COVID Developments and News

[AnalogMan]

Originally Posted by MuseChaser

The increasing number of doctors PRESCRIBING ivermectin indicates that ivermectin has, indeed, shown some efficacy in alleviating Covid symptoms.

Or, another possible explanation might be that some doctors will prescribe anything for money or give patients whatever they want, medically justified or not (but of course that never happens, and especially not in Florida).

https://www.healthline.com/health-ne...pioid-epidemic

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030470/

This is a recently published meta-analysis of 29 randomized, controlled clinical trials of ivermectin in the treatment of COVID-19. The authors conclude, "The certainty of the evidence was very low to low."

https://www.medrxiv.org/content/10.1....19.21262304v1

This is another meta-analysis of 10 ivermectin clinical trials. The authors conclude "IVM did not reduce all-cause mortality, length of stay or viral clearance in RCTs in COVID-19 patients with mostly mild disease. IVM did not have effect on AEs or SAEs. IVM is not a viable option to treat COVID-19 patients."

https://www.medrxiv.org/content/10.1....21.21257595v2

Yet one more meta-analysis of 12 clinical trials of ivermectin in the treatment of COVID-19. The authors conclude, "Ivermectin was not associated with reduced mortality, or reduced patient recovery. All studies had a high risk of bias, and showed a very low certainty of the evidence."

https://www.medrxiv.org/content/10.1....26.21250420v1

Over the past 35 years, I've overseen or worked on clinical programs for 16 different therapeutic drugs. One can always torture data, play statistical games, or inadvertently (or intentionally) introduce bias that can skew outcomes. Desperation to find treatments for dire conditions can also be a factor. Which is why the above meta-analyses examining all of the trials to date are particularly interesting.

Your mileage may vary.

[wbradley]

Dadhawk, I feel for your son having to isolate. On the other hand, he gets home cooked meals or whatever you bring him, possibly gain a couple of Covid pounds, which he will burn off in a week after.
As far as the rest of the household, I guess you can always text message each other for the duration, even if one is just down the hall from the other. It's the common areas that makes is harder, kitchen etc.
Hopefully he has a Playstation in his room or likes being in the backyard weather permitting. Since he can't taste or smell, bring him food that YOU like But not too spicy! .lol

[MuseChaser]

Originally Posted by AnalogMan

Or, another possible explanation might be that some doctors will prescribe anything for money or give patients whatever they want, medically justified or not (but of course that never happens, and especially not in Florida).

https://www.healthline.com/health-ne...pioid-epidemic

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030470/

This is a recently published meta-analysis of 29 randomized, controlled clinical trials of ivermectin in the treatment of COVID-19. The authors conclude, "The certainty of the evidence was very low to low."

https://www.medrxiv.org/content/10.1....19.21262304v1

This is another meta-analysis of 10 ivermectin clinical trials. The authors conclude "IVM did not reduce all-cause mortality, length of stay or viral clearance in RCTs in COVID-19 patients with mostly mild disease. IVM did not have effect on AEs or SAEs. IVM is not a viable option to treat COVID-19 patients."

https://www.medrxiv.org/content/10.1....21.21257595v2

Yet one more meta-analysis of 12 clinical trials of ivermectin in the treatment of COVID-19. The authors conclude, "Ivermectin was not associated with reduced mortality, or reduced patient recovery. All studies had a high risk of bias, and showed a very low certainty of the evidence."

https://www.medrxiv.org/content/10.1....26.21250420v1

Over the past 35 years, I've overseen or worked on clinical programs for 16 different therapeutic drugs. One can always torture data, play statistical games, or inadvertently (or intentionally) introduce bias that can skew outcomes. Desperation to find treatments for dire conditions can also be a factor. Which is why the above meta-analyses examining all of the trials to date are particularly interesting.

Your mileage may vary.

I appreciate the reply. When I first looked into the studies about ivermectin, I did find more negative "hits" rather than positive, although there were enough studies showing some promise that, coupled with the WHO's view that clinical trial usage may still be warranted, completely discounting any usage or effectiveness of ivermectin appears premature.

The homepage to the medrxiv site to which you linked can he found here...

https://www.medrxiv.org/content/about-medrxiv

In the first paragraph on that page, it states,

"medRxiv (pronounced "med-archive") is a free online archive and distribution server for complete but unpublished manuscripts (preprints) in the medical, clinical, and related health sciences. Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information."

The bold emphasis is theirs, on the site, not mine. I'm not suggesting that the points you made should not be considered....they definitely should be, and you are correct that there are more easily accessible studies questioning the usage of ivermectin than touting it...but there have been studies showing positive results.

https://www.thelancet.com/journals/e...464-8/fulltext

"Among patients with non-severe COVID-19 and no risk factors for severe disease receiving a single 400 mcg/kg dose of ivermectin within 72 h of fever or cough onset there was no difference in the proportion of PCR positives. There was however a marked reduction of self-reported anosmia/hyposmia, a reduction of cough and a tendency to lower viral loads and lower IgG titers which warrants assessment in larger trials."

https://ivmmeta.com/

The data gathered from the metadata on that site appears to be quite definitively positive in favor of ivermectin efficacy in certain usages.

https://journals.lww.com/americanthe...ment_of.7.aspx

"Meta-analysis of 15 trials found that ivermectin reduced risk of death compared with no ivermectin (average risk ratio 0.38, 95% confidence interval 0.19–0.73; n = 2438; I2 = 49%; moderate-certainty evidence). This result was confirmed in a trial sequential analysis using the same DerSimonian–Laird method that underpinned the unadjusted analysis. This was also robust against a trial sequential analysis using the Biggerstaff–Tweedie method. Low-certainty evidence found that ivermectin prophylaxis reduced COVID-19 infection by an average 86% (95% confidence interval 79%–91%). Secondary outcomes provided less certain evidence. Low-certainty evidence suggested that there may be no benefit with ivermectin for “need for mechanical ventilation,” whereas effect estimates for “improvement” and “deterioration” clearly favored ivermectin use. Severe adverse events were rare among treatment trials and evidence of no difference was assessed as low certainty. Evidence on other secondary outcomes was very low certainty.

Conclusions:
Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally."

Just another quick sampling of some of the positive findings. I have no idea where the dust will settle, and I'm not a physician, chemist, epidemiologist, or biologist. To piggybck on your point about "some doctors will prescribe anything for money," perhaps the fact that ivermectin is inexpensive and not very profitable could make it less attractive to certain parts of the healthcare and pharmaceutical industries. I'm NOT sceptical enough to believe that's the case, but who knows.

[Dadhawk]

Originally Posted by wbradley

Hopefully he has a Playstation in his room or likes being in the backyard weather permitting. Since he can't taste or smell, bring him food that YOU like But not too spicy! .lol

Let's see, at last count he had in his room a 55" OLED TV, a PS4 and PS5, an Xbox One, and a gaming PC, plus now he has room service. Since (as of this morning) his only symptom is taste and smell, he's doing OK.

Fortunately he's a grown-ass adult and I didn't pay for any of this! They never had TVs or computers in their rooms, we had them in a common (visible) area of the house.

[spike021]

Originally Posted by Dadhawk

Well, after being exposed to the virus pretty much every 12 hour shift for the last 18 months at the behavorial health hospital where my fully vaccinated Son works, he has come down with COVID.

48 hours in, his only symptom is loss of taste and smell. No fever, cough, etc. He's here in the Hawk Nest, isolated in his room for another 8 days. I was around him quite a bit before his symptom showed up so I'm WFH this week out of an abundance of caution (first time a full week since the second week of COVID lockdown).

Of course, every time I get a twitch I'm convinced I've got a breakthrough case as well.

Hope he comes out of it quick and that you've bypassed a breakthrough infection.

[AnalogMan]

Originally Posted by MuseChaser

"medRxiv (pronounced "med-archive") is a free online archive and distribution server for complete but unpublished manuscripts (preprints) in the medical, clinical, and related health sciences. Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information."

You're correct that medRxiv is a pre-print server. Once in a while, a submitted paper will be withdrawn because subsequent experimental data will show a different outcome than preliminary results. That's the inherent nature of the scientific process. You learn from the data, but new data will teach you new things.

In actual practice, that doesn't happen very often. Most bona fide investigators are very careful to insure the robustness, validation, and reproducibility of their results before making them public, because having to retract claims can be damaging to one's reputation. It's a big deal to have a paper withdrawn.

Ironically, one of the few purportedly positive trials on ivermectin has been withdrawn:

https://www.nature.com/articles/d41586-021-02081-w

In the case of the meta-analyses I referenced, it also seems extremely unlikely that there will ultimately be a different outcome. Those studies were not experimental, but rather mathematical analyses of concluded trials. Statistics is statistics. The equations and conclusions don't evolve over time.

Here is yet another meta-analysis, evaluating 14 different ivermectin clinical trials in 1,678 participants. Like the previous three studies, the authors conclude "The reliable evidence available does not support the use of ivermectin for treatment or prevention of COVID‐19."

https://www.cochranelibrary.com/cdsr...5017.pub2/full

With at least four different meta-analyses evaluating a total of 65 ivermectin clinical trials (albeit certainly with some overlap, I didn't do a statistical analysis for how many of those were independent trials), I would say the results are abundantly clear. If analyses of 65 clinical trials all say the same thing, it's unlikely the 66th study will overturn all of that and show a convincingly different outcome. Ivermectin just does not work for the effective treatment of COVID-19.

Most recently, the Together Trial, run by McMaster University, was designed to be the largest, best structured, most comprehensive clinical study of ivermectin in COVID-19 to date. On August 6 the trial was stopped because of lack of efficacy. The investigators concluded "Ivermectin shows no effect whatsoever on the disease."

https://www.latimes.com/business/sto...o-effect-covid

The full scientific presentation:

https://rethinkingclinicaltrials.org...ills-phd-frcp/

It's very common in scientific research for an agent to show exciting in vitro experimental results, to be active in a 'test tube' experiment, but fail to provide benefit in actual clinical use. This is, by far, the rule rather than the exception (and I am a scientist who has been doing this, including schooling, for over 45 years; I've seen this countless times).

A common reason is dosing and selectivity. In a 'test tube' experiment, you can use as high of a concentration of a test article as you want. In test tubes, it's easy to deactivate the SARS-CoV-2 virus. Gasoline, bleach, alcohol, and countless other things will do it. But they're not usable as drugs, because you can't give a high enough dose to be effective without harming the patient.

With many agents, while they might 'work' in in vitro experiments, you could never dose it high enough to achieve that effective concentration in a person without harming or killing them. The doses that could be safely administered, are too low to work. From the studies I've seen, I think that's the case with ivermectin.

The World Health Organization is a fantastic, impressive group essential for the health of mankind (I interacted with them on some tuberculosis and malaria work years ago). But they have their own biases. WHO is desperate to find cheap, readily available drugs to treat COVID-19 in poorer countries. They realize that vaccines will be difficult to distribute in much of the third world, and many people won't take them anyway. If an existing, inexpensive drug were found to be a useful treatment, it could save millions of lives. Of course such a thing would be phenomenal.

Unfortunately, desperate needs and wishful thinking doesn't make something happen, and the preponderance of evidence shows that ivermectin just isn't it.

The danger of promoting things like ivermectin is the false hope it gives people. Some people will not get vaccinated because they think ivermectin is available to treat them in case they become infected. Many will die as a result. Promoting it to people who don't know better is tantamount to killing them.

[/QUOTE] I'm NOT sceptical enough to believe that's the case, but who knows.[/QUOTE]

Welcome to reality. The harsh, unpleasant truth is, some people will do anything for money. Including prescribe completely ineffective drugs to people who don't know any better. It happens all the time (like the old joke goes, 'What do you call the person who graduated last in their medical school class? Doctor.')

There have been numerous cases of unscrupulous physicians prescribing drugs that were not medically justified for personal financial profit. Just a couple of examples (this seems to be especially common in Florida) -

https://www.justice.gov/opa/pr/pain-...ee-and-florida

https://www.justice.gov/usao-edva/pr...ll-mill-scheme

https://www.jsonline.com/story/news/...ll/8121934002/

https://www.dea.gov/press-releases/2...eme-fort-worth

https://www.npr.org/2019/10/02/76640...llion-opioid-d

https://bioethics.georgetown.edu/201...ted-of-murder/

Sadly, that's the reality of ethics in the U.S. today. Some people will do literally anything for money.

It's happening with ivermectin as well -

https://www.pushhealth.com/drugs/ive...SAAEgKzzvD_BwE

https://sevencells.com/products/iver...iAAEgI8M_D_BwE

https://twitter.com/pharmersonly_/st...45172272173062

https://www.kimt.com/content/nationa...2.html?ref=762

[Irace86.2.0]

Originally Posted by MuseChaser

I appreciate the reply. When I first looked into the studies about ivermectin, I did find more negative "hits" rather than positive, although there were enough studies showing some promise that, coupled with the WHO's view that clinical trial usage may still be warranted, completely discounting any usage or effectiveness of ivermectin appears premature.

You have to be careful here. You could find 5 studies in a sea of 2000 studies that support medication X's use. The point of the meta analysis is to survey a large quantity of random studies and then to determine what the studies show. Occasionally, studies are omitted on either side for bad statistical analysis or low sampling size, and weight is attributed to robust studies that follow large sample sizes and that use techniques like having a randomized, double-blind, placebo-controlled studies. The saying goes you could demonstrate anything if you cherrypick, which is why a meta analysis is done after there is a large body of research.

If there isn't a large body of research or the research is inconclusive then it will be the suggestion of the community to continue to not use said medication outside of research studies. The community will suggest that more studies are need for a conclusive understanding, which isn't to say that they are dismissing the possibility, but that the use is contraindicated until such time that it has been demonstrated to be efficacious.

Originally Posted by MuseChaser

The increasing number of doctors PRESCRIBING ivermectin indicates that ivermectin has, indeed, shown some efficacy in alleviating Covid symptoms.

Originally Posted by MuseChaser

To piggybck on your point about "some doctors will prescribe anything for money," perhaps the fact that ivermectin is inexpensive and not very profitable could make it less attractive to certain parts of the healthcare and pharmaceutical industries. I'm NOT sceptical enough to believe that's the case, but who knows.

Prescribers have been giving out prescriptions for antibiotics to treat URIs for a long time, and this has been problematic, but you can read the reasons why doctors do it in the articles. The chief reasons are patient satisfaction, time constraints to explain why antibiotics are not needed, for a lack of understanding of the literature, or for fear of the possibility of being sued for malpractice if they don't provide something the patient wants and the patient gets worse or dies.

Similarly, we have gotten patients coming in our ED demanding hydroxychloroquine or whatever. At the PCP level, they probably just avoid a 15 minute conversation on why the medication isn't efficacious, a conversation that leads to the patient leaving upset and wanting to switch PCPs, so these providers just write the prescription to appease the patient, speed up their work flow and improve their Yelp rating, even if it is contraindicated or is nothing more than a placebo effect.

In light of this well-documented phenomenon, it would be inappropriate for you to conclude that 'prescribing prevalence' is proportional to 'use efficacy'.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC140007/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542152/

[wbradley]

I pity the person that takes a big 'ol dose of horse dewormer.

Couldn't begin to imagine what the side effect might be.

I suppose it's prudent to wear a diaper when using this medicine.

[Capt Spaulding]

Originally Posted by AnalogMan

Welcome to reality. The harsh, unpleasant truth is, some people will do anything for money. Including prescribe completely ineffective drugs to people who don't know any better. It happens all the time (like the old joke goes, 'What do you call the person who graduated last in their medical school class? Doctor.')

Yep. Some people will do anything for money.

And

Some people will pay money for anything (or nothing).

There's a sucker born every minute.

It's one of the reasons governments exist. To promote and ensure the common good by, among other things, protecting the gullible from predatory sellers and by extension, from themselves.

[Irace86.2.0]

Originally Posted by wbradley

I pity the person that takes a big 'ol dose of horse dewormer.

Couldn't begin to imagine what the side effect might be.

I suppose it's prudent to wear a diaper when using this medicine.

Butler County judge orders West Chester Hospital to treat COVID-19 patient with ivermectin, despite CDC warnings



https://www.google.com/amp/s/amp.cin...amp/5647432001

[AnalogMan]

[QUOTE=Irace86.2.0;3461296]Butler County judge orders West Chester Hospital to treat COVID-19 patient with ivermectin, despite CDC warnings



Holy sh!t!!!!



I didn't know a judge could force a physician to administer an unapproved drug (at least not for that indication) to a patient!

The subsequent malpractice suit, and assignment of blame, will be interesting to see. Should be Olympic-class finger pointing.

[MuseChaser]

Originally Posted by AnalogMan

.... Promoting it to people who don't know better is tantamount to killing them. ...

I appreciate, again, your insight throughout most of your post, but statements like the one you made above are so irrational that it makes one question the rationality of the rest of your post, simply because it came from the same source, regardless of how clinical and learned the rest appears to (and may very well) be. Suggesting that ivermectin may have some use under the care of a doctor based on some findings simply is NOT tatamount to murder, in any way, shape, or form. That makes a LOT of assumptions...

1. Awareness of possible ivermectin benefits, true or false, always leads to refusing a vaccine.
2. If you do not get the vaccine, you will become infected with Covid.
3. If you DO get the vaccine, you will not get Covid.
4. If you get Covid, you will die.

None of those are always true, some are false the majority of the time, and some are false the VAST majority of the time. If they were all true a large majority of the time, then you could make a case for your statement. As it is, the percentage of the population that dies due to having heard something positive about ivermectin is so low it would be extremely difficult to compute.....and much lower than the percentage of people who have been helped by ivermectin, even if that help was just a placebo effect. Again, there IS SOME evidence that is has been helpful well beyond the placebo effect. If those studies turn out to all be false, red herrings, or otherwise completely incorrect, so be it. It doesn't appear we're there yet, although the studies you presented certainly make a strong case in that direction.

I understand what you're trying to say, but irrational hyperbole only serves to further the divide in opinions.


[/QUOTE] I'm NOT sceptical enough to believe that's the case, but who knows.[/QUOTE]

When I wrote that, I wasn't refering to doctors prescribing drugs for money, I was refering to various health care, pharmaceutical corporations, and government interests potentially actively discrediting ivermectin and other cheap readily available drugs for financial reasons. I do believe doctors over- or incorrectly prescribe medications for their own gain. Unfortunately, if that happens, I suppose one should also be open to the possibility that similar poor motivations could and do exist on a much larger scale.

[MuseChaser]

If I may share a bit of metaphorical musing.....

As a teacher, one of the stories we were often told at various team-building and professional development days was about a starfish. Starfish-based "thank you" gifts.. charms, coasters, plaques, etc.,.. were popular things for students to give us, and were always appreciated.

For those that don't know the story, it's basically...

Person comes upon a beach littered with stranded starfish, and sees a small child throwing one of them back. When the adult saw the child doing that, a sad smile appeared on the adult's face and the adult walked over to the child and said, "Honey, that's a nice thing to do, but it won't really make a difference because they're so many of them." The child replied, "I made a difference to THAT one."

Of course, the moral is that, as a teacher, never stop trying to make a difference regardless of how insurmountable the number of struggling pupils you have may seem.

As far as our current struggles with Covid and those afflicted, two disparate parallels (if that's even possible physically?) could be drawn. Yes, we should make a difference to as many stranded starfish as possible, and take great heart in doing so. However, this time with Covid has stranded a lot of people for reasons not limited just to the direct effects of the virus itself, and in trying to make a difference to one starfish stranded by Covid, we should make sure we are not causing the stranding of thousands more for each saved starfish.

Something like that. I can't quite get it clear enough in my own head right now to articulate what's rattling around up there. The allegory in teaching was equally difficult to balance... focusing on one very troubled student in a class situation had to be balanced with the effect that would have on the rest of the pupils in the class. Always a delicate balance, and always a great challenge to find creative ways to address ALL of the pupils' needs, making a positive difference for as many starfish as possible.

[BrahmaBull1990]

Originally Posted by soundman98

i said, i think it was in the first thread-that-was, we need another world war. helps reduce the population. too many people overall.

You sound like Bill Burr hahaha