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A patient with Type 1 diabetes called to tell me the pharmacist at our local Walgreens refused to fill the prescription I had written for ivermectin, so I called to ask why.

The young pharmacist, a few years out of pharmacy school, informed me he did not understand why I was using ivermectin for early treatment of COVID because “SARS-CoV-2 does not have an exoskeleton.”

I explained I was not using ivermectin as an anti-parasitic medication, but that it had impressive data as an anti-inflammatory and anti-viral.

Furthermore, as a pediatrician, I have more than 40 years of experience managing multiple viral illnesses. There is value in treating viruses early, often with inexpensive natural remedies, rather than “staying at home until you have problems breathing then go to the hospital” as U.S. public officials have

advised for COVID.

The pharmacist was not buying my initial explanation. “I am not going to fill prescriptions for ivermectin that are used in pseudo vaccine doses,” he told me.

I was surprised a young pharmacist was able to override an experienced physician’s prescription, effectively removing an inexpensive prevention and treatment option for selected patients in the middle of a pandemic.

The medical educator in me kicked in. “I would be happy to send you some references about the use of ivermectin for treatment and prevention. There are impressive studies from Argentina, Peru, Africa and India that suggest much better outcomes than we are achieving here in the U.S. with our single-minded focus on vaccines.”

He told me the U.S. Food and Drug Administration (FDA) did not recommend ivermectin for COVID. I asked to see the documentation and he agreed to fax it to me.

I hand-delivered 93 references and a great review article to the Walgreens.

The pharmacist faxed back a post from March 5, on the FDA website entitled “Why You Should Not Use Ivermectin to Treat or Prevent COVID-19.”

The next day, I received notice that a pharmacy in Northern Virginia would not fill any prescriptions for ivermectin if the diagnosis code mentioned COVID.

I had written an ivermectin prescription for a patient who has a history of bad reactions to vaccines and significant autoimmune illness. His adolescent age means that he is at very low risk of death from COVID itself.

Based on my experience as his doctor for over a decade, I was worried about potential adverse events if he got the COVID vaccine. I dug into the data about ivermectin, and it seemed like a great option for him to have on hand for early treatment of COVID if he got sick.

A pharmacist in a drug store, who never examined my patient or learned his extensive medical history, got to trump my best medical judgment by refusing to fill the prescription.

The same day, in a conversation with a compounding pharmacy, we learned of a case in which a patient’s family had to take a hospital to court to obtain treatment with ivermectin.

Bear in mind that the safety profile for ivermectin is excellent and the drug is spectacularly less expensive than the vast majority of hospital interventions.

Three days later, on a zoom call with a colleague whose parents live in Colorado, I learned that a pharmacist at a major drugstore was not only refusing to fill ivermectin for 86- and 87-year-old patients who held valid prescriptions, but the pharmacist was taking the initiative to remind the other King Soopers pharmacies in the state not to fill those prescriptions either.

My analysis of the medical literature is that ivermectin has an impressive safety record and there are multiple studies from around the globe suggesting it can decrease morbidity and mortality from COVID 19.

Two doctors who were actually in the ICU treating real patients, Dr. Paul Marik and Dr. Pierre Kory, looked at their prior experience with similarly sick patients and reviewed treatment strategies to determine what could be helpful.

As Dr. Anthony Fauci advised us to “stay home and wait for the vaccine,” frontline doctors took care of the patients before them, learning valuable lessons about what worked and what did not.

Let’s hit the highlights, quoting directly from the review paper by Kory et al, Jan 2021:

Kory and Marik compiled eight studies (three randomized controlled studies and five observational controlled studies) demonstrating efficacy in prevention of COVID-19 with significant decreased transmission.

They found 19 controlled studies that showed significant impacts on time to recovery, hospital stay, decrease in viral loads, reductions in duration of cough and decreased mortality.

In medical history pre-COVID, this body of research about ivermectin would be applauded for bringing value in the midst of a pandemic. In the medical era pre-COVID, the judgment and experience of clinicians at the patient’s bedside counted for something.

Pre-COVID, we taught medical students to use keen observational skills and keep accurate records of whether the patient improved or deteriorated after the treatment strategies used.

In the Age of COVID, pharmacists who chide doctors that “COVID does not have an exoskeleton” deny patients ivermectin — a safe, cheap, effective and potentially life-saving early treatment.

Ivermectin

If you or your patients are having trouble getting ivermectin prescriptions filled for COVID 19 prevention or treatment, see this excellent resource from the Front Line COVID 19 Critical Care Alliance.