Do you think ivermectin cures COVID-19? Think carefully: in the age of culture wars, your answer defines your politics. If you think ivermectin is useful, you are an anti-vaxxer, Trump-supporting libertarian; If you think it isn’t, you are a godless, big-government cosmopolitan. Sorry, we don’t make the rules.
Fine, but still, who is right? The truth is it’s still too early to say. The sorts of bold claims both sides are making are simply premature. The results of the TOGETHER Trial and the flaws recently detected in other trials weaken ivermectin’s case. On the other hand, one trial, that seems to have been well-conducted, points to it being mildly effective if taken at the onset of infection. Overall judgement? it may be useless, or it may be effective under certain circumstances.
But fixating on who is right misses the forest for the trees. Each side blames the other for Covid-19 deaths because of their supposedly wrong answer to this question. But, as it turns out, both sides are promoting deadly policies.
The damage ivermectin’s die-hard supporters cause is plain to see. Dubbing it a “miracle cure” provides false confidence to the masses to disregard other effective measures. The damage caused by the other side is more insidious, but likely just as lethal. Let us explain why: when dealing with safe, cheap drugs even a moderate probability that they work is reason enough to recommend them. Sure, you may later discover some of the treatments weren’t effective, as may have happened with ivermectin, but that’s negligible compared to the damage of waiting and then discovering some treatments were effective all along.
When experts focus on a study’s flaws, discarding any merit it may otherwise have, what the public hears is: ignore this, vaccines are your only possible hope.
The only way we’ll get out of this quagmire is probabilistic reasoning coupled with a cost-benefit analysis.
The best demonstration of this is in the FLCCC treatment protocol, which recommends a range of low-risk, potentially-useful repurposed drugs. While the TOGETHER trial showed that their ivermectin recommendation may have been ineffective, it also showed that Fluvoxamine, another drug in their protocol, reduced hospitalizations by 35%, and possibly cuts deaths dramatically (1 death vs 12 among those adhering to the protocol). Similarly, the FLCCC protocol recommended corticosteroids months before those became the standard of care. It is fair to assume that in the future more treatments in their protocol will be discovered to be effective.
So, regardless of the harmful, overconfident statements made by the FLCCC, doctors following their protocol saved lives, and the conservative, supposedly responsible, approach of their detractors has caused millions of deaths.
So what went wrong?
In a word: incentives. The market is not incentivized to conduct the kind of large, costly clinical trials needed for high confidence results, when the treatment is a repurposed drug that costs a few dollars per patient.
When the free market fails, the government should step in; after all, it has a massive public health incentive to find cheap, safe, and effective treatments. The trouble is that there is no single person within the government who has the authority, knowledge, and incentive to make the sorts of cost-benefit or probabilistic analyses needed in a pandemic. Authority-wielding politicians are not experts in health, statistics, or probability, and the few knowledge-wielding bureaucrats with the necessary expertise are mostly incentivized to not make mistakes, and don’t really care if one type of mistake exacts a far higher cost on society than the other. No one is at the helm.
Recommending a low-risk treatment that turns out to be ineffective wastes a modest amount of resources. Delaying a treatment that turns out to be effective may easily kill on a mass scale. But this gross asymmetry in results is not manifested in the decision-maker’s incentives.
So, they inevitably take the safe route of recommending we wait for more information and better quality trials. No one is ever blamed for such a “levelheaded” decision. But in a pandemic, there are no neutral options for decision makers.
This happens time and again. Our analysis of vitamin D is that it is likely highly effective at combating COVID-19. Given its low risk, it should be a top priority for health authorities to ensure no patient is left fighting the disease while being deficient in this essential hormone of the immune system.
Meanwhile, the US National Institute of Health flounders, proclaiming that “There is insufficient evidence to recommend either for or against the use of vitamin D for the prevention or treatment of COVID-19”. But what is the risk in recommending it, exactly?
The approach taken by both sides is lethal. Both need to change.
To ivermectin’s supporters and the FLCCC: we advise you to stop making overconfident claims on specific drugs. Bold claims such as these may cause people to ignore other effective treatments and they stake all the credibility of a balanced, probabilistic approach on one drug. If that drug turns out to be ineffective, the whole project is undermined. Instead, focus on the strong benefit of a protocol that uses multiple, promising low-risk drugs.
To the skeptics: finding flaws in clinical trials is important and necessary work. But it’s more important to help fix the system so that conducting high quality trials on cheap, repurposed treatments becomes highly profitable. And in the meantime, remember not every flaw means a trial is useless. Help identify promising signals within imperfect trials that indicate the probable efficacy of low-risk treatments, and push for their immediate adoption, so the Fluvoxamine disaster is not repeated.
The ever-present culture war around who is right and the rigid approach maintained by each side is killing people. Please stop.
November 26, 2021 at 11:55 pm
Looking at the actual evidence without a political filter? Didn’t realize this was possible.
August 2, 2022 at 2:40 am
It is obvious the anonymous author (GIL?) of this piece was operating on very limited and premature facts, seasoned with snide inferences directed at sources. No. 1, no credible advocate stated it was a cure for Covid-19. All argued for early treatment of the disease. None made a dime for their efforts, and all suffered insults and personal attacks.
August 23, 2022 at 1:52 pm
If this comment is referring to the FLCCC, we partially agree. While the FLCCC did not state that ivermectin was a cure for COVID-19 in their early treatment protocol, two leading doctors in The FLCCC did state that ivermectin was a ‘miracle cure’. This was a misleading statement however, we thought the organization, as a whole, took the right approach to treating COVID-19. In a pandemic with many uncertainties and no purpose-built drugs yet, the best approach is to treat patients with repurposed drugs that have a reasonable chance of working and have few, if any, negative side effects.
August 3, 2022 at 2:15 pm
Disregards abundant evidence of Big Pharma fraud and collusion.
Note: These factors are proven by multiple fines, the largest in history, for fraud, levied against Pfizer and other pharma companies.
They have a proven and lengthy track record of fraud. Failing to include that in the analysis invalidates the analysis.
August 23, 2022 at 3:49 pm
Big Pharma indeed gets fined all the time for problematic practices. How do you think this played a role in the ivermectin case last year?
January 18, 2023 at 7:26 am
I agree the FLCCC did get too emotionally invested in their narrative and started to feel unhinged. However, the Pharma industry can control the narrative via ad spend in mass media/social media and lobbying efforts in government. The Biopharma Industry also has many health care professionals in their direct and indirect employ who are biased towards industry narratives/products.
January 19, 2023 at 10:23 am
These are good points. As it is important to always be aware of the influence the pharmaceutical industry can have on the narrative through advertising and lobbying, and take that into consideration when evaluating information on this subject.
February 9, 2023 at 1:03 pm
Maybe it is time to revisit this issue?
My main issue is that ivmmeta.com is a site that, from the eyes of a lay man, has done absolutely impressive work to show the evidence. It currently has all ivermectin studies, regardless of outcome . Its real time meta analysis shows 60%+ efficacy for prophylaxis and early treatment.
I’ve been following this site since 2021 and notice how they update frequently and criticism seems included quickly. They rebut openly any public discussions like Scott Alexander’s review. They also do exactly the same for many other medications. I cannot see how the anonymous site owners could profit on ivermectin or any of the other medications. On paper, they are the dream of the internet to spread information come true.
Either ivmmeta.com is a fraud then shouldn’t it be trivial for medical experts to show this fraud? So far I can only see it is rejected out of hand based on innuendo or unsubstantiated claims.
If ivmmeta.com is not a fraud, we’re looking a scandal of humongous proportions, worse, we will repeat the same mistake in the next crisis.
Isn’t it time to take another look?
February 12, 2023 at 2:01 pm
Thank you for your comment. Ivmmeta.com is a great project, but it has been criticized for generous interpretations of existing studies, as well as for choosing favorable results from existing studies.
A much larger concern is not with ivmmeta, but with the quality of the studies, as there is a lack of incentives for conducting high-quality, large-scale trials on repurposed drugs. This is the real problem that needs to be addressed in order to improve response in future pandemics.