Is Informed Consent Being Used as a Guise for Spreading Misinformation?

The website for the group Physicians for Informed Consent (PIC) reads like an apolitical, educational resource that provides information on vaccines and why they shouldn’t be government-mandated. Its mission is “that doctors and the public are able to evaluate the data on infectious diseases and vaccines objectively, and voluntarily engage in informed decision-making about vaccination.”

The group’s accompanying social media accounts, however, tell a different story. On PIC’s Facebook, Twitter, Instagram, and LinkedIn feeds, you’ll find post after post about reasons to be scared of vaccinesespecially for children – often highlighting selective portions of scientific research that contain vaccination risks.

Who’s Behind PIC?

The group was founded in 2015 after California passed a law that prohibited the use of personal belief exemptions from vaccinations required for children to attend any public or private school in the state.

Three years later, the number of waivers issued by doctors to parents seeking medical exemptions for their children tripled. As a result, another law was passed in 2019, cracking down on the inappropriate use of medical exemptions.

The group’s founder, Shira Miller, MD, is a concierge integrative medicine doctor based in Los Angeles, specializing in menopausal care. On her own Twitter profile, she describes herself as “Facebook’s Most Popular Menopause Doctor.”

Miller earned her medical degree in 2002 from Technion-Israel Institute of Technology in Haifa, Israel, and has reportedly been working as a concierge physician since 2010.

PIC’s leadership team also includes 20 physicians from a wide range of specialties, most of whom, like Miller, don’t specialize in infectious diseases.

Among its leaders is Paul Thomas, MD, an Oregon-based pediatrician. Thomas, who is listed as one of PIC’s founding directors, was issued an emergency suspension order of his medical license in 2021 by the state medical board, in which they cited at least eight cases of alleged patient harm. In line with PIC’s philosophy, Thomas maintains that he isn’t “anti-vax” – he’s pro-informed-consent.

Also on the team is Jane Orient, MD, internist and executive director of the Association of American Physicians and Surgeons (AAPS), a group that also opposes vaccine mandates. Orient received her medical degree from Columbia University and currently practices in Arizona. In 2020, the AAPS sued the federal government for withholding its stockpile of hydroxychloroquine from COVID patients, despite research showing that the drug is ineffective. The complaint was dismissed in September 2021.

Doug Mackenzie, MD, a plastic surgeon who graduated from Johns Hopkins University of Medicine, is PIC’s treasurer. He has previously identified himself as an “ex-vaxxer” rather than an anti-vaxxer when speaking on a panel in 2019.

The only RN on the team is Tawny Buettner. After California mandated vaccinations for healthcare workers, Buettner organized a protest outside of her place of work, Rady Children’s Hospital in San Diego; she later sued the hospital after she was dismissed from her job. According to the complaint, Buettner and the 36 other plaintiffs alleged that their requests for religious exemptions from the COVID-19 vaccine were all denied.

Kenneth Stoller, MD, also listed on the leadership team, graduated from the American University of the Caribbean School of Medicine and completed pediatric residency training at the University of California Los Angeles. Stoller was disciplined in 2019 for doling out medical exemptions to children without adequate evidence. According to state records, his license in California has since been revoked; he currently holds a medical license in New Mexico.

What’s PIC?

The most notable physician groups accused of spreading COVID-19 misinformation since the vaccine rollout have been affiliated with right-wing media, if not overtly proclaiming conservative, anti-vaccination beliefs.

For example, America’s Frontline Doctors, a group notorious for its support of hydroxychloroquine as a treatment for COVID-19, has made its values well-known. The group’s founder, Simone Gold, MD, JD, was arrested for participating in the Jan. 6 capitol riot and has openly opposed mask-wearing. Similarly, physician leaders of the Front Line COVID-19 Critical Care Alliance, known for promoting the use of ivermectin to treat COVID-19, tout their appearances on the ultra-conservative Newsmax on the website’s homepage.

PIC wants to be different. The group’s focus, according to its general counsel Greg Glaser, JD, of Copperopolis, California, is on the “authoritative citations that show, or calculate, the risks [of vaccines] to the public,” he told MedPage Today.

“We are pro-informed consent, pro-ethics, pro-health. PIC is not anti-vaccine, and PIC is not pro-vaccine – PIC is neutral,” Glaser said on behalf of the group.

In August 2021, Glaser submitted an amicus brief to the Supreme Court PIC’s behalf, arguing against the implementation of vaccine mandates. The document claims that “government statements confirm there is no evidence that COVID-19 vaccines prevent the spread of SARS-CoV-2 or COVID-19,” ignoring the breadth of existing literature that says otherwise.

What should you take if you get Covid-19? 

https://link.vox.com/view/608adc4e91954c3cef03e60dfi7ya.jor/68bd1086

Hey readers, 

Last week, Florida Surgeon General Joseph Ladapo released a public service announcement talking about protecting your health from Covid-19. The PSA stood out for a couple of reasons:

1. While “vaccination” briefly appeared onscreen in a list of options, it didn’t merit a mention in the video.

2. The surgeon general listed guidance on “emerging” treatments that was … remarkably on point.

The absence of focus on vaccines in the video is unfortunate, if entirely in keeping with the GOP’s willingness to play to its anti-vax base. That’s bad, but not surprising.

What was surprising was No. 2. The information Ladapo shared about treatments was fairly accurate. In the video, he told Floridians to ask their doctor about monoclonal antibodies, fluvoxamine, and inhaled budesonide should they come down with Covid-19. 

I’ve been reporting on the Covid-19 treatment beat for much of this year, and I’ve uncovered a massively confusing pile of contradictory information. But those are the top three treatments I’d recommend sick loved ones talk to doctors about, and while there’s much we still don’t know, solid science suggests they have real promise.

That said, the fact that such important (and accurate) information stood out in a government PSA indicates just how dismal the state of public communications on treatments is — and just how much misinformation and distrust are hampering the fight against Covid-19. 

What should you take if you get Covid-19? 

There’s been little public health communication about which treatments to pursue if you get Covid-19, perhaps because for much of the pandemic, it’s been unclear what options are better for mild Covid than just resting at home. While in 2021 the best treatment recommendations have gotten clearer, public health messaging over the last year has rightly been focused on vaccination.

The official CDC page on what to do if you get sick with Covid-19 advises you to wear a mask, wash your hands, and clean high-touch surfaces to avoid infecting those around you. If your breathing deteriorates or you show signs of severe illness like confusion or an inability to stay awake, the CDC advises you to go to the hospital. 

All sound guidance — but what it doesn’t offer is advice on a question that patients who aren’t sick enough for hospitalization might desperately need to know: What medication should I take if I come down with Covid-19? 


That’s not because there’s a lack of options. For instance, the FDA has approved monoclonal antibodies as a treatment for Covid-19 patients at risk of progressing to severe disease. They recently expanded this approval to include monoclonal antibodies for children as well. The treatment has to be administered in a clinic, as an IV infusion or as four shots, but it is highly effective, with some high-quality studies finding an 85 percent reduction in the risk of hospitalization or death.

Meanwhile, large, high-quality, peer-reviewed, and published randomized controlled trials (RCTs) have found promise for cheap therapies that are already FDA approved for other purposes and have an established safety profile. 

One medication, fluvoxamine, is an antidepressant that appears to reduce hospitalizations from Covid-19 by about 30 percent. Another, budesonide asthma inhalers, was found in one large RCT to speed at-home recovery considerably and in another to reduce risk of hospitalization. In the US, there’s been no formal guidance on when to consider budesonide, but in the UK, health agencies have advised doctors they can consider prescribing it off-label to help older and at-risk patients recover at home, while in Canada doctors are encouraged to consider budesonide on a case-by-case basis.

Research underway will help provide a better understanding of both of these therapies, but there’s enough evidence that some doctors are already prescribing them to patients. If you have the opportunity to enroll in an ongoing clinical trial of these medications, you can get access to a potentially promising treatment and help contribute to our scientific understanding of whether these treatments really work.

Another exciting treatment in the pipeline is Paxlovid, an antiviral developed by Pfizer that showed impressive 90 percent efficacy in preventing hospitalization — so effective that in November, the clinical trial stopped enrolling new participants because investigators concluded it’d be unethical to put them in the control group. It has not yet been approved by the FDA, but it might be a game changer if, as is expected, it’s approved in January.

The FDA is also in the process of considering molnupiravir, another repurposed drug that looks to be moderately effective, though there are some concerns it could spur new viral variants.

Why is it so hard to find good guidance about treatments?

The US government has communicated little about Covid-19 treatment options. NIH guidelines about treatments like fluvoxamine haven’t been updated since this past spring, meaning results from recent high-quality studies haven’t been incorporated into that guidance. Without it, physicians considering whether to prescribe these medications can’t turn to official public health resources for help. 


From a certain perspective, that reticence is understandable. Learning which Covid-19 treatments work is very hard. While large-scale RCTs found promising evidence for fluvoxamine and inhaled budesonide, “promising” is still the most we can say — it could absolutely turn out that the real-world effects are much smaller than hoped for, or even fail to materialize altogether.

But it’s precisely because this area is so difficult to navigate for doctors and patients that the CDC, FDA, and NIH could play an important role in pointing out good treatments — yet it’s a role they have been puzzlingly reluctant to play.

Perhaps because of the dearth of formal federal government guidance on treatments — and because of politically driven crazes over drugs like hydroxychloroquine and ivermectin, which evidence thus far suggests do little to fight Covid-19 — Florida media has been critical of Ladapo’s PSA and its recommendations.

Politicians who pander to anti-vax sentiment are harming their constituents, and it’s very reasonable to be frustrated with their conduct. Ladapo is a DeSantis appointee who has forcefully opposed Covid-19 restrictions — and has refused to wear a mask in meetings with immunocompromised legislators — and lots of people are reasonably reading his PSA in that light. 

But that justified irritation shouldn’t get in the way of a needed conversation about the possible benefits and drawbacks of monoclonal antibodies, fluvoxamine, and budesonide. As the US braces for an omicron surge that is likely to hit even vaccinated people, effective treatment is going to be essential for saving lives. Yes, promoting vaccines is a must, but tens of thousands of Americans are getting sick each day, which makes clear, accurate communication about which treatments to ask your doctor about extremely important. 

The more society and public health get aligned on what works, the better off we’ll be in confronting omicron and other future variants.

The Delta variant is a monster and our last weapon is the unvaccinated

An illustration of coronavirus spike proteins

Oh, how the tide has turned. Three months ago, COVID was ravaging my homeland, India. The Delta variant was burning through the country like an uncontrolled wildfire. People carted dying relatives town to town, desperately seeking hospital beds or a whiff of oxygen. A cousin in India said, “COVID is not taking lives, just the beds. Lack of oxygen is taking lives.”

I watched India’s suffering unfold and felt guilty for living in one of the world’s most resourceful and scientifically advanced countries. My homeland was floundering, but at least my other homeland — the U.S. — was finally on track.

104 million Americans had been vaccinated. The Pfizer vaccine alleviated the worst outcomes of the B.1.1.7 and B.1351 variants. Adolescents aged 12-15 were gearing up for vaccine eligibility within days, and the CDC was reporting the U.S. could see a sharp decline in COVID cases by July if nationwide vaccinations continued. Health care workers had proper PPE, millions of people were getting vaccinated each week, and infection rates were declining steadily. We could finally see Spring’s light at the end of the year’s tortuous dark tunnel. Our country was in the home stretch.

Now the Delta variant is here and I have to wonder, Who were we kidding? We don’t live in a world where vertical borders prevent airborne particles from crossing time zones. Planes and boats carry viruses from one country to the next like microscopic stowaways. The virus doesn’t abandon ship. It mutates, and adapts, and colonizes.

We had a real chance to strangle this monster, to show the rest of the world how it was done, to help them all in the process. We let that chance slip away. Not everyone and not everywhere, but enough people got complacent. Some waited for herd immunity to carry the load—a number that crept from 60 to 70 to 85 percent, depending on what you read and when you read it—and others just figured it would pass. Now the Delta variant, the same one that tore through India and Great Britain, has twisted out of our flimsy grip and is roaring with laughter.

How did this happen?

Misinformation. Political discord. Vaccine hesitancy. The bottom line is our vaccination rate faltered. The CDC reported that on August 1, 2021, approximately 400,000 Americans received their first COVID dose. While that seems high, it’s less than a quarter of the peak in mid-April. We haven’t maxed out eligible people (only 58.1 percent of eligible people were fully vaccinated as of a week ago). We’re maxing out the number of people who know COVID’s real repercussions are far worse than the vaccine’s feared ones.

The U.S now has the third-highest rate of vaccine skepticism among 15 of the world’s largest economies. Our vaccine surplus is so large the FDA extended Johnson & Johnson’s vaccine expiration dates to avoid throwing out perfectly good doses. Less than a week ago, President Biden announced the U.S. has donated and shipped more than 110 million doses to 60 countries. While I applaud the humanitarian effort, I question the fate of those doses if the 41.9 percent unvaccinated eligible people in our country had wanted them.

It makes me wonder: Why does science take a backseat to unsubstantiated pseudoscientific claims?

Spreaders of vaccine disinformation fill their social media accounts with statements questioning COVID’s existence and purporting unproven treatments (never mind the fact that we wouldn’t need treatments if COVID didn’t exist) with little to no peer-reviewed scientific research to support their anti-vaccine claims. According to Imran Ahmed, CEO of the Center for Countering Digital Hate, twelve people — the “disinformation dozen” — produce 65 percent of the shares of anti-vaccine misinformation on social media platforms.”

Is it easier for some to believe that a science-backed treatment is inherently more dangerous than an unknown herb plucked from a field? Perhaps. But what do they say to the approximately 216 kids hospitalized daily in the U.S. over the past week, particularly in areas where vaccine coverage is low? Bad luck? You weren’t strong enough? What would have made them stronger?

Yes, there are measures underway to increase vaccinations—full FDA approval, social media crackdowns on misinformation, and government, companymilitary, and college mandates. But let’s be honest, many Americans are fighting these measures, as they will fight future mandates, and the next vaccine.

Only two things can change how non-vaxxers perceive COVID vaccines: education and trust. We need to sincerely hear their reasons, and then gently clarify misinformation—vaccines don’t introduce disease into our bodies. They stimulate our immune systems to obtain immunity without getting the disease. Vaccines don’t alter our DNA. Their safety has been tested. Medicines have potential side effects, but illnesses have definite ones. COVID kills indiscriminately; vaccines don’t.

Trust is harder. How can we help people trust these vaccines? I suppose on a deeper level, it’s more about trusting the people that make the vaccines. Big pharma, for-profit companies—sure, they are the money makers. But behind the scenes, the vaccines are created by men and women who’ve accepted the charge to make this world—not just individuals—safer and healthier. They’ve spent years studying, researching, and testing potential vaccines with dedication and patience, including the mRNA technology in COVID vaccines. Just because the COVID vaccine’s rollout was fast-tracked to combat the pandemic doesn’t mean the scientists cut corners in designing and testing it.

Unfortunately, we don’t have the luxury of slowly educating and gradually building trust. COVID is terrorizing our planet now. The world is shaking its heads at the U.S., wondering what happened. We were supposed to be the leader. This morning, an aunt in a small town in India sent me a WhatsApp message: “I have taken the vaccine … the positivity rate has gone down … I am worried for America … how r u?” I don’t know. America, how are we? It’s not too late to destroy this monster, but if the unvaccinated remain unmoved, it will be soon.

Cartoon – State of the Union (Vaccine Hesitancy)

May be a cartoon of text that says 'JON ADAMS @CITYCYCLOPS "Honey, come look! I've found some information all the world's top scientists and doctors missed."'

Healthcare will expand and deal with the fallout of COVID-19 for decades, says Fitch

https://www.healthcarefinancenews.com/news/healthcare-will-expand-and-deal-fallout-covid-19-decades-says-fitch

The U.S. may have entered into a new phase of the COVID-19 pandemic, but the public health crisis is far from over. The nation’s hospitals and health systems will likely be dealing with its after effects for decades, according to new findings from Fitch Ratings.

Specifically, health implications related to the coronavirus will drive elevated health system utilization long after the acute phase of the pandemic has ended, likely leading to increasing costs and higher insurance premiums for years to come. 

These costs will emerge from the necessary addition to outpatient capacity to deal with the ongoing treatment of chronic conditions related to what may be permanent damage caused by the virus.

WHAT’S THE IMPACT?

It’s nigh impossible to determine the magnitude of these effects, said Fitch. It will be dependent on tangential health issues related to deferred diagnostic testing and treatment during the pandemic. Since related conditions are likely to develop over time, Fitch doesn’t anticipate these issues to directly affect the credit profile of issuers in the U.S. healthcare system.

In the near term, health insurers have been able to incorporate expanding COVID-19 claims data, estimates of infection trends and pent-up demand for previously deferred care into 2021 premium rates, which should benefit cost management and pricing this year and next. 

However, for healthcare providers, the expansion of the healthcare system over the long term will likely exacerbate traditional pressures on operating performance, such as tight labor and wage markets for experienced staff, rising pharmaceutical expenses and supply costs in general.

Although the U.S. has glimpsed signs of the pandemic’s potential end over the past couple of months, the ultimate story of the pandemic is still being told. 

The infection rate is once again trending up, presumably due to a combination of factors, including a dramatic reduction in demand for new vaccinations, the rapid spread of the more infectious Delta variant and the reduction in mitigation measures.

THE LARGER TREND

The rising numbers of COVID-19 infections in the U.S. are occurring mostly in communities with low rates of vaccinations, with Centers for Disease Control and Prevention Director Dr. Rochelle Walensky saying in July that “This is becoming a pandemic of the unvaccinated.” 

Data published by USA Today shows that cases are rising in all 50 states, with some startling increases in certain areas. Rhode Island, for example, saw cases almost triple in a one-week period, with Maine and Vermont following closely behind. Massachusetts, Alaska and Kentucky have seen their cases more than double in that time, followed by Minnesota, Florida and Texas.

Cases are rising fastest in Arkansas, Florida, Missouri and Nevada, all of which have low vaccination rates, according to Market Watch. In all four of those states, less than half of residents are fully vaccinated.

Vaccine hesitancy remains a problem, with many Americans reluctant to get their shots or unwilling to do so. In May, a Sermo poll showed that more than 72% of physicians surveyed said that patients continue to voice concerns over vaccine side effects.

Still others have reported ongoing misinformation discouraging people from getting vaccines. And close to 30% of physicians reported encountering patients who have skipped their second dose due to unpleasant side effects from the first dose, or concerns over side effects.

Cartoon – Some things never change, they just recycle. Stupidity has no season nor expiration date.

May be a cartoon of 1 person, standing and text

Cartoon – Never Reaching Herd Immunity

Herd immunity hard to achieve if you've heard wrong info

Cartoon – Reaching Herd Immunity

Cartoon: Herd Immunity | Columnists | tulsaworld.com