Who do you believe?

Editor’s note: This is the final story in a three-part series on health misinformation, vaccine hesitancy and distrust in Idaho. The Idaho Capital Sun interviewed dozens of people, asking how the state ended up on a path to catastrophe — and what, if anything, can turn it around.

State legislators, public health officials, lawyers, health care workers and a media scholar all described one common theme: distrust, fueled by forces within Idaho and beyond.

A strange complaint came into the Idaho Attorney General’s Office in 2000. A business called “Sound Health Society” said it could diagnose medical problems, using only a person’s blood or saliva sample — sent in by fax. It also sold “sound wave” machines to cure terminal illnesses, including cancer.

Idaho’s top consumer protection lawyers opened an investigation. They smeared a bit of ketchup on a piece of paper and faxed it in. The ketchup’s diagnosis: an iron imbalance.

The Idaho Attorney General’s Office later sued Sound Health Society and its now-deceased proprietors from Nampa, among other parties involved in the alleged scheme, saying they violated Idaho’s consumer protection laws and bamboozled “multiple” Idahoans.

Twenty years later, the attorney general’s consumer protection division is one of few blockades against health misinformation in Idaho.

During the pandemic, it investigated people who claimed to have treatments or prophylactics for COVID-19, taking one to court.

Since the pandemic began, Idahoans haven’t been sure whom to trust. They want to survive, be healthy and make the right choices for themselves and their family.

“The vast majority of people want to do the right thing,” said Maggie Mann, director of the Southeastern Idaho Public Health department. “It boils down to a question of who do you believe? Who do you put your trust in?”

As nurses and doctors interviewed by the Sun have said, nobody they’ve encountered chose to ignore public health advice because they wanted to be critically ill or die — or infect their loved ones.

“My advice to our health system, and my advice to health care workers, and my advice to people of goodwill who want to see this thing put behind us, is to direct your frustration and your anger where it’s more healthy, and that is at the people who are selling the misinformation,” said Dr. James Souza, chief physician executive for St. Luke’s Health System and a pulmonologist and intensive care physician.

“Please remember that when the people who are being misinformed get this infection, and they take the false treatments offered by these doctors, and then they get really sick, who do they come to? They don’t go to them. They come to us,” Souza said.

FALSE CURES, FALSE INFO

David Flowers in Payette runs a website and Facebook page called “True Wisdom True Immunity.” It claims to be “the only source using the body, its immune system, organs, glands, and natural ability to self-heal and self-repair. It seems to us, everyone else in the current healthcare industry is simply selling products with no regard to the (body’s) healing capacity.”

The Facebook page has nearly 10,000 followers.

The Attorney General’s Office won a lawsuit last year against Flowers over his claims. Flowers told the Sun in a phone interview that he plans to “let sleeping dogs lie” instead of complying with the court’s order to cease doing business and pay $15,000 in penalties.

“They’ve maintained that the science is the end all, be all, and there’s nobody else capable of coming up with better information or understanding of health care, outside of science, and they’d be wrong. So that’s where it sits,” Flowers said.

Stephanie Guyon is the deputy attorney general who worked on that lawsuit, and many others, to enforce laws protecting consumers from unscrupulous practices.

When a licensed or unlicensed health care provider makes a false claim, it doesn’t just cost the patient money and time, it can damage their health directly — and indirectly, if it keeps them from getting evidence-based medical care.

For example, Guyon sometimes notices advertisements for “ionic foot bath” cleansing treatments, which claim to remove toxins by pulling them out through a person’s feet.

Those kinds of claims trouble her.

Treatments without solid evidence to back them up are “certainly not going to cure your child’s autism,” Guyon said in a June interview.

“It’s not going to cure cancer. It’s not going to help your back pain,” she said. “But people who are in pain, people who have problems with any parts of their body, they’re desperate. They want to believe that they can take a pill, they can get a treatment that is going to relieve their pain, and they are willing to pay for it.”

The coronavirus offered an opportunity to Idahoans who peddle false cures or make unfounded claims about health: a new, unpredictable virus that challenged even the world’s top scientists and medical providers.

Steven Baker, a chiropractor in Meridian, has claimed to have answers.

Before the pandemic, he developed a large social media presence, with a Facebook page that has since been removed. He shared videos that cited, for example, misleading information about child vaccinations.

Pertussis, or whooping cough, “currently affects less than 0.1% of the population,” Baker says in one video, urging people to move away from states that require vaccinations for public schools, and highlighting that Idaho allows exemptions. “You’re worried about something that affects … less than 0.1% of babies that are born,” he says.

Pertussis was once a common illness. Because of vaccinations, it is now rare, according to the U.S. Centers for Disease Control and Prevention. Still, cases do occur, and the bacterial infection can be deadly in infants. Between 2000 and 2017, the CDC recorded 307 deaths from pertussis, with newborns making up 84% of those deaths.

In the school year before COVID-19 arrived, 7.7% of Idaho’s kindergarten, first- and seventh-grade students had an exemption for at least one vaccine — a total of about 5,600 children in those grades. That exemption rate was 6.4% two years earlier, Idaho Ed News reported.

Reached on the phone Wednesday, Baker did not answer the Sun’s questions about his videos or his chiropractic practice.

“Your opinion doesn’t matter, and your opinion of what I say doesn’t matter, so you can print whatever,” he told the Sun.

Baker has been licensed as a chiropractor in Idaho since 2009 with no disciplinary actions on his record.

MISINFORMATION PAYS

Baker attracted national attention last year for claiming that silver could prevent coronavirus infections.

“Baker’s Facebook page has just over 70,000 followers, while his Instagram account hovers at about 6,000,” BuzzFeed News reported in April 2020. “The videos he has been publishing during the pandemic have seen the highest engagement rate of anything he’s posted, according to data from social media analysis firm CrowdTangle.”

Facebook took down his page.

His Instagram account remains active, now with more than 53,000 followers. On Instagram, he directs people to buy supplements from his website, which sells an “immune bundle” of several products that cost $22 to $59 each.

An Idaho doctor also became a leading figure in the COVID-19 anti-mask and anti-vaccination movement — while making money from coronavirus tests.

Dr. Ryan Cole has called the COVID-19 vaccine a “clot shot,” “needle rape,” an “experimental” drug and a “poisonous attack on our population” that must be stopped. His unsupported claims include that the vaccines open a door to cancer and other diseases, that COVID-19 survivors “are now immune,” and that children should not receive the vaccine.

He advocates, in interviews and public comments, for unproven methods of avoiding illness and death from COVID-19.

Local emergency physicians said in sworn affidavits that patients with severe COVID-19 came to their emergency rooms after taking Cole’s prescriptions and advice. Their complaints are among several made this year against Cole to Washington’s medical licensing board.

Cole has told the Sun that he went into debt to offer COVID-19 testing, in an effort to aid Idahoans in the early stages of the pandemic.

Cole Diagnostics performed more than 100,000 coronavirus tests as of summer 2021, according to paperwork Cole submitted to Ada County. The Sun estimated a gross income of nearly $10 million for those tests, based on the lab’s out-of-pocket price and typical reimbursement rates for testing.

Cole said in text messages that the lab’s net income was “much less than half of that” amount.

“Keep in mind that we spent over $2 million on supplies and equipment” and that Cole Diagnostics also had staff wages and overhead, he said. The pandemic’s toll on preventive care such as cancer screenings took a toll on his business, too, he said.

Cole Diagnostics relied heavily on COVID-19 testing for income, according to public records obtained through a request to the Idaho Department of Health and Welfare.

Idaho Medicaid is one of the state’s largest health insurers. Many low-income Idahoans with Medicaid got their COVID-19 test results through Cole’s laboratory.

The Idaho Medicaid program paid Cole Diagnostics more than $282,000 for COVID-19 testing claims between March 2020 and September 2021. That was about 45% of the lab’s income from Medicaid during that time period. (The other 55% was for cervical cancer test results, blood tests, insulin and hormone levels, and sexually transmitted infection tests, among other things.)

“My personal net income last year was zero. (I took home a stipend to pay food, lights, heat and mortgage),” Cole wrote in a text message to the Sun. “I did what I did to serve my fellow citizens and patients, at great risk to the edge of insolvency, during a health crisis.”

KIDS AND VACCINES

Health disinformation, myths and vaccine hesitancy go back decades in Idaho.

“It just feels like it, it’s on such a … huge scale now. You can feel that anger really quickly now, with the tools we have with the internet. But vaccine misinformation … it’s really not new, unfortunately,” said Idaho Immunization Program Manager Sarah Leeds. “It can gain so much traction as legitimate, so quickly.”

It has been six weeks since Idaho officials announced the state’s first death of a child — an infant — from COVID-19, and only 13% of Idaho children ages 5 to 11 received a first dose of the coronavirus vaccine.

Those daily vaccination numbers have already begun to slow down.

The topic of child immunizations is an open wound in Idaho. Instead of healing the wound, the pandemic has left it weeping and raw.

Hundreds of people submitted public comments on Idaho’s vaccine rules in 2019 — many of them part of Health Freedom Idaho, a nonprofit organization formed in 2016 to oppose vaccination requirements, among other things.

The group has organized mask protests, events with anti-vaccination speakers and advocacy campaigns in Idaho during the pandemic. It also helped to spread false and misleading information on COVID-19 and vaccines.

In a meeting this month of the regional public health board he was appointed to last summer, Cole addressed questions to Dr. Kenneth Bramwell, medical director of St. Luke’s Children’s, Idaho’s only children’s hospital.

Cole repeated a claim to Bramwell, a pediatric emergency medicine doctor, that kids are more likely to be hospitalized from the vaccine than from COVID-19.

Cole cited no source for his claim, which is false.

More than 280 Idaho children have been hospitalized with COVID-19.

Meanwhile, more than 89,500 Idaho children had received the COVID-19 vaccine as of Dec. 22. The Vaccine Adverse Event Reporting System shows only three instances of Idaho children being hospitalized at some point after vaccination.

(Those reports do not imply a child was hospitalized because of the vaccine. “While very important in monitoring vaccine safety, VAERS reports alone cannot be used to determine if a vaccine caused or contributed to an adverse event or illness,” the system’s disclaimer says. “The reports may contain information that is incomplete, inaccurate, coincidental, or unverifiable.”)

Health Freedom Idaho and other groups have used the internet and various media platforms to amp up their advocacy efforts, as well as to spread misinformation.

As Idaho went into a never-before-seen crisis in its hospitals this fall, the group sent out a mass email that claimed breathing in a mist of hydrogen peroxide was “a simple remedy for COVID-19.”

A Michigan family doctor “has successfully treated over 200 patients with what has become my favorite intervention for COVID-19 and other upper respiratory infections, namely nebulized hydrogen peroxide,” the email said.

A month later, fact checkers and health organizations such as the Asthma and Allergy Foundation of America warned the public not to try inhaling hydrogen peroxide for COVID-19.

“DO NOT put hydrogen peroxide into your nebulizer and breathe it in,” the AAFA said. “This is dangerous!”

That email from Aug. 21 also advertised several large gatherings — and an email campaign to county commissioners in support of Cole.

That week, according to federal and state data, Idaho hospitals admitted 455 adults and nine children with COVID-19. They saw nearly 2,300 patients for COVID-19 in the ER. And 69 Idahoans died from the disease.

SIDEBAR:

Where do we go from here?

The approach that Idaho Gov. Brad Little and several other Idaho leaders have taken in the pandemic is not to force compliance with public health advice.

“In states where there’s already a lot of support for the measure, it’s easier to do a mandate and … it’s going to work,” said Dr. Christine Hahn, Idaho state epidemiologist. “But in states where there’s not support, it can actually be counterproductive.”

Instead, leaders have encouraged people to listen to experts and choose to get vaccinated, to wear masks and to protect themselves and others.

But what happens when people aren’t listening to experts? What happens if they’re consuming misinformation? Experts in medicine, the law, public health and media literacy were almost unanimous on how to combat the polarization of facts in public health: “I don’t know.”

“What changes it? I don’t know. You’re talking about changing an attitude, a belief system,” said Dr. Paul Offit, director of the Vaccine Education Center, co-inventor of the RotaTeq rotavirus vaccine and a vaccine safety adviser to the Food and Drug Administration. “I think, in a better world, people care about their neighbor.”

Americans have a right to speak their minds.

The First Amendment protects freedom of speech, and sources interviewed by the Idaho Capital Sun agreed that it’s crucial to American society.

However, there are limits to free speech. It is a felony in Idaho to spread “any false statement, rumor, or suggestion, written, printed or by word of mouth” about a financial institution, if it causes a bank run or otherwise harms the bank.

“If you’re saying something that you either know isn’t true, or you’re totally reckless in disregarding whether it’s true or false … and people are injured by that, you should be accountable,” said John Culhane, a law professor, fellow in constitutional law and co-director of the Family Health Law & Policy Institute at Widener University Delaware Law School.

Accountability through the courts?

Culhane recently spearheaded a project “to research and examine the sources of misleading information about COVID-19 vaccines” by talking with survivors and people who lost a loved one to COVID-19, and evaluating whether they could merit “legal recourse.”

“If you say something negligently, like you don’t do the full research, I don’t think people should be liable for that,” Culhane said. “But if you deliberately are lying, (or) you have no idea what you’re talking about, you just are spouting nonsense, that should be actionable if people rely on it to their detriment. And I would say, if they’re dying from COVID, that’s to their detriment. And their family members should be bringing wrongful deaths.”

Idaho Rep. Greg Chaney, R-Caldwell, lost his mother in September to COVID-19. She was 74 and unvaccinated.

“I don’t think a mandate would have made my mother more likely to get vaccinated,” he said in an interview. “I think she would have dug in more and resisted, more, getting the vaccine.”

But, with accurate information, he believes she would have chosen differently, he said.

Chaney, who is an attorney, said creating “some kind of civil liability for people who spread misinformation” might be warranted. There is no appetite for that in the Idaho Legislature now, though, he said.

Accountability at the polls?

Idaho legislators themselves have spread false information.

For example, Rep. Greg Ferch, R-Boise, falsely claimed on the House floor that “there appears to be some credible evidence that Pfizer executives were hiding the fact that there were aborted fetus cells were used in the production of the vaccine,” the Sun previously reported.

Rep. Tammy Nichols, R-Middleton, last year claimed that an Idaho nurse who died of COVID-19 actually died from a heart attack and has shared false and misleading information about COVID-19 treatments and masks.

On his Facebook page, Rep. Chad Christensen, R-Iona, often shares conspiracy theories about the pandemic. He refers to the “COVID agenda” as a planned health crisis “to destroy small business and erode freedoms.” He shares baseless claims about the coronavirus — that variants like delta and omicron “must be manufactured” — and about the COVID-19 vaccine.

“I think, in a big way, we as Idahoans need to hold politicians accountable for spreading misinformation,” Chaney said. “Maybe it happens in 2022, maybe it doesn’t happen until 2024. We need to go to the ballot box, and we need to remember how opportunistic and damaging some of these comments have been.”

’Care and compassion for your community’

Idaho Public Health Division Administrator Elke Shaw-Tulloch, who has overseen project after project during the pandemic, worries that the problem runs deep — that, maybe, people just don’t care about others.

“What’s been really striking to me, throughout the course of this pandemic so far — whether it’s wearing a mask, or any of the measures that we’ve taken, is that people are so stuck in their (stance of) ‘But this is affecting me, personally,’” she said. “If that’s all you can see and hear is just … how it impacts you and relates to you, as opposed to your care and compassion for your community, for the greater good, how do you shift that?”