Today, Explained - Horse paste?

Episode Date: September 8, 2021

Neigh! Today’s show was produced by Will Reid with help from Amina Al-Sadi, edited by Matt Collette, engineered by Efim Shapiro, fact-checked by Laura Bullard, and hosted by Sean Rameswaram. Transcript at vox.com/todayexplained. Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts. Learn more about your ad choices. Visit podcastchoices.com/adchoices

The all-new FanDuel Sportsbook and Casino is bringing you more action than ever. Want more ways to follow your faves? Check out our new player prop tracking with real-time notifications. Or how about more ways to customize your casino page with our new favorite and recently played games tabs. And to top it all off, quick and secure withdrawals. Get more everything with FanDuel Sportsbook and Casino. Gambling problem? Call 1-866-531-2600.

Visit connectsontario.ca. It's Today Explained. I'm Sean Ramos-Verm, and I don't know where you thought we'd be with this pandemic in September 2021, but I definitely didn't see horse paste coming. There are a lot of crazy news stories in the last couple years, but this one just struck me as particularly nuts. Marissa Cabus wrote about horse paste for Huffington Post. And I really wanted to understand how people ended up eating horse paste, because it didn't make any sense to me. And in case this makes no sense to you, when we say horse paste we mean the active ingredient

in the horse paste, a drug called ivermectin. Ivermectin paste sales are on the rise at farm supply stores all because people think it can cure COVID-19. Ivermectin is an anti-parasitic. It's been used in humans and animals for decades. The human dose usually comes as a tablet, not a paste. Its creators won the Nobel Prize. And then you got to fast forward a few decades.

We get the coronavirus, then the vaccines, and now... We've seen a pretty good increase in the ivermectin. I don't know if it's from cows getting wormy or other issues, but it's hard to get right now. Marissa wanted to find out how ivermectin specifically in the form of horse paste started flying off the shelves. And so I just started going down a Twitter rabbit hole as all my investigations pretty much begin and found all these people referencing an organization called the FLCCC, the Frontline COVID-19 Critical Care Alliance. What is that?

I had no idea, and I kept seeing it come up. So I found out that they are an alliance of doctors kind of loosely affiliated from around the United States and now around the world. And they just put their heads together in early COVID to try and figure out how can we treat this pandemic. A lot of them were critical care specialists who were working in ERs at the time. And they first came up with this protocol to use steroids to treat COVID. And at the time, people called them crazy. They said, you can't use steroids for that. What are you talking about? And then within a few months, that became a part of the protocol for treating COVID patients in hospitals around the country. For every 25 patients in the ICU treated with either dexamethasone or hydrocortisone,

deaths fell from 10 to 8. So they kind of felt emboldened by this early success that they were proven right. And so they said, okay, let's take it a step further and let's find the thing that will help us prevent it and treat it. And that's how they landed on ivermectin. So they developed these two protocols, one for prevention and one for treatment. And they incorporated ivermectin into both of them starting in October of last year. And it was just sort of spread throughout the Internet, spread through their different networks,

seeing their doctors working at major institutions. And then in December of last year, Dr. Pierre Corey, who's one of the founders, was giving Senate testimony at the invitation of Senator Ron Johnson from Wisconsin. And he called it a miracle drug. Mountains of data have emerged from all from many centers and countries around the world showing the miraculous effectiveness of ivermectin. If you take it, you will not get sick. It has immense... Was he right? Is ivermectin a miracle? Not for COVID. No, it's not. But that is what he was trying to say. He was trying to say that it's a miracle treatment for

COVID? Yes. There have been a number of small studies around the world. And he believes that those prove its efficacy, but there hasn't been a large-scale trial yet to really prove that. And a lot of those small studies have a lot of ethical issues. One of the largest studies involving ivermectin, the drug that was being administered worldwide to treat COVID patients, has been withdrawn amid concerns of plagiarism and problems with their raw data. A lot of things get said in Senate testimony that do not go mainstream.

How does ivermectin become such a buzzy treatment? So Dr. Corey's testimony kind of became this right-wing lore when it was posted on the C-SPAN YouTube page and subsequently pulled down as a COVID misinformation. And so people started to think, what are they trying to hide from us? YouTube has banned any videos that even mention ivermectin as a possible COVID treatment. But here's the kicker. Alphabet owns 12% of Vaxitech, who created the AstraZeneca vaccine. Aren't these conflicts of interest? It was feeding into this idea that big tech was somehow getting involved in censoring COVID information and that they didn't want us to know about ivermectin. And the truth was that there was just not enough evidence to prove that it was

effective and YouTube didn't want to be responsible for hosting a video that says to the contrary. However, they have no problem hosting videos about how people can do it yourself with horse paste. Hi guys, I wanted to do a quick video. I had several people asking if I could show how to do the tube for the horse paste properly. And those have been up for months. It does have a very bitter taste. I could compare it to dandelions. It has a very bitter taste. But just put it in your mouth, swallow it, and your dose will be over with. So that's how the horse treatment becomes popular over, say, the human treatment? Yes. So people hear about ivermectin late last year.

They are asking their doctors to prescribe it to them as a preventative measure for COVID. And most good doctors are saying, no, that's not FDA approved for that. In fact, the FDA specifically said last year, don't use ivermectin for COVID. And so people realized, well, there is an ivermectin that's available over the counter. It's just for animals. But what if we took it and portioned it out for humans? It's based on weight. So you just do it for a human size instead of a horse size.

And they thought this was a really clever fix. And is the FLCCC, the Frontline COVID Critical Care Alliance, aware that people are doling out horse ivermectin for humans? They are aware, but they are not doing enough to distance themselves from that, because I think their perspective is that all press for ivermectin is good press. I mean, this has been around for a number of months now, but it blew up a couple of weeks ago when the FDA issued a tweet saying, you are not a horse, you are not a cow. Stop, y'all. Is the FDA trying to be cute on Twitter? Yeah, they're like, slide into my DMs, let's talk about ivermectin. Like, it's weird. What a time. What a time. I mean, I imagine they

were trying to get people to stop, but it actually had the opposite effect. Of course it did. And organizations like the FLCCC and people who are pro-Ivermectin saw that as an attempt to undermine all their research and all the good work that they've done in prescribing it for humans. And they felt like it was a concerted effort to tie the drug to the horse medication and make it seem completely ridiculous. And so it's become very conspiratorial. And nothing fans a conspiracy better than Joe Rogan? Yeah. I mean, Dr. Corey was on Joe Rogan a couple months ago.

First of all, Dr. Corey, please explain who you are and introduce yourself. Yeah, sure. So I'm a lung and ICU specialist. And says that big pharma and the government are pushing the vaccine, and that's why they don't want you to know about ivermectin. Which is known as one of the safest drugs in history. It's been mass distributed across continents, billions of doses, and they want to bring up cautions around safety. While there are other guidelines for the other diseases that ivermectin is, from the WHO, they'll write in there that billions of doses have been administered,

the side effects are minor and transient. So they're inconsistent depending upon what disease they're talking about ivermectin being prescribed for. With COVID, they are off the reservation. What are the criticisms in terms of... And he was on as well with Brett Weinstein, who is a very popular anti-vaxxer, has a podcast of his own. And so the millions of people who listen to Joe Rogan, who are looking for an alternative to the vaccine, we're handed one. Do we have any idea how many people are actually doing this versus how much people on the internet want to talk about doing this or not doing this? I don't think we could really quantify it at this point. There is a viral story about Oklahoma emergency rooms being so overrun by ivermectin patients that they weren't

letting gunshot victims come in. And that turned out to be not entirely true. So there's a lot of misinformation flying around, but it's flying around from both sides because I feel like this conflation of everyone's taking horse medication with no people are trying to take this human medication and are just getting creative. It sort of sets up this idea

that people came to this all on their own because they're idiots, when in fact, they were fed this idea by influential people, and then it just kind of spun out of their control. And so at this point, we have lots of people talking about people taking horse paste, but as far as how many are actually doing it, you know, sitting down and portioning out a livestock drug for themselves, we don't know yet. Is Dr. Corey and this organization he belongs to, the Frontline COVID Critical Care Alliance, are they all anti-vax? I asked Dr. Corey what the makeup was of the doctors there. Like, are they split between vax, anti-vax, and pro-vax.

And he said there's a mixture, but then he himself contracted COVID recently. And they've been very upfront that ivermectin is not good on the Delta variant. It does not work against the Delta variant. And that's what Dr. Corey got. And he was very lucky to have recovered from his case of COVID. But he said he was taking ivermectin for eight to nine months before he got it. And then afterwards, he doesn't need to get the vaccine because he has natural immunity now. I think a thing that sort of frustrates a lot of people about this horse pace situation is that it sounds like people are more willing to try a drug intended for horses than a COVID vaccination that has been broadly tested and shown to have, you know, historic efficacy. Yeah, I don't think more people are trying it than the vaccine. I mean,

our vaccine rates as a country continue to go up. I believe the latest number I saw is that 53% of the population is fully vaccinated. 63% has at least one shot. So we're definitely trending in the right direction. But there are still a good amount of people who just want to try an alternative because they just don't trust anything that the government is telling them, but they trust what some random person in a Facebook group says. And that is just a reflection on our media ecosystem, the way people digest media these days. And it's really tough watching people just reject real good medical advice. Marissa Capus is a freelance journalist. You can find her piece on Horse Paste at the Huffington Post.

At this point, there's no good evidence that ivermectin works, but we'll talk about some treatments that do in a minute on Today Explained comes from Aura. Aura believes that sharing pictures is a great way to keep up with family, and Aura says it's never been easier thanks to their digital picture frames. They were named the number one digital photo frame by Wirecutter. Aura frames make it easy to share unlimited photos and videos directly from your phone to the frame. When you give an Aura frame as a gift, you can personalize it, you can preload it with a thoughtful message, maybe your favorite photos. Our colleague Andrew tried an AuraFrame for himself.

So setup was super simple. In my case, we were celebrating my grandmother's birthday. And she's very fortunate. She's got 10 grandkids. And so we wanted to surprise her with the AuraFrame. And because she's a little bit older, it was just easier for us to source all the images together and have them uploaded to the frame itself. And because we're all connected over text message, it was just so easy to send a link to everybody. You can save on the perfect gift by visiting AuraFrames.com to get $35 off Aura's best-selling Carvermat frames with promo code EXPLAINED at checkout.

That's A-U-R-A-Frames.com promo code EX at checkout that's a ura frames.com promo code explained this deal is exclusive to listeners and available just in time for the holidays terms and conditions do apply bet mgm authorized gaming partner of the nba has your back all season long from tip off to the final buzzer you're always taken care of with a sportsbook born in vegas that's a feeling you can only get with bet mgm and no matter your team your favorite player or your style there's something every nba fan will love about bet mgm download the app today and discover why bet mgm is your basketball home for the season. Raise your game to the next level this year with BetMGM, a sportsbook worth a slam dunk,

and authorized gaming partner of the NBA. BetMGM.com for terms and conditions. Must be 19 years of age or older to wager. Ontario only. Please play responsibly. If you have any questions or concerns about your gambling or someone close to you, please contact Connex Ontario at 1-866-531-2600

to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. Kelsey Piper, you're a staff writer with Vox's Future Perfect. What non-horse treatments are out there to help with COVID-19? So we're in a much better position than we were a year and a half ago when this hit. We've developed a lot of treatments that are reasonably effective, you know,

both at saving people who are in the hospital and at preventing things from even getting that far in the first place. There's been a lot of recent evidence coming out for like dexamethasone, which is administered to people in the hospital who have severe COVID. And studies have shown significantly reduced the risk that those people end up dying. And there are treatments like monoclonal antibodies that are intended to help prevent them from getting hospitalized in the first place. That's one of the treatments that Trump took when he got sick last fall. But anyway, I took this drug. I wasn't feeling good.

It's a transfusion, as they say, like one hour. And the next day I felt like Superman. I got up and said, what the hell is going on? It is reasonably effective against hospitalization. So are these two treatments, the monoclonal antibodies and dexamethasone, are they enough? Can we be like, all right, we're good now? So not exactly. Like this is a huge improvement over the situation a while ago. But the big downside of dexamethasone is it is only helpful against severe disease. It actually has negative effects if it's administered early in the course of illness because it suppresses the immune system. And then monoclonal antibodies are a really big step forward, but they cost $2,000 a dose. In the US, that's paid for by the government, so you're not paying it out of pocket,

but it means it's not an option for lots of people worldwide who are experiencing COVID. And then because you have to go get an infusion under medical supervision, even in the US, a lot of people aren't doing that. So, we still really need a COVID treatment that can happen early, that's cheap, and that doesn't need medical supervision to administer if we want to really change the course of the disease. Are we working on one of those? Yes. So, researchers have been looking since the start of the pandemic for something like that. And I think right now, the evidence is starting to shape up that there are some good options. One exciting one is fluvoxamine. Fluvoxamine? Fluvoxamine.

The brand is strong. It's an antidepressant. It's an antidepressant? Yep. Like Prozac or Zoloft or something? Yeah, it is in that genre. It is an SSRI. So Zoloft is also an SSRI. It is cheap and generic. It's been around in the U.S. since the 90s, and it's approved by the FDA already for the treatment of OCD. Why are people using this to treat COVID? So back at the start of the pandemic, a researcher at the University of Washington-St. Louis had been researching patients with a rare genetic disease that caused cellular stress response. And she noticed that fluvoxamine, for whatever reason,

seemed to like really improve things for those patients. And she looked it up and there was some research suggesting that antidepressants in general, but fluvoxamine especially, manages cellular stress response. And in particular, manages like the cytokine storm and the inflammation that's what causes so much lung damage in COVID. Was that like a surprising finding that an antidepressant is a great COVID treatment? You know, certainly people tried at the start of the pandemic lots and lots of cheap generic

drugs that were known to be safe, just hoping that something would turn up some COVID benefits. And the overwhelming majority of them did not, which isn't surprising because why would most drugs work against COVID? But a couple of them turned out to work, which is really good news for the fight against COVID. But this isn't just like random anecdotal evidence, right? There have been some larger trials, I hope? Yes, absolutely. And they got really promising results. A big difference between the control group and the experimental group in the odds of the disease getting more severe, depending on whether they'd taken fluvoxamine. But that's a small trial, as we saw with ivermectin. Sometimes you see one trial that has exciting results, but then it turns out there's nothing

there when you go a little bit deeper. So starting this winter, a team at McMaster University, which has been running a really large, thousands of patients, multi-armed clinical trial, added fluvoxamine to the list of treatments that they were studying. And they gave 800 patients fluvoxamine and noticed about a 30% reduction in hospitalization as a result of taking the fluvoxamine. So that's a smaller benefit than monoclonal antibodies. But monoclonal antibodies cost $2,000 a dose, and fluvoxamine costs $4 a dose. So pretty promising. So will this drug be authorized to treat COVID and not just as a, you know, like a thing that people tried on their own one time? The FDA has already authorized fluvoxamine for OCD. And the way that things work is that once a drug is fully authorized by the FDA,

not an emergency use authorization, but just a standard full authorization this drug is safe, then doctors can prescribe it off-label for other uses. And this is super common in general, and it's common with fluvoxamine in particular because it's only technically approved for OCD, but it is also commonly prescribed as an antidepressant. So doctors could, in principle, now look at the evidence base and go, okay, I feel confident also prescribing this for COVID treatment. But a lot of them might be reluctant to do that. So there's also the potential that the FDA will review the evidence and formally authorize or at least change its clinical recommendations with respect to the drug and COVID as well. And that hasn't happened yet, probably because the McMaster study went up like a week ago.

But over time, as more evidence comes out, I think we'll see government officials sort of revisit their clinical recommendations just as we learn more. Kelsey, help me understand why fluvoxamine is maybe better than the horse-paced ivermectin situation. So I think it would be a mistake to have the takeaway from the ivermectin situation be repurposed treatments don't work. I think the correct takeaway there is like, you have to actually run high quality clinical trials that randomize the population, report all of their data, are published, are transparent,

make their methodology really clear. The ivermectin studies are really, really bad. And as a result, like they can't teach us whether their drug works. The fluvoxamine studies are higher quality. And actually the TOGETHER trial at McMaster University, the large randomized trial that found promising results for fluvoxamine, also had an ivermectin arm. And their finding was that ivermectin just doesn't work. So you got to think about the difference between these drugs as like,

when we conduct high quality studies, what do we find? And you shouldn't say, okay, we shouldn't take ivermectin because it's a repurposed drug. That would be the wrong lesson. You shouldn't take ivermectin because the data really doesn't hold up and it doesn't look like it works. But like last week, the talk of the town was horse pace and ivermectin. Why isn't fluvoxamine getting much attention? Or is that just my perception? No, that is my perception as well. The ivermectin conversation is 100 times louder and more enthusiastic than the fluvoxamine conversation, despite the fact that I think the evidence base for fluvoxamine looks a lot better.

I sort of think that the fact that ivermectin is discouraged by the FDA and the fact that the evidence base around it is so mixed and that a lot of people are, you know, saying there's nothing here has encouraged the ivermectin fandom rather than sort of putting a damper on it. Like in a lot of ways, I think people are looking for something that is suppressed by the FDA, something that, you know, the government won't tell them about. So the government needs to say, don't take fluvoxamine, and then it'll get the buzz. You know, I can't rule that out. These are kind of crazy times, but it seems possible that more people would take fluvoxamine

if the FDA condemned it as, I don't know what the equivalent of horse paste for Vox would be. Kelsey Piper writes for Future Perfect at Vox. Today's show was produced by Will Reed with help from Amina Alsadi. Stay safe, people. you