Glad to see this being spoken about! I’ve been assisting with data analysis for an eclectic group of people (who funded this study).
Been really disheartening to watch the politics around alternative treatments. Personally, I expect this to be attacked as well, but am hopeful! The stuff really does seem effective, particularly when combined with other drugs...
If it’s a good study, you probably want it to be scrutinized. If it holds up in other studies that it works, congrats, we just did science! If it doesn’t, it’s just a belief that it works.
There are many problems here... from monetary (all the pharmaceutical companies want a new, expensive drug, and not something old and cheap), to political (who wan't to deal with another experimental drug, after all the contraversy about the others), to political2 (who want's to be a antivax hero, cited by all the virus deniers), to risky (whatever you publish, all of your previous and future work will be scuritinized by everyone, and one small rounding mistake ina paper you wrote 20 years ago might destroy your career), etc.
It's a lot easier to work on AnotherCure(TM) for baldness, than touch this pile of political crap.
That sounds like it works like that, but that is not always the case. They do try out promising could be medicines, especially since Covid costs enough as-is.
There is no such thing as alternative medicine. If the drug is tested and found to be effective then it is medicine. But you must expect rigorous analysis and provide significant evidence to support you claims. This is how it works. If you can't handle it then you are in 'alternative' medicine, which is not real.
I think you misread, I said “alternative treatments”, there definitely can be alternative treatment methods to the main method. For instance, some people can’t take Tylenol, so they take Ibuprofen. It’s an alternative treatment to handle pain.
I understand what you’re referring in terms of “alternative medicine”, but that’s it’s own genre.
"Alternative treatment" implies an unapproved, off-label use. Maybe you meant "promising therapeutic" or something along those lines? Throwing around the term "alternative" is dicey, especially in a world where people take advice about COVID vaccines and "alternative treatments" from podcasts hosted by former comedians.
Once enough studies have been done, this off-label use for fluvoxamine will likely be blessed by the agencies that regulate these sorts of things and at that point it will become an approved treatment for long COVID symptoms. Most things spoken of as "alternative treatments" don't even get to the first stage of this process (since they can't be substantiated with evidence).
Joe rogan explained what his doc gave him. He’s also had multiple doctors and researchers on his show providing information regarding treatments they are attempting. Frankly, Ivermectin and the like have more research than the vaccine, they’ve been deployed for longer and at least passed phase 1 trials, which the vaccine has not (only preliminary results).
In terms of “off-label” drugs, the FDA approval process is there to protect against liability. Effectively, the government accepts some liability and in return medical companies get some protections. It’s highly likely you’ve taken drugs “off label” yourself.
Thus far, this research is promising. Similar to other treatments / therapeutics to covid19, and it has a known risk profile. Making it a potentially better alternative to the standard approach (stay hydrated if infected and vaccinate ahead of time if possible)
> Ivermectin and the like have more research than the vaccine
That's very very unlikely. Even considering the Nobel prize for it. Simply because the sheer scale of the pandemic.
There are more vaccines in development and use against COVID than there are Ivermectin clinical trials in total.
> they’ve been deployed for longer and at least passed phase 1 trials, which the vaccine has not (only preliminary results).
That doesn't mean they are not safe. The phase 1 trials run to 2022 Nov, because there's a long follow up period.
Nothing can guarantee that there's not some mysterious missed interaction. It's probability is low and getting lower day-by-day. This tail risk is just not that important for safety. It makes very little sense to emphasize this, because we also don't know the long term interaction of Ivermectin and COVID-19.
>In terms of “off-label” drugs, the FDA approval process is there to protect against liability. Effectively, the government accepts some liability and in return medical companies get some protections. It’s highly likely you’ve taken drugs “off label” yourself.
Off label drug use/ approval isn't about government liability. As far as I know, it has none. The noteworthy exception is the vaccine's, where the government has a special injury compensation fund, but I wouldn't call this liability . It IS about manufacturer liability, and insurance reimbursement.
OP said alternative treatment. Presumably they meant an alternative to the treatments currently en vogue versus faith healing or some such thing.
Also, it sounds like they are involved with people who are working on providing evidence...I'm not clear what is causing your criticism.
Ivermectin has been tested and proven time and time again to be a safe and effective treatment for early covid, yet it's constantly attacked and suppressed by the non-alternative crowd, seemingly for political purposes.
I've developed a sort of morbid curiosity around how everything now gets politicized. Looking at the comments here, it seems like it is currently up in the air. I can see it going at least two ways: the way of invermectin, where it is ridiculed by blue tribe and favoured by red, or the opposite could happen due to the antidepressant/sexual dysfunction angle, it may be demonized by the red tribe (e.g. as part of a scheme to turn population into sheep and curb reproduction) but hailed as an alternative that actually works to invermectin by the blue tribe.
I hope this isn't attacked, because this isn't an "alternative" drug.
Things move from "alternative medicine" to being "medicine" when people do good, peer-reviewed science to actually study the effects and find them to be effective. "Alternative medicine" like ivermectine or hydroxychloroquine have no scientific, properly studied basis for being used.
Things go from “under investigation” medicine to medicine once good peer reviewed science shows them to be effective.
If the peer reviewed research shows them to not be effective, and if snake oil salesmen figure out a business model to fleece people with it, that’s when it becomes “alternative” medicine.
I am somewhat curious how many products used in scams were not actually scams themselves. Meaning, the molecule had benefits but the people pushing it were shady and deceptive exaggerating claims of beneifts so now people psychologically associate the word with a scam or quackery. I ask this as someone that consumes Krill Oil, Coconut Oil, Oregano Oil and misc other oils.
>"Alternative medicine" like ivermectine or hydroxychloroquine have no scientific, properly studied basis for being used.
When a medical doctor prescribes a drug for a purpose that is currently being studied scientifically, that is not "alternative medicine". Ivermectin is still being studied. Hydroxychloroquine was emergency authorized by the FDA.
I've read a debunking of that as well, which was basically that the study uses poisonously high levels of HCQ (much higher than normal or required), and that it uses no zinc. Zinc is the actual virus killer, HCQ just lets in into the cell (it's a zinc ionophore).
This is a distressingly common technique for making studies say what you want them to say. I've dug into several dietary studies over the years claiming how this or that diet is good or bad for you, and a lot of them basically involve feeding the worst-possible $DIET_X to one set of mice and the best possible $DIET_Y to the other, and lo, $DIET_Y wins. So, for instance, you can feed a "low carb" diet that fills in the fats with a ton of transfats or with good fats, and you can feed a "high carb" diet that has a lot of whole grains or has a whole lot of bleached, refined flour, and produce whichever results you want. This is a non-trivial part of the reason why "peer reviewed" studies keep continuously putting out what seems like contradictory results.
Unfortunately, it means just "trusting a peer reviewed study" is even harder than it should be. You have to dig into the study to see if it even makes any sense which can be very difficult. And you have to follow the money, not "even" if the study says what you think it ought to say, but especially when it says what you want it to say.
I actually think it might be a good example because it highlights the distinction between "medicine" and "alternative medicine": approval for use. Many drugs have been approved for a use in the past, only to be superseded by better drugs or found to be dangerous or ineffective.
Take for example acetaminophen (aka paracetamol/tylenol): it is borderline ineffective, has been superseded by ibuprofen for almost all use cases, and the required dosage for its tiny effect is also very close to dangerous levels. Yet it is still the go-to drug of parents, GPs and hospitals for a range of ailments from the common cold to post-operative pain. "Good old paracetamol" is in every medicine cabinet in the Western world. I've told my folks a hundred times that it simply doesn't work, but they use it for pretty much any condition. Mum even gave it to her old dog. It's trusted like oxo cubes, Campbell's soup or a nice cup of tea. And that's why it's the foremost cause of acute liver failure in the Western world. While it hasn't had it's approval removed yet, I wouldn't be surprised if it did some day, and I doubt it would be approved today if it were being introduced.
Even so: is it still very much "medicine", not "alternative medicine".
>> Take for example acetaminophen (aka paracetamol/tylenol): it is borderline ineffective, has been superseded by ibuprofen for almost all use cases, and the required dosage for its tiny effect is also very close to dangerous levels.
This is only really accurate in a small window of analysis. It's been shown that paracetamol + ibuprofen has synergistic effects for most pain-related issues and paracetamol is superior to ibuprofen for migraine headaches; furthermore, the obvious correct headache drug of choice is aspirin/paracetamol/caffeine, aka Excedrin, which is vastly superior to ibuprofen.
I won't argue that paracetamol has acute liver toxicity issues (the largest drug of overdose problems, though a lot of this is intentional rather than accidental), but ibuprofen is abused in a chronic fashion with buildup over time leading to renal failure and worse (pro/amateur athletes are particularly at risk of chronic abuse issues).
I won't argue that paracetamol is way more dangerous than people think, and there should be far more warning labels (which J&J fights against), but I would be genuinely shocked if it got its approval revoked; similarly, I'd expect it to be approved if it was around today as well - especially if we knew about the synergistic effects it has with aspirin and caffeine.
> When a medical doctor prescribes a drug for a purpose that is currently being studied scientifically, that is not "alternative medicine".
It really is, as there is absolutely no evidence it has any effect whatsoever and at best it only serves as a placebo. In short, it's snake oil. Worse: politically-motivated snake oil.
> Are the people participating in the scientific studies of the drug participating in alternative medicine?
Please let me know when a reputable study that undergoes peer review in an established and respected journal reports that the drug does work as their fans and militants claim.
Until then, keep in mind that "alternative" in "alternative medicine" stands for "hand-waving". As the old adage goes, alternative medicine that works does have a special name. It's called medicine.
> Please let me know when a reputable study that undergoes peer review in an established and respected journal reports that the drug does work as their fans and militants claim.
There is one ongoing right now: Oxford University's PRINCIPLE trial. Until results of that trial are reported, about the only accurate thing anyone can say is that current evidence is ambiguous.
Complementary and alternative medicines (CAMs) are treatments that fall outside of mainstream healthcare.
> Are the people participating in the scientific studies of the drug participating in alternative medicine?
Well the placebo group taking sugar pills for their cancer are not exactly going 'by the book' or lamestream healthcare and the active group taking whatever ... well lets just agree to disagree shall we?
This epidemiologist points out several major flaws with that website. For one, the website selectively picks the best result from each paper, which results in the website aggregating a bunch of unrelated measurements, including measurements that were not even each paper's main outcome/measurement. https://twitter.com/GidMK/status/1422044335076306947
" Ivermectin is currently not approved in the UK for the prophylaxis or treatment of COVID-19," [1]
There are no good studies demonstrating the validity of Ivermectin, and the Oxford study is not complete and there's no indication results are positive.
Why are people so crazy about this drug?
It doesn't look like it works, though there is some possibility it will, but we'll only know when the Oxford trial is complete. Given the knowledge we have today, it just isn't a therapy for COVID.
> It doesn't look like it works, though there is some possibility it will, but we'll only know when the Oxford trial is complete. Given the knowledge we have today, it just isn't a therapy for COVID.
There's a big trial ongoing, and the rest of the evidence is mixed. You can't say that "it doesn't look like it works"...we just don't know.
I personally put the prior probability of any intervention working for any illness at a very low number, but too many people are eager to dismiss things -- or accept them -- before they've been tested.
It's disturbing, and is mostly about politics. Many of the same people who dismiss Ivermectin for low-quality evidence eagerly seize upon any dubious shred of evidence for their favored interventions, and enact widespread mandates.
'Non results' from 'not good studies' are negative indicators - not 'neutral' indicators. That's they key thing to understand.
If Ivermectin did work, it should show up, but it's not.
We're doing the Oxford trial really because of some shady information and results, that could possibly indicate that there's some theraputic value. Not because people have high hopes.
Here is Merk's statement:
" It is important to note that, to-date, our analysis has identified:
No scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies;
No meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease, and;
A concerning lack of safety data in the majority of studies."
While it would be good if the Oxford trials showed something, they probably won't.
> Non results' from 'not good studies' are negative indicators - not 'neutral' indicators. That's they key thing to understand.
No, that's a thing you made up. The biggest problem with the "not good studies" of Ivermectin is that they've been underpowered or poorly controlled. The efficacy signal ranges from neutral to strongly positive, but the neutral signal could be due to under-powered studies. The positive results could be due to confounders. Neither are "negative indicators". That's silly. It's like saying that having weak efficacy data for a drug in vitro is a "negative indicator" prior to trials. Any efficacy data is a positive indicator. Some positive indicators are stronger than others.
The Merck quote is an opinion. They're entitled to their opinion, but it's not definitive.
The point is: we'll see. You don't need to predict the future. You can just wait for the data. Science is great that way. Everything else is politics.
It's disturbing how this topic is treated like a tribalistic team sport. Comments like yours seem to follow "Rules for Radicals"[0], such as rules 5 and, especially, 13:
"Ridicule is man's most potent weapon. There is no defense. It is almost impossible to counterattack ridicule. Also it infuriates the opposition, who then react to your advantage."
"Pick the target, freeze it, personalize it, and polarize it."
You practically invent your own enemies to knock down.
Your reasoning would apply equally well to almost any acknowledgement that there are any differences at all between any two groups on any given subject.
>"Alternative medicine" like ivermectine or hydroxychloroquine have no scientific, properly studied basis for being used.
There are more than 60 peer reviewed studies showing positive effect for ivermectin. Similarly the single trial that the media touted as "proof" that HCQ did not work administered what amounted to an overdose to terminally ill patients, in contrast to the recommended early/prophylactic regimen.
These lies have gone on for far too long - no thanks to irresponsible and, frankly, inexcusable censorship by fb, youtube et al on grounds of "misinformation".
This site[0] has been up for over a year now and the citation count has continued to grow.
It seems people are more interested in poo pooing proponents of ivermectin/HCQ than actually examining evidence. Medicine should not be a political team sport.
There are multiple trials showing HCQ didn’t work. It was heavily studied and bombed over and over again in all 3 contexts: prophylaxis, early treatment, and treatment of hospitalized patients.
Just use google directly to find the trials I’m talking about, instead of being blinded by the ivm meta site creators (who created a similar site last year for HCQ). IvmMeta mixes in poor quality studies with studies that actually found no significant effect for IVM and claims they all are pro IVM.
> There are more than 60 peer reviewed studies showing positive effect for ivermectin.
I couldn't help but notice your use of purposely vague and misleading weasel words such as "positive effect".
Meanwhile I recall reading one of those ivermectin studies presented on another discussion on HN, and it certainly raised some red flags regarding how it was put together. For instance, if my memory doesn't fail me, it relied on an astonishingly small sample (100 patients, all reported as mild cases, divided into control and treatment) and to make matters worse the control group was given hydroxychloroquine instead of a placebo, effectively comparing ivermectin to hydroxychloroquine.
In the end the study reported that the fatality rate in the control and treatment groups was the same, and the only claim was that the statistical analysis suggested more patients from the ivermectin group were discharged earlier, which could very well be just statistical noise. Other than this the paper reported no benefit at all.
So, this is what weasel words buy: they are used to hide facts and misguide people. So unless you actually substantiate your claims and point exactly the very best study you feel shows that said "positive effect" is and how it was quantified, I have to dismiss your claim as something between a baseless assertion and blatant misinformation.
So you start by accusing him of being purposely misleading. He mentions 60 studies (which he didn't cite specifically, but at least offered a link which one could use to verify his claims).
But then you pull a bait-and-switch in your own comment, complaining about just one study, which you completely neglect to cite (so it could be made up, for all we know). You subtly outsource your opinion, trying to lend it an air of objectivity by saying that it "raised some red flags" (after you accused him of using weasel words). You couch the whole comment in an air of faux fairness by writing as if you are some judge called upon to arbitrate a dispute, who just has to rule a certain way because, of course, that's what the evidence requires. And you imply that your unsourced complaint about one study invalidates all such studies, therefore he must be wrong.
You accused him of being purposely misleading, but at least he offered a link, and he didn't try to trick people into thinking that a criticism of one thing invalidates other things, which you did.
Your whole comment is a textbook example of propaganda techniques. And then you wonder why people don't know what to believe anymore. It's like the whole Internet is a political, psychological battleground for public mindshare, and the truth doesn't matter at all.
> So you start by accusing him of being purposely misleading. He mentions 60 studies
I did more than that: I pointed out not only the use of weasel words but also that no assertion is substantiated in what boils down to a baseless appeal to authority.
Consequently, it's critical that, for the sake of objectiveness and to avoid spreading misinformation, these personal assertions cannot be backed up by handwaving and instead must be supported by concrete evidence, such as references to said studies, if they exist at all.
It's not very helpful to just describe a study you simply recall based on memory. If you have an actual link to it, myself and others may take you more seriously.
> It's not very helpful to just describe a study you simply recall based on memory.
Actually it is. The whole point of that was to illustrate the importance of actually looking into what these papers actually said, if they exist at all, instead of pulling the appeal to authority card with numbers pulled out of thin air.
The OP asserted that ivermectin worked. He proceeded to state that 60 papers report it. Well... Where are they? Can anyone like me actually take a look at one of these supposedly decisive papers? I'd be happy if I could just check the best one out of the hypothetical 60.
Are you being intentionally obtuse? I linked you a compendium of 60 papers. Surely you can cherry pick one or two and claim poor quality.
>I couldn't help but notice your use of purposely vague and misleading weasel words such as "positive effect".
This isn't a weasel word, this is exactly the correct term to capture the uncertainty considering that there has to my knowledge not been a large scale double blind RCT. But there are, once again, over 60 studies showing positive effect which, individually, are not absolute proof that the medicine works, but together clearly show promise. Your bias is rather extreme and frankly I don't appreciate your dishonest insinuation that I am somehow arguing in bad faith. Again, I linked a collection of more than 60 positive studies. It is unlikely that every one is poor quality and/or fraudulent.
Here is the link again[0], maybe you could actually click the link before responding, as you should have done previously. And yes, I've read a number of them. I can also provide the following [1] which suggests (in silico) the mechanism of action of ivermectin is inhibition of protease, which is the target enzyme of at least one other drug under development by pfizer for treatment of covid.
If you think "positive effect" is a weasel word then perhaps you do not understand the scientific process. I'm not claiming with certainty that ivermectin works, only that in light of, again, some 60 studies showing positive effect, inneffectiveness is unlikely. While you check these sources, please also check your rabid bias.
It might not be an alternative drug but it's certainly an alternative narrative. The momentum for the jab is all but unstoppable at this point. The continued talk of jab passports, and such. Once a narrative becomes normalized it's difficult to change.
Note: This isn't a political statement or criticism. It's Human Comms and Human Behaviour 101.
Then clearly you need to read more. I suggest starting with "Power for All." Words matter. They create worlds. Narratives matter. They enable myths to persist.
The reference to "horse dewormer" is the fact that a substantial volume of people started actually ingesting horse dewormer bought straight from farm supply stores because ivermectin was listed as a component.
Demand for horse dewormer intended for this ad-hoc use grew so much that its availability was jeopardized, and in some cases ceased to be available to farmers who needed it to treat their cattle.
CNN used the term to falsely describe what Joe Rogan took to treat COVID - he did not take horse dewormer but a normal human dosage prescribed by a doctor.
Sure, there were reports of people taking horse dewormer and nobody objects that reporting, just the usage of the term in relationship to JR.
Been really disheartening to watch the politics around alternative treatments. Personally, I expect this to be attacked as well, but am hopeful! The stuff really does seem effective, particularly when combined with other drugs...