So interesting. They basically admit that Ivermectin might be effective, has low toxicity, is cheap, BUT, the science community has spent 18 months pushing vaccines and refuse to seriously look into Ivermectin.
This is serious, serious malfeasance. The amount of effort out into destroying the doctor patient relationship and taking ivermectin out of the doctors toolbox is too great. That energy should have instead been spent answering the question.
"One very large trial in humans appeared to show that ivermectin was effective against COVID-19, but it was later withdrawn following accusations of plagiarism and manipulated data. Since then, a number of small, variable-quality trials have had varying results. An analysis of the state of the field published in late July indicated it wasn't possible to use these studies to determine if ivermectin was helpful or harmful. The situation doesn't seem to have changed dramatically since. Currently, most health authorities indicate that there is no evidence supporting ivermectin's use against COVID-19."
"None of this is to say that more definitive studies won't eventually determine that ivermectin is effective against COVID-19. But experienced public health authorities have concluded that those studies haven't been done yet and that the studies that have been done don't collectively amount to evidence."
> the science community has spent 18 months pushing vaccines and refuse to seriously look into Ivermectin.
The thing is, vaccines just work. They don't "might be effective", "could be", "maybe, perhaps". They just work.
Ivermectin, might work, with "might" the crucial word. Running randomized double blind trials is not cheap. The "science community" is not a monolith, and doesn't have infinite resources.
> This is serious, serious malfeasance.
Who exactly is guilty of that "malfeasance"? Who had the money and the mandate to run the trials for Ivermectin and didn't?
The US Government had the money and the Congressional mandate to run the Warp Speed program, and some of the programs it has underwritten have ended up in success (Pfizer, Moderna, J&J), and some didn't.
Ivermectin was not part of Warp Speed. Again, who was supposed to do the trials, and is therefore guilty of "malfeasance" ?
It would have been nice if the congress spent a few 10s of millions for a RCT. Funding could easily be through the NIH. Treatment options with even minor impact could have huge returns on investment given that we have seen 600k deaths and millions of severe cases. Treatment options are not a substitute for vaccination and are only framed as such out of political dogma. The government has an ethical mandate to overcome such dogma and act in the interests of saving lives, especially when the the cost is so low compared to trillions thrown around wildly in pandemic spending. People with public trust who are categorically opposed to treatment research are morally culpable for the deaths that could be prevented.
Yes, this exactly.
I would have liked to see this type of work start much earlier given the potential to save lives in the US and globally. A completion date of 2022/2023 is pretty unreasonable for a pandemic starting in 2019.
On a social level, I think we should all be hope such treatments to be a success, and don't understand people rooting for them to fail.
> I would have liked to see this type of work start much earlier given the potential to save lives in the US and globally.
In that case you will be delighted to learn that this type of work did start much earlier. If you follow the link I provided above, you'll see that the trials for Activ-1 started on 15-Oct-2020, for Activ-2 on 19-Aug-2020, for Activ-3 on 4-Aug-2020, for Activ-4 on 4-Sep-2020, for Activ-5 on 5-Oct-2020, etc.
Even before that, on 19-Mar-2020, there's the start of the Recovery trial, which tested, among others, hydroxychloroquine, azithromycin and tocilizumab (and about a dozen more)
Well I am glad some researchers and the NIH have their heads screwed on right. Thanks for sharing this.
Any thoughts on why this topic is so polarized in public discourse and what we can do to unwind it?
It seems like we are in a really unhealthy place where specific medicines are bashed. In the media people are shamed for perusing experimental treatment under their doctors supervision.
Of course people should be cautioned against self diagnosis and self prescription, but surely there is some middle ground. Hopefully one without villianizing patients and doctors.
> In the media people are shamed for perusing experimental treatment under their doctors supervision.
Instead of perusing such experimental treatments, they could just get vaccinated.
Story time: this Monday (i.e. 2 days ago) I got Covid. Terrible headache, complete loss of taste. But I had the vaccine (Moderna). The whole experience was just some amusing thing for me. I took some ibuprofen, aleve and tylenol to deal with the headache (yes, I had to take multiple medications, it was that bad) and aspirin, just to be on the safe side with the potential blood clots. Yesterday I had just a slight headache, and right now I'm absolutely fine.
I did not need to do any sort of experiments with Ivermectin, or anything else. The vaccine just took care of it.
>Instead of perusing such experimental treatments, they could just get vaccinated.
This is the attitude I am talking about.
As I said earlier, I agree treatment options are not a substitute for vaccination. Why does being pro-vaccine necessitate being hostile to treatment options?
First off, Some people can't get vaccinated, and some vaccinated still get ill.
Second, for those who refuse to get vaccinated (as ill advised as it may be), don't we want them to have the 2nd best health outcome possible? Don't we want to minimize healthcare burden and social harm?
It seems like there is a large contingent of the population that want these people to suffer and die, and root for treatments to fail. Some sort of vindictiveness where folks are willing to sacrifice the public interest and their own to spite the vaccine-resistant.
> Why does being pro-vaccine necessitate being hostile to treatment options?
There are treatment options. Remdesivir, dexomethazone, monoclonal antibodies, anti-clotting drugs, etc. NIH has put out guidelines [1], especially p. 62-63.
One year or one year and a half ago not much was known about Covid, so people were looking at vitamin D, aspirin, hydroxychloroquine, etc. Now there are quite a few options.
As you can see, the NIH continues to investigate additional options like Ivermectin. There's no grand conspiracy to hide cures from people. The need for people to experiment by themselves is simply not there. It probably was in the first half of 2020, but not anymore.
I feel like you are side stepping the thrust of my question and mischaracterizing my argument.
1) I am glad the NIH continues to investigate additional options like Ivermectin, and acknowledge that some treatments currently exist. Thank you for sharing some of the more recent NIH studies that I was not aware of.
2) Im not claiming any grand conspiracy to hide cures, just a general public resentment of people trying experimental therapeutics.
3) I am disheartened by vitriol, outrage, and focus on people making medical decisions in consultation with their doctors. I don't understand how it is newsworthy or worthy of outside criticism/condemnation.
4) Despite known treatments, there have been 400k deaths in the last 12 months, so there is clearly room for improvement. If I put myself in the shoes of someone hospitalized with Covid, I would want to look to what additional drugs are being studied, and ask my doctor if the risk/benefit based on current data warrants administration. I wouldn't want to be shamed for enrolling in an RCT for Ivermectin, or being prescribed it by my doctor off label if he thought it had benefit. I wouldn't want a pharmacy overruling my doctors prescription.
5) I was curious about your take on the negative reaction to people seeking and trying potential therapeutics, but you dont seem interested in engaging on why this might be. If your position is that people & doctors should not be able to deviate from the NIH guidelines, that's OK, but we disagree, and I don't know why. Are you saving them from themselves? Is it to enshrine control or keep costs down?
You are right that I didn't address that part of your question. I simply don't know much about it. I am not following a lot social media (outside Hacker News) or regular media, and I'm simply not in the loop with the topic.
The only thing I have noticed myself was that the CDC and the FDA (and the NIH) are quite conservative institutions. If some drug does not have the solid evidence showing it is effective, they will not endorse it. Sometimes this is frustrating, but if you put yourself in their shoes, what else can you do? When you judge a drug for yourself, you have a lot of information, you know everything about your own body, what it tolerates, what it doesn't, etc. But these organizations have to make a judgment that potentially affects the lives of hundreds of millions of people. They will err on the side of being conservative: it's better from their point of view if 1 million people die because they don't use an unproven drug than if 1 million people are saved, but 100k other people die of side-effects. For the simple reason that the 1 million who are saved will become invisible, and only the 100k who die of side-effects will be the center of attention in the media. It's unfortunate, but it is what it is.
The serious malfeasance part is more the media blitz to demonize, and the public health push to inject beaurocratic restrictions between patients and doctors, going so far as to tell pharmacies not to fill prescriptions.
Anyone trying to convince people Ivermectin is an animal drug also falls into this malfeasance category
If people are looking for a real meta-analysis, currently the best one is from Cochrane. They recently put out an author interview[1] putting it into context.
I find this whole topic fascinating, first the actual science, then the patterns of why people believe what they do.
There is a non-anonymous sort of meta-analysis in the form of a letter containing corrections to an earlier flawed meta-analysis. (I'm not endorsing this letter, just pointing out that it exists.)
I think though that most people aren't asking the right question about ivermectin. From a population health standpoint it's clearly not a viable alternative to vaccination (and I encourage everyone to get vaccinated if they can). But vaccination isn't 100% effective so there will continue to be many symptomatic breakthrough cases. So the real question is whether ivermectin should be added to the treatment protocol along with other drugs including monoclonal antibodies? Is it clinically justified on a risk / reward basis?
While waiting for results from that study does it make sense to act based on lower quality research? There are at least some small studies which appear to show a significant clinical benefit with minimal risk.
> From a population health standpoint it's clearly not a viable alternative to vaccination
But from a sociological standpoint there's a strong case for its inclusion.
The reason there even is a divide in politics is because people lean towards one style of thinking. To either stay cautious and follow historical precedence, or to believe change is needed and want to move on from it.
Vaccines are the new and most likely to be effective solution, but we don't know its long term side effects simply because it hasn't been around long enough. Ivermectin on the other hand has been around and has been used for many illnesses on many creatures, including people and horses, successfully and may potentially be effective against Covid for which the risks outweigh potential death.
Some people, due to how they think, will never be getting the vaccine short of being strapped in a chair and shot. And that's a good thing, the diversity of thinking patterns is what keeps our species alive. Disparaging them and labeling them as idiots for refusing it, then trying to force feed it to them is bordering on what we should expect of a dystopian government.
Again, its a good thing that some people are unwilling to try new things, it keeps things balanced, but what that also means is they will never be getting vaccinated until there is more evidence. Look further than the simple math of herd immunity, factor in the fact that we aren't cattle to be vaccinated by some statistician, that we all have individual rights and different modalities of making decisions, and suddenly the solution of using vaccination _along with_ alternative drug treatments should make way more sense than trying to replicate some statistical analysis. Vaccinate as many people as possible and for those more cautious with new things, provide treatments that show some promise for which long term effects are known.
But like you said, this whole thing is so politically motivated, I dont see either side giving up any ground.
Of course it makes sense to act on low quality evidence, it’s called a risk benefit discussion and it’s done everyday in doctors offices. Risk of ivermectin is low. Possible benefit is high. Calling something contrarian doesn’t make it any less true. It’s nuts how the basics of medicine have also been thrown out the window. Get the vaccine. And do your best to stay safe, including staying up to date on potential treatments.
Utter Pradesh. 241 million mostly impoverished people. 13% of the population is vaccinated. But they're handing out prophylactic doses of ivermectin. And something has essentially eradicated Delta variant Covid.
That's the issue. With healthcare being so expensive and strained, and especially young and poor (and the young are often poor) people not seeing doctors as often, people are less likely to have a doctor they trust.
if your doctor prescribes it to you and you have doubts about it, ask the doctor for clarification.
pharmacies should not be refusing to fill a prescription, unless there is a doubt around the authenticity of the prescription (and the pharmacy probably has a procedure to report it). if it's possible to file some sort of complaint, that definitely should be done. the people at the pharmacy don't know more about your health than your doctor.
A pharmacist’s professional role is as an expert on medication, and their scope of practice includes refusing to fill therapeutically inappropriate prescriptions. Normally this serves to catch dosing errors or drug interactions, but it’s also a safety net for other inappropriate prescriptions. We don’t put pharmacists through 8 years of post-secondary education to blindly fill whatever a physician writes for.
In the US, the requirement for pharmacists to police prescriptions even goes as far as criminal liability for dispensing inappropriately prescribed controlled substances (see: “corresponding responsibility”).
Choosing to dispense, or not dispense ivermectin isn’t going to rise to that level, but no state Board of Pharmacy is going to take action against a pharmacist who judges that ivermectin is inappropriate for a COVID diagnosis.
File a complaint?
What good is that?
Every day that passes is vital when you have a fever and are getting increasingly ill by the hour.
If only ivermectin was available without a prescription...
Odd how HN is replete with posts and articles about the supposed therapeutic effects of pot, LSD, and shrooms... but, bemoan the use of any medicine not approved by Rachel Maddow, Don Lemon, or Anderson Cooper.
If the people reading these meta-analyses spent equivalent time reading the meta-analyses for any of the three U.S. developed vaccines, maybe they could get an actually effective treatment.
But these people are contrarian-first. They'd much rather delude themselves that self-administered nicotine enemas are proven effective by cargo cult science websites by anonymous "Q" types than believe anything served by a .gov domain.
why don't more of these people trust the government? were they wrong or perceived that they were wronged in some way? seems like a public relations image nightmare tbh.
Because an entire branch of political ideology is built around the notion that the state cannot ever be possibly useful, and has worked for decades doing PR work to get people to believe this.
Unfortunately, this turns into a self-fulfilling prophecy, since people running on this platform tend to be the worst kind of bureaucrats you could have.
> an entire branch of political ideology is built around the notion that the state cannot ever be possibly useful,
This of course is used to reject the reality that too much of the any sort of government can be very dangerous thing and it’s often difficult to see this until it’s too late - tyrants often rise to power propelled by popular appeal.
Ergo grudging skepticism towards the expansion of government power is perfectly reasonable...
This is serious, serious malfeasance. The amount of effort out into destroying the doctor patient relationship and taking ivermectin out of the doctors toolbox is too great. That energy should have instead been spent answering the question.
"One very large trial in humans appeared to show that ivermectin was effective against COVID-19, but it was later withdrawn following accusations of plagiarism and manipulated data. Since then, a number of small, variable-quality trials have had varying results. An analysis of the state of the field published in late July indicated it wasn't possible to use these studies to determine if ivermectin was helpful or harmful. The situation doesn't seem to have changed dramatically since. Currently, most health authorities indicate that there is no evidence supporting ivermectin's use against COVID-19."
"None of this is to say that more definitive studies won't eventually determine that ivermectin is effective against COVID-19. But experienced public health authorities have concluded that those studies haven't been done yet and that the studies that have been done don't collectively amount to evidence."