Ivermectin’s False Reputation Exemplifies How Misinformation Spread
This article is part of The State of Science, a series featuring science stories from public radio stations across the United States. This story, by Farah Yousry, was originally published on Side Effects Public Media.
Not a single scientific or health authority in the U.S. recommends the use of the anti-parasitic drug ivermectin to treat or prevent COVID-19. Still, some Americans see the unproven drug as a way out of the pandemic.
Ivermectin is mostly used in large animals and is approved by the U.S. Food and Drug Administration for treating human conditions, including head lice and stomach worms. But across the country, demand for the drug has surged in recent months — leading to a spike in hospitalizations for human exposures to ivermectin.
The drug is among the latest politically divisive public health issues unfolding across the country. The situation has fast-tracked conversations about the risks and benefits of publicizing research findings that have not yet been vetted by the scientific community. That’s because much of the misinformation on ivermectin draws on insufficient data — some coming from low-quality studies, including ones that were retracted after further examination revealed problems and even potential fraud.
The fact that unvetted research conducted in labs overseas could wreak such havoc across the U.S. is a testament to the vulnerable social and political situation in the country, said Jennifer Reich, a sociologist at the University of Colorado Denver.
Many Americans don’t trust experts and believe health decisions should be a matter of personal choice — even when those decisions affect other people.
“The thing about COVID, and I think any infectious disease, is that they don’t necessarily create new problems. But they magnify the problems we already have,” Reich said. “Claims only make sense because they resonate against things that are already happening.”
As is the case with many coronavirus treatments, the jury is still out on ivermectin. There are dozens of ongoing ivermectin clinical trials across the world with mixed results. According to the National Institutes of Health, “there is insufficient evidence … to recommend either for or against the use of ivermectin for the treatment of COVID-19.”
Until reliable, high-quality data shows promise, the FDA cautions against its use for COVID.
Ivermectin’s connection to the coronavirus can be largely traced back to a lab in Egypt, which claimed in December 2020 that data from its randomized clinical trial showed the drug is more than 90 percent effective against COVID-19.
The study had not been peer reviewed. It was posted on a preprint server — a website that makes research quickly available to the scientific community and the broader public.
Local Arabic media interviews hailed the study as a national victory. It was, after all, the largest study at the time among dozens of trials taking place around the globe that were posted on preprint platforms around the same time.
This caught the attention of Andrew Hill, a pharmacology researcher at Liverpool University in the U.K., who has played an instrumental role in HIV and Hepatitis C research globally—but when the pandemic hit, he shifted gears to focus on COVID.
Hill and about 40 of his scientific colleagues aggregated the data from studies from around the world, including the trial from Egypt and others from Argentina, Bangladesh, India and Nigeria.
“We had Zoom calls with [people from] 20 or 30 countries, all pulling all their data and saying, ‘Here’s what my country is working on; look at this study; look at that study,'” Hill said.
The team conducted a meta-analysis — a study that systematically combines the results of numerous studies — and published a paper that concluded ivermectin is nearly 50 percent effective against COVID. But such analyses are only as good as the studies they are based on. Not long after the meta-analysis was published, Hill discovered major problems in some of the studies — including the largest one from Egypt.
Jack Lawrence, a master’s student at St. George’s University in London, was the first to notice the problems. His graduate class had been assigned several scientific papers to critique, and Lawrence said he was shocked at what he found in the study from Egypt. Most notably: plagiarism and other ethical issues.
“The biggest [concern], perhaps, is that they had reported the study as starting on the eighth of June. And they included a number of patients who had died before that date,” Lawrence said.
The paper from the Egyptian lab has since been removed from the preprint server.
Ahmed Elgazzar, the lead author of the Egyptian trial, did not respond to multiple emails and phone calls from Side Effects. In interviews with local Egyptian media outlets, Elgazzar said the decision to remove his paper from the preprint website was politically driven.
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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.