3 ms·

I very much doubt the results of this study when there's been huge successes with Ivermectin in Mexico, India and several others. I'd like to read more details

by wsc981 5y ago

I very much doubt the results of this study when there's been huge successes with Ivermectin in Mexico, India and several others. I'd like to read more details on how the study was done, but details in the article are scarce.

gus_massa 5y ago
Do you have a source for the success in Mexico and India? I have seen are not blind studies where the control group is unrelated and difficult to compare, or very small studies where the good result is just a fluke that is not statistically significant.
- shaicoleman 5y ago
  This is the study from Mexico (n=156,468) showing ~66% reduction in hospitalisations. https://osf.io/preprints/socarxiv/r93g4/ https://osf.io/preprints/socarxiv/r93g4/ Mexico has low vaccination rates, didn't lock down, didn't close the borders, and their hospitals are almost empty. https://joannenova.com.au/wp-content/mexico-2021.png https://joannenova.com.au/wp-content/mexico-2021.png https://joannenova.com.au/2021/07/mexico-uses-ivermectin/ https://joannenova.com.au/2021/07/mexico-uses-ivermectin/
  - gus_massa 5y ago
    About the last two links: It's common to have waves that disappear. If you start to administer a drug at the top of the second wave, it will go down and look like it was a success. That's why you need a randomized control group. About the first one: I saw it a few days ago. They are mixing people that got Ivermectin, people that went to the hospital the previous month and people contacted by phone "Locatel". Mixing groups can cause many problems an unexpected results, a well known case is the Simpson's paradox https://en.wikipedia.org/wiki/Simpson%27s_paradox https://en.wikipedia.org/wiki/Simpson%27s_paradox . To be sure that, you need a randomized control group. Also, from the article: > The intervention consisted in providing the ivermectin kit, but also in offering a patients follow up implemented by the Locatel call center. To isolate the effect of the ivermectin kit from the Locatel tracking. They claim that the can remove the effect of the follow-up calls by phone, but this is one of the classic spots were there are problem. That's the reason why the studies should have a double blind control group, that has an identical treatment to the test group.
    - shaicoleman 5y ago
      Repeatedly when Ivermectin was widely deployed, you see consistenly sharp drops in cases within two weeks, shortly followed by drops in hospitalizations and deaths. https://covid19criticalcare.com/ivermectin-in-covid-19/epidemiologic-analyses-on-covid19-and-ivermectin/ https://covid19criticalcare.com/ivermectin-in-covid-19/epide... The same thing has been consistenly reproduced in dozens of trials, including dozens of RCTs. https://pubmed.ncbi.nlm.nih.gov/34145166/ https://pubmed.ncbi.nlm.nih.gov/34145166/ https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofab358/6316214 https://academic.oup.com/ofid/advance-article/doi/10.1093/of... And you don't need a big RCT for everything. You need to do a risk/benefit analysis and ensure that it makes clinical sense. Doctors talk between each other and share what works for their patients and what doesn't. If there's near zero risk and cost, and it's shown repeatedly to save at least 60% of lives then erring on the side of caution would be to use it. The cost of doing nothing is millions of deaths and trillions in economic damage. Even the failed RCTs show improvement, just not a statistically significant one. This is usually due to bad trial design: too small doses, too late treatment, widespread self medication in the placebo group, undisclosed financial interests, no exclusion of vaccinated or those who already had COVID, etc. For comparison, Remdesivir has 539 reported deaths, Ivermectin has 20 deaths total over 4 billions doses, which makes it order of mangitude safer. http://www.vigiaccess.org/ http://www.vigiaccess.org/ Remdesivir was approved based on a single sponsored RCT that showed negligible improvement, and yet it was approved, and yet a safe drug studies by hundreds of scientists isn't in dozens of trials isn't. Ivermectin is not a panacea, that's why it should be combined with other things that are safe and have evidence of improved outcomes (e.g. Vitamin D, Vitamin C, Quercetin, Zinc). https://covid19criticalcare.com/covid-19-protocols/i-mask-plus-protocol/ https://covid19criticalcare.com/covid-19-protocols/i-mask-pl...
      - gus_massa 5y ago
        > Even the failed RCTs show improvement, just not a statistically significant one. This is usually due to bad trial design: This is usually caused by report and publication bias. All the similar studies that show no improvement or a bad outcome are never published. > And you don't need a big RCT for everything. You need to do a risk/benefit analysis and ensure that it makes clinical sense. Doctors talk between each other and share what works for their patients and what doesn't. Here is were we disagree. Except for cases when it's impossible (like open heart surgery), it's necessary to do a good RCT. Doctors sharing anecdotes is not reliable, for example it has a lot of confirmation bias. I've read very similar arguments to justify using hydroxychloroquine without a good RCT last year.
- verdverm 5y ago
  There are several interesting studies coming out of Africa, where Ivermectin is administered quite frequently as an antiparasitic, like a population wide flu shot. The history of the drug is really fascinating and the research up until politicization quite promising for application to a wide variety of ailments. It looks to also be anti-inflammatory and anti-viral as well. Pretty cool for a microbe discovered by accident from some dirt in Japan. Here is two: https://pubmed.ncbi.nlm.nih.gov/33795896/ https://pubmed.ncbi.nlm.nih.gov/33795896/ https://www.medrxiv.org/content/10.1101/2021.03.26.21254377v1.full.pdf https://www.medrxiv.org/content/10.1101/2021.03.26.21254377v... It has some interesting findings. Google "Ivermectin Africa" for more Another interesting fact about Ivermectin or any existing drug that could prove effective... If any do indeed work, then the Emergency Authorization from the FDA would not have been allowed. The fact that it has been politicized raises questions, especially given what we know about how Big Pharma operates.
  - gus_massa 5y ago
    Neither of them use randomized control group. The second one just compare the countries "community-directed treatment with ivermectin" with the other countries. As they note, the countries that don't use ivermectin systematically have a average life expectancy of 6 years greater than the others. So they are quite different. A 6 years of difference in life expectancy may mean that they have better hospitals (that probably should reduce the covid-19 mortality) but also that they have more old people that has worse prognosis (that probably should increase the covid-19 mortality). So ... it's difficult to compare the two kind of countries and get a conclusion, that's why it's important to have randomized control group. The first one is very similar, but they use the African Programme for Onchocerciasis Control (APOC), from 1995 until 2015, and the countries that were/are not in that programme. (What happened between 2015 and 2020?) Anyway, they control for different factors, including the Human Development Index (HDI), that should fix the problem with the available hospitals and the age, or not, it's difficult to be sure. At least they are trying, but without a randomized control group is difficult to be sure.
- wsc981 5y ago
  Since someone else linked some data on Mexico already, I will add link some data from India [0]. The interesting thing about India is that states apparently can choose their own medical policies regarding their fight against COVID. So some states chose to use Ivermectin (against WHO recommendations) while others follow the WHOs recommendations. The states that used Ivermectin have shown a dramatic drop in cases and hospitalisations. To me it seems there's very little interest by the WHO to properly test the efficacy of Ivermectin against COVID. As long as Ivermectin is not properly tested, the WHO can claim that "Ivermectin has not proven to be effective in the fight against COVID", since that would then be technically true. However outside of clinical trials it seems that Ivermectin has been effective both in prevention of COVID cases as well as helping people recover from COVID. And I know this will sound like a conspiracy theory (and I guess at this point it is - since I have no proof), but I can't help but think that Big Pharma has a great influence on WHO policies and Big Pharma is not really interested in seeing a cheap medicine like Ivermectin becoming popular in the fight against COVID. --- [0]: https://www.thedesertreview.com/opinion/letters_to_editor/ivermectin-saves-india/article_14b1f1d6-cd2f-11eb-8b78-9710d864f627.html https://www.thedesertreview.com/opinion/letters_to_editor/iv...

by wsc981 5y ago

gus_massa 5y ago

Do you have a source for the success in Mexico and India? I have seen are not blind studies where the control group is unrelated and difficult to compare, or very small studies where the good result is just a fluke that is not statistically significant.

shaicoleman 5y ago
This is the study from Mexico (n=156,468) showing ~66% reduction in hospitalisations. https://osf.io/preprints/socarxiv/r93g4/ https://osf.io/preprints/socarxiv/r93g4/ Mexico has low vaccination rates, didn't lock down, didn't close the borders, and their hospitals are almost empty. https://joannenova.com.au/wp-content/mexico-2021.png https://joannenova.com.au/wp-content/mexico-2021.png https://joannenova.com.au/2021/07/mexico-uses-ivermectin/ https://joannenova.com.au/2021/07/mexico-uses-ivermectin/
- gus_massa 5y ago
  About the last two links: It's common to have waves that disappear. If you start to administer a drug at the top of the second wave, it will go down and look like it was a success. That's why you need a randomized control group. About the first one: I saw it a few days ago. They are mixing people that got Ivermectin, people that went to the hospital the previous month and people contacted by phone "Locatel". Mixing groups can cause many problems an unexpected results, a well known case is the Simpson's paradox https://en.wikipedia.org/wiki/Simpson%27s_paradox https://en.wikipedia.org/wiki/Simpson%27s_paradox . To be sure that, you need a randomized control group. Also, from the article: > The intervention consisted in providing the ivermectin kit, but also in offering a patients follow up implemented by the Locatel call center. To isolate the effect of the ivermectin kit from the Locatel tracking. They claim that the can remove the effect of the follow-up calls by phone, but this is one of the classic spots were there are problem. That's the reason why the studies should have a double blind control group, that has an identical treatment to the test group.
  - shaicoleman 5y ago
    Repeatedly when Ivermectin was widely deployed, you see consistenly sharp drops in cases within two weeks, shortly followed by drops in hospitalizations and deaths. https://covid19criticalcare.com/ivermectin-in-covid-19/epidemiologic-analyses-on-covid19-and-ivermectin/ https://covid19criticalcare.com/ivermectin-in-covid-19/epide... The same thing has been consistenly reproduced in dozens of trials, including dozens of RCTs. https://pubmed.ncbi.nlm.nih.gov/34145166/ https://pubmed.ncbi.nlm.nih.gov/34145166/ https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofab358/6316214 https://academic.oup.com/ofid/advance-article/doi/10.1093/of... And you don't need a big RCT for everything. You need to do a risk/benefit analysis and ensure that it makes clinical sense. Doctors talk between each other and share what works for their patients and what doesn't. If there's near zero risk and cost, and it's shown repeatedly to save at least 60% of lives then erring on the side of caution would be to use it. The cost of doing nothing is millions of deaths and trillions in economic damage. Even the failed RCTs show improvement, just not a statistically significant one. This is usually due to bad trial design: too small doses, too late treatment, widespread self medication in the placebo group, undisclosed financial interests, no exclusion of vaccinated or those who already had COVID, etc. For comparison, Remdesivir has 539 reported deaths, Ivermectin has 20 deaths total over 4 billions doses, which makes it order of mangitude safer. http://www.vigiaccess.org/ http://www.vigiaccess.org/ Remdesivir was approved based on a single sponsored RCT that showed negligible improvement, and yet it was approved, and yet a safe drug studies by hundreds of scientists isn't in dozens of trials isn't. Ivermectin is not a panacea, that's why it should be combined with other things that are safe and have evidence of improved outcomes (e.g. Vitamin D, Vitamin C, Quercetin, Zinc). https://covid19criticalcare.com/covid-19-protocols/i-mask-plus-protocol/ https://covid19criticalcare.com/covid-19-protocols/i-mask-pl...
    - gus_massa 5y ago
      > Even the failed RCTs show improvement, just not a statistically significant one. This is usually due to bad trial design: This is usually caused by report and publication bias. All the similar studies that show no improvement or a bad outcome are never published. > And you don't need a big RCT for everything. You need to do a risk/benefit analysis and ensure that it makes clinical sense. Doctors talk between each other and share what works for their patients and what doesn't. Here is were we disagree. Except for cases when it's impossible (like open heart surgery), it's necessary to do a good RCT. Doctors sharing anecdotes is not reliable, for example it has a lot of confirmation bias. I've read very similar arguments to justify using hydroxychloroquine without a good RCT last year.
verdverm 5y ago
There are several interesting studies coming out of Africa, where Ivermectin is administered quite frequently as an antiparasitic, like a population wide flu shot. The history of the drug is really fascinating and the research up until politicization quite promising for application to a wide variety of ailments. It looks to also be anti-inflammatory and anti-viral as well. Pretty cool for a microbe discovered by accident from some dirt in Japan. Here is two: https://pubmed.ncbi.nlm.nih.gov/33795896/ https://pubmed.ncbi.nlm.nih.gov/33795896/ https://www.medrxiv.org/content/10.1101/2021.03.26.21254377v1.full.pdf https://www.medrxiv.org/content/10.1101/2021.03.26.21254377v... It has some interesting findings. Google "Ivermectin Africa" for more Another interesting fact about Ivermectin or any existing drug that could prove effective... If any do indeed work, then the Emergency Authorization from the FDA would not have been allowed. The fact that it has been politicized raises questions, especially given what we know about how Big Pharma operates.
- gus_massa 5y ago
  Neither of them use randomized control group. The second one just compare the countries "community-directed treatment with ivermectin" with the other countries. As they note, the countries that don't use ivermectin systematically have a average life expectancy of 6 years greater than the others. So they are quite different. A 6 years of difference in life expectancy may mean that they have better hospitals (that probably should reduce the covid-19 mortality) but also that they have more old people that has worse prognosis (that probably should increase the covid-19 mortality). So ... it's difficult to compare the two kind of countries and get a conclusion, that's why it's important to have randomized control group. The first one is very similar, but they use the African Programme for Onchocerciasis Control (APOC), from 1995 until 2015, and the countries that were/are not in that programme. (What happened between 2015 and 2020?) Anyway, they control for different factors, including the Human Development Index (HDI), that should fix the problem with the available hospitals and the age, or not, it's difficult to be sure. At least they are trying, but without a randomized control group is difficult to be sure.
wsc981 5y ago
Since someone else linked some data on Mexico already, I will add link some data from India [0]. The interesting thing about India is that states apparently can choose their own medical policies regarding their fight against COVID. So some states chose to use Ivermectin (against WHO recommendations) while others follow the WHOs recommendations. The states that used Ivermectin have shown a dramatic drop in cases and hospitalisations. To me it seems there's very little interest by the WHO to properly test the efficacy of Ivermectin against COVID. As long as Ivermectin is not properly tested, the WHO can claim that "Ivermectin has not proven to be effective in the fight against COVID", since that would then be technically true. However outside of clinical trials it seems that Ivermectin has been effective both in prevention of COVID cases as well as helping people recover from COVID. And I know this will sound like a conspiracy theory (and I guess at this point it is - since I have no proof), but I can't help but think that Big Pharma has a great influence on WHO policies and Big Pharma is not really interested in seeing a cheap medicine like Ivermectin becoming popular in the fight against COVID. --- [0]: https://www.thedesertreview.com/opinion/letters_to_editor/ivermectin-saves-india/article_14b1f1d6-cd2f-11eb-8b78-9710d864f627.html https://www.thedesertreview.com/opinion/letters_to_editor/iv...