a) "In vitro studies have shown the efficacy of Ivermectin (IV) to inhibit the SARS—CoV-2 viral replication, but questions remained as to in-vivo applications" [0]
b) "Sixty-three patients with positive PCR result were randomized into three arms of the study. There was 1 withdrawal, thus 62 patients completed the study" [0]
c) "We cannot conclude in this study that Ivermectin has a place in prophylaxis, but this warrants investigation." [0]
Trial group of 62 patients and no parasite screening in those patients - yawn. But could be interesting grounds for a more significant and controlled study with patients with comorbidities.
Depends where -just found a paper showing 54% of school children tested by sample (not seeking medical attention) in at least one area of Lagos. Probably lower in adults but it's not a sub-1% number or even close to it. So were the results due to the anti-parasitic action or something else?
If you look on Twitter there are other methodological concerns people have with this study. The more important thing is just that it's relatively old, and there have been meta-analyses done; like, lots of people are studying the ivermectin question, and the weight of the evidence doesn't seem to be positive.
For what it's worth: the boy rebuts this with the observation that you'd expect worsening symptoms for patients with actual parasitic infection, since there's an immune response to necrotic parasite tissue when ivermectin works. None of us here are ivermexperts though!
Separately, I'm having trouble parsing your comment, but I'm curious so I will ask: when you say "the boy rebuts", who is the boy here, yourself? Or..? Maybe I'm just not familiar with this turn of phrase.
We begin to see why you are #1 in the leaderboard; you have help.
But concerning controversy surrounding ivermectin I found this interesting text:
An important controversial point to consider in any rationale is the 5 µM required concentration to reach the anti-SARS-CoV-2 action of ivermectin observed in vitro,17 which is much higher than 0.28 µM, the maximum reported plasma concentration achieved in vivo with a dose of approximately 1700 µg/kg (about nine times the FDA-approved dosification).24 25 In this sense, basic fundamentals for assessing ivermectin in COVID-19 at a clinical level appear to be insufficient. Among other reasons, we believe this might have led WHO to exclude ivermectin from its Solidarity Trial for repurposed drugs for COVID-19,12 which raises questions about the pertinence of conducting clinical studies on ivermectin.
If its effective it means there is a treatment available. If there is a treatment available in the beginning stages of ncov19 then the justification for EUA, by law, becomes invalid.
And pfizer and pharma companies lose billions and billions of dollars.
Under an EUA, FDA may allow the use of unapproved medical products, or unapproved uses of approved medical products in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions when certain statutory criteria have been met, including that there are no adequate, approved, and available alternatives.
No I have it exactly right and you still don't understand the law. The FDA has wide latitude in how they interpret the word "adequate". And while it's possible that ivermectin may prove effective for COVID-19 treatment, as of today it's still not formally "approved" for that use. Doctors can prescribe it to COVID-19 patients but it's considered off-label use.
Except you are still dancing around the topic here. The OP being responded to here, which is clearly widely available if you pay any attention to the news, is that the mainstream, FDA, CDC and pharma companies are seeking to extremely downplay, or outright declare ivermectin to be out of line, without doing any research, AND ignoring already existing clinical studies that show it to be efficacious.
Thats the conversation, not splitting hairs on what is or is not adequate. FDA won't even seem to bother EVALUATING if it IS in fact adequate. Instead these players are acting like it does not exist, or is deadly, when it has a 30+ year history of clearly not being so.
Edit: Hence my point about the billions of dollars in loss.
Were the FDA to declare ivermectin efficacious and adequate then the EUA's would likely have to be rescinded. If not, then people would still have an alternative treatment to the vaccines, and thus pharma would lose billions to alternative treatment anyway.
Option:
Take 30+ year medicine with proven track record
or
take experimental vaccines that have not completed FDA approval or clinical trials, no cross sectional longitudinal studies of effects?
Apparently you haven't been paying attention. The federal government is sponsoring research. The scientific method is not instantaneous. Have a little patience.
Ivermectin isn't a magic cure for covid or there wouldn't be so many trials showing it doesn't work. Even if future studies prove its useful the effect size is small. So other mitigation efforts will continue.
Even if Ivermectin were established as adequate in its conjectured/hyped/potential COVID-related role, it and vaccines would not be alternatives, since they don't substitute for each other.
Some of the monoclonal antibody treatments under EUA would be closer to being at risk.
Please only take this medication by prescription from a medical doctor. Even if these results are replicated, there is a huge difference between 12mg/day IV for 5 days under medical supervision and consuming a tube of apple flavored paste containing 6 grams of ivermectin. Ivermectin is neurotoxic at high doses and can absolutely kill you.
Someone said the exact same thing to me when HCQ was pushed with bad quality studies by certain doctors to Fox News hosts who then pushed it to Trump. Higher quality studies later found it wasn't useful. So there.
You seem to be confused. The studies which "later found it wasn't useful" were fabricated, as was discovered mere days after they hit the news. They weren't even plausible.
The initial studies were bad quality, they just removed the people who got admitted to ICUs from the treatment group. They were run by a doctor known to be a charlatan. They were pushed to Trump as a magic way to calm the people and market down.
I don't get why people like you think the world is so US centric. The world doesn't give a flying fuck about giving Trump a very slight lower chance of getting re-elected, much less kill their people and their economy for it. I don't see how studies across the world were fabricated, there's no reason for, say, India to kill millions of their citizens and destroy their economy by faking studies about HCQ when they don't hate Trump and may have even liked him.
You're the one that's confused, here's an analysis on HCQ from someone that has worked on drug discovery for decades.
And I don't think Trump pushed Ivermectin? If it works so well as you think, one would think the Democrats would be all over it so they can say Biden cured Covid and restored the economy.
Pretty sure if your case of Covid is severe enough to warrant treatment, you will not be calling around looking for a second opinion just because your doc prescribed an Rx that might be “internet controversial”.
Frankly I trust my doctor more than I trust FB, YouTube, and the government.
Well… if we start from the premise I am desperate enough to throw reason out the window, then yeah, why not take horse dewormer, malaria drugs, fish tank cleaner, crystals and prayer?
Honestly…people who toss out the whole “horse dewormer” talking point should also refuse to take penicillin if your doctor prescribed it because they also give that drug to horses too.
It’s not just a “horse dewormer” folks, it’s a “people dewormer” that has also been used in anti-viral treatments as well. Argue that’s it’s not effective, but stop pretending that this isn’t a drug that is prescribed to people all over the world.
I would also add, before you argue that it's ineffective, please consider it in the context of its place in the "triple therapy". We use drug combinations to treat things like cancer and peptic ulcers because of synergies. My understanding is that the ivermectin and doxycycline help zinc to get into our cells and the zinc is what does the work to inhibit virus replication.
I think you are going to have a hard time convincing someone who only refers to ivermectin as a “horse dewormer” to think of it beyond whatever their summary talking points tell them. That is why the talking point is to try and mislead folks as it being only a veterinary Rx, they don’t have to go into details…just dump the misinfo out there.
BTW, I’m not arguing for or against it for Covid. I am just saying that if my doctor decided to prescribe it for me, I’m going to trust their judgement, because I trust them.
There's probably a proper term for this but it seems to me there's a lot of absolute-izing language being thrown around, on issues that aren't absolute. Eg, anyone not 100% onboard with immediately taking whatever vaccine is on offer is an anti-vaxxer. Anyone interested in searching out possible off-label uses of ivermectin might as well just cease and desist because we all know ivermectin is just for killing worms in horses.
It's designed to shut down any reasoned discourse or critical thinking and I'm surprised it's still working.
I saw a post on NIH studies showing possible benefits and people dismissing it because it wasn't a preponderance of evidence. Totally valid to dismiss a selected sample but made me realize there was more of a basis for its usage than, let's say, bleach.
That said, I was wrong, removed. I guess it's too much to ask for people to trust the recommended medicine, perhaps we should get more pro-vaccine conspiracy theories out there =/
did you read the study?
They explicitly say :"We cannot conclude in this study that Ivermectin has a place in prophylaxis, but this warrants investigation."
This does not seem to match the HackerNews title very well ;)
Yes I read the study. It involved in vivo use of ivermectin in human subjects. The study authors acknowledged that further research is needed. What's the problem?
And yet every study backing up the efficacy and safety of the covid vaccine for particular subsets has around 20 total participants, often times with an invalid control group in place....but I'm sure you eat that up and share away
Do you know the control group details and when they will be complete?
I'm talking about things like "New study for Covid vaccine use on pregnant women shows to be safe and beneficial"...then the study includes ~20 women (read that yesterday, front page of google
news)
There are a lot of studies done on small sample sizes. It some sense it’s necessary: if something is unsafe on a small sample, it’s more than likely unsafe on a large sample.
That study is included in the meta-studies discussed here, all of which apparently lose all statistically-significant support for ivermectin once the fraudulent Egyptian study is removed from the data set. You can, for instance, find the Tlaxcalan study in the Cochrane meta-study I linked upthread.
All these kinds of comments seem premised on the idea that nobody is studying ivermectin, and that any research results, even if just in 60 patients in Lagos, must be huge news. But lots of people are studying ivermectin! If it's effective, we should be seeing clear results.
If you go to https://ivmmeta.com/ I suggest to ignore all the non RCT studies because they are usually very bad.
There are only 31 RTC studies. Most of them are very small and not even statically significant. It is a known problem that studies that show no effect or a bad effect are never published due to report and publication bias. So it's better to ignore the not statically significant studies.
So there are only 6 of the 31 RTC studies that are statically significant. If Ivermectin has no effect, we expect to see like 1.5 studies that are "statistically significant" due to a flukes. We don't know how many other studies have been tried but never published, so let's be very conservative and assume that if Ivermectin has no effect, we would get 2 studies that are "statistically significant" due to a flukes.
There are 6. I read a few of them and have very strange things. Not smoking guns, but big red flags.
So ... can you choose your favorite 3 statistically significant? I'll dismiss 2 as flukes and hopefully I can explain why the other study has a very big red flag and is not reliable.
Ivermectin is proven to work, but it's out of patent. That means pharmaceutical companies can't profit from it. Hence the Ivermectin FUD campaign.
Big Pharma will do everything in their power, including manipulate the media, to buy time while they develop new oral Covid drugs with a slightly tweaked chemical composition (just enough for them to legally profit off it). Knowing they have a certain % of the population that will blindly follow and argue for them helps.
I'm skeptical of those conspiracy theories. Merck is the biggest of pharma and they still manufacture ivermectin. Apparently they're still making some profit on it.
Africa in general is faring relatively very well against the SARS2 epidemic, despite having the lowest vaccination rates and being disadvantaged as far as medical spending and medical and sanitary infrastructure.
One possible explanation is the widespread use of Ivermectin in that continent (because of widespread parasites).
There are of course other reasons too. For instance, it helps that they don't have a population that is 42%+ obese. (Though Ghana is on track to soon having a similar percentage of the adult population being overweight "Rates of overweight/obesity increased nearly 139 percent over a 15-year period from 1993–2008" --- https://www.usaid.gov/sites/default/files/documents/1864/Gha... ).
60 comments
[ 2.7 ms ] story [ 115 ms ] threadb) "Sixty-three patients with positive PCR result were randomized into three arms of the study. There was 1 withdrawal, thus 62 patients completed the study" [0]
c) "We cannot conclude in this study that Ivermectin has a place in prophylaxis, but this warrants investigation." [0]
[0] https://academic.oup.com/qjmed/advance-article/doi/10.1093/q...
Here's Cochran's meta-study; Cochran is, from what I can tell, very well-regarded. It appears to include this study. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
Later
For what it's worth: the boy rebuts this with the observation that you'd expect worsening symptoms for patients with actual parasitic infection, since there's an immune response to necrotic parasite tissue when ivermectin works. None of us here are ivermexperts though!
Separately, I'm having trouble parsing your comment, but I'm curious so I will ask: when you say "the boy rebuts", who is the boy here, yourself? Or..? Maybe I'm just not familiar with this turn of phrase.
But concerning controversy surrounding ivermectin I found this interesting text:
An important controversial point to consider in any rationale is the 5 µM required concentration to reach the anti-SARS-CoV-2 action of ivermectin observed in vitro,17 which is much higher than 0.28 µM, the maximum reported plasma concentration achieved in vivo with a dose of approximately 1700 µg/kg (about nine times the FDA-approved dosification).24 25 In this sense, basic fundamentals for assessing ivermectin in COVID-19 at a clinical level appear to be insufficient. Among other reasons, we believe this might have led WHO to exclude ivermectin from its Solidarity Trial for repurposed drugs for COVID-19,12 which raises questions about the pertinence of conducting clinical studies on ivermectin.
from BMJ, "Misleading clinical evidence and systematic reviews on ivermectin for COVID-19" -- https://ebm.bmj.com/content/early/2021/05/26/bmjebm-2021-111...
And pfizer and pharma companies lose billions and billions of dollars.
Hence why it has been so strange...
Under an EUA, FDA may allow the use of unapproved medical products, or unapproved uses of approved medical products in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions when certain statutory criteria have been met, including that there are no adequate, approved, and available alternatives.
Thats the conversation, not splitting hairs on what is or is not adequate. FDA won't even seem to bother EVALUATING if it IS in fact adequate. Instead these players are acting like it does not exist, or is deadly, when it has a 30+ year history of clearly not being so.
Edit: Hence my point about the billions of dollars in loss.
Were the FDA to declare ivermectin efficacious and adequate then the EUA's would likely have to be rescinded. If not, then people would still have an alternative treatment to the vaccines, and thus pharma would lose billions to alternative treatment anyway.
Option: Take 30+ year medicine with proven track record or take experimental vaccines that have not completed FDA approval or clinical trials, no cross sectional longitudinal studies of effects?
https://www.law.cornell.edu/uscode/text/21/360bbb-3
https://www.nih.gov/research-training/medical-research-initi...
And Pfizer is already fully approved btw.
Some of the monoclonal antibody treatments under EUA would be closer to being at risk.
And, if they prescribe it for treating COVID, look for a better doctor.
https://www.dailymotion.com/video/x7wwdo6
https://www.youtube.com/watch?v=POfIMGS2D6A
I don't get why people like you think the world is so US centric. The world doesn't give a flying fuck about giving Trump a very slight lower chance of getting re-elected, much less kill their people and their economy for it. I don't see how studies across the world were fabricated, there's no reason for, say, India to kill millions of their citizens and destroy their economy by faking studies about HCQ when they don't hate Trump and may have even liked him.
You're the one that's confused, here's an analysis on HCQ from someone that has worked on drug discovery for decades.
https://www.science.org/content/blog-post/hydroxychloroquine...
You're a not a drug researcher.
And I don't think Trump pushed Ivermectin? If it works so well as you think, one would think the Democrats would be all over it so they can say Biden cured Covid and restored the economy.
Frankly I trust my doctor more than I trust FB, YouTube, and the government.
It’s not just a “horse dewormer” folks, it’s a “people dewormer” that has also been used in anti-viral treatments as well. Argue that’s it’s not effective, but stop pretending that this isn’t a drug that is prescribed to people all over the world.
BTW, I’m not arguing for or against it for Covid. I am just saying that if my doctor decided to prescribe it for me, I’m going to trust their judgement, because I trust them.
It's designed to shut down any reasoned discourse or critical thinking and I'm surprised it's still working.
That said, I was wrong, removed. I guess it's too much to ask for people to trust the recommended medicine, perhaps we should get more pro-vaccine conspiracy theories out there =/
This does not seem to match the HackerNews title very well ;)
Days to negative in the three trial arms: Ivermictine: avg= 6.0 95% CI= (4.61–7.38) Control: avg= 9.15 95% CI= (5.68–12.62)
there was only 20 patient in the control group this would give a margin of error of 21.91% for that 95% confidence interval.
Most statisticians agree that the minimum sample size to get any kind of meaningful result in this case would be ~385
Sounds very underpowered
I'm talking about things like "New study for Covid vaccine use on pregnant women shows to be safe and beneficial"...then the study includes ~20 women (read that yesterday, front page of google news)
There are a lot of studies done on small sample sizes. It some sense it’s necessary: if something is unsafe on a small sample, it’s more than likely unsafe on a large sample.
All these kinds of comments seem premised on the idea that nobody is studying ivermectin, and that any research results, even if just in 60 patients in Lagos, must be huge news. But lots of people are studying ivermectin! If it's effective, we should be seeing clear results.
That's not my understanding from reading here: https://ivmmeta.com/
Looks at the graphs there, and then check out a few of the studies with low p-values.
There are only 31 RTC studies. Most of them are very small and not even statically significant. It is a known problem that studies that show no effect or a bad effect are never published due to report and publication bias. So it's better to ignore the not statically significant studies.
So there are only 6 of the 31 RTC studies that are statically significant. If Ivermectin has no effect, we expect to see like 1.5 studies that are "statistically significant" due to a flukes. We don't know how many other studies have been tried but never published, so let's be very conservative and assume that if Ivermectin has no effect, we would get 2 studies that are "statistically significant" due to a flukes.
There are 6. I read a few of them and have very strange things. Not smoking guns, but big red flags.
So ... can you choose your favorite 3 statistically significant? I'll dismiss 2 as flukes and hopefully I can explain why the other study has a very big red flag and is not reliable.
Big Pharma will do everything in their power, including manipulate the media, to buy time while they develop new oral Covid drugs with a slightly tweaked chemical composition (just enough for them to legally profit off it). Knowing they have a certain % of the population that will blindly follow and argue for them helps.
https://www.merck.com/research-and-products/products-list/
One possible explanation is the widespread use of Ivermectin in that continent (because of widespread parasites).
There are of course other reasons too. For instance, it helps that they don't have a population that is 42%+ obese. (Though Ghana is on track to soon having a similar percentage of the adult population being overweight "Rates of overweight/obesity increased nearly 139 percent over a 15-year period from 1993–2008" --- https://www.usaid.gov/sites/default/files/documents/1864/Gha... ).
https://www.cdc.gov/obesity/data/adult.html
Getting vaccinated.