I had no intention on doing another post about using ivermectin in treating Flu Manchu (and Rolling Stone‘s shabby Oklahoma hit piece), but too many links of interest on the subject have popped up to ignore.
Again, I’m not a doctor, and can’t pretend to knowledgeably evaluate the competing claims and evidence of using ivermectin to relieve coronavirus symptoms. But a whole lot of The Usual Suspects in the Democratic Media Complex who have been wrong about almost everything when it comes to Mao Tze Lung seem suspiciously anxious to attack the possibility it’s efficacious. Such claims should be evaluated not for whether they help or hinder Democratic Party policy goals, but for results shown in well-constructed clinical trials. (And not the “Hey, we gave Ivermectin to coronavirus patients without zinc, vitamin D or antibiotics and they didn’t get any better” variety.)
So: Some links.
First up, here’s Joe Rogan discussing his own coronavirus treatment including Ivermectin, monoclonal antibodies, Z-pack, Prednisone, a NAD drip and a vitamin drip:
The there’s this piece pointed out by commenter Alec Rawls, which cites much lower coronavirus morbidity among Africans who regularly took Ivermectin for parasite control than among those who didn’t:
In the graphic above, the blue area shows the countries of Africa that distribute ivermectin once or twice a year for the control of parasites. The brown area is the countries that don’t. The brown line is the daily deaths from Covid per one hundred thousand people in those countries. The blue line is the same for the blue area — which is enjoying a far, far lower Covid death rate. A lot of the poor and backward countries of South America, Africa and Asia have now approved ivermectin for Covid.
Here’s a balanced assessment of using Ivermectin to treat coronavirus:
It’s worth taking a bit of time first to understand the basis behind the excitement for ivermectin as a possible agent against Covid-19, as well as the reservations expressed by the medical establishment. Ivermectin, much more than a “horse dewormer,” is a genuinely useful anti-parasitic medication, used widely in our own species primarily for tropical diseases like onchocerciasis and lymphatic filariasis. While never tested in human subjects for possible antiviral properties prior to the arrival of SARS-CoV-2, it had been studied in the laboratory setting for theoretical properties against multiple viral pathogens. The potential for anti-inflammatory properties – the sort that, like fellow old generic, dexamethasone, could prove useful against Covid-19’s infamous cytokine storm – was also known. Topically applied, it has been shown to be anti-inflammatory, and is prescribed for the autoimmune skin condition, rosacea; and systemically, there exists some in vivo evidence (albeit in mice).
What are the chances that an antiparasitic with mere hints of anti-viral and anti-inflammatory properties would amount to the most effective medication on the face of the planet against SARS-CoV-2 on both counts? Slim, indeed. Much of the skepticism that I, and most of the medical establishment, felt towards ivermectin can be explained through that lens: the prior probability of these rather remarkable assertions being true was so low, that the bar for evidence was set rather high.
The evidence stacks up in rather complicated fashion. If your blister pack of ivermectin is half-full, you might find the arguments in favor of ivermectin’s efficacy convincing. Biological plausibility for its antiviral potential was established in April, 2020, by an Australian team led by Dr Leon Cary, Dr Kylie Wagstaff, and Dr David Jans, who showed that, in a laboratory in vitro setting, ivermectin rapidly cleared SARS-CoV-2 RNA from cells. Doubts were raised that real world human dosing of ivermectin could ever reach those experimental concentrations, but a single modeling study concluded that it would at least be a possibility in lung tissue. In any case, the race to study ivermectin in humans was on. Given the dismal circumstances in the spring of 2020, many regions, especially South America, began both to embrace and to study the use of ivermectin against Covid-19 on the premise of this hope.
The positive reports have been numerous. There are country-level, “ecologic” reports of Covid-19 cases, hospitalizations, and deaths improving after large scale distribution and/or deployment efforts, such as in Peru. The most visible supporter of ivermectin among physician groups, the controversial Front Line Covid-19 Critical Care Alliance (“FLCCC Alliance”), led by respected intensive care specialist, Dr Paul Marik, and his protégé, Dr Pierre Kory, is keen to share anecdotal reports of physicians seeing remarkable success via prescribing ivermectin both as prophylaxis (prevention before becoming infected with SARS-CoV-2) and treatment of early/mild as well as severe disease. A multitude of favorable observational studies has been published, which generally involve studying how patients treated with ivermectin did in contrast to those left untreated; these are described in detail on the FLCCC Alliance position paper. Finally, dozens of our evidential gold standard, the randomized control trial, have been performed, and the vast majority have found benefit to using ivermectin. A recent ivermectin meta-analysis by outspoken ivermectin advocate, Dr Tess Lawrie, Dr Andrew Bryant, and their team, combining data from 24 such trials, found an overall 62% reduction in risk of death when used for treatment, but has been fairly questioned for including a fraudulent study. Another meta-analysis by Yuani Roman et. al., which had excluded the study in question, expressed concerns over trial quality and concluded that ivermectin was “not a viable option” for covid-19 treatment, but did find a similar mortality benefit of around 60%, albeit without statistical significance.
And if your blister-pack is half-empty? There are many valid reasons to view the data on ivermectin with healthy skepticism. Ecologic studies, anecdotal reports, and case series are useful in science, but primarily to signal the need for higher quality studies, not as validation for adopting a novel treatment. Regional epidemic curves shift and swerve constantly, for a variety of reasons which can confound any effort to attribute causation to one factor; some of the same people who credit improvements in Mexico or India to ivermectin campaigns are less sanguine if told that a lockdown or mask mandate was the cause of a Covid-19 outbreak leveling off. As a physician, I might be tempted to give a patient a steroid injection for an arthritic knee because my personal experience tells me that I am usually a hero afterwards; but broader study of this practice tells me I should not overvalue my own experiences.
Most importantly, there are real concerns about the quality of the many RCTs performed on ivermectin. Many trials were unregistered or unreported (opening the door for mid-stream protocol changes and publication bias); a large number were self-funded; and the only trial performed at what might be considered a major medical academic center, at Spain’s University of Navarra, was one of the only trials with negative results. While I might be termed an “-ist” of some sort for saying this, it’s easier for me to trust the scholarship of major institutions oozing with grant money and filled with talented researchers skimmed from the rest of the world than from places with a very limited history of performing and publishing clinical trials.
Adding to these concerns, the issue of fraud has reared its head on several important ivermectin studies. One of the first papers claiming a mortality benefit for ivermectin in hospitalized patients was taken from the tainted (or quite possibly imaginary) Surgisphere database, and was quickly retracted (but not before influencing policy in South America). So, too, was the hugely influential Elgazzar et. al. study from Egypt, which claimed a 90% reduction in mortality, but was rather convincingly exposed to be fraudulent this past July. Finally, the remarkable study from Argentina’s Dr Hector Carvallo, finding a head-scratching 100% effectiveness at preventing Covid-19 infection among health care workers (none of the 788 workers taking ivermectin and carageenan contracted the disease, while 57% of those using standard PPE did), fell at the end of August, with compelling arguments that it is nearly inconceivable that it even happened as advertised.
To be clear, I do not see any suggestion of a Big Pharma conspiracy or cover-up here. Surgisphere’s other biggest retraction was related to the study which unfairly bashed the safety of ivermectin fellow-traveler, hydroxycholoquine. Oxford researcher Andrew Hill, one of the most visible, respected scientists supporting the utility of ivermectin in Covid-19, retracted his team’s positive meta-analysis once the Elgazzar study was withdrawn. Even biologist-turned-podcaster, Dr. Bret Weinstein, high on the list of vocal ivermectin supporters, has concurred that Dr Carvallo will not share his data from Argentina, and that “we should rate the evidentiary value of this study as zero.”
Where does this leave us? Cautious, I would say, but still curious. Evidence of fraud is not evidence of ineffectiveness.
Plus a discussion of dosage debate and possible side effects, and a warning not to self-dose with animal formulations:
For the curious: a typical 7.3 gram tube of veterinary equine-grade 1.87% ivermectin is about 135mg of ivermectin, or ten times a normal dose; as someone who has had to calculate mg/kg doses at midnight on pediatric wards, this sort of math always makes me nervous. What really makes me nervous is the Proprietary Component A, B, and C that make up the other 98.13% of the tube – please, please do not ingest this stuff.
Dr. Hollander also urges vaccination.
Kevin D. Williamson notices a pattern that applies to recent ivermectin reporting:
In 2015, I taught a journalism seminar at Hillsdale College, the subject of which was Sabrina Erdely’s 2014 Rolling Stone article, “A Rape on Campus,” which related the story of a horrifying, brutal sexual assault at the University of Virginia, a crime that — and this part still matters! — did not happen. The story was a fantasy, a concoction, and a libel — and Rolling Stone’s report was, in the words of Erik Wemple at the Washington Post, a “complete crock.”
A crock of what precisely, though?
Like most of the phony hate crimes and fabricated racial and sexual insults that have for years been an epidemic among young Americans, especially on college campuses, the Rolling Stone rape hoax was a neurotic casserole of familiar ingredients: social and romantic disappointment, weaponized envy, prejudice, mental-health problems, and a progressive-activist culture in which the effort to discredit and abominate cultural enemies — more often than not dishonest — takes the place of argument.
These things follow a pattern: When Lena Dunham made up a story about being raped while a student at Oberlin, her fictitious villain was not a member of the chess team or the president of the campus Sierra Club chapter but a swaggering College Republican; when North Carolina Central University student Crystal Mangum made up a story about being gang-raped, the malefactors were the Duke lacrosse team; the UVA hoax author, Jackie Coakley, falsely claimed that she was gang-raped by members of the Phi Kappa Psi fraternity as part of an initiation ritual. When feminist activist Judy Munro-Leighton made up a story about being raped, she chose as her assailant Brett Kavanaugh, who was at the time a Supreme Court nominee in confirmation hearings. Jussie Smollett alleged that he was assaulted in the wee hours by . . . weirdly bitey Trump-loving Empire fans who just happened to have a length of rope and a quantity of bleach on their persons as they roamed the freezing streets of Chicago on an early January morning.
In all of these cases, the story wasn’t about what the story was about.
None of those fabricated rapes was presented as a mere crime of sexual violence — a crime that happens every day in these United States, disproportionately affecting not college women (who are, in fact, less likely to suffer rape than are women the same age who are not in college) or well-heeled activists but poor women in isolated urban and rural communities, women with little education, women on Indian reservations, illegal immigrants, etc. The stories and the data associated with some of these places are shocking.
But here’s the thing: Nobody cares about those women.
Not really. Of course, they’ll say they do. In reality, the kind of women our newspaper editors and magazine publishers care about are college students, white tourists abroad, and celebrities. But the most important variable in these hoaxes is not any of the personal qualities of the fictitious victims but the cultural resonance of the fictitious attackers. If you want to see a Native American leading the nightly news, put him in front of some white high-school kids wearing MAGA hats.
Magazines such as Rolling Stone, the major newspapers, the academic establishment, and the professional-activist class are not staffed in the main by people who grew up on Indian reservations or in dysfunctional mountain villages, people who dropped out of high school, people who have been incarcerated, or other people from the margins. You may find one or two or those at any given media property, but you’ll find a lot more Oberlin and UVA graduates. Their interests, anxieties, and obsessions are those associated with their class. They don’t know — or care — what’s happening at Pine Ridge or in Owsley County. But they do know what sort of class-adjacent people they like and don’t like, they do know what sort of lifestyles and cultural affiliations they disapprove of, they do remember being snubbed or insulted (even if they only imagined it) by some frat goofus at UVA, and they do know what sort of people they resent.
They don’t know much, but they know what they hate.
And so these made-up rape stories are not stories about rape — they are indictments of fraternity culture, or jock culture, or Southern institutions, or Republicans, or anybody else who wanders into the cultural crosshairs of the hoax artists. The Oklahoma ivermectin story works in the same way, fitting into a prefab politico-cultural narrative that is not strictly speaking connected to the facts of the case at hand. Stephen Glass’s fictitious report from CPAC is another example of the same thing at work. No one questions tales of victimization involving people they assume to be, always and everywhere, victims. No one questions tales of depravity discrediting people they believe to be depraved. Joe Rogan can’t be a half-bright meathead who sometimes says things Professor Plum doesn’t like — he has to be a monster, responsible for the deaths of hundreds or thousands of people. Of course the corpses of those rubes in Oklahoma are piling up like cordwood — Joe Rogan has to be stopped!
There’s just too much quotable material in that Williamson piece:
For progressives who see those who do not share their political priorities not as having different views but as enemies, publishing a made-up story about deranged gang-rapists at UVA pushes all the right buttons: white privilege, rich-jerk privilege, male privilege, Southern brutality, maybe even Christian hypocrisy if you can figure out a way to shoehorn it in there.
You can be sure that if someone had come forward with an unsubstantiated, loosey-goosey story about having been gang-raped by the staff of Rolling Stone, that claim would have received a good deal more scrutiny — not only at Rolling Stone, but at any mainstream-media outlet. Not because they are personally connected to Rolling Stone staffers, but because they live in the same world as Rolling Stone staffers. Southern fraternity members and college athletes are natural bogeymen to the media-staffer demographic, and so claims about them, however outrageous, are treated sympathetically. Oklahoma, on the other hand, inspires more fear among big-city progressives than the terrifying prospect of . . . being made to pay their own property taxes.
Snip.
This is a problem of political bias, but political bias is part of a larger cultural bias, a particular social orientation. Rolling Stone has always been left-leaning, but it also was for many years the home of great writing from conservatives, notably P. J. O’Rourke and Tom Wolfe. But we have closed ranks, socially, in recent years, for a variety of reasons, many of them just blisteringly stupid. This has coincided with certain social and economic changes that have undermined the quality of American journalism. It is not that we do not know how to get it right, or even that we do not have the resources to get it right — it is that our petty hatreds and cultural tribalism have led us to believe that it does not matter if we get it right, that lies and misrepresentations about cultural enemies are virtuous in that they serve a “greater truth.” And this is not an exclusively left-wing phenomenon: Donald Trump’s lies, and the distortions and misrepresentations of right-wing talk radio and cable news, are excused and even celebrated on the same grounds.
The test of a political claim in our time is not whether it is true or false but whether it raises or lowers the status of our enemies.
Matt Taibbi also weighs in on the same subject:
The line spread the next day with a retweet by Rachel Maddow — the real patient zero of this mess — followed by tweet-pushes by MSNBC executive producer Lauren Peikoff, the Guardian, the Business Insider, the Daily Mail, Newsweek, the New York Daily News, Daily Kos, Occupy Democrats, Reid, moral mania all-star Kurt Eichenwald, the humorously dependable wrongness-barnacle Eoin Higgins, and of course my former employers at Rolling Stone. My old mag got most of the catcalls on social media, after adding a full written story that widened the scope beyond Oklahoma to note in a tsk-tsking tone that “even podcaster and anti-vaccine conspiracy theorist Joe Rogan bragged” of taking ivermectin.
The original report would have been sensational enough, if true. McElyea told stories of backed-up ambulances, patients “in worse conditions than if they’d caught COVID,” and “scariest” of all, “people coming in with vision loss.” Nonetheless, in the game of Twitter telephone that led from KFOR to the Stone, details were magically added. Reid somehow knew the hated overdosers not only swallowed “horse paste” but had done so “instead of taking the vaccine.” Occupy Democrats knew for whom the horse-pasters voted, noting that “so many Trumpers are overdosing” that emergency rooms are full.
Snip.
The problem lay in the reason the error spread, which happens to be the same reason underlying innumerable other media shipwrecks in the last five years. These include everything from wrong reports of Russians hacking a Vermont energy grid, to tales of Michael Cohen in Prague, to the pee tape, to Julie Swetnick’s rape accusation, to the Covington high school fiasco, to Russian oligarchs co-signing a Deutsche Bank loan application for Donald Trump, to Bountygate, to the “mass hysterectomies” story, and dozens beyond: the media business has become a machine for generating error-ridden moral panics.
I note that all the stories here with the exception of the hysterectomies one (which I don’t remember receiving nearly the play of the others) all involve MSM outlets hyping fabrications to bash Trump.
News has become a corporatized version of the “Two Minutes Hate,” in which the goal of every broadcast is an anxiety-ridden audience provoked to the point of fury by the un-policed infamy of whatever wreckers are said to be threatening civilization this week: the unvaccinated, insurrectionists, Assadists, Greens, Bernie Bros, Jill Stein, Russians, the promoters of “white supremacy culture,” etc. Mistakes are inevitable because this brand of media business isn’t about accuracy, but rallying audiences to addictive disgust. As a result, most press people now shrug off the odd error or six — look at Maddow leaving her tweet up — so long as they feel stories are directionally right, i.e. aimed at deserving targets.
Are there people out there damaging themselves with overdoses of veterinary ivermectin? It wouldn’t surprise me. There are a lot of stupid people in the world. We know that outpatient prescriptions for ivermectin increased earlier this year, but actual certified medical reports of ivermectin overdoses seem pretty thin on the ground.
The reluctance of the Democratic Media Complex to skeptically investigate claims that fit into their narrow worldview, especially in reference to populations they regard as political enemies, is a far greater threat to the body politic than any ivermectin abuse.