Background
For the context in which this post was created please go here and read the comments.General
In case you'd like to use facts in any argument with anyone over Ivermection (IVM)... if they said, for example, "There have been clinical trials of ivermectin. All but one have failed to show any benefit, and that one outlier had a huge number of problems." Say this:
1. Cite your sources.
2. I disagree because...
I did a Google search on "Ivermectin (IVM) and CoViD-19". I found only negative papers. Or more precisely, I didn't find any positive ones on the first page of the results (as I'd expected). I kept looking into the later pages, mostly because I consider it a given that Google ("Be Evil"™) will be 'protecting' me from what they consider 'misinformation' (a.k.a. anything that does not line up with the official woke/left beliefs). Anyways, the difference between me and a person who would make a statement such as the above is that I distrust all of the media, while they seem to trust the media that tells them are smarter than everyone else. (Why does that sound familiar?)
It wasn't hard to find two studies that are positive (and I stopped after the first two because my intent was to READ them so I could make up my own mind and hey, two, and specifically the first two from Google, disproved the statement that there is only one, and they seem like as good a good place to start as any).
The first paper is the one that I suspect would be the "outlier" referred to as having "a huge number of problems" - if I'm wrong, see response 1. This paper is available here. From here on in I will call this T+ve (short for the treatment paper indicating a positive result). In the interest of full disclosure I believe the claims of that paper having 'huge problems' is based on this study. This paper was on the first page of Google results, and I will refer to it a T-ve (Treatment negative). The other positive paper is available here.
So now I have to read 3 papers. Oh well. It took me a couple days, but I've read them all. Here my takes.
The Two Conflicting Papers - Huge Problems or Science in Progress?
The two conflicting papers are both "meta-analysis" reports. In both cases the authors have done a literature search and then tried to analyze the combined data from all of the reports. By far the most interesting things I found are:
1) The T-ve paper is based on 10 papers covering 1,131 trial subjects (they listed the papers and the number of subjects for each study). That's pretty impressive.2) The T+ve paper is based on 22 papers covering 3,428 trial subjects (they also listed the papers and the number of subjects for each study). That's even more impressive.And3) The far and away most interesting thing is that the sheer numbers pale in light of the fact that the larger set of studies (paper T+ve) includes every one of the 10 papers of the studies from the T-ve paper.
Now I'm no expert on meta-analysis, nor would I claim to understand the details of the analyses, but I do understand statistics well enough to know that a study with 1,131 subjects may well be too small to be confident that they see an effect, while 3,428 might be big enough. I also note that the effect in the T+ve paper is given as "ivermectin reduced risk of death compared with no ivermectin (average risk ratio 0.38, 95% confidence interval 0.19–0.73)". Note that a 95% confidence level (a.k.a. a p-value of 0.05) means they are reporting a 2σ error bound. That means if you want to go to the 99% confidence level (3σ), the result would not differ from the null hypothesis. It also means that a sample only 1/3 the size would almost certainly not report a result different from the null hypothesis (as σ would be bigger by roughly a factor of √3).
Conclusions: In any case, while I'm not yet willing to say that IVM is clearly an effective treatment, I would insist that at the barest minimum the book is still open as to that possibility, I see no reason to claim huge problems with the larger study (as the difference may be nothing more than the march of science), and that further studies are absolutely necessary and should be underway NOW!
The Third Paper (Second Positive Result)
This paper differs from the first two in that it is not a paper about treatment of those having CoViD-19, but rather a study of IVM as a prophylactic medicine. My comments are as follows:
1 - just pre-print, but has been up since 15 FEB 2021 and has not been removed, presumably it is still out for review.2 - The study is not double blind, the participants either chose to take or not take the ivermectin. The size of two classes were sufficiently large to produce decent statistics (3532 total, 1147 no dose, 188 one dose, & 2197 two doses).3 - The study was only one month long and no extra treatments were applied if they became infected.
Results:
A) For those who showed symptoms during the month: 6% of those who took the drug and 15% of those that didn't. Those with symptoms were then tested for CoViD-19.
B) The positive rates (as a percentage of the total sub-populations not of the 'showed symptoms' subsets) were 2% and 11.7% (took drug, did not, respectively).
C) They then analyzed only those who had not gotten the disease previously. In this case the probability of getting the disease was 85% lower (or about 1/6th as many). This enables them to compare the estimated probabilities for disease in samples of people with no antibodies against CoViD-19 (the study was before the availability of the vaccine and none of this subgroup had previously tested positive hence they could not have any antibodies), given treatment/no treatment:
<p|t> ± σ|t = 0.002 ± 0.003 and <p|nt> ± σ|nt = 0.117 ± 0.009. The rates differ by approximately 12σ.
Would this constitute proof for IVM's effectiveness as a prophylactic treatment? Proof is a very strong word (note that Nobel Prizes in Physics, such as for particle discoveries and gravity wave discovery only require 6σ). For now, I would consider it as very strong evidence in the affirmative and that further studies are absolutely necessary and should be underway NOW!
The Upshot
Anyways, having done this background work I think it is fair to say the following (in the interest of full disclosure). I am fully vaccinated and have no personal interest in IVM as a preventive, a treatment, or in any other way. However, I have told Mrs. Ohioan that should I contract CoViD-19, I will be demanding "compassionate/Right-to-Try" use for human IVM.
I would ask if the CDC or FDA have asked for or approved any trials of IVM for use as an early treatment or possible preventative. I have not been able to find any such (although I concede that I am completely unfamiliar with how those get started). If they haven't perhaps we should lose faith in them, (perhaps their credibility is suffering?).
Lastly, and slightly off topic, I'm baffled by those who are calling for mandatory vaccination. I encourage everyone to get vaccinated. But I also concede that the vaccine (despite its recent - and very hurried - full approval) has not been demonstrated to have no significant long term consequences. As such, for those healthy individuals (particular for healthy individuals under 50 or so), they may yet to be convinced that the vaccine is sufficiently tested over the long haul, so that taking their chances with the disease (which would be quite small) may well be a reasonable choice. Also, the real goal of mass vaccination is to reach herd immunity (which would effectively make all of us safe from the disease). But the simple fact is that the vaccine does not STOP the disease. Yes, it reduces the chance of getting the disease, it also reduces the risk of serious consequences to the disease, but it does not prevent an infection nor does it make infected individuals unable to communicate the disease to others. It is known that typical evolutionary pressure leads to more contagious and generally less virulent variants. However, it has been shown that vaccines, particularly less than completely effective vaccines can (paradoxically) lead to more virulent strains (see this1 and this for example), so pushing an ineffective vaccine may bite us on our collective butts. Finally, even the CDC (who may or may not be losing their credibility in this fiasco) and the UK's equivalent have conceded that CoViD-19 will become, if it isn't already, endemic in the human population, and therefore will never go away (even the New York Times has reported such). Given such it is time to learn to live with the disease.
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1- A quote from the Abstract of this paper "... We go on to show that host immunity can exacerbate selection for virulence and therefore that vaccines that reduce pathogen replication may select for more virulent pathogens, ..."
