8 ms·

A recently released meta—analysis from the British Medical Journal suggests that the evidence base for ivermectin’s efficacy in treating COVID-19 is low. https

A recently released meta—analysis from the British Medical Journal suggests that the evidence base for ivermectin’s efficacy in treating COVID-19 is low. https://ebm.bmj.com/content/early/2021/05/26/bmjebm-2021-111678 https://ebm.bmj.com/content/early/2021/05/26/bmjebm-2021-111...

shaicoleman 5y ago
If you'll look carefully, you'll see that's a non peer-reviewed opinion piece. That's a prime example of disinformation, and indeed the most reputable journals unfortunately play a role in it. Just to rebut the first thing random thing I saw: "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)" They are bringing up the in-vitro studies initially done on monkey kidney cells, and then claiming that you'll need such a high dose in a clinical setting. The doses for prophylactic and early treatment are an order of magnitude lower (0.2mg/kg) [1], and in that dose it's safer than paracetamol. "Ivermectin was generally well tolerated, with no indication of associated CNS toxicity for doses up to 10 times the highest FDA-approved dose of 0.2mg/kg." [2] In my second link, there's a talk rebutting the in-vitro safety concerns in detail: [3] There are over 50 studies showing that Ivermectin is effective, and more are coming in every day. [4] 1. https://covid19criticalcare.com/covid-19-protocols/i-mask-plus-protocol/ https://covid19criticalcare.com/covid-19-protocols/i-mask-pl... 2. https://pubmed.ncbi.nlm.nih.gov/12362927/ https://pubmed.ncbi.nlm.nih.gov/12362927/ 3. https://player.vimeo.com/video/554350476?autoplay=1#t=4702 https://player.vimeo.com/video/554350476?autoplay=1#t=4702 4. https://c19ivermectin.com/ https://c19ivermectin.com/
- chimprich 5y ago
  > That's a prime example of disinformation, and indeed the most reputable journals unfortunately play a role in it. I'm going to trust an opinion in the BMJ over: > There are over 50 studies showing that Ivermectin is effective There have been a vast number of junk studies produced during the pandemic and rolling out 50 of them means very little. How many of them are pre-registered RCTs? How many of them are in low-quality journals? The BMJ article actually refers to that https://c19ivermectin.com/ https://c19ivermectin.com/ site: "Different websites (such as https://ivmmeta.com/ https://ivmmeta.com/, https://c19ivermectin.com/ https://c19ivermectin.com/, https://tratamientotemprano.org/estudios-ivermectina/ https://tratamientotemprano.org/estudios-ivermectina/, among others) have conducted meta-analyses with ivermectin studies, showing unpublished colourful forest plots which rapidly gained public acknowledgement and were disseminated via social media, without following any methodological or report guidelines. These websites do not include protocol registration with methods, search strategies, inclusion criteria, quality assessment of the included studies nor the certainty of the evidence of the pooled estimates. Prospective registration of systematic reviews with or without meta-analysis protocols is a key feature for providing transparency in the review process and ensuring protection against reporting biases, by revealing differences between the methods or outcomes reported in the published review and those planned in the registered protocol."
  - codeflow2202 5y ago
    To be fair the c19ivermectin site only states: Database of all ivermectin COVID-19 studies. If you want a meta-analysis that picks for you the quality studies from that list that's also avilable: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088823/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088823/
  - shaicoleman 5y ago
    > I'm going to trust an opinion in the BMJ over: If that opinion contains patently false information and assumptions (e.g. early in-vitro study needed a high dose, therefore that same dose must be required in clinical patients), then that opinion is not trustworthy, regardless of whether it's on the BMJ website or not. See also here [1] under the "Big Science" heading, why the current system is broken. 1. https://covid19criticalcare.com/videos-and-press/flccc-releases/flccc-alliance-statement-on-the-irregular-actions-of-public-health-agencies-and-the-widespread-disinformation-campaign-against-ivermectin/ https://covid19criticalcare.com/videos-and-press/flccc-relea...
- sharperguy 5y ago
  Notice how if the same censorship rules were applied here, this entire conversation would be disallowed, and no learning on the topic could take place.
lawnchair_larry 5y ago
This is kind of doing the same thing that the “fact checkers” are doing. There is indeed a lack of proper studies to validate it. That’s the problem. There are mountains of evidence that show it as very promising and worthy of a proper study. That’s what people are asking for. The FDA keeps saying not to use it, because we don’t know for certain that it works, because we haven’t had any rigorous RCTs to validate it, even though it appears by all accounts to be an extremely valuable tool. They don’t claim that it doesn’t work. They don’t claim that it’s harmful (we know it’s not, it’s been broadly deployed for like 30 years and is known to be far safer than the vaccines, which are already quite safe, at least in the short to medium term). Also, this article is misinformed on the dosage requirement, which has been raised and addressed - looks like sibling comment called this out as well. See, it’s clear who actually follows the science, and who disregards the science but brow beats others with phrases like “follow the science.” Other things known to people following the science? Schools are safe to open and masks don’t do shit outdoors because the probability of infection is < 0.1%. Many of us knew this was the latest science long ago, but again, we weren’t allowed to talk about it, lest someone call us the R word (republican). To not drop everything and study this aggressively is criminally negligent imo. I believe I read that we have finally decided to fund looking into validating what appears to be strong evidence. But it’s 30 years old, dirt cheap, and not patented. And all of this only came to light well after we sunk billions into vaccines. So, there is not exactly a profit motive or a strong appetite to potentially upend all of that. But if people unwilling to be vaccinated are willing to take that instead, it might be the only hope for herd immunity. Because there is no way we will get there by vaccines alone. Too much of the population are refusing the vaccines.
- admax88q 5y ago
  The FDA doesn't tell people what to research, it tells the public what existing research confirms is safe to use. If a bunch of scientists think iverwhatever is viable they can do a proper study on it and get it published and peer reviewed. To "drop everything" would be criminally negligent, there's lots of things that can and should be researched in parallel.
  - shaicoleman 5y ago
iammisc 5y ago
You have to be careful though because we've seen medical journals engage in deceptive practices recently around drugs that could potentially treat COVID. For example, the data showing hydroxychloroquine to be harmful to COVID patients was completely made up or non-existent. Unfortunately, medical academia, in some failed attempt to 'stick to the facts', have led themselves to have a lower a priori assumption of correctness.
- pessimizer 5y ago
  Yes. Hydroxychloroquine ultimately turned out to be nothing, but the media and journals did a shameful job covering it. The media made it the latest episode of the Trump show with all that entails, and journals published garbage quickly to back them up. The result is that Trumpers would never believe it didn't work, and the #resistance would never believe it did, no matter what the science would ever say. It's fine to point at the journals as the definers of what smart people should believe, but can't we say that the Lancet sucks for starting the anti-vax movement by publishing a shit paper by Wakefield, and damaged the integrity of science in general during an epidemic by publishing the hydroxychloroquine trash? Can we point out that they started some of our scariest antiscience trends?
  - shaicoleman 5y ago
    There was a disinformation campaign against Hydroxychloroquine as well. In the failed JAMA study, they administered a nearly toxic dose at late stage patients (when there's no viral replication). This is now being investigated [1]. The largest peer-reviewed study on HCQ (29K patients) showed 70% reduction in death with early treatment. [2] 1. https://www.moneytimes.com.br/heinze-pede-a-pf-que-investigue-estudo-sobre-uso-elevado-de-cloroquina-em-manaus/ https://www.moneytimes.com.br/heinze-pede-a-pf-que-investigu... (In Portuguese) 2. https://c19hcq.com/mokhtari.html https://c19hcq.com/mokhtari.html
- deleted 5y ago
  [deleted]

shaicoleman 5y ago

If you'll look carefully, you'll see that's a non peer-reviewed opinion piece. That's a prime example of disinformation, and indeed the most reputable journals unfortunately play a role in it. Just to rebut the first thing random thing I saw: "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)" They are bringing up the in-vitro studies initially done on monkey kidney cells, and then claiming that you'll need such a high dose in a clinical setting. The doses for prophylactic and early treatment are an order of magnitude lower (0.2mg/kg) [1], and in that dose it's safer than paracetamol. "Ivermectin was generally well tolerated, with no indication of associated CNS toxicity for doses up to 10 times the highest FDA-approved dose of 0.2mg/kg." [2] In my second link, there's a talk rebutting the in-vitro safety concerns in detail: [3] There are over 50 studies showing that Ivermectin is effective, and more are coming in every day. [4] 1. https://covid19criticalcare.com/covid-19-protocols/i-mask-plus-protocol/ https://covid19criticalcare.com/covid-19-protocols/i-mask-pl... 2. https://pubmed.ncbi.nlm.nih.gov/12362927/ https://pubmed.ncbi.nlm.nih.gov/12362927/ 3. https://player.vimeo.com/video/554350476?autoplay=1#t=4702 https://player.vimeo.com/video/554350476?autoplay=1#t=4702 4. https://c19ivermectin.com/ https://c19ivermectin.com/

chimprich 5y ago
> That's a prime example of disinformation, and indeed the most reputable journals unfortunately play a role in it. I'm going to trust an opinion in the BMJ over: > There are over 50 studies showing that Ivermectin is effective There have been a vast number of junk studies produced during the pandemic and rolling out 50 of them means very little. How many of them are pre-registered RCTs? How many of them are in low-quality journals? The BMJ article actually refers to that https://c19ivermectin.com/ https://c19ivermectin.com/ site: "Different websites (such as https://ivmmeta.com/ https://ivmmeta.com/, https://c19ivermectin.com/ https://c19ivermectin.com/, https://tratamientotemprano.org/estudios-ivermectina/ https://tratamientotemprano.org/estudios-ivermectina/, among others) have conducted meta-analyses with ivermectin studies, showing unpublished colourful forest plots which rapidly gained public acknowledgement and were disseminated via social media, without following any methodological or report guidelines. These websites do not include protocol registration with methods, search strategies, inclusion criteria, quality assessment of the included studies nor the certainty of the evidence of the pooled estimates. Prospective registration of systematic reviews with or without meta-analysis protocols is a key feature for providing transparency in the review process and ensuring protection against reporting biases, by revealing differences between the methods or outcomes reported in the published review and those planned in the registered protocol."
- codeflow2202 5y ago
  To be fair the c19ivermectin site only states: Database of all ivermectin COVID-19 studies. If you want a meta-analysis that picks for you the quality studies from that list that's also avilable: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088823/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088823/
- shaicoleman 5y ago
  > I'm going to trust an opinion in the BMJ over: If that opinion contains patently false information and assumptions (e.g. early in-vitro study needed a high dose, therefore that same dose must be required in clinical patients), then that opinion is not trustworthy, regardless of whether it's on the BMJ website or not. See also here [1] under the "Big Science" heading, why the current system is broken. 1. https://covid19criticalcare.com/videos-and-press/flccc-releases/flccc-alliance-statement-on-the-irregular-actions-of-public-health-agencies-and-the-widespread-disinformation-campaign-against-ivermectin/ https://covid19criticalcare.com/videos-and-press/flccc-relea...
sharperguy 5y ago
Notice how if the same censorship rules were applied here, this entire conversation would be disallowed, and no learning on the topic could take place.

lawnchair_larry 5y ago

This is kind of doing the same thing that the “fact checkers” are doing. There is indeed a lack of proper studies to validate it. That’s the problem. There are mountains of evidence that show it as very promising and worthy of a proper study. That’s what people are asking for. The FDA keeps saying not to use it, because we don’t know for certain that it works, because we haven’t had any rigorous RCTs to validate it, even though it appears by all accounts to be an extremely valuable tool. They don’t claim that it doesn’t work. They don’t claim that it’s harmful (we know it’s not, it’s been broadly deployed for like 30 years and is known to be far safer than the vaccines, which are already quite safe, at least in the short to medium term). Also, this article is misinformed on the dosage requirement, which has been raised and addressed - looks like sibling comment called this out as well. See, it’s clear who actually follows the science, and who disregards the science but brow beats others with phrases like “follow the science.” Other things known to people following the science? Schools are safe to open and masks don’t do shit outdoors because the probability of infection is < 0.1%. Many of us knew this was the latest science long ago, but again, we weren’t allowed to talk about it, lest someone call us the R word (republican). To not drop everything and study this aggressively is criminally negligent imo. I believe I read that we have finally decided to fund looking into validating what appears to be strong evidence. But it’s 30 years old, dirt cheap, and not patented. And all of this only came to light well after we sunk billions into vaccines. So, there is not exactly a profit motive or a strong appetite to potentially upend all of that. But if people unwilling to be vaccinated are willing to take that instead, it might be the only hope for herd immunity. Because there is no way we will get there by vaccines alone. Too much of the population are refusing the vaccines.

admax88q 5y ago
The FDA doesn't tell people what to research, it tells the public what existing research confirms is safe to use. If a bunch of scientists think iverwhatever is viable they can do a proper study on it and get it published and peer reviewed. To "drop everything" would be criminally negligent, there's lots of things that can and should be researched in parallel.
- shaicoleman 5y ago

iammisc 5y ago

You have to be careful though because we've seen medical journals engage in deceptive practices recently around drugs that could potentially treat COVID. For example, the data showing hydroxychloroquine to be harmful to COVID patients was completely made up or non-existent. Unfortunately, medical academia, in some failed attempt to 'stick to the facts', have led themselves to have a lower a priori assumption of correctness.

pessimizer 5y ago
Yes. Hydroxychloroquine ultimately turned out to be nothing, but the media and journals did a shameful job covering it. The media made it the latest episode of the Trump show with all that entails, and journals published garbage quickly to back them up. The result is that Trumpers would never believe it didn't work, and the #resistance would never believe it did, no matter what the science would ever say. It's fine to point at the journals as the definers of what smart people should believe, but can't we say that the Lancet sucks for starting the anti-vax movement by publishing a shit paper by Wakefield, and damaged the integrity of science in general during an epidemic by publishing the hydroxychloroquine trash? Can we point out that they started some of our scariest antiscience trends?
- shaicoleman 5y ago
  There was a disinformation campaign against Hydroxychloroquine as well. In the failed JAMA study, they administered a nearly toxic dose at late stage patients (when there's no viral replication). This is now being investigated [1]. The largest peer-reviewed study on HCQ (29K patients) showed 70% reduction in death with early treatment. [2] 1. https://www.moneytimes.com.br/heinze-pede-a-pf-que-investigue-estudo-sobre-uso-elevado-de-cloroquina-em-manaus/ https://www.moneytimes.com.br/heinze-pede-a-pf-que-investigu... (In Portuguese) 2. https://c19hcq.com/mokhtari.html https://c19hcq.com/mokhtari.html
deleted 5y ago
[deleted]