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Health misinformation was an Idaho-grown product for years. Now it has a body count.

The COVID-19 pandemic gave a renewed purpose to health misinformation in Idaho. The state has a long tradition of allowing licensed and unlicensed health care providers to treat patients with unproven methods and substances. With pressure from anti-vaccination groups, the state’s vaccine rules also are among the most lenient in the U.S. Clockwise from upper left: Anti-vaccine protesters outside St. Luke’s hospital in downtown Boise; anti-mask protesters outside the Idaho State Capitol; Michael Karlfeldt, Dr. Ryan Cole and Dr. Vicki Wooll. (Images from Idaho Capital Sun, Getty and screen shots from video presentations)
The COVID-19 pandemic gave a renewed purpose to health misinformation in Idaho. The state has a long tradition of allowing licensed and unlicensed health care providers to treat patients with unproven methods and substances. With pressure from anti-vaccination groups, the state’s vaccine rules also are among the most lenient in the U.S. Clockwise from upper left: Anti-vaccine protesters outside St. Luke’s hospital in downtown Boise; anti-mask protesters outside the Idaho State Capitol; Michael Karlfeldt, Dr. Ryan Cole and Dr. Vicki Wooll. (Images from Idaho Capital Sun, Getty and screen shots from video presentations)

More than 1,400 Idahoans have died from COVID-19 since vaccines became widely available.

The parking lot was overflowing at a Garden City church, the site of a day-long “Healing America Medical Truth Symposium.”

It was early October, one of the last warm Saturdays of the year, and health officials were pleading with Idahoans to avoid indoor gatherings. Judging by the parking situation, at least 220 people declined to take their advice.

A “truth” event hosted by a political group, featuring speakers who preach a gospel of distrust in public health, is familiar in pandemic-era Idaho.

But it would have been just as familiar before the pandemic.

A cottage industry of health misinformation has flourished in Idaho for years, with help from Idaho’s laissez-faire approach to governance and a faction of Idaho Republican lawmakers who support and amplify the misinformation. Some of the players promote unproven, unsafe and unorthodox treatments, seemingly without consequence.

The pandemic gave locally grown health misinformation a new marketplace — and a body count.

“We have people that are needlessly suffering in hospitals and … frankly, we have people dying because of misinformation that’s out there,” said Idaho Health and Welfare Director Dave Jeppesen. “And that’s a real tragedy.”

On the day of the symposium, 751 people were hospitalized with COVID-19 in Idaho, and 32 people died from the disease.

As hospitals buckle and deaths mount, many Idahoans refuse vaccines

Idaho is the least vaccinated state of the pandemic, with only 48% of the population having received a first dose, according to data from the U.S. Centers for Disease Control and Prevention.

With no mask requirements and very few restrictions in place statewide, the coronavirus has seized an opportunity in Idaho.

The state’s prolonged surge began in early July and is ongoing in mid-October. The delta-fueled surges in states like Texas, with higher vaccination rates, also began in early July but have long since dropped from their peaks.

Hospitals in Idaho became so overburdened with coronavirus patients that, in September, officials declared a statewide crisis — a last-resort measure that allowed hospitals to operate in mass-casualty triage mode.

While the summer COVID-19 wave across the country may have prompted more Americans to vaccinate, the opposite happened in Idaho. There was a small bump in vaccination rates after delta began to spread; it was short lived. The worse Idaho’s situation became, it seemed, the fewer people got vaccinated.

In the month since Idaho’s hospitals buckled and the state declared “crisis standards of care,” vaccine uptake fell 56% — from an average of 1,835 first doses administered per day, to an average of 814.

"We don't know exactly why" that happened, said Sarah Leeds, manager of Idaho’s immunization program.

Sowing distrust in public health advice

One of the nation’s most prominent naysayers of COVID-19 vaccines, masking and other public health measures hails from Idaho. Last month, county commissioners appointed him to help oversee the budget and leadership of Idaho’s largest regional public health agency.

Dr. Ryan Cole, a local pathologist and owner of Cole Diagnostics, is now the lone physician on the board for Central District Health — an agency that is pivotal to vaccine distribution and public health initiatives in the Boise area.

Since his appointment, Cole has spread false information about COVID-19 vaccines and criticized infectious disease specialists.

"You have NBA players speaking more scientific truth than your public health (officials)," Cole said in an Oct. 3 roundtable discussion.

Tommy Ahlquist, a former emergency physician, created the Crush The Curve Idaho nonprofit last year to boost access to COVID-19 testing and vaccinations in Idaho. He got to know Cole early in the pandemic, when Crush The Curve was working on antibody testing.

“The amount of work it takes on the other side to discredit the misinformation is a big problem,” Ahlquist told the Sun in a July interview, as the delta variant was spreading in Idaho.

When he worked in local emergency rooms, Ahlquist would see patients who just returned from Mexico seeking a cure for their cancer.

“I would think, ‘Oh my God, I'm so sorry for you,’” he said. “There’s just always been this element of taking advantage of people. They’re vulnerable, they’re looking for a cure. (They believe) there’s going to be some other fix or answer that’s not traditional.”

The pandemic made Idahoans vulnerable to a new pathogen, and to a new crop of misinformation about its cure.

“You just pour gasoline on that fire, and it goes,” Ahlquist said.

Ahlquist is one of several Idaho Republicans who have spoken out against the politicization of the pandemic and vaccines.

But another group of Idaho Republicans — including the lieutenant governor and several state lawmakers — is turning public health into an opportunity for revolt.

"Sixteen conservative legislators tried and failed to establish a quorum in an attempt to bring the Idaho Legislature back into session Wednesday at the Statehouse," the Idaho Capital Sun reported Sept. 15. "The legislators ... put out a call over the weekend encouraging their colleagues to return to the Capitol and attempt to fight President Joe Biden’s vaccine rules."

A political action committee puts on a COVID-19 event in a church

The “Medical Truth Symposium” was broadcast live from the Garden City church on Brighteon.TV — a video platform created as a “pro-liberty” alternative to YouTube by longtime health misinformation and anti-vaccine publisher Mike Adams.

The event cost $10 to $25, presented by the ConservativesOf:PAC, an Eagle-based political action committee whose website says it supports the “propagation, adherence and preservation of Constitutional Judeo-Christian principles upon which our nation is established, and opposition to authoritarianism and ideological collectivism, of which Progressivism, Socialism, Communism and Fascism are a part.”

The symposium featured a slate of speakers and guests, including:

  • Michael Karlfeldt, an unlicensed local naturopath.
  • Dr. Vicki Wooll, a local physician.
  • A representative from Health Freedom Idaho, an anti-vaccine nonprofit with a long track record of fighting public health recommendations.

Karlfeldt and Wooll last year gave false and misleading information about COVID-19 to a public health board, on the invitation of Adams County Commissioner Viki Purdy. (“I can’t think of a better platform than we can provide to hear all the medical points of view and concerns,” Purdy told her fellow board members in an email explaining why she invited them to speak.)

That was before COVID-19 vaccines came around.

On the church stage at the Garden City symposium, Karlfeldt took aim at the vaccines. He asked why anyone would take a vaccine for COVID-19.

He called the shots “Russian roulette, and maybe I'll survive, you know, maybe there won't be a bullet in the chamber when I'm pulling the trigger.”

Karlfeldt also repeated a myth that COVID-19 vaccines can alter DNA. They carry “a little piece of information that's going to make us different,” he told the audience. “Who are they to say what is missing in my genes?”

That is untrue. It isn’t possible for the vaccine to alter a person’s genes.

“COVID-19 vaccines do not change or interact with your DNA in any way,” the CDC explains. “Both mRNA and viral vector COVID-19 vaccines deliver instructions (genetic material) to our cells to start building protection against the virus that causes COVID-19. However, the material never enters the nucleus of the cell, which is where our DNA is kept.”

Karlfeldt delivered a fusillade of misinformation, for at least 40 minutes.

Despite being unlicensed to practice medicine of any kind, he described treating patients who have COVID-19.

“I have, like, an acute viral pack that I like to put together in my center,” Karlfeldt said. “If somebody gets hit with the COVID ... I urge them to get going on that immediately, and with vitamin D, I bring dosages up to like 200,000 iu per day.”

“That is what I call a therapeutic level to change something,” he said of the vitamin D dosage.

The National Institutes of Health would call it something else: 50 times higher than the tolerable maximum dose of vitamin D.

“Excess amounts of vitamin D are toxic,” the NIH says. “Because vitamin D increases calcium absorption in the gastrointestinal tract,” too much can elevate calcium levels and “in turn, can lead to nausea, vomiting, muscle weakness, neuropsychiatric disturbances, pain, loss of appetite, dehydration, polyuria, excessive thirst, and kidney stones. In extreme cases, vitamin D toxicity causes renal failure, calcification of soft tissues throughout the body (including in coronary vessels and heart valves), cardiac arrhythmias, and even death.”

Vitamin D toxicity is “a rare but potentially serious condition that occurs when you have excessive amounts of vitamin D in your body,” such as 60,000 iu per day for months,according to the Mayo Clinic.

The NIH says toxicity “has been caused by consumption of dietary supplements that ... were taken inappropriately or in excessive amounts, or that were incorrectly prescribed by physicians.”

In Idaho, spotty laws and rules allow unlicensed care

Karlfeldt has offered his services to the public since at least 2006, when he advertised in the Idaho Statesman newspaper for community education workshops on reflexology, weight loss for women and dietary supplements for cancer patients.

He now operates a clinic with several health care providers and hosts a health-themed radio show. He has never been licensed.

The history ofnaturopathic licensing in Idaho is long, complicated and political.

Idaho law changed in 2019 and 2020. It allows licensed naturopathic medical doctors to act as primary care providers, with a limited scope of practice. They can prescribe some drugs and medical devices, order some lab tests, and perform some minor procedures like treating wounds.

While naturopathic medical doctors can now choose to be licensed in Idaho, the state has no regulatory oversight of naturopaths like Karlfeldt. A naturopath can hang a shingle and call themselves a “naturopathic doctor,” but only those with licenses can call themselves a “naturopathic medical doctor.”

Under Idaho’s system, only the licensed naturopath can face professional discipline.

Who does have jurisdiction over people who practice health care without a license?

That depends.

The Idaho Attorney General’s Office has jurisdiction over consumer protection violations. If someone with no credentials claims to have a cure for COVID-19, the office can take action against the false, misleading or deceptive claim.

If the person isn’t just selling bogus cures but is practicing medicine without a license, that’s a felony under state law, punishable by up to five years in prison and $10,000 fine. Unlicensed practice of naturopathic medicine is a misdemeanor. Since those are criminal offenses, the law leaves it up to a county prosecutor to hold unlicensed providers accountable.

The Idaho Board of Medicine has, so far, never disciplined a doctor for spreading false information about COVID-19, discouraging vaccines or prescribing unauthorized drugs for COVID-19.

But it has issued a “letter of concern” to a few physicians. That is a “nondisciplinary letter issued for a minor violation the Board feels may pose a risk to public safety,” according to board documents.

The discipline committee recommended inits February 2021 meeting that the board send a letter of concern to a doctor accused of “sharing unsolicited information regarding COVID-19 that was not scientifically sound.” During its August 2020 meeting, the committee voted to send a letter reminding a doctor to follow CDC guidelines for wearing masks, to “improve communication with patients and to not make mask wearing a political issue.”

The committee also recommended sending a letter of concern to Dr. Vicki Wooll “for giving false and misleading information regarding COVID-19 during a presentation to the Southwest District Health Board.”

The board adopted those recommendations and presumably sent the letters.

Because the letters are not disciplinary actions, they’re never available to the public — nor are the names of doctors who receive them.

The Sun identified Wooll because she was the only licensed medical doctor to present false information to the board of Southwest District Health. She told the health board last year that Idaho is the “victim of a very sophisticated psy-ops, psychological warfare,” and she linked 5G wireless internet to COVID-19, among other claims.

Wooll has not responded to messages from the Sun.

Several people have filed or signed on to complaints against Dr. Ryan Cole for his public statements.

Cole is an outspoken critic of COVID-19 vaccines. He discouraged people against the shots and said they are “a poisonous attack on the population” that must stop.

But it’s also his conduct as a laboratory doctor, offering to treat patients for COVID-19, that attracted the scrutiny of his peers.

This month, the Idaho Medical Association filed a 12-page complaint with the Idaho Board of Medicine.

“We believe his practice, as he has described it himself, is not in keeping with the Idaho community standard of care and does more harm than good. It should be stopped,” the complaint said.

Cole reacted to the board complaint with a statement.

“There are many ways to care for patients, and in times of crisis, as we have experienced in the last year, our profession must come together to examine all ways we can provide optimal medical care,” he wrote in the statement. “I am an experienced and educated physician with authority to analyze data and share medical science. … We can do better as a profession than to silence those who have a different perspective.”

The Idaho Board of Medicine will review the complaint, and its professional discipline committee may recommend formal action, informal action or dismissal. The board is scheduled to meet later this month.

The board did not take any formal action in response to a complaint filed this summer by Idaho 97 Project Executive Director Mike Satz. The complaint pointed to Cole’s public statements on COVID-19 and the Federation of State Medical Boards’ position that spreading false information may be cause for discipline.

The Board of Medicine pointed to Idaho’s law as its reason for dismissing the complaint.

“The Board’s jurisdiction is governed by what is in its statutes and rules,” the board’s response to Satz said. “Neither the Idaho Medical Practice Act nor the applicable administrative rules provide a basis for the Board to discipline licensees for statements made during a conference, to the media, or in any other public setting.”

The board’s investigators can, however, review patient records. Since the outcome of any non-discipline complaint is not public, it’s impossible to determine whether the board has reviewed Cole’s patient care records from telehealth visits.

Nicki Chopski, health professions section chief for the Idaho Division of Occupational and Professional Licensing, did not respond to requests for an interview.

The Washington Medical Commission has found cause to open an investigation into Cole’s conduct. He is licensed in Idaho, Washington and seven other states.

‘The truth will always prevail’

Cole was supposed to be one of the headliners at the symposium in Garden City.

But that weekend, another conference was under way — a meeting of the Association of American Physicians and Surgeons in Pittsburgh.

That group has a long history of publicizing “discredited medical theories, including possible links between vaccines and autism and between abortion and an increased risk of breast cancer,” according to the New York Times.

More recently, it moved into the pandemic space. It promotes “home-based COVID treatment” andpublishes a directory of unauthorized and unsupported “early treatment” for COVID-19.

Health care workers at local hospitals have told the Idaho Capital Sun that, during the most recent surge, more patients arrived in the emergency room near death, after trying to treat themselves at home.

There is an authorized early treatment available in Idaho: monoclonal antibodies.

But there’s also a free, easy-to-access vaccine.

“The truth is that vaccinated people in Idaho are five times less likely than unvaccinated people to contract (the highly transmissible delta variant), making it much harder for them to spread it to others,” Idaho Health and Welfare Director Jeppesen wrote in a recent blog post. Based on Idaho data, the vaccines have nearly wiped out the risk of death and slashed the risk of hospitalization.

That’s not what Cole says.

He called the vaccines a "genetic juice experiment," in a tweet June 30. "For the safety of yourself and your children, just say no! Your mom wouldn't let you do experimental drugs. Don't do them Now! #NurembergCode"

Cole has referred to 20-somethings who take COVID-19 vaccines as “lambs to the immune slaughter” and claimed the media is hiding “thousands” of vaccine-related deaths “while medical technocrats jab thousands of kids with the investigational spike poison.”

And his presentations have been shared widely around the world. They have been translated into French, Chinese, German and Spanish.

A video of Cole speaking at the Idaho Legislature went viral early this year, just as Idaho’s vaccine rollout was hitting a peak. He was invited by Lt. Gov. Janice McGeachin to speak on her “Capitol Clarity” series, and made a number of claims that fact checkers jumped on to correct.

“Man, the negative impact of that in our valley cannot be measured,” Tommy Ahlquist said of that one presentation. “It’s significant.”

Since then, Cole has been a fixture on the COVID-19 skeptics’ speaking circuit.

He argued, in a letter last month to his laboratory’s clients, that media outlets, fact checkers and other medical professionals are misconstruing his statements.

"The media wants to create a caricature of an unhinged, far right, conspiracy theorist, fringe medical provider. This simply is untrue," he wrote in the letter, obtained by the Idaho Capital Sun.

Cole has spoken out against vaccines and medical authorities on conservative radio, in videos for Health Freedom Idaho and, last month, joined two other doctors on Steve Bannon’s War Room podcast to announce their new group, the “Pandemic Health Alliance.”

“Yes, we’re kind of a rag tag, fugitive fleet trying to save planet Earth,” Cole said on Bannon’s podcast.

“We have informational flooding coming from these agencies and propagandistic stuff coming from different media outlets, trying to diminish and demean basic science,” he said.

Who is prescribing unproven drugs to Idahoans?

The “Pandemic Health Alliance” website lists health care providers who will treat COVID-19 with drugs like ivermectin. As of mid-October, it listed three Idaho providers — Cole, Foothills Functional Medicine and Gem Express Care — who have offered to prescribe drugs not recommended by global health authorities or backed up by adequate research.

Joseph Petrie, the physician assistant who practices telehealth for Gem Express Care, declined to comment. He then said, in an email, that his reticence is because “those of us that are actually implementing early outpatient treatment protocols for covid vs telling patients to go home and treat it like a cold until they can't breathe are getting a ton of scrutiny and have targets on our backs. I can tell you this though, early treatment saves lives!”

Cynthia Culp, nurse practitioner at Foothills Functional Medicine, could not be reached for comment. The website lists treatment protocols that aren’t recommended by health authorities, and it directs anyone experiencing COVID-19 symptoms to get tested through Cole’s laboratory. The website lists the cost for her COVID-19 care as:

  • $200 for a consultation to get a 90-day prescription for “ivermectin and other medications and supplements to support immune health and prevent COVID-19.”
  • $125 for appointments to get a refill.
  • $250 to $300 for COVID-19 care for someone who is already sick, which includes prescriptions such as ivermectin and vitamins “and possibly referrals for medical supplies if necessary.”
  • $75 to $200 for follow-up appointments.

There is no cost for a COVID-19 vaccine. There is no cost for monoclonal antibody treatments for patients who recently tested positive and are at risk of severe disease.
Cole and others routinely omit that information.

On the stage at the Pittsburgh conference, Cole invited other doctors to sign his new alliance’s declaration.

“Physicians are now advising their patients to simply go home, allowing the virus to replicate and return when their disease worsens, resulting in hundreds of thousands of unnecessary patient deaths due to failure to treat,” he said, reading from the declaration. “This is not medicine, this is not care, these policies may actually constitute crimes against humanity.”

In his presentation, he repeated false claims about COVID-19 vaccine safety and referred to people who contradict his claims as Nazis.

“Misinformation? Disinformation? No, there's information. The cream should always rise to the top, but to be labeled by the brownshirtsas just giving misinformation is a propaganda strategy,” Cole said. “What we should have is just information and dialogue, and the truth will always prevail.”

The same week, Cole appeared on a roundtable with Wooll, Karlfeldt and others. In a video of the roundtable, Cole and the other health care practitioners allege that hospitals are withholding food and water from patients and issuing blanket “do-not-resuscitate” orders — basically, letting patients die. That is not true.

Idaho doctors weren’t just sending their patients home, as Cole’s alliance claimed. They were sending high-risk patients to sites where nurses and pharmacists gave monoclonal antibodies to hundreds of people, in an effort to keep unvaccinated patients from getting deathly ill.

But the virus was still pinballing through every region of the state as of early October, because so many Idahoans resisted the vaccine.

More than 750 patients were hospitalized with COVID-19 in Idaho on the day of the symposium. Almost 200 were in the ICU, with high-flow oxygen masks strapped to their heads, or paralyzed with breathing tubes down their throats.

Some of them would survive. Others wouldn’t.

The Friday after the symposium, Idaho added 53 new deaths from COVID-19. It was the same number of deaths reported that day for the entire state of New York.

Correction: The declining rate of COVID-19 vaccine uptake, in first doses, has been corrected to "per day." (10/19/2021)

The Idaho Capital Sun is a nonprofit news organization delivering accountability reporting on state government, politics and policy in the Gem state.