Doctors fear California law aimed at COVID-19 misinformation could do more harm than good

California doctors will soon face disciplinary action for giving their patients information about COVID-19 they know to be false or misleading.

At first glance, the new state law sounds like a clear blow to the forces that have fueled skepticism about life-saving vaccines, encouraged fearful people to trust discredited and dangerous drugs like ivermectin and hydroxychloroquine, and reduced face masks to symbols of political partisanship. The measure was signed into law by Gov. Gavin Newsom last week and will go into effect on January 1.

But critics of the law, including many mainstream doctors who have been passionate about masks and vaccines, say it could result in well-intentioned conversations between patients and doctors about a disease changing from one month to the next , to be contained.

“There is clear misinformation out there, which is as black and white as you can get. But there’s also a lot of gray out there,” said Dr. Eric Widera, a UC San Francisco medical professor specializing in geriatrics.

With COVID-19, he said, “the standard of care has changed a lot in 2½ years.” At the beginning of the pandemic, he recorded instructional videos for his children’s school on how to properly wear cloth masks. Today, such masks are largely dismissed as ineffective.

That’s a non-clinical example of a truth about the development of medical research, Widera said: “What was misinformation one day is current scientific thinking another day.”

The new law only applies to discussions between patients and their doctors about the patient’s care. For example, it will not cover fringe claims that a COVID-19 skeptic with a medical degree could be aired on social media or at a public rally. An attempt to limit a doctor’s public statements would likely not survive a First Amendment challenge in court, a legislative analysis of the bill found.

In his signing statement, Newsom acknowledged that he was “concerned about the deterrent effect” of the legislation on doctor-patient consultations.

But this law, he wrote, “is narrowly tailored to apply only to those egregious instances where a licensee acts in bad faith or clearly deviates from the required standard of care while interacting directly with a patient in his care.”

The text of the action fails to explain what constitutes a egregious entity or what metrics are used to determine malicious intent.

Investigating and adjudicating a suspected violation by traditional physicians is the responsibility of the Medical Board of California. The law also applies to osteopathic physicians, and the Osteopathic Medical Board of California will handle these cases. Penalties include probation, suspension and loss of license.

In a way, the legislation appears more symbolic than material. State law already prohibits doctors from lying to their patients or giving substandard medical advice that doesn’t meet basic standards for quality care. This applies to the care of all diseases, including COVID-19.

Medical treatment changes as understanding of a disease evolves, and the committee’s complaints process is intended “to reflect the reality that medicine in general is an ever-changing field,” said Carlos Villatoro, a spokesman for the state medical board.

When a complaint is received against a doctor, the committee “deploys doctors who are experts in their field to review the individual facts and circumstances of the situation under investigation and to express an opinion on the appropriate standard of care that should have been followed at the time” said Villatoro. “No case is the same, and the board would make that decision based on the facts and circumstances of each case.”

By making the ban on COVID-19 unequivocally clear, the new law will strengthen a medical board’s hand if a sanctioned doctor attempts to challenge that decision, said State Senator Richard Pan (D-Sacramento), a pediatrician and co-author of the measure.

This isn’t the first California law against a specific type of medical malpractice. Over the years, the state business and professional code has been updated to specifically bar doctors from breaking laws related to human cloning and the long-discredited cancer treatments laetrile and amygdalin. The code states that it is “unprofessional conduct” to distribute liquid silicone for breast implants or fail to provide written summaries to patients prior to cosmetic collagen injections.

The Code is designed to protect patients. Its authors wrote it with the most lurid examples in mind, Pan said, as Dr. Simone Gold, the Beverly Hills doctor who founded the anti-vaccine group America’s Frontline Doctors. Gold has promoted debunked COVID-19 treatments like the antimalarial drug hydroxychloroquine and made outlandish claims about vaccine safety.

(Gold also participated in the January 6, 2021 attack on the US Capitol and pleaded guilty to unlawful entry. She was sentenced to 60 days in prison and had her medical license suspended after her conviction.)

“When someone is providing blatantly misinformation, grossly inaccurate information — especially on purpose — that harms patients,” Pan said. “This deprives the patient of the ability to make appropriate decisions.”

But critics of the new law say they are concerned that single-handling a rapidly evolving and relatively new disease could have unintended harm.

“I’m concerned that this bill will not take into account how quickly information about COVID-19 is changing,” said Dr. Monica Gandhi, an infectious disease specialist at UCSF.

She cited the antiviral drug Paxlovid as an example. The Food and Drug Administration’s guidelines for emergency use of the drug aren’t being updated fast enough to reflect the latest research showing that while it helps seniors, it’s not doing much for patients under 65.

dr Leana Wen, an emergency physician and health policy expert at George Washington University, said it’s easy to imagine a similar law being used to suppress medical facts.

“We should be very concerned about the chilling effect on medical practice and scientific discourse — and be on the lookout for copycat laws in other states on other issues (such as reproductive medicine) that use politics to censor doctors,” Wen said in an email.

It’s not an empty concern. Since the pandemic began, 14 states have enacted laws to protect doctors who spread COVID-19 misinformation from professional censorship.

In 2021, the Association of State Medical Associations warned that doctors who spread misinformation about COVID-19 could risk losing their licenses. When the Tennessee Board of Medical Examiners attempted to adopt the national FSMB policy as its own, the state legislature threatened to dissolve the board if it took such an action, the legislative analysis pointed out.

Misinformation surrounding this pandemic has done deep and irreversible damage. Of the more than 1 million deaths from COVID-19 in the United States to date, up to 318,000 could have been prevented with available vaccines, according to an analysis by the Brown School of Public Health and others. People have died because they made decisions based on false information spread by people who could have known better.

Both the law’s authors and critics say their arguments rest on the same idea: patients should be able to trust their doctors.

“Trust in one’s doctor is one of the most important tools we have when talking to patients about the importance of evidence-based interventions like COVID vaccines,” Widera said. When patients feel their doctors can’t speak freely, “it will only compound the ongoing trust issues that we’ve seen over the last two and a half years,” he said. Doctors fear California law aimed at COVID-19 misinformation could do more harm than good

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