JAMA article about ivermectin
This is a rather long post that probably should be ignored by most everyone. If you're interested in the JAMA article (you shouldn't be, because it's one neutral RCT out of dozens of prospective trials). But if you're interested in that, just google it...I'm not going to link to it, or anything, in this post (you can do your own searching, if inclined). Anyway, this post is a bit of what I'd call an "informed rant" about how disappointed I am in the way the medical establishment (businesses and governments) appear to be failing to act in the interest of public health. It's complicated and nuanced, so exploration in this space is not for the impatient.
Anyway..... Thankfully, with the speedy vaccine roll-outs, we have less to worry about with respect to treating the disease of the pandemic. But treatment is nowhere near to inconsequential...yet. We hope for no viral variant "escapes", that the vaccines do their job, and we can get back to whatever the new normal will be. But for the mean time, it would be nice to have a way to keep people out of the hospital.
Commonly in treating viral disease, I have found no one that suggests that early treatment is not a good thing. But we don't really have accepted and effective early treatments. The NIH has lots of things that are in the "can't recommend for or against" category: monoclonal antibodies (the *mab drugs), zinc, dexamethasone, remdesivir, and ivermectin. The standard protocol is stay home, do nothing, and wait for your O2 saturation to drop below 85, then go to the hospital to get oxygen, LMWH and steroids (and hope you don't become a statistic). If you're at higher risk, and you alert your doctor shortly after symptoms appear, you might get monocolonal antibodies early enough to do some good, but you really need to be on the ball to go that route.
Even though we have huge vaccination programs, we are not done treating the disease, and we still really don't have accepted effective treatments. We have one non-accepted, possibly effective treatment, ivermectin, but it's facing an uphill battle, as there is no large pharmaceutical company that can make any money from it. In fact, they stand to loose money because ivermectin could reduce demand for the things they make that also can treat the disease.
For people who aren't immersed in the Covid-19 treatment options from around the world, a recent JAMA article might have been the first time someone heard of the drug "ivermectin". JAMA is probably the most high impact medical journal out there, so when they publish something, it makes the news; several news outlets picked-up on the article, as they should. So the choice by JAMA to publish this particular study from Columbia, which shows no efficacy of ivermectin, is puzzling. If I were not paying attention, I'd say "Oh, that's JAMA and they say ivermectin doesn't work...good enough for me". But I am paying attention, and it might sound like a "sour grapes" position, but I really don't think it's fair or wise to weight this particular study such that it overrides all of the earlier published studies on ivermectin. This study used a young population. Young people typically don't have much room for improvement with any therapy, so the fact that there wasn't statistical significance in the outcomes isn't all that surprising. But there is another problem: the study was powered such that their primary outcome would be statistically significant, but after the study started, they changed their primary outcome, and so now the study became under-powered (making the difference between the treatment and placebo arm insignificant only because the numbers were too small). Then there's the fact that the authors take money from big pharma. The other disturbing thing was that the side-effects reported by the placebo arm included the typical side-effects of ivermectin. They aren't serious side-effects, but ivermectin at the relatively higher doses used in this study have nausea and diarrhea as occasional side-effects. The intervention and control arms had almost identical rates of these side-effects. And this, at a time when ivermectin was available over-the-counter to the community where the study was undertaken. We probably won't ever know if the placebo arm knew they weren't being treated and so self treated. The trial used an oral solution instead of pills (which was weird, because it comes in pills), and the participants could probably taste the difference. Anyway, a weird study to put in the JAMA.
So, again, I find it puzzling that JAMA decided to publish this particular study, as there are dozens of higher quality studies that don't have the confounding variables found in this study that they chose to publish. We've talked earlier in this thread about FLCCC meta analysis, but there's other people around the world that have done their own meta analysis (search "ivermectin meta analysis andrew hill" or "ivermectin meta analysis tess lawrie"). These doctors and researchers have used conservative prescribed methodologies to conduct their research, yet have faced problems getting their papers published. But the point here was that if you choose to, you can look at those meta analysis reports and dig into the individual trials that don't have as many glaring flaws of the JAMA paper.
So if I type "fda ivermectin" in the search box, I see "Why You Should Not Use Ivermectin to Treat or Prevent COVID-19". If you read the page, there's almost nothing that supports the headline. They say not to take horse medicine. Ok, no problem. They claim to have received "multiple reports" of people who did use the horse medicine and needed "medical support". The problem there is that all inquiries into the specifics by news agencies have lead to a dead-end. But don't take horse medicine, fine, I got it.
FDA says it's not approved for Covid-19 (but is for parasites). Ok. Taking large doses is "bad". Ok, don't take large doses because that can have side effects. Nobody is suggesting anything larger than the parasite dose anyway. Take it the way your doctor prescribes it. Ok.
FDA says "Ivermectin is not an anti-viral (a drug for treating viruses)." Maybe what they meant is that the typical use of ivermectin is as an anti-parasitic. That does not mean it does not exhibit antiviral properties. There are loads of peer-reviewed studies that indicate anti-viral properties of ivermectin. Under this logic, Viagra is not an erectile dysfunction drug because it was originally used for hypertension.
So you get lazy (or worse) journalists who look at one JAMA article, and one page on the FDA site, and write an "ivermectin doesn't work" article, without understanding the whole picture. And you get revolving door, government, k-street, big pharma types that cherry pick the news that suits their purpose, at the expense of public health.
When I go to "Consumer Health Digest" and type-in "ivermectin" in the search, I get no hits whatsoever, but I have a trusted source who received an email from them. The content of the email was cherry-picked to match their headline: "Ivermectin panned for COVID-19 treatment and prevention." They found one obscure government health body in New South Wales that agrees with the NIH (insufficient data for or against), but managed not to mention that Slovakia, Belize, Macedonia, Bulgaria, South Africa, Zimbabwe and more have approved the drug for treatment of Covid-19. What? No mention that some governments have formally adopted ivermectin for treatment of Covid-19? Puru was an early adopter and was handing it out like candy. There's a convincing population study on the effects of that protocol. Unfortunately, a new president came into office and not only did he stop those programs, but also changed the drug to prescription only, whereas it was over the counter. The cases in Puru shot back up after that. The CHD email goes on to cherry pick the "not an anti-viral" line from the FDA, and the under powered JAMA study. This CHD email provides links to everything negative, but does not link to anything balanced, or to the dozens of prospective RCT's, case studies and population studies that show the other side of the discussion (for specifics on that, I'll suggest again, search "ivermectin meta analysis andrew hill" or "ivermectin meta analysis tess lawrie"). These are authors that do meta analysis for a living.
Above, I've alluded to one aspect of my theory as to why the story of ivermectin is so clouded, and that's money. This stuff (ivermectin) is literally made by the ton. There is zero money to be made on it. And if popularized, would stand to take the place of things that do make money (not naming any names, although I could).
Another idea for why there is such a clouded story around ivermectin is the idea that the public isn't smart enough to handle the truth. Everyone remembers the flip-flop on PPE; when masks were needed by the healthcare workers, rather than the message be "please don't buy masks because the healthcare workers need them more than you do", the message was "masks don't work". There was nuance on my brief historical recount of that situation, of course, which I don't wish to explore here because it's not relevant. I just want to make the point that the entities that control and release such messages to the public don't seem to trust the public with the truth. What if "they" gave up the fight, and allowed ivermectin a fair shake? I think the government medical industrial complex apple cart would be quite upset.
As an update to my trial experience here are a few links for those interested in the trial.
