What do the people who think ivermectin is effective against COVID-19 believe is the reason health providers do not want to prescribe it?

Right. At least one early study was very promising. Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial (nih.gov)

Also right. That’s kind of the point. :slight_smile:

The irony is, vaccines are one of those medicines that really does bring only a very small profit to the drug companies. It’s much more profitable to keep administering many expensive doses to treat something, than it is to administer one cheap dose that prevents it entirely.

If the drug companies really were as cynically evil as the conspiracy theorists claim, they’d be secretly funding the anti-vax movement.

Now that I mention that… Hmm.

Fluvoxamine also has potentially serious side effects, which is why it’s pretty much never used as an antidepressant. Of course, we have lots of other safe and effective options for depression, the risk/benefit analysis could be completely different for COVID.

A common argument is that they use it because they don’t trust Big Pharma.

Ivermectin is made by Merck.

Follow-up question: why ivermectin? Why did that somehow become the “real” treatment for covid?

Possibly because somebody stumbled over one or more studies that actually do say it works – in populations likely to have significant worm infestations. Which there are few of in the USA.

See the post above by @Pardel-Lux, part of which I’ll quote as an easy way to link to it:

I don’t think that played much of a role. It’s my understanding that those studies didn’t come out until after ivermectin had already become established as a “real” treatment. Here’s my (layman’s) understanding:

Early in the pandemic, a lot of medical researchers were looking at a lot of different treatments for COVID-19. Previous laboratory work had indicated that ivermectin had some significant anti-viral activity in vitro. A number of researchers decided to take a look at it, and some of them published a number of quick, small, low-quality studies which seemed to indicate ivermectin might be useful as a treatment for COVID-19. Subsequent studies, which were larger and of higher quality, showed no significant anti-viral activity in vivo. (As @Pardel-Lux points out, some still later studies showed significant protective effects against COVID-19 when ivermectin is used to treat the kinds of parasitic infections it’s supposed to be used for, since those infections can weaken the immune system and make sufferers more vulnerable to other infections, like COVID-19.)

A lot of substances show some anti-viral activity in vitro but don’t pan out in vivo. And, like a lot of those substances, the concentrations of ivermectin used in the in vitro tests would be highly toxic if used in vivo.

But, by the time those disconfirming studies came out, it was too late. The meme of ivermectin as a wonder drug had already infected the trust networks of a lot of people. For a lot of people, the CDC, WHO, FDA, and similar organizations are outside of their trust networks. A lot of people are conditioned to believe the opposite of what organizations like that contend.

Ivermectin is fairly widely available as a prescription medication (for treating parasites), and quite widely available in veterinary formulations as an over-the-counter medication. For scared, desperate people, the lure of a relatively cheap and widely available treatment for a frightening disease, especially for people whose trust networks are already overwhelmed by opposition to effective infection control measures (anti-mask, anti-vax, anti-social distancing), is going to be very seductive.

Excellent explanation.

The part about in vitro (cell culture) studies often not translating to living systems also explains why many promising anti-cancer substances never make it past initial small-scale trials.

Just as an aside – and maybe this is better for Factual Questions: Are there are proven therapeutic substances that do nothing in vitro, but are highly effective in vivo?

On the subject of ivermectin, there are detainees in an Arkansas jail suing the prison doctor for secretly treating them with ivermectin. Probably paywalled:

@Qadgop_the_Mercotan, is that you being sued? (Just kidding, of course!!)

Nah. I’m sued for not giving them ivermectin, or hydroxychloroquine, or urine therapy. Not that they needed a prescription from me for them to drink their own urine. Go figure.

Ivermectin’s great for scabies that’s resistant to topical treatment, though. That’s the only reason I ever prescribed it.

Bleach, for example…

Obviously you are not a believer in the One True Church.

https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/press-releases/florida-family-indicted-selling-toxic-bleach-fake-miracle-cure-covid-19-and-other-serious-diseases

Aspirin? There are just no suitable in vitro assays for many treatments.

Fundamentally, they really believe that predatory profit-motivated corporations aren’t really all that predatory, or profit-motivated.

What’s better, a $10 billion market spread amongst 10 companies, vs. a $2 billion market where you’re the only company?

The first company to patent this “effective treatment for cancer” will dominate the industry, and make gobs of money, even if the overall amount of money decreases. And it’s not like people will stop getting cancer now, just because we’ve “found a cure”, so the market will exist in perpetuity.

So why wouldn’t they do that? Some principled stand in which they’re willing to sacrifice billions of their own profits in order to keep their competitors in the market? Yeah, right.

It also ignores the fact that in most countries, you can patent a “new use for an old substance”. So, sure, ivermectin might already be known as an anti-parasitic medication, but if you can show it’s also effective as an anti-COVID medication, you could patent that new use.

Getting a patent can take a long time, but these days, there are ways to speed that up, so someone would have done something by now. Here in Canada, we even have a special program to process COVID-related patents faster than normal.

I’m hoping this is tongue in cheek. No one is really threatening to sue you for not treating them with bad medicine, I hope.

Hey, I was once sued for depriving an inmate of companionship by removing a wart. That he asked me to remove. And gave full written informed consent for removing. That was just one item on the list of complaints (his finger was sore after, he was unhappy with the cosmetic result, he didn’t understand removal meant he wouldn’t have it anymore, and there’s more. . . ).

Haha! Do you see your shoes? The ones you’re wearing? I wouldn’t want to be in them.

I get sued over shoes, too. For not approving Air Jordans or other trendy sports shoes as ‘medically necessary’.