6 ms·

In fact, as the author cites from another researcher, the trials are a strong piece of evidence for "add[ing] ivermectin to mass drug administration programs."

In fact, as the author cites from another researcher, the trials are a strong piece of evidence for "add[ing] ivermectin to mass drug administration programs." In other words, global medical welfare, where we just give everyone a bunch of a cheap and effective medications to counteract the most prolific diseases. When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections. Medical stuff doesn't work the way most people would like to imagine it does. This sounds like a terrible thing to conclude. I'm rather unsettled to see it lauded here on HN.

darrenf 5y ago
> When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections. > Medical stuff doesn't work the way most people would like to imagine it does. This sounds like a terrible thing to conclude. I'm rather unsettled to see it lauded here on HN. Indeed, this exact thing is headline news in the UK today from our Health Security Agency - don't take antibiotics unless you definitely have something treatable by them: https://www.bbc.co.uk/news/health-59310099 https://www.bbc.co.uk/news/health-59310099
- DoreenMichele 5y ago
  Parasites are notoriously hard to treat. They are harder to treat than bacterial infection. Places with lots of parasitic infections need better infrastructure and general hygiene to prevent infection. They don't need all the locals actively breeding drug-resistant parasites. Parasites are enough of a nightmare without cavalierly passing out drugs for funsies.
  - yorwba 5y ago
    The WHO's guideline for "preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups" https://apps.who.int/iris/handle/10665/258983 https://apps.who.int/iris/handle/10665/258983 isn't about "passing out drugs for funsies". They recommend mass drug administration for at-risk groups because hundreds of millions of people are suffering from parasitic worm infections that can easily be treated with a single dose of a cheap anthelmintic drug, but diagnosing every single case beforehand would be much more expensive. Of course improving hygiene to prevent infection is important (that's also stressed in the guideline), but that will take much longer, while mass drug administration has immediate benefits. Fear of drug resistance isn't a good reason to withhold treatment from people who really need it. The WHO's much more sensible strategy is to encourage research into alternative drugs in case drug resistance becomes a significant concern.
LordDragonfang 5y ago
>When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections. I think this is an extremely jaded take, resulting from growing up in a post-antibiotics society. The risk factor for those "scary antibiotic-resistant infections" is still an order of magnitude less than the class of diseases antibiotics almost totally eliminated. In the 30 years following penicillin's discovery, deaths from bacterial infection dropped from accounting for over 22% of all deaths to just 6% [1] (MRSA deaths, by comparison, currently represent less than half a percent). "End of disease" may be hyperbole, but between antibiotics and vaccines, infectious diseases were almost totally knocked off the leading causes of death. The only reason why we even have antibiotic resistant bacteria is because they keep getting prescribed, because they're so damn useful. "Medical stuff" does, in fact, work like that, to some extent. [1] https://dash.harvard.edu/bitstream/handle/1/8889467/Gottfried05.pdf https://dash.harvard.edu/bitstream/handle/1/8889467/Gottfrie...
- adrianN 5y ago
  The major reason why we have antibiotic resistant bacteria is because we use literal tons of the stuff for meat production and too many countries have too lax controls for antibiotic use in humans, which means they are taken for things were they don't help, or are not necessary, and are taken in the wrong dosage and for the wrong duration.
  - jacquesm 5y ago
    Exactly, if we only used it when there was a chance of it being effective that would be that, but instead your average cow is a walking antibiotic laboratory.
  - ncmncm 5y ago
    Malaria seems to develop resistance pretty fast. Are farm animals getting those treatments in their feed?
    - adrianN 5y ago
dkga 5y ago
Veterinarian here, used to ivermectin as it should be used - as an anti parasitic. I fully agree with this view above.
- WithinReason 5y ago
  You mean you believe that a widespread administration of ivermectin would lead to development of ivermectin resistance in parasites?
  - marcosdumay 5y ago
    Widespread administration does lead to the development of resistant parasites. That's not an hypothetical, that's what you see on any farm if you prolong the treatment for too long. It's always recommended that you cycle through different anti-parasite treatments.
  - crazyjncsu 5y ago
    That’s certainly already the case. Ivermectin has lost effectiveness against particularly insidious parasites such as Haemonchus Contortus (barber pole worm). We’ve resorted to other treatments such as Moxidectin, Levamisole, etc, all of which are more expensive and harder to dose safely and effectively. I can totally understand how Ivermectin got its following— it’s an amazing general purpose medicine around the farm. I generally use it responsibly by verifying the presence of parasites before administering (which can be literally any animal on the farm with almost any parasite) … but then there are times such as when my daughter had a single pet chicken (among many healthy ones) that wasn’t looking so hot … Whereas previously I’d just dispatch the animal and be done with it, now I give a dose of Ivermectin and isolate for a few days before calling in the grim reaper. So far the success rate is something like 90% where now my 9 year old daughter administers it herself. While I acknowledge this isn’t the most responsible, I can imagine others have had similar experiences which explain some of the popularity of Ivermectin with rural folk.
    - WithinReason 5y ago
      What's the downside of giving Ivermectin to livestock that don't have parasites?
deleted 5y ago
[deleted]
mrow84 5y ago
I’m certainly no expert but isn’t the evolutionary timescale for parasites considerably longer than for bacteria? That would presumably lead to quite different consequences (though of course the evolutionary pressure, and thus the risk, is still there).
aaron695 5y ago
> I'm rather unsettled to see it lauded here on HN. What are you against exactly? What are you saying? What does Ivermectin have to do with antibiotics? Antibiotics can produce resistant in diseases that the body would cure naturally. A popular use of Ivermectin is to kill worms in humans, they do not just disappear naturally. Ivermectin treats many fucking evil parasitic infections. Why are you restricting it from poor people? We use it on livestock all the time. I've used it on my goats. Google pictures of onchocerciasis, it's just evil (looking, nothing is actually evil) It's easy to find articles about "Mass treatment with ivermectin: an underutilized public health strategy" https://apps.who.int/iris/handle/10665/269206 https://apps.who.int/iris/handle/10665/269206 (This is the World Health Organisation) > Places with lots of parasitic infections need better infrastructure and general hygiene to prevent infection. They don't need all the locals actively breeding drug-resistant parasites. Parasites are enough of a nightmare without cavalierly passing out drugs for funsies. You seem to be blaming locals and saying tough luck. I don't treat my goats that badly. We do watch worm load in the goats (FAMACHA), to cut back on resistance, exactly the same as any "global medical welfare" would... however that relates to human beings.
HelloNurse 5y ago
Wouldn't we risk force-evolving ivermectine resistant parasites with the same mechanism as antibiotic resistant bacteria?
- toolz 5y ago
  The CDC estimates that _at least_ 30% of all anti-biotic prescriptions are inappropriately prescribed. I'd wager an over-prescription of Ivermectin (that by some unknown characteristic appears it would save massive numbers of lives) isn't likely to evolve parasites (which evolve much more slowly than bacteria to begin with) to be resistant in a dangerously meaningful way given what we see with bacteria resistance. This is of course just a gut feeling and not a studied understanding.
  - PaulDavisThe1st 5y ago
    >This is of course just a gut feeling I see what you did there.
- MissionInfl 5y ago
  I'm curious whether a similar mechanism would apply to the COVID vaccines? Can someone with some expertise in the area help clarify if this is the case? Are we accidentally creating vaccine resistant COVID strains with mass vaccination similar to how mass ivermectin creates ivermectin resistant parasites?
BurningFrog 5y ago
You have a valid point. But note that it's a much easier point to make from a region where parasitic worms don't exist.

darrenf 5y ago

> When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections. > Medical stuff doesn't work the way most people would like to imagine it does. This sounds like a terrible thing to conclude. I'm rather unsettled to see it lauded here on HN. Indeed, this exact thing is headline news in the UK today from our Health Security Agency - don't take antibiotics unless you definitely have something treatable by them: https://www.bbc.co.uk/news/health-59310099 https://www.bbc.co.uk/news/health-59310099

DoreenMichele 5y ago
Parasites are notoriously hard to treat. They are harder to treat than bacterial infection. Places with lots of parasitic infections need better infrastructure and general hygiene to prevent infection. They don't need all the locals actively breeding drug-resistant parasites. Parasites are enough of a nightmare without cavalierly passing out drugs for funsies.
- yorwba 5y ago
  The WHO's guideline for "preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups" https://apps.who.int/iris/handle/10665/258983 https://apps.who.int/iris/handle/10665/258983 isn't about "passing out drugs for funsies". They recommend mass drug administration for at-risk groups because hundreds of millions of people are suffering from parasitic worm infections that can easily be treated with a single dose of a cheap anthelmintic drug, but diagnosing every single case beforehand would be much more expensive. Of course improving hygiene to prevent infection is important (that's also stressed in the guideline), but that will take much longer, while mass drug administration has immediate benefits. Fear of drug resistance isn't a good reason to withhold treatment from people who really need it. The WHO's much more sensible strategy is to encourage research into alternative drugs in case drug resistance becomes a significant concern.

LordDragonfang 5y ago

>When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections. I think this is an extremely jaded take, resulting from growing up in a post-antibiotics society. The risk factor for those "scary antibiotic-resistant infections" is still an order of magnitude less than the class of diseases antibiotics almost totally eliminated. In the 30 years following penicillin's discovery, deaths from bacterial infection dropped from accounting for over 22% of all deaths to just 6% [1] (MRSA deaths, by comparison, currently represent less than half a percent). "End of disease" may be hyperbole, but between antibiotics and vaccines, infectious diseases were almost totally knocked off the leading causes of death. The only reason why we even have antibiotic resistant bacteria is because they keep getting prescribed, because they're so damn useful. "Medical stuff" does, in fact, work like that, to some extent. [1] https://dash.harvard.edu/bitstream/handle/1/8889467/Gottfried05.pdf https://dash.harvard.edu/bitstream/handle/1/8889467/Gottfrie...

adrianN 5y ago
The major reason why we have antibiotic resistant bacteria is because we use literal tons of the stuff for meat production and too many countries have too lax controls for antibiotic use in humans, which means they are taken for things were they don't help, or are not necessary, and are taken in the wrong dosage and for the wrong duration.
- jacquesm 5y ago
  Exactly, if we only used it when there was a chance of it being effective that would be that, but instead your average cow is a walking antibiotic laboratory.
- ncmncm 5y ago
  Malaria seems to develop resistance pretty fast. Are farm animals getting those treatments in their feed?
  - adrianN 5y ago

dkga 5y ago

Veterinarian here, used to ivermectin as it should be used - as an anti parasitic. I fully agree with this view above.

WithinReason 5y ago
You mean you believe that a widespread administration of ivermectin would lead to development of ivermectin resistance in parasites?
- marcosdumay 5y ago
  Widespread administration does lead to the development of resistant parasites. That's not an hypothetical, that's what you see on any farm if you prolong the treatment for too long. It's always recommended that you cycle through different anti-parasite treatments.
- crazyjncsu 5y ago
  That’s certainly already the case. Ivermectin has lost effectiveness against particularly insidious parasites such as Haemonchus Contortus (barber pole worm). We’ve resorted to other treatments such as Moxidectin, Levamisole, etc, all of which are more expensive and harder to dose safely and effectively. I can totally understand how Ivermectin got its following— it’s an amazing general purpose medicine around the farm. I generally use it responsibly by verifying the presence of parasites before administering (which can be literally any animal on the farm with almost any parasite) … but then there are times such as when my daughter had a single pet chicken (among many healthy ones) that wasn’t looking so hot … Whereas previously I’d just dispatch the animal and be done with it, now I give a dose of Ivermectin and isolate for a few days before calling in the grim reaper. So far the success rate is something like 90% where now my 9 year old daughter administers it herself. While I acknowledge this isn’t the most responsible, I can imagine others have had similar experiences which explain some of the popularity of Ivermectin with rural folk.
  - WithinReason 5y ago
    What's the downside of giving Ivermectin to livestock that don't have parasites?

deleted 5y ago

[deleted]

mrow84 5y ago

I’m certainly no expert but isn’t the evolutionary timescale for parasites considerably longer than for bacteria? That would presumably lead to quite different consequences (though of course the evolutionary pressure, and thus the risk, is still there).

aaron695 5y ago

> I'm rather unsettled to see it lauded here on HN. What are you against exactly? What are you saying? What does Ivermectin have to do with antibiotics? Antibiotics can produce resistant in diseases that the body would cure naturally. A popular use of Ivermectin is to kill worms in humans, they do not just disappear naturally. Ivermectin treats many fucking evil parasitic infections. Why are you restricting it from poor people? We use it on livestock all the time. I've used it on my goats. Google pictures of onchocerciasis, it's just evil (looking, nothing is actually evil) It's easy to find articles about "Mass treatment with ivermectin: an underutilized public health strategy" https://apps.who.int/iris/handle/10665/269206 https://apps.who.int/iris/handle/10665/269206 (This is the World Health Organisation) > Places with lots of parasitic infections need better infrastructure and general hygiene to prevent infection. They don't need all the locals actively breeding drug-resistant parasites. Parasites are enough of a nightmare without cavalierly passing out drugs for funsies. You seem to be blaming locals and saying tough luck. I don't treat my goats that badly. We do watch worm load in the goats (FAMACHA), to cut back on resistance, exactly the same as any "global medical welfare" would... however that relates to human beings.

HelloNurse 5y ago

Wouldn't we risk force-evolving ivermectine resistant parasites with the same mechanism as antibiotic resistant bacteria?

toolz 5y ago
The CDC estimates that _at least_ 30% of all anti-biotic prescriptions are inappropriately prescribed. I'd wager an over-prescription of Ivermectin (that by some unknown characteristic appears it would save massive numbers of lives) isn't likely to evolve parasites (which evolve much more slowly than bacteria to begin with) to be resistant in a dangerously meaningful way given what we see with bacteria resistance. This is of course just a gut feeling and not a studied understanding.
- PaulDavisThe1st 5y ago
  >This is of course just a gut feeling I see what you did there.
MissionInfl 5y ago
I'm curious whether a similar mechanism would apply to the COVID vaccines? Can someone with some expertise in the area help clarify if this is the case? Are we accidentally creating vaccine resistant COVID strains with mass vaccination similar to how mass ivermectin creates ivermectin resistant parasites?

BurningFrog 5y ago

You have a valid point. But note that it's a much easier point to make from a region where parasitic worms don't exist.