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Comment by xadhominemx | Hacker News Reader

Ivermectin is hawked as a COVID miracle cure within right wing circles and spoken about constantly on right wing media programs. Many millions have been convinced ivermectin will save them from COVID, discouraging vaccination and even prompting some to remove family members in critical condition from hospitals because staff refuse to prescribe the de-wormer. It’s killed people and there is an organized effort to push the drug for cynical partisan gain. So yea, it is appropriate to “pounce” on this study or at least be very clear why it is not applicable to first world countries (very few people have worms)

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Do you believe it is possible you could be wrong and what data would it take for you to change your mind?

There would have to be high quality studies that showed that ivermectin worked in countries that are not beset with parasitic worms (a known COVID comorbidity). And since ivermectin in practice is pitched as an alternative to vaccination, those studies would have to show efficacy against death/hospitalization in the ballpark of full vax + boosted (ie ~95%+)

I think that is a pretty safe position to take.

I have a more moderate take. I think it is likely that ivermectin will show some therapeutic benefit against death and hospitalization, but well below the efficacy of vaccination.

If so, I think there will be interesting reactions when the NIH Activ-6 trial reads out as the American public tries to digest this. Even low double digit efficacy will mean that slow implementation and pushback will have cost 10's to 100's of thousands of American lives.

There is no reason to believe it has that efficacy net known side effects in developed countries and if even it did, a small fraction of individuals users declined vaccination in favor of the prophylactic effects of ivermectin there would be no net benefit. Also, there is not anywhere near enough supply of ivermectin for a meaningful proportion of citizens in first world countries and that supply should go to people in countries with parasitic worms.

and here I thought we might have compatible points.

In the hypothetical where it is demonstrated to be effective, I don't think it is ethical to suppress the use of one effective treatment to incentivize uptake of another (vaccination). That is to say, we shouldn't deny treatment with an effective treatment or post exposure prophylatic because it might embolden other people to forgo an earlier intervention (vaccination).

Your supply objection is a valid concern, but not absolute. I agree populations with parasites should get first priority if their relative benefit is greater. That said, there is additional manufacturing capacity and the ability to easily expand it. If you say excess supply cannot be used, this is the same as your argument above.

"Ivermectin is hawked as a COVID miracle cure within right wing circles"

Might it have anything to do with the recovery rate of patients treated by frontline doctors who prescribe it (amongst other medicines), their patients are staying off ventilators and not, you know, dying? That's a huge observation and should be incorporated into the body of clinical medicine, without politics involved.

That’s good enough reason to initiate more careful examination. That happened, and the conclusion was ivermectin only worked in countries where people have worms, because worms are a covid comorbidity

Yeah, that's how science works with regard to covid (i.e. tainted by politics) now, which is sad and stupid.

Ok, so you answered you own question. Ivermectin would not even be in the conversation in the United States if cynical right wing partisans and right wing media apparatus were not keeping it there for short term political gain at the expense of peoples’ lives. So it’s important to forcefully address their misleading statements and innuendo about the drug.

Alternatively, if cynical right wing partisans and right wing media apparatus had not lached on to ivermectin, it is possible that it would be frequently used as part of treatment regimens, effective or not.

Probably not

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