Doubt is crucial in science—in the version we call curiosity or healthy skepticism, it drives science forward—but it also makes science vulnerable to misrepresentation, because it is easy to take uncertainties out of context and create the impression that everything is unresolved. This was the tobacco industry's key insight: that you could use normal scientific uncertainty to undermine the status of actual scientific knowledge. Individual clinicians cannot single-handedly combat this kind of antiscience, a climate that has only been fostered by some political and religious leaders and by the social media. But at the very least, we can make our patients aware of the forces at play and the mind games that such merchants of doubt employ. - John D. Halamka, M.D., M.S.

1. STATE OF HAWAII DEPARTMENT OF HEALTH STATEMENT
ON THE PONO COALITION FOR INFORMED CONSENT
Posted on August 26, 2021
<https://health.hawaii.gov/news/newsroom/doh-statement-on-the-pono-coalition-for-informed-consent/>
Hawaii Department of Health Director DR. ELIZABETH CHAR, FACEP released the following
statement on the Pono Coalition for Informed Consent:
“This week, COVID-19 took the lives of 19 Hawaii residents. Over 9,000 of our family, friends, and
neighbors are sick with COVID. THE TRAGEDY OF THIS SPIKE IN CASES IS THAT BY AND
LARGE, IT'S PREVENTABLE. We have vaccines that will save the lives of Hawaii residents.
“We listen to all sides in public health. We believe in dialogue. But in this case, the science is clear.
More than 350 million doses of COVID-19 vaccines have been administered under the most intense safety
monitoring in U.S. history. The vaccine will protect you against severe illness, hospitalization and
death.
“The Pono Coalition for Informed Consent is spreading misinformation about these lifesaving
vaccines. This is dangerous. The Coalition proliferates misinformation about the severity of the
disease and the safety of the vaccines.
“I want to be clear—hydroxychloroquine and ivermectin should not be used to treat COVID-19.
Taking UNPRESCRIBED LARGE DOSES of ivermectin or doses intended for animals can cause
serious harm.
“We are in a crisis. COVID-19 will continue to take lives until we do the right thing and come together
behind vaccination. Those with questions about the safe and effective COVID-19 vaccines should seek
information from official sources like DOH or the U.S. Centers for Disease Control and Prevention.”
________________________________
PONO COALITION FOR INFORMED CONSENT advocates for true informed consent.
PONO COALITION FOR INFORMED CONSENT does not provide medical advice.
LORRIN PANG, MD, MPH, CO-CHAIR
INTERNATIONAL ADVISORY COUNCIL
PONO COALITION FOR INFORMED CONSENT
Lorrin Pang has served as Maui District Health Officer for the Hawaii State Department of
Health for over 20 years, during which time he was also a leading activist and scientific advisor
for the GMO Moratorium Citizens' Initiative. Before returning to Hawaii, he was an international
researcher for 20 years at the Walter Reed Army Institute of Research and the World Health
Organization, where he co-founded a training course for researchers from developing countries in
conducting clinical studies.
For the past several years, he has advised the U.S Congress Medical Research Program. A
Preventive Medicine Specialist and a leading voice for Hawaii's Public Health, he holds a B.A. in
Chemistry from Princeton University and earned his M.D. and M.P.H. (Master in Public Health)
from Tulane University. He has authored about six dozen peer-reviewed medical publications.

2. AS A PRIVATE CITIZEN, Lorrin serves as Co-Chair, International Advisory Council for Pono
Coalition for Informed Consent (DR. LORRIN PANG'S VIEWS DO NOT REPRESENT
THE HAWAII STATE DEPARTMENT OF HEALTH).
Source: Pono Coalition for Informed Consent <http://www.mauicenter.org/about.html>
__________________________
WHAT IS INFORMED CONSENT
Informed consent to medical treatment is fundamental in both ethics and law. Patients have the
right to receive information and ask questions about recommended treatments so that they can
make well-considered decisions about care. Successful communication in the patient-physician
relationship fosters trust and supports shared decision making.
Source
American Medical Association (2021)
AMA Principles of Medical Ethics: I, II, V, VIII
Informed Consent
<https://www.ama-assn.org/deliveringcare/ethics/informed-consent>
__________________________
DR. LIBBY CHAR
“I want to be clear—hydroxychloroquine and ivermectin SHOULD NOT be used to treat COVID-19.
Taking unprescribed large doses of ivermectin or doses intended for animals can cause serious harm”
__________________________
WHO ADVISES THAT IVERMECTIN ONLY BE USED TO TREAT COVID-19
WITHIN CLINICAL TRIALS
31 March 2021
<https://www.who.int/news-room/feature-stories/detail/who-advises-that-ivermectin-only-be-used-to-treat-covid-19-within-clinical-trials>
[Emphasis Supplied]
The current evidence on the use of ivermectin to treat COVID-19 patients is inconclusive.
Until more data is available, WHO recommends that the drug only be used within clinical trials.
This recommendation, which applies to patients with COVID-19 of any disease severity, is now
part of WHO's guidelines on COVID-19 treatments.
Ivermectin is a broad spectrum anti-parasitic agent, included in WHO essential medicines list for
several parasitic diseases. It is used in the treatment of onchocerciasis (river blindness),
strongyloidiasis and other diseases caused by soil transmitted helminthiasis. It is also used to treat
scabies. A guideline development group was convened in response to the increased international
attention on ivermectin as a potential treatment for COVID-19. This group is an independent,
international panel of experts, which includes clinical care experts in multiple specialties and also
include an ethicist and patient-partners. The group reviewed pooled data from 16 randomized
controlled trials (total enrolled 2407), including both inpatients and outpatients with COVID-19.
They determined that the evidence on whether ivermectin reduces mortality, need for mechanical
ventilation, need for hospital admission and time to clinical improvement in COVID-19 patients
is of “very low certainty,” due to the small sizes and methodological limitations of available trial
data, including small number of events.

3. Previous RECOMMENDATIONS on the use of therapeutics for COVID-19:
Strong recommendation for the use systemic corticosteroids for severe or critically ill COVID-19
patients; with a conditional recommendation against their use in patients with mild/moderate
COVID-19
Conditional recommendation against administering remdesivir in addition to usual care
Strong recommendation against the use of hydroxychloroquine or chloroquine for
treatment of COVID-19 of any severity
Strong recommendation against administering lopinavir/ritonavir for treatment of COVID-19 of
any severity
Conditional recommendation for the use of low dose anticoagulants in hospitalized patients (this
recommendation is part of the clinical management guidelines). We suggest the use of low dose
anticoagulants rather than higher doses, unless otherwise indicated.
The panel did not look at the use of ivermectin to PREVENT COVID-19, which is outside of scope of the
current guidelines.
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters#dexamethasone%3E
As the world responds to the COVID-19 pandemic, we face the challenge of an overabundance of
information related to the virus. Some of this information may be false and potentially harmful.
Inaccurate information spreads widely and at speed, making it more difficult for the public to
identify verified facts and advice from trusted sources, such as their local health authority or WHO.
However, everyone can help to stop the spread. If you see content online that you believe to be
false or misleading, you can report it to the hosting social media platform.
Facebook LinkedIn Instagram YouTube Twitter
WhatsApp TikTok Viber VK
<https://www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/how-to-report-misinformation-online>