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These days, ivermectin reminds me of acupuncture

As high-quality evidence increasingly and resoundingly shows that ivermectin does not work against COVID-19, advocates are doing what acupuncture advocates do: Turning to lower quality “positive” studies to claim incorrectly that their favorite ineffective treatment actually does “work.”

I’m getting tired of writing about ivermectin as a “miracle cure” for COVID-19, just as in 2020 I got tired of writing about hydroxychloroquine as a miracle cure for COVID-19. Oddly enough, as high-quality evidence accumulated that hydroxychloroquine doesn’t work, it faded in importance such that by early 2021 it was no longer the preferred wonder drug among COVID-19 conspiracy theorists. Ivermectin rose to replace it, or, as I like to say, ivermectin became the new hydroxychloroquine. These days, though, it reminds me more of acupuncture.

As high-quality evidence accumulates that ivermectin doesn’t work, I keep wondering what will be the new ivermectin, but, for some reason, ivermectin seems to have “legs”. So far, it’s withstanding a far greater assault in terms of evidence and even demonstration of probable fraud in the largest randomized controlled clinical trials cited to support its use to treat COVID-19. Moreover, as has long been the case with quackery like acupuncture, as the evidence from RCTs show it not to be any better than placebo, similarly as negative RCTs accumulate and serious deficiencies and probable outright fraud invalidating the positive RCTs, advocates are increasingly citing lower quality observational studies as “proof” that ivermectin “works” against COVID-19. It’s reminding me very much of a much older topic that we’ve been writing about since the founding of this blog, acupuncture, so much so that I’m beginning to think that ivermectin is the acupuncture of COVID-19 treatments.

Because of this, I find myself saying, “Once more unto the breach.” The reason is that ivermectin advocates are back and they’re flogging two more studies as evidence that ivermectin is the cheap, highly effective, nontoxic treatment for COVID-19 that “they” don’t want you to know about, for example:

I’ll get to those studies in a moment. In the meantime, legislative efforts to bypass science and professional recommendations continue apace, as touted here on TrialSiteNews, one of the largest antivaccine and medical conspiracy theory websites out there right now:

The New Hampshire’s state House approved a bill making ivermectin available by a medical prescribers’ “standing order,” meaning pharmacists will be able to dispense the medication without individual prescriptions. 

Narrowly approved

The Republican dominated House in Concord voted 183-159 to approve the bill.

Republicans had argued that the drug is already over the counter in several countries and had been used specifically for COVID-19.

According to the legislation, a pharmacist would be able to fill a request for the drug under a “standing order“.

Meanwhile, Jeffery Tucker, who founded the libertarian “free market” think tank, the Brownstone Institute as the “spiritual child of the Great Barrington Declaration” (which advocated in essence a do-nothing let ‘er rip” strategy for the COVID-19 plus a poorly defined strategy of “focused protection” for those vulnerable to severe disease or death) gloats that New Hampshire voted for “pharmaceutical freedom“:

The New Hampshire House of Representatives has voted to make Ivermectin available at any pharmacy that wants to distribute this drug even without a prescription. It will likely pass the Senate and become law.

It’s a hugely positive breakthrough for medical and pharmaceutical freedom. It’s only tragic that this was not the situation two years ago. The doctors the world over who have rallied behind this treatment believe that many lives might have been saved. If one state in the Northeast had at least made the option available, outcomes might have been very different.

The Epoch Times reports that “Similar bills are pending legislative approval in Oklahoma, Missouri, Indiana, Arizona, and Alaska.”

Magnificent! What’s key here is the concept of human choice.

The irony is very bitter: the vaccine mandates have been universal and people have lost careers for refusing or been rejected for participation in public life. People were forced to get shots of doubtful efficacy in most cases that many people did not want or because they did not see the need and feared their side effects.

Meanwhile, a drug they would have chosen to take was denied to them, again by force, and physicians who believed they were saving lives had their licenses taken away for using their professional discretion.

For a good part of last year, many people in the world could freely buy Ivermectin, a generic drug that at least 8 quality studies have shown to be an effective treatment for Covid-19. It has long been part of the alternative treatment protocol for Covid since it was first tried in early 2020, but never recommended by the FDA, CDC, or NIH. At some point, the CDC was tweeting denunciations of it, somehow with the implication that this treatment was distracting from the main push of vaccine fanaticism.

I quote Mr. Tucker because it’s important to remind you before I discuss the studies of how the promotion of ivermectin has so easily become part of the COVID-19 disinformation machine plus a much older phenomenon. That older phenomenon is one of which long-time readers are very aware, specifically how quacks and antivaxxers have long argued that people should be allowed to “choose” their quackery (or “choose” not to vaccinate their children), portraying such “choice” as “health freedom” while portraying those trying to hold medicine to a scientific standard of being, in essence, fascists and authoritarians trying to keep the “people” from the “cures”. There’s also a conspiracy theory at the heart of such appeals, namely that “they” are “covering up the evidence” and “they” don’t want you to know the “truth”. Such appeals have been very effective over the last decade, as I’ve pointed out that the main reason that the politics of vaccine resistance have shifted very much rightward is because of a longstanding campaign by antivaxxers to rebrand their antivaccine views as “health freedom” and “parental choice”, even co-opting the women’s health slogan “my body, my choice” in a highly cynical way.

That’s why it’s important to look at the whole conspiratorial package behind “COVID-19 resistance”, and not just the individual parts, such as antivaccine pseudoscience or resistance to masks and other nonpharmaceutical interventions (NPIs) to mitigate the spread of COVID=19. Indeed, Tucker explicitly makes this case for me. First, he mocks a CDC cartoon about how to identify health misinformation:

You are welcome to peruse the entire document, the main message of which is that the government is always correct, always knows the most science at the time, while front-line doctors with experience are very likely quacks, crazies, or ruthless profiteers. 

Sometimes it seems like the people who produce such propaganda are forever attempting to live in the world of the movie Contagion, where every alternative treatment is a scam promoted by a corrupt “blogger” and where the CDC knows all. This cartoon is a smear in every way.

I perused the document. It’s actually quite reasonable and mild, perhaps even too much so. It warns people to look out for professional-looking websites that feature quote-mined quotes, cherry-picked statistics, deceptively edited videos, old images being recirculated as though they were recent, and misleading diagrams. It identifies several types of misinformation creators and spreaders, such as the disinformer, the casual sharer, the believer, the mischief maker, and others. It suggests the CDC as one of several sources to fact check claims against, urging people, “If you’re not sure, don’t share!” All of this is very reasonable; so I wonder why Tucker reacts so violently against this message and uses a straw man huge enough that, if set afire, it could be seen from space to mischaracterize the message. Actually, no I don’t.

Unsurprisingly, though, Tucker pivots to cry “Freedumb!”:

This battle is much larger than the legal status of Ivermectin. That’s just one symbol. What’s really at stake here is the idea of medical freedom itself. And freedom is a precondition for scientific inquiry and the search for the truth. It is also essential for public health. This is one of many lessons of the disastrously botched pandemic. 

The decisions of the New Hampshire legislature to enshrine that freedom into law in this one instance represent a mighty tribute to the principle and a repudiation of the use of force in disease management.

That’s exactly what I’ve been saying, except that, unlike Tucker, I realize that ivermectin doesn’t work and vaccines do, while also understanding that denialists like him might portray what they are doing as a “medical freedom” and a “search for the truth,” but what they are really doing is spreading misinformation that doesn’t really much care for what is “true” or not, as long as it decreases the power of government.

On to ivermectin. Again.

Observational studies a-go-go

If there’s one principle that should help you to identify when a medical claim is probably nonsense, it’s that you should look at the quality of evidence cited by the proponents of that medical claim. That’s why I mentioned acupuncture. I’ve long pointed out how, as higher quality evidence from randomized controlled clinical trials of acupuncture that use proper blinding and better controls (i.e., sham acupuncture needles, acupuncture at the “wrong” sites that aren’t acupuncture points, actual double blinding to experimental group), it’s become increasingly obvious that acupuncture is nothing more than a theatrical placebo with no therapeutic effects, acupuncture advocates have shifted to preferring “pragmatic” trials. As Steve Novella pointed out so long ago, such studies are nothing more than the “rebranding” of unblinded trials. Early in the process of investigating a new treatment, unblinded studies can be justified as hypothesis-generating studies, but they are generally not considered the final word. Similarly, nonrandomized observational studies can be justified for a similar reason, in order to test whether larger randomized studies are justifiable.

It’s true that so-called “pragmatic” studies are also unblinded, but their purpose is different. They are not so much hypothesis generating as “real world” testing. As I’ve pointed out, such studies are “putting the cart before the horse“. The reason is that pragmatic trials do have a specific use in medicine. They are designed to test the “real world efficacy” of an intervention outside the highly controlled auspices of controlled randomized clinical trials (RCTs). The assumption is thus that the medical treatment being tested has already been demonstrated to be efficacious in RCTs and that the pragmatic trial is going to see how much less efficacious the treatment is when, as always happens when a new treatment is released “into the wild”, so to speak, it’s applied to a larger, less defined population with less rigor in methodology and follow-up.

The situation with ivermectin is similar in that ivermectin advocates prefer lower-quality clinical evidence than RCTs, because, as has been discussed here a number of times, all the high quality RCTs for ivermectin to treat COVID-19 have been resoundingly negative thus far, and the positive RCTs cited have all been found to contain, at best, serious flaws that invalidate their results, or to have been likely outright fraudulent. It turns out that all the dubious meta-analyses promoted by ivermectin advocates also become negative if these studies are left out (as they should have been, given their poor quality). In brief, all the higher-quality RCTs that tested whether ivermectin works are, as is the case of the higher quality RCTs of acupuncture for pretty much any indication, negative. There’s a definite rule of thumb at work here for the two. The higher quality the study, the more likely it is to be negative. Just as acupuncture advocates cite low quality unblinded studies that might have been acceptable early in the process of investigation, ivermectin advocates now cite lower quality studies that aren’t RCTs, and that’s exactly what Kim Iversen cites above.

Two observational studies that show…nothing

So let’s take a look at the two studies that Ms. Iversen touted in the Tweet that I quoted above. I’ll remind you of them by citing the Tweets again:

The first cited study comes from Cureus and is titled “Ivermectin Prophylaxis Used for COVID-19: A Citywide, Prospective, Observational Study of 223,128 Subjects Using Propensity Score Matching“. Most of the investigators are from Brazil, but one name stands out: Pierre Kory, MD of Front Line COVID-19 Critical Care Alliance (FLCCC). I’m not sure why it’s making the rounds now, given that it was first published two months ago, but such is life on social media. Either that, or it’s been making the rounds since then, but I just never noticed. I suspect that part of the reason is that it started out as a preprint that made the rounds even earlier. Indeed, in January, the FLCCC was flogging it thusly:

You might well recall that the FLCCC is a group of doctors who are not at all “frontline” doctors treating COVID-10 but, as I’ve suggested, are prolific spreaders of COVID-19 misinformation, including antivaccine misinformation and the promotion of ivermectin as a cure-all for COVID-19. Last fall, they were even caught running a telehealth prescription mill selling ivermectin and hydroxychloroquine prescriptions to anyone who had the cash.

But what about the study itself? You can see how it might impress someone like Ms. Iversen, given that it involved looking at 223,128 subjects. However, quantity doesn’t always trump quality, and one notes right away that this study is not a randomized controlled clinical trial, but rather an observational study:

We analyzed data from a prospective, observational study of the citywide COVID-19 prevention with ivermectin program, which was conducted between July 2020 and December 2020 in Itajaí, Brazil. Study design, institutional review board approval, and analysis of registry data occurred after completion of the program. The program consisted of inviting the entire population of Itajaí to a medical visit to enroll in the program and to compile baseline, personal, demographic, and medical information. In the absence of contraindications, ivermectin was offered as an optional treatment to be taken for two consecutive days every 15 days at a dose of 0.2 mg/kg/day. In cases where a participating citizen of Itajaí became ill with COVID-19, they were recommended not to use ivermectin or any other medication in early outpatient treatment. Clinical outcomes of infection, hospitalization, and death were automatically reported and entered into the registry in real time. Study analysis consisted of comparing ivermectin users with non-users using cohorts of infected patients propensity score-matched by age, sex, and comorbidities. COVID-19 infection and mortality rates were analyzed with and without the use of propensity score matching (PSM).

Reading the paper, I honestly was a bit confused. Reading the abstract and the methods, it came across to me that ivermectin was offered as prophylaxis to everyone but if anyone became sick with COVID-19 it was not recommended, and, yes, that appears to be what was done:

Patients who presented signs or the diagnosis of COVID-19 before July 7, 2020, were excluded from the sample. Other exclusion criteria were contraindications to ivermectin and subjects below 18 years of age. The dose and frequency of ivermectin treatment was 0.2 mg/kg/day; i.e., giving one 6 mg tablet for every 30 kg for two consecutive days every 15 days.

During the study, subjects who were diagnosed with COVID-19 underwent a specific medical visit to assess COVID-19 clinical manifestations and severity. All subjects were recommended not to use ivermectin, nitazoxanide, hydroxychloroquine, spironolactone, or any other drug claimed to be effective against COVID-19. The city did not provide or support any specific pharmacological outpatient treatment for subjects infected with COVID-19.

This is, to say the least, a rather strange design. First, of all, when this study first started, people were asking the same question as I was: Why on earth would you recommend that patients take two doses, separated by a day, every two weeks?

Odd protocol or not, let’s see what the authors claim to have found:

Ivermectin as acupuncture
A strange design indeed.

Summarized thusly:

Of the 223,128 citizens of Itajaí considered for the study, a total of 159,561 subjects were included in the analysis: 113,845 (71.3%) regular ivermectin users and 45,716 (23.3%) non-users. Of these, 4,311 ivermectin users were infected, among which 4,197 were from the city of Itajaí (3.7% infection rate), and 3,034 non-users (from Itajaí) were infected (6.6% infection rate), with a 44% reduction in COVID-19 infection rate (risk ratio [RR], 0.56; 95% confidence interval (95% CI), 0.53-0.58; p < 0.0001). Using PSM, two cohorts of 3,034 subjects suffering from COVID-19 infection were compared. The regular use of ivermectin led to a 68% reduction in COVID-19 mortality (25 [0.8%] versus 79 [2.6%] among ivermectin non-users; RR, 0.32; 95% CI, 0.20-0.49; p < 0.0001). When adjusted for residual variables, reduction in mortality rate was 70% (RR, 0.30; 95% CI, 0.19-0.46; p < 0.0001). There was a 56% reduction in hospitalization rate (44 versus 99 hospitalizations among ivermectin users and non-users, respectively; RR, 0.44; 95% CI, 0.31-0.63; p < 0.0001). After adjustment for residual variables, reduction in hospitalization rate was 67% (RR, 0.33; 95% CI, 023-0.66; p < 0.0001).

Leading to the conclusion:

In this large PSM study, regular use of ivermectin as a prophylactic agent was associated with significantly reduced COVID-19 infection, hospitalization, and mortality rates.

If you believe this study, then, everyone should be taking ivermectin, two doses separated by a day, every two weeks. But should we believe it? There are a number of reasons not to, not the least of which is Kyle Sheldrick’s analysis:

And:

And:

In other words, data being presented…changed. Also, as pointed out by Sheldrick, the analysis claimed is pretty much impossible and hidden behind “data available upon request”:

In other words, not only is this study not a randomized clinical trial, which is how you really determine if a drug treatment works, either to treat or prevent a disease, but it has a lot of…issues. These are issues similar to some of the randomized trials. It’s not clear to me whether this is sloppiness or potentially outright fraud; it could be either. However, this is not a good study. It does appear very impressive, though, to people like Ms. Iversen. I also rather doubt that it was truly a prospective study. Rather, it appears to be a retrospective study masquerading as a prospective study:

This was a prospective, observational study. Although study design, institutional review board (IRB) approval, and data analysis occurred after completion of the voluntary prophylaxis program, all data were collected prospectively in real time with mandated reporting to the registry of all events as they occurred during the citywide governmental COVID-19 prevention with ivermectin program, from July 2020 to December 2020, developed in the city of Itajaí, in the state of Santa Catarina, Brazil. Demographic and clinical data were reported from medical records of patients followed in a large outpatient setting (a provisional outpatient clinic set in the Convention Center of Itajaí) and several secondary outpatient settings, as part of the universal health system (Sistema Único de Saúde [SUS]).

Why is this important? In retrospective studies, one looks at an existing dataset; i.e., patients in the past. In a prospective study, one sets up and looks at patients as they present and collects the data as it happens. Given that, retrospective studies tend to be more bias-prone. What we appear to have here is a prospective data collection for residents of Itajaí onto which was later grafted a retrospective study. Here’s a hint: Just because the data were collected prospectively, you can’t call your study prospective if you designed it after data collection had been completed.

Similarly, the claim that there was a dose-response, I love how Sheldrick described how a massive apparent decrease in mortality could be observed even if ivermectin did nothing. I quote him here because he describes it better and more succinctly than I ever could:

On to the next study.

This study is titled “ Treatment with Ivermectin Is Associated with Decreased Mortality in COVID-19 Patients: Analysis of a National Federated Database“. Not giving me confidence in their abilities, the investigators are plastic surgeons and urologists at the University of Miami. Nothing against University of Miami, but rather plastic surgeons and urologists are generally not the ones who have the correct skills to do a study like this. In any event, this study is also being promoted by FLCCC. Amusingly, one of the authors, a medical student, pushed back:

And he’s right! I didn’t notice that at first, namely that it’s published in a supplement of the International Journal of Infectious Diseases dedicated to publishing Abstracts from the Eighth International Meeting on Emerging Diseases and Surveillance, IMED 2021, November 4-6, 2021. That’s why there’s just an abstract with no full article. I’ll give the student, Iakov Efimenko, credit for being honest. What I won’t do is to spare his mentors. Students can be forgiven for this bad a study, particularly when they learn from the mistake, mentors less so.

Basically, this is an example of confounding by indication. In a retrospective database review, the authors compared patients who received remdesivir for COVID-19 to those who received ivermectin. Can anyone see the problem? It should be obvious, and the name of the confounding should tell you: Patients who receive remdesivir receive it intravenously and are pretty much all hospitalized, while those who receive ivermectin take it as outpatients. As a result, it would be expected that the remdesivir patients would do worse; they’re all hospitalized, and the study didn’t correct for that!

Or:

Personally, after perusing this thread, I’m less harsh, at least on the students:

As Dr. Mark must know, peer review of abstracts for meetings is pretty perfunctory. Usually most of them are approved for at least a poster presentation. Also, these days, it seems that all specialties seem to view themselves as qualified to do COVID-19 research. I have, after all, seen orthopedic surgeons, ophthalmologists, and all manner of specialties without special expertise in infectious diseases doing COVID-19 research.

In any event, this, too, is not a good study, even as a preliminary hypothesis-generating paper, given the obvious confounders based on indication, hospitalization, and age. It is, however, an excellent case study in the creation of COVID-19 misinformation in real time:

Notice the part where the author woke up to find that his conference abstract had been shared thousands and thousands of times on social media. Notice also how YouTube’s accursed algorithm “suggests” a couple of the very videos by ivermectin-pushing influencers that were mentioned in this video as falsely portraying this abstract as slam-dunk evidence that ivermectin works against COVID-19. It had even been included in the “meta-analysis” at IVMmeta, an anonymous pro-ivermectin site that claims to be doing a “real time meta-analysis” of ivermectin studies.

Ivermectin: The acupuncture of COVID-19

Coming out last week were stories about yet another negative RCT for ivermectin versus COVID-19, for example, this one in The Wall Street Journal, “Ivermectin Didn’t Reduce Covid-19 Hospitalizations in Largest Trial to Date“:

The latest trial, of nearly 1,400 Covid-19 patients at risk of severe disease, is the largest to show that those who received ivermectin as a treatment didn’t fare better than those who received a placebo.

“There was no indication that ivermectin is clinically useful,” said Edward Mills, one of the study’s lead researchers and a professor of health sciences at Canada’s McMaster University in Hamilton, Ontario. Dr. Mills on Friday plans to present the findings, which have been accepted for publication in a major peer-reviewed medical journal, at a public forum sponsored by the National Institutes of Health.

And:

The researchers prescribed half of the patients a course of ivermectin pills for three days. The other half received a placebo. They tracked whether the patients were hospitalized within 28 days. The researchers also looked at whether patients on ivermectin cleared the virus from their bodies faster than those who received a placebo, whether their symptoms resolved sooner, whether they were in the hospital or on ventilators for less time and whether there was any difference in the death rates for the two groups.

But, but, but…, I can hear some of you saying. This study hasn’t been published yet! You’re just citing a newspaper article! True enough. That’s exactly why I only mention this study—and only very briefly, at that—because it is yet another RCT that has failed to find a therapeutic effect for ivermectin versus COVID-19. (If it were the only RCT, I would have waited for it to be published in the peer-reviewed literature before discussing it.) There are a number of other such RCTs, and, again, all the high quality RCTs are negative, including another recent RCT, which was also negative. Again, I’m getting serious acupuncture vibes from ivermectin.

Add to that the extreme biological implausibility behind the hypothesis that ivermectin can treat COVID-19. While it is true that ivermectin demonstrates antiviral activity against SARS-CoV-2 in cell culture, the concentrations required are much higher than what can be achieved in the human body. These observations alone meant that it was always highly unlikely that this repurposed anthelminthic drug (used to treat roundworm infestation-based diseases) would ever show activity against COVID-19 in humans at nontoxic (or even toxic) doses. As I described the last time I wrote about ivermectin a few months ago, the pharmacokinetics and pharmacodynamics always meant that the drug probably wouldn’t work in humans, and ivermectin is not “Pfizermectin,” as is claimed in a common conspiracy theory based on the fact that Pfizer’s new COVID-19 drug Paxlovid is a protease inhibitor and ivermectin also demonstrates protease inhibitor activity in cell culture.

The bottom line is that there is now an increasing body of high quality evidence demonstrating that there is no detectable therapeutic effect due to ivermectin against COVID-19. So what are activists doing? Like acupuncture advocates, they’ve stopped looking at high quality RCTs, which are pretty much all negative, and turned their attention to poorer quality studies. Just as acupuncture advocates turned their attention to touting unblinded studies and pragmatic studies, so too are ivermectin advocates now touting retrospective analyses, which can be hypothesis-generating in the absence of an RCT but are, from my perspective, close to pointless in the context of a situation in which several negative RCTs exist. They’re even doing the same thing as acupuncture advocates; i.e., lobbying state legislators for laws that permit their treatment even in the absence of high quality evidence for it, all in the name of “health freedom.”

Truly, ivermectin has become the acupuncture of COVID-19.

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.

To contact Orac: [email protected]

54 replies on “These days, ivermectin reminds me of acupuncture”

What makes all these people, doctors and otherwise, so motivated to try so hard to prove theat ivermectin works? Is it just politics or more of a neurological or psychological quirk?

Why not both—and for profit too?

As Bacon said: “Knowledge Itself is Power.”

He did not say that it had to be right.

Control the discussion, control the world.

The motivation no doubt combines a number of factors, but IMO the central motive is a desire to accrue power/influence/authority/status/attention. So i more-or-less agree with has, I guess, except that I think for the ivermectin contrarians, profit is not an end in itself, but a means to the ends of the motive complex I just mentioned. I base this in part on having spent my career in academic circles where money is not a primary motivation, but has no shortage of dog-eat-dog pissing contests to determine who is the biggest fish in the (sometimes fairly small) pond.

Looking at the behavior of our closest relatives among the primates, I’m not sure we can label this a neurological or psychological “quirk”. Which is not to excuse how it plays out with ivermectin studfes, or anything else that might be a negative outcome of some sort of evolutionary biological “programming”, but to re-direct the question away from individuals to broader systems. Not ‘why is this person so messed up?’, but ‘what’s wrong with the context that works to turn these fundamental human drives turn so exaggerated and so toxic?”

“at least 8 quality studies have shown to be an effective treatment”

And? How many quality studies showed it was not? Or did those dumb chuds forget to count those entirely?

On second thoughts, I take that back. They are not dumb: they know very well that the efficacy of their quack treatment is directly proportional to their ability to sell it to rubes. And to those venal turds that’s the only metric that counts.

Also, congratulations to @jordanbpeterson and his licentious choir on their actual #MarshallMcLuhanMoment. Pathological inability to own one’s own mistakes—the fatal “tell” of megalomaniac dumbshits everywhere. And the grift keeps rolling on.

” while portraying those trying to hold medicine to a scientific standard of being, in essence, fascists and authoritarians ”

If you don’t want to be portrayed as a fascist authoritarian, maybe don’t tout censorship as “quality control”.

“The researchers prescribed half of the patients a course of ivermectin pills for three days. The other half received a placebo. They tracked whether the patients were hospitalized within 28 days. ”

It’s hilarious that you cite this new study — after being (let’s be charitable) appropriately skeptical of numerous other Ivermectin studies — without pointing out that the described protocol is NOT the same that is recommended by FLCCC. This makes the study worthless as counter-evidence since they clearly did not test the actual claim(s) being made about Ivermectin. I guess your skepticism is selective.

Meanwhile, you’ve only got about 50 more studies to “debunk” over at ivmmeta.com in order to avoid finding efficacy. Until you do that, you’re basically cherry-picking.

Heck, even if Orac is intentionally selecting bad studies out of all those presented, this is a 100% valid use for that selectivity. Remember: the goal here is not to prove that ivermectin works or doesn’t work, but to prove that the claimants’ claim that their evidence is “high-quality” is wrong.

There is absolutely no need to critique every single study, as Chaos Confusion insists. It is only necessary to find a few studies out of all those that the ivermectin boosters have declared to be both “high-quality” and “demonstrates efficacy”, and show how they are neither. Because while including one bad study in their dataset might be an honest and forgivable error, two is getting careless and 3+ is leaning into downright ineptitude and/or malice.

Having thus demonstrated that the IV advocates can’t distinguish “high-quality evidence” from the ass end of a cow, it is 100% reasonable (and sensible) to push the responsibility entirely back on them to clean up their own house first and not come back until they’ve rigorously reduced that huge Gish-galloping list of “studies” down to those that genuinely do qualify as both. After which—and assuming they haven’t already completely pissed off everyone else with their bad-faith antics—they are welcome to try again to make their claims stand on their own merits.[1]

Because, here’s a clue for Clueless Infarction about how science actually works:

It’s not our job to disprove the claimant’s claims. It’s theirs.

In so obviously failing to perform their own basic due dilligence/quality control, the only thing these jackasses have proven is that they and their claims are at best incompetent; at worst knowingly deceptive. So until they declare an honest mea culpa and clean their own shit up[2], nobody else here owes them so much as the time of day.

And if Caca Conniptions is feeling butthurt about that, they can cram their firehose right up it. Because we are not your free garbage collection service, ass.

[1] Of course, in only listing high-quality studies that do show efficacy while omitting high-quality studies that don’t they are still cherry-picking—and not the valid “cut to the chase” kind either, but the “lying by omission” kind. But I’m trying to keep things super simple here for the terminally hard of learning, which is an uphill struggle I know.

[2] Which we already know they won’t, because unlike CI we aren’t 100% stupid.

Indeed. One only needs to show that the “best” studies are a load of rubbish to demolish the argument.

But it is more than that. We understand the hierarchy of evidence. If the “best” studies in support are low down on the hierarchy of evidence, and studies higher on the hierarchy don’t support the claim, we can dismiss the claims easily as disproven by better quality studies. There is no need to whack all the moles.

It’s OK when the conspiracy nuts have done the cherry picking for you: this is what they tout as their best stuff.

Orac has no interest in being fair or objective. He has blind faith in the drug industry, even though it is well known they cannot be trusted. https://www.bmj.com/content/376/bmj.o702

The vaccine pushers want to bury ivermectin, and any other inexpensive covid treatments. It isn’t difficult to make the “science” look the way they want it.

They have also succeeded in burying the covid lab origin theory. Was this based on high quality research? Of course not, no need, when the public is so gullible. Fauci and the vax pushers don’t have to worry about being blamed for the pandemic.

Science is in this any number of RCTs.Tell us how they were made show results drug industry wants. There are actually many studies by ivermetin pushers that are corrupted this way.

“indie Rebel” – drinking urine and licking toilets is even cheaper than ivermectin. Why are you shilling for Big Veterinarian and hiding the benefits of the human centipede treatment that requires no drugs at all?

If Chaos Infusion wants, Chaos Infusion can point to the two studies he, she or they think are the best, strongest evidence for ivermectin, and we can go from there. Every study is clearly an unreasonable demand, but if Chaos Infusion thinks these two studies – which leaders promoting (and selling) ivermectin are touting as strong proof – aren’t the strongest, we can discuss a couple that are.

After requesting that someone debunk the 50+ studies at ivmmeta.com, maybe you shouldn’t call quality control censorship.
Freedom of speech means that you have a right to say what ever you want, in effect that you have a right to be wrong. But you don’t have a right to think that you are right. See the difference?
BTW – Freedom of speech also means that other people have the right to tell you that you’re wrong. Savoir your right, without crying ‘censorship’.

If ivermectin works, why it does not work in all studies ? Perhaps it “works” only in low quality one ?

What this has to do with idovermectin ? Many trials have been published, none of them by pharmacutical companies.Real problem is trials by ivermectin pushers are not believable

Iverson, Kory and Peterson are often cited at the Sinkholes of Unreason(tm) I survey.

re Peterson: my usual criteria signifying alties/ woo-meisters doesn’t hold ( having bogus, spurious or unrelated degrees) : he has legitimate degrees in psych and training ( plus political sci) from decent institutions and he writes about psychology/ social/ political issues.
BUT he still purveys wacky ideas and has, with his daughter, speculated about the effects of diet on psychological and physical symptoms: they created a meat diet that cures things. All meat.
That and he has solutions for benzo addiction.

Orac says he only trusts RCTs. But RCTs are expensive and are usually funded by the drug companies. And he DOES trust observational studies when they turn out well for the drug companies. How about testing mRNA vaccines on the world, with no control group?

Medical research can no longer be trusted, as this BMJ article explains: https://www.bmj.com/content/376/bmj.o702

I am sure Orac knows about this, and my guess is he is one of the drug industry proselytizers.

“Orac says he only trusts RCTs. ”

Citation needed. Please state clearly where in this post Orac says that.

And if you’re so against pharmaceuticals, why are you in favor of the use of a pharmaceutical (ivermectin) rather than non-pharmaceutical interventions like improved air cleaning and circulation in buildings?

Where did I say I was against pharmaceuticals? And where did I say I was against non-pharmaceutical interventions? The number one priority from the start of the pandemic should have been weight loss, improved nutrition, and exercise. None of that gets mentioned by people like Fauci or Orac. All they care about is vaccines.

Every time I hear statements like ‘The number one priority from the start of the pandemic should have been weight loss, improved nutrition, and exercise’, I remember the ‘warm’ response there was to ‘let’s move’, calling it a ‘nanny state’ (and then Rand went to Dunkin’ Donuts).

1) Way to ignore the simple question I ask. Again, please provide a citation from this post that “Orac says he only trusts RCTs. ”

2) Weight loss? How does weight loss prevent the transmission of a respiratory virus? And while we’re at it, let’s talk about this frankly bizarre idea that weight loss is a good, useful or healthy goal for everyone everywhere.

My aunt has recently lost about 50 pounds. She’s down to about 89 pound and still losing weight. Do you think that this is a good thing? (Oh yeah, and the weight loss is completely out of her control.) It certainly hasn’t improved her health one iota.

NPIs aren’t “loose weight, eat kale, exercise to exhaustion”. They’re wearing masks in public indoor spaces, improved air filtration and sick leave so people can stay home from work or school when they are sick.

There are follow up studies after RCTs, not financed by pharmaceutical industry.These should show a manipulated RCTs.
There are lots of trials twsting ivermectin, clinicaltrials.gov has 88. 31 completed 10 has results. One wonders about reporting bias.

this is an opinion piece and does not in any way obviate use of the medical literature to create evidence based treatment algorithms

How about testing mRNA vaccines on the world, with no control group? Yeah, how about that: A majority of Americans have received these vaccines. >90% of the people dying from COVID are in the unvaccinated minority. What does that tell you?

Kyle Sheldrick is now flat-out labeling a study co-authored by FLCCC co-founder (and ivermectin advocate) Paul Marik* as fraudulent – it’s the study that claimed a dramatic decrease in death from sepsis in patients treated with a protocol including vitamin C.

http://kylesheldrick.blogspot.com/2022/03/evidence-of-fabricated-data-in-vitamin.html

*A paper co-authored by Marik which reported a big drop in Covid deaths in patients receiving a treatment protocol that included vitamin C was retracted, after Marik’s hospital revealed that mortality figures contradicted the paper’s claims.
**odd how woo-shippers rant about how published research can’t be trusted, but have no problem with the minority of research (often deeply flawed/retracted) that aligns with their beliefs.

We only gave remdesivir to inpatients who had a supplemental O2 requirement. It’s like they picked that group on purpose.

Indie Rebel- I think it is fair to say that there have been campaigns and programs on may levels, for decades, in many different countries, tackling the problems of obesity, poor nutrition and lack of suitable exercise and this because of the known and suspected influences on general health, well being and longevity. We could also include here smoking and alcohol consumption. There has been much success but also intractable difficulties, not with the scientific knowledge but the inability to change longstanding habits for any length of time.
What new approaches would you suggest should have been introduced at the onset of the Covid -19 pandemic that would have improved on what has been tried for many years with varying success? And with all that ‘new thinking’ and effort still a highly indeterminate prognosis for any success in stemming the pandemic! Methinks you are barking up the wrong tree: in fact this has been discussed on this blog many times and it is known not to be the solution to stemming the tide.
Some very healthy groups of people people, in history ( read ‘Guns, Germs and Steel’ by Jared Diamond) have died in their millions to viruses to which they had never previously been exposed.

I’m rather amazed that the health benefits of exercise and a balanced diet have been known for decades, but a simple recommendation from the government, a couple of years ago, would have succeeded where Fat Camp failed.

(Does the sarcasm come through clearly?)

David- you do have a right to think what you like, right or wrong, unless perhaps living in a dystopian , totalitarian environment where control of your thoughts might be a priority. Koestler, Orwell and Huxley ( among others) wrote about this.

I agree – and we all (including IR) have the right to say what they believe to be true. But we are not entitled to cry ‘censorship’ when another person uses their right to disagree. It should be obvious that criticism is not discrimination or repression.
I’m glad that we live in a world where we have the right to be wrong, and others have the right to tell us.

David- a perusal of almost any of the posts on RI invariably invoke responses and comment that should satisfy any concept of freedom of speech. Here there is great tolerance ( usually!) of all manner of contrary nonsense. misinformation , lies and much else. I am glad you agree that we may think as we wish. There can be no absolute freedom to write or say anything you wish although in democracies there is a great licence for most things. Consideration must always be given to possible harm to our fellow humans since we are social animals.

Learning how to critique evidence is a must. When I taught an undergraduate class in communicable and noncommunicable disease, I frequently referenced the evidence pyramid. But even that’s not enough. Some thought should be given to how something works, not just whether or not it might appear to work after creative statistical analysis.

Being “normal” BMI did and does NOT protect older patients who come down with covid, we have been over and over this. You would think that people like IR would stop posting bs that has been refuted by direct experience by people who actually treat covid patients like me…at least quit posting it here. Alas, no.

Roughly half of the folks hospitalized were in the obese range for bmi…so sayeth the data. Guess what? Roughly 69% of Americans are obese or overweight on the verge of obese…so sayeth the data.

Having now done this for two years straight I’ll proffer the following:

Patient A – 68 y/o female with COPD but no home oxygen requirement; BMI=23

Patient B – 68 y/o female with type 2 diabetes but no insulin requirement; BMI=38

For all of our resident cranks let’s say both are unvaccinated. Both come into the ER short of breath, require O2 supplementation, and come back covid positive. They get admitted. This is a scenario I have dealt with daily since this began.

The fat lady must be dead meat according to IR, right? WRONG. She gets dexamethasone, her O2 requirement drops after say day four, by day five or six she’s back home with her grandkids and hopefully gets vaccinated six months later.

Meanwhile-Patient A continues to become hypoxic, requires invasive ventilation, and spends three weeks on a vent in the unit. 85-90% chance she never walks out.

Ask anyone who has been doing this and they’ll confirm this little demo.

@Justatech

“Weight loss? How does weight loss prevent the transmission of a respiratory virus? And while we’re at it, let’s talk about this frankly bizarre idea that weight loss is a good, useful or healthy goal for everyone everywhere.”

What a nutty comment. It is WELL KNOWN that MANY or MOST serious covid cases and deaths have occurred in obese patients.

And no, duh, it is not healthy to lose weight from starvation or a terminal illness. It IS healthy for an obese person to lose weight!!!!

But that’s not what you said, IR. You didn’t condition your weight loss statement on “if a person is overweight or obese”. You just said “weight loss”, as though it applied to everyone equally.

The thing is, better air handling can be applied to everyone, regardless of their health status. So can sick leave. But you don’t like those ideas because they require a change to the system, where you want to put all of the onus on individuals, even though that just isn’t enough in a pandemic.

Please think about why you prefer individual actions (even when they can not be sufficient to prevent transmission) over systemic actions (HEPA filters and sick leave).

Did you not read what I posted before barfing out more baloney?? 68% of the country is overweight or obese.

Your plan to scoop out the 1.5 pounds of meat in your skull that you have no use for will not lower your weight enough to save you

Recommended Reading (I’d requite ’em if I could)
Two recent articles highly relevant to our discussions here despite the fact the headlines and advertised frames may not have piqued tour interest:

Jill LePore’s piece in The New Yorker, “Why the School Wars Still Rage.”
The ‘CRT’ controversy might seem far far afield from medical science issues, but LePore persuasively traces the whole “Parents Rights” thing back to anti-evolution laws and… antivaccination politics around the last great pandemic. She interprets this as a conflict between the forces of Progressivism on one hand (in the sense of “Progressive Era’, which spanned all political parties, and mas basically just a belief in and advocacy for ‘progress’.) — which embraced science among other things, and the forces of reactionary tradition on the other — including racism and fundamentalist religion. The connections to our current quandaries definitely fit the “history may not repeat itself, but it does often rhyme” category.
https://www.newyorker.com/magazine/2022/03/21/why-the-school-wars-still-rage

Dana Milbank’s column at WaPo: “Why do smart Republicans say stupid things?”
This was accompanied on the front page with a photo of Ginni Thomas, which was enough to put me off, frankly expecting a less-than-smart take failing somehow to deal with the idea that Ginni is just bat guano bonkers. But it turns out this is one of those columns trying to connect a current headline to a deeper inquiry, the former acting as a rationale to talk about the latter in a click-dependent universe, and even if the headline case is a bad illustration, that deeper thing may well be worthwhile. In this case, that deeper thing is “recent advances in cognitive science [that suggest] highly intelligent people are more susceptible to ‘identity-protective cognition,’,” which is sort of like ‘motivated reasoning’ but more expansive. One of the researcher is quoted:
“The really upsetting finding is that the better you are at particular types of cognitive tests … the better you are at manipulating the facts to reflect your prior beliefs, the more able you are to cognitively shape the world so it fits with your values.” Another study tested numeracy in relation to ideology and discovered that “those with higher numeracy skills” generally were still prone to error on ‘story’ math problems if the correct answer was not “congenial to the subjects’ political outlooks.”
https://www.washingtonpost.com/opinions/2022/03/28/ginni-thomas-republicans-psychology-conspiracy-theories/

This research probably raises more questions that it answers, but it seems pretty interesting, and a useful corrective to a lot of ad hominem rhetoric directed at right-wingers, ‘contrarian’ doctors and scientists, maybe even RI trolls (yes, I’m thinking of elements of Dr. Joel’s posts as exemplars of that tendency.) IMO predictably and sadly, the comments under the Milbank column tend to pooh-pooh the research, and declare ‘they say stupid things because they are stupid.’

Milbank does include a link (you might miss) to a site devoted to the research into “cultural cognition”. I haven’t explored it yet, but it looks to house a lot of interesting material, with a “current projects” list including: The Science of Science Communication; Evidence-based Science Filmmaking; Science Literacy and Cultural Polarization, and Evidence based science communication initiative.
http://www.culturalcognition.net/

Re: Milbank’s column.

We (the SBM crew and I) have long said that highly intelligent people are more dangerous because they are much better at motivated reasoning and countering any disconfirming information that might challenge their worldview. The studies described seem fairly consistent with what we’ve known regarding ideology and conspiracy theories.

Agreed. It’s not just their intellectual skills but perhaps because they have a history of being
“right” or rewarded for perceptive, innovative or intriguing views.
” I was right about transistors so my views on heredity are totally excellent” Someone may have once thought.

Not my field but psych colleagues have told me that there is a growing body of evidence that intelligence, per se, might have developed and been driven by selective pressures to make one more “Cunning” or “Manipulative.”

It would stand to reason that rationality doesn’t even factor in. If you were “smarter” than the next ape, you could convince him to give you his stuff, etc. You would be fitter and more likely to reproduce. That ape might die and not reproduce.

Again, I’m not an evolutionary biologist or psychiatrist but this oversimplification seems logical on its face. I think Dawkins proposed something similar but I don’t have the time to dig around at the moment…

@ Dr Yeti:

Of course, I’m only guessing but I venture that the alties I survey would not do as I well as I’ve done on standardised testing/ course work/ written material BUT they sure can talk trusting customers out of their hard-earned money and make them happy about doing so!

I also doubt that Orac or his any of his physician or scientist readers live on 50 acre estates or ranches.

Oddly enough, I’m not hearing much about ivermectin or HCQ or even vaccines these days ( NN, PRN) especially the last two days: the great altie prevaricators confabulate about food riots, energy rationing, currency collapse, hyperinflation, internecine deep state wars led by ‘white hats’, why Putin is a genius, why it wasn’t Russia’s fault, why Putin is more trustworthy than the various presidential ‘crime families’, Ukrainian Nazis and how to survive the oncoming financial collapse, mass starvation, nuclear war…

This makes me think that perhaps the pandemic is winding down and it’s too late to scare people about vaccines because most are already vaccinated so they need other hobgoblins with which to scare their followers with like the above. Adams is selling “Ranger Buckets” with emergency food supplies and someone stole 8000 lbs of his beans ( in emergency situations, it will be so easy to cook dry beans /s) and the other idiot is pushing veganism as the key to global warming along with his products,

That’s part of my question. What’s going to happen to the ivermectin pushers when the pandemic passes?

I can think of a few possibilities.

First, the grifters stop pushing it. But based on past experience with the alt-med crowd, this seems unlikely. Grifters gotta grift.

Second, the grifters continue to push it as a prophylactic against covid-19 (and other variants) even if the risk of contracting covid-19 becomes very low. Aside from overdoses it’s a win-win for the grifters.

Third, the grifters find other scary diseases which they claim ivermectin works against and it joins the phony panacea pharmacopoeia.

I suspect the third possibility will win. Any bets on which disease will be chosen next? Ebola? Common Cold? Liberals?

Ooops! I spoke too soon. A few places report upticks in Covid.
Alties can resume their usual dreck including railing against new boosters and ” hundreds of thousands” of vaccine-related deaths ( see Jessica Rose substack)

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