Donald Trump and the Perils of Practicing Medicine Without a License

Hydrochloroquine for COVID? Remember when that was a thing?

From The Messenger (Jan. 4):

In a study published this week in the journal Biomedicine & Pharmacotherapy, French researchers found that 17,000 people died across six countries because they depended on [the] drug. Researchers say this is because the drug was used in lieu of more effective treatments, and the potential cardiovascular issues it can cause as a side effect.

That number includes 12,000 deaths in the U.S. alone. Politico adds: "In fact, they say the figure may be far higher given the study only concerns six countries from March to July 2020, when the drug was prescribed much more widely."

You may recall that hydrochloroquine was then-President Trump's treatment of choice (along with household bleach). Here's the history reminder from The Messenger:

It was quickly shown to be ineffective. However, in a situation The Lancet describes as a “comedy of errors”, many political figures continued to endorse the drug as a legitimate COVID treatment. According to one report, Donald Trump, who was president at the time, was among the most prominent advocates of the medication as a treatment for COVID, mentioning it on Twitter and in press briefings.

“What do you have to lose? Take it,” Trump said during a White House briefing in 2020. “I really think they should take it. But it’s their choice. And it’s their doctor’s choice or the doctors in the hospital. But hydroxychloroquine. Try it, if you’d like.”

Physician Discipline: Covid Denier's License Suspended, but Not For Lying

Sherri Tenpenny, D.O., testified before the Ohio legislature that the Covid vaccine "magnetizes" recipients and interfaces with 5G cellphone towers. Soon after, her medical license came up for renewal and the Ohio Medical Board renewed it, no muss, no fuss, despite the good doctor having been named as "one of the 12 most prolific spreaders of COVID-19 misinformation on social media, according to research from the Center for Countering Digital Hate." (Becker's Hospital Review, Sept. 20, 2021).

At the time of the renewal, the Board said that renewal was an automatic process and did not foreclose a future investigation. After receiving approximately 350 complaints, the Board did start an investigation. Dr. Tenpenny, however, unwisely blew off the Board's discovery requests and a subpoena to testify, and for that she got her license suspended until she starts to cooperate with the Board's investigation. (Becker's Hospital Review,  Aug. 9, 2023).

This case offers two teaching points: (1) many licensing boards are slow to react to quackery, and (2) turning your back on a board’s investigation never pays off  

Meanwhile, Dr. Tenpenny's anti-vaccine and conspiracy-spewing firm rakes in an estimated $4.04 million in annual sales. There's gold in them thar lies!

Q: When is a Doctor not a "Doctor"?

A: When she (and the nursing field is still predominately women) has a doctorate (could be a D.N.P. or a Ph.D. or . . .  It really doesn't matter, as long as it's not a medical doctorate). That's how California sees it anyway. 

Becker's Hospital Review (July 18) reports on a challenge to California's law: 

Under California law, only physicians and surgeons can use the word "doctor" or the prefix "Dr." In November, Sarah Erny, a nurse practitioner with a doctorate, was found violating the law by allegedly describing herself as a doctor on professional websites and social media. She was fined $20,000 by the state and another $2,500 by the state medical association.

In June, three nurse practitioners with doctorates of nursing sued the California attorney general, leaders of the medical board of California and leaders of the state board of registered nurses, arguing they have a right to call themselves doctors. 

States have a legitimate interest in avoiding deceptive practices, such as deceiving patients about whether they are consulting a medical doctor (M.D. or D.O.) or some other person with a doctorate. And nurses have an interest in honestly and accurately informing the public about their advanced practice credentials. A number of states prohibit the use of the term "Doctor" by non-physicians, so the outcome of this litigation is a matter of national interest. It's actually an international issue, as described by a 2016 article in the Canadian Association of Medicine Journal. 

There's a First Amendment issue here. The strict scrutiny accorded to state-imposed content-based restrictions on speech requires that the state's use of its police powers be the least restrictive means possible. Wouldn't California accomplish its goal by  requiring that anyone using the prefix "Dr." add their doctoral degree(s) after their name? This appears to be how it is handled in Texas. If the degree isn't a medical degree, how likely is it that patients would be deceived? I'm on the side of the nurses on this one.

Contra: When speech is deemed to be "commercial speech," the level of judicial scrutiny is "intermediate," not "strict." A claim by California that the nurses are engaged in commercial speech would require an inquiry into the circumstances surrounding their use of the title "Doctor." Business cards? Professional listings on a job board? Letterhead? 

Medical boards and professional associations are constantly fighting to protect the boundaries of their profession against interlopers. They traditionally do so in the name of good patient care. This dispute has that feature, as well. It should be interesting.