is a letter received via e-mail from Michael W. Skoien, R.Ph., MBA, Senior Director of Marketing
for Merck & Co., Inc. directed to Deborah Z. Altschuler, NPA President, commenting on the use
of ivermectin (currently utilized in veterinary
medicine as a cow wormer and to combat the
disease know as River Blindness) for treatment of
head lice and scabies:
I am the director of the marketing Unit at
Merck [& Co., Inc.] who has U.S.
responsibility for marketing oral ivermectin,
brand name STROMECTOL.
We do not have an FDA approved indication for
the treatment of scabies or head lice. However,
as one of your links points out, health care
professionals have studied this product for use
in this area.
The Medical Letter and Dermatology
Times have recently commented on the
unapproved use of STROMECTOL for scabies and lice.
We do not advocate this use until such time as we
receive an approved indication. When customers
and consumers call for information, we send them
prescribing information, and refer them to
published articles in the medical literature if
it is germane to their request. (Most requests
are for use in scabies in immuno-compromised
patients such as HIV/AIDS patients who get
afflicted with scabies due to the Norwegian
scabies which I understand to be more difficult
We also explicitly state that STROMECTOL is
not approved for use in treating scabies and head
You have an informative and interesting site.
Altschuler responded as
Thank you for your
detailed message about ivermectin* and your well-taken
comments. We agree that it is premature to
suggest ivermectin at this time.
We are working to help
others "appreciate" the broader
implications of pediculosis -- and the urgent
need to establish a standardized public health
strategy. Otherwise, we risk taking what might be
a better and safer treatment and setting it up
for extinction through the predictable misuse
that will occur.
For the record -- the
NPA is not anti-chemical (as some might choose to
portray us), and the issues aren't just about
pesticides. They are about the children on the
receiving end of them. There are growing numbers
of children vulnerable to even the most
appropriately used chemical product.
Many children have
already had more than their fair share of
repeated head lice infestations, beds sprayed
with permethrin, flea bombs ("just to be
sure"). . . antibiotics for ear infections, Ritalin for attention problems -- and you know
We want to discourage
the "system" from painting this problem
with one big brush or one new pill. Each kid must
be looked at as an individual, bringing his or
her own unnatural history to the head lice
If Merck does have
something safer and more effective for lice in
the fast lane, we will be the first to sing its
praises. We will also be the first to promote its
prudent use. Anything less would underestimate
the ability of the head louse to zig when we zag.
As it is, we sit with a
population of children endemically infested with
a blood-obligate parasite that is winning.
Deborah Z. Altschuler
* The NPA also strongly
discourages the use of the antibiotic Bactrim for