"You are not a horse. You are not a cow. Seriously, y'all. Stop it." This actual tweet from the U.S. Food and Drug Administration sounds better suited for an April Fool’s Day joke than for an actual federal health advisory posted just days before the FDA fully approved Pfizer's Covid-19 vaccine for those 16 and older.
It’s easy to joke about ignorant or desperate people taking horse dewormers, but misinformation like this really is deadly. Hydroxychloroquine was used off-label by many around the world, with devastating results, and the same thing is now happening again.
The internet was supposed to revolutionize how we share information. However, as we head into the second autumn of the pandemic with cases once again surging across the United States — despite a monumental vaccination effort — misinformation is still rampant. Risky coronavirus cures and unproven treatments, from hydroxychloroquine and azithromycin to oleandrin and now ivermectin, prove an epidemic of science denial has flourished online.
Ivermectin is a medication widely used to treat parasitic infections in humans and animals. Some of the more common medical uses are against worms, mites and insects, like scabies and roundworms, and tropical diseases like river blindness. If you have a dog, you may know it as a heartworm medicine, and if you have livestock, like horses, cows and pigs, then you may know it as a deworming agent.
Ivermectin has shown antiviral effects at very high doses. However, it has never been proven to effectively treat or prevent viral infections in humans. Like much in vitro data, meaning research done on cell cultures in petri dishes, any positive findings have not been replicated in vivo in actual human subjects. And a quick look at this data suggests a reason why: The doses and concentrations necessary for antiviral activity are much higher than are safe for humans, and would be toxic to human life as well as viruses. If this sounds familiar it’s because the same misapplication of in vitro science has been used to promote hydroxychloroquine and disinfectants like bleach.
Meanwhile, the human data on ivermectin tells a much different story. The available scientific evidence has consistently shown a lack of benefit in both treating and preventing Covid-19, and empiric evidence from widespread off-label use has objectively not made a difference. Notably, the only papers that showed any significant benefit for ivermectin have been retracted because they were fraudulent, but not before being shared hundreds of thousands of times around the world. The same disgraced Surgisphere server — a data sharing and analytics company that rose to prominence early in the pandemic — that posted fraudulent hydroxychloroquine science shared another fraudulent paper on ivermectin that set off this current craze.
That paper and Surgisphere no longer exist, but the damage is done. Another popularly shared study on ivermectin, which claimed to demonstrate better success than almost any other medical intervention in modern history, was also found to be falsified and was retracted. But again, only after being shared extensively online.
The pro-ivermectin crowd would have you believe that the science on ivermectin is being “suppressed.” It is not. Some of the largest scale scientific efforts ever have involved the study of ivermectin in Covid-19. Another claim is that the pharmaceutical industry does not want to lose potential profits to a relatively cheap, older drug. This claim conveniently ignores the fact that one of the only drugs with good evidence for use in Covid-19 is dexamethasone, a cheap, old drug that has been implemented worldwide during this pandemic. Even the manufacturer of ivermectin, the pharmaceutical giant Merck, has released statements warning against the use of their product for coronavirus, citing safety and efficacy concerns.
The pro-ivermectin crowd would have you believe that the science on ivermectin is being “suppressed.” It is not.
Groups of contrarian physicians have emerged to promote “cures” without adding any evidence, and despite names like “America’s Front Line Doctors” and “Front Line COVID-19 Critical Care Alliance,” their members often do not work clinically — meaning they do not actually have credentials to practice medicine in any hospital settings — and do not treat Covid-19 patients. The founder of FLCCC, who is not currently affiliated with any health care institutions, recently disclosed that he and his family came down with coronavirus despite taking his unproven ivermectin protocol. The AFLD is actually selling ivermectin prescriptions online, a conflict of interest.
True believers have turned to livestock preparations, which can be obtained at feed stores and other places that sell animal supplies without a prescription and without any oversight. And now poison control centers across the country are being overwhelmed with calls related to this off-label ivermectin use, because like most drugs that are used to kill pathogens, ivermectin can also easily be toxic to human life. Animal formulations, which are not FDA approved, usually contain higher concentrations and doses, making it much easier to get sick. But even human doses of ivermectin can have significant side effects and interactions. Not only are people poisoning themselves, there are now shortages of ivermectin for its legitimate uses and prices have skyrocketed.
Furthermore, the fixation on these false cures distracts from the tremendous achievement of Covid-19 vaccines, which we know not only prevent infection but also prevent disease severity in the way that ivermectin believers hope their drug will. I am a doctor and a scientist, and I desperately hope we discover more viable therapeutics for treatment of this pandemic. But here in the United States, we already have access to something much better: safe, effective, life-saving vaccines. Now we just need people to stop looking for false cures in the feed store and get vaccinated.