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IN December 2020, US family doctor Steven LaTulippe had his licence to practise medicine suspended over his opposition to mask wearing and other preventive measures against COVID-19.
According to the Oregon Medical Board, LaTulippe regularly advised patients it was “very dangerous” to wear a mask, particularly for older people and children.
Masks increased the body’s carbon dioxide content, he said, exacerbating chronic obstructive pulmonary disease and asthma and increasing the risk of multiple serious conditions, including heart attacks, stroke, collapsed lungs, methicillin‐resistant Staphylococcus aureus (MRSA), pneumonia and hypertension. Signs posted in his clinic warned of carbon dioxide toxicity with mask wearing.
The Board found LaTulippe’s continued practice would constitute an immediate danger to public health and safety. His advice to patients about the alleged failure of masks to prevent viral transmission and their potential harm was counter to basic principles of epidemiology and physiology, the Board said.
When a clinician advises patients to act in a way that risks their own health and that of others, the situation seems fairly clear. But how should regulators respond when a doctor makes similar claims in a public forum, particularly if they use their medical training to bolster their authority?
LaTulippe’s opposition to masks was not confined to his clinic. At an Oregon political rally in November 2020, he had exhorted those attending to “take off the mask of shame”, the Washington Post reported.
Other US doctors have publicly touted debunked cures or described the pandemic as a manufactured crisis.
New York psychiatrist Dr Andrew Kaufman, for example, has built a huge global following through his denial of the existence of multiple viruses, including those behind measles, poliomyelitis, HIV/AIDS, chickenpox, and of course COVID-19.
He has described vaccines as “syringes full of poison” and promised followers that, if it gets to the point where soldiers are holding people down to vaccinate them against COVID-19, he will “give out a ‘recipe’ that can mitigate things for people that are held down by force and vaccinated”.
Dr Kaufman’s statements and opposition to mask wearing appears to have lost him some employment as a doctor but has not, so far as I am aware, posed any risk to his licence to practise medicine.
In Australia, professional watchdogs tend to take a harder line on promotion of non-evidence-based views with the potential to undermine public health, particularly in relation to vaccination.
The Australian Health Practitioner Regulation Agency (Ahpra) issued a statement in March 2021 warning clinicians to stick to the evidence when commenting on the COVID-19 vaccination program.
“Any promotion of anti-vaccination statements or health advice which contradicts the best available scientific evidence or seeks to actively undermine the national immunisation campaign … may be in breach of the codes of conduct and subject to investigation and possible regulatory action,” the statement said.
“Advertising that includes false, misleading or deceptive claims about COVID-19, including anti-vaccination material, may result in prosecution by Ahpra.”
Melbourne GP Michael Ellis had his licence to practise medicine suspended in 2020 as a result of a series of posts he made on social media before the COVID-19 pandemic with titles like “PROOF OF THE TOXICITY OF VACCINES!!!!”.
More recently, he had reposted on Facebook a claim that vitamin C supplements were very effective at killing the coronavirus.
The Victorian Civil and Administrative Tribunal in August rejected his appeal against the suspension, saying they had “a reasonable belief that Dr Ellis poses a serious risk to persons and that it is necessary to take immediate action to protect public health or safety”.
Should doctors have the right to spout unscientific, even harmful, nonsense outside clinical settings?
US psychiatrist and bioethicist Dr Jacob Appel argues for a three-tiered approach to answering that question, one that distinguishes between “citizen speech”, “physician speech” and “clinical speech”.
In his country, physicians have generally been given “wide latitude to voice empirically false claims outside the context of patient care”, he writes in the Journal of Medical Ethics.
In an age of mass communication and social media, that allows dissenting physicians to offer misleading medical advice to the general public on a mass scale, he argues.
Dr Appel’s proposed solution to the problem would preserve a right for doctors to speak on issues such as health policy as private citizens (“citizen speech”), while introducing some degree of regulation around public statements that claim to be evidence-based and could be taken as medical advice (“physician speech”).
“Laypeople are likely to rely on such statements and to act accordingly, often at the expense of their own health,” he writes.
A doctor should, Dr Appel argues, be free to argue against use of a vaccine derived from fetal tissue on the grounds of belief but not on the basis of false claims that it caused autism.
“The standard for evaluating physician speech should be the malpractice standard,” he writes. “In other words, if the advice given collectively or publicly were offered to an individual patient in a clinical setting, and he or she acted on it, would that speech justify a malpractice claim?”
Dr Appel acknowledges the boundaries between different types of speech will not always be clear, and his recommendations might seem laissez-faire by Australian standards, but we could all benefit from more regulation of some of those prominent US dissenters who use their medical standing to spruik quackery and conspiracy theories.
Jane McCredie is a Sydney-based health and science writer.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
The Science is never settled. To accept dogmatically, for years, the status quo is the reason we lack progress in so many areas in medicine. The time, effort, life years and productivity of a healthy society is a massive trade off so that a small percentage of the world’s population can live without ever knowing hardship. There are people among us that have never known hunger or what stale or mouldy bread tastes like. Medical protectionism is what powers the pharmaceutical industrial complex. Our institutions are irreparably corrupt and believe me, woe is what follows should we all allow it to moulder and continue unchecked and unchallenged. I’m ashamed of health care in it’s current form.
Thank you for calling out quackery! I called out Kaufman on instagram for his post advising people to engage in water fasting as a “one size fits all” cure for each and every diagnosis of pathology. First of all, he’s a psychiatrist and general medicine is way out of his scope of practice. That alone should be reported to his governing body. And second of all, there is no credible data to back up what he says.
I completely agree with you Jill that there are many charlatans out there particularly at the present time in respect of Covid.
The point I was trying to make is that there are few if any forums that I know of where novel ideas can be discussed. and brought to the attention of people who do have the funds and resources to consider and initiate research if appropriate. My experience of attending conferences is that participants are invited to ask questions of presenters but rarely provided with opportunities to make significant comments.
I particularly recall a RACGP conference in Adelaide where in a keynote session on residential aged care, the head of the organisation representing nursing homes, started the first presentation by saying “We do not want to be seen to be places where people come to die.” This is in my opinion one of the reasons why the psychospiritual if not symptomatic care of the great aged is often so poor and palliative care principles not applied.
When I tried to make this point , I was aggressively silenced.
I was advocating advanced care directives over 30 years ago and could never find anyone in medicine to listen. Even now, there is scant real regard to having GPs promote this as an essential part of the care of older patients. I attend a large accredited GP practice and when I asked them to incorporate my advanced directive in the My Health record, they told me to go away and do it myself. They showed no interest. In terms of such directives. How are they to be accessed at the point of acute care if they are not in the My health record. From what i can see this is one of the most useful functions that it offers.
I think that there are critical aspects of mental health care that are woefully inadequate and based upon unsound paradigms. Some I believe do more harm than good. I have attempted to respectfully engage some of the leaders in this field and have been dismissed as some nobody from the bush.
Perhaps we shouldn’t worry so much about being evidence-based as about being evidence averse. The quoted examples are so egregious and have the potential to do a great deal of harm – the opposite of the first tenet “Primum non nocere”. Although it was a struggle, Barry Marshall’s work was in fact funded. The statement that “It is often the clinicians outside the established tent of academia, power and influence who are able by careful observation and thought, uncontaminated by confirmation bias to recognise that orthodox views are wrong” simply is not true. It does happen, from time to time, that a maverick makes an important contribution to science, but in the vast majority of cases it is the careful, persistent, conscientious work of underpaid academic researchers that carries our knowledge forward. The last thing we need is people like Steven LaTulippe, Andrew Kaufmann and Michael Ellis passing themselves off as unrecognised heroes. They are just charlatans.
The problem with the requirement that all medical practice be based on “evidence” is that there is then no clear path for innovation and new ideas to be shared. Where can ideas be published that don’t require “evidence” to be quoted in the form of academic references? How does any research project reach the stage of a properly constituted trial? It usually comes from a practitioner daring to try something outside the accepted paradigm, observing empirically that it seems to work and then somehow sharing that observation until someone with access to research funds and facilities decides to set up a trial. To achieve that is no mean feat and requires that those with a vested interest in the status quo are prepared to evaluate the new idea.
The perfect example is the relatively unknown (at the time) WA physician Barry Marshall who struggled for years to have his proposition that peptic ulcer disease was caused by an infective agent to be taken seriously. It took the dramatic step of him infecting himself with H pylori, developing peptic ulcer disease and then then curing himself with a simple course of antibiotics to become recognised culminating in the end with a Nobel prize.
The outcome is that peptic ulcer surgery, only two decades ago incredibly commonplace is now almost relegated to history.
It is often the clinicians outside the established tent of academia, power and influence who are able by careful observation and thought, uncontaminated by confirmation bias to recognise that orthodox views are wrong. Yet these people are often the first to be managed out of the system in various ways. In saying this, I am not in any way a critic of anything do do with vaccination and Covid. Just making a point that needs to be discussed.
The shadow side of this is the swamp of the ignorant mentality of individuals who reflexively uphold the conservative momentum of accepted knowledge.
Think about this: Barry Marshall was ridiculed and condescended to for several years by colleagues in his field, whom one would expect to be a community of interested wise peers. They weren’t! Post Nobel Prize, he’s their lauded after-dinner speaker. Where was their rigorous curiosity beforehand?
These will be the kind of people who would create the consensus about some new maverick. Or tell AHPRA you are a misguided fool. => Need for balances.
‘…health advice which contradicts the best available scientific evidence…’ would, in years gone by, have seemed to be an unremarkable statement.
Regrettably, with the corruption of some peer review processes, the politicization of health departments and even of science itself, and the weaponization of ‘The Science’ to suppress free expression, the ‘best available scientific evidence’ is now hard always to see as value-free and above the fray.