Ivermectin advocates hate it when we say this, but it’s true. Ivermectin is the new hydroxychloroquine. It’s been promoted the same way and by the same people. The same conspiracy theories have sprung up around it as the scientific evidence supporting its use is weak at best, negative at worst. That’s why I’m going to go back to what I once wrote about hydroxychloroquine: "Because I’m dedicated to evidence and science when it comes to medical decision making, I always concede that it is still possible that hydroxychloroquine might still be found to have some anti-COVID-19 activity, although it’s becoming increasingly clear that, if there is any activity it will likely be very modest and require large clinical trials to detect, to the point where it’ll probably be clinically insignificant. That being said, it’s amazing how much believers in acupuncture, vitamin C to treat cancer, and hydroxychloroquine to treat COVID-19 have in common. It’s also distressing how much like the villain in a slasher flick the drug is. No matter how many times it appears to have died, it always comes back." Substitute the word “ivermectin” for every instance of “hydroxychloroquine,” and the paragraph above is still accurate. Again, I concede that it is possible that ivermectin has clinically relevant in vivo antiviral activity against SARS-CoV-2. Based on current evidence, however, it seems unlikely that it does, when pharmacokinetics considerations are taken into account. As I routinely used to say when discussing hydroxychloroquine, I’d be happy to change my mind if compelling scientific evidence for ivermectin were published. It’s just that neither of these reviews qualify, nor do any of the clinical trials I’ve seen thus far. That’s why I agree that ivermectin shouldn’t be used to treat COVID-19 outside of the context of a well-designed clinical trial with a strong scientific rationale. Certainly, the conspiracy mongering by Bret Weinstein, Pierre Kory, and their fans are not leading me to reconsider that opinion.