December 2022 – January 2023

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Doctored facts in The Australian

By Elizabeth Finkel
Illustration by Jeff Fisher
The danger of misrepresenting new malpractice regulations as muzzling doctors’ opinions

On Saturday October 8, The Australian published an op-ed titled: “Health disgrace: bureaucrats in bid to silence our doctors”. In a call to arms, Ramesh Thakur alerted readers to imminent Queensland legislation that would muzzle doctors’ medical opinions, particularly with respect to COVID-19 vaccinations. “So now it’s official. They have outlawed opinions,” he wrote.

The piece was certainly alarming. Especially given Thakur’s eminence: he is emeritus professor at the ANU Crawford School of Public Policy, and a former assistant secretary-general of the United Nations.

Online responses show readers were duly rallied. “One of the most important articles in The Australian all year. The ramifications are significant and every one of us should be made aware. Thank you The Australian for leading,” posted reader Jaybird. Reader Tim expressed admiration for the scholarly analysis: “The article itself is based on aggregating peer reviewed sources from journals with high impact factors.”

What Tim and others didn’t know was that Thakur’s aggregations from “peer reviewed sources” were brazen distortions rehashed from social media that have already been debunked by fact checkers, including most recently at RMIT University’s FactLab. While readers of social media are alive to the risks, the op-ed in our national broadsheet was a Trojan horse. Clad in the livery of scholarship, unsuspecting readers consumed the content wholesale.

Misinformation is the scourge of informed debate and democracy. It is also toxic to public health. By way of an antidote, let’s deconstruct the architecture of this narrative, beginning with its foundations.

Thakur’s opening assertion was a false alarm. He claimed that a bill, ultimately passed by the Queensland parliament on October 13, will trample doctors’ rights to express their medical opinions. It does no such thing.

The Health Practitioner Regulation National Law and Other Legislation Amendment Bill follows from a 2008 decision by the Commonwealth, states and territories to harmonise the regulation of health professions, from pharmacists to medical practitioners. Like a driver’s licence, this meant a health practitioner registered in one state would be recognised in another. Queensland was appointed the host state to pass legislation. The other states will mirror it through their own processes, except for Western Australia, which is expected to enact similar legislation. The latest amendment to the bill, the third since 2010 and three years in the making, allows for publicly naming health practitioners under investigation for serious malpractice. It’s not without its critics: the Australian Medical Association is concerned that the public naming of doctors under investigation would lead to an irretrievable loss of reputation even if a doctor is subsequently cleared.

Thakur, however, drew a long bow to equate the Queensland bill to Californian legislation passed in September that punishes doctors for providing false medical information to their patients about vaccines and treatments for COVID-19. “California’s legislature has just passed a similar law empowering the state’s medical board to revoke the licence of physicians who express opinions,” he wrote.

But according to a spokesperson for the Australian Health Practitioner Regulation Agency, which administers the health practitioner law, “the amendments to the national law have not changed the code of conduct for medical practitioners. Those guidelines are the same today as they were two months ago.”

As far as opinions about COVID vaccines, the spokesperson added, “we expect practitioners to use their professional judgement and the best available evidence to help their patients make safe and informed choices. We can only intervene if the public is at serious risk.”

A doctor’s opinion is a time-honoured part of the practice of medicine, and rightly so: the patient in front of them is a complex individual. But that opinion needs to be based on a sound understanding of the evidence and its limits: “evidence-based medicine”. Most doctors lack the expertise to filter the constant stream of evidence, especially when it becomes an unruly flood as it did during the early days of the pandemic. That did not stop some doctors from exercising firm opinions to the detriment of their patients. In 2021, the vast majority of COVID patients in US hospitals were unvaccinated, some of them following their doctor’s advice to reject vaccines in favour of the worming drug ivermectin. Fred Wagshul, a lung specialist based in Ohio, even tried to legally force a hospital to administer ivermectin against the recommendations of the US Food and Drug Administration.

Australia had the self-appointed doctors’ lobby group, the Covid Medical Network, enthusiastically promoting ivermectin and hydroxychloroquine while warning about the dangers of vaccines and railing against lockdowns and the wearing of masks. In early 2021, it promoted hydroxychloroquine, an erstwhile anti-malarial drug, as an early COVID treatment on its website, and was issued with a cease-and-desist notice by the Therapeutic Goods Administration. The TGA’s code requires that the advertising of therapeutic goods should “not mislead or deceive the consumer or create unrealistic expectations about product performance”. By July 2021, a British study showed that the use of hydroxychloroquine on seriously ill COVID patients not only failed to help them, it slightly increased their chance of dying.

The Covid Medical Network now seems to have rebranded itself as the Australian Medical Network. In September 2022, it wrote to the TGA requesting that the administration approve the use of ivermectin for treating COVID infections. This, after an April publication of the largest and most conclusive trial to date in the New England Journal of Medicine that showed ivermectin did not improve outcomes for COVID patients. In October, an even larger study published in the Journal of the American Medical Association showed the same result.

Thakur quoted the views of the Australian Medical Network in his article, parroting its claim that the Queensland bill would give health regulators “the power to sanction doctors for expressing their professional opinion based on their assessment of the best available science”.

In Thakur’s narrative, health bureaucrats, particularly the TGA, are the villains. His hero is the Australian Medical Network, which has a bizarre understanding of what constitutes “the best available science”.

Pandemic science is complex. Viruses mutate, infections rise and fall in waves, immunity wanes, different groups face different risks. Bottom line: the risk–benefit equation changes with time and is different for different people. Reflecting that complexity, “we try to give nuanced information”, says Allen Cheng, an infectious disease specialist at Monash University and a member of the Australian Technical Advisory Group on Immunisation (ATAGI).

The health bureaucrats at the TGA take advice on vaccines from ATAGI, whose members include university-based immunologists, infectious disease specialists, epidemiologists and paediatricians. For COVID treatments, that advice comes from a group with different expertise, the National COVID-19 Clinical Evidence Taskforce, which led the world with its rapid distillation of the emerging data on life-saving treatments.

The remainder of Thakur’s article attempted to build a case that Australia’s health bureaucrats bungled the advice on “the vexed issue of vaccines for young people”. It is indeed a vexed issue. While children are less likely than adults to become seriously ill with COVID, super-spreading variants such as Omicron mean more children will be seriously affected. On the other hand, current mRNA vaccines are less effective against Omicron and other new variants. They also carry the risk of myocarditis – inflammation of the heart muscle. The risk is highest in young men after the second dose, and greater with Moderna’s vaccine than Pfizer’s. Different countries have come up with different figures as to the actual risk. Let’s go with Israel’s, as it was the first country to carry out nationwide vaccination with the Pfizer vaccine and has vigilantly collected and analysed the data. The results show approximately one in 10,000 males aged between 16 and 29 developed myocarditis after vaccination. But the risk declines in younger age groups. For 12- to 15-year-old Israelis of all genders, the rate was one in 20,000 and all the cases were mild. Israel has yet to publish an analysis for younger age groups, but based on global studies to date ATAGI states that for children under the age of 11 “there is no clear attributable risk of myocarditis and/or pericarditis [inflammation of the heart membrane] from the COVID vaccines”.

To build his case, Thakur riled the reader by creating a false contrast between Australia’s vaccine advice and that of Scandinavian countries: “Denmark and Norway have banned Covid vaccines for healthy under-50s/65s … Yet our own Therapeutic Goods Administration has approved vaccines for children aged six months to five years.” There is a grain of truth here, in that each country arrives at slightly different positions in their recommendations for different age groups. With high rates of vaccination, and the lesser severity of the Omicron variant, mass vaccination campaigns for younger age groups have been rolled back. But neither Denmark nor Norway have banned COVID vaccines.

Thakur echoed a misinformation meme that went viral back in September, which claimed Denmark had banned vaccines for anyone under 50. Younger Danes are free to get a vaccine if they wish, and are encouraged to do so if they work with vulnerable people. Norway made vaccines available for those aged 5 to 11 last January. Thakur also omitted to explain that in Australia, the TGA only gives “provisional” approval for vaccines; the advice on how they should be used comes from ATAGI. Its advice: “ATAGI does not currently recommend vaccination for children aged 6 months to <5 years who are not in [high-risk] categories for severe COVID-19.” ATAGI’s website provides a nuanced discussion of the benefits, risks and rationale behind the advice. Importantly, ATAGI flags that recommendations may change with the new variants and vaccines on the horizon.

So, in fact, at this moment the Scandinavian countries and Australia have all advised against vaccinating healthy children between 6 months and 5 years.

The second piece of misinformation Thakur used to build his case was the opposite of actual findings published in September in the New England Journal of Medicine. The study compared the immunity of children who had been vaccinated with those who had previously had COVID and had never been vaccinated. According to Thakur, “The likely, albeit not definitive, explanation is that the vaccines themselves are damaging natural immunity.” This brazen misinformation had already done the rounds of social media and was debunked by the study’s lead author Danyu Lin, a biostatistics professor at the University of North Carolina: “The evidence we have supports the finding that natural immunity is boosted by vaccination rather than being destroyed by vaccination as claimed.”

Finally, let’s dismantle the capstone of Thakur’s narrative: the lament of British cardiologist Aseem Malhotra, whose 73-year-old father died of a heart attack six months after being vaccinated. Previously a champion of COVID vaccines, Malhotra electrified social media with his conversion story, saying he now believes the vaccine caused his father’s cardiac arrest. But with more than 12 billion shots of vaccine delivered globally, the scientific jury finds otherwise. There is clear, quantifiable evidence for a small increased risk of myocarditis after vaccination, predominantly in young men. There is also worrying evidence that a COVID infection itself raises the risk of subsequent heart attacks and strokes. There is, however, no evidence of a link between vaccines and the clogged arteries that led to Malhotra’s father’s death. Malhotra is no stranger to capturing the media with his contrarian views – he’s also been a major critic of using cholesterol-lowering drugs to prevent heart attacks.

So what was the response to Thakur’s mangling of the truth? Disappointingly neither ATAGI nor the TGA elected to respond to his article. In fairness, correcting misinformation is a game of whack-a-mole, and academics have their hands full analysing the latest information, leaving no time to fight endless rearguard battles. It’s an uneven playing field that pitches the measured and nuanced language of science against hyperbole and outrage.

For this reason, truth in the media is crucial. Thakur himself said as much, in an article he penned for Spectator Australia in 2021. It was titled “Democracy dies when the media lies”.

Elizabeth Finkel

Melbourne-based Elizabeth Finkel is a former biochemist who switched to telling the stories of other scientists. She is the former editor of Cosmos magazine.  

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