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Comment by CiceroCiceronis | Hacker News Reader

A recently released meta—analysis from the British Medical Journal suggests that the evidence base for ivermectin’s efficacy in treating COVID-19 is low.

https://ebm.bmj.com/content/early/2021/05/26/bmjebm-2021-111...

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If you'll look carefully, you'll see that's a non peer-reviewed opinion piece.

That's a prime example of disinformation, and indeed the most reputable journals unfortunately play a role in it.

Just to rebut the first thing random thing I saw:

"An important controversial point to consider in any rationale is the 5 µM required concentration to reach the anti-SARS-CoV-2 action of ivermectin observed in vitro,17 which is much higher than 0.28 µM, the maximum reported plasma concentration achieved in vivo with a dose of approximately 1700 µg/kg (about nine times the FDA-approved dosification)"

They are bringing up the in-vitro studies initially done on monkey kidney cells, and then claiming that you'll need such a high dose in a clinical setting. The doses for prophylactic and early treatment are an order of magnitude lower (0.2mg/kg) [1], and in that dose it's safer than paracetamol.

"Ivermectin was generally well tolerated, with no indication of associated CNS toxicity for doses up to 10 times the highest FDA-approved dose of 0.2mg/kg." [2]

In my second link, there's a talk rebutting the in-vitro safety concerns in detail: [3]

There are over 50 studies showing that Ivermectin is effective, and more are coming in every day. [4]

1. https://covid19criticalcare.com/covid-19-protocols/i-mask-pl...

2. https://pubmed.ncbi.nlm.nih.gov/12362927/

3. https://player.vimeo.com/video/554350476?autoplay=1#t=4702

4. https://c19ivermectin.com/

> That's a prime example of disinformation, and indeed the most reputable journals unfortunately play a role in it.

I'm going to trust an opinion in the BMJ over:

> There are over 50 studies showing that Ivermectin is effective

There have been a vast number of junk studies produced during the pandemic and rolling out 50 of them means very little. How many of them are pre-registered RCTs? How many of them are in low-quality journals?

The BMJ article actually refers to that https://c19ivermectin.com/ site:

"Different websites (such as https://ivmmeta.com/, https://c19ivermectin.com/, https://tratamientotemprano.org/estudios-ivermectina/, among others) have conducted meta-analyses with ivermectin studies, showing unpublished colourful forest plots which rapidly gained public acknowledgement and were disseminated via social media, without following any methodological or report guidelines. These websites do not include protocol registration with methods, search strategies, inclusion criteria, quality assessment of the included studies nor the certainty of the evidence of the pooled estimates. Prospective registration of systematic reviews with or without meta-analysis protocols is a key feature for providing transparency in the review process and ensuring protection against reporting biases, by revealing differences between the methods or outcomes reported in the published review and those planned in the registered protocol."

> I'm going to trust an opinion in the BMJ over:

If that opinion contains patently false information and assumptions (e.g. early in-vitro study needed a high dose, therefore that same dose must be required in clinical patients), then that opinion is not trustworthy, regardless of whether it's on the BMJ website or not.

See also here [1] under the "Big Science" heading, why the current system is broken.

1. https://covid19criticalcare.com/videos-and-press/flccc-relea...

To be fair the c19ivermectin site only states: Database of all ivermectin COVID-19 studies. If you want a meta-analysis that picks for you the quality studies from that list that's also avilable: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088823/

Notice how if the same censorship rules were applied here, this entire conversation would be disallowed, and no learning on the topic could take place.

This is kind of doing the same thing that the “fact checkers” are doing. There is indeed a lack of proper studies to validate it. That’s the problem. There are mountains of evidence that show it as very promising and worthy of a proper study. That’s what people are asking for. The FDA keeps saying not to use it, because we don’t know for certain that it works, because we haven’t had any rigorous RCTs to validate it, even though it appears by all accounts to be an extremely valuable tool. They don’t claim that it doesn’t work. They don’t claim that it’s harmful (we know it’s not, it’s been broadly deployed for like 30 years and is known to be far safer than the vaccines, which are already quite safe, at least in the short to medium term). Also, this article is misinformed on the dosage requirement, which has been raised and addressed - looks like sibling comment called this out as well. See, it’s clear who actually follows the science, and who disregards the science but brow beats others with phrases like “follow the science.” Other things known to people following the science? Schools are safe to open and masks don’t do shit outdoors because the probability of infection is < 0.1%. Many of us knew this was the latest science long ago, but again, we weren’t allowed to talk about it, lest someone call us the R word (republican).

To not drop everything and study this aggressively is criminally negligent imo. I believe I read that we have finally decided to fund looking into validating what appears to be strong evidence. But it’s 30 years old, dirt cheap, and not patented. And all of this only came to light well after we sunk billions into vaccines. So, there is not exactly a profit motive or a strong appetite to potentially upend all of that. But if people unwilling to be vaccinated are willing to take that instead, it might be the only hope for herd immunity. Because there is no way we will get there by vaccines alone. Too much of the population are refusing the vaccines.

The FDA doesn't tell people what to research, it tells the public what existing research confirms is safe to use.

If a bunch of scientists think iverwhatever is viable they can do a proper study on it and get it published and peer reviewed.

To "drop everything" would be criminally negligent, there's lots of things that can and should be researched in parallel.

Part of the problem that there is censorship on publishing in the big journals.

That said, there are published RCT showing Ivermectin effectiveness.

In my second link on my first comment, there's a talk about the overwhelming data, censorship and hindrances for publishing.

Sharing evidence on Ivermectin - Dr. Tess Lawrie

https://player.vimeo.com/video/554350476?autoplay=1#t=5756

Effectiveness is not the only criteria that experts need to evaluate for treatments. Ivermectin is fairly easy to overdose on, and people started self-treating prophylactically because it was easy to find from veterinary supply chains.

The majority of available Ivermectin also contained inactive ingredients that had no been safety tested on humans, again because of its primary veterinary uses.

WHO looked at these facts and data from 16 trials that yielded “very low certainty" of efficacy before recommending against its use, but leaving the door open for further research suggesting additional trials were needed.

This is exactly what is being put into discussion. This “very low certainty" doesn't stand against the amount of research that is being released on a daily basis. It's also weird that so many people can selectively blindly trust the WHO on this topic, while at the same time, commenting on how the whole scientific apparatus can be so wrong on a related subject.

Also I'm not buying into this theory that we shouldn't allow an effective treatment, just because someone is supposedly overdosing the veterinary version of the drug. It might be partially true for addicting drugs I suppose, but even in this case, that's why we have doctors and prescriptions.

Ivermectin is at least an order of magnitude safer than paracetamol. There's 30 years of safety data, more than 3.7 billion doses, and on average less than 1 death per year.

In the talk above, the Ivermectin safety profile is specifically discussed here: [1]

"Ivermectin was generally well tolerated, with no indication of associated CNS toxicity for doses up to 10 times the highest FDA-approved dose of 0.2mg/kg." [2]

The only way you can overdose is if you use horse paste, and get the dose wrong by more than an order of magnitude. Even then, it's unlikely to result in hospitalization or death. The only reason people have to use horse paste is because they are unable to safely obtain Ivermectin by other means.

1. https://player.vimeo.com/video/554350476?autoplay=1#t=6300

2. https://pubmed.ncbi.nlm.nih.gov/12362927/

Is there widespread censorship?

https://ivmmeta.com links to all sorts of studies published on the effectiveness of ivwhatever, all as support for using it.

It sounds more like the rest of the research/medical community is just not convinced.

Yes, indeed. Again, this discussed here:

https://covid19criticalcare.com/videos-and-press/flccc-relea...

And in video form here:

https://youtu.be/LkIKCbwBcLU?t=702

Yeah I don't buy it. You're moving the goalposts. Censorship is when they prohibit information being distributed. It looks like Government Health Agencies are just not believing the evidence and are therefore not recommending it. They're not saying "don't talk about it" they're not saying "don't research it" they're saying "the evidence so far is inconclusive, we don't recommend treating with it"

That's not censorship.

Just found this overview by NIH on why they don't recommend treament. https://www.covid19treatmentguidelines.nih.gov/antiviral-the...

Pretty detailed overview of why they are not convinced. Are they wrong? Maybe, but they're not censoring anything in my books.

> Just found this overview by NIH on why they don't recommend treatment.

What do they recommend? Wait until you're sick enough to go to hospital. This a year in a half into the pandemic, and you don't see the problem?

Compare this to the treatment protocol of the FLCCC

https://covid19criticalcare.com/covid-19-protocols/i-mask-pl...

> Maybe, but they're not censoring anything in my books.

I'd estimate about 90% of social media posts about Ivermectin get censored on social media.

https://www.wsj.com/articles/youtube-cancels-the-u-s-senate-...

https://www.theguardian.com/australia-news/2021/feb/16/craig...

They literally have policies saying if you're posting anything about Ivermectin, it's misinformation, and it will get removed. How is that not censorship?

https://support.google.com/youtube/answer/9891785

Just now the Ivermectin Global Summit has been removed from YouTube. A medical conference gets removed and you claim that there's no censorship?

https://www.youtube.com/watch?v=nGefHqcnmio

You probably won't believe the censorship until you'll experience it first hand.

You started by claiming

> Part of the problem that there is censorship on publishing in the big journals.

and so far your evidence is censorship by youtube and facebook.

You have to be careful though because we've seen medical journals engage in deceptive practices recently around drugs that could potentially treat COVID. For example, the data showing hydroxychloroquine to be harmful to COVID patients was completely made up or non-existent. Unfortunately, medical academia, in some failed attempt to 'stick to the facts', have led themselves to have a lower a priori assumption of correctness.

Yes. Hydroxychloroquine ultimately turned out to be nothing, but the media and journals did a shameful job covering it. The media made it the latest episode of the Trump show with all that entails, and journals published garbage quickly to back them up. The result is that Trumpers would never believe it didn't work, and the #resistance would never believe it did, no matter what the science would ever say.

It's fine to point at the journals as the definers of what smart people should believe, but can't we say that the Lancet sucks for starting the anti-vax movement by publishing a shit paper by Wakefield, and damaged the integrity of science in general during an epidemic by publishing the hydroxychloroquine trash? Can we point out that they started some of our scariest antiscience trends?

There was a disinformation campaign against Hydroxychloroquine as well. In the failed JAMA study, they administered a nearly toxic dose at late stage patients (when there's no viral replication). This is now being investigated [1].

The largest peer-reviewed study on HCQ (29K patients) showed 70% reduction in death with early treatment. [2]

1. https://www.moneytimes.com.br/heinze-pede-a-pf-que-investigu... (In Portuguese)

2. https://c19hcq.com/mokhtari.html

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