This is a strange paper, though it makes sense . But the rationale for publishing it seems to be to say: “See? The Republicans took the quack drugs.” That happens to be true, but how does documentation help public health? Well, the authors of this JAMA Internal Medicine paper give a reason at the end, but it’s hardly convincing.
The paper—rather, a “letter”—was meant to determine how prescriptions for various drugs, including the bogus Covid remedies hydroxyquinone and ivermectin—were correlated with both time and with the political sentiments of the region where the drug was prescribed. The patterns are interesting, but I suspect the authors (all from Harvard or affiliates) were Democrats and really wanted to show that quackery is higher among Republicans.
They did—at least after mid-2020.
The authors looked at prescriptions written under insurance for four drugs from January 2019 to Dec 2020. The drugs were, as I said, ivermectin and hydroxychloroquine, as well as as the two drugs specified below, which are in effect “control drugs” not used to treat (or rumored to treat) Covid-19. The sample size was huge: 18,555,844 adults, pretty evenly divided between men and women, with the mean overall age of 49.1
The hypothesis:
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.
What they’re trying to say is, “We hypothesized that Republicans fell for quack remedies more often than Democrats.” (I bet the authors are all Democrats.) And their hypothesis was confirmed, except for one brief span of time (see below).
The methods:
In this cross-sectional study, we used deidentified medical claims for all outpatient visits by adults aged 18 years or older in counties with 50 or more enrollees from January 2019 through December 2020 included in the OptumLabs Data Warehouse, which includes medical claims for commercial and Medicare Advantage enrollees, as well as US Census data and 2020 US presidential election results. The institutional review board at Harvard University deemed the study exempt from review and waived the requirement for informed consent because deidentified data were used. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
We divided the county-level Republican vote share in the 2020 presidential election into quartiles. We assessed county-level rates of new prescriptions for hydroxychloroquine and ivermectin (ie, patients with no fills for the medication in the previous 6 months) per 100 000 enrollees and 2 control medications, methotrexate sodium and albendazole (which have similar clinical applications as hydroxychloroquine or ivermectin, respectively, but are not proposed as COVID-19 treatments).
The four plots below show drug prescriptions throughout the survey region over two years. The first two show both methotrexate and hydroxychloroquine.
Plot A) shows total prescriptions, plot C) new prescriptions. In both graphs methotrexate (in orange) doesn’t change over time, while hydroxychloroquine (in green) spikes around April, 2020, and then goes down almost immediately, except for new prescriptions, which also shoot up around July of 2020, nearing election time (more on that later). The April spike for hydroxychloroquine presumably reflects the FDA’s allowing emergency use of hydroxycholoroquine for Covid-19 on April 3 and then revoking that usage on June 15. (I’d forgotten about that!)
Remember that there was a time when people thought hydroxychloroquine might be useful. The graph below is for ivermectin (green) versus Albendazole (orange). Total prescriptions on top, new prescriptions on the bottom. Prescrptions for Albendazole don’t change over the two years, but Ivermectin shoots up beginning in August, 2020, both in terms of general usage and new prescriptions. As we’ll see below, this reflects a general increase in Americans trying to get prescriptions for ivermectin, but most of the rise is due to Republicans seeking prescriptions.
The next four graphs show only new prescriptions for drugs, and this time there are four plots reflecting four levels of Republican voting by country in which prescriptions were written. Orange shows the highest quartile of counties (most Republican) and then in descending order light blue, gray, and green (most Democratic). During the two months of hydroxychloroquine being allowed (period between numbers 1 and 2 on the first graph), people of all political stripes got more prescriptions, but in fact the more Democratic counties got more prescriptions. This presumably reflects Democrats following health guidelines a bit more assiduously than Republicans, though the difference is tiny.
Towards election time, though, new prescriptions for hydroxychloroquine again rose steeply, though much more steeply for more Republican than for more Democratic counties (remember, these are quartiles for Republicanism, so blue, green, and grey lines don’t necessarily mean “Democratic-voting counties”).
Ivermectin doesn’t show the April-May spike that hydroxychloroquine does, as the government didn’t allow and then disallow ivermectin, but there’s a huge spike in new presciptions towards election time, again much more pronounced in the more Republican counties. Note that in the second graph, the numbers 1-4 correspond to different events that might cause more usage of ivermectin. I’ve put the ivermectin key in bold in the paragraph below:
Here’s what the numbers on the X-axis mean:
Arrows show key dates for hydroxychloroquine: (1) announcement of the US Food and Drug Administration’s emergency use authorization on March 28, 2020; and (2) revocation of the emergency use authorization on June 15, 2020. Key dates for ivermectin include: (1) the initial in vitro study claiming a potential antiviral effect of ivermectin5 on April 3, 2020; (2) the National Institutes of Health recommendation against ivermectin use2 on August 1, 2020; (3) release of a now-retracted manuscript preprint that described a clinical trial claiming 90% efficacy of ivermectin against COVID-196 on November 13, 2020; and (4) a widely publicized hearing of the US Senate Committee on Homeland Security and Governmental Affairs that included testimony by Pierre Kory, MD, of St Luke’s Aurora Medical Center, who promoted using ivermectin to treat COVID-19 on December 8, 2020. . . . . .
Not much going on with the two control drugs:
The conclusions. If you’re a Democrat, you’ll want to say that the Democrats were following the science (including the April-May spike in hydroxychloroquine use, since the government said it was okay), but the Republicans followed the rumors against the science, accounting for the higher number of new prescriptions at election time. But, as the authors emphasize, what we have here are correlations, not causations.
Why a spike around election time? The authors don’t really say, but i suppose one could theorize that Trump was whipping up Covid-19 sentiments with his pronouncements, making his people more liable to go for quack remedies. Note that the rise in all four quartiles doesn’t really imply that Democrats were taking more ivermectin around election time; the spike could be caused by prescriptions for Republicans in counties that were more likely to vote Democratic overall. I could dig deeper into that, but I don’t think the paper’s worth it. Here’s the authors’ brief discussion:
In late 2020, the number of new prescriptions for hydroxychloroquine and ivermectin was higher in counties with higher Republican vote share, whereas in early 2020, before revocation of the Food and Drug Administration’s emergency use authorization, prescribing volume for hydroxychloroquine was higher in counties with a lower Republican (ie, higher Democrat) vote share. These findings were absent before the COVID-19 pandemic and for 2 control drugs.
This study has limitations. In an observational study, we could not address the causality of the association between county-level political voting patterns and prescribing of 2 ineffective COVID-19 treatments. Also, we were unable to assess the specific contribution of patient, physician, or other factors to the prescribing patterns.
These limitations notwithstanding, our findings are consistent with the hypothesis that US prescribing of hydroxychloroquine and ivermectin during the COVID-19 pandemic may have been influenced by political affiliation. Because political affiliation should not be a factor in clinical treatment decisions, our findings raise concerns for public trust in a nonpartisan health care system.
Here’s what I think the authors are saying, translated into normal language:
We found what we thought: Democrats follow the science and Republicans follow rumors and conspiracy theories. This raises concern for the American system because it shows that the damn Republicans endanger everybody by mistrusting the government.
Now of course I’m a Democrat and have exaggerated the “translation”. But if you read the paper, don’t you think this is what the authors really want to say?
It would be interesting to do a study on, say, the proposition: “A person’s intelligence and personality is strongly influenced by their genes”. I’m willing to bet that such a study would find rampant science-denialism among Democrat voters, and much less so among Republicans.
I was thinking of a study on prescribing puberty blockers and hormones for transitioning.
How many sexes are there? What is a woman? Good questions that quite a few Democrat voters would pretend not to know the answer to.
What is a woman?
Republicans have the answer.
We are vessels (a polite euphemism for livestock).
Is it better to not be sure, or is it better to be absolutely sure?
L
Linda, all Republicans? Even my sister, who raised her kids as a single working mother and who ended up as one of the owners of a small profit sharing construction company after working her a** off for many years? I don’t think she would consider herself a mere vessel. And it saddens me that someone would characterize her as thinking that way.
I took Linda’s comment to be addressing the Republican Party’s position on women’s reproductive rights — viz. that women shouldn’t have any. (Of the 261-member Republican delegation on Capitol Hill, to my knowledge there are precisely three, all women US senators, who are even remotely pro-choice.)
I don’t think Linda meant to imply that all registered Republicans are bad people.
I see it took but one comment to bring out the false equivalencies.
Care to point to anything among the Democrats remotely resembling Birtherism or Pizzagate, QAnon or The Big Lie that Donald Trump was denied a second term by massive voting fraud? The Democrats are far, far from perfect, but there’s but one of the two major US political parties that’s gone in whole-elephant on the paranoid style in American politics.
And there’s but one US political party in which the mainstream is willing to call out its own extremists. Among Republicans that’ll get you drummed out of the GOP. Ask Liz Cheney or Adam Kinzinger or Justin Amash.
I like a challenge, so here goes. 🙂 On “remotely resembling Birtherism or Pizzagate, QAnon or The Big Lie”, how about:
* “Defund the police” and the narrative that the police are killing blacks in wildly disproportionate numbers. (The truth being that ratios are pretty much in-line with crime rates; and the likelihood of an unarmed black person who cooperates and does not resist arrest then being killed is as near zero as makes little difference.)
* The Portland CHAZ and the instructions to police not to intervene.
* San Francisco: spending $100,000 per year per homeless person to support the lifestyle of unemployable drug addicts living homeless in public squares.
* The idea that the only allowable explanation for group-outcome differences is “systemic racism”.
* Advocacy of open borders.
* And, lastly, the counterpart of “massive voting fraud” would be “election lost owing to massive Russian interference”.
As Ken pointed out, none of these are part of the Democratic Party platform. The Dems have not ceded control of their party to the radical fringe, unlike the R’s who have done so.
That’s right, nothing Coel points to is part of the Democratic Party platform (though there does exist overwhelming evidence of Russian interference in the 2016 election; he should actually read the Mueller report and the Republican-led senate intelligence committee report.)
And as for the Republican Party platform? For the first time in its history, it hasn’t one. At its 2020 national convention, it simply declared “Donald Trump über alles.”
Yes, I chuckled at the irony that Coel was using more false equivalencies to counter your charge of false equivalencies.
Well I don’t think that (e.g.) QAnon and ivermectin are official Republican policies, so I’m not sure why these equivalencies are false.
Tough to say, since (as observed above) the GOP no longer bothers with an official party platform (heretofore the sine qua non of major US political parties).
Aside from the three third rails of Republican politics (which is to say, you touch ’em, you die) — guns, god, and controlling women’s uteri — what constitutes official Republican policy on any given day depends (much like the valuation of the assets of the Trump Organization) on Donald Trump’s mood.
Wow, conservative talking points. I expect there’ll be plenty of blowback here, but the one concerning me is your implication there’s no systemic racism. I suppose your next going to say white privilege doesn’t exist. I recommend you watch the movie Colin in Black and White. A woman friend of color (I’m of Northern European descent) has opened my eyes to what she and her family have had to deal with all their lives. She does agree that white people should leave it alone. Bringing up these issues is like trying to get rid of a hornet’s nest by beating it with a stick, serving only to produce a swarm of vicious white supremacy.
“Anyone-sensible talking points”, if you ask me. And rejecting the idea that the only allowable explanation for group-outcome differences is “systemic racism” is not the same as saying that there is no systemic racism at all.
But, I am indeed of the Glenn Loury school that says that, today, “systemic racism” is at historically low levels and that nowadays other factors are much more important in group-outcome differences.
“Conservative talking points” is just a leftist shibboleth, usually preceded, as here, by “Wow”, for extra gravitas. It means, loosely, to the extent that it means anything at all, that these are ideas that the Elect have closed their minds to and no longer need to think about. Instead they devote their energies to silencing people who express them. There is a self-delusion that no one actually believes these ideas, just because The Elect do not, and anyone who does express them is doing so dishonestly, for some dark nefarious purpose. The Canadian Prime Minister is an accomplished practitioner, as are any Ministers he allows to speak.
Left-wing ideas can never, by definition, be talking points. Partly because conservatives don’t say “Wow” in argument.
One source of differential outcome due to systemic racism is generational accumulation of wealth. Contemporary data exists to support the experience of a young woman of color who found that she could increase the valuation of her property by 30% after having a white friend pretend to be the owner. Banks discount Black property making wealth accumulation through property, something available to white people, very difficult.
Things may be better for people of color, but my friend, a woman of color, assures me she continues every day to have to deal with white micro-aggressions.
I’m willing to bet that the valuation of the WOC’s property plummeted a lot more than 30% when the bank found out she had defrauded it by listing someone as an owner on a legal document who really wasn’t. The do-gooder white co-conspirator would have some ‘splaining to do, too.
Sometimes there are reasons unrelated to skin colour why people are unable to accumulate wealth. Misrepresentation and fraud are two of them. A chip on one’s shoulder about micro-aggressions would be a third.
White people are incessantly reminding people of color that they aren’t white. Of course, not always with overt intention, but nevertheless telling them whiteness is a club they’ll never be allowed to join.
Regarding property appraisals, the real fraud are the racist appraisals. Attention is being brought to it by research and hopefully at least reduced. Black Americans have to deal with systemic racism all the time, but progress in eliminating it is being defeated by the indifference of white Americans to the problem.
Banks have no motive to pass up a chance to do business with a good customer. They have every motive to avoid doing business with a bad customer. If the bank knows by history that Black borrowers are, on average, more likely to default than white borrowers, that goes into the process of estimating credit-worthiness and it will downgrade the securing asset in order to minimize the size of the loan at risk. If the bank believes that Black and white borrowers are equally unlikely to default, there is no reason for it to downgrade either borrower’s asset values. It would like all borrowers to borrow as much as they can service. That, plus avoiding making bad loans, is how banks make money.
You may think this is ugly and racist. The bank’s shareholders do not; they call it loss-prevention. No one has a civil right to borrow money at terms they like.
This would be okay if banks actually were responding to their bottom line, but what is really happening is they can discount property of black people, and then sell at a greater profit to white people. Racism is making them money.
Okay, what they’re really doing is supporting a secondary market, Black property, with a lower valuation where Black people buy and sell property.
It’s still racist.
I think you mean Seattle, not Portland.
sub.
Ken, Politico has posted an excellent article on Mike Pence and January 6th. His role in preserving our Republic will someday be celebrated, but perhaps not immediately by the branch of the Republicans who believe the Big Lie.
It is a sad indictment of US politics that supporting a ‘peaceful’ transfer of power is something to be ‘celebrated’. It used to be expected, like a lot of things (such as competence)…
Republicans are wrong in their own way – they think whites are genetically superior. And of course when you think of the whole rest of science, it’s the Rs that are pathetic.
Curt, please share your evidence. Thank you.
Oh for crying out loud–you think ALL Republicans are white supremacists? That’s ludicrous. Either cite your evidence or stop posting this garbage here.
I think the entire study is just strange and a great waste of time. Why go to all this trouble studying a couple of items on the virus. It is pure politics. Most people with half a brain who follow credible news (not Fox or Facebook) would know all they need to know about Trump and the republicans. They would never vote them into any office of responsibility. They are racist, they care nothing for our democratic system, they care nothing about helping the people and families of this country, they care only about enriching one family named Trump.
We already know that U.S Counties voting for Trump have a greater Covid-19 death toll.
https://medium.com/@The_Last_Age/exploding-delta-wave-mostly-trump-voters-3a88f592909c
Speculation about an explanation is all we have. Perhaps this JAMA article could spur some better investigation.
My thought is that this instance of partisan way-of-knowing will be taught in Public Health and Health Policy curricula for generations. And almost certainly ‘accepted facts’ will be questioned. I think we owe it to the future to document the patterns of belief and persuasion, and I put studies like this one in that light
I don’t see a problem with the study. It was to test a hypothesis, and found some data to support it. Is it that you think the hypothesis was cynical or politically tainted? Wouldn’t that be a good reason to test it?
There isn’t a problem with the study or the data that I can see. The issue for me is that a. it’s bloody obvious and b. pretending this is going to help public health is a bogus justification for the study.
Dang. A lot of anger and judgment in here. Regardless of whether one’s statement or insight is correct or not, adding an ‘all republicans are dumb racists’ component seems rather Low Road (at best).
I think there could be a more interesting conversation that goes deeper into why these different trends occur within political parties without just stopping at ‘they are stupid.’
Of note, it could just be my perception, but I’m often left with the sense that democrats exhibit this high degree of (ruinous) empathy for the down trodden in society. Though when it comes to ‘republicans’ they’re beyond the pal and just stupid racists, etc. What’s up with that? No thoughtful insights about the ‘unfortunate mix of bad luck, genes, etc?’
My observations would tell me that this general scorn (and hypocrisy) from ‘liberals’ towards the ‘conservatives’ likely causes much of the distrust of science and institutions seen with conservatives.
If liberals really thought they had the wisdom and vision of what would make the world the best it could be, seems to me that they’d have a leadership responsibility to take extreme ownership of helping to educate and improve others, lifting people up rather than break people down.
But yes, please, let’s keep banging on about how urbanites are more educated and follow the science whereas their rural counterparts are a bunch of dummies. That’ll show ‘em!
(Crap – this is the first time I’ve posted in a comments section on the internet in a long long time and I’m likely about to find out why I stopped. Haha. Love WEIT and you guys. Cheers!)
The only thing I can gather from your comments is you do not keep up with events. Let’s just mention one issue – republicans are racist. You give me some evidence they are not. From the Supreme court down to the individual red states they reek of racism with their voter suppression. They are racing backwards to jim crow. And then tell me about all they are doing for democracy. All they are doing for women’s rights. Name them.
“If liberals really thought they had the wisdom and vision of what would make the world the best it could be, seems to me that they’d have a leadership responsibility to take extreme ownership of helping to educate and improve others, lifting people up rather than break people down.”
I think a big part of the problem here is that a lot of the problems that we face as a nation, and as citizens of the planet are complex and involve tradeoffs. The wisdom and vision vary with the emphasis of particular subgroups.
Conservatives always have The Answer, because they think in binary absolutes. It’s easier to spread lies than to confront complex realities that may need endless adjustment.
As an example: When COVID first hit our country, we were confronted with a situation where economic growth and public health were directly at odds. Our president at the time was someone for whom money was the only thing that mattered, plus he “didn’t want to scare people”. So, denial was the strategy.
It might have been a lot more effective to opt for an extreme public health strategy, or possibly some mix of a balance between closures and distancing that could be evaluated in an ongoing way.
But when you are mired in dichotomous black-and-white thinking, complexity is the last thing you want to confront.
So, it’s a lot easier to say, “All Democrats should be shot” than it is to look at people who might have different opinions from yours as not-monolithic.
Doubts can be crippling. Certainty, not so much, but if your certainty is wrong, then what?
L
“If liberals really thought they had the wisdom and vision of what would make the world the best it could be, seems to me that they’d have a leadership responsibility to take extreme ownership of helping to educate and improve others, lifting people up rather than break people down.”
That would be (among others) the infrastructure bill and Build Back Better, plus the two Voting Rights bills. Since only the infrastructure bill has passed, I can’t speak for the “wisdom or vision of what would make the world the best it could be”, but at least the Dems have a plan and a platform and are trying to lift people up. The GOP has no plans or platforms to lift people up (except tax cuts for the rich and constant implementation of their failed, decades-old “theory” of trickle-down economics). At the moment, the vast majority in the GOP follow corrupt Trumpism, and that’s about it. Trumpism is a grave danger to America and the world, and I assume I don’t have to explain why? in any detail.
Please stay Michael. This is a great group of posters but, as is true of anyone or group, it has its blind spots and benefits from well argued points free of animus.
The study could certainly be interpreted in the manner proposed by our host. Personally, I take the researchers at their word that the study shows politics interfering with science-based health care decisions, not on the relative susceptibility to quack recommendations.
Could it be that the majority of people trust their leaders and during this fractious period each party’s members do not accept leaders of the opposing party as their leaders?
I think you nailed it with the trust angle.
If leadership (be it of a public business, government, etc) focuses more on Conformity and how people are wrong, rather than focusing on creating Clarity and what’s working, you will drive a depressed culture climate rather than a productive high achievement climate.
So very interesting. Both sides accuse the other of “not following the science” and both sides say that “science” is strongly on their side.
The results of this study do not surprise me in the least. Interestingly, since the findings are based on new prescriptions, they are skewed low (at least for ivermectin) but understandably some objective way of measuring was necessary. The actual use of ivermectin is even higher than that! Here in Idaho, many people get their ivermectin at the feed store. Neigh, you say?
It would be interesting to compare the political alignment of districts with the sales frequencies of quack brain boosters, such as Neuriva, Prevagen, or omega-whatever-it-is. Old joke: a disappointed consumer (a Democrat or Republican?) complains that 3 months on one of these elixirs hasn’t helped his thinking detectably; to which the seller replies, “See, you are smarter already.”