Should California discipline doctors who “disseminate misinformation or disinformation related to COVID-19?” Here’s one California physician’s take.

 
Full transcript in the “transcript” tab below! And here’s the interview with Dr. Paul Offit I referenced. Read the full text of AB2098 here.

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– All right! Ah, let’s talk about California’s new bill that would punish physicians for disseminating misinformation or disinformation around COVID-19. Let’s dive into this. So this bill is sitting on Governor Newsom’s desk. It’s AB 2098, and it was actually written, I’m gonna try to steelman the argument for this, meaning my best understanding of the argument of of the good intentions behind this bill, which is the following: misinformation around COVID-19 and disinformation. What’s the difference by the way? Disinformation is intentionally misleading people, often for profit, right?

Versus misinformation, where it’s like you actually believe this incorrect fact about something and you spread it around. Either of those done by healthcare professionals by physicians in particular can be extremely damaging during a time of pandemic. For example, let’s say you have a 70 year old with multiple medical problems and they go to see their doctor and their doctor is someone who believes that ivermectin and hydroxychloroquine are superior treatments to vaccines for preventing COVID-19 morbidity in that patient. Well, we know from all the available data currently that that’s not true in that patient population.

And therefore, that advice is actually contrary to the medical consensus. It’s also contrary to data that’s pretty easily obtainable and contrary to the ethical sort of pact that a physician makes to do no harm because by giving them an ineffective medication when there’s a known standard of care that’s better, that’s professional misconduct. So when that happens, you’re actually potentially costing someone their life or limb, right? And when physicians do it, it’s actually that much more egregious, because they ought to know better based on training. Now I’m still steelmanning this argument, meaning I’m trying to make the strongest argument for the bill, because as you can tell, I disagree with this bill quite strongly and there’s several reasons why.

So the idea then that, even in pre-COVID times, there are physicians who are spreading misinformation and disinformation about certain treatments around cancer, giving people hope when it’s really snake oil, around vaccines, especially children’s vaccines, that they cause harm and that they have no benefit, which is not true, and that can potentially cost lives and can injure people. And so even pre-pandemic, I would’ve been like, “Well, this kind of a bill feels emotionally really good as a physician because there’s so many doctors that I would not send my dog to that are out there committing this kind of practice that is harming people.” And it would be great if the medical board, which by the way, is not on the physician’s side, anyone who thinks the medical board is there to protect doctors is wrong. They are there to protect consumers. And in California, it’s like, I think eight physicians and eight non-physicians that are appointed by the government.

These are not elected appointees, they’re appointed officials. And they’re there to decide, “Oh, should you lose your license? Should you be reprimanded? Should you have to do remedial training?” All these kind of things that can happen. And the idea is that you regulate professional conduct and that’s important when people’s lives are at stake, when the consumer, the patient’s, life is at stake. And there’s plenty, if you are a doctor, you get these notifications once a month, like here are all the people that are being disciplined and for what. And it’s really funny when you see one of your old med school classmates show up on that list and you’re like, “Oh, snap!” And then part of you is like, “When am I gonna show up on the list?” And the reason you worry about is not because you’re out there committing professional misconduct, but because what defines professional misconduct? Is it because you failed to document something appropriately, that you did correct, but you didn’t write it down? So there’s all this stress, this medical legal stress on physicians as it is. So the idea then is, well, let’s control disinformation and let’s save lives. And this is a good use of state resources and regulatory bodies to do this and that’s the argument. And that there’s precedent like you wouldn’t violate the standard of care for an infection or for cancer and people would potentially get their licenses revoked if they consistently violated those things.

So why not do it about COVID-19? Well, let me read to you. Now, that’s the argument, okay? And I think a lot of people support this with good intent. But I wanna argue the nuance around this that makes this a terrible effing idea to do. And a slippery slope that’s gonna lead us potentially to ruin. And I’m not being hyperbolic. And I’ll tell you why. Let me read the statement in the bill. “It shall constitute unprofessional conduct for a physician and surgeon to disseminate misinformation or disinformation related to COVID-19, including false or misleading information regarding the nature and risks of the virus, its prevention and treatment, and the development, safety, and effectiveness of COVID-19 vaccines.” Well that’s a mouthful. Everything I just read has been evolving over the course of the pandemic. What was scientific consensus, like this thing is an airborne, it’s all passed by fomites, by surfaces.

And Fauci said, don’t wear a mask. That was scientific consensus. If he said that today, that would be considered disinformation or misinformation. So today, one time’s disinformation, misinformation is another times scientific consensus. So of course science is evolving, there is no, “the science.” There is science as a process of discovering finer and finer details of unfolding understanding and truth. And so by saying, “Oh, we’re gonna punish you for spreading disinformation or misinformation,” well, what does that constitute? For example, if I were to tell you now, and by the way, by the way, this is very important, this covers a relationship between a doctor and the patient they are treating. This is not covering social media, like myself talking on a show. This covers you in the privacy of the doctor-patient relationship. So there’s a few things that evolve out of that. Like how does the board find out that you’ve told a patient something?

Well the patient has to tell them or something adverse has to happen and it comes out in discovery, in a malpractice lawsuit, or something, or another doctor snitches. So that’s how it comes out. But it’s about a treating patient. Now let’s say I have a patient and I tell them, “Listen, I think that your two year old should not wear a mask in their daycare if it’s optional. I don’t think it’s necessary and I think it might be harmful for their speech and language development.” And the “scientific consensus,” like say CDC says mask everybody over two, which is what they say. Well, where is that scientific consensus coming from? You have CDC saying that, but then WHO, which is another august worldwide body says, “No, not until six.” And some countries don’t require masking at all. And the same would go with the flip flopping on closing schools. It was scientific consensus to close schools. Terrible idea, caused incredible harm. And yet here we are.

So if a physician were to tell their patient, “Listen between you and me and the wall, I don’t think closing school is a good idea.” They could lose their license under this bill because that was scientific consensus. So who determines what scientific consensus is? It doesn’t quite say in the bill, which makes it incredibly broad and open ended and incredibly dangerous and unscientific. That’s actually gonna harm patient care. Now here’s another example that actually Leana Wen brought up in a Washington Post op-ed that she wrote opposing this bill as well. And she’s a pretty hardcore COVIDian.

She brought up this point that imagine, so something like ivermectin, which all the data so far, that’s good data, that’s randomized, that’s looking at it specifically, shows it’s not a good treatment for COVID-19. And it’s of course been very politicized. So Trump and and Republicans were talking about this early on, hydroxychloroquine as well, and ivermectin and it’s polarized out, because our whole society is polarized now. And so just so happens that Conservatives seem to like ivermectin and Liberals think it’s dumb and they call it horse tranquilizer. And it’s this polarization. All right, well, there was a case where one of her colleagues said, “You know what? This patient of mine is gonna go get ivermectin no matter what and they’re gonna go get it from a veterinary source where it’s at horse dosing and could possibly harm them. So I’m gonna write them a prescription for ivermectin ’cause they’re gonna get it anyways and I’m gonna give them the safe and low dose prescription and that way we’re minimizing harm.” Well, that physician could lose their license under this bill.

They’re trying to minimize harm. It’s not like they believe ivermectin works, they told the patient they don’t think it works, but I’m gonna give you, how many times do we do that in medicine? Harm reduction. In fact, it’s the principle of public health in many situations. And yet here, we’re no longer allowed to think in that nuanced holistic Health 3.0, Alt-Middle, looking at all viewpoints, an overall picture way. So that’s a big problem with this. The other problem is you’re now inserting the medical board, again, back into the room there where it has jurisdiction, but it is going to further reduce physician autonomy and reduce their ability to practice nuanced complex medicine. Now how can this also be a problem? Here’s something that I should talk about.

So I’m licensed in Nevada and California. Nevada has a statute for unprofessional conduct and it’s very broad. It’s kind of like this. This actually at least just limits it to COVID and to a patient you are treating. In Nevada, you can actually be censored for unprofessional speech practically. And so here’s what happened to me. I do a show with Dr. Paul Offit who’s a vaccine advocate, who by the way, would be censured under this bill for saying the following, “An 18 year old does not need a third booster, particularly if they’ve been infected with COVID already because they already have good protection against severe disease. And the benefit of the booster is tiny and the risks, although tiny, would outweigh it just because there are risks and there’s no benefit or minimal benefit.” He would potentially lose his license and he’s the fiercest, most consistent vaccine advocate, rational thinker, and scientist that I know.

So I had Paul on the show, this was back in, you know, few years ago, pre-pandemic, and some anti-vaccine activists found out that we were doing the show, echolocated our facility by looking at old pictures, and found a McDonald’s and said, “Oh, their studio is here.” Literally found us. And started banging on the glass as we were live streaming, shouting, we couldn’t hear what they were saying, and holding up pictures of dead babies and things like that. And I think I said something on the show about, “Wow, Paul, you really attract the kind of lunatic, aggressive, dangerous people.” Something, I forget what I said. Well people, a bunch of anti-vaccine activists actually filed complaints with the medical board of Nevada saying that was unprofessional conduct on my part. And even though they weren’t my patients, I’ve never seen them, I had to respond with big letters to protect my license.

And it worked out fine, but now Nevada’s board is on alert. They know who I am. Anytime that happens, I have to respond with a letter. So this is almost a kind of harassment that can happen that’s political. So for example, imagine this, because this is so politicized, by the way, do you think Republicans wrote this bill? No. Do you think Republicans signed the bill? Not that many I bet. This is a very politicized bill, because COVID has become politicized and free speech has become politicized. So what happens if I’m a, say a conservative physician, and my patient is a liberal patient. And they disagree on a lot of things and it comes out, they have some argument or something, or it comes out that the patient sees a social media post where they realize their doctor is conservative. And then the doctor says something like, “You know, I’m not really sure that closing schools was a good idea and I don’t think you necessarily need a fourth dose since you’re young and healthy.”

That patient, being polarized by the great mistruths, that the world is a battle between good and evil people, now brands that physician as evil, goes to the medical board, and writes a complaint saying, “This doctor recommended to me that I don’t need a fourth dose.” And then the doctor has to defend themself at personal time, cost, and emotional hardship in front of the board to defend their livelihood. Okay, so whatever good effing intentions this bill had, that’s what’s going to fucking happen when this bill goes. Do you know why? Because our society is so polarized that people with good intent who think they’re doing the right thing, who are segregated into these different hive minds with group think, actually think the other side is evil, because they’re disconnected from fucking reality, because of social media that tells us that the other person who thinks differently than you is inhuman, they’re actually like an alien, evil presence.

And the AI that runs Facebook and YouTube and TikTok and all of that actually knows that that gets your attention and gets you outraged the way I’m outraged right now. It hijacks your lower angels of your nature and your brain stem and it feeds you more of that until it turns you into a fucking robot. And then what happens? That patient goes to the board and says, “Hey, guess what? My doctor did this thing.” Now the doctor’s gotta defend themselves. And guess what? The doctor now hates this patient. They’re stressed. Now they’re doing political screens for their patients. “Hey, if I see you virtue signaling about masks, you can’t be my patient.” Why wouldn’t that happen? That’s what a bill like this could potentially do. Now here’s the thing, liberals may be saying, “Well, Z, listen, conservatives are stupid and if they didn’t promote disinformation, then we wouldn’t have to have a bill like this.” Okay, I get it.

Then what about this, when Trump had the gag order under Title 10 saying you can’t talk about abortion if you’re in a federally funded clinic, you can’t recommend it. What do you think of that? That’s a very similar control over physician speech, isn’t it? Would you agree with that? What if under now the new world order about abortion, a state passes a bill that says physicians are no longer allowed to advise patients to cross state lines or give them information on how to do that to get an abortion, that’s illegal. How would you feel about that? Well, is that very different than how somebody with a different moral matrix might see this bill? Talking about the nuance around COVID. And yeah, there are horrible people out there who I won’t name because I don’t want to get sued, spreading disinformation and misinformation. Dr. Oz. Yet he’s running for office. Like he had a show platform where he is doing this.

He’s still licensed. He’s still doing that stuff. And now he’s gonna potentially be a senator from Pennsylvania. Okay, these are the things we let slide, but we wanna punish frontline clinicians for having nuanced discussions. That’s why I think this bill is a terrible freaking idea . A terrible freaking idea. It’s infused with politics, it has good intention, like most things initially, and I get why people wanna do it and it feels emotionally good when you want to do it until it doesn’t, until you’re on the side of the standing in front of the medical board, having to pay for a lawyer and defend your livelihood and your ability to practice when you don’t even have the tools, resources, and autonomy to do your job on a daily basis. And you have moral injury every single day practicing. They wanna do this to us. So I think physicians should revolt. And I know a lot of docs support this bill, I get it and I know why you do it.

And there’s a part of me that is deeply uncomfortable with not having a bill like this in the sense that the disinformation is harmful. I get it, I’m with you on that. But this is not the answer. You know what the answer is? Okay, number one, public health pull its head out of its fucking ass because they have dropped the ball throughout the pandemic, there are very many good public health officials who’ve done a great job of nuance and discussion, but do you think Fauci did a great job when everybody’s so polarized? I don’t think so. And I’m glad that he’s retired and he’s done it with grace and so on, great. But we need better communication, we need an understanding of the epistemic breakdown, meaning we don’t even agree on facts anymore. Why? Because AI has polarized us, cable news has polarized us into camps that think the other camp is idiotic or evil or worse. Well, how are we gonna find truth? So we need to start building those fibers of connection, that alt-middle that I talk about, the corpus callosum that brings the left and the right hemispheres together.

Otherwise we’re forever separated, we’re forever across an impassable schism, and we’ll never get back together. So having those conversations, debating to find truth, and allowing speech and discussion and nuance would actually create a situation where misinformation is much less likely to be believed. And if it is believed, you have to understand that there’s gonna be some cost of having free and open discussion and a scientific process that unfolds. There’s gonna be a cost to it. Some people are gonna believe things that aren’t true. And you just do your best by communicating the best you can. And by the way, if the disinformation and misinformation communicators are better than you, public health, then that’s your fucking problem. You better wake up to how you communicate. If you can’t communicate well, if you don’t do social media well, if you can’t fight fire with fire, then you better learn to do it.

Try that instead of trying to legislate your way out of it, because it’s not gonna work and it’s gonna have tertiary second order effects that you are gonna regret happening. When someone else politically is in power, what happens if anti-vaxxers suddenly win the Senate or something and they pass a bill saying you can’t talk about childhood vaccines. How you gonna feel about that, right? So that’s my take on this. Sorry for all the F bombs. I get a little fired up. I hate it when I do it, because then people, they start yelling at me, and I get all these angry emails and I don’t give a fuck.

All right guys, I love you so much. I was unprofessional. You know, send a letter to the board. I don’t even care anymore because I just don’t care. I’m just here to speak truth. If you like what we do, please hit the subscribe button. I know it sounds cheesy to say that, but honestly it grows our reach, which allows us to build an alt-middle movement much more effectively. You can support our show by going to ZDoggMD.com/supporters or go to paypal.me/ZDoggMD and you can make a one time donation. I respond to all of those with an email and deep gratitude. I love you guys. And we are out. Oh, do not let Governor Newsom sign this bill. Do whatever it takes to advocate to make sure this doesn’t go through. All right guys, I love you and we’re out. Peace.

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