Stella Immanuel, MD, was the nation's top prescriber of hydroxychloroquine and ivermectin over the past 2 years, a MedPage Today analysis of prescription data has found.
In 2021, Immanuel wrote just over 69,000 prescriptions for hydroxychloroquine -- vastly above the average of 43 prescriptions in the database MedPage Today reviewed. Rheumatologists, who prescribe hydroxychloroquine for autoimmune diseases, wrote 561 hydroxychloroquine prescriptions, on average, that year.
Immanuel also wrote almost 32,000 prescriptions for ivermectin in 2021, well above the average of 15.
Although her prescribing declined in 2022, Immanuel remained the highest prescriber of both medications in the U.S. last year, writing 30,996 prescriptions for hydroxychloroquine and 16,085 prescriptions for ivermectin.
As for 2020, data were only available for the second half of the year, but for those 6 months, Immanuel was the highest prescriber of hydroxychloroquine and ivermectin, at nearly 10,000 and 1,500 ivermectin prescriptions, respectively.
The figures come from an analysis of data from Symphony Health, which tracks U.S. prescription data by analyzing claims from both commercial and federal sources.
While the database does not provide the specific indication for which the drugs were prescribed, sources believe that based on Immanuel's telemedicine operation, they were likely doled out for COVID-19 treatment and prevention.
"It verges on malpractice," Adrian Hernandez, MD, vice dean and executive director of the Duke Clinical Research Institute in Durham, North Carolina, said of Immanuel's prescribing practices. "Prescribing a drug that has zero benefits [in COVID-19], and potential harm, is not what we should be doing in medical practice."
Michael Abrams, MPH, PhD, a senior researcher at watchdog group Public Citizen, said the prescribing figures "seem excessive, and plausibly irresponsible."
The numbers "seem to point to substantial rogue and potentially dangerous prescribing of hydroxychloroquine and ivermectin as treatments or prophylactics for COVID," Abrams said.
Immanuel said in an email to MedPage Today that the prescriptions were written "both in clinic and under the umbrella of our telemedicine service and all the doctors working for me." She also stated that her "legal team will be contacting [MedPage Today] if there was any negative backlash as a result of this unnecessary disclosure of information."
Enabled Through Telemedicine?
It's unclear how, exactly, Immanuel achieved such a high volume of prescribing, but she does run a telemedicine operation through her website, DrStellaMD.com.
On its homepage, visitors can click a button to "register to get Hydroxychloroquine or Ivermectin via a telemedicine consultation with one of [sic] licensed physicians or nurse practitioners."
Once patients fill out the online request form, those seeking hydroxychloroquine or ivermectin as prophylaxis will receive a text message, phone call, or email depending on their medical history, the website states. Sick patients, however, require a phone call.
The website then offers something of a disclaimer: "Remember that these are controversial treatment protocols used off label so do your research before you sign up," it states.
Patients can choose from a list of options based on their condition: COVID treatment with symptoms, COVID prevention, drug refill, or general treatment. There's an option for new or existing patients.
When MedPage Today browsed the online clinic, a pop-up message stated that all prescriptions for hydroxychloroquine and ivermectin would be paid for on the website and shipped directly by mom-and-pop pharmacies, as mainstream pharmacies were pushing back on filling the scripts.
Abrams warned that online prescribers are "a general concern these days."
"Despite highly questionable diagnostic and treatment-plan quality, online prescribers are increasingly steering consumers to remedies that may be wrong or even dangerous," Abrams said.
In 2021, the House Select Subcommittee on the Coronavirus Crisis launched an investigation into another COVID-related telemedicine company, SpeakWithAnMD.com. The site was affiliated with America's Frontline Doctors, a controversial group whose founder, Simone Gold, MD, JD, served time in prison for storming the U.S. Capitol on Jan. 6, 2021.
The subcommittee accused the operation of profiting off of COVID-19 misinformation. A final report, however, was never issued, and is unlikely to come now that a new Congress is in session.
Dangerous Prescribing
During the pandemic, controversial groups touted hydroxychloroquine and ivermectin as "miracle" cures for COVID-19, even though study after study has consistently shown both to be ineffective for treating or protecting against the disease.
Hernandez, who was one of the principal investigators in the ACTIV-6 trial that examined repurposed medicines for COVID, said that while both hydroxychloroquine and ivermectin are relatively safe drugs, there's an "opportunity cost" to prescribing them for COVID patients.
Since safe and effective prophylactics such as vaccines and treatments such as antivirals exist, clinicians can harm patients by using these ineffective alternatives, Hernandez said.
Beyond a lack of efficacy and an opportunity cost, experts told MedPage Today that the volume of prescriptions Immanuel logged seems too high to afford quality care to patients.
Andrea Sikora, PharmD, associate professor of clinical and administrative pharmacy at the University of Georgia in Augusta, said it would be "difficult to know a patient well enough to make a nuanced decision about the risks and benefits of any prescription drug."
Information about a patient's medical history, their labs, or even their COVID test results may not be possible to obtain when prescribing at such a volume, Sikora said.
Medical Board Action
The Texas Medical Board previously took action against Immanuel for failing to provide informed consent to a patient who received a hydroxychloroquine prescription from her.
On Oct. 15, 2021, the board issued a "remedial plan" in which Immanuel was to submit her informed consent plan to the board for all off-label treatments she provides.
But on Jan. 4, 2022, the remedial plan was terminated "due to completion of all requirements," according to the website of the Texas Medical Board.
In addition to Texas, Immanuel holds active licenses in Arizona, Arkansas, Colorado, Connecticut, Kentucky, Louisiana, and Michigan. None of those states list the Texas action in their databases.
A Powerful Platform
Immanuel initially made headlines in July 2020 when she spoke at a rally held on the steps of the U.S. Supreme Court organized by America's Frontline Doctors. She claimed to have treated 350 patients with hydroxychloroquine at that point, and none had died.
Since then, Immanuel has ridden a wave of COVID-related infamy. In addition to telemedicine, her website includes a marketplace for supplements to fight against COVID and mpox, a place to click to "receive prayers for the jab," and bookings for a religious retreat at her Bethel Revival Ranch.
Immanuel also runs the Fire Power Ministries, which features her sermons on its Facebook page. She also runs a brick-and-mortar clinic, Rehoboth Medical Center, in Houston.
Immanuel was banned from Twitter during the pandemic, but after Elon Musk took over the platform and scrapped its COVID misinformation policy late last year, Twitter reinstated Immanuel's account.
"Finally my personal account is restored after two years being suspended for saying Hydroxychloroquine works," Immanuel tweeted in January. She added that she would continue to tweet from the account for Fire Power Ministries, which is verified on Twitter.
"Covid is completely treatable and preventable," Immanuel tweeted from her ministry account late last year. Adding that hydroxychloroquine and ivermectin work early, she encouraged patients to "get it in your medicine cabinet now" and "don't wait till you are sick."