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Complementary and Alternative Medicine

Association of County-Level Prescriptions for Hydroxychloroquine and Ivermectin With County-Level Political Voting Patterns in the 2020 US Presidential Election

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JAMA Internal Medicine

Published Online: February 18, 2022

Research Letter

Article Information and Disclosures

Michael L. Barnett, MD, MS^1,2,3;

Marema Gaye, MA¹;

Anupam B. Jena, MD, PhD⁴;

Ateev Mehrotra, MD, MPH^4,5

Author Affiliations

¹Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
²Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
³Department of Medicine, Harvard Medical School, Boston, Massachusetts
⁴Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
⁵OptumLabs Visiting Fellow, Eden Prairie, Minnesota

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Original Investigation

Efficacy of Ivermectin on Disease Progression in Patients With COVID-19

Steven Chee Loon Lim, MRCP; Chee Peng Hor, MSc; Kim Heng Tay, MRCP; Anilawati Mat Jelani, MMed; Wen Hao Tan, MMed; Hong Bee Ker, MRCP; Ting Soo Chow, MRCP; Masliza Zaid, MMed; Wee Kooi Cheah, MRCP; Han Hua Lim, MRCP; Khairil Erwan Khalid, MRCP; Joo Thye Cheng, MRCP; Hazfadzila Mohd Unit, MRCP; Noralfazita An, MMed; Azraai Bahari Nasruddin, MRCP; Lee Lee Low, MRCP; Song Weng Ryan Khoo, MRCP; Jia Hui Loh, MRCP; Nor Zaila Zaidan, MMed; Suhaila Ab Wahab, MMed; Li Herng Song, MD; Hui Moon Koh, MClinPharm; Teck Long King, BPharm; Nai Ming Lai, MRCPCH; Suresh Kumar Chidambaram, MRCP; Kalaiarasu M. Peariasamy, MSc; I-TECH Study Group; Wen Yea Hwong; Ee Vien Low; Mohan Dass Pathmanathan; Muhammad Luqman Hamzah; Yew Chung Chan; James Yau Hon Voo; Chun Fei Yap; Yon Quan Chan; Lee Kuen Vun; Kent Kian Keong Kong; Yi Fang Lim; Yee Jie Teoh; Ammar Rashidi Abdullah; Anitha Ramadas; Chee Loon Leong; Noor Hidayu Wahab; Nadiah Ismail; Ismaliza Ismail; Tung Meng Lee; Pei Jie Khoo; Sook Hui Phua; Prethivan Pillai Gopalakrishnan; Sangeetha Jaya Selan; Iswaran Ampalakan; Jen Fai Khuan; Wan Nur Farra’Ain Abdul Rashid; Siti Sha’ada Zakaria; Kalaiarasan Gemini; Haslina Burahan; Thaanveer Singh Santokh Singh; Noorfarzlina Jaafar; Nor Atikah Mohd Shukri; Syaza Izhar Hisham; Sheng Hao Teow; Chit Yeh Lim; Shageetha Rajantran; Siti Izzatul Annis Kamaruddin; Izarin Izmir Izhar; Nur Syuhada Mohd Mustapha; Zulkefli Mohamad; Seri Rabiatul Nur Abu Salim; Delarina Frimawati Othman Andu; Nurnadiah Kamarudin; Karamjit Kaur Sarban Singh; Eek Poei Tay; Siti Hir Huraizah Md Tahir; Shalini Vijayasingham; Yik Zhi Kum; Peter Andrew Natarajan; Yih Harng Soh; Syed Omar Farouk Syed Alwi; Hemaarubeni Murugan; Chuan Huan Chuah; Shin Wuei Tan; Kar Nim Leong; Peng Shyan Wong; Wendy Tyng Tyng Chen; Ru Shing Ng; Yen Li Lim; Farah Nadiah Bidin; Mann Leon Chin; Han Lin Guan; Mohd Hafiz Mohamad Rasli; Rafidah Abdullah; Mohd Akmal Jamaludin; Nabilah Mohd Shohaime; Syafiqah Mohd Mansor; Ruhaizad Rasliza; Lisa Mohamed Nor; Kah Mean Thong; Balasurindiran Muniandy; Pamela Varn Teing Saw; Kah Shuen Thong; Kee Cheong Wong; V. Rubini Nair Muthi; Qhairyl Iylman Ahmad Shanizza; Lavanya Jeevaraj; Ee Lin Chew; Poh Ching Huang; Jasmine Retnasamy; Philip Rajan Devesahayam ; Mei San Lim; Thilagavathi Thanusia Viswanathan; Muhammad Syafiq Mahamad Azazis; Gregory Domnic; Muhammad Fursanallah Tengku; Jeanette Qiu Yi Wong; Xin Hui Choo; Ambika Nair Prabhaharan; Nur Shakirah Zaharudin; Asma Usa’diyah Abu Bakar Sayuti; Nabilah Abdul Wahid; Nurul Hasanah Saat; Nurul Huda Othman; Aisyah Ahmad Zubaidi; Nurul Miza Shasheiha Abdul Mutalib; Viknesh Dev Lekh Raj Sharma; Daleni Gunaraj; Muhammad Na'imuddin'alim Hanafi; Nurul Atiqah Embok Ungah; Muhammad Ariffadilah Mohd Zahari; Chun Lian Chaw; Jennifer Arokisamy; Puteri Amira Mohd Hassan; Ainun Jariah Ayub; Azrin Nurfarahin Zainal Abidin; Khai Sin Choong; Lee Rhui Teoh; Huan Yean Kang; Kesavathy Krishnan; Peacchaima Purusothman; Mohamad Izwan Zainol; Mei Mei Tew; Mohd Fyzal Bahrudin; Kah Chuan Lim; Sharmila Mohd Nadzir; Lavanya Narayanan; Amira Naziffa Shamsuddin; Kok Tong Tan; Shaharudeen Kamaludeen ; Nur Munirah Ibrahim; Pearly Kim Aik Sim; Irdina Aminuddi ; Raja Nurulain Raja Nahar Putra; Lin Ye Yah; Boon Seng Liew; Tharmini Ravi; Syarifah Nurul Ain Syed Badaruddin; Nur Suriana Mah Hassan; Zulaika Roslan; Reshaini Nadarajan; Jian-Gang Ang; Minalosani Arumugam; Kin Wei Chua; Calvin Gim Seong Ooi; Siew Huang Lee; Way Ti Ooi; Xing Yi Tang; Kunaraj Perumalu; Muhammad Hazazi Razali; Mohamad Shamirul Afiq Murat; Nor Syahirah Hamdan; Muhammad Syafiq Hamidi; Amalina Anuar; Wei Chern Ang; Chee Kong Wong; Irma Liyana Mushaddik ; Shafarul Halimi Mohamed; Raja Ahmad Reza Raja Lope Ahmad; Wan Mohd Khairul Wan Zainudin; Ahmad Fikhri Mohd Zin; Sze Kye Teoh; Mohd Yusran Yusoff; Siti Norizan Abdul Rani; Mazilah Ab Rahman; Maizatul Akmal Mohd Noor; Tuan Norhafiza Tuan Mat; Mohd Khairi Othman; Mohammad Sayed Sahul Hamid Gani; Ching Zin Ngua; Andrew Kean Wei Chang; Zhun Han Wong; Andy Tze Yang Ko; Su Fui Thung; Xun Ting Tiong; Hock Hin Chua; Kiam Seong Goh; Shanthini Muthusamy; Wai Yang Loo; Thamarai Supramaniam; Rakesh Lingam; Logadharshini Chandra Kumar; Siew Theng Chun; Dariel R Selvarajah; Darshinnee Mohan Raja; One Ling Low; Prathiv Supparmaniam; Husna Ad Suhadak; Boon Cong Beh; Yi Lin Lee; Cheng Lee Ooi; Khairul Nisa' Ishak; Rozila Harun; Soon Leng Lee; Kok Soon Lee; Ji Ken Ow; Neerusha Kaisbain; Caryn Jia Wern Leong; Yun Lee Chee; Keng Long Teh; Kam Veng Chan; Kee Tat Lee; E Jinq Wong; Ibtisam Ismail; Mohd Azri Mohd Suan; Ahmad Lutfi Mohamed Yusoff; Tuan Muhd Fairuz Tuan Ismail @Tuan Manah; Khairul Azmi Ibrahim; Hazfadzila Mohd Unit; Norsima Nazifah Sidek; Noraini Seman

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Public opinion about the COVID-19 pandemic in the US is deeply divided by political affiliation,¹ including beliefs about the value of ineffective²^,3 COVID-19 treatments such as hydroxychloroquine sulfate, an antimalarial drug, and ivermectin, an antiparasitic drug. There is increased prescribing⁴ of these treatments despite evidence against their effectiveness. We hypothesized that the county-level volume of prescriptions for hydroxychloroquine and ivermectin—but not other, similar medications—would be associated with county-level political voting patterns in the 2020 US presidential election.

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Article Information

Accepted for Publication: January 21, 2022.

Published Online: February 18, 2022. doi:10.1001/jamainternmed.2022.0200

Corresponding Author: Michael L. Barnett, MD, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Kresge 411, Boston, MA 02115 (mbarnett@hsph.harvard.edu).

Author Contributions: Dr Barnett had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Barnett, Jena, Mehrotra.

Acquisition, analysis, or interpretation of data: Barnett, Gaye, Jena.

Drafting of the manuscript: Barnett, Gaye.

Critical revision of the manuscript for important intellectual content: Barnett, Jena, Mehrotra.

Statistical analysis: Barnett, Gaye, Jena.

Obtained funding: Mehrotra.

Administrative, technical, or material support: Mehrotra.

Supervision: Barnett, Jena.

Conflict of Interest Disclosures: Prof Jena reported receiving personal fees from Bioverativ, Merck, Janssen, Edwards Lifesciences, Novartis, Amgen, Eisai, Otsuka Pharmaceuticals, Vertex Pharmaceuticals, Celgene, Sanofi Aventis, Precision Health Economics (now PRECISIONheor), Analysis Group, and Doubleday and hosting the podcast Freakonomics, M.D. outside the submitted work. Dr Mehrotra reported receiving personal fees from Sanofi Aventis for consulting on telemedicine outside the submitted work. No other disclosures were reported.

References

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National Institutes of Health. COVID-19 treatment guidelines: ivermectin. Updated February 11, 2021. Accessed September 10, 2021. https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ivermectin/

Singh B , Ryan H , Kredo T , Chaplin M , Fletcher T . Chloroquine or hydroxychloroquine for prevention and treatment of COVID-19. Cochrane Database Syst Rev. 2021;2(2):CD013587. doi:10.1002/14651858.CD013587.pub2 PubMed Google Scholar

Geller AI , Lovegrove MC , Lind JN , Datta SD , Budnitz DS . Assessment of outpatient dispensing of products proposed for treatment or prevention of COVID-19 by US retail pharmacies during the pandemic. JAMA Intern Med. 2021;181(6):869-872. doi:10.1001/jamainternmed.2021.0299 PubMed Google Scholar Crossref

Caly L , Druce JD , Catton MG , Jans DA , Wagstaff KM . The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res. 2020;178:104787. doi:10.1016/j.antiviral.2020.104787 PubMed Google Scholar

Elgazzar A , Eltaweel A , Youssef SA , Hany B , Hafez M , Moussa H . Efficacy and safety of ivermectin for treatment and prophylaxis of COVID-19 pandemic. Research Square. Preprint posted online November 13, 2020. Retracted in: Research Square. July 14, 2021. doi:10.21203/rs.3.rs-100956/v4 Google Scholar

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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