Hiltzik: Another bogus treatment for COVID

Amid all the confounding features of the COVID-19 pandemic, one stands out: We have vaccines of established efficacy against the disease which millions of Americans have shunned for partisan reasons, and nostrums of obvious ineffectiveness that millions of people prefer.

The quintessential model for the latter — a supposed COVID treatment promoted by prominent politicians and medical commentators that proved to be useless — is the anti-malarial drug hydroxychloroquine.

That drug has pretty much fallen off the front pages, but it has been supplanted by another treatment claimed to be spectacularly effective despite an utter lack of scientific evidence.

Say hello to ivermectin.

Like the anti-malarial, ivermectin has been around for years as a known remedy for certain diseases. In hydroxychloroquine’s case, it was effective against malaria and some auto-immune conditions such as lupus.

Ivermectin is commonly prescribed by veterinarians to deworm dogs, cats and farm livestock. It also has been prescribed for humans suffering from some parasitic infections.

The drug was initially injected into the COVID treatment debate in mid-2020, thanks to a paper by Australian researchers who determined that at extremely high concentrations it showed some efficacy against the SARS-CoV-2 virus, which causes COVID, in the lab.

As pharmacological experts pointed out from the start, because of ivermectin’s particular properties, it would be almost impossible to achieve the same concentrations of the drug in the human bloodstream that were used in the lab tests.

Nevertheless, ivermectin was soon being promoted as a magic bullet against COVID, in part by anti-vaccine activists and advocates of alternative medicine. The drug quickly became something of a political darling.

Ivermectin politics are rather different from those of hydroxychloroquine, however. The latter had a partisan coloration, for its chief advocate was Donald Trump, who as president was interested in tamping down criticism that he wasn’t doing anything to win the war against the virus. Trump is gone from the White House now, however.

The political underpinning of the ivermectin craze involves a conspiracy-infused attack on the pharmaceutical and medical establishment. In this it resembles the anti-vaccine movement, as the veteran pseudoscience debunker David Gorski has pointed out.

Like anti-vaxxers, ivermectin advocates claim that information about the drug is being “suppressed,” generally by agents of Big Pharma; the core idea is that because drug companies can’t make very much money out of a drug available in generic form, they prefer to foist vaccines, on which they can make billions of dollars in profits, on the innocent public.

An especially loopy variation on this theme comes from the generally worthless pen of Matt Taibbi, who charged earlier this month that the truth about ivermectin has been stifled by “internet censorship.”

Taibbi took up arms to defend one Pierre Kory, a physician in the front lines of ivermectin promotion who complained that his posts building up the drug kept getting removed.

“Every time we mention ivermectin, we get put in Facebook jail,” Kory told Taibbi, who added the following paranoid gloss:

“With the world desperate for news about an unprecedented disaster, Silicon Valley had essentially decided to disallow discussion of a potential solution…Once, people weren’t allowed to take drugs before they got FDA approval. Now, they can’t talk about them.”

Kory hasn’t exactly been silenced, by the way. On Dec. 8 he gave lengthy testimony to the Senate Homeland Security Committee in which he called ivermectin “effectively a ‘miracle drug’ against COVID-19.”

On the other hand, he was invited to testify by Sen. Ron Johnson (R-Wis.), , the owner of one of the most universally disrespected intellects in that august chamber and a promoter even now of yes, hydroxychloroquine.

The new conspiracy claim may be even more dangerous than the promotion of hydroxychloroquine, which was more or less played out before vaccines were even available.

The ivermectin craze threatens to discourage people from getting vaccinated, the only sure path to widespread immunity from COVID. It also undermines faith in medical science, which can have profound consequences for public health.

So let’s take a look at the evidence for ivermectin as a COVID treatment. Cutting to the chase: There isn’t any evidence with scientific validity.

The most recent research paper invoked to support the use of ivermectin is a meta-analysis purporting to find that administering the drug to COVID patients reduced the risk of death by an average 62%. This is a spectacular result, if true.

Meta-analyses are done by aggregating results from many smaller studies to produce a large study sample with credible statistical power. In this case the researchers combined 15 clinical trials with a total of 2,438 participants. As Gorski and others point out, though, meta-analyses are only as good as their raw material, a phenomenon Gorski labels “garbage in, garbage out.”

In this analysis, the quality of the components is poor; many are too small to have useful results, in some cases the subjects are poorly described so that the meta-analysts can’t tell what’s being measured.

All the members of the research team are associated with a British pro-ivermectin organization and the money for the research was raised by a GoFundMe campaign headlined “Help us get a life-saving drug approved for COVID-19.”

The biggest problem with the meta-analysis concerned one of its key component studies. This was a 600-patient trial conducted by Egyptian researchers in 2020 that found a strong therapeutic effect. As data researchers Nick Brown and Jack Lawrence showed, however, there were glaring problems with that trial, its data and the report itself.

To begin with, Lawrence found what he termed “significant levels of plagiarism” in the report. Brown found that the data were a mess, with indications that some of the data were duplicated within the report. The results, he concluded, had “probably been extensively manipulated by hand.”

The report was not peer-reviewed before publication, so it probably should never have been incorporated in the meta-analysis at all. At any rate, on July 14, as the Brown and Lawrence reports went online, the preprint server that had published the Egyptian paper withdrew it “due to an expression of concern” that is “now under formal investigation.”

Dropping the Egyptian results from the meta-analysis changes the conclusion about ivermectin completely. According to Australian epidemiologist Gideon Meyerowitz-Katz, if one removes the Egypt data and re-runs the meta-analysis, “the benefit…largely loses its statistical significance.” In other words, ivermectin has no effect on COVID-19.

That wouldn’t be a surprise to the World Health Organization, the Food and Drug Administration or, indeed, Merck, a manufacturer of ivermectin. The drug company says there is “no scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies; no meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease, and; a concerning lack of safety data in the majority of studies.”

To put it another way, the ivermectin craze could threaten your health and the health of the community.

“The rather horrifying reality is that there have been enormous numbers of people treated with ivermectin largely based on a trial that, if it is not entirely fraudulent, is so flawed that it should never have been used for any treatment decisions anyway,” Meyerowitz-Katz remarked in reference to the Egyptian paper.

The same thing happened with hydroxychloroquine. Legions of people were misled by the promotion of a supposed remedy that was not only ineffective, but dangerous. Money and time were spent on clinical trials to debunk claims for a drug that should never have been part of the anti-COVID arsenal in the first place.

Now the same process is happening with ivermectin. Let’s be clear: Information about the drug isn’t being “suppressed” for political reasons. It’s being treated as what it is: dangerous misinformation.

*** This article has been archived for your research. The original version from Los Angeles Times can be found here ***