On July 16, the Ron Paul Institute for Peace and Prosperity web site published an article that began “After 62 studies, 32 of them randomized controlled trials, establishing ivermectin as an effective treatment and an even more effective preventative to keep people out of the hospital in the first place, our government refuses to endorse its use and Big Tech continues to censor it. They claim they need more studies.”
On Sept 1, the Washington Post reported, “Doctors dismayed by patients who fear coronavirus vaccines but clamor for unproven ivermectin.” Ivermectin, brand name Stromectol® for humans, Ivomec® or Heartgard® for cats and dogs, and DuraMectin Paste® and other names for treatment of horses, has become a cause célèbre as a preventive and/or treatment for COVID-19, particularly among the extreme right wing.
US Senator Rand Paul MD (R-Ky.), the son of Ron Paul, has explained that the FDA hasn’t approved this wonder drug for use in COVID-19 because “The hatred for Trump deranged these people so much, that they’re unwilling to objectively study it, … So someone like me that’s in the middle on it, I can’t tell you because they will not study ivermectin.” But weren’t there 62 studies, 32 of them randomized controlled trials that … never mind.
The number of studies conducted, or even published, is less important than how well they were conducted and how carefully they were read. This becomes more important as the number of prepublished papers expands. The idea that a study has been published implies that it has been reviewed by a qualified expert and approved for publication in a medical journal. It’s a first step towards legitimacy – but it’s not enough. Often, a study is published and then retracted by the journal, because a major flaw has been found only after publication. The web site RetractionWatch.com reports on papers that have been retracted by the publisher, and has a separate section of studies of COVID-19 that have been withdrawn. Five of these papers dealt with ivermectin.
The Cochrane Library (cochranelibrary.com) is an invaluable resource for drug information. Cochrane Reviews are summaries of medical topics, with studies examined the way they should be but rarely are. Too often, physicians will read a title, abstract and conclusions without bothering to read the details of the methods by which the studies were conducted. While there seems to be little doubt that ivermectin, besides its use for treatment of parasitic worms in dogs, cats, horses and humans, is effective in killing a number of viruses under laboratory conditions, its safety and efficacy in prevention and/or treatment of COVID-19 has not been proven.
Consider that some foods and drugs that are safe and effective for humans may be dangerous for other species. Foods that can be harmful to dogs and cats include chocolate, onions and garlic. In contrast, cows, and horses have no problem eating belladonna, where a human would definitely die.
There’s also the question of the proper dose to use and when to use drugs. When aspirin is used for pain relief, the proper dose is 300 to 650 milligrams every four to six hours as needed. The same drug, used to prevent heart attacks, the dose is only 81 milligrams once a day. When the first drugs for HIV disease (AIDS) were available, treatment wasn’t started until the number of t-cells was down to 50% of normal, Now treatment is begun as soon as a diagnosis is made.
Since drugs are usually measured by their level in the bloodstream, can an effective level be reached at safe doses? Ivermectin has very low solubility, and an effective dose may not be achievable.
And mostly, was the study well designed? Was the drug compared with placebo, or with the best available current treatment, or perhaps both? Was the study double blind, so that neither the researchers nor patients knew what treatment the patients were receiving but could only observe which patients were improving, and which weren’t. This method reduces the risk of bias by researchers who want to get a good result for their test drug.
When the reviewers at the Cochrane Library considered all the studies that were reasonably well designed, they reported, “Based on the current very low- to low-certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID-19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use of ivermectin for treatment or prevention of COVID-19 outside of well-designed randomized trials.”
Ivermectin may ultimately prove to be safe and effective in preventing or treating COVID-19 – but not yet. Not yet.
Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sdu01@outlook.com.
From The Progressive Populist, October 15, 2021
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