Medical Disinformation

Should we permit it and if not, what should we do about it?

The case of Ryan Cole

It is hard to imagine that we all have not said something to others at some point in our life that was misinformation. At times, we have all been misinformed.

Perhaps, if you are as old as me, you learned something in school that is no longer true, but you had not kept up in that area and didn’t realize that forty years later, something that we had been taught was found no longer to be the case. When I was doing my studies, I took a course in a field of science that was still in its infancy. I was listening to a podcast on the subject with experts in 2022 and realized that something I had been taught and learned as a concept has a new understanding that is quite different than what I was taught. Had I recently told others what I thought to be true, I would be innocently spreading misinformation – the unintentional spreading of information that I thought was true, but wasn’t. Fortunately, this particular concept has not been the subject of conversation or frankly, even of much interest, so I hadn’t spread it. It was something that was true in 1980, but no longer true in 2022.

Sometimes, my wife and I will get into a debate about what band or group first performed a song from our past or who is married to a certain celebrity. At times I dig in because I am certain I am correct. One would think after 42 years of marriage, I would know better than to challenge her breadth of knowledge on these subjects, but I hold out hope that one day, I might win an argument. Most of the time, I am misinformed or simply have an incorrect memory.

For the rest of this blog piece, I am not going to be discussing misinformation. It happens. It is by my definition unintentional, and in my experience, when people are confronted with the facts or correct information, they abandon their previously held thought and don’t continue to spread misinformation, unless they are a politician or running for office.

On the other hand, disinformation is an intentional spreading of incorrect information. Misinformation is generally spread with an intention to benefit the person it is being shared with. For example, during the pandemic, a person contacted me to check on a recommendation that a family member gave her for preventing COVID-19 (colloidal silver). I was glad she did ask me because that remedy being recommended will invariably harm a person if they take a high enough dose or a lower dose for a long-enough time. Obviously, this person who made the recommendation was completely unaware and thought she was being helpful to her family member and certainly was not trying to harm her relative. On the other hand, disinformation is never provided for the benefit of others, but rather the purveyors’ own self-interests. From time-to-time, we have all been provided with disinformation – perhaps because someone is trying to convince us to take actions to support their efforts that we would not absent being motivated by the untruths, perhaps someone is trying to convince us to buy their product through deceiving us, or perhaps someone is trying to protect their relationship or reputation with us by blaming someone else for a mishap.

Over the course of my life, my career and this pandemic, I have had many experiences in which people have tried to deceive me or I have had the opportunity to watch them try to deceive others. Just as there are clues that you should be hesitant to fall for an email or phone call scam, I have noticed many clues to identifying when someone is trying to peddle disinformation. These clues are important because few in the public will have the expertise to know if the information being presented is true, but you can identify clues from just listening to someone that should sound the alarm in your mind that this person may be trying to deceive you. We will be discussing the case of Dr. Ryan Cole, and he exemplifies almost all of these. I will contrast these points with what characterizes the experts that I trust.

1. They never admit that they have been mistaken in the past, or could be wrong now. In the case of this pandemic unfolding with a novel virus over three years now, any legitimate commentator or expert who has been offering perspective throughout the course of this event, will admit that they have been wrong about some things (I certainly have been), that they have learned new things from this virus (I have), and that they have been surprised that certain things they predicted did not come to pass (I have been surprised on more than one occasion). I know many brilliant epidemiologists, virologists, pulmonologists, infectious disease experts, pediatricians, etc. and everyone of us comment on errors we made or surprises that we did not see coming. In contrast, you can listen to those purposely attempting to deceive the public, and they will never admit a mistake or that anything they have said in 3 years has now been proven wrong with information we have gained from clinical trials.

• They make absolute, emphatic and dogmatic statements. There are few things in this world that are black and white in all people under all situations. That is especially true in medicine. My medical advice for a child is often different than for an adult with the same condition, especially if that adult is elderly. Sometimes patients have underlying conditions or are taking certain medications that cause us to modify our approach to a disease or condition than how we would treat that same disease or condition in someone without any other medical problems who is taking no medications. Experts also understand that our treatments change over time as we learn more about diseases or new medications and treatments are developed. Therefore, when you listen to respected experts, you will often hear them use qualifiers, such as, “in adults…,” “based upon what we know today,” “based upon the results of this study,” “we think that…,” “we don’t know the answer to that, but I would suggest,” or “I can tell you that in general …, but you should check with your doctor.” On the other hand, when you listen to purveyors of disinformation, they make absolute, blanket statements that are directed at everyone under all situations, without acknowledging that there is any need for you to talk to your doctor to assess your particular situation. One example from Dr. Cole is his statement that “Children survive [COVID-19] at a hundred percent.” Again, very few things are 100 percent in life. And, even if children rarely become severely ill with COVID-19, everyone should be alerted to a statement such as this one that surely there are some children who are immunocompromised, receiving cancer treatment, or have underlying health conditions that place them at risk. No medication is 100 percent effective [another statement from Dr. Cole is that “A hundred percent of world (ivermectin) trials have shown benefit.”], no treatment is 100 percent safe and few infections that can cause death in adults spare 100 percent of children. Of course, his statements were demonstrably false.

• They resort to emotionally-charged language and hyperbole. For example, Dr. Cole’s references to “the clot shot” and “needle rape” are so inflammatory and offensive that the language is meant to stir an emotional reaction from the listener rather than to engage in any real scientific debate about the vaccines. I don’t know any legitimate experts that would use derogatory knick-names for medical treatments or language like this. Many of us have treated victims of rape and sexual abuse. We would never compare one of the most psychologically damaging acts of violence against another human to a vaccination intended to safeguard their health.

Most recently, I have also noted a troubling set of recurring language and phrases reminiscent of Nazi Germany and white supremacy commonly being used by those purveying the disinformation or defending them. Phrases like “Nuremburg Code” and “crimes against humanity” seem to be favorites in referencing the vaccination programs and those who administer the vaccines.

• They often make claims from anecdotes to “prove” their assertions. Purveyors of disinformation often refer to anecdotal experiences to try to prove their point, such as “I treated xx patients with ivermectin and they all improved within 24-48 hours.” There are so many problems with this. First of all, how was the diagnosis of COVID-19 established? Do we know for sure that they had COVID-19? Second, were these all young, healthy 20- and 30-something-year-olds who would have been expected to have mild illnesses and get better regardless of treatment? Third, did the physician really follow-up the patients? The complaint from the Washington Medical Commission (WMC) alleges that Dr. Cole was not providing adequate follow-up on his patients. If that is true, how would he know whether they did well? In fact, the WMC also refers to sworn affidavits from physicians who did treat patients of Dr. Cole’s who deteriorated and ended up hospitalized, evidencing that Dr. Cole either did not follow-up on these patients or was not being truthful. Further, hospitalization and death often doesn’t occur with COVID-19 until the second week or later of illness. If a physician only follows patients for a day or two, he may be completely unaware that the patients decompensated, were hospitalized and/or died. This is especially true since Dr. Cole is a pathologist and would likely not have admitting hospital privileges and permission to treat hospitalized patients.

• They often will not back up their assertions with studies from reputable scientific journals or even provide a reference to data they are using to support their claims, and on the few occasions that references are provided, it is not uncommon for them to misrepresent the findings. Audrey Dutton of the Idaho Capital Sun has done some great reporting on this and I highly encourage readers to take a look at her article exposing Dr. Cole’s disinformation https://idahocapitalsun.com/2022/08/10/dr-ryan-coles-journey-from-boise-to-nashville-to-france-his-new-focus-monkeypox/.

• They almost never disclose their financial conflicts of interest. Early on in my blogging about COVID, I went into great detail about any potential conflicts of interest that could influence my points of view. From a psychological view, no one engages in a systemic campaign of disinformation without some personal benefit or potential benefit. Perhaps they merely seek publicity, fame and attention; perhaps they seek political favor or office; but I suspect most often, especially if one is willing to put their livelihood at risk, there must be significant financial reward. At the conferences they speak at and on the cable networks they are interviewed, I have never seen a disclosure of these conflicts of interest nor in the interviews, have I heard them asked about them.

We are not helpless victims when it comes to disinformation. First, we need to learn to recognize highly suspect sources and information with some of the clues I have outlined above. Further, we need to educate ourselves on how to assess credibility and reliability of sources and information.

First, as to credibility, take a look at what kind of doctor is providing this information. If the topic is complications of pregnancy and a dermatologist is offering advice on the subject, it doesn’t mean that it is necessarily wrong, but it should be cause for us to check it out to see if that advice is consistent with the advice of obstetricians and their professional associations, such as the American College of Obstetricians and Gynecologists. In this case, Dr. Cole, a pathologist might not be the kind of physician one would expect to be an expert in treating infectious illnesses. Again, that doesn’t mean that he can’t be knowledgeable, but one should probably check his advice against that of physicians who are experts or experienced in treating infectious illnesses. When you do, you find that Dr. Cole’s information is at odds with experts in the field as well as their professional organizations.

Second, you can search for fact checks on the internet. There are many available with experts disputing the information Dr. Cole has been spreading in his interviews and on videos.

Another easy thing to do is just to google local news sources and Dr. Cole. For example, you will come up with a number of articles (great reporting from Audrey Dutton) that provide all kinds of warning signs:

https://idahocapitalsun.com/2021/10/11/it-should-be-stopped-idaho-medical-group-files-complaint-against-dr-ryan-cole/.

• The Idaho Medical Association filed a complaint with the Idaho Board of Medicine against Dr. Ryan Cole
• According to the complaint, ““As a licensee under your jurisdiction, Dr. Cole has made numerous public statements in 2020 and 2021, concerning COVID-19 that are at significant odds with commonly understood medical treatment of COVID-19 and fail to meet the community standard of care.”
• “We believe many of those statements to be profoundly wrong, unsupported by medical research and collected knowledge, and dangerous if followed by patients or members of the public. Many of those statements have advocated that people not be treated appropriately and undoubtedly have led to and will continue to lead to poor health outcomes.”

And, this: https://idahocapitalsun.com/2021/12/16/idaho-doctors-pathology-board-accuse-dr-ryan-cole-of-endangering-public-health/. (by Audrey Dutton)

• Idaho physicians allege, in complaints to a Washington medical board, that patients came into their hospitals sick with COVID-19 after taking advice or treatment from Dr. Ryan Cole.
• The American Board of Pathology (ABP) also submitted a complaint against Dr. Cole and stated: ““He has advised patients to take hydroxychloroquine and ivermectin without scientific data to support their use in the treatment of patients with COVID-19.”
• The ABP’s complaint went on to state: “We also received an allegation that Dr. Cole may have provided prescriptions to patients in the absence of a physician-patient relationship and without sufficient medical record keeping.”
• The article also referenced sworn affidavits submitted by physicians in the Treasure Valley, including one from a physician that stated that her patients reported taking ivermectin “upon the advice or prescription of Dr. Ryan Cole” and were “quite surprised to learn that ivermectin did not prevent or cure their COVID infection.”
• Another physician’s affidavit indicated that he had seen some of Dr. Cole’s patients who were taking ivermectin for prevention or treatment of COVID-19, and yet “had developed severe COVID-19 and many require hospital admission, with some requiring critical care services.”

And, yet another article, https://www.spokesman.com/stories/2022/may/08/taking-covid-19-funds-pathologist-dr-ryan-cole-was/ with more great reporting by Audrey Dutton:

• VA officials “were flabbergasted” by Cole’s public statements, VAMC spokesperson Josh Callihan said in an interview earlier this year. The hospital removed Cole as a consultant last year.
• St. Luke’s Health Partners also removed Cole from its network as a result of its peer review.
• Dr. Cole touted his Mayo Clinic training, however, in a statement, Mayo Clinic distanced itself from Cole stating: ““Mayo Clinic is aware of claims made by Dr. Ryan Cole regarding vaccines. Dr. Cole was trained at Mayo Clinic but is not a Mayo Clinic employee. His views do not represent Mayo Clinic.” 
• Dr. Cole was a member of the College of American Pathologists (CAP). They issued a statement indicating: “The CAP fosters robust exchanges of varying professional opinions in the practice of medicine and individual pathologists are free to express their own personal views. However, the CAP does not condone Fellows of the organization disseminating COVID-19 information that is not firmly grounded in science.”

In hindsight, there were plenty of warning signs.

Let’s dig into the WMC statement of charges.

The WMC alleges that Dr. Cole violated four provisions of law that fall under the umbrella of “unprofessional conduct.”

1. The commission of any act involving moral turpitude or dishonesty relating to the practice of medicine.
2. Incompetence, negligence, or malpractice that presents an unreasonable risk of harm or actual harm to a patient.
3. Misrepresentation or fraud in any aspect of the conduct of the profession.
4. Interference with an investigation or disciplinary proceeding by willful misrepresentation of the facts before the disciplining authority or its authorized representative.

We can also look to the facts that the WMC has made public as a result of its investigations.

1. Dr. Cole made numerous false and misleading statements during public presentations regarding COVID-19, the COVID-19 vaccines, the use of ivermectin to treat COVID-19, and the effectiveness of masks.
2. Dr. Cole generated mistrust in the medical profession and in public health, and had a wide-spread negative impact on the health and well-being of our communities.
3. The WMC provides information about the negligent care of four patients by Dr. Cole, including:
   1. Prescribing medications that are not indicated for treatment of COVID-19;
   1. Failing to document adequate justification for the treatment in the medical record;
   1. Failure to take a history or perform a physical examination;
   1. Failing to obtain appropriate informed consent;
   1. Not providing an adequate opportunity for follow-up care;
   1. Treating patients beyond his competency level;
   1. Failure to advise patients about standard treatment guidelines and preventative measures.

No doubt that there will be supporters of Dr. Cole or physicians like him who will take any number of positions in support of him:

1. It should be his First Amendment right to say whatever he wants.
2. He’s a doctor and he should be able to prescribe whatever he wants.
3. He was just giving patients what they wanted.

I will address each of these, in turn, but before I do, I always find an exercise helpful to make sure that we are having an objective discussion and not allowing emotions to get in the way. There is no doubt the country is politically divided and the politicalization of COVID-19 has made objective, rational discussions about policy difficult, if not impossible. Most of us experience this kind of divide within our own families.

You may not even realize that your thoughts and beliefs regarding how COVID-19 should be handled are more emotionally-driven than fact-driven. Here is the exercise. For this discussion, make some changes to the fact scenarios and see if that changes your view. If so, your responses to the COVID-19 fact situations are likely being influenced by emotions or a philosophical point of view. I’ll help you do this below.

Let’s start with the First Amendment issue. While the First Amendment of the U.S. Constitution does guarantee citizens the right of free speech, there are long-held exceptions to this right. Constitutional Law professors commonly use the example that one does not have the right to go into a crowded movie theatre and shout “Fire!” just because that person wants the freedom to do so. The U.S. Supreme Court long ago upheld restrictions on publishing pornography on the internet despite claims that this would infringe upon First Amendment rights. We also have federal restrictions on marketing such that a pharmaceutical company cannot make the kinds of assertions about the effectiveness of its medications similar to the ones Dr. Cole made. The common theme here is that restrictions of the First Amendment are proper and legal where they serve to protect the health and welfare of the public.

Let’s distinguish Dr. Cole’s situation from some others that I would never support pursuing. First, if Dr. Cole wished to raise concerns about the effectiveness of treatments, the safety of vaccines or related issues with his colleagues or at medical conferences and engage in scientific debate, that would be fine. That is not what Dr. Cole did. Recall that Dr. Cole repeatedly spoke about seeing something on the order of a 20-fold increase in cancers that he impliedly or explicitly connected to the COVID-19 vaccines at his public speaking engagements, but to my knowledge, never allowed independent review of these cases (we already know of one case made public in which Dr. Cole diagnosed a patient with cancer that led to extensive surgery to remove the associated organs and tissues only for the hospital and outside consulting pathologists to find no evidence of cancer) nor to my knowledge did he ever notify the FDA, the CAP, or any other regulators or medical associations or even submit his findings for publication and peer review  (despite the fact that I can find no other similar such reports from any laboratory in the world).

It would also be fine if Dr. Cole wanted to give his thoughts or opinions with a disclaimer that he is not offering them as a physician or as medical advice, and that his positions are not supported by the medical community at large. The problem is that Dr. Cole engaged in a several years-long campaign of disinformation touting his medical and scientific expertise to influence the public to adopt his advice and positions.

It would also be fine for Dr. Cole to argue policy, e.g., the benefit or harms of mandates. These can be legitimate points of debate. The problem was that Dr. Cole presented false information as facts. This was not a debate about policies or uncertainties concerning the virus or the disease – this was an intentional, well-coordinated disinformation campaign.

Let’s look closer at some of the specific allegations.

1. Dr. Cole made numerous false and misleading statements during public presentations regarding COVID-19, the COVID-19 vaccines, the use of ivermectin to treat COVID-19, and the effectiveness of masks.

I could probably write 30 pages just on this topic, so let’s just take one part of it, the part that I suspect many are not concerned about, but should be: The use of ivermectin to treat COVID-19. Many, Dr. Cole included I suspect, will say, “Big deal. What is the harm in that? It is a long-used medication that has already been approved for treating other conditions and is reasonably safe.”

Is it ever appropriate for a physician to prescribe a medicine for a use other than what it is approved for? Certainly, there are occasions where this is appropriate. Those situations include when a patient has failed the usual and customary treatment, when a patient has an underlying condition for which the usual and customary treatment would not be appropriate, or when the patient is on medications that cannot be stopped that would interact negatively with the usual and customary treatment. Even so, the physician should discuss the situation with the patient, explain the risks and obtain the patient’s consent prior to proceeding. From what I can read of the WMC charges, none of these factors appear to be at play.

Ivermectin is relatively safe, however, it has a long list of possible side effects and adverse events – some common, others not; some minor; some just annoying (e.g., generalized itching); but others can be serious. Now, we all make risk/reward decisions every time we prescribe or take a medication. There is no medication that is completely safe for everyone and without any side effects or adverse events. Doctors make these risk/reward decisions with their patients all the time. Often, patients find their symptoms or disease so distressing that they find the potential risks well worth taking. Sometimes, people have a relatively minor problem and decide that they are not willing to assume the risk of significant side effects to treat something that is not that distressing to the patient.

But, all of the many well-designed, randomized trials have failed to detect any benefit for ivermectin in treating COVID. So, if you were in the exam room with me, I diagnosed your condition, and told you that I can prescribe a medication that won’t help you, what amount of risk of adverse effects would you be willing to accept? Would you be willing to accept any chance of a adverse event that would land you in the hospital or take your life? What about visual disturbances? What about one of the most serious skin disorders that there is? Would you take the risks even if I told you the risks were rare? Most people would say no. Why? Because the risk (a small or rare risk of a serious problem) will outweigh the  benefit (in this case, zero) of treatment in the minds of most rational people.

Some will respond, okay, but Dr. Cole said he treated people and they all got better. First, those statements are contradicted by physicians making sworn statements that they treated patients of Dr. Cole who ended up being hospitalized, in critical care or even dying from their COVID, despite Dr. Cole’s assertion that they all got better. I’m not saying that Dr. Cole is necessarily lying, he simply appears to not have followed at least some of these patients and may not know that they got worse. Most people don’t think of calling a pathologist when they can’t breathe and need an ambulance, and ER doctors are not likely going to call a pathologist to admit a patient to the hospital or the ICU.

To point out how flawed relying on anecdotes is, let’s assume that I had a group of 12 friends. We all got fully vaccinated and we all wore masks whenever we were out in public. We have no children living in the home and we all were retired or working from home. We would get together every day outside, distanced, taking our masks off only to have a daily cup of coffee. None of us got COVID. I then tweet, go on cable networks and make viral videos saying that I have the key to preventing getting COVID-19 – drink one cup of coffee each day. I then make up a reason to explain why coffee works – the heat and steam of the coffee clears out your sinuses and rids you of any virus in your nasal passages and the coffee has antiviral properties as it turns out that someone in some lab somewhere in the world put coffee in a culture with the SARS-CoV-2 virus and it was unable to grow. How strong of a scientific argument for coffee do you think I made? I hope you are not impressed. The sample size is small (13 if you count me). There was no comparison group to see if people who did get COVID drank coffee. There was also no accounting for confounding factors, such as the fact that my friends and I were at lower risk (no kids in the house and working from home) and we employed other public health measures known to protect us from getting infected. You should not rely on my anecdote and neither should we be persuaded by Dr. Cole’s.

But, even if I still haven’t persuaded you, there are two more problems with Dr. Cole prescribing ivermectin or me prescribing a cup of Joe every day. One problem is the lack of documentation in the medical records mentioned in the charges made by WMC. As I said above, there can be reasons for a physician to prescribe a medication that is not usually used for a certain condition, but in every state of the country, physicians are required to document their reasoning. First, in prescribing something out of the ordinary, the physician needs to document why in order to protect him or herself from a latter claim of negligence if the patient does suffer harm, and second, if there were reasons not to treat the patient with the standard medications for a disorder, you want those documented so that if the patient worsens and comes in for care, the doctor, or someone covering for that doctor, can be reminded of why the patient should not be prescribed the standard medications.

The key thing that should bother everyone reading this is that based upon what we can glean from the WMC complaint, it was not a matter that the patients had contraindications to vaccines or contraindications to treatments that we know work for COVID, but rather that Dr. Cole never offered these to the patients or explained why he didn’t. Had he done so, the patients refused, but asked for ivermectin and he then explained that we really don’t have good quality evidence to support their use, but they indicated that they still were willing to accept the risks with little chance of benefit, Dr. Cole might have avoided these charges.

Still, I may not have convinced you, so let’s put my little exercise into practice. Now, let’s take the situation of your child or your spouse or your parent. They unfortunately have a very serious cancer that is serious, but if left untreated will kill them. You seek the advice of a doctor for treatment. The doctor does not tell you about the treatments that are proven to work, but rather suggests an unproven treatment, or one that is not considered the standard of care. You take the doctor’s advice. Your child, spouse or parent deteriorates and requires hospitalization, intensive care or dies. (Remember, while Dr. Cole states that all of his patients did well on his treatment, other doctors have provided sworn testimony that they did treat some of Dr. Cole’s patients and they required hospitalization, intensive care or died). If you trusted the doctor, but he did not tell you about proven treatments for your family member, but instead pushed a drug that the majority of physicians and medical organizations stated should not be used, how would you feel? If you feel the same way that you did about ivermectin that it is perfectly fine for a physician not to offer you the standard and proven treatments, then we will just agree to disagree. However, if you think this situation is wrong, but it is fine for ivermectin, then you should consider that you are making an emotional or biased decision, not a logical one. Remember, that in the case of ivermectin, even the company that manufactures and distributes it, that would stand to financially benefit from wide-spread use of its medication for COVID, publicly warned against its use and indicated that the pharmaceutical company’s scientists saw no evidence of benefit of ivermectin in treating COVID-19.

I am going to finish up with three of the specific allegations under #3 above:

1. Failure to take a history or perform a physical examination;
2. Failing to obtain appropriate informed consent;
3. Not providing an adequate opportunity for follow-up care;

Why is failing to take a history or perform a physical examination a big deal? As doctors, we need to understand the particulars of a patient we are treating. With COVID, I need to understand the patient’s risk factors – age, health conditions that may increase risk and whether the patient may be immunocompromised in any way. You get this information from taking the patient’s history so that you can assess which treatment the patient needs and whether they can be safely treated at home or need to come to the hospital. Further, in taking a history, you will review the patient’s medications. This can be very important in considering potential drug interactions that may result from whatever I may prescribe to the patient (especially the case when prescribing Paxlovid). The physical examination allows me to assess how sick the patient is and whether there may be other medical problems going on (remember, there is no rule that you can only get one infection or condition at a time). Again, the findings from examining the patient are likely to influence which treatment I offer to a patient and whether that can be outpatient or needs to be inpatient treatment. I know of no state in which prescribing medication for a patient with whom you do not already have an existing doctor-patient relationship, a patient for which you have no medical history and have never performed a physical examination on would be considered acceptable medical practice.

The point about not obtaining informed consent, to me, is one of the gravest aspects of Dr. Cole’s conduct, if ultimately proven. It is one of the fundamentals of our profession that patients, so long as they are competent to do so, should decide which treatments we offer that they wish to undergo, if any. To equip a patient to decide on a course of treatment, we must explain what is wrong with them, what treatments are recommended, what the potential risks are of treatment, and if they are not inclined to be treated, what the risks of non-treatment are. Informed consent captures the notion that a patient cannot really provide consent unless they are informed.

If, as appears to be alleged in this case, Dr. Cole did not explain what the recommended treatments were, only offered non-recommended treatments, did not document a good reason why, and did not explain the risks of taking non-recommended treatment and forgoing recommended treatments, this is not informed consent; it is manipulation and coercion of the worst kind.

Finally, the WMC makes a charge for not providing adequate follow-up of patients. We can certainly have a debate about whether pathologists who do not have a hospital practice or hospital privileges, do not have an office or clinic in which to see patients on an ongoing basis, and do not typically treat infectious diseases should be offering their services to treat patients with a serious infection like COVID-19 that can last weeks and cause health consequences in the ensuing months or years. However, even if you come out on the side that yes, this makes great sense, then those physicians must meet the same basic standards of care as physicians who normally treat these patients. Another foundation of our profession is that we do not abandon patients. If you are going to engage in the practice of treating such patients, you must either make yourself available for follow-up needs of the patient, have a system in place for other physicians to provide that ongoing care when you are off or traveling to other states or countries to spread disinformation, or you must arrange for a hand-off to another physician or notice and a sufficient time for the patient to be able to identify and schedule a visit with another physician. What if a patient that Dr. Cole treated is experiencing an adverse effect from the ivermectin? What if the patient is unable to get the prescription filled as many pharmacies have refused to fill these prescriptions? What if the patient is worsening and the ivermectin does not seem to be working? We simply cannot leave patients without options for continuing care than to go to already overloaded and over-burdened emergency rooms.

Obviously, Dr. Cole will have his opportunity to respond to the charges and present his defense. However, if the charges are substantiated, we all should be able to agree that this conduct is unprofessional and is not what we would want for our friends and families. We should never embrace those who would try to manipulate the public for their own personal gains, especially those who have taken a solemn oath to help people and protect their health and who have been granted a privilege to practice medicine when so many are turned away each year from this amazing opportunity.

We should support telling the public the truth, providing them with the facts, and then allowing them to assess their own personal risks, those of their families and what they consider their obligation to society is, to then determine which health recommendations they will adopt. Our job as physicians is to provide our patients and the public with information upon which they may be informed to make their own health care decisions. Having the privilege to practice medicine is a tremendous honor, and with privilege comes responsibility. If the allegations against Dr. Cole are true, then he has violated every core tenant of our profession. That is terrible enough. The only thing worse would be if our state boards of medicine, our professional associations and our specialty certification organizations allow that conduct to continue and the public to be harmed without consequences to the physician.