Libertarians and medical misinformation:  the case of ivermectin

A 73-year-old woman died of COVID because she got caught up in conspiracy theories and medical misinformation.  NPR has the details:

When Stephanie caught COVID-19 just before Thanksgiving of last year, her daughter Laurie suggested that she get help.

“She was really not feeling well, and I was like, ‘Just go to the doctor,'” Laurie recalls.

But Stephanie, who was 75 at the time, didn’t go. A few years before, she had been sucked into a world of online conspiracy theories — far-fetched ideas like one claiming John F. Kennedy Jr. is still alive. With the pandemic, it got worse. She became deeply distrustful of the medical system.

. . .

COVID cases and hospitalizations are once again on the rise, thanks to a new omicron subvariant. Vaccines and certain proven treatments can help prevent the worst outcomes. But for Americans like Stephanie who don’t trust the medical establishment, there’s a network of fringe medical doctors, natural healers and internet personalities ready to push unproven cures for COVID. And a shady black market where you can buy them. Stephanie was plugged into that alternative medical network, and doctors say it ultimately cost her life.

. . .

The array of alternative COVID treatments is vast. Some offer kosher multivitamins, others suggest more radical interventions, such as drinking your own urine.

But one drug in particular has become the center of many alternative therapies: ivermectin. Originally used to treat parasitic worms, ivermectin has developed an enormous following over the course of the pandemic — especially in politically conservative circles. That’s, in part, because of a small cadre of licensed doctors who promote it as an alternative to vaccination against COVID. Among the most prominent is Dr. Pierre Kory, whose group, the Front Line COVID-19 Critical Care Alliance, has become a major force promoting ivermectin.

“Ivermectin is effectively a ‘miracle drug’ against COVID-19,” Kory told a Senate committee in December of 2020.

But rigorous studies show ivermectin is far from miraculous. Ivermectin was studied early in the pandemic as a potential treatment for COVID, but it hasn’t panned out. Large clinical studies show that ivermectin does not lower rates of hospitalization. Meanwhile, some of the early, promising results have been retracted, including one study led by Kory himself. Today, everyone from the American Medical Association to the Food and Drug Administration tells doctors not to prescribe ivermectin to treat COVID.

. . .

After she fell ill with COVID, Stephanie went looking for ivermectin. A friend gave her the name of a woman in Jacksonville, Fla., who was willing to sell it to her along with some other unproven COVID drugs. Stephanie’s order totaled $390.

“She was just waiting for the pills and really did not want to do anything else,” Laurie remembers.

. . .

Stephanie became so ill she had to be rushed to the local hospital. That same day the drugs arrived, stuffed inside a plain brown envelope with Miller’s home address on the return label.

. . .

Stephanie’s faith in the drugs cost her valuable time. Doctors who treated her at the hospital told NPR they believe she wasted critical days waiting for them. Stephanie grew weaker and eventually succumbed to COVID just a few days after Christmas.

Libertarians and COVID misinformation

Now let’s take a look at an article by libertarians David Henderson and Charles Hooper published in Regulation back in March.  Here is the final paragraph:

As described above, many medical authorities have claimed the drug does not work against COVID-19. Their reasons for claiming this may have more to do with biases and structural limitations than with the drug itself. Science has taken a back seat to prejudice and process. People are dying because many medical authorities say that therapies such as ivermectin do not work, while the actual clinical results suggest otherwise. These medical authorities should “follow the science” rather than rationalize their reasons not to.

The article makes some potentially legitimate points, but at the end of the day Henderson and Hooper are more interested in discrediting scientific authorities and boosting ivermectin than in giving people good, evidence-based advice.  We can tell this without wading through the evidence on ivermectin, because even if the evidence suggests that ivermectin modestly reduces hospitalization and death among unvaccinated COVID patients, the best advice to give people at the time they wrote their article was clear:  get vaccinated, and if you get sick, call your doctor.  Do not take ivermectin; there are much better treatments available.

Telling people that ivermectin is effective and criticizing the FDA for not approving its use – without emphasizing the importance of getting vaccinated, the existence of far better treatments, and the need to seek medical treatment immediately if you get COVID – is highly irresponsible.  It undermines trust in the FDA approval process and in conventional medicine.  It will predictably get people killed.  

This doesn’t mean people should be encouraged to bow down like sheep before the FDA, and it doesn’t mean that the current procedures and standards are perfect.  But any criticism of the FDA’s handling of ivermectin should emphasize that whatever the FDA’s shortcomings in this area, good vaccines are available, as well as far better treatments than ivermectin.

Naturally, the Henderson/Hooper article got amplified by Donald Boudreaux, and not in a good way.  This is what Boudreaux excerpted from the article:

One existing medication has received considerable attention recently: ivermectin, an antiparasitic that is widely used in the developing world. Many commentators, including several health officials, have dismissed the drug’s usefulness against COVID. Yet, these dismissals seldom cite empirical evidence, or if they do, they don’t detail the findings.

Ivermectin, which is the generic name for the drug, was discovered in 1975 by William Campbell of the Merck Institute for Therapeutic Research and Satoshi Ōmura of Kitasato University, in work that would win them the 2015 Nobel Prize in Physiology or Medicine. Merck first marketed the drug as a veterinary antiparasitic (today it is best known by the brand name Heartgard), with human applications (and the requisite government approvals, under the brand‐​names Stromectol and Mectizan) coming a few years later. In the developing world, the drug has proven so effective at combating parasitic illness that it is on the World Health Organization’s list of essential medicines. It has been dosed four billion times to patients in Africa and Central and South America.

Ivermectin works through a variety of mechanisms to kill the targeted parasites. Some of those mechanisms have also been found to attack single‐​strand RNA viruses like SARS‐​CoV‑2, which causes COVID. That led scientists to test the medication in vitro, finding that it does in fact kill the virus in cell cultures.

Because ivermectin has been around for decades, can be taken as an oral pill, is safe, and is now off‐​patent and therefore cheap, it would be an ideal drug to give to COVID patients — if it is, in fact, effective in the body and not just in the petri dish. Is it?

Boudreaux then quotes the final paragraph I reproduced above, which strongly suggests that ivermectin is effective against severe COVID.  Nowhere does he tell people to get vaccinated, nowhere does he emphasize that there is no reason whatsoever to seek treatment with ivermectin.

This is an old pattern.  Boudreaux is only interested in using the COVID pandemic to stoke distrust in government and science; helping people avoid dying needlessly from COVID is not on his agenda.  We have seen Boudreaux encourage vaccine hesitancy by “explaining” it, and twist information to fit his anti-government narrative.  

Boudreaux could try to muster a just bit of basic human decency and share Stephanie’s story with his readers.  Or he could remind his readers that the treatment of choice for COVID is Paxlovid, not ivermectin.  Or maybe “focused protection” and “protecting the vulnerable” is just a con.