Targeting truth: gagging pharmacists in Missouri

There’s so much COVID-19 misinformation out there, it’s easy to become desensitized to it. But, a recently passed Missouri law (the Gag Rule) takes misinformation to a new height (low?) and may shock even the most cynical among us. 

The Gag Rule, which went into effect this week, bars pharmacists from proactively telling patients and physicians that two drugs, hydroxychloroquine and ivermectin, are not effective COVID-19 treatments (i.e., the truth). By using the power of the State to prevent the dissemination of critical and accurate clinical advice, the law is both a serious public health concern and an egregious attack on scientific integrity. Oh, and it also violates the First Amendment.

This blog has written extensively about the evidence clearly demonstrating that hydroxychloroquine and ivermectin are ineffective against COVID-19. It has also covered the boom in the sales of these drugs as a result of the politically motivated efforts by conservative media and politicians to promote them, evidence be damned. Those efforts have had real public health consequences, including unnecessary loss of life, health complications, spread of the virus, and burden on the healthcare system as patients forsake proven therapies for evidence-free practices. 

We have come a long way since March 2020, when President Trump, citing little-to-no evidence, first proclaimed hydroxychloroquine a “game changer.” Virtually every major public health authority, including the Trump administration’s Food and Drug Administration and National Institutes of Health, as well as the World Health Organization, has now come out against the use of either drug to treat COVID-19, and we now have several effective COVID-19 treatments, such as paxlovid and molnupiravir. So, please forgive us for hoping we had turned the page on this sad chapter of our pandemic response. 

But the saga of COVID-19 is a tale of hopes gone unfulfilled. In the face of this scientific consensus, Missouri’s legislature and Governor have chosen politics over public health. Not to be outdone by politicians who “merely” declared that these drugs were nothing short of miracle cures, Missouri saw fit to affirmatively ban pharmacists from countering those lies. That’s deeply concerning for two reasons. First, it prevents pharmacists from providing truthful advice about an issue with life-or-death consequences: the proper treatment for COVID-19. Second, it represents an alarming intrusion of politics into science and medicine. 

Pharmacists have played a key role in our pandemic response. They worked on the frontlines to ensure that patients received vital medications, they administered over 250 million doses of life-saving COVID-19 vaccines, and they have often acted as patients’ first point of contact with the health system. In that latter capacity, pharmacists help reduce vaccine hesitancy and educate patients on the best ways to prevent and treat COVID-19. This type of advice, from trusted community members, can save lives and reduce the spread of the virus. By preventing pharmacists from countering a particularly pernicious form of COVID-19 misinformation, the Gag Rule puts Missourians’ health at risk. 

The Gag Rule is also the consequence of a pattern of politicizing COVID-19 vaccines and treatments that has severely undermined the United States’s response to the pandemic. Scientific evidence, not the whims of politicians, needs to be the driving force behind clinical treatment, especially during a pandemic. This not only helps ensure sound decisions, but also public trust in those decisions. 

Fortunately, Ashley Stock, a Missouri pharmacist represented by the Hamilton Lincoln Law Institute, recently filed a federal lawsuit challenging the law as an infringement of the First Amendment. That lawsuit, in our opinion, is on firm ground. 

Missouri pharmacists want to engage in truthful speech, essential to the public health, on a matter of intense public debate. Such speech is entitled to full First Amendment protection. The State targeted that speech because it disagrees with its message. That violates the First Amendment’s core tenet. See Nat’l Inst. of Family & Life Advocates v. Becerra, 138 S. Ct. 2361, 2371 (2018) (“The fundamental principle” underlying the First Amendment is “that governments have ‘no power to restrict expression because of its message, its ideas, its subject matter, or its content.’” (quoting Reed v. Town of Gilbert, 576 U. S. 155, 163 (2015)). 

As such, to pass First Amendment muster, the State will have a heavy burden of demonstrating that the Gag Rule is carefully drawn to serve a compelling state interest. We believe that the State cannot carry that burden. Former Justice Anthony Kennedy previously wrote that laws that attempt to “manipulate the public debate through coercion rather than persuasion” strike at the “heart” of First Amendment. The Gag Rule is nothing more than a blundering effort to further that plainly illegitimate aim.

We’ll keep watch on this lawsuit and on any other state that has the poor judgment to follow in Missouri’s footsteps.