Medical-Board Intimidation Won’t Increase Vaccination

The same day that President Joe Biden issued a series of proposed coronavirus-vaccine mandates, thousands of doctors were threatened with having their board certification revoked if they appeared to dissent from current consensus on the vaccine. 

I share some of the president’s frustration with those who refuse to get vaccinated. There is ample evidence that the vaccines are safe and effective. With only a few exceptions, I have consistently advised my patients to get vaccinated. We should all be very grateful to former president Donald Trump that he made vaccines and therapeutics a centerpiece of his COVID-19 response.

But I do not share a desire to put people out of work for their varying views on the vaccine.

The email that I received came from the American Board of Internal Medicine (ABIM). It was presented as a joint statement with the American Board of Family Medicine (ABFM) and the American Board of Pediatrics (ABP). The letter begins by stating that the Federation of State Medical Boards has determined that “providing misinformation about the COVID-19 vaccine contradicts physicians’ ethical and professional responsibilities.” 

This is a very deliberate choice of words, one that physicians should be very concerned about. Of course, spreading true misinformation and falsehoods about the vaccine would and should be punishable. But I worry this goes beyond that definition. The same paragraph in the statement that decries “falsehoods” also voices concern about any doctor using their authority to “denigrate” vaccination.

What constitutes “denigrate”? These professional societies that hold the keys to board certification and licensure have apparently determined it is “unethical” to have an opinion that deviates from the currently accepted medical consensus. This determination allows the above-mentioned medical boards to proceed with the following threatening language: “We also want physicians certified by our boards to know that such unethical or unprofessional conduct may prompt their respective board to take action that could put their certification at risk.”

The approach of the ABIM, ABFM, and ABP here is contrary to the scientific method that doctors are supposed to follow. We should always maintain a healthy skepticism and be willing to look at other data and opinions. Data, not threats of punishment from licensing boards, have guided my support of coronavirus vaccination. 

Threatening board certification of doctors is no small thing. Becoming board-certified and maintaining board certification is a rigorous process. It requires completing years of training and studying followed by a lengthy test. Until now, it did not require absolute allegiance to the views of the certifying boards.

Over time, board certification for doctors has become increasingly important. Many hospitals require board certification for members of medical staff. Not being board-certified can also cause issues with insurance-credentialing. Without board certification, it becomes increasingly difficult to practice medicine in certain areas of the country.

This language cannot help but have a chilling effect on practicing physicians. Speaking for myself: Having received this warning, physicians are almost certainly going to be less likely to report possible adverse events related to the vaccine for fear that they will be targeted by their professional boards. This threat will have a very negative effect on the post-marketing surveillance that the FDA relies on to assure the safety of medications. Even though we have ample evidence that the vaccines are safe and effective, it is important to know what, if any, adverse effects they might have on certain individuals. The goal here is not to stoke anti-vaccine paranoia, but to improve medical outcomes for everyone.

If anything, the heavy hands of these boards is likely to increase apprehension about the vaccines. Over the course of this pandemic, we have seen the government’s medical experts frequently change recommendations. New guidance is often in direct conflict with the prior recommendations. These “recommendations” have almost always become someone’s mandate. This inconsistent messaging has caused many to loose faith in the government’s experts. Rather than attempting to regain the trust of the American people, the “experts” are simply threatening their critics.

We would be much better served if our leaders and experts would be honest and admit that they are presenting their opinions, rooted as much as possible in currently available data, and not in absolute fact. We could all understand this in an evolving and ongoing crisis, with new information available to us almost daily. 

Good arguments are based on facts and reasoning. They are not based on intimidation. Our leaders need to understand this and start treating the American people with the respect that we deserve. They need to stop acting as all-knowing sages and admit their limitations. We could handle that, and we would all appreciate it.