Not all “game-changers” are treated equally.
Earlier this month Scott Gottlieb, the former chair of the U.S. Food and Drug Administration (currently a director of Pfizer Inc.), declared that molnupiravir, a new drug developed by pharmaceutical giant Merck & Co. claiming to offer early and effective treatment of Covid-19, was a “game changer.” Said Gottlieb on CNBC: “For an oral pill to have this kind of effect…is quite profound.” Wall Street joined in the celebration, with Merck’s stock soaring as Reuters reported that molnupiravir “could halve the chances of dying or being hospitalized for those most at risk.” With phase 3 trials near completion, Merck announced on October 11 that the company is seeking federal Emergency Use Authorization for the drug.
The U.S. government has already announced it will buy 1.7 million courses of molnupiravir for US$1.2 billion, or US$700 per course, making it one of a highly select lineup. Among the few other currently approved drugs for Covid-19 treatment are the antiviral remdesivir (costing US$3,100 per treatment) and the generic steroid dexamethasone, both of which are given to hospitalized patients, plus Regeneron’s monoclonal antibodies (US$2,100), which require an outpatient facility for intravenous infusion. Merck’s molnupiravir, however, can be taken in pill form at home. If it works, it should significantly reduce hospitalizations and fatalities, not only saving lives but reducing strains on hospitals and reducing overall health care costs.
Molnupiravir’s arrival seems a welcome and important development in the fight against Covid-19. But it wasn’t the first time the world had been promised a breakthrough treatment against the pandemic. Back in March 2020 U.S. President Donald Trump declared the inexpensive and promising anti-malaria drug hydroxychloroquine (HCQ) “a game-changer.” Yet HCQ is nowhere to be seen on treatment schedules today. Instead, the U.S. government has banned further study of the drug, a number of states have threatened to suspend the licences of doctors who prescribe it for “off-label” use, and in Canada the mainstream view is that HCQ is useless if not downright dangerous. Merely advocating the further study or trial use of HCQ is likely to trigger mockery if not threats of deplatforming.
So how come one alleged game-changer gets hero’s billing in the media and on Wall Street and the other becomes the stuff of conspiracy tales and lost opportunities? HCQ isn’t even the only existing drug or non-prescription health aid to suffer this kind of treatment. Instead, it has become something of a routine.
A Desperate Need for Treatments
As highly-credentialed physician Peter McCullough explained in a November 2020 presentation to the U.S. Senate Committee on Homeland Security and Government Affairs, there are four pillars to any proper pandemic response. They are: contagion control, early ambulatory (or “outpatient”) treatment, later-stage hospital treatment and vaccination. As we have seen since March 2020, three of these pillars have been widely and vigorously deployed with varying degrees of success. Lockdowns, mask mandates, hygiene requirements and social distancing are all attempts at contagion control. Hospitalization was, obviously, initiated as soon as the first sick patients began showing up. Last fall, vaccination went from distant dream to imminent promise and, since then, Canadians have been obsessed for months on end with vaccination rates.
Especially in Canada, however, conspicuously absent almost throughout this period has been an official commitment to the second pillar – early treatment. And this second pillar is arguably the crucial one. Yet more than 20 months into the pandemic, the main outpatient “treatment” approach for Covid-19-positive Canadians is to tell them to stay home, self-isolate, drink plenty of fluids and ride it out. There appears to be almost no medical middle ground between getting a positive test result and calling 911 for an ambulance ride to the emergency room. In fact, patients are routinely warned not to attempt any sort of self-medication.
But not only is early treatment an accepted part of any pandemic response, it seems particularly urgent for Covid-19. The virus has repeatedly threatened to overwhelm hospital systems in a number of countries, U.S. states and Canadian provinces. Recovered patients often report that hospitalization for the disease is an excruciating experience. Variants are now threatening to overtake vaccines either because of waning efficacy or because, having been encoded for the original strain, vaccines are ineffective against new strains.
This appears to be the lesson emerging from Israel where, as one of the world’s most vaccinated countries and with the best data to match, a rampaging delta-induced wave was underway this August. Alarmingly, 87 percent of new infections in Israel were appearing in vaccinated over-50-year-olds. Of the gravely ill, 59 percent were “fully jabbed.” A grim headline from Israel warned that, “The vaccine blunts but does not defeat delta.”
The need to improve outpatient treatments for Covid-19 and the broad benefits of doing so both seem self-evident. And therapies have been available from the earliest days of the pandemic. Individual physicians in many countries have used a cascade of prophylactics and treatments, including everything from vitamins and inhalants, virucidal mouth and nasal rinses, to sophisticated cocktails of widely available, time-tested and repurposed drugs to treat untold numbers of patients across the disease’s three stages.
The key to early treatment at the ‘ambulatory’ or pre-hospitalization stage, Bernstein said in an interview, is the right drug or combination of drugs ‘customized to the patient’s needs’ based on their age and co-morbidities. Timely delivery is crucial to addressing the different stages of the disease.
According to Ira Bernstein, a Toronto-based physician and member of the Canadian Covid Care Alliance, the first stage is during the initial five to seven days after a person is infected, when the virus replicates in the nose and throat and the person often has few or no symptoms. The second stage consists of an inflammatory auto-immune response before settling in, finally, as the third stage, a blood-clotting thrombosis in which the cardiovascular and pulmonary systems are affected and the patient’s life is at risk.
The key to early treatment at the “ambulatory” or pre-hospitalization stage, Bernstein said in an interview, is the right drug or combination of drugs “customized to the patient’s needs” based on their age and co-morbidities. Timely delivery is crucial to addressing the different stages of the disease – the goal being to nip it in the bud and avoid having the patient hospitalized at all, let alone enduring days or weeks in ICU on a ventilator.
Bernstein’s approach to Covid-19 treatment has a solid basis, being influenced by the thinking of Peter McCullough, a world-class expert on the virus and editor of two medical journals. In his statement to the U.S. Senate last year, McCullough noted that his work on early treatment, published in the American Journal of Medicine, is based on observations from numerous “doctors [who]…have innovated and identified both inside and outside of the hospital, aided by clinical trials and observational studies, an approach that involved combination antivirals, followed by corticosteroids and antithrombotic agents. Doctors in the outpatient community, faced with thousands of patients calling and begging for help, have innovated.”
According to McCullough, some doctors using their own mix of treatments were “achieving rates of hospitalization and death of less than 3 percent for high-risk Americans over fifty with multiple conditions. Most doctors can achieve less than 1 percent. With no treatment in the United States right now, an individual over fifty with medical problems faces a 7 percent rate of hospitalization and death. In their eighties that skyrockets to 40 percent.”
Had these customized treatments been applied early in the pandemic, McCullough estimates that American Covid-19 fatalities, standing at a total of about 681,000 at the time of his testimony (about 715,000 by mid-October), might have been reduced by 85 percent. Extrapolating from his data to Canada, nearly 24,000 Canadian lives might have been saved by applying a similar approach in our country. Worldwide, 85 percent of the 4.6 million total fatalities means that 3.9 million victims might still be alive.
So why are Covid-19 patients not routinely receiving these treatments? Why is it only recently that any treatments have been approved at all, and that these routinely cost over US$1,000 per course? (With Merck’s molnuprivar looking like a bargain at US$700.) The intrusion of politics and profits into science and medicine is very likely part of the answer. Another part is a methodological fundamentalism in the scientific and medical establishments that nearly always prioritizes randomized controlled trials (RCTs), which come the closest to providing proof that a new drug or therapy provides the intended benefits without harming or killing the patient. RCTs are indeed the “gold standard” of science – and C2C Journal has defended them vigorously (for example here and here).
In a genuine emergency, however, when thousands of people are dying daily, there is also a case for setting aside the gold standard and accepting a good-enough “silver standard.” This is one that allows trying out drugs and treatments originally aimed at other problems and, thanks to their years or decades of use, already proven safe. Being familiar with these drugs, physicians can easily manage their risks. Observational studies and clinical trials that add valuable information can also be part of the process – with RCTs undertaken when money and time become available. HCQ was one such drug. Yet much of the world soon rounded upon it as if it was a deadly toxin.
Methodological fundamentalism has coincided with and perhaps accentuated the massive power concentrated in the hands of centralized regulatory bodies which, along with billions in funds flowing to academic and industry research facilities, control a process that is vulnerable to losing sight of the most important objective: the best interests and lives of patients. Sadly, jurisdictions small and large around the world acquiesce to this modus operandi, despite widespread evidence that ignoring the innovations happening at the grassroots level – among individual physicians – shuts the system’s ears to promising new approaches, ultimately leaving the world less healthy.
The Crushing of Hydroxychloroquine
The story of how a potentially “game-changing” treatment for Covid-19 became hopelessly politicized and derailed is told by Canadian psychiatrist Norman Doidge in Hydroxychloroquine: A Morality Tale in the August 2020 issue of Tablet. It is a tale, Doidge writes, that exposes the perilous “vulnerability of our scientific discourse, models and institutions” and thus became an example of how “extra-scientific factors overrode clear-cut medical evidence.”
As Doidge explains, quinine had been used to treat malaria for 400 years before it became known as hydroxychloroquine in 1955. It was HCQ’s more recent use for the treatment of the blood disease lupus that suggested to Chinese scientists its potential as a Covid-19 treatment. Lupus patients were not contracting the new virus and so, the scientists surmised, HCQ might be playing a role in its prevention.
In New York, where 80 percent of hospitalized patients at the time were dying, a doctor named Vladimir Zelenko was determined to avoid the same fate for his patients. Zelenko combined Raoult’s work with studies from South Korea that added zinc, which has anti-viral properties and whose absorption hydroxychloroquine would facilitate.
In March 2020, their studies published in Nature reported how, in a test tube, HCQ blocked not only malaria but Covid-19, “making it a potent antiviral [which also] decreased inflammation…and…blocked cytokines [without damaging] cells in the process.” The uncontrolled autoimmune response in Covid-19 patients known as the “cytokine storm” is often their ultimate cause of death. If administered early, HCQ also appeared to prevent thrombosis or blood clots, which can lead to strokes.
Following these positive lab results, Doidge continues, studies in humans were necessary. This task was undertaken by one of Europe’s most highly cited microbiologists, an eccentric professor of infectious disease and virology at a medical faculty in Marseille, France. A specialist in repurposing generic drugs, Didier Raoult targeted the growth of viral load during the infection’s earliest stage by combining HCQ with azithromycin, an antibiotic that a large body of research suggests could be effective against the Zika virus (meaning it could also be an anti-viral).
Aside from the immense cost and precious time involved in randomized trials, conducting an RCT was out of the question for Raoult on moral grounds. An RCT requires a “control group” of patients who receive only a placebo, and Raoult believed no patient with a potentially lethal illness should be denied treatment. So he instead focused his efforts on small study groups, treating 20 patients during the first two weeks of March 2020. The resulting paper reported that, “Despite its small sample size, our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in Covid-19 patients and its effect is reinforced by azithromycin.”
Others began noticing Raoult’s work. Physicians at the Henry Ford Health System, a collection of six hospitals in Detroit, were already experimenting and requesting supplies. In New York, where 80 percent of hospitalized patients at the time were dying, a doctor named Vladimir Zelenko was determined to avoid the same fate for his patients. Doing his own research, Zelenko combined Raoult’s work with studies from South Korea that added zinc, which has anti-viral properties and whose absorption HCQ would facilitate. What he dubbed his “Zelenko Protocol” – primarily HCQ, zinc and azithromycin, plus vitamins, all administered early in the infection – produced a reported 84 percent success rate in preventing hospitalization among the patients he and others eventually treated. And HCQ was eminently affordable; according to the Good Rx website, 180 tablets can be purchased at Safeway for under US$60.
By late March of last year, Trump’s enthusiasm for HCQ became public knowledge. While this triggered some hopes his support would unleash the widespread application of inexpensive HCQ-based protocols, instead it became a turning point in how the media and authorities viewed the drug. In a world already polarized about his presidency, Trump’s opponents extended their hostilities all the way to demonizing a potentially life-saving treatment for Covid-19, emphasizing HCQ’s minor safety issues and mocking Raoult as an off-the-rails non-entity. In an odd coincidence, a study using HCQ as a late-stage therapy – as opposed to the early treatment where it held the most promise – produced disappointing results, which were widely reported.
The final nail in HCQ’s coffin was hammered that May when the Lancet and the New England Journal of Medicine each published studies purporting to show that HCQ and the related drug chloroquine “increased the death rate of COVID patients by thirty percent.” Largely in response, the World Health Organization, the United Kingdom’s regulators and French authorities suspended their studies. On June 15, HCQ’s special emergency use status was revoked by the FDA. In Canada, trials being planned for HCQ in Alberta were abruptly cancelled and the drug was essentially never heard from again.
By July 1, however, both prestigious journals had retracted (and removed) these studies which, by the Lancet authors’ own admission, were based on flawed data that were subsequently described by the Lancet editor as a “monumental fraud.” Then a large, peer-reviewed observational study by the Henry Ford Health System in Detroit concluded there was a 50 percent lower mortality rate for hospitalized patients treated with HCQ. Meanwhile, Raoult’s recently completed study, declined by the Lancet, concluded that the “HCQ-AZ combination, when started immediately after diagnosis, is a safe and efficient treatment for COVID-19, with a mortality rate of 0.5%, in elderly patients.” There has been more recent evidence as well, such as this meta-analysis of existing studies archived on reputable databases, and published in April of this year in the Journal of Family Medicine and Primary Care, suggesting that HCQ has remarkable efficacy in helping patients (particularly those with comorbidities) rid themselves of the Covid-19 virus.
One might think that such results – a widely available, inexpensive, safe and easy-to-administer drug combination demonstrating strong and recurring evidence that it might save millions of lives – would have been enough to rehabilitate the HCQ protocols. Unfortunately, one would be wrong. Instead, the New York Times reported on the state of medical journals while obliquely referencing Trump’s “antimalaria drug.” As for the Henry Ford study, selected experts eviscerated it. Addressing a U.S. House of Representatives subcommittee, the ubiquitous Anthony Fauci deemed it “flawed…I think anyone who examines it carefully [will see] that it is not a randomized placebo-controlled trial.” When the Henry Ford Health System asked to continue studying HCQ for patient care, the FDA denied it permission.
It was apparently more important to oppose Trump than to save lives.
The Alberta Angle
To be sure, Trump became a lightning rod in an HCQ story that went global with little before- or aftereffect in Canada. But when HCQ along with another promising drug, the anti-parasitic ivermectin, was prescribed within a protocol of vitamins, antibiotics and inhalants for a handful of patients in a small-town Alberta hospital last month, the whole country took note.
With 2.8 billion courses administered to humans between 1987 and 2017 alone – reaching a quarter of a billion people every year – ivermectin is available over-the-counter in many countries. And yet, as with HCQ, the medical and regulatory establishments have rejected ivermectin and sought to discredit its proponents.
Canada’s news media recently have done their best to discredit ivermectin as suitable purely for animals and useless or dangerous for humans. But it is anything but. It was discovered by Japanese microbiologist Satoshi Omura and Irish biologist William C. Campbell in 1975 and it proved so remarkably beneficial that it eventually won the duo the Nobel Prize for medicine in 2015 (shared with a third scientist working on malaria). According to a press release from the Nobel Assembly at the Karolinska Institute, ivermectin’s use has had “immeasurable” consequences for “improved human health and reduced suffering.”
In particular, ivermectin has “radically lowered the incidence of River Blindness and Lymphatic Filariasis, as well as showing efficacy against an expanding number of other parasitic diseases” affecting hundreds of millions of people, particularly in sub-Saharan Africa. Ivermectin also treats scabies and lice, as well as parasites in pets and farm animals (which the Canadian news media have now been suggesting are its sole uses).
With 2.8 billion courses administered to humans between 1987 and 2017 alone – reaching a quarter of a billion people every year – ivermectin is sold over-the-counter in many countries and was available as an off-label drug in Canada for humans and through animal feed stores for animals. Like HCQ, ivermectin is highly affordable, with 40 tablets currently quoted at Good Rx for about US$60 at Walgreens. And yet, as with HCQ, the medical and regulatory establishments have largely rejected ivermectin and sought to discredit its proponents.
Studies into ivermectin as well as on-the-ground use as a possible Covid-19 treatment had been underway in various parts of the world since early in the pandemic. In due course it became well-known on social media and websites used by medical practitioners. Ivermectin therefore seemed predestined to attract attention in late-summer-2021 Alberta, where the delta variant was wreaking its worst. For, despite rising caseloads, ICUs packed to double their normal capacity, over 1,000 hospitalized for Covid-19 at any given time and (as of mid-October) 30 dying from the virus on an average day, ambulatory patients were still being offered little in the way of treatment except isolation.
Instead, after word spread that a lone visiting physician had treated a few rural patients with an ivermectin-based protocol, Alberta Health Services issued the stark warning that, “[N]either the veterinary nor human drug versions of ivermectin has been deemed safe or effective for use in treating or preventing Covid-19.” Once again, extreme risk-aversion and a seeming need to maintain centralized control prevailed over scientific curiosity, concern for individual patients and willingness to experiment in an emergency situation.
Alberta isn’t the only place where such conflicts have played out. Ivermectin is also well-known among millions of concerned Americans, and some are using every means at their disposal to see that it is applied. In late August, a U.S. judge ordered that ivermectin be used to treat a hospitalized patient for Covid-19. Following similar cases earlier in the year, Butler County, Ohio Judge Gregory Howard ruled in favour of a woman whose ventilated husband faced diminishing chances of survival in a Cincinnati hospital.
It is yet another troubling sign of our times when, in the absence of affordable, approved early treatments, Covid-19 patients are still told to self-isolate as their main defence against the disease and to show up at the hospital only when, in effect, their lips turn blue. In such circumstances, should it really be surprising that families might choose to resort to other measures to obtain promising treatments not sanctioned by public health authorities?
Fighting Therapeutic Nihilism
The widely read article The Drug that Cracked Covid, by best selling non-fiction author and four-time Pulitzer Prize nominee Michael Capuzzo, published in May in the heretofore little-known magazine Mountain Home, explains how five of the world’s top critical care doctors “set out to save the world, with a better chance at it than most.” The ad hoc team of medical experts was led by Paul Marik, Professor of Medicine and Chief of Pulmonary and Critical Care Medicine at Eastern Virginia Medical School in Norfolk, Virginia, with more than 500 peer-reviewed papers and books to his credit.
‘We have 100,000 patients in the hospital right now dying. I’m a lung specialist, I’m an ICU specialist…They’re dying because they can’t breathe…I cannot keep caring for patients when I know they could have been saved by earlier treatment with a drug…that will prevent hospitalization, and that is ivermectin.’
Marik’s “HAT Therapy” of hydrocortisone, intravenous Vitamin C and thiamine for sepsis, a condition found in one-third of hospital deaths, had already saved countless lives. Astonished that public health agencies were instructing physicians to stand down and wait for a vaccine, Marik rejected what he termed “therapeutic nihilism” in favour of treating the inflammation and clotting that often accompany Covid-19 with corticosteroids and anticoagulants. This, explained Marik, should be regarded as “first-grade science.”
In spring of last year, Marik and colleagues founded the Front Line COVID-19 Critical Care Alliance (FLCCC) and soon reported high survival rates with their anti-inflammation and clotting protocols at a time when, horrifically, 40-80 percent of hospitalized patients were dying in New York. The FLCCC would join a growing number of organizations including America’s Frontline Doctors, the Association of American Physicians and Surgeons, Early Covid Care Experts, and the Canadian Covid Care Alliance in offering innovative outpatient help to patients.
By the end of April, the team unveiled its MATH+ regimen for in-hospital care – consisting of methylprednisolone, ascorbic acid, thiamine and heparin, plus other medicines such as melatonin, zinc and vitamin D3, “based on high safety, low cost, and emerging scientific data suggesting efficacy.” Although MATH+ was published in The Journal of Intensive Care Medicine last December, it gained relatively little official traction.
At the same time, Marik was also noting studies emerging from Latin America in which ivermectin was demonstrating anti-viral and anti-inflammatory properties. This would lead to the publication of the I-MASK, the world’s first comprehensive Covid-19 prevention and treatment protocol. In December Marik’s protégé, Pierre Kory, former Chief of the Critical Care Service and Medical Director of the Trauma and Life Support Center at the University of Wisconsin, addressed a Senate committee with news of dozens of trials covering outpatient, prophylaxis and hospital treatment with ivermectin. His charts showed positive results in Central and South America. In the Indian state of Uttar Pradesh, mass distribution of ivermectin to 200 million of the state’s 232 million people was reported to dramatically reduce fatalities. (And yet, true to form, in recent months other Indian states cancelled plans to mass-administer ivermectin.)
“We have a solution to this crisis,” Kory told the Senators. “There is a drug that is proving to be of miraculous impact…It basically obliterates transmission of this virus.” In a pleading tone he added, “We have 100,000 patients in the hospital right now dying. I’m a lung specialist, I’m an ICU specialist…They’re dying because they can’t breathe…I cannot keep caring for patients when I know they could have been saved by earlier treatment with a drug…that will prevent hospitalization, and that is ivermectin.”
Within 10 days of posting, the video of Kory’s Senate testimony reached 5 million viewers. After six weeks and 8 million views, it was deleted by YouTube as contributing to “misinformation.” This was done even though Kory’s data was corroborated by a meta analysis by Tess Lawrie, an independent medical researcher and adviser to the World Health Organization.
For hundreds of years, Western medicine has regarded the individual doctor’s personal judgment to be central in the practice of medicine. Innumerable innovations and improvements have been achieved by individual physicians and, until recently, these were usually lauded. The world’s first effective vaccine, for smallpox, was developed by an English country doctor working alone – and hundreds of millions of lives were saved as a result. Yet despite the growing evidence accumulated by doctors about ivermectin’s efficacy, regulatory authorities seemed to have already decided this drug was a non-starter. Clinical trials, study groups and the professional word of practitioners – even when delivered under oath – weren’t good enough.
In this vein, the New York Times did its part in dismissing the recent Senate hearings as a group of “anti-science kooks” who, much like Trump promoting HCQ, were now pushing “fringe theories.” The hearing had been boycotted by all seven Democrat and four of its seven Republican committee members who, according to Capuzzo, had collectively received millions in campaign donations from large pharmaceutical firms. In an irony that seemed as bizarre as it was sinister, even Merck, which had originally developed ivermectin under the generic name Stromectol, actually issued a release warning against its use for Covid-19. Like HCQ, ivermectin was seemingly done.
In Case of Emergency, Smash Your Competitor
U.S. federal regulations provide ample scope for Emergency Use Authorization (EUA) for any promising pharmaceutical product if “there are no adequate, approved, and available alternatives.” EUA offers indemnification against liability for death or injury by the product being authorized; it also allows drugs still in an experimental stage to be released to public use.
This legal release underpinned the rapid rollout of the Covid-19 vaccines developed under the Trump-ordered Operation Warp Speed – the very vaccines that billions of people around the world have taken. If alternatives were to hand, however, such vaccines could only be released after going through the standard process of full approval – which would only take much more time but also leave their manufacturers exposed to full liability, such as for adverse reactions.
In his telling of the HCQ morality tale, psychiatrist Doidge marvelled at the double standards of the public health establishment. On the one hand it has no qualms about endorsing novel vaccines (to which we might now add novel treatments such as molnupiravir) whose long-term effects can’t possibly be known. On the other it displays redoubtable caution, risk aversion, heightened criticism and even prejudice in preventing safe and well-known medications currently used by billions from being applied in the fight against Covid-19.
“It is happening because there is, right now, a much bigger problem: with our experts, and with the institutions that we had trusted to help solve our most pressing scientific and medical problems,” Doidge writes. “Unless these are attended to, HCQ won’t be remembered simply as that major medical issue…[that left] overwhelming controversy, confusion and possibly unnecessary deaths of tens of thousands in its wake; it will be one of many in a chain of such disasters.” We may soon be able to add one new link to this chain: ivermectin.
For some reason, however, ivermectin has proved much harder to kill off than HCQ. On August 10, the Duke Clinical Research Institute announced its launch of a nationwide, double-blind “Randomized Trial to Evaluate Efficacy of Repurposed Medications.” Part of a $155 million exercise funded by the U.S. National Institutes of Health, the Duke study is testing ivermectin, fluticasone and fluvoxamine as one of “four fast-track focus areas.” In early September, hugely-popular podcaster Joe Rogan, with over 13 million followers, declared that he was “throwing the kitchen sink” at his own diagnosis of Covid-19 – including ivermectin.
On full alert, Fauci, the American Medical Association and Health Canada all mobilized to denounce ivermectin. Professional associations threatened physicians with the loss of their licences if they spread “misinformation” regarding Covid-19 vaccines or alternative treatment.
Australia’s federal medical regulator blurted out what cynics would regard as the truth, namely that the promise of ivermectin was interfering with the country’s vaccine rollout. And the physician who prescribed ivermectin to patients in the Rimbey, Alberta hospital? Speaking at a rally to mark the 75th Anniversary of the Nuremberg Code, Daniel Nagase told the audience that Alberta Health Services officials had forbidden him from “administering medication and from practising soon after.”
Still, with or without ivermectin, proponents of physician-initiated treatment refuse to give up. In September, doctors and scientists from around the world gathered in Rome for what was called the Global Covid Summit. There they issued the “Physicians Declaration,” which they said is aimed at helping individual physicians stand their ground to uphold and restore the “dignity, integrity, art and science of medicine.” Renewing their commitment to the Hippocratic Oath, the declaration also aims to reclaim the primacy of the physician-patient relationship and calls for an end to political intrusion into the practice of medicine.
Among the declaration’s 12,000 signatories (as of October 14) were doctors Bernstein, Kory, Marik, McCullough and Lawrie. At the summit, physician Robert W. Malone, the inventor of the mRNA technology that led to most of today’s Covid-19 vaccines, read aloud from the Declaration:
“Physicians, and all health care providers, must be free to practice the art and science of medicine without fear of retribution, censorship, slander, or disciplinary action, including possible loss of licensure and interference from government entities and organizations – which further prevent us from caring for patients in need…More than ever, the right and ability to exchange objective scientific findings, which further our understanding of disease, must be protected.”
As if on cue, a little-known paper published in April began circulating in the blogosphere. It is both a testament to the ingenuity of physicians and a heartbreaking reminder of society’s massive failure in caring for elderly Covid-19 patients in long-term care facilities. It tells the tale of how, at the height of the pandemic’s first wave in March and April 2020, Spanish doctors were left on their own to develop clinical guidelines to combat the fearsome new virus.
When infection spread throughout two nursing homes in a rural area around Toledo, 84 patients with a mean age of 85 and serious co-morbidities were treated with antihistamines, antibiotics and acetaminophen plus nasal washing and gargling with a warm solution of sodium bicarbonate. Bronchodilators and prednisone were used as necessary. Remarkably, according to the paper, not one patient died or required hospitalization.
Perhaps many of the answers really could have been found right at the front lines.
By the time Big Pharma’s new therapies are rolled out for general use – if they are – two years will have gone by since the pandemic’s onset. This is time that will have been wasted, as promising innovations developed mainly at the grassroots level by daring and driven physicians were ignored, dismissed or, when they wouldn’t quietly disappear, remorselessly crushed.
Better Late than Never
At last, therapies for Covid-19 are being intensively developed with the full buy-in of the scientific-medical establishment. In addition to Merck’s molnupiravir, Pfizer in early September announced it was initiating Phase 2/3 trials of ritonavir, an ambulatory therapy which could become a two-pill-daily medication that would be taken in conjunction with periodic Pfizer booster shots. Two weeks before Pfizer’s news, AstraZeneca announced what it called highly promising results of a randomized controlled trial of PROVENT, a therapy using long-acting antibodies intended to prevent the onset of Covid-19 symptoms and keep people out of hospital. If any or all of these therapies work, their widespread use could provide relief for millions of people exposed to Covid-19 and save innumerable lives.
In and of themselves, then, these developments can only be celebrated. But noteworthy is that all of this is being done on the pharmaceutical industry’s and medical establishment’s own terms, with the backing of regulators and governments. As we saw with Merck, these new drugs are likely to be very expensive. And by the time Big Pharma’s new therapies are rolled out for general use – if they are – two years will have gone by since the pandemic’s onset. This is time that will have been wasted, as promising innovations developed mainly at the grassroots level by daring and driven physicians were ignored, dismissed or, when they wouldn’t quietly disappear, remorselessly crushed.
The refusal to open-mindedly and in good faith consider and test all possible therapies for Covid-19 represents one of the most perverse dimensions of a global crisis that has seen more than its share of incompetent, bizarre, sinister or plain damaging decision-making. Even as what happened and how it happened are increasingly illuminated in books, articles and public testimony, why this occurred in the way it did – when apparently viable therapies were staring public health officials, medical leaders and pharmaceutical executives in the face, and continue to do so, and when millions of lives were at stake – remains one of the pandemic’s great mysteries. Many thousands, perhaps millions, of innocent Covid-19 patients have probably died needlessly along the way.
Margret Kopala is author of The Dog Bone Portfolio: A Personal Odyssey Into the First Kondratieff Winter of the Twenty First Century and a former columnist who has written on public health issues, notably the mental health effects of cannabis and the UK’s BSE or “mad cow disease” crisis of the early 1990s.
