- Ivermectin is good at killing parasites, but it’s still not clear it can do much for COVID-19.
- Some of the most popular studies people use to tout its benefits against the coronavirus are deeply flawed.
- Better answers are on the way.
Chinese chemist Tu Youyou (wearing the yellow scarf) won the other half of that prize for discovering new malaria drugs.
“Parasitic diseases affect the world’s poorest populations and represent a huge barrier to improving human health and wellbeing,” the Nobel committee said in a release at the time. “This year’s Nobel Laureates have developed therapies that have revolutionized the treatment of some of the most devastating parasitic diseases.”
She said ivermectin is “necessary to deworm patients,” including some of those who develop COVID-19 symptoms.
Ivermectin can clear out roundworm infections, which is critical to do before people are given immunosuppressing steroids for coronavirus treatment. Left untreated, it’s possible those roundworms could invade the lungs.
“In the context of COVID-19, it can worsen your respiratory failure,” Antonio said. “It’s a concern for low-income countries.”
The FLCCC is frequently cited by America’s Frontline Doctors, a top destination among people searching the internet for ivermectin tablets, and their work is included in various internet roundups of ivermectin research which proclaim the drug is not only safe, but extremely effective against COVID-19.
At first blush, it may look like all this evidence stacks up to provide an impressive track record, demonstrating ivermectin’s supreme usefulness in fighting COVID-19. But the truth is far murkier than that.
“It doesn’t say that this drug is effective in real life clinical practice, but it gives you the hint that it needs to be studied further,” Dr. Zain Chagla, an infectious-disease physician at St. Joe’s Hamilton and associate professor at McMaster University in Canada, said.
In other words, just because something works in a petri dish doesn’t mean it’ll do the same thing in humans.
Chagla, and many other experts, have also pointed out that the ivermectin dosage used in the study is far higher than anything that could safely be given to us.
“There’s effective ways to kill viruses in a lab that don’t translate into what we could safely do in people,” Dr. Kevan Akrami, an infectious-disease and critical-care physician working in Salvador, Brazil, recently told Insider.
Even the study authors from Monash say their work does not “provide a definitive answer to whether or not ivermectin is a potential treatment for COVID-19.”
(They are committed to conducting further research on the drug to better answer that question.)
That’s not what happened here. Patients were ferried into different groups in seemingly haphazard ways, making it impossible to draw firm conclusions about what effect the medicine might’ve had on their outcomes.
For example, there is a far greater percentage of patients in the non-ivermectin group with hypertension (12.9%, compared to 7.9% in the ivermectin group). That could be one reason why they didn’t fare as well in the trial, which has nothing to do with the ivermectin.
“You have to read about research in a critical way,” Susanna Priest, editor in chief of the peer-reviewed journal Science Communication, previously told Insider. “What we have here is a conflict between our commitment to freedom of speech, and a clash with the nature of scientific truth.”
(The Journal of Clinical and Diagnostic Research, where this study was published, did not respond to Insider’s questions about whether this study was being investigated and/or retracted.)
“Amazingly, the study found that people treated with ivermectin were 90% less likely to die than people who got the placebo, which if true would make ivermectin the most incredibly effective treatment ever to be discovered in modern medicine,” epidemiologist Gideon Meyerowitz-Katz from the University of Wollongong wrote in a blog post combing through the study’s various errors.
The introduction has been plagiarized, many of the data are near-identical from patient to patient (raising questions about whether they were fabricated), and some of the participants included in the study were already dead when this research began.
Dr. Alkis Psaltis, an Australian author on the paper who was not involved in collecting the data for it (but lent his expertise to the writing and editing stage), later grew so alarmed at all the red flags that he asked to have his authorship withdrawn.
“I trusted the information provided to me,” the head and neck surgeon at The Queen Elizabeth Hospital told BuzzFeed.
Medical Press, which is a pay-to-publish journal, did not respond to Insider’s questions about whether it was investigating and/or retracting this study.
Pay to publish scientific journals don’t charge readers, but instead charge the scientists who publish in them hundreds to thousands of dollars to have a single study printed. Not all pay-to-publish journals are bad, but there is often a monetary incentive for them to push out lots of studies quickly, even if the quality of that work is not up to par, and there is little incentive to retract inaccurate work.
“It doesn’t matter how many studies there are, ultimately we still haven’t answered the question,” he said.
That’s because the study wasn’t designed to parse out what role ivermectin is playing in patient outcomes, versus all the other factors in people’s lives that might affect how they fare.
Large, well-designed randomized controlled trials (RCT), the gold standard for all drug research, are needed.
None so far have surfaced for ivermectin that stand up to scrutiny.
“The quantity of evidence is meaningless, it’s the quality of evidence that we care about,” Meyerowitz-Katz added.
But “a review that includes research that’s been retracted is not very useful,” Meyerowitz-Katz said.
In addition to relying heavily on flawed research, this meta-analysis also points to “natural experiments” with ivermectin in Brazil as proof the drug can combat COVID-19. But doctors working in that country have told Insider that Brazil’s experience with ivermectin should be a warning to anyone who thinks the drug could be useful to treat COVID, or replace vaccines.
“Whether somebody was taking it or not didn’t seem to have any impact on whether or not they got hospitalized or ended up dying from their COVID infection,” Akrami told Insider. “At this point in the pandemic, we really don’t have any reason to continue prescribing ineffective medications for prophylaxis or treatment.”
“People will find poor quality studies to justify prescribing, and that would almost be equal to malpractice,” Dr Akrami said, adding that there’s “a lot more faith than evidence behind some of these practices.”
According to the slide shown here, the researchers found no meaningful difference in the outcomes of patients who were treated early on in their COVID-19 infection with ivermectin, versus those who had recieved a placebo pill.
That’s quite similar to what researchers found in a March RCT of 476 COVID-19 patients in Colombia. Their research was published in the peer-reviewed journal JAMA, which does not make authors pay to have their studies printed.
More definitive answers may come soon from Oxford’s Principle trial, the world’s largest study of at-home treatment for COVID-19.
“Once we have findings from our study about ivermectin that have been validated, I would be delighted to comment,” Principle investigator Christopher Butler told Insider.