Alaska medical board declines to take public stance on off-label COVID-19 treatments and misinformation

As it investigates several complaints against medical professionals involving possible COVID-19 misinformation or false treatments, the Alaska State Medical Board declined to take a public stance on such issues and instead said that it is seeking to “remain impartial.”

Describing an influx of letters and testimony — including requests that the board come out against the use of off-label COVID-19 treatments, or that the board sanction the licenses of those who don’t support such treatments or have spoken out against them — the board last week said that it believed its role was to investigate each case on its merits.

“The Alaska State Medical Board recognizes that there are many issues surrounding the care and treatment of Covid-19 patients,” reads the statement, which was drafted by Dr. Richard Wein, board chair. “However, as the body that must review and adjudicate matters as they present to us, we recognize and maintain as a foundational ideal to remain impartial in our evaluations to the best of our ability.”

“While we welcome and encourage input on regulatory matters, any decision to sanction the license of a medical professional is based on state law, not board member preference or public opinion,” the board said in the statement, which was posted on the division’s website Friday.

The medical board’s statement comes after nearly 150 Alaska physicians signed a letter asking the board to investigate doctors who publicly advocated for the use of unproven COVID-19 treatments such as ivermectin and hydroxychloroquine during the latest and deadliest virus surge, which peaked this fall.

Anchorage psychiatrist Merijeanne Moore drafted the letter because of concerns over an October event in Anchorage that highlighted COVID-19 early treatments and featured prominent vaccine skeptics. Two local doctors — Ilona Farr and John Nolte — spoke at the summit, which was organized by a group calling itself the Alaska Covid Alliance. Around 1,200 people attended the event in person, according to event organizers.

The summit was held at a time when Alaska’s COVID-19 case and hospitalization rates were leading the nation, multiple hospitals had enacted crisis standards of care and the state’s vaccination rate was in the bottom third nationwide.

Many of the speakers questioned the safety and effectiveness of currently available COVID-19 vaccines. The vaccines, which have been administered to more than 200 million Americans, are backed by the Food and Drug Administration and the Centers for Disease Control and Prevention and, according to a study from the Peterson Center on Healthcare and the Kaiser Family Foundation, may have prevented an estimated 163,000 COVID-19 deaths in the country since June 2021.

[After omicron variant detected in Alaska, health officials highlight importance of vaccination]

Farr said last month that she spoke at the summit to raise awareness. “I’ve been very successful in treating hundreds of patients, and keeping them out of the hospital,” she said. “I have used these treatments on myself, family members and patients.”

In an unsigned statement posted on Hillside Family Medicine’s website, clinic administrators wrote that “Dr. Nolte’s involvement in the conference was in hopes to help educate people regarding the importance of early treatment of COVID-19 and keep people out of the hospital.”

Once Moore’s letter surfaced, early treatment event organizers mounted their own campaign asking supporters to back the doctors and treatments like ivermectin in comments to the medical board.

The board received more than 600 written comments before a November meeting deadline — the majority in opposition to any sanctions, according to Sara Chambers, director of the state Division of Corporations, Business and Professional Licensing, which provides staffing for the medical board.

Formal complaints and public stances

The medical board’s process for investigating complaints against physicians is posted on a state website.

By late last week, the board had received a total of 16 complaints related to possible misinformation about COVID-19: 13 against physicians, one physician assistant and two advanced practice registered nurses, according to a division spokesperson.

Six complaints were closed with no action taken while 10 were ongoing, the spokesperson said.

Other state medical boards and commissions around the country have interpreted their role differently from the Alaska State Medical Board, and several have come out publicly on the improper use of certain medications for treating COVID-19 and the spread of misinformation.

The Federation of State Medical Boards’ board of directors said in July that physicians who spread COVID-19 misinformation risk jeopardizing their medical license or facing other disciplinary actions from state medical boards, adding that sharing inaccurate vaccine information “threatens to further erode public trust in the medical profession and puts all patients at risk.”

Since then, at least 15 state medical boards have published statements about licensees spreading misleading or false information and at least 12 have taken disciplinary action against a licensee who spread misleading or false information, the federation said this month.

Washington state’s medical commission voted to unanimously adopt a “COVID-19 Misinformation Position Statement” in September.

“It has never been more vital for trusted healthcare professionals to band together against the threat of misinformation,” the Washington Medical Commission said in its statement.

“Now more than ever we must align with the oath we took to ‘do no harm,’ and part of that means trusting science, listening, educating and caring for our patients according to the guidelines set by the FDA, the CDC,” the commission said.

Medical boards in other states have declared similar public stances. Sometimes, those decisions have become politicized: Last week, Tennessee’s medical board voted to delete its anti-misinformation policy from its website as a result of pressure from a conservative lawmaker, the Tennessean reported.

The Alaska State Medical Board is made up of eight members appointed by the governor, including five physicians, a physician assistant and two people with no direct financial interest in the health care industry. According to an online roster, one position is currently vacant and all current members were appointed by Republican Gov. Mike Dunleavy.

‘Demonstrable harm to the patient’

In response to the Alaska State Medical Board’s position, some Alaska doctors said they’re disappointed by what they say feels like a lack of support.

“I think this is unfortunate, that the State Medical Board doesn’t see this as something they could directly address,” said Dr. Madeleine Grant, an internist in Anchorage.

“In the setting of a pandemic when a physician is condoning unproven treatments, then misinformation becomes infectious, and it also gets this sort of stamp of approval,” Grant said.

The Alaska statute referenced by the board allows the medical board to sanction a doctor only if it finds, after a hearing, that a licensee has demonstrated “professional incompetence, gross negligence, or repeated negligent conduct.”

”The board may not base a finding of professional incompetence solely on the basis that a licensee’s practice is unconventional or experimental in the absence of demonstrable physical harm to a patient,” the statute says.

But exactly what constitutes professional incompetence or gross negligence is not clearly defined in state law.

“Interpretation of law is done by reviewing the context of relevant statutes, the facts of each case, board precedent in similarly situated cases, and court decisions on related matters,” Chambers wrote in an emailed response to questions about how the board defines those grounds for disciplinary sanctions.

“One of the key elements to this citation is that — in cases of unconventional or experimental treatment — there must be ‘demonstrable harm to the patient.’ Off-label prescribing is extremely common as treatment for many diagnoses, so harm to the patient must be demonstrated,” Chambers wrote.

One of the treatments in question is ivermectin, an anti-parasitic medication being promoted by prominent conservative media figures and politicians, as well as some physicians, as an effective treatment for COVID-19 despite the lack of scientific evidence showing there are benefits of taking the drug for that purpose — and despite not being approved by the FDA or the CDC for such uses.

While ivermectin has been approved to treat infections caused by some parasitic worms and head lice and skin conditions like rosacea, both the FDA and CDC recommend against using ivermectin as a treatment for COVID-19.

Currently available data do not show ivermectin is effective against COVID-19. Clinical trials assessing ivermectin tablets for the prevention or treatment of COVID-19 in people are ongoing. Taking large doses of ivermectin is dangerous, the FDA has said.

“On a personal basis, I would consider a physician who was right now in 2021 prescribing ivermectin to be incompetent, and I would not recommend that that person see them,” Grant said.

“I would say that there’s definitely the potential for harm,” she said. “There’s no question about that.”