A county judge in Ohio has ordered a hospital in Cincinnati to administer ivermectin to an intensive care patient, a move raises questions about the role of the courts in the medical system.

“It is absurd that this order was issued,” Arthur Caplan, professor of bioethics at New York University’s Langone Medical Center, told Ars. “If I were these doctors, I simply wouldn’t do it.”

The order was spurred by a lawsuit filed by Julie Smith, whose 51-year-old husband, Jeffrey, is being treated in West Chester Hospital for COVID-19. The lawsuit was first reported by the Ohio Capital Journal. Jeffrey has been in the hospital since July 15, and as his condition declined, his wife Julie began investigating alternative treatments.

A treatment without supporting evidence

During her husband’s time in the hospital, Julie found groups espousing the purported benefits of ivermectin, which she asked the hospital’s doctors to administer. They refused.

Ivermectin was initially developed as a treatment for river blindness and other parasitic infections. In the US, the FDA has approved it for two specific forms of parasitic infection as well as topical treatments for head lice. Importantly, the doses at which it’s administered for internal use in humans are far lower than what’s available over-the-counter for treating parasitic infections in livestock. At high doses, ivermectin can cause serious side effects in humans, ranging from nausea, vomiting, and diarrhea to low blood pressure, seizures, coma, and death. 

But people have clung to the idea that ivermectin can treat COVID after a study early in the pandemic suggested that it disrupted SARS-CoV-2’s ability to infect cells. What’s often overlooked is that study was limited to cells in Petri dishes. What’s more, when the NIH looked into it, the agency found that to achieve the ivermectin’s reported disruptive effects, the dose would have to be 100-times greater than what’s currently approved in humans. At those levels, the side-effects would likely be serious. The FDA has pleaded with people not to take ivermectin for COVID.

Still, that hasn’t stopped people on the Internet from encouraging its use. Prescriptions of the drug have spiked, and some people have resorted to buying livestock-grade ivermectin when they can’t obtain a script. Poison control centers have been inundated with calls, yet some doctors continue to push the drug for COVID despite potentially grave side effects and a lack of evidence.

Outside doctor

After watching her husband suffer in the hospital for more than a month, Julie Smith was desperate. He had been in the ICU since the day he was admitted, and he had to be intubated on August 1, according to the lawsuit. Two days later, his sedation wore off and he woke up, ripping the tube out of his throat and “disturbing and/or breaking the feeding tube, which caused food particles and toxins to escape into his lungs; this caused him to aspirate,” the lawsuit says. He developed an infection, which he is still fighting.

Distressed, his wife began investigating “other forms of treatment for COVID-19” and requested that the hospital doctors “administer Ivermectin pursuant to its dosage schedule,” the lawsuit says. Julie offered to sign a form releasing the doctors of any liability, but they refused.

It’s unclear when Julie contacted Dr. Fred Wagshul, but on August 20, he prescribed ivermectin for Jeffrey. Wagshul is a pulmonologist with a practice near Dayton, Ohio, and he helps run the Front Line COVID-19 Critical Care Alliance, a group of doctors which encourage treatment of COVID with ivermectin, fluvoxamine, famotidine, and a smorgasbord of other drugs. Some of those drugs may work in limited circumstances, but most of them appear useless against the virus. Currently, Wagshul does not appear to have any privileges at any hospitals.

“Try anything”

Ivermectin “is absolutely not indicated for COVID. There is no standard of care saying you have to use it,” Caplan said. “Indeed, major medical groups advising against using it because people have died from it.” The judge’s order was asking hospital doctors to do something “unethical and illegal,” he said. “The doctors who are caring for the guy in the hospital are his doctors, not this guy,” Caplan added, referring to Dr. Wagshul.

The judge in the case likely feels that, because Jeffrey Smith is dying, that doctors should “try anything,” Caplan said. “Well, that’s false, because you can still kill him faster.” 

“The judge is trying to throw a life preserver to a dying man. The problem is what he’s throwing is actually a 50 pound weight that’ll sink him.”

https://arstechnica.com/?p=1790673