Ethics beyond Goldwater? Analyzing policies from American medical organizations on public communications from physicians in the digital age

Ethics beyond Goldwater? 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Analyzing policies from American medical organizations on public communications from physicians in the digital age Alexander Smith, Stefanie Hachen, Maria A. Oquendo, Dinesh Bhugra, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4750590/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Nov, 2024 Read the published version in Scientific Reports → Version 1 posted 13 You are reading this latest preprint version Abstract As a professional duty, physicians often publicly comment on health-related topics. However, ethical complexities can arise during discussions about high-profile individuals or events, especially in an era of rapid news cycles and digital media. The American Medical Association (AMA) has policies concerning physician commentary and media interactions, as does the American Psychiatric Association (i.e., the Goldwater Rule). Nevertheless, the extent to which other US medical associations have adopted similar protocols remains underexplored. Focusing on non-psychiatric members of the AMA’s policymaking body, the Federation of Medicine (FMMs), this study sought to analyse cross-speciality perspectives. Between January-March 2024, online resources for n = 122 FMMs were reviewed (e.g., professional codes and position statements), followed by email outreach to verify positions and garner further insights. n = 47 FMMs provided sufficient information for inclusion, cumulatively representing approximately 950,000 members. n = 16 FMMs (34%) had guidelines or policies regarding public commentary, generally emphasizing accuracy, consent, and confidentiality. Yet, for the majority of FMMs (n = 31/66%), no specific regulations were identified; these organizations did not cite any proprietary statutes or deferred to AMA materials. Moreover, existing FMM policies largely overlooked the impact of Artificial Intelligence and digital misinformation, warranting cross-specialty exchanges to uphold credible discourse amid societal and technological shifts. Health sciences/Health care/Health policy Health sciences/Health care/Medical ethics Goldwater Rule American Medical Association Medical ethics Artificial intelligence misinformation 1. Introduction 1.1. Public commentary from physicians and media interactions Amid technological changes and fast-paced news cycles, physicians are regularly called upon to discuss health-related subjects across various public and media platforms. The COVID-19 pandemic underlined the impact of medical perspectives on wider behaviors, reinforcing the duty of physicians to engage in reliable communications for health promotion and educational purposes [ 1 – 3 ]. However, when physicians provide opinions in relation to specific people or incidents, this can provoke moral concerns about role responsibilities and possible malpractice or defamation [ 4 – 8 ]. Again, this was demonstrated in the COVID-19 pandemic, with physicians in the United States and elsewhere propagating misinformation and erroneous messaging about vaccines, masks, and other public health measures [ 7 ]. Likewise, ethical dilemmas can transpire when unsubstantiated medical opinions or speculative “armchair diagnoses” are proffered without firsthand examinations of the person in question or the person’s consent [ 4 – 6 , 8 ]. Such situations may obfuscate the boundaries between statements intended to expand public health literacy and those conveying conjectural views, potentially undermining patient confidentiality and trust in medicine [ 4 – 6 , 8 ]. These scenarios may be particularly pertinent in the digital age, where clinical insights can be quickly disseminated and misinterpreted, conceivably adding to the spread of misinformation [ 2 , 3 , 7 ]. Contemporary innovations in Artificial Intelligence (AI) and digital tools can further complicate the authenticity and accuracy of health-related discourse, with deepfakes and distorted content gaining increasing traction [ 9 ]. In the United States, communications from physicians about prominent figures (especially political leaders) have divided opinion, thereby reflecting these complex dynamics. Notably, contentious exchanges emerged in the psychiatric discipline after the 2016 election when specialists hypothesized about the mental health of the then-president, Donald Trump [ 10 – 12 ]. More recently, psychopathological conjecture has abounded about the current president, Joe Biden [ 9 ]. Likewise, specialists have discussed the mental health of other politicians and celebrities across academic and public forums, such as the singer, Britney Spears, and the actors, Robin Williams and Johnny Depp [ 4 , 8 , 13 , 14 ]. Similar cases have also occurred in different medical specialties in the United States; this includes anesthesiology, forensic medicine, plastic surgery, cardiology, neurology, and oncology, among others [ 4 , 8 , 15 – 17 ]. Relatedly, in Europe, the Russian President, Vladimir Putin, has elicited psychiatric speculation, which intensified following the 2022 invasion of Ukraine [ 18 ]. In Germany, when the-then Chancellor, Angela Merkel, exhibited persistent tremors in 2019, neurologists theorized about this in the press, triggering a media backlash for perceived privacy infringements [ 19 ]. In 2024, physicians discussed the cancer diagnoses of King Charles III and Princess Catherine, again prompting considerations around the sensitivity and probity of medical discourse conveyed via traditional and digital media [ 20 ]. Elsewhere, questions have materialized about physician conduct in India and South Korea [ 6 ], where openly-expressed medical opinions may have contributed to sensationalist reporting. 1.2. Existing ethical frameworks around public commentary in the United States The American Medical Association (AMA) is the preeminent body representing physicians in the United States. The AMA seeks to uphold professional and ethical standards through its Code of Medical Ethics [ 21 ]. Alongside the seven general Principles of Medical Ethics, the Code contains Opinions that “represent AMA policy” and address “issues and challenges confronting the medical profession” [ 21 ], including public commentary and physician-media interactions. While the judicial status of these Opinions varies state-by-state [ 22 ], they have recurrently shaped practice laws and the role responsibilities of American physicians. Opinion 8.12. from the AMA states that physicians should: “[b]e aware of how their medical training, qualifications, experience, and advice are being used by media forums and how this information is being communicated to the viewing public”; “[r]efrain from making clinical diagnoses about individuals (e.g., public officials, celebrities, persons in the news) they have not had the opportunity to personally examine”; “[p]rotect patient privacy and confidentiality by refraining from the discussion of identifiable information”; and “[c]onfine their medical advice to their area(s) of expertise” [ 23 ]. Correspondingly, Opinion 3.1.15. centers around physician-media relationships and implications for patients. This enjoins physicians to “[o]btain consent from the patient or the patient’s authorized representative before releasing information” and “[e]nsure that no statement regarding diagnosis or prognosis is made except by or on behalf of the attending physician” [ 24 ]. As a member of the Federation of Medicine (which is part of the AMA’s policymaking body, the House of Delegates [ 25 , 26 ]), the American Psychiatric Association (APA) created annotations to the AMA’s Principles of Medical Ethics. Section 7.3. (i.e., the Goldwater Rule) notes that psychiatrists may be: “asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement” [ 27 ]. This was instituted in 1973 after a Fact Magazine feature presented medical conjectural about Senator Barry Goldwater [ 6 ]. Subsequently, the APA’s position has attracted scrutiny, especially following public exchanges about President Trump [ 12 ]. 1.3. The current study The AMA’s Code of Medical Ethics and the APA’s Goldwater Rule are influential frameworks for guiding public communications by American and international medical experts [ 6 , 21 ]. With over 250,000 AMA members, the Code of Ethics is broadly recognized among physicians and state legislatures in the United States [ 22 , 28 ]. Likewise, certain European national-level psychiatric association have adopted the discipline-specific Goldwater Rule (e.g., [ 29 ]). Nonetheless, it remains unclear whether bodies from other medical domains in the United States follow these standards or have formulated specific recommendations and protocols for their discipline and membership. Consequently, this study aims to explore organizational positions on public commentary and media interactions, beyond those from the AMA and the APA. To that end, we sought to assess the policy landscape from members of the Federation of Medicine [ 25 , 26 ] (FMMs). Given the potential complexities when medical and clinical perspectives are publicly communicated, these insights may be particularly timely, with cross-jurisdictional debates and contexts of practice continuing to evolve [ 2 – 6 , 9 , 19 , 20 , 30 ]. 2. Results 2.1. Overview of FMM positions This study yielded an inclusion rate of 38% from the total sample of n = 122 FMMs, capturing the perspectives of n = 47 organizations. Covering a range of medical specialties these 47 entities together have approximately 950,000 members in the US and globally (per available data); that said, these 950,000 members may not be unique since individuals may be affiliated with more than one professional entity. Membership demographics varied by FMM but primarily included individual physicians. Yet, dependent on the organization and specialty, FMMs may also represent medical students, researchers, allied health professionals, accredited centers, and other non-physician providers. Per our analysis, of these n = 47 FMMs, n = 16 (34%) were classified into the “Organizational-level policy or guidelines” group, while n = 31 (66%) were coded as having “No organizational-level policy or guidelines”. An overview of included FMMs and their categorization is available in the Supplemental Materials, with detailed positions described below. 2.2. Organizational-level policy or guidelines (n = 16) In this category, the American College of Physicians (ACP) had the largest membership base, representing around 161,000 individuals. This FMM publishes an extensive Ethics Manual containing provisions on public commentary and press interactions. Here, the ACP exhorts that “physicians should provide news media with accurate information, recognizing this as an obligation to society, but confidentiality of patients must be respected” [ 31 ]. The American College of Surgeons (ACS) has instituted a Code of Professional Conduct for its members, with apposite clauses around public representation and media engagements. The ACS assert that a “surgeon’s release of material to communications media or nonprofessional publications should be designated only for education and public information” [ 32 ]. For the ACS, public interactions “must be accurate” and “must not convey false, untrue, deceptive, or misleading information through statements, testimonials, photographs, graphics, or other means, and “must contain sufficient supporting material” [ 32 ]. Additionally, if “a surgeon is reimbursed or sponsors a communication, that fact must be made clear” and “[r]eleases must not create unjustified expectations of results”, “must not misrepresent a surgeon’s credentials, training, experience, or ability” and should contain substantiated claims [ 32 ]. Analogously, the American Academy of Orthopaedic Surgeons (AAOS), the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNSF), and the American Association of Neurological Surgeons (AANS) all share equivalent statements prohibiting communications that are “false”, “untruthful” “misleading” or “deceptive” [ 33 – 35 ]. The American Academy of Ophthalmology (AAO) has rigorous rubric on commentary and media statements, akin to the ACS. In Section 13 of its Code of Ethics, the AAO avers that public communications “must be accurate. They must not convey false, untrue, deceptive, or misleading information through statements, testimonials, photographs, graphics or other means” [ 36 ]. Members “must not omit material information without which the communications would be deceptive”, “must not appeal to an individual’s anxiety” excessively or unfairly and “must not create unjustified expectations of results” [ 36 ]. Moreover, like other FMMs, the AAO emphasizes that communications “must not promote health-related misinformation” or “false, deceptive, or misleading” claims [ 36 ]. AAO Fellows and Members “must not” misrepresent their training or expertise and “statements based on opinion must be identified as such” and must not contain unsubstantiated “material claims of safety and/or efficacy” [ 36 ]. This also applies to social media exchanges [ 37 ]. Additionally, the North American Neuro-Ophthalmology Society (NANOS) upholds near-identical standards to the AAO in its Code of Ethics (Section 6.1) and its advisory on social media usage [ 38 , 39 ]. This FMM stipulates in “no event should a neuro-ophthalmologist publicly use or otherwise disclose any patient’s medical condition or treatment” without “prior written consent” [ 38 ]. Elsewhere, the American College of Cardiology (ACC) has instituted regulations pertaining to public commentary. In Section 1.7 of its Code of Ethics, the ACC notes that members should “provide pertinent medical information” to “the public only with the appropriate consent and permission of the patient” [ 40 ]. Further, the American Academy of Neurology (AAN) addresses this topic in its Code of Professional Conduct (Section 7.1). Similar to other FMMs, this organization writes that “AAN members must not represent themselves to the public in an unprofessional, untruthful, misleading, or deceptive manner” [ 41 ]. Supplementing their Code of Professional Conduct, the AAN produced a position paper on social media comprising of recommendations and case vignettes; this reinforces the centrality of patient privacy when discussing health-related information [ 42 ]. Comparable wording has been adopted by the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). In its ethical statutes about clinical practice (Section 6), this FMM declares that physicians “should not represent themselves to the public in an untruthful, misleading, or deceptive manner regarding qualifications, credentials, and expertise through statements, testimonials, photographs, graphics, or other means” [ 43 ]. The AANEM also proclaim that a “patientʼs medical condition must not be discussed publicly without his or her consent” [ 43 ]. The American Urological Association (AUA), the American College of Allergy, Asthma & Immunology, and the American Academy of Dermatology had bespoke positions on social media. Generally, this underscored the importance of professional probity, patient confidentiality, and protecting the reputation of medicine [ 44 – 46 ]. For instance, the AUA write “[s]ocial media must be used in an ethical and transparent way” and that “[m]embers, in their professional communications, must not post inappropriate, discriminatory, or unprofessional content” or “disclose any patient health information without consent” [ 44 ]. Finally, the American Institute of Ultrasound in Medicine stated that it refrains from making comments about high-profile figures, maintaining a neutral stance as a formal policy. This was echoed by the American Society of Transplant Surgeons and the National Association of Medical Examiners, who both avowed that they would not comment on the health status of individuals. 2.3. No organizational-level policy or guidelines (n = 31) For the FMMs in this group, we did not identify any express ethical recommendations or provisions around public commentary, and the n = 31 organizations did not highlight any measures in their responses. Yet, this does not necessarily mean that FMMs in this category did not have broader stances that might implicitly affect the scope of public communications. For instance, with around 54,000 members, the Radiological Society of North America formally adopted the AMA’s Principles of Medical Ethics in its bylaws [ 47 ]. These promote general expectations for professional conduct but do not contain detailed ethical rules on the probity of public statements from physicians [ 21 ]. Similarly, certain FMMs had potentially relevant guidelines regarding patient confidentiality, research ethics, protecting patient interests, societal responsibilities, and expert witness requirements (e.g., [ 48 – 50 ]). Again, however, these did not contain protocols or clauses explicitly for public ccommentary. Elsewhere, FMMs cited different reasons for their lack of organizational-level rubric. This included the American Geriatrics Society, the American Society for Clinical Pathology, and the International College of Surgeons: U.S. Section; these FMMs attested that they are not governing bodies or regulatory agencies or focus on educational and humanitarian initiatives rather than policymaking. Additionally, the American Academy of Physicians in Clinical Research indicated that it does not have its own documentation and defers to those from federated entities (e.g., the AMA). Notably, several organizations suggested that they had not yet encountered a need for bespoke policies, instead referring to the AMA’s Code. 3. Discussion 3.1. Professional and ethical frameworks surrounding public commentary from FMMs Our findings underline various cross-specialty perspectives and regulations from FMMs. The n = 16 FMMs who had policies on physician commentary and media representation often shared broad consistencies that largely corresponded with the AMA’s Opinions and standards from international regulatory bodies (e.g., [ 51 , 52 ]). Thus, within wider contexts of practice, this implies a harmonization on upholding tenets of factual and evidence-based communication that respects patient privacy; by extension, this would prohibit “armchair diagnoses”, which are based on incomplete data where the person in question has not been duly examined. As general physician values, these could be promoted in training and education schemes, even by those FMMs who rely on principlism and do not enforce comprehensive ethical or professional codes [ 53 ]. Common language from FMMs foregrounded patient confidentiality and avoiding “untruthful”, “misleading”, “deceptive”, or unsubstantiated statements through traditional or social media. This mirrors sections of the AMA’s Code, the APA’s Goldwater Rule, and other well-recognized literature. Notably, the AMA’s Opinion 8.1.2 enjoins physicians to “ensure that the medical information they provide is […] based on valid scientific evidence and insight gained from professional experience”, underscoring the importance of personal privacy [ 23 ]. Elsewhere, the International Code of the World Medical Association (WMA) affirms that “[p]hysicians play an important role in matters relating to health, health education and health literacy” [ 51 ]. In doing so, the WMA contends that physicians “must be prudent in discussing new discoveries, technologies, or treatments in non-professional, public settings, including social media, and should ensure that their own statements are scientifically accurate and understandable” [ 51 ]. Comparable principles are highlighted by the United Kingdom’s General Medical Council’s (GMC) in its Good Medical Practice, asserting that medical communications should be “accurate” and physicians “must not present opinion as established fact” [ 52 ]. For public statements from physicians, several FMMs accentuated the necessity of accurately indicating clinical competencies and training (e.g., the ACS, the AAO, and the AANEM), individual consent (e.g., the ACC, the AAO, the AAU, and the AANEM), and disclosing conflicts of interest (e.g., the ACS and the AAO). Again, this aligns with aspects of the Goldwater Rule, together with the AMA’s Code and the GMC’s Good Medical Practice [ 23 , 24 , 52 ]. Specifically, the AMA’s Opinions 3.1.5 and 8.1.2 stipulate that physicians should “[c]onfine their medical advice to their area(s) of expertise”, “clearly distinguish the limits of their medical knowledge”, and “[o]btain consent from the patient” before “releasing information” [ 23 , 24 ]. Moreover, in media interactions, the AMA urges physicians to “disclose any conflicts of interest and avoid situations that may lead to potential conflicts” [ 24 ]. Similarly, the APA deems public commentary from psychiatrists about individuals unethical unless they have been “granted authorization” [ 27 ]. Nevertheless, there were semantic discrepancies between FMM stances and the AMA’s Opinions, possibly informed by disparate organizational missions or the scope of their ethical documentation. This was evident in the Code of Professional Conduct by the ACS and the Code of Ethics from the AAO, who have sizeable membership bases and have implemented rigorous rubric [ 32 , 36 ]. For clauses on public and media interactions, the ACS and the AAO recurrently employed the didactic “must” (as periodically did different FMMs (e.g., [ 34 , 41 , 44 ])). This would appear to accord with the prescriptive nature of the APA’s Goldwater Rule, rather than the implicit flexibility in the AMA’s Opinions that frequently state “Physicians should ” (italics ours) [ 23 , 24 ]. Other FMMs in our results also used “ should ” (e.g., the ACP [ 31 ]). Conceivably, this stronger terminology from certain FMMs may indicate a desire to apply stricter frameworks for their members, accentuating definitive notions of accountability over contextual interpretation or principlism. Interestingly, the AAO [ 36 ] and additional FMMs (e.g., [ 34 , 38 ]) outlined specific disciplinary processes for ethical breaches, including membership revocation. Previously, there have been discussions about applicable sanctions for APA members for apparent Goldwater Rule violations [ 53 ]. Yet, at the time of writing, it remains unclear if any organizations have expelled members for transgressing provisions on public representation, or if these are intended more as a deterrence, despite instances of inappropriate commentary continuing to emerge. 3.2. Current gaps and emerging challenges The majority of included FMMs (i.e., n = 31/66%) had no explicit stances or documentation governing the scope of public commentary. As highlighted, this could be conditioned by specific organizational missions or the membership compositions of FMMs who may cover a large proportion of non-clinical professionals. Likewise, it is probable that many FMM physician-members have overlapping affiliations to the AMA or other discipline-specific associations. These physicians would be simultaneously governed by the rubric of several bodies; for instance, one of these organizations may have established documentation that strictly prohibits speculative diagnoses without comprehensive data or patient consent, whereas others do not. Consequently, physicians may need to navigate a complex landscape of overlapping statutes and standards, which can enhance accountability but also complicate adherence to divergent organizational rules. Additionally, as several FMMs indicated, the paucity of guidelines reflected in our results may stem from disparate professional or clinical responsibilities and membership demands, influencing perceptions about the dimensions of public communications. Simply put, it could follow that physicians in clinical settings or disciplines with higher burdens of disease (e.g. psychiatrists) may be more likely to encounter public or media requests for expertise than those in less clinically-facing domains (e.g., insurance medicine practitioners). Nonetheless, past incidents have repeatedly illustrated how physicians across various medical specialties have offered insights on high-profile events or subjects [ 3 – 20 ], resulting in contentious and problematic statements. Analogously, the proliferation of fast-paced news cycles and sensationalist reporting have compounded ethical considerations in this area, as exemplified in the COVID-19 pandemic where medical misinformation was quickly shared [ 1 – 3 , 7 ]. In sum, the findings underline a need for greater organizational awareness from FMMs about the complexities surrounding public communications from physicians. There have been prior exchanges about implementing new or adapted regulations at a specialty-specific level (e.g., in sports medicine [ 54 ]) and revising established frameworks like the APA’s Goldwater Rule [ 6 , 12 , 30 ]. Accordingly, as a foundational basis, FMMs lacking comprehensive ethical or professional protocols could consider developing educational resources (e.g., position statements or case vignettes) to help their members deal with complex media requests or interactions about sensitive matters. This should be underpinned by collaborations involving existing organizational-level ethics committees, individual memberships, and other applicable stakeholders in the Federation of Medicine, particularly those FMMs working in disciplines where press interest is commonplace. Of the FMM materials summarized above, there was limited consideration about the impact of modern technologies and AI on medical communications; many guidelines were drafted prior to these innovations. Notably, this has been cited as a criticism of the Goldwater Rule, which was conceptualized before the advent of digital media [ 6 , 9 , 12 ]. Yet, as recently demonstrated, such tools can be manipulated to amplify health-related misinformation. This can present significant ethical problems for physicians who may be requested to comment on fake cases with limited information or context; in doing so, they risk further propagating misinformation. Examples include deepfakes of President Joe Biden appearing to exhibit signs of cognitive decline, an AI-generated hoax about a fatality following complications from cosmetic surgery, and researchers who intentionally created blog posts showcasing erroneous clinical testimonies [ 55 – 57 ]. Equally, the wide-reaching and instantaneous nature of social media can support the spreading of deliberate medical misinformation or render physician commentary open to misinterpretation, which, again, has entailed controversies (e.g., [ 2 , 7 , 20 ]). Alongside the AMA [ 58 ], certain FMMs have developed bespoke member-facing information regarding conduct on social media (e.g., [ 37 , 39 , 42 , 44 , 45 , 46 ]). Yet, there was scant material covering the associations between AI and clinical discourse (except an AUA provision on AI content creation [ 44 ]), especially regarding the implications of digitally-distorted content. This is a substantial gap in current provisions, warranting additional scrutiny about how physicians can combat misinformation while following recognized standards [ 9 ]. The AMA and the APA have launched projects on misinformation [ 59 , 60 ], but proactive cross-specialty approaches are necessary as these technologies continue to shape modern communications. To that end, FMMs should acknowledge the increasing urgency of these challenges, considering pragmatic adaptations to their ethical regulations and leveraging their influence to enhance wider initiatives across the medical community, both in the United States and internationally. 3.3. Limitations and future research directions This investigation sought to gain perspectives about the ethical and professional guidelines surrounding public commentary from physicians on the health status of individuals. Although the findings present a range of positions on this subject from US FMMs, the study has several limitations that could be considered in future research. The methodology yielded a 37% inclusion rate, with 47 FMMs providing sufficient information. While these bodies represent around 950,000 members, several major specialty-specific FMMs remained absent from our analysis; this limits the ability to generalize the findings. Data gathering involved reviewing publicly available documentation, followed by correspondence with FMMs. In these communications, it is possible that certain organizations may have misunderstood the purpose of the study, influencing both the response rate and the sample size, as we only included FMMs who replied to our enquiries. Taken together, this may affect the representativeness and comprehensiveness of the results, potentially overlooking organizations with pertinent policies who did not engage with our emails or display accessible literature online (e.g., in a members-only area). Equally, as this study was cross-sectional, certain FMMs may have updated their regulations or policies on public communications since data collection ended. Again, this might impinge upon the reliability of the investigation. Additionally, the coding and analysis of FMM responses could entail subjectivity or reproducibility concerns. To uphold accuracy, detailed searches were conducted of FMM websites and comparisons were made between responses and publicly available documentation. In cases of disagreement or where there were discrepancies between FMM responses and web resources, a third member of the research team was consulted, and a consensus was reached. Despite this, the potential for misinterpretation cannot be entirely discounted. Overall, this study offers insights into the ethical frameworks around public commentary by American physicians, raising possible research avenues. As a follow-up, future inquiries could explore how specific medical disciplines adapt to evolving challenges, particularly emerging technologies like AI and evolving societal attitudes toward public-medical discourse. Moreover, investigating the role of medical education in preparing physicians for media interactions and AI would also be beneficial. This could encompass various methodological designs, such as survey-based projects or qualitative interviews examining the salience and importance of these topics in curricula materials. Finally, views from international organizations should also be explored to identify possible best practices that can be adapted to different cultural and national contexts of practice. While the ethics of “armchair diagnoses” have been scrutinized outside the United States (e.g., [ 6 , 9 , 19 , 29 ]), there remains a need for comprehensive, cross-national studies to help synthesize wider positions on this topic. 3.4. Conclusions This investigation sought to examine current stances and policies surrounding public commentary from physicians in the United States. While n = 16 FMMs have developed guidelines on this issue, a significant number of organizations lacked specific documentation addressing the ethical dimensions of public communications and the potential harms from uninformed opinions. Further, there was a scarcity of resources related to digital technologies and AI, which is concerning in the context of health-related misinformation. Resultantly, these findings suggest a need for comprehensive initiatives to be more widely considered. To that end, intra- and cross-specialty collaborations involving FMMs, the AMA, and other international stakeholders should be encouraged to promote accurate and respectful medical discourse, aligning with the demands of the digital era. 4. Materials and methods 4.1. Sample and data gathering As a conceptual basis, this study utilized a prior methodology exploring the positions of European national psychiatric associations on the APA’s Goldwater Rule [ 6 ]. The current inquiry focused on members of the Federation of Medicine [ 25 ] (FMMs), a collective body within the AMA’s House of Delegates that includes 126 national US societies. Excluding the APA and psychiatric subspecialty groups, we examined a sample of n = 122 FMMs to derive official positions and statutes concerning public communications from physicians. A two-tiered approach for data collection was adopted between January-March 2024. The first stage involved reviewing apposite FMM web materials, including ethical and professional codes of conduct, position statements, bylaws, or constitutions that were publicly displayed. FMM web addresses were obtained from the Federation of Medicine directory, which is accessible through the AMA [ 26 ]. Subsequently, to verify existing information or where applicable resources were not available online, the research team contacted all n = 122 FMMs via email to ascertain if they had explicit provisions on public commentary or similar rubric as the Goldwater Rule. Again, contact details were sourced through the Federation of Medicine directory or FMM websites [ 26 ]. In these communications, FMMs were informed that their responses would be used for a project to be published in an academic journal. No financial compensation was offered for participation. 4.2. Analysis At the end of data collection, two members of the research team compared FMM answers to extant web resources to uphold accuracy. During this process, FMM positions were synthesized and coded to three classifications, namely: “Organizational-level policy or guidelines”, “No organizational-level policy or guidelines”, and “No response”. Where discrepancies or disagreements arose, another member of the research group was consulted, and a consensus decision was adopted. Specifically, the FMMs within the “Organizational-level policy” category had implemented their own rules around public commentary. Conversely, “No organizational-level policy or guidelines” refers to those FMMs that had not yet introduced specific recommendations or produced documentation about this issue. Finally, the “No response” group contained FMMs that did not reply to our correspondence or provided insufficient information for the final analysis. 4.3. Ethical considerations Information from FMMs was either willingly provided by respondents or was publicly accessible. Although some human participation was needed for our enquiries, the primary goal of the study was to collate organizational stances and perspectives. Therefore, since no personal or sensitive information was acquired or assessed, formal ethical approval was not sought. Nevertheless, the research team took care to ensure respect during data collection, especially in FMM communications, and to maintain integrity and accuracy throughout the analysis. Abbreviations AAN - American Academy of Neurology AANEM - American Association of Neuromuscular & Electrodiagnostic Medicine AANS - American Association of Neurological Surgeons AAO - American Academy of Ophthalmology AAOS - American Academy of Orthopaedic Surgeons AAO-HNSF - American Academy of Otolaryngology—Head and Neck Surgery ACC - American College of Cardiology ACP - American College of Physicians ACS – American College of Surgeons AI – Artificial Intelligence AMA - American Medical Association APA - American Psychiatric Association AUA - American Urological Association FMM – Federation of Medicine Member GMC - General Medical Council NANOS - North American Neuro-Ophthalmology Society WMA - World Medical Association Declarations Competing Interests Maria A. Oquendo is a past president of the American Psychiatric Association and is a member of the National Academy of Medicine in the United States. Dinesh Bhugra is a past president of the British Medical Association, the World Psychiatric Association, and the Royal College of Psychiatrists. The other authors have no competing interests to declare. Author Contribution AS: Conceptualization; Writing – original draft; Writing – review and editing; Methodology; Formal analysis. SH: Conceptualization; Writing – original draft; Writing – review and editing; Methodology; Formal analysis. MAO: Conceptualization; Writing – review and editing. DB: Conceptualization; Methodology; Writing – review and editing. AV: Conceptualization; Writing – review and editing. ML: Conceptualization; Writing – original draft; Writing – review and editing; Methodology; Formal analysis; Supervision Acknowledgement The authors are grateful to those FMMs who engaged with our correspondence during this study. Data Availability All data generated or analysed during this study are included in this published article and its supplementary information files. References Solnick RE, Chao G, Ross RD, Kraft-Todd GT, Kocher KE. Emergency Physicians and Personal Narratives Improve the Perceived Effectiveness of COVID-19 Public Health Recommendations on Social Media: A Randomized Experiment. Acad Emerg Med. 2, 172–183 (2021). Baron RJ, Ejnes YD. Physicians Spreading Misinformation on Social Media - Do Right and Wrong Answers Still Exist in Medicine?. N Engl J Med. 387, 1–3 (2022). Carlo AD, Barnett BS, Essien UR, Galea S. Redefining Medicine's Relationship with the Media in the Era of COVID-19. Am J Prev Med. 60, 142–145 (2021). Schumann JH. Speculating on a public figure's mental health. Virtual Mentor. 15, 829–833. (2013). Cooke BK, Goddard ER, Werner TL, Cooke EO, Griffith EE. The risks and responsible roles for psychiatrists who interact with the media. J Am Acad Psychiatry Law. 42, 459–468 (2014) Smith A, Hachen S, van Wijnkoop M, Schiltz K, Falkai P, Liebrenz M. The Goldwater Rule at 50 and its relevance in Europe: Examining the positions of National Psychiatric Association Members of the European Psychiatric Association. Eur Psychiatry. 66, e34; 10.1192/j.eurpsy.2023.22 . (2023). Sule S, DaCosta MC, DeCou E, Gilson C, Wallace K, Goff SL. Communication of COVID-19 Misinformation on Social Media by Physicians in the US. JAMA Netw Open. 6, e2328928; 10.1001/jamanetworkopen.2023.28928 (2023) Friedman RA. Role of physicians and mental health professionals in discussions of public figures. JAMA. 300, 1348–1350. (2008). Smith A, Bhugra D, Chisolm MS, Oquendo MA, Ventriglio A, Liebrenz M. Ethics and disinformation on the campaign trail: psychiatry, the Goldwater Rule, and the 2024 United States presidential election. Lancet Reg Health Am. 31, 100692. (2024). Greenhalgh T. “Do doctors have a duty to hold their silence or to voice concern about Donald Trump’s health?”. BMJ Blogs . https://blogs.bmj.com/bmj/2017/01/30/trish-greenhalgh-do-doctors-have-a-duty-to-hold-their-silence-or-to-voice-concern-about-donald-trumps-health/ (2017). Lee, BX. Silence versus bearing witness: Psychiatrists' responsibility to society. Forensic Science International: Mind and Law 2, 100069; 10.1016/j.fsiml.2021.100069 (2021). McLoughlin A. The Goldwater Rule: a bastion of a bygone era?. Hist Psychiatry. 33, 87–94 (2022). Today. Psychiatry prof lists Britney’s crazy credentials. Today . https://www.today.com/popculture/psychiatry-prof-lists-britney-s-crazy-credentials-wbna21743405 (2007). Tohid H. Robin Williams' suicide: a case study. Trends Psychiatry Psychother. 38, 178–182 (2016). Benjamin C. Damar Hamlin injury: NFL cardiologist offers insight into what may have happened to Bills safety, what's next. CBS Sports. https://www.cbssports.com/nfl/news/damar-hamlin-injury-nfl-cardiologist-offers-insight-into-what-may-have-happened-to-bills-safety-whats-next/ (2023). Weigel D. Body doubles, secret doctors: Clinton conspiracy theories blossom after pneumonia diagnosis. The Washington Post . https://www.washingtonpost.com/news/post-politics/wp/2016/09/12/body-doubles-secret-doctors-clinton-conspiracy-theories-blossom-after-pneumonia-diagnosis/ (2016). Glover S. Doctor talks about Donda West’s death. Los Angeles Times . https://www.latimes.com/archives/la-xpm-2007-nov-20-me-west20-story.html (2007). Polskie Radio. Professor Lew-Starowicz: "Putin has many typical features of a psychopath". Polskie Radio.; https://www.polskieradio.pl/395/9766/artykul/3025332,professor-lewstarowicz-putin-has-many-typical-features-of-a-psychopath (2022). Stokowski M. Einfach mal still sein [Just be quiet]. Der Spiegel . https://www.spiegel.de/kultur/gesellschaft/angela-merkel-und-ihr-zittern-in-den-medien-einfach-mal-still-sein-a-1277507.html (2019). Matthews S. NHS doctor sparks backlash with 'irresponsible' and 'childish' claim that Princess Kate would have been sent home within a DAY had she been treated on the NHS - as he is accused of speculating what is wrong with her. The Daily Mail. https://www.dailymail.co.uk/health/article-12977721/Doctor-sparks-social-media-row-Princess-Kate.html (2024). American Medical Association. Code of Medical Ethics. Available from: https://code-medical-ethics.ama-assn.org/ [accessed 23rd January 2024]. Ardery J. The AMA Code of Medical Ethics-What is Its Legal Effect?. Medical News. 2, (2004). American Medical Association. 8.12 Ethical Physician Conduct in the Media. https://code-medical-ethics.ama-assn.org/sites/default/files/2022-09/8.12%20Ethical%20Physician%20Conduct%20in%20the%20Media%20--%20background%20reports.pdf . American Medical Association. Opinion 3.1.5 Professionalism in Relationships with Media. https://code-medical-ethics.ama-assn.org/ethics-opinions/professionalism-relationships-media . American Medical Association. Member organizations of the AMA House of Delegates. https://www.ama-assn.org/house-delegates/hod-organization/member-organizations-ama-house-delegates . American Medical Association. Federation Directory. https://federationdirectory.ama-assn.org/federations . American Psychiatric Association. Opinions of the Ethics Committee on The Principles of Medical Ethics. With Annotations Especially Applicable to Psychiatry . (American Psychiatric Association, 2017). Baker R, ed. The American medical ethics revolution: how the AMA's code of ethics has transformed physicians' relationships to patients, professionals, and society . (JHU Press, 1999). Royal College of Psychiatrists. Goldwater Rule. https://www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/other-policy-areas/goldwater-rule . Robertson M, Walter G, Bloch S. Ethical use of the media by psychiatrists: towards an antipodean formulation of the "Goldwater Rule". Australas Psychiatry. 24, 26–29 (2016). Sulmasy LS, Bledsoe TA; ACP Ethics, Professionalism and Human Rights Committee. American College of Physicians Ethics Manual: Seventh Edition. Ann Intern Med. 170(2_Suppl), S1-S32. (2019). American College of Surgeons. Statements on Principles. https://www.facs.org/about-acs/statements/statements-on-principles/ (2016). American Academy of Orthopaedic Surgeons. Code of Medical Ethics and Professionalism for Orthopaedic Surgeons. https://www.aaos.org/contentassets/b5bdb0610ad4411cbe400ce53a2ccdab/code-of-ethics-2013-color-logo.pdf (2011). American Academy of Otolaryngology–Head and Neck Surgery Foundation, Inc. Code of Ethics. https://www.entnet.org/about-us/leadership-governance/ethics/code-of-ethics/ . American Association of Neurological Surgeons. AANS Code of Ethics. https://www.aans.org/-/media/Files/AANS/About-Us/Governance/AANS_Code_of_Ethics_Approved_-_Nov_2023.ashx (2023). American Academy of Ophthalmology. Code of Ethics. https://www.aao.org/education/ethics-detail/code-of-ethics (2023). American Academy of Ophthalmology. Advisory Opinion - Social Media and Professionalism. https://www.aao.org/education/ethics-detail/advisory-opinion-social-media-professionalism . North American Neuro-Ophthalmology Society. Code of Ethics. https://www.nanosweb.org/i4a/pages/index.cfm?pageid=3663 (2021). North American Neuro-Ophthalmology Society. Advisory Opinion - Social Media and Professionalism. https://www.nanosweb.org/i4a/pages/index.cfm?pageid=4220 (2021). American College of Cardiology. Code of Ethics. https://www.acc.org/-/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/About-ACC/Governance/ACC-Code-of-Ethics.pdf (2023). American Academy of Neurology Code of Professional Conduct. Neurology. 97, 1096 (2021). Busl KM, Rubin MA, Tolchin BD, et al. Use of Social Media in Health Care-Opportunities, Challenges, and Ethical Considerations: A Position Statement of the American Academy of Neurology. Neurology. 97, 585–594 (2021). American Association of Neuromuscular & Electrodiagnostic Medicine Ethics Committee. Guidelines for ethical behavior relating to clinical practice issues in neuromuscular and electrodiagnostic medicine. Muscle Nerve. 65, 391–399 (2022). American Urological Association. Code of Ethics. https://www.auanet.org/myaua/aua-ethics/code-of-ethics (2024). American College of Allergy, Asthma & Immunology. Social Media Policy. https://college.acaai.org/acaai-policies/social-media-policy/ . American Academy of Dermatology. Position Statement on Medical Professionalism in the Use of Social Media. https://server.aad.org/forms/policies/Uploads/PS/PS-Medical%20Professionalism%20in%20the%20Use%20of%20Social%20Media.pdf . Radiological Society of North America, Inc. Bylaws. 2017. Available from: https://www.rsna.org/uploadedFiles/RSNA/Content/About_RSNA/RSNA_bylaws.pdf (2017). American College of Occupational and Environmental Medicine. Code of Ethics. Available from: https://acoem.org/about-ACOEM/Governance/Code-of-Ethics (2022). The Endocrine Society. Code of Ethics of the Endocrine Society. https://www.endocrine.org/-/media/endocrine/files/about/codeofethics.pdf (2013). The American College of Gastroenterology. Code of Professional Conduct. https://s3.gi.org/members/committees/FinalCodeofProfessionalConductandWitnessing.pdf . Parsa-Parsi RW. The International Code of Medical Ethics of the World Medical Association. JAMA . 10.1001/jama.2022.19697 (2022). General Medical Council. Good Medical Practice. https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/good-medical-practice (2024). Pouncey C. Is the Goldwater Rule out of step with medical ethics? How four past APA presidents morally justify the Goldwater Rule. Centre for Ethics and the Rule of Law, University of Pennsylvania . https://www.penncerl.org/the-rule-of-law-post/is-the-goldwater-rule-out-of-step-with-medical/ (2021). Bernstein J. Not the Last Word: A Goldwater Rule for Sports Medicine. Clin Orthop Relat Res. 476, 1149–1153 (2018). Carnahan D. Faked videos shore up false beliefs about Biden’s mental health. The Conversation . https://theconversation.com/faked-videos-shore-up-false-beliefs-about-bidens-mental-health-145975 (2020). Katira K. AI hoax? 'Death of Canadian who got plastic surgery to look like BTS' Jimin' was fake news: Report. WION . https://www.wionews.com/entertainment/ai-hoax-death-of-canadian-who-did-plastic-surgery-to-look-like-bts-jimin-was-fake-news-report-587496 (2023). Menz BD, Modi ND, Sorich MJ, Hopkins AM. Health Disinformation Use Case Highlighting the Urgent Need for Artificial Intelligence Vigilance: Weapons of Mass Disinformation. JAMA Intern Med. 184, 92–96 (2024). American Medical Association. Professionalism in the Use of Social Media. https://code-medical-ethics.ama-assn.org/ethics-opinions/professionalism-use-social-media . American Medical Association. AMA adopts new policy aimed at addressing public health disinformation. https://www.ama-assn.org/press-center/press-releases/ama-adopts-new-policy-aimed-addressing-public-health-disinformation (2022). American Psychiatric Association. APA Ethics Committee Issues Opinion on the Spread of Disinformation. https://www.psychiatry.org/news-room/apa-blogs/ethics-committee-on-the-spread-of-disinformation (2021). Additional Declarations Competing interest reported. Maria A. Oquendo is a past president of the American Psychiatric Association and is a member of the National Academy of Medicine in the United States. Dinesh Bhugra is a past president of the British Medical Association, the World Psychiatric Association, and the Royal College of Psychiatrists. The other authors have no competing interests to declare. 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Maria A. Oquendo is a past president of the American Psychiatric Association and is a member of the National Academy of Medicine in the United States. Dinesh Bhugra is a past president of the British Medical Association, the World Psychiatric Association, and the Royal College of Psychiatrists. The other authors have no competing interests to declare.","formattedTitle":"Ethics beyond Goldwater? Analyzing policies from American medical organizations on public communications from physicians in the digital age","fulltext":[{"header":"1. Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1. Public commentary from physicians and media interactions\u003c/h2\u003e \u003cp\u003eAmid technological changes and fast-paced news cycles, physicians are regularly called upon to discuss health-related subjects across various public and media platforms. The COVID-19 pandemic underlined the impact of medical perspectives on wider behaviors, reinforcing the duty of physicians to engage in reliable communications for health promotion and educational purposes [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, when physicians provide opinions in relation to specific people or incidents, this can provoke moral concerns about role responsibilities and possible malpractice or defamation [\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Again, this was demonstrated in the COVID-19 pandemic, with physicians in the United States and elsewhere propagating misinformation and erroneous messaging about vaccines, masks, and other public health measures [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLikewise, ethical dilemmas can transpire when unsubstantiated medical opinions or speculative \u0026ldquo;armchair diagnoses\u0026rdquo; are proffered without firsthand examinations of the person in question or the person\u0026rsquo;s consent [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Such situations may obfuscate the boundaries between statements intended to expand public health literacy and those conveying conjectural views, potentially undermining patient confidentiality and trust in medicine [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These scenarios may be particularly pertinent in the digital age, where clinical insights can be quickly disseminated and misinterpreted, conceivably adding to the spread of misinformation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Contemporary innovations in Artificial Intelligence (AI) and digital tools can further complicate the authenticity and accuracy of health-related discourse, with deepfakes and distorted content gaining increasing traction [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the United States, communications from physicians about prominent figures (especially political leaders) have divided opinion, thereby reflecting these complex dynamics. Notably, contentious exchanges emerged in the psychiatric discipline after the 2016 election when specialists hypothesized about the mental health of the then-president, Donald Trump [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. More recently, psychopathological conjecture has abounded about the current president, Joe Biden [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Likewise, specialists have discussed the mental health of other politicians and celebrities across academic and public forums, such as the singer, Britney Spears, and the actors, Robin Williams and Johnny Depp [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similar cases have also occurred in different medical specialties in the United States; this includes anesthesiology, forensic medicine, plastic surgery, cardiology, neurology, and oncology, among others [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRelatedly, in Europe, the Russian President, Vladimir Putin, has elicited psychiatric speculation, which intensified following the 2022 invasion of Ukraine [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In Germany, when the-then Chancellor, Angela Merkel, exhibited persistent tremors in 2019, neurologists theorized about this in the press, triggering a media backlash for perceived privacy infringements [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In 2024, physicians discussed the cancer diagnoses of King Charles III and Princess Catherine, again prompting considerations around the sensitivity and probity of medical discourse conveyed via traditional and digital media [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Elsewhere, questions have materialized about physician conduct in India and South Korea [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], where openly-expressed medical opinions may have contributed to sensationalist reporting.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2. Existing ethical frameworks around public commentary in the United States\u003c/h2\u003e \u003cp\u003eThe American Medical Association (AMA) is the preeminent body representing physicians in the United States. The AMA seeks to uphold professional and ethical standards through its Code of Medical Ethics [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Alongside the seven general Principles of Medical Ethics, the Code contains Opinions that \u0026ldquo;represent AMA policy\u0026rdquo; and address \u0026ldquo;issues and challenges confronting the medical profession\u0026rdquo; [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], including public commentary and physician-media interactions. While the judicial status of these Opinions varies state-by-state [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], they have recurrently shaped practice laws and the role responsibilities of American physicians.\u003c/p\u003e \u003cp\u003eOpinion 8.12. from the AMA states that physicians should: \u0026ldquo;[b]e aware of how their medical training, qualifications, experience, and advice are being used by media forums and how this information is being communicated to the viewing public\u0026rdquo;; \u0026ldquo;[r]efrain from making clinical diagnoses about individuals (e.g., public officials, celebrities, persons in the news) they have not had the opportunity to personally examine\u0026rdquo;; \u0026ldquo;[p]rotect patient privacy and confidentiality by refraining from the discussion of identifiable information\u0026rdquo;; and \u0026ldquo;[c]onfine their medical advice to their area(s) of expertise\u0026rdquo; [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Correspondingly, Opinion 3.1.15. centers around physician-media relationships and implications for patients. This enjoins physicians to \u0026ldquo;[o]btain consent from the patient or the patient\u0026rsquo;s authorized representative before releasing information\u0026rdquo; and \u0026ldquo;[e]nsure that no statement regarding diagnosis or prognosis is made except by or on behalf of the attending physician\u0026rdquo; [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs a member of the Federation of Medicine (which is part of the AMA\u0026rsquo;s policymaking body, the House of Delegates [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]), the American Psychiatric Association (APA) created annotations to the AMA\u0026rsquo;s Principles of Medical Ethics. Section 7.3. (i.e., the Goldwater Rule) notes that psychiatrists may be: \u0026ldquo;asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement\u0026rdquo; [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This was instituted in 1973 after a Fact Magazine feature presented medical conjectural about Senator Barry Goldwater [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Subsequently, the APA\u0026rsquo;s position has attracted scrutiny, especially following public exchanges about President Trump [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3. The current study\u003c/h2\u003e \u003cp\u003eThe AMA\u0026rsquo;s Code of Medical Ethics and the APA\u0026rsquo;s Goldwater Rule are influential frameworks for guiding public communications by American and international medical experts [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. With over 250,000 AMA members, the Code of Ethics is broadly recognized among physicians and state legislatures in the United States [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Likewise, certain European national-level psychiatric association have adopted the discipline-specific Goldwater Rule (e.g., [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]). Nonetheless, it remains unclear whether bodies from other medical domains in the United States follow these standards or have formulated specific recommendations and protocols for their discipline and membership.\u003c/p\u003e \u003cp\u003eConsequently, this study aims to explore organizational positions on public commentary and media interactions, beyond those from the AMA and the APA. To that end, we sought to assess the policy landscape from members of the Federation of Medicine [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] (FMMs). Given the potential complexities when medical and clinical perspectives are publicly communicated, these insights may be particularly timely, with cross-jurisdictional debates and contexts of practice continuing to evolve [\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Overview of FMM positions\u003c/h2\u003e \u003cp\u003eThis study yielded an inclusion rate of 38% from the total sample of n\u0026thinsp;=\u0026thinsp;122 FMMs, capturing the perspectives of n\u0026thinsp;=\u0026thinsp;47 organizations. Covering a range of medical specialties these 47 entities together have approximately 950,000 members in the US and globally (per available data); that said, these 950,000 members may not be unique since individuals may be affiliated with more than one professional entity. Membership demographics varied by FMM but primarily included individual physicians. Yet, dependent on the organization and specialty, FMMs may also represent medical students, researchers, allied health professionals, accredited centers, and other non-physician providers. Per our analysis, of these n\u0026thinsp;=\u0026thinsp;47 FMMs, n\u0026thinsp;=\u0026thinsp;16 (34%) were classified into the \u0026ldquo;Organizational-level policy or guidelines\u0026rdquo; group, while n\u0026thinsp;=\u0026thinsp;31 (66%) were coded as having \u0026ldquo;No organizational-level policy or guidelines\u0026rdquo;. An overview of included FMMs and their categorization is available in the Supplemental Materials, with detailed positions described below.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Organizational-level policy or guidelines (n\u0026thinsp;=\u0026thinsp;16)\u003c/h2\u003e \u003cp\u003eIn this category, the American College of Physicians (ACP) had the largest membership base, representing around 161,000 individuals. This FMM publishes an extensive Ethics Manual containing provisions on public commentary and press interactions. Here, the ACP exhorts that \u0026ldquo;physicians should provide news media with accurate information, recognizing this as an obligation to society, but confidentiality of patients must be respected\u0026rdquo; [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe American College of Surgeons (ACS) has instituted a Code of Professional Conduct for its members, with apposite clauses around public representation and media engagements. The ACS assert that a \u0026ldquo;surgeon\u0026rsquo;s release of material to communications media or nonprofessional publications should be designated only for education and public information\u0026rdquo; [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. For the ACS, public interactions \u0026ldquo;must be accurate\u0026rdquo; and \u0026ldquo;must not convey false, untrue, deceptive, or misleading information through statements, testimonials, photographs, graphics, or other means, and \u0026ldquo;must contain sufficient supporting material\u0026rdquo; [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditionally, if \u0026ldquo;a surgeon is reimbursed or sponsors a communication, that fact must be made clear\u0026rdquo; and \u0026ldquo;[r]eleases must not create unjustified expectations of results\u0026rdquo;, \u0026ldquo;must not misrepresent a surgeon\u0026rsquo;s credentials, training, experience, or ability\u0026rdquo; and should contain substantiated claims [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Analogously, the American Academy of Orthopaedic Surgeons (AAOS), the American Academy of Otolaryngology\u0026mdash;Head and Neck Surgery (AAO-HNSF), and the American Association of Neurological Surgeons (AANS) all share equivalent statements prohibiting communications that are \u0026ldquo;false\u0026rdquo;, \u0026ldquo;untruthful\u0026rdquo; \u0026ldquo;misleading\u0026rdquo; or \u0026ldquo;deceptive\u0026rdquo; [\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe American Academy of Ophthalmology (AAO) has rigorous rubric on commentary and media statements, akin to the ACS. In Section 13 of its Code of Ethics, the AAO avers that public communications \u0026ldquo;must be accurate. They must not convey false, untrue, deceptive, or misleading information through statements, testimonials, photographs, graphics or other means\u0026rdquo; [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Members \u0026ldquo;must not omit material information without which the communications would be deceptive\u0026rdquo;, \u0026ldquo;must not appeal to an individual\u0026rsquo;s anxiety\u0026rdquo; excessively or unfairly and \u0026ldquo;must not create unjustified expectations of results\u0026rdquo; [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Moreover, like other FMMs, the AAO emphasizes that communications \u0026ldquo;must not promote health-related misinformation\u0026rdquo; or \u0026ldquo;false, deceptive, or misleading\u0026rdquo; claims [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAAO Fellows and Members \u0026ldquo;must not\u0026rdquo; misrepresent their training or expertise and \u0026ldquo;statements based on opinion must be identified as such\u0026rdquo; and must not contain unsubstantiated \u0026ldquo;material claims of safety and/or efficacy\u0026rdquo; [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This also applies to social media exchanges [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Additionally, the North American Neuro-Ophthalmology Society (NANOS) upholds near-identical standards to the AAO in its Code of Ethics (Section 6.1) and its advisory on social media usage [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This FMM stipulates in \u0026ldquo;no event should a neuro-ophthalmologist publicly use or otherwise disclose any patient\u0026rsquo;s medical condition or treatment\u0026rdquo; without \u0026ldquo;prior written consent\u0026rdquo; [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eElsewhere, the American College of Cardiology (ACC) has instituted regulations pertaining to public commentary. In Section 1.7 of its Code of Ethics, the ACC notes that members should \u0026ldquo;provide pertinent medical information\u0026rdquo; to \u0026ldquo;the public only with the appropriate consent and permission of the patient\u0026rdquo; [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Further, the American Academy of Neurology (AAN) addresses this topic in its Code of Professional Conduct (Section 7.1). Similar to other FMMs, this organization writes that \u0026ldquo;AAN members must not represent themselves to the public in an unprofessional, untruthful, misleading, or deceptive manner\u0026rdquo; [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Supplementing their Code of Professional Conduct, the AAN produced a position paper on social media comprising of recommendations and case vignettes; this reinforces the centrality of patient privacy when discussing health-related information [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComparable wording has been adopted by the American Association of Neuromuscular \u0026amp; Electrodiagnostic Medicine (AANEM). In its ethical statutes about clinical practice (Section 6), this FMM declares that physicians \u0026ldquo;should not represent themselves to the public in an untruthful, misleading, or deceptive manner regarding qualifications, credentials, and expertise through statements, testimonials, photographs, graphics, or other means\u0026rdquo; [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The AANEM also proclaim that a \u0026ldquo;patientʼs medical condition must not be discussed publicly without his or her consent\u0026rdquo; [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe American Urological Association (AUA), the American College of Allergy, Asthma \u0026amp; Immunology, and the American Academy of Dermatology had bespoke positions on social media. Generally, this underscored the importance of professional probity, patient confidentiality, and protecting the reputation of medicine [\u003cspan additionalcitationids=\"CR45\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. For instance, the AUA write \u0026ldquo;[s]ocial media must be used in an ethical and transparent way\u0026rdquo; and that \u0026ldquo;[m]embers, in their professional communications, must not post inappropriate, discriminatory, or unprofessional content\u0026rdquo; or \u0026ldquo;disclose any patient health information without consent\u0026rdquo; [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFinally, the American Institute of Ultrasound in Medicine stated that it refrains from making comments about high-profile figures, maintaining a neutral stance as a formal policy. This was echoed by the American Society of Transplant Surgeons and the National Association of Medical Examiners, who both avowed that they would not comment on the health status of individuals.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3. No organizational-level policy or guidelines (n\u0026thinsp;=\u0026thinsp;31)\u003c/h2\u003e \u003cp\u003eFor the FMMs in this group, we did not identify any express ethical recommendations or provisions around public commentary, and the n\u0026thinsp;=\u0026thinsp;31 organizations did not highlight any measures in their responses. Yet, this does not necessarily mean that FMMs in this category did not have broader stances that might implicitly affect the scope of public communications. For instance, with around 54,000 members, the Radiological Society of North America formally adopted the AMA\u0026rsquo;s Principles of Medical Ethics in its bylaws [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. These promote general expectations for professional conduct but do not contain detailed ethical rules on the probity of public statements from physicians [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Similarly, certain FMMs had potentially relevant guidelines regarding patient confidentiality, research ethics, protecting patient interests, societal responsibilities, and expert witness requirements (e.g., [\u003cspan additionalcitationids=\"CR49\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]). Again, however, these did not contain protocols or clauses explicitly for public ccommentary.\u003c/p\u003e \u003cp\u003eElsewhere, FMMs cited different reasons for their lack of organizational-level rubric. This included the American Geriatrics Society, the American Society for Clinical Pathology, and the International College of Surgeons: U.S. Section; these FMMs attested that they are not governing bodies or regulatory agencies or focus on educational and humanitarian initiatives rather than policymaking. Additionally, the American Academy of Physicians in Clinical Research indicated that it does not have its own documentation and defers to those from federated entities (e.g., the AMA). Notably, several organizations suggested that they had not yet encountered a need for bespoke policies, instead referring to the AMA\u0026rsquo;s Code.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Discussion","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Professional and ethical frameworks surrounding public commentary from FMMs\u003c/h2\u003e \u003cp\u003eOur findings underline various cross-specialty perspectives and regulations from FMMs. The n\u0026thinsp;=\u0026thinsp;16 FMMs who had policies on physician commentary and media representation often shared broad consistencies that largely corresponded with the AMA\u0026rsquo;s Opinions and standards from international regulatory bodies (e.g., [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]). Thus, within wider contexts of practice, this implies a harmonization on upholding tenets of factual and evidence-based communication that respects patient privacy; by extension, this would prohibit \u0026ldquo;armchair diagnoses\u0026rdquo;, which are based on incomplete data where the person in question has not been duly examined. As general physician values, these could be promoted in training and education schemes, even by those FMMs who rely on principlism and do not enforce comprehensive ethical or professional codes [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCommon language from FMMs foregrounded patient confidentiality and avoiding \u0026ldquo;untruthful\u0026rdquo;, \u0026ldquo;misleading\u0026rdquo;, \u0026ldquo;deceptive\u0026rdquo;, or unsubstantiated statements through traditional or social media. This mirrors sections of the AMA\u0026rsquo;s Code, the APA\u0026rsquo;s Goldwater Rule, and other well-recognized literature. Notably, the AMA\u0026rsquo;s Opinion 8.1.2 enjoins physicians to \u0026ldquo;ensure that the medical information they provide is [\u0026hellip;] based on valid scientific evidence and insight gained from professional experience\u0026rdquo;, underscoring the importance of personal privacy [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Elsewhere, the International Code of the World Medical Association (WMA) affirms that \u0026ldquo;[p]hysicians play an important role in matters relating to health, health education and health literacy\u0026rdquo; [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. In doing so, the WMA contends that physicians \u0026ldquo;must be prudent in discussing new discoveries, technologies, or treatments in non-professional, public settings, including social media, and should ensure that their own statements are scientifically accurate and understandable\u0026rdquo; [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Comparable principles are highlighted by the United Kingdom\u0026rsquo;s General Medical Council\u0026rsquo;s (GMC) in its Good Medical Practice, asserting that medical communications should be \u0026ldquo;accurate\u0026rdquo; and physicians \u0026ldquo;must not present opinion as established fact\u0026rdquo; [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor public statements from physicians, several FMMs accentuated the necessity of accurately indicating clinical competencies and training (e.g., the ACS, the AAO, and the AANEM), individual consent (e.g., the ACC, the AAO, the AAU, and the AANEM), and disclosing conflicts of interest (e.g., the ACS and the AAO). Again, this aligns with aspects of the Goldwater Rule, together with the AMA\u0026rsquo;s Code and the GMC\u0026rsquo;s Good Medical Practice [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Specifically, the AMA\u0026rsquo;s Opinions 3.1.5 and 8.1.2 stipulate that physicians should \u0026ldquo;[c]onfine their medical advice to their area(s) of expertise\u0026rdquo;, \u0026ldquo;clearly distinguish the limits of their medical knowledge\u0026rdquo;, and \u0026ldquo;[o]btain consent from the patient\u0026rdquo; before \u0026ldquo;releasing information\u0026rdquo; [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Moreover, in media interactions, the AMA urges physicians to \u0026ldquo;disclose any conflicts of interest and avoid situations that may lead to potential conflicts\u0026rdquo; [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Similarly, the APA deems public commentary from psychiatrists about individuals unethical unless they have been \u0026ldquo;granted authorization\u0026rdquo; [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNevertheless, there were semantic discrepancies between FMM stances and the AMA\u0026rsquo;s Opinions, possibly informed by disparate organizational missions or the scope of their ethical documentation. This was evident in the Code of Professional Conduct by the ACS and the Code of Ethics from the AAO, who have sizeable membership bases and have implemented rigorous rubric [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. For clauses on public and media interactions, the ACS and the AAO recurrently employed the didactic \u0026ldquo;must\u0026rdquo; (as periodically did different FMMs (e.g., [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e])). This would appear to accord with the prescriptive nature of the APA\u0026rsquo;s Goldwater Rule, rather than the implicit flexibility in the AMA\u0026rsquo;s Opinions that frequently state \u0026ldquo;Physicians \u003cem\u003eshould\u003c/em\u003e\u0026rdquo; (italics ours) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Other FMMs in our results also used \u0026ldquo;\u003cem\u003eshould\u003c/em\u003e\u0026rdquo; (e.g., the ACP [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]).\u003c/p\u003e \u003cp\u003eConceivably, this stronger terminology from certain FMMs may indicate a desire to apply stricter frameworks for their members, accentuating definitive notions of accountability over contextual interpretation or principlism. Interestingly, the AAO [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] and additional FMMs (e.g., [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]) outlined specific disciplinary processes for ethical breaches, including membership revocation. Previously, there have been discussions about applicable sanctions for APA members for apparent Goldwater Rule violations [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Yet, at the time of writing, it remains unclear if any organizations have expelled members for transgressing provisions on public representation, or if these are intended more as a deterrence, despite instances of inappropriate commentary continuing to emerge.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Current gaps and emerging challenges\u003c/h2\u003e \u003cp\u003eThe majority of included FMMs (i.e., n\u0026thinsp;=\u0026thinsp;31/66%) had no explicit stances or documentation governing the scope of public commentary. As highlighted, this could be conditioned by specific organizational missions or the membership compositions of FMMs who may cover a large proportion of non-clinical professionals. Likewise, it is probable that many FMM physician-members have overlapping affiliations to the AMA or other discipline-specific associations. These physicians would be simultaneously governed by the rubric of several bodies; for instance, one of these organizations may have established documentation that strictly prohibits speculative diagnoses without comprehensive data or patient consent, whereas others do not. Consequently, physicians may need to navigate a complex landscape of overlapping statutes and standards, which can enhance accountability but also complicate adherence to divergent organizational rules.\u003c/p\u003e \u003cp\u003eAdditionally, as several FMMs indicated, the paucity of guidelines reflected in our results may stem from disparate professional or clinical responsibilities and membership demands, influencing perceptions about the dimensions of public communications. Simply put, it could follow that physicians in clinical settings or disciplines with higher burdens of disease (e.g. psychiatrists) may be more likely to encounter public or media requests for expertise than those in less clinically-facing domains (e.g., insurance medicine practitioners). Nonetheless, past incidents have repeatedly illustrated how physicians across various medical specialties have offered insights on high-profile events or subjects [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], resulting in contentious and problematic statements. Analogously, the proliferation of fast-paced news cycles and sensationalist reporting have compounded ethical considerations in this area, as exemplified in the COVID-19 pandemic where medical misinformation was quickly shared [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn sum, the findings underline a need for greater organizational awareness from FMMs about the complexities surrounding public communications from physicians. There have been prior exchanges about implementing new or adapted regulations at a specialty-specific level (e.g., in sports medicine [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]) and revising established frameworks like the APA\u0026rsquo;s Goldwater Rule [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Accordingly, as a foundational basis, FMMs lacking comprehensive ethical or professional protocols could consider developing educational resources (e.g., position statements or case vignettes) to help their members deal with complex media requests or interactions about sensitive matters. This should be underpinned by collaborations involving existing organizational-level ethics committees, individual memberships, and other applicable stakeholders in the Federation of Medicine, particularly those FMMs working in disciplines where press interest is commonplace.\u003c/p\u003e \u003cp\u003eOf the FMM materials summarized above, there was limited consideration about the impact of modern technologies and AI on medical communications; many guidelines were drafted prior to these innovations. Notably, this has been cited as a criticism of the Goldwater Rule, which was conceptualized before the advent of digital media [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Yet, as recently demonstrated, such tools can be manipulated to amplify health-related misinformation. This can present significant ethical problems for physicians who may be requested to comment on fake cases with limited information or context; in doing so, they risk further propagating misinformation. Examples include deepfakes of President Joe Biden appearing to exhibit signs of cognitive decline, an AI-generated hoax about a fatality following complications from cosmetic surgery, and researchers who intentionally created blog posts showcasing erroneous clinical testimonies [\u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Equally, the wide-reaching and instantaneous nature of social media can support the spreading of deliberate medical misinformation or render physician commentary open to misinterpretation, which, again, has entailed controversies (e.g., [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]).\u003c/p\u003e \u003cp\u003eAlongside the AMA [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e], certain FMMs have developed bespoke member-facing information regarding conduct on social media (e.g., [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]). Yet, there was scant material covering the associations between AI and clinical discourse (except an AUA provision on AI content creation [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]), especially regarding the implications of digitally-distorted content. This is a substantial gap in current provisions, warranting additional scrutiny about how physicians can combat misinformation while following recognized standards [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The AMA and the APA have launched projects on misinformation [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], but proactive cross-specialty approaches are necessary as these technologies continue to shape modern communications. To that end, FMMs should acknowledge the increasing urgency of these challenges, considering pragmatic adaptations to their ethical regulations and leveraging their influence to enhance wider initiatives across the medical community, both in the United States and internationally.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Limitations and future research directions\u003c/h2\u003e \u003cp\u003eThis investigation sought to gain perspectives about the ethical and professional guidelines surrounding public commentary from physicians on the health status of individuals. Although the findings present a range of positions on this subject from US FMMs, the study has several limitations that could be considered in future research.\u003c/p\u003e \u003cp\u003eThe methodology yielded a 37% inclusion rate, with 47 FMMs providing sufficient information. While these bodies represent around 950,000 members, several major specialty-specific FMMs remained absent from our analysis; this limits the ability to generalize the findings. Data gathering involved reviewing publicly available documentation, followed by correspondence with FMMs. In these communications, it is possible that certain organizations may have misunderstood the purpose of the study, influencing both the response rate and the sample size, as we only included FMMs who replied to our enquiries. Taken together, this may affect the representativeness and comprehensiveness of the results, potentially overlooking organizations with pertinent policies who did not engage with our emails or display accessible literature online (e.g., in a members-only area).\u003c/p\u003e \u003cp\u003eEqually, as this study was cross-sectional, certain FMMs may have updated their regulations or policies on public communications since data collection ended. Again, this might impinge upon the reliability of the investigation. Additionally, the coding and analysis of FMM responses could entail subjectivity or reproducibility concerns. To uphold accuracy, detailed searches were conducted of FMM websites and comparisons were made between responses and publicly available documentation. In cases of disagreement or where there were discrepancies between FMM responses and web resources, a third member of the research team was consulted, and a consensus was reached. Despite this, the potential for misinterpretation cannot be entirely discounted.\u003c/p\u003e \u003cp\u003eOverall, this study offers insights into the ethical frameworks around public commentary by American physicians, raising possible research avenues. As a follow-up, future inquiries could explore how specific medical disciplines adapt to evolving challenges, particularly emerging technologies like AI and evolving societal attitudes toward public-medical discourse. Moreover, investigating the role of medical education in preparing physicians for media interactions and AI would also be beneficial. This could encompass various methodological designs, such as survey-based projects or qualitative interviews examining the salience and importance of these topics in curricula materials. Finally, views from international organizations should also be explored to identify possible best practices that can be adapted to different cultural and national contexts of practice. While the ethics of \u0026ldquo;armchair diagnoses\u0026rdquo; have been scrutinized outside the United States (e.g., [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]), there remains a need for comprehensive, cross-national studies to help synthesize wider positions on this topic.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Conclusions\u003c/h2\u003e \u003cp\u003eThis investigation sought to examine current stances and policies surrounding public commentary from physicians in the United States. While n\u0026thinsp;=\u0026thinsp;16 FMMs have developed guidelines on this issue, a significant number of organizations lacked specific documentation addressing the ethical dimensions of public communications and the potential harms from uninformed opinions. Further, there was a scarcity of resources related to digital technologies and AI, which is concerning in the context of health-related misinformation. Resultantly, these findings suggest a need for comprehensive initiatives to be more widely considered. To that end, intra- and cross-specialty collaborations involving FMMs, the AMA, and other international stakeholders should be encouraged to promote accurate and respectful medical discourse, aligning with the demands of the digital era.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Materials and methods","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Sample and data gathering\u003c/h2\u003e \u003cp\u003eAs a conceptual basis, this study utilized a prior methodology exploring the positions of European national psychiatric associations on the APA\u0026rsquo;s Goldwater Rule [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The current inquiry focused on members of the Federation of Medicine [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] (FMMs), a collective body within the AMA\u0026rsquo;s House of Delegates that includes 126 national US societies. Excluding the APA and psychiatric subspecialty groups, we examined a sample of n\u0026thinsp;=\u0026thinsp;122 FMMs to derive official positions and statutes concerning public communications from physicians.\u003c/p\u003e \u003cp\u003eA two-tiered approach for data collection was adopted between January-March 2024. The first stage involved reviewing apposite FMM web materials, including ethical and professional codes of conduct, position statements, bylaws, or constitutions that were publicly displayed. FMM web addresses were obtained from the Federation of Medicine directory, which is accessible through the AMA [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSubsequently, to verify existing information or where applicable resources were not available online, the research team contacted all n\u0026thinsp;=\u0026thinsp;122 FMMs via email to ascertain if they had explicit provisions on public commentary or similar rubric as the Goldwater Rule. Again, contact details were sourced through the Federation of Medicine directory or FMM websites [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In these communications, FMMs were informed that their responses would be used for a project to be published in an academic journal. No financial compensation was offered for participation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Analysis\u003c/h2\u003e \u003cp\u003eAt the end of data collection, two members of the research team compared FMM answers to extant web resources to uphold accuracy. During this process, FMM positions were synthesized and coded to three classifications, namely: \u0026ldquo;Organizational-level policy or guidelines\u0026rdquo;, \u0026ldquo;No organizational-level policy or guidelines\u0026rdquo;, and \u0026ldquo;No response\u0026rdquo;. Where discrepancies or disagreements arose, another member of the research group was consulted, and a consensus decision was adopted.\u003c/p\u003e \u003cp\u003eSpecifically, the FMMs within the \u0026ldquo;Organizational-level policy\u0026rdquo; category had implemented their own rules around public commentary. Conversely, \u0026ldquo;No organizational-level policy or guidelines\u0026rdquo; refers to those FMMs that had not yet introduced specific recommendations or produced documentation about this issue. Finally, the \u0026ldquo;No response\u0026rdquo; group contained FMMs that did not reply to our correspondence or provided insufficient information for the final analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Ethical considerations\u003c/h2\u003e \u003cp\u003eInformation from FMMs was either willingly provided by respondents or was publicly accessible. Although some human participation was needed for our enquiries, the primary goal of the study was to collate organizational stances and perspectives. Therefore, since no personal or sensitive information was acquired or assessed, formal ethical approval was not sought. Nevertheless, the research team took care to ensure respect during data collection, especially in FMM communications, and to maintain integrity and accuracy throughout the analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAAN - American Academy of Neurology\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAANEM - American Association of Neuromuscular \u0026amp; Electrodiagnostic Medicine\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAANS -\u0026nbsp;American Association of Neurological Surgeons\u003c/p\u003e\n\u003cp\u003eAAO - American Academy of Ophthalmology\u003c/p\u003e\n\u003cp\u003eAAOS - American Academy of Orthopaedic Surgeons\u003c/p\u003e\n\u003cp\u003eAAO-HNSF - American Academy of Otolaryngology\u0026mdash;Head and Neck Surgery\u003c/p\u003e\n\u003cp\u003eACC - American College of Cardiology\u003c/p\u003e\n\u003cp\u003eACP - American College of Physicians\u003c/p\u003e\n\u003cp\u003eACS \u0026ndash; American College of Surgeons\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAI \u0026ndash; Artificial Intelligence\u003c/p\u003e\n\u003cp\u003eAMA - American Medical Association\u003c/p\u003e\n\u003cp\u003eAPA - American Psychiatric Association\u003c/p\u003e\n\u003cp\u003eAUA - American Urological Association\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFMM \u0026ndash; Federation of Medicine Member\u003c/p\u003e\n\u003cp\u003eGMC - General Medical Council\u003c/p\u003e\n\u003cp\u003eNANOS - North American Neuro-Ophthalmology Society\u003c/p\u003e\n\u003cp\u003eWMA - World Medical Association\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eMaria A. Oquendo is a past president of the American Psychiatric Association and is a member of the National Academy of Medicine in the United States. Dinesh Bhugra is a past president of the British Medical Association, the World Psychiatric Association, and the Royal College of Psychiatrists. The other authors have no competing interests to declare.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAS: Conceptualization; Writing \u0026ndash; original draft; Writing \u0026ndash; review and editing; Methodology; Formal analysis. SH: Conceptualization; Writing \u0026ndash; original draft; Writing \u0026ndash; review and editing; Methodology; Formal analysis. MAO: Conceptualization; Writing \u0026ndash; review and editing. DB: Conceptualization; Methodology; Writing \u0026ndash; review and editing. AV: Conceptualization; Writing \u0026ndash; review and editing. ML: Conceptualization; Writing \u0026ndash; original draft; Writing \u0026ndash; review and editing; Methodology; Formal analysis; Supervision\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors are grateful to those FMMs who engaged with our correspondence during this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analysed during this study are included in this published article and its supplementary information files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSolnick RE, Chao G, Ross RD, Kraft-Todd GT, Kocher KE. Emergency Physicians and Personal Narratives Improve the Perceived Effectiveness of COVID-19 Public Health Recommendations on Social Media: A Randomized Experiment. Acad Emerg Med. 2, 172\u0026ndash;183 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaron RJ, Ejnes YD. Physicians Spreading Misinformation on Social Media - Do Right and Wrong Answers Still Exist in Medicine?. N Engl J Med. 387, 1\u0026ndash;3 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarlo AD, Barnett BS, Essien UR, Galea S. Redefining Medicine's Relationship with the Media in the Era of COVID-19. Am J Prev Med. 60, 142\u0026ndash;145 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchumann JH. Speculating on a public figure's mental health. Virtual Mentor. 15, 829\u0026ndash;833. (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCooke BK, Goddard ER, Werner TL, Cooke EO, Griffith EE. The risks and responsible roles for psychiatrists who interact with the media. J Am Acad Psychiatry Law. 42, 459\u0026ndash;468 (2014)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith A, Hachen S, van Wijnkoop M, Schiltz K, Falkai P, Liebrenz M. The Goldwater Rule at 50 and its relevance in Europe: Examining the positions of National Psychiatric Association Members of the European Psychiatric Association. Eur Psychiatry. 66, e34; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1192/j.eurpsy.2023.22\u003c/span\u003e\u003cspan address=\"10.1192/j.eurpsy.2023.22\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSule S, DaCosta MC, DeCou E, Gilson C, Wallace K, Goff SL. Communication of COVID-19 Misinformation on Social Media by Physicians in the US. JAMA Netw Open. 6, e2328928; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamanetworkopen.2023.28928\u003c/span\u003e\u003cspan address=\"10.1001/jamanetworkopen.2023.28928\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFriedman RA. Role of physicians and mental health professionals in discussions of public figures. JAMA. 300, 1348\u0026ndash;1350. (2008).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith A, Bhugra D, Chisolm MS, Oquendo MA, Ventriglio A, Liebrenz M. Ethics and disinformation on the campaign trail: psychiatry, the Goldwater Rule, and the 2024 United States presidential election. Lancet Reg Health Am. 31, 100692. (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreenhalgh T. \u0026ldquo;Do doctors have a duty to hold their silence or to voice concern about Donald Trump\u0026rsquo;s health?\u0026rdquo;. \u003cem\u003eBMJ Blogs\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://blogs.bmj.com/bmj/2017/01/30/trish-greenhalgh-do-doctors-have-a-duty-to-hold-their-silence-or-to-voice-concern-about-donald-trumps-health/\u003c/span\u003e\u003cspan address=\"https://blogs.bmj.com/bmj/2017/01/30/trish-greenhalgh-do-doctors-have-a-duty-to-hold-their-silence-or-to-voice-concern-about-donald-trumps-health/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee, BX. Silence versus bearing witness: Psychiatrists' responsibility to society. \u003cem\u003eForensic Science International: Mind and Law\u003c/em\u003e 2, 100069; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.fsiml.2021.100069\u003c/span\u003e\u003cspan address=\"10.1016/j.fsiml.2021.100069\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLoughlin A. The Goldwater Rule: a bastion of a bygone era?. Hist Psychiatry. 33, 87\u0026ndash;94 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eToday. Psychiatry prof lists Britney\u0026rsquo;s crazy credentials. \u003cem\u003eToday\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.today.com/popculture/psychiatry-prof-lists-britney-s-crazy-credentials-wbna21743405\u003c/span\u003e\u003cspan address=\"https://www.today.com/popculture/psychiatry-prof-lists-britney-s-crazy-credentials-wbna21743405\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTohid H. Robin Williams' suicide: a case study. Trends Psychiatry Psychother. 38, 178\u0026ndash;182 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenjamin C. Damar Hamlin injury: NFL cardiologist offers insight into what may have happened to Bills safety, what's next. CBS Sports. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cbssports.com/nfl/news/damar-hamlin-injury-nfl-cardiologist-offers-insight-into-what-may-have-happened-to-bills-safety-whats-next/\u003c/span\u003e\u003cspan address=\"https://www.cbssports.com/nfl/news/damar-hamlin-injury-nfl-cardiologist-offers-insight-into-what-may-have-happened-to-bills-safety-whats-next/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeigel D. Body doubles, secret doctors: Clinton conspiracy theories blossom after pneumonia diagnosis. \u003cem\u003eThe Washington Post\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.washingtonpost.com/news/post-politics/wp/2016/09/12/body-doubles-secret-doctors-clinton-conspiracy-theories-blossom-after-pneumonia-diagnosis/\u003c/span\u003e\u003cspan address=\"https://www.washingtonpost.com/news/post-politics/wp/2016/09/12/body-doubles-secret-doctors-clinton-conspiracy-theories-blossom-after-pneumonia-diagnosis/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlover S. Doctor talks about Donda West\u0026rsquo;s death. \u003cem\u003eLos Angeles Times\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.latimes.com/archives/la-xpm-2007-nov-20-me-west20-story.html\u003c/span\u003e\u003cspan address=\"https://www.latimes.com/archives/la-xpm-2007-nov-20-me-west20-story.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePolskie Radio. Professor Lew-Starowicz: \"Putin has many typical features of a psychopath\". Polskie Radio.;\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.polskieradio.pl/395/9766/artykul/3025332,professor-lewstarowicz-putin-has-many-typical-features-of-a-psychopath\u003c/span\u003e\u003cspan address=\"https://www.polskieradio.pl/395/9766/artykul/3025332,professor-lewstarowicz-putin-has-many-typical-features-of-a-psychopath\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStokowski M. Einfach mal still sein [Just be quiet]. \u003cem\u003eDer Spiegel\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.spiegel.de/kultur/gesellschaft/angela-merkel-und-ihr-zittern-in-den-medien-einfach-mal-still-sein-a-1277507.html\u003c/span\u003e\u003cspan address=\"https://www.spiegel.de/kultur/gesellschaft/angela-merkel-und-ihr-zittern-in-den-medien-einfach-mal-still-sein-a-1277507.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatthews S. NHS doctor sparks backlash with 'irresponsible' and 'childish' claim that Princess Kate would have been sent home within a DAY had she been treated on the NHS - as he is accused of speculating what is wrong with her. The Daily Mail. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.dailymail.co.uk/health/article-12977721/Doctor-sparks-social-media-row-Princess-Kate.html\u003c/span\u003e\u003cspan address=\"https://www.dailymail.co.uk/health/article-12977721/Doctor-sparks-social-media-row-Princess-Kate.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Medical Association. Code of Medical Ethics. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://code-medical-ethics.ama-assn.org/\u003c/span\u003e\u003cspan address=\"https://code-medical-ethics.ama-assn.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [accessed 23rd January 2024].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArdery J. The AMA Code of Medical Ethics-What is Its Legal Effect?. Medical News. 2, (2004).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Medical Association. 8.12 Ethical Physician Conduct in the Media. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://code-medical-ethics.ama-assn.org/sites/default/files/2022-09/8.12%20Ethical%20Physician%20Conduct%20in%20the%20Media%20--%20background%20reports.pdf\u003c/span\u003e\u003cspan address=\"https://code-medical-ethics.ama-assn.org/sites/default/files/2022-09/8.12%20Ethical%20Physician%20Conduct%20in%20the%20Media%20--%20background%20reports.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Medical Association. Opinion 3.1.5 Professionalism in Relationships with Media. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://code-medical-ethics.ama-assn.org/ethics-opinions/professionalism-relationships-media\u003c/span\u003e\u003cspan address=\"https://code-medical-ethics.ama-assn.org/ethics-opinions/professionalism-relationships-media\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Medical Association. Member organizations of the AMA House of Delegates. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ama-assn.org/house-delegates/hod-organization/member-organizations-ama-house-delegates\u003c/span\u003e\u003cspan address=\"https://www.ama-assn.org/house-delegates/hod-organization/member-organizations-ama-house-delegates\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Medical Association. Federation Directory. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://federationdirectory.ama-assn.org/federations\u003c/span\u003e\u003cspan address=\"https://federationdirectory.ama-assn.org/federations\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Psychiatric Association. \u003cem\u003eOpinions of the Ethics Committee on The Principles of Medical Ethics. With Annotations Especially Applicable to Psychiatry\u003c/em\u003e. (American Psychiatric Association, 2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaker R, ed. \u003cem\u003eThe American medical ethics revolution: how the AMA's code of ethics has transformed physicians' relationships to patients, professionals, and society\u003c/em\u003e. (JHU Press, 1999).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoyal College of Psychiatrists. Goldwater Rule. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/other-policy-areas/goldwater-rule\u003c/span\u003e\u003cspan address=\"https://www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/other-policy-areas/goldwater-rule\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobertson M, Walter G, Bloch S. Ethical use of the media by psychiatrists: towards an antipodean formulation of the \"Goldwater Rule\". Australas Psychiatry. 24, 26\u0026ndash;29 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSulmasy LS, Bledsoe TA; ACP Ethics, Professionalism and Human Rights Committee. American College of Physicians Ethics Manual: Seventh Edition. Ann Intern Med. 170(2_Suppl), S1-S32. (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican College of Surgeons. Statements on Principles. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.facs.org/about-acs/statements/statements-on-principles/\u003c/span\u003e\u003cspan address=\"https://www.facs.org/about-acs/statements/statements-on-principles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Orthopaedic Surgeons. Code of Medical Ethics and Professionalism for Orthopaedic Surgeons. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aaos.org/contentassets/b5bdb0610ad4411cbe400ce53a2ccdab/code-of-ethics-2013-color-logo.pdf\u003c/span\u003e\u003cspan address=\"https://www.aaos.org/contentassets/b5bdb0610ad4411cbe400ce53a2ccdab/code-of-ethics-2013-color-logo.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2011).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Otolaryngology\u0026ndash;Head and Neck Surgery Foundation, Inc. Code of Ethics. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.entnet.org/about-us/leadership-governance/ethics/code-of-ethics/\u003c/span\u003e\u003cspan address=\"https://www.entnet.org/about-us/leadership-governance/ethics/code-of-ethics/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Association of Neurological Surgeons. AANS Code of Ethics. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aans.org/-/media/Files/AANS/About-Us/Governance/AANS_Code_of_Ethics_Approved_-_Nov_2023.ashx\u003c/span\u003e\u003cspan address=\"https://www.aans.org/-/media/Files/AANS/About-Us/Governance/AANS_Code_of_Ethics_Approved_-_Nov_2023.ashx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Ophthalmology. Code of Ethics. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aao.org/education/ethics-detail/code-of-ethics\u003c/span\u003e\u003cspan address=\"https://www.aao.org/education/ethics-detail/code-of-ethics\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Ophthalmology. Advisory Opinion - Social Media and Professionalism. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aao.org/education/ethics-detail/advisory-opinion-social-media-professionalism\u003c/span\u003e\u003cspan address=\"https://www.aao.org/education/ethics-detail/advisory-opinion-social-media-professionalism\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNorth American Neuro-Ophthalmology Society. Code of Ethics. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nanosweb.org/i4a/pages/index.cfm?pageid=3663\u003c/span\u003e\u003cspan address=\"https://www.nanosweb.org/i4a/pages/index.cfm?pageid=3663\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNorth American Neuro-Ophthalmology Society. Advisory Opinion - Social Media and Professionalism. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nanosweb.org/i4a/pages/index.cfm?pageid=4220\u003c/span\u003e\u003cspan address=\"https://www.nanosweb.org/i4a/pages/index.cfm?pageid=4220\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican College of Cardiology. Code of Ethics. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.acc.org/-/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/About-ACC/Governance/ACC-Code-of-Ethics.pdf\u003c/span\u003e\u003cspan address=\"https://www.acc.org/-/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/About-ACC/Governance/ACC-Code-of-Ethics.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Neurology Code of Professional Conduct. Neurology. 97, 1096 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBusl KM, Rubin MA, Tolchin BD, et al. Use of Social Media in Health Care-Opportunities, Challenges, and Ethical Considerations: A Position Statement of the American Academy of Neurology. Neurology. 97, 585\u0026ndash;594 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Association of Neuromuscular \u0026amp; Electrodiagnostic Medicine Ethics Committee. Guidelines for ethical behavior relating to clinical practice issues in neuromuscular and electrodiagnostic medicine. Muscle Nerve. 65, 391\u0026ndash;399 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Urological Association. Code of Ethics. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.auanet.org/myaua/aua-ethics/code-of-ethics\u003c/span\u003e\u003cspan address=\"https://www.auanet.org/myaua/aua-ethics/code-of-ethics\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican College of Allergy, Asthma \u0026amp; Immunology. Social Media Policy. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://college.acaai.org/acaai-policies/social-media-policy/\u003c/span\u003e\u003cspan address=\"https://college.acaai.org/acaai-policies/social-media-policy/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Dermatology. Position Statement on Medical Professionalism in the Use of Social Media. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://server.aad.org/forms/policies/Uploads/PS/PS-Medical%20Professionalism%20in%20the%20Use%20of%20Social%20Media.pdf\u003c/span\u003e\u003cspan address=\"https://server.aad.org/forms/policies/Uploads/PS/PS-Medical%20Professionalism%20in%20the%20Use%20of%20Social%20Media.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRadiological Society of North America, Inc. Bylaws. 2017. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.rsna.org/uploadedFiles/RSNA/Content/About_RSNA/RSNA_bylaws.pdf\u003c/span\u003e\u003cspan address=\"https://www.rsna.org/uploadedFiles/RSNA/Content/About_RSNA/RSNA_bylaws.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican College of Occupational and Environmental Medicine. Code of Ethics. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://acoem.org/about-ACOEM/Governance/Code-of-Ethics\u003c/span\u003e\u003cspan address=\"https://acoem.org/about-ACOEM/Governance/Code-of-Ethics\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Endocrine Society. Code of Ethics of the Endocrine Society. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.endocrine.org/-/media/endocrine/files/about/codeofethics.pdf\u003c/span\u003e\u003cspan address=\"https://www.endocrine.org/-/media/endocrine/files/about/codeofethics.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe American College of Gastroenterology. Code of Professional Conduct. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://s3.gi.org/members/committees/FinalCodeofProfessionalConductandWitnessing.pdf\u003c/span\u003e\u003cspan address=\"https://s3.gi.org/members/committees/FinalCodeofProfessionalConductandWitnessing.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParsa-Parsi RW. The International Code of Medical Ethics of the World Medical Association. \u003cem\u003eJAMA\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2022.19697\u003c/span\u003e\u003cspan address=\"10.1001/jama.2022.19697\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeneral Medical Council. Good Medical Practice. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/good-medical-practice\u003c/span\u003e\u003cspan address=\"https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/good-medical-practice\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePouncey C. Is the Goldwater Rule out of step with medical ethics? How four past APA presidents morally justify the Goldwater Rule. \u003cem\u003eCentre for Ethics and the Rule of Law, University of Pennsylvania\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.penncerl.org/the-rule-of-law-post/is-the-goldwater-rule-out-of-step-with-medical/\u003c/span\u003e\u003cspan address=\"https://www.penncerl.org/the-rule-of-law-post/is-the-goldwater-rule-out-of-step-with-medical/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernstein J. Not the Last Word: A Goldwater Rule for Sports Medicine. Clin Orthop Relat Res. 476, 1149\u0026ndash;1153 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarnahan D. Faked videos shore up false beliefs about Biden\u0026rsquo;s mental health. \u003cem\u003eThe Conversation\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://theconversation.com/faked-videos-shore-up-false-beliefs-about-bidens-mental-health-145975\u003c/span\u003e\u003cspan address=\"https://theconversation.com/faked-videos-shore-up-false-beliefs-about-bidens-mental-health-145975\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatira K. AI hoax? 'Death of Canadian who got plastic surgery to look like BTS' Jimin' was fake news: Report. \u003cem\u003eWION\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wionews.com/entertainment/ai-hoax-death-of-canadian-who-did-plastic-surgery-to-look-like-bts-jimin-was-fake-news-report-587496\u003c/span\u003e\u003cspan address=\"https://www.wionews.com/entertainment/ai-hoax-death-of-canadian-who-did-plastic-surgery-to-look-like-bts-jimin-was-fake-news-report-587496\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenz BD, Modi ND, Sorich MJ, Hopkins AM. Health Disinformation Use Case Highlighting the Urgent Need for Artificial Intelligence Vigilance: Weapons of Mass Disinformation. JAMA Intern Med. 184, 92\u0026ndash;96 (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Medical Association. Professionalism in the Use of Social Media. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://code-medical-ethics.ama-assn.org/ethics-opinions/professionalism-use-social-media\u003c/span\u003e\u003cspan address=\"https://code-medical-ethics.ama-assn.org/ethics-opinions/professionalism-use-social-media\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Medical Association. AMA adopts new policy aimed at addressing public health disinformation. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ama-assn.org/press-center/press-releases/ama-adopts-new-policy-aimed-addressing-public-health-disinformation\u003c/span\u003e\u003cspan address=\"https://www.ama-assn.org/press-center/press-releases/ama-adopts-new-policy-aimed-addressing-public-health-disinformation\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Psychiatric Association. APA Ethics Committee Issues Opinion on the Spread of Disinformation. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.psychiatry.org/news-room/apa-blogs/ethics-committee-on-the-spread-of-disinformation\u003c/span\u003e\u003cspan address=\"https://www.psychiatry.org/news-room/apa-blogs/ethics-committee-on-the-spread-of-disinformation\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Goldwater Rule, American Medical Association, Medical ethics, Artificial intelligence, misinformation","lastPublishedDoi":"10.21203/rs.3.rs-4750590/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4750590/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAs a professional duty, physicians often publicly comment on health-related topics. However, ethical complexities can arise during discussions about high-profile individuals or events, especially in an era of rapid news cycles and digital media. The American Medical Association (AMA) has policies concerning physician commentary and media interactions, as does the American Psychiatric Association (i.e., the Goldwater Rule). Nevertheless, the extent to which other US medical associations have adopted similar protocols remains underexplored. Focusing on non-psychiatric members of the AMA\u0026rsquo;s policymaking body, the Federation of Medicine (FMMs), this study sought to analyse cross-speciality perspectives. Between January-March 2024, online resources for n\u0026thinsp;=\u0026thinsp;122 FMMs were reviewed (e.g., professional codes and position statements), followed by email outreach to verify positions and garner further insights. n\u0026thinsp;=\u0026thinsp;47 FMMs provided sufficient information for inclusion, cumulatively representing approximately 950,000 members. n\u0026thinsp;=\u0026thinsp;16 FMMs (34%) had guidelines or policies regarding public commentary, generally emphasizing accuracy, consent, and confidentiality. Yet, for the majority of FMMs (n\u0026thinsp;=\u0026thinsp;31/66%), no specific regulations were identified; these organizations did not cite any proprietary statutes or deferred to AMA materials. Moreover, existing FMM policies largely overlooked the impact of Artificial Intelligence and digital misinformation, warranting cross-specialty exchanges to uphold credible discourse amid societal and technological shifts.\u003c/p\u003e","manuscriptTitle":"Ethics beyond Goldwater? Analyzing policies from American medical organizations on public communications from physicians in the digital age","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-12 10:36:45","doi":"10.21203/rs.3.rs-4750590/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-04T06:47:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-24T16:00:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39263190644626225558243441293494471859","date":"2024-10-21T15:21:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-21T11:03:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"313760371623691070108447924700493977658","date":"2024-10-21T10:55:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-12T04:33:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103479359470401835540053923318497535974","date":"2024-09-21T10:00:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90044914258422413116217849669411165528","date":"2024-09-20T03:09:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-18T03:06:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-17T10:00:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-22T17:08:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-18T06:47:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-07-16T14:46:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c775981f-a8eb-4465-9dd5-88eb49f9381b","owner":[],"postedDate":"August 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":35816816,"name":"Health sciences/Health care/Health policy"},{"id":35816817,"name":"Health sciences/Health care/Medical ethics"}],"tags":[],"updatedAt":"2024-12-02T15:59:42+00:00","versionOfRecord":{"articleIdentity":"rs-4750590","link":"https://doi.org/10.1038/s41598-024-81176-6","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-11-28 15:57:03","publishedOnDateReadable":"November 28th, 2024"},"versionCreatedAt":"2024-08-12 10:36:45","video":"","vorDoi":"10.1038/s41598-024-81176-6","vorDoiUrl":"https://doi.org/10.1038/s41598-024-81176-6","workflowStages":[]},"version":"v1","identity":"rs-4750590","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4750590","identity":"rs-4750590","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}