Public Health

Ivermectin: Chemists Come Between Doctor and Patient

Back in July, Health Minister Greg Hunt responded to a doctor who had been prescribing ivermectin as a prophylactic and treatment for COVID-19. The correspondence followed soon after Dr Mark Hobart was reported to the Australian Health Practitioner Regulation Agency (AHPRA) for doing likewise. After AHPRA found there was no case to answer, Mr Hunt wrote:

I acknowledge some physicians are presecribing ivermectin off-label. As you would know, the practice of prescribing medications outside of their approved indications is not regulated nor controlled by the Therapeutic Goods Administration, as it is at the discretion of the prescribing official

You can’t get much more clear than that. According to both the AHPRA and the minister, doctors have every right to recommend the cheap, off-patent drug when and as they see fit.

But not according to the Pharmaceutical Society of Australia, which has decided your local neighbourhood chemists can trump prescribing doctors if they suspect the drug is being used for other than its primary designated purpose, the treatment of roundworm parasites.

PSA recommends that pharmacists do not supply ivermectin for the treatment or prevention of COVID-19. Should pharmacists be unable to establish intended use of an ivermectin prescription, supply should be declined. — Pharmaceutical Society of Australia alert to members

That pharmacists should place themselves between doctor and patient, presuming the right to countermand a decision made a physician on the basis of suspicion alone, so outraged Phillip Altman, a veteran pharmacologist who specialises in the testing and trials of new drugs, he sent off the letter below.

Reproduced below Dr Altman’s letter is the PSA’s alert to members.

_______________________

 

TO: Renae Beardmore
President: Pharmaceutical Society of Australia (PSA)

I refer to the attached advice from the PSA (received 29 August 2021) on ivermectin prescribing in Australia which cannot go unanswered.

The Pharmaceutical Society of Australia is a professional organisation of Australian pharmacists. PSA is the peak national body for pharmacists, representing all of the pharmacy profession in Australia, with approximately 31,000 members.  The stated PSA mission is: “As the peak pharmacists’ body, we lead and support innovative and evidence-based healthcare service delivery by pharmacists”. 

The directive by the PSA instructs pharmacists not to supply ivermectin on prescription if they deem the prescription has been written for the management of COVID-19.  This is disturbing in that the PSA has taken upon itself, for the first time of which I am aware, to interfere with the sacred doctor-patient relationship by denying a medication, considered necessary by a doctor and legally prescribed, for a potentially serious infection.

The PSA has clearly overreached the boundary of the profession and should immediately withdraw this advice.

As a pharmacist myself, I have been proud of a profession whose members are both highly knowledgeable and eager to interface with the public to provide both valuable and easily accessible day to day health advice.  There remains a high degree of respect by the community for the service which they provide.  But this latest foray into the ideological battle regarding the management of COVID-19 brings them no credit whatsoever.

I am unsure if the PSA is unaware of the enormous weight of literature regarding the use of ivermectin in the management of COVID-19.  It would be useful for the PSA to keep abreast of the published papers regarding ivermectin which would give the PSA a better perspective (eg. Santin et al) rather than blindly accept and promulgate views without themselves interrogating the evidence.

The PSA relies on two sources upon which it has based its advice to all pharmacists.  The first is reference to a Cochrane Review and the second is reference to the current National COVID-19 Clinical Evidence Taskforce (NCCET) recommendations in relation to ivermectin. 

The Cochrane statement “At this time there is no evidence to support the use of ivermectin for treating or preventing COVID-19 infection” is incorrect.

Ivermectin has shown efficacy in the management of COVID-19 in more than 20 randomised controlled clinical trials and has been used in several successful national programs to treat the pandemic.  It is a therapeutic agent with a high therapeutic index (ie., is it a relative safe therapeutic) and highly skilled doctors around the world are using ivermectin to protect their patients from the serious consequences of COVID-19 infection and keep them out of hospital.  The body of evidence in support of ivermectin would normally be considered adequate to support a consideration for the extension of use indications for a drug like ivermectin which has been used for decades.  

The PSA needs to be aware that there are other major published reviews of the safety and efficacy of ivermectin in the literature aside from the Cochrane Review which conclude that ivermectin is a potentially safe and effective therapeutic agent for the treatment of Covid-19 (Bryant et al and Kory et al). 

The PSA also needs to be aware that the NCCET recommendations relating to ivermectin (see Quadrant article referenced below by the author of this Open Letter and the attached NCCET Commentary) have been brought into question.  The NCCET (as of this date) has failed to respond to the critical analysis of its recommendation on ivermectin.

Advice on the supply of a potentially important therapeutic agent such as ivermectin deserves more than a quick “drive-by” look at the evidence by politicians, bureaucrats and health professionals writing literature reviews of variable quality.  This is too serious.

Phillip Altman BPharm(Hons), MSc, PhD
Clinical Trial and Regulatory Affairs Consultant

 

 

Santin, AD, Scheim, DE, McCullough, PA, Yagisawa, M and Borody, TG.

Ivermectin: a multifaceted drug of Nobel prize-honoured distinction with indicated efficacy against a new global scourge, COVID-19

 

The PSA’s letter to members, 29 August 2021

PSA is aware that some pharmacists have experienced an increase in presentations of prescriptions for ivermectin, including where the patient is unwilling or unable to discuss what they are being used for. The approved indications in Australia for ivermectin are for the treatment of roundworm infections, scabies and inflammatory rosacea.

The use of ivermectin for the treatment of COVID-19 has not been proven. The Cochrane Review published on 28 July, 2021, included that: 

There is uncertainty about the efficacy and safety of ivermectin used to treat or prevent COVID-19, although the evidence base is limited. Evaluation is continuing in 31 ongoing studies. At this time there is no evidence to support the use of ivermectin for treating or preventing COVID-19 infection.

Current Australian advice includes the following:

♦ The National COVID-19 Clinical Evidence Taskforce has issued a high priority recommendationDo not use ivermectin for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval

♦ Advice has also been issued by the TGA that ivermectin has not been approved in Australia (or other OECD countries) to prevent or treat COVID-19 disease, and should not be imported for this indication.

Some doctors may decide to prescribe ivermectin for off-label use taking into account potential risks and benefits and with appropriate informed consent. However, given the lack of evidence to support use of ivermectin for COVID-19, it would be difficult for a pharmacist to professionally justify off-label supply of ivermectin outside of a well-designed clinical trial.

Therefore, PSA recommends that pharmacists do not supply ivermectin for the treatment or prevention of COVID-19. Should pharmacists be unable to establish intended use of an ivermectin prescription, supply should be declined.

As a Member of PSA, we are here to support you. If you identify unusual requests for ivermectin, please make contact so that we can pass your concerns to regulatory authorities:

    • send an email to policy@psa.org.au, or 
    • call 1300 369 772, the Pharmacist to Pharmacist Advice Line exclusive to PSA Members.

 

 

References supplied to the PSA

Santin, AD, Scheim, DE, McCullough, PA, Yagisawa, M and Borody, TG.

Ivermectin: a multifaceted drug of Nobel prize-honoured distinction with indicated efficacy against a new global scourge, COVID-19

Mini-Review New Microbe and New Infec. 2021; 43: 100924 (2021)

A Total Lack of Therapeutic Perspective’ – Quadrant Online.  22 Aug. 2021

Commentary on NCCET Statement on IvermectinQuadrant Online.  22 Aug. 2021 

Bryant, A, Lawrie, TA, Dowswell, T, Fordham, EJ, Mitchell, S, hill, SR and Tham, TC. Ivermectin for Prevention and Treatment of COVID-19 infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. American Journal of Therapeutics 28, e434-e460 (2021).

Kory, P, Meduri, U, Varon, J, Iglesias, J and Marik, PE. Review of the Emerging Evidence Demonstrating the Efficacy of Invermectin in the Prophylaxis and Treatment of COVID-19.   

American Journal of Therapeutics 28, e299-e318 (2021).

 

14 comments
  • Ceres

    Federal Privacy Act 1988 – no one can demand you provide medical information. Privacy between you and your Dr. Pharmacist may grill you on what the script is for and unless you volunteer the information you can decline to divulge.

  • Daffy

    A clear case of ‘we can be heroes’ (too) on the part of the pharmacists. Better leave that to David Bowie.

  • J. Vernau

    Ceres
    Of course one “can decline to divulge”. But the PSA letter to its members clearly states “Should pharmacists be unable to establish intended use of an ivermectin prescription, supply should be declined.”

  • STD

    If you know what you want to buy, and you have a script, one does not require sales spiel or utterances . The art of salesmanship is to sell the patient, now customer, something they do not want to buy and something the pharmacist wants to sell and no longer wants. In other words it’s all about giving people what they don’t want. Just like , politicians and politics. Commercial self interest always wins the day. Once proud professions. CORRUPT BEYOND REDEMPTION, NO LESS.

  • ianl

    @J. Vernau

    Yes. As usual, there is no practical, useful way around this – yet another hypocritical intervention by an in-your-face busybody seeking to cloak greed with its’ version of the collective good.

    I’d resisted the idea that Big Pharma had orchestrated the demise of ivermectin to allow vaccines untrammelled market access. This PSA advice to members puts my resistance to the sword. Pharmacies can now run their own vaccination clinics. This is too lucrative to admit that a cheap drug could be sufficient if legally prescribed.

  • diane1

    Interesting that the PSA requests pharmacists to report wicked doctors and their patients further along the line: “If you identify unusual requests for ivermectin, please make contact so that we can pass your concerns to regulatory authorities”. Now why would that be??

  • peter james moss

    PJM: The following is an extract from the article by Professor emeritus Clancy published in these pages recently:

    “The extreme of this arrogance was the rejection of several cheap and safe repositioned drugs, notably hydroxychloroquine (HCQ) and ivermectin (IVM), both of which have been shown to reduce admission to hospital and death by around 60 to 70 per cent. The role of Big Pharma in denigrating these drugs and supporting the political mantra at a time when they were taking hundreds of millions of dollars in government grants to produce patented and high-profit drugs for early COVID-19 treatment was indefensible.”

  • andrew2

    Now that Joe Rogan has said he used Ivermectin to treat Covid the media will be going into overdrive trying to discredit it. The latest gimmick seems to be to lable it purely as a livestock drug and “quack cure” (Samantha Maiden “Ivermectin Dangers Outlined after Man Hospitalised”. The lack of truthful information in mainstream media over issues like this leads to zero trust in anything they publish. Once again, I’m looking to people like Professor Emeritus Clancy, with his vast experience in Immunology, to provide me with the information I need to make an informed personal decision. My sister worked with Professor Clancy at the John Hunter Hospital AIDS clinic back in the 1990’s so I’m happy to trust his opinion on the subject over some low information media scribe. These are today’s heroes.

  • lroyjh

    Dr Altman,

    I read your Ivermectin article in Quadrant Online of 31 September 2021. To say it resonated with me would be an understatement.

    If I may summarise my case, I’m a moderately fit 81 year old Male with a history of Pulmonary Embolism and Deep Vein Thrombosis with a more recent diagnosis of Cerebral Small Vessel Disease.

    My GP gave me a letter recommending against the AstraZenica Covid-19 Vaccine, yet I have twice been refused the Pfizer vaccine in Canberra, firstly by a private clinic and secondly by An ACT Health clinic. I fully support the Government’s decision to protect the most vulnerable first.

    Having read a number of papers on Covid-19 treatment with Ivermectin, I asked my GP for a script.

    Then after ringing my local chemist in Tuggeranong and six or eight Pharmacies around Canberra/Queanbeyan, I realised there probably was none available.

    Yesterday I decided to give the Canberra Hospital Pharmacy a call, yes they did have some Ivermectin, so I drove out of my allocated ‘lock down’ area for a valid reason only to find my local chemist had ‘Deferred’ supply of my eScript which meant the Hospital Pharmacist had to ring the local pharmacist to release the script.

    Clearly the local Pharmacist convinced the hospital pharmacist not to dispense my script, although the hospital pharmacist gave me a hard copy of the script and would make the drug available to another pharmacist should he be requested to do so.

    I have Zinc Chelate and Vit D3 which I take daily along with my Prescription Drugs including Rivaroxaban.

    I believe the local Pharmacist may have acted illegally and I look forward to supporting a class action brought against them.

    Who would have thought such a thing could happen in Australia today!

    Keith Goggin

    Fadden ACT

  • Jill England

    I find this absolutely staggering and my confidence in my local chemist has taken a big hit. The extent of this, the number of lives that could have been saved and the harm to many of those vaccinated… It is like something out of a Hollywood movie, but it’s real and we are all caught up in it. Thank God for those who are speaking up and circulating this information. We need to be pressuring our politicians like never before.

  • lroyjh

    It Gets worse, today I went to a different Pharmacy (surprise surprise) to get a totally unrelated prescription drug Probenecid to treat advanced osteoarthritis which I have been taking for more than a year and was refused supply. It seems my separate eScript had been ‘deferred’ by some one authorised to do so. I’ll leave it to the reader to discover who that might be.

  • irisr

    “As a Member of PSA, we are here to support you. If you identify unusual requests for ivermectin, please make contact so that we can pass your concerns to regulatory authorities”
    so not just refuse the sale of a prescribed medicine, but also DOB IN the requester and perhaps their doctor!
    My God, what has become of my country?

  • Ed

    The PSA is an pharmacy organisation that competes with the pharmacy guild, a pharmacy owner organisation, for government project grants & contracts. The PSA represents mostly employee, retired, academic & government pharmacists membership.

    That the PSA would issue such a statement with the overwhelming evidence for ivermectin is unforgivable in my opinion. Eventually they must be held accountable.

    A lot of pharmacists will now ‘play it safe’ & defer to this statement. AHPRA has all health professionals running scared. Terrified of a complaint letter. If AHPRA target a pharmacist NOW they can say, ‘ your professional body issued this statement’ and probably get a complaint process initiated.

    Not all chemists are the same. Similar to finding a doctor that would prescribe ivermectin off label. A valid script for ivermectin once written is still a valid script. Find a pharmacist that you can talk to that has looked at the data & not the propaganda. Ivermectin can be prescribed off label, until that changes, end of story.

    A big issue will be the lack of ivermectin brand stromectin available. Community pharmacy will only have access to stromectin, a low volume medicine in Australia. Any unexpected volume will most definitely run out available stock, as is the case currently. Do you think Merck will ramp up supply?

    Some Pharmacies can compound ivermectin from the raw ingredient. It depends on what your doctor writes & which protocol he is referencing.

    What are we up against though? The state is resisting any attempts to change course. Even if it’s logic, narrative & argument collapse. This is a serious propaganda campaign.

    It seems monstrous to imagine the damage done by just ivermectin censorship & misinformation alone.

    Our government, corporations, media & bureaucracy don’t have its peoples best interest obviously. We live in dark times.

  • simonbenson65

    Pharmacists playing doctor now! What next? If some pharmacists, including those at the helm of their august trade union, are really just frustrated medicos who couldn’t cut it in medicine or couldn’t get in to begin with, this has to be the best evidence demonstrating why they’re still pharmacists and not doctors. If this keeps up, and these Ivermectin-type directives become standard practice, maybe drug reps for companies like the maker of Ivermectin should be permitted to take pharmacists out of the equation altogether, and supply doctors direct. Maybe it’s high time to end the pharmacists’ monopoly of supplying drugs, the therapeutic benefits of which they don’t understand, and let them get on with the giddy business of dispensing cough drops and bandaids.

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