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Ivermectin is the new hydroxychloroquine, take 5: But it won the Nobel Prize!

Ivermectin continues to be the new hydroxychloroquine, an unproven repurposed drug promoted to treat COVID-19. Now the advocates are pointing to the history of the drug’s developers being awarded the Nobel Prize in Medicine, as though that has anything to do with its effectiveness against COVID-19.

As regular readers know, I’ve been saying for quite a while that the anti-helminthic (anti-parasitic worm) drug ivermectin is the new hydroxychlorquine, namely a repurposed drug touted by COVID-19 contrarians, minimizers, conspiracy theorists, and antivaxxers as a miracle cure for the disease based on very little evidence. Early in the pandemic, hydroxychloroquine was all the rage; that is, until a drip-drip-drip of evidence showed that it didn’t work.. Since earlier this year it’s been ivermectin. Not long ago, I noted Bret Weinstein’s conspiracy mongering over ivermectin, as well as that of others. Little did I suspect last week that I’d be adding “take 5” to my “Ivermectin is the new hydroxychloroquine” series. It came in the form of a Tweet by Peter Kory, who has been featured in previous installments:

Dr. Pierre Kory, as you might recall, has featured prominently in past installments of this series as one of the most prominent advocates promoting ivermectin as a miracle cure for COVID-19. Indeed, he is president of the Frontline COVID-19 Critical Care Alliance (FLCCC) and has testified before Congress. During that testimony, Dr. Kory claimed that ivermectin, used with other medicines such as vitamin C, zinc, and melatonin, could “save hundreds of thousands of people”, and cited more than 20 studies.

As I’ve discussed before, ivermectin is an anti-helminthic drug used as a dewormer in veterinary medicine and to treat parasitic diseases in humans, including internal nematode infections such as Onchocerciasis, Strongyloidiasis, Ascariasis, cutaneous larva migrans, filariases, Gnathostomiasis and Trichuriasis, as well as for oral treatment of ectoparasitic infections, such as Pediculosis (lice infestation) and scabies (mite infestation). However, as I’ve also discussed before (and will again in this post), there is no good evidence that ivermectin is effective against COVID-19, although there are low quality studies and, yes, meta-analyses. Worse still for ivermectin as a COVID-19 treatment, the prior plausibility on the basis of basic science is low, because the in vitro cell culture studies that showed activity against SARS-CoV-2, the coronavirus that causes COVID-19, required a much higher concentration of ivermectin than is achievable in the blood with standard (or even high) doses of the drug. So, as I have said repeatedly, it’s possible that ivermectin might have activity against COVID-19 in humans, but not very likely and, even if it does, it’s even less likely that it will be as efficacious as is being claimed.

My first reaction was: So somebody published a review. My second reaction was to see the sorts of things being posted on social media about it. As you might imagine, there was a lot of conspiracy mongering:

Of course, I’m partial to this one:

Yes, I must admit that I’m hard pressed to remember ever having seen a title of an ostensibly scientific article so obviously click-baity. Then there are the authors. Whenever considering an article, it is always useful to consider the source, and the authors of this review are…quite something.

The authors

The review is as bad as you might imagine, given certain members of its author list. What do I mean? Let’s just say that at least one of the authors should be familiar to regular readers of this blog: Peter McCullough.

I first encountered Dr. Peter McCullough in May, when he was promoting an imminent “Holocaust” due to COVID-19 vaccines. At the time, he was being billed by the likes of Joe Mercola and Mike Adams as “doctor with the most citations in the National Library of Medicine on these topics” (i.e., COVID-19). He’s also a consultant cardiologist and Vice Chief of Medicine at Baylor University Medical Center and Principal Faculty in internal medicine for the Texas A & M University Health Sciences Center who’s been making the rounds on the COVID-19 conspiracy circuit. By June, I encountered him promoting the idea that COVID-19 vaccines are designed for “global depopulation“. By July, I noted “holistic cardiologist” Dr. Joel Kahn citing Dr. McCullough for the purposes of fear mongering about COVID-19 vaccines.

Thomas Borody is a real scientist from Australia, known for having developed antibiotic triple therapy for Helicobacter pylori infections that cause duodenal ulcers, after Robin Warren and Barry Marshall had described and then cultured spiral bacteria from the stomachs of patients with gastritis and gastric and duodenal ulcers. Unfortunately, like a fair number of formerly reputable scientists, he appears to have fallen down the ivermectin rabbit hole. as a search for his name quickly reveals, complete with a number of interviews in which he touts a triple therapy including ivermectin as a near-cure for COVID-19, some dating back to last summer. He is the closest thing to an absolute “Giant in Medicine” in the list.

David Scheim, I had never heard of before. However, a quick search of his name revealed that he has authored books claiming that the mafia killed John F. Kennedy, Jr. He does, however, list his affiliation as being a Commissioned Officer, US Public Health Service, Inactive Reserve, Blacksburg, VA. He has also been promoting ivermectin to treat COVID-19 since at least June of last year. I couldn’t find what “Inactive Reserve” means (maybe someone in the USPHS can explain), but there is a “Ready Reserve“, consisting of three main components: Selected Ready Reserve (SELRES), Individual Ready
Reserve (IRR), and Retired Reserve. Then I found this article:

After 15 years as chief of NEI’s Management Information Systems Branch, Dr. David Scheim has retired. He will remain on “inactive duty” as a commissioned officer.

Scheim joined NEI in 1981 as chief of the computer support branch. NEI has been a wonderful place to work and a “privileged life of technology,” he says, because NEI management allowed him the opportunity to explore and work with state-of-the-art computer hardware and software. “Most of what I’ve done at NEI is database development,” he says.

Scheim was one of the pioneers of client-server database technology at NIH. He designed and implemented several such extramural computing systems, and demonstrated client-server concepts and methodologies at various intercampus forums. He also was a member of the NIH Architectural Management Group.

So Mr. Scheim is a retired computer database developer and hasn’t been an active member of the NIH or the US Public Health Service for 25 years.

Dr. Alessandro Santin, it turns out, is a gynecological oncologist and researcher at Yale. He, too, has apparently fallen into the ivermectin rabbit hole and has been touted by Frontline COVID-19 Critical Care (FLCCC):

Most of his prominence in the ivermectin promotion circuit has come from Italy, however, for example, this article, having been quoted as saying, “Ivermectin can really be the game-changer against Covid 19. It works. Now the literature is going in one direction only.” (I can’t help but note that Dr. Santin is correct that the literature is going in one direction with respect to ivermectin. Unfortunately for him, it’s not the direction that in which he claims it’s going.)

Finally, Morimasa Yagisawa is a visiting professor at Kitasato University, Omura Satoshi Memorial Institute in Tokyo, and, yes, he believes that ivermectin is a very effective treatment for COVID-19, having given a statement to the World Health Organization declared that “ivermectin is almighty for prophylaxis, for treatment of early and late stage, and also for long COVID-19 (or) post-acute sequelae (of SARS-CoV-2).” Well, even given potential issues with English aside, that’s a rather…bold…statement.

So it’s clear that the authors of this review are very much fans of ivermectin. Of course, that doesn’t necessarily mean that they don’t make some good points (although I’d be more inclined to be less skeptical of them if they hadn’t included Dr. McCullough as a co-author, given just how utterly bonkers his ramblings about COVID-19 are). Still, after reading this post, it became clear to me that this was more propaganda than science, as you will see.

In praise of an unproven drug: The Nobel gambit

What amused me as I read the article is the whole framing of ivermectin. It’s clear that all the criticism of ivermectin proponents and the poor quality of evidence that they marshal to make their cases has gotten to them, particularly sarcastic cracks about using a horse or sheep dewormer to treat or prevent COVID-19. So the authors bend over backwards to discuss just how awesome a drug ivermectin is—for worms and parasites, that is:

The 2015 Nobel prize for the discovery of ivermectin (IVM) and an antimalarial treatment was the Nobel committee’s first award for treatment agents for infectious diseases since that of 1952 for streptomycin [1]. A macrocyclic lactone of multifaceted potency [2, 3], IVM as deployed worldwide since 1987 has made major inroads against two devastating tropical diseases, onchocerciasis and lymphatic filariasis [4]. During the year since IVM treatment of another global scourge, COVID-19, was first applied [5], results from more than 20 randomized clinical trials (RCTs) of IVM treatment of COVID-19 have been reported [2, 6, 7], with inpatient and outpatient treatments of COVID-19 conducted in 25 countries [2]. A likely biological mechanism has been indicated to be competitive binding with SARS-CoV-2 spike protein sites, as reviewed [8, 9].

I remember this well. The antimalarial treatment included in the 2015 Nobel Prize was artemisinin, which is a derivative of a compound used in traditional Chinese medicine (TCM). As I noted at the time, just because artemisinin came from TCM did not mean that TCM’s precepts were scientifically valid, leading me to point out that artemisinin was a triumph of natural products pharmacology and the scientific method, not TCM. Scott Gavura, for his part, echoed this criticism, pointing out that the 2015 Nobel Prize in Medicine did not validate herbalism or naturopathy, while Steve Novella pointed out that artemisinin had low bioavailability and a short half-life, meaning that it had to be chemically modified (that pesky natural products pharmacology again!) before it could be an effective antimalarial drug.

Why do I mention this? Simple. TCM proponents are still pointing to artemisinin as “evidence” that TCM has a scientific basis, and the arguments in the ivermectin review article reminds me of the same tactic. Basically, the authors are pointing out how awesome ivermectin is as a drug to treat various parasites and worms—so awesome that its developers shared a Nobel Prize—and using that glow to argue that the drug is also highly effective against SARS-CoV-2 infections, even though antiviral activity is a much different thing than activity against parasites. In fairness, ivermectin is a pretty awesome drug for worms and parasites, as this pre-pandemic review from 2011 points out:

There are few drugs that can seriously lay claim to the title of ‘Wonder drug’, penicillin and aspirin being two that have perhaps had greatest beneficial impact on the health and wellbeing of Mankind. But ivermectin can also be considered alongside those worthy contenders, based on its versatility, safety and the beneficial impact that it has had, and continues to have, worldwide—especially on hundreds of millions of the world’s poorest people. Several extensive reports, including reviews authored by us, have been published detailing the events behind the discovery, development and commercialization of the avermectins and ivermectin (22,23-dihydroavermectin B), as well as the donation of ivermectin and its use in combating Onchocerciasis and lymphatic filariasis.16) However, none have concentrated in detail on the interacting sequence of events involved in the passage of the drug into human use.

And the effects of ivermectin on human health have been spectacular:

Ivermectin proved to be even more of a ‘Wonder drug’ in human health, improving the nutrition, general health and wellbeing of billions of people worldwide ever since it was first used to treat Onchocerciasis in humans in 1988. It proved ideal in many ways, being highly effective and broad-spectrum, safe, well tolerated and could be easily administered (a single, annual oral dose). It is used to treat a variety of internal nematode infections, including Onchocerciasis, Strongyloidiasis, Ascariasis, cutaneous larva migrans, filariases, Gnathostomiasis and Trichuriasis, as well as for oral treatment of ectoparasitic infections, such as Pediculosis (lice infestation) and scabies (mite infestation).14) Ivermectin is the essential mainstay of two global disease elimination campaigns that should soon rid the world of two of its most disfiguring and devastating diseases, Onchocerciasis and Lymphatic filariasis, which blight the lives of billions of the poor and disadvantaged throughout the tropics. It is likely that, throughout the next decade, well over 200 million people will be taking the drug annually or semi-annually, via innovative globally-coordinated Mass Drug Administration (MDA) programmes. Indeed, the discovery, development and deployment of ivermectin, produced by an unprecedented partnership between the Private Sector pharmaceutical multinational Merck & Co. Inc., and the Public Sector Kitasato Institute in Tokyo, aided by an extraordinary coalition of multidisciplinary international partners and disease-affected communities, has been recognized by many experts and observers as one of the greatest medical accomplishments of the 20th century.15) In referring to the international efforts to tackle Onchocerciasis in which ivermectin is now the sole control tool, the UNESCO World Science Report concluded, “the progress that has been made in combating the disease represents one of the most triumphant public health campaigns ever waged in the developing world”.16)

None of this, of course, means that ivermectin is effective against COVID-19, only that it has been spectacularly effective against certain scourges of the developing world, such as onchocerciasis, the second leading cause of blindness caused by an infectious disease, and lymphatic filariasis, also known as Elephantiasis for its ability to cause severe lymphedema and “elephant” limbs.

So, yes, ivermectin is a fantastic drug, both for animals and humans, when used for purposes supported by medical science.

But what about the evidence?

I knew there was something fishy about this review when I saw this in the abstract:

The RCT using the highest IVM dose achieved a 92% reduction in mortality vs. controls (400 total subjects, p<0.001).

That part about 400 subjects plus the 92% reduction in mortality is a narrative I had heard before. Hmmm, I wondered, Which study is that? It sure sounds familiar. It didn’t take me long to realize that this was a study out of Egypt (Elgazzar 2020) that (1) had never been peer reviewed and only been available on a preprint server; (2) as the largest randomized trial of ivermectin for COVID-19 drove seemingly “positive” results in meta-analyses even though the rest of the studies without it wound up producing a negative result; and (3) was very likely was fraudulent, complete with plagiarism and data that appeared to have been made up, leading to its retraction from a preprint server—surely the first time I had ever seen that before!

Let’s just put it this way, if the results from Elgazzar 2020 reflected ivermectin’s true activity, then, as Gideon Meyerowitz-Katz (whom I have quoted before) noted in his discussion of the potential fraud, ivermectin would be “most incredibly effective treatment ever to be discovered in modern medicine”. As a physician (opposed to an epidemiologist), I did quibble a bit with Meyerowitz-Katz (we do have treatments that are greater than 90% effective at eliminating the diseases or conditions that they treat, especially a number of vaccines), I couldn’t deny that he was certainly correct if one were to restrict this observation to antiviral drugs. If Elgazzar 2020 were accurate and generalizable, ivermectin would indeed be the most incredibly effective antiviral treatment ever to be discovered. I further noted that that result alone should have raised a number of red flags. Of course, it did among authors doing meta-analyses who were not ivermectin advocates from the BIRD Group or the FLCCC, which is why they excluded it from their analyses. Apparently it did not for the authors of this review, who accept its results as basically fact, stating again in the text:

The RCT that used the largest dose of IVM, 400 µg/kg on each of days 1-4 [22], had 2 vs. 24 deaths in the treatment vs. control groups (n=200 each), a 92% reduction in COVID-19 mortality (p<0.001).

In fairness, this review was just published, and the retractions and allegations of fraud occurred less than a month ago. Perhaps the paper was already too far along in the pipeline towards publication to note this. On the other hand, this is currently an online pre-proof of a journal article in press. There is, of course, time to correct it by removing any reference to Elgazzar 2020 and also pointing out that the meta-analyses from the BIRD Group and the FLCCC cited so prominently in this article become negative without it.

The authors make another point that seems reasonable but is definitely arguable:

Another objection that has been raised to the RCT evidence supporting IVM efficacy was that study populations were too small [31]. Yet it is well known in clinical trial design that highly effective drugs will establish statistically significant results with smaller sample sizes, with larger study populations required for minimally effective drugs [32]. For example, as noted above, the highest dose IVM treatment study for COVID-19 that tracked mortality had 2 vs. 24 deaths in treatment vs. control arms of 200 subjects each [22], with a z test p-value of 0.0006 [33]. But for a drug with a more modest RR of 75%, for example, the treatment and control arms would need more than 3,800 subjects each to yield the same statistical significance [33].

Yes and no. (Also, there they go citing Elgazzar 2020 again as if it weren’t at the least bogus and at the worst fraudulent!) In theory, yes, if an effect due to a drug on a given disease is really dramatic it should be detectable in smaller randomized clinical trials. However, smaller trials are also more subject to spurious results, particularly if they are not well-conducted. Why? Because they will have a small number of events, such that even a spurious event by random chance alone could affect their results far more than such an event could affect a larger trial. And, make no mistake, none of these trials were particularly well conducted, with many of them biased. There is one exception, though. Unsurprisingly, this trial produced a negative result for ivermectin, at least when used in adults with mild to moderate disease. In any event, there’s a saying about meta-analyses:

That saying applies to every meta-analysis thus far of ivermectin, simply because the evidence base is so bad. I also have another saying, namely that equivocal clinical trials of a drug with low prior plausibility = “the drug almost certainly doesn’t work”. Again, the low prior plausibility is based on the in vitro studies in which ivermectin required a high concentration, far higher than is achievable in human blood, to exhibit antiviral activity against SARS-CoV-2. Having worked with an anticancer drug for which the effective concentration in mice was barely achievable—and then only with a potentially toxic dose—this observation alone made me very skeptical of ivermectin as a COVID-19 treatment. I always leave open the possibility that I could be wrong and the drug might be effective, but based on what I know now I think the probability that the drug will be shown to work against COVID-19 in larger randomized trials is quite low. Under normal circumstances, I’d estimate those chances as being so low that the trials aren’t worth doing, but in the current political climate, particularly with so many ideologues and grifters promoting ivermectin as a cure for COVID-19, I have to hold out hope that a negative large clinical trial might help slow the grifting or that the best result that could likely be expected, a modest effect, would at least put ivermectin into perspective. No, I’m not naïve. I know that a resoundingly negative clinical trial of ivermectin probably won’t achieve that, but I can hope, can’t I?

What about the rest of the studies cited in this review? There were two animal studies, one of which is a study in golden hamsters that’s been on a preprint server since November, not a good sign it will ever passing peer review. Interestingly, the study showed no effect of ivermectin on viral load, although it claimed to show a major effect on SARS-Cov-2-associated pathology, including loss of sense of smell. The study was not blinded, something that researchers doing animal research often forget to do, even though failure to blind can cause the same problems in animal research as in human clinical trials. The second study wasn’t even of SARS-CoV-2, but of mouse hepatitis virus (MHV), a type 2 family RNA coronavirus similar to SARS-CoV-2. This study was not blinded, either, except for the pathologist examining the liver sections for signs of viral infection. Given that it didn’t even test ivermectin against SARS-CoV-2 and didn’t really show that MHV is so similar to SARS-CoV-2 that the results would be generalizable, color me less than impressed by these animal studies.

Lastly, the authors cite data from Peru:

The clinical experience of IVM treatments of COVID-19 in 25 countries extends far beyond the RCT results summarized, yet incomplete tracking and lack of control data exclude most of this for evaluation. The record of nationally authorized such treatments in Peru provides a notable exception [42]. In ten states of Peru, mass IVM treatments of COVID-19 were conducted through a broadside, army-led effort, Mega-Operación Tayta (MOT), that began on different dates in each state. In these MOT states, excess deaths dropped sharply over 30 days from peak deaths by a mean of 74%, in close time conjunction with MOT start date (Figure 1B). In 14 states of Peru having locally administered IVM distributions, the mean reduction in excess deaths over 30 days from peak deaths was 53%, while in Lima, which had minimal IVM distributions during the first wave of the pandemic due to restrictive government policies there, the corresponding 30-day decrease in excess deaths was 25%.

Reductions in excess deaths by state (absolute values) correlated with extent of IVM distribution (maximal-MOT states, moderate-local distributions, and minimal-Lima) with Kendall τb = 0.524, p<0.002, as shown in Figure 1C. Nationwide, excess deaths decreased 14-fold over four months through December 1, 2020. After a restrictive IVM treatment policy was enacted under a new Peruvian president who took office on November 17, however, deaths increased 13-fold over the two months following December 1, through February 1, 2021 (Figure 1A).

Does this sound familiar? It’s the same sort of ecological “analysis” that an astroturf group was doing for hydroxychloroquine last year that I discussed. The methods of this study are equally awful, which is probably why this article, too, is only on a preprint server thus far, and guess what? It’s a study whose first author is David Scheim, a man with no discernable expertise in the sort of complex epidemiology that would be required to make sense of the Peruvian data, while the other author is Juan Chamie of—you guessed it!—the FLCCC. I’ll say about this study the same thing that I said about the HCQ astroturf site: This is all utter rubbish, methods, conclusion, and all, as you will see. It’s so bad that it reminds me of a study by two antivaxxers without any qualifications in epidemiology, Neil Z. Miller and Gary S. Goldman, that tried—and failed—to correlate the number of vaccines in the recommended vaccine schedules of various countries with those countries’ infant mortality rates.

Seriously, this is some really bad stuff. Let’s just put it this way. Ecological studies of the use of a drug are pretty much worthless because it’s impossible to control adequately for other potentially confounding factors or, in the case of a pandemic, the unexpected resurgence of a virus due to new variants, such as what we are seeing in the US due to the delta variant. But COVID-19 cranks do love their “real world evidence,” don’t they?

I can’t resist finishing this section with these Tweets:

This tells you a lot about the quality of this review.

A notable omission

I’ll conclude by pointing out a very notable omission of a study in this review. The authors cite meta-analyses that use what they refer to as “Cochrane methodology”, which is all well and good, except that they forget to mention that a real, honest-to-goodness Cochrane systematic review and meta-analysis of ivermectin for COVID-19 has actually been published. Its conclusions were—shall we say?—not particularly good for ivermectin:

We found no evidence to support the use of ivermectin for treating or preventing COVID-19 infection, but the evidence base is limited.

Evaluation of ivermectin is continuing in 31 ongoing studies, and we will update this review with their results when they become available.

And:

Based on the current very low- to low-certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID-19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use ivermectin for treatment or prevention of COVID-19 outside of well-designed randomized trials.

Coming back to small studies and small numbers of events, Cochrane noted:

Our confidence in the evidence is very low because we could only include 14 studies with few participants and few events, such as deaths or need for ventilation. The methods differed between studies, and they did not report everything we were interested in, such as quality of life.

The Cochrane Collaborative, being the Cochrane Collaborative, didn’t really include prior plausibility/prior probability in its analysis, but even without it the best that it could say about ivermectin to treat COVID-19 is that there isn’t good evidence to support it and that maybe ongoing trials will clarify the question. That’s far less…optimistic…a picture than this particular review paints.

In fairness, this Cochrane review wasn’t published until late July, and the publication date of the “Nobel”-touting review was early August. So in this case it really is possible that the authors didn’t know about the Cochrane review. I’m sure they’ll get to correcting their preprint online-only article right away to remove any mention of Elgazzar 2020 and add a citation and discussion of the Cochrane review.

The bottom line

There is a vast disinformation campaign about COVID-19, public health interventions to slow its spread, and especially vaccines. Back when the pandemic was new, hydroxychloroquine was promoted as a treatment in part because if there were a highly effective treatment for COVID-19 advocates could argue that masks, social distancing, and “lockdowns”—and even vaccines—were unnecessary. As the evidence finally convincingly showed that hydroxychloroquine doesn’t work, the same antimaskers and antivaxxers pivoted to ivermectin. Again, I suspect that there’s a reason why the FLCCC and BIRD Groups always included Elgazzar 2020 in their meta-analyses, just as I suspect that this latest clickbait “review” prominently features this same study, despite flaws and bias that were obvious even before the analysis that led it to be retracted. Basically, this review article is part of this disinformation campaign.

I originally entitled this series, “Ivemectin is the new hydroxychloroquine” because of the obvious parallels between the quality of evidence for hydroxychloroquine and ivermectin (low) and the concerted astroturf campaign designed to promote both drugs as a rationale to argue that public health interventions and vaccines to slow the spread of COVID-19 are unnecessary when a “highly effective” treatment supposedly exists. I note, though, that hydroxychloroquine advocates never went as far as ivermectin advocates have gone. Perhaps future posts in this series should be entitled, “Once, ivermectin was but the learner. Now it is the master.” The subtitle could be, “Only a master of astroturfing and grift.”

Yes, I’m still a Star Wars fan, and I had to work that quote in, even if the result was a bit awkward.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

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78 replies on “Ivermectin is the new hydroxychloroquine, take 5: But it won the Nobel Prize!”

Next up: Chicken noodle soup, prednisone and hot foot baths for covid 19! Absolute Quackery!

Well, the placebo effect is quite powerful as you might know, it seems to be more powerful the more the subject believes in it, hence the latest numbers from Israel:

According to the Israeli Ministry of Health “COVID Dashboard” website in Hebrew, these are the numbers as of 16 August 2021, for seriously ill:

302 FULLY VACCINATED SERIOUSLY ILL

216 NOT VACCINATED SERIOUSLY ILL

10 PARTIALLY VACCINATED (ONLY ONE DOSE) SERIOUSLY ILL

Makes one want to fund a study of a new (inert) “wonder pill” to prevent covID…

Look up “חולים קשה – התחסנות” at the MOH website:

datadashboard.health.gov.il/COVID-19/general

Israel has 80% of its adult population fully vaccinated and a further 6% partially vaccinated.

So quick back of the envelope calculation yields the frequency of seriously ill people is:

5.5 per 100,000 for fully vaccinated
2.3 per 100,000 for partially vaccinated
23.4 per 100,000 for unvaccinated.

On raw numbers it looks pretty good odds for getting vaccinated.

@ Quasi

(sigh) This has been explained to you and others already. Multiple times

The more vaccinated people are in a population, then the more vaccinated people getting sick there will be.

Where the chips go down is when you compare the proportions in regards to the whole population.

Israel has what? Above 80% of the population vaccinated?

Then, if the vaccines were doing nothing, you should have 80% of seriously ills who are also vaccinated. Give or take a few %. That’s not the case with your numbers.
Sick, fully-vaccinated people represent only 57% of the cases (302/528). Non-vaccinated people are over-represented among these cases.

Further, consider age groups. Vaccination was pushed/prioritized on the elderly/populations at more risk of becoming seriously ill if infected.
So the vaccinated people, if they are infected, are on average more likely to end up in hospital than the younger/less at risk non-vaccinated population.
That means that non-vaccinated population is even more over-represented in hospitals, currently.

And that’s not just in Israel. Same thing in the US and in Europe. Patients are younger than usual, and non-vaccinated people are over-represented.

You called me, some time ago, a goat-herder.
I am puzzled why you would think it’s an insult.
Anyway, if I am a goat-herder, then it’s appropriate. You bleat like a goat.

I laughed when I saw Nobel Prize in the paper title. It was an immediate indicator to me that the authors knew their evidence was weak. Otherwise why not just provide the evidence? A Nobel Prize for treating nematodes is no evidence that the same chemical is effective for treating viruses.

It’s the kind of title you’d expect from a high school student trying to impress their teacher.

@Chris Preston and anyone interested:

Right, but don’t you think it might be a good idea to study why/by what mechanism drugs like ivermectin and chloroquine “for treating nematodes”, Trypanosome, malaria, etc. caused by insect-borne protozoa might work on Wuhan-SARS-cov-2 and similar viruses?

For example:
“…widespread and often fatal disease occur as the result of the second process, which is termed antigenic shift. This happens when there is reassortment of the segmented RNA genome … leading to major changes in the hemagglutinin protein on the viral surface. The resulting virus is recognized poorly, if at all, by antibodies and by T cells directed against the previous variant, so that most people are highly susceptible to the new virus, and severe infection results.

The third mechanism of antigenic variation involves programmed rearrangements in the DNA of the pathogen. The most striking example occurs in African trypanosomes, where changes in the major surface antigen occur repeatedly within a single infected host. … So, by having their own system of gene rearrangement that can change the VSG protein produced, trypanosomes keep one step ahead of an immune system … These cycles of evasive action make trypanosome infections very difficult for the immune system to defeat .. Malaria is another major disease caused by a protozoan parasite that varies its antigens to evade elimination by the immune system.”

From:
ncbi.nlm.nih.gov/books/NBK27176/

Another good study to get funded…

Right, but don’t you think it might be a good idea to study why/by what mechanism drugs like ivermectin and chloroquine “for treating nematodes”, Trypanosome, malaria, etc. caused by insect-borne protozoa might work on Wuhan-SARS-cov-2 and similar viruses?

Nope.

First it needs to be established that drugs like ivermectin and chloroquine have a positive effect in treating COVID-19. Waste of time investigating mechanisms of action for drugs that don’t work.

@ Quasi

For example:

Yes, the trypanosome is very good at evading its hosts’ immune system.
That’s why making a vaccine against this parasite has been eluding us for three of four decades.

But that’s a non sequitur. What does that have to do with the mechanism of action of IVM and HCQ on parasites?
AFAIK, these drugs don’t involve our immune system. They kill the parasites all on their own.

IVM is a neurotoxin and kills worms because of this, Trypanosoma is not a worm, it is protozoa. >Antigenic variation (trypanosomes} is not same thing as framshift mutation (RNA virus).

Good to study? “Before we try to explain something, we should be sure it actually happened.”–Ray Hyman. You want us to spend money and time studying why something happens when it seems clear already that it doesn’t actually happen.

Quasimodo:

ncbi.nlm.nih.gov/books/NBK27176/

The cited book chapter fails to mention either ivermectin or COVID-19. The latter omission is hardly surprising, since the book’s copyright date is 2001.

The best scientists among the best scientists? You mean members of the National Academy of Sciences are writing about ivermectin? Do tell!

You keep repeating yourself.

There’s a new study out of Israel that shows ivermectin is a good prophylactic (not reviewed yet but you link to unreviewed studies when it suits you)

Also, I understand you’re probably not up to speed with scientific developments but ivermectin has been used on few viruses already for at least a decade (west nile for example).

“…ivermectin has been used on few viruses already for at least a decade (west nile for example).”

How odd then that leading medical authorities state there is no proven specific treatment for West Nile virus infection.* For instance:

“Supportive care remains the mainstay of treatment for WN virus infection…
The potential use of several different therapeutic agents has also been described. However, there are no data to support the routine use of any agents, and uncontrolled studies or case reports suggesting treatment efficacy should be cautiously interpreted, since the clinical course and outcomes with WN virus neuroinvasive disease are highly variable.

http://uptodate.com/contents/treatment-and-prevention-of-west-nile-virus-infection

*gotta be a conspiracy by Big Intravenous Fluid.

@Scientism Dave. If Narad’s paper was what you meant, it was about viral load- Proving clinical efficiency is actuallyt needed.

And you do not, of course cite the study. You being you, I suspect that you misunderstood everything.

What’s the point?

It would take you 2 seconds to find it on google if you (or him) were interested.

Me linking here to yet another study is like sending a math book to the taliban.

“like sending a math book to the taliban.”

Why not? Some may stop with the three finger sweep and yeet and the girls who clean the base/latrine may yet get a secret education anyways.

https://twitter.com/theNuzzy/status/1427051039404957697

You disparage them, Scientism Dave? I misunderstand? They seem scientismy enough and, from what I’ve been told, local y’all-Qaeda yeehawdists should get along swimmingly with them should they ever come doing tourism.

^ He may also have been slow to notice that it’s pretty thoroughly dismantled in the comments. (My confidence in the ID has increased — even though it was posted at the very end of May, its circulation in the crankoverse only seems to have started picking up a couple of weeks ago. “Not up to speed with scientific developments,” indeed.)

“like sending a math book to the taliban”

Partly correct. Who needs maths books in this day and age?

Prove this is a triangle.

Tesla – 4,000,000 lines of cloud code. “there.”

Waymo – Just look at it, my dude. What the fuck else could it be?

@coriolis

You disparage them, Scientism Dave?

LOL you think little girls in Afghanistan are members of the taliban?
I think the vaccines might have crossed your brain membrane.

@Narad

My nick is in honor of the author of the blog. I know you’re too dense to have gotten it.

Are you ready for your booster biaatch?

@ Scientism Dave

So, accusing others of linking to unreviewed studies; yet, where is link in your comment to unreviewed Israeli study???

Do tell, do tell, unless you cannot provide a link. You seem to avoid them, lest they indicate some tiny flaw in your claims or understanding

I understand you’re probably not up to speed with scientific developments but ivermectin has been used on few viruses already for at least a decade (west nile for example).

Ivermectin is an insecticide as well as a treatment for roundworms. That is where it gets used with insect-borne diseases.

The “consilience of evidence” supports ivermectin therapy against Covid-19, according to James Lyons-Weiler.* A “consilient” approach means we’ve got to look beyond medical evidence to other disciplines, maybe philosophy, art and abnormal psychology.

*he’s also pushing honey and Nigella sativa as Covid-19 treatment, like they do in Pakistan. Anything except vaccination.

A “consilient” approach means we’ve got to look beyond medical evidence to other disciplines, maybe philosophy, art and abnormal psychology.

I suspect tealeaf-reading, coprology and navel-gazing are the main go-to disciplines.

In other Covid/ vaccine news…

Americans are creating their own vaccine mandates by cutting ties with the unvaccinated Market Watch, today.

As governmental bodies and major businesses mandate vaccines for workers and/ or customers, individuals polled say that they have personally cut off unvaccinated people in their lives, with Millennials and Gen Xers at 30% and 33% respectively. The older groups report less than 10% BUT those groups are already the most heavily vaccinated while younger groups may have unvaccinated kids at home.

— Today NYC inaugurates a “soft opening” for vaccine-only admissions to various events/ business, including dining.
Get out your cards or cell phones!

Personally, I think that NYers will do just about anything if chic/ hip dining or entertainment is involved.

I read an article from the BBC yesterday where some restaurant owners in NYC were all “how could I possibly police people’s vaccine cards?!” and I thought, isn’t that what every bar and club in NYC already does (is supposed to do) as far as age restrictions?

Like, you probably already card people for wine and cocktails, now you card them at the door for their vaccination status. Yes, hoity-toity Fancy McMoneyPants will probably complain, but they were going to complain about everything anyway, and they don’t tip, so are you really losing any business if they leave?

Right.
Although it will take time and effort to check people’s status, I’m sure that many restauranteurs/ bar owners prefer the extra work rather than going back to closures/ take-out only and less business. If people feel confident about safety, they’ll come out – businesses also need security measures for when it gets colder and everyone goes back indoors.
The city now has an app which might make “carding” automatic or very quick.

I have to mention that the airlines might follow United’s lead: make employees get vaccinated, advertise how you clean planes, require masks- I felt safe on my recent trip.

Qantas in Australia has just announced that COVID-19 vaccines will be mandatory for all staff (medical exemptions excepted). They already require masks on all flights, as do all airports. They see it as the only way to even start to get back to normal business.

They are not going to be alone. A number of other businesses have already stated their intention of making COVID-19 vaccines mandatory for customer facing staff. The vaccine laissez-faire that has occurred in Australia (due to next to no cases and risks with the AZ vaccine) has really started to bite business now the delta strain is loose. More than half the population has been in lockdown of various types for a couple of months. Vaccination has become the only way out. I now have an app on my phone that shows my vaccination status. It also comes up when I use the QR check in, which is mandatory for every business here. 98% of people just do it and get on with their lives. It is better than being in lock down.

“Today NYC inaugurates a “soft opening” for vaccine-only admissions to various events/ business, including dining.”

AKA “Separate but equal”

@ Scientism Dave

You write: “Separate but equal.” And several have claimed same as Nazis requiring Yellow Star. Well, not even close. If, say, a man in his younger years converted to Christianity, was active in Church, married a Christian woman, raised their children actively in Church, and, in turn, their children had children. Didn’t matter, one grandparent who was Jewish made them Jewish. If a Jew served in German army, won Iron Cross (some did, equivalent to Congressional Medal of Honor), still treated as Jew. If a Jewish doctor did his best to treat poor Germans, not charging them, still Jewish. In other words, nothing could change the Nazi treatment of Jews; but getting vaccinated, wearing a mask, are behaviors, not inborn unchangeable traits. And during segregation in United States, the “separate but equal” based on inborn non-changeable traits, not on the individual person’s behaviors. Having grown up knowing survivors of the Holocaust and having followed the Civil Rights movement, you and others analogizing the requirement to be vaccinated and wear a mask is disgusting; but then when have you posted a comment that wasn’t both STUPID and DISGUSTING?

It’s really funny to see folks say things “Separate but Equal”. and show that they have no idea what it means.

I can’t see my comment but I may have erred:
The groups at 30& and 33% are Gen Z and Millennials.

He’s also a consultant cardiologist and Vice Chief of Medicine at Baylor University Medical Center and Principal Faculty in internal medicine for the Texas A & M University Health Sciences Center

Actually McCullough is lying about Baylor according to an August 3 article in Med Page Today (https://www.medpagetoday.com/special-reports/exclusives/93936):

Baylor Scott & White Health sued former employee and cardiologist Peter McCullough, MD, last week, alleging that he illegitimately affiliated himself with its facilities when promoting controversial views about COVID-19.

Nearly 6 months after McCullough’s employment had ended, he continued to use his former professional titles — such as “vice chief of internal medicine at Baylor University Medical Center” — in media interviews in which he spread his opinions about the pandemic, the lawsuit alleged.

Really not surprising yet another shady grifting physician who’s gone for the ego/$$$ over actually helping people during this pandemic.

A “grifter” who has published 47 papers on Covid and, unlike you, has actually treated Covid patients. (Also a Baylor alum and major donor, but I guess that doesn’t matter.) But have fun with your pathetic witch hunt, which of course is the primary reason for this website’s existence. I NEVER read anything positive from Oracle, just shit-smears of others who don’t have the luxury of pontificating from a tower of feigned superiority.

@ John Kirby

It would be nice if someone like you actually chose some of what Orac writes, that is, literally cite, and, of course, not taking out-of-context, and then explain why it is wrong. Not just your opinion; but back with science, logic, etc. Your entire comment basically says nothing, well, actually says a lot about you. Talk about pontificating! ! !

As for “witch hunt”, well, if looking for papers, claims, etc. by people who don’t meet the smell test for scientific validity is a witch hunt, not exactly what the books I own and have read on Medieval witch hunts and trials were all about.

So, in your mind, people shouldn’t challenge claims by others, often claiming some expertise; but just accept at face value. Wow! And how would you deal with conflicting claims???

And I guess you support antiscoience blogs that attack science without any basis other than they know they are right.

Broadway star loses out on show because of refusal to get vaccinated, but preserves fertility.

“After Page Six reported that Broadway superstar Laura Osnes was fired from a show for refusing to get a COVID-19 vaccination, Osnes issued a statement defending her decision to skip the injection because “there’s so much that’s still unknown” about the shots.”

“She also denied that she was fired, and said that she decided to quit the one-night production of “Crazy for You” after producers at the Guild Hall Theater in East Hampton told her she’d have to get vaxxed to take part.”

http://foxnews.com/entertainment/broadway-laura-osnes-quit-vaccinated

In other news…

( reported by NBC, patch, njspotlight, others)
18 students sued Rutgers University** in federal court about its vaccination mandate for students, an effort led by Children’s Health Defense ( see website). One student was quoted as saying he didn’t want to ” play Russian Roulette” ( although he already IS by being unvaccinated). The news sources variously reported on CHD’s being associated with RFKjr- some noted it, others didn’t. Patch mentions that 95% of students have already complied with vaccination.

** I imagine Orac is familiar with the area since IIRC he worked at their medical school

He may be right that he won’t be playing Russian Roulette. In that game you put a bullet in one chamber. In the game he proposes to play he’s putting bullets in 4 chambers.

In other news 2….

( Times Union)
Anti-vaxxers plan a “festival in a field” in Claverack, NY which includes RFK jr’s and Del’s CHD and ICAN groups this weekend joining a local group.

Claverack is a small town ( population 6000) in Upstate NY’s Columbia County which is rural and not especially right wing ( my cousin’s daughter lives right next door) : this area recently was to host the cancelled Naomi Wolf fest a few months ago,

I wonder what brings two major anti-vax dynamos thousands of miles to rural NY, 100 miles form the city? Photo ops? Bird watching? Farm to Table cuisine?

We need a song here.

Some folks like water
Some folks like gin
But I like the taste
Of ivermectin

You may think it’s funny
That I like this stuff
But once you’ve tried it
You can’t get enough (wow!)

Wine is red
Poison is blue
Shop the livestock aisle
for what’s ailing you

If you listen to what they say
You’ll try ivermectin some day
Make you jump, it’ll make you shout
It’ll even knock your parasites out

Some folks like water
Some folks like gin
But I like the taste
Of ivermectin (wow!)

Ivermectin hey, hey
Ivermectin hey, hey (wow!)
Ivermectin hey, hey
Ivermectin hey, hey
Ivermectin hey, hey
Ivermectin hey, hey

Or if you prefer a classic:

http://youtube.com/watch?v=gQgPAEbwSrE

@ John Kirby

Nice how you base your comment on some little known blog. In order to know if he actually had a better success rate than others we would have to have some independently validated diagnosis of the severity of the patients and exactly the protocols he used. However, given that numerous international reports have NOT found Ivermectin to be effective; but, believe what you choose to believe.

If you took a course from me, basing answer on an exam on such flimsy evidence would get you an F; but, heh, all the other reports and those reporting on Ivermectin are wrong, at least in your mind.

@ John Kirby

I found a better article on Dr. John Varon: “In hopes of avoiding patient intubation, they landed on a combination of treatments that they say significantly improves outcomes, including
steroids, anticoagulants and ascorbic acid. Varon CLAIMS the treatment cocktail has kept the death rate of patients at UMCC about 6 percent over the course of the pandemic. The mortality rate in New York reached 25 percent in March, and has come down to 7.6 in August, . . . Varon is keeping an open mind about the coronavirus, too, urging health officials to review the prophylactic potential of Ivermectin, a drug commonly used to treat parasitic worms . . . “His dream come true will be the day he beats the virus back down with a combination of vaccine and medicine that you give people early before they get sick,” Note also that the article only compares his claimed rate with New York’s. Yep, they experienced the blunt of cases in the beginning; but lots of cases around from March to December when the article was published.

So, we don’t have independent confirmation of his claim of 6%; but if approximately true, we don’t know the level of severity of his patients compared to those early on in New York and New York may have reach 25% in March; but probably brought it down month after month. Notice also he only speculates about Ivermectin and that he supports vaccines.

I’ll leave it to Orac if he feels a topic worth pursuing?

Paula Villegas (2020 Dec 12). This doctor has fought covid-19 in his patients for 268 days straight. ‘I was meant to do this.’ Washington Post.

I know IVM is being used successfully. As a stylist I hear the success of it and the horror without it. So criticize all you want but it works. I have seen it in close friends besides just hearing others stories. We should be open to all treatments from the doctors that are actually working day and night treating it. They also follow the science. May God bless you and keep you safe.

We just got an email today from the state licensing folks warning against setting up “Ivermectin clinics.” Apparently, providers have been doing “Cash only” telemedicine appointments and then handing it out after. They made it clear this is a no-go and they are investigating anyone who does so.

I wonder…for all the people posting here saying things about the opioid crisis…does this sound familiar?

Fri Aug 27, 2021 – 2:48 pm EDT
TOKYO (LifeSiteNews) – The chairman of the Tokyo Medical Association, Haruo Ozaki, held a press conference this week announcing that the anti-parasite medicine Ivermectin seems to be effective at stopping COVID-19 and publicly recommending that all doctors in Japan immediately begin using Ivermectin to treat COVID.

From NHK World-Japan News:

“Japan’s health ministry’s COVID-19 treatment guidelines revised in July places ivermectin in a category of drugs whose efficacy and safety have not been established.”

“The guidelines refer to reports that the drug does not improve mortality, shorten hospitalization or hasten the reduction of viral loads in patients with mild symptoms.”

Wonder if some pro-ivermectin sentiment in Japan stems from the drug’s discovery there in the 1970s.

That reminds me – time to give Pluto his heartworm and flea chewables.

yes, the vaccine will kill, or greatly shorten the life of anyone taking it. but also notice that very few Blacks are taking the vaccine. so when all you facist Krackers die off, only the Black Race will remain

we win

“There is one exception, though. Unsurprisingly, this trial produced a negative result for ivermectin, at least when used in adults with mild to moderate disease.”

That study is in trouble: https://osf.io/u7ewz/ (preprint)

Quotes:

“Three of the study investigators reported receiving grants and personal fees from companies that manufacture COVID-19 therapeutics, collectively including Sanofi Pasteur, a vaccine manufacturer; Janssen, a J&J vaccine partner; and GlaxoSmithKline, Merck, and Gilead, which manufacture COVID-19 drugs.”
“Study participants who could taste that their placebo dose was not ivermectin and felt sicker purchased and used IVM in the same 0.6% liquid solution available OTC at a pharmacy. The result was almost identical rates of characteristic IVM AEs as well as similar clinical outcomes (0 IVM deaths, 1 control death) in two study arms.”

The preprint I linked refers to this study: https://jamanetwork.com/journals/jama/fullarticle/2777389 – which Orac has presented as “And, make no mistake, none of these trials were particularly well conducted, with many of them biased. There is one exception, though.” – “exception, though” linked to this well conducted study which is being analyzed for retraction, on the basis of the report I linked above. It’s a 7-page .pdf document which probably contains the evidence you speak of.

But this is still in the making, so I only mentioned that it was in trouble, not that it was debunked. I know the difference. 🙂

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