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The classic definition of a “quack” – going back to the 16th century – is a medical charlatan, a “deceitful display of medical skills”. Derived from the old Dutch kwakzalver or ointment seller, quacks typically mislead patients into buying useless or even harmful therapies by falsely promising miracle cures. Imagine a snake oil salesman selling a proprietary elixir or “tonic” from the back of a car and then quickly driving to the nearest town before people start asking for refunds.
But today’s COVID quack is forcing us to rethink this common stereotype that challenges state medical associations and other organizations tasked with self-regulation by the medical profession.
Today, many doctors who act like quacks see themselves not as suppliers of snake oil, but as mere medical iconoclasts ready to question the status quo.
They seem to be embarking on quackery by convincing themselves that the unprecedented circumstances of the pandemic should lower the bar on what counts as practice-changing evidence – not a wholly unreasonable claim. Next, however, they argue that it is actually unethical to wait for research to be published in peer-reviewed journals and reviewed by experts with years of experience in relevant fields. And then convince yourself that they have personal experience that will help them spot patterns and interpret data that epidemiology, public health, and infectious disease experts either can’t or won’t.
Of course, today’s COVID quacks are in some ways just like the quacks of yore. They often carry some kind of medical credentials and often claim to have uncovered secrets that their mainstream counterparts are either too stupid or too corrupt to see. Certainly some are scammers who want to make money. Almost all of them feature the epitome of a quack – offering patients a false sense of security and promising miracle cures.
But for the most part, today’s COVID quacks seem to believe the stories they are telling. Most are not getting rich from the pandemic, and we can assume they are honest if they claim to be frustrated with the lack of mainstream acceptance of their fringe ideas. Many have convinced themselves that they are saving lives by opposing a medical institution they consider ignorant or corrupt.
In other words, they are misguided, but most of them do not intentionally hurt anyone because their beliefs are sincere.
That means that today’s COVID quacks could be better imagined as followers of a cult or as doctors with addictions rather than as snake oil sellers. That said, they’re likely more victims than villains. If so, we should try to understand how they got into the rabbit holes of conspiracy theory and, using exit counseling methods, gently guide them back into the real world, where fortunately the vast majority of doctors are still alive.
But these well-intentioned COVID quacks pose a serious question to the medical profession, proud of their extensive, if admittedly imperfect, system of self-regulatory structures such as board certification, government approvals, and codes of ethics. Is the fact that most of these doctors do not want to harm anyone important to professional self-regulation?
This question is made even more difficult by the fact that medical science values challenges to the status quo. For us, this is not just a matter of free speech – proving the falseness of theories is the way of medicine. It is no accident that statistical tests (the P-value) are used in medical research not to prove that a hypothesis is true, but rather to determine how likely it is that the hypothesis is false.
It also doesn’t help that some of the same doctors promoting unproven therapies today promoted both hydroxychloroquine and steroids for patients with severe COVID-19 at the start of the pandemic. It turned out they were wrong about hydroxychloroquine, but they were right to question conventional wisdom about steroids. Sometimes medical iconoclasts are on the right side of history.
Of course, it’s also evidence of the value of the scientific method that solid research – not anecdotes – quickly proved that hydroxychloroquine doesn’t work, but that steroids are helpful for patients with severe COVID-19.
The bottom line is that we don’t want a job in which everyone participates unconditionally. We need a profession where conventional theories are tested, where new information changes practice. In a rapidly evolving pandemic in particular, collecting and using new information is of crucial importance. We want doctors who can change their minds based on data.
But we don’t want doctors to make fancy promises based on very limited data, or worse, unable to give up their pet theories no matter what the data shows. And we cannot tolerate a profession in which doctors who hold on to disproved theories kill patients.
Of course, there are many unknowns and many areas of legitimate disagreement in medicine, but to put it bluntly, any doctor who is still promoting hydroxychloroquine or claiming that ivermectin is a “miracle cure” or that vaccines make COVID-19 infections worse is hurting and killing patients – whether they like it or not. Every time a pregnant woman hears one of these doctors, decides not to have a vaccination, and then ends up in the hospital or morgue, these women and their babies are injured by these doctors.
The bottom line is that neither the intention nor the ability to acknowledge the damage one has done matters when patients are injured – that is, they are irrelevant to professional self-regulation.
This may seem counterintuitive as intent is often involved in assessing guilt in a courtroom, and the professional self-regulatory processes employed by government bodies, professional bodies, and medical societies typically follow legal procedures, with due process and the right to appeal. There is one major difference, however, between a courtroom and an admissions committee: intent does not matter in assessing whether harm has occurred. And our job in professional self-regulation is not to decide whether a doctor is innocent or guilty, but to prevent our colleagues from harming patients.
The purpose of professional self-regulation is to protect public safety – that’s it. When significant harm is done due to a doctor’s persistent and proven false beliefs, good intentions and sincerity no longer play a role in holding the false beliefs. The medical profession must sanction the COVID quacks.
Matthew K. Wynia, MD, MPH, is a professor at the University of Colorado School of Medicine and the Colorado School of Public Health. He heads the University’s Center for Bioethics and Humanities and is a specialist in internal medicine and infectious diseases. He directed the American Medical Association’s Institute for Ethics for over a decade and has advised several state and specialized bodies and other health self-regulatory agencies.