IVERMECTIN 101 💊🪱

A humble deworming tablet has built quite a mystique for itself this year.

But finding a clear answer online is not so easy:
Can it treat COVID-19?

A thread: 🧵
1) WHAT IS IVERMECTIN?

A cheap, human & veterinary anti-parasite drug which has won the Nobel prize.

Broad-spectrum, primarily used to treat scabies and similar organisms.
2) WHY HAS IT GAINED ATTENTION RECENTLY?

We have been thrown into the unknown with COVID.

Vaccines divide opinion.

Any glimmer of hope for a cheap, well tolerated pill has been keenly embraced.
Ivermectin has a massive psychological allure compared to the vaccine:

People (often rightly) distrust the mainstream view, and ivermectin is the symbol of the underdog.

It fits the narrative that there’s a simple, cheap cure that big pharma don’t want you to know.
There's plenty of disinformation in both directions about it.

Disinformation spreads faster.

Disinformation gets the clicks.

But for the media, ACCURACY doesn’t pay the bills,

REACH does.
3) PEJORATIVELY CALLING IT ‘HORSE DEWORMER’ DOESN’T HELP ANYONE

There are human formulations, and there are horse formulations.

This is because animal medications have different additives to account for different metabolisms.
As a general rule, don’t take veterinary drugs.
- Chocolate or raisins kill dogs.
- Cattle can eat nightshade with no problems.
4) SO LET'S LOOK AT THE DATA:

Ivermectin won the nobel prize and has a great track record for treating many diseases.

At first glance, the data shows significant benefit for COVID too, both in theory and practice.

But keep reading. Not is all as it seems.
In vitro (test tube) experiments: inhibits growth of SARS-CoV-2. (albeit at 20x higher concentration than clinically tested in humans).
Meta-analyses look at the aggregated data, assigns studies a weighting based on their strength & sample size, and irons out individual flaws by taking a big picture view.

Some of the independent meta-analyses & visualisations you see online appear very convincing at first glance
5) HERE’S WHERE THINGS BECOME DODGY

This stuff looks promising right?

One of the strongest looking studies, Elgazzar et al, was cited 30 times, included in many meta analyses and initially accounted for a large chunk of ivermectin’s status as a wonder-drug.
“Amazingly, the study found that people treated with ivermectin were 90% less likely to die than people who got the placebo, which if true would make ivermectin the most incredibly effective treatment ever to be discovered in modern medicine.” - @GidMK
But... on closer inspection of the original data, they had:
- Recruited dead patients
- Copied, pasted & fudged their study data (while using inappropriate statistical tests)
- Plagiarised parts of the text

This is highly suspicious of fraud.
I’m talking caught-photocopying-bank-notes level of suspicious.

Many other studies included in independent online meta-analyses were published as preprints and in protocol repositories, without a peer review process.
Fortunately, the Cochrane doods are the gold standard for this stuff: stringent selection criteria and transparency.

Their conclusion: Little to no benefit.
6) WHAT TO BELIEVE?

Aside from the occasional dodgy study, is there deliberate fraud, or is it innocent internet momentum?

Why would you write a fraudulent study? Honestly I don’t know. Perhaps to further your career. The scientific equivalent of clickbait fake prank videos.
Evidence is growing.

Independent projects are sifting through the data.

But the few high quality randomised trials that DO exist mostly show little-to-no-effect.

7) “IF YOU REFUSE THE VACCINE, ISN’T THIS BETTER THAN NOTHING? OR JUST DANGEROUS?”

There is no guaranteed way to prevent COVID. But minimising risk factors:
- Getting active
- Stopping smoking
- Controlling blood sugar
- Taking vitamin D & sunlight

These may be helpful.
Zinc and vitamin C are cheap and helpful in theory but haven’t been demonstrated to shorten COVID symptoms.

Current evidence-based TREATMENT options are:
- Oxygen
- Dexamethasone
- Remdesivir
- Monoclonal antibodies
You might say “Well if it’s probably safe at normal doses, then why not have a go?”

Of course you could ‘have a go’ (if you can even get hold of any).

There’s any number of drugs you could ‘have a go’ with.
That’s just gambling.

8) BIG PHARMA PROFITS:
I get it. The systemic mistrust in governments, public health systems, and by extension, modern medicine.

But distributors would stand to gain 💰️from ivermectin.

Pharma could RINSE profits from a new formulation, ivermectin 2.0 - return of the worm.
I am excited to see ANYTHING work.

I have no attachment to any particular treatment or modality.

I would LOVE for ivermectin to save the world.

UK doctors earn a piffling salary and no financial bonuses. I’ve never received a penny from a drug company.
Ivermectin should continue to be studied, but at present there is NO clear clinical indication.

This will change as we learn more, and I am optimistic.

Other drugs being tested include IV vitamin C, probenecid, doxycycline, azithromycin etc.
CONCLUSION:

Poor quality evidence and suspicious sources claim ivermectin carries significant benefit for COVID.

Higher quality evidence with transparency currently fails to show benefit.

We will gain a clearer answer over time.
Believe it or not, your doctor DOES want you to be healthy.

Ask for their advice & for reading recommendations, and look at the original sources.

I'm not an expert. I hope the data proves me wrong.

My recommendations:
Garbage in, garbage out.

Information is getting noisier.

Reading opinion pieces from randomers on facebook is NOT an efficient way to get to the truth.

Read systematic reviews, meta-analyses, clinical trials from peer reviewed journals.
Distrust any ‘expert’ who has a clear political agenda.

Share this with friends, post your abuse below and follow me for more synthesis of murky topics.

Here's a primer on the vaccine to start with:
If despite reading this you still want to get aboard the ivermectin train 🚂, you could always sign up to a clinical trial: secure.phc.ox.ac.uk/sentry/nationa…
Sources available on request but this thread is long enough.

The science will continue to evolve.

I hope we can follow up on this in 2-3 months with a clear conclusion, or perhaps a new contender.

But for now, the jury is out. 👋

[+follow me, read pinned tweet etc 👀]
I've had a few people query including remdesivir in this list.

NICE guidelines (conditionally) recommend it. WHO recommend against it.

It is not first line, and I've not prescribed it personally

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28 Jan
COVID VACCINE 101 💉

On Twitter, it's difficult to get a clear, objective view on the COVID vaccine.

I have just had mine today, after I spent some time reading around it.

So here’s a thread to clear things up 🧵:

👇️👇️👇️
💉 The purpose of any vaccine:

To give you a HEAD START on an infection.

🦠 When infected with a pathogen (disease organism), the body has to identify and create an antibody to neutralise it.

This can take several days.
A vaccine, however, is designed to give your immune system a ‘taste’ of a pathogen before you are exposed.

(A practice run).

This is done in the following ways:
1️⃣ Weakened Virus [Easy-mode]
2️⃣ DNA/RNA [Blueprint]
3️⃣ Protein [Deliveroo]
4️⃣ Viral vector [Vehicle]
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propanefitness.com/7dayonramptw

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Here are some lessons you'll value 🧵:
BUSINESS 📈: WHAT I LEARNED
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“But what about Goodharts law?”
Goodhart’s law states:

“When the measure becomes the target, it ceases to become an accurate measure.”

This is true.

But it doesn’t kick in straight away. Everything works until it doesn’t.

Optimising for ONE thing is better than not optimising for anything.
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