Imagine if you were in the hospital with a life-threatening yet treatable illness. Your doctor enters the room with four vials: the first three contain drugs that have been tested many times, and shown repeatedly to be very good at reducing death and hospitalization for those with your illness. Studies of these drugs involved thousands of people of different demographics, and the strong correlations shown in these studies were published in peer-reviewed journals.
The fourth vial contains a drug that has little evidence that it works against your illness: yes, there was one study from Bangladesh, but it was very small and had questions around how it was conducted. All other studies showed little or no effect from this drug, at least for treating your illness. And one of the seemingly promising studies was done in a test-tube, which means little in the world of clinical evidence — many substances, including bleach, will kill viruses in test tubes as well, but this doesn't translate well to the inside of the human body.
Just about everyone, stripped entirely of cultural context, would opt for one of the first three drugs. But add the cultural context back in, and millions upon millions of Americans can — and do — opt for the fourth vial.
As you might have guessed, this is not a hypothetical. These are real facts about real drugs: the first three vials are equivalent to Molnupiravir, Paxlovid, and Sotrovimab. Molnupiravir is an anti-viral medication that was originally developed to treat influenza, and was adapted to treat Covid when a large double-blind study showed that it nearly halved the risk of hospitalization or death. Paxlovid, a combination of two anti-viral medications, reduced risk of hospitalization or death by 88 to 89 percent compared to a placebo in a large double-blind trial. Sotrovimab is a monoclonal antibody, a special type of cloned antibody akin to what the immune system makes itself; a study of 583 patients published in the New England Journal of Medicine found that it greatly reduced risk of death or hospitalization compared to a placebo.
The fourth vial is the equivalent of ivermectin — a drug for which there is little to no evidence that it treats or helps Covid patients. By "evidence," I mean specifically this: repeatable results and strong correlations in multiple, randomized, large, double-blind clinical trials. All the other three drugs mentioned earlier have passed this test; ivermectin has not.
As Edward Mills, principal investigator of a large trial looking into repurposed medicines for treating Covid, told Salon, repeated studies just aren't finding any compelling evidence that ivermectin works.
"As more and more higher quality forms of evidence, usually large randomized trials, have been completed, they did not find compelling-enough findings," Mills said. He explained that a recent test-tube study of ivermectin's effects on the virus were overblown: "It doesn't provide any evidence on the role of IVM [ivermectin] on clinical use," he noted. "It really should have not received a press release and no legitimate news source should have reported on it."
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It is odd, then, that anyone would opt for ivermectin to treat COVID-19 when there are all these other drugs that really do work. This would be tantamount to buying a small rock to defend oneself against tigers when there are plenty of good fences and tranq guns that have been proven to be superior tiger repellants. Yet many do opt for ivermectin to treat Covid, and many of these people express fury at those who doubt its (nonexistent) efficacy.
Given what we know about these three great drugs, this is admittedly weird — and this weird situation speaks to how the media has lost the plot when it comes to discussing ivermectin.
Because ivermectin is a drug now associated with the right-wing — whose pundit class repeats incessantly that there is some kind of vague conspiracy withholding public knowledge of its effectiveness — taking ivermectin to treat COVID-19 has become a point of pride, a cultural signifier among a certain caste of right-wing culture warriors. Podcaster Joe Rogan says he took ivermectin when he had Covid, and has repeatedly hinted at a conspiracy regarding its efficacy. Fox News host Tucker Carlson advanced the narrative that ivermectin was a possible Covid treatment on his show, and Fox's print news site often publishes articles hinting at a conspiracy around it.
I see the ways in which the obsession over ivermectin have infected public consciousness through angry letters to the editors. I receive dozens of missives a months from readers angry about our coverage of ivermectin — more than any other category of hate mail. Again, this is not a drug that has proved efficacious to treat COVID-19 — unlike Molnupiravir, Paxlovid, and Sotrovimab, drugs for which I have never received a single email. If the science and health media were purely a 1:1 reflection of medical advancement, unhindered by culture wars, the news media would devote as much column space to excitedly reporting on Molnupiravir, Paxlovid, and Sotrovimab as they do to reporting on disappointing studies of ivermectin and hydroxychloroquine (which previously occupied the same place in the right-wing imagination as ivermectin). And yet, this is not what the media landscape looks like; we don't see a lot of reporting on Molnupiravir, Paxlovid, and Sotrovimab, unfortunately.
Outlets like Fox News and One America News Network and Joe Rogan are some of the most prominent promoters of the narrative that there is some kind of mass conspiracy regarding reporting on the effectiveness of ivermectin for treating COVID. Yet in their coverage, they ignore the details that I mentioned above: That these few studies that suggested a positive effect of ivermectin were either not repeatable and done across a wide enough demographic to illustrate effectiveness (the Bangladesh study) or done in test tubes and largely meaningless (the press release alluded to above). But most importantly, an analysis of 23 randomized clinical trials for ivermectin treatments found "a borderline significant effect on duration of hospitalization in comparison with standard of care" and "no significant effect of ivermectin on time to clinical recovery." These are not the kind of results that speak to an effective drug.
Doctors and researchers are often puzzled by the obsession over ivermectin at the expense of these other drugs that actually work. "People shouldn't want to use things that don't work," Monica Gandhi, infectious disease doctor and professor of medicine at the University of California, San Francisco, told Salon. Gandhi, who wrote an article for The Atlantic on "miraculous" new COVID-19 medications, said she was "bothered" by the fixation on ivermectin: "Both hydroxychloroquine and ivermectin really were studied, and they really don't work in large clinical trials," she noted.
Those who work in medicine, and who understand statistics and epidemiology, have a good grasp on what studies are meaningful and which aren't. But the general public, and even a number of those in the health and science journalism world, often do not. Fox and its peers play off of the innumeracy of the masses, and the tendency to trust perceived authoritative sources like a wealthy podcast host or a Fox News anchor over statisticians and epidemiologists with smaller megaphones.
Innumeracy is a scourge on human progress in democratic societies. As a high school statistics teacher in my younger years, students would often look at their homework and ask me some variant of "why do I need to know this?" My answer was that statistics knowledge is crucial to a functioning democracy. We need citizens who can understand charts and graphs, and statistics concepts like correlation and standard deviation. As the pandemic has shown, such knowledge can preserve and save lives. Mathematics knowledge is not merely a boon to one's own career, but to society as a whole.
The ability to parse scientific studies is, regretfully, a rare one; few Americans, including podcast hosts and news anchors, seem to understand much if anything of how clinical trials work, what makes one robust, or why in vitro (test tube) studies are generally close to meaningless. Indeed, if news anchors were imbued with this kind of knowledge, they would structure their reporting about scientific studies quite differently: perhaps by noting the demographic caveats in certain studies; or noting which ones were double-blind and which weren't; or by discussing sample size; or even just by getting a statistician or epidemiologist to comment on them.
The confusion over ivermectin is not entirely the fault of the right-wing media, but also of the general way in which the news media covers studies. Scientists have come to expect that even the most minor study may be blown out of proportion by headline-writers. My mother, a retired epidemiologist who previously worked on asthma research, complained once that a small study she was involved with was billed by local journalists as a "potential cure" for asthma. This type of headlining practice obfuscates the slow, steady thrum of scientific research, and the way that small studies may be of little importance alone — though they may lead to larger ones with bigger sample sizes that are more meaningful to developing a scientific consensus.
Worse, studies that show no correlation are unlikely to be reported on at all, because the human attention span — like nature — abhors a vacuum. Studies with few or no correlations between their subjects of study rarely make for exciting headlines. Thus, a selection effect occurs among which studies enter the popular consciousness, and which don't — which, again, obfuscates the arc of scientific discovery.
In the case of ivermectin, the situation is further compounded by the fact that misinformation, willful or ignorant, is sometimes profitable. Fox News enjoys good ratings (and therefore ad money) by pushing the narrative that there is a conspiracy against ivermectin, because it plays into the general sense that it perpetuates (and which its viewers believe) that certain elites of the world do not have their best interests at heart; and that these imagined elites occupy a separate universe in which they are plotting against the patriotic masses in some unspecified way. Ivermectin can be drafted readily into this worldview, just as hydroxychloroquine, Starbucks cups, and George Soros were.
Still, I am perpetually disappointed by how ivermectin is covered by all media, not merely the right-wing news. Having been subsumed into the culture war, mainstream outlets that are either centrist or left-leaning often cover ivermectin studies as "gotcha" journalism that only serves to make the opposing side of the culture war madder and further dig in their heels.
As a result, there are psychological reasons that the ivermectinites won't back down on their beliefs. "We are social animals instinctively reliant on our tribe for safety and protection," risk perception expert David Ropeik told UC Berkeley's magazine Greater Good. "Any disloyalty literally feels dangerous, like the tribe will kick you out. This effect is magnified in people already worried."
Likewise, some of the fervor for ivermectin can be explained by the psychology of desperation.
"I can totally understand why people wanted a treatment, like, just to use some old drug that worked," Gandhi said. She noted that during the height of the omicron surge, many hospitals experienced shortages of drugs like Molnupiravir, Paxlovid, and Sotrovimab, meaning they had to ration. Now that the shortage is mostly over, however, Gandhi said she was unclear why ivermectin hype hadn't died down.
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"It's not like [ivermectin] doesn't have toxicities of its own — why not use something that's so much better?" she asked.
All of these aforementioned minutiae — media, psychological, political and scientific — are flattened in the coverage of ivermectin. Never before in the era of modern medicine has a treatment for which there is little evidence become so widely prescribed to millions, to the extent that state legislators are getting involved to ensure patients can access a treatment regimen of ivermectin that, as scientific consensus thus far shows, does not work.
Because of the peculiar way in which the culture war has collided with science journalism, innumeracy, human psychology, and the profit motive, it seems probable that long after the pandemic is over there will be more drugs like this — more false cures pushed for which there is little evidence for their effectiveness. These drugs will unwillingly become advance guards in the culture war, scrolling chyrons, the cause of angry dinner-table fights between politically distant relatives.
Yes, these quack treatments existed before the pandemic — colloidal silver, for instance, was for years a popular cure-all among a certain libertarian fringe — but under current conditions, it seems assured that quackery will become more commonplace, to the extent that legislators will fight for patients' rights to access useless, occasionally harmful treatments.
Read more on what happens when medicine and culture wars collide:
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