A combination of flawed studies, irresponsible politicians, and misinformation campaigns have made a lot of people opt for unproven and potentially dangerous treatment. This cynical misinformation has got to stop.

Doctors are fighting misinformation, alongside the pandemic

Ivermectin is a medication used to treat parasite infestations, mostly in animals, but also in humans in rare instances. The drug has some serious side effects, ranging from fever, vomiting, and skin rash to death, especially in an overdose (and possibly due to interaction with other medications). So far, nothing special.

In recent months, however, demand for this anti-parasitic medication has skyrocketed. From an average of 4,600 weekly prescriptions in the US, demand has surged to over 88,000 in just one week in August. Poison control centers have recorded a surge in calls related to ivermectin.

“You are not a horse,” the Food and Drug Administration declared last month (yes, really).“You are not a cow. Seriously, y’all. Stop it.”

By now, doctors have already gotten used to fighting misinformation in the pandemic, but the ivermectin crazy has somehow managed to surpass even the drinking bleach problem.

Officials at many hospitals are desperately asking people to stop taking this unproven treatment and instead, focus on the only prevention mechanism that has been shown to work against COVID-19: vaccines. Yet despite several working, effective, and proven vaccines freely available on the market, an alarming number of people (especially in the US, but in other countries as well) are opting for ivermectin instead.

“We are alarmed by reports that outpatient prescribing for and dispensing of ivermectin have increased 24-fold since before the pandemic and increased exponentially over the past few months,” the Americal Medical Association said in a statement, joined by the American Pharmacists Association and American Society of Health-System Pharmacists. “As such, we are calling for an immediate end to the prescribing, dispensing, and use of ivermectin for the prevention and treatment of COVID-19 outside of a clinical trial.”

It’s not just the fact that people are opting for an unproven (and potentially toxic treatment); if they would do so in addition to proven treatment, the problem would be lower in scale. But the problem is that they are opting to do so instead of taking a vaccine.

“When people get fixated on inappropriate recommendations, then they unfortunately don’t get vaccinated,” said Hawaii Lt. Gov. Josh Green (D), an emergency room doctor who blames conservative media for fanning unfounded hopes about ivermectin. “They don’t do the things that will actually help.”

So where is all this enthusiasm for deworming medicine coming from?

Talking heads

Ivermectin has been promoted incessantly recklessly by some politicians, conservative talk show hosts, and even some physicians as a potential cure for COVID-19 — often, in opposition with vaccines.

For many, vaccines are part of a major international conspiracy. Sometimes it’s Big Pharma, other times it’s the government, or the Illuminati, or Bill Gates — it depends on which corner of the internet you ask — and they want you to take the evil vaccine, and not the magic cure that is ivermectin. Or something like that. Which doesn’t even make any sense as a conspiracy theory — pharma companies make far more money from treatments you take regularly than for a dose of vaccine. For instance, J&J estimated its vaccine price at $5 per dose, comparable to a single ivermectin pill. Even considering the more expensive vaccines, the theory just doesn’t add up.

These myths were further amplified in some corners of the media. For instance, one Wall Street Journal opinion piece was titled “Why Is the FDA Attacking a Safe, Effective Drug?” — but what the Wall Street Journal didn’t mention was that the author previously worked for the company that developed and marketed ivermectin, and was currently a fellow at a right-leaning, pro-free market think tank. Hardly what you’d call reliable journalism.

It gets even worse — if anything, the WSJ piece is an example of how not to do journalism. The article in case used one study from Egypt as one of its main arguments. But the study was withdrawn due to charges of data manipulation. Not only did the WSJ not retract the article, but the only correction they added is a paragraph of text at the end of the article. As a result, the article is still widely circulating as “evidence” that ivermectin works against COVID-19.

The connection between conservative media and ivermectin is unlikely to be a coincidence. Fox News hosts like Tucker Carlson, Sean Hannity, and Laura Ingraham have all repeatedly mentioned ivermectin as a treatment for COVID-19, using it to attack public health officials. Something similar has happened with hydroxychloroquine in 2020, which has since been proven ineffective.

This type of propaganda seems to be working. Republicans are much more likely to be anti-vaccines and pro-ivermectin, polls show. This would also explain why Republican states have the highest COVID-19 incidence and death rates.

Another staunch supporter of ivermectin against COVID-19 is Rand Paul, a United States Senator from Kentucky. Paul has taken numerous anti-scientific positions in the pandemic, from denying the usefulness of masks to minimizing the benefits of vaccines. His latest idea is less of science denial and more a flat-out lie. Paul claims that scientists won’t study ivermectin because they hate Donald Trump.

“The hatred for Trump deranged these people so much, that they’re unwilling to objectively study it,” Paul told a group in northern Kentucky late last week. “So someone like me that’s in the middle on it, I can’t tell you because they will not study ivermectin.”

But that couldn’t be further from the truth. Over a dozen studies on ivermectin are ongoing, including a large trial supported by NIH, which recently found that the results “cannot confirm the widely advertised benefits.” According to the World Health Organisation’s database of clinical studies for COVID-19, there are currently 16 trials investigating ivermectin, so Paul’s comments are demonstrably false.

We’ve also had quite a few studies that are already published, but they don’t really support ivermectin either.

What the science says about ivermectin

To be clear, it’s not completely impossible for ivermectin to offer minor benefits in treating the coronavirus. That’s why there are still ongoing studies, because if there’s even a slight chance, researchers want to know. But the existing data does not currently support taking ivermectin, and the prospects are slim at best.

Ivermectin was first identified as a potential treatment for COVID-19 based on experiments in isolated cells. Here’s one thing you should always remember with these studies: a lot of substances kill a lot of pathogens in a lab. That doesn’t mean they also translate to human treatments (and in the vast majority of cases, they don’t). Furthermore, the initial lab studies were done on very high concentrations of the drug, much more than what the human body can safely withstand (and much more than what is prescribed for killing parasites). But, out of desperation at first, the drug was prescribed widely in poorer countries — especially when vaccines were not available.

As months went by, several studies were published, but most involve a small sample size and questionable methodologies (in which ivermectin was prescribed at various dosages, and in conjunction with other drugs). Results were generally inconsistent and were often based on weak study designs.

The most viable evidence we have for ivermectin against COVID-19 comes from reviews of multiple studies; one such review was published in June 2021. The review eliminated low-quality studies and carefully examined ten higher quality (randomized-controlled) clinical trials. Its conclusions are clear:

“Compared with the standard of care or placebo, Ivermectin did not reduce all-cause mortality, length of hospital stay, or viral clearance in randomized controlled trials in patients with mostly mild COVID-19. IVM did not have an effect on adverse effects or severe adverse effects and is not a viable option to treat patients with COVID-19.”

You could argue that the ten studies here still only amounted to 1,100 patients (compared to studies on millions for vaccines), but this is still doesn’t justify the enthusiasm with which some are promoting this drug in the pandemic. As we’ve covered previously, there are other promising treatments being researched, and they don’t seem to be as popular — which is a good thing, because they’re not yet fully proven.

Another study from Argentina in 2020 claimed benefits for ivermectin. But again, a larger study from Brazil found “no effect whatsoever on our primary outcomes” for ivermectin. “So in our specific trial … we do not see the treatment benefits that a lot of advocates believe there should have been,” one of the study authors said at a symposium.

For now, at least, there’s simply no convincing reason to take ivermectin against COVID-19 — let alone to take it as a preventive measure.

As if all this wasn’t evidence enough that you shouldn’t take ivermectin, some of the most high-profile studies supporting its use were withdrawn amidst claims of data manipulation and ethical concerns. The above-mentioned study from Egypt had glaring data discrepancies and suspicions of plagiarism and was eventually withdrawn — though not after being widely shared as “evidence”. Another prominent paper supporting the use of ivermectin was withdrawn, but only after leading to the widespread usage of the drug in Latin America. The study had not been peer reviewed and was withdrawn from the preprint servers.

So in the end, what we have so far supporting ivermectin are flimsy observational studies and rogue clinicians’ opinions, whereas large-scale, reliable studies found no benefit to the drug. Even Merck, which manufactures the drug, says there is currently “no scientific basis for a potential therapeutic effect against COVID-19”. No matter where you look, there’s not much evidence supporting it.

A cynical play

We’re all understandably worried, sick, and tired of this ongoing pandemic. We all want a way to stay safe and get back to normal. The good thing is we have it in the form of vaccines. The bad news is that a large part of the public seems to not want it, and instead wants an unproven, potentially dangerous drug.

At first, it seems surprising to see just how popular ivermectin has become, but when you look at all the misinformation circulating social media and some right-leaning outlets, it all kind of fits. Promoted on right-leaning Facebook groups and through well-funded advertisments, ivermectin has become a part of the culture war.

The more you look at it, the more the push for ivermectin looks like a cynical attempt to either make money or push an agenda. If ivermectin does work, then the science will show it — but so far at least, it doesn’t really seem to work. So then why do so many, especially in conservative circles, promote it? Unlike what the likes of Rand Paul are claiming, politics isn’t stifling research on ivermectin, plenty of research is being carried out. But even as the research disproves their claims, they cling on to their beliefs and fuel more vitriol and distrust against the authorities and actual health experts — the last thing you want in a pandemic.

Opting for an unproven (and dangerous) treatment and acting against the vast majority of researchers, the CDC, FDA, WHO, and pretty much every health organization in the world, isn’t smart; it isn’t “sticking it to the man”, or “fighting the expert”; it’s not fighting against a conspiracy. It’s dumb. It’s putting people at risk, and it’s making it harder to put the pandemic behind us.