Politicians should not be deciding what constitutes good medicine

Most people get their medical advice from their doctors. But many may soon get it from state legislators, a frightening prospect that has already become law in two states and may happen in 24 more, with 47 pieces of active legislation under consideration.

Throughout the Covid-19 pandemic, many politicians have offered medical advice. President Trump endorsed bleach and hydroxychloroquine, an anti-malaria drug, as Covid therapies. YouTube suspended the account of Sen. Ron Johnson (R-Wis.) after he shared a clip touting the benefits of ivermectin and hydroxychloroquine. Similarly, Rep. Louis Gohmert (R-Texas) encouraged the use of ivermectin shortly after the Centers for Disease Control and Prevention and Food and Drug Administration had spoken out against its use.

Few politicians are physicians. And most are decidedly not experts at parsing the evidence about what makes an effective therapy for Covid-19 or anything else, for that matter.

Millions of Americans are foregoing proven, safe, lifesaving Covid-19 vaccines while relying on unproven drugs like hydroxychloroquine and ivermectin to protect them from the ravages of SARS-CoV-2, the virus that causes Covid-19. Now, in the name of liberty, governors and state legislatures say it’s up to them to decide how physicians should advise their patients, and what therapies they should prescribe.

This ominous new front in the tension between medicine and politics threatens the public’s health and safety in an insidious way. By taking aim at the well-established process of physician licensure that has been long been operating in the background to protect the public, state legislators undermine the reliability of medical advice.

In the U.S., each state licenses the physicians who practice in its borders. Typically, an independent licensing board — composed of trained physicians and members of the public — evaluates which applicants are fit to practice medicine or who should have their license suspended or revoked because of egregious behaviors. The power that comes to those who hold a state medical license is substantial, including the ability to perform surgery, prescribe drugs, and order tests and other treatments.

For the last 150 years or so, this process — designed to protect the public from quacks and charlatans — has determined who should be licensed to practice medicine and to judge the quality of their practice.

But like almost everything related to Covid-19, this process is being threatened by politics. In September 2021, the Tennessee State Board of Medical Examiners voted unanimously to adopt a policy that physicians who spread demonstrably false information about Covid-19 vaccines could have their medical licenses suspended or potentially revoked. The Federation of State Medical Boards, the American Board of Internal Medicine (which one of us, R.J.B., leads), and other medical boards have endorsed this position.

Two months later, the Tennessee legislature struck back. It passed a law — and crossed a bright red line — that prohibits the medical licensing board from taking action against licensees based solely on their prescribing or dispensing medications treat Covid-19. Taking this action a step further, a state legislator forced the Tennessee State Licensing Board to delete its policy warning doctors against providing misinformation.

Tennessee is not alone. North Dakota has passed a similar law. Twenty-four other states — both red and blue — are considering similar laws.

The advances of modern medicine have not occurred by doctors prescribing whatever they think is best. The existence of lifesaving organ transplantation, cancer chemotherapy, insulin for diabetes, medications to lower cholesterol and blood pressure, and countless other advances exist because they have been rigorously tested and proven to prolong life and improve quality of life. The reliance on evidence is a major reason life spans have increased since 1960.

Medicine works best when individual professionals accept the authority of scientific evidence and the collective judgment of the profession over personal anecdotes, opinions, and preferences.

In medical school, internship, residency, and beyond, physicians learn the methods used to generate trustworthy evidence and how to assess the quality of biomedical data. They agree that standards of care point the way to how patients should be treated based on the best available evidence. These standards are determined by the collective wisdom of the community of physicians.

To be sure, the standard of care changes as new evidence become available. That’s why physicians no longer prescribe mercury or purgatives: The evidence shows they are harmful and not beneficial. Innovation and research happen based on well-designed studies, not haphazardly offered hunches.

People have access to all kinds of goods and services that are not recommended or endorsed by the community of licensed physicians. But they count on licensed physicians to guide their care based on the best current evidence.

We are terrified by the notion that state legislators think they know better than the medical community what constitutes a medically acceptable test or treatment. You should be, too.

Changing state laws in the way Tennessee and North Dakota have already done means that licensed doctors who chose to make up any number of interventions based on their opinion — or on what they read on the internet or hear from a politician — will be free to offer those treatments on equal footing with treatments that have been shown to work. No rational person should be in favor of that.

Whatever authority state legislators may have to regulate medical practice, they should be careful in following what Tennessee and North Dakota have done. The public is best served by physicians who have demonstrated they are knowledgeable about the scientific method and willing to guide their practice by it. And in a world characterized by rampant misinformation that spreads widely and rapidly on social media, the public is well served by having clear lines drawn between physicians who have committed to follow the science and those who want to freelance, making up therapies on their own.

Blurring that line will put Americans at risk.

Richard J. Baron is a physician and president of the American Board of Internal Medicine and the ABIM Foundation. Ezekiel J. Emanuel is a physician, vice provost for global initiatives, co-director of the Health care Transformation Institute at the University of Pennsylvania, and author of several books, most recently “Which Country Has the World’s Best Health Care?” (Public Affairs Books, 2020).