- Coronavirus pandemic
image copyrightAssembleia Legislativa do RN/Divulgaçãoimage captionAlbert Dickson prescribes fake remedies for Covid in exchange for a subscription to his YouTube channel
A Brazilian state representative and doctor is trading social media subscriptions and likes for medicines that have not been proved to be safe or effective against Covid-19.
Brazil has been hit hard by Covid, and many people are looking for help. Dr Albert Dickson, an ophthalmologist in Brazil's north-east region, offers prospective patients "free medical consultations" as well as prescribing "prophylactic measures" against the virus.
The catch? You have to subscribe to his YouTube channel.
"How are you going to be entitled to the consultation? You will subscribe to our channel… You will make a screenshot and send it to my WhatsApp. When you send it, you will start to have access," he said in a video published on Facebook in March.
"The secret is to send the screenshot."
In addition to being an ophthalmologist, Dr Dickson is a Brazilian state representative from the minor Pros party, which supports President Jair Bolsonaro.
In his consultations, he prescribes drugs such as ivermectin. That's a treatment for lice and scabies which he and others say prevents Covid – but according to several leading health authorities, there's no evidence to back up those claims.
BBC News Brasil interviewed a number of patients who contacted Dr Dickson on WhatsApp, and each confirmed they received a stock response reiterating the process and encouraging them to follow him on Instagram.
We contacted Dr Dickson via email. He says he "suggests" signing up for his Instagram and YouTube channels because he puts "up-to-date research there and explains the disease in detail and our experience with it, in addition to answering questions live".
"It is not mandatory to subscribe to the channel to get a consultation," he says. "We just suggest it. Many don't comply and we continue to respond. The virtual consultation is free, I have never charged."
image copyrightYouTube/Reproduçãoimage captionDr Dickson and his wife celebrating when his YouTube channel reached 100,000 followers – it now has more than 200,000
Dr Dickson also said he was "above all a doctor" and said that the Federal Council of Medicine in Brazil, which regulates doctors, gives him the right to "medicate against Covid-19".
His YouTube channel has more than 200,000 subscribers. He has around 140,000 followers on two Instagram profiles, along with 50,000 on Facebook.
YouTube recently told BBC Brasil that, under a new rule, it had removed 12 of the doctor's videos for spreading medical disinformation, such as stating there is a guaranteed cure for Covid and recommending the use of ivermectin or another drug, hydroxychloroquine.
The channel itself was not taken down, however, because the videos had been published prior to 12 April, when the new rule came into force.
A spokesman for Facebook, which owns Instagram, said it "removes proven false claims about the disease". However, a claim by the doctor that ivermectin can prevent Covid was still live on Facebook at the time of publication of this story.
Dr Dickson is not the only Brazilian doctor who advocates drugs unproven to treat Covid or even proven to be ineffective against the virus.
Some call it "early treatment", and the drugs they prescribe include hydroxychloroquine, which has not been proven to be effective against Covid in several studies.
President Bolsonaro has hailed hydroxychloroquine, ivermectin and "early treatment" in public several times.
More than 439,000 people have died with Covid in Brazil.
image copyrightYouTube/Reproduçãoimage captionDr Dickson claims he treats 500 people a day
Dr Dickson told us via email that he's been an "advocate of 'early treatment' since the beginning of the pandemic" and said he would continue to suggest it.
His service appears to be very popular. In one of his videos, the doctor says he helps 500 people a day "from Sunday to Sunday, from 07:00 to 03:00 every day".
At a meeting in Brazil's Congress in July last year, Dickson said he had tended to "31,000 patients from all over the world" and had followed up by email with more than 6,000 others. Two had died, he said.
We asked the doctor how many people he had "treated" for Covid since the beginning of the pandemic, but he declined to give us a figure.
In May last year, Dr Dickson introduced two bills on "early treatment" at the Legislative Assembly of Rio Grande do Norte, where he is a representative.
One of the bills proposed the "free availability of drug kits with hydroxychloroquine, ivermectin and azithromycin drugs". The other bill proposed the distribution of these drugs by health insurance companies.
BBC News Brasil has seen three prescriptions sent by Dr Dickson. All three contain his signature and a religious expression ("God be exalted! Read the Bible").
One of Dickson's prescriptions for Covid lists ivermectin, but a cocktail of other drugs: azithromycin (an antibiotic), prednisone (a steroid), dutasteride (which treats prostate enlargement), spironolactone (a diuretic), bromhexine (used in cough syrup), apixaban (an anticoagulant), and vitamin D.
"There is no proof that any of this works against Covid," says André Bacchi, professor of pharmacology at the Federal University of Rondonópolis, who was shown the list by BBC Brasil.
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"The idea of 'supplementing', taking increased doses of various substances to give someone a 'superimmunity' is fallacious, and unfortunately it is widespread in general society as well as among specialists," Dr Bacchi says.
BBC News Brasil has spoken directly to a number of Dr Dickson's patients – one of whom has been taking ivermectin weekly since last year.
image copyrightGetty Imagesimage captionThere is no evidence that ivermectin can prevent or cure Covid-19Studies
Not only are there no robust studies that show the drugs recommended in Dr Dickson's prescription regime have any effect against Covid, Dr Bacchi says, but taking them pre-emptively could cause serious harm.
By taking an anticoagulant like apixaban, he says, "you put yourself at risk of unnecessary adverse effects, such as an increased risk of bleeding."
"It is not a medication to be used prophylactically for anyone," he says. "And corticosteroids such as prednisone taken in the early stages of the disease can actually decrease immunity."
Hydroxychloroquine, touted by both former US President Donald Trump and Brazilian President Jair Bolsonaro over the last year, has been shown to be ineffective against Covid. In March this year, a panel of international experts from the WHO made a "strong recommendation" not to use it in treating the disease.
The same is true of azithromycin. In December 2020, a large-scale randomised clinical trial found the antibiotic had no beneficial effect in patients hospitalised with Covid.
Some studies have shown an association between vitamin D and better Covid outcomes. But these studies only observed what happens to people with higher and lower levels of the vitamin, without controlling for other factors – the evidence is not yet definitive.
Sergio Rego is a physician, and professor of bioethics at the Fiocruz National School of Public Health. He says that doctors who prescribe "early treatment" can be held responsible for any adverse effects resulting from it.
A section of Brazilian law, Dr Rego says, forbids "exposing the life or health of others to direct and imminent danger", with a penalty of three months to one year in prison.
"The doctor has autonomy, but that does not exempt him from the consequences of his actions," says Dr Rego. "It is not a carte blanche."
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