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99% Invisible

Drug Story: Ivermectin

26 May 2026

Transcription

Chapter 1: What is the main topic discussed in this episode?

1.094 - 24.267 Roman Mars

This 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.

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24.247 - 47.301 Roman Mars

you could tell the story of the world through the drugs we take and the diseases they are designed to manage this is what the new podcast drug story is all about on the show creator and host thomas getz 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

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47.281 - 58.997 Roman Mars

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.

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Chapter 2: How does onchocerciasis affect communities?

59.258 - 68.11 Roman Mars

I've listened to every episode. Here's one of my favorites.

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68.13 - 96.087 Unknown

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, taken once or twice a year, helps stop transmission and protects entire communities.

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Chapter 3: What role does ivermectin play in treating river blindness?

96.218 - 106.75 Unknown

This is how itching stops. This is how blindness is prevented. And this is how a generation grows up free from river blindness.

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112.636 - 137.085 Thomas Goetz

Imagine that you are a worm. A very specific kind of worm, Uncocerca 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.

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137.105 - 164.501 Thomas Goetz

They curse you and your larvae, your larvae especially, because once they get into humans, they 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.

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165.682 - 193.419 Thomas Goetz

This pill, ivermectin, makes life very difficult for a parasite. Welcome to Drug Story. I'm Thomas Goetz. Today'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.

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194.68 - 215.68 Thomas Goetz

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 in 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.

220.148 - 229.802 Unknown

I 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 have too.

Chapter 4: How was ivermectin discovered and developed?

229.822 - 252.469 Unknown

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, 12 milligrams for seven days.

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252.569 - 257.156 Unknown

And the reason is all the literature that's coming out about ivermectin is an anti-cancer.

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257.176 - 270.878 Roman Mars

You know, if you have a hidden parasite and how do you get rid of it? I 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 fenbendazole.

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272.326 - 298.03 Thomas Goetz

So yeah, Google tells me that right now there are many tens of thousands of videos on YouTube raving about ivermectin. But 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.

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298.415 - 320.907 Thomas Goetz

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, but 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.

321.768 - 346.559 Thomas Goetz

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. We 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.

347.36 - 358.315 Thomas Goetz

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.

Chapter 5: What challenges did ivermectin face in gaining acceptance?

360.478 - 388.219 Thomas Goetz

Oftentimes, 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.

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388.239 - 414.504 Thomas Goetz

And 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. There are thousands, maybe millions of parasites on Earth. It just makes your skin crawl.

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414.524 - 438.597 Thomas Goetz

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.

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439.478 - 469.615 Thomas Goetz

There is no evidence that those cleanses work. If 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. Many of these parasitic diseases started in the tropics.

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470.084 - 495.248 Thomas Goetz

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.

495.987 - 521.1 Thomas Goetz

In fact, let'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.

521.553 - 541.818 Thomas Goetz

At the time, the study of parasites, this is called parasitology, this was a brand new field of medicine. Parasites, 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.

542.519 - 570.184 Thomas Goetz

So around 1900, Charles Stiles took a job as the chief zoologist for the U.S. Public Health Service. And 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.

571.746 - 602.454 Thomas Goetz

He took stool samples from everyone willing to let him. And soon he had definitively identified hookworms as a cause of widespread malaise. Based on his poop studies, he estimated that around 40% of Southerners, whites and blacks, almost always poor, they carried hookworms. He called these parasites Nekator americanus, which translates as American murderer. This was a misnomer, actually.

Chapter 6: How did ivermectin's use change during the COVID-19 pandemic?

620.908 - 649.409 Thomas Goetz

People pooped, well, wherever, in the woods, behind bushes. And most poor people went without shoes, children especially. It was just easier that 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.

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650.33 - 675.007 Thomas Goetz

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 and 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.

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676.288 - 695.588 Thomas Goetz

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 and grows to just half an inch long at most.

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696.479 - 720.583 Thomas Goetz

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. But 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.

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721.544 - 745.043 Thomas Goetz

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 Sanitary Congress in Washington, D.C., Charles Stiles announced his discovery.

745.683 - 770.621 Thomas Goetz

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.

771.282 - 799.458 Thomas Goetz

As 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. So Charles Stiles had found his cause. But what about the cure?

800.859 - 826.037 Thomas Goetz

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 for the fledgling U.S.

826.057 - 841.42 Thomas Goetz

Public Health Service or the growing nation. So Stiles started stumping and lecturing about what he thought should be done. He said, my hobby may be summarized in the two words, clean up.

Chapter 7: What evidence exists for ivermectin's effectiveness against COVID-19?

842.501 - 862.583 Thomas Goetz

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.

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863.305 - 886.208 Thomas Goetz

Rockefeller was interested in putting his wealth towards philanthropy, and Stiles' work fit 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. Stiles and the Rockefeller team identified three strategies to fight hookworm.

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886.576 - 908.397 Thomas Goetz

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.

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909.278 - 934.369 Thomas Goetz

One estimate at the time held that 35% of 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.

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934.99 - 959.175 Thomas Goetz

The hookworm campaign quickly took off. State 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 healthcare across the land.

960.758 - 988.875 Thomas Goetz

The Rockefeller Coalition framed this as a movement for the conservation of country life. But they were really demanding that people change how they lived, where they lived, what they wore, how they ate. Change was the only way to keep disease at bay. And many people did not like all that change. Enter the National League of Medical Freedom.

989.362 - 1016.01 Thomas Goetz

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. At first, it worked.

1016.598 - 1036.598 Thomas Goetz

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.

1042.231 - 1070.314 Thomas Goetz

That idea of defending medical freedoms against 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.

Chapter 8: What is the current status of ivermectin in medical practice?

1537.218 - 1563.402 Roman Mars

This is unfair. It's unfair to real parasites. To the innumerable and influential parasites from the world of nature. Your Majesties, Your Royal Highnesses, Your Excellencies, ladies and gentlemen, it is time for parasites to get a little more respect.

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1568.849 - 1586.039 Thomas Goetz

We could end our story here. A miracle drug, a Nobel Prize, millions of lives improved, billions of dollars earned. Somehow everyone is a winner. What a story. But that is not where this drug story ends. because here our story takes a turn.

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1586.28 - 1607.603 Unknown

Growing concern about a new and rare pneumonia-like virus that has caused at least two deaths and has spread from China to other countries in Asia. The Centers for Disease Control and Prevention has confirmed the first U.S. case has been detected in Washington state. This is truly an unprecedented situation. This virus doesn't discriminate. It attacks everyone.

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1607.924 - 1609.646 Unknown

I want every American to be prepared.

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1609.666 - 1617.672 Thomas Goetz

In late 2019, a new disease emerged, COVID. and suddenly ivermectin was front page news.

1617.922 - 1624.53 Roman Mars

I have today declared that the coronavirus presents a public health emergency in the United States. Public health emergency.

1624.67 - 1632.279 Unknown

A declaration of emergency. State of emergency. COVID-19 can be characterized as a pandemic.

1632.299 - 1635.443 Roman Mars

We will be suspending all travel from Europe.

1635.463 - 1644.874 Unknown

I am officially declaring a national emergency. It was quite crowded and we had to wait outside for about 20 minutes before they let us in. Jumping to March 16th.

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