• A G Parrish, M Blockman, K Cohen, H Dawood, R De Waal, A L Gray, T Kredo, T D Leong, J Nel, H Rees, and G Reubenson.
• Chair, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Department of Internal Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa; Frere and Cecilia Makiwane hospitals, East London, South Africa. andygp@mweb.co.za.
• S. Afr. Med. J. 2021 Aug 17; 111 (10): 934-937.

AbstractSome clinicians prescribe ivermectin for COVID-19 despite a lack of support from any credible South African professional body. They argue that when faced by clinical urgency, weak signals of efficacy should trigger action if harm is unlikely. Several recent reviews found an apparent mortality benefit by including studies at high risk of bias and with active rather than placebo controls. If these studies are discounted, the pooled mortality effect is no longer statistically significant, and evidence of benefit is very weak. Relying on this evidence could cause clinical harm if used to justify vaccine hesitancy. Clinicians remain responsible for ensuring that guidance they follow is both legitimate and reliable. In the ivermectin debate, evidence-based medicine (EBM) principles have largely been ignored under the guise thatin a pandemic the 'rules are different', probably to the detriment of vulnerable patients and certainly to the detriment of the profession's image. Medical schools and professional interest groups are responsible for transforming EBM from a taught but seldom-used tool into a process of lifelong learning, promoting a consistent call for evidence-based and unconflicted debate integral to clinical practice.

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