I’ve been following some of the medical research related to COVID-19 and its treatment since the spring of 2020, although my interest in the details of the research is waning. Lately in my news feed I’ve been seeing articles in CNN, Mother Jones, the Washington Post and such sources examining why Americans are taking a “dewormer medication for horses and livestock” (Ivermectin). Ivermectin has been one of the medications showing some promise as a helpful drug for reducing mortality and symptoms of COVID-19 disease, but what amazes me is how poorly researched these articles are. All of them make the point that there are “conservative” doctors and “Anti-Vaccination” people promoting the use of Ivermectin. This observation is true, but it disguises the fact that many politically neutral scientists are also suggesting the weight of the evidence supports the idea that Ivermectin is useful. Also, the fact that crazy people (anti-vaccination activists) support a claim tells us nothing about whether the claim is likely to be true. All the reports make claims that there is “scant evidence” that Ivermectin works, or “flawed studies” suggest it works whereas better studies show it does not. That’s not my understanding of the scientific literature. I wonder what these journalists were reading to reach such conclusions. I suspect they were reading accounts by other journalists in an echo-chamber of group-thinking consensus where the assumption is that Ivermectin is wrong. The Mother Jones article even mentioned Senator Rand Paul suggesting that people were ignoring Ivermectin because they hated Trump. It’s odd to find myself agreeing with Senator Paul, a politician with whom I generally strongly disagree on almost everything, but I think he might have been right in this case.
The Mother Jones article ties interest in Ivermectin to an April 2020 pre-print of a study based on data provided by Surgisphere, and points out that there was a scandal around a finding concerning hydroxychloroquine studies involved with Surgisphere. But, the journalist failed to mention that the study in the mentioned scandal was published in The Lancet (not a pre-print, and supposedly peer-reviewed), and gave a finding “debunking” hydroxychloroquine. If the author of the Mother Jones piece (senior editor Kiera Butler) wanted to illuminate the issue of why people believe Ivermectin might work, she should have explained that at a time when many people thought hydroxychloroquine might be beneficial, a major study was published in a prestigious medical journal showing that the drug was dangerous and ineffective, and days after the publication of the article based on Surgisphere data, authoritative research bodies such as the NIH and WHO seemed to lose interest in studying hydroxychloroqine, Days later, when The Lancet retracted the article after an outcry by many scientists, journalists did not cover the retraction. This could have undermined people’s faith in prestigious medical journals, authoritative research bodies, and the journalists in the media that gave coverage to a flawed study and ignored the retraction of the study. But, instead of illustrating how the Surgisphere scandal might have supported interest in treatments ignored by mainstream journalism, the Mother Jones article tied belief in Ivermectin as a plausible treatment to Surgisphere’s (garbage) data. And, the Surgisphere data and reports based on it came out in the spring of 2020, whereas continuing research on Ivermectin and Hydroxychloroquine has been coming out for over a year afterwards.
So, the articles that are reporting that there is little reason to believe that Ivermectin is effective are shoddy and misleading. But, what is the evidence for Ivermectin being helpful in some cases of COVID-19? There is a research review of over 50 studies at https://c19ivermectin.com. A look over the research accumulated and reviewed there suggests that the evidence for Ivermectin being at least somewhat effective in early treatment is hardly “scant” and looks more like it’s “overwhelming” to me. What we need is a serious journalist to look over this evidence and explain why it is flawed or biased, or else explain how it is not flawed and biased, and likely to be correct. Now, the closest thing we have to this (that I am aware of) is the Cochrane Library entry on Ivermectin by Maria Popp and colleagues. And particularly, if you read the discussion by Popp et al. at the end of their Cochrane review (under the heading "Agreements and disagreements with other studies or reviews"). It explains that positive ivermectin results in other people's studies are because the researchers included studies with greater limitations (e.g., using ivermectin and doxycycline together instead of just using ivermectin, or including a sample in which some persons did not have positive COVID tests, etc.).
Since the overwhelming proportion of studies investigating Ivermectin that are cited by the Frontline Critical Care Alliance and the Ivermectin website have been positive, I wanted to look at the studies showing it is not effective. The Brazilian study headed by Luis Enrique Bermejo Galan (https://www.tandfonline.com/doi/pdf/10.1080/20477724.2021.1890887?needAccess=true&) for example, compared Ivermectin, chloroquine, and hydroxychloroquine in treating patients in a Brazilian hospital in Roraima. The team found mortality rates of 21.3% to 23.0% for patients, without any significant difference depending upon which drug they received. However, there was no control group of similarly severely afflicted patients to compare to the three groups that received medications, and the authors suggest that mortality rates of 21-23% are standard for other studies where patients receive placebos, which is why they interpret their results as showing the medications were ineffective. But the pro-Ivermectin research review site https://c19ivermectin.com reviews this paper and points out that Northern Brazil (where Roraima is located) had mortality rates of 43% for persons with COVID-19 who were admitted to hospitals, and if there had been a randomized fourth group of patients who received none of the three medications with a mortality rate of 43%, that would have indicated that the three examined drugs were effective in lowering morality.
I’m open-minded about Ivermectin, and I think that the evidence (flawed though it is) showing Ivermectin works is persuasive. The handful of studies showing it does not effectively improve survival or diminish symptoms in COVID-19 cases are also flawed, and do not convincingly show it is ineffective. If Ivermectin is effective, and I think it probably is, it seems to work best as a prophylaxis or in early treatment, and it seems about half as effective used in cases where symptoms are severe and patients are being admitted to hospitals. It’s quite plausible to me that some things like Zinc and Vitamin D and so forth could be mildly beneficial if levels are high before infection or if someone takes doses immediately after infection, but the same substances might be entirely ineffective if taken after symptoms have become severe. This is a possibility that many journalists writing about such interventions seem to miss or dismiss. But, diseases often go through different stages, and interventions that are appropriate at one stage of a disease may be inappropriate at other stages. There is nothing unusual about that. But studies that only test the effectiveness of interventions that are administrated in later stages, after they would be effective, will be misinterpreted to "prove" that the interventions are "ineffective" when in fact they may be effective if provided at a an earlier (or later) stage, or in combination with some other substance.
Critiques of those who hold faith in Ivermectin I’ve read do get one thing right. People who don’t like vaccinations and others who do accept vaccinations are sometimes exaggerating the supposed (and probable) benefits of Ivermectin. One friend suggested to me that Ivermectin and vitamins were more effective than vaccines. Even persons who are frequently accurate and competent in their analysis of COVID-19 (such as Chris Martenson of Peak Prosperity), are sometimes getting caught up in this idea that the research we have on Ivermectin suggests it’s more effective than, for example, the Pfizer or Moderna vaccines.
Let me point out a few things. First of all, America has been vaccinating adults since late December with vaccines, now three of them, including Pfizer (I had Pfizer shots in April). A bit more than half of American adults are fully vaccinated. If the vaccines were entirely ineffective, current hospitalization rates and death rates would be about equal between vaccinated adults and non-vaccinated adults. Maybe a little over half of adults are vaccinated, so a little over half of those in hospitals and morgues from COVID-19 would be vaccinated. Instead, about 95% or more of those who are dying or hospitalized are unvaccinated. Some reports suggests that it’s 99% of the hospitalized and dying who are unvaccinated. That suggests to me that the vaccines are significantly reducing risks of death or hospitalization. It turns out that those of us who are fully vaccinated are also more likely to be continuing our social distancing, mask-wearing, and better hygiene, so that complicates the picture, but still, it seems about 90% to 98% fewer vaccinated adults are in hospital or morgues due to COVID-19. The studies of Ivermectin suggest it reduces risks of death or hospitalization by something between 40% and 80%, and if there is an effect (there almost certainly is), it’s probably something like a 60% to 70% protection. That’s not as good as the vaccines.
The vaccines we are using in the USA are proven to reduce chances of getting sick from COVID-19, going to the hospital because of the severity of COVID-19, and dying from COVID-19. The demographics of those now in hospitals or cemeteries from COVID-19 in the past few months compared to the demographics of who has been vaccinated suggest the vaccines are over 90% effective. Studies of Ivermectin, even the most promising studies, do not suggest it is that effective. Both the vaccines and ivermectin are relatively safe. Ivermectin probably is “safer” than the vaccines, but neither Ivermectin nor the vaccines are likely to cause serious harm or death, if appropriate doses are taken. Getting an overdose of ivermectin can be serious, however. The high death rates we are now experiencing are from unvaccinated persons who are dying from COVID-19 or other persons who can’t get medical care for other problems because unvaccinated persons with COVID-19 are clogging up our hospitals. We are not seeing many deaths due to bad reactions to vaccination (or overdosing on Ivermectin, for that matter). Ivermectin use (and belief that the scientific evidence supports the proposition that Ivermectin is likely to be beneficial in preventing bad cases of COVID-19) is compatible with use of vaccines (and belief that vaccine use dramatically helps prevent bad COVID-19 cases).
Some people are claiming that natural immunity and ivermectin plus vitamins is safer and better than vaccination. If one is vaccinated, there is a slight chance of death or a serious reaction that causes long-term harm, and I don’t know what that risk is precisely, but I believe it’s something like 1-in-800,000 or 1-in-a-million. The odds of getting a “serious” reaction with fever and feeling sick for an afternoon, or a day, or a few days is much higher, but death and permanent serious harm is, as far as I can figure, very rare. Without a vaccine if one gets COVID-19 one’s risk of death varies by one’s age and underlying health, but even robust young persons have died from COVID-19, and risk of death seems to be something like 1-in-300 for young and healthy to 1-in-50 for elderly persons in poor health. So, even if natural immunity from getting COVID is “better” than vaccination, the risks you take by seeking a natural immunity are far, far more threatening than the risks of getting a vaccine. There are many “breakthrough” cases where fully vaccinated persons get COVID-19, but it seems most of the positive test results for fully vaccinated persons who get COVID-19 are associated with no symptoms of illness or very mild symptoms such as a runny nose. Very few get seriously ill, and almost none die. Those fully vaccinated persons who do get seriously ill or die seem to almost entirely have multiple risk factors, and the most serious risk factor is a compromised immune system. Persons with compromised immune systems seem to be at high risk from getting bad or lethal cases of COVID even if they get vaccinated. It’s true that a large percent (perhaps a third) of non-vaccinated persons who get COVID also show no symptoms, and most have only mild flu-like symptoms, but a large minority of those who get COVID get very sick, or are sick for a very long time, or have long-term impairments even if they had no serious illness. Maybe a third of unvaccinated persons who get COVID-19 have serious illness or long-term problems, and maybe 0.5% to 2% die. The facts suggests that almost everyone is better off getting their natural immunity from direct exposure to the actual SARS-CoV-2 after they have been vaccinated.
I think governments and health authorities are promoting vaccine use because the evidence shows us that vaccines are extremely effective and relatively safe (but not perfectly safe). I think governments and health authorities in many countries are resisting the use of Ivermectin because, although there is good evidence for Ivermectin’s value, that evidence is associated with deviant ideas or critical ideas that question the accuracy of government health authorities and leading research bodies. Those who lead medical establishment institutions in governments or health authorities and research bodies do not like criticisms of them, especially unfair and conspiracy-mongering criticisms, and since they associate Ivermectin research and support with those ideas, they have a bias against Ivermectin. That is my understanding the most likely explanation for why there is not a more positive and open-minded attitude toward Ivermectin.
Humans are not really good at running conspiracies. The larger the conspiracy, the easier it is for people to betray the conspiracy. But, humans are very good at suffering from cognitive distortions, confirmation bias, and tribal us-versus-them thinking. I think many mainstream scientists and journalists are blinded about ivermectin because of their biases and their group thinking and conformity. A similar situation goes on with many who remain uncertain about vaccinations. Those who doubt the efficacy of vaccinations and trust in ivermectin or hydroxychloroquine or Vitamin D or Zinc will tend to notice all the good evidence for those things, and ignore any evidence that those don’t work as well as they hope. They will be hyper-alert in perceiving how mainstream journalists and scientists are ignoring the positive evidence for the efficacy of those approaches. They will note all the real issues with vaccines, the real problems with how profits go to large pharmaceutical companies, and the real cases of governments using stupid policies to control COVID-19, but they will give disproportionate mental energy to thinking about such things, and not get an objective perspective. Yes, the vaccines aren’t as good as they were supposed to be, and there are some people having bad reactions to them, but those facts are essentially trivial noise around the very significant fact that vaccines are mostly safe and very good at preventing hospitalization and death from COVID-19. Yes, big pharmaceutical companies are raking in money, and many leading researchers have been “captured” by the mentality and approaches that allow big pharmaceutical companies to set up the health care system in ways that make their owners rich and supply many doctors with medications of dubious value. That, however, is a tangent that has no bearing on the fact that the vaccines are working pretty well to prevent hospitalization and death from COVID-19.
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Update a couple years later. The evidence for the efficacy of ivermectin against COVID-19 has not entirely melted away, but it has diminished. The evidence of dishonesty and unethical behavior by some of the leadership in the American public health bureaucracy has confirmed that there were attempts to deceive the public on a few matters (for example, the claim that "all the experts agree it is impossible that the virus came from a lab" was false and the people who made that claim knew it was false when they made it). Within two years of the release of the COVID vaccines I'll have had five shots, I continue to wear masks when I'm in crowded indoor places for any significant length of time, and I have so far never knowingly had COVID-19.
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