People self-medicating with Ivermectin, a medication used to address parasites in animals, to treat or prevent COVID-19 led the Food and Drug Administration (FDA) to issue a consumer update about why this should not be taken.
“You are not a horse. You are not a cow. Seriously, y’all. Stop it,” the FDA tweeted on Aug. 21, with a link to their consumer update.
The American public should never be allowed to “treat itself.”
An unintended consequence of the COVID-19 pandemic has been to remind me of this truism learned over 30 years in clinical medicine.
If ever there were a prescription for danger, a recipe for unintended consequence, this is it.
All drugs and medications are potential poisons – Aspirin, Tylenol, Ibuprofen, any drug you can name.
And the more common and readily available these drugs are, the more likely they are to be misused and improperly dosed, not uncommonly with severe and, at times, lethal effects.
Tylenol and Aspirin overdosage are two of the most common.
The typical scenario is a distraught individual who reaches the point of either crying out for help or definitively wanting to commit suicide. In either case, that individual may take those drugs which are most easily procurable from their local pharmacy or home medicine cabinet.
When taken in excess, despite the intention of the person, the effect is predictably the same: severe, life-threatening illness that may culminate in death. And all it takes is a short car ride to the local drugstore or walk down the hallway to one’s bathroom cabinet.
The foundational concept to remember is the risk-benefit ratio.
Modern medicine operates under the principle that the benefits of a medication in a particular situation for a specific condition must be carefully considered against the negative, unintended consequences or side effects.
The drug is deemed worthy to be used only when a consensus has been reached that the benefits of giving a specific drug outweigh potential deleterious effects. The caveat is that they must be used for the intended purpose in the correct dose.
Medical science has made a pact with society to be entrusted with the privilege of safely and consistently making these calls and recommendations for society’s benefit.
In return, society gets peace of mind in knowing that when it uses prescribed medication, or receives chemotherapy or other medical treatment, that these are the result of the accumulated knowledge of professionals.
Society is also the beneficiary of “evidence-based medicine.” This means modern medicine “follows the science.”
Any drug that reaches the market, even over-the-counter medication, has undergone an extensive, scientific vetting process before it is offered to the public.
This does not mean that any of these drugs are risk-free, but it does ensure that, when taken as prescribed, they are as safe as possible given the available data at that particular point in history.
The dilemma is that the public cannot be trusted to accurately and consistently arrive at safe conclusions, even when it believes it is acting in its own best interest.
The non-medically trained lack the knowledge of the complexity of human physiology, the interaction with other drugs and myriad other factors required to prescribe and take many drugs safely.
I have seen several errors — consistent, predictable and understandable — during the pandemic.
People will predictably grasp at various explanations during times of emotional distress or physical threat to placate the troubled mind or body. When these options are poorly considered, they can lead down the path of medical perdition.
First, the error of transferability.
Some erroneously think that because a medication is good for one condition, it can be applied across the board for others, including circumstances for which it was not developed or studied. Because a medication is good for one condition does not mean its value transfers to others.
Second, the error of anecdotal medicine.
Instinctively, some will practice medicine on themselves arbitrarily. Their reasoning for taking a certain pill or pursuing a particular course of treatment is often flimsy, based more on emotion or a relationship rather than science.
Emotion may cloud their better judgement, leading educated, intelligent people to make medical decisions based on statements such as, “My friend said,” “I know someone who took this and got better,” and ”I saw a video on Facebook.”
Who said? What training do they have? Are their assertions defensible by rigorous science? Has this claim been studied and published in a peer-reviewed journal?
These are simple questions that should be asked before sticking anything into your body. Lacking important nuance, detail and context, using such anecdotal information to treat oneself will consistently lead to poor outcomes.
Third, the error of false causation.
Just because a medicine was taken, or a vaccine given, and the recipient subsequently developed another problem does not automatically mean the former caused the latter.
You cannot assume that because two events are temporally related that one necessarily caused the other. While this may sound like simple logic, human nature makes such discernment difficult in the heat of battle — particularly when it involves one’s life or that of a loved one.
This emphasizes the importance of the pact between the public and the medical community in helping to navigate through difficult emotional and medical issues.
The medical community has been trained to do so dispassionately and with adherence to strict scientific protocol, which results in evidence-based decisions.
Fourth, the error of degree.
Thinking “if a little is good, a lot must be better” is incorrect, sometimes lethally so.
Professionals spend years obtaining graduate degrees studying concepts most have never heard of so that they can safely prescribe medication.
It is not necessary that these nuances be studied or even understood by the general public. What is necessary is that there is a basic level of trust in your medical professional that they will not lead you astray.
Put bluntly: when it comes to making medical decisions, most are their “own worst enemies.” Within a medical context, perhaps the better metaphor would be, “The road to hell (or in this case the morgue) is paved with good intentions.”
My plea, as a physician, is to follow the science by trusting the advice of your physicians.
We have spent years in training and decades in practice to give you the best advice regarding your health. There are no attached strings. There is no secondary gain.
Turn off the noise and turn on your brain. Most importantly, open up your heart.
Your medical community is here to serve you. And remember, our first rule is “do no harm” — and, because of our knowledge and training, we can do this better than you can.
A nephrologist in Little Rock, Arkansas, and a member of the Good Faith Media governing board.
