With the worst of the Covid nightmare hopefully in the rear-view mirror, there are lingering policy questions that will be addressed for years to come. One important issue surrounds who controls medicine that could be harmful or lifesaving — depending on whose opinion you get. During Covid, thousands of people with legal prescriptions found their medicine blocked by the local pharmacy. Today, we hear both sides in a debate over medical freedom.
In October of 2021, Bill Salier and his wife got seriously ill with Covid. When they couldn’t get treated quickly in person, they were among the millions who consulted a doctor online.
Salier: She told me that I was about to go critical, and she believed within 48 hours I would be headed to the hospital. And she thought at that point, I had a 50/50 shot of coming back out. But she also said, "That's the scary news. The good news is we can turn this around for you."
The doctor’s recommended treatment included steroids, Vitamin D, and ivermectin — an FDA-approved drug long used in people and even longer in animals to fight worms and parasites.
Salier: The ivermectin was the one that I think, combined with the steroids, was going to be kind of her punch on it. That's my thought.
Trying to find current drugs that may work on new viruses is a well-endorsed strategy, since it’s faster than inventing new medicines.
Just two months earlier, an analysis in the American Journal of Therapeutics looked at 15 studies and concluded that “ivermectin reduced the risk of [Covid] death” and “large reductions in COVID-19 deaths are possible using ivermectinThe apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the [Covid] pandemic globally.”
But the reviews and messaging on ivermectin were mixed. CDC issued a warning, saying the drug could make some people seriously ill and reported a rise in ivermectin calls to poison control centers. And there was a media campaign to discourage its use.
NBC: There’s a surge in demand for a drug that is often used to treat worms in animals as a false cure for Covid-19.
In the small town of Albert Lea, Minnesota, where the Saliers live, two pharmacies refused to fill the Saliers' ivermectin prescription. That included the local Walmart.
Sharyl: How did they tell you that? Was it the pharmacist himself on the phone?
Salier: Yes, it was. It was the pharmacist himself, and he talked to my wife because I was kind of incoherent. And I remember her walking into the bedroom, and she was so upset, and I heard her say, "You can't do that. You can't just not fill a prescription because you feel like you don't want to." And I could hear her responding to his answer of, "Yes I can, and I won't fill it." And she continued to try and argue the case, but it was, it was a losing case.
Pharmacists do have the right to use their professional discretion to turn away prescriptions.
But ivermectin proved more than a fringe hope promoted by a handful of doctors. According to CDC, by November of 2021, more than 377,000 people a month were being prescribed ivermectin, a 24-fold increase compared to before Covid. Nobody we spoke to could point to an instance prior to the pandemic where so many people were blocked from getting legally-prescribed medicine.
The mass refusals have sparked a national debate over patient rights and whether pharmacists should overrule a doctor’s judgement.
Salier: To have that denied, especially when our physician contacted them directly and said, "This is the correct prescription. This is the correct dosage. You need to fill this for my patient." And “no” was the answer. “I won't do this.” In fact, it even ended up with our doctor becoming more firm and saying, "No, you need to fill this." And the pharmacist at Walmart hung up on her.
Bill Salier says he turned to desperate measures.
Salier: Being a farm boy, I mean, I'd been around ivermectin all my life, and I'd been giving it to livestock for, oh gosh, since I was 10 years old. So we were very familiar with it.
He consulted their doctor and their veterinarian, translated the horse formulation into a human dosage, and...
Salier: We squirted horse paste into applesauce, and down the hatch it went.
Fortunately, Salier and his wife did not get sick after taking what they call "pony paste"— quite the opposite.
Salier: And astonishingly — now granted, yes, the steroids were in use and some of the other things too, but my wife only had the ivermectin. Four hours later she was turning around. Eight hours later, I walked out of the bedroom for the first time. And my children cheered. It was remarkable. I could tell I was winning.
Salier felt so strongly about his experience, he sued Walmart and the grocery store. The judge dismissed the case. Salier is appealing.
Salier: It was take the gamble or die. Which is the point of the lawsuit. They're putting us in a situation where were holding hands and praying and taking vet medication because they will not fulfill the prescription that the doctor writes. And then in my own way of thinking or pattern of thinking, essentially they're practicing medicine without a license. So they are not physicians. And to be able to step in and deny me the health care that my physician had prescribed, that's unethical. And to me, that just needed to be brought to a halt.
The judge who tossed out Salier’s claim said in part, “virtually every medical and governmental authority to address the issue has said that ivermectin and hydroxychloroquine should not be used to treat COVID19.”
Walmart declined our interview request but told Full Measure, “Our pharmacists have exercised their professional judgement and we stand behind them.” We asked if anyone from the federal government urged Walmart to reject the prescriptions. The company declined to answer, citing the ongoing case appeal.
Sharyl: Has something like this happened before on this scale?
Dr. Andrea Sikora: To my knowledge, no.
Andrea Sikora is a highly-credentialed intensive care pharmacist who says the unprecedented prescription rejections were proper.
Sikora: I think that there is sometimes a misconception that you're going to go in and get this prescription filled, and the pharmacist's job is really just to make sure that the correct pills are in the correct bottle, and they go to you.
Sharyl: That's what I thought.
Sikora: Yeah. But a key thing to understand is that a pharmacy is not like a waffle house. A pharmacist is not a short-order cook. So you don't just show up and say, "Hey, I want, you know, waffles and sausage." And then they give that to you. You actually have someone who's providing you a cognitive service as a medication expert.
Sharyl: It could be argued that the people who see their physician — that's a much closer relationship, in terms of what the physician knows about that patient's particular problems and needs, versus the pharmacist who fills the prescription. Why should the pharmacist be able to overrule what the doctor decided?
Sikora: I think it's a good point — but to realize that most providers get two or three semesters of drug training in their training, compared to four years in a doctor of pharmacy degree.
Many pharmacies did fill ivermectin prescriptions. One of them told Full Measure that he examined the many studies, believes ivermectin is effective against Covid, and that his own family has taken it.
Salier: But somebody had to step up to the fight.
Whichever way Salier’s appeal turns out, it’s clear the Covid experience has raised new conflicts over what some argue is a matter of safety, and Salier sees as restrictions on medical freedom that forced him to look for a miracle.
Salier: The pharmacies didn't exactly come through on that miracle, but that farm boy spirit did, and my wife and I did the pony paste, and I believe I am here because of that decision.
Sharyl (on-camera): We asked, but nobody from the government is tracking the number of people supposedly helped or hurt by ivermectin and other such therapies.