The deadly partisanship behind prescribing unproven Covid-19 treatments.
Fads like hydroxychloroquine and ivermectin have had massive harms—but not the ones that worried toxicologists.
When the Covid-19 pandemic erupted, an attractive idea gained attention and momentum: the repurposing of long-existing medications to treat Covid-19. The notion had—and continues to have—great appeal. If we already had safe, inexpensive, and widely-available therapies that could just knock Covid-19 out, that would mean we wouldn’t have to do all the things. We could just pop a few pills and resume our lives as normal. No physical distancing. No cancelled events. No missed school. No masks. No tests. No vaccines. Sounds wonderful, right?
Ah, were it only that easy. Indeed, we’ve been here before. During the 1918 influenza pandemic, physicians also tried using anti-malarial drugs. It failed then too.
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It seems that hydroxychloroquine gained widespread attention because Elon Musk tweeted about it and then-President Trump spoke about it, a devastating one-two punch of muppet punditry.
What followed was even worse. The US Food and Drug Administration issued an “emergency use authorization” for hydroxychloroquine use in Covid-19 in March of 2020, despite the fact that such a declaration wasn’t even necessary (off-label prescribing laws are such that physicians could already prescribe it without further permission). By summer the FDA had revoked that EUA, and specifically discouraged its use for Covid-19 outside of clinical trials. That was more understandable; the earlier EUA had lent hydroxychloroquine the FDA’s imprimatur and once there was ample evidence that the drug had no benefit, the least the FDA could do was rescind its pointless previous declaration. Nevertheless, hydroxychloroquine had entered the popular imagination of those with over-active ones. Prescription rates continued to soar.
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Ivermectin came next. Like hydroxychloroquine, the original enthusiasm for its possible use in treating Covid-19 came from legitimate laboratory experiments which had indeed shown that the compounds inhibit the replication of SARS-CoV-2 in test tubes. The problem is that the doses that would be required to exert a similar effect in humans would be toxic ones. Why ivermectin gained ascendancy over other equally aspirational ideas for treating Covid-19 with existing medications is less clear, though I suspect that it simply was picked up by a small but influential clique of loud hydroxychloroquine peddlers.
Despite an ever-increasing mountain of high-quality evidence to the contrary, hydroxychloroquine and ivermectin believers continue to cling to fantasies that these medications make all the difference, if only the medications are given in the exact right dose and at the exact right moment. (This is how they shrug off negative results they don’t like, always moving the goalposts).
Some have argued that prescribing medications like these, and other even safer ones like Vitamin D and antacids, is relatively harmless. After all, they are known to be quite safe. If they only help a few people a little bit, the argument goes, then it’s worth it.
But that’s not how things play out. Instead, people who buy into false miracle cures are apt to take more risks and to spurn important actions like vaccination. They’re at higher risk of getting Covid-19 and, when they ultimately do, are at higher risk of a bad outcome.
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These harms are not only real, but they have also been distributed non-randomly. A new paper published in JAMA Internal Medicine, led by my Harvard friend and colleague Dr. Michael Barnett, shows that both hydroxychloroquine and ivermectin were far more likely to be prescribed in parts of the country that more heavily voted for Republicans in recent elections.
The harm that has resulted from this is not really about rare toxicities that have occurred, both in therapeutic and unintentionally high doses. Yes, we know that calls to poison control centers increased as a result of these fads, but the reality is that large clinical trials of both hydroxychloroquine and ivermectin have had one important thing in common: they have consistently shown neither harm nor benefit. That means that feared increases in population-level hydroxychloroquine- and ivermectin-related toxicities have been too small to be routinely detected.
No, the major harm comes from an unfortunate combination: regions where false miracle cures are popular are precisely the ones with lower rates of vaccination against Covid-19. That cognitive error has some internal consistency, if you think about it. If you believe that these medications solve every problem, why bother vaccinating? Of course, in regions with high rates of hydroxychloroquine and ivermectin prescriptions and low rates of vaccination, both Covid-19 and all-cause mortality has been much higher during the vaccine era than in regions with the opposite pattern.
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To me, the saddest part of the problem is that most people who have fallen for miracle cures while rejecting safe and effective vaccines have not made their decisions based on well-reasoned data-driven risk-benefit analyses. Instead, they’ve been herded by partisan media towards the receiving end of a feeding tube that consistently pipes misinformation sausage down their gullets. These people may have willingly gone along with it; they came hungry for good news in the first place. But now, largely through no fault of their own, they are dangerously full of it.
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