BBC/Brijesh PatelA man whose wife died after a drain was mistakenly left in her abdomen for 21 hours has condemned the increased use of physician associates (PAs) within the National Health Service.

PAFailing hospitals will be revealed in league tables and NHS managers sacked if they do not turn things around, the health secretary will tell health leaders at a conference in Liverpool.

Mouth-to-mouth CPR with chest compressions are still the priority when rescuing victims of drowning, according to a focused update of American resuscitation and emergency cardiovascular guidelines.
The American Heart Association (AHA) and American Academy of Pediatrics (AAP) released a more codified and elaborate list of recommendations that replaces existing drowning guidelines from 2020 and years earlier.
Trained rescuers and laypeople alike are now formally advised that:Anyone removed from the water without signs of normal breathing or consciousness should be presumed to be in cardiac arrest. Provide CPR — with rescue breaths and chest compressions — to all individuals in cardiac arrest following drowning after removal from the water. (Class I recommendation)If a person is untrained, unwilling, or unable to give breaths, they can provide chest compressions only until help arrives. (Class IIa)In both adults and children, automated external defibrillator (AED) use is reasonable in cardiac arrest even though shockable rhythms occur less commonly in the drowning process. (Class IIa)Importantly, CPR should not be delayed to obtain or apply an AED on drowned people. (Class III)Trained rescuers may find it reasonable to perform in-water rescue breathing on unresponsive adults and children only if it doesn’t compromise their own safety. (Class IIb)Supplemental oxygen should be provided by trained rescuers to all people with cardiac arrest after drowning. (Class I)
“CPR for cardiac arrest due to drowning must focus on restoring breathing as well as restoring blood circulation,” said writing group co-chair Cameron Dezfulian, MD, critical care specialist of Baylor College of Medicine in Houston, in a joint press release from AHA and AAP.
The present AHA-AAP drowning recommendations were published in two parts: a general publication addressing adult and pediatric victims in Circulation, and a separate paper specific to the resuscitation of children in Pediatrics.
Dezfulian and colleagues based their recommendations in part on recent systematic reviews from the International Liaison Committee on Resuscitation (ILCOR).
“These updated guidelines are based on the latest available evidence and are designed to inform trained rescuers and the public how to proceed in resuscitating people who have drowned. Drowning can be fatal. Our recommendations maximize balancing the need for rapid rescue and resuscitation, while prioritizing rescuer safety,” Dezfulian said.
In most cases, cardiac arrest following drowning progresses from initial respiratory arrest due to submersion-related hypoxia. Less commonly, the drowning event may have occurred after a primary cardiac event.
“[T]hus, it can be challenging to distinguish respiratory arrest from cardiac arrest because pulses are difficult to accurately palpate within the recommended 10-second window. Therefore, resuscitation from cardiac arrest attributable to this specific circumstance must focus on restoring breathing as much as it does circulation,” the writing group reasoned.
According to the CDC, drowning deaths are on the rise in the U.S. after decades of decline. Over 4,500 people died due to drowning each year from 2020-2022, 500 more per year compared to 2019. Drowning is the top killer of children age 1-4 years old in the nation; most infants drown in bathtubs, and the majority of preschool-aged children drown in swimming pools.
AHA and AAP say it is reasonable to implement public access to defibrillators in aquatic environments pending cost-effectiveness data (Class IIa recommendation).
Meanwhile, the guideline writing group acknowledged that many questions in drowning resuscitation remain unanswered. The ILCOR reports had identified few studies with sufficient rigor to inform best practices, and topics such as extracorporeal CPR and the necessity of drying the victim’s chest before applying an AED are among the important knowledge gaps.
“While we work on a daily basis to lower risks of drowning through education and community outreach on drowning prevention, we still need emergency preparedness training that can be used in tragic circumstances if a drowning occurs,” said writing group co-chair Tracy McCallin, MD, of Rainbow Babies and Children’s Hospital in Cleveland, in a statement.

Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures
Dezfulian and McCallin had no relevant disclosures.

Primary Source
Circulation
Source Reference: Dezfulian C, et al “2024 American Heart Association and American Academy of Pediatrics focused update on special circumstances: resuscitation following drowning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care” Circulation 2024; DOI: 10.1161/CIR.0000000000001274.

Secondary Source
Pediatrics
Source Reference: McCallin TE, et al “”2024 American Heart Association and American Academy of Pediatrics focused update on special circumstances: resuscitation following drowning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care” Pediatrics 2024; DOI: 10.1542/peds.2024-068444.

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The American Medical Association (AMA) House of Delegates endorsed subsidizing healthcare for undocumented immigrants on the Affordable Care Act (ACA) exchanges during their interim meeting in Orlando, Florida, on Monday.
As of June, six states and the District of Columbia provide fully state-funded coverage to some income-eligible adults regardless of immigration status, and as of Nov. 1, some Deferred Action for Childhood Arrivals (DACA) recipients may be eligible for coverage on the ACA exchanges.
On a related question of whether to support extending the enhanced ACA subsidies overall, the House also voiced its support, with some changes.
However, not all delegates were on board. Jordan Warchol, MD, MPH, a delegate from Nebraska, said she worried that passing such a resolution right now wasn’t prudent.
Given the current political climate and that President-elect Trump only recently named a “border czar,” Warchol, who spoke on her own behalf, suggested that the House wait a few months.
“Passing this policy today … may unnecessarily put a target on the back of this organization at a time that we really do not want that,” she said, arguing that if the media got wind of the resolution’s passage, it might negatively impact the association’s priorities for the next 4 years.
The resolution was not “bad policy,” she stressed, calling it a “reasonable” statement for the AMA to make, but for the optics and the timing.
A committee focused on medical service and practice advocacy appeared to draw a similar conclusion, suggesting that the policy statement be referred for study.
However, on Monday afternoon, the House overruled the committee’s recommendation, and in a vote of 362-259, adopted the resolution.
Luis Seija, MD, a delegate for the Minority Affairs Section, the primary sponsor of the policy statement, argued that no further investigation was necessary, as the resolution included nearly 20 different references to studies backing the concept.
“The evidence shows that uninsured individuals, particularly those in undocumented communities, experience higher rates of preventable illness or chronic disease and worse overall health outcomes,” Seija said. “Subsidizing health insurance would allow undocumented immigrants to access care when they need it, not just in emergencies, leading to healthier communities overall, as well as a more inclusive, equitable, and efficient healthcare system.”
Frank Zhou, a medical student speaking on behalf of the PacWest Conference, also argued against referring the statement for further study.
“This policy is simply good for everyone and all stakeholders involved,” Zhou said, noting that it’s good for patients, because they get better healthcare, and good for the healthcare system, because it keeps immigrant patients from relying on emergency departments, which not only lowers costs, but reduces boarding.
It’s also good for physicians, he added. “When undocumented folks come and seek care and actually have insurance, then we get compensated … And I think we like getting paid for the work that we do.”
Zhou also pointed out that undocumented immigrants pay more than $90 billion in taxes every year. “They deserve to be able to buy insurance on the ACA marketplace … like everyone else with these subsidies,” he said.
Other delegates disagreed.
Deepak Kumar, MD, a delegate from Ohio speaking on his own behalf, said as a legal immigrant he opposed the resolution. When his wife was immigrating to the U.S., he had to show proof of insurance without any support, and demonstrate that his wife would not “be on the dole,” he said. More recently, his daughter married a Canadian, who also had to prove “evidence of insurance with no subsidies.”
“So, if you want to provide for undocumented individuals … some sort of subsidies, that needs to be provided to legal immigrants as well,” he said.
James Milam, MD, a delegate from Illinois who also spoke for himself, shared Kumar’s concerns, pointing to his conflict of interest: “My wife is on the exchange.”
He argued that any coverage gaps experienced by American citizens should be addressed before the nation extends those subsidies to undocumented people.
“Please understand, people, I am not unsympathetic to undocumented folks getting care, but I have to take care of my own family first,” Milam said.
As for the concerns about optics, Katrina Saba, MD, a pediatrician and California delegate speaking on her own behalf, urged the committee not to wait to adopt the resolution. “If there is a target on the AMA’s back, I think we should wear that target proudly,” she said.
Carl G. Streed Jr., MD, MPH, a delegate for the LGBTQ+ Section, agreed. “We have sufficient evidence to show this is a critically important issue, and I’m not willing to shirk just because of a headline that may or may not happen,” he said.
A separate resolution on whether to support the extension of the enhanced ACA subsidies, which expire at the end of 2025, was also approved.
However, an amendment to that policy statement eliminated a provision calling for the AMA to “immediately initiate or substantially invest in a focused grassroots campaign” around such an extension.
Sherif Z. Zaafran, MD, a delegate for the Texas Medical Association, who introduced the amendment, argued that while his delegation supports extending the tax credits, it did not want any other effort to distract from what it views as AMA’s primary priority: Medicare payment reform.
“We need to be focusing on the one item that is absolutely essential for all of us, which is having a Medicare economic inflationary index applied to our Medicare payments so that we’re not getting cut on an annual basis,” Zaafran said. “If we dilute that effort by having multiple other asks, then we lose that effort.”
While delegates from the Medical Student Section, the Resident and Fellow Section, the American Academy of Pediatrics, and the Massachusetts delegation opposed the amendment, their concerns were overruled, and the final amended resolution was adopted in a vote of 507-51.

Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

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The FDA declined to grant full approval to obeticholic acid (Ocaliva) for treating primary biliary cholangitis (PBC), Intercept Pharmaceuticals announced on Tuesday.
The decision follows a September meeting of the agency’s Gastrointestinal Drugs Advisory Committee, which agreed that the farnesoid X receptor (FXR) agonist did not have a favorable benefit-risk profile as a second-line agent in PBC patients without contraindications. On whether the available data supported a clinical benefit, 13 of the 14 panelists said no.
Intercept said it will work with the FDA on next steps, and the drug remains on the market.
It is unclear if the agency will seek to withdraw the drug in the future, as it has done with multiple cancer drugs that failed confirmatory trials. In September, the European Commission revoked obeticholic acid’s marketing authorization for PBC.
The FDA in 2016 granted accelerated approval to the FXR agonist as a second-line treatment for adults with PBC, either in combination with ursodeoxycholic acid (UDCA) for those with an inadequate response to the standard therapy or as a single agent in patients unable to tolerate UDCA. Safety concerns in patients taking obeticholic acid — including a risk for liver failure and need for liver transplant — narrowed the indication in 2021. The drug is now limited to PBC patients without cirrhosis or with compensated cirrhosis but no evidence of portal hypertension.
PBC is a rare and chronic liver disease that disproportionately affects women. The condition causes the small bile ducts in the liver to become inflamed and destroyed, resulting in damage to liver cells as bile remains trapped. Untreated, PBC can lead to cirrhosis, liver failure, and death.
COBALT (Study 747-302), the main trial supporting Intercept’s bid for full approval, was hampered by unblinding and treatment crossover but nonetheless failed to demonstrate a significant benefit in the full study population and showed trends of excess liver transplants and death in patients assigned to obeticholic acid without contraindications.
“I don’t know if OCA [obeticholic acid] is good or not, don’t know if it’s safe or not,” Theo Heller, MD, hepatology chief of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland, said during the advisory committee meeting in September. “Design a real study, do a real study, then we can talk about the data.”
In its complete response letter, FDA “said it was continuing to consider safety data from Study 747-302, along with other safety information,” according to Intercept.
Notably, the FDA this year granted accelerated approval to two other drugs — seladelpar (Livdelzi) and elafibranor (Iqirvo) — for PBC.

Ian Ingram is Managing Editor at MedPage Today and helps cover oncology for the site.

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Gender-affirming healthcare shouldn’t be limited to adults, members of the American Medical Association (AMA) House of Delegates said Monday at the delegates’ interim meeting in Orlando, Florida.
“As a pediatric endocrinologist myself, I’ve seen how appropriate, guideline-based [gender-affirming] care for my patients can be lifesaving,” said Brittany Bruggeman, MD, of Gainesville, Florida, an alternate delegate for the American Academy of Pediatrics who spoke for the delegation. “I have really seen the tremendous effects that when this care is done right by physicians and is based on guidelines — which is what this report calls for — it can dramatically improve the health of my patients. For this reason, the AMA should support doctors who are providing this care in a guideline-based way.”
The delegates were discussing a resolution offered by the Virginia delegation related to a report from the AMA Board of Trustees on “Advocating for the Informed Consent for Access to Transgender Healthcare.” The report, which an AMA reference committee had recommended that the delegates vote to adopt, stated that the association supports the provision of medically necessary gender-affirming care (GAC) but does not take a position on whether determination of medical necessity needs to include a gender dysphoria diagnosis.
The report further noted that the AMA “does not wish to … endorse one particular model of care over another. Rather, the AMA vigorously advocates for equitable payment policies while relying on the evidence-based professional guidelines and recommendations set by professional medical associations, as well as individual physician clinical judgment, on questions of appropriate clinical criteria.” The authors added that “GAC may be provided during or before adolescence; however, recognizing that providing GAC for children is fundamentally different than for adults due to differences in biology, psychology, and autonomy, the scope of this report is limited to gender-affirming medical interventions provided to adults.”
Tom Eppes, MD, of Forest, Virginia, speaking for the Virginia delegation, at first tried to get the report referred to the Board of Trustees for further study, with a report due back at the delegates’ 2025 annual meeting in June. He noted that “This report was released Saturday morning … less than 2 hours before the reference committee began. And unless you’re a speed reader, you didn’t have any chance to get through it. There was no chance to read it, no chance to discuss with delegations [or] comment online … We feel that this report needs to be reviewed in our House of Delegates in the same order that all other resolutions and reports have, and [the trustees should] report back next June for a vote.”
When that effort was voted down by delegates, Eppes, this time speaking for himself, then proposed that the new policy proposed in the board report — which said that the AMA “unambiguously supports access to and insurance coverage of medically necessary GAC” — include the words “for adults [over age 18]” at the end of that phrase. He added that the amendment “is to clearly delineate that this is about adults, not children. In the body of the report, it states there is a difference in children and adults, but later conflates adolescents as [sic] adults. I believe this addition makes clear that the intent of this report is for adults only.”
That proposal received a lot of pushback. “I don’t think that this amendment is necessary,” said Sophia Spadafore, MD, of New York City, a resident and fellow sectional delegate for the American College of Emergency Physicians, who was speaking for herself. “The words ‘medically necessary’ already appear in this report. This House of Delegates should defer to physicians who do this care … We have many adolescent physicians in this house — pediatricians who know what is medically necessary. I think that is fully covered. We don’t need this amendment.”
Catherine Gutfreund, MD, a family physician in Santa Rosa, California and alternate delegate from California who spoke for herself in opposition to the proposal, said she was the mother of a trans child “who was suicidal until she was able to get the treatment … And I can tell you with the biggest heart that now that she’s getting gender-affirming care, she’s doing fabulous.” Joanna Bisgrove, MD, of Evanston, Illinois, an alternate delegate for the American Academy of Family Physicians and the mother of a non-binary child who spoke for herself, said her family “changed states for a number of reasons, but the primary one was that my now-17-year-old could not get the care that they need, and we now have an ability for insurance to cover them.”
Frank Dowling, MD, of Islandia, New York, who spoke for the New York State delegation, said that “We have policy in New York that says that we will support physicians and other professionals who are providing gender-affirming care … I ask that we finally stop persecuting my children and their friends, myself, and others who identify as gender minority people, and just give us what everyone else has.”
No one besides Eppes spoke in favor of the amendment. In the end, the House of Delegates voted 127-486 against adding the phrase and then voted in favor of accepting the report as is.

Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow

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LOUISVILLE, Ky. — Large tumor size and high disease grade were associated with an increased risk of early cancer-related death in patients with high-risk, non-metastatic kidney cancer.
Patients with grade 4 tumors larger than 10 cm had an early cancer-specific mortality (CSM) rate of 41% — defined as cancer-related death within 24 months of nephrectomy — compared with 14% of all other patients. Extension into the inferior vena cava (IVC) thrombus, a rare but frequently fatal condition, did not increase the likelihood of early CSM.
The findings could help inform decision making regarding use of adjuvant immune checkpoint blockade in patients with high-risk, non-metastatic renal cell carcinoma (RCC), reported Mitchell T. Hayes, MD, of the Moffitt Cancer Center in Tampa, Florida, at the International Kidney Cancer Symposium.
“Patients with high-level thrombi have a high risk of perioperative death, which is more likely related to bleeding or some aspect of the surgery,” said Hayes. “We wanted to know more about cancer death at a later point in time, so we can really begin to think about who benefits from adjuvant immunotherapy. We don’t want to count patients who died from bleeding, vascular complications.”
“We found that when you combine just two variables — large, bulky, grade 4 tumors — there’s a statistically significant increased risk of non-perioperative death after surgery,” he continued. “We wanted to look at our own institutional cohort in light of recent trials of adjuvant immunotherapy. To all urologists who might not be sending everybody for adjuvant immunotherapy discussions, if you’re going to send anybody, maybe these patients with larger, grade 4 tumors definitely should have these discussions.”
The recent KEYNOTE-564 trial showed a survival benefit with adjuvant pembrolizumab (Keytruda) in high-risk RCC, but not all patients need adjuvant therapy, noted Priyanka Chablani, MD, of the University of Pittsburgh Medical Center.
“Some patients who are at low risk of recurrence and get adjuvant therapy might develop hypophysitis or adrenalitis or thyroiditis and then require long-term supplements to live with these effects,” she said. “It’s still unclear who really needs adjuvant therapy. We need more biomarkers.”
“I like how it was pretty clear here — greater than 10 cm, grade 4 tumors,” Chablani noted. “Sarcomatoid tumors, where even with T2 tumors we think about referring for adjuvant therapy, did not have an association, although you only had three patients. We need more studies like this and more biomarkers to understand who really should be getting adjuvant therapy.”
Hayes and colleagues retrospectively reviewed records of 134 consecutive patients treated from 2000 to 2019 who met KEYNOTE-564 inclusion criteria: clear cell histology; pT2G4 or sarcomatoid N0M0, pT3+ N0M0, or pTany N+M0; and an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1. The primary outcome was cancer-specific death within 24 months of nephrectomy.
Men accounted for 70% of the patients, median age was 66, and median follow-up was 72 months. A third of patients had IVC thrombus, a third had tumors ≥10 cm, and three-fourths had grade 3-4 tumors. Tumors >10 cm had a statistically significant association with early CSM (P=0.035), as did grade 4 disease (P=0.046).
Age at surgery, tumor thrombus classification, performance status, systemic symptoms at diagnosis, sarcomatoid features, rhabdoid features, and T4 disease did not significantly influence the likelihood of early CSM.
Hayes and colleagues acknowledged limitations to their study, primarily small numbers (17 patients total with large, grade 4 tumors), the retrospective design of the study, and reliance on data from two affiliated institutions.

Charles Bankhead is senior editor for oncology and also covers urology, dermatology, and ophthalmology. He joined MedPage Today in 2007. Follow

Disclosures
Hayes reported no relevant relationships with industry.Chablani disclosed relationships with Astellas, Aveo Oncology, Bayer, Exelixis, Seagen, Curio Science, DAVA Oncology, Gilead, and Mashup Media.

Primary Source
International Kidney Cancer Symposium
Source Reference: Miller JW, et al “Early postoperative cancer-specific death amongst patients with high-risk non-metastatic clear cell renal cell carcinoma: Refining risk stratification to optimize selection for adjuvant therapy” IKCS 2024; Abstract D8.

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The Justice Department and four Democratic state attorneys general argued that United’s takeover would limit competition and harm consumers needing home or hospice care.The Justice Department and four Democratic state attorneys general on Tuesday filed an antitrust lawsuit against the giant UnitedHealth Group in an attempt to block its $3.3 billion deal to take over Amedisys, a large home health company.“Unless this $3.3 billion transaction is stopped, UnitedHealth Group will further extend its grip to home health and hospice care, threatening seniors, their families and nurses,” Jonathan Kanter, the assistant attorney general who heads the department’s antitrust division, said in a statement on Tuesday.Antitrust regulators have been reviewing the proposed acquisition amid a federal inquiry into UnitedHealth’s sprawling dominance across nearly every segment of health care. As one of the biggest U.S. companies overall, with $372 billion in revenue in 2023, UnitedHealth’s operations include the nation’s largest health insurer and its Optum subsidiary, which oversees some 90,000 physicians, clinics and is a large pharmacy benefit manager. Last year, United bought one of the nation’s largest home health outfits, LHC Group.The company had come under broader scrutiny this year when the Justice Department began an antitrust investigation as part of the Biden administration’s crackdown on what it considered to be anti-competitive behavior among corporate behemoths like Apple and Google.Filed in federal court in Maryland just one week after the presidential election, the lawsuit was joined by the Democratic attorneys general from Maryland, Illinois, New Jersey and New York.UnitedHealth Group argued that its merger would give consumers more choices. “The Amedisys combination with Optum would be pro-competitive and further innovation, leading to improved patient outcomes and greater access to quality care,” Optum said in a statement. “We will vigorously defend against the D.O.J.’s overreaching interpretation of the antitrust laws.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Being disciplined for spreading misinformation made up less than 1% of medical board sanctions, making it the least common reason for physician discipline, a cross-sectional study found.
Among 3,128 medical board disciplinary proceedings involving physicians in the top five most populous states, sanctions for spreading misinformation to the community only occurred six times (0.1% of offenses) and spreading misinformation to patients under treatment occurred 21 times (0.3%), reported Richard Saver, JD, of the University of North Carolina School of Law in Chapel Hill.
Conversely, physician negligence (28.7%), problematic record-keeping (14.9%), and inappropriate prescribing (13.5%) were the most common reasons for discipline, Saver reported in JAMA Network Open.
“Misinformation offenses are not just at the bottom, but exponentially at the bottom compared to the other more common reasons medical boards are disciplining physicians,” Saver told MedPage Today.
During the early days of the COVID pandemic, there were alarming stories about physicians spreading falsehoods, Saver said, some of which resulted in public outcry. For instance, Stella Immanuel, MD, the highest prescriber of hydroxychloroquine and ivermectin during the pandemic, and Simone Gold, MD, JD, of America’s Frontline Doctors, are among physicians who openly promoted discredited COVID treatments, yet faced little punishment.
“As I started to look into it as a health lawyer, I realized it’s actually a very complicated regulatory matter, and that there are many potential barriers that medical boards might have to overcome in addressing this issue,” he said.
Saver also found that the frequency of disciplinary actions related to COVID-19 care, even if not about misinformation, were low (0.2%) and sanctions were relatively light. Additionally, physicians who spread falsehoods to patients faced discipline three times as often as those who disseminated misinformation to the community, “even though community-directed misinformation may pose greater harm overall,” he wrote.
“It is easier to regulate false communications to patients because that crosses the line from speech to conduct, and potentially, the inappropriate practice of medicine,” Saver said, noting that the First Amendment complicates things.
Spreading falsehoods to the community isn’t something medical boards have traditionally dealt with, and boards are often driven by complaints, which occur more often with adverse patient experiences.
Ultimately, Saver concluded that “limited discipline of physicians for spreading medical misinformation occurred,” and study findings suggested deeper problems and raised “doubt as to whether medical boards are institutionally suited to police medical misinformation.”
In an accompanying editorial, Megan Ranney, MD, MPH, of the Yale School of Public Health in New Haven, Connecticut, and Lawrence Gostin, JD, of Georgetown University Law Center in Washington, D.C., cautioned against Saver’s conclusion and argued that the onus shouldn’t necessarily fall on medical boards, especially because physicians are protected by free speech.
“Because the First Amendment protects information conveyed between health professionals and patients, licensing boards cannot impose sanctions without clear and compelling reasons,” they wrote. Instead, “medical board sanctions should be rare and used only if physicians consistently spread verifiably false information, in their professional capacity, that has demonstrated potential for harm.”
The editorialists also noted that other regulatory agencies — like the FDA and the Federal Trade Commission — also discipline the worst purveyors of misinformation, which they said might be a more appropriate response than medical board sanctions.
For the study, Saver analyzed all publicly reported licensure actions against physicians in the top five most populous U.S. states: California, Florida, New York, Pennsylvania, and Texas, from January 2020 through May 2023 (except for Texas, which was through March 2022). Based on a literature review, a list of 11 codes was developed to capture possible offenses leading to medical board discipline. The primary outcome was medical board disciplinary action that resulted in a sanction.
Saver noted four limitations, including that the medical board data only addressed licensure sanctions imposed after some form of administrative adjudication concluded and therefore may not show the full extent of their response to physician-spread misinformation. The frequency of physician-spread misinformation is also unknown, so it’s possible that the low levels of discipline reflect the rarity of this behavior. Third, variation in disciplinary activity likely exists between states, though the five reviewed were politically and geographically diverse. Lastly, instances of misinformation may be sanctioned in later medical board cycles.
Future research could analyze other states to add to the generalizability of these findings, as well as dig into the reasons why boards rarely discipline misinformation, Saver said.

Rachael Robertson is a writer on the MedPage Today enterprise and investigative team, also covering OB/GYN news. Her print, data, and audio stories have appeared in Everyday Health, Gizmodo, the Bronx Times, and multiple podcasts. Follow

Disclosures
Neither the study author nor the editorialists had conflicts of interest to disclose.

Primary Source
JAMA Network Open
Source Reference: Saver RS “Medical board discipline of physicians for spreading medical misinformation” JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.43893.

Secondary Source
JAMA Network Open
Source Reference: Ranney ML, Gostin LO “State medical board sanctions for misinformation should be rare” JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.43878.

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An estimated 16% of U.S. adults have diabetes, and 4.5% of cases are undiagnosed, according to a CDC report.
Supplementation with cholecalciferol (vitamin D3) and calcium reduced blood pressure in a 1-year randomized trial of older patients with overweight. (Journal of the Endocrine Society)
Novo Nordisk leadership acknowledged reports of mortality and hospitalizations among people taking compounded copies of semaglutide (Wegovy, Ozempic). (CNN)
Among postmenopausal women who had received denosumab (Prolia) for 2 or more years, sequential therapy with zoledronate did not prevent loss of bone mineral density in the lumbar spine in the first year, a randomized trial showed. (JAMA Network Open)
Few state Medicaid programs cover GLP-1 drugs for obesity, citing the agents’ high cost, a new KFF analysis found.
Diabetes and weight-loss drug tirzepatide (Mounjaro, Zepbound) was listed as a contributing factor in the death of a 58-year-old nurse from Scotland who died of multiple organ failure, septic shock, and pancreatitis. (BBC)
Lower income was tied to higher all-cause mortality among younger adults with type 2 diabetes in a South Korean cohort study. (JAMA Network Open)
Social media influencers may be driving a surge in testosterone replacement therapy in middle-age women. (NBC News)
Levels of plasma F2-isoprostanes — a reliable oxidative stress marker — was associated with an increased fracture risk in type 2 diabetes patients, an observational cohort study showed. (Journal of Clinical Endocrinology & Metabolism)

Kristen Monaco is a senior staff writer, focusing on endocrinology, psychiatry, and nephrology news. Based out of the New York City office, she’s worked at the company since 2015.

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