The head doctor at an Arkansas jail has been treating inmates suffering from COVID-19 with ivermectin, a drug commonly used to treat parasites in animals. A version of the same drug has been approved by the FDA for topical diseases in humans, but warned against by the agency as completely unproven—and downright dangerous—in treating the coronavirus.

Still, the drug has been prematurely and widely hyped by conservatives and far-right types—some of whom oppose vaccines—as a sort of latter-day pandemic miracle drug. As The Daily Beast reported, this recently set off a wave of disturbing prescriptions and even calls to poison-control centers, in some cases over people who apparently took the “horse paste” version of the drug intended for animals.

Eva Madison, a justice of the peace in Washington County, told The Daily Beast she found out about the treatments of the inmates on Tuesday; they were first reported by the Northwest Arkansas Democrat Gazette.

According to Madison, a county employee had been sent to the jail to get a COVID test, which turned out to be negative. Nonetheless, Robert Karas, a doctor who has overseen treatment and testing of inmates throughout the pandemic, allegedly prescribed the employee 50 tablets of ivermectin, with a recommended dosage of 10 tablets per day. The pharmacy where the prescription was sent, Live + Well Pharmacy, confirmed to The Daily Beast that Karas has been filling out prescriptions there for ivermectin for both inmates and other patients.

Karas did not immediately respond to a request for comment for this story.

According to Madison, the county employee instead told his primary care physician about the prescription and his doctor told him to “throw it in the trash.”

Madison said she is concerned that the more than 600 inmates rotating in and out of the Washington County Detention Center don’t have the same ability to get a second opinion or question the treatment they’re given. “Our inmates do not have that choice,” she said.

Madison said she brought the issue up to Washington County Sheriff Tim Helder on Tuesday, who she said she’d always had a good relationship with. She expected Helder to handle the situation or at least express concern. But instead, she said, he defended Karas.

“I was shocked,” Madison told The Daily Beast.

A spokeswoman for Helder initially declined to answer questions about the treatment or when it began to be used on inmates. “Dr. Karas with Karas Correctional Health is the medical provider contracted to care for the needs of the detainees, so I will have to refer you to him,” she told The Daily Beast.

Later, the spokeswoman told The Daily Beast that Helder only learned about Karas treating inmates who had tested positive for COVID with ivermectin on Tuesday afternoon. The Democrat Gazette reported Helder was informed about the use of ivermectin on inmates in July by Karas, but the spokeswoman said that was incorrect.

Madison said she spoke to Karas directly about the treatment on Tuesday, but that the doctor seemed unmoved and told her that he and members of his family have been taking the treatment to prevent against COVID. When questioned about the fact that the FDA has been adamant in warning against the use of the drug for COVID treatment, she said Karas cited a National Institutes of Health study to make his case.

But when Madison said she pointed out that the NIH concluded in a February report that there was “insufficient evidence” to recommend for or against the use of the drug for COVID treatment, Karas cited a web page published by the Front Line COVID-19 Critical Care Alliance that purports to contain the “scientific rationale that justifies the use of ivermectin in COVID-19.”

According to The Scientist, the FLCCC wrote a paper arguing the benefits of ivermectin as a treatment that had been provisionally accepted and posted by the journal Frontiers in Pharmacology in January. However, by March, the paper was rejected and removed because editors found that it contained unsubstantiated claims. Nonetheless, the outlet reported, the paper had been widely viewed and shared by that point.

“So you take a website over the FDA?” Madison said of Karas’ defense. “It was just bizarre.”

Last week, the FDA tweeted out a page with information about ivermectin, mentioning that they had received multiple reports of patients requiring medical support and getting hospitalized after self-medicating with ivermectin intended for use on horses. The information they release said the drug, even when prescribed to humans to treat skin conditions or lice, is not an antiviral drug.

“Taking large doses of this drug is dangerous and can cause serious harm,” the FDA said.

At a county budget meeting on Tuesday evening, in which representatives from the Sheriff’s Office were requesting a larger budget for the next year—including a 10 percent increase in the budget for Karas and his staff to bring the total to over $1.5 million—Madison brought up the information she’d learned about the treatment.

But representatives from the Sheriff’s Office during the budget meeting defended Karas and his team, saying they’d been “fantastic” throughout the pandemic. Sheriff Helder later spoke to the board in their defense, too, calling them “amazing partners.”

“Whatever a doctor prescribes, that is not in my bailiwick,” he said, discussing the ivermectin treatments. “I haven’t been to medical school.”

Nonetheless, he said he believed that whatever Karas’ team had been doing was working. “As far as our morbidity rate,” he said, “it is zero.” He said that out of over 500 people infected in the detention center, only one was hospitalized for a brief stint. “I will stack their record against any medical provider in a correctional institution anywhere in the United States,” Helder added.

Clint Schnekloth, the pastor of Good Shepherd Lutheran Church, Fayetteville, said he learned about the treatments from his followers on Facebook who sent him screenshots of Karas allegedly defending the treatment. Schnekloth then posted the images on his page, he said, to expose the doctor.

According to the screenshots, Karas pushed back about the lack of studies showing the drug’s effectiveness: “I got experience and don’t really need more studies.” He also suggested that he may have treated as many as 350 patients at the jail with ivermectin.

Schnekloth said that although he believes taking ivermectin when it isn’t approved is “dumb,” he also believes people who aren’t in jail have the ability to make their own medical choices. But he said the one doctor prescribing experimental drugs to a jail population that doesn’t have those same liberties is entirely different.

“That starts to look like Tuskegee,” he said. “I have a lot of moral concerns about that.”

“He’s got all this control over people, unilaterally,” he said.

The pastor added that he’d be fine with inmates taking the treatment if they had access to other options, too, or if they’d requested it personally. “I don’t know that prisoners have that same ability to be informed. They probably feel some pressure.”

Anna Hively, a technician at the pharmacy in Lowell, Arkansas, told The Daily Beast Karas works closely with the pharmacy and confirmed that he sends prescriptions of ivermectin to be filled there.

“There’s no incentive or anything like that he gets from the prescriptions,” she said, adding that Karas’ prescriptions of ivermectin often vary depending on weight and whether someone has tested positive or not.

She also said he has been prescribing a “preventative” dose for people who are not COVID-19 positive.

Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University and the World Health Organization’s Collaborating Center on National and Global Health Law, told The Daily Beast he was alarmed by the treatments being prescribed.

“It’s very dangerous to treat somebody with a drug that isn’t approved for the use that you’re treating the person for,” he said. Since the pandemic began, Gostin said, the medical community has dealt with “bogus treatments” that have caused real harm and “raised false hopes” with no evidence that they’re effective.

But he said the use of ivermectin on inmates was particularly egregious and bordered on negligence. “Prisoners have no choice. They’re not free to choose their own doctors and make decisions about their own treatments,” he said.

Holly Dickson, executive director of the ACLU of Arkansas, called the treatment “medical experimentation” in a statement on Wednesday.

Dickson added that the use of the treatment by the detention center “illustrates the larger systemic problem of mistreatment of detainees and over incarceration in Arkansas that has persisted—even in the midst of a pandemic.”

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