Drug Story: Ivermectin

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1:00This is 99% Invisible. I'm Roman Mars. For every disease, illness, or discomfort, there is a drug. There are so many drugs. Drugs that seemingly work miracles and change the world, and drugs that are put in the service of fighting a malady for decades, only to learn much too late that they have almost no effect at all. You could tell the story of the world through the drugs we take and the diseases they are designed to manage.

1:30This is what the new podcast Drug Story is all about. On the show, creator and host Thomas Goetz tells the story of the disease business one drug at a time. Each episode explores one disease and one drug. Drugs end up being an incredible lens to view our world. This week, we are featuring an episode of Drug Story, an independent documentary journalism podcast. The kind of podcast you just don't hear about anymore and one that deserves your full attention. It is so good. I've listened to every episode.

2:01Here's one of my favorites. Imagine living with constant itching that never stops or slowly losing your sight, not because of age, but because of a simple fly bite. That is the reality of Onchocerciasis, also known as river blindness. One small tablet of Ivermectin, taking once or twice a year, helps stop transmission

2:33and protects entire communities. This is how itching stops. This is how blindness is prevented. And this is how a generation grows up free from river blindness.

2:52Imagine that you are a worm, a very specific kind of worm, Onchocercia volvulus. Your goal in life, your mission, your only purpose is to worm your way into the human body. You are a parasite. You need the human body to survive and to thrive. Humans, perhaps understandably, do not care for you. They curse you and your larvae. Your larvae especially, because once they get into humans,

3:23they squirm everywhere. They crawl into legs and they cause unbelievable itching, horrible, infernal itching. And when they writhe into the eyes, humans go blind. For centuries, there was nothing humans could do but spite you. But then they found a pill, a horrible pill that kills your darlings. This pill, ivermectin, makes life very difficult for a parasite. Welcome to Drug Story. I'm Thomas Getz.

3:55Today's drug is ivermectin, which truly is a wonder drug, a veritable miracle cure. It is really, really good at killing parasites that cause diseases like river blindness or elephantiasis. These tropical diseases mostly happen in Africa or South America or parts of Asia. Ivermectin is also effective against hookworm, which a century ago was endemic in the southern United States. And it's good on heartworm, which affects pets, dogs, and cats. And it kills parasites

4:25in horses or other livestock. But in the United States, these days, you have probably heard of ivermectin not as a treatment for river blindness, but for different purposes altogether.

4:40I just did a parasite cleanse. I never thought those words would come out of me. Things literally came out of me. I've used ivermectin when I was really sick. I had to. Yeah, and honestly, I actually think, you know, I've seen a lot of studies. I think that it's probably not a bad idea to use it once or twice a year to cleanse it out of your body, right? Right. Some of my patients will take ivermectin as a prevention for viral illnesses. Totally fine. Totally safe. I use ivermectin for 12 by 12, seven days, which is every 12 hours,

5:1112 milligrams for seven days. And the reason is all the literature that's coming out about ivermectin as an anti-cancer. You know, if you have a hidden parasite and how do you get rid of it? Thirly recommend doing a parasitic detox, which you should talk to your own doctor about because I am not licensed to practice medicine, but I do take a form of ivermectin and venbendazole. So, yeah. Google tells me that right now there are many tens of thousands of videos on YouTube raving about ivermectin.

5:41But cancer? Parasite cleanses? And viruses? What is this drug? What does ivermectin do, really? In this episode of Drug Story, we're going to tell the story of ivermectin, this amazing medicine. We are going to talk about parasites a lot. And we will dig into what got all those people on YouTube and Instagram talking about ivermectin. What they hope it could be, what they believe it works on. Not just parasitic diseases,

6:11but viral diseases like COVID or even cancer. Which would be great if there's, you know, evidence that it actually works for those other diseases. So we're going to explore that today with an open mind, an open notebook, and an open door to science in the drug story ahead.

6:33We tell each episode in three parts. The diagnosis, the prescription, and side effects. This is part one, the diagnosis, where we explore the disease behind the drug. Or in this case, the diseases. Because ivermectin is proven to work on many diseases. Diseases with one thing in common. They are caused not by a bacteria or a virus, but by an animal, a parasite.

7:00Oftentimes, it's a type of worm called a helminth. Now, technically speaking, a parasite is an organism that lives inside or on another creature and feeds off of it. A tick is a parasite, so are lice, as is the tongue-eating louse. That's this little crustacean. It's a relative of a shrimp that swims into a fish's gills, winds its way into the mouth, and then eats the fish's tongue. Yeah.

7:28And get this. It then takes the place of that tongue. It lives there, in the mouth, helping the fish eat just as a tongue would, but taking a nibble of food every now and again. That, my friends, is a parasite.

7:47There are thousands, maybe millions, of parasites on Earth.

7:52Yeah, it just makes your skin crawl. In fact, there's actually a condition called delusional infestation, also called delusional parasitosis, where people are convinced that they have parasites. You might feel a bit of this right now, feeling like something is crawling on your skin, under your socks, maybe under your shirt. It's a little itchy. And no, a parasitic cleanse is not the answer. There is no evidence that those cleanses work.

8:23If you really think you have parasites, go see a doctor. Do not DIY this. Anyway, parasites have been worming their way into the human body for as long as there have been humans, even before. Just as fish and birds and dogs and horses all get parasitic infections, so do we.

8:46Many of these parasitic diseases started in the tropics. Since about 1492, basically over the past 600 years of conquest and migration and slavery, parasitic diseases have spread around the world. Parasites are everywhere. Here's a factoid. The U.S. Centers for Disease Control and Prevention is based in Atlanta, Georgia because 75 years ago, parasitic diseases were common in the Deep South. It was mostly malaria, but also hookworm. In fact,

9:17let's start our tale there in the southern United States with a story about hookworms, circa 1900. Charles Stiles was born in New York and educated in the zoological sciences at the finest institutions in Europe. Stiles was particularly interested in parasites in livestock, like trichinosis in swine and tapeworm in cattle. At the time, the study of parasites, this is called parasitology, this was a brand new field of medicine.

9:48Parasites, it was discovered, caused diseases like giardia and malaria and compared to bacteria, parasites were easier to find, sometimes even visible to the naked eye without a microscope. But that did not make them any easier to deal with. So, around 1900, Charles Stiles took a job as the chief zoologist for the U.S. Public Health Service.

10:10And when he heard about health problems in the American South, anemia, stunted growth, he had a hunch that parasites were involved. So, Stiles began to research, well, there's really no other way to say this, he went on a study of human shit across the South. He took stool samples from everyone willing to let him, and soon he had definitively identified hookworms as a cause of widespread malaise.

10:41Based on his poop studies, he estimated that around 40% of Southerners, whites and blacks, almost always poor, they carried hookworms. He called these parasites Necator Americanus, which translates as American murderer.

11:01This was a misnomer, actually. People rarely die of hookworm infections, but hookworms did make daily life much, much worse. At the time, this was the first years of the 20th century, to be poor in the South meant almost no sanitation. No running water, no toilets, often no outhouses. People pooped, well, wherever, in the woods, behind bushes. And most poor people went without shoes, children especially. It was just easier

11:31that way. Shoes cost money. These were ideal conditions for the hookworm to prosper. Let's start in the dirt. Hookworm larvae live in the soil and burrow through to reach their target, human feet, where they quickly slip into the pores of bare skin. This might cause a rash. It was called ground itch. But the worm is in. The larvae, which are super tiny, scarcely visible to the human eye, they then wriggle their way into blood vessels

12:02and enter the bloodstream. And now, the ride is on. The larvae flow to the heart and they are pumped out into the lungs. This usually causes a cough, which is just what the hookworm needs. Because with every cough, the hookworm is forced out of the lungs into the mouth and then, gulp, swallowed. And now the worm is home free. In the small intestine, the worm latches onto the intestinal wall. There it feeds on blood

12:33and grows to just half an inch long at most. From there, the adult worm produces more larvae, which are expelled with a stool into the dirt past the bush, where the worms wait for other feet to pass by. And so the cycle continues.

12:50But let's hook back, sorry, to the adult worms back in the intestines. As they fester, sucking the blood out of their host, hookworms cause anemia. That is a severe and chronic iron deficiency caused by blood loss. Symptoms of anemia are weakness and extreme fatigue. The English language is full of words to describe this. Indolence, sloth, lethargy, lassitude, laziness. In 1902, at the Pan-American

13:20Sanitary Congress in Washington, D.C., Charles Stiles announced his discovery. And he noted that there might be a connection between this hookworm, the American killer, and the characteristic state of Southern lassitude. And that became front page news. The headline in the New York Sun screamed, germ of laziness found. At the time, this stereotype of a lazy Southerner, especially white Southerners, it was commonplace.

13:51As the North expanded in a frenzy of industrialization, the South was still overwhelmingly rural. Poor white Southerners were scorned as unmotivated and slow. And the stereotype lined up neatly with racial slurs about lazy Black people. And that has been an even more enduring smear.

14:14So Charles Stiles had found his cause. But what about the cure? Once the germ for laziness headlines faded, no one seemed that interested in following up on Stiles' work to do anything about the hookworms. It may have affected 40% of the population, sure, but hookworm was mostly an affliction of the very poor and often Blacks. Remember, this was the Jim Crow era South, not a time of great progress. So this was just not a priority

14:45for the fledgling U.S. Public Health Service or the growing nation. So Stiles started stumping and lecturing about what he thought should be done.

14:56He said, My hobby may be summarized in the two words clean up. In our filthy American habits of daily life, I see the cause of more preventable sickness and preventable death than I do in any other one factor. Eventually, in 1908, Stiles hooked up, sorry, with advisors to John D. Rockefeller, the founder of the Standard Oil Company and the richest person in the United States at the time. Rockefeller was interested in putting his wealth towards philanthropy and Stiles' work

15:28fit the bill. Soon, there was a Rockefeller Sanitary Commission dedicated to eradicating hookworm in the southern United States. This would later become the Rockefeller Foundation.

15:41Stiles and the Rockefeller team identified three strategies to fight hookworm. First, infected people were to be treated with thymol. This was a naturally occurring chemical used as a disinfectant. And Epsom salt to kill and purge the worms. This involved a lot of vomiting and diarrhea. But it usually worked to rid a body of worms within 24 hours. Second, they went on an outhouse building campaign. One estimate at the time held that 35%

16:12of white households and 75% of black households had no privies. That would have to change. The goal was to build an outhouse for every home with a pit at least four feet deep. Third, shoes. Now this was a big cultural change. Children in the South rarely wore shoes, especially in the summer. But shoes keep the worms out. The hookworm campaign quickly took off.

16:39State governments got engaged. With Rockefeller money, many southern states established sanitary commissions and better state departments of health. Soon, there was talk of an expanded national public health service. one that could build on the success of the hookworm campaign and advance sanitation and health care across the land. The Rockefeller Coalition framed this as a movement for the conservation of country life. But they were really demanding that people change

17:10how they lived, where they lived, what they wore, how they ate.

17:15Change was the only way to keep disease at bay. And many people did not like all that change.

17:26Enter the National League of Medical Freedom. This opposition group condemned scientific medicine, arguing that people should be free to pursue whatever form of treatment they believed best, and that the federal government should steer clear of endorsing certain kinds of medicine as more worthy than others. The league was funded by homeopaths, osteopaths, and others in the alternative medicine business.

17:54At first, it worked. The league and a successor group, the American Medical Liberty League, they managed to delay approval of what was called the Medical Octopus, a stronger national health organization. But by the time of the New Deal and more effective drugs and treatments in the 1930s, the opposition faded, though it did not disappear. That idea of defending medical freedoms

18:24against mainstream medicine, does that sound familiar? That idea would not die. It has not died. So now, back to hookworm. That was eliminated in the southern U.S. more or less by the 1950s, though it's not entirely gone from the south. And it still appears in dogs and cats and horses nationwide. And hookworm is still sadly common around the world. Which takes us to another worm. Let's follow our drug story

18:56to Africa to meet another parasitic disease, river blindness. in the villages of sub-Saharan Africa in countries like Ghana, Nigeria, and Cameroon, people depend on rivers. Because that is where the food is, where the water is, that's where the work is. The water from the rivers is precious indeed. But the rivers are treacherous. They produce the black fly that brings blindness. That's from a 1983

19:31documentary about river blindness. The black flies bite. And when they bite, they transmit the larvae of a worm called Onchocerca volvulus. The worm grows and breeds under the skin. The human body generally tolerates the adult worms with a low immune response. But when the baby worms, the larvae, get into the eye, a more intense immune reaction can cause inflammation. And that leads to blindness.

20:02River blindness itself is rarely deadly to individuals. But it can prove fatal to a family or to a village. Because blindness often comes to men and women in their prime productive years. Sons or daughters must drop out of the workforce to care for a blind parent. Marriages and parenthood are less common. Eventually, young people flee the village.

20:28For decades, there was little to be done for Onchocerciasis. As many as 20 million people were infected with the parasite worldwide. And hundreds of thousands were blinded or had impaired vision because of the disease.

20:42In the 1970s, the World Bank began using DDT and other insecticides to kill black fly populations in West Africa. This worked in places, but it was terrifically dangerous to the environment and to human health. And then, in 1981, a new drug appeared that might work for river blindness and for other parasitic diseases too, including hookworm. This was ivermectin. And we'll get into that

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24:48at business.att.com. Welcome back to Drug Story. This is part two, The Prescription, where we explore the creation and the use of a drug to treat disease. And today's drug is, of course, ivermectin. The creation of ivermectin begins, of all places, on a golf course south of Tokyo, Japan in 1973. On the edge of the course, looking east over Sagami Bay,

25:19a young scientist named Satoshi Omura was digging up dirt. Now, at the time, it was well known that soil, dirt, was full of life and full of microbes. In any patch of earth, a war is going on, with various bacteria producing chemical agents to kill off rival bacteria in the quest for food and survival. Since 1943, it was known that some of those microbes could be isolated and turned into medicines. One of the first antibiotics,

25:50streptomycin, was isolated out of soil.

25:55Tetracycline, rapamycin, and a dozen other medicines started in dirt. Omura was a director at the Kida Sato Institute, and he had just begun a research project with Merck, the New Jersey-based pharma company. Part of Omura's habit was to carry sample bags with him so that when the mood struck him, he could shovel up a soil sample for testing later. The sample from that golf course was just one of 40,000 cultures isolated in Omura's lab.

26:26The promising ones were then sent overseas