"Ivermectin, For and Against" is a Rebel Wisdom broadcast that aired before World Ivermectin Day last July 24. Although certainly additional data have emerged since, this is still one of the most complete and balanced conversations regarding the controversy over use of this drug since the pandemic began.
Journalist David Fuller interviews three authorities who review both scientific evidence clarifying and technological censorship obscuring our knowledge and understanding about ivermectin in ongoing COVID crisis conversations. An extensive briefing document by Ed Prideaux accompanies the video, for us visual learners.
A prior Rebel Wisdom newsletter, "The Uncanny Valley," elaborates. The valley (more like a canyon) "exists because the mainstream refuses to platform 'heterodox' opinions for fear of giving 'fringe' perspectives too much prominence [or] a false equivalence with medical consensus." The result is that "conspiracy theories tend to grow in the gaps…filling the void of unanswered questions."
The practice of "nonplatforming" from social media "pushes people with 'fringe perspectives' to appear only on alternative channels [where their views will be aired, but] where their claims are rarely challenged," according to the newsletter.
But, scientifically speaking, such apartheid isn't how you find truth — or trust.
"Nonplatforming" is when tech outlets, fearing public health–based government pressure or censorship, appoint themselves as guardians of scientific accuracy and summarily remove from social media any comment (or commentator) who goes against an officially sanctioned message. Vaguely reminiscent of Kapo or even Zersetzung tactics, all commenters are encouraged to report, sometimes without explanation, any posts that might violate community "standards" or "guidelines."
I have held my breath after posting things to medical social media that, if not read carefully or not fully understood by whoever is doing such gatekeeping, might be considered subversively heterodox. I've also wondered whether those performing this function for these outlets actually have any medical or scientific expertise, or whether they are lay "screeners" of what might go against (their interpretation of) a prevailing public health message.
Recently, on a physician-only platform, a brief educational piece by the AMA about ivermectin (containing the sanctioned public health message) spurred a conversation in the comments about possible benefits of the drug in COVID. I posted that I had just noticed for the first time a more recent AMA story that did not reference ivermectin pejoratively, and that even provided a link to the recently initiated HHS-publicized ACTIV-6 study comparing fluvoxamine, fluticasone, and ivermectin in symptomatic early mild COVID.
A young physician reader asked for references to support that there could be some usefulness to ivermectin in combating COVID. Several respondents provided examples (such as this one). A polite back-and-forth ensued with no discernible violations of published "community guidelines," which even state "[this platform] acknowledges and respects the value of different opinions, and our policies reflect our impartiality." Really?
Someone mentioned me by name in a comment. Investigating, I found that the entire discussion had been removed, and it was no longer possible to even comment on the article. The guidelines advise that "if you can no longer see [it] on the network, your comment has been removed for violating one or more of our community standards." Since no prior comment had violated them, I can only assume that some subsequent comment did (maybe even the one about me? Yipes!), and that this eventuated removal of the entire thread. Or, alternatively, the original poster decided that the conversation was just too dangerous to allow its continuation. There's no way to know, as the platform reserves complete discretion.
This rankles me. There is plenty of evidence that ivermectin, like many other already approved drugs, has numerous actions that could be of benefit in combating specific aspects of COVID infection. The chief arguments made against its use are:
There has as yet been no large, randomized, double-blind clinical trial of its use in COVID (because no organization is willing to undertake such a study, given that ivermectin is long off patent);
Some findings of the small clinically driven studies seem "too good to be true"(this being asserted without any evidence or supportive study finding);
It is not pharmacologically possible, without adjuvants like ritonavir, to safely achieve plasma levels in humans necessary to prevent infection by the mechanism suggested in the first in vitro study, or to function as a 3CL protease inhibitor;
If people are free to take ivermectin, they might use this as an excuse to avoid vaccination (as has happened in some countries); and
Since ivermectin is principally used in the US as a veterinary medicine, it could be (and indeed has been) misused by the public (which explains the remarkably sophomoric FDA tweet, especially insulting to Southerners).
If there is any audience able to examine this evidence and come to a reasonable consensus, it is (in my opinion) the physician community. Why shouldn't we be allowed to attempt to bridge the "uncanny valley"? Is it just too unsafe for physicians to collaboratively discuss any topic that might eventually undermine a current public health message?
Of course there is always a hazard, if such discussions are taken out of context or shared with less discerning audiences, as explored in my last post.
But dissemination is an unavoidable hazard of free speech.
Something attributed to Voltaire (but penned by Beatrice Hall) and paraphrased by many a judge, including former Harvard Medical Dean Dr Chief Justice Oliver Wendell Holmes, embodies the spirit of the US Constitution's First Amendment and resonates with me: "I disapprove of what you say, but I will defend to the death your right to say it."
Mentioning that ivermectin is not just a horse-deworming medicine is hardly tantamount to yelling "Fire!" in a crowded theater. What do you think? Please comment, or correspond on this or other topics at Medscape-Blogs@webmd.net.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Louise B. Andrew. Should We Be Gatekeeping Repurposed Drug Discussions? - Medscape - Jan 19, 2022.