The ivermectin battle isn't over: COVID-19 doctors are prescribing the drug in plain sight
iStock; Rebecca Zisser/Insider
A week before Christmas, I got the dreaded call from my physician: "Your COVID-19 test came back positive." It was my second time with the disease, so I thought I knew what came next. The physician recited the standard protocol for isolation. I asked if there were any medications I could take to help my sore throat, chills, and nasal congestion. Suddenly, the physician veered off script.
"What have you heard about ivermectin?" he asked.
I answered honestly: "Not great things."
In 2020, preliminary studies suggested that ivermectin might be an effective COVID-19 treatment, but follow-up studies revealed the drug held no real benefit for the disease. The Food and Drug Administration does not recommend ivermectin to treat COVID-19, though the agency has approved ivermectin tablets for rosacea, head lice, and certain parasites in humans, and ivermectin paste for the prevention of heartworm disease in some animals.
My physician doubled down, insisting he saw "lots of benefit" from ivermectin among his COVID-19 patients. He wasn't alone. A subset of US doctors remains convinced that ivermectin helps people with COVID-19 — namely because they've heard that it does, either from conservative peers or fringe organizations that tout ivermectin as a COVID-19 treatment.
Medical experts say ivermectin prescriptions fall into murky ethical territory. At best, the drug is ineffective for COVID-19 — though clinical trials are still studying whether ivermectin might assist with the treatment of mild to moderate symptoms. At worst, it's dangerous. The FDA warns that large doses of ivermectin can cause nausea, vomiting, seizures, coma, and even death.
But health risks and lack of evidence haven't slowed ivermectin prescriptions in the US. Doctors dispensed around 84,000 ivermectin prescriptions for COVID-19 during just one week in August 2021, according to research from the University of Michigan. From July to August 2021, US poison control centers saw a dramatic spike in calls from people who had self-medicated with ivermectin and suffered hallucinations, tremors, diarrhea, and nausea. The Centers for Disease Control and Prevention also reported a surge in ivermectin prescriptions around that time, though it's unclear how many scripts have been filled since.
US insurers, including both private and Medicare plans, still cover the cost of ivermectin prescriptions. Insurers spent around $2.5 million on ivermectin prescriptions for COVID-19 during the week of August 13, 2021 — or nearly $130 million per year if that data were extrapolated annually, the Michigan researchers estimated. That means both taxpayers and insurance members are partially footing the bill for a drug that is not proven to effectively treat COVID-19.
Kolina Koltai, a postdoctoral scholar at the University of Washington who specializes in misinformation research, said doctors are often swayed by the rhetoric of America's Frontline Doctors (AFLDS) and Front Line COVID-19 Critical Care Alliance (FLCCC), two groups that promote ivermectin.
"There are plenty of doctors out there who have fallen victim to misinformation," Koltai said. "America's Frontline Doctors and FLCCC are particularly dangerous in that way. Their type of misinformation is really powerful, because they know the language of the medical community. I often see their stuff ending up in physicians' hands."
Fringe doctors seized on ivermectin's growing popularity
Tom Williams/CQ-Roll Call via Getty Images
Ivermectin's popularity can be traced, in large part, to two men: Dr. Pierre Kory, a former critical-care specialist at the University of Wisconsin, and Dr. Paul Marik, the former chief of critical care at Eastern Virginia Medical School. The duo formed the FLCCC in April 2020, along with six other doctors and two former journalists.
In October 2020, the group claimed that ivermectin demonstrated "profound activity" against COVID-19. Kory said ivermectin was effectively a "miracle drug" before a Senate committee in December 2020. Then in June 2021, he extolled the benefits of ivermectin on Joe Rogan's widely popular podcast. (Rogan later announced that he took ivermectin following his own COVID-19 diagnosis.)
Both Kory and Marik have also written their own reviews of ivermectin research, which appear on the FLCCC website. The organization often points to studies that have been debunked, withdrawn, or haven't been peer reviewed.
"There's a lot of ways you can manipulate science to make it look more legitimate," Koltai added. "This is a common tactic that happens within anti-vax pages and groups. They like to cherry-pick components of a research article. They'll even call something a research article when it's maybe just a letter to the editor."
Kory pushed back on that claim.
"We've been at the tops of our field and then to suddenly cast the term misinformation is absolutely laughable," he told Insider, adding, "What's been cherry-picked is data to show that [ivermectin] doesn't work."
He estimated that thousands of doctors now prescribe ivermectin across the US. While Insider was not able to verify this statistic, the FLCCC website lists nearly 430 doctors who support its COVID-19 treatment protocols, which include ivermectin.
America's Frontline Doctors uses similar tactics to herald ivermectin's supposed benefits. The organization formed in July 2020 as part of the Free Speech Foundation, an Arizona nonprofit backed by the Tea Party Patriots (a pro-Trump group listed on the website for "March to Save America," the pro-Trump rally that preceded the storming of the US Capitol on January 6, 2021). In December 2020, the founder of AFLDS, California physician Simone Gold, promoted ivermectin on the conservative Daystar Television Network.
"We've known ivermectin works on COVID-19 for months and months," Gold said. "We just didn't talk about it because we know that the press is going to get ahold of it and start saying 'no.'" Neither Gold nor AFLDS responded to Insider's request for comment.
Doctors aren't impervious to these arguments, Koltai said.
"It's really easy to fall for the misinformation that's out there," she said, adding, "It happens to experts. It doesn't just happen to someone who's uneducated."
The politicization of ivermectin "has spilled over into the practice of clinicians," Dr. Johan Bester, director of bioethics at the University of Nevada, Las Vegas School of Medicine, told Insider. "Doctors are people, too."
Why one doctor gave out more than 100 ivermectin prescriptions
Rodrigo Urzagasti/picture alliance via Getty Images
For certain groups, promoting ivermectin can be lucrative. AFLDS refers people to a telemedicine site where patients spend millions of dollars on prescriptions for drugs like ivermectin, according to hacked data obtained by The Intercept last year. The FLCCC also solicits donations through its website, and used to sell ivermectin t-shirts, mugs, and fanny packs online.
But those financial gains usually don't trickle down to doctors, Dr. Nora Becker, an assistant professor at the University of Michigan, told Insider.
"I don't think there's a strong financial incentive for physicians to prescribe ivermectin as opposed to something else," she said.
Instead, ivermectin appeals to the desire for a quick fix: It's relatively cheap (around $30 to $40 per prescription for people with insurance), and while high doses can be toxic, it poses minimal safety risk when prescribed in appropriate amounts.
"There might be some who just hear the rumor of ivermectin maybe helping and then they think, 'Well, what do you have to lose? Let's just try this,'" Bester said.
Dr. Cliff Porter, founder of the membership-based primary care service Texas Direct Medical Care, said he once fell into that camp. Porter stumbled upon ivermectin research early in the pandemic and thought it showed promise, he said, so he prescribed the drug to more than 100 COVID-19 patients.
"Early on, when the data looked good, I thought, 'This might be a really good bridge to vaccines for people [at] higher risk,'" Porter told Insider, adding, "That looked like a good idea, so I got on the FLCCC website as someone who would prescribe it."
News of the ivermectin's potential as a COVID-19 treatment began circulating in spring 2020, after a lab study showed that ivermectin prohibited the coronavirus from replicating in cell cultures. Preprints from 2020 also suggested that ivermectin might reduce COVID-19 death rates, but the studies didn't pass the scientific muster of peer review.
"There were big issues with those studies that, if you go and look closer, show that there's really no indication that people who are on ivermectin do any better than people who are not on ivermectin," Bester said.
At the same time, credible studies of ivermectin lagged.
Porter said he worried that if he waited for ivermectin to go through a randomized controlled trial — the gold standard for evaluating treatments — patients might die in the meantime. Over time, he said, he noticed the drug didn't offer much benefit. He stopped prescribing ivermectin after the Delta variant became dominant last year, and started prescribing monoclonal antibodies instead, among other treatments.
FLCCC, on the other hand, is now encouraging doctors to prescribe higher ivermectin doses.
"With subsequent variants, the viral loads have greatly increased," Kory told Insider. "For instance, [with] Delta, we noticed we had to increase the dose."
Porter said he took issue with the organization "advocating higher and higher doses for which we had no safety data."
Politics or ego may compel doctors to prescribe ivermectin
Phil Didion, USA Today Network via Reuters Connect
Ivermectin also appeals to vaccine skeptics or those who distrust government recommendations, positions more commonly held among conservatives in the US.
"It has become the darling drug in the view of those who are skeptical of things that have actually been shown to work," Bester said.
Dr. Benjamin Marble, a former ER doctor who runs a telemedicine site, estimated that he has personally prescribed ivermectin at least 10,000 times. His telemedicine site has written more than 100,000 ivermectin scripts, he told USA Today. Marble called COVID-19 vaccines "bad medicine" and accused the FDA of following "fake science" — despite ample scientific evidence that shows COVID-19 shots protect against hospitalization and death.
Kory, however, resisted the characterization of ivermectin as a right-wing drug.
"The right side of the spectrum is more willing to challenge orthodoxy coming from the [federal] agencies, so it gets cast as a right-wing thing and it's just stupid," he said. "It has nothing to do with politics."
For other doctors, prescribing ivermectin is an altruistic mission.
"There's something really appealing to us about the rogue scientist who makes the big discovery, who is fighting against the man, who is being silenced," Koltai said.
Dr. James Johnston, a concierge doctor who also works in family practice and urgent care in North Carolina, said he treats between 10 and 60 patients per day with ivermectin. He thinks the drug is saving lives, he said, so he tries to get prescriptions filled within 24 to 48 hours — a demand that often requires him to wake up at 4:00 a.m.
"I'm a physician and a family man. I want to sit on the front porch, drink a glass of tea, turn my phone off, and watch my kids ride the bikes, knowing I'm helping people as best I can. But now when I look at our country, I see a disaster of the government's making and, yeah, it pisses me off," Johnston said.
He believes in the drug so much, he added, that he's willing to open himself up to professional scrutiny.
Just last week, a Pennsylvania doctor was fired from her position at Tower Health Medical Group for prescribing ivermectin to patients. Johnston said a doctor at his urgent care recently complained about him writing ivermectin prescriptions, forcing him to have a "humiliating" conversation with his boss.
"I'm living in fear of somebody complaining to the [North Carolina Medical] Board," he said.
Insurance companies have power to push back against rampant ivermectin prescriptions
Photo by Soumyabrata Roy/NurPhoto via Getty Images
Since ivermectin is an FDA-approved medication, there's little oversight to limit off-label use for COVID-19. As Bester put it, "There's nobody that stands over the shoulder of the doctor to say, 'Hey, what's the reason you're prescribing this?'"
When I contacted my local health network, Hoag, to report the physician who offered me ivermectin, the network declined to say whether its doctors faced repercussions for prescribing the drug.
"Ivermectin is not part of our general practice in the treatment of patients with COVID-19. Hoag follows NIH and IDSA guidelines," a Hoag spokesperson told me, referring to the National Institutes of Health and Infectious Diseases Society of America.
"We give physicians a lot of leeway to use their own clinical judgment," Becker said. "There's a strong professional expectation that doctors will provide what we call evidence-based care, but ultimately that decision is one that's made on an individual basis."
Doctors also aren't required to keep up with the latest scientific research, so it's common for them to prescribe treatments that are outdated or ineffective.
There is, however, at least one regulatory mechanism to dissuade doctors from prescribing ivermectin. Becker's research team suggests that insurance companies should require prior authorization of the drug, meaning doctors would have to get approval for insurance to cover the cost of ivermectin, no matter how they intend to use it.
Blue Cross Blue Shield of Michigan instituted this policy in October 2021 "to discourage unauthorized use" of ivermectin for COVID-19.
"When insurance companies are covering it, that cost is then being subsidized by everybody who's enrolled with that insurance company and, when it comes to Medicare, taxpayers," Becker said.
"All of us should not be subsidizing this treatment, since there's no evidence for it."
With more regulatory hurdles in place, fewer patients would carry the burden of challenging their doctors' recommendations. As a science journalist, I had enough professional knowledge to reject my ivermectin prescription — but not every American may know to opt out.
Has a doctor tried to prescribe you ivermectin for COVID-19? We want to hear from you. Send credible tips to abendix@insider.com.
from Business Insider https://ift.tt/p6r01FO
No comments