Ivermectin Systematic Study: Inconclusive | Hacker News Reader

Ivermectin Systematic Study: Inconclusive

cochranelibrary.com

43 pointsbb8858 comments

The paper's actual headline is different than the one on the submitted link. (And I'm not sure it accurately reflects the last line of this paper.)

"Overall, the reliable evidence available does not support the use ivermectin for treatment or prevention of COVID‐19 outside of well‐designed randomized trials."

Another quote from this paper:

"Ivermectin showed no evidence of an effect on increasing or decreasing mortality at 28 days, the most important outcome during this pandemic, neither in inpatients (two studies), outpatients (two studies), or the preventive setting (one study). The certainty for this finding was very low. The same accounts for clinical worsening up to 28 days in an inpatient setting and up to 14 days in an outpatient setting."

They chose 14 studies of more than 50 available. Their method for screening studies looks biased towards finding an inconclusive result.

Bear in mind that 'bias' with regard to ivermectin is less likely to come from doctors than it is pharma companies. Doctors stand to gain nothing from the efficacy of ivermectin since it's a generic drug on the market since 1987. Pharma companies have a lot to lose if it's proven effective.

To control for bias one ought to look at larger sample sizes. And each time that happens there's a significant result.

Assuming it works, you have to take ivermectin constantly, and the pro-ivermectin studies generally only say that it reduces mortality / severe outcomes, not thy it significantly prevents infection or transmission. So if the world goes the ivermectin route, there's still a lot of value in the vaccines, and until the virus is eradicated we have to keep taking ivermectin.

This is an obvious financial win to any slightly competent evil pharmaceutical - e.g., make some small chemical variant of ivermectin, patent it, and p-hack a bit. Or just manufacture the generic and sell lots of it; plenty of companies have a good business selling aspirin, which literally grows on trees.

I'm not buying the "big pharma is trying to censor it" angle. Also, like any conspiracy theory, it requires a whole lot of people to be perfectly loyal and silent. If ivermectin is actually effective, some pharma exec with family in a part of the world with poor vaccine access is going to push for it.

Regarding your last sentence, 'If ivermectin is actually effective.." Pharma execs wouldn't have to push for it? They would just tell their family member to take it. I know anecdotes are not medical studies, but I know two people who caught covid, were feeling relatively 'incapacitated'. They were prescribed ivermectin by a doctor I know personally. They took it and started getting significantly better very quickly. Just anecdotes, but it's real life data point for me (high confidence). Not for you as you cannot know if I'm telling the truth unfortunately.

What I mean is that it would be hard to collectively keep a secret that ivermectin works. Your acquaintance's doctor happened to prescribe it - but I'm guessing most doctors would not. So this pharma exec (or researcher, or whomever) would need to tell their family to go find a doctor willing to prescribe it, or would send information to the doctor to convince them to prescribe it, or something. And that would leak.

Also I'm mostly referencing the idea, which I believe I've seen in some of these papers, that people should take ivermectin on an ongoing basis to protect against getting infected in the first place. If I were a pharma exec who knew that ivermectin secretly worked, I wouldn't want my family to get sick at all if I could help it - I'm pretty sure no paper is claiming it's 100% effective, it just reduces the chance of poor outcomes. So I'd have to tell them to find a doctor willing to prescribe ivermectin even before they're sick, and that would definitely leak.

So I hope I'm not talking past you, my perspective on the situation seems to somewhat oppose your intuition. Ivermectin is not a tightly kept secret. It has just been suppressed in the mainstream channels. Bret Weinstein has discussed this.

https://covid19criticalcare.com/guide-for-this-website/take-...

That website lists doctors who will hotline you a prescription. Maybe it's harder outside the US, but I know you can get off branded forms of it (perhaps those are worth less confident in?)

I would argue the secret isn't being kept. It just circulates in one silo and not all silos of our reality schism.

Like how hydroxychloroquine was suppressed in mainstream channels? Like ivermectin, hydroxychloroquine also had some initial positive studies, but when large scale studies were done it was shown to actually cause more deaths than not taking it.

Brett Weinstein has made a lot of dubious claims so I am skeptical to what he says. He at one point has claimed that Ivermectin is 100% effective when taking prophylactically based on a single study that has received a lot of criticism for having numbers that dont make sense. To me it seems that he needs to be more critical of the sources he uses.

I've done my own "literature review" [ https://www.notion.so/The-Cure-for-COVID-19-e052c9d829d34bc4... ], and "Inconclusive" is correct. It's astonishing that after 18 months of COVID and 12 months of rumors this type of question is unanswered.

So we have one band of Twitterati saying it is the "Crime of the Century" that Ivermectin is not being used, and another band saying you'd have to be an idiot to take horse pills, and neither group cares what the scientific research actually is.

Hopefully the Oxford study will finally give some conclusive data.

The Oxford study is using patients so far down the viral infection it has most certainly been designed to fail. All the evidence suggests ivermectin works best when used early, and Oxford plan to use it on late stage patients.

Funny that - given that Oxford are being funded by the pharma companies to make the vaccine and novel therapies.

Never bite the hand that feeds you and all. I don't know why we are expected to wait for a study from Oxford when it has already been written off by the actual doctors saving lives because of strange doses and late stage patients.

There are already 50+ studies. Nation states are already using ivermectin.

You are commenting on a thread about a Cochrane meta-review of the available studies that concludes that there is no conclusive evidence that ivermectin works. They know about the studies; that's the point. They don't show what you want them to.

Whatever the results of the Oxford study, the goalposts will be moved to fit the conspiracy theories. Especially since Oxford is involved in one of the vaccines...

For those not in the medical field, Cochrane does high quality literature reviews and is a reliable source.

for those who keep repeating some strange conspiracy theory, explain how this drug would be more successful than a vaccine that absolutely is effective and is available prior to anyone getting any trace of covid.

sure, theres a lack of vaccines in undeveloped country and this coukd be a stop gap, but so could vitamin D. Theres no reality where i take ivermictin today and 6 months from now im protected. most vaccines for mostm people, that is the routine and normal expectations.

its a medical curiousity and so is vitamin D, but this false idea that its going to some how displace vaccines is antivaxx wishfulfillment. wake up, antivax is a viral meme bourne by ignorant and transmissible by people who view science through obtuse political lenses and no drug will penetrate that viscious type of stupidity because its spreas by super spreaders like russia, american theology and republican monied interest.

the real viral threat is the meme and ivermictan wont stop that either. people arnt antimask because theres a vaccine.

Wide spread use of an effective prophylactic would help a lot in reducing case numbers and spread. This is about using a multifaceted approach to get covid under control. Wearing a mask or socially distancing today wont protect you in 6months either in a direct sense, but doing those things can assist in reducing the prevalence of the virus which does decrease your likelihood of contracting it.

Yes, but if the proposal is "everyone takes ivermectin and they get the vaccine when vaccines are available locally," that's strictly more profitable for pharma companies than "everyone gets the vaccine when vaccines are available." There's no reason for Big Pharma to suppress that, if it worked.

(Speaking of vitamin D, I personally did exactly that with vitamin D + vaccine. My doctor told me a few years back I was low on vitamin D and should supplement anyway, and the vague evidence that it maybe helps against covid was enough for me to decide to take it regularly at a high dose, because there aren't really any downsides besides getting through my bottle faster. But I also got the vaccine!)

The thing also with the vaccines and ivermectin possibly causing an issue for big phrama vaccines is that - The COVID-19 vaccines from Pfizer, Moderna and Johnson & Johnson have all received an Emergency Use Authorization (EUA) from the FDA. EUAs may be granted only during a public health emergency *and when there are no adequate, approved, and available alternatives.*

If ivermectin was found to be safe and effective and got FDA approval itself, the vaccines of Pfizer, Moderna and J&J would need to get full approval - meaning longer and more rigorous clinical trial and safety testing. (not that they haven't gone through a certain level of those things, just the bar is set lower with EUAs)

p.s. Sounds like you talked to your doctor about supplementing VitD - but you're mistaken to say there aren't any downsides (especially for regular high doses of D) --- It can cause hypervitaminosis D which in turn causes hypercalcemia (a buildup of calcium in your blood). Just saying as it may be worth double checking :)

Isn't "adequate" the key word there, though?

We do have an alternative that works in theory - if everyone wore an N95 (or knockoff, even!) mask at all times in public, indoors and outdoors, and if all restaurants did takeout only, the risk of transmission would be extraordinarily low. And it's not zero even with the vaccine. The vaccine does different things from masks, though.

I think money-grubbing Big Pharma execs who were recently regulators on the other side of the revolving door would easily be able to argue that ivermectin (or vitamin D, or whatever), useful as it may be, is not an adequate alternative to the vaccine, just (as you put it) another facet in a multifaceted approach, and the vaccine still needs an EUA.

Ivermectin would have to go through similar approval to put treatment of Covid on the label, so no.

> people who view science through obtuse political lenses

It's not really that surprising. Prescribing Opioids like candy, outlandish prices for things like Insulin, bankrupting poor and uninsured for end of life treatments, covering up the gain of function research funded by the NIH, censoring all kinds of stuff, beginning with their President and probably a few of their friends. I'm sure some of those anti-vaxxers have friends who had COVID and came through it ok. And now, trust us, take this experimental vaccine without any backup plan in case it has adverse effects lasting a couple of weeks. Loss of work, maybe a hospital bed to pay for, etc.

The vaccine would better tolerated with a national health care plan and letting people take Ivermectin if they want it. At the moment, CVS won't fill a Ivermectin prescription, even though it quite safe, but they will fill up your pain pills no problem. I do think that the vaccine is marvelous, but I'm not naive to the failings of our medical system.

Is there any conflict of interest declared anywhere in that paper? Could not find any paragraph about this.

Declaration of interest link right under the title.

Well, about that ...

https://blogs.bmj.com/bmj/2021/07/05/time-to-assume-that-hea...

"Richard Smith was ... for many years the chair of the Cochrane Library Oversight Committee, and a member of the board of the UK Research Integrity Office."

"Stephen Lock, my predecessor as editor of The BMJ, became worried about research fraud in the 1980s, but people thought his concerns eccentric. Research authorities insisted that fraud was rare, didn’t matter because science was self-correcting, and that no patients had suffered because of scientific fraud. All those reasons for not taking research fraud seriously have proved to be false, and, 40 years on from Lock’s concerns, we are realising that the problem is huge, the system encourages fraud, and we have no adequate way to respond. It may be time to move from assuming that research has been honestly conducted and reported to assuming it to be untrustworthy until there is some evidence to the contrary."

So a former Chair of the Cochrane Library Oversight Committee thinks medical research is filled with fraud. How reliable can it be really?

For some balance --

[1]excerpts from abstract

" Background: Repurposed medicines may have a role against the SARS-CoV-2 virus. The antiparasitic ivermectin, with antiviral and anti-inflammatory properties, has now been tested in numerous clinical trials."

" Conclusions: Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally. "

[1] https://journals.lww.com/americantherapeutics/fulltext/2021/...

-- Referenced in below article

https://www.jpost.com/health-science/israeli-scientist-says-...

( bypass paywall -- https://twitter.com/westmeeteast/status/1420470317005352964 )

At least one of the studies included in the above analysis was discovered to very likely be fraudulent.

The authors say it didn't change the overall finding but it certainly takes away my confidence in their ability to discern a well designed study from a fraudulent one.

And as we all know in CS: garbage in, garbage out

Details: https://www.nature.com/articles/d41586-021-02081-w

The American Journal of Therapeutics paper you linked includes falsified data from a since-retracted paper. It is also the only literature review that indicated Ivermectin does anything at all against COVID-19. If you remove the falsified data, you will see that the drug no longer seems effective.

Not true. The removed study was just one of 50. The study already had a control for bias attached to it. Even if the study is removed the effect remains certain.

The hit job on that study was also coordinated. The study was done by an Egyptian doctor in the middle of a pandemic. An actual doctor on the front line trying to save lives. They way he has been sullied in the name of protecting the financial interests of pharma companies is shameful.

A bunch of the ivermectin studies were paid for by pharma companies that make ivermectin. Do they have any financial interests?

Also the vaccines are pretty cheap. Which do you think is cheaper, one $5 vaccine or multiple days of medical care? If the goal was maximizing money to a pharma company, you certainly don't want to prevent people from getting sick.

Wouldn’t one also perhaps analyze manufacturers of drugs may be given during a course of treating covid on a hospitalization? Ivermectin is a very very cheap drug, used in bulk with livestock for worming, and likely with low margins.

I think you're coming to a strange conclusion in what you've said...Ivermectin is out of patent - far less money can be made from it. US pharmaceutical company Merck – one of the manufacturers of patent-free Ivermectin actively discourages use of ivermectin -- Also Merck signs $356M deal to supply US with experimental coronavirus drug. These are the financial interests you should be looking at.

https://swprs.org/merck-claim-exposing-big-pharma-lobbyists/

Vaccine prices have been increasing.

https://www.brusselstimes.com/news/belgium-all-news/health/1...

Additionally, 'one $5 vaccine' is just wrong. There is already 3rd booster shots being administered in Israel with the pfizer vaccine as its effectiveness is diminished with the delta strain (and Epsilon..no doubt till Omega) ...The possibility of these vaccines being used similar to annual/bi annual flu booster shots is far from 0.

Nor is your comparison a fair one...It isn't a split between use the vaccine or have everyone require days of medical care (that would of course cost more...Not necessarily to the benefit of pharma companies though) -- IF ivermectin was a effective (even just 5%) prophylactic OR treatment/therapy against severe covid symptoms (let alone possibly doing both of these things) that certainly would affect the profits of phara companies getting contracts and sales of their patented offerings.

To be fair, Insulin is out of patent, and yet prices have still gone up.

> Also the vaccines are pretty cheap

cheap times billions of doses is not cheap anymore. And Pfizer and co continuously increased the prize of the vaccines without any pushback.

How many doses of ivermectin are needed? If it is billions of doses for the vaccine, it is tens of billions of ivermectin, because you would have to take it regularly prophylacticly (forever?).

The ivermectin paste everybody is using for a few doses costs $7. People aren't paying wholesale costs for these drugs.

You can't say they pharma companies that make the vaccines are evil and only want money, but the other pharma companies that produce ivermectin are only promoting the drug out of the goodness of their hearts.

The Wall Street Journal actually published a follow-up to that "Also related" link, with the headline "Writers Missed Ivermectin Study Retraction

(Subhed: "We have egg on our faces.")

https://www.wsj.com/articles/egyptian-ivermectin-study-retra...

The link you provided still stands behind the main claim... - "We retract the part of our article that relied on the data from Dr. Elgazzar’s study. But the broader point stands: There’s strong evidence of ivermectin’s efficacy in treating Covid-19."

The problem is that there isn't. A metastudy found that virtually the entire positive affect attributed to ivermectin derived from the Elgazzar study, which was fraudulent. Ivermectin doesn't work on COVID.

Two family members are physicians.. they've seen just an astounding number of people sick with Covid who picked up some horse dewormer at the local Tractor Supply Co. to "treat" or "prevent" their illness. It obviously didn't work for them since they ended up in the hospital... these are very commonly the same people who won't get vaccines since they're unproven. Worms in the brain actually might be a decent diagnosis.

Yesterday in a local paper they featured a front-page story about some dipshit who won't get vaccinated, refuses to wear a mask, and is covered in tattoos from his jaw to his ankles. The rate of severe reactions to tattooing (amputations and whatnot) is 2 in 10000.

Citation needed for that tattoo stat. I'd believe 1 in 5k have a minor infection; I seriously doubt that many are getting amputations or related.

It appears he may have the rate right for severe reactions, but has too narrow a definition of "severe". See "Severe Adverse Events Related to Tattooing: An Retrospective Analysis of 11 Years", Indian J Dermatol. 2012 Nov-Dec; 57(6): 439–443 [1].

> The incidence of severe adverse medical reactions has been estimated as 0.02%. Infectious and non-infectious severe reactions have been observed. The consequences were medical drug therapies and surgery.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519250/

Other studies, with a larger sample of studies, found a moderate certainty of effect even when controlling for a study which later removed.

https://journals.lww.com/americantherapeutics/fulltext/2021/...

Another study from Queen Mary University also found certainty of effect

https://www.researchgate.net/publication/353195913_Bayesian_...

Study in Asian Pacific Journal of Tropical Medicine shows certainty of effect.

https://www.apjtm.org/article.asp?issn=1995-7645;year=2021;v...

I could go on. To really understand what is happening in relation to Ivermectin I can highly recommend Ben Goldacres book Bad Pharma..it shows in detail exactly what we are seeing happen with ivermectin.

There is a significant financial interest in having ivermectin perceived as ineffective. Firstly, if it works it makes the emergency use authorisation for the vaccines look quite precarious. Secondly, and probably more likely, there are novel therapies being developed for Covid right now. Nasal sprays. Anti virals.

They are patented. Ivermectin is not - it's post patent and can be manufacured by multiple companies. Merck who manufacture ivermectin themselves have a new anti viral they hope to bring to market.

If ivermectin - a $3 treatment - proves to be effective then the emergency use Authorization for novel Covid therapies goes out the window.

When we are looking at meta analysis that take about 20% of the available studies and conclude 'inconclusive' we should be mindful that there's a massive financial interest for this. Science works. But like everything else, if you influence how science is funded you influence the results it finds.

The cat is out of the bag on ivermectin. Its already being used in india (where I am) and where the second wave was brought under control without vaccines. There was just 5% vaccine penetration at the peak of second wave but ivermectin started to get administered at that time in delhi.

You'll hear more about the mega doses of horse paste. Its in super high concentration since....it's for horses. In the UK it's not even imported in tablet 12mg form. Hence the stupid situation in which people desperately try to get it via vets and the dosage is way out.

At 12mg doses it's very well tolerated. I should know since I use it india the moment I feel I have any symptoms. 18 months and so far so good. I am just one person of course but I know many many others who have been prescribed it when they got sick and they then recovered.

Science works but financial interests influence what does and does not publish.

The study at that link includes Elgazzar's "retracted" results (which appear to have been fabricated).

https://www.theguardian.com/science/2021/jul/16/huge-study-s...

The studies from India and others have not yet been retracted

> If ivermectin - a $3 treatment - proves to be effective then the emergency use Authorization for novel Covid therapies goes out the window.

No, they don't, because the vaccines still prevent you from getting infected in the first place. If ivermectin (or hydroxychloroquine, or Vitamin D, or whatever) had been discovered to work last year, I would have taken it but I would also have gotten the vaccine, because every story I've heard from survivors sounds like it was a deeply unpleasant experience. And I probably would have paid more for the vaccine than the government-negotiated rates, too.

Also, those government-negotiated rates are about $20. A $3 treatment, as an ongoing preventative measure for the whole population, can easily add up to more than $20!

I posted this previously but HN moderated my personal story. —> Story of how I came close to losing my life and how Ivermectin saved me. Ivermectin just saved my life. I woke up with thick mucous and blood that I couldn’t extricate or cough up and called my doctor and the hospital. They threw up their hands and said there is nothing we can do, monitor your saturation levels and let us know if you feel faint. And within 8 hours I could not walk or talk, my wife called the hospital and they said I need to be brought into ER. A friend of ours who was taking prophylactic treatment with Ivermectin brought in his medication and begged us not to go ER and wait for 6 more hours. I was put in touch with one of FLCCC doctors who immediately asked me to take Ivermectin and prescribed a steroid to ease my respiratory issue. 6 hours has passed, the symptoms started to stabilize and reverse. I was able to talk, walk and drink. Within 10 hours my saturation levels turned around. I still continued the protocol for the next 2 days, I was out of the woods with barely a sore throat. Continued the protocol and even the sore throat was gone. I am as good as new. My PCP is dumbfounded and refuses to acknowledge the work of ivermectin.

Are steroids not known to be an actually effective treatment for Covid? Are you just trolling?

I’m not trolling. Woke up scared to DEATH ! 3 weeks ago to date. blood and mucus in the sink and back of throat. I only had one steroid. All of the treatment was primarily Ivermectin. I am unbelievably lucky to be alive.

Due to lockdowns and remote work I gained unhealthy weight and the morning I woke up with that thickest mucus and blood in my entire life I knew I have become one of those people I read on the newspapers. Basically the hapless feeling of being handed the death warrant. I am still shaking as I write this. No need to troll. I’m sharing my story so others don’t need to needlessly die. They can research and seek treatment ask their doctors if they are infected.

I'm glad you got better. I wish you good health going forward.

Until relatively recently, wasn't talking about ivermectin in conjunction with covid basis for suspension from Twitter?

If so, and Ivermectin is useful in treating people with Covid under specific circumstances, are Twitter not responsible for spreading disinformation which could have prevented people from having _some_ treatment?

It's still apart of youtubes guidelines. [1]

YouTube doesn't allow content that spreads medical misinformation that contradicts local health authorities’ or the World Health Organization’s (WHO) medical information about COVID-19.

If your content violates this policy, we’ll remove the content and send you an email to let you know.

*Content that recommends use of Ivermectin or Hydroxychloroquine for the treatment of COVID-19

*Categorical claims that Ivermectin is an effective treatment for COVID-19

*Content that recommends use of Ivermectin or Hydroxychloroquine for the prevention of COVID-19

[1]https://support.google.com/youtube/answer/9891785?hl=en

I posted several times how Ivermectin saved my life. The mods at HN have immediately removed by comment as soon as I posted it. Goes to show they are being told to extinguish any sign of dissent over Covid treatment. Scary

You do understand that a single anecdote is neither compelling nor conclusive. Many people recover from covid naturally. That's why we do science so that we don't have to take the word of random people on the internet

I know two people that died from covid early this year even though they were taking ivermectin. Anecdotal, I know...

That's not how we roll, so it must have been something else.

Edit: it sounds like you're talking about https://news.ycombinator.com/item?id=27992387. Mods didn't touch that comment. It was killed by software, most likely because you've been breaking the site guideline that asks people not to create new accounts for every few posts they make.

Speaking of which, would you please stop? We ban accounts that do that. You needn't use your real name, of course, but for HN to be a community, users need some identity for other users to relate to. Otherwise we may as well have no usernames and no community, and that would be a different kind of forum. https://hn.algolia.com/?sort=byDate&dateRange=all&type=comme...

https://news.ycombinator.com/newsguidelines.html

Something that IS conclusive[1]: a myriad of documented cases of physical harm, caused by vaccines, inflicted on humans that have no legal recourse to hold their Modern Mengeles accountable.

[1] https://vaers.hhs.gov/

I’m not anti vax, I always cash my free flu vax coupons, but last year the flu vax put me out for 3 weeks and I had bronchitis for 6 months. Nearly all of my professional contacts also got sick from it.

I wonder if they put the interns on the flu vax whilst everyone else was working on COVID.

A commercial product incapacitated you for 3 weeks and made you sick for another 6 months -- and the manufacturers are immune from all liability.

May be time to rethink your priorities.

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