Ivermectin as a Covid-19 Therapy
blogs.sciencemag.org
blogs.sciencemag.org
Anyone can check the comments in the article, or here https://osf.io/u7ewz/
Lowe mentions: "Objections have been raised to that trial’s use of an oral suspension formulation, I should note.". But by reading the linked article we can see that there is much more to note:
"In the statistical analysis subsection of the article, the authors acknowledged 2 RCT issues: i) they modified the primary end point to time from randomization to complete resolution of symptoms within the 21-day follow-up period and ii) a labeling error occurred between September 29 and October 15, 2020, resulting in an unblinded protocol during this time frame."
Seems weird that while everyone is pushing hard on the limitations of the studies that favor IVM, we get a pass for this study by making it so influential.
The basics here are very strong for me: run larger tests (which btw, are still too small) and the numbers become at BEST equivocal. Run small tests, you can get some "stunning" evidence it works.
Stunning, because 6/10 vs 5/10 is an apparent huge leap in efficacy, when in fact, its a single flip in the margins. 6/10 is probably 5.01/10 when you do it to 100+ test subjects. 60/100 vs 40/100 would of course be more interesting, but the likelihood of 6/10 converting to 60/100 is actually low: it was most likely a single flip, not a statistical flip of a cohort. Thats what the bigger studies appear to be telling us.
https://www.tabletmag.com/sections/science/articles/randomiz...
Well, now that it’s not august 2020 and we actually have the results of well conducted HCQ RCTs, we know that HCQ turned out to be no better than snake oil. All the claimed observational improvements were just anecdotes and luck. https://www.nih.gov/news-events/news-releases/hydroxychloroq...
The mistaken conclusion that he came to around HCQ should be factored into evaluating the validity of the arguments he makes - which led him to downplay the need to study and verify whether HCQ was actually working.
https://www.moneytimes.com.br/heinze-pede-a-pf-que-investigu... (in Portuguese)
See for example this peer-reviewed study of 29K patients, showing 73% reduction in death.
https://c19hcq.com/mokhtari.html
That said, Ivermectin is superior in almost every way, so you won't find too many people advocating for HCQ now.
A test of 20 people would very probably not have uncovered the unusual clotting problem in AZ, which is 1:100,000 order occurance. Yet, it has shaped public policy.
Tests of the order 1,000 would confirm AZ worked. Tests of the order 10,000 confirmed Pfizer and Moderna worked "better"
The PEG problem in mRNA, like the clotting problem, needs tests of the order 1m to become apparent.
If Ivermectin and HCQ had benefits, they'd be clearer if better RCT at scale were done. The benefit of steroids (for instance) were so clear, they were able to decide the protocols from thousands of tests (from what I read) which is maybe what "big RCT fundamentalism" tells us: These trials of 10 or 20 people, observational, are too strongly distorted by one and two person effects to say what the underlying trend is.
In primary school we were warned away from small sample sizes in basic stats. I'm not seeing anything here to make me think this was wrong. 100 people tell you more than 10 do, and 1000 confirms the accuracy. 1 person variance in 100 is not altering the fundamentals the way 1 person variance in 10 is.
Whats so "fundamentalist" about this?
For example take this peer-reviewed study for Ivermectin as a prophylaxis which was published back in Nov/2020.
https://c19ivermectin.com/carvalloprep.html
https://medicalpressopenaccess.com/upload/1605709669_1007.pd...
* 0 out of 788 (0%) in the treatment group got COVID.
* 237 out of 408 (58.2%) in the control group got COVID.
The treatment group were volunteers who agreed to take it, so it wasn't an RCT.
"Big RCT Fundamentalism" discards that study, because it wasn't a big RCT, even though the signal to noise is obviously clear, and it has been replicated study after study, including smaller RCTs (when using a weekly dose of at least 0.2mg/kg).
There are no big RCTs that show the same effect, because they can cost millions and there's no incentive for anyone to fund it.
You could (for instance) cite PLOS one reports on Ivermectin instead of random domains with an axe to grind:
https://journals.plos.org/plosone/article?id=10.1371/journal...
https://journals.plos.org/plosone/article?id=10.1371/journal...
https://journals.plos.org/plosone/article?id=10.1371/journal...
https://www.researchgate.net/publication/346034534_Study_of_...
The ivmmeta website is a collection of public information, you can always refer to the original study/journal if you don't find it trustworthy.
It's not a lack of data. Ivermectin already has many times more data (including RCTs) compared to other WHO approved treatments (Ivermectin vs. Remdesivir, Ivermectin for COVID-19 vs Ivermectin for Scabies).
Not really, you can read the rebuttal from FLCCC here
This is a response to the NIH/WHO judgement from FLCCC Alliance. I think it should be considered as well.
https://covid19criticalcare.com/videos-and-press/flccc-relea...
https://covid19criticalcare.com/wp-content/uploads/2021/03/F...
Its promising to see something in Science which I hope has a higher bar, although I'm not familiar with the blogs section
Edit: > An editorially independent blog from the publishers of Science Translational Medicine. All content is Derek’s own, and he does not in any way speak for his employer.
The apparently-rational argument the shady-type make that Ivermectin is so good you don't need vaccines. But I don't think any honest advocates can claim that.
The fuzzy-irrational argument is you can't "trust" the medical industrial complex 'cause they're pushing vaccines and suppressing Ivermectin.
This stuff is terrible but there's method to their madness.
The problem is that an epistemic closure around this issue has emerged for a variety of reasons, so the people who are skeptical and willing to talk about it are few in number and looking for allies, so you end up with a rather motley crew.
I’m interested in what people like Pierre Kory and Tess Lawrie say on this issue because they seem like credible people without a track record of crankery, and they’ve looked at the same evidence as the WHO and come to different conclusions. Even if they are wrong it is interesting to engrave with and figure out why. And if they are right, it would be good to figure that out sooner rather than later. But any time I stick around in the forums where their work is discussed the comments section is often overrun by unhinged wackos with different motivations.
I would assume that the core of this sentiment is something like “vaccine is a semi-permanent modification of immune response while ivermectin is a temporary chemical adjustment”
I’m just guessing though.
The emergency use authorization for the vaccines was predicated on there being no effective approved alternatives. If there's an effective approved alternative, the vaccines lose their EUA and are back to being clinical trials until full approval.
So anti-vax people want an effective treatment to be found to invalidate the EUA. Pro-vax people don't want an effective treatment to be found because it would invalidate the EUA.
This seems highly unlikely. Do you have a reputable source for this, because thus far I’ve only seen it as a conspiratorial anti-vax talking point.
I am not sure there is any actual proof that if ivermectin was shown to be, e.g., as effective as dexamethasone in reducing covid-19 mortality that it would stop the FDA from issuing a EUA for a vaccine. After all there is a big difference between a vaccine and a treatment anyway.
These are the same doctors that recommended the use of corticosteroids when everyone else was recommending against it.
These are the same doctors that recommended anti-coagulation treatment when everyone else was recommending against it.
These are the same doctors that identified airborne transmission of disease, the WHO is only starting to acknowledge it more than a year later.
They were ridiculed and criticised at the time for things that are now standard of care, and proved right time and time again.
They are the same doctors that are now recommending Ivermectin, and are now being censored (e.g. senate hearing removed from YouTube) and labelled as spreading medical misinformation.
Dr. Pierre Kory also testified multiple times to the senate.
He published multiple studies on the matter.
If they get it right again and again it's because they follow the data, and have actual expertise in the matter.
That said, the WHO reputation is becoming more and more tarnished day by day. That's why more and more countries are starting to ignore the WHO, and with great results.
https://covid19criticalcare.com/ivermectin-in-covid-19/epide...
Wanna know what does have high risk for long term side effects? COVID.
Politicians talking about "getting everyone medicated (or vaccinated) as soon as possible" with anything that doesn't have long-term studies should be worrying to all. And the fact that some SV companies will not allow this discourse to happen should be even more so.
Ivermectin's trial results are mediocre at best. So it can't be that powerful a treatment. It's probably helping a bit, or at least not hurting, but it's not a wonder drug. We'd have seen that if it were!
So then you get into the usual lines of bullshit, as we saw before with the hydroxychloroquine people. "Augment with unicorn horn dust" and "dose more" and "dose earlier" and all that. But COVID-19 is the sort of disease that is impractical to dose too early, so "must dose very early" just means "drug is useless".
Thus the facts are clear: even if ivermectin works, it isn't useful. It was a great hypothesis to test. It failed in the clinic. So it's irresponsible to continue beating against it when we have better avenues to pursue.
Having said that, it remains to be seen if can work for covid too.
Yes, its safety profile and production are well-established.
But as far as covid is concerned, it is some random drug. Metformin is also a wonder drug, should we bet our lives on it for covid? No? You say there are more useful things?
I really don't understand why people think this drug can work. It was trialled. It neither passed with flying colors nor flamed out. That's... pretty much what most drug candidates do. It doesn't really "remain to be seen" here: there's plenty of evidence for "doesn't move the needle".
It could have some covid uses, sure. But it can't change the game. Hence my label of "useless" in overall pandemic management (much like contact tracing). I admit that "almost useless" or "only useful in very niche situations" is more accurate. But it is useless 99.9% of the time.
What are we doing here? Is this really the hill they want to die on?
Although the CDC has decided to stop counting them, breakthrough infections and even death are common among the vaccinated. There's not going to be a point where we don't need to worry about treatment unless the virus is going to go away like the Spanish flu once enough people are immune.
> And I do hope you were lucky enough to stockpile it beforehand, because you'd better not be going out too often with such a test result....
It's pretty clear from this that you have never looked into how ivermectin was used in certain Indian states or in Chiapas, where local officials readied pre-made kits which could be distributed to high risk people and those who tested positive. This would be easy enough to do in the US if we could shift the thinking on Covid away from "you have to wait until you're gasping for breath at the hospital to start any treatment other than acetaminophen."
Do you feel similarly about lockdowns being "useless" given their demonstrated inability to fully eliminate spread of the virus, and the lack of any large RCTs in support of them? I mean, I see all the same arguments made in their favor: "you have to do them early enough, you have to pair them with such-and-such other NPIs, etc"
One of the people I know is one of these people. Pro Ivermectin and anti vaccine.
It’s tied together by their belief that COVID was overblown, an attempt by the government to seize control, or an attempt by big pharma to make piles selling COVID vaccine. Or all three.
Basically to this person, Ivermectin being a cure is proof that the government/doctors/pharma manufactured the crisis.
I'm a regular reader of this blog. I have an specialization in Chemistry in the Secondary School, so I can vouch that his articles about Chemistry are solid (and adobe my knowledge level). I'm convinced that the articles about the pharmaceutical industry are correct, but that's a little more far away from my specialization.
About Ivermectin, someone posted a few days ago a site that collect all the favorable evidence. I read a few of the papers and in my opinion it's not convincing. The papers are studies with a small number of persons, or with a small difference or instead of the control group they compare with dubious numbers. Essentially, the same conclusion of this blog post, but I only skimmed a few papers and he probably read most of them carefully. If I were you, I'd thrust his opinions more than mine, but in this case we agree.
Not familiar with American idioms. What does this mean? Secondary School is what you go to after Primary School where I come from, but clearly you can’t mean that.
My "Secondary School" was from 13 to 18 (6 years). https://es.wikipedia.org/wiki/Educaci%C3%B3n_Secundaria_T%C3... You had one additional year than a normal "Secondary School" here, it [1] includes normal classes in the morning but less History/Geography/Whatever and in my case more Chemistry, a lot of Chemistry. Half of the days in the afternoon we had practical classes, making Chemistry experiments. At the end, I get a the "Secondary School" degree that enables me to go to the university and also some official habilitation to run a small chemistry factory or laboratory (oversimplifying the legal details) (probably is more accurate to say that I can supervise a few persosns in a factory or a lab).
Other students instead of Chemistry classes had Masonry classes and got an habilitation to build a small house (up to 2 stories?) and other Electronic classes, ... Each School has a different specialization, a bunch of specializations.
Edit: [1] The last 4 years. And the first 2 years have also more technical classes than a usual school, but they mix other stuff like basic electricity or metalworking.
I am not anti-vaccine, but I don't think we should be as gung-ho as we are with these vaccines, especially on young people who are at very low risk from covid. Vaccinating children seems immoral.
This is a good introduction to the overwhelming wealth of data showing that Ivermectin is a safe and effective in the prevention and early treatment of COVID-19.
https://www.reddit.com/r/ivermectin/comments/nj9713/ivermect...
I’m not making a claim that ivermectin is that treatment, but saying “who cares” goes against the old advice that “if you have one you have none, and if you have two you have one.” It’s always good to have options.
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.
https://www.who.int/news-room/feature-stories/detail/who-adv...
https://www.thesprucepets.com/ivermectin-based-heartworm-med...
Get your damn shots, ffs.
If someone does accept the validity of the scientific studies of vaccine effectiveness, they probably aren’t so jazzed about promoting ivermectin because they’d realize vaccines are even more effective and a permanent or semi permanent solution, rather than having everyone in the country have to regularly take a new medication.
In any case ivermectin appears to be the new hydroxychloquine. A medicine that was randomly seized on as theoretically being effective against viruses and has failed in every properly conducted RCT.
Therapeutic efforts would be far better focused on making mAb treatments cheaper and more available, since they’ve been proven about 80% effective both as prophylaxis and a therapeutic.
* Vaccination
* Get naturally infected - natural infection offers broad and long lasting immunity
* Prophylaxis
* Early treatment
The data is showing that Ivermectin is almost 100% effective as a prophylaxis, and that early treatment on first symptoms, it's on par with a flu.
Currently we're only pursuing vaccination as the only solution, resulting in millions of unnecessary deaths and trillions of economic damage.
Some people are hesitant to use a vaccine without long term safety data, and using Ivermectin is a safe alternative that also contributes to herd immunity.
Baffling to see this listed as a way to get covid “under control”. If people getting naturally infected is fine, what is there to control? The whole reason people are concerned about getting covid under control is that natural infection would kill around 0.5% of a population in a developed country, or more if the hospital system becomes overwhelmed and oxygen or other standard of care treatment isn’t available.
> The data is showing that Ivermectin is almost 100% effective as a prophylaxis
No placebo controlled RCT has shown this that I’m aware of for ivermectin (as discussed in the parent article). The evidence for the vaccines, steriod, or mAb treatments working is backed by placebo controlled RCT. The article states: “ All in all, though, the most compelling reports of ivermectin’s effects seem to come from the smallest and least controlled samples (all the way down to anecdotal results) while the larger and more well-controlled trials tend to produce equivocal evidence at best.”
> and using Ivermectin is a safe alternative that also contributes to herd immunity.
How would it create herd immunity? Would people have to take ivermectin for the rest of their lives as an alternative to the vaccine?
Nobody in their right minds thinks that this is the ideal way to get it under control, but it's one of the ways that can contribute to herd immunity.
> No placebo controlled RCT has shown this that I’m aware of for ivermectin
There are as of today 58 studies, out of which there are 29 RCTs showing Ivermectin is effective.
> How would it create herd immunity? Would people have to take ivermectin for the rest of their lives as an alternative to the vaccine?
Let's say you need 75% for herd immunity. If you have 25% vaccinated, 25% who have already got the infection, and 25% who are taking Ivermectin once a week, you've reached herd immunity. When the R0 is below 1, it will exponentially reduce infections towards zero within months.
With effective early treatments, it doesn't even matter how many people get infected as long as they don't get severely ill.
It can also contribute with mutations...
This number is way, way off. It's not even close to the actual number of officially tallied deaths divided by confirmed cases so far, which would itself overstate the real IFR for a number of reasons.
> or more if the hospital system becomes overwhelmed and oxygen or other standard of care treatment isn’t available.
To the extent this is even a real phenomenon, it correlates better with places which have underfunded and straining hospital systems as opposed to those which eschew lockdowns and other NPIs.
It's much lower than the number of officially tallied deaths divided by confirmed cases so far. That number is around 1.8% in the USA. If you divide officially tallied deaths by the CDC's best estimate of total infections, including unreported and asymptomatic cases, you get an IFR of 0.52%.
What?! Most states have lifted all restrictions and deaths are at the lowest in a year.
Agree.
Not everyone is willing to take them and there aren't enough of them to vaccinate the entire world.
If the disease is still raging in any part of the world, that will lead to variants which will eventually escape the vaccine, thus restarting the cycle again.
Some vaccines are already ineffective with the variants, e.g. Chile has one of the highest vaccination rates in the world, but doesn't have the disease under control.
* 18% Pfizer
* 2% Oxford/AstraZeneca
* 1% CanSino
https://ourworldindata.org/grapher/covid-vaccine-doses-by-ma...
Sinovac has been recently approved by the WHO for emergency use
https://www.who.int/news/item/01-06-2021-who-validates-sinov...
https://covid19criticalcare.com/videos-and-press/flccc-relea...
https://covid19criticalcare.com/wp-content/uploads/2021/03/F...