Ivermectin: still horsewash

September 26, 2021 • 10:30 am

Yes, I know that ivermectin is used against human lice, rosacea, and worms, and is safe when used properly. And it’s also used against worms in horses, though the veterinary formula appears to differ from the human drug, so those people who buy and swallow animal ivermectin are just dumb.

What I do not know, because the data are unclear, is whether ivermectin is a palliative or preventive of Covid-19. Some studies say that, but none of the studies published so far adhere to the gold standards of drug testing: double-blind randomized tests with very large sample sizes, carried out over a decent length of time. If you look at the FDA link to existing studies below, you’ll see that only one study used a placebo, and only a couple used “standard care”, (i.e. neither vaccination nor drug given).  Most studies appear to be retrospective analyses of ivermectin treatments without controls, and those are worthless.

Because of this, the FDA has definitely warned against ivermectin’s use against covid (and gives a link to existing tests). FDA says this:

Here’s What you Need to Know about Ivermectin. 

  • The FDA has not authorized or approved ivermectin for use in preventing or treating COVID-19 in humans or animals. Ivermectin is approved for human use to treat infections caused by some parasitic worms and head lice and skin conditions like rosacea.
  • Currently available data do not show ivermectin is effective against COVID-19. Clinical trials assessing ivermectin tablets for the prevention or treatment of COVID-19 in people are ongoing.
  • Taking large doses of ivermectin is dangerous.
  • If your health care provider writes you an ivermectin prescription, fill it through a legitimate source such as a pharmacy, and take it exactly as prescribed.
  • Never use medications intended for animals on yourself or other people. Animal ivermectin products are very different from those approved for humans. Use of animal ivermectin for the prevention or treatment of COVID-19 in humans is dangerous.

It also notes that ivermectin, though safe when taken as directed by itself, can interact negatively with other drugs taken by humans.

And here’s one other thing I don’t know for sure, but strongly suspect: if you have a choice of getting vaccinated with any of the major vaccines, and not taking ivermectin, versus another choice of not getting vaccinated but taking ivermectin, your chances of illness and death will be higher if you choose the latter, and that includes possible side effects of both treatments. I don’t think there’s been a controlled study of this, but we’ll have the data some day.

Sure, it’s possible that ivermectin may have some useful effects against Covid-19, preventing or mitigating its symptoms. But we can’t say that with confidence until the results of large studies in progress are completed. They’re not, so those who tell you to take ivermectin and avoid “dangerous” vaccinations are, insofar as they’re influencing anyone, putting lives at risk.

A new letter by five researchers in Nature Medicine (below) examines the studies combined in meta-analyses that purport to show the efficacy of ivermectin for Covid-19. The researchers find flaws in some of them that are so serious that they probably invalidate the conclusions. Click on the screenshot to read for free:

I’ve left out the references, but you can see them in the original letter. Here’s the gist of the author’s conclusions:

Research into the use of ivermectin (a drug that has an established safety and efficacy record in many parasitic diseases) for the treatment and/or prophylaxis of COVID-19 has illustrated this problem [relying on “high volumes of recent, often unpublished trial data of variable quality”] well. Recently, we described flaws in one randomized control trial of ivermectin, the results of which represented more than 10% of the overall effect in at least two major meta-analyses. We described several irregularities in the data that could not be consistent with them being experimentally derived. That study has now been withdrawn by the preprint server on which it was hosted. We also raised concerns about unexpected stratification across baseline variables in another randomized controlled trial for ivermectin, which were highly suggestive of randomization failure. We have requested data from the authors but, as of 6 September 2021, have not yet received a response. This second ivermectin study has now been published, and there is still no response from the authors in a request for data.

It is highly unethical for scientists to withhold published data from other researchers! The letter continues:

The authors of one recently published meta-analysis of ivermectin for COVID-19 have publicly stated that they will now reanalyze and republish their now-retracted meta-analysis and will no longer include either of the two papers just mentioned. As these two papers were the only studies included in that meta-analysis to demonstrate an independently significant reduction in mortality, the revision will probably show no mortality benefit for ivermectin.

Several other studies that claim a clinical benefit for ivermectin are similarly fraught, and contain impossible numbers in their results, unexplainable mismatches between trial registry updates and published patient demographics, purported timelines that are not consistent with the veracity of the data collection, and substantial methodological weaknesses. We expect further studies supporting ivermectin to be withdrawn over the coming months.

Since the above primary studies were published, many hundreds of thousands of patients have been dosed with ivermectin, relying on an evidence base that has substantially evaporated under close scrutiny.

All I know is that I wouldn’t take ivermectin without FDA or CDC approval, and if you’re doing so in lieu of getting vaccinated, you’re foolish.

The researchers also suggest a different way besides large double-blind tests or meta-analysis to analyze data (assuming it’s good data):

Most, if not all, of the flaws described above would have been immediately detected if meta-analyses were performed on an individual patient data (IPD) basis. In particular, irregularities such as extreme terminal digit bias and the duplication of blocks of patient records would have been both obvious and immediately interrogable from raw data if provided.

We recommend that meta-analysts who study interventions for COVID-19 should request and personally review IPD in all cases, even if IPD synthesis techniques are not used. In a similar vein, all clinical trials published on COVID-19 should immediately follow best-practice guidelines and upload anonymized IPD so that this type of analysis can occur. Any study for which authors are not able or not willing to provide suitably anonymized IPD should be considered at high risk of bias for incomplete reporting and/or excluded entirely from meta-syntheses.

Hurdles to the release of IPD from clinical trials are well described, and generally addressable with careful anonymization and integration of data sharing plans at the ethical approval stage of trial planning.

We recognize that this is a change to long-accepted practice and is substantially more rigorous than the standards that are typically currently applied, but we believe that what has happened in the case of ivermectin justifies our proposal: a poorly scrutinized evidence base supported the administration of millions of doses of a potentially ineffective drug globally, and yet when this evidence was subjected to a very basic numerical scrutiny it collapsed in a matter of weeks. This research has created undue confidence in the use of ivermectin as a prophylactic or treatment for COVID-19, has usurped other research agendas, and probably resulted in inappropriate treatment or substandard care of patients.

Meta-analyses, of course, usually combine the results of different studies of a treatment to arrive at an overall conclusion, while IPD uses each patient across many studies as an individual datum to get an overall conclusion. I haven’t investigated the niceties of this analysis, but you can go here or here to see how it’s done.  I am not necessarily recommending this type of analysis, as I haven’t studied it, and those combined patients could also represent data that is dubious but undetectably so. I would therefore still recommend a large number of random, double-blind tests of ivermectin, each including large samples of patients as well as a control group given a placebo.

In the meantime, don’t listen to the neigh-sayers about vaccines. If you don’t have medical contraindications, get your jabs! (This is my recommendation as a doctor, though the wrong kind of doctor.)

32 thoughts on “Ivermectin: still horsewash

  1. To make people stop taking it, someone jokingly suggested that everyone be told that the horse version of Ivermectin causes sterility/erectile dysfunction in human males.

        1. Fear of death doesn’t seem to work. Perhaps fear of ED would. Again, we’re not dealing with critical thinkers here in the U S of A. It’s knee jerk reactionary water heads in this anti-vax movement.

  2. My question has always been: “Who in the hell decided Ivermectin was a cure for Covid in the first place?” Someone who thought viruses and parasites are the same thing? Maybe some Russian troll started it…

    1. The Center for Inquiry’s Morning Heresy newsletter linked to an article that appeared online at https://www.businessinsider.com/why-ivermectin-being-used-treat-covid-2-doctors-leading-charge-2021-9?IR=T
      The piece seems to claim that two doctors, Kory and Marik, started the ivermectin religion, under the banner of FLCCC – Front Line COVID-19 Critical Care Consortium. From what I read, two good doctors, who, for reasons of their own, went off the rails…

    2. It has been used since at least 2012 as an off label treatment for West Nile virus.
      It is expained that ” Ivermectin exerts its effect at a timepoint that coincides with the onset of intracellular viral RNA synthesis, as expected for a molecule that specifically targets the viral helicase.”

      Drugs like Ivermectin are not really synthesized out of nothing for a specific targeted use. They are ‘discovered”, in this case, as a bacteria (Streptomyces avermitilis) native to Honshu. The active compounds from the bacteria were isolated and replicated to produce the commercial drug.
      It might just be chance that the compounds ended up in the lab of a parasitologist instead of a virologist.

  3. It is a bizarre mindset they have indeed, those who would forgo a safe, effective, and free vaccine in favor of forking over dough for some janky, unproven remedy.

  4. Meanwhile, horse owners are having trouble getting it for legitimate use. Our local feed store says they have trouble keeping it in stock. My wife used to de-worm our equines regularly when they and our daughters were going to various lessons, events, etc., and being exposed to other horses, pastures, etc. Fortunately now we see no need as the remaining few don’t go anywhere.

  5. Just a thought: in New Zealand, ivermectin is a frequently used sheep drench, with a much lesser use in horses.

    Of note is that the “sheeple”, ie science followers, are not the tiny minority who fantasise that it has a role in management of Covid-19.

  6. Anyone that chooses ivermectin over vaccination is stupid and deserves to die. Unfortunately, most highly contagious respiratory viruses like Covid-19 do not have high morbidity and mortality, since they require infected people to be ambulatory to effectively spread the disease.

    If Covid-19 was like small pox with a 10-50% mortality rate, we wouldn’t be having this conversation. Users of ivermectin, bleach, chloroquine, and snake venom would have all died by now.

  7. “but none of the studies published so far adhere to the gold standards of drug testing: double-blind randomized tests with very large sample sizes, carried out over a decent length of time”
    Considering the short amount of time that we have faced this situation, it is not reasonable to expect careful, long-term studies to have been carried out. The big drug companies have the cash to do such studies, and the political pull to see lots of red tape cut here and there, But those companies would not benefit from the exclusivity of holding a patent on the drug. So they are not interested. The opposite might be a closer position. They very much want to market expensive treatments for the disease, as well as boosters and other solutions to preventing it.
    If an inexpensive, plentiful, public domain treatment would emerge, The Pfizer folks would find that they will not be buying as many solid gold mansions this year. It would certainly make sense for them to convene a few focus groups, and settle on a strategy of mocking even well qualified doctors who believe it is in the best interests of their patients to add it to their treatment options.

    Also, this is being presented as a binary choice between vaccines and Ivermectin. Vaccinated people who caught the disease anyway are also being treated with Ivermectin.

  8. Only indirectly related, but curiously in South Africa this belief in the usefulness of Ivermectin in Covid is an almost exclusively White thing. Few Coloureds use it, and I know of no Black patient using it.
    Still trying to figure out why that would be.
    [My patients are about 20% white, 25% black and over half are coloured.]

  9. I am neither fan nor foe of Ivermectin. There are, however, two things which greatly concern me regarding the subject.

    First – anyone can take a look at charts which show relative usage of Ivermectin by country, and Covid death rates per capita by country. Pick any “reason” you want, the result is the same – an immense inverse correlation (yes I know that does not mean causation) between widespread routine use of Ivermectin and deaths per capita. It is made even MORE disturbing by the fact that they don’t even “rate” many countries with widespread Ivermectin use because Covid does not even seem to be a factor there. This can be considered a “natural study” with 4 billion participants (countries with widespread Ivermectin use = roughly 2 billion; vs Western countries where “experts” have actively discouraged or banned its use for Covid).
    Ivermectin use: https://ivmstatus.com/
    Covid Deaths per capita by country: https://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/

    The comparison is stark – western countries have 10x or higher rate of death from Covid. Accident? Perhaps, but nobody has offered a good explanation.

    Second – Ivermectin formulated for human use is nearly risk free. BEFORE we had the vaccines which had to be re-defined to be vaccines, why did our “Experts” demand that no one be allowed to have their doctors prescribe the drug? It’s literally part of daily life in countries across the globe. Had we done so on a VOLUNTARY basis (with doctors screening for that small subset of humanity at risk of side effects to preclude unnecessary deaths), we would have all the “evidence” we could ask for to answer the question quantitatively, instead of political arguments.

    Whether Ivermectin works or not, it was handled entirely wrong by our “experts.”

    1. As you say yourself, this is a correlation, not a causation. I don’t know the statistics of ivermectin use, but the reasons American doctors didn’t prescribe the drug before vaccines is that it was not approved for coronavirus use. Why not? Because there were no FDA-approved controlled tests for such a use.

      As for you admitting that this is merely a correlation (chocolate consumption would probably also be correlated with Covid-19 incidence), you then describe it as a “natural study”, conflating correlation with causation. That’s the same “natural study” that I’ll talk about in my 9:15 post today: correlational retrospective analysis that has led to many, many ineffective treatments.

      Sorry, but I disagree with what you have to say. Ivermectin should not have been recommended for coronavirus without controlled studies of the kind the FDA accepts. One is going on now, but there are no results yet.

      Note that in the map, China reports NO COVID 19!

      You are indeed a fan of ivermectin despite your first statement: you are touting it as efficacious, and that’s dangerous whether it’s ineffective or harmful.

    2. What’s the provenance of the ivmstatus.com website and its data? I only took a quick look but they don’t seem to claim any authority. Who maintains this website? I can’t claim that the site is bogus but, if I was going to create a bogus website, that’s exactly what it might look like.

    3. I don’t know how to say this without appearing rude, but it needs to be said – you either have no idea how to interpret data or you are being wilfully obtuse. Either way, you are so far wide of the mark it’s laughable. Your cockyness in thinking you are proving the “experts” wrong is even sillier. However, it’s also what encouraged me to point out just how mistaken you really are.

      Let’s start with the Covid deaths per capita. Firstly, your claims of “an immense inverse correlation” aren’t even consistent. Peru (hardly a ‘western’ country) is top of the list with 6130 deaths / million.

      The rest of the top 20 looks like this: North Macedonia, Bosnia and Herzegovina, Hungary, Bulgaria, Chechnya, Brazil, Argentina, Moldova, Colombia, Georgia, Slovakia, Paraguay, Belgium, Slovenia, Italy, Mexico, Tunisia, Croatia. Hardly the who’s who of westernised hyper-regulated medical establishments.

      Then the next 20: USA, United Kingdom, Poland, Chile, Ecuador, Romania, Spain, Armenia, Lithuania, Portugal, Uruguay, Panama, France, Kosovo, Bolivia, South Africa, Sweden, Iran, Latvia, Namibia. Oh, and the next one is Russia. Same again, just wrong.

      Then there’s your challenge to: “Pick any “reason” you want, the result is the same – an immense inverse correlation” , OK I will. The data points you refer to are the deaths per million, and it is an incredible leap of faith to decide for yourself that these figures represent the actual deaths per million due to Covid. You’re wrong here for several reasons:

      1) You are assuming that the reporting of Covid deaths is performed with equal accuracy across all countries in the list.

      2) You are not taking into account the rate of infection vs number of deaths

      3) You are certainly not controlling for prevention versus treatment (also, for which are you claiming that ivermectin is most efficacious?)

      4) You are ignoring the numerous problems that the statista website lists with regard to why the data cannot be viewed as representative for calculating meaningful death rates

      In respect of point no. 1, the deaths per million of the ‘best’ three countries: Tanzania, Laos & Burundi are recorded as 0.86, 2.23 & 3.3 respectively. Even the country with the 10th lowest death rate – Eritrea – is only 12.01 / mil. Using those stats USA has a rate of 2085, the UK’s is 2031. Do you really believe that Tanzania has a death rate which is lower than the UK’s or USA’s by a factor of 2400? Come on.

      Also, I’m willing to be proved wrong, but is ivermectin really so freely available in Burundi and Eritrea? Available enough to cut the death rates by a factor of hundreds or even thousands? Again, come on.

      Then your claim: “It is made even MORE disturbing by the fact that they don’t even “rate” many countries with widespread Ivermectin use because Covid does not even seem to be a factor there.” is simply not true.

      This is what the editors at Statista say about excluded countries: ” For consistency, countries with a smaller population (and a potentially much higher impact of coronavirus deaths) were not included in the table. These countries were as follows…. ”

      There are many other issues I could mention, but let’s move on to https://ivmstatus.com/ . The website is a joke, it has no scientific credibility whatsoever – I invite others to visit, just to see how bad it really is. It’s utter drivel. The banner on the main page says: “Ivermectin is currently used for about 28% of the world’s population. Countries where COVID-19 mortality is close to zero may not have incentive to adopt treatments. When excluding these countries, ivermectin adoption is about 36%. “. Eh? What on earth does that mean?

      The site offers nothing useful or reliable; it’s merely a propaganda tool based on a mish mash of references to twitter links, very poor quality ‘research’, and even worse preprints, many of which have been withdrawn. I even clicked on one paper and it asked me – a random internet user – if I wanted to be a reviewer!

      On the left hand side of the site there is a list of dozens of other Covid ‘treatments’. When you click on these you are then sent to an identical-looking site dedicated to that ‘treatment’. Here are some the sites for other ‘treatments’:

      https://c19curcumin.com/ – turmeric extract
      https://c19probiotics.com/ – yoghurt?
      https://c19fluvoxamine.com/ – SSRI antidepressant
      https://c19aspirin.com/ – ???

      Each of these lists a bunch of links to a Twitter post / preprint etc. that claims to have demonstrated efficacy against Covid. They are all total nonsense, complete rubbish.

      Unusually for a respected internet-based research portal, the PKI certificate used by the website was issued on 3rd August 2021, it expires on 2nd November 2021. Hmmmm……

      All I can say to you, without falling foul of our host’s rools re incivility, is: you are not even wrong.

      1. Thanks for doing the legwork (I had neither the will nor the time), but the site did look wonky. Thanks as well for obeying the Roolz. Due to arrogance, intransigence, gulibility, and promoting a remedy that, even if efficacious, is no substitute for vaccines, Mr. Galt will be posting here no more.

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