The ivermectin story is even dumber than you think

The dumb controversy around hydroxychloroquine for COVID is what inspired me to start this newsletter in the first place.

When the pandemic started to unfold, there was a huge amount of media coverage that didn’t actually capture a coherent medical viewpoint all that well, and certainly without any of the nuance describing the way that physicians are actually interpreting the COVID data.

As a consequence of the journalism sort of missing the point, smart people who are trying to stay informed can often miss the forest for the trees and end up more confused the more information they consume.

Things in that realm have only gotten worse, which is why I anticipate continuing this newsletter in some form even when the pandemic comes to an end (although that’s up for debate depending on the ongoing reader response that I receive).

And so initially, I thought that my take on ivermectin wasn’t all that important - “ivermectin is the new hydroxychloroquine” sums it up well.

Unfortunately, however, ivermectin continues to pop up, now with increasing poison control calls after people are ingesting ivermectin from horse medication as a COVID treatment. And equally unfortunately, Hanlon’s razor doesn’t apply to the ivermectin story, which we’ll get into a bit later.

So it turns out that somehow the ivermectin story has gotten dumber than the hydroxychloroquine story - which I didn’t actually think was possible.

The premise behind “they don’t want you to have ivermectin” is both wrong and dumb

One of the major arguments used to advance ivermectin as a treatment is that they don’t want you to have it because Big Pharma can’t make any money off of it.

And sure, if you think about remdesivir treatment as the only part of COVID therapy that doctors are prescribing, then its high cost may raise some eyebrows.

Throw in some monoclonal antibodies, and it’s more money in already deep pockets.

And then you add in the talk of boosters without high quality evidence behind them - and I can almost understand thinking that Big Pharma is making money off this pandemic and keeping ivermectin a secret because they don’t want you to have it.

But there’s a huge flaw in this argument - dexamethasone! This is a dirt cheap drug that has become the gold standard of treatment for patients with severe COVID infection.

If they didn’t want you to have access to a cheap drug that improved outcomes, why would they have let the RECOVERY trial on dexamethasone be published?

Because dexamethasone is pretty damn good as a treatment for severe COVID and it costs almost nothing to give.

Ask any doctor who treats these patients what the most important medication for COVID treatment is and I guarantee that you’ll get the same answer - it’s dexamethasone and we’re giving it to anyone who gets super sick.

We’re not skipping over this cheap therapy because our Big Pharma Overlords want to steal your money.

The ivermectin studies are all incredibly flawed - or made up entirely

There’s allegedly a huge meta-analysis (a study of studies - considered the top tier of scientific evidence if it includes multiple randomized trials) demonstrating that ivermectin treatment improves outcomes in patients with severe COVID.

You can look at it here. There’s also an ongoing database here.

And when you just read the top line stuff, you may start to think that ivermectin = good.

But to really understand this, you need to dig through the data. I’m a bit embarrassed at how much time I spent looking at the studies on ivermectin included in the meta-analysis.

The studies are nowhere near practice changing - they’re super low quality, for a few reasons:

  • They don’t all have placebo arms

  • Some compare ivermectin to a different treatment (which may be harmful) rather than placebo

  • They don’t all measure things of clinical importance like death or hospitalization

  • The effect size is tiny, which means that even if ivermectin works, it only has a small benefit

And that’s without even getting into the fact that the biggest study in the meta-analysis is likely comprised of fraudulent data and has been retracted, leading the journal that published meta-analysis to put out an “expression of concern.

The fraudulent trial is the one that drives the results of the meta-analysis since it’s the largest study and has the biggest effect size.

So when you take the fake data out of the ivermectin analysis and you look at a bunch of crappy studies, it just doesn’t do all that much. Its impact on death or hospitalization becomes trivial.

Even if you assume the best about ivermectin, it’s not a parachute. It’s a drug that may have a tiny impact on COVID severity on the margins.

And the highest quality study on ivermectin showed no benefit in exactly the population that the ivermectin advocates would tell you should be treated - those with early and mild disease.

I’m not super interested in discussing the ivermectin grift - but that’s why you’re hearing about this drug

America’s Frontline Doctors has been a firehose of misinformation throughout the pandemic.

They have captured a ton of attention through the use of social media and production of misleading content.

I can’t tell you how many patients I’ve seen that reference America’s Frontline Doctors or Dr. Simone Gold as their trusted sources of information on COVID. It’s incredibly depressing how easy it is to pray on people’s scientific illiteracy as a monetization strategy.

And this group has been making a ton of money from pushing medications that don’t work against COVID - first hydroxychloroquine and now ivermectin.

They charge $90 for a televisit to get a prescription for ivermectin and then not scheduling the televisits!

So when you hear that doctors won’t prescribe this life-saving medication for you because they’re trying to line their pockets instead of saving your life, that isn’t a substantive accusation. It’s projection.

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