Talk:Ivermectin during the COVID-19 pandemic

Treatments for COVID-19: Current consensus

A note on WP:MEDRS: Per this Wikipedia policy, we must rely on the highest quality secondary sources and the recommendations of professional organizations and government bodies when determining the scientific consensus about medical treatments.

1. Ivermectin: The highest quality sources (1 2 3 4) suggest Ivermectin is not an effective treatment for COVID-19. In all likelihood, ivermectin does not reduce all-cause mortality (moderate certainty) or improve quality of life (high certainty) when used to treat COVID-19 in the outpatient setting (4). Recommendations from relevant organizations can be summarized as: Evidence of efficacy for ivermectin is inconclusive. It should not be used outside of clinical trials. (May 2021, June 2021, June 2021, July 2021, July 2021) (WHO, FDA, IDSA, ASHP, CDC, NIH)
2. Chloroquine & hydroxychloroquine: The highest quality sources (1 2 3 4) demonstrate that neither is effective for treating COVID-19. These analyses accounted for use both alone and in combination with azithromycin. Some data suggest their usage may worsen outcomes. Recommendations from relevant organizations can be summarized: Neither hydroxychloroquine nor chloroquine should be used, either alone or in combination with azithromycin, in inpatient or outpatient settings. (July 2020, Aug 2020, Sep 2020, May 2021) (WHO, FDA, IDSA, ASHP, NIH)
3. Ivmmeta.com, c19ivermectin.com, c19hcq.com, hcqmeta.com, trialsitenews.com, etc: These sites are not reliable. The authors are pseudonymous. The findings have not been subject to peer review. We must rely on expert opinion, which describes these sites as unreliable. From published criticisms (1 2 3 4 5), it is clear that these analyses violate basic methodological norms which are known to cause spurious or false conclusions. These analyses include studies which have very small sample sizes, widely different dosages of treatment, open-label designs, different incompatible outcome measures, poor-quality control groups, and ad-hoc un-published trials which themselves did not undergo peer-review. (Dec 2020, Jan 2021, Feb 2021)

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Last updated (diff) on 27 February 2023 by Sumanuil (t · c)

Semi-protected edit request on 17 May 2022

In the second paragraph of this section there is a small spelling inconsistency with the American English used in the article. I propose to change the bolded sceptical to its American English spelling skeptical.

Early in the COVID-19 pandemic, laboratory research suggested ivermectin might have a role in preventing or treating COVID-19. Online misinformation campaigns and advocacy boosted the drug's profile among the public. While scientists and physicians largely remained sceptical, some nations adopted ivermectin as part of their pandemic-control efforts. Some people, desperate to use ivermectin without a prescription, took veterinary preparations, which led to shortages of supplies of ivermectin for animal treatment. The FDA responded to this situation by tweeting "You are not a horse" to draw attention to the issue. Samipokanikan (talk) 13:58, 17 May 2022 (UTC)

What makes you think that this article uses American English? It includes the template {{Use Oxford spelling}} near the beginning. Phil Bridger (talk) 14:08, 17 May 2022 (UTC)

I thought seeing words like "organizations" instead of "organisations" suggested so, but yeah, I just saw the template and checked the spelling is consistent with it. Sorry! Samipokanikan (talk) 14:13, 17 May 2022 (UTC)

References

Semi-protected edit request on 17 May 2022 (2)

typo: sceptical -> skeptical Ssxdd (talk) 22:45, 17 May 2022 (UTC)

 Not done per section above. Please see MOS:ENGVAR. -- Tamzin^{[cetacean needed]} (she/they) 22:57, 17 May 2022 (UTC)

Silly joke tweet in the lead

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

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Can we not have memes in the leads of medical articles, please? I removed the line The FDA responded to this situation by tweeting "You are not a horse" to draw attention to the issue, but it was reverted. Endwise (talk) 13:17, 28 July 2022 (UTC)

It's not a "meme", it's what the FDA said in response to people (unwisely) taking horse paste and the consequent rise in poisonings and squeeze on vet supplies. As it's interestingly expressed it also helps draw the reader into the article (as a lede should). Alexbrn (talk) 13:46, 28 July 2022 (UTC)

As it's interestingly expressed it also helps draw the reader into the article (as a lede should) it also helps draw the reader into the article (as a lede should) -- A Wikipedia lead should specifically not "tease people into reading further" (see MOS:NOTLEDE). The tweet itself is a joking PSA that went viral because it's funny, and subsequently became a meme. The lead already mentions that people were taking veterinary ivermectin products. The only thing the tweet adds is its humour value, which is not the kind of thing we should be including in a summary of the most important contents of a medical article. Endwise (talk) 14:00, 28 July 2022 (UTC)

Oh it's not a "tease" but it does cultivate interest in reading on. I don't think it's funny people were taking horse paste and dying as result; it's interesting a weighty body like the FDA messaged in this way however. Alexbrn (talk) 14:13, 28 July 2022 (UTC)

I think this tweet is a notable event in this saga, and thus deserves inclusion. — Shibbolethink ^{(♔ ♕)} 15:15, 29 July 2022 (UTC)

Yes, and this article is in large part about the lunacy/quackery that swept though parts of the world, and the response to that. It's not really a dry medical topic. Ben Garrison's ivermectin cartoon is also kind of iconic[1] I wish we could use it somehow. Alexbrn (talk) 15:30, 29 July 2022 (UTC)

I would totally include that with a caption like: "During the early pandemic, pro-ivermectin fervor was often placed in opposition to Anthony Fauci and Allopathic medicine in general." I would put it in Scientists targeted or Regulatory status and off-label use. is it open for our use, copyright-wise though? — Shibbolethink ^{(♔ ♕)} 15:38, 29 July 2022 (UTC)

I'm quite uncomfortable with the tweet. First of all, I don't need to explain that tweets fail WP:MEDRS and as such should never be quoted in support of any medical opinion. Two, the lead section should offer a WP:WORLDWIDE view on the subject matter wherever possible. Yes I understand that a large proportion of our editors live in the US, but let's don't forget that the US is still barely 5% of the world's population, and the local US squabbles or agencies are of little relevance to the remaining 95%.

A rough comparison: As a non-US person, I frankly wouldn't care what, say, the FAA would tweet to its followers about Boeing 737 MAX – because FAA's (flawed) approval process (fortunately) does not apply where I live and my national aviation agency issues type approvals independently. So, while a mention of the formal FAA certification process in the lead of Boeing 737 MAX groundings would be fine, dedicating a whole sentence to a FAA tweet would certainly be undue. — kashmīrī ^TALK 15:58, 29 July 2022 (UTC)

Strangely the tweet is WP:MEDRS as it embodies the position of a major medical organization (not that the statement that people are not horses is a particularly controversial biomedical assertion in need of weighty sourcing!). I'm not a Yank either, but cannot help but observe that the USA has been the locus of most of the ivermectin lunacy. It is what it is. Alexbrn (talk) 16:06, 29 July 2022 (UTC)

No, a tweet is NOT MEDRS, however you try to tweak WP:MEDRS. This lunacy was prevalent everywhere; it's just we mostly rely on English-language media (a known WP bias). — kashmīrī ^TALK 16:09, 29 July 2022 (UTC)

Thirdly, this tweet does look incredibly silly, even idiotic, given that a fair number of veterinary medications have been repurposed for human use. WP should offer unbiased knowledge and not advocacy, even if for a noble cause. — kashmīrī ^TALK 15:58, 29 July 2022 (UTC)

Sounds like fringey special pleading. Eating horse paste is not drug "repurposing"; hence the FDA tweet! Alexbrn (talk) 16:15, 29 July 2022 (UTC)

You are not a horse suggests that veterinary medications in general should not be used in humans; which is untrue. — kashmīrī ^TALK 17:30, 29 July 2022 (UTC)

What rubbish. If you want to write about how it's good to take veterinary preparations, write a blog post or something - but don't try to influence Wikipedia with this nonsense. Alexbrn (talk) 17:43, 29 July 2022 (UTC)

Did I write so? No? So why are you manipulating my words? I suggest you retract this personal "remark". — kashmīrī ^TALK 18:12, 29 July 2022 (UTC)

If you want to assert that the FDA is "idiotic" for wanting to stop people taking animal medicine, Wikipedia probably isn't the place for you. Alexbrn (talk) 18:20, 29 July 2022 (UTC)

If you are unable to understand written word, perhaps you should rethink your participation, too. Now point me to where I wrote that the FDA is idiotic. Let me remind you that casting aspersions is a form of personal attack, and you're doing it for the third time in this thread. — kashmīrī ^TALK 18:54, 29 July 2022 (UTC)

"this tweet does look incredibly silly, even idiotic" ← and enough of the sealioning. You've been around long enough to be better than that. Alexbrn (talk) 19:00, 29 July 2022 (UTC)

(1) Where did I term the FDA as idiotic as you claim? (2) Where did I write that it's good to take veterinary preparations as you claim? You'd rather present evidence or retract your absurd accusations. You've been around not much shorter than me to know there are lines that should not be crossed in a discussion. — kashmīrī ^TALK 01:05, 30 July 2022 (UTC)

Neither of you, as far as I can ascertain, have crossed any lines that should not be crossed in a discussion. Let's refrain from derailing this discussion into special pleading, ad hominem, or tone policing. — Shibbolethink ^{(♔ ♕)} 12:49, 30 July 2022 (UTC)

The mistake here is conflating ivermectin horse treatments with human ivermectin treatments. The tweet is relevant because people were using the large animal dosage veterinary treatment, which is completely unsafe. It's not even a veterinary medicine "repurposed" for human use, it's two different dosages, which makes it inappropriate for human consumption. Not to mention ivermectin was never effective at treating COVID-19, so warning people off using the veterinarian medication is relevant. — The Hand That Feeds You:^Bite 16:42, 29 July 2022 (UTC)

Exactly, this is the whole point of this aspect of the topic. Alexbrn (talk) 16:46, 29 July 2022 (UTC)

Once again: a quote from a FDA drug review stating that ivermectin is ineffective and unsafe in such doses would be absolutely fine and helpful. A tweet saying "You are not a horse" is idiotic for all the reasons I stated above, and also in violation of MEDRS. — kashmīrī ^TALK 17:27, 29 July 2022 (UTC)

"also in violation of MEDRS" - MEDRS is irrelevant here. — Shibbolethink ^{(♔ ♕)} 13:23, 30 July 2022 (UTC)

Oh, just because you say so? — kashmīrī ^TALK 21:07, 31 July 2022 (UTC)

I agree with Shibboble that MEDRS isn't an issue here. The tweet basically just says that human beings aren't horses; I don't think that's the kind of biomedical information you need a MEDRS-compliant source for. It's so trivially true that humans aren't horses as to be humorous, because the tweet was a joke. Endwise (talk) 02:48, 31 July 2022 (UTC)

I'll third this: it's a WP:SKYBLUE statement by the FDA that humans shouldn't be taking horse-dosed medication. MEDRS isn't necessary. — The Hand That Feeds You:^Bite 16:53, 31 July 2022 (UTC)

I think it's worth keeping the tweet and comment about horse medicine being used. However, the lead could also benefit by including that the FDA warned against treating or preventing COVID-19 with ivermectin. An archived page says March 5, 2021. I'm not sure if there's an earlier statement to refer to. ScienceFlyer (talk) 21:25, 1 August 2022 (UTC)

Yknow what's interesting? We don't have to rely on editor opinions alone to determine whether or not this tweet is worth including. We have guidelines such as WP:DUE and essays such as WP:RSUW. This tweet is noteworthy enough to be referenced in many multiple high quality RSes [2][3][4][5][6][7][8][9] (also outside the US [10][11][12] and even scholarly publications [13][14][15], therefore it has DUE weight and should be included. If the NYT, NPR, WaPo, Guardian, El Pais, and scholars all think this is noteworthy, who are we to disagree?— Shibbolethink ^{(♔ ♕)} 13:20, 30 July 2022 (UTC)

MEDRS still applies to this article. In addition we also have:

• MOS:LEAD which requires that the lead section should be a summary of [the article's] most important contents – and we see nothing that the "horse tweet" could be a summary of;
• WP:NOTGUIDE, i.e., articles should not aim to influence the reader's behaviour (and instead offer objective knowledge) – whereas it seems that some editors here believe they are running a public health campaign.

That tweet in the lead fails on so many fronts that I can't believe my eyes that some editors still keep pushing it in. Is it because ivermectin use has become a political statement in the United States, or what? — kashmīrī ^TALK 21:07, 31 July 2022 (UTC)

I'll remind you of WP:NPA, comments like some editors here believe they are running a public health campaign is not assuming good faith. — The Hand That Feeds You:^Bite 21:14, 31 July 2022 (UTC)

Oh, public health campaigns are mostly run in good faith. Besides, pointing out to our WP:NOT policy is not against WP:AGF. — kashmīrī ^TALK 22:28, 31 July 2022 (UTC)

That's clearly not what you were implying, but whatever. The discussion has petered out with no consensus in support of your change. — The Hand That Feeds You:^Bite 22:36, 31 July 2022 (UTC)

I would actually agree with WP:AGF being applicable here for @Kashmiri. In reference to this statement they made: That tweet in the lead fails on so many fronts that I can't believe my eyes that some editors still keep pushing it in. Is it because ivermectin use has become a political statement in the United States, or what?

Proposing that everyone else (especially those who disagree with you) is pushing a political agenda is the exact opposite of WP:AGF. — Shibbolethink ^{(♔ ♕)} 22:55, 31 July 2022 (UTC)

Not "pushing a political agenda", but making a political statement. Certainly, not a medical or scientific statement. Ivermectin use for COVID-19 is a minor public health problem compared to, for instance, the widespread antibiotic use for minor viral infections (which is incorrect, obviously, and can lead to severe complications). Yet I don't see a separate article dedicated to the topic, complete with tweets in the lead. Not even a single tweet in antibiotic. Why? Why ivermectin has apparently become a cause worth dying for some? Or at least worth flouting so many Wikipedia policies? — kashmīrī ^TALK 23:39, 31 July 2022 (UTC)

The FDA don't think it's "a minor public health problem", which is kind of the point (ivermectin taken as an alternative to vaccination is kind of serious). If you think Antimicrobial resistance#Clinical misuse could be worked up into a standalone article (and maybe it could) then do that, but it's not relevant to what we have here. What we do have is fine, and consensus seems firm on that point. Time to drop the WP:STICK methinks. Alexbrn (talk) 05:58, 1 August 2022 (UTC)

compared to, for instance, the widespread antibiotic use for minor viral infections (which is incorrect, obviously, and can lead to severe complications). Yet I don't see a separate article dedicated to the topic.... yknow there actually is an article which pretty closely covers that topic: Antibiotic misuse. If the FDA put out a joke tweet about it...and it was covered by many multiple reputable and trustworthy RSes (including scholarly ones and non-US ones)... Then I think it would pretty clearly deserve inclusion in that article. if you hear about such a tweet, let me know and I'll add it myself. — Shibbolethink ^{(♔ ♕)} 07:09, 1 August 2022 (UTC)

(In fact they put out a poster in 2009(?) [16] I guess they're just moving with the times and adopting informal comms via social media for their public health messaging. All great stuff worthy of coverage as the sourcing indicates.) Alexbrn (talk) 07:47, 1 August 2022 (UTC)

• I don't really mind seeing this tweet in here; it demonstrates the authorities' willingness to conflate mechanism and dosage, and therefore unintentionally informs the reader of the cavalier and un-academic approach by the FDA on this matter. (If I contract giardia and take metronidazole, does that make me a dog?) SmolBrane (talk) 20:42, 1 August 2022 (UTC)

  Well important to say that Flagyl (AKA metro) is off-label in such uses for dogs. Whereas, with ivermectin, it's on-label for horses in the paste form, and off-label for us humans. So it's actually kind of the inverse. And if you take it 1-2 hours before a full moon, you'll have to tell us what happens cuz I've never actually seen it, only heard the rumors. — Shibbolethink ^{(♔ ♕)} 20:44, 1 August 2022 (UTC)

  That's exactly what's unwelcome: ridicule. This was a valid medical question: whether ivermectin could be repurposed, or at least effectively used off label, like hundreds of other medications are routinely used off label with good effects (read Off-label use#Frequency of off-label use). Some clinical studies showed ivermectin was effective for COVID19, others showed it wasn't. Meta-analyses were carried out and showed it was not effective based on existing evidence. That's it, end of story – there's lack of strong evidence to support such a use of ivermectin. Slogans like "You are not a horse" are out of place in a medical article, as are your words about full moon, etc. Focus on facts, not on ridiculing; it's science, not petty politics. — kashmīrī ^TALK 04:16, 2 August 2022 (UTC)

  I don't think you understand "the story" is you think it was the dry sequence you describe, or that this is purely "a medical article". Alexbrn (talk) 05:09, 2 August 2022 (UTC)

  Pretty much agreeing with kashmiri here, ivermectin was taken as a speculative treatment given its extraordinary safety record, generic status and plausible value as a protease inhibitor, not because people thought they were horses. But the FDA doesn't do a great job with speculative utility, as illustrated here, and as we can tell by the poor efficacy of the vaccines that were emergency-approved by this organization. The issue is deeper though, wiki defers to sources and the established reliable sources are not so sympathetic to the speculative use of ivermectin. Readers have deductive skills, luckily. SmolBrane (talk) 16:24, 4 August 2022 (UTC)

  FDA wasn't saying people were horses, but that they shouldn't take horse medicine (formulated for 2 tonne animals!). People took it because they were conned by the cranks, frauds and grifters pushing this stuff. As to your antivax rant - much more of that and you can expect to be removed from the Project. Alexbrn (talk) 16:29, 4 August 2022 (UTC)

  No, the FDA was reminding people that they were not horses, which actually has no relevance to the issue at hand, as I stated. As for your last sentence, please AGF and refrain from threats. (And shibb, metronidazole is not off-label for dogs.) SmolBrane (talk) 16:35, 4 August 2022 (UTC)

  You: "shibb, metronidazole is not off-label for dogs."

  The reliable sources:
  "Metronidazole is not approved for use in dogs in the U.S." [17]

  "Veterinarians use metronidazole as an off-label medication since it is not FDA-approved for dogs" [18]

  "Metronidazole is not approved for use in dogs in the U.S." [19]

  @SmolBrane, what expertise do you have again? Remember, I'm a microbiologist. — Shibbolethink ^{(♔ ♕)} 23:29, 4 August 2022 (UTC)

  Please see the American Kennel Club ("Metronidazole is considered very safe.") and our own wiki article, Metronidazole#Veterinary_use("Metronidazole is used to treat infections of Giardia in dogs"). Sometimes indication has varying opinions, to at least try to stay on topic here. SmolBrane (talk) 15:52, 5 August 2022 (UTC)

  Oh of course, it is quite safe, and I believed so before this conversation and continue to believe so. Does not change that it is off-label, which was the original property key to the point I was making.

  Lots of off-label uses are considered standard practice, also in human medicine. Ivermectin is not one of them. — Shibbolethink ^{(♔ ♕)} 00:09, 7 August 2022 (UTC)

  Perhaps it's a mistake to comment since this discussion seems dead, but one thing seems to have been missed in earlier discussion: My assumption has always been dosage risks is only one factor. Depending on the size of the pill (or whatever) and other factors, someone who understands what they are doing deal with dosage issues but I can't imagine many medical authorities are going to say it's okay for humans to take medication intended for other animals even if you properly account for dosage except in very extreme circumstances given the different production and regulatory environment etc. Giving human medication to other animals, in some circumstances sure but not the reverse. (I mentioned extreme circumstances earlier. I imagine when there is very good evidence of the benefits of a drug and they are important enough to outweigh the risks and there is really no human version available then I guess maybe it will happen. But this never applied to ivermectin.)

  And I agree comparisons of repurposing drugs currently used with other animals in humans is just weird. Yes I'm sure it happens, although I'd note the 3 refs given by Kashimiri don't actually seem to demonstrate any drugs used in other animals that have actually been repurposed for use in humans. All 3 seem to just talk about the potential with some preliminary investigation of their possible use in humans. Most are so recent that it seems unlikely to me that any of those examples have already repurposed. Yet funnily enough they demonstrate a point that Kashmiri didn't seem to be trying to make. To actually repurpose drugs used in other animals for use in humans is a long and expensive process requiring a lot of work.

  And in the end it's just a weird thing to talk about. It isn't necessary to repurpose ivermectin from its use in other animals since it's already approved for use in humans in other circumstances. In other words, the whole repurposing drugs used in other animals angle is irrelevant. Repurposing doesn't mean you randomly give drugs intended for other animals to humans simply by adjusting the dosage and hoping for the best, and it was never necessary with ivermectin anyway.

  There was never any reason why humans should have been taking ivermectin intended for horses or any other animals. I know some people like to blame the FDA or others for the inability of people to access ivermectin for humans. But even if you believe that, it does not mean it was a good ides for humans to take ivermectin intended for anything but humans. I'd note that there is some irony in saying it's fine to try offlabel use of ivermectin for COVID-19 as a "speculative treatment given its extraordinary safety record", but in any way suggesting it was okay for humans to taken ivermectin intended for other animals. And if no one is suggesting that, then why is there controversy over the tweet?

  The tweet seems an entirely fair point being made by the FDA since some people were trying to take ivermectin intended for horses. And even if these people properly accounted for dosage differences, which sadly not everyone did, it was still an incredibly bad idea. So if we all agree with that, whatever the fact that some drugs used in other animals may be repurposed for use in humans after a long and expensive process for use in humans, which also means they will then be produced for humans with all the safety and regulatory processes in place that we expect for production of drugs taken by humans, what's the fuss?

  Nil Einne (talk) 15:35, 19 August 2022 (UTC)

  I think the POV was that the FDA's messaging "suggests that veterinary medications in general should not be used in humans; which is untrue". As you say, it is true (and more to the point well-sourced). Anyway, this is now settled so I suggest we move on. This article really needs a bit of expansion on how IVM is enjoying a crazy afterlife among the antivaxxers and/or how some proponents are now vectoring away into news scams. Alexbrn (talk) 15:54, 19 August 2022 (UTC)

  I can't imagine many medical authorities are going to say it's okay for humans to take medication intended for other animals even if you properly account for dosage except in very extreme circumstances given the different production and regulatory environment Absolutely 100%. There are differences in the quality standards and "allowable contaminants" in medications made for animals vs those made for humans. And it's not even that we, as a society, care less about animals. There are substances which would kill animals (e.g. chocolate for dogs) that would be totally fine as an inactive ingredient in human medications and vice versa (e.g. there are children's medications which include chocolate as flavoring). We are not dogs, they are not us. And we should not be taking their medications. The exception is medications for which a "human equivalent" exists. And that would mean dosage and form equivalency. In such cases, human pharmacies can fill pet prescriptions. And even THEN, the animal form of the drug is still better. It would also not include horse paste containing ivermectin. Horses need much larger doses of dewormer than humans do. It's a pharmacokinetics thing.

  I'd note the 3 refs given by Kashimiri don't actually seem to demonstrate any drugs used in other animals that have actually been repurposed for use in humans. There's a reason for this! There's a lot more funding in human-centric medical research, so most drugs trickle down the other way, from humans to animals. We invent it for humans, it gets approved and works great, so a veterinary researcher sees if it could also work for dogs/cats. This is similar to what happens with pediatrics, where many techniques trickle down from adult medicine. There are just plain more adult humans, and we put a lot more funding into adult human medical research!

  Anyway, this is now settled so I suggest we move on. - Alexbrn
  the whole repurposing drugs used in other animals angle is irrelevant - Nil Einne

  100%, agree with both of you, I'm going to collapse this thread so we all move on. RV at will. — Shibbolethink ^{(♔ ♕)} 16:46, 19 August 2022 (UTC)

  @Alexbrn, I strongly suggest you to consider stopping personal attacks. If you continue with your groundless allegations (that I promote "fringey theories" or that SmolBrane is an antivaxxer), you will be dragged to ANI, quickly.

  If you want to educate yourself about the existing COVID-19 vaccines, there are plenty of systematic reviews which – to save you reading – demonstrate that virtually all the existing COVID-19 vaccines are significantly less effective than any other vaccine commonly used in routine immunisation programmes.[20][21] The efficacy against the omicron variant is even smaller.[22]. Now compare it to, say, the efficacy of the polio vaccine[23]. Will it be too much to expect you to walk back your attack on SmolBrane? — kashmīrī ^TALK 22:32, 4 August 2022 (UTC)

  The vaccines were 94+% effective when first formulated [24]. Is our memory really that short?

  Also, that Lancet paper doesn't show what you think it does. It demonstrates really good protection and longevity of vaccine efficacy in preventing hospitalization (what the vaccines were actually intended to do) for 4+ months (the longest period they studied) against BA.1.

  We in the vaccine community always expected BA.2, BA.5 etc would require reformulated vaccines, based on their spike protein sequences. Hence why such vaccines are almost done with post-phase 3 approval in the US and will likely be on store shelves by the fall.

  The systematic reviews you linked also do not show what you claim. Three mRNA doses appear to be "96%" effective" against documented COVID-19 infection, according to Table 2 [25]

  Always a bad idea to try and out-science a scientist (me) in their field of expertise. Alexbrn, while not classically trained, is probably the most well-read on the topic of COVID-19 treatment and prevention of anyone I've met on this site. — Shibbolethink ^{(♔ ♕)} 23:34, 4 August 2022 (UTC)

  I don't know about vaccine science, but I do know antivax rhetoric (and pompous apology for it) when I see it. I also know this is WP:NOTAFORUM and think this thread should be closed as any prospect of it leading to article improvements seems past. Alexbrn (talk) 01:10, 5 August 2022 (UTC)

  ANI may be where this is headed, I was hoping to stay on topic. Thank you for your collaborative efforts and tone here kashmiri. SmolBrane (talk) 15:57, 5 August 2022 (UTC)

  FYI @SmolBrane, WP:ASPERSIONS cautions users against repeated ANI threats, which may or may not be intended to discourage other users from participating in discussions. This is also a component of tendentious editing. Just something to keep in mind. If you're going to bring something to ANI (and I would caution you against it in general because of how much of a headache that board is), just do it. You don't have to (and probably shouldn't) allude to it in discussions like this. — Shibbolethink ^{(♔ ♕)} 16:49, 19 August 2022 (UTC)

References

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Why is recent RCT result undue in intro? Why revert update to "Research and clinical guidelines"?

I updated the "Research and clinical guidelines" section with some minor, but relevant detail such as names of RCTs. Give the publication of the result of a major RCT (with hundreds of authors), I also added to the introduction "Large-scale randomised controlled trials, described as 'the final nail in the coffin' for ivermectin as a treatment for covid, found it to be no different from placebo" (citing the same source as in the more detailed section).

All this was reverted with the summary "Undue". I think the changes to the introduction, and to "Research and clinical guidelines" improve the article. What do others think? Best wishes, Pol098 (talk) 15:23, 29 October 2022 (UTC)

Results of a RCT are not really compliant with WP:MEDRS and, given that meta-analyses are available, should not be used, esp. in the lead. — kashmīrī ^TALK 16:03, 29 October 2022 (UTC)

You deleted the part on the United Kingdom, apparently. This was restored. — kashmīrī ^TALK 16:06, 29 October 2022 (UTC)

• Stuff sourced to primary sources is undue in the lede. Bon courage (talk) 16:41, 29 October 2022 (UTC)

Request to reverse POV

Collapse screed. Bon courage (talk) 12:25, 24 January 2023 (UTC)

This page is misleading in several ways and don't reflect the reality regarding scientific research about ivermectin in prevention and treatment of covid-19. Lot of positive data are published in the scientific litterature. There are 3 main axes and many potential modes of action for ivermectin: https://www.nature.com/articles/s41429-021-00491-6 1/Re: antiviral effect. Most studies are underpowered, like https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30464-8/fulltext however the results are much compatible with an antiviral effect, with a reduction of 1.2 log10 copies/ml on day 7 (comparable with paxlovid (Hammond et al.) and more than molnupiravir (Jayk Bernal et al.). Krolewiecki et al. showed an antiviral effect when high plasma concentration of ivm is obtained. High plasma concentration can be obtained if IVM is prescribed in a fed state, what is generally what ivm promoters advocate for (FLCCC). In all trials qualified here as " failing to confirm the utility of ivermectin for COVID-19", the drug was prescribed on an empty stomach. All new antiviral drugs (molnupiravir, paxlovid) have been tested in trials that satisfy some conditions: a) early treatment (generally <5 days after symptom onset) b) at risk population (old or with some comorbidities, unvaccinated) in order to asses an effect on c) hard outcome (hospitalization or death). Ivermectin was not tested this way in large RCT accepted by western medical community. 2/Re: prophylaxis. Ivermectin is the only antiviral that is proven to be efficient as a prophylactic drug: https://www.medincell.com/wp-content/uploads/2023/01/PR-results-TTG-VF-EN.pdf confirming antiviral effect. Paxlovid failed in a trial sponsored by pfizer: https://www.pfizer.com/news/press-release/press-release-detail/pfizer-shares-top-line-results-phase-23-epic-pep-study. All prophylaxis studies before the MedinCell press release were profoundly positive (Shouman et al., Kerr et al.) but not qualified as good enough quality research by agencies. WHO specifically stated that they were not interested in looking at prevention for IVM in his guideline for treatment published in March 2021, in which the meta-analysis showed an astonishing 81% reduction of mortality, but the evidence was downgraded by 2 levels due to "very serious imprecision" in contradiction with GRADE guidelines. 3/Re: mortality. The data are still positive for reducing mortality in hospitalized patients, see for example highly credential live meta-analysis: https://covid-nma.com/metacovid/ showing a 54% reduction of mortality. 4/Re: severely hypoxic patients: it has been claimed that ivermectin in combination with doxycycline, zinc and vitamine D could be highly effective to treat severely hypoxic patients (Hazan et al., Stone et al.). This hypothesis was never tested in big randomized trials. There was an anti-ivermectin campaign orchestrated by 5 young scientists, corporate media and ... wikipedia to sell the narrative which is written on this page. The story was that research conducting to positive results were poor or fraudulent. Only 2 studies were retracted, and there were no other evidence of fraud to substantiate claim of these 5 scientists. In contrary, it seems they didn't apply same criteria for trials that have negative results, like Reis et al. The investigator of this trial never published raw data of their trial as announced, but the anti-IVM squad never judged it poorly as they did for other trials.

Please retract this misleading page and write a narrative which reflects the truth of the controversy and is in accordance with the whole body of evidence. 2A02:1210:7A82:8F00:E53A:2892:16B6:9BCE (talk) 12:18, 24 January 2023 (UTC)

Wikipedia is based on reliable sources, particularly WP:MEDRS for biomedicine. The consensus of such sources is that ivermectin for COVID is ineffective (though it persists as a scam/conspiracy theory). You have produced no reliable sources that would alter that assessment. Bon courage (talk) 12:25, 24 January 2023 (UTC)

There is no such thing as a consensus regarding use of ivermectin for prevention and treatment of covid-19. While it is true that health authorities don't recommend it, there is a true dissensus and some group of highly published scientists continue to advocate for its use. Discrediting them by labbelling "conspiracy theory" doesn't reflect the actual scientific discord. 2A02:1210:7A82:8F00:E53A:2892:16B6:9BCE (talk) 13:18, 24 January 2023 (UTC)

The article cites 88 sources, all of them pretty good. You have produced no source worthy of consideration. Bon courage (talk) 13:23, 24 January 2023 (UTC)

No, the sources are not good. For example, none of your sources support your claim: "doses much higher than the maximum approved or safely achievable for use in humans would be required for an antiviral effect while treating COVID-19." This assertion is refuted by research assessing antiviral effect of ivermectin in vivo (Chaccour et al., Biber et al., Krolewiecki et al.).

Some other references are pretty bad. For example, Roman et al. contains 2 blatant mistakes: the authors created imaginary data regarding length of hospitalization of Niaee et al. trial, and mistakenly reported data about viral clearance of Bukhari et al. This is not a good paper. Authors of this page should check before referecing to such poor and full of mistakes research. 2A02:1210:7A82:8F00:E53A:2892:16B6:9BCE (talk) 13:45, 24 January 2023 (UTC)

Poor research refutes nothing. Wikipedia requires high-quality WP:MEDRS sources. See the cited Cochrane review for a systematic review of the evidence. As for dosage, the cited JAMA sources says:

inhibitory concentrations of ivermectin are unlikely to be achieved in humans at clinically safe doses

Bon courage (talk) 14:19, 24 January 2023 (UTC)

Mind you, I read both versions of the Cochrane review. It is not good.

1/They completely changed the protocol between both version,

2/They created new tool which allow them to exclude lot of trials using highly subjective criteria (they can exclude some trials based on results that don't suit their preconceived belief),

3/They didn't apply their own new criteria: https://doyourownresearch.substack.com/p/the-cochrane-review-on-ivermectin

Once again: this is bad scientific practice. Wikipedia should not refer to bad scientific practice.

Re: concentrations. Why refering to Lopez-Medina et al.? The paper referenced here is Momekov et al. but it is not a consensus. For example it is contradicted by Arshad et al. analyzing concentrations in the lung: https://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.1909. and it should be accredited that Caly et al. is an in vitro study done on monkey kidney cells, which isn't a good model to assess IC50. Authors have also repeated experiments with human lung cells showing 6-8 times improved IC50.

Wikipedia should take into account the whole body of evidence and not chose one side of the scientific controversy and claim it is the truth. 2A02:1210:7A82:8F00:E53A:2892:16B6:9BCE (talk) 14:53, 24 January 2023 (UTC)

Wikipedia reflects reliable published sources, and for biomedicine secondary sources rule. Silly stuff on Substack is the opposite of a reputable source. These good sources agree: ivermectin was a distraction that turned into a scam. If you want to publish conspiracy theories and junk science do it elsewhere. Bon courage (talk) 15:23, 24 January 2023 (UTC)

I hope you are joking here. "Wikipedia reflects reliable published sources". No, this article is full of references such as mainstream media in which a journalist shares his own view as a journalist about the efficacy of a drug, or such as articles from https://sciencebasedmedicine.org/ which is... a blog, just as substack.

I pointed to dozens peer-reviewed scientific papers contradicting this page's narrative.

Moreover, the Merck's reference is listed under "Clinical guidance" ! In which world have you seen a pharma company is a reliable clinical guidance on off-patent repurposed drugs? This is a joke. Merck's statement has no clinical value, it contains no scientific data. 2A02:1210:7A82:8F00:E53A:2892:16B6:9BCE (talk) 16:05, 24 January 2023 (UTC)

The article contains media references for citing the public reaction to the topic of ivermectin for COVID-19. But actually discussing the drugs efficacy requires the much more strict WP:MEDRS policy, which this article conforms to. — The Hand That Feeds You:^Bite 17:03, 24 January 2023 (UTC)

For example, none of your sources support your claim: "doses much higher than the maximum approved or safely achievable for use in humans would be required for an antiviral effect while treating COVID-19." This assertion is refuted by research assessing antiviral effect of ivermectin in vivo

In vivo =/= in organism. The pharmacokinetics of whole organisms is more complex than in cells or organoids.

3/They didn't apply their own new criteria: https://doyourownresearch.substack.com/p/the-cochrane-review-on-ivermectin
If you're trying to refute the best available sources on Wikipedia (see WP:MEDASSESS), you probably shouldn't use "doyourownresearch.substack.com" to do it.

this is bad scientific practice. Wikipedia should not refer to bad scientific practice

This (and most of your comments) appear to be your opinion, otherwise known as original research, which is not permitted on wikipedia.

In assessing your linked sources, I do not see any which are more reliable than the current cited sources by our standards (see MEDASSESS linked above, the banner at the top of this page, and especially WP:MEDSCI). As such, I see no reason to change anything on this page. Come back with higher quality sources (no primary research, no animal papers, no substack newsletters, etc. see WP:MEDRS), or find a more lenient venue for arguing about the topic itself.

Wikipedia is not a forum for debates. We care only about the quality of sources, and what they say. — Shibbolethink ^{(♔ ♕)} 19:29, 24 January 2023 (UTC)

Fifth Circuit Court

The Fifth Circuit Court just criticized the FDA for discouraging doctors from using Ivermectin to treat patients with Covid-19.

Source: https://www.ca5.uscourts.gov/opinions/pub/22/22-40802-CV0.pdf

SquirrelHill1971 (talk) 03:44, 16 September 2023 (UTC)

So in the USA doctors have the legal freedom to be quacks if they want to, and it's not the FDA's job to try to stop 'em. Would need a sensible secondary source to make sense of this. Bon courage (talk) 04:01, 16 September 2023 (UTC)

That's not entirely what happened. The court smacked the FDA for making a careless statement which equated Ivermectin (which does have a human dosage) with "horse paste." The court believed that was improper and may have discouraged doctors from prescribing the human dosage.

Of course, the human dosage was also utterly useless against COVID, but the court didn't consider that, they just took the FDA to task for its wording on social media.

@Bon courage is right though, we need reliable sources which explain this in order to consider it for this article. — The Hand That Feeds You:^Bite 15:52, 16 September 2023 (UTC)