Doctors don’t “decide to” do things like this. They ask you if you yourself would like to try a still-experimental intervention, and then they get you to sign a consent form. If you don’t want the drug then you say no. So no, there aren’t any ethical issues here.
Um … they can. Ordinarily. As long as they have some justification and (as above) they explain to you what their intentions are an seek informed consent.
Well, look. Kory and his team are asserting that this has been proven in multiple populations, and indeed is being recommended by various national authorities. So I dunno where you get “unproven” from. If you think Kory et al are lying through their teeth, then you (a) need to show some evidence and (b) you need to explain what on earth their motivation might be. Putting your career on the line for something that you believe in is very difficult. Doing the same thing for something that you know (in your heart of hearts) doesn’t even work would make you certifiably nuts.
What do you mean “probably?”. Kory and his team have established a useful dose at somewhat less than the antiparasitic dose. They suggest that the widespread use of ivermectin as an antiparasitic probably explains the extremely low number of cases/deaths in Africa.
EDIT: you’re right that they’re recommending high doses in critical cases. This doesn’t appear to be true for prophylaxis.
They were granted EUAs. They did some testing, but not the expected suite of testing. And the reality is that it was assumed a priori that they would be safe; no alternative treatments were even considered.
Perhaps you’re from a country where it isn’t true, but in most locations physicians are granted wide latitude for prescribing. The only difference with off-label prescription is that they expose themselves to a higher risk of lawsuits if there’s a problem, which means there’s a strong incentive to make sure of their facts.
Nobody is talking here about just giving out random pills to see what happens. The evidence of efficacy and safety is there. The conversation is about the deliberate restriction of ivermectin - telling patients that they cannot have it.
I think it’s also worth pointing out that an RCT can be designed to fail, either deliberately or inadvertently. Kory mentions the example of steroids in this regard.