Cont: Corona Virus Conspiracy Theories Part IV

[crescent]

.... we need to reevaluate that in the medical community. That's going to be a seriously uphill battle given ivermectin is already in the quack medicine category.

That's kind of how I see it. It looks like it might have some value to some people if used at the right time and in the right dose - maybe. It looks like it dos not harm if used in the right dose, especially if it is only used early on.

But to the cultural/political right it is Manna-Medicine from Heaven! I mean I have even seen someone recommend using to "cure" homosexuality (I'm not making that up). On the left it is horse paste and nothing but horse paste and there is a deliberate unwillingness to admit that the drug has ever had any legitimate use to humans.

In other words, the drug got caught up in the black and white thinking of the political extremes. There is no doubt whatsoever that people have died due to inappropriate use of the drug. We have yet to determine if any Covid death has been prevented due to proper use of the drug.

By the way, except for probable denial of insurance coverage, healthcare providers with prescriptive authority in the US can prescribe FDA approved drugs for off-label purposes. We don't need special FDA approval.

Wouldn't employers of medical professionals also have a say in that? Could it such practices be prohibited as a condition of hospital admitting privileges?

 

[michaelsuede]

No. My advice is when introducing a new protocol you evaluate it prospectively, ideally with an RCT. If you do an RCT in house it does not cost large amounts of money. Indeed the fact you quote an RCT of the HAT protocol shows it can be done.

FWIW Large multi centre RCTs were done to show dexamethasone / steroids were effective for covid despite being cheap out of patent generic drugs. Large RCT are being done for a number of repurposed generic drugs. Our own Darat was in a large RCT looking at Ivermectin in mild covid run by Oxford University. McMasters University is co-ordinating trials of a number of repurposed drugs, some of which are far more likely to be effective than Ivermectin. Indeed the McMaster trial of Ivermectin failed to show significant benefit.

I am interested to know did you read the papers you quote?
https://pubmed.ncbi.nlm.nih.gov/31469984/
Not a prospective RCT. Conclusion;

https://pubmed.ncbi.nlm.nih.gov/32194058/
Iglesias et al; a prospective RCT. Conclusion;

I did read the papers, I said they found benefit, which they clearly did.

https://pubmed.ncbi.nlm.nih.gov/31469984/

Although no significant mortality benefit was observed, the vitamin C protocol was not associated with patient harm. In this Veteran population, there was reduced ICU length of stay, suggesting possible benefit. Though further investigation is warranted, utilization of IV vitamin C, thiamine, and hydrocortisone in patients with sepsis or septic shock may be a treatment option worth considering.

https://pubmed.ncbi.nlm.nih.gov/32194058/

Our results suggest that the combination of IV ascorbic acid, thiamine, and hydrocortisone significantly reduced the time to resolution of shock. Additional studies are needed to confirm these findings and assess any potential mortality benefit from this treatment.

As for the RCTs, I like to refer to what ivmmeta notes about them in this context.

Designed to fail. Additional upcoming trials including ACTIV-6, COVID-OUT, and PRINCIPLE have been designed in a way that favors finding no effect, with a number of methods including late treatment, selecting low-risk patients, fasting administration, very high conflict of interest medication sourcing, and dosing below current clinical practice. For discussion see [Goodkin].

along with

RCTs have a bias against finding an effect for interventions that are widely available — patients that believe they need the intervention are more likely to decline participation and take the intervention. This is illustrated with the extreme example of an RCT showing no significant differences for use of a parachute when jumping from a plane [Yeh]. RCTs for ivermectin are more likely to enroll low-risk participants that do not need treatment to recover, making the results less applicable to clinical practice. This bias is likely to be greater for widely known treatments such as ivermectin. The bias may also be greater in locations where ivermectin is more easily obtained. Note that this bias does not apply to the typical pharmaceutical trial of a new drug that is otherwise unavailable.

Evidence shows that non-RCT trials can also provide reliable results. [Concato] find that well-designed observational studies do not systematically overestimate the magnitude of the effects of treatment compared to RCTs. [Anglemyer] summarized reviews comparing RCTs to observational studies and found little evidence for significant differences in effect estimates. [Lee] shows that only 14% of the guidelines of the Infectious Diseases Society of America were based on RCTs. Evaluation of studies relies on an understanding of the study and potential biases. Limitations in an RCT can outweigh the benefits, for example excessive dosages, excessive treatment delays, or Internet survey bias could have a greater effect on results. Ethical issues may also prevent running RCTs for known effective treatments. For more on issues with RCTs see [Deaton, Nichol].

 

[Planigale]

You're not going to find any. There are no treatment recommendations published by western governmental bodies recommending ANY repurposed off-patent medications. The only recommendations that exist include patented drugs costing $700+ per treatment regimen.

I don't know if you've done this or not, but you really need to take a minute to listen to Paul Marik's story in the OP.

I do not believe you have reviewed every western governments guidelines.
But I only have to find one example to refute your statement and prove to untrue.
https://www.nice.org.uk/guidance/ng...-version-of-the-guideline-pdf-pdf-51035553326
Current UK (technically England and Wales) guidelines. Number one in treatment protocol is Dexamethasone a cheap off-patent repurposed medication.

 

[michaelsuede]

What belief system?



They are running trials on a variety of treatments, to have informed consent I needed to know which group I was in.



I was very ill, and I didn’t have any symptoms that quickly resolved, it was a slow recovery over about a week after my peak of feeling ill before my symptoms were down to the level of a cold.

That's interesting. Did they tell you what the medication dosage was? Were you prescribed dosage by weight?

 

[michaelsuede]

I do not believe you have reviewed every western governments guidelines.
But I only have to find one example to refute your statement and prove to untrue.
https://www.nice.org.uk/guidance/ng...-version-of-the-guideline-pdf-pdf-51035553326
Current UK (technically England and Wales) guidelines. Number one in treatment protocol is Dexamethasone a cheap off-patent repurposed medication.

I'm sorry, I should have been more specific. There are no treatment protocols for early treatment that include off-patent medication. Once a patient is hospitalized, steroids have been authorized as you note. Treatments like ivermectin are known to work best when given with in the first 72 hours of symptomatic infection.

Continue corticosteroids for up to 10 days unless there is a clear indication to stop early, which includes discharge from hospital or a hospital-supervised virtual COVID ward.

 

[Planigale]

I did read the papers, I said they found benefit, which they clearly did.

https://pubmed.ncbi.nlm.nih.gov/31469984/


https://pubmed.ncbi.nlm.nih.gov/32194058/


As for the RCTs, I like to refer to what ivmmeta notes about them in this context.



along with

I am afraid at the end of the day, the question is did the treatment save lives. Marik claimed that HAT 'cured' sepsis. He claimed a reduction in mortality from 40% to 8%. Yet no one else has been able to show a mortality benefit.

The problem is this is all reminiscent of the azithromycin and hydroxychloroquine claims based on small non randomised studies. Or the Ivermectin studies claiming what I said were unbelievably good results which subsequently turned out to be fraudulent. Badly done studies claiming dramatic effects that then require inordinate amount of resources to refute. If Ivermectin had the dramatic results that some claim, it would be easy to demonstrate in an RCT. If HAT had the magnitude of effect Marik claimed it would have been demonstrated in an RCT. Prospective cohort studies may be as reliable as RCT (though recruiting larger numbers), but it does not mean you can not detect a survival benefit with an RCT. The bigger a benefit, the easier it is to claim. When you start having to claim that study failed because the moon was in the wrong phase or the patient took the treatment the wrong way then your treatment does not have a big effect and is not going to work in the real world.

 

[michaelsuede]

I am afraid at the end of the day, the question is did the treatment save lives. Marik claimed that HAT 'cured' sepsis. He claimed a reduction in mortality from 40% to 8%. Yet no one else has been able to show a mortality benefit.

The problem is this is all reminiscent of the azithromycin and hydroxychloroquine claims based on small non randomised studies. Or the Ivermectin studies claiming what I said were unbelievably good results which subsequently turned out to be fraudulent. Badly done studies claiming dramatic effects that then require inordinate amount of resources to refute. If Ivermectin had the dramatic results that some claim, it would be easy to demonstrate in an RCT. If HAT had the magnitude of effect Marik claimed it would have been demonstrated in an RCT. Prospective cohort studies may be as reliable as RCT (though recruiting larger numbers), but it does not mean you can not detect a survival benefit with an RCT. The bigger a benefit, the easier it is to claim. When you start having to claim that study failed because the moon was in the wrong phase or the patient took the treatment the wrong way then your treatment does not have a big effect and is not going to work in the real world.

I think what you are forgetting is that other data exists, besides RCTs, showing ivermectin is effective. There is a vast body of literature encompassing tens of thousands of patients showing it works. Just because an RCT doesn't show a clear benefit doesn't mean it doesn't work, which could be due to a wide variety of reasons as ivmmeta notes.

Further, ivermectin is safer than aspirin. If ivermectin had the same adverse event history as remdesivir, I would be in COMPLETE agreement that it should never be given unless first proven by a very broad controlled double blind placebo control trial, but that is not the case. There is NO HARM in giving ivermectin, even if it doesn't work at all. The precautionary principle indicates it should be given, even if it has no benefit at all.

Further, there is absolutely NO reason why the FDA, hospital administration or medical boards should be targeting doctors for prescribing a drug that is safer than aspirin in the hopes that it might work, even if it doesn't.

 

[Azrael 5]

Tin foil hatters https://twitter.com/Lyndonx/status/1486050696516489216?t=A8SsfP3f4c8G0a1tA304NA&s=19#

 

[Darat]

That's interesting. Did they tell you what the medication dosage was? Were you prescribed dosage by weight?

Yes and yes.

 

[michaelsuede]

Yes and yes.

What was the mg per Kg they gave you?

 

[Jim_MDP]

I am afraid of Rogan, too. He is spreading consequential falsehoods.

Neil Young had something to say to Spotify about that... "You can have Rogan, or Young... not both."
An ultimatum or pull his catalog. All of it.

Good on ya, Neil. [emoji2955]

 

[Skeptic Ginger]

It seems like you are processing some of my information, but not all of it. You say providers with prescriptive authority in the US can prescribe FDA approved drugs for off-label purposes, but seem to not be comprehending that Marik was suspended for doing exactly that.

This is not a question of legality, hospital administrators are dictating patient treatments, overriding doctors and firing doctors who do not do what administrators demand. Further, medical boards are threating the licenses of doctors who prescribe off-label drugs for COVID.

What is it about I don't give a **** about that, I do, however care about this that you don't understand? That's why I want to start a new thread.

As for medical boards, none of them are suspending licenses for prescribing ivermectin alone.

 

[Planigale]

I think what you are forgetting is that other data exists, besides RCTs, showing ivermectin is effective. There is a vast body of literature encompassing tens of thousands of patients showing it works. Just because an RCT doesn't show a clear benefit doesn't mean it doesn't work, which could be due to a wide variety of reasons as ivmmeta notes.

Further, ivermectin is safer than aspirin. If ivermectin had the same adverse event history as remdesivir, I would be in COMPLETE agreement that it should never be given unless first proven by a very broad controlled double blind placebo control trial, but that is not the case. There is NO HARM in giving ivermectin, even if it doesn't work at all. The precautionary principle indicates it should be given, even if it has no benefit at all.

Further, there is absolutely NO reason why the FDA, hospital administration or medical boards should be targeting doctors for prescribing a drug that is safer than aspirin in the hopes that it might work, even if it doesn't.

You do not know ivermectin is safe in Covid-19 until you do the studies. You may guess that because ivermectin is safe pre-Covid-19 when used to treat parasitic infections that it is safe to treat covid-19, but you do not know until the RCT has been done.

if you speculate that covid-19 affects virus-host interactions based on in vitro studies the actual real world impact can only be confirmed by properly planned studies.

There is not a vast body of high quality evidence of the efficacy of ivermectin for covid-19. It disappears as soon as you look at it.

If a properly powered RCT fails to show that there is not a significant effect you can be reasonably sure there is not a significant effect. In clinical medicine, one cannot just count up unpublished papers pro and con, you have to assess the quality power and relevance of studies. High quality, well performed, large studies fail to show an effect. Small, fraudulent, poor quality studies, show unbelievable results. You cannot say 6 terrible non-peer reviewed unpublished papers beat 4 good studies. Anyone who starts an argument in clinical science with the number of studies on one side versus the other has lost.

Anyone who uses an argument based on a fantasy about big pharma influencing the FDA has lost. The NHS easily deals with big pharma. Just look at the number of pharma companies who come to 'confidential' arrangements with the NHS when the NHS refuses to pay the price asked.

If a drug works, it works in a RCT. I do not disagree prospective cohort studies are good trials; but they are as good as RCT not better.

FWI you do the study appropriate to the intervention. For the 'parachute' study you would use a 'play the winner' study not a RCT. There is actually a lot of finesse in clinical research.

 

[angrysoba]

Has anyone mentioned Uttar Pradesh yet? Or Japan?

 

[Skeptic Ginger]

...
Wouldn't employers of medical professionals also have a say in that? Could it such practices be prohibited as a condition of hospital admitting privileges?

Yes, not all doctors in the US are "employees". Often they merely have admitting privileges at certain hospitals. So a hospital can withdraw admitting privileges.

 

[Skeptic Ginger]

I do not believe you have reviewed every western governments guidelines.
But I only have to find one example to refute your statement and prove to untrue.
https://www.nice.org.uk/guidance/ng...-version-of-the-guideline-pdf-pdf-51035553326
Current UK (technically England and Wales) guidelines. Number one in treatment protocol is Dexamethasone a cheap off-patent repurposed medication.

What are you talking about? Marik works in the US, not in the UK.

You really should take a closer look at those meta-analyses. They are worth the time to consider.

 

[angrysoba]

What are you talking about? Marik works in the US, not in the UK.

You really should take a closer look at those meta-analyses. They are worth the time to consider.

Before heading down the Ivermectin rabbit hole, it may be worth listening to this podcast.

This goes very into the weeds, but the TL;DL is that the meta-analyses rely on a few large studies to generate large outcomes for ivermectin, and these have very serious question marks over their reliability. In fact, some are probably outright fraudulent research and have been retracted.

Once you remove studies with a high level of bias there seems to be little left.

Link

One of the people on the pod is an epidemiologist who has his own Medium articles here.

 

[angrysoba]

There are ongoing trials in the UK and in Japan for ivermectin.

That said, so far the data from the Together trial does not look good for ivermectin.

The TOGETHER Clinical Trial was initiated in June of 2020, as an international collaboration in response to the worsening pandemic of SARS-CoV-2 / COVID-19. Utilizing an adaptive platform trial design, the international researchers and teams in Brazil, Canada, Australia, and the United States sought to identify evidence-informed therapeutics, through the re-purposing of existing medications.

The randomized adaptive platform trial aims to investigate the efficacy of repurposed treatments for COVID-19 disease among high-risk adult outpatients. Currently, there are 22 identified research sites in Brazil, and over 4,000 research participants.

https://www.togethertrial.com/trial-specifications

They looked at hydroxichloroquine, ivermectin, metformin and fluvoxamine. Apparently only fluvoxamine looks promising.

(I am told that when fluvoxamine showed promise, the FLCCC decided to quietly add it to their protocol although they had never even talked about it before. The idea being that people might go to their site and say, "Oh look! They got fluvoxamine right. Probably they are right about ivermectin as well, then!"

 

[Planigale]

What are you talking about? Marik works in the US, not in the UK.

You really should take a closer look at those meta-analyses. They are worth the time to consider.

The reference was to 'any western government' I did not think the reference meant the governments of California, Oregon and Washington.

Re meta-analyses.
Considered them mostly crap. They include fraudulent studies. Stick to the cochrane collaboration, they at least have expertise in meta-analysis.

 

[Craig4]

Thats nice. Thanks.

VAERS reporting is voluntary.

How many non-fatal adverse events were not reported ?

How many were killed by the injections, which were not reported ?

What's the point in telling you? When have you ever demonstrated the ability to parse and understand the data? Please show us somewhere in your posting history where you have shown a capacity to understand the data you've asked for.