In the world’s history of pandemics, doctors have taken center stage: as healers, as companions, as chroniclers, and as innovators. Doctors and scientists figured out the germ theory of disease, identified organisms, created vaccines and therapeutics, and advised nations on pandemic response.

In the COVID pandemic, a lot has changed. These changes have upset the entire foundation of medical practice, and yet there is very little discussion about them. I am talking about the disappearance of fundamental ethical principles of medicine, and the substitution of non-medically-based directives and prohibitions. 

Yes, doctors created the COVID vaccines and some new therapeutics, and a few doctors advised world leaders. But the response to this pandemic has been strangely non-medical. Common sense medical practice has been ignored in many instances. Ethical principles have been left quietly by the wayside. Doctors have been enjoined by politicians to treat a disease this way and not that way, and have largely been forbidden to question what is happening, or to assert those ethical principles that, until two years ago, we had all accepted as good and true. And there has been very little push-back by doctors and medical organizations. 

Examples?

• Why did doctors allow mask mandates for two years—with no stipulation that it had to be a fitted N95 mask—when every doctor in America knows that surgical masks do very little to stop an airborne virus, and that cloth masks do literally nothing?1 “Just cover your face” is a political directive: it has no medical significance to it.

• It would seem to be basic common sense that if a worldwide pandemic occurs, we would want doctors the world over to try different medications to see what would work, especially if those medications were already proven to have anti-viral activity2. Then those doctors could keep records, and if something seemed to work, other doctors could try it. Eventually there would be studies, and the best medications would rise to the top and everyone would know to use them. Wouldn’t every doctor know—from the principles we learned in medical school—that it is better to take advantage of the accumulated knowledge and experience of the world’s doctors than to mandate that all of that experience be shut down, and that only new, unproven medications be used—even when those new medicines weren’t available? We could have used the new medicine, too—I am not suggesting that we should not have tried those—but why discourage, prohibit, and literally ban, in some cases3, the use of re-purposed medications that everyone could afford, that were already available, and that from early on showed significant decreases in mortality in patients who took them4? Why NOT try them? What harm would it have done, compared to the ravages of a new virus that was killing hundreds of thousands? An age-old principle of relying on the wisdom of doctors to treat their own patients was suddenly discarded.

• Hydroxychloroquine and Ivermectin are cheap generic drugs with already proven anti-viral properties2. Their safety profiles are as long and as deep as any medications we have: they are used every year in the billions of doses around the world. We were, literally, telling patients with COVID who had respiratory distress and desaturation to go home and use home oxygen, unless they saw purple toes (by which time mortality was extremely high). We were discouraging the use of HCQ and Ivermectin. Why? Why? How many lives could we have saved? We allowed this reason not to use them to be given: “they may not be safe”. But was it safe to stay home on oxygen until you get purple toes and you were in full COVID storm? It was not then and is not now ethical to withhold possibly helpful medication in a lethal illness when the medication is well known to be safe.

• Doctors have always, as far as I know, had the leeway to use FDA-approved medications as they saw fit, even for purposes not specifically approved by the FDA. That is how we got anti-seizure medications for chronic nerve pain, and calcium channel blockers for headache prevention. But with COVID, the FDA gave an emergency use authorization (EUA) for HCQ and Ivermectin—because they were showing promise—and then suddenly pulled the EUAs and put out warnings against using them. I remember why they did that—and it wasn’t a medical reason. I was standing right there when it happened (listening to the radio). When has the FDA done that before, absent reliable reports of the medication doing harm? The FDA, long a trusted agency we all thought was helping us to prescribe safely, was suddenly political.

• Similarly, the Federation of State Medical Boards has put out a directive7 that says that physicians who make unapproved statements about COVID will be subject to discipline, including the loss of their licenses. The ABIM has sent out its own letter with the same message. What? Seriously? The ABIM now has to approve what doctors say? And this is ok with us? This is an earth-shaking change in the way medicine works, and yet there has been no outcry. This directive is not medically based, for sure. For one thing, the “science” is not settled, as we all know in medicine it never is. New information is coming out all the time. Shutting down inquiry and discovery has never in our history been thought to be good for science. To demonstrate that this is not about medicine, I will point to a far more significant epidemic of misinformation that goes unpunished: this occurs when doctors prescribe antibiotics for viral infections. This has caused the development of resistant organisms that threaten lives and increase hospital costs. Yet no medical board has threatened doctors with loss of license if they give an antibiotic to a patient with a cold. The difference is that the shutdown regarding COVID information is not medically-based. It is political.

• Finally, there are the vaccines. There have been several-fold more serious adverse events with the current COVID vaccines than for other vaccines. There seems to be an epidemic of young people (mostly male) with myocarditis and sudden death. VAERS reports of life-threatening adverse effects topped 24,300 at the end of December 2021, over 50% higher than the total number of similar events from all other vaccines since 19908. Deaths topped 21,000, over twice the number of deaths from other vaccines again in the last 30 years. Even though these are self-reported, this is no different from how VAERS data usually is reported, and we all have taken VAERS data seriously in the past. Virtually no safety data was available when the vaccine mandates went out across the country. Again, this is not the way we have done things in the past. Existing elementary school vaccine mandates were only put in place after decades of safety data was known (and the vaccines we have mandated are extremely safe).

Not only does the COVID vaccine carry risk (which it is not permitted to mention—see ABIM above), but it has long been clear that the vaccine does not stop transmission effectively9, and yet vaccine mandates persist. There has been virtually no risk to healthy children even from alpha and delta. The risk is highly skewed toward older people. So why were children masked in school, with all the downstream harm that has done? Why are they being vaccinated with a vaccine that has a troubling safety profile and that doesn’t stop the spread after a few months? None of this is medical. This is not good medicine. This is politics, and the reasons behind these actions are not the one we abide by in our profession: to act for the benefit of the patient. 

We all have our own reasons for not speaking out, or not doing so sooner. I personally think that doctors are among the most trusting people on Earth, and also among the most obedient. We have more and more burdens and responsibilities put on us—you all know what I mean—and we just keep accepting them. After all, our job is to walk without complaint into the middle of a pandemic to treat people. We are not used to thinking we have rights, and we are not used to speaking up. Then there is fear: of being ostracized, fired, shamed or isolated. I know I have been subject to that fear, and that it stopped me from speaking out when I believed I should. I think this fear might be the main reason we have not spoken out. Those in power who have made their decisions based on political considerations have done so with such confidence and such authority that it seems hopeless to be one voice speaking out. Furthermore, the costs for doing so are evidently great. But it is time to start speaking out. Otherwise, it is more than a little unbearable to look too closely at the situation as it is now, and realize how in jeopardy our precious profession has come to be.

1. https://brownstone.org/articles/more-than-150-comparative-studies-and-articles-on-mask-ineffectiveness-and-harms/ 
2. https://www.nature.com/articles/s41421-020-0156-0
3. In the US, the FDA gave Emergency Use Authorizations (EUA)to both HCQ and Ivermectin, and then abruptly withdrew them. The FDA then posted warnings against these two drugs for use with COVID. However, there were no studies at that time that demonstrated significant risks that were not known, and the risks that were known had been managed by doctors already for decades. There were many studies, admittedly with contradictory results, but generally favoring the efficacy of use in COVID to reduce mortality. The lack of definitive evidence in favor of these drugs might have been reason to pull the EUAs, but would not have been a reason to issue warnings. Many pharmacies would not dispense HCQ, even with a legitimate doctor’s prescription, and many hospitals banned the use—internally-of both HCQ and Ivermectin for treatment of COVID.  
4. https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext
5. https://c19ivermectin.com
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968425/ 
7. https://www.fsmb.org/advocacy/news-releases/fsmb-spreading-covid-19-vaccine-misinformation-may-put-medical-license-at-risk/
8. vaersanalysis.info 
9. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2787183