Comment by prohobo | Hacker News Reader

Comment by prohobo | Hacker News Reader

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That is not the effect they're trying to test. Yes, ivermectin is an anti-parasitic, and yes that's probably why there's anecdotal evidence of it working.

The reason people are testing it is because it has potential anti-viral properties as well. Researchers discovered that ivermectin is a protease inhibitor - which means it can prevent viral replication when it comes to Covid. The problem, from what I understand, is that no one knows the dose required for that effect to occur, or whether the drug needs to be modified in some way to do so.

The new Pfizer anti-viral drug is based on the same protease inhibition mechanism and seems to work very well, but costs hundreds of dollars for a single round of treatment. So, finding a way to make ivermectin work would create an extremely cheap treatment.

You talk about misunderstandings but it's funny how badly you misunderstand the situation.

Sources:

https://pubs.acs.org/doi/abs/10.1021/acsptsci.0c00108#

https://pubs.rsc.org/en/content/articlelanding/2021/cp/d1cp0...

https://www.nature.com/articles/s42003-020-01577-x

You also seem confused. Yes, some people are interested in Ivermectin as a protease inhibitor. But the reason the de-wormer came to prominence in the first place was because some lower quality studies found it has a positive effect on COVID-19 outcomes. The most famous study in this collection came out of Brazil. But the reason that study found a positive impact from Ivermectin is that parasites are a harmful COVID co-morbidity, Ivermectin effectively treats parasites, and a lot of people in Brazil are afflicted with parasites.

Not entirely true as there was a retirement home in France during the first outbreak where residents were treated with Ivermectin due to scabies where they had no Covid deaths and less bad cases than the other surrounding homes.

But I guess it was not replicated.

Scabies is caused by a parasitic mite. This example likely supports the “parasite” theory.

But not the "third world bad health" theory so much.

You and the parent comment are in complete agreement. They even said, in the first sentences:

> Yes, ivermectin is an anti-parasitic, and yes that's probably why there's anecdotal evidence of it working. The reason people are testing it is because it has potential anti-viral properties as well.

And then you said:

> Yes, some people are interested in Ivermectin as a protease inhibitor. But the reason the de-wormer came to prominence in the first place was because some lower quality studies found it has a positive effect on COVID-19 outcomes.

Hey, prohobo was first to agree completely with the parent post:

> Yes, ivermectin is an anti-parasitic, and yes that's probably why there's anecdotal evidence of it working.

and then shit on it for not discussing their pet theory:

> it's funny how badly you misunderstand the situation

That pet theory is what got it classified as a drug of interest in the first place. That's why most of us even know what ivermectin is.

> But the reason that study found a positive impact from Ivermectin is that parasites are a harmful COVID co-morbidity, Ivermectin effectively treats parasites, and a lot of people in Brazil are afflicted with parasites.

Can you link the follow up study confirming this?

> The most famous study in this collection came out of Brazil.

The famous study done in Brazil was a fraudulent one, without authorization from the public health agency, where the patients that took Ivermectin had a 2 to 3 times higher mortality rate (very likely due to unrelated issues), but the numbers were cooked to make the drug look useful. That's the one with thousands of people that registered an effect.

There is also another one, with dozens of people that got an week effect. This one is most likely spurious.

> it has potential anti-viral properties as well

doses much higher than the maximum approved or safely achievable for use in humans would be required for an antiviral effect while treating COVID-19

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172803/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934083/

Right. Figuring out the dose would not take years if it actually worked.

There are always leads, always more possibilities to try, so it's a critical scientific skill to understand how promising they actually are. Nobody will ever publish a peer-reviewed scientific paper saying "this shit is completely fucking hopeless" -- even if it is -- so you have to make that inference from a growing pile of negative evidence "we haven't been able to replicate / determine dosing / find support for" and from the shift of attention to different theories.

While the benefits of ivermectin in a single-drug regime are heavily contested, a lot of folks here seem to be unaware that certain multi-drug regimes have shown promising results. For example see the positive outcomes of this double blind placebo controlled RCT evaluating ivermectin with doxycycline.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127799/

Translation: "this shit is completely fucking hopeless."

Multi-drug combination treatments are where studies of ineffective treatments go to die. "X didn't work, but maybe X+Y or X+Z will" is one of those low-quality ever-present followup leads I was talking about in the sibling post. To a researcher, seeing attention shift to combination treatments means that the primary hypothesis failed and people are throwing Hail Marys. It's not impossible that one of them will work, and that's why nobody will actually publish a paper saying "this shit is completely fucking hopeless," but in a situation where this shit really was completely fucking hopeless I would expect to see exactly this: a couple of positive "hail mary" results that squeak over the significance threshold with low N and low effect size.

Simply Throw enough Hail mary tests with 95% confidence intervals and one will come up as good simply due to randomness.

"if you add antibiotics the result might be better"

Your study says that 183 people in Bangladesh saw their median recovery period reduced from 9 to 7 days when on both drugs, and downplays Ivermectin's influence.

"The effective dose of ivermectin required to reach IC50 at a pulmonary level is considerably higher than that used in this study. However, evaluation at higher doses requires detailed safety analysis"

Nope not even close.

Ivermectin does not help covid. Period. It is not contested. The people who tell you it is contested are interested in selling it to you. It is snake oil in the context of covid.

It is great for other things. But for covid it is a good indication you are a deluded idiot. (with 95% confidence)

"bonIvermectin" - I see what you did there.... chefs kiss golf clap....

That's likely true. Hopefully someone can modify it to create the effect without the huge dosage?

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