Distribution of Ivermectin in CDMX, discredit and false evidence

Several doctors close to the current administration were left in evident international disrepute after a publication in which they tried to demonstrate the effectiveness of having distributed Ivermectin as a sound public policy to attack the pandemic in Mexico City. And for Governor Claudia Sheinbaum, who supported the measure, the blow dealt also has a resounding impact.

Ivermectin is a medicine against parasites that has not been authorized for Covid by any health authority. On the contrary, it was rejected as such by the US health regulator (FDA), by the European Medicines Agency (EMA) and by the World Health Organization (WHO).

Dr. Malaquías López Cervantes, professor at the UNAM Faculty of Medicine and member of the University Commission for the Attention of the Coronavirus Emergency, tells us that it is true that between 2020 and 2021 a full debate was triggered in the scientific world around to the use of Ivermectin in the absence of adequate experimental designs, and medical treatments for Covid19 resulted in an intuitive use of possibly beneficial options, but none with sufficient evidence of efficacy against the pandemic virus.

The option of Ivermectin was triggered by work carried out in Australia that apparently showed that such an existing drug had the in vitro capacity to limit the reproduction of the new virus. The news aroused wide interest but, in the absence of convincing evidence, positions soon polarized: some promoting the use of Ivermectin and others calling for rigorously designed clinical trials to decide whether to use it or not and when.

Here, an apparently uncompromising solution was the so-called “compassionate use” based on the idea that Ivermectin might not benefit the patient, but it would not cause harm due to extensive experience in the world about its very low toxicity.

In a scenario of total uncertainty about the possibilities of treating Covid-19, the mere mention of a possible benefit derived from a cheap and widely available product motivated an enthusiastic use amid opposing positions, conflicts and disagreements.

As Dr Malaquías tells us, in Mexico the positions of public institutions were divided: In favor were IMSS, led by Zoé Robledo, and the Secretary of Health of Mexico City with Dr. Olivia López at the head. Against, the Coordinating Commission of the National Institutes of Health (CCINSHAE) in charge of Gustavo Reyes-Terán.

The federal Ministry of Health, specifically its head Jorge Alcocer, was also against it and should have imposed itself and given the order not to use Ivermectin, but given its lack of leadership, it preferred to be ignored as always and today the consequent costs are evident.

Total, that the IMSS authorized the prescription of Ivermectin throughout the country and the Ministry of Health of the capital acquired and included Ivermectin in its anti-Covid19 kits that it delivered to hundreds of thousands of people with a positive result in their test, so that they practically self-medicated .

The aggravating circumstances -which will already involve investigations into the responsibilities of those who decided- are clear: in no case was it decided to warn the patients that it was an “experimental” treatment, and their informed consent signatures were not collected to participate in such programs. of clinical management. This is the basic aspect that sets the standard for the use of any unapproved substance, and it was completely ignored.

Not satisfied, the owners of the project -José Merino, Víctor Hugo Borja, Oliva López, José Alfredo Ochoa, Eduardo Clark, Lila Petersen and Saúl Caballero- proudly published on the SocArXiv site -focused on papers on social issues- the results of their pseudo research. In it, the authors did not reveal their conflicts of interest, admitting that it was a quasi-experimental study, but promoting Ivermectin as a treatment for Covid-19 in an unethical manner.

The article was generating a high number of visits for months, but it was accumulating complaints and nonconformity from scientists from various countries accusing the lack of ethics of said Mexican doctors, to the extent that last week the directors of the site – headed by the sociologist demographer of the University of Maryland, Philip N. Cohen – was pressured by the scandal and the widespread demand to withdraw the publication, and they did so.

Cofepris, the Academy and Bioethics raise your hand

The Government of Mexico City ruled arguing that the decision was the result of consulting experts -although it must specify who they are. What is missing -and very important- is that the authorities involved speak out: In principle, Alejandro Svarch’s Cofepris, which says how it is that -without being an approved treatment for Covid- allowed hundreds of thousands of doses to be distributed in CdMX of Ivermectin among infected residents of the capital.

They must also say this mouth is mine: the National Academy of Medicine of Mexico, chaired by Dr. Enrique López Loyo, and the National Bioethics Commission, whose leadership was resigned by Dr. Manuel H. Ruiz de Chávez, but whose name continues to appear in Conbioethics page.

They seek Insabi to attack against non-adhering states

Incredible that the 4T insists on wanting to control from Insabi the operation of the entire health system -thousands of hospitals and health centers of the 32 entities of the country- when clearly said Health Institute has demonstrated incapacity, lack of strategy and , therefore, null results. It has not even been able to regularize the supply of medicines and other supplies to the member institutions. The 4T has two and a half years left and what it could not do until today, it is already too much for it to continue insisting.

It is really not understood where this desire to want to forcefully dominate comes from when it is already evident that the entities that have resisted and continue to operate their hospitals autonomously from the Federation are better off than those attached to Insabi… It is the successful case of Guanajuato – recently awarded by the federal Ministry of Health, as we explained here in a previous column- that without Insabi has better results.

The reality is that if there were consistency, the entities should rather join Guanajuato along with the other 5 state Health Secretaries not adhered to Insabi that operate autonomously and are achieving results in health coverage for their population in the midst of a pandemic.

maribel.coronel@eleconomista.mx