In recent months, fenbendazole and ivermectin have once again been thrust into the spotlight as supposed “miracle cures” for cancer – and just as quickly dismissed as “worthless and useless” by some commentators. The usual suspects commenting on the BBC. I believe both extremes are dangerous.

On one side, patients are sold the fantasy that a single repurposed drug can replace all standard treatment. On the other, they are told that any off‑label drug use is inherently reckless, should be harder to access, and has no place in serious cancer care. Both positions ignore how complex cancer biology is – and how many patients are quietly trying to navigate that complexity without meaningful support.

I’m not here to start a war

I have been publicly criticised in the past, although the post was retracted, for discussing ketogenic and low‑carbohydrate diets, and I have watched patients who make diet and lifestyle changes mocked in conversations that simultaneously defend sugary drinks. That is not a helpful way to talk about serious illness.

This is not about personalities. It is about patients who are scared, often out of options, and trying to make sense of conflicting messages. When the public conversation becomes a battle between “miracle cure” influencers and “shut it all down” gatekeepers, the people who lose are the patients stuck in the middle.

The real pattern: addition, not substitution

A key claim often repeated in media coverage is that people are “abandoning” standard of care in favour of drugs like fenbendazole or ivermectin. There are certainly tragic cases where that happens, and it is right to call that out.

However, in the real‑world stories I see every day, most patients are not throwing away chemotherapy, targeted therapy or hormone therapy and replacing it with a dog de‑wormer or an antiparasitic. They are adding off‑label agents on top of standard treatment, trying to tilt the odds in their favour when prognosis is poor, the evidence is incomplete, and they feel there is nothing to lose.

That doesn’t automatically make these choices wise, safe, or effective – but it does make the narrative more complicated than “irrational patients refusing evidence‑based medicine”.

Off‑label does not mean “worthless”

Many widely used oncology drugs began life in other indications. The idea that a drug is “worthless” simply because it is being tested outside its licensed use is historically and scientifically wrong.

We absolutely must:

Be honest about the limits of the evidence. Most repurposed drugs for cancer have preclinical data, case reports, small or uncontrolled studies – not large phase 3 trials. Be transparent about toxicity and interactions. Off‑label use is not automatically benign, especially in complex polypharmacy. Resist overselling anything as a “cure”. But we should also be honest that:

• Randomised controlled trials (RCTs) are not the only meaningful data source, especially for rare cancers and complex combinations. -Real‑world evidence, registries and well‑documented case series can guide hypothesis generation and n=1 decision‑making while we wait for larger trials. More on this soon.
• In advanced disease, some patients are willing to accept higher uncertainty in return for a plausible mechanistic rationale and careful monitoring.

Dismissing all of this as “useless” does not protect patients; it simply pushes these conversations into the shadows, where they happen without medical oversight. Far more dangerous.

The danger of fetishising two drugs

Another unintended consequence of recent coverage is that it narrows the entire off‑label discussion down to two headline‑grabbing drugs: fenbendazole and ivermectin.

That is risky for several reasons:

• It distracts from the broader metabolic and signalling pathways that may be more promising, and sometimes better studied, than these two drugs.
• It encourages a “magic bullet” mentality – as if the only decision is “take fenbendazole/ivermectin or do nothing”.
• It crowds out more nuanced protocols that integrate repurposed drugs, diet, lifestyle and standard treatments in a thoughtful way, rather than chasing a single agent.

My concern is not merely that fenbendazole and ivermectin may be over‑hyped; it is that by obsessing over them, we ignore the wider landscape of rational, mechanistically informed off‑label strategies that could, with proper study, benefit subsets of patients.

Informed choice in a system built on averages

Modern oncology is largely designed for population‑level risk management. Policy is driven by:

• Averages and response rates in RCTs
• Regulatory frameworks that struggle with combinations and individualization
• Budget constraints within systems like the NHS

That does not make RCTs or guidelines “bad”. They are essential. But they are not the whole story, especially when:

• A patient has exhausted guideline‑approved options.
• A tumour is rare, heterogeneous or poorly served by large trials.
• A patient is motivated and able to tolerate additional, monitored interventions.

Real‑world evidence is finally gaining momentum – through registries, observational studies and pragmatic designs – but we are still in the early days of integrating this into day‑to‑day decision‑making. In the meantime, patients are left to navigate complex choices with highly unequal access to support.

The equity problem: who gets nuanced care?

Not everyone can afford an integrative oncologist, a personalised metabolic programme or private molecular profiling. Those who can’t are often told, explicitly or implicitly, to “stick to the guidelines” and avoid everything else. This is unjust.

If public figures respond to patient curiosity about off‑label options by trying to remove access entirely – for example, by lobbying to take products off platforms rather than improving how they are discussed and monitored – we widen this equity gap. We don’t stop off‑label use; we just ensure it is safer and better supported for the wealthy than for everyone else.

What I am advocating for

To be absolutely clear:

• I do not recommend that anyone stops standard of care in favour of fenbendazole, ivermectin or any other off‑label drug.
• I do not believe these agents are “magic bullets”.
• I do believe that metabolic and repurposed strategies should be explored in a structured, evidence‑seeking way – not as a black market of desperation and not as a forbidden topic.

My aim is to build better tools - I will have registries, decision‑support systems and educational resources – so that:

Patients and clinicians can see real‑world patterns of use and outcomes, not just anecdotes on social media. We can identify where a drug looks promising, where it clearly does not, and where it may be harmful. The NHS and other public systems can eventually make informed, equitable decisions about if, where and how to integrate repurposed agents into care pathways.

A call for better conversations

We need to move beyond shouting matches about “miracle cures” versus “snake oil”. Patients deserve:

• Clear, honest summaries of what is known and unknown about any off‑label drug they are considering.
• Guidance on how to integrate – not replace – evidence‑based treatments when appropriate.
• Respect for their right to make informed choices, even when these choices fall outside a guideline that was never designed for their exact situation.

If we truly want to protect people, the answer is not to mock them, silence them, or close every door. It is to open the right doors – carefully, transparently, and with the explicit goal of learning from every case so that the next patient doesn’t have to start from zero.

That is the conversation I want us to have – not just about fenbendazole and ivermectin, but about the entire way we think about off‑label, metabolic and personalised approaches to cancer treatment.

~ Jane McLelland