Arthur L. Caplan is the director of the Division of Medical Ethics at NYU Langone Medical Center’s Department of Population Health.
Amateurs and hucksters are not the only people telling parents not to vaccinate their children. Unfortunately some doctors — men and women sworn to the Hippocratic Oath — are purveying junk science. They say that vaccines cause autism, as in the famous case of Andrew Wakefield, whose study drawing the link has been retracted. Or that measles isn’t that bad, so your child can skip the shots, as Jack Wolfson, a cardiologist in Arizona, says, adding that “the facts” show vaccines to be full of “harmful things” like “chemicals.” Or that, according to some parents, vaccines cause “profound mental disorders,” as Sen. Rand Paul, an ophthalmologist, warned before he walked the statement back. Or that vaccines cause “permanent disability or death,” in the words of Bob Sears, a pediatrician in California.
Thankfully, only a few physicians in America have embraced fear-mongering in the middle of this dangerous and costly measles epidemic. They deserve a place of honor next to climate-change skeptics, anti-fluoridation kooks and Holocaust deniers. They doubt the facts, ignore established evidence and concoct their own pet theories. They shouldn’t be allowed near patients, let alone TV cameras. But because their suggestions are so surprising and controversial, they often find themselves on cable news shows and in news reports about the “anti-vaxx” crowd. Their power, therefore, is radically disproportionate to their numbers.
Doctors who purvey views based on anecdote, myth, hearsay, rumor, ideology, fraud or some combination of all of these, particularly during an epidemic, should have their medical licenses revoked. Thankfully, states have the right tools to do so. It’s time to use them.
Going after doctors for speaking their minds is a tricky business. Doctors use their judgment and experience all the time to recommend things to patients that regulatory bodies have not approved or that their peers might think inadvisable: “Yes, there are risks involved, but I don’t wear a helmet when I ride my motorcycle, and I understand if you don’t want to, either.”
This is generally okay: By the time someone is licensed to practice medicine, she has acquired so much knowledge and training — seven to 12 years, not including college — that she can balance any maverick ideas against best practices and known risks. Doctors are within their rights to take certain gambles with novel drugs such as Viagra (originally developed as a treatment for hypertension) or to espouse unusual lifestyles such as the paleo diet. The effect is generally limited to a physician’s patients.
But a doctor is not just another person with First Amendment rights to free speech. When a doctor tells you not to vaccinate, it is not the same as when a layperson says the same thing. And when a doctor ignores the evidence to claim that the measles vaccine will harm your child, it is not the same as when your bartender or hairdresser says so. Physicians’ speech invokes medical authority, so when they speak, patients tend to listen. Especially when they speak on TV.
Because lives hang in the balance, medical speech is held to a higher standard. A doctor must consider the public health and patient good in all that he says in his role as an expert. To do otherwise, as the ethics codes in medicine and nursing suggest, is unprofessional. It might even constitute misconduct if such talk contributed to an epidemic.
Counseling against vaccination is exactly that kind of misconduct. The science is unimpeachable: Vaccines do not cause autism; measles is dangerous and contagious; inoculating against the disease is neither pointless nor riskier than abstention. Those doctors who counsel otherwise — who distort what patients need to know to preserve their health or that of their children — have crossed a bright red line. They have violated a patient’s right to informed consent, which depends on accurate information.
That is why medical speech is subject to scrutiny by a doctor’s peers and can be curtailed by state licensing boards. My home state of New York, for instance, warns doctors that they may not use speech that is “false, fraudulent, deceptive, misleading” or relies on the use of “testimonials.” Violations may be punished by revoking a medical license. Those whose misinformation leads to harm can be charged by a patient, doctor or other health-care professional; investigated by the medical board; and found guilty by a hearing panel composed of doctors and a member of the public. I have testified in many court and licensing hearings about physicians who abjure the standard of care for their own pet theories. Many of them are now ex-doctors.
The vaccine crisis has introduced several worthy candidates — proponents of distrust and dishonesty — for dismissal from the ranks of doctors, and the rules in their states provide the mechanism.
Kentucky is home to Paul, the fear-mongering senator who said he could not support mandatory immunization because many parents had told him that vaccines can cause mental disorders. He walked those comments back but appears to have believed them for many years. Kentucky statute KRS 311.595(9) says that “dishonorable, unethical, or unprofessional conduct of a character likely to deceive, defraud, or harm the public or any member thereof” is grounds to consider yanking a physician’s license. He may also be sanctioned if he “issues, publishes, or makes oral or written representations in which grossly improbable or extravagant statements are made which have a tendency to deceive or defraud the public.”
Arizona is home to cardiologist Wolfson, who told the Arizona Republic: “We should be getting measles, mumps, rubella, chickenpox. These are the rights of our children to get it.” He told this newspaper, USA Today, CNN and anyone else who cared to listen to his unfounded views of vaccination: “Don’t be mad at me for speaking the truth about vaccines. Be mad at yourself, because you’re, frankly, a bad mother. You didn’t ask once about those vaccines. You didn’t ask about the chemicals in them. You didn’t ask about all the harmful things in those vaccines . . . People need to learn the facts.”
Arizona’s Medical Practice Act says, “The board on its own motion may investigate any evidence that appears to show that a doctor of medicine is or may be medically incompetent, [or] is or may be guilty of unprofessional conduct.” Given that Wolfson has gone so far as to fulminate against “chemicals,” there is ample room for a charge of incompetence.
California is home to Sears, the anti-vaxx pediatrician who favors alternative medicine and told CNN that “every year in the United States, between 3,000 and 4,500 severe vaccine reactions are reported to the Centers for Disease Control. Not mild reactions. Severe reactions that land somebody in the hospital, the intensive-care unit or cause a permanent disability or death.” You would have to be a child abuser to vaccinate your kid given those numbers! But of course his stats are drivel. The CDC maintains the database that Sears used to generate his irresponsibly scary figures, and it includes a clear warning that there is no evidence that the reported adverse events are actually related to vaccines. They are simply things that happened around the time vaccines were administered. Correlation does not show causality. Otherwise we might attribute the rise in autism to the increased consumption of organic food or the number of years Jenny McCarthy has existed on Earth.
California’s medical licensing board frowns on doctors who endanger the public health — “whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount” — and says that “the board shall take action against any licensee” charged with unprofessional conduct, incompetence or dishonesty. That unprofessionalism is not, the courts have said, limited to “the actual treatment of a patient.” Sears is squarely in violation.
The American Medical Association, too, has trouble with physicians like Sears who make up numbers in the middle of a measles epidemic and push them to a nervous public. Its Code of Ethics (in a section devoted to social media) says: “When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities,” meaning, in this case, the California licensing board.
When politicians ignore the evidence, fail to cite appropriate medical authorities, and rely on hearsay and rumor, with the result that people — out of ignorance or error — don’t vaccinate their children, we can and should deny them elective office. When a doctor does so, we should demand that he forfeit his right to use his medical degree to misinform, confuse or lie.