The classic definition of a “quack” — dating as far back as the 1500s — is a medical charlatan, a “fraudulent pretender to medical skills.” Derived from the old Dutch kwakzalver, or hawker of salves, quacks typically mislead patients into buying useless or even harmful therapies by falsely promising miraculous cures. Picture a snake oil salesman peddling a proprietary elixir or “tonic” from the back of a wagon, then moving on quickly to the next town before folks start asking for refunds.
But today’s COVID quacks force us to rethink this common stereotype, which is creating challenges for state medical boards and other organizations charged with self-regulation of the medical profession.
Today, many doctors acting like quacks see themselves not as purveyors of snake oil but as mere medical iconoclasts, willing to challenge the status quo.
They seem to start down the path to quackery by convincing themselves that the unprecedented circumstances of the pandemic should lower the bar for what counts as practice-changing evidence — not an entirely unreasonable assertion. Next however, they argue that it’s actually unethical to wait for research published in peer-reviewed journals and vetted by experts with years of experience in relevant fields. And then they convince themselves they have personal experience that helps them see patterns and interpret data that experts in epidemiology, public health, and infectious disease either can’t or won’t.
Of course, in some ways today’s COVID quacks are just like the quacks of yore. They often carry medical credentials of some sort, and they often claim to have uncovered secrets their mainstream colleagues are either too dumb or too corrupt to see. Some are certainly scammers, seeking to make a buck. Almost all display the quintessential mark of a quack — offering patients a false level of certainty and the promise of miracle cures.
But more often than not, today’s COVID quacks appear to believe the stories they tell. Most are not getting rich off the pandemic, and we can presume they are being honest when they claim to be frustrated by the lack of mainstream acceptance of their fringe ideas. Many have convinced themselves they are saving lives by standing up to a medical establishment they view as ignorant or corrupt.
In other words, they are misguided but most are not intentionally hurting anyone, because their beliefs are sincere.
This means one might better think of today’s COVID quacks as followers in a cult, or as doctors with an addiction, rather than as snake oil salesmen. That is, they are probably more victims than villains. When this is the case, we should seek to understand how they ended up down conspiracy theory rabbit holes and use exit counseling methods to gently guide them back to the real world that the vast majority of physicians thankfully still inhabit.
But these well-intended COVID quacks pose a serious question for the medical profession, which prides itself on its comprehensive, if admittedly imperfect, system of self-regulatory structures like board certifications, state licensure, and codes of ethics. Namely, does the fact that most of these doctors don’t mean to harm anyone matter when it comes to professional self-regulation?
Making this question even more challenging is that medical science values challenges to the status quo. For us this isn’t just a matter of free speech — proving theories wrong is how medicine moves forward. It is not a coincidence that statistical testing in medical research (the P-value) isn’t used to prove a hypothesis is true, it’s used to determine how likely the hypothesis is to be false.
It also doesn’t help that some of the same doctors promoting unproven therapies today also promoted both hydroxychloroquine and steroids for patients with severe COVID-19 early in the pandemic. It turned out they were wrong about hydroxychloroquine but they were right to question the conventional wisdom on steroids. Sometimes, medical iconoclasts are on the right side of history.
Of course, it is also a demonstration of the value of the scientific method that it was solid research — not anecdotes — that quickly proved hydroxychloroquine doesn’t work but steroids are helpful for patients with severe COVID-19.
The bottom line is that we don’t want a profession where everyone goes along unquestioningly. We need a profession where conventional theories are tested, where new information changes practice. Especially in a rapidly evolving pandemic, gathering and using new information is critical. We want doctors who can change their minds based on data.
But we don’t want doctors making outlandish promises based on very limited data, or worse, those who are unable to give up on their pet theories no matter what the data show. And we cannot tolerate a profession where doctors clinging to disproven theories are killing patients.
Of course there are many unknowns and many areas of legitimate disagreement in medicine but, to be blunt about it, any doctor still promoting hydroxychloroquine, or suggesting that ivermectin is a “wonder drug,” or that vaccines make COVID-19 infections worse, is hurting and killing patients — whether they intend to or not. Every time a pregnant woman listens to one of these doctors, decides not to get vaccinated, and then ends up in the hospital or the morgue, those women and their babies were harmed by these doctors.
The bottom line is that neither intent nor the ability to acknowledge the harms one has caused matter when patients are being hurt — this means they don’t matter for professional self-regulation.
This might seem counterintuitive, since intent often matters in adjudicating guilt in a courtroom, and the processes of professional self-regulation used by state boards, specialty boards, and medical societies typically follow legalistic procedures, with considerable attention to due process and the right to appeal. But there is a key difference between a courtroom and a licensure board: intent does not matter in adjudicating whether harms have occurred. And our task in professional self-regulation is not to decide whether a physician is innocent or guilty, it’s to prevent our peers from harming patients.
The purpose of professional self-regulation is to protect public safety — that’s it. When significant harms are arising due to a doctor’s persistent and demonstrably false beliefs, good intentions and sincerity in holding the false beliefs no longer matter. The medical profession must sanction the COVID quacks.
Matthew K. Wynia, MD, MPH, is a professor in the University of Colorado School of Medicine and the Colorado School of Public Health. He directs the University’s Center for Bioethics and Humanities, and he is board certified in internal medicine and infectious diseases. For over a decade he led the Institute for Ethics at the American Medical Association, and he has consulted with multiple state and specialty boards and other self-regulatory entities in healthcare.