Ivermectin’s counterfactual appeal

Defying authoritative scientific voices attesting to its uselessness as a cure or prophylactic against COVID-19, a good number of Filipinos are turning to the antiparasitic drug ivermectin as an answer to the coronavirus. A cursory look at the profile of its advocates (e.g., in chat groups) would immediately tell us that these are not ignorant or irresponsible individuals. Most of them are well-meaning and well-informed professionals.

What could possibly be behind ivermectin’s counterfactual appeal?

To begin to answer this question, we must distinguish between the technical world of medical scientists and experts, and the real-world situations in which people make decisions for themselves and their loved ones. The former typically supplies the legitimation for official policy; the latter forms the complex setting in which individuals calculate the practical actions they must take in an emergency.

It won’t do to merely cite ivermectin’s unproven effects and ban its use, or worse, to threaten with arrest and imprisonment those who promote its use. This will only trigger a backlash and heighten people’s distrust of authority and of science itself. Italy’s Five Star Movement arose partly as a reaction to the country’s mandatory vaccination laws.

It’s important to understand where people are coming from. I can think of at least seven reasons why it won’t be so easy for the authorities to turn public opinion against ivermectin.

One, it is in the nature of science to question and qualify what previous studies have established as fact. The growth of science feeds on such skepticism. That is the reason for the use of caveats and reservations in scientific papers, something that most policymakers and implementers would rather omit in their own pronouncements. Self-correcting moves are part and parcel of the scientific activity. A year ago, the wearing of masks was prescribed only for those who were sick, so they don’t infect others. Today, everyone has to wear a mask.

Two, in the age of the internet, personal testimonial evidence has become a powerful element in shaping people’s beliefs about medicine and science. Between findings drawn from clinical trials, on one hand, and direct testimonials from real-life persons we know, on the other, people would usually assign greater weight to the latter. They are not necessarily anti-science. Obscure scientific journals, previously the domain of a small community, have become easily accessible to lay people. Today, often to their doctors’ annoyance, they may take up with them the latest findings on experimental treatments.

Three, when the findings of experts are translated into coercive policy as though to cut further discussion and debate, the ground is set for the growth of all kinds of conspiracy theories. The collusion between big pharma and scientists, or between corporate giants and regulatory bodies, is not entirely fictional. People will follow the money trail when they are not given convincing explanations for official decisions taken supposedly on the advice of scientists.

Four, it is not easy to explain why so-called “emergency use authorization” is granted to vaccines for use in mass vaccination programs on a global scale, based only on interim findings concerning their efficacy and safety. Yet not even a small measure of this guarded optimism is accorded to possible cures like ivermectin.

Five, when Filipinos talk of ivermectin, along with other herbal cures like Lianhua and immune boosters like ImmunPro, they do so in the context of a steep rise in new coronavirus infections. And with no guaranteed supply of vaccines in sight, they are fearful for their families. They want to be ready with every possible alternative protection they can get just in case they catch the virus and need to self-medicate.

Six, ivermectin is relatively inexpensive, compared to the drugs prescribed in most hospitals for the management of COVID-19 symptoms, and to the cost of hospitalization itself. People hear of COVID-19 patients hooked onto ventilator machines for weeks, only to die alone in the ICU. In the face of overcrowded ERs and COVID-19 makeshift tents, many are prompted to self-isolate at home and deal with their symptoms, using any drug preparation at hand that holds even the faintest promise of a cure.

Seven, ivermectin may not be as effective as it is touted to be, but most people are not aware either of adverse effects resulting from its use—outcomes as serious as those possibly linked to one popular COVID-19 vaccine—like blood clots in the brain. The experts will have to state emphatically that this antiparasitic drug is not only ineffective but also highly injurious to human health if taken without a responsible doctor’s advice and supervision. Reported cases of long-term brain damage supposedly associated with ivermectin have to be validated with the same judiciousness invested in the scrutiny of the serious side effects of vaccines.

I am sure there are more reasons for ivermectin’s continuing appeal than I have laid out here. To give voice to them is not to endorse or affirm their validity. It is only to elucidate the unspoken rationality that underpins them. It is also to underscore the importance of resisting the temptation to employ coercive means to stamp out dissident voices that run counter to the discourse of experts.

It is part of modernity to allow science to speak its truth autonomously, free from political, economic, or other forms of interference. We are not quite there yet, unfortunately—as the handling of the COVID-19 pandemic has abundantly shown.

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