It most certainly does, and I appreciate it. With ALL of the information you collected, I have narrative believers who are trying to find holes. This was a question someone asked me, and I couldn't believe THAT was what they were focusing on.
Great piece Joomi! I admire people's abilities to translate science in a more approachable manner. I feel like my writings kind of get bogged down too deep into the jargon without deeply analyzing a lot of the nuance. There's a lot of appreciation to drawing comparisons between studies.
It's strange the type of battlefield that has arisen around Ivermectin. I will never state that people should use it because that's not my place (and something something medical advice) but the idea that practicing physicians are being blocked from practicing medicine is absolutely ludicrous. It's also quite frustrating that so many people who claim to understand a lot of the science around ivermectin shouting things such as "horse dewormer". I've pointed out multiple times in my posts that Ivermectin is a common ingredient in cat and dog dewormers, so why isn't it called a dog dewormer? How many people own cats and dogs vs those who own horses? There's a reason that label stuck because it makes the whole concept appear ludicrous to people who don't do their own analysis outside of anything within the mainstream media.
I should also remind the readers here that Ryan Grim made the claim that myocarditis is recoverable and it's a sign that the vaccines are working because inflammation is a sign that the immune system is responding! Yes, he legit said myocarditis is a sign that the immune system is working!
A few more things to point out.
I never understand the "worm" hypothesis. Quite frankly, it just feels like some sort of uneven comparison. How is it that Africa fares better because no worms means they are better at fighting off COVID, while we are told it doesn't work in the US because we don't have any worms here. Wouldn't that mean that "no worms" would be the baseline, and that Africans are "returning to baseline" by removing worms? How would you still explain why they are faring better? And if we get into talks about comorbidities then the issue would have been comorbidities aside from worm status!
I have written a bit about PAXLOVID and Ivermectin, here's one pertinent post to add to your argument about dosing:
One thing to point out is that PAXLOVID is using a P450 inhibitor called Ritonavir which prevents the protease inhibitor from being metabolized. However, Ritonavir targets the same P450 isozyme that metabolizes Ivermectin. If blood concentrations and half-life are an issue why not try Ivermectin with Ritonavir? Certainly we would at least have comparable data to PAXLOVID if we do so! Also, I posted Dr. Chris Martensen's video about Ivermectin's toxicity as well to highlight that point.
Overall, great post! I hope more people view it and at least attempt to dig a bit deep into the data rather than listen to whatever the media tells them.
Thank you! I know nothing about paxlovid but very cool to know. I came across a few other things that also seem to work in synergy to ivm, but sadly I doubt they will get much attention.
It's quite frustrating that even the mere thought of investigating Ivermectin is not allowed, but then pair it with the idea of providing a synergistic effect and there is no way it would be touched. It's a shame, especially if effective concentrations are a concern but I guess that's the struggle of COVID and dissenting viewpoints.
I've been both fascinated and appalled at what seems to be a campaign against repurposed generics being used as COVID therapeutics.
Do you remember that campaign pharma launched warning people about the dangers of acetaminophen and how it's responsible for 50,000 ER visits each year?
Or that other one warning about the over use of antibiotics and how it promotes antibiotic resistant bacteria?
Yeah, me neither. Maybe they were too busy handing out opiods like Halloween candy. It's hard to believe this level of push back is simply because they think they don't work.
Thanks for an outstanding article summarizing the issue.
Thanks for sharing many fascinating things about IVM that I had not been previously aware of. I did kinda laugh out loud when I read about the adipose tissue (so men store their fat on the inside where it isn't seen and women store it on the outside). Honestly, it's a shame that people cherry-pick a tiny bit of information and use it to unequivocally disprove something. There's a lot going on in a human body and these in vitro studies just don't capture that. Anecdotally it does appear to be helpful for COVID and it really isn't harmful (which can't necessarily be said for the vaccines and newly approved COVID drugs) ... so why not?
TLDR, but I promise to take a crack at it later (I'm a former science/pharm writer/editor) but I'm currently working on a big article about CLIMATE (another area of massing DUPING by our EXPERTS). Reason being, Money Mike survived Covid and all variants with nary a thought of getting vaxxed, or even worrying about it that much because of my strong heart and lungs and everything else... but I would have tried ivermectin if I ever got really sick, which, I never did. Keep digging!
When I got Omicron, I took both Ivermectin 18mg b.i.d and hydroxychloroquine 200mg b.i.d (among other things) and I was pretty sick with fever and cough for ~5 days before getting better. I started on Day -3 (that is, when my wife tested positive, but three days before I became symptomatic). I was kind of disappointed in the fact that I got that ill at all, though I am grateful that as a 59yo man with a BMI of ~25 it was not worse. I sure do wish we had more, better studies to find the correct dose based on a large number of patient criteria. But alas, we will never know.
Joni are you aware of the active6 study? It’s looking at the effectiveness of IVM. I am actually enrolled. Came down with CoVID two weeks ago. Obviously I don’t know whether I am test or placebo, but my concern is by the time I got the meds most of my symptoms had resolved. I am also curious about the dosage. As it seems double what the FLCC recommends, and taken over a week could show some mild adverse effects that coupled with start of treatment, >5 days, would make IVM look less effective.
the efficacy of IVM is __very clear__ and beyond any reasonable doubt. Period.
The matter is settled after the following papers got published and after thousands of patients got treated with it.
Not mentioning any of the studies by world experts such as Tess Lawrie, Prof. Fenton, Flavio Cadegiani, etc. (but mentioning Alexandros Marinos, who's not an expert, just a techie) is beyond reprehensible:
Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines
From 21,232 subjects, ICU admission was significantly lower in the ivermectin group compared to controls among participants ≥40 year-old (1.2 vs. 2.0%, odds ratio 0.608; p = 0.024). Similarly, mortality was lower in the ivermectin group in the full group analysis:
I didn't link to all these studies but I link to the ivmmeta site which I think should include all the ones you've linked to. Also the article was not meant to be a review of all the evidence, as was mentioned. Btw the analysis in the article by Marinos was done by a world expert (but I'm not saying who, in order to respect their privacy).
In other words, before doubting efficacy, one must disprove 81 studies by 782 professional scientists on 128,000 patients. Not quote some guy on the Internet coming up with an unproven worm hypothesis and home-baked meta-analysis...
Just curious: did you interpret my article as doubting efficacy? Because that was not the intention. I quote the worm guy as part of steelmaning the opposing case.
Macro, with all due respct, I really think your criticism of Joomi's article is a mistake... probably an honest mistake... maybe your first impression of his article led you into the typical 'confirmation bias' mode... this happens often to people, including myself.
Joomi made it pretty clear early on about his focus. I'm impressed with the depth of detail he went into.
It is indeed good to have a critical eye towards all these posts... but here I just want to avoid people dismissing Joomi based on your comment. I think Joomi has good stuff to offer. Thanks.
Hey Me, or I should say... you, looking at the tree and missing the forest--if done on purpose--ain't good really. If done for lack of depth of analysis ain't good either. You choose (not me): which one is it?
I understand your point, and agree in general. But when the bottom line which you are after... in this case the precise efficacy of ivermectin for COVID-19, is clearly not well known, not even by supporters of ivermectin, and is not one answer (eg people have biological differences), then it is necessary to understand the "trees" that make up the "forest"... I won't elaborate on this... I'll assume you get the point.
Dosage is one of the "trees" that needs understanding.
One of the odd things about both hydroxychloroquine and ivermectin is that the proponents seem so awfully sure that they know the "right" dosing, timing, and combination with other drugs---even though there's no clinical evidence for any of that. Even worse, this certainty only emerges whenever (as is often the case) an RCT shows that the drug in question doesn't work. When it comes to low-quality observational studies showing a correlation between hydroxychloroquine/ivermectin and Covid rates, suddenly the dosage, timing, and combination don't matter at all--the only thing that matters is that a Japanese official said something positive about ivermectin, and then later Covid rates went down, or some such nonsense.
But there is clinical evidence for the right dosing, timing, etc. and I would say it's the practitioners who have treated thousands of patients who know the most about that. And I think the reason the issue tends to come up when talking about the RCTs is because there have been several RCTS that were set up to fail from the beginning. It's a subtle level of scientific fraud, but it's fraud nonetheless. Like I mentioned, RCTs are unfortunately quite gameable. I can't speak to what you said about "low quality observational studies" because I haven't looked at all of them, because there are a lot of them, but unless you yourself have looked at all of them I'm not sure I'd buy the narrative that they're all low quality, due to the propaganda surrounding all this. My guess is that the quality is mixed, as you'd expect with any body of literature that has a lot of studies.
Doctors' anecdotal impressions don't constitute "clinical evidence" here, any more than for hormone replacement therapy, autologous stem cell transplants, radical mastectomies, anti-arrythmic drugs (before the CAST trial), stenting for stable angina, meniscectomies, lumbar fusions, and more. In all of those cases, doctors thought they had ample clinical evidence that they were helping their patients, but rigorous RCTs showed that the treatment didn't work (and often that it made things worse).
Saying that RCTs were "set up to fail" is literally begging the question. It starts out by assuming that we "know" the correct dose/timing (by some magical source other than rigorous evidence), but that's precisely a point in contention.
As for low-quality observational studies--the very word "study" is too strong of a term. I had in mind the kinds of stuff that Pierre Kory (the chief ivermectin hustler in the world) says about Japan, Uttar Pradesh, etc. https://twitter.com/PierreKory/status/1473148088902684673 When he eyeballs a chart that shows Covid rates went down, it suddenly doesn't matter whether ivermectin was used in the "correct" dosage, timing, combination, or even how often it was used at all!
If doctors' "anecdotes" are not evidence, why bother going to experienced doctors then? Wouldn't going to a doctor fresh out of med school be the same thing as seeing someone with decades of experience? I know I'd rather go to the one with more experience, all other things being equal. That's common sense. Obviously clinical experience matters and that was something I said explicitly. It's just not easily quantifiable. Claiming that RCTs are the only or even "best" kind of evidence sets us up to ignore good solid evidence.
So far, there isn't any good reason to trust the hustlers and the "true believers" who have been pushing ivermectin. Ivermectin may have some small effect, but the notion that it prevents 80-100% of deaths is supported by nothing except the self-serving and unverified testimonials of snake oil salesmen.
With respect, even the most ardent naysayer against Ivermectin, Gideon Meyerowitz-Katz acknowledges that it is plausible that IVM works against Covid. And that’s with a meta-analysis that weights the Together trial at 33%, even though it is not actually published yet. Take a few percent off that (and a few percent off Fonseca, which he weights at 34%) and suddenly it appears that IVM has quite a significant effect. Combine it with other multi modal therapy such as Vit C,D and Zinc and you might find the results are quite impressive.
In regards to “designed to fail” trials, the genesis of any clinical trial is asssessing what appears to anecdotally work by experienced clinicians or is postulated to work based on mechanism of action and then formally studying those regimes.
Many IVM trials do not appear to follow the general protocol of what the anecdotes say work, which is either sloppy research or on purpose.
IVM in terms of studying its effect in early treatment would therefore ideally need to be given as thus:
1. Within 5 days max of onset of symptoms
2. After food, preferably a fatty meal
3. Minimum 0.4mg/kg for minimum 5 days
4. Multiple arms including one arm straight IVM, one placebo and another with IVM in combination with something like C/D and zinc
Broody and Clancy had excellent results in their cohort series when given in combination with C, D and zinc
Sure, it's possible that ivermectin has a modest effect. It's not possible that ivermectin has the "miracle drug" effects that have been claimed.
Moreover, I'm 90% confident that even if someone did what you claim is the ideal randomized trial (ideal dosing and timing, etc.), the results would be disappointing, and then all the ivermectin hustlers like FLCCC would change the goalposts for the umpteenth time.
What is your technique for mind-probing? I would be useful for me if I could master it as well.
The problem with many of the criticisms about protocol and dosage is that taken collectively, they become unfalsifiable and intenally inconsistent (or even contradictory), and the putative optimal protocol varies with the practitioner and the context. If there's a valid causal mechanism, wouldn't you expect to see a consistent signal across context - such as less of an effect with a lower dosage as opposed to no clear signal at all? It's similar to the criticisms that the standard for outcomes was too high in the context of claims that its a "miracle drug" with 100% efficacy.
Efficacy advocates always have the option of picking and choosing the criteria they use to reject a trial that doesn't confirm efficacy, but not then turning around and assessing the studies they say DO show efficacy based on the same criteria. Not saying that all the efficacy advocates do that, but it's certainly something that is easily found.
It's like saying "Well, credible practitioners day they've seen it work" without having a standard for evaluating the prevalence of practitioners who say they've seen it fail. Anecdotal testimony shouldn't just be dismissed, but it should ALWAYS be placed into context.
Another outstanding piece. Thank you!! Glad to be a paying subscriber of your work.
Thank you!
If someone else hasn't asked this, would you mind providing in the piece some references for Andrew Hill's conflicts of interest related?
I put in a little update with a link to a video where Hill talks about Unitaid explicitly. Hope that helps
It most certainly does, and I appreciate it. With ALL of the information you collected, I have narrative believers who are trying to find holes. This was a question someone asked me, and I couldn't believe THAT was what they were focusing on.
Great piece Joomi! I admire people's abilities to translate science in a more approachable manner. I feel like my writings kind of get bogged down too deep into the jargon without deeply analyzing a lot of the nuance. There's a lot of appreciation to drawing comparisons between studies.
It's strange the type of battlefield that has arisen around Ivermectin. I will never state that people should use it because that's not my place (and something something medical advice) but the idea that practicing physicians are being blocked from practicing medicine is absolutely ludicrous. It's also quite frustrating that so many people who claim to understand a lot of the science around ivermectin shouting things such as "horse dewormer". I've pointed out multiple times in my posts that Ivermectin is a common ingredient in cat and dog dewormers, so why isn't it called a dog dewormer? How many people own cats and dogs vs those who own horses? There's a reason that label stuck because it makes the whole concept appear ludicrous to people who don't do their own analysis outside of anything within the mainstream media.
I should also remind the readers here that Ryan Grim made the claim that myocarditis is recoverable and it's a sign that the vaccines are working because inflammation is a sign that the immune system is responding! Yes, he legit said myocarditis is a sign that the immune system is working!
A few more things to point out.
I never understand the "worm" hypothesis. Quite frankly, it just feels like some sort of uneven comparison. How is it that Africa fares better because no worms means they are better at fighting off COVID, while we are told it doesn't work in the US because we don't have any worms here. Wouldn't that mean that "no worms" would be the baseline, and that Africans are "returning to baseline" by removing worms? How would you still explain why they are faring better? And if we get into talks about comorbidities then the issue would have been comorbidities aside from worm status!
I have written a bit about PAXLOVID and Ivermectin, here's one pertinent post to add to your argument about dosing:
https://moderndiscontent.substack.com/p/pfizer-releases-an-interim-report?s=w
One thing to point out is that PAXLOVID is using a P450 inhibitor called Ritonavir which prevents the protease inhibitor from being metabolized. However, Ritonavir targets the same P450 isozyme that metabolizes Ivermectin. If blood concentrations and half-life are an issue why not try Ivermectin with Ritonavir? Certainly we would at least have comparable data to PAXLOVID if we do so! Also, I posted Dr. Chris Martensen's video about Ivermectin's toxicity as well to highlight that point.
Overall, great post! I hope more people view it and at least attempt to dig a bit deep into the data rather than listen to whatever the media tells them.
Thank you! I know nothing about paxlovid but very cool to know. I came across a few other things that also seem to work in synergy to ivm, but sadly I doubt they will get much attention.
It's quite frustrating that even the mere thought of investigating Ivermectin is not allowed, but then pair it with the idea of providing a synergistic effect and there is no way it would be touched. It's a shame, especially if effective concentrations are a concern but I guess that's the struggle of COVID and dissenting viewpoints.
I've been both fascinated and appalled at what seems to be a campaign against repurposed generics being used as COVID therapeutics.
Do you remember that campaign pharma launched warning people about the dangers of acetaminophen and how it's responsible for 50,000 ER visits each year?
Or that other one warning about the over use of antibiotics and how it promotes antibiotic resistant bacteria?
Yeah, me neither. Maybe they were too busy handing out opiods like Halloween candy. It's hard to believe this level of push back is simply because they think they don't work.
Thanks for an outstanding article summarizing the issue.
Thanks for sharing many fascinating things about IVM that I had not been previously aware of. I did kinda laugh out loud when I read about the adipose tissue (so men store their fat on the inside where it isn't seen and women store it on the outside). Honestly, it's a shame that people cherry-pick a tiny bit of information and use it to unequivocally disprove something. There's a lot going on in a human body and these in vitro studies just don't capture that. Anecdotally it does appear to be helpful for COVID and it really isn't harmful (which can't necessarily be said for the vaccines and newly approved COVID drugs) ... so why not?
TLDR, but I promise to take a crack at it later (I'm a former science/pharm writer/editor) but I'm currently working on a big article about CLIMATE (another area of massing DUPING by our EXPERTS). Reason being, Money Mike survived Covid and all variants with nary a thought of getting vaxxed, or even worrying about it that much because of my strong heart and lungs and everything else... but I would have tried ivermectin if I ever got really sick, which, I never did. Keep digging!
Also, you might be interested in this article from 2020. You probably have better sources, but Reuters reported this... and it all died. Never seen anything since. https://news.yahoo.com/maybe-too-soon-rule-hydroxychloroquine-062705897.html
When I got Omicron, I took both Ivermectin 18mg b.i.d and hydroxychloroquine 200mg b.i.d (among other things) and I was pretty sick with fever and cough for ~5 days before getting better. I started on Day -3 (that is, when my wife tested positive, but three days before I became symptomatic). I was kind of disappointed in the fact that I got that ill at all, though I am grateful that as a 59yo man with a BMI of ~25 it was not worse. I sure do wish we had more, better studies to find the correct dose based on a large number of patient criteria. But alas, we will never know.
Joni are you aware of the active6 study? It’s looking at the effectiveness of IVM. I am actually enrolled. Came down with CoVID two weeks ago. Obviously I don’t know whether I am test or placebo, but my concern is by the time I got the meds most of my symptoms had resolved. I am also curious about the dosage. As it seems double what the FLCC recommends, and taken over a week could show some mild adverse effects that coupled with start of treatment, >5 days, would make IVM look less effective.
Joomi,
the efficacy of IVM is __very clear__ and beyond any reasonable doubt. Period.
The matter is settled after the following papers got published and after thousands of patients got treated with it.
Not mentioning any of the studies by world experts such as Tess Lawrie, Prof. Fenton, Flavio Cadegiani, etc. (but mentioning Alexandros Marinos, who's not an expert, just a techie) is beyond reprehensible:
Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines
https://journals.lww.com/americantherapeutics/fulltext/2021/08000/ivermectin_for_prevention_and_treatment_of.7.aspx
Bayesian Meta Analysis of Ivermectin Effectiveness in Treating Covid-19 (with sensitivity analysis to account for possibly flawed studies)
https://www.researchgate.net/publication/353794395_Bayesian_Meta_Analysis_of_Ivermectin_Effectiveness_in_Treating_Covid-19_with_sensitivity_analysis_to_account_for_possibly_flawed_studies
https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8415515/
Ivermectin Prophylaxis Used for COVID-19: A Citywide, Prospective, Observational Study of 223,128 Subjects Using Propensity Score Matching
https://www.cureus.com/articles/82162-ivermectin-prophylaxis-used-for-covid-19-a-citywide-prospective-observational-study-of-223128-subjects-using-propensity-score-matching
From 21,232 subjects, ICU admission was significantly lower in the ivermectin group compared to controls among participants ≥40 year-old (1.2 vs. 2.0%, odds ratio 0.608; p = 0.024). Similarly, mortality was lower in the ivermectin group in the full group analysis:
https://www.frontiersin.org/articles/10.3389/fpubh.2022.813378/full
I didn't link to all these studies but I link to the ivmmeta site which I think should include all the ones you've linked to. Also the article was not meant to be a review of all the evidence, as was mentioned. Btw the analysis in the article by Marinos was done by a world expert (but I'm not saying who, in order to respect their privacy).
Sander?
In other words, before doubting efficacy, one must disprove 81 studies by 782 professional scientists on 128,000 patients. Not quote some guy on the Internet coming up with an unproven worm hypothesis and home-baked meta-analysis...
Just curious: did you interpret my article as doubting efficacy? Because that was not the intention. I quote the worm guy as part of steelmaning the opposing case.
I interpreted it as I interpreted the Marinos article: "looking at the tree and missing the forest"...
Macro, with all due respct, I really think your criticism of Joomi's article is a mistake... probably an honest mistake... maybe your first impression of his article led you into the typical 'confirmation bias' mode... this happens often to people, including myself.
Joomi made it pretty clear early on about his focus. I'm impressed with the depth of detail he went into.
It is indeed good to have a critical eye towards all these posts... but here I just want to avoid people dismissing Joomi based on your comment. I think Joomi has good stuff to offer. Thanks.
Hey Me, or I should say... you, looking at the tree and missing the forest--if done on purpose--ain't good really. If done for lack of depth of analysis ain't good either. You choose (not me): which one is it?
I understand your point, and agree in general. But when the bottom line which you are after... in this case the precise efficacy of ivermectin for COVID-19, is clearly not well known, not even by supporters of ivermectin, and is not one answer (eg people have biological differences), then it is necessary to understand the "trees" that make up the "forest"... I won't elaborate on this... I'll assume you get the point.
Dosage is one of the "trees" that needs understanding.
One of the odd things about both hydroxychloroquine and ivermectin is that the proponents seem so awfully sure that they know the "right" dosing, timing, and combination with other drugs---even though there's no clinical evidence for any of that. Even worse, this certainty only emerges whenever (as is often the case) an RCT shows that the drug in question doesn't work. When it comes to low-quality observational studies showing a correlation between hydroxychloroquine/ivermectin and Covid rates, suddenly the dosage, timing, and combination don't matter at all--the only thing that matters is that a Japanese official said something positive about ivermectin, and then later Covid rates went down, or some such nonsense.
But there is clinical evidence for the right dosing, timing, etc. and I would say it's the practitioners who have treated thousands of patients who know the most about that. And I think the reason the issue tends to come up when talking about the RCTs is because there have been several RCTS that were set up to fail from the beginning. It's a subtle level of scientific fraud, but it's fraud nonetheless. Like I mentioned, RCTs are unfortunately quite gameable. I can't speak to what you said about "low quality observational studies" because I haven't looked at all of them, because there are a lot of them, but unless you yourself have looked at all of them I'm not sure I'd buy the narrative that they're all low quality, due to the propaganda surrounding all this. My guess is that the quality is mixed, as you'd expect with any body of literature that has a lot of studies.
Doctors' anecdotal impressions don't constitute "clinical evidence" here, any more than for hormone replacement therapy, autologous stem cell transplants, radical mastectomies, anti-arrythmic drugs (before the CAST trial), stenting for stable angina, meniscectomies, lumbar fusions, and more. In all of those cases, doctors thought they had ample clinical evidence that they were helping their patients, but rigorous RCTs showed that the treatment didn't work (and often that it made things worse).
Saying that RCTs were "set up to fail" is literally begging the question. It starts out by assuming that we "know" the correct dose/timing (by some magical source other than rigorous evidence), but that's precisely a point in contention.
As for low-quality observational studies--the very word "study" is too strong of a term. I had in mind the kinds of stuff that Pierre Kory (the chief ivermectin hustler in the world) says about Japan, Uttar Pradesh, etc. https://twitter.com/PierreKory/status/1473148088902684673 When he eyeballs a chart that shows Covid rates went down, it suddenly doesn't matter whether ivermectin was used in the "correct" dosage, timing, combination, or even how often it was used at all!
If doctors' "anecdotes" are not evidence, why bother going to experienced doctors then? Wouldn't going to a doctor fresh out of med school be the same thing as seeing someone with decades of experience? I know I'd rather go to the one with more experience, all other things being equal. That's common sense. Obviously clinical experience matters and that was something I said explicitly. It's just not easily quantifiable. Claiming that RCTs are the only or even "best" kind of evidence sets us up to ignore good solid evidence.
So far, there isn't any good reason to trust the hustlers and the "true believers" who have been pushing ivermectin. Ivermectin may have some small effect, but the notion that it prevents 80-100% of deaths is supported by nothing except the self-serving and unverified testimonials of snake oil salesmen.
With respect, even the most ardent naysayer against Ivermectin, Gideon Meyerowitz-Katz acknowledges that it is plausible that IVM works against Covid. And that’s with a meta-analysis that weights the Together trial at 33%, even though it is not actually published yet. Take a few percent off that (and a few percent off Fonseca, which he weights at 34%) and suddenly it appears that IVM has quite a significant effect. Combine it with other multi modal therapy such as Vit C,D and Zinc and you might find the results are quite impressive.
In regards to “designed to fail” trials, the genesis of any clinical trial is asssessing what appears to anecdotally work by experienced clinicians or is postulated to work based on mechanism of action and then formally studying those regimes.
Many IVM trials do not appear to follow the general protocol of what the anecdotes say work, which is either sloppy research or on purpose.
IVM in terms of studying its effect in early treatment would therefore ideally need to be given as thus:
1. Within 5 days max of onset of symptoms
2. After food, preferably a fatty meal
3. Minimum 0.4mg/kg for minimum 5 days
4. Multiple arms including one arm straight IVM, one placebo and another with IVM in combination with something like C/D and zinc
Broody and Clancy had excellent results in their cohort series when given in combination with C, D and zinc
Sure, it's possible that ivermectin has a modest effect. It's not possible that ivermectin has the "miracle drug" effects that have been claimed.
Moreover, I'm 90% confident that even if someone did what you claim is the ideal randomized trial (ideal dosing and timing, etc.), the results would be disappointing, and then all the ivermectin hustlers like FLCCC would change the goalposts for the umpteenth time.
Exactly (I didn't read this before my comment above).
"Set up to fail."
What is your technique for mind-probing? I would be useful for me if I could master it as well.
The problem with many of the criticisms about protocol and dosage is that taken collectively, they become unfalsifiable and intenally inconsistent (or even contradictory), and the putative optimal protocol varies with the practitioner and the context. If there's a valid causal mechanism, wouldn't you expect to see a consistent signal across context - such as less of an effect with a lower dosage as opposed to no clear signal at all? It's similar to the criticisms that the standard for outcomes was too high in the context of claims that its a "miracle drug" with 100% efficacy.
Efficacy advocates always have the option of picking and choosing the criteria they use to reject a trial that doesn't confirm efficacy, but not then turning around and assessing the studies they say DO show efficacy based on the same criteria. Not saying that all the efficacy advocates do that, but it's certainly something that is easily found.
It's like saying "Well, credible practitioners day they've seen it work" without having a standard for evaluating the prevalence of practitioners who say they've seen it fail. Anecdotal testimony shouldn't just be dismissed, but it should ALWAYS be placed into context.