Why Has "Ivermectin" Become a Dirty Word?

At the worst moment, Internet censorship has driven scientific debate itself underground

On December 8, 2020, when most of America was consumed with what The Guardian called Donald Trump’s “desperate, mendacious, frenzied and sometimes farcical” attempt to remain president, the Senate’s Homeland Security and Governmental Affairs Committee held a hearing on the “Medical Response to Covid-19.” One of the witnesses, a pulmonologist named Dr. Pierre Kory, insisted he had great news.

“We have a solution to this crisis,” he said unequivocally. “There is a drug that is proving to have a miraculous impact.”

Kory was referring to an FDA-approved medicine called ivermectin. A genuine wonder drug in other realms, ivermectin has all but eliminated parasitic diseases like river blindness and elephantiasis, helping discoverer Satoshi Ōmura win the Nobel Prize in 2015. As far as its uses in the pandemic went, however, research was still scant. Could it really be a magic Covid-19 bullet?

Kory had been trying to make such a case, but complained to the Senate that public efforts had been stifled, because “every time we mention ivermectin, we get put in Facebook jail.” A Catch-22 seemed to be ensnaring science. With the world desperate for news about an unprecedented disaster, Silicon Valley had essentially decided to disallow discussion of a potential solution — disallow calls for more research and more study — because not enough research and study had been done. Once, people weren’t allowed to take drugs before they got FDA approval. Now, they can’t talk about them.

“I want to try to be respectful because I think the intention is correct,” Kory told the committee. “They want to cut down on misinformation, and many doctors are claiming X, Y, and Z work in this disease. The challenge is, you’re also silencing those of us who are expert, reasoned, researched, and extremely knowledgeable.”

Eight million people watched Kory say that on the C-SPAN video of the hearing posted to YouTube, but YouTube, in what appears to be a first, removed video of the hearing, as even Senate testimony was now deemed too dangerous for public consumption. YouTube later suspended the Wisconsin Senator who’d invited Kory to the hearing, and when Kory went on podcasts to tell his story, YouTube took down those videos, too. Kory was like a ghost who floated through the Internet, leaving suspensions and blackened warning screens everywhere he went.

The December, 2020 hearing on ivermectin wasn’t Kory’s first Senatorial rodeo. In May of that same year, he’d appeared before the same committee on a different subject: the use of corticosteroids in treating Covid-19 patients.

Kory belongs to a group called the Front Line Covid-19 Critical Care Alliance (FLCCC), founded by a well-known if controversial figure, Dr. Paul Marik. The author of 4 books and 400 peer-reviewed articles, Marik is a colossal figure in Critical Care — the word “giant” came up in more than one interview for this story — yet one with a definite reputation for bucking medical convention. At the outset of the pandemic, Marik and a group of like-minded colleagues around the world got in contact to form the FLCCC, trading stories about what doctors were seeing on the ground with Covid-19 cases everywhere from Italy to New York to South America.

“It was like a command center,” Kory recalls. “And we were reading papers like you wouldn’t believe.”

One of the first questions the group tackled was the proper treatment plan for hospitalized Covid-19 patients. Marik was famous for disagreeing with conventional wisdom about treatment protocols. He waged a long campaign to argue that the widely accepted practice of “fluid-loading” or “large-volume fluid resuscitation”— pumping patients in septic shock full of fluids — is unnecessary and may even be harmful or “worsen shock.” He was far from the only critical care doctor to have such thoughts, with some even comparing the groupthink around “fluid-bolusing” to the medieval certainty about bloodletting.

Such debates are normal in medicine, where authorities may come down on one side or the other of debates for a time, but consensus isn’t Talmudic law. Doctors argue in good faith about best practices, just like journalists argue about “objectivity” or legislators argue about everything from the filibuster or public campaign financing.

With Covid-19, early consensus favored what Kory calls a “supportive care only” strategy: water, Tylenol for fever, ventilation if necessary — anything, he says, but corticosteroids. “That was the one thing they agreed on, no steroids,” he says. It’s true that the WHO initially recommended against corticosteroid therapy for coronaviruses for a variety of reasons. However, there were many doctors who were anxious to bring more weapons to the fight against Covid-19.

Marik and the FLCCC were in the latter camp. They developed a protocol for Covid-19 patients called Math+ that included vitamin C, the blood thinner heparin, and the steroid methylprednisone. A few doctors in the U.S. tried out Math+ early on, but official bodies remained against it, and some doctors found, and still find, the claims about the vitamin C treatments in particular either dubious or harmless but unlikely to be effective (one I emailed about Math+ sent back an “eye-roll” emoji). Incidentally: while the FLCCC doctors have good reputations, their ideas have also met with plenty of pushback. MedPage described Kory and Marik as having a “knack for making headlines,” in a piece full of doctor quotes exuding clearly mixed enthusiasm for their “maverick” colleagues.

That didn’t make them wrong about steroids, however. Kory in his May 6 testimony reported that FLCCC doctors, in analyzing the use of steroids in treating other diseases like SARS, found that “contrary to the WHO recommendations… corticosteroids were life-saving in those prior pandemics when given to anyone beyond mild illness.”

Within months, researchers at Oxford released the results of a large-scale, randomized, controlled study called the “RECOVERY trial,” which found that steroids were highly effective for patients with severe and critical Covid-19. By September, the WHO issued a new guidance with a “strong” recommendation for steroid use for such patients.

“We were criticized,” Kory says now. “But it became the standard of care.”

Meanwhile, doctors all over the globe launched studies into a huge range of Covid-19 treatment possibilities, from the protease inhibitors used to treat HIV to the ace inhibitors used to treat high blood pressure to interferons to zinc and vitamin D and dozens of other candidates. Ivermectin was just one the many. It generated a little buzz within the medical community when an April, 2020 study in Antiviral Research found it inhibited SARS CoV-2 from multiplying under a microscope.

Other studies were less flattering, though, with one insisting humans would need to massively overdose in order to get even a theoretical benefit. As of last summer, the official take on ivermectin was unequivocal. The FDA on August 26th of 2020, acting out of concern that people might self-medicate using anti-parasitic drugs intended for their pets, issued a stern ruling.

“The FDA is concerned about the health of consumers who may self-medicate by taking ivermectin products intended for animals,” they wrote. “People should never take animal drugs.” A day later, on August 27th, the National Institutes of Health issued a guideline that “recommends against the use of ivermectin for the treatment of COVID-19, except in a clinical trial (AIII).”

For most of last year, ivermectin was not on the radar of the FLCCC doctors. One by one, however, studies boosting ivermectin kept coming to their attention. These trials were going on in Egypt, Bangladesh, Brazil, Spain, India, Peru, Paraguay, and other countries, and many claimed dramatic results.

They were small studies, but this was and is by no means a fringe or dismissed topic, with upwards of 220 papers published in just two years. Some were genuinely thought-provoking, like for instance one hypothesizing that the reason African countries have a lower incidence of Covid-19 is because so many Africans are already taking ivermectin. Absolutely none of this was hardcore proof, but there was reason to keep researching.

A consultant to the WHO, Dr. Andrew Hill of the University of Liverpool, presented an analysis of these ivermectin studies that came to a lot of the same conclusions as the FLCCC, in perhaps less excitable tones. Ivermectin was an alluring possibility, Hill said, because a course of treatment in third world countries costs just $1-$2, and though the available studies were nearly all small — between 100 and 500 subjects — there were some very attractive results. Overall, though, there wasn’t enough data to make a WHO recommendation.

Not everyone was impressed. Dr. Zain Chaglia of McMaster University in Ontario wrote a long Twitter thread calling the studies Hill cited “very low grade” evidence. “This is complete echoes of what happened in hydroxychloroquine - where people raced to prescribe it offline, rather than study it in trials,” he said. “There is a higher standard here for all.”

The word got out around the world fast, and in many poorer countries, huge portions of the population began regimes of self-medication, often with the assent of local governments. In May of last year, health care workers passed out 350,000 doses in Bolivia, while a university in Peru announced it would give away 30,000 doses. Some doctors and researchers began to complain that it had become difficult to do studies on the drug, because too many people were already on it. “What we’re having is a populist treatment, instead of an evidence-based treatment,” Patricia Garcia, a former Peruvian health minister who was running an early ivermectin trial, complained to Nature.

Still, the issue with most of the early studies wasn’t that they showed negative results, so much as insufficient or ambiguous data. The overall take was promising, but not definitive. This was in this context that Kory returned to the Senate last December. He said a lot had changed in the 3-4 months since the first NIH-FDA rulings. “Mountains of data have emerged showing the miraculous effectiveness of ivermectin,” he urged. Describing an Argentine study in which no one out of 800 subjects given Ivermectin had fallen ill, he said, “It obliterates transmission of this virus. If you take it, you will not get sick.”

Kory says he regrets using the world “miraculous,” that “the descriptor made me seem uncredible and sensationalizing.” He wonders if “some slight moderation would have been more ‘palatable’ for the censors,” but at the same time isn’t sure anything would have made a difference. Was the language over-the-top? Maybe. Was what Kory said so dangerous that it needed to be removed from the Internet? That’s harder to argue, unless you see such talk as part of a larger pattern of offenses, which seems to be part of the issue with Covid-19 content moderation generally.

One of the challenges of the pandemic period is the degree to which science has become intertwined with politics. Arguments about the efficacy of mask use or ventilators, or the viability of repurposed drugs like hydroxychloroquine or ivermectin, or even the pandemic’s origins, were quashed from the jump in the American commercial press, which committed itself to a regime of simplified insta-takes made opposite to Donald Trump’s comments. With a few exceptions, Internet censors generally tracked with this conventional wisdom, which had the effect of moving conspiracy theories and real scientific debates alike far underground.

A consequence is that issues like the ivermectin question have ended up in the same public bucket as debates over foreign misinformation, hate speech, and even incitement. The same Republican Senator YouTube suspended for making statements in support of ivermectin, Ron Johnson, has also been denounced in the press for failing to call the January 6th riots an insurrection, resulting in headlines that blend the two putative offenses.

“You have these ideas about the need to censor hate speech, calls for violence, and falsity,” Kory says, “and they’ve put science on the same shelf.”

As a result, doctors and organizations that may have little to do with politics but have advocated for ivermectin, from Dr. Tess Lawrie’s British Ivermectin Recommendation Development (BIRD) to California pulmonologist Roger Seheult to many others, have been shut down online with the same unilateral abruptness platforms apply to hate speech or threats. Dr. Sabine Hazan, a gastroenterologist and CEO of a genetic sequencing laboratory called ProGenaBiome in Ventura, California, was blindsided. She got involved with ivermectin when she was pulling out the stops for Covid-19 patients.

“I’m a doctor. My job isn’t to do nothing. If I wanted to do nothing, I’d be selling shampoo,” Hazan says. When patients got really sick, she tried everything, treating off-label with a number of drugs in combination, including ivermectin. Eventually, she ended up taking it upon herself to run clinical trials with repurposed, off-patent drugs like ivermectin and hydroxychloroquine, fearing that the lack of a profit angle would prevent a major corporate effort in that direction.

“I felt, no one is going to be investigating a cheap solution, so I did it myself,” she says.

Some weeks ago, Hazan got up early on a Sunday to present findings to a group of physicians that included Dr. Kylie Wagstaff, one of the physicians in the first in vitro ivermectin study, a family doctor in Zimbabwe named Jackie Stone, and others. She uploaded the talk on YouTube, and “lo and behold, it got taken down. It’s amazing. These are doctors talking. It’s not anyone selling anything.”

Hazan doesn’t necessarily believe ivermectin is a miracle cure by itself — “I’m not sure just ivermectin is going to do the trick” — but she’s adamant that censorship and interference by both the media and politicians is “ruining science.” Like many of the doctors who’ve been censured for discussing the topic, she believes Internet carriers and politicians alike have a fundamental misunderstanding of how medicine works.

“All science, all medicine, is a hypothesis,” she says. “Until you have a valid, verifiable, reproducible cure, it’s all hypothesis. You need humility about what you don’t know. It’s like Einstein said: if we knew what we were doing, it wouldn’t be called research.”

The suspensions and bans have triggered a dystopian chase game, in which ivermectin backers rush to take their case to media figures before the media figures themselves end up sitting next to them in the same Facebook or YouTube “jail.”

One of the most prominent examples involves Bret Weinstein, whose DarkHorse podcast is one of the faster-growing independent political shows online. In May, for instance, DarkHorse scored 4.9 million views on YouTube and generated over 43,000 new subscribers. This growth is due in significant part to the fact that Weinstein and wife Heather Heying made a conscious effort to provide a forum for discussions about Covid-19 that live outside the narrow realm of allowable debate on commercial media. Because that debate has become so constrained, independents like Weinstein have a virtual monopoly on content about a whole range of effectively banned topics.

On June 1, Weinstein did a show that included an interview with Kory called, “COVID, Ivermectin, and the Crime of the Century.” That was swiftly removed by YouTube, with a notice declaring, “Our team has reviewed your content, and, unfortunately, we think it violates our spam, deceptive practices and scams policy.” Another episode, “Why is Ivermectin not being used in other countries?” was removed with a similar warning. Two more videos were either taken down or marked with warnings, and another, with Robert Malone, the inventor of mRNA vaccine technology, was taken down during the writing of this article after 587,331 views, leaving Weinstein in a precarious position.

He and Heying have two YouTube channels. After four warnings and one official strike on each channel, they’re a couple of poorly received shows away from being out of business. Weinstein is particularly concerned about their more profitable “clips” channel, which seems to have attracted more of YouTube’s attention.

“If they give me a third strike,” says Weinstein, “that would represent more than half of our income.”

YouTube, in a statement, says the distinction in Weinstein’s case has to do with actively advocating for ivermectin’s use. “While we welcome content discussing possible treatments for COVID-19, our policies don't allow videos that encourage people to use Ivermectin to treat or prevent the virus and as a result we removed videos from Bret Weinstein’s channel,” they told TK. “We apply our policies consistently to all content on YouTube, regardless of speaker or political views.”

YouTube’s policy is elaborately thought out. At least in theory, it doesn’t simply zap anyone who mentions ivermectin. It does, however, require that any discussion in favor of the drug include disclaimers that either refutes those positive claims or outlines official guidelines on the subject. In essence, YouTube is making the FDA’s current position a mandatory element of any public discussion.

Not all the platforms have the same policy. A spokesperson for Twitter says the company refrains from yanking content unless it would be “immediately dangerous to someone reading and taking action based on a Tweet (e.g. ‘drink bleach to cure COVID’).” Twitter’s standard stresses the idea of “immediate” physical harm, not unlike actual speech laws. By contrast, YouTube and Facebook have much broader and tougher rules, and the appeals process is either glacial or nonexistent.

Ivermectin may never be proven effective as a Covid-19 treatment, but its story has already appeared as a powerful metaphor of the Internet’s transformation. Once envisioned as a vast democratizing tool, which would massively raise global knowledge levels by allowing instant cross-global communication between all people, it’s morphed instead into a giant unaccountable bureaucracy for suppressing dialogue, run by people with an authoritarian vision for information flow. Many ivermectin advocates believe discussion of the the drug is being suppressed because of its status as a threat to a billion-dollar vaccine business, but it’s just as likely that its reputation worldwide as a “populist” treatment, a medicine taken by people not waiting for official validation, has made it a target of censors and pundits alike.

“I think what happened is that at the outset of the pandemic, it was decided that all information must go in one direction, from the Gods of Science down,” says Kory. “But that’s not the way it works. Science happens on the ground. That’s where the little discoveries are made. They don’t happen at the top of the mountain.”