apart. The most recent IDSA Guidelines on cystitis and pyelonephritis was published in 2010 and is now considered “archived” by the IDSA. Since 2010, FDA has approved seven antibiotics for treatment of UTIs. Since the most recent IDSA Guidelines on Skin and Soft Tissue Infections was published in 2014, the FDA has approved five antibiotics for treatment of ABSSSI. Clearly, not following clinical guidelines cannot be used judge clinicians’ care of patients.
You mentioned “Covid guidelines” as if there existed only one set of guidelines for treatment of Covid. This is not accurate, of course. There are, at least, three different Covid treatment guidelines. Two of the three are from the US organizations, IDSA and the NIH on Covid treatment as does the WHO.(1–3) These guidelines are fluid, but they are not updated weekly. So, if data from a new trial is published, then standard of care may change well before any of these three guidelines includes the new treatment. Further, each of these guidelines has recommendations which differ from one or both of the others. So, which guidelines were used to judge the Oregon physician? The absurdity of using Covid guidelines to judge a physician’s treatment is hopefully obvious.
You then reported on MSNBC’s report of an Idaho doctor who “had promoted ivermectin and “falsely claimed there’s statistically no efficacy in masks.”” What are the statistics or data which make this statement inaccurate with regards to mask efficacy? The CDC’s retrospective study showed masks did not protect wearers.(4) The Dutch study, published in the Annals of Internal Medicine, was a cluster-controlled study and showed masks did not protect against Covid-19 infection.(5) A large, randomized study in Bangladesh also showed little to no efficacy.(6) So, the best data show little to no protection with mask use. Are there quality data showing how well masks protect against Covid?
The final example of bad behavior was “According to USA Today, a physician declared during an Indiana school board meeting that “everything being recommended by the [CDC] and state board is actually contrary to all the rules of science."” In the past 22 months, the CDC has made several questionable recommendations or interpretations. In 2020, the CDC literally put forward an anecdote as evidence of the mask’s efficacy. This anecdote involved a hair salon in Springfield, Missouri.(7) This was not a study; it was pure anecdote. In that publication and others, the CDC has only presented and discussed data, which support their recommendations, and have not included data, which contradict their recommendations. As referenced above, the CDC published data on a case-control study on the risks of Covid.(4) In this MMWR study, 70.6% of the case subjects and 74.2% of the controls reported wearing a mask all of the time and 14.4% and 14.5% of cases and controls respectively wore masks “often”. In short, mask wearing was not associated with a decreased risk of Covid. Regarding the use or effect of vaccinating people with prior history of Covid infection, the CDC only discussed the results of the study from Kentucky’s Department for Public Health.(8) Flaws, weaknesses and contradictory data were ignored. The several studies, published in the NEJM, CID, JAMA, and the Lancet, had already established that people with antibodies against SARS-CoV-2 after infection, are well protected against re-infection.(9–12) These studies were not included I the discussion. So, if a doctor criticizes the CDC and does so accurately, will that be used to take away her/his medical license?
No doctor should support limiting other doctors’ interpretations of the available data. That would be an enormous mistake. It would also severely stifle physicians, who need to treat their patients, based upon the best, available data, not upon guidelines made by others of similar training. This totalitarianism has to stop before more damage to American Medicine is done.
In closing, I remind Healio that many innovations and discoveries in Medicine were ignored, dismissed and laughed at, before finally being accepted as true and accurate. Dr. Ignaz Semmelweis showed, in a controlled study, that hand washing reduced postpartum sepsis and mortality. Dr. Stanley Prusiner discovered that a protein-based life form existed and caused disease. Drs. Barry Marshall and Robin Warren discovered that a bacterium was the principal cause of peptic ulcer disease. In each of these instances, establishment Medicine ignored the discoveries and ridiculed the discoverer(s). If American Medicine allows this totalitarianism to continue, then there will never be another Semmelweis, Prusiner or Marshall/Warren.
Without a doubt, the establishment’s failure to properly consider and evaluate the data behind the above discoveries cost lives, many lives. Said another way, if the establishment had properly and fairly evaluated the data from these doctors, then many lives would have been saved. If American Medicine is in the business of saving lives still (and that sadly, is up for debate), then the leaders in America Medicine must stop far reaching interferences with the practice of Medicine.
Sincerely,
Stephen M. Smith, M.D.
Founder and Director
Smith Center for Infectious Diseases & Urban Health
References:
1. COVID-19 Guideline, Part 1: Treatment and Management [Internet]. [cited 2021 Oct 10]. Available from: https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/
2. Information on COVID-19 Treatment, Prevention and Research [Internet]. COVID-19 Treatment Guidelines. [cited 2021 Oct 10]. Available from: https://www.covid19treatmentguidelines.nih.gov/
3. Therapeutics and COVID-19: living guideline [Internet]. [cited 2021 Oct 10]. Available from: https://app.magicapp.org/#/guideline/nBkO1E
4. Fisher KA, Tenforde MW, Feldstein LR, Lindsell CJ, Shapiro NI, Files DC, et al. Community and Close Contact Exposures Associated with COVID-19 Among Symptomatic Adults ≥18 Years in 11 Outpatient Health Care Facilities - United States, July 2020. MMWR Morb Mortal Wkly Rep. 2020 Sep 11;69(36):1258–64.
5. Bundgaard H, Bundgaard JS, Raaschou-Pedersen DET, von Buchwald C, Todsen T, Norsk JB, et al. Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers. Ann Intern Med [Internet]. 2020 Nov 18 [cited 2021 Jan 31]; Available from: https://www.acpjournals.org/doi/10.7326/m20-6817
6. The Impact of Community Masking on COVID-19: A Cluster-Randomized Trial in Bangladesh [Internet]. Innovations for Poverty Action. 2021 [cited 2021 Oct 10]. Available from: https://www.poverty-action.org/publication/impact-community-masking-covid-19-cluster-randomized-trial-bangladesh
7. Hendrix MJ. Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy — Springfield, Missouri, May 2020. MMWR Morb Mortal Wkly Rep [Internet]. 2020 [cited 2021 Oct 10];69. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/mm6928e2.htm
8. Cavanaugh AM. Reduced Risk of Reinfection with SARS-CoV-2 After COVID-19 Vaccination — Kentucky, May–June 2021. MMWR Morb Mortal Wkly Rep [Internet]. 2021 [cited 2021 Oct 10];70. Available from: https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm
9. Lumley SF, O’Donnell D, Stoesser NE, Matthews PC, Howarth A, Hatch SB, et al. Antibody Status and Incidence of SARS-CoV-2 Infection in Health Care Workers. N Engl J Med. 2021 Feb 11;384(6):533–40.
10. Vitale J, Mumoli N, Clerici P, De Paschale M, Evangelista I, Cei M, et al. Assessment of SARS-CoV-2 Reinfection 1 Year After Primary Infection in a Population in Lombardy, Italy. JAMA Intern Med. 2021 May 28;e212959.
11. Leidi A, Koegler F, Dumont R, Dubos R, Zaballa M-E, Piumatti G, et al. Risk of reinfection after seroconversion to SARS-CoV-2: A population-based propensity-score matched cohort study. Clin Infect Dis Off Publ Infect Dis Soc Am. 2021 May 27;ciab495.
12. Hall VJ, Foulkes S, Charlett A, Atti A, Monk EJM, Simmons R, et al. SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN). Lancet Lond Engl. 2021;397(10283):1459–69.
BRAVO, Dr. Smith !!!!