In July 2020, as the country faced its first summer wave of coronavirus cases, a group of physicians stood in front of the steps of the U.S. Supreme Court and held their first self-titled "White Coat Summit" to tout the unproven benefits of hydroxychloroquine as a COVID-19 treatment.
"It is called hydroxychloroquine, zinc, and Zithromax," Dr. Stella Immanuel, a Houston-based primary care physician, told the crowd. "I know you people want to talk about a mask. Hello? You don't need a mask. There is a cure."
But as those doctors were promoting unproven COVID-19 cures like hydroxychloroquine and ivermectin, and denouncing proven non-pharmaceutical mitigation measures like mask-wearing and lockdowns, another group of physicians was emerging.
No License for Disinformation, a group of doctors motivated by the unproven claims of the White Coat Summit, came together with a mission to call on state medical boards and other governing bodies to take disciplinary measures against doctors spreading dangerous misinformation.
"They were anti-mask. They were anti-lockdown. They wanted everybody to believe that it was safe to continue life as normal," the group's founder, California physician Dr. Nick Sawyer, told ABC News. "It was anti all of the public health measures that had been put out as guidance to help prevent the transmission of this novel virus."
Calling the group that spoke on the steps of the Supreme Court "very well-funded physicians who are essentially weaponizing the white coat in order to spread disinformation," Sawyer said there has been an "institutional failure" by state medical boards to protect patients by not going after doctors more aggressively.
In Pennsylvania, Texas and Maine, some physicians have faced repercussions for spreading misinformation about coronavirus vaccines and treating COVID-19 patients with unproven drugs like ivermectin or hydroxychloroquine -- but Sawyer says there's still a long way to go.
"Disinformation is needlessly killing Americans. And the people who have the authority to stop just information, whether it be the social media platforms, legislators, the medical boards need to step up and protect the public from this dangerous, conspiratorial information that's being pushed out in a massively coordinated way," Sawyer told ABC News.
'We see it in real life'
ABC News interviewed Dr. Peter McCullough, a Texas cardiologist, who promotes ivermectin as part of a "multi-drug protocol" aimed at early treatment of COVID-19 outpatients -- despite the FDA and CDC's warning that people should not be taking ivermectin at all for COVID-19 treatment outside of a clinical trial.
Sawyer said that because physicians like McCullough tout unproven COVID-19 treatments like ivermectin and hydroxychloroquine while discouraging vaccines, many patients who believe disinformation "like a matter of faith" become critically ill from COVID-19.
"We see patients who come into the emergency department who've had COVID for a number of days, who've been taking these medications, and they're very, very, very sick," said Sawyer. "We see it in real life."
The heated debate has spilled over into hospitals, with some patients demanding unproven medications to treat COVID-19, like ivermectin, from doctors.
"If a patient is denied ivermectin, but the doctor says, 'Listen, I'm comfortable with giving Paxlovid,' I'm perfectly fine with that, OK? But when the doctor says no ivermectin, no hydroxychloroquine, no Paxlovid, no drugs at all, go home and wait until you come back sick, I'm not OK with that," McCullough told ABC News.
In December 2021, the FDA granted emergency use authorizations for new antivirals like Pfizer's Paxlovid and Ridgeback Biotherapeutics and Merck's molnupiravir for the treatment of mild-to-moderate coronavirus disease. At the time, Paxlovid was scarce -- but Pfizer has since been ramping up its production and distribution, and the drug is a key part of the "test to treat" initiative President Biden mentioned at the State of the Union on Tuesday, where patients can get tested at a pharmacy and receive the pills "on the spot at no cost."
"This isn't about dying on the hill for one drug or another," McCullough said. "And we will, just like with any other medical problem, we will move on to better drugs as they come along."
"Historically, hydroxychloroquine played a big role in year one, ivermectin year two, and I'm thinking probably Pfizer and Merck in year three," McCullough said, despite there being no evidence that hydroxychloroquine played a big role in combating the coronavirus in the first year of the pandemic nor that ivermectin played a big role or was an effective treatment in the second year.
But the bigger problem, experts say, is that doctors like McCullough tout ivermectin as a better safeguard against COVID-19 illness than using scientifically proven COVID-19 vaccinations, against the consensus of nearly all major medical institutions.
Studying the studies
Advocates of using ivermectin for COVID-19 treatment often cite "dozens" of studies that show benefits of ivermectin in combating COVID-19, but a closer look at the studies shows that some of them have been retracted for flawed or fabricated data and analysis, while many of the other solid randomized trials have shown no benefits. There have been some small studies that did suggest positive effects of ivermectin on treating COVID-19 patients, but no large, rigorous, randomized controlled trial has shown that ivermectin is effective at treating or preventing COVID-19, medical experts say.
Dr. David Fajgenbaum, assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine, told ABC News that the positive outcomes cited by proponents of ivermectin around the world can't be credited to ivermectin.
"In a disease like COVID-19, where the large majority of people -- whether they receive a treatment or not -- will improve, just giving someone a drug and then improving doesn't mean that the drug made them improve," Fajgenbaum said.
The general consensus in the medical community now is that there's not enough data to recommend ivermectin for use as a COVID-19 treatment, said Dr. Adrian Hernandez, professor of medicine and vice dean and executive director of Duke Clinical Research Institute, who is leading the largest ivermectin trial ever to see if three existing medications used for other conditions could help in the early treatment of COVID-19 patients outside of the hospital.
The nationwide study, which is randomized, has enrolled 3,000 patients so far and has plans to enroll 15,000 patients overall. To date, about 1,500 participants are being treated with ivermectin in the trial, with patients in all 50 states.
"Right now, there's not any suggestion of, does it do better than these other treatments that have proven evidence around it now?" Hernandez said. "Could it be an option in the future? That's what we're trying to understand."
Meanwhile, Fajgenbaum is leading a team of more than a dozen researchers tracking more than 600 drugs to identify the most promising ones that may be helpful for COVID-19 -- including ivermectin. So far, about 10 of them have shown potential for treating COVID-19, including paxlovid and remdesivir, which are already being used as part of coronavirus treatment.
Fajgenbaum's team has looked at the highest quality studies on ivermectin published so far, and he says the data shows the drug is unlikely to be widely helpful "for a large portion of patients."
Yet when asked if it's time to stop prescribing ivermectin since there are other therapeutics that have met the FDA's emergency use authorization threshold, McCullough instead told ABC News, "I think it is time to stop the vaccines," as he repeated false information about vaccine safety.
Federal data shows that unvaccinated Americans are 14 times more likely to die of COVID-19 than fully vaccinated Americans, and public health experts say that deaths and serious side effects from COVID-19 vaccines are extremely rare. Major health institutions have said the benefits of COVID-19 vaccination far outweigh the known and potential risks.
'I wish I had gotten the vaccine'
Phil Valentine, a Nashville-based conservative radio host, subscribed to the same thinking about ivermectin and COVID-19 vaccines as McCullough.
Valentine said that he was not going to get the vaccine because his chances of dying from the virus were "way less than one percent." In July, he posted on Facebook, "...you have a doctor on speed dial who will write you a prescription for ivermectin. Then you're ready to go."
Soon after, Valentine was diagnosed with the coronavirus and took ivermectin the following day. After taking ivermectin, he appeared to get better, according to his brother -- but then his condition worsened significantly and he was hospitalized.
He died in August from COVID-19 complications.
Phil Valentine's brother Mark told ABC News that even though ivermectin did not prevent his brother from dying, he still believes the drug was helpful. But Mark said his brother did regret not getting the vaccine.
While Phil was in the hospital, Mark says Phil told him that after he recovered from the virus, he would go on his radio show to encourage others to get vaccinated and be more "pro-vaccine."
"'I wish I had gotten the vaccine,'" Mark Valentine recalled his brother saying. "'I don't think I'd be here in this circumstance had I gotten the vaccine.'"
The brothers' reliance on ivermectin and initial dismissal of the COVID-19 vaccine isn't unique among conservatives. Over the past year, multiple studies have shown a strong correlation between political leanings and vaccination rates. And a new study conducted by the Harvard School of Public Health shows that heavily Republican-leaning counties are more likely to prescribe ivermectin and hydroxychloroquine than counties with lower Republican vote shares.
According to the study, prior to the pandemic, there was no difference in prescription volumes of new ivermectin prescription between counties with the highest Republican vote shares and counties with the lowest Republican vote shares. In December 2020, however, the prescribing of ivermectin was significantly higher in strongly Republican-leaning counties compared to counties with the lowest Republican-vote shares, the study showed. The observational study from Harvard does not reflect the political affiliations of individual physicians, pharmacists or patients prescribing or seeking ivermectin.
Seeing his brother get sick and die from the coronavirus shifted Mark Valentine, who was previously against getting vaccinated. He's now gotten his shots and is encouraging others to do so. He said that promoting vaccines in his conservative community isn't a common path -- but his brother's experience changed the views of many.
"It's gratifying to some extent because I can take you to about 12 houses in this neighborhood where people got vaccinated because of what happened to Phil," Mark Valentine said.
For Sawyer, seeing people like Phil Valentine fight for their lives or fall victim to the virus is "devastating."
"What we're seeing is the unnecessary suffering and death of people who were refusing to get the vaccines," Sawyer said.
"That's not just something we just shake off and walk away from," he said. "Especially when we know that it didn't need to happen."