“driven by a very generous motivation to try to find inexpensive cures"
October 2, 2021 3:25 PM Subscribe
Scientific American's round-up and run-down of what's up with Ivermectin. Despite what fringe physicians' groups recommend -- “twice a week for as long as [COVID] risk is elevated" -- ivermectin is usually given as a one-time dose when it is used as a parasite treatment for humans. Cases of severe poisoning and even death are on the rise. At the same time, clinical trials of Ivermectin as well as Fluvoxamine (serotonin uptake inhibitor), Metformin (glucose/insulin regulator), and Fluticasone (steroid) continue as researchers explore the possibility that drugs "known to decrease inflammatory proteins (cytokines) in the body" will treat covid.
COVID-OUT trial at University of Minnesota: If we give metformin, ivermectin, fluvoxamine, or a combination of these medications to individuals soon after they develop COVID-19, will it decrease the severity of their symptoms? Will it prevent them from needing hospitalization? This study hopes to answer these questions.
COVID-OUT trial at University of Minnesota: If we give metformin, ivermectin, fluvoxamine, or a combination of these medications to individuals soon after they develop COVID-19, will it decrease the severity of their symptoms? Will it prevent them from needing hospitalization? This study hopes to answer these questions.
I’m going to vent a tiny little bit. I’ve been disturbed by the reaction of people on “my side” to the ivermectin craze. It’s certainly true that it had not been proven to treat COVID, and the CDC’s guidance against using it is sound.
But calling it “horse paste”, and passing around hoax news stories about how it’s filling up emergency rooms, and generally lacking context about the history and nature of the drug: that’s unscientific too.
In particular, the messaging that positions ivermectin as a purely veterinary medication is disingenuous and unhelpful.
Ivermectin is a cheap, safe drug with an excellent global distribution network in place. On a clinical level, it’s well understood: hundreds of millions of doses have been delivered. These facts alone make the question “does this do anything to COVID” worthwhile, even if a hypothetical mode of action isn’t obvious. And there are intriguing in vitro studies showing activity against alphaviruses, which are positive-sense RNA viruses like SARS-CoV-2.
Which is to say that while we do not have convincing clinical evidence of ivermectin’s effectiveness, the idea is not ridiculous, or foolish, or even particularly unscientific.
Antivax charlatans promoting ivermectin as a COVID treatment in lieu of vaccination are hurting people. But I don’t think “ha ha look at that MAGA shoving horse paste up his ass” is a helpful response.
posted by mr_roboto at 4:12 PM on October 2, 2021 [49 favorites]
But calling it “horse paste”, and passing around hoax news stories about how it’s filling up emergency rooms, and generally lacking context about the history and nature of the drug: that’s unscientific too.
In particular, the messaging that positions ivermectin as a purely veterinary medication is disingenuous and unhelpful.
Ivermectin is a cheap, safe drug with an excellent global distribution network in place. On a clinical level, it’s well understood: hundreds of millions of doses have been delivered. These facts alone make the question “does this do anything to COVID” worthwhile, even if a hypothetical mode of action isn’t obvious. And there are intriguing in vitro studies showing activity against alphaviruses, which are positive-sense RNA viruses like SARS-CoV-2.
Which is to say that while we do not have convincing clinical evidence of ivermectin’s effectiveness, the idea is not ridiculous, or foolish, or even particularly unscientific.
Antivax charlatans promoting ivermectin as a COVID treatment in lieu of vaccination are hurting people. But I don’t think “ha ha look at that MAGA shoving horse paste up his ass” is a helpful response.
posted by mr_roboto at 4:12 PM on October 2, 2021 [49 favorites]
Meanwhile, Merck plans to apply for emergency use authorization for molnupiravir after it shows a 50% reduction in hospitalization and death among (unvaccinated) patients who had not yet progressed to severe disease. It also has good safety indicators, and Merck is trialing it as a pre-exposure prophylaxis for high risk individuals.
I’d be pretty dang surprised if any of these drugs show efficacy and safety that good.
posted by jedicus at 4:16 PM on October 2, 2021 [6 favorites]
I’d be pretty dang surprised if any of these drugs show efficacy and safety that good.
posted by jedicus at 4:16 PM on October 2, 2021 [6 favorites]
See also, via NIH, the American Journal of Therapeutics, April 2021: Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19.
posted by BWA at 4:16 PM on October 2, 2021 [1 favorite]
posted by BWA at 4:16 PM on October 2, 2021 [1 favorite]
A roundup from the Guardian about the progress of some treatments being studied/trialed
posted by trig at 4:21 PM on October 2, 2021
posted by trig at 4:21 PM on October 2, 2021
One of earliest, and largest, studies that was cited in the NIH review upthread has been withdrawn because it's bullshit.
posted by rdr at 4:37 PM on October 2, 2021 [34 favorites]
posted by rdr at 4:37 PM on October 2, 2021 [34 favorites]
So if I’m reading the Scientific American article about monoclonal antibody treatments (mAbs) accurately:
* They involve injecting mice with basically the mRNA COVID vaccine (or something that’s the same idea, just targeting a different protein on the sars-cov-2 virus) and harvesting the antibodies the mice cells produce. Then using human cancer cells to make more of those antibodies (I recall reading elsewhere that these would generally be from stem cell lines?). Then injecting those mouse-human-cancer-derived antibodies into COVID patients. It seems like many of the objections I’ve heard expressed about the COVID vaccines would apply just as much to mAbs?
* They are only authorized in the US by an emergency use authorization (which has restrictive conditions such that not everyone is eligible to receive mAbs). Just like the vaccines were until just recently.
* The mode of administration of the Regeneron version is the same as for vaccines, so would have similar issues with anything else in the shot as a vaccine shot would (except mAbs require four simultaneous sub-cutaneous shots - two in arm and two in stomach - or 20 minutes on an IV).
* The efficacy is lower than for most of the vaccines.
* The side effects are more common. In particular, you have to stick around for an hour, not just 15 minutes, in case of severe allergic reaction.
* They have been developed in a for-profit model by some of the same companies now manufacturing COVID vaccines.
I’m glad the folks who are pushing vaccine disinformation and scaremongering haven’t also come out against mAbs - they’re definitely far better than nothing, for those who are eligible to receive a treatment. But there clearly isn’t any objective, scientific or evidence-based reasoning behind opposing COVID vaccines but accepting mAbs. (I recalll reading that one of the anti-BAC governors - DeSantis, perhaps? - had a financial stake in the regeneron treatment though.)
posted by eviemath at 4:47 PM on October 2, 2021 [6 favorites]
* They involve injecting mice with basically the mRNA COVID vaccine (or something that’s the same idea, just targeting a different protein on the sars-cov-2 virus) and harvesting the antibodies the mice cells produce. Then using human cancer cells to make more of those antibodies (I recall reading elsewhere that these would generally be from stem cell lines?). Then injecting those mouse-human-cancer-derived antibodies into COVID patients. It seems like many of the objections I’ve heard expressed about the COVID vaccines would apply just as much to mAbs?
* They are only authorized in the US by an emergency use authorization (which has restrictive conditions such that not everyone is eligible to receive mAbs). Just like the vaccines were until just recently.
* The mode of administration of the Regeneron version is the same as for vaccines, so would have similar issues with anything else in the shot as a vaccine shot would (except mAbs require four simultaneous sub-cutaneous shots - two in arm and two in stomach - or 20 minutes on an IV).
* The efficacy is lower than for most of the vaccines.
* The side effects are more common. In particular, you have to stick around for an hour, not just 15 minutes, in case of severe allergic reaction.
* They have been developed in a for-profit model by some of the same companies now manufacturing COVID vaccines.
I’m glad the folks who are pushing vaccine disinformation and scaremongering haven’t also come out against mAbs - they’re definitely far better than nothing, for those who are eligible to receive a treatment. But there clearly isn’t any objective, scientific or evidence-based reasoning behind opposing COVID vaccines but accepting mAbs. (I recalll reading that one of the anti-BAC governors - DeSantis, perhaps? - had a financial stake in the regeneron treatment though.)
posted by eviemath at 4:47 PM on October 2, 2021 [6 favorites]
Aspirin is a cheap, safe drug with an excellent global distribution network in place. On a clinical level, it’s well understood: hundreds of millions of doses have been delivered. These facts alone make the question “does this do anything to COVID” worthwhile, even if a hypothetical mode of action isn’t obvious. Cheese is a cheap, safe food with an excellent global distribution network in place. On a clinical level, it’s well understood: hundreds of millions of doses have been delivered. These facts alone make the question “does this do anything to COVID” worthwhile, even if a hypothetical mode of action isn’t obvious.
Just because we have a lot of something doesn't mean it makes sense to ask "does this do anything to COVID." A hypothetical mode of action is the exact thing that separates science from quackery.
posted by rikschell at 5:18 PM on October 2, 2021 [60 favorites]
Just because we have a lot of something doesn't mean it makes sense to ask "does this do anything to COVID." A hypothetical mode of action is the exact thing that separates science from quackery.
posted by rikschell at 5:18 PM on October 2, 2021 [60 favorites]
I’ve been disturbed by the reaction of people on “my side” to the ivermectin craze.
Broad public scepticism of Ivermectin treatment will probably not halt genuine scientific studies. I mean, it hasn’t so far, right? On the other hand, kooks and grifters have in fact seized on any scrap of scientific equivocation as justification for refusing vaccination and social distancing measures. Only one of these things is a genuine concern.
posted by Joe in Australia at 5:18 PM on October 2, 2021 [60 favorites]
Broad public scepticism of Ivermectin treatment will probably not halt genuine scientific studies. I mean, it hasn’t so far, right? On the other hand, kooks and grifters have in fact seized on any scrap of scientific equivocation as justification for refusing vaccination and social distancing measures. Only one of these things is a genuine concern.
posted by Joe in Australia at 5:18 PM on October 2, 2021 [60 favorites]
To be a useful drug, it’s not enough to just do what is desired, it’s also necessary to do so at a dose that doesn’t do excessive damage. Hydrochloric acid is a very effective cancer treatment, in vitro. Ivermectin is effective against SARS-CoV2 replication in vitro at concentrations approximately 3000x the peak plasma concentration achieved in standard ivermectin anti-parasitic therapy in humans (3 uM vs 100 nM)
So it’s likely to require truely heroic doses to be effective in vivo (especially since the above compares peak concentration to that which would have to be sustained for useful prophylaxis). That’s not to say we shouldn’t defer to the clinical information when it becomes available - maybe there are other mechanisms at play in terms of cytokine modulation or something - but the in vitro inhibition of viral replication is not a sound basis for claims of clinical promise.
posted by memetoclast at 5:19 PM on October 2, 2021 [44 favorites]
So it’s likely to require truely heroic doses to be effective in vivo (especially since the above compares peak concentration to that which would have to be sustained for useful prophylaxis). That’s not to say we shouldn’t defer to the clinical information when it becomes available - maybe there are other mechanisms at play in terms of cytokine modulation or something - but the in vitro inhibition of viral replication is not a sound basis for claims of clinical promise.
posted by memetoclast at 5:19 PM on October 2, 2021 [44 favorites]
I saw a study yesterday for Ivermectin from Duke.
Subjects were supposed to self report testing positive, then they were going to be sent the pills in the mail.
I can't see how that passed any kind of review process at all.
posted by atchafalaya at 5:21 PM on October 2, 2021 [10 favorites]
Subjects were supposed to self report testing positive, then they were going to be sent the pills in the mail.
I can't see how that passed any kind of review process at all.
posted by atchafalaya at 5:21 PM on October 2, 2021 [10 favorites]
And there are intriguing in vitro studies showing activity against alphaviruses, which are positive-sense RNA viruses like SARS-CoV-2.
They're only intriguing if you fail to note that the plasma levels that are required to have any effect on viruses are well in excess of what kills a human.
Also, until very recently in most hospitals in my state someone who ends up in the ER because they poisoned themselves in an attempt to use Ivermectin prophylactically was literally taking a bed away from someone else because they were completely fucking full thanks to their fellow traveler vaccine refuseniks.
Perhaps the reactions have not been as kind as might be desirable, but there's good reason for it. People overdosing on horse paste are/were exacerbating a crisis of care. When the ERs aren't full to the brim, I can leave it at "play stupid games, won stupid prizes," but when they're taking up what little space is left over for people with non-COVID emergencies, it's a problem for all of us, not just those who have convinced themselves that bullshit actually smells like roses.
posted by wierdo at 5:22 PM on October 2, 2021 [66 favorites]
They're only intriguing if you fail to note that the plasma levels that are required to have any effect on viruses are well in excess of what kills a human.
Also, until very recently in most hospitals in my state someone who ends up in the ER because they poisoned themselves in an attempt to use Ivermectin prophylactically was literally taking a bed away from someone else because they were completely fucking full thanks to their fellow traveler vaccine refuseniks.
Perhaps the reactions have not been as kind as might be desirable, but there's good reason for it. People overdosing on horse paste are/were exacerbating a crisis of care. When the ERs aren't full to the brim, I can leave it at "play stupid games, won stupid prizes," but when they're taking up what little space is left over for people with non-COVID emergencies, it's a problem for all of us, not just those who have convinced themselves that bullshit actually smells like roses.
posted by wierdo at 5:22 PM on October 2, 2021 [66 favorites]
there are intriguing in vitro studies showing [ivermectin] activity against alphaviruses
nah. mundane is the right word. you can kill any virus in vitro with, well, a lot. household bleach does it. says nothing about a drug's potential therapeutic value.
do you want magas drinking bleach? 'cause this is how you get magas drinking bleach. or going on horsepaste binges.
posted by j_curiouser at 5:24 PM on October 2, 2021 [21 favorites]
nah. mundane is the right word. you can kill any virus in vitro with, well, a lot. household bleach does it. says nothing about a drug's potential therapeutic value.
do you want magas drinking bleach? 'cause this is how you get magas drinking bleach. or going on horsepaste binges.
posted by j_curiouser at 5:24 PM on October 2, 2021 [21 favorites]
It would take a lot to make me run down to the farm store and put medicine marked as being for horses into my body for a disease that in this scenario I don't even believe exists. I mean I hope it would take a lot.
posted by bleep at 5:26 PM on October 2, 2021 [12 favorites]
posted by bleep at 5:26 PM on October 2, 2021 [12 favorites]
horse paste
If the box says "ivermectin paste" on it with a picture of a horse, a lot of people are gonna call that horse paste. That's fair, I think.
Sheep paste would have been funnier, though.
posted by ryanrs at 5:30 PM on October 2, 2021 [45 favorites]
If the box says "ivermectin paste" on it with a picture of a horse, a lot of people are gonna call that horse paste. That's fair, I think.
Sheep paste would have been funnier, though.
posted by ryanrs at 5:30 PM on October 2, 2021 [45 favorites]
If the box says "ivermectin paste" on it with a picture of a horse...
"If they don't have a picture of their horse, they probably don't have a horse ...” said Megan Wilton of Westway Feed and Seed in Delta. The store’s “horse selfie” test has allowed it to politely turn away customers and preserve the medication for those that need it.
posted by Thella at 5:46 PM on October 2, 2021 [50 favorites]
"If they don't have a picture of their horse, they probably don't have a horse ...” said Megan Wilton of Westway Feed and Seed in Delta. The store’s “horse selfie” test has allowed it to politely turn away customers and preserve the medication for those that need it.
posted by Thella at 5:46 PM on October 2, 2021 [50 favorites]
I agree with ryanrs that sheep paste would have been funnier. "Sheep dip" is, I think, the term of art for that particular veterinary medication, and even funnier, imo.
I'm disappointed to see the kind of concern trolling that mr_roboto displays here, because it obscures the responsibility of the antivaxers (many are vaccinated themselves, of course) for convincing people to avoid a safe, extremely effective, and free vaccine—an act that has caused countless deaths. That these actions have caused sickness and death in people who were vaccinated means that their evil actions are beneath contempt. It's an insult to every person who is not a sociopath. We can talk all day about what is and what isn't a "helpful response," a discussion which is the essence of concern trolling, which is itself the essence of unhelpful.
This is venting more than a tiny bit because of the way it's being done. If you're worrying about by the actions of people on "our side," you are worrying about the wrong things. You should be worrying about unscrupulous people who want to install theocratic fascism in this country and are willing to kill people with COVID to advance that goal.
posted by ivanthenotsoterrible at 5:52 PM on October 2, 2021 [71 favorites]
I'm disappointed to see the kind of concern trolling that mr_roboto displays here, because it obscures the responsibility of the antivaxers (many are vaccinated themselves, of course) for convincing people to avoid a safe, extremely effective, and free vaccine—an act that has caused countless deaths. That these actions have caused sickness and death in people who were vaccinated means that their evil actions are beneath contempt. It's an insult to every person who is not a sociopath. We can talk all day about what is and what isn't a "helpful response," a discussion which is the essence of concern trolling, which is itself the essence of unhelpful.
This is venting more than a tiny bit because of the way it's being done. If you're worrying about by the actions of people on "our side," you are worrying about the wrong things. You should be worrying about unscrupulous people who want to install theocratic fascism in this country and are willing to kill people with COVID to advance that goal.
posted by ivanthenotsoterrible at 5:52 PM on October 2, 2021 [71 favorites]
passing around hoax news stories about how it’s filling up emergency rooms
If they are hoaxes, they are passed around by generally reputable news outlets. So we really don't need to come here to defend antivaxxers here from their own stupid behaviors. And we really do need to call out how their behaviors are breaking access to healthcare for all, which is already problematic for many, at best.
posted by They sucked his brains out! at 6:02 PM on October 2, 2021 [16 favorites]
If they are hoaxes, they are passed around by generally reputable news outlets. So we really don't need to come here to defend antivaxxers here from their own stupid behaviors. And we really do need to call out how their behaviors are breaking access to healthcare for all, which is already problematic for many, at best.
posted by They sucked his brains out! at 6:02 PM on October 2, 2021 [16 favorites]
At this point if Ivermectin actually had anything more than a slight effect we would have seen it. There are countries were a significant portion of the population already takes it and they’ve also had outbreaks.
posted by interogative mood at 7:12 PM on October 2, 2021 [4 favorites]
posted by interogative mood at 7:12 PM on October 2, 2021 [4 favorites]
I'm going to echo mr_roboto here a bit, on the slightly related issue that, as a fully-vaccinated, science-believing mask-wearer, I am very tired of people listing things like Fluvoxamine in the same sentence as Ivermectin. The latter is total crap; the former is promising, albeit in less-than-intuitive ways. We should wait on the formal studies (which are underway!), but preliminarily it appears to fight early-stage COVID more effectively than placebo. Maybe only slight improvement, but it's quite cheap and safe and it should be widely distributed to fight COVID to achieve at least that margin.
Generally, investigating existing therapies that have at least a plausible mechanism of action is actually commonplace and even essential in the context of a newly-discovered disease to effectively combat it ASAP. See generally Repurposing drugs can speed new treatments for Covid-19. This is a recent article in STAT News, which has consistently been at the forefront of real scientific investigations into COVID testing, therapies, etc. It is not "doing your own research" Facebook junk.
And like mr_roboto I think it is very important to be precise and careful in our thinking here because everything COVID related has become so politicized. There is a real risk that associating ivermectin with other genuinely promising, though yet unproven, therapies could contaminate them in peoples' minds and reduce their uptake when and if they are ever approved.
posted by Joey Buttafoucault at 7:46 PM on October 2, 2021 [2 favorites]
Generally, investigating existing therapies that have at least a plausible mechanism of action is actually commonplace and even essential in the context of a newly-discovered disease to effectively combat it ASAP. See generally Repurposing drugs can speed new treatments for Covid-19. This is a recent article in STAT News, which has consistently been at the forefront of real scientific investigations into COVID testing, therapies, etc. It is not "doing your own research" Facebook junk.
And like mr_roboto I think it is very important to be precise and careful in our thinking here because everything COVID related has become so politicized. There is a real risk that associating ivermectin with other genuinely promising, though yet unproven, therapies could contaminate them in peoples' minds and reduce their uptake when and if they are ever approved.
posted by Joey Buttafoucault at 7:46 PM on October 2, 2021 [2 favorites]
do you want magas drinking bleach?
I know the expected answer here is "no", ...
posted by Greg_Ace at 7:50 PM on October 2, 2021 [26 favorites]
I know the expected answer here is "no", ...
posted by Greg_Ace at 7:50 PM on October 2, 2021 [26 favorites]
Robert Evans did some great coverage of the ivermection phenomenon over at Behind the Bastards last month. I think he offers a lot of really great perspectives, eg, sometimes humans take drugs intended for animals because they're cheaper, and also, in places that have been outbought by the US et al for vaccinations, it actually may be worthwhile to investigate ivermectin. (Obviously, being vaccinated is best, but, unfortunately, vaccine economics exist in this our home sweet hell dimension).
Also, his guest is Jamie Loftus, so you know it's a good time.
posted by snerson at 8:24 PM on October 2, 2021 [9 favorites]
Also, his guest is Jamie Loftus, so you know it's a good time.
posted by snerson at 8:24 PM on October 2, 2021 [9 favorites]
We should wait on the formal studies (which are underway!), but preliminarily it appears to fight early-stage COVID more effectively than placebo. Maybe only slight improvement, but it's quite cheap and safe and it should be widely distributed to fight COVID to achieve at least that margin.
I am prepared for metafilter to correct me but my understanding is that there isn't any good reason to believe that Ivermectin is an effective trieatment for covid. I mentioned upthread that there were problems with a paper that claimed to report on a large 600 person study. That paper was pre-print and it was withdrawn. With that withdrawal, as I should have explicitly noted upthread, the the case for ivermectin as as a covid treatment becomes pretty weak.
Even if Ivermectin turns out to be effective the problem is really how it's being used. Rather than getting vacinated, wearing masks, and social distancing tha anti-vax crowd are minimizing the consequences of covid. When they do get infected they're clamoring for a magic bullet. Monclonal antibodies are far more expensive than vaccination and they're only effective during a limited window in the course of an infection. Even if the costs and risks of vaccination and magic bullets were roughly equivalent we still need to distance and mask to control the spread of covid. It's irresponsible to run around being plague rats and then demand society fix you when your behaviour effects you instead of the people around you.
posted by rdr at 8:55 PM on October 2, 2021 [21 favorites]
I am prepared for metafilter to correct me but my understanding is that there isn't any good reason to believe that Ivermectin is an effective trieatment for covid. I mentioned upthread that there were problems with a paper that claimed to report on a large 600 person study. That paper was pre-print and it was withdrawn. With that withdrawal, as I should have explicitly noted upthread, the the case for ivermectin as as a covid treatment becomes pretty weak.
Even if Ivermectin turns out to be effective the problem is really how it's being used. Rather than getting vacinated, wearing masks, and social distancing tha anti-vax crowd are minimizing the consequences of covid. When they do get infected they're clamoring for a magic bullet. Monclonal antibodies are far more expensive than vaccination and they're only effective during a limited window in the course of an infection. Even if the costs and risks of vaccination and magic bullets were roughly equivalent we still need to distance and mask to control the spread of covid. It's irresponsible to run around being plague rats and then demand society fix you when your behaviour effects you instead of the people around you.
posted by rdr at 8:55 PM on October 2, 2021 [21 favorites]
Ivermectin is effective against SARS-CoV2 replication in vitro at concentrations approximately 3000x the peak plasma concentration achieved in standard ivermectin anti-parasitic therapy in humans (3 uM vs 100 nM)3 uM = 100 nM * 30, not 3000.
posted by inexorably_forward at 9:04 PM on October 2, 2021 [6 favorites]
oh well thank goodness I'd only be 30x dead
's only a flesh wound
posted by Greg_Ace at 9:30 PM on October 2, 2021 [5 favorites]
's only a flesh wound
posted by Greg_Ace at 9:30 PM on October 2, 2021 [5 favorites]
I know a guy who is a devotee of Alex Jones who has been telling me for years that virus does not exist and that all disease is caused by parasites. I can see why people who hold that belief would be total suckers for Ivermectin.
posted by a humble nudibranch at 9:40 PM on October 2, 2021 [6 favorites]
posted by a humble nudibranch at 9:40 PM on October 2, 2021 [6 favorites]
If they are hoaxes, they are passed around by generally reputable news outlets
Don’t act like that’s not a thing that happens, especially with local news outlets. There are some real overdoses, but I’m pretty sure the earlier comment was referring to claims that ivermectin overdoses are meaningfully filling up hospital capacity, which have been going around and which are obvious bullshit.
That said my position on the whole thing has always been that the claims made for ivermectin also smell extremely off, just too good to be true and my understanding is that most things that show some in vitro relevance like this don’t pan out as treatments. It’s worth doing the studies to prove that, but I know what I’d bet on.
And people just like to talk about horse paste because it’s funny and self-medicating with animal formulations of a speculative drug is a remarkably bad idea.
posted by atoxyl at 10:34 PM on October 2, 2021 [1 favorite]
Don’t act like that’s not a thing that happens, especially with local news outlets. There are some real overdoses, but I’m pretty sure the earlier comment was referring to claims that ivermectin overdoses are meaningfully filling up hospital capacity, which have been going around and which are obvious bullshit.
That said my position on the whole thing has always been that the claims made for ivermectin also smell extremely off, just too good to be true and my understanding is that most things that show some in vitro relevance like this don’t pan out as treatments. It’s worth doing the studies to prove that, but I know what I’d bet on.
And people just like to talk about horse paste because it’s funny and self-medicating with animal formulations of a speculative drug is a remarkably bad idea.
posted by atoxyl at 10:34 PM on October 2, 2021 [1 favorite]
I don’t think “ha ha look at that MAGA shoving horse paste up his ass” is a helpful response
Helpful or not, that would certainly be my own response to learning that some MAGA had shoved horse paste up his ass.
You should be worrying about unscrupulous people who want to install theocratic fascism in this country and are willing to kill people with COVID to advance that goal.
I'd be even more worried about them than I am, were it not for the fact that so many of the people they appear willing to kill with COVID constitute their own support base.
there clearly isn’t any objective, scientific or evidence-based reasoning behind opposing COVID vaccines but accepting mAbs.
The evidence I have available to me suggests that fuckhead reactionary rubes will reflexively and passionately oppose anything that Democratic messaging campaigns present as a good idea, and so far the amount of positive messaging from Democrats on vaccines absolutely dwarfs that on monoclonal antibodies.
posted by flabdablet at 10:52 PM on October 2, 2021 [11 favorites]
Helpful or not, that would certainly be my own response to learning that some MAGA had shoved horse paste up his ass.
You should be worrying about unscrupulous people who want to install theocratic fascism in this country and are willing to kill people with COVID to advance that goal.
I'd be even more worried about them than I am, were it not for the fact that so many of the people they appear willing to kill with COVID constitute their own support base.
there clearly isn’t any objective, scientific or evidence-based reasoning behind opposing COVID vaccines but accepting mAbs.
The evidence I have available to me suggests that fuckhead reactionary rubes will reflexively and passionately oppose anything that Democratic messaging campaigns present as a good idea, and so far the amount of positive messaging from Democrats on vaccines absolutely dwarfs that on monoclonal antibodies.
posted by flabdablet at 10:52 PM on October 2, 2021 [11 favorites]
Let's hope that the drug named after Thor's hammer works as well as the trial suggests it does. It can't eliminate COVID and is contracted to sell to the feds for $700 per course, making it over an order of magnitude more expensive than any of the vaccines, but it's still cheaper and likely more effective than the monoclonal antibodies.
If people can be convinced to at least get tested when they have symptoms, it would be enough to solve the hospital overcrowding issues. It won't quite render the anti-vaxxers moot, but it will make them less of an immediate public health hazard to the rest of the populace and will almost certainly keep the body from damaging itself severely in response to the infection. Plus it would give the immunosuppressed a viable treatment option.
Of course, the dimwits that refuse to take a COVID vaccine are probably also likely to ignore their symptoms until they are gasping on the floor, at which point the damage is already done. By that time the problem isn't the virus, it's an immune system going haywire.
posted by wierdo at 11:16 PM on October 2, 2021 [3 favorites]
If people can be convinced to at least get tested when they have symptoms, it would be enough to solve the hospital overcrowding issues. It won't quite render the anti-vaxxers moot, but it will make them less of an immediate public health hazard to the rest of the populace and will almost certainly keep the body from damaging itself severely in response to the infection. Plus it would give the immunosuppressed a viable treatment option.
Of course, the dimwits that refuse to take a COVID vaccine are probably also likely to ignore their symptoms until they are gasping on the floor, at which point the damage is already done. By that time the problem isn't the virus, it's an immune system going haywire.
posted by wierdo at 11:16 PM on October 2, 2021 [3 favorites]
When I first learned about people self-treating Covid with Ivermectin, my first thought was, "The goo we sprayed on cows' backs on the farm to prevent ringworm? Fucking idiots."
Then I did some reading and learned a form of Ivermectin was used to treat parasites in humans, and my thought was "Well, I would think using a antiparasitic for a virus may not be the most efficacious treatment, but what do I know?"
Then I did more reading and learned people were taking the cow goo, not the human product, and there was an army of quacks and flim-flammers and general pieces of shit pushing the cow goo, and the gubmint doesn't want you to take the cow goo, and you better stock up on cow goo, and oh hey I know I cow goo guy and my thought went back to "Fucking idiots."
posted by Alvy Ampersand at 12:02 AM on October 3, 2021 [31 favorites]
Then I did some reading and learned a form of Ivermectin was used to treat parasites in humans, and my thought was "Well, I would think using a antiparasitic for a virus may not be the most efficacious treatment, but what do I know?"
Then I did more reading and learned people were taking the cow goo, not the human product, and there was an army of quacks and flim-flammers and general pieces of shit pushing the cow goo, and the gubmint doesn't want you to take the cow goo, and you better stock up on cow goo, and oh hey I know I cow goo guy and my thought went back to "Fucking idiots."
posted by Alvy Ampersand at 12:02 AM on October 3, 2021 [31 favorites]
3 uM = 100 nM * 30, not 3000.
That’s what I get for posting before waking up. The concentrations are approximately correct (although I used generous assumptions) so you are quite right the ratio as stated is 30. I still think it’s too high - I used the highest reported peak plasma concentration from the first paper I found (81 ng/mL where 35 is more typical) and the in vitro IC50 from the Wagstaff paper which would clearly need to be exceeded substantially - but not quite as convincingly so at first glance.
posted by memetoclast at 12:52 AM on October 3, 2021 [1 favorite]
That’s what I get for posting before waking up. The concentrations are approximately correct (although I used generous assumptions) so you are quite right the ratio as stated is 30. I still think it’s too high - I used the highest reported peak plasma concentration from the first paper I found (81 ng/mL where 35 is more typical) and the in vitro IC50 from the Wagstaff paper which would clearly need to be exceeded substantially - but not quite as convincingly so at first glance.
posted by memetoclast at 12:52 AM on October 3, 2021 [1 favorite]
And claiming that it's a horse/sheep medication and therefore people shouldn't use it is just an insult. It doesn't help.
Wait, but this is literally true, right? People are scamming vets and feed stores for horse medicine. Is it controversial to say people shouldn't eat horse drugs?
posted by ryanrs at 12:57 AM on October 3, 2021 [19 favorites]
Wait, but this is literally true, right? People are scamming vets and feed stores for horse medicine. Is it controversial to say people shouldn't eat horse drugs?
posted by ryanrs at 12:57 AM on October 3, 2021 [19 favorites]
And while yes I am laughing at these idiots, I must acknowledge a grudging admiration for their dedication to the cause. Eating horse paste to own the libs, goddamn.
posted by ryanrs at 1:01 AM on October 3, 2021 [4 favorites]
posted by ryanrs at 1:01 AM on October 3, 2021 [4 favorites]
The interesting thing I've heard is that countries which use ivermectin to control parasites have less trouble with COVID than similarly situated companies that don't.
Ivermectin treats scabies. It's highly effective against scabies! But populations most likely to need treatment against scabies, including folks who live in nursing homes and shelters and prisons and tenement-style housing, haven't exactly been spared from covid. Quite the opposite, in fact.
I thought we went through all this last year with the "studies" about the BCG vaccine supposedly being protective, at least until the devastation in India and Brazil.
Ivermectin is the new bleach and hydroxychloroquine; remember those? I'm disappointed to see this kind of snake oil getting any traction on Metafilter.
posted by basalganglia at 2:27 AM on October 3, 2021 [17 favorites]
Ivermectin treats scabies. It's highly effective against scabies! But populations most likely to need treatment against scabies, including folks who live in nursing homes and shelters and prisons and tenement-style housing, haven't exactly been spared from covid. Quite the opposite, in fact.
I thought we went through all this last year with the "studies" about the BCG vaccine supposedly being protective, at least until the devastation in India and Brazil.
Ivermectin is the new bleach and hydroxychloroquine; remember those? I'm disappointed to see this kind of snake oil getting any traction on Metafilter.
posted by basalganglia at 2:27 AM on October 3, 2021 [17 favorites]
If people can be convinced to at least get tested when they have symptoms
I live in upstate NY and getting tested here for less than a $75 urgent care copay (and a three hour wait there) is bizarrely difficult, like it requires waiting two days and driving an hour to a Walgreens that finally has an open appointment. I am furious that at this point in the pandemic we do not have easy affordable testing available. Even those of us trying to do the right thing are finding it challenging.
posted by metasarah at 4:22 AM on October 3, 2021 [8 favorites]
I live in upstate NY and getting tested here for less than a $75 urgent care copay (and a three hour wait there) is bizarrely difficult, like it requires waiting two days and driving an hour to a Walgreens that finally has an open appointment. I am furious that at this point in the pandemic we do not have easy affordable testing available. Even those of us trying to do the right thing are finding it challenging.
posted by metasarah at 4:22 AM on October 3, 2021 [8 favorites]
You can pick up anti-gen rapid tests at CVS and Amazon has a mail in PCR test. You do have to order the Amazon test well in advance, though.
posted by rdr at 4:32 AM on October 3, 2021
posted by rdr at 4:32 AM on October 3, 2021
Is it controversial to say people shouldn't eat horse drugs?
It is, if the feelings of antivaxxers and their sympathizers are more important than ending this pandemic.
posted by They sucked his brains out! at 5:07 AM on October 3, 2021 [10 favorites]
It is, if the feelings of antivaxxers and their sympathizers are more important than ending this pandemic.
posted by They sucked his brains out! at 5:07 AM on October 3, 2021 [10 favorites]
Willingness to get vaccinated correlates more closely with education level than with any other factor. Like most human behaviors, vaccination choice, and likewise susceptibility to use of ineffective or dangerous medical remedies, is influenced by structural factors that are larger than us as individuals.
Part of my job is to talk to people who are vaccine hesitant and gently and respectfully support them in getting vaccinated. It may surprise people in this thread, but research has been done on this topic as well, and telling people they are selfish stupid horse paste eaters is not an effective way to bring someone from non vaccinated to vaccinated.
posted by latkes at 5:30 AM on October 3, 2021 [14 favorites]
Part of my job is to talk to people who are vaccine hesitant and gently and respectfully support them in getting vaccinated. It may surprise people in this thread, but research has been done on this topic as well, and telling people they are selfish stupid horse paste eaters is not an effective way to bring someone from non vaccinated to vaccinated.
posted by latkes at 5:30 AM on October 3, 2021 [14 favorites]
The interesting thing I've heard is that countries which use ivermectin to control parasites have less trouble with COVID than similarly situated companies that don't.
Where did you get this information?
posted by Anonymous at 5:59 AM on October 3, 2021
Where did you get this information?
posted by Anonymous at 5:59 AM on October 3, 2021
In re Ivermectin and countries where it's used against parasites, I'm sorry to say I don't have a link and my comment has disappeared. I'm not sure whether this one will be eliminated.
Unfortunately, I was hearing about this from Bret Weinstein and I don't want to sort through his long podcasts to find it again.
For what it's worth, I've quit listening to him. Still, this didn't seem like the sort of thing he'd make up, but I don't really know. I haven't seen this angle discussed anywhere else.
posted by Nancy Lebovitz at 7:15 AM on October 3, 2021
Unfortunately, I was hearing about this from Bret Weinstein and I don't want to sort through his long podcasts to find it again.
For what it's worth, I've quit listening to him. Still, this didn't seem like the sort of thing he'd make up, but I don't really know. I haven't seen this angle discussed anywhere else.
posted by Nancy Lebovitz at 7:15 AM on October 3, 2021
there clearly isn’t any objective, scientific or evidence-based reasoning behind opposing COVID vaccines but accepting mAbs.
First, generally looking for logical consistency within conspiracy-driven thinking is always going to be an exercise in frustration. (Conspiracy-driven because some folks who are skeptical of the vaccines are definitely not full-on conspiracy heads)
But also I think there is a big psychological difference between “there’s a virus going around but you don’t have it, take this injection to prevent it” and “oh shit I’m very sick please do whatever you can to help me!” The first requires a higher order of trust is larger systems.
That divide, and the trust required for the first, is partly what conspiracy advocates exploit.
posted by wemayfreeze at 7:57 AM on October 3, 2021 [3 favorites]
First, generally looking for logical consistency within conspiracy-driven thinking is always going to be an exercise in frustration. (Conspiracy-driven because some folks who are skeptical of the vaccines are definitely not full-on conspiracy heads)
But also I think there is a big psychological difference between “there’s a virus going around but you don’t have it, take this injection to prevent it” and “oh shit I’m very sick please do whatever you can to help me!” The first requires a higher order of trust is larger systems.
That divide, and the trust required for the first, is partly what conspiracy advocates exploit.
posted by wemayfreeze at 7:57 AM on October 3, 2021 [3 favorites]
Like Mr. Roboto, I have been disappointed with the way Ivermectin has been polarized and thus demonized. I’ve seen a lot about it from a few sources I was surprised that are not anti-VAX in fact are quite pro vac’s (Dr. John Campbell, phD is one of them). I’ve seem to of found myself on medical YouTube, and I’m always cautious to make sure I’m seeing an MD that is reputable and doesn’t have a history of fringe theories. And this is what concerns me about ivermectin, there is a reaction because of scams like hydroxichloroquine that has shut down rational discussion.
Ive noticed on places like YouTube, that real MDs that promote actual evidence based medicine, vaccination, etc . .. are starting to say ‘we might’ve rushed and dismissed ivermectin too quickly, but the data isn’t there yet.” And this is the root of all these issues, the nuances just lost. I’m sad to see that happening here on metafilter as well.
I believe Dr. John Perry is one of the big advocates for ivermectin. And the one thing that has given me pause is open until his interest and promotion of ivermectin as a treatment in COVID-19, he by all accounts appeared to be a highly respected doctor, one that was instrumental in getting steroids into the treatment protocol for COVID-19. So that he’s been branded as a quack now does concern me a bit. It doesn’t necessarily mean he’s not wrong here, but I have some genuine concern about demonizing ivermectin and those that wonder about its efficacy. I don’t agree with the idea people self medicating with it, or demanding it outside of their doctors recommendation, or demanding being treated by doctor via court orders.
It may simply work as an anti-inflammatory. We know inflammation is problematic in COVID-19 and I remember correctly, ivermectin has a decent profile as an anti inflammatory medication.
What I’m saying here is that there does need to be some new ones in this discussion. If we can’t have it and are reactionary because of extremes, we’re no better than the people that are promoting antivax and this becomes about tribalism, not science.
posted by [insert clever name here] at 7:57 AM on October 3, 2021
Ive noticed on places like YouTube, that real MDs that promote actual evidence based medicine, vaccination, etc . .. are starting to say ‘we might’ve rushed and dismissed ivermectin too quickly, but the data isn’t there yet.” And this is the root of all these issues, the nuances just lost. I’m sad to see that happening here on metafilter as well.
I believe Dr. John Perry is one of the big advocates for ivermectin. And the one thing that has given me pause is open until his interest and promotion of ivermectin as a treatment in COVID-19, he by all accounts appeared to be a highly respected doctor, one that was instrumental in getting steroids into the treatment protocol for COVID-19. So that he’s been branded as a quack now does concern me a bit. It doesn’t necessarily mean he’s not wrong here, but I have some genuine concern about demonizing ivermectin and those that wonder about its efficacy. I don’t agree with the idea people self medicating with it, or demanding it outside of their doctors recommendation, or demanding being treated by doctor via court orders.
It may simply work as an anti-inflammatory. We know inflammation is problematic in COVID-19 and I remember correctly, ivermectin has a decent profile as an anti inflammatory medication.
What I’m saying here is that there does need to be some new ones in this discussion. If we can’t have it and are reactionary because of extremes, we’re no better than the people that are promoting antivax and this becomes about tribalism, not science.
posted by [insert clever name here] at 7:57 AM on October 3, 2021
Part of my job is to talk to people who are vaccine hesitant and gently and respectfully support them in getting vaccinated. It may surprise people in this thread, but research has been done on this topic as well, and telling people they are selfish stupid horse paste eaters is not an effective way to bring someone from non vaccinated to vaccinated.
Which brings us around to the primary cause of many problems in our world -- the subculture of people who live in an alternate reality and have been taught to reject the real one.
The fervor surrounding ivermectin, including the people picketing hospitals demanding that it replace other forms of prevention and treatment, and also including the people who have been purchasing veterinary versions of the compound and self-medicating, exists separately from whatever legitimate research concerning the human version's effect on COVID-19 is taking place. It is taking place because a large percentage of the pushback against vaccinations and masking is political and tribe-based, not reality-based. These people have a vested mental interest in "proving" that COVID never was a real threat, that simple and cheap drugs can be used to thwart it, that there's a vast conspiracy between the government and the mainstream media and Big Pharma to control the populace and enslave them with phony fears of medical doom and expensive treatments for them, and that Trump was right all along to downplay it.
The messaging is not that ivermectin should be researched and inserted into existing anti-COVID regimens if proven effective; the messaging is that it is already a cheap wonder drug that THEY are hiding from the masses for nefarious reasons. Same tune as hydroxychloroquine, from the same singers.
There are people who can be reached among them, and calling them selfish stupid horse paste eaters for believing that they are being told over and over and over and over again by the Mirror Universe Media may not be the best approach to do so. There are people who are investigating ivermectin for the right reasons, and they should not be discouraged. But there are people who are howling at the moon about ivermectin and deliberately passing on misinformation that may be costing people's lives in the meantime, and to refrain from pushing back against that because the former people also exist is a mistake.
posted by delfin at 8:25 AM on October 3, 2021 [19 favorites]
Which brings us around to the primary cause of many problems in our world -- the subculture of people who live in an alternate reality and have been taught to reject the real one.
The fervor surrounding ivermectin, including the people picketing hospitals demanding that it replace other forms of prevention and treatment, and also including the people who have been purchasing veterinary versions of the compound and self-medicating, exists separately from whatever legitimate research concerning the human version's effect on COVID-19 is taking place. It is taking place because a large percentage of the pushback against vaccinations and masking is political and tribe-based, not reality-based. These people have a vested mental interest in "proving" that COVID never was a real threat, that simple and cheap drugs can be used to thwart it, that there's a vast conspiracy between the government and the mainstream media and Big Pharma to control the populace and enslave them with phony fears of medical doom and expensive treatments for them, and that Trump was right all along to downplay it.
The messaging is not that ivermectin should be researched and inserted into existing anti-COVID regimens if proven effective; the messaging is that it is already a cheap wonder drug that THEY are hiding from the masses for nefarious reasons. Same tune as hydroxychloroquine, from the same singers.
There are people who can be reached among them, and calling them selfish stupid horse paste eaters for believing that they are being told over and over and over and over again by the Mirror Universe Media may not be the best approach to do so. There are people who are investigating ivermectin for the right reasons, and they should not be discouraged. But there are people who are howling at the moon about ivermectin and deliberately passing on misinformation that may be costing people's lives in the meantime, and to refrain from pushing back against that because the former people also exist is a mistake.
posted by delfin at 8:25 AM on October 3, 2021 [19 favorites]
Unfortunately, I was hearing about this from Bret Weinstein and I don't want to sort through his long podcasts to find it again.
For what it's worth, I've quit listening to him. Still, this didn't seem like the sort of thing he'd make up, but I don't really know. I haven't seen this angle discussed anywhere else.
Bret Weinstein is a bigot and a crank, and a dangerous one at that. He is consistently cited as one of the worst peddlers of COVID misinformation and antivaxxer propaganda in the US, if not the world.
In short: Weinstein is so untrustworthy that if says the sky is blue, I'd still recommend looking out the window to make sure. His word on anything pandemic related is worse than trash.
posted by Glegrinof the Pig-Man at 8:29 AM on October 3, 2021 [13 favorites]
For what it's worth, I've quit listening to him. Still, this didn't seem like the sort of thing he'd make up, but I don't really know. I haven't seen this angle discussed anywhere else.
Bret Weinstein is a bigot and a crank, and a dangerous one at that. He is consistently cited as one of the worst peddlers of COVID misinformation and antivaxxer propaganda in the US, if not the world.
In short: Weinstein is so untrustworthy that if says the sky is blue, I'd still recommend looking out the window to make sure. His word on anything pandemic related is worse than trash.
posted by Glegrinof the Pig-Man at 8:29 AM on October 3, 2021 [13 favorites]
Ive noticed on places like YouTube, that real MDs that promote actual evidence based medicine, vaccination, etc . .. are starting to say ‘we might’ve rushed and dismissed ivermectin too quickly, but the data isn’t there yet.” And this is the root of all these issues, the nuances just lost.
I think part of the issue is that several of the initial papers on Ivermectin that looked the most promising seem to have used falsified data or questionable methodology. Even if there does turn out to be some protective effect, high-quality evidence to support that claim today just does not exist. (Also, I don't know about you, but in my experience most MDs are not scientists or statisticians. They don't tend to analyze and review studies carefully and skeptically, and as a result they're often not a great source for cutting-edge information one way or the other. They can often latch on to things that happen to be true, but I wouldn't expect them to look at a study's data and say "you know, this seems to have been tampered with or cherry-picked" - especially when even most scientists, who are trained to read that carefully, don't do it.)
Anyway, given the shaky-at-best evidence for Ivermectin you'd expect responsible scientists and leaders to proceed with great caution even if they do happen to believe in its potential. So it's not strange to conclude that someone who is not proceeding cautiously but instead proclaiming Ivermectin as some kind of miracle drug with proven effects is perhaps not very responsible or trustworthy, regardless of what position they hold or how good of a reputation they had previously.
Also, whether those individuals are anti-vax or not, Ivermectin has been adopted wholesale by the anti-vax movement; that's the situation today. Which means that again you'd expect a responsible figure of authority to proceed even more cautiously given that fact. If people want to take Ivermectin in addition to the vaccine, in safe dosages and forms of application, that's one thing; if they believe Ivermectin can replace the vaccine, that's absolutely another. Scientists, MDs, and anyone else touting it in good faith need to consider whether, by not waiting until there is (if ever) actual solid evidence for Ivermectin (while there is a surplus of solid evidence for the vaccine), they're potentially doing a lot of harm. And I think it's right for us, watching all this go down, to consider whether the judgment of those touters is more questionable than we thought.
posted by trig at 8:40 AM on October 3, 2021 [11 favorites]
I think part of the issue is that several of the initial papers on Ivermectin that looked the most promising seem to have used falsified data or questionable methodology. Even if there does turn out to be some protective effect, high-quality evidence to support that claim today just does not exist. (Also, I don't know about you, but in my experience most MDs are not scientists or statisticians. They don't tend to analyze and review studies carefully and skeptically, and as a result they're often not a great source for cutting-edge information one way or the other. They can often latch on to things that happen to be true, but I wouldn't expect them to look at a study's data and say "you know, this seems to have been tampered with or cherry-picked" - especially when even most scientists, who are trained to read that carefully, don't do it.)
Anyway, given the shaky-at-best evidence for Ivermectin you'd expect responsible scientists and leaders to proceed with great caution even if they do happen to believe in its potential. So it's not strange to conclude that someone who is not proceeding cautiously but instead proclaiming Ivermectin as some kind of miracle drug with proven effects is perhaps not very responsible or trustworthy, regardless of what position they hold or how good of a reputation they had previously.
Also, whether those individuals are anti-vax or not, Ivermectin has been adopted wholesale by the anti-vax movement; that's the situation today. Which means that again you'd expect a responsible figure of authority to proceed even more cautiously given that fact. If people want to take Ivermectin in addition to the vaccine, in safe dosages and forms of application, that's one thing; if they believe Ivermectin can replace the vaccine, that's absolutely another. Scientists, MDs, and anyone else touting it in good faith need to consider whether, by not waiting until there is (if ever) actual solid evidence for Ivermectin (while there is a surplus of solid evidence for the vaccine), they're potentially doing a lot of harm. And I think it's right for us, watching all this go down, to consider whether the judgment of those touters is more questionable than we thought.
posted by trig at 8:40 AM on October 3, 2021 [11 favorites]
There are currently 294 published papers in PubMed/MEDLINE looking at ivermectin and covid-19, and probably several dozen more in preparation or submitted.
I have not looked at all 294, because I have a fucking day job. But this rapid review and this meta-analysis and this other meta-analysis all conclude that there is insufficient evidence of benefit for ivermectin, and what evidence exists is of low-quality/poorly designed/should not be used for decision-making.
This is not an area of clinical or scientific uncertainty.
More to the point, this "just asking questions!" line that some of y'all are using is straight out of Andrew Wakefield's anti-vaxxer playbook, and requiring scientists to waste time proving yet again that a particular treatment does not work not only takes away valuable resources (financial and human) from other areas, it also legitimizes a deplorable (yes, I said it) perspective.
posted by basalganglia at 8:41 AM on October 3, 2021 [50 favorites]
I have not looked at all 294, because I have a fucking day job. But this rapid review and this meta-analysis and this other meta-analysis all conclude that there is insufficient evidence of benefit for ivermectin, and what evidence exists is of low-quality/poorly designed/should not be used for decision-making.
This is not an area of clinical or scientific uncertainty.
More to the point, this "just asking questions!" line that some of y'all are using is straight out of Andrew Wakefield's anti-vaxxer playbook, and requiring scientists to waste time proving yet again that a particular treatment does not work not only takes away valuable resources (financial and human) from other areas, it also legitimizes a deplorable (yes, I said it) perspective.
posted by basalganglia at 8:41 AM on October 3, 2021 [50 favorites]
> he by all accounts appeared to be a highly respected doctor, one that was instrumental in getting steroids into the treatment protocol for COVID-19.
Which has actually been shown to be a mixed bag at best. In a meta-analysis study “Steroids in non-oxygen requiring COVID-19 patients can be more detrimental than beneficial.”
So, I personally wouldn’t actually take this as a sign that this particular doctor is someone with special insight into what’s good for treating covid.
posted by Bottlecap at 8:57 AM on October 3, 2021 [2 favorites]
Which has actually been shown to be a mixed bag at best. In a meta-analysis study “Steroids in non-oxygen requiring COVID-19 patients can be more detrimental than beneficial.”
So, I personally wouldn’t actually take this as a sign that this particular doctor is someone with special insight into what’s good for treating covid.
posted by Bottlecap at 8:57 AM on October 3, 2021 [2 favorites]
Antivax charlatans promoting ivermectin as a COVID treatment in lieu of vaccination are hurting people. But I don’t think “ha ha look at that MAGA shoving horse paste up his ass” is a helpful response.
mr_roboto has been around these parts a long time and has always been a mensch as far as i can remember. so i'd like to abstract this away from their particular comment as this type of thinking is common.
i just can't understand this -- it reads / feels like an overwhelming need to both-sides an issue even when the asymmetry in harm is so incredibly unbalanced that one side of the scale is literally on the floor.
i just don't understand it. is this a human impulse thing? a really tough to shake cognitive bias? am i just more neurodivergent than my doctors and therapists know? because i just cannot fathom the impulse to follow the first sentence with the second.
the first encapsulates the needless deaths of untold scores of people.
the second balances that first with...shitposting on the internet.
i just can't.
posted by lazaruslong at 9:06 AM on October 3, 2021 [11 favorites]
mr_roboto has been around these parts a long time and has always been a mensch as far as i can remember. so i'd like to abstract this away from their particular comment as this type of thinking is common.
i just can't understand this -- it reads / feels like an overwhelming need to both-sides an issue even when the asymmetry in harm is so incredibly unbalanced that one side of the scale is literally on the floor.
i just don't understand it. is this a human impulse thing? a really tough to shake cognitive bias? am i just more neurodivergent than my doctors and therapists know? because i just cannot fathom the impulse to follow the first sentence with the second.
the first encapsulates the needless deaths of untold scores of people.
the second balances that first with...shitposting on the internet.
i just can't.
posted by lazaruslong at 9:06 AM on October 3, 2021 [11 favorites]
And like mr_roboto I think it is very important to be precise and careful in our thinking here because everything COVID related has become so politicized.
I'm glad you have the capacity to be more precise and careful in your thinking, I'm not so clever by half. A good portion of the past several months has been spent contracting COVID-19 and recovering, getting vaccinated as soon as possible, and generally missing out on a lot of stuff as I watch my community forming up on one side or the other of this pandemic. I have no energy to be 'precise' and careful in my thinking, I am already planning for the long-term effects of this pandemic. We have the research and understanding to mitigate the effects of COVID-19 and we are discovering that, far beyond supply chain issues if you give a percentage of your population reasons--any reason!--to resist basic public health measures, they will run with it (in between plotting to overthrow democracy etc). The bullies are ascending and the 1% who care to poke and probe to see what they can get out of this are having their own go at it. How's that for conspiracy thinking?
When I see folks coming out with "think about the poor anti-vaxxers" and "we should not dismiss these horse paste claims out of hand, lest we be as bad as they" my gawd I wish you'd stfu.
posted by elkevelvet at 9:18 AM on October 3, 2021 [15 favorites]
I'm glad you have the capacity to be more precise and careful in your thinking, I'm not so clever by half. A good portion of the past several months has been spent contracting COVID-19 and recovering, getting vaccinated as soon as possible, and generally missing out on a lot of stuff as I watch my community forming up on one side or the other of this pandemic. I have no energy to be 'precise' and careful in my thinking, I am already planning for the long-term effects of this pandemic. We have the research and understanding to mitigate the effects of COVID-19 and we are discovering that, far beyond supply chain issues if you give a percentage of your population reasons--any reason!--to resist basic public health measures, they will run with it (in between plotting to overthrow democracy etc). The bullies are ascending and the 1% who care to poke and probe to see what they can get out of this are having their own go at it. How's that for conspiracy thinking?
When I see folks coming out with "think about the poor anti-vaxxers" and "we should not dismiss these horse paste claims out of hand, lest we be as bad as they" my gawd I wish you'd stfu.
posted by elkevelvet at 9:18 AM on October 3, 2021 [15 favorites]
I heard the other side of the messaging the other day, while surfing through the political channels on my satellite radio. (You know, listening to what one's enemies are talking about, to be better prepared when Aunt Gladys starts spouting the same arguments over Sunday brunch.)
One of the afternoon guys was talking about ivermectin, and prefaced it by saying, "I am not anti-vax. I've had the vaccine. I believe that the vaccine is safe and effective at what it does." But he then went into a rant about how none of that mattered because everything in life should be a personal choice, the government has no place dictating medical choices to anyone for any reason, and how excluding non-vaxxed from public life to any degree was a horrible infringement of liberty and a violation of the Constitution.
So there's that to contend with, as well.
posted by delfin at 9:23 AM on October 3, 2021 [4 favorites]
One of the afternoon guys was talking about ivermectin, and prefaced it by saying, "I am not anti-vax. I've had the vaccine. I believe that the vaccine is safe and effective at what it does." But he then went into a rant about how none of that mattered because everything in life should be a personal choice, the government has no place dictating medical choices to anyone for any reason, and how excluding non-vaxxed from public life to any degree was a horrible infringement of liberty and a violation of the Constitution.
So there's that to contend with, as well.
posted by delfin at 9:23 AM on October 3, 2021 [4 favorites]
Having to cover your ass to be out and about in public is likewise a horrible infringement of liberty. If Aunt Gladys is okay with you forgoing that, then at least you'll have a fun Sunday brunch.
posted by trig at 9:40 AM on October 3, 2021 [2 favorites]
posted by trig at 9:40 AM on October 3, 2021 [2 favorites]
Science communication is hard.
And I get why people are all out of fucks to give for misinformation AND information that has been co-opted for the purposes of misinformation. I have very little patience, for example, about the lab leak hypothesis getting more air time even as I also want scientists to continue to investigate the possibility. There's already enough anti-Asian and conspiracy b.s. floating around, I don't want any oxygen for that fire.
And yet, in the case of unlikely but potentially beneficial treatments like ivermectin, I have much more patience for the idea that in addition to mockery there is also room for gentle dialogue from those with the patience: "oh yeah, I read an article about that. But the studies so far aren't very convincing though there are a few big studies continuing to look into it. Also, why are these fringe doctors pushing a totally non evidence-based dosing regimen using super high dose animal formulations? Anyway it's so fascinating how it was developed from soil microbes and how useful it is against parasites like roundworm. It would be cool if it was useful as a treatment for people who have covid but there are other drugs that looked promising and didn't pan out. I know, it's just human nature to hope for a silver bullet treatment but we do have vaccines as a first line of defense. I'm so glad I got vaccinated!"
posted by spamandkimchi at 9:56 AM on October 3, 2021 [9 favorites]
And I get why people are all out of fucks to give for misinformation AND information that has been co-opted for the purposes of misinformation. I have very little patience, for example, about the lab leak hypothesis getting more air time even as I also want scientists to continue to investigate the possibility. There's already enough anti-Asian and conspiracy b.s. floating around, I don't want any oxygen for that fire.
And yet, in the case of unlikely but potentially beneficial treatments like ivermectin, I have much more patience for the idea that in addition to mockery there is also room for gentle dialogue from those with the patience: "oh yeah, I read an article about that. But the studies so far aren't very convincing though there are a few big studies continuing to look into it. Also, why are these fringe doctors pushing a totally non evidence-based dosing regimen using super high dose animal formulations? Anyway it's so fascinating how it was developed from soil microbes and how useful it is against parasites like roundworm. It would be cool if it was useful as a treatment for people who have covid but there are other drugs that looked promising and didn't pan out. I know, it's just human nature to hope for a silver bullet treatment but we do have vaccines as a first line of defense. I'm so glad I got vaccinated!"
posted by spamandkimchi at 9:56 AM on October 3, 2021 [9 favorites]
Oops, Dr. Pierre Kory, not Dr. John Perry (haven’t a clue)
As for the would you please just stfu request above, I don’t know what to say if that is what we’ve become here on metafilter, or to public discourse generally.
And believe me, I understand the problem with “I’m not antivax but…” I do. I get it. I get sealioning. I understand the problem with “just asking questions” in bad faith.
So how do we have this conversation? About anything?
posted by [insert clever name here] at 9:57 AM on October 3, 2021 [2 favorites]
As for the would you please just stfu request above, I don’t know what to say if that is what we’ve become here on metafilter, or to public discourse generally.
And believe me, I understand the problem with “I’m not antivax but…” I do. I get it. I get sealioning. I understand the problem with “just asking questions” in bad faith.
So how do we have this conversation? About anything?
posted by [insert clever name here] at 9:57 AM on October 3, 2021 [2 favorites]
In other words, if you are too angry (for good reasons!) and don't have the patience to communicate with people mired in shitty ideologies and terrible science, that is fine. I didn't have the bandwidth to even try to deal with xenophobes post 9-11, for example. But if someone else wants to try to reach out to them, please don't tell them it's stupid to try. We need all the things.
posted by spamandkimchi at 10:01 AM on October 3, 2021 [6 favorites]
posted by spamandkimchi at 10:01 AM on October 3, 2021 [6 favorites]
I believe part of my concern here comes from the small handful of health experts I’ve been following during covid, that have been largely showing themselves to be reputable and rely on best available research, while also expressing extreme caution around pre-print data and other early research. When one of them mentioned ivermectin as possibly having a role in the profile is treatment, I did kind of wince and wonder if he went down the quack hole. Then I stopped and asked myself why I thought that someone who had been largely consistent with public health messaging and concerns would go so far off course, i had to actually question why I thought that. And when it came up through another medical source, I decided that while I had no idea if they were credible, they knew a lot more than I did and had decades of experience in public health, maybe I should put an asterisk in my mind about ivermectin. Not embrace (but they had not either), but recognize it’s not clear cut yet and reacting to it as though it were a quack idea would just add to the burden on getting more research done.
posted by [insert clever name here] at 10:09 AM on October 3, 2021 [2 favorites]
posted by [insert clever name here] at 10:09 AM on October 3, 2021 [2 favorites]
But he then went into a rant about how none of that mattered because everything in life should be a personal choice, the government has no place dictating medical choices to anyone for any reason, and how excluding non-vaxxed from public life to any degree was a horrible infringement of liberty and a violation of the Constitution.
So there's that to contend with, as well.
Bingo, Delfin. The coronavirus home remedy shitshow--not just ivermectin! let's not forget other atrocities like nebulizing hydrogen peroxide and even some hardy soul inquiring about whether it's possible to acquire an ECMO machine for home use--is the Libertarian wet dream of individuals seizing control of their own medical treatment against the oppression by The State. Hell, a quick google for "libertarian FDA" brought up this choice statement from the Libertarian Party in April 2020, telling the FDA to get out of the way.
Going about as well as that business with the bears.
posted by Sublimity at 10:14 AM on October 3, 2021 [2 favorites]
So there's that to contend with, as well.
Bingo, Delfin. The coronavirus home remedy shitshow--not just ivermectin! let's not forget other atrocities like nebulizing hydrogen peroxide and even some hardy soul inquiring about whether it's possible to acquire an ECMO machine for home use--is the Libertarian wet dream of individuals seizing control of their own medical treatment against the oppression by The State. Hell, a quick google for "libertarian FDA" brought up this choice statement from the Libertarian Party in April 2020, telling the FDA to get out of the way.
Going about as well as that business with the bears.
posted by Sublimity at 10:14 AM on October 3, 2021 [2 favorites]
I'm taking my own advice (stfu) because my level of anger that arises on this topic is not healthy. I guess in my personal circumstances the threat is so massive and present, it's quite beyond if and when we get past the pandemic.. Anyhow, apologies for the strident posts. Take care all.
posted by elkevelvet at 10:20 AM on October 3, 2021 [4 favorites]
posted by elkevelvet at 10:20 AM on October 3, 2021 [4 favorites]
In other words, if you are too angry (for good reasons!) and don't have the patience to communicate with people mired in shitty ideologies and terrible science, that is fine. I didn't have the bandwidth to even try to deal with xenophobes post 9-11, for example. But if someone else wants to try to reach out to them, please don't tell them it's stupid to try. We need all the things.
Somehow this always seems to come up in discussions here. Maybe I just missed it and that's on me, but I just never really see anyone on MetaFilter telling science communicators with emapthy reserves intact that reaching out to try and sway unvaxxed people to get vaxxed is "stupid". It always strikes me as a weird concern troll that feels more like moving the goalposts on people expressing frustration with the unvaxxed than anything else.
posted by lazaruslong at 10:29 AM on October 3, 2021 [4 favorites]
Somehow this always seems to come up in discussions here. Maybe I just missed it and that's on me, but I just never really see anyone on MetaFilter telling science communicators with emapthy reserves intact that reaching out to try and sway unvaxxed people to get vaxxed is "stupid". It always strikes me as a weird concern troll that feels more like moving the goalposts on people expressing frustration with the unvaxxed than anything else.
posted by lazaruslong at 10:29 AM on October 3, 2021 [4 favorites]
My mom is now an anti-vaxxer after listening to my brother who became an anti-vaxxer recently due to algorithm poisoning & in my experience trying to talk them out of it only makes them more convinced that I'm just another brainwashed sheeple. Instead of home remedies for COVID we need home remedies for this new kind of mind poisoning.
posted by bleep at 10:36 AM on October 3, 2021 [13 favorites]
posted by bleep at 10:36 AM on October 3, 2021 [13 favorites]
“So, I personally wouldn’t actually take this as a sign that this particular doctor is someone with special insight into what’s good for treating covid.”
Bottlecap, I got Dr. Pierre Kory’s name wrong so understand. But it’s clear his work early in the pandemic saved a lot of lives. And he might be really wrong on the ivermectin front. Maybe he’s just overconfident since he was so right early on. But he’s also being demonized in a way that I don’t think is appropriate. Even his Wikipedia page has changed in a way to minimize his legitimacy and legacy.
I think in 5 years time when emotions are not as high, even if he’s not right on ivermectin (and to this point, I actually think he’s wrong or at least overstating it’s benefit), it will be more apparent that we (society) harmed someone that was doing good work and was essential to saving a lot of lives. He’s now being associated with quack cures he never promoted because he advocated ivermectin, so I’m a little afraid of what we’re going to do to the next guy that could save lives but is afraid to speak up.
And I just don’t know, but I think we are standing on some really dangerous ground when we react to disinformation by zero tolerance for nuanced discussion.
posted by [insert clever name here] at 10:37 AM on October 3, 2021 [1 favorite]
Bottlecap, I got Dr. Pierre Kory’s name wrong so understand. But it’s clear his work early in the pandemic saved a lot of lives. And he might be really wrong on the ivermectin front. Maybe he’s just overconfident since he was so right early on. But he’s also being demonized in a way that I don’t think is appropriate. Even his Wikipedia page has changed in a way to minimize his legitimacy and legacy.
I think in 5 years time when emotions are not as high, even if he’s not right on ivermectin (and to this point, I actually think he’s wrong or at least overstating it’s benefit), it will be more apparent that we (society) harmed someone that was doing good work and was essential to saving a lot of lives. He’s now being associated with quack cures he never promoted because he advocated ivermectin, so I’m a little afraid of what we’re going to do to the next guy that could save lives but is afraid to speak up.
And I just don’t know, but I think we are standing on some really dangerous ground when we react to disinformation by zero tolerance for nuanced discussion.
posted by [insert clever name here] at 10:37 AM on October 3, 2021 [1 favorite]
And I just don’t know, but I think we are standing on some really dangerous ground when we react to disinformation by zero tolerance for nuanced discussion.
Do you think that's what 'we' in this thread are doing?
posted by lazaruslong at 10:40 AM on October 3, 2021 [1 favorite]
Do you think that's what 'we' in this thread are doing?
posted by lazaruslong at 10:40 AM on October 3, 2021 [1 favorite]
How much tolerance are we supposed to have for things that aren't true?
posted by bleep at 10:42 AM on October 3, 2021 [7 favorites]
posted by bleep at 10:42 AM on October 3, 2021 [7 favorites]
[Pierre Kory]’s now being associated with quack cures he never promoted because he advocated ivermectin, so I’m a little afraid of what we’re going to do to the next guy that could save lives but is afraid to speak up
Honestly, I just looked at his Twitter page. Some decent things, interspersed with attacks on Merck and "the press and media", "the Ivory Tower", the NIH, and more. Here's a tweet where he rails at someone for "literally citing a FRAUDULENT paper to support their lies". Maybe that's true? I'm not in a position to evaluate it. But his own published article about how Ivermectin is da boss rests on at least two fraudulent studies, and he doesn't seem to be retracting it.
And throughout, he makes repeated claims about Ivermectin's total effectiveness against covid. No "potential", "possible", "early evidence shows signs". No caveats. No nuance. His account says Ivermectin is the One True Answer and that everyone saying otherwise is a corrupt, lying fraud.
Here is his websites. More of the same, in the most absolutist terms. And his "protocol" for dealing with covid has a total, glaring absence of the one thing that's been most effective so far: vaccines.
So I don't get the sense, looking at his own words, that he's a good guy. I don't get the sense that he's being unfairly labeled a quack. Instead I'm a little afraid of what he and his followers will do and are doing to anyone who disagrees with them.
Seriously, this is not the guy to be defending. He's everything you say you disagree with, and more.
posted by trig at 11:02 AM on October 3, 2021 [20 favorites]
Honestly, I just looked at his Twitter page. Some decent things, interspersed with attacks on Merck and "the press and media", "the Ivory Tower", the NIH, and more. Here's a tweet where he rails at someone for "literally citing a FRAUDULENT paper to support their lies". Maybe that's true? I'm not in a position to evaluate it. But his own published article about how Ivermectin is da boss rests on at least two fraudulent studies, and he doesn't seem to be retracting it.
And throughout, he makes repeated claims about Ivermectin's total effectiveness against covid. No "potential", "possible", "early evidence shows signs". No caveats. No nuance. His account says Ivermectin is the One True Answer and that everyone saying otherwise is a corrupt, lying fraud.
Here is his websites. More of the same, in the most absolutist terms. And his "protocol" for dealing with covid has a total, glaring absence of the one thing that's been most effective so far: vaccines.
So I don't get the sense, looking at his own words, that he's a good guy. I don't get the sense that he's being unfairly labeled a quack. Instead I'm a little afraid of what he and his followers will do and are doing to anyone who disagrees with them.
Seriously, this is not the guy to be defending. He's everything you say you disagree with, and more.
posted by trig at 11:02 AM on October 3, 2021 [20 favorites]
Yeah, I think one huge cause of friction here is that some people (most of whom are not trained in this kind of science, if any) want to debate the hypothetical maybe-potentially-promising-one-day nuanced-discussion data that there's something about Ivermectin that has some kind of useful effect we will understand more about at some point well in the future, and then there's people on other forums saying "I now have emergency custody of an infant and a toddler because my sister was giving them horse paste."
This is a literal public health crisis and it is not the time on the openly-googlable internet to be both-sidesing agricultural dewormer as a legitimate treatment. It is not a legitimate treatment. It is not going to suddenly become one. And while it's fine if real scientists want to study the science on it in a science lab with science review and they don't have anything more promising to study, it is absolutely 100% stupid for an unvaccinated person in the general public to try it in lieu of vaccination, and I assure you that is who is trying it. I think any medical professional musing about efficacy to the general public for attention rather than within academic lines of communication should lose their license for stoking this fire.
I haven't seen any numbers on paste-poisoning cases in emergency rooms, but I know from both grief groups and q-adjacent (as in family/friends of q-believers) groups I participate in that hospitals are FULL of people who wouldn't get vaccinated because they'd "prefer" to get COVID and just use the paste (and also real or homemade hq, and peroxide in a nebulizer, and super-high dosages of certain vitamins and supplements), which has been represented to them as equivalent if not better than vaccination. Patients (and their families) are assaulting medical personnel for not giving these things to them. Parents of dependents are choosing to lose their jobs because their employers "refuse to recognize" the efficacy of those treatments, and people are overrunning school boards and running for local office on the same grounds.
Real people are getting hurt here. This is not just a fun thought experiment. Anyone here who actually has the training and funding to work on this problem in a scientific manner should go do that and not be here idly musing about it.
posted by Lyn Never at 11:09 AM on October 3, 2021 [29 favorites]
This is a literal public health crisis and it is not the time on the openly-googlable internet to be both-sidesing agricultural dewormer as a legitimate treatment. It is not a legitimate treatment. It is not going to suddenly become one. And while it's fine if real scientists want to study the science on it in a science lab with science review and they don't have anything more promising to study, it is absolutely 100% stupid for an unvaccinated person in the general public to try it in lieu of vaccination, and I assure you that is who is trying it. I think any medical professional musing about efficacy to the general public for attention rather than within academic lines of communication should lose their license for stoking this fire.
I haven't seen any numbers on paste-poisoning cases in emergency rooms, but I know from both grief groups and q-adjacent (as in family/friends of q-believers) groups I participate in that hospitals are FULL of people who wouldn't get vaccinated because they'd "prefer" to get COVID and just use the paste (and also real or homemade hq, and peroxide in a nebulizer, and super-high dosages of certain vitamins and supplements), which has been represented to them as equivalent if not better than vaccination. Patients (and their families) are assaulting medical personnel for not giving these things to them. Parents of dependents are choosing to lose their jobs because their employers "refuse to recognize" the efficacy of those treatments, and people are overrunning school boards and running for local office on the same grounds.
Real people are getting hurt here. This is not just a fun thought experiment. Anyone here who actually has the training and funding to work on this problem in a scientific manner should go do that and not be here idly musing about it.
posted by Lyn Never at 11:09 AM on October 3, 2021 [29 favorites]
maybe I should put an asterisk in my mind about ivermectin. Not embrace (but they had not either), but recognize it’s not clear cut yet and reacting to it as though it were a quack idea would just add to the burden on getting more research done.
It is not a quack idea to investigate Ivermectin or any other drug. It is a quack idea to actually recommend it or take it to prevent or treat COVID outside of a clinical trial setting. A lot of the loudest voices promoting Ivermectin are quack doctors prescribing it on a website for $80 a pop.
posted by wierdo at 11:11 AM on October 3, 2021 [8 favorites]
It is not a quack idea to investigate Ivermectin or any other drug. It is a quack idea to actually recommend it or take it to prevent or treat COVID outside of a clinical trial setting. A lot of the loudest voices promoting Ivermectin are quack doctors prescribing it on a website for $80 a pop.
posted by wierdo at 11:11 AM on October 3, 2021 [8 favorites]
Hah, I wasn't reading carefully enough either for my last comment. Kory's top pinned tweet says "No matter what you think about IVM, molnupiravir, HCQ or Nigella Sativa, please can we all agree on the below? I am horrifically estranged from my specialty already but if we can unite on the Rome Declaration".
I looked up "rome declaration covid" and got this declaration by "Leaders of G20 and other states, in the presence of the Heads of international and regional organisations meeting at the Global Health Summit in Rome, May 21, 2021" about how "the pandemic continues to be an unprecedented global health and socio-economic crisis, with disproportionate direct and indirect effects on the most vulnerable, on women, girls and children, as well as on frontline workers and the elderly."
Fine, right? That was what I meant by "some decent things" above. Except then I followed the link in the tweet and it turns out he's using the old tactic of cooping names of respected entities to peddle his own stuff. Here's his "Rome Declaration".
I'm sorry. This is a conspiracy-mongering quack. I agree with the plea for nuance, but he doesn't.
posted by trig at 11:14 AM on October 3, 2021 [20 favorites]
I looked up "rome declaration covid" and got this declaration by "Leaders of G20 and other states, in the presence of the Heads of international and regional organisations meeting at the Global Health Summit in Rome, May 21, 2021" about how "the pandemic continues to be an unprecedented global health and socio-economic crisis, with disproportionate direct and indirect effects on the most vulnerable, on women, girls and children, as well as on frontline workers and the elderly."
Fine, right? That was what I meant by "some decent things" above. Except then I followed the link in the tweet and it turns out he's using the old tactic of cooping names of respected entities to peddle his own stuff. Here's his "Rome Declaration".
I'm sorry. This is a conspiracy-mongering quack. I agree with the plea for nuance, but he doesn't.
posted by trig at 11:14 AM on October 3, 2021 [20 favorites]
I'd like to note that as of about a month ago, the moderators of /r/medicine, a subreddit for medical professionals, put a new policy into place:
posted by MrVisible at 11:20 AM on October 3, 2021 [22 favorites]
Half a year ago now, we promulgated a policy of trying to require flair and evidence for posts and comments about vaccines and COVID. At the time, vaccines were new, concerns were high, and data were still sparse.I'm surprised that Metafilter hasn't put anything similar in place.
We're now six months and more past that, the results are clearer and yet baseless anti-vaccine sentiment, anti-mask animus, and even flat denial of basic science are louder and more prevalent than ever in some quarters. Unfortunately, those quarters are happy to come flooding into medical subreddits and spew their nonsense. It spurs no fruitful discussion, it just causes work for moderators.
Your moderators are running low on patience. We've discussed this enough here in r/medicine to know we aren't the only ones.
We will from now on have a zero tolerance policy towards garbage and nonsense. New accounts or new participants in r/medicine raising "concerns" will be summarily banned. Anyone "just asking questions" will be banned. Anyone pushing debunked treatments or simply not evidence-based treatments will be banned. Anyone who skirts the edge may be banned, and anyone who skirts the edge and has a history indicating bad faith—including participation in subreddits that are reliable hotbeds of anti-science nonsense—will be banned.
This isn't a new rule, this is a clarification on our existing rules and how we will apply them.
posted by MrVisible at 11:20 AM on October 3, 2021 [22 favorites]
It should also be noted that (as I understand it) the reason steroids are not appropriate in early stages of disease is that they are immunosuppressive. They are good for reducing inflammation if one develops severe COVID because most people who are on the verge of being put on a ventilator have already eliminated the virus. At that point it's not the virus itself doing damage to the body, it's one's own immune system going haywire. Giving steroids earlier would, in most cases, only increase the chance of getting to that point by prolonging the infection.
If Thor's hammer drug pans out, steroids may be useful in combination with the antiviral earlier in treatment since it acts directly on the virus, much like antibiotics do for bacteria, no immune system necessary.
A year and a half ago, there were in fact a lot of things doctors didn't know yet about the best treatments. Not so much today, when the actual treatment protocols have been written in the blood of millions of people.
posted by wierdo at 11:29 AM on October 3, 2021 [5 favorites]
If Thor's hammer drug pans out, steroids may be useful in combination with the antiviral earlier in treatment since it acts directly on the virus, much like antibiotics do for bacteria, no immune system necessary.
A year and a half ago, there were in fact a lot of things doctors didn't know yet about the best treatments. Not so much today, when the actual treatment protocols have been written in the blood of millions of people.
posted by wierdo at 11:29 AM on October 3, 2021 [5 favorites]
I'm not particularly interested in the discussion of ivermectin qua ivermectin. (Though I'm a little bemused by the fact that per my dermatologist's prescription, I've been smearing ivermectin paste on my face every day for the past three years). What concerns me more is the pro-vax, "pro-science" discourse around ivermectin, which is more and more resembling the kind of thinking we associate with the right-wing media bubble.
I noticed this first in this Metafilter thread, in which the Oklahoma emergency room ivermectin hoax news story was repeated. Though it was immediately pointed out as a hoax, I saw two interesting responses within the thread:
1. Citation of a NY Times piece which while repeating the hoax story, contained no original reporting. This non-journalistic echo chamber approach is remarkably similar to what we typically see with fox news and right wing social media, with an unsubstantiated story being repeated uncritically by a news outlet that makes no effort to investigate or verify. The news outlet's repetition is then used as evidence for veracity of the story. Notably, the NY Times removed reference to the Oklahoma emergency room story with no note of retraction.
2. Knee-jerk dismissal of the hospital's refutation of the story because the hospital is a corporate entity and corporations are not to be trusted. While this may be the case, it is remarkably similar to the right's blanket dismissal of entire classes of sources due to perceived sins.
I'm also seeing, even in this thread, a trend towards cruelty and dehumanization that very much mirrors right-wing rhetoric. While many of the people taking ivermectin to treat COVID are getting off-label prescriptions of an FDA-approved (not for this use!) human pharmaceutical, there are constant references to ivermectin as a veterinary drug. And the term "veterinary drug" is not used. Instead it's always something like "horse dewormer" or "cow paste". This is textbook dehumanization of an out group.
And I understand! I'm so very, very angry. I've spent the past four months working with my therapist on my all-consuming inchoate rage towards antivaxers. And lazaruslong, I appreciate you saying I'm a mench around here, but I got my first Metafilter timeout not long ago for absolutely losing my shit about some COVID culture thing or another.
I guess I've gotten to the point where I don't think there's anything we can do about it, other than encouraging our government officials and employers to impose and enforce vaccination mandates. And the anger and cruelty is exhausting.
posted by mr_roboto at 11:37 AM on October 3, 2021 [10 favorites]
I noticed this first in this Metafilter thread, in which the Oklahoma emergency room ivermectin hoax news story was repeated. Though it was immediately pointed out as a hoax, I saw two interesting responses within the thread:
1. Citation of a NY Times piece which while repeating the hoax story, contained no original reporting. This non-journalistic echo chamber approach is remarkably similar to what we typically see with fox news and right wing social media, with an unsubstantiated story being repeated uncritically by a news outlet that makes no effort to investigate or verify. The news outlet's repetition is then used as evidence for veracity of the story. Notably, the NY Times removed reference to the Oklahoma emergency room story with no note of retraction.
2. Knee-jerk dismissal of the hospital's refutation of the story because the hospital is a corporate entity and corporations are not to be trusted. While this may be the case, it is remarkably similar to the right's blanket dismissal of entire classes of sources due to perceived sins.
I'm also seeing, even in this thread, a trend towards cruelty and dehumanization that very much mirrors right-wing rhetoric. While many of the people taking ivermectin to treat COVID are getting off-label prescriptions of an FDA-approved (not for this use!) human pharmaceutical, there are constant references to ivermectin as a veterinary drug. And the term "veterinary drug" is not used. Instead it's always something like "horse dewormer" or "cow paste". This is textbook dehumanization of an out group.
And I understand! I'm so very, very angry. I've spent the past four months working with my therapist on my all-consuming inchoate rage towards antivaxers. And lazaruslong, I appreciate you saying I'm a mench around here, but I got my first Metafilter timeout not long ago for absolutely losing my shit about some COVID culture thing or another.
I guess I've gotten to the point where I don't think there's anything we can do about it, other than encouraging our government officials and employers to impose and enforce vaccination mandates. And the anger and cruelty is exhausting.
posted by mr_roboto at 11:37 AM on October 3, 2021 [10 favorites]
Anyhow, I feel all prickly and probably ill-equipped to read tone/intent at this point (and thank you elkevelvet for acknowledging anger, I was bummed out about the stfu but also trying to not take things personally). I posted the Scientific American article -- "Fringe Doctors’ Groups Promote Ivermectin for COVID despite a Lack of Evidence" -- because I had _no idea_ why anyone would even consider ivermectin and I thought it did a good job of explaining both the horror of how it has gotten taken up by anti-vaxxers, and why it even is/was being considered. I am gonna run away before I get more defensive!
posted by spamandkimchi at 11:47 AM on October 3, 2021 [2 favorites]
posted by spamandkimchi at 11:47 AM on October 3, 2021 [2 favorites]
I'm also seeing, even in this thread, a trend towards cruelty and dehumanization that very much mirrors right-wing rhetoric. While many of the people taking ivermectin to treat COVID are getting off-label prescriptions of an FDA-approved (not for this use!) human pharmaceutical, there are constant references to ivermectin as a veterinary drug. And the term "veterinary drug" is not used. Instead it's always something like "horse dewormer" or "cow paste". This is textbook dehumanization of an out group.
This is a response to reports, echoed by the FDA, of many other people self-medicating with explicitly veterinary versions of ivermectin. While the one report of emergency rooms overflowing with ivermectin overdoses proved inaccurate and was rightly criticized, feed stores and their customers are indeed finding unprecedented demand for the horse version because they cannot get the human version from their doctor, or choose not to involve doctors in their medical choices.
This is not a Saturday Night Live sketch coming to life or a TikTok meme. This is people like Laura Ingraham declaring that ivermectin is the miracle cure that Big Pharma and the Medical Deep State are hiding from you, and a percentage of their listeners actually self-medicating with veterinary compounds based on that maladjusted advice.
People are referring to "horse paste" not because all Ivermectin is horse paste, but because some people are using horse paste as their Ivermectin source. You get that, right?
posted by delfin at 12:28 PM on October 3, 2021 [15 favorites]
This is a response to reports, echoed by the FDA, of many other people self-medicating with explicitly veterinary versions of ivermectin. While the one report of emergency rooms overflowing with ivermectin overdoses proved inaccurate and was rightly criticized, feed stores and their customers are indeed finding unprecedented demand for the horse version because they cannot get the human version from their doctor, or choose not to involve doctors in their medical choices.
This is not a Saturday Night Live sketch coming to life or a TikTok meme. This is people like Laura Ingraham declaring that ivermectin is the miracle cure that Big Pharma and the Medical Deep State are hiding from you, and a percentage of their listeners actually self-medicating with veterinary compounds based on that maladjusted advice.
People are referring to "horse paste" not because all Ivermectin is horse paste, but because some people are using horse paste as their Ivermectin source. You get that, right?
posted by delfin at 12:28 PM on October 3, 2021 [15 favorites]
I teach pharmacology to medical students, including in years past ivermectin as an anthelminth. Each year the PhD students in my class receive an additional assignment of preparing a report on a hot topic. This year, one student chose the topic ivermectin in COVID-19. He is supposed to make a first draft of his presentation tomorrow. I'll write back after that.
I will say, having gone through this with HIV (most prominently) and other diseases, there are always a lot of compounds with sketchy backgrounds that are claimed to work, the desperation caused by the disease being the critical factor in determining the number.
Finding a good antiviral agent is very hard. Even the ones who go through the regular route often have marginal efficacy and quickly-obtained resistance.
I have posted my first new COVID analysis on my blog in months.
It looks at the question of Where Has COVID-19 Had Its Highest Death Rates Since The Delta Variant Appeared?
I probably should have included in the title: U.S. states. Spoiler alert: Florida has done the worse, per 100,000 people over the past seven months since the Delta variant appeared and at a time when vaccines became generally available.
posted by dances_with_sneetches at 12:36 PM on October 3, 2021 [10 favorites]
I will say, having gone through this with HIV (most prominently) and other diseases, there are always a lot of compounds with sketchy backgrounds that are claimed to work, the desperation caused by the disease being the critical factor in determining the number.
Finding a good antiviral agent is very hard. Even the ones who go through the regular route often have marginal efficacy and quickly-obtained resistance.
I have posted my first new COVID analysis on my blog in months.
It looks at the question of Where Has COVID-19 Had Its Highest Death Rates Since The Delta Variant Appeared?
I probably should have included in the title: U.S. states. Spoiler alert: Florida has done the worse, per 100,000 people over the past seven months since the Delta variant appeared and at a time when vaccines became generally available.
posted by dances_with_sneetches at 12:36 PM on October 3, 2021 [10 favorites]
mr_roboto, it's pretty clear from looking at the discussion in various places online that a huge number of people using Ivermectin are in fact using the stuff they can get from feed stores, Tractor Supply, etc, not finding an unscrupulous doctor to write them a prescription. They are quite literally taking horse paste or sheep dip.
As far as the story about the hospital in Oklahoma, it strains credulity that they haven't at any point had to redirect patients to the larger hospitals in Fort Smith since they often have to do that in normal times. I used to live in the area, so I'm not speculating on this. In addition to the depressingly frequent news stories talking about it in the context of ever decreasing state support for keeping hospitals open in small towns, I actually met many people who had that exact problem all the way back in the 90s when I had to spend several months over the course of a few years sitting in waiting rooms in one of those hospitals in Fort Smith because of my mom's health problems.
It only took a couple of heart attacks or car crashes at the same time to force them to redirect emergency patients even then. Even one person presenting with an Ivermectin overdose could easily put them over the top. That's just how health care works in the rural parts of this country.
Even in Tulsa, which has historically had the highest number of beds per capita in the country, hospitals have been turning people away or sending people home with a bottle of oxygen who really should have been admitted for several periods during the pandemic. The problem was undeniable enough that despite the very Republican bent of the place, the city imposed public mask mandates and restaurant restrictions.
Given the context, it's not at all unreasonable to be skeptical of the hospital's denial.
posted by wierdo at 12:39 PM on October 3, 2021 [4 favorites]
As far as the story about the hospital in Oklahoma, it strains credulity that they haven't at any point had to redirect patients to the larger hospitals in Fort Smith since they often have to do that in normal times. I used to live in the area, so I'm not speculating on this. In addition to the depressingly frequent news stories talking about it in the context of ever decreasing state support for keeping hospitals open in small towns, I actually met many people who had that exact problem all the way back in the 90s when I had to spend several months over the course of a few years sitting in waiting rooms in one of those hospitals in Fort Smith because of my mom's health problems.
It only took a couple of heart attacks or car crashes at the same time to force them to redirect emergency patients even then. Even one person presenting with an Ivermectin overdose could easily put them over the top. That's just how health care works in the rural parts of this country.
Even in Tulsa, which has historically had the highest number of beds per capita in the country, hospitals have been turning people away or sending people home with a bottle of oxygen who really should have been admitted for several periods during the pandemic. The problem was undeniable enough that despite the very Republican bent of the place, the city imposed public mask mandates and restaurant restrictions.
Given the context, it's not at all unreasonable to be skeptical of the hospital's denial.
posted by wierdo at 12:39 PM on October 3, 2021 [4 favorites]
Thinking it over, is there really a good antiviral that isn't anti-HIV or hepatitis C?
There are a lot of others including for flu and herpesviruses but they are limited in their efficacy. Maybe I'm being too critical of them (or forgetting another decent antiviral).
posted by dances_with_sneetches at 12:40 PM on October 3, 2021
There are a lot of others including for flu and herpesviruses but they are limited in their efficacy. Maybe I'm being too critical of them (or forgetting another decent antiviral).
posted by dances_with_sneetches at 12:40 PM on October 3, 2021
Delfin, that’s not correct either- it’s being reported widely as an animal medication with no acknowledgment it has use in human medicine. If you aren’t familiar with the drug, or that it is a human medication as well, ivermectin then becomes only associated with an animal medication.
And unfortunately it makes the people who do take it seem like pure idiots instead of the, again, nuance of the situation.
It actually reminds me of how we have demonized Asian cultures for traditional Chinese medicine practices and therefore made a lot of people who use TCM much more resistant to conservation efforts. By conflating all TCM to sexual enhancement, it’s been easy for the west to waggle their fingers at eastern traditions for being dumb and selfish. When it’s much more complicated than that.
The point, as incredulous as we might be, pointing a finger and saying “you eat horse paste” doesn’t change minds, even if it feels good.
posted by [insert clever name here] at 12:40 PM on October 3, 2021 [3 favorites]
And unfortunately it makes the people who do take it seem like pure idiots instead of the, again, nuance of the situation.
It actually reminds me of how we have demonized Asian cultures for traditional Chinese medicine practices and therefore made a lot of people who use TCM much more resistant to conservation efforts. By conflating all TCM to sexual enhancement, it’s been easy for the west to waggle their fingers at eastern traditions for being dumb and selfish. When it’s much more complicated than that.
The point, as incredulous as we might be, pointing a finger and saying “you eat horse paste” doesn’t change minds, even if it feels good.
posted by [insert clever name here] at 12:40 PM on October 3, 2021 [3 favorites]
If you're complaining about people mocking actual horse paste users directly to those users, you've got a grave misunderstanding of the situation. People are literally asking "how much of this horse paste should I take" in FB groups dedicated to the use of livestock dewormer. People aren't going into those groups to mock those that are, they're pointing (and maybe laughing) from afar.
posted by wierdo at 12:46 PM on October 3, 2021 [7 favorites]
posted by wierdo at 12:46 PM on October 3, 2021 [7 favorites]
Even one person presenting with an Ivermectin overdose could easily put them over the top. That's just how health care works in the rural parts of this country.
Ivermectin is hard to overdose on. Even harder to overdose on beyond feeling crummy. It’s not impossible, by any means, especially with the larger volume formulations available for farm animals. But it’s actually a very safe drug, unlike hydroxichloroquine.
So that one patient may not ever wander through the ER doors.
My first thought upon hearing ivermectin was the new covid fad was “well at least they chose one that they wouldn’t kill themselves with”. Tbh, I was surprised to hear people were, because they must be trying hard.
posted by [insert clever name here] at 12:49 PM on October 3, 2021 [1 favorite]
Ivermectin is hard to overdose on. Even harder to overdose on beyond feeling crummy. It’s not impossible, by any means, especially with the larger volume formulations available for farm animals. But it’s actually a very safe drug, unlike hydroxichloroquine.
So that one patient may not ever wander through the ER doors.
My first thought upon hearing ivermectin was the new covid fad was “well at least they chose one that they wouldn’t kill themselves with”. Tbh, I was surprised to hear people were, because they must be trying hard.
posted by [insert clever name here] at 12:49 PM on October 3, 2021 [1 favorite]
The point, as incredulous as we might be, pointing a finger and saying “you eat horse paste” doesn’t change minds, even if it feels good.
And yet, once the dense clouds of nuance have cleared, there they are - eating horse paste.
posted by thatwhichfalls at 12:51 PM on October 3, 2021 [19 favorites]
And yet, once the dense clouds of nuance have cleared, there they are - eating horse paste.
posted by thatwhichfalls at 12:51 PM on October 3, 2021 [19 favorites]
Delfin, that’s not correct either- it’s being reported widely as an animal medication with no acknowledgment it has use in human medicine. If you aren’t familiar with the drug, or that it is a human medication as well, ivermectin then becomes only associated with an animal medication.
You've made this assertion; cite it, please. Show us mainstream news sources that are reporting on ivermectin as "horses lol" without acknowledging that (a) they are referring to human beings specifically obtaining and misusing non-human versions of it or (b) that its human-version use for COVID prevention/treatment is significantly off-label.
Tide pods have a common use that makes them a part of many everyday households. That does not mean that, should I hear stories of people misusing them horribly by eating them, that I will not mock those people and their terrible judgment in a very loud voice.
posted by delfin at 12:54 PM on October 3, 2021
You've made this assertion; cite it, please. Show us mainstream news sources that are reporting on ivermectin as "horses lol" without acknowledging that (a) they are referring to human beings specifically obtaining and misusing non-human versions of it or (b) that its human-version use for COVID prevention/treatment is significantly off-label.
Tide pods have a common use that makes them a part of many everyday households. That does not mean that, should I hear stories of people misusing them horribly by eating them, that I will not mock those people and their terrible judgment in a very loud voice.
posted by delfin at 12:54 PM on October 3, 2021
Weirdo, I’m saying that is less an irrational decision than you think. Someone upthread pointed out that people have long taken farm medications. It’s Not a good idea because they’re generally not held to the same quality standards as human medication and the dosages are formulated for animals. But it’s not entirely irrational to recognize that the medications are the same.
I say this with one side of the family being farmers. No we, never did (at least as far as I’m aware) but it definitely wasn’t a crazy idea in that community.
posted by [insert clever name here] at 12:54 PM on October 3, 2021 [1 favorite]
I say this with one side of the family being farmers. No we, never did (at least as far as I’m aware) but it definitely wasn’t a crazy idea in that community.
posted by [insert clever name here] at 12:54 PM on October 3, 2021 [1 favorite]
If this thread ends with someone eating horse paste... well lets just say I called it first.
posted by some loser at 12:55 PM on October 3, 2021 [3 favorites]
posted by some loser at 12:55 PM on October 3, 2021 [3 favorites]
Delfin, that’s not correct either- it’s being reported widely as an animal medication with no acknowledgment it has use in human medicine. If you aren’t familiar with the drug, or that it is a human medication as well, ivermectin then becomes only associated with an animal medication.
I don't know what news sources you're looking at, but this doesn't seem to be the case at all. Here's an article from NBC News:
And unfortunately it makes the people who do take it seem like pure idiots instead of the, again, nuance of the situation.
No nuance here, they're disregarding the overwhelming evidence from the epidemiological community, going to the store and buying livestock materials, and using them. Those who are getting medical advice seem to be getting it either from quacks or doctors with poor knowledge of anti-COVID effectiveness.
posted by Glegrinof the Pig-Man at 1:03 PM on October 3, 2021 [13 favorites]
I don't know what news sources you're looking at, but this doesn't seem to be the case at all. Here's an article from NBC News:
Originally introduced as a veterinary drug for livestock animals in the late-1970s, ivermectin quickly proved useful in combating certain human diseases caused by parasites, a discovery that won the Nobel Prize for medicine in 2015. It comes in pills and pastes, in versions meant for humans and for animals.And here's another from CNN:
Ivermectin has been called a “wonder drug” because of its use in treating parasitic diseases, but it has not shown the same results in studies against viruses.
The drug was the subject of research into possible use as a Covid-19 treatment — including a promising non-peer-reviewed study that was later determined to be “flawed” and taken down by the website Research Square, which hosts preprints of research papers that have not yet been published in academic journals.
Ivermectin is used to treat parasites such as worms and lice in humans and it is also used by veterinarians to de-worm large animals[. . .]The CDC reminded doctors that ivermectin is not authorized or approved for use in Covid-19 patients. Doctors did investigate the possibility, but clinical trials of the drug "yielded insufficient evidence" to treat Covid-19. Scientists would need to perform more clinical trials to see if it actually worked to treat the disease. Overdoses of the drug can cause stomach problems, nerve damage, seizures, disorientation, coma and death.Both articles explicitly state that (a) anti-vaxxers are buying the animal products aka the "horse dewormer", (b) that ivermectin has human uses but with different doses and delivery methods, and (c) that there is no proof that ivermectin is effective against COVID.
And unfortunately it makes the people who do take it seem like pure idiots instead of the, again, nuance of the situation.
No nuance here, they're disregarding the overwhelming evidence from the epidemiological community, going to the store and buying livestock materials, and using them. Those who are getting medical advice seem to be getting it either from quacks or doctors with poor knowledge of anti-COVID effectiveness.
posted by Glegrinof the Pig-Man at 1:03 PM on October 3, 2021 [13 favorites]
And this isn't the first veterinary drug these dumbasses have taken for covid. Fish drug drinkers were the first generation, the farm vet pioneers. Now we're getting the second-generation horse paste eaters.
posted by ryanrs at 1:07 PM on October 3, 2021
posted by ryanrs at 1:07 PM on October 3, 2021
[insert clever name here], I get that. I don't even have a huge problem with it other than how much of an indictment of our health care system it is that people feel the need to do that. However, they are a very small proportion of the people eating horse paste and aren't likely to overdose unless it's through bioaccumulation from long term use. They aren't on Facebook asking for dosage information since they are already be familiar with calculating appropriate doses based on weight and the strength of the formulation since they're already doing that for their animals.
Even if they were overdosing, it wouldn't be a huge issue since there simply aren't that many farmers any more. What is a problem is J. Random Suburb Dweller popping over to the local Tractor Supply Center and grabbing some horse paste for themselves and their kids because Facebook or Tucker Carlson said it was a good idea. They are the reason why Ivermectin is in short supply, not farmers who are used to using it on their animals.
Poison control centers in multiple states have issued statements about the drastic rise in calls, almost exclusively related to the consumption of veterinary Ivermectin. This isn't about disapproving of off label use, it's a reaction to a very real problem that is actually harming people. Not just because they think they're getting protection they actually aren't, but because they are making themselves sick.
posted by wierdo at 1:10 PM on October 3, 2021
Even if they were overdosing, it wouldn't be a huge issue since there simply aren't that many farmers any more. What is a problem is J. Random Suburb Dweller popping over to the local Tractor Supply Center and grabbing some horse paste for themselves and their kids because Facebook or Tucker Carlson said it was a good idea. They are the reason why Ivermectin is in short supply, not farmers who are used to using it on their animals.
Poison control centers in multiple states have issued statements about the drastic rise in calls, almost exclusively related to the consumption of veterinary Ivermectin. This isn't about disapproving of off label use, it's a reaction to a very real problem that is actually harming people. Not just because they think they're getting protection they actually aren't, but because they are making themselves sick.
posted by wierdo at 1:10 PM on October 3, 2021
I don't even have a huge problem with it other than how much of an indictment of our health care system it is that people feel the need to do that.
I think of it as a failure of our education system, since there are few critical thinking skills and knowledge of what sources to trust at play.
posted by tiny frying pan at 1:12 PM on October 3, 2021 [3 favorites]
I think of it as a failure of our education system, since there are few critical thinking skills and knowledge of what sources to trust at play.
posted by tiny frying pan at 1:12 PM on October 3, 2021 [3 favorites]
Weirdo, I’m saying that is less an irrational decision than you think.
No one has yet succeeded — perhaps because human language lacks the capacity — in overstating the irrationality of placing oneself and others at mortal risk by substituting a likely-ineffective and potentially dangerous veterinary formulation of ivermectin for a miraculously effective and safe vaccine in the face of a pandemic of deadly viral pneumonia.
There are certainly circumstances where it is eminently sensible for people to exploit the ready availability and affordability of formulations other than those available at the local CVS. this is nowhere near any of those circumstances and conflating them is just flat wrong.
posted by multics at 1:16 PM on October 3, 2021 [11 favorites]
No one has yet succeeded — perhaps because human language lacks the capacity — in overstating the irrationality of placing oneself and others at mortal risk by substituting a likely-ineffective and potentially dangerous veterinary formulation of ivermectin for a miraculously effective and safe vaccine in the face of a pandemic of deadly viral pneumonia.
There are certainly circumstances where it is eminently sensible for people to exploit the ready availability and affordability of formulations other than those available at the local CVS. this is nowhere near any of those circumstances and conflating them is just flat wrong.
posted by multics at 1:16 PM on October 3, 2021 [11 favorites]
On the bright side, this thread is a great illustration of the perniciousness of disinformation and the ease with which intelligent people can fall victim to the depredations of Russian troll farms and grifters. None of us are immune, even if we've gotten the metaphorical shot. Like the pandemic, we can't leave it to individual action to keep ourselves safe. Even if a given person is unusually resistant, it doesn't matter much if everyone around them is falling victim.
posted by wierdo at 1:18 PM on October 3, 2021 [10 favorites]
posted by wierdo at 1:18 PM on October 3, 2021 [10 favorites]
Since we're discussing all things ivermectin, we should also note that Merck has been literally giving it away for free since 1987, to combat river blindness and lymphatic filariasis.
posted by Sublimity at 1:54 PM on October 3, 2021 [3 favorites]
posted by Sublimity at 1:54 PM on October 3, 2021 [3 favorites]
If this thread ends with someone eating horse paste...
Maybe they are just asking questions.
This and previous threads have definitely highlighted to me some serious issues. One of them is giving in to the horse-paste crowd, even in degrees, which looks and smells like another social media platform capitulating to genuinely malicious people. And we've discussed vaccine hesitancy here before, and the horse-paste crowd does not seem to overlap with those who are genuinely hesitant — the main qualitative difference being behaviors motivated by active disinformation campaigning, as opposed to lack of information from trusted medical professionals, or even lack of access to said individuals — which is a situation made even worse by the ivermectin disinformation crowd.
posted by They sucked his brains out! at 1:55 PM on October 3, 2021 [1 favorite]
Maybe they are just asking questions.
This and previous threads have definitely highlighted to me some serious issues. One of them is giving in to the horse-paste crowd, even in degrees, which looks and smells like another social media platform capitulating to genuinely malicious people. And we've discussed vaccine hesitancy here before, and the horse-paste crowd does not seem to overlap with those who are genuinely hesitant — the main qualitative difference being behaviors motivated by active disinformation campaigning, as opposed to lack of information from trusted medical professionals, or even lack of access to said individuals — which is a situation made even worse by the ivermectin disinformation crowd.
posted by They sucked his brains out! at 1:55 PM on October 3, 2021 [1 favorite]
Excuse me, but when I spend hours researching COVID vaccine alternatives on twitter, I am being a smart and well-informed citizen, taking control of my health decisions. It's those other people who are falling for disinformation campaigns.
Here, look at this highly-respected scientist's shouty facebook post, because that's how science is done, apparently.
posted by ryanrs at 2:18 PM on October 3, 2021 [5 favorites]
Here, look at this highly-respected scientist's shouty facebook post, because that's how science is done, apparently.
posted by ryanrs at 2:18 PM on October 3, 2021 [5 favorites]
Bottlecap, I got Dr. Pierre Kory’s name wrong so understand. But it’s clear his work early in the pandemic saved a lot of lives. And he might be really wrong on the ivermectin front. Maybe he’s just overconfident since he was so right early on. But he’s also being demonized in a way that I don’t think is appropriate. Even his Wikipedia page has changed in a way to minimize his legitimacy and legacy.
holy shit yeah, that dude is bonkers. like 5 mins on his socials / website is enough. His wikipedia will not get any better from here on out -- he's fully on the TimeCube path towards shouty grift, in 20 years that guy will be either be President or hucking brain pills on whatever replaces Alex Jones.
posted by lazaruslong at 2:22 PM on October 3, 2021 [1 favorite]
holy shit yeah, that dude is bonkers. like 5 mins on his socials / website is enough. His wikipedia will not get any better from here on out -- he's fully on the TimeCube path towards shouty grift, in 20 years that guy will be either be President or hucking brain pills on whatever replaces Alex Jones.
posted by lazaruslong at 2:22 PM on October 3, 2021 [1 favorite]
It was only recently that I learned that Ivermectin is used to treat certain human health problems. Previous to reading an article on NPRs website reporting just that, all I had seen/heard was "God these stupid idiots are out there randomly eating tons of horse paste. " While this new information gained from the NPR article in no way tempted me to go out and dose myself with any form of Ivermectin (animal preperation or human preperation), I did find the information useful because facts help round out my perceptions of what's going on in the world. I'm pretty darn sure that the sort of folks who frequent Meta Filter are not about to run out and eat a bunch of veterinary medicine just because someone else on meta filter commented that perhaps we all didn't at first have a compete understanding of the situation. In my opinion this thread is a depressing pile on composed of really frightened, angry people, who might could stand to just take breath, reread the actual comments, and maybe tone it down a bit. Nobody needs to tell anybody to shut the fuck up, or imply that anyone here is going to be responsible for anyone else going out and eating horse paste. This thread and others like it are why I sometimes have to ask myself if meta filter is really the right place for me.
posted by WalkerWestridge at 2:35 PM on October 3, 2021 [4 favorites]
posted by WalkerWestridge at 2:35 PM on October 3, 2021 [4 favorites]
One thing I have been wondering is if the horse paste formulation tastes better than the human ivermectin creams. I think it might because there is less concern of human users overdosing because it tastes good, since it's dispensed to farm animals. So the manufacturer can just cram it full of sugar and fake apple flavor, with little concern for kids getting into it, etc.
If any mefi farmers would care to take a little lick and report back, I would be interested in hearing the results!
posted by ryanrs at 2:52 PM on October 3, 2021
If any mefi farmers would care to take a little lick and report back, I would be interested in hearing the results!
posted by ryanrs at 2:52 PM on October 3, 2021
One thing I have been wondering is if the horse paste formulation tastes better than the human ivermectin creams.
Human formulations prescribed as antiparasitics are pills--tablets or caplets--so taste isn't really an issue. The topical cream formulation prescribed for rosacea is under patent, and is much, much more expensive than the tablets. It's also much less concentrated, so you'd wind up eating a much larger volume to get the same ivermectin dose as a tablet formulation.
That said, I just tasted my rosacea cream, and it's fine. Slightly sweet, inoffensive.
posted by mr_roboto at 3:13 PM on October 3, 2021 [2 favorites]
Human formulations prescribed as antiparasitics are pills--tablets or caplets--so taste isn't really an issue. The topical cream formulation prescribed for rosacea is under patent, and is much, much more expensive than the tablets. It's also much less concentrated, so you'd wind up eating a much larger volume to get the same ivermectin dose as a tablet formulation.
That said, I just tasted my rosacea cream, and it's fine. Slightly sweet, inoffensive.
posted by mr_roboto at 3:13 PM on October 3, 2021 [2 favorites]
Information is, indeed, quite important and useful. I will certainly encourage everyone reading this to seek out all the credible information possible regarding COVID and, well, anything else that interests them.
But context is important, too. For example, one of the first posts in this thread complained about "messaging that positions ivermectin as a purely veterinary medication"... but the linked tweet in it does nothing of the sort. It shows a vet and a GP side-by-side, and when clicked through, the third paragraph explains carefully what ivermectin is used for in animals and in humans. It then specifies that ivermectin is not authorized or approved to treat COVID, has not shown effectiveness against COVID but clinical trials are ongoing, and that if your health care provider writes you an ivermectin prescription, you should fill it via a pharmacy and take it exactly as prescribed.
A far cry from "Ivermectin is horse paste LOL."
I will repeat my request for citations from earlier; please link mainstream media and news sources (i.e. not a meme image from Reddit, but something that a rational person might recognize as unbiased news) that are mocking Ivermectin as strictly animal medicine without any context. As Glegrinof demonstrated upthread, there are certainly mainstream sources that are making the distinction between approved human-version use, off-label human-version use and extremely off-label cross-species-version use.
No one who is reading this now is likely to go out and dose up on sheep dip; I would like to think that we are a somewhat more discerning crowd than that. People who take/use ivermectin for what it is designed to treat should, by all means, continue to take/use it with zero fanfare or abuse, and I feel bad that this drug's misuse is causing them discomfort.
But people who are stocking up on equine ivermectin to fight COVID, or who are picketing hospitals demanding that human-ivermectin therapy be implemented immediately, are not doing it because their doctor is willing to prescribe it but the horse version is cheaper and tastier. They are doing it because of conspiracy theories and crackpots, as well as bad actors like Laura Ingraham and Tucker Carlson deliberately encouraging those theories in an attempt to discredit and undercut their perceived enemies.
And in doing so, they are encouraging (deliberately and/or indirectly) the spread of a potentially deadly virus that my wife tested positive for nine days ago. (She's fine. She was previously vaccinated.) They are encouraging people to try unproven remedies instead of what we already know to be safe, effective and reasonable, the bottom line of which results in more COVID+ people. They are doing this not out of good faith, but to score political points and more viewers and listeners.
So if my responses seem uncivil towards those who are horsing around, they are not without pity as well; these people are misinformed. Many of them deliberately so, choosing to disdain everything that does not tell them what they want to hear as "mainstream propaganda." Many of them because they simply do not understand that what they are being told is not credible. There is some hope for the latter camp.
posted by delfin at 3:18 PM on October 3, 2021 [15 favorites]
But context is important, too. For example, one of the first posts in this thread complained about "messaging that positions ivermectin as a purely veterinary medication"... but the linked tweet in it does nothing of the sort. It shows a vet and a GP side-by-side, and when clicked through, the third paragraph explains carefully what ivermectin is used for in animals and in humans. It then specifies that ivermectin is not authorized or approved to treat COVID, has not shown effectiveness against COVID but clinical trials are ongoing, and that if your health care provider writes you an ivermectin prescription, you should fill it via a pharmacy and take it exactly as prescribed.
A far cry from "Ivermectin is horse paste LOL."
I will repeat my request for citations from earlier; please link mainstream media and news sources (i.e. not a meme image from Reddit, but something that a rational person might recognize as unbiased news) that are mocking Ivermectin as strictly animal medicine without any context. As Glegrinof demonstrated upthread, there are certainly mainstream sources that are making the distinction between approved human-version use, off-label human-version use and extremely off-label cross-species-version use.
No one who is reading this now is likely to go out and dose up on sheep dip; I would like to think that we are a somewhat more discerning crowd than that. People who take/use ivermectin for what it is designed to treat should, by all means, continue to take/use it with zero fanfare or abuse, and I feel bad that this drug's misuse is causing them discomfort.
But people who are stocking up on equine ivermectin to fight COVID, or who are picketing hospitals demanding that human-ivermectin therapy be implemented immediately, are not doing it because their doctor is willing to prescribe it but the horse version is cheaper and tastier. They are doing it because of conspiracy theories and crackpots, as well as bad actors like Laura Ingraham and Tucker Carlson deliberately encouraging those theories in an attempt to discredit and undercut their perceived enemies.
And in doing so, they are encouraging (deliberately and/or indirectly) the spread of a potentially deadly virus that my wife tested positive for nine days ago. (She's fine. She was previously vaccinated.) They are encouraging people to try unproven remedies instead of what we already know to be safe, effective and reasonable, the bottom line of which results in more COVID+ people. They are doing this not out of good faith, but to score political points and more viewers and listeners.
So if my responses seem uncivil towards those who are horsing around, they are not without pity as well; these people are misinformed. Many of them deliberately so, choosing to disdain everything that does not tell them what they want to hear as "mainstream propaganda." Many of them because they simply do not understand that what they are being told is not credible. There is some hope for the latter camp.
posted by delfin at 3:18 PM on October 3, 2021 [15 favorites]
I don't believe the Cochrane review of ivermectin (from late July) has been linked here. Cochrane reviews are gold standard (or high standard) and typically critical.
In contrast to the American Journal of Physiology review, Cochrane comes to no deep conclusion beyond there is a lack of good studies. Or, you could say for example, (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.14 to 2.51) for decreasing mortality compared to standard of care which roughly says that we are 95% confident that ivermectin either increases mortality by 7-fold or decreases mortality by 2.5 fold.
posted by dances_with_sneetches at 3:38 PM on October 3, 2021 [4 favorites]
In contrast to the American Journal of Physiology review, Cochrane comes to no deep conclusion beyond there is a lack of good studies. Or, you could say for example, (risk ratio (RR) 0.60, 95% confidence interval (CI) 0.14 to 2.51) for decreasing mortality compared to standard of care which roughly says that we are 95% confident that ivermectin either increases mortality by 7-fold or decreases mortality by 2.5 fold.
posted by dances_with_sneetches at 3:38 PM on October 3, 2021 [4 favorites]
Funny that you should mention bears.
To be fair, water she believed contaminated with bear urine and not, as far as the story tells, as a COVID cure. She seems to be a careless jerk; we know nothing about her medical beliefs.
posted by GenjiandProust at 3:40 PM on October 3, 2021
To be fair, water she believed contaminated with bear urine and not, as far as the story tells, as a COVID cure. She seems to be a careless jerk; we know nothing about her medical beliefs.
posted by GenjiandProust at 3:40 PM on October 3, 2021
That's a damn shame. She had no idea where the best beer comes from.
posted by delfin at 3:44 PM on October 3, 2021
posted by delfin at 3:44 PM on October 3, 2021
What the hell was that?? It looked like a low budget Kentucky Fried Movie knock-off...
posted by Greg_Ace at 4:00 PM on October 3, 2021
posted by Greg_Ace at 4:00 PM on October 3, 2021
Preceded KFM by a few years, actually. That's a clip from the movie version of Firesign Theatre's "Everything You Know Is Wrong" album.
posted by delfin at 4:10 PM on October 3, 2021 [2 favorites]
posted by delfin at 4:10 PM on October 3, 2021 [2 favorites]
Other news from the shortage front-- I read something from a person with scabies who needed ivermectin and had trouble getting it.
posted by Nancy Lebovitz at 5:16 PM on October 3, 2021 [1 favorite]
posted by Nancy Lebovitz at 5:16 PM on October 3, 2021 [1 favorite]
I think the fact that it's for horses is actually a big selling point. Haven't you guys seen the tips about how you can avoid big pharmacy bills by getting vetinary medicine instead? I've even seen it as a plot on a few TV shows. I think people having been taking vetinary medicine for years as a way to avoid high drug costs. I'm sure the promotion of ivermectin fits into that framework.
It still costs more than getting vaccinated, which is free, though.
posted by subdee at 7:39 PM on October 3, 2021
It still costs more than getting vaccinated, which is free, though.
posted by subdee at 7:39 PM on October 3, 2021
From what I've seen, the horse community online - which skews pretty conservative in general and is also often comfortable using products intended for horses on themselves - thinks this is absurd and annoying. I was honestly a little surprised.
Ivermectin may be used occasionally for humans, but it's very routinely and frequently used for horses. I don't think it's unreasonable to call it primarily a livestock drug, as used in the US.
posted by sepviva at 8:43 PM on October 3, 2021 [1 favorite]
Ivermectin may be used occasionally for humans, but it's very routinely and frequently used for horses. I don't think it's unreasonable to call it primarily a livestock drug, as used in the US.
posted by sepviva at 8:43 PM on October 3, 2021 [1 favorite]
Mod note: Many comments deleted. Please feel free to discuss new studies, medical evidence, actual information, and research in a reasonable way, and drop the hatefest and goading of each other so that maybe we can have some space to actually talk about the science.
posted by taz (staff) at 12:16 AM on October 4, 2021 [5 favorites]
posted by taz (staff) at 12:16 AM on October 4, 2021 [5 favorites]
Someone upthread pointed out that people have long taken farm medications.
WRT ivermectin in particular, I've read that uninsured people wiith rosacea (i.e. a legitimate human need for topical ivermectin) have on occasion gone for veterinary substitutes, because Soolantra's label price is ridiculous. Which, yes, is an indictment of how pharmaceutical pricing works rather than an indication that veterinary formulations are actually a good substitute: it's better than going unmedicated and better than poverty but not as good as getting a reasonably priced human formulation.
posted by jackbishop at 8:17 AM on October 4, 2021 [5 favorites]
WRT ivermectin in particular, I've read that uninsured people wiith rosacea (i.e. a legitimate human need for topical ivermectin) have on occasion gone for veterinary substitutes, because Soolantra's label price is ridiculous. Which, yes, is an indictment of how pharmaceutical pricing works rather than an indication that veterinary formulations are actually a good substitute: it's better than going unmedicated and better than poverty but not as good as getting a reasonably priced human formulation.
posted by jackbishop at 8:17 AM on October 4, 2021 [5 favorites]
My remaining talking point goes out to those who don't just consider ivermectin to be a potential component of future COVID therapy, but who insist that it already is a cure and a preventative for COVID and that is being hidden from the general public because BIG PHARMA and the government want to make quadzillions off of EXPENSIVE DRUGS and HOSPITAL FEES and CONTROLLING THE POPULACE.
(This is, thankfully, not apparently any of us, but you can go onto social media and search and hit three dozen of these people with a hurled bread roll at any given time.)
This would be the same BIG PHARMA and government that are currently providing and subsidizing millions of vaccinations and lab tests, free of charge, along with massive awareness campaigns dedicated to trying to get people to avoid the disease in the first place.
Imagine for a moment that this pandemic that has severely disrupted commerce on a global scale had a existing remedy that was cheap, easy to produce and distribute, safe and reliably effective, and whose efficacy could be demonstrated with ease.
Now imagine that every store in America would not be authorized quickly to sell over-the-counter versions of that remedy, each chain having its own house brand of it and providing it in six delicious fruit flavors. McDonald's would introduce an IverMcTin combo meal. Chain stores would inquire as to whether they could pump an aerosolized version into the air in order to ensure that shoppers remained healthy enough to shop indefinitely. It would be the new high fructose corn syrup, a little bit in just about everything.
A bit hyperbolic, of course. But politicians and scientists would be climbing over each other to be the first to have endorsed this wonderful wonder drug all along, and to encourage everyone to have their doctors prescribe it so that everyone can get back out there and go back to work, school and buying things.
So I suggest, humbly, that there are reasons why they have not.
posted by delfin at 8:24 AM on October 4, 2021
(This is, thankfully, not apparently any of us, but you can go onto social media and search and hit three dozen of these people with a hurled bread roll at any given time.)
This would be the same BIG PHARMA and government that are currently providing and subsidizing millions of vaccinations and lab tests, free of charge, along with massive awareness campaigns dedicated to trying to get people to avoid the disease in the first place.
Imagine for a moment that this pandemic that has severely disrupted commerce on a global scale had a existing remedy that was cheap, easy to produce and distribute, safe and reliably effective, and whose efficacy could be demonstrated with ease.
Now imagine that every store in America would not be authorized quickly to sell over-the-counter versions of that remedy, each chain having its own house brand of it and providing it in six delicious fruit flavors. McDonald's would introduce an IverMcTin combo meal. Chain stores would inquire as to whether they could pump an aerosolized version into the air in order to ensure that shoppers remained healthy enough to shop indefinitely. It would be the new high fructose corn syrup, a little bit in just about everything.
A bit hyperbolic, of course. But politicians and scientists would be climbing over each other to be the first to have endorsed this wonderful wonder drug all along, and to encourage everyone to have their doctors prescribe it so that everyone can get back out there and go back to work, school and buying things.
So I suggest, humbly, that there are reasons why they have not.
posted by delfin at 8:24 AM on October 4, 2021
Ivermectin is about 50% bioavailable. This means about 50% of an oral formulation makes it to the bloodstream, and about 50% remains unabsorbed in the GI tract. That's good news for GI worm infections inasmuch as a sizeable dose remains behind, but that 50% is lost in regards to doing anything via the circulatory system. What percent is absorbed is highly variable (which is problematic).
The average peak human ivermectin plasma levels after taking a typical oral dose to treat a worm infection (150 ug/kg patient body weight) is about 40 ng/mL. Ivermectin can be used to treat a whole variety of worm infections (especially good against flat worms and many third world diseases), so how many repeat doses are needed is different from disease to disease, but it is typically taken short term. A rule of thumb: peak levels after a single dose are about 70% of the peak levels with repeat doses (assuming you are not varying the dosing rate/amount).
In this study, ivermectin inhibits 50% of virus production (from the supernatants) or 50% of cell associated virus at concentrations of 2.2 to 2.8 uM or 1.9 to 2.4 ug/mL. Note, and this is a bit alarming, the downslopes are defined by single points (I would not let them get away with that as a reviewer). Note, and this is really alarming, what I would eyeball as 2.0 uM has no effect whatsoever (except in graph D) with all the effect coming suddenly.
I wonder about this experiment. They state toxicity controls were performed and no toxicity was found. (The easiest explanation to such an all-or-nothing downslope is cell toxicity or the promotion of cell stasis). I wish they published their numbers on that. Other studies have presented their results on the acute cytotoxicity of ivermectin and have found it safe below 10 uM (one study) and 100 uM (a different study). These however are short term toxicities rather than chronic toxicity, which is another animal.
For prophylaxis, you must maintain the inhibitory concentration in absence of disease for an indefinite period of time. For treatment, you need maintain the inhibitory concentration until recovery. The concentrations of ivermectin for 50% inhibition needed to be maintained in patients is about 60 times higher than the peak concentration from standard anti-worm doses for humans.
For the record, I am very critical of big pharm. Pointing at them doesn't excuse promoting meme remedies whether they be Laetrile or ivermectin.
posted by dances_with_sneetches at 8:46 AM on October 4, 2021 [8 favorites]
The average peak human ivermectin plasma levels after taking a typical oral dose to treat a worm infection (150 ug/kg patient body weight) is about 40 ng/mL. Ivermectin can be used to treat a whole variety of worm infections (especially good against flat worms and many third world diseases), so how many repeat doses are needed is different from disease to disease, but it is typically taken short term. A rule of thumb: peak levels after a single dose are about 70% of the peak levels with repeat doses (assuming you are not varying the dosing rate/amount).
In this study, ivermectin inhibits 50% of virus production (from the supernatants) or 50% of cell associated virus at concentrations of 2.2 to 2.8 uM or 1.9 to 2.4 ug/mL. Note, and this is a bit alarming, the downslopes are defined by single points (I would not let them get away with that as a reviewer). Note, and this is really alarming, what I would eyeball as 2.0 uM has no effect whatsoever (except in graph D) with all the effect coming suddenly.
I wonder about this experiment. They state toxicity controls were performed and no toxicity was found. (The easiest explanation to such an all-or-nothing downslope is cell toxicity or the promotion of cell stasis). I wish they published their numbers on that. Other studies have presented their results on the acute cytotoxicity of ivermectin and have found it safe below 10 uM (one study) and 100 uM (a different study). These however are short term toxicities rather than chronic toxicity, which is another animal.
For prophylaxis, you must maintain the inhibitory concentration in absence of disease for an indefinite period of time. For treatment, you need maintain the inhibitory concentration until recovery. The concentrations of ivermectin for 50% inhibition needed to be maintained in patients is about 60 times higher than the peak concentration from standard anti-worm doses for humans.
For the record, I am very critical of big pharm. Pointing at them doesn't excuse promoting meme remedies whether they be Laetrile or ivermectin.
posted by dances_with_sneetches at 8:46 AM on October 4, 2021 [8 favorites]
Fish drug drinkers were the first generation, the farm vet pioneers.
Isn’t that mostly people wanting to buy antibiotics without a prescription? That’s not good, because of the contribution to antibiotic resistance, but also clearly relates to legitimate medical access issues.
posted by atoxyl at 12:08 PM on October 4, 2021
Isn’t that mostly people wanting to buy antibiotics without a prescription? That’s not good, because of the contribution to antibiotic resistance, but also clearly relates to legitimate medical access issues.
posted by atoxyl at 12:08 PM on October 4, 2021
"Instead of home remedies for COVID we need home remedies for this new kind of mind poisoning."
I've been having incremental success with Street Epistemology.
posted by ambulocetus at 6:08 AM on October 5, 2021
I've been having incremental success with Street Epistemology.
posted by ambulocetus at 6:08 AM on October 5, 2021
Ivermectin binds to 93.2% to plasma proteins. With 6.8% free, this means the concentration for inhibition in culture needs to be multiplied by 14.7 to represent plasma concentrations. (I have researched a lot about plasma protein binding issues. I do have some skepticism about how directly they translate to real life, still 93.2% binding is a fair bit)
posted by dances_with_sneetches at 8:58 AM on October 5, 2021
posted by dances_with_sneetches at 8:58 AM on October 5, 2021
So what are we even doing in this thread? Working out suggested ivermectin dosage schedules?
Even in this heavily-moderated mefi thread, you can tell fellow mefites to eat horse paste, and it's allowed because the comments are moderated for politeness, not disinformation.
posted by ryanrs at 9:18 AM on October 5, 2021
Even in this heavily-moderated mefi thread, you can tell fellow mefites to eat horse paste, and it's allowed because the comments are moderated for politeness, not disinformation.
posted by ryanrs at 9:18 AM on October 5, 2021
The underlying message behind my posts is not what dose to take. I hope nobody is interpreting it that way. I am pointing out that the dose is ridiculously high compared to what is recommended as a worm medicine in humans. Between 800 times to 900 times more is needed if you take into account the in vitro doses and the plasma protein binding.
That is not a recommendation.
posted by dances_with_sneetches at 9:36 AM on October 5, 2021 [3 favorites]
That is not a recommendation.
posted by dances_with_sneetches at 9:36 AM on October 5, 2021 [3 favorites]
Even in this heavily-moderated mefi thread, you can tell fellow mefites to eat horse paste
For the life of me I can not see how this is your take away... I see nothing in any of the comments where anyone is recommending anyone eat horse paste, let one saying they do it themselves.
posted by WalkerWestridge at 10:40 AM on October 5, 2021 [1 favorite]
For the life of me I can not see how this is your take away... I see nothing in any of the comments where anyone is recommending anyone eat horse paste, let one saying they do it themselves.
posted by WalkerWestridge at 10:40 AM on October 5, 2021 [1 favorite]
I’ve been disturbed by the reaction of people on “my side” to the ivermectin craze.
The United States (and maybe Brazil?) is the only place on earth where there are sides associated with Covid. It is seriously through the looking glass stuff, even for people from otherwise *more* politically fragmented populations.
Anyway, it was perfectly reasonable given how cheap, readily distributed, and safe Ivermectin is to be interested in the very early in vitro data from spring 2020 and equally unreasonable to be medically interested in it now.
Thinking it over, is there really a good antiviral that isn't anti-HIV or hepatitis C?
There are a lot of others including for flu and herpesviruses but they are limited in their efficacy. Maybe I'm being too critical of them (or forgetting another decent antiviral).
It is a lot easier to get antivirals to work on chronic than acute infections basically. So Remdesivir works quite well on Covid... if you dose it in a very short window, probably peak efficacy actually starts before symptom onset. Given that it has to be administered IV the practicalities of that are not great. However the same drug works very well against FIP in cats because that is a chronic disease.
A lot of antivirals block replication and chronic viral infections have a lot of replication cycles to disrupt. Covid-19 viral titres are already decreasing by the time symptoms begin and in many cases there is probably not much replicating virus left by the time most people get remdesivir which it why it doesn't work very well in practice.
See also oseltamivir for flu. Technically works great... but in practice you would need to have it stockpiled, realise immediately that your symptoms are flu, and then take it right away. BTW it does work quite well in outbreaks in care homes / nursing homes where everyone is vulnerable to influenza so you can give it prophylactically to everyone as soon as anyone gets it.
posted by atrazine at 1:27 PM on October 5, 2021 [4 favorites]
The United States (and maybe Brazil?) is the only place on earth where there are sides associated with Covid. It is seriously through the looking glass stuff, even for people from otherwise *more* politically fragmented populations.
Anyway, it was perfectly reasonable given how cheap, readily distributed, and safe Ivermectin is to be interested in the very early in vitro data from spring 2020 and equally unreasonable to be medically interested in it now.
Thinking it over, is there really a good antiviral that isn't anti-HIV or hepatitis C?
There are a lot of others including for flu and herpesviruses but they are limited in their efficacy. Maybe I'm being too critical of them (or forgetting another decent antiviral).
It is a lot easier to get antivirals to work on chronic than acute infections basically. So Remdesivir works quite well on Covid... if you dose it in a very short window, probably peak efficacy actually starts before symptom onset. Given that it has to be administered IV the practicalities of that are not great. However the same drug works very well against FIP in cats because that is a chronic disease.
A lot of antivirals block replication and chronic viral infections have a lot of replication cycles to disrupt. Covid-19 viral titres are already decreasing by the time symptoms begin and in many cases there is probably not much replicating virus left by the time most people get remdesivir which it why it doesn't work very well in practice.
See also oseltamivir for flu. Technically works great... but in practice you would need to have it stockpiled, realise immediately that your symptoms are flu, and then take it right away. BTW it does work quite well in outbreaks in care homes / nursing homes where everyone is vulnerable to influenza so you can give it prophylactically to everyone as soon as anyone gets it.
posted by atrazine at 1:27 PM on October 5, 2021 [4 favorites]
The United States (and maybe Brazil?) is the only place on earth where there are sides associated with Covid
Sadly not the case. The Murdoch death star has been absolutely shameless in pushing the Public Health Is A Threat To Mah Freedumb narrative in Australia as well, with predictably influenzial results.
posted by flabdablet at 12:47 AM on October 6, 2021 [2 favorites]
Sadly not the case. The Murdoch death star has been absolutely shameless in pushing the Public Health Is A Threat To Mah Freedumb narrative in Australia as well, with predictably influenzial results.
posted by flabdablet at 12:47 AM on October 6, 2021 [2 favorites]
Sadly not the case. The Murdoch death star yt has been absolutely shameless in pushing the Public Health Is A Threat To Mah Freedumb narrative in Australia as well, with predictably influenzial results. yt
Certainly. There are political differences on the handling of Covid everywhere. Substantial protests in Germany, the leader of a minor political party in The Netherlands getting weirder and weirder throughout Covid, disagreements within the UK Conservative party about when to lift certain restrictions. The difference here is that, while I disagree with many of these people all of them except for Baudet in NL (who has seen his political fortunes crater as a result), are fundamentally operating in a reality based world.
There is a big difference between thinking that the tradeoff between disease control and personal liberty has not been made in the way one might prefer, and a substantial fraction of a major political party simply departing from biological reality. All of the "lockdown skeptics" in positions of political relevance in the UK have had their vaccines and are not out there endorsing anti-helminthics as alternatives to evidence based medical treatment.
posted by atrazine at 2:57 AM on October 6, 2021 [3 favorites]
Certainly. There are political differences on the handling of Covid everywhere. Substantial protests in Germany, the leader of a minor political party in The Netherlands getting weirder and weirder throughout Covid, disagreements within the UK Conservative party about when to lift certain restrictions. The difference here is that, while I disagree with many of these people all of them except for Baudet in NL (who has seen his political fortunes crater as a result), are fundamentally operating in a reality based world.
There is a big difference between thinking that the tradeoff between disease control and personal liberty has not been made in the way one might prefer, and a substantial fraction of a major political party simply departing from biological reality. All of the "lockdown skeptics" in positions of political relevance in the UK have had their vaccines and are not out there endorsing anti-helminthics as alternatives to evidence based medical treatment.
posted by atrazine at 2:57 AM on October 6, 2021 [3 favorites]
Modi in India is another politician who was on the side of the virus.
posted by Nancy Lebovitz at 5:05 AM on October 6, 2021 [2 favorites]
posted by Nancy Lebovitz at 5:05 AM on October 6, 2021 [2 favorites]
Modi is a titanic creep (and in most ways much more dangerous than world leaders he is often compared to) but India's initial response though extremely cruel to migrant workers was very far from pro-virus.
I do think that the BJP as a whole though is maybe a good comparison because there also there were senior political leaders promoting dangerous and unscientific nonsense as cures.
posted by atrazine at 5:08 AM on October 6, 2021 [2 favorites]
I do think that the BJP as a whole though is maybe a good comparison because there also there were senior political leaders promoting dangerous and unscientific nonsense as cures.
posted by atrazine at 5:08 AM on October 6, 2021 [2 favorites]
With regard to this pandemic please stop doing your own research and eschewing the advice of officials at the CDC, National Institute of Allergies and Infectious Disease and WHO.
I know this probably violates your natural instincts. Perhaps you are neurodivergent like me and so called expert advice has been an instrument of torture, leading to a ingrained skepticism of medical experts. Perhaps you are smart and looked to by your friends and family as the one with answers. Perhaps your coping mechanisms for anxiety include a need for control and hyper vigilance so you’ve been frantically Googling and crawling social media in holes of being among the first to know that there is some as yet too obscure treatment that can save us.
Nothing is worse than having to accept that for all the reading you actually know fuck all and that your just going to have to trust those experts to let us know what to do. It sucks. But that’s what it is.
posted by interogative mood at 5:32 AM on October 6, 2021 [3 favorites]
I know this probably violates your natural instincts. Perhaps you are neurodivergent like me and so called expert advice has been an instrument of torture, leading to a ingrained skepticism of medical experts. Perhaps you are smart and looked to by your friends and family as the one with answers. Perhaps your coping mechanisms for anxiety include a need for control and hyper vigilance so you’ve been frantically Googling and crawling social media in holes of being among the first to know that there is some as yet too obscure treatment that can save us.
Nothing is worse than having to accept that for all the reading you actually know fuck all and that your just going to have to trust those experts to let us know what to do. It sucks. But that’s what it is.
posted by interogative mood at 5:32 AM on October 6, 2021 [3 favorites]
I've been in viral research for 30 years and one of the frustrations regarding the COVID crisis is how many people think that equality of people means an equality of opinions.
The opinion that the sun circles the earth is not equally valid.
If I go to an experienced auto mechanic with a diagnosis of what's wrong with my car, something I looked up on the internet, it is not equal to the opinion of someone who has an expertise in auto repair (which I don't have).
Should we defer to what people who have gained lifelong expertise in a matter? Not absolutely. Should we respect their opinion as the most likely valid? Yes.
There is nothing wrong with researching online to get to an answer. To fulfill your curiosity and gain knowledge. However, researching online to reach a valid conclusion is a skill set and most don't know how to look beyond "these studies say."
There is a lot of bad information and bad faith information out there.
posted by dances_with_sneetches at 8:48 AM on October 7, 2021 [6 favorites]
The opinion that the sun circles the earth is not equally valid.
If I go to an experienced auto mechanic with a diagnosis of what's wrong with my car, something I looked up on the internet, it is not equal to the opinion of someone who has an expertise in auto repair (which I don't have).
Should we defer to what people who have gained lifelong expertise in a matter? Not absolutely. Should we respect their opinion as the most likely valid? Yes.
There is nothing wrong with researching online to get to an answer. To fulfill your curiosity and gain knowledge. However, researching online to reach a valid conclusion is a skill set and most don't know how to look beyond "these studies say."
There is a lot of bad information and bad faith information out there.
posted by dances_with_sneetches at 8:48 AM on October 7, 2021 [6 favorites]
The crazy thing is that actually, this was a great time to do "your own research".
I took an online introduction to virology course, an immunology course, listened to a lot of episodes of TWiV, read a lot of papers. I mean, I did train as a scientist and I'm sure that helps in terms of understanding methods but I had no substantive knowledge of viruses or biology after high school before this.
Obviously at the end of the day, I still just do whatever the official advice is but the crazy thing is that some of these people are spending four-five hours a day doing "research" on facebook. If they applied themselves to actually learning about viruses, human immune response to them, vaccine development, etc. over the last year and a half then they genuinely would know more about those specific things than, say, their GP. Obviously without the general medical knowledge, and still much less than ID experts with decades of experience so they should still in that case have deferred to expert opinion but they really could have learned a lot.
None of these people have done that kind of work to build up even a rudimentary understanding of the underlying basic science and they easily could have.
Then again, I still see journalists who have been covering covid stories almost non-stop for 18 months say things like "the pandemic is now growing exponentially" when, come on, by page 3 of Fisher Price's My first epi curve they should know that it's always either growing or shrinking exponentially. Articles about how this or that test is "accurate" without using the words specificity and sensitivity. It would be like becoming a political correspondent and two years later still not knowing the difference between a bill being proposed and a law having passed, basic mechanical stuff without which the whole field makes no sense.
posted by atrazine at 3:09 AM on October 8, 2021 [3 favorites]
I took an online introduction to virology course, an immunology course, listened to a lot of episodes of TWiV, read a lot of papers. I mean, I did train as a scientist and I'm sure that helps in terms of understanding methods but I had no substantive knowledge of viruses or biology after high school before this.
Obviously at the end of the day, I still just do whatever the official advice is but the crazy thing is that some of these people are spending four-five hours a day doing "research" on facebook. If they applied themselves to actually learning about viruses, human immune response to them, vaccine development, etc. over the last year and a half then they genuinely would know more about those specific things than, say, their GP. Obviously without the general medical knowledge, and still much less than ID experts with decades of experience so they should still in that case have deferred to expert opinion but they really could have learned a lot.
None of these people have done that kind of work to build up even a rudimentary understanding of the underlying basic science and they easily could have.
Then again, I still see journalists who have been covering covid stories almost non-stop for 18 months say things like "the pandemic is now growing exponentially" when, come on, by page 3 of Fisher Price's My first epi curve they should know that it's always either growing or shrinking exponentially. Articles about how this or that test is "accurate" without using the words specificity and sensitivity. It would be like becoming a political correspondent and two years later still not knowing the difference between a bill being proposed and a law having passed, basic mechanical stuff without which the whole field makes no sense.
posted by atrazine at 3:09 AM on October 8, 2021 [3 favorites]
The BBC can reveal that more than a third of 26 major trials of the drug for use on Covid have serious errors or signs of potential fraud. None of the rest show convincing evidence of ivermectin's effectiveness.
It is interesting and frightening to see how some fringe scientists and doctors were willing to propagate obvious lies and how those lies were taken up by a segment of the public eager for any solution to the Covid pandemic that did not include the vaccine. For example Joseph Ladapo and Christopher Rake were both doctors at UCLA. They were outspoken members of America's Frontline Doctors. They opposed vaccines, masking mandates, and hyped Ivermectin. Ladapo is no longer with UCLA, having been appointed by DeSantes as Florida's surgeon general. Rake was in the news in the last few days because he shared a video on twitter of him being escorted out of UCLA's hospital. Even if they make money grifting their actions don't make any sense. Rake is probably going to lose his job at UCLA and it's going to be difficult for him to find another gig as an anesthesiologist because he refuses to be vaccinated. That's a little under 250,000 a year he'll be out. Ladapo is doing better. He jumped from associate professor at UCLA to professor at University of Florida. I don't know if that's a jump up or down but at least he'll have a job after DeSantes is gone.
posted by rdr at 9:20 AM on October 8, 2021 [4 favorites]
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posted by spamandkimchi at 3:37 PM on October 2, 2021 [1 favorite]