We thank Shukla and colleagues for summarizing the evidence on ivermectin in treating COVID-19 patients.1 We agree that humility is essential when discussing and learning lessons from the clinical use of ivermectin. In the early stages of the pandemic, physicians might have decided, despite a considerable degree of uncertainty due to limited available data, by considering a trade-off between side effects and benefits to patients. With the accumulated evidence from various studies, it is the right time to reflect scientifically on the application of ivermectin for COVID-19 patients. Here we share a few lessons from the debates on ivermectin to prepare for future pandemics when there might be limited evidence on the clinical use of existing interventions.
First, clinicians must be aware of confirmation bias and avoid blindly believing in particular hypotheses.2 The COVID-19 pandemic reveals the impact of political, socio-economic, and ethical factors that confound health systems’ responses in an unprecedented manner.3 Physicians are not the exception and are understandably affected by these factors when considering their treatment options. Consequently, they are likely to give more weight to the information that suits their prior views or ignore contradictory information even if the findings are scientifically significant.2
Second, this is further aggravated by rapidly updated scientific findings and media reports as the situation evolves, making it difficult for physicians to catch up with the latest scientific evidence in the early phase. As an excellent example of the efficacy of ivermectin as a treatment for COVID-19, a meta-analysis shows that ivermectin reduced mortality only in the endemic area of strongyloidiasis, indicating confounding bias.4
Finally, social media has fueled the spread of scientifically unproven “junk” information, even among the medical community. Such information is amplified across society, politicizes scientific debates, and downplays concerted efforts, which may eventually cause harm to patients.3 New technologies, such as AI-driven Large Language Model tools (e.g., ChatGPT), will undoubtedly augment our productivity. However, it may also pose further challenges to the medical community, patients, and the general public. The clinical use of ivermectin is the tip of the iceberg, where a flood of misinformation and disinformation easily damages our integrity and trust. It is time for the medical community to seriously discuss how physicians could continue to be informed of the latest scientific evidence and maintain a balanced view of the complex interactions of clinical medicine, politics, and society.
Declarations
Ethical Statement
NA.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Footnotes
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Contributor Information
Takashi Watari, Email: wataritari@gmail.com.
Yasuharu Tokuda, Email: yasuharu.tokuda@gmail.com.
Kiyosu Taniguchi, Email: tngk7g04@gmail.com.
Kenji Shibuya, Email: shibuya@tkfd.or.jp.
References
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