17 ms·

Ivermectin Prophylaxis Used for Covid-19

135 points by tamaharbor 5y ago

tamaharbor 5y ago
- tasogare 5y ago
  - scarby2 5y ago
  - donw 5y ago
    Of course they don't. They look at citizens as a barrier between where they are now, and their desire to live like the feudal lords of old, except with modern conveniences.
  - dang 5y ago
    We've asked you repeatedly to stop posting flamewar comments to HN and you've continued to do it repeatedly. Therefore I've banned the account. No, this has nothing to do with your views. It has to do with not wanting flamewars here, because they're not compatible with the kind of website HN is trying to be. If you don't want to be banned, you're welcome to email hn@ycombinator.com and give us reason to believe that you'll follow the rules in the future. They're here: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html.
- mike00632 5y ago
  That quote isn't from the NIH though. Look at the disclaimer: > This disclaimer relates to PubMed, PubMed Central (PMC), and Bookshelf. These three resources are scientific literature databases offered to the public by the U.S. National Library of Medicine (NLM). NLM is not a publisher, but rather collects, indexes, and archives scientific literature published by other organizations. The presence of any article, book, or document in these databases does not imply an endorsement of, or concurrence with, the contents by NLM, the National Institutes of Health (NIH), or the U.S. Federal Government. And this is the disclaimer from the publisher: > The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein.
srcreigh 5y ago
Key points > 113,845 (71.3%) regular ivermectin users and 45,716 (23.3%) non-users > 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 > 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). > Missing data from patients were clarified with patients or relatives directly, via phone or in person, by the investigators. Since this is a citywide program, all recorded data must have matched the exact number of COVID-19 cases and deaths of the city. > An important conservative bias was present. Major risk factors for severe COVID-19 and mortality due to COVID-19, including aging, diabetes, and hypertension, were more present among ivermectin users, which may have underestimated the benefits of ivermectin The only questionable part of this I can find is a small unfounded semi negative comment about vaccines near the end. > lack of effectiveness of vaccines in real-life all-cause mortality analyses to date Vaccines correlate with 5.6x reduction in hospitalization and 12x reduction in ICU cases in Ontario as of today (Jan 22 2022) so not sure where that comes from. However their results still seem pretty clear that ivermectin helps. I'm curious if ivermectin and vaccines compound in effectiveness. 2x effective prevention could speed things up a lot.
- tptacek 5y ago
  They don't even know who took ivermectin. The city they studied the ivermectin protocol in had the highest rate of COVID mortalities in the state during the ivermectin protocol. Here's a long Twitter thread shredding this research (read to the end and follow the links, it gets more damning as it goes). https://twitter.com/GidMK/status/1471320883461378048 https://twitter.com/GidMK/status/1471320883461378048
  - srcreigh 5y ago
    Thanks. Not sure if this critique counts as shredding. It's mostly A) needs to meet XYZ higher quality bar B) small mistakes in computations. In this world anything can be put to a higher bar and small mistakes are expected.. etc Is anyone aware of any ivermectin study which meets the quality bar, has no mistakes and concludes that it doesn't work? That would shred the paper to me. As the critic you link says > It might be useful as the very first piece of research into a medication I wonder if/how the 2nd study will happen.
tomlockwood 5y ago
https://healthfeedback.org/claimreview/ivermectin-study-itajai-contains-methodological-weaknesses-questionable-conclusions/ https://healthfeedback.org/claimreview/ivermectin-study-itaj... Seems like this study may have some methodological issues.
- srcreigh 5y ago
  I read this. I am no epidemiologist but it does seem like a pretty weak critique. The core of this critique is that ivermectin may not have been used consistently among the treatment group, therefore negative results may be masked, or confounding variables may be present. It seems that ivermectin is generally known to be safe drug for use to treat other antiviral conditions. Is the critic calling that into question? I would expect more evidence for that claim. Furthermore every science experiment can have confounding variables, so yeah. Even in that case I would expect more of a curious response as 66% reduction in hospitalization at very low p-value is very significant. What could the confounding variables be? Could they be surveyed? The authors of the article did look into some confounding variables and did find that people more at risk of covid self selected to be in the ivermectin group. I would like more info about all this. I don't think it's as simple as "bad study move on".
  - tptacek 5y ago
    That's one of several critiques of the study; others includes the fact that it's not controlled for confounders, that the city in question had the highest COVID mortality in its state during the program, and that several of the study authors have either conflicts, bad reputations, or both. The Twitter link itself links to even more damning critiques, including some evidence of falsified data.
    - srcreigh 5y ago
      I read the city had high mortality from the beginning of the pandemic[0]. Would it be a bad case if the population happens to be more aged etc? Is the falsified data just the off by one in deaths among the under 30 cohort or is there more?[1] [0]: https://mobile.twitter.com/sean_purdy/status/1470416523076542464 https://mobile.twitter.com/sean_purdy/status/147041652307654... [1]: https://mobile.twitter.com/GidMK/status/1478975913094090752 https://mobile.twitter.com/GidMK/status/1478975913094090752
NikolaeVarius 5y ago
Wow this is a POS study. > Study Group: 223,128 citizens of Itajaí considered for the study, a total of 159,561 subjects were included in the analysis > 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). Are you serious? This is such a shitty sample size you might as well be rolling dice. Why do these studies assume people can't read
- pomdapi 5y ago
  Now do the Pfizer and Moderna vaccine clinical studies. Don't forget the retrospective updates made during the following year, particularly concerning later hospitalisations and mortality.
  - blip54321 5y ago
    Cite? (That's a serious request, not a cynical one -- I'd like to see those updates)
- sinsterizme 5y ago
  Wait, 159,561 subjects is considered small? Maybe I’m not understanding what you mean
- ekianjo 5y ago
  Ever seen the pfizer data with which the fda approved the vaccine? Sample size wise you are in for a good laugh.
- FabHK 5y ago
  Mate, the p-value is given right there. Obviously, the difference is large enough to be highly significant.
- s1artibartfast 5y ago
  Consider now that the Pfizer 5-11 trial was ~2000 people and didn't have a difference in symptoms or hospitialzation
kevin_b_er 5y ago
I suggest the real website. Posting NIH Pubmed links tends to be used to suggest the NIH has something to do with it, when this website is just a library catalog of papers. This is a mirror maintained by a government agency. https://www.cureus.com/articles/82162-ivermectin-prophylaxis-used-for-covid-19-a-citywide-prospective-observational-study-of-223128-subjects-using-propensity-score-matching https://www.cureus.com/articles/82162-ivermectin-prophylaxis... or the DOI link: https://dx.doi.org/10.7759%2Fcureus.21272 https://dx.doi.org/10.7759%2Fcureus.21272
- g42gregory 5y ago
  The NIH reference makes it harder to shut down the thread.
  - deleted 5y ago
    [deleted]
  - avs733 5y ago
    Just to be clear, this is the same concept the parent comment is referencing. Posting the link this way from an NIH aggregator seems designed to give the false appearance of NIH credibility to
- a_bonobo 5y ago
  Cureus is a bit of a weird journal, they have very fast peer review time instead relying officially on post-publication peer review Here's a weird case on a different paper in the same journal: http://retractionwatch.com/2015/11/02/sex-addiction-article-retracted-republished/ http://retractionwatch.com/2015/11/02/sex-addiction-article-... In this case, the two first authors Lucy Kerr and Flavio Cadegiani are (partially?) funded by Vitamedic, a company that makes Ivermectin. That's not mentioned in the Cureus paper. It is mentioned in some of their papers, like this one: https://www.researchgate.net/publication/357313430_Ivermectin_Prophylaxis_Used_for_COVID-19_Reduces_COVID-19_Infection_and_Mortality_Rates_A_City-Wide_Prospective_Observational_Study_of_223128_Subjects_Using_Propensity_Score_Matching https://www.researchgate.net/publication/357313430_Ivermecti... They seem to be based in Brazil. Given that intestinal worms are still common in Brazil it may have been that people saw a health improvement in Covid-patients after Ivermectin got rid of the worms.
weare138 5y ago
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8734085/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8734085/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765325/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765325/
Kenneth21 5y ago
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timmytokyo 5y ago
Parasitic diseases are highly prevalent in Brazil [1]. Also, as quoted in [2], "Helminth [ie worm] infections are among the most common infectious diseases. Bradbury et al. highlight the possible negative interactions between helminth infection and COVID-19 severity in helminth-endemic regions and note that alterations in the gut microbiome associated with helminth infection appear to have systemic immunomodulatory effects. It has also been proposed that helminth co-infection may increase the morbidity and mortality of COVID-19, because the immune system cannot efficiently respond to the virus; in addition, vaccines will be less effective for these patients, but treatment and prevention of helminth infections might reduce the negative effect of COVID-19. During millennia of parasite-host coevolution helminths evolved mechanisms suppressing the host immune responses, which may mitigate vaccine efficacy and increase severity of other infectious diseases." It seems strange that the referenced study did not consider the possible confounding factor of parasitic infection. [1] https://pubmed.ncbi.nlm.nih.gov/34105625/ https://pubmed.ncbi.nlm.nih.gov/34105625/ [2] https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted https://astralcodexten.substack.com/p/ivermectin-much-more-t...
- srcreigh 5y ago
  Cool. This makes sense as a confounding factor. For what it's worth, Itajai in southeastern region Brazil has the lowest rate of parasitic infections among the regions at 37%. (your [1]) Probably can't be equated this easily, but 37% could make up a significant chunk of the purported 66% reduction in hospitalizations.
jjeaff 5y ago
After clicking to read the middle authors, I saw some familiar names, Pierre Kory being one of them. A doctor that testified to a congressional committee early last year that "the pandemic will end, the economy can reopen, social interactions and activity can resume, and life can normalize" if we simply give ivermectin to everyone. He has made countless claims like these long before any good research had been done. So he and his organization have a lot riding on proving that ivermectin works for COVID.
- ComradePhil 5y ago
  What's the problem with that? Pfizer and their friends have everything riding on the idea that it never ends, none of the cheap treatments work and the only solution is to slow the spread (so that it stays around for longer) while vaccinating everyone frequently... and they are only motivated by profits.
  - acdha 5y ago
    Vaccines are far less profitable than most of their other drugs. If they were looking to get rich, they'd want something like the HIV inhibitors where each patient is buying from them on a frequent basis.
    - brippalcharrid 5y ago
      Vaccines can potentially be mandated for entire populations and funded by the US taxpayer for distribution around the world and require adjustments several times per year. The development of new related vaccines of this type is apparently quite cheap and straightforward (this was boasted about at various points over the last few years) and vaccines are also pretty unique in the way that manufacturers can effectively be immune from liability. Add in the magic word Pandemic, with careful orchestration from public health authorities and politicians I think you can have a dream combination of volume, revenue and commercial risk limitation.
      - Vrondi 5y ago
Gravyness 5y ago
Here's a brazilian interpretation of the paper results and its findings if anyone is interested: https://filiperafaeli.substack.com/p/ivermectina-preventiva-revisao-internacional https://filiperafaeli.substack.com/p/ivermectina-preventiva-...
- marcodiego 5y ago
  From the same blog: Hidroxicloroquina para profilaxia da COVID-19 atinge o mais alto nível de evidência científica COVID-19: um dia glorioso para a ciência brasileira. Dr Cadegiani encontra a cura pra pacientes graves. 92% de redução nas mortes Too clickbaity to be considered.
jcims 5y ago
Ivermectin and other anthelmintics (mebendazole, febendazole) are showing quite a bit of promise in cancer therapy. It’s been a while since I looked at it but if I recall correctly at least one mechanism of action is to promote (well, unsuppress) autophagy in diseased cells.
ncmncm 5y ago
This is the same as posted a week ago. The answer is the same: COVID outcomes are better without parasites. If you don't have worms, ivermectin will not help you.
- xupybd 5y ago
  Are worms really that common?
  - Pigalowda 5y ago
    In undeveloped countries. Ascariasis: 800- 1.2 billion worldwide https://www.cdc.gov/parasites/ascariasis/index.html https://www.cdc.gov/parasites/ascariasis/index.html Strongyloides: 100 million https://www.cdc.gov/parasites/strongyloides/epi.html https://www.cdc.gov/parasites/strongyloides/epi.html Cystercicosis: 50-100 million https://pubmed.ncbi.nlm.nih.gov/25296005/ https://pubmed.ncbi.nlm.nih.gov/25296005/
    - xupybd 5y ago
      Well that's another sad fact about the developing world. It sounds like treating underlying heath problems before getting COVID is a good idea in the developing world.
      - ncmncm 5y ago
        Treating underlying health problems exceeded their resources, many places, even before COVID. COVID has not made it easier.
  - marcodiego 5y ago
    Yes. In Brazil specially.
  - mschuster91 5y ago
    Yes, particularly in India [1], and other countries with widespread poverty. Given that, it's not surprising that the promising Ivermectin studies came out of such countries - most Western researchers at the time simply didn't know, think or care about parasite prevalence as an explanation and the general public has even less knowledge as parasitic infections are incredibly rare in developed countries. And by the time it became clear, too many people already had jumped on the hype train. [1]: https://ciff.org/news/worms-india-scale-and-success-world-leading-deworming-programme/ https://ciff.org/news/worms-india-scale-and-success-world-le...
nbzso 5y ago
I know it is a sensitive topic. Thats why I listen to people with experience. https://www.youtube.com/watch?v=ufy2AweXRkc https://www.youtube.com/watch?v=ufy2AweXRkc
- dgb23 5y ago
  This video was suggested on my feed a while ago. I tried to make sense of the author and his other content, but it all seems incredibly shady and snake-oily to me. But I'm a layman Does someone care to clarify the credibility of the author and his content?
  - raws 5y ago
    From what I understand it is saying that ivermectin is useful and efficient at blocking the tool (protein scissors; protease) that the virus needs in order to spread a protein out of the cell. The new Pfizer COVID drug is supposed to do that too but ivermectin is 0.06$ vs new Pfizer drug with a 20year patent lots of cash for a good lobbying company :) Credibility of the author idk :s
  - ifyoubuildit 5y ago
    > Does someone care to clarify the credibility of the author and his content? What are the potential outcomes here? You're sure to find people on this site (whose credibility you also can't judge) who claim he's the antichrist and others who claim he is actual Jesus, mostly depending on what their social circle happens to believe. What do you do with that information? That said, John Campbell is one of the few YouTube sources I've found myself continuously going back to throughout the pandemic. Like anything else, I take things he says as "Ok, now I know someone has said this", not "OK, this is a thing that I now know to be true".
  - cableshaft 5y ago
    "John L. Campbell is a British YouTuber, retired nurse educator and author of nursing textbooks who has posted a number of widely-viewed YouTube videos on his Dr. John Campbell channel commenting on the COVID-19 pandemic. In August 2020, Campbell's channel was referred to by UNICEF's regional office for Europe and Central Asia as good example of expert engagement with social media. By January 2022, his videos had been viewed more than 429 million times." "Campbell worked as a nursing educator at the University of Cumbria, and has experience as an A&E nurse. He has also taught health workers in India and Cambodia. He is the author of Campbell's Physiology Notes and Campbell's Pathophysiology Notes nursing-related biosciences text books. A 2011 book review in Emergency Nurse magazine said Campbell's Physiology Notes was "excellent, inexpensive notes on the causes, pathophysiological changes and clinical features seen in disease processes"."[1] To be fair, a good chunk of his Wikipedia article mention his videos about Ivermectin and how they're false claims based on some articles people have posted in response to his video, which is to be expected since anything positive said about Ivermectin is bound to have people counter it. Dr. Campbell has posted almost 2000 videos, pretty much every day since the pandemic started (although if you sort by oldest on his channel you can see 14 year old low-res, poor audio/lighting videos[2] of him going over various medical concepts, btw, pretty interesting), where he reviews and explains probably 20+ charts and graphs and statistics and quotes and studies to the best of his understanding. He's also human and may very well have been led down a wrong rabbit hole by his interpretation of some studies (or perhaps not, Ivermectin seems to have become one of the things that everyone decided they'll believe in its efficacy based pretty much exclusively on political party alignment). You should always take in information with a critical eye, including Dr. Campbell. I've watched probably a hundred of his videos and I don't always agree with his conclusions 100% either, but I can't say that about anyone ever, so I don't expect that of him either. What I have seen is, especially on his more general update videos, the most comprehensive compilation of data (as digestible to a layperson as possible) for complicated medical concepts. [1]: https://en.wikipedia.org/wiki/John_Campbell_(YouTuber) https://en.wikipedia.org/wiki/John_Campbell_(YouTuber) [2]: https://youtu.be/tmkH87YPN4g https://youtu.be/tmkH87YPN4g
sydthrowaway 5y ago
Dumb question Do we all have worms and don’t realize it? I say yes. Should we take ivermectin for quality of life improvements.. is it a medicine or vitamin?
- marcodiego 5y ago
  In Brazil worms are very common. Some people take anti-hemlminths prophylactically every 6 months.
- tartoran 5y ago
  If you think you have worms get yourslef checked. It’s all in your stool and can be easily detected.
  - giardini 5y ago
    Worms are very common in the USA and are endemic in the the southern states. As a child I had a stool test every year. I often took pills for hookworms. As an adult no doctor has ever prescribed a stool test, even when asked about the likelihood of parasites. One doctor mumbled something to the effect that "if you have worms it will show up in the blood tests..." but I think he was full of it, as usual: https://www.cdc.gov/parasites/references_resources/diagnosis.html https://www.cdc.gov/parasites/references_resources/diagnosis... I often walk or run barefoot; I don't usually use insect repellant. I eat wild berries and leaves sometimes. Bugs bite me and sting me. I am likely periodically exposed to parasites. An annual test for parasites seems like a good idea. But, since my doctors (most whom are from Asia and should know better) do not concur, I also treat myself to anti-parasitic medications occasionally.
throwawaymanbot 5y ago
apinstein 5y ago
They went to all the trouble to create a huge trial and didn’t make it double-blind, placebo controlled? That is so suspect. We know how to create good experiments, so I just have little trust in bad experiments, especially at this scale. I don’t care what the outcome is, treatments are treatments. I have no hope for a particular outcome. It’s just bad science. And I might argue bad faith science. Potential biases: for instance in Brazil there is a very high level of prior Covid infections. What I’d previously infected people were more likely to opt in to treatment bc they are more afraid of reinfection, and the result came from reduction due to prior immunity? What if people that took the Medecine behaved differently than non-takers?
- incrudible 5y ago
  I'm inclined to agree, but I must ask: Would you have the same standards when it comes to the vaccines? I'm not aware of any double-blind placebo-controlled trial that is powerful enough to determine risk reduction for death or severe disease in vaccines, much less over several months.
  - cloutchaser 5y ago
    As far as I know this was explained away with - it's too urgent and it's not ethical to have placebo controlled vaccine trials at this time, since everyone will contract covid. So we didn't have any.
    - incrudible 5y ago
      An all-too-convenient excuse, considering how many people now willingly put themselves into the control group called "anti-vaxxer".
    - ericb 5y ago
      The vaccine studies were placebo controlled.
      - incrudible 5y ago
marcodiego 5y ago
Cadegiani is part of the "medicos pela Vida" a Brazillian group advocating "tratamento precoce/inicial/integral". The pandemic had an hilarious course in Brazil and there are doctors indicating medicines based on their political views. Brazil health ministry published an on-line service which suggested HCQ for newborn infants and recently they published a table putting HCQ as better than vaccines. Beaware of Brazillian studies related to ivermectin and HCQ.
- felideon 5y ago
  Oh, you mean Cadegiani, the same "crazy person [that] decided to put his patients on every weird medication he could think of [... and] helpfully designated some random patients in his area as a sort-of-control, and then synthetically generated a second control group"[1]? Who would have thought? [1] https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted https://astralcodexten.substack.com/p/ivermectin-much-more-t...
ucha 5y ago
The best meta-study review of Ivermectin I've seen was done by Scott Alexander [0]. He individually reviewed a few dozen studies. His take was that Ivermectin is an effective dewormer that is useful as a prophylactic when people are widely exposed to worms. Because they don't catch worms, they're in better shape to fight Covid when infected. However Ivermectin has no effect in most developed countries where the general population isn't subject to worm infections. [0] https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted https://astralcodexten.substack.com/p/ivermectin-much-more-t...
- felideon 5y ago
  He also describes one of Cadegiani's other studies with some helpful color.
- disruptalot 5y ago
  I would also read ivmmeta's response [0] and his reply [1] . At first I walked away fairly confident at what I had read. Later when I came across the responses, things got more uncertain. The example which quickly comes to mind is that most if not all the prophylaxis studies were not reviewed in Scott's analysis. [0] https://ivmmeta.com/#sa https://ivmmeta.com/#sa [1] https://astralcodexten.substack.com/p/higlights-from-the-comments-on-ivermectin https://astralcodexten.substack.com/p/higlights-from-the-com...
  - rsfern 5y ago
    The Covid therapeutic and prophylactic literature has been chock full of crap studies, so you really have to be careful taking meta analysis at face value. Some interesting discussion on this, which includes the prophylactic literature: https://www.nature.com/articles/s41591-021-01535-y https://www.nature.com/articles/s41591-021-01535-y
    - dionian 5y ago
      Same issue with relying on single studies, you might rely on a crap one.
kerneloftruth 5y ago
The groupthink here is disappointing. Rather than be glad that a cheap and widely available drug is possibly effective at treating the effects of covid, armchair experts here instead pounce on it with attacks. I wonder if Twitter and Facebook will suppress the study.
- martneumann 5y ago
  People are rightly skepctical if the same group of doctors continues to publish studies that support their opinion, while all other studies contradict their results.
  - good8675309 5y ago
    Skepticism is fine but dismissively throwing it out and mocking people that want to know more because it's a politically divisive topic is not. Science is not political and should not be influenced by politics. We should be throwing more studies at this, especially if you don't trust the current researchers.
- xadhominemx 5y ago
  Ivermectin is hawked as a COVID miracle cure within right wing circles and spoken about constantly on right wing media programs. Many millions have been convinced ivermectin will save them from COVID, discouraging vaccination and even prompting some to remove family members in critical condition from hospitals because staff refuse to prescribe the de-wormer. It’s killed people and there is an organized effort to push the drug for cynical partisan gain. So yea, it is appropriate to “pounce” on this study or at least be very clear why it is not applicable to first world countries (very few people have worms)
  - s1artibartfast 5y ago
    Do you believe it is possible you could be wrong and what data would it take for you to change your mind?
    - 5y ago
m0llusk 5y ago
This still demands investigation. The main issue is that the dosage known to be effective is higher than the dosage known to be safe. It could be that this consistent ongoing use regimen helped by increasing the tolerable concentration or boosting the effects or both.
- q1w2 5y ago
  > the dosage known to be effective is higher than the dosage known to be safe. This is misleading a little. Only the high dose was tested in cell cultures. That does not mean that low doses are not also very effective. In the lab, they usually use very high doses to confirm that there is any effect at all. A second set of experiments (not done yet) then calibrate to discover the minimum effective dose.
phonypc 5y ago
Regarding one of the principal authors: >Brazil’s attorney general is investigating the possible violations of medical ethics and human rights on the recommendation of the National Research Ethics Commission (CONEP), which forms part of the CNS. The trial’s principal investigator, Flavio Cadegiani, was identified in October along with 68 others by a parliamentary inquiry into Brazil’s management of the pandemic as having committed “crimes against humanity.” https://www.bmj.com/content/375/bmj.n2819 https://www.bmj.com/content/375/bmj.n2819
tamaharbor 5y ago
I think all the greyed-out responses here are indicative of the problem.

135 points by tamaharbor 5y ago

tasogare 5y ago
- scarby2 5y ago
- donw 5y ago
  Of course they don't. They look at citizens as a barrier between where they are now, and their desire to live like the feudal lords of old, except with modern conveniences.
- dang 5y ago
  We've asked you repeatedly to stop posting flamewar comments to HN and you've continued to do it repeatedly. Therefore I've banned the account. No, this has nothing to do with your views. It has to do with not wanting flamewars here, because they're not compatible with the kind of website HN is trying to be. If you don't want to be banned, you're welcome to email hn@ycombinator.com and give us reason to believe that you'll follow the rules in the future. They're here: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html.
mike00632 5y ago
That quote isn't from the NIH though. Look at the disclaimer: > This disclaimer relates to PubMed, PubMed Central (PMC), and Bookshelf. These three resources are scientific literature databases offered to the public by the U.S. National Library of Medicine (NLM). NLM is not a publisher, but rather collects, indexes, and archives scientific literature published by other organizations. The presence of any article, book, or document in these databases does not imply an endorsement of, or concurrence with, the contents by NLM, the National Institutes of Health (NIH), or the U.S. Federal Government. And this is the disclaimer from the publisher: > The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein.

Key points > 113,845 (71.3%) regular ivermectin users and 45,716 (23.3%) non-users > 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 > 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). > Missing data from patients were clarified with patients or relatives directly, via phone or in person, by the investigators. Since this is a citywide program, all recorded data must have matched the exact number of COVID-19 cases and deaths of the city. > An important conservative bias was present. Major risk factors for severe COVID-19 and mortality due to COVID-19, including aging, diabetes, and hypertension, were more present among ivermectin users, which may have underestimated the benefits of ivermectin The only questionable part of this I can find is a small unfounded semi negative comment about vaccines near the end. > lack of effectiveness of vaccines in real-life all-cause mortality analyses to date Vaccines correlate with 5.6x reduction in hospitalization and 12x reduction in ICU cases in Ontario as of today (Jan 22 2022) so not sure where that comes from. However their results still seem pretty clear that ivermectin helps. I'm curious if ivermectin and vaccines compound in effectiveness. 2x effective prevention could speed things up a lot.

tptacek 5y ago
They don't even know who took ivermectin. The city they studied the ivermectin protocol in had the highest rate of COVID mortalities in the state during the ivermectin protocol. Here's a long Twitter thread shredding this research (read to the end and follow the links, it gets more damning as it goes). https://twitter.com/GidMK/status/1471320883461378048 https://twitter.com/GidMK/status/1471320883461378048
- srcreigh 5y ago
  Thanks. Not sure if this critique counts as shredding. It's mostly A) needs to meet XYZ higher quality bar B) small mistakes in computations. In this world anything can be put to a higher bar and small mistakes are expected.. etc Is anyone aware of any ivermectin study which meets the quality bar, has no mistakes and concludes that it doesn't work? That would shred the paper to me. As the critic you link says > It might be useful as the very first piece of research into a medication I wonder if/how the 2nd study will happen.

tomlockwood 5y ago

https://healthfeedback.org/claimreview/ivermectin-study-itajai-contains-methodological-weaknesses-questionable-conclusions/ https://healthfeedback.org/claimreview/ivermectin-study-itaj... Seems like this study may have some methodological issues.

srcreigh 5y ago
I read this. I am no epidemiologist but it does seem like a pretty weak critique. The core of this critique is that ivermectin may not have been used consistently among the treatment group, therefore negative results may be masked, or confounding variables may be present. It seems that ivermectin is generally known to be safe drug for use to treat other antiviral conditions. Is the critic calling that into question? I would expect more evidence for that claim. Furthermore every science experiment can have confounding variables, so yeah. Even in that case I would expect more of a curious response as 66% reduction in hospitalization at very low p-value is very significant. What could the confounding variables be? Could they be surveyed? The authors of the article did look into some confounding variables and did find that people more at risk of covid self selected to be in the ivermectin group. I would like more info about all this. I don't think it's as simple as "bad study move on".
- tptacek 5y ago
  That's one of several critiques of the study; others includes the fact that it's not controlled for confounders, that the city in question had the highest COVID mortality in its state during the program, and that several of the study authors have either conflicts, bad reputations, or both. The Twitter link itself links to even more damning critiques, including some evidence of falsified data.
  - srcreigh 5y ago
    I read the city had high mortality from the beginning of the pandemic[0]. Would it be a bad case if the population happens to be more aged etc? Is the falsified data just the off by one in deaths among the under 30 cohort or is there more?[1] [0]: https://mobile.twitter.com/sean_purdy/status/1470416523076542464 https://mobile.twitter.com/sean_purdy/status/147041652307654... [1]: https://mobile.twitter.com/GidMK/status/1478975913094090752 https://mobile.twitter.com/GidMK/status/1478975913094090752

NikolaeVarius 5y ago

Wow this is a POS study. > Study Group: 223,128 citizens of Itajaí considered for the study, a total of 159,561 subjects were included in the analysis > 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). Are you serious? This is such a shitty sample size you might as well be rolling dice. Why do these studies assume people can't read

pomdapi 5y ago
Now do the Pfizer and Moderna vaccine clinical studies. Don't forget the retrospective updates made during the following year, particularly concerning later hospitalisations and mortality.
- blip54321 5y ago
  Cite? (That's a serious request, not a cynical one -- I'd like to see those updates)
sinsterizme 5y ago
Wait, 159,561 subjects is considered small? Maybe I’m not understanding what you mean
ekianjo 5y ago
Ever seen the pfizer data with which the fda approved the vaccine? Sample size wise you are in for a good laugh.
FabHK 5y ago
Mate, the p-value is given right there. Obviously, the difference is large enough to be highly significant.
s1artibartfast 5y ago
Consider now that the Pfizer 5-11 trial was ~2000 people and didn't have a difference in symptoms or hospitialzation

kevin_b_er 5y ago

I suggest the real website. Posting NIH Pubmed links tends to be used to suggest the NIH has something to do with it, when this website is just a library catalog of papers. This is a mirror maintained by a government agency. https://www.cureus.com/articles/82162-ivermectin-prophylaxis-used-for-covid-19-a-citywide-prospective-observational-study-of-223128-subjects-using-propensity-score-matching https://www.cureus.com/articles/82162-ivermectin-prophylaxis... or the DOI link: https://dx.doi.org/10.7759%2Fcureus.21272 https://dx.doi.org/10.7759%2Fcureus.21272

g42gregory 5y ago
The NIH reference makes it harder to shut down the thread.
- deleted 5y ago
  [deleted]
- avs733 5y ago
  Just to be clear, this is the same concept the parent comment is referencing. Posting the link this way from an NIH aggregator seems designed to give the false appearance of NIH credibility to
a_bonobo 5y ago
Cureus is a bit of a weird journal, they have very fast peer review time instead relying officially on post-publication peer review Here's a weird case on a different paper in the same journal: http://retractionwatch.com/2015/11/02/sex-addiction-article-retracted-republished/ http://retractionwatch.com/2015/11/02/sex-addiction-article-... In this case, the two first authors Lucy Kerr and Flavio Cadegiani are (partially?) funded by Vitamedic, a company that makes Ivermectin. That's not mentioned in the Cureus paper. It is mentioned in some of their papers, like this one: https://www.researchgate.net/publication/357313430_Ivermectin_Prophylaxis_Used_for_COVID-19_Reduces_COVID-19_Infection_and_Mortality_Rates_A_City-Wide_Prospective_Observational_Study_of_223128_Subjects_Using_Propensity_Score_Matching https://www.researchgate.net/publication/357313430_Ivermecti... They seem to be based in Brazil. Given that intestinal worms are still common in Brazil it may have been that people saw a health improvement in Covid-patients after Ivermectin got rid of the worms.

weare138 5y ago

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8734085/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8734085/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765325/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765325/

Kenneth21 5y ago

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timmytokyo 5y ago

Parasitic diseases are highly prevalent in Brazil [1]. Also, as quoted in [2], "Helminth [ie worm] infections are among the most common infectious diseases. Bradbury et al. highlight the possible negative interactions between helminth infection and COVID-19 severity in helminth-endemic regions and note that alterations in the gut microbiome associated with helminth infection appear to have systemic immunomodulatory effects. It has also been proposed that helminth co-infection may increase the morbidity and mortality of COVID-19, because the immune system cannot efficiently respond to the virus; in addition, vaccines will be less effective for these patients, but treatment and prevention of helminth infections might reduce the negative effect of COVID-19. During millennia of parasite-host coevolution helminths evolved mechanisms suppressing the host immune responses, which may mitigate vaccine efficacy and increase severity of other infectious diseases." It seems strange that the referenced study did not consider the possible confounding factor of parasitic infection. [1] https://pubmed.ncbi.nlm.nih.gov/34105625/ https://pubmed.ncbi.nlm.nih.gov/34105625/ [2] https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted https://astralcodexten.substack.com/p/ivermectin-much-more-t...

srcreigh 5y ago
Cool. This makes sense as a confounding factor. For what it's worth, Itajai in southeastern region Brazil has the lowest rate of parasitic infections among the regions at 37%. (your [1]) Probably can't be equated this easily, but 37% could make up a significant chunk of the purported 66% reduction in hospitalizations.

jjeaff 5y ago

After clicking to read the middle authors, I saw some familiar names, Pierre Kory being one of them. A doctor that testified to a congressional committee early last year that "the pandemic will end, the economy can reopen, social interactions and activity can resume, and life can normalize" if we simply give ivermectin to everyone. He has made countless claims like these long before any good research had been done. So he and his organization have a lot riding on proving that ivermectin works for COVID.

ComradePhil 5y ago
What's the problem with that? Pfizer and their friends have everything riding on the idea that it never ends, none of the cheap treatments work and the only solution is to slow the spread (so that it stays around for longer) while vaccinating everyone frequently... and they are only motivated by profits.
- acdha 5y ago
  Vaccines are far less profitable than most of their other drugs. If they were looking to get rich, they'd want something like the HIV inhibitors where each patient is buying from them on a frequent basis.
  - brippalcharrid 5y ago
    Vaccines can potentially be mandated for entire populations and funded by the US taxpayer for distribution around the world and require adjustments several times per year. The development of new related vaccines of this type is apparently quite cheap and straightforward (this was boasted about at various points over the last few years) and vaccines are also pretty unique in the way that manufacturers can effectively be immune from liability. Add in the magic word Pandemic, with careful orchestration from public health authorities and politicians I think you can have a dream combination of volume, revenue and commercial risk limitation.
    - Vrondi 5y ago

Gravyness 5y ago

Here's a brazilian interpretation of the paper results and its findings if anyone is interested: https://filiperafaeli.substack.com/p/ivermectina-preventiva-revisao-internacional https://filiperafaeli.substack.com/p/ivermectina-preventiva-...

marcodiego 5y ago
From the same blog: Hidroxicloroquina para profilaxia da COVID-19 atinge o mais alto nível de evidência científica COVID-19: um dia glorioso para a ciência brasileira. Dr Cadegiani encontra a cura pra pacientes graves. 92% de redução nas mortes Too clickbaity to be considered.

jcims 5y ago

Ivermectin and other anthelmintics (mebendazole, febendazole) are showing quite a bit of promise in cancer therapy. It’s been a while since I looked at it but if I recall correctly at least one mechanism of action is to promote (well, unsuppress) autophagy in diseased cells.

ncmncm 5y ago

This is the same as posted a week ago. The answer is the same: COVID outcomes are better without parasites. If you don't have worms, ivermectin will not help you.

xupybd 5y ago
Are worms really that common?
- Pigalowda 5y ago
  In undeveloped countries. Ascariasis: 800- 1.2 billion worldwide https://www.cdc.gov/parasites/ascariasis/index.html https://www.cdc.gov/parasites/ascariasis/index.html Strongyloides: 100 million https://www.cdc.gov/parasites/strongyloides/epi.html https://www.cdc.gov/parasites/strongyloides/epi.html Cystercicosis: 50-100 million https://pubmed.ncbi.nlm.nih.gov/25296005/ https://pubmed.ncbi.nlm.nih.gov/25296005/
  - xupybd 5y ago
    Well that's another sad fact about the developing world. It sounds like treating underlying heath problems before getting COVID is a good idea in the developing world.
    - ncmncm 5y ago
      Treating underlying health problems exceeded their resources, many places, even before COVID. COVID has not made it easier.
- marcodiego 5y ago
  Yes. In Brazil specially.
- mschuster91 5y ago
  Yes, particularly in India [1], and other countries with widespread poverty. Given that, it's not surprising that the promising Ivermectin studies came out of such countries - most Western researchers at the time simply didn't know, think or care about parasite prevalence as an explanation and the general public has even less knowledge as parasitic infections are incredibly rare in developed countries. And by the time it became clear, too many people already had jumped on the hype train. [1]: https://ciff.org/news/worms-india-scale-and-success-world-leading-deworming-programme/ https://ciff.org/news/worms-india-scale-and-success-world-le...

nbzso 5y ago

I know it is a sensitive topic. Thats why I listen to people with experience. https://www.youtube.com/watch?v=ufy2AweXRkc https://www.youtube.com/watch?v=ufy2AweXRkc

dgb23 5y ago
This video was suggested on my feed a while ago. I tried to make sense of the author and his other content, but it all seems incredibly shady and snake-oily to me. But I'm a layman Does someone care to clarify the credibility of the author and his content?
- raws 5y ago
  From what I understand it is saying that ivermectin is useful and efficient at blocking the tool (protein scissors; protease) that the virus needs in order to spread a protein out of the cell. The new Pfizer COVID drug is supposed to do that too but ivermectin is 0.06$ vs new Pfizer drug with a 20year patent lots of cash for a good lobbying company :) Credibility of the author idk :s
- ifyoubuildit 5y ago
  > Does someone care to clarify the credibility of the author and his content? What are the potential outcomes here? You're sure to find people on this site (whose credibility you also can't judge) who claim he's the antichrist and others who claim he is actual Jesus, mostly depending on what their social circle happens to believe. What do you do with that information? That said, John Campbell is one of the few YouTube sources I've found myself continuously going back to throughout the pandemic. Like anything else, I take things he says as "Ok, now I know someone has said this", not "OK, this is a thing that I now know to be true".
- cableshaft 5y ago
  "John L. Campbell is a British YouTuber, retired nurse educator and author of nursing textbooks who has posted a number of widely-viewed YouTube videos on his Dr. John Campbell channel commenting on the COVID-19 pandemic. In August 2020, Campbell's channel was referred to by UNICEF's regional office for Europe and Central Asia as good example of expert engagement with social media. By January 2022, his videos had been viewed more than 429 million times." "Campbell worked as a nursing educator at the University of Cumbria, and has experience as an A&E nurse. He has also taught health workers in India and Cambodia. He is the author of Campbell's Physiology Notes and Campbell's Pathophysiology Notes nursing-related biosciences text books. A 2011 book review in Emergency Nurse magazine said Campbell's Physiology Notes was "excellent, inexpensive notes on the causes, pathophysiological changes and clinical features seen in disease processes"."[1] To be fair, a good chunk of his Wikipedia article mention his videos about Ivermectin and how they're false claims based on some articles people have posted in response to his video, which is to be expected since anything positive said about Ivermectin is bound to have people counter it. Dr. Campbell has posted almost 2000 videos, pretty much every day since the pandemic started (although if you sort by oldest on his channel you can see 14 year old low-res, poor audio/lighting videos[2] of him going over various medical concepts, btw, pretty interesting), where he reviews and explains probably 20+ charts and graphs and statistics and quotes and studies to the best of his understanding. He's also human and may very well have been led down a wrong rabbit hole by his interpretation of some studies (or perhaps not, Ivermectin seems to have become one of the things that everyone decided they'll believe in its efficacy based pretty much exclusively on political party alignment). You should always take in information with a critical eye, including Dr. Campbell. I've watched probably a hundred of his videos and I don't always agree with his conclusions 100% either, but I can't say that about anyone ever, so I don't expect that of him either. What I have seen is, especially on his more general update videos, the most comprehensive compilation of data (as digestible to a layperson as possible) for complicated medical concepts. [1]: https://en.wikipedia.org/wiki/John_Campbell_(YouTuber) https://en.wikipedia.org/wiki/John_Campbell_(YouTuber) [2]: https://youtu.be/tmkH87YPN4g https://youtu.be/tmkH87YPN4g

sydthrowaway 5y ago

Dumb question Do we all have worms and don’t realize it? I say yes. Should we take ivermectin for quality of life improvements.. is it a medicine or vitamin?

marcodiego 5y ago
In Brazil worms are very common. Some people take anti-hemlminths prophylactically every 6 months.
tartoran 5y ago
If you think you have worms get yourslef checked. It’s all in your stool and can be easily detected.
- giardini 5y ago
  Worms are very common in the USA and are endemic in the the southern states. As a child I had a stool test every year. I often took pills for hookworms. As an adult no doctor has ever prescribed a stool test, even when asked about the likelihood of parasites. One doctor mumbled something to the effect that "if you have worms it will show up in the blood tests..." but I think he was full of it, as usual: https://www.cdc.gov/parasites/references_resources/diagnosis.html https://www.cdc.gov/parasites/references_resources/diagnosis... I often walk or run barefoot; I don't usually use insect repellant. I eat wild berries and leaves sometimes. Bugs bite me and sting me. I am likely periodically exposed to parasites. An annual test for parasites seems like a good idea. But, since my doctors (most whom are from Asia and should know better) do not concur, I also treat myself to anti-parasitic medications occasionally.

throwawaymanbot 5y ago

apinstein 5y ago

They went to all the trouble to create a huge trial and didn’t make it double-blind, placebo controlled? That is so suspect. We know how to create good experiments, so I just have little trust in bad experiments, especially at this scale. I don’t care what the outcome is, treatments are treatments. I have no hope for a particular outcome. It’s just bad science. And I might argue bad faith science. Potential biases: for instance in Brazil there is a very high level of prior Covid infections. What I’d previously infected people were more likely to opt in to treatment bc they are more afraid of reinfection, and the result came from reduction due to prior immunity? What if people that took the Medecine behaved differently than non-takers?

incrudible 5y ago
I'm inclined to agree, but I must ask: Would you have the same standards when it comes to the vaccines? I'm not aware of any double-blind placebo-controlled trial that is powerful enough to determine risk reduction for death or severe disease in vaccines, much less over several months.
- cloutchaser 5y ago
  As far as I know this was explained away with - it's too urgent and it's not ethical to have placebo controlled vaccine trials at this time, since everyone will contract covid. So we didn't have any.
  - incrudible 5y ago
    An all-too-convenient excuse, considering how many people now willingly put themselves into the control group called "anti-vaxxer".
  - ericb 5y ago
    The vaccine studies were placebo controlled.
    - incrudible 5y ago

marcodiego 5y ago

Cadegiani is part of the "medicos pela Vida" a Brazillian group advocating "tratamento precoce/inicial/integral". The pandemic had an hilarious course in Brazil and there are doctors indicating medicines based on their political views. Brazil health ministry published an on-line service which suggested HCQ for newborn infants and recently they published a table putting HCQ as better than vaccines. Beaware of Brazillian studies related to ivermectin and HCQ.

felideon 5y ago
Oh, you mean Cadegiani, the same "crazy person [that] decided to put his patients on every weird medication he could think of [... and] helpfully designated some random patients in his area as a sort-of-control, and then synthetically generated a second control group"[1]? Who would have thought? [1] https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted https://astralcodexten.substack.com/p/ivermectin-much-more-t...

ucha 5y ago

The best meta-study review of Ivermectin I've seen was done by Scott Alexander [0]. He individually reviewed a few dozen studies. His take was that Ivermectin is an effective dewormer that is useful as a prophylactic when people are widely exposed to worms. Because they don't catch worms, they're in better shape to fight Covid when infected. However Ivermectin has no effect in most developed countries where the general population isn't subject to worm infections. [0] https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted https://astralcodexten.substack.com/p/ivermectin-much-more-t...

felideon 5y ago
He also describes one of Cadegiani's other studies with some helpful color.
disruptalot 5y ago
I would also read ivmmeta's response [0] and his reply [1] . At first I walked away fairly confident at what I had read. Later when I came across the responses, things got more uncertain. The example which quickly comes to mind is that most if not all the prophylaxis studies were not reviewed in Scott's analysis. [0] https://ivmmeta.com/#sa https://ivmmeta.com/#sa [1] https://astralcodexten.substack.com/p/higlights-from-the-comments-on-ivermectin https://astralcodexten.substack.com/p/higlights-from-the-com...
- rsfern 5y ago
  The Covid therapeutic and prophylactic literature has been chock full of crap studies, so you really have to be careful taking meta analysis at face value. Some interesting discussion on this, which includes the prophylactic literature: https://www.nature.com/articles/s41591-021-01535-y https://www.nature.com/articles/s41591-021-01535-y
  - dionian 5y ago
    Same issue with relying on single studies, you might rely on a crap one.

kerneloftruth 5y ago

The groupthink here is disappointing. Rather than be glad that a cheap and widely available drug is possibly effective at treating the effects of covid, armchair experts here instead pounce on it with attacks. I wonder if Twitter and Facebook will suppress the study.

martneumann 5y ago
People are rightly skepctical if the same group of doctors continues to publish studies that support their opinion, while all other studies contradict their results.
- good8675309 5y ago
  Skepticism is fine but dismissively throwing it out and mocking people that want to know more because it's a politically divisive topic is not. Science is not political and should not be influenced by politics. We should be throwing more studies at this, especially if you don't trust the current researchers.
xadhominemx 5y ago
Ivermectin is hawked as a COVID miracle cure within right wing circles and spoken about constantly on right wing media programs. Many millions have been convinced ivermectin will save them from COVID, discouraging vaccination and even prompting some to remove family members in critical condition from hospitals because staff refuse to prescribe the de-wormer. It’s killed people and there is an organized effort to push the drug for cynical partisan gain. So yea, it is appropriate to “pounce” on this study or at least be very clear why it is not applicable to first world countries (very few people have worms)
- s1artibartfast 5y ago
  Do you believe it is possible you could be wrong and what data would it take for you to change your mind?
  - 5y ago

m0llusk 5y ago

This still demands investigation. The main issue is that the dosage known to be effective is higher than the dosage known to be safe. It could be that this consistent ongoing use regimen helped by increasing the tolerable concentration or boosting the effects or both.

q1w2 5y ago
> the dosage known to be effective is higher than the dosage known to be safe. This is misleading a little. Only the high dose was tested in cell cultures. That does not mean that low doses are not also very effective. In the lab, they usually use very high doses to confirm that there is any effect at all. A second set of experiments (not done yet) then calibrate to discover the minimum effective dose.

phonypc 5y ago

Regarding one of the principal authors: >Brazil’s attorney general is investigating the possible violations of medical ethics and human rights on the recommendation of the National Research Ethics Commission (CONEP), which forms part of the CNS. The trial’s principal investigator, Flavio Cadegiani, was identified in October along with 68 others by a parliamentary inquiry into Brazil’s management of the pandemic as having committed “crimes against humanity.” https://www.bmj.com/content/375/bmj.n2819 https://www.bmj.com/content/375/bmj.n2819

tamaharbor 5y ago

I think all the greyed-out responses here are indicative of the problem.