Misinformation about ivermectin

by George J. Dance

As readers know, the blog is interested in possible treatments for Covid19. I do not think, like some, that vaccines make those unnecessary; even if it were true (which it is not) that vaccines provided complete protection against catching covid, they would still be useless for those who have already caught it. Plenty of people are still catching it these days, many of whom had no access to a vaccine anyway (either because it was not available, or due to government restrictions). So Covid medicines and treatments should concern us. 

One of the medicines I have blogged about is ivermectin (IVM); some of those stories have been encouraging, but the truth is still out there. We are a long way from having all the data we need on the drug's efficacy, or possibly (despite its 40 years of approved use as a human medicine) even on its safety. That is why this weekend's news from Oklahoma was so alarming. I have seen plenty of stories about ivermectin poisoning before, but those usually concluded, like this recent report from Mississippi, that "No one has been hospitalized" from ingesting it. The news out of Oklahoma was different.    

According to the story, first reported on KFOR-TV (video below), eastern Oklahoma was seeing an epidemic of people being hospitalized for overdosing on IVM. So many were being hospitalized, in fact, that local hospitals were overwhelmed and on the verge of collapse. That story was picked up by, among others, BBC News, yahoo news, Newsweek, the New York Daily News, The Guardian, The Independent,  MSN.com, and even Rolling Stone magazine. As the last reported, under the title "Gunshot Victims Left Waiting as Horse Dewormer Overdoses Overwhelm Oklahoma Hospitals, Doctor Says":  

The rise in people using ivermectin, an anti-parasitic drug usually reserved for deworming horses or livestock, as a treatment or preventative for Covid-19 has emergency rooms “so backed up that gunshot victims were having hard times getting” access to health facilities, an emergency room doctor in Oklahoma said.

This week, Dr. Jason McElyea told KFOR the overdoses are causing backlogs in rural hospitals, leaving both beds and ambulance services scarce.

“The ERs are so backed up that gunshot victims were having hard times getting to facilities where they can get definitive care and be treated,” McElyea said.

“All of their ambulances are stuck at the hospital waiting for a bed to open so they can take the patient in and they don’t have any, that’s it,” said McElyea. “If there’s no ambulance to take the call, there’s no ambulance to come to the call.”

The doctor added that IVM OD victims "have arrived at hospitals with negative reactions like nausea, vomiting, muscle aches, and cramping — or even loss of sight. 'The scariest one that I’ve heard of and seen is people coming in with vision loss,' the doctor said."

The one thing that amazed me was that there was no attempt to corroborate Dr. McElyea's report, or to factcheck it either; it was reported as a factual account requiring no independent support. Rolling Stone did cite a story in Tulsa World, which reported that  "a rural emergency room physician, had a gunshot victim in his facility whom for hours he was unable to transfer to a higher level of care because no one had space." However, (1) the gist of that article was that a surge in patients suffering from Covid (not IVM overdoses, which were not mentioned) was causing the problem; and (2) the physician in question turned out to be Dr. McElyea himself.  

Not one of the media outlets running the story bothered to pick up a telephone, or get onto the internet, and check with a single Oklahoma hospital. Only one source, BBC News, bothered even to speak with Dr. McElyea to verify his quotes. What McElyea told the BBC, though, was only that "a 'handful' of people overdosing on [IVM] were putting further strain on hospital staff already stretched by a surge in Covid cases." Oklahoma hospitals were being overwhelmed, but by Covid cases, not by "horse dewormer overdoses."

After reading the BBC story, I began thinking that McElyea's original remarks had been either misunderstood, or misrepresented for the sake of a better story, by the KFOR reporter, Katelynn Ogle. Meanswhile, over at Reason magazine, Robby Soave had reached a similar conclusion:

One might be tempted to blame McElyea for embellishing his story.... But a closer look at the KFOR story reveals something quite startling: At no point did McElyea actually come out and say that ivermectin overdoses were straining hospitals.... McElyea clearly states that ivermectin overdoses have been a problem, and he claims that some hospitals are dealing with strain. But he never actually connects these two issues. It was the journalist, Ogle, who added that framing. She did not respond to a request for comment.

Eventually a statement was issued by an Oklahoma hospital where Dr. McElyea has worked. There turned out to a few discrepancies between their account and the TV station's: 

Although Dr. Jason McElyea is not an employee of NHS Sequoyah, he is affiliated with a medical staffing group that provides coverage for our emergency room. With that said, Dr. McElyea has not worked at our Sallisaw location in over 2 months. NHS Sequoyah has not treated any patients due to complications related to taking ivermectin. This includes not treating any patients for ivermectin overdose. All patients who have visited our emergency room have received medical attention as appropriate. Our hospital has not had to turn away any patients seeking emergency care. 

Once again, no hospitalizations due to use of IVM. But that was not the end of the story. A day later, a second hospital had issued its own statement, which confirmed Dr. McElyea's claims about IVM overdoses. However, the same statement also noted that the doctor had repudiated the KFOR story: 

Jason McElyea, D.O. ... has privileges at INTEGRIS Grove Hospital. He also works in several other emergency departments in rural Oklahoma. There is a lot of media attention surrounding remarks reportedly made by Dr. McElyea. While we do not speak on his behalf, he has publicly said his comments were misconstrued and taken out of context. What we can confirm is that we have seen a handful of ivermectin patients in our emergency rooms.... And ... while our hospitals are not filled with people who have taken ivermectin, such patients are adding to the congestion already caused by COVID-19 and other emergencies. 

That looks like the end of the story. Dr. McElyea had told KFOR-TV about this "handful" of IVM overdoses (the same word the BBC quoted him as using), some of which might have led to hospitalization (though the hospital does not confirm that any did). KFOR-TV selectively used the good doctor's recorded comments to construct a piece of fake news, and thereby spread misinformation.  

Updated, September 8, 2021

One more thing needs to be said on the subject. While the above story was pure misinformation, there was a real problem throughout the summer, not just in Oklahoma, with some people eating horse dewormer paste, and other livestock medications containing IVM, and accidentally overdosing. The U.S. Food and Drug Administration (FDA) found it necessary to issue an advisory warning:

Never use medications intended for animals on yourself or other people. Animal ivermectin products are very different from those approved for humans. Use of animal ivermectin for the prevention or treatment of COVID-19 in humans is dangerous.... animal drugs are often highly concentrated because they are used for large animals like horses and cows, which weigh a lot more than we do — a ton or more. Such high doses can be highly toxic in humans. Moreover, the FDA reviews drugs not just for safety and effectiveness of the active ingredients, but also for the inactive ingredients. Many inactive ingredients found in  products for animals aren’t evaluated for use in people.

While the FDA considers both human- and animal-formulated IVM to be ineffective, it calls only "Use of animal ivermectin for the prevention or treatment of COVID-19 in humans" dangerous. IVM for humans is formulated in a dosage safe for humans, and uses only ingredients that the FDA has approved for use in humans. So why were so many people taking animal-formulated products like horse dewormer paste instead? 

The answer is simple: The FDA has approved the over-the-counter (OTC) sale of horse dewormer paste; but it has not allowed the OTC sale of IVM formulated for humans. To get the latter, those wishing to try the medicine need a doctor's prescription, which creates a high (in some cases impassable) barrier to access. If Americans could buy ivermectin for humans OTC, there would have been no reason for them to eat horse dewormer paste instead. That the horse dewormer epidemic happened at all was solely due to the FDA's own regulations; any increased danger to Americans caused by it was danger caused by the FDA itself. 

(It is theoretically possible to overdose on human-formulated IVM. However, the chance of that is extremely improbable; not only is the dosage fully controlled, but the labelling and the pharmacist are both available to instruct users on how to safely use it.)  

In the above video, Dr. McElyea says: "There’s a reason you have to have a doctor to get a prescription for this stuff because it can be dangerous.' However, in this case it looks like the doctor reversed causation. Ivermectin was only dangerous, in this instance, because Americans were taking an unsafe formulation; and they were taking an unsafe formulation because without a doctor's approval they could not take a safe one. 

Updated December 8, 2021