Could ivermectin have ended the pandemic?
The official story on ivermectin. It’s a horse dewormer. There’s no evidence that it’s effective for treating Covid. It’s dangerous. The only people advocating it are loony right-wingers, conspiracy theorists. It should not be used. Only trust medical authorities. They say it’s no good.
Ivermectin is toxic in another way: anyone who thinks it should be taken seriously as a possible treatment for Covid is suspect. They are deluded. In fact, just by discussing ivermectin, they harm public health by raising doubts about health authorities.
So by treating positive claims about ivermectin seriously, I’m taking a risk of contributing to the spread of dangerous misinformation.
Okay, I’m taking the risk. I read The War on Ivermectin by critical-care physician Pierre Kory, and I’m going to say a bit about the book. Kory tells a story so contrary to the official line that it is like entering an alternative reality, one in which health authorities turned away from a cheap, safe drug that could have ended the pandemic and saved millions of lives, indeed a drug that did save millions of lives in parts of the world where it was used extensively.
The Kory story
Medical authorities and the mass media denounced Kory when he publicly challenged the official Covid line, but for many he is a hero, fighting the establishment. I haven’t read all the research papers addressing ivermectin and other treatments for Covid, so I’m not proposing to offer an authoritative evaluation of Kory’s claims. Instead, I will just summarise some of his views and, based on my study of the politics of medicine, comment on whether I think these views are outlandish — or plausible. If Kory’s views are potentially correct, the attack on ivermectin may have enabled one of the greatest medical disasters ever.
Kory was an emergency care physician, working in the US, handling the most acute cases in crisis conditions. Before Covid hit, he was involved in using intravenous vitamin C for sepsis, following the finding by Paul Marik, a leading figure in critical-care medicine. Discovering an effective treatment is one thing.
Paul Marik
More difficult is convincing practitioners and authorities, and Kory helped win allies to promote intravenous vitamin C.
In this story, there’s something important to remember later. Doctors regularly prescribe drugs “off-label” when a drug is approved for one condition but is found useful for others. It’s not only legal to prescribe drugs off-label, it’s quite common. For example, doctors might note that a drug approved for heart problems is effective against migraines and prescribe it for migraine years before regulatory approval.
At the beginning of the pandemic, Kory was one of many doctors putting heart and soul into treating patients on the frontlines, conferring with doctors internationally, learning everything he could about Covid, and especially searching for treatments. He helped form a group called the Front Line Covid-19 Critical Care (FLCCC) Alliance. The group posted a protocol for early treatment of Covid using methylprednisolone, vitamin C, thiamine, heparin, melatonin, zinc and vitamin D. Doctors using the protocol had great results, but the medical establishment and mass media showed no interest.
“The first six months of the FLCCC [in 2020] certainly resulted in better outcomes for many patients, but little did we know that we were teetering on the brink of a revolution. Paul was about to identify ivermectin, an inexpensive, incredibly safe, generic, repurposed drug as an immensely effective and potent therapy against SARS-CoV2. It was a discovery that could and should have saved lives and ended the pandemic — if not for one major problem: Repurposed drugs like ivermectin are generally off-patent, which means the manufacturer has lost exclusive marketing rights. In other words, competitors can make and sell dirt-cheap versions.” (p. 90)
To cut a long story short, there was more and more evidence that ivermectin was effective against Covid, so effective that it was almost a miracle cure when used early and with strong enough dosages. Patients who were extremely sick recovered quickly. And there was other information. Places where ivermectin was introduced population-wide saw dramatic falls in Covid morbidity and mortality.
Opposition
Many medical authorities, it seemed, didn’t want to know. Rather than enthusiastically exploring possibilities for using and studying ivermectin, some hospital administrators refused to allow it to be used. A common argument was that the drug shouldn’t be offered until it had been proven effective in randomised controlled trials (RCTs).
Kory kept a record of evidence, and co-authored a paper showing ivermectin’s effectiveness, including evidence from RCTs. He thought the evidence was overwhelming, and that ivermectin was so effective against Covid that it would end the pandemic then and there.
The opposition grew stronger. There was hostile media coverage and official statements condemning ivermectin. Kory and others were dismissed from their positions. There was a publicity campaign to discredit ivermectin, introducing the label “horse dewormer.”
Pharmaceutical companies ran their own RCTs, which showed limited benefits from ivermectin. Kory and others examined these studies and discovered serious flaws. For example, the dosages of ivermectin used were too small, or treatment was started too late. However, each negative RCT received saturation media coverage, while critiques of these studies, and RCTs supporting ivermectin, were ignored by the media.
What was going on? For Kory, this was the most amazing thing he had ever seen. Here was a cheap, safe drug that seemed to work amazingly well against Covid, yet it was attacked, and so were those who advocated it. It even got to the stage that when doctors prescribed ivermectin for patients, some pharmacists refused to fill their orders, something Kory had never encountered in his career.
When hospital administrators refused to allow patients to access ivermectin, an attorney named Ralph Lorigo took them to court, winning half the time. Kory reports that of 40 cases that Lorigo won, only 2 of the patients he represented died; of the 40 cases he lost, 39 of the patients died.
The easiest explanation for the attack on ivermectin was that big pharma shaped the entire response to the pandemic. Pharmaceutical companies stood to make billions of dollars from expensive drugs and from vaccines. This massive income stream was in jeopardy if there was a cheap and safe treatment, so it had to be discredited. Big pharma has penetrated hospitals, medical associations, governments, media and tech companies, all of which acted to shut down ivermectin and its advocates.
A revealing table
One table in the book especially impressed me. It lists all the treatments for Covid ranked by treatment benefit. Here I only list a few illustrative items from the table.
ivermectin, 62%, 95 studies, $1
Casirivimab/imdevimab, 52%, 27 studies, $2100
Bamlanivimab/etesevimab, 51%, 15 studies, $1250
diet, 48%, 24 studies, $0
vitamin D, 36%, 109 studies, $1
Paxlovid, 34%, 28 studies, $529
The percentage figures indicate the estimated treatment benefit, 62% for ivermectin (higher is better). The next figure is the number of studies on which the benefit estimates are based, 95 for ivermectin. The final figure is the cost of a full course of treatment. Now guess which items from this list were recommended by the US government during the pandemic. Yep: Casirivimab/imdevimab, Bamlanivimab/etesevimab and Paxlovid. The same pattern holds for the full table. Only high-priced therapies were recommended, with one exception, acetaminophen, whose treatment benefit is negative, -28%.
Is it plausible?
The War on Ivermectin is filled with information, though with two weaknesses: there is no index and all the references are in the form of URLs. Even so, it is not hard to track down sources for most of the points covered.
The book is also Kory’s personal story, well told in part due to co-author Jenna McCarthy. It is filled with Kory’s rage and anguish: his rage at the forces blocking a treatment for Covid and his anguish over the people who died unnecessarily.
Jenna McCarthy
But are Kory’s central claims plausible? I haven’t studied the original articles in medical journals, for example to assess Kory’s claim that RCTs showing ivermectin is ineffective were flawed. However, I can assess some of the general claims that underpin his arguments. These are shocking enough.
1. Big pharma corruption To believe that Kory might be right, it is necessary to accept that large pharmaceutical companies are so corrupt and unethical that they will promote their own products and attack cheap alternatives at the expense of large numbers of lives. Some people just can’t accept this, but it’s plausible to me. One revealing bit of evidence is that many of the companies have been fined billions of dollars for illegal actions. Kory cites a book by Peter Gøtzsche, Deadly Medicine and Organised Crime.
Gøtzsche gives extensive documentation of corrupt behaviour by big pharma, and it is eye-opening. I read it and wrote a blog post about it. I had also read Sergio Sismondo’s book Ghost-managed Medicine, which offers a close-up account of big-pharma manipulations, and was so impressed that I wrote a review of it. With this background, believing there could be more criminal behaviour during the pandemic is not a stretch.
2. Fiddling RCTs Kory alleges that six important randomised controlled trials of ivermectin were fudged to give negative results. It is shocking to imagine that companies, and the researchers who work for them, would traduce scientific principles to obtain a desired result. This is shocking for anyone who believes scientists operate on a higher ethical plane than other mortals, but it was not surprising to me, having studied bias in science since the 1970s.
Ben Goldacre wrote a book, Bad Pharma, in which he described the many ways in which companies manipulate research to give desired results. Reading Bad Pharma, and other similar accounts, gives reason to believe pharma-run ivermectin RCTs might have been fiddled.
3. Mass media partisanship Kory says the US mass media trumpeted every pharma RCT showing ivermectin was ineffective, while ignoring evidence that it is effective. How could the mass media — including prestigious outlets such as the New York Times — be so one-sided? This was no surprise to me. Critiques of the mass media abound, especially of the US mass media. For several years, there was even a magazine titled Lies of Our Times — I subscribed to it —with critical analyses of stories (and the absence of stories) in the New York Times and other US media. You can also turn to Project Censored for media analysis.
Given the power of the pharmaceutical industry, with its vast profits and sway over the media, mass media partisanship during the pandemic was only to be expected.
4. Censorship Kory tells about having YouTube videos taken down and a host of other actions taken to silence anyone questioning the government line on Covid. There is a large body of evidence for this sort of censorship. I wrote about it, and a group of us reported on interviews with scientists and doctors who were censored. With the release of the Twitter files, more evidence has become available. Kory’s stories of being censored are typical features of this wider picture.
5. Neglect of generic drugs There is plenty of evidence for the neglect of cheap alternatives to drugs. One example is exercise as a way of addressing depression. Many studies show that exercise is just as effective against mild and moderate depression as antidepressants, and furthermore has beneficial side-effects — physical health — rather than negative ones. Yet this finding, rather than being trumpeted by the media and in medical circles, receives relatively little attention. Initially during the pandemic, evidence for the effectiveness of ivermectin was ignored. As Kory recounts, a full-scale attack began when ivermectin began to gain attention.
6. Political retractions When a scientific paper is exposed as fraudulent, for example based on manufactured data, journal editors may withdraw it. It is “retracted” and usually this means it is discredited. Just being wrong is not considered a sufficient reason for retraction, because many if not most scientific papers are wrong. However, in recent years, there has emerged a new sort of retraction, not because of fraud or gross error but because of hostility towards a paper based on disagreement with its findings. Sometimes there is a pretext for such retractions, such as conflict of interest, but these sorts of retractions are quite different from the usual sort. Kory’s claim that retractions of papers supporting ivermectin were unwarranted is compatible with evidence for “political retractions.”
7. Guilt by association One of the most effective attacks on ivermectin was to label it a horse dewormer. This is an example of guilt by association, in which a person or thing is stigmatised by being linked to something with negative connotations. Another example is claiming that scientists advocating ivermectin are right-wing. Kory says he and most of his FLCCC colleagues are liberals politically, yet the only media willing to report on their findings were identified as right-wing. By this association, Kory thus was tarred as right-wing. Ivermectin was caught in US left-right political polarisation.
Conclusion
The War on Ivermectin presents a shocking story. If we are to believe Kory and others in FLCCC, the actions of the pharmaceutical company and its allies — including medical authorities, governments and tech companies — have allowed the unnecessary deaths of millions of people, by discrediting the use of a cheap, safe and effective treatment for Covid, a treatment that could have stopped the pandemic in its tracks.
I examined general claims underlying Kory’s arguments, for example that pharmaceutical companies are capable of corrupt actions on a large scale. To the extent that Kory’s story seems shocking, it is because such general claims are shocking, yet for every one of them there are ample precedents. In short, Kory’s arguments should not be dismissed out of hand simply because they clash with widespread beliefs, for example that decisions by medical authorities are always in the public interest. Instead, it is worth the effort to independently assess Kory’s claims carefully and systematically. Millions of lives were at stake with Covid, and millions more may be at risk in future pandemics.
It might seem that Kory is proposing there is a giant conspiracy to serve big-pharma profits, but there is another way of thinking about the story.
The belief system in which salvation from Covid is provided by vaccines and expensive drugs can be likened to a paradigm, a way of understanding the disease and how to respond to it that shapes research priorities and policies. If you believe that only vaccines and proprietary drugs can be trusted and that “natural” remedies are inherently suspect, then claims about the benefits of ivermectin can be ignored, as they are bound to be bogus or, worse, they may discourage people from being vaccinated. This belief system serves the interests of big pharma, but it does not mean those who subscribe to it are consciously conspiring to hide the truth.
Kory was previously an uncritical believer in the standard view of medicine. Pursuing the wellbeing of his patients led him into an alternative reality in which everything he thought he knew about medicine was turned on its head. He has provided his story so readers can decide whether to venture into this alternative reality.
Pierre Kory
There is much more to The War on Ivermectin than I’ve been able to cover here, including hospital power plays, mass media bias and the politics of vaccination. One highlight is Kory’s account of the founding and operation of FLCCC in the face of powerful opposition. If you plan to help organise a challenge to a ruthless opponent during an emergency, you can learn a lot from the FLCCC’s methods and efforts. Just be prepared to lose your job and be labelled a conspiracy theorist.
Brian Martin, bmartin@uow.edu.au
Thanks to Tonya Agostini, Kelly Gates, Kurtis Hagen, Anneleis Humphries, Julia LeMonde, Susan Maret and Erin Twyford for helpful comments. None of them necessarily agree with Kory’s views or my own.