Ivermectin’s False Reputation Exemplifies How Misinformation Spread

IRA FLATOW: This is Science Friday. I’m Ira Flatow. This next story is a follow-up to a story you may have thought had come and gone– ivermectin, a so-called treatment for COVID-19 that made the news last summer. Just to recap, ivermectin is an anti-parasitic drug used by humans and animals for treatments of lice and stomach worms. But last year, particularly in anti-vaccine circles, it became hailed as an alternative treatment for COVID-19.

Now, it’s important to note that no health authority here in the US recommends the use of ivermectin to treat COVID. Even so, last August, the CDC said there was a 24-fold increase in human use of ivermectin compared to pre-pandemic times. The history of why ivermectin gained notoriety is an international tale of what happens when scientific experiments go unvetted and when some medical practices seek to profit off people’s worst fears. Here to take the story further is a journalist who has been digging into this story, Farah Yousry, reporter for Side Effects Public Media based in Indianapolis, Indiana. Welcome to Science Friday.

FARAH YOUSRY: Thank you. So happy to be here.

IRA FLATOW: Nice to have you. Farah, as I said before, ivermectin was in the news so much in the latter half of last year, to the point where I think some people may think the story has come and gone. So why did you get interested in the story behind the story, the faulty science behind many ivermectin studies?

FARAH YOUSRY: Yeah, well, I’m a nerd. That’s one thing. But really, what caught my attention was the FDA tweeting, “You are not a horse,” in an attempt to warn people not to take the ivermectin version meant for animals. And so I was like, what? Why are people even doing that? There must be some sort of reasoning or something.

At the same time, I speak Arabic. And around winter of 2020, I noticed a research team giving Arabic interviews in local Egyptian media saying that they had put out a very successful study. It was the largest clinical trial that could potentially, quote unquote, “end the pandemic.” And they were referring to ivermectin. They were calling it a national victory. And you know, any time big, sweeping claims like that are made, I get a bit dubious.

IRA FLATOW: Yeah, so is ivermectin still as popular as a so-called treatment as it was months ago?

FARAH YOUSRY: Yeah, so I asked physicians who are collecting data from poison centers. And they said as recently as August, like you mentioned earlier, the rates of ivermectin prescriptions had continued to spike. But they say as of December, the numbers are not increasing, but they’re still a lot higher than before the pandemic.

And in my reporting in December, I set out to find clinics that prescribe ivermectin. And honestly, at the beginning I was expecting this to be some sort of underground, hard-to-find kind of market. But it was not like that at all. There are hundreds of clinics nationwide that continue to prescribe the drug, and they’re listed online, accessible to anyone.

And the process is fairly simple, but costly. So for most clinics, you go on their website, you pay an upfront fee of around $100 to $300 for a telemedicine appointment. And you almost certainly would get an ivermectin prescription. Then you pay a few hundred dollars more to get the prescription filled from certain pharmacies these clinics deal with.

But the thing that was most stunning to me is that most of these clinics who I spoke with said that they can prescribe you ivermectin even if you’re not currently sick with COVID, so sort of as a preventative measure. One physician in rural Indiana I spoke with even told me that the clinic was extremely busy. They have to schedule group telemedicine appointments, so with more than one patient on the same call, to fulfill the demand. And again, the science does not back any of this up.

IRA FLATOW: That is really sad to hear. I know you dove into a group of studies on ivermectin from a variety of countries that were ultimately retracted. The studies were retracted or discredited. What were the concerns about these studies?

FARAH YOUSRY: Yeah, so it’s important to note that there is an influx of studies about different COVID-related issues coming from all over the world, as you surely know. And that’s the case with ivermectin, too. So there are dozens of studies out there. And one thing to mention is that the jury is still out when it comes to ivermectin, meaning that maybe in a few months or so there could be enough reliable data to say it works, but maybe not. So as of now, ivermectin remains an unproven COVID treatment.

The National Institutes of Health listed a number of often-cited ivermectin studies and pointed out the limitations of each. For instance, the sample size of most of the trials was very small. In some studies, various doses of ivermectin were used for different patients. Some studies even had patients receiving other medications along with ivermectin, which naturally makes it hard to assess the efficacy or safety of ivermectin.

For my story, the reason I focused on the Egyptian study was that it was the largest randomized controlled trial at the time. And as it turns out, it had big problems. Have a listen to Jack Lawrence. He’s a biomedicine master’s student in London whom I spoke with. He was looking at this study as part of his master’s classes.

JACK LAWRENCE: The first thing I found was the plagiarism. And then, again, pretty concerningly, I found some serious ethical issues. The biggest perhaps is that they had reported the study as starting on the 8th of June, and they included a number of patients who had died before that date.

IRA FLATOW: No kidding.

FARAH YOUSRY: So the Egyptian study is not the only one riddled with problems. There were others coming from Argentina, for example, that were reported to have major inconsistencies and potential fraud as well. That’s not to say that there is no honest research on ivermectin. But until now, this research has limitations, as I mentioned earlier, and is not enough for health authorities to recommend ivermectin for COVID.

IRA FLATOW: So why do you think that many people are seeking out ivermectin to treat COVID? Is it just distrust of the health care system, like people say they don’t want to get a shot for COVID, the same thing happens? I’m not going to listen to what the government tells me about ivermectin.

FARAH YOUSRY: Yeah. Yeah. I mean, that’s what’s most perplexing to me during a global pandemic, you know? I mean, I understand with the amount of death the virus has caused, it’s just mind blowing. And when a family is losing a loved one, I can see why they may be so desperate to try any and everything in their power to save them. But I also think that the pandemic, like you said, has become so politicized, and that’s a big reason people are flocking to an unproven treatment while turning down vaccines that the FDA and health authorities in Europe and even the World Health Organization say are safe and effective.

IRA FLATOW: Yeah, speaking of misinformation and the Egyptian trial, do you have any sense that the study was done with the intention to misinform people about the efficacy of ivermectin?

FARAH YOUSRY: Yeah, so I haven’t been able to reach the lead author of the study. I’ve emailed, called on the phone, with no success. So I cannot speak to the intention of the researchers. But my guess is that it was not exactly meant to misinform people. Certainly this study, which comes out of a rural town in Egypt, was not meant to misinform people in the US. I don’t think the researchers ever imagined that their work may be one contributing factor to what’s happening here in the US.

Again, the study out of Egypt is not the only one with problems. There is an influx of studies coming from across the globe. In the academic world, there is this publish-or-perish kind of culture in which your worth and career advancement is reliant on how often you publish and how widely your research is cited. So the pandemic being a global thing makes it a golden chance for many scientists across the world.

In the process, honest mistakes may happen. Cutting corners may happen, and even fraud. And I’m pretty sure that COVID is not the only area of research that this happens in, but all eyes are on COVID research right now. And the general public and even politicians are more involved than ever with scientific research on COVID. And so when shaky science is posted online, the implications are much bigger than ever before.

IRA FLATOW: Yeah, we have seen this happen before. OK, let’s talk about takeaways. Are there lessons the scientific community should take away from this ivermectin saga moving forward?

FARAH YOUSRY: Yeah, I mean, during a global pandemic, it makes sense that scientists want to share research as quickly as possible. And so that’s why many have resorted to preprint platforms, which are basically websites you can share non-peer-reviewed initial research. And it can take just a few days, and your study is out in the world.

And that was crucial during the early days of the pandemic, you know, when scientists learned the genetic code of the virus and how it’s transmitted. But that also means that some of this research makes it to social media platforms and is misinterpreted by non-scientists, whether out of ignorance or for some sort of personal gain or ulterior motive. And so it’s hard to contain the spread of misinformation and the dangerous impact that it could have on society.

So yeah, the landscape of science communication has changed dramatically over the past couple of years. There are good things coming out of it in terms of collaborations and more funding. But there’s also this political and social aspect facing scientists, and they need to think of that.

IRA FLATOW: Thank you, Farah. We have run out of time. Farah Yousry, reporter for Side Effects Public Media based in Indianapolis. Thank you for joining us.

FARAH YOUSRY: Thank you.

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