Dr. Bow Tie
You're Making Me Talk About Ivermectin. And Joe Rogan.
*Sigh*...Joe Rogan has COVID-19. He announced it on Twitter on September 1st, mere months after he ignored what physicians and scientists said and told his millions of podcast listeners that "I don't think that if you're a young, healthy person, that you need [the vaccine]." Just like when Donald Trump was infected with COVID-19, I do not derive any joy from this. I am not happy when anyone gets infected with COVID-19. What irritates me is the amount of disinformation spread via these celebrities' platforms. Trump recovered from what was undoubtedly a severe infection and hospitalization and immediately downplayed the virus and did nothing to protect American people (and later received the vaccine in secret to keep up his "image"). Rogan Tweeted about using "the kitchen sink" including monoclonal antibodies (EUA, can be helpful), prednisone (a steroid which, in mild cases, is not all that helpful), azithromycin (a Z-pak, not really useful against COVID-19)...and ivermectin (ugh). He also got an NAD drip and a vitamin drip, which have zero real evidence. I have discussed ivermectin briefly in previous posts, but I have not done a full post. I had hoped that my previous mentions would be enough, but like hydroxychloroquine before it, the myth of ivermectin in COVID-19 persists. So let's discuss.
WHAT EVEN IS IVERMECTIN, ANYWAY?
Ivermectin is an antiparasite medication. It was approved by the FDA to treat certain parasitic infections in humans, such as Strongyloidiasis (infections caused by certain parasitic worms), onchocerciasis ("River blindness," spread by black flies), scabies, and others. It is used in relatively low doses and is effective at combating these parasites. It is also used by veterinarians to treat parasitic infections in animals.
AND IT WORKS ON COVID-19, RIGHT? RIGHT?
Ivermectin took on a new meaning as the new "it drug" against COVID-19. It showed some possible in vitro (in a lab/petri dish-type setting) activity against viruses and, just like hydroxychloroquine (HCQ) before it, people pounced. The initial lesson here is that while in vitro activity can be important to identify a potential research subject or as a foundation for future studies (not the only applications), it does not always transfer to in vivo activity, meaning it does not necessarily work the same way or as effectively in real humans. That proved true for hydroxychloroquine and it did so for ivermectin as well.
From the earliest studies it was noted that, to have any antiviral properties against SARS-CoV-2, one required high doses of ivermectin. REALLY high doses. 8.5 TIMES the FDA-approved dose was barely enough! That already should have raised red flags.
In October 2020, a retrospective chart review study appeared to show lower mortality in patients that received ivermectin than those who did not. However (just like with hydroxychloroquine) the patients who got ivermectin (often because they were sicker) also got...steroids! You remember steroids, they did the actual work in the trials that were originally touted as showing hydroxychloroquine's effects on COVID-19. Later, a small randomized, controlled trial showed a possible effect at more reasonable doses...but then a larger RCT did not. A published review of the available literature found significant bias in many of the supposedly-positive trials.
In December 2020, a friend sent me a video that was making its way around the Internet (similar to when the Breitbart-sponsored America's Frontline Doctors touted HCQ). I wrote this back in February (you know what the funniest thing is? People asked me if I wrote anything on ivermectin and I forgot I had written this!):
"There is a video that recently went around of Dr. Pierre Kory testifying in front of a Senate hearing on early outpatient treatment of COVID-19. He gives a very impassioned testimony about the results of using ivermectin in early treatment of COVID-19. However, most of the studies [the ones that were even published at the time, and not just raw numbers] he points to are in vitro studies or smaller observational studies or anecdotal evidence. For every positive study or report, there is at least one negative one. And the positive studies are not randomized controlled trials - many of them utilize other medications that probably had more effect (like dexamethasone, which is the same drug that did the heavy lifting in the hydroxychloroquine studies).
My biggest issue is that he keeps touting it as a miracle drug."
As I've stated in the past, there is no miracle cure for COVID-19 - it is just not that easy. But that does not stop people from trying. Twitter was abuzz with claims of "suppression" of ivermectin results and the unfairness of holding back treatments. The Frontline COVID-19 Care Critical Care Alliance (FLCCC, a non-scientific sensationalist group of whom Dr. Kory is a member) launched a full-scale offensive, touting numerous studies and lifting Kory to a pedestal based on his testimony video. Their cries swelled when Kory and others submitted a "systematic review" to the journal Frontiers in Pharmacology. The journal initially accepted it provisionally, and then rejected it:
"Upon further scrutiny by our Research Integrity team about the objectivity of this paper during the provisional acceptance phase, it was revealed that the article made a series of strong, unsupported claims based on studies with insufficient statistical significance, and at times, without the use of control groups. Further, the authors promoted their own specific ivermectin-based treatment which is inappropriate for a review article and against our editorial policies." That is not suppression, that is accountability.
The final nail in the coffin took a while to hammer in. Dr. Ahmed Elgazzar, et al, uploaded a paper to a preprint server in November 2020 titled, "Efficacy and Safety of Ivermectin for Treatment and Prophylaxis of COVID-19 Pandemic." The paper claimed a significant reduction in number of deaths and length of hospital stay. The paper was cited as a source in multiple other papers and in a meta-analysis, and was deemed the ultimate proof of ivermectin's effectiveness against COVID-19. It, among many other studies, led to the widespread of use of ivermectin against COVID-19 in places like India and Brazil. Except...
If you look at the raw data, it does not actually match up with what is reported in the paper. It actually looks like they copied patient data to inflate their numbers! There are even the same typos. It could not stand up to the most basic scrutiny.
The paper was retracted due to fraud. The meta-analyses were re-run and, without the Elgazzar paper, they showed no effect of ivermectin on COVID-19.
AREN'T THEY HAVING THE AFGHAN REFUGEES COMING TO OUR COUNTRY TAKE IVERMECTIN FOR COVID-19?
Nope. They're taking it for Strongyloidiasis and other parasitic infections common to those regions. It's on the CDC website.
WELL, WHY CAN'T I TAKE IT JUST IN CASE? WHAT IF IT HELPS?
No medication is without side effects. We have talked about side effects of vaccines at length (the ones that exist and the ones people have started rumors about). Ivermectin causes nausea, vomiting, diarrhea, and low blood pressure, which seem relatively benign. However, and especially at the exorbitant doses claimed for effectiveness, we can see abnormal heart rhythms, liver failure, seizures, hallucinations, and even coma and death. There are now people going to the hospital because they tried taking high doses of ivermectin and suffered these effects, adding even more burden to the healthcare system.
This does not sound like a great trade-off for...NOT preventing/treating COVID-19. Instead, take something with much rarer (and usually milder) side effects that do not linger. #GetVaccinated
SO? MAYBE WE SHOULD JUST DO BETTER STUDIES?
Perhaps. That's why there are multiple large-scale randomized, controlled trials and other smaller studies (in addition to the many that have already been done) underway to study ivermectin properly (without faking data) in different settings (preventative and treatment). None of them have shown any real promise yet. Our best options for COVID-19 treatment are oxygen (when required by measurement of oxygen levels), steroids (in more severe, hospitalized cases), and in certain situations, remdesivir or monoclonal antibody infusions. Our best option for COVID-19 prevention remains...you know what I'm going to say.
Unfortunately, the damage has been done, and instead we see so many people rushing to take too-high doses of a medication that has not been shown to work. Just like with hydroxychloroquine, people are making a run on ivermectin and taking it away from people that need it for parasitic infections (not viral ones) (and unlike HCQ, they are also taking it from pets and livestock that need it). Believe me, if these studies show anything and it turns out a relatively cheap medication actually CAN treat COVID-19, I will gladly recommend it. But that has not happened yet.
Do not take ivermectin for prevention or treatment of COVID-19. Do not take hydroxychloroquine for COVID-19, either. The one proven preventative pharmaceutical method (and any doctor worth their salt will tell you that prevention is preferable to cure) is the vaccine. Until we get this pandemic back under control, keep wearing a mask in schools, crowds, or unfamiliar situations, keep washing your hands, maintain some distance when needed, and get vaccinated!
This next part is weird because usually I would cite research articles, but...it would be a bunch of articles that are either bad or don't show anything. So here are great articles that go further in-depth in investigating this issue.