UKH

Seems like the darling drug of the Covid conspiracists may have legs after all...

https://www.clinicaltrialsarena.com/news/ivermectin-principle-trial-covid/

Oxford Uni going to include it in their large scale PRINCIPLE study.

Thought this was a Scottish crag you’d  just discovered.

There’s no real data on it. There’s no conspiracy there’s just no money to be had for anyone to spend time and money on. 
 

Wasn’t this the subject of a UKC ‘pile on’ last year? Didn’t  someone have the audacity to suggest Ivermectin as a possible treatment and, since it went against accepted wisdom at the time, they were pilloried by the usual suspects. Perhaps my memory is wrong.

IIRC Ivermectin was one of a number of possibles that was being tested at the time, (rather than being excluded by 'conventional wisdom’). The conspiracists seemed to have latched onto it by chance.

My recollection is that someone kept ranting about the lack of priority assigned to testing Ivermectin and vitamin-C whilst blaming this on nationalised healthcare being inept and drug companies being disinterested in products not under patent protection any longer.  They showed a singularly unscientific approach to interpreting the results of the many studies in to both compounds when overtly slagging off the UK’s response in repurposing, despite the methodologically based repurposing trials here producing the compelling case for dexamethasone, a drug not subject to patent protection that made a massive decrease to deaths across the world.   They kept demanding that drugs no longer encumbered by patents have new IP rights auctioned off to the private sector to generate commercial interest in funding more repurposing studies. 

It was one of the most frankly bizarre, illogical, non scientific campaigns I’ve ever seen on here. The poster got themselves banned over some insanely bizarre and utterly uncalled for allegation of anti semitism against another poster, rooted in outrage over that poster’s (entirely reasonable IMO) comment on covid IIRC.  Because some people who die from covid are Jewish.  It was astounding illogical and frankly demented as well as outright offensive and uncalled for.

My view expressed at the time and I believe that of several others including a couple in directly relevant fields, was that the many trial results to date did not offer a compelling case to priories either of the poster’s advocated compounds over the judgment of the domain experts running the repurposing trials - this was 12 to 6 months ago.

Almost all of this went on in the Pub forum.

The longer this goes on, the more compounds are going to go in for re purposing trials.

Quite from the OP’s article:  

Looking for harms as well as benefits.

I look forwards to the trial’s results with interest.

Thanks for clearing that up.

I haven't listened to the link below yet, but the previous discussion between Pierre Kory and Bret Weinstein was removed by Youtube and Weinstein has being threatened with a ban...all for making what sounds like a nuanced and reasoned discussion about the potential advantages of Ivermectin as part of a multi-faceted attack on covid.  So I assume in this interview they are restating the case, but from the relative safety of Spotify.

A central point of their argument is that emergency use clearances have been granted for similar drugs and the contrasting treatment of Ivermectin (or simply talking about it) is noteworthy.  In some ways their argument appears reminiscent of the early calls from some clinical specialists in Italy to delay ventilation of patients; it is an argument based on field experience and in the absence of time for lengthily studies it would be a pity to push their experience into the realms of "no evidence" or potential "conspiracy". 

A key consideration that Weinstein makes is that any potentialyl effective, cheap, widely available and safe prophylactics should be used in the absence of and along-side vaccination programmes and could eradicate covid.  Instead, and this is being charitable, by only accepting gold-standard treatments we lose the possibility for eradication and increase the death-toll.  Having worked in an unrelated field but where a similar approach was taken (utilising only specialised, high-quality, "acceptable" approaches to a post-conflict social-health problem, and essentially banning ones we deemed insufficient), it inflicted 50 years (and probably 50 more) of suffering on the populations of several countries.  The issue looks starkly similar, is a mistake we seem prone to making, especially from our Western vantage point, and a potential flaw in our idea that we know best and that our approach is the most scientific.

In fact, the tone of the arguments against Ivermectin, and the claims that its proponents are using bad science or worse, to the point that even discussing it will guarantee you being banned by Google (and seemingly other social media platforms) and is specifically mentioned as a violation of their terms of service, is deeply concerning.

https://open.spotify.com/episode/7uVXKgE6eLJKMXkETwcw0D

"Conspiracy" is a loaded term.  It implies those making the claim are cranks, lunatics, something you shouldn't go near and that the opposite viewpoint is the one you should gravitate towards. But one should be careful of automatically saying there is no conspiracy. 

I think there's money everywhere when it comes to potential covid responses.  Or more to the point, the costs of covid harms make unprofitable ventures attractive. So I don't think there being inadequate money for research is necessarily the issue.  Part of their claim is that there is something far more active being undertaken against Ivermectin.  It is possible that there are less than innocent, or at least biased, reasons for the way the Ivermectin issue has been approached.

Sounds to me like another of your conspiracies dressed up in rhetoric. How would the whole world be made to avoid testing a cheap potential treatment given the quote from  Weinstein has clear merit under some likely circumstances and would have led to action somewhere? What experience do you have in such research to imply it can be controlled in some unspecified active way?

Also how about a peer reviewed link on your explanation of 50 to 100 years of damage in a post conflict social health problem.

None of the main critics on earlier threads said conspiracies never happen but in most cases its better to look for other explanations first. A good example for covid is face coverings. You can show these work by filming a cough in slow motion with and without it and see the difference in droplet dispersal that clearly reduce risk. Yet worries about clinical mask shortages and experts in different areas who didn't understand the physics led to dumb public pronouncement and lethal public health action. That's a c*ck-up and it's always best to check for that before going anywhere near conspiracy.

For people interested in the science of improving how drugs are tested in terrible situations like a pandemic,  the Oxford recovery trial sets a great example.

https://en.wikipedia.org/wiki/RECOVERY_Trial

One could speculate that their hype has been driven by 'the illuminati' in exactly the same way that those advocating it are saying it's being suppressed by the illuminati.  The reality is that proper trials weren't done and it didn't demonstrate enough effect to warrant more attention.

I think you are missing the point.  Why should social media be dictating in such strong terms acceptable discussion? Even if it is potentially life-saving and harmless discussion?

It looks to me as if people have got a little too comfortable with tech monopolies deciding it is their "moral duty" to intervene, quite possibly strengthened by the degree of support they received when exorcised a certain ex-president for engaging in similar discussions.  Such is the slide; restrictions you support today might be applied tomorrow with far less rationale.

And while I'm not usually one to join the "big-pharma" rants (on the whole I'm grateful for big-pharma and the improvements it has brought to the world) perhaps on this one, the examples of where financial decisions run up against harm-reduction decision might be in evidence again?  As a corollary, if the UNODC, largely at the behest of one country, has been able to dictate worldwide policy on recreational drug prohibition, against all available evidence, for the better part of half a century why is it inconceivable that pressure applied by massive multi-national drug companies (suddenly declaring their own existing drug unsafe despite decades of use and no apparent evidence?) about to release a potentially profitable replacement on to the market won't do likewise?

Weinstein and Kory's point isn't really the conspiracy.  They only go into that in trying to come up with some rationale for why a perfectly safe and seemingly effective remedy, and discussion of it, has been pushed into the realm of blasphemy.  Their real point is trying to create some kind of mass mindeset change so a real discussion can be had.  The very fact that mentioning Ivermectin has people shifting uncomfortably in their seats speaks volumes.  It's like the lab-leak hypothesis all over again.  Toxic to go near for months, until suddenly it isn't. 

The issue was the subject of my masters dissertation, has been written about by a number of academics, but is in a rather niche area of international development practice.  For the same reason I use an alias here, I am not going to identify the exact issue. 

The point is the existing practices evolved to be the way they are through a combination of "we know best" mindsets, the primacy of certain aid organisations and ex-military experts in the area, institutional and funding capture by those organisations, and a risk-bias based on donor and aid organisation standards inappropriate in the context of the beneficiary countries. 

The outcomes were clear to anyone who bothered to look at the data (it was niche, so few did) however, with a complete failure to address the problem at hand almost 50 years after it was created.  This despite ample evidence that the alternative methodology not only would work but was being practiced under-the-radar and despite having been banned at the request of the organisations officially tasked with (and monumentally failing) to provide the service.  That those same organisations have now adopted these same policies in all but name says everything.

Whether that is "conspiracy" or not is beside the point.  It is a culmination of factors leading to an institution slide and bias, all perpetuated by ostensibly well-meaning individuals, that becomes very difficult to resolve down the line.  And once so much has been invested, it becomes impossible to admit failure.

The area of my experience is somewhat tangential but watching this unfold for weeks now, the socio-political backdrop is strikingly similar.

Wintertree has given a good summary. The issue was never ‘it’s heresy to claim this could work, burn the heretic’- it was the poster’s entrenchment in their position and insistence that their solutions were manifestly the right ones, and that there must be some sort of malignancy or incompetence which was preventing them being adopted, that were the reason for the heated debate. 
 

My view remains as it was then- space on the “platform trials” such as will now evaluate ivermectin is limited; including one drug means omitting another; no one on this thread is sufficiently qualified to make the judgement over which to include and which to hold for now; but the performance of these trials  in picking candidates that do show efficacy reassures me that the people running them are the best people to me making these judgments. 
 

it would be great if ivermectin does turn out to work, we could certainly use another effective drug; but just being tested doesn’t mean it will turn out to work. 

It does. It speaks volumes about the problem of people latching on to 'a solution' without real understanding, and obsessively pushing that 'solution'. Whatever the actual merits, that 'solution' gets tainted. A mathematician mate of mine is reluctant to mention that some of his original work has parallels with Fermat's Last Theorem, as that topic is perceived to be the domain of cranks. But his work isn't cranky.

As for Invermectin being safe and effective, IIRC, there were significant side effects (for its original purpose), and it hadn't been shown to be effective against COVID.

That dexamethasone turned out to be effective is interesting, but not that surprising that the RECOVER trials chose it as a candidate; it was actually suggested, quite early on, as a possible treatment, here on UKC. Because it is known as a treatment for HAPE, which is not unlike the pulmonary issues associated with severe COVID.

Both can also be true. 

Some people, and certain groups of people, obsessively promoting Ivermectin can make people awkward around the subject.

But simultaneously, those who so easily dismiss the proponents of Ivermectin (professional or otherwise) may also be putting too much weight on, or being insufficiently sceptical of, its opponents and their evidence.

Which is why the original point here was, why is it deemed a good thing that social media monopolies, with no more expertise in the matter, deem it acceptable to explicitly ban the discussion around such things?  Especially when the discussion (of the sorts Kory is giving) are little more than relaying the experiences of front-line medical experts with daily direct experience of treating covid? 

While Google will no doubt be all too happy to take credit for saving lives if preventing misinformation being distributed, I doubt they will in any way take responsibility for, nor will there be any reckoning or calculation, if they cost lives by inhibiting the deployment of life saving treatments.  The progressive slide by the planet's biggest information providers/monopolies into curating the sorts of discussion we are allowed to access is concerning.

Here are results from two of the massive platform trials, which have been the most successful at identifying effective treatments for COVID- Ivermectin will be tested by the first of them.

https://www.principletrial.org/results

https://www.recoverytrial.net/results

And this site has a longer list of other drugs which have been tested in other studies:

https://pharmaceutical-journal.com/article/feature/everything-you-need-to-k...

Given the list of possible candidates the two platform trials could have picked next, it doesn’t look to me that the investigators in these studies have been scared off ivermectin by baying Twitter mobs. If you think that it should have been picked ahead of the drugs they’ve looked at already, then you’ll have to persuade me that people off the internet are better at judging evidence for likely effectiveness than the people running possibly the most important and successful clinical trial in history.

Trials are not the issue.  Ivermectin is a known quantity in terms of harm and in an emergency situation resulting in a global shutdown, should we be shunning potential remedies until gold-standard trials prove their effectiveness?  Especially if that potentially shuts the door on any chance of eradicating covid in the near future?  We are 18 months in, and throughout that time to even discuss Ivermectin has been tantamount to claiming the royal family are shape-shifting lizards and considered harmful.

Doctors take an oath to “first do no harm”. Giving people a medicine on the off chance it might work just isn’t how doctors practice (certainly not ones that want to remain being doctors). 
 

Ivermectin is relatively safe, but that doesn’t mean it’s harm free. Here are the side effects, as listed in the BNF:

Abnormal sensation in eye; anaemia; appetite decreased; asthenia; asthma exacerbated; chest discomfort; coma; confusion; conjunctival haemorrhage; constipation; diarrhoea; difficulty standing; difficulty walking; dizziness; drowsiness; dyspnoea; encephalopathy; eosinophilia; eye inflammation; faecal incontinence; fever; gastrointestinal discomfort; headache; hepatitis; hypotension; joint disorders; leucopenia; lymphatic abnormalities; Mazzotti reaction aggravated; myalgia; nausea; oedema; pain; psychiatric disorder; seizure; severe cutaneous adverse reactions (SCARs); stupor; tachycardia; tremor; urinary incontinence; vertigo; vomiting
 

While some of these will be very rare, if you give it to tens of millions of people, even the rare things happen a lot. 
 

and- the third link in my previous post lists other drugs which are being investigated as COVID treatments. There are 80 of them. All have the sort of evidence that ivermectin has at present- observational studies, open label trials, small and poorly controlled RCTs. Which of the 80 should we give? Why should we pick ivermectin over any of these? If we can’t be sure, maybe we should give people more than one of them? When should we give them- dexamethasone is lifesaving in severe COVID, ineffective or even harmful in mild disease. 
 

And- more drugs put through Recovery and Principle have failed than been found effective. All of them had decent theoretical and small interventional study findings suggesting they would work before they were tested. 
 

it turns out, you do need large, well designed RCTs to determine if treatments are effective or not; and you can do a lot of harm by using unproven treatments ahead of these. Before ivermectin, hydroxychloroquine was the darling of social media, with a vociferous campaign demanding the same as ivermectin advocates are now. Millions received it, many were harmed, no one benefited. 
 

As to the toxicity of being a supporter- well the death threats to people advocating caution in its use, or even to people carrying out trials to see if it works (see segment on this week’s radio 4 Inside Science podcast) don’t help. Nor the intransigence of its supporters when misapprehensions are explained, the claims of miraculous effectiveness,  and willingness to connect ivermectin caution with wider conspiracies. And the arbitrariness of the ivermectin cult- why it, and not any of the 80 other medications from which it’s current evidence for effectiveness is not materially different? 
 

The claim it is being shunned is itself a conspiracy theory, and at odds with the real world. There’s 70 or so medications which could have been picked for the vacant “slot” on one of the platform studies, and ivermectin has been picked ahead of them. Away from the bizarre alternative world of social media, medical researchers are approaching it in exactly the same way as every other candidate treatment- looking at the evidence, examining it with the benefit of expert knowledge about the flaws inherent in small trials, and advancing promising candidates for large trials. In doing so they will find out what works, for whom, and when it should be given ; and it will keep people safe from iatrogenic harm in the process 

edit- relevant article in JAMA - on the hydroxychloroquine debacle, with relevance to the current ivermectin situation 

https://jamanetwork.com/journals/jama/fullarticle/2772921

An interesting twist from the ivermectin 'supporters' :

https://www.covid19assembly.org/2021/06/2845/

You can’t see if (I presume) but I’m currently smashing my head in to the kitchen worktop repeatedly.  
 

I can see you through your WiFi, just had second vaccine dose today and it's incredible.

That reeks of desperation, doesn’t it? You can feel the panic in the sloppy way that page is drafted.

“We want to very quickly produce a report to prove that the methodology of this study is not how it should be“

it doesn’t read like it was written by a Harvard Professor of Medicine, who supposedly sits on their advisory board (Martin Kulldorff, of Great Barrington infamy).

Indeed you’d  think with such a stellar advisory board, they wouldn’t need to beg for people off the internet to tell them what’s wrong with the study.

The funny thing is, they clearly believe that the study is going to  find it doesn’t work. It’s almost as if they don’t actually believe that it works themselves….

My immediate reaction to this is that they KNOW it's efficacy is complete b0ll0cks themselves.

Why can't we infect the sh1ts with Covid and then treat them solely with Invermectin.

That way we both prove it's useless AND get rid of the a$$holes that are pushing it at the same time.

(I know, reputable and competent scientists wouldn't do such a thing - bugger).