Friday, November 12, 2021

For the Alternative Medicine Community, the Fact that Ivermectin has not been Approved for COVID is a Feature, not a Bug

 by Michael C. Dorf

In his terrific new book, Choose Your Medicine: Freedom of Therapeutic Choice in America, historian and law professor Lewis Grossman traces the expert-skeptical democratic strand of American thought about health and medicine to centuries-old patterns. Such expert-skepticism is hardly irrational. For most of human history, a healthy skepticism towards mainstream medicine was, well, healthy. Horrors like the 1799 deathbed scene of George Washington that Grossman recounts were all too common. To treat the Father of our country, "who was suffering from a severe throat infection," doctors "dosed him with calomel and tartar emetic, applied blisters to his throat and legs, and drained about half of the blood from his body."

Even today, too much medical practice relies on habit and anecdote. For example, many obstetricians prescribe bed rest for a wide variety of pregnancy complications, despite the evidence that bed rest does not improve patients' conditions and adds additional risks. The longstanding current of health libertarianism that Grossman documents is a not-entirely-unreasonable response to the arrogance and quackery one finds in the mainstream medical profession.

Yet, increasingly, the movement for evidence-based medicine makes across-the-board skepticism not just unwarranted but itself dangerous. Indeed, it is not even across-the-board skepticism. People rarely replace faith in one institution with consistently critical thinking. Instead, they typically replace one kind of faith with another. Thus, what starts in skepticism becomes ingenuousness.

How? Consider the roots of perfectly reasonable skepticism of pharmaceutical companies. Some people who suffer from hypertension, elevated blood sugar, and other unhealthy conditions are able to improve their health substantially through lifestyle changes: by eating a healthier diet and exercising more. Many medical professionals recommend such changes, along with quitting smoking (if patients smoke) and reducing alcohol consumption. However, pharmaceutical companies don't make money when people walk instead of drive or when they substitute kale salad with walnuts for a burger with fries. The companies make money selling drugs that prevent or treat diseases. As profit-maximizing entities, they will invest more in research on interventions that can be patented than on those that cannot be (like diet and lifestyle changes).

Moreover, some pharmaceutical company innovations do little even for people who wouldn't otherwise make lifestyle changes. They might simply combine two out-of-patent drugs into a new one to gain a new monopoly. Oxycontin, which was at the root of the opioid epidemic, is just an old drug (oxycodone) with a time-release coating on it. It made Purdue Pharma gazillions of dollars before the legal liability for the thousands of ruined lives ultimately bankrupted the company.

There is no reason in principle why vaccines and treatments for COVID-19 would be different. If it turned out that eating two raisins per day completely prevented COVID infection or that an existing out-of-patent vaccine or medicine prevented or treated COVID, a pharmaceutical company could not make money from generating new vaccines and treatments. Thus, if the search for vaccines and treatments were entirely in the hands of Big Pharma, it would be sensible to worry that the searchers would have a financial incentive to overlook potentially effective but non-monetizable tools.

In March 2020, it would have been perfectly reasonable to look to nature and existing medicines, rather than simply to unleash pharmaceutical innovators. At that time, and later in the pandemic, one might have worried that the pharmaceutical companies were paying insufficient attention to the potential of hydroxychloroquine, ivermectin, and other existing medicines. Indeed, even today, there is no reason not to continue to consider existing medications and lifestyle interventions as a means of preventing or treating COVID.

BUT, it's one thing to say that scientists ought to investigate off-label uses of existing medications for possible efficacy against COVID. It's quite another to reject new vaccines that have been rigorously tested and found to be remarkably safe and effective in favor of off-label uses of existing medicines that might be safe and effective but have not been shown to be so. That's especially true given that, despite the incentives of the pharmaceutical industry, there has actually been great effort to find treatments using existing medications--partly because governments, researchers affiliated with universities and hospitals rather than pharmaceutical companies, and other actors without the full distorting effect of the profit motive have been involved in the search for measures to combat COVID from the beginning.

Nonetheless, the quackery persists. Two examples illustrate the slide down the rabbit hole from healthy skepticism to unhealthy ingenuousness.

Let's start with ivermectin. In some of the mocking coverage of the Ivermectin-as-miracle-cure phenomenon, we see people point to the fact that its main use is to deworm horses. That's a silly objection. For one thing, ivermectin has been approved (albeit in different doses) for human use. Moreover, a substance that is effective against one condition in one species could be effective against another condition in another species. Horses love carrots and apples. So do I. And consumed in moderation, carrots and apples promote both equine and human health. Accordingly, given anecdotal evidence that ivermectin could be effective against COVID in humans, it's reasonable to investigate it.

But many of the people who cited the speed with which the pharmaceutical companies developed and the FDA approved the Pfizer, Moderna, and J&J vaccines as their reason for refusing vaccination have been eager for ivermectin without anything resembling full investigation. Now, more than three months after the leading clinical study finding ivermectin efficacy was shown to be fraudulent, the very people who distrust official medicine continue to promote it.

To be sure, the fact that a study finding ivermectin effective was deeply flawed does not preclude the possibility that rigorously conducted studies could show it to be effective. A federally funded clinical trial of ivermectin is being undertaken right now. If the drug proves effective against COVID, that would be great. It would be another available tool. However, that would hardly vindicate the people who are currently eschewing the vaccines in favor of ivermectin. If you eat a strange-looking mushroom you find in the forest and it turns out to be delicious and it improves your diabetes, you are lucky, not wise, for having eaten it without first determining whether it was poisonous.

My second example of the slide into irrationality is mask-skepticism. The unskeptical acceptance of alternative remedies can be explained, though not justified, by legitimate concerns about the profit motives of Big Pharma. However, that hardly explains why many of the same people who tout ivermectin and other unproven medicines are skeptical of or flout masks. Some of those people express purely libertarian objections to mask mandates, but others--a great many others--doubt that masks are actually an effective means of preventing the spread of COVID. Why? It cannot be because Big Mask stands to make a financial killing by selling masks at monopoly prices. There is no Big Mask.

Instead, mask-skepticism is a symptom of the belief system that replaces trust in authorities. "Do your own research" is not a warning to read the actual clinical studies of the medicines that doctors prescribe or the government approves; it is a license to accept the advice of whatever quack has produced the video that your friends shared on social media.

Finally, I recognize that politics explains a great deal of what has come to be naive faith in almost anything that the medical establishment hasn't approved. Many of the people who won't get vaccinated or wear masks but have faith in ivermectin are simply in the thrall of the right-wing pundits and politicians who promote and reinforce this belief system. However, that is not everyone. There is a robust alternative medicine community on the left as well as the right. And in any event, my goal here is to illuminate the general phenomenon of healthy skepticism of authority turning into belief in substantially less reliable alternatives.


Michael A Livingston said...

Just a note that there is a whole literature on expertise and resistance to expertise that I think goes back some ways, in many cases to nineteenth century England. Certainly it is not the case that “experts” or “scientific experts” are always correct. For example, a large part of “expert” opinion accepted the superiority of the White Race, whatever that means, for quite some time. And so forth. This doesn’t disprove your point, of course, but one has to be vary careful of how one defines expertise and what level of deference one attributes to it. I believe Foucault discusses this at length, although in fairness, he discusses almost everything (and typically at great length):: one is tempted to say that he is the world’s leading expert on the limitations of everyone else’s expertise.

Bob Moss said...

An excellent summary of the salient considerations, one group of which is consistently omitted by the left, and another group of which is consistently omitted by the right (I use the terms "left" and "right" loosely; I believe most readers will get my drift).

The article is a bit too hard on "mainstream" medicine when it goes further back into history, as I am not aware of, for example, an alternate movement that rejected bleeding as the cure for all aliments. Another example is the cause of malaria (mal-aria, or "bad air"), a topic of personal interest, as in 1990 I was cured of falciparum malaria, normally fatal to people not of recent West African descent, by proper treatment with mefloquine. In the 19th century, Mary Kingsley summed up the common European belief on this topic by describing noxious vapors flowing out of malarial swamps, across the waters of the harbor at Bonny, in what is now southeastern Nigeria, to ascend the sides of the ships at anchor and sicken everyone on board.

Anonymous said...

Should anyone be interested in further exploring several topics raised in Mike’s post, or least relevant to the ethos of his ruminations, I have a handful of bibliographies chock full of helpful literature. These are freely available for viewing or download on my Academia (.edu) page.

• Alternative and Complementary Medicine
• Biological Psychiatry, Sullied Psychology and Pharmaceutical Reason
• Diseases, Epidemics, and Pandemics
• Health: Law, Ethics & Social Justice
• Public Health: Social Epidemiology, Ethics, and Law
• Sullied (Natural & Social) Sciences

Greg said...

I am mask skeptical.

Looking at the clinical research, it is kind of all over the place, particularly when expanding your view to look at the mask research around influenza. I'm not sure anyone advocating for or against masks really knows their effectiveness.

HOWEVER, regardless of being mask skeptical, I wear a mask. Why? For one, because it is unlikely to hurt much (although some of the influenza research indicates it may hurt some) and so I choose to listen to the experts, even though I am skeptical that they can know what they claim to. Second, it's admittedly a form of virtue signaling. I don't want to be perceived as someone who actively refuses to wear a mask or who is inconsiderate of others.

I see very few experts saying "don't wear masks." I do see some experts saying "masks are over-sold, we really need people to get the vaccine." That latter attitude matches my personal non-expert analysis of the available data.

I agree that it's frustrating that a number of people have turned to substantially less reliable sources for their attitudes than scientists who are respectfully disagreeing on the best course of action. Indeed, I find that those who vehemently defend their adherence to unreliable sources of authority make it harder to have a discussion about areas where various reliable sources disagree. This is partially due to the virtue signaling, but also because the reliable sources become overly defensive because of the effort required to argue with those who use unreliable sources of information.

I don't find this effect limited to COVID-19, and see it across a wide range of issues, where if you don't thoroughly agree with the extremists in either party, you are perceived as being a bad person by both of them.