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The Ivermectin Debate - Swiss Policy Research 2022
Is ivermectin highly effective or totally useless against covid? And why is there still no agreement on this question?
Please note: Patients are asked to consult a doctor.
To date, about 60 studies – among them about 30 randomized controlled trials and about 40
peer-reviewed publications – have been done on the use of ivermectin against
covid. Most of these studies found that the use of ivermectin was associated
with a positive outcome, such as a reduced risk of infection, hospitalization
or death (see chart above; not all of these results were significant).
Based on these studies, several meta-analyses computed positive results, too. Most recently, a WHO-supported meta-analysis of 24 randomized controlled trials found a 56% mortality reduction
overall and a 70% mortality reduction in patients who received early
outpatient treatment. There even appears to be a positive dose-response
relationship, which is another indicator of effectiveness. (Update: The WHO-supported meta-analysis has been updated, see postscript below.)
Nevertheless, several concerns have been raised regarding the reliability of these results, and major
– although not necessarily “independent” – health authorities like the WHO,
the US FDA and the European EMA all continue to advise against the use of ivermectin outside of clinical trials.
First, it has been argued
that there might be some publication bias, that is, only positive studies may
have been published, while negative studies may have remained unpublished.
However, the above mentioned meta-analysis was able to show that there is in
fact no publication bias: studies that had been registered or announced did indeed get published, at
least as a pre-print.
But secondly, and more
importantly, it has been argued that many of the existing studies are of rather low quality: due to
budget constraints, many of them are small, single-center, open-label (not
double-blinded) and not perfectly randomized, thus significantly limiting
their reliability. It is possible that at least some of these studies were
biased towards getting a positive result.
Thirdly, and most worryingly,
some of the ivermectin studies may simply be fraudulent or fake. As a matter
of fact, one of the first positive studies on ivermectin, published in
mid-April 2020, was from the very same group (Surgisphere) that published a
fraudulent (negative) study on HCQ in the Lancet (both studies were ultimately retracted). And just last week, another seemingly positive study on ivermectin by an
Egyptian group was shown to be very likely fraudulent. (See updates below.)
It remains debatable whether the groups behind these fraudulent studies simply
tried to jump on the bandwagon of a promising medication, or if their role was
in fact more substantial. In a context unrelated to ivermectin and covid,
a former editor of the British Medical Journalrecently argued that “we have now reached a point where those doing systematic reviews must
start by assuming that a study is fraudulent until they can have some evidence
to the contrary.”
Finally, and contrary to what
some ivermectin proponents have argued, the epidemiological evidence in favor
of ivermectin is rather weak. Ivermectin hasn’t “crushed the curve” anywhere;
rather, decreases in infections were mostly driven by seasonal and endemic effects. In fact, ivermectin pioneers like Peru
and Mexico have some of the highest covid mortality rates in the world; to their defense, even in Latin America, ivermectin use
has often been limited and local.
On the other hand, the few
studies claiming that ivermectin did not work against covid are also of rather
low or dubious quality. The most famous one – a Colombian trial published in
JAMA – was done so poorly that over 100 scientists and doctors called for its retraction. Furthermore, the only negative meta-analysis simply excluded most positive
trials, confused the control and treatment group of another trial, and made
several statistical mistakes, also triggering calls for retraction.
Some of the weakest arguments against ivermectin include questioning its safety (as done by Merck, the WHO and the US FDA, despite the fact that it is one of the safest drugs in the world), or calling it a “veterinary medicine” (it is used as an
anti-parasitic drug in both humans and animals, as are many other drugs). Such
dubious arguments, as well as some rather obvious conflicts of interest, raise legitimate questions about the motivations of some of the critics of
Regarding the potential mode(s) of action of ivermectin against Sars-CoV-2 and covid, proposals by various studies (molecular simulations, in vitro and in vivo) range from direct
anti-viral action or interference with cellular receptors to immuno-modulatory
mechanisms. Critics argue that doses needed to achieve anti-viral action are
too high, but some ivermectin study authors have disagreed.
Most recently, a detailed covid animal study by the renowned French Institute Pasteur found that ivermectin “limited inflammation and prevented clinical
deterioration”, but did not reduce viral load. The study “supports the use of
ivermectin as an immuno-modulatory drug in covid patients”, but it would also,
if applicable to humans, directly question the validity of several studies
that claimed ivermectin works as an anti-viral prophylaxis against coronavirus
infection (more on this).
To resolve this situation and finally answer the question of the effectiveness
of ivermectin against covid, several high-quality randomized controlled trials (RCTs)are currently ongoing, sponsored by large foundations or public funds. While rather late in the
pandemic, these trials are certainly of crucial importance to settle the
Large and expensive RCTs may, however, come with their own intricacies. Specifically, RCTs may to some extent be “designed to succeed” – as was the
case with some covid vaccine trials as well as remdesivir – or be “designed to fail”. In the case of covid – a multi-phasic
disease with a very steep age-based risk gradient – a trial can be designed to
fail by enrolling (young) low-risk participants, using a drug late instead of
early, under-dosing the drug or in some cases even over-dosing it.
For instance, the ongoing TOGETHERtrial of
ivermectin, sponsored by the Gates Foundation, was caught using just a single dose of ivermectin, whereas successful trials used two to four doses per day
for up to five days. The Oxford PRINCIPLEtrial, meanwhile, was
caught enrolling participants up to 15 days after symptom onset, at which point some high-risk covid patients are already dead. Of note, the
Oxford group had previously “botched” several other early treatment trials.
Finally, ivermectin is also a prime example of the media war that has been going on during the covid pandemic, with US social media
platforms – most notably Facebook and Youtube – having censored numerous doctors, scientists and politicians supporting ivermectin,
while the GAVI vaccine alliance has been buying Google ads discouraging its use. Moreover, one of the major social media “fact
checking” organizations turned out to have financial ties to a covid vaccine manufacturer.
In conclusion, the current
evidence base concerning the use of ivermectin in the early treatment of covid
continues to be positive, but important questions regarding the quality and
certainty of many studies remain. It is to be hoped that ongoing high-quality
RCTs will be able to resolve the debate. Given a still rising global covid mortality of currently about ten million people, if ivermectin is even just 10%
effective against covid, its professional use could already have saved a
In the meantime, preliminary results of the Gates-funded TOGETHER trial of ivermectin have been published: the trial found a non-significant reduction in hospitalization of 9% and a
non-significant reduction in deaths of 18%; the probability of superiority
(vs. standard treatment) was calculated as 76%. Limitations of the trial
include a rather short treatment duration (just three days) and a rather young
patient cohort (18+, median age 52); the treatment delay is not yet known.
Overall, the trial results are consistent with ivermectin being either useless
or being up to 30% effective.
Update October 2021
Several additional ivermectin studies turned out to be likely fraudulent (detailed discussion here). Once low-quality studies are excluded from the analysis, the mortality
benefit of ivermectin is no longer statistically significant.
The epidemiological evidence doesn’t support a strong effect of ivermectin,
either: for instance, in the Indian state of Uttar Pradesh, known for its use
of ivermectin, the total death count turned out to be 43 times higher than the official covid death toll.
Some beneficial immuno-modulatory effect – as found by the French Institute Pasteur – is still plausible, but the available evidence has become rather
uncertain. Two high-quality RCTs of ivermectin are still ongoing, and
ivermectin recently passed the “futility threshold” in both of these trials (i.e. >33% chance of benefit).
Dr. Peter McCullough is an internist, cardiologist, epidemiologist, a full professor of medicine at Texas A&M College of Medicine in Dallas, USA. He also has a master's degree in public health and is known for being one of the top five most-published medical researchers in the United States and is the editor of two medical journals. McCullough et al. Reviews in Cardiovascular Medicine, 2020 McCullough Protocol 2022 In this Sept 14, 2021 interview with Peter Breggin MD, author of Talking Back to Prozac, Dr. Peter McCullough discusses the routine use of diluted (1%) Povidone Iodine mouth wash i n the dental office as an excellent preventive measure for COVID-19. 10% Povidone Iodine is available OTC (Over the Counter) without a prescription at any drug store for a few dollars. Here is the link: Povidone 10% Iodine on Amazon Note: This 10% Povidone Iodine must be diluted by one tenth, to 1% strength before use as a mouth wash, otherwise it is too strong and irritating. Dilute b
Well-respected North Texas cardiologist, Dr. Peter McCullough has impeccable academic credentials. He's an internist, cardiologist, epidemiologist, a full professor of medicine at Texas A&M College of Medicine in Dallas. He also has a master's degree in public health and is known for being one of the top five most-published medical researchers in the United States and is the editor of two medical journals. McCullough et al. Reviews in Cardiovascular Medicine, 2020 McCullough Protocol 2022 Dr. Peter McCullough, has recovered well after being diagnosed with coronavirus in October 2020. The 57-year-old phy
SELF-HELP without a Doctor ( source ) Zinc 50 mg daily (can take half twice daily if upset stomach) Quercetin 500 mg twice a day three times a day if sick (switch to HCQ/IVM if available) Vitamin D3 40,000-50,000 for five days Melatonin 5 mg - 20 mg nightly for 14 days stomach) Pepcid 40-80 daily 14 days – women or Cimetidine 400 daily -men Full Aspirin (325 mg) daily one month N acetyl cysteine (NAC) Up to 2000-2400 mg 1-2 days, then 1000-1200 mg for a week Treatment: Latest Prescriptions ( source ) Monoclonal Antibodies: outpatient, FDA approved, early treatment, within 10 days Only HCQ 200 mg twice a day 7 days or IVM (weight based 0.4/kg) 20-36 mg daily 2-5 days Fenofibrate (Tricor – anti-lipid) 145 mg daily (inflammatory/cytokine phase. Antioxidant) Cyproheptadine (Periactin – antihistamine) 4 mg BID for 14 days (cytokine phase) Decadron 6-10 once or twice a day one week or prednisone 80 mg. daily two days then taper or Colchicine 0.6 mg twice a day Fluvoxamine 50 m
Is povidone iodine the next ivermectin or hydroxychloroquine? Is there any evidence that povidone iodine can treat COVID-19? Iodine 1% Nasal Spray is part of the FLCCC I-CARE early treatment protocol : Nasal spray with 1% povidone-iodine: 2-3 times a day. Do not use for more than 5 days in pregnancy. If 1% product is not available, dilute the more widely available 10% solution and apply 4-5 drops to each nostril every 4 hours. Use 1 % povidone iodine commercial product as per instructions 2–3 x daily. If 1 %-product not available, must first dilute the more widely available 10 %-solution. To make 1% povidone iodine concentrated solution from 10% povidone iodine solution, one dilution method is as follows: – First pour 1½ tablespoons (25ml) of 10% povidone/ iodine solution into a nasal irrigation bottle of 250ml. – Then fill to top with distilled, sterile or previously boiled water. – Tilt head back, apply 4–5 drops to each nostril. Keep tilted for a few minutes, let drain. - Not reco
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