If you think no one is getting rich off of ivermectin, definitely don't watch this video from FLCCC founder Dr. Fred Wagshul.

For just $276 (cash only, no insurance), this quack will prescribe ivermectin "no questions asked." Don't worry he's got "plenty of product."

Yikes!
1/
His website makes it really clear.

You just fill out this form (including your SSN) and send it to a not at all sketchy gmail address.

Then you pay $211 for a 3 minute phone call and get your prescription. Plus $75 for a followup. Then $75 recurring every 6 months.
2/
There are quite a few 🚩 on this website.

Aside from referring to $276 telehealth prescriptions for ivermectin as "preventive maintenance" this pulmonologist is also apparently an expert in... interstitial cystitis?

So pulm and urology under one roof. Not at all sketchy.
3/
Also apparently you can get treatment for "overgrowth of normal flora" that doesn't "for most people" doesn't cause any urinary symptoms... sounds like this pulmonary clinic is totally on the up and up.

Just ask all these people hanging out on the beach... in Ohio?
4/
But despite weirdly effusive testimonials all over the website... definitely don't ask his clients what they think.
5/
The testimonials on the website (also a big 🚩btw) also suggest quackery:
- patients placed on long standing antibiotics to treat chronic infections
- another person who was “rushed to the hospital and put on an exfoliating mask”
6/
Bottom line: sketchy organization (FLCCC) referring patients to a very sketchy doc’s (Washgul) $276 ivermectin teleHealth pill mill.
7/7

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More from @nickmmark

27 Oct
Interesting results from the #TOGETHER RCT of #fluvoxamine vs placebo in n=1497 high risk outpatients in 🇧🇷 with #COVID:
-people who received fluvoxamine were less likely to require extended ED visit or hospitalization (11% vs 16%, RR 0.68 CI 0.52-0.88)
thelancet.com/journals/langl…
1/ ImageImageImageImage
TOGETHER was a large, multi-arm adaptive platform DB-RCT done in 🇧🇷 Brazil from June 2020 to Jan 2021.

Patients were identified after testing positive, stratified by age (>50 or <50 yo) & randomized to fluvoxamine 100 mg BID x 10 days vs placebo.
2/
It builds upon 2 studies:
-an observational study in 🇫🇷 that found better outcomes among inpts already taking SSRIs
nature.com/articles/s4138…
-a small n=152 RCT done in 🇺🇸 showing a decrease in clinical deterioration among outpts randomized to Fluvoxamine
jamanetwork.com/journals/jama/…
3/ ImageImageImageImage
Read 10 tweets
24 Oct
I’m old enough to remember when the #cultOfVitaminC claimed it was unethical to do more RCTs of vitamin C in sepsis. Now the #CultOfIvermectin is making the same claims about ivermectin in COVID.

Charlatans & quacks don’t like RCTs. Especially when they disprove snake oil.
1/
I guess this shouldn’t come as a surprise; It’s the exact same people (Marik et)

After vitamin C as a miracle cure imploded in January 2020 they decided to go double or nothing on a different miracle cure: ivermectin.

2/
It should come as no surprise that they are making literally identical arguments about ivermectin that they made about their last miracle cure:
“I’ve seen it work thousands of times”
“Real world medicine”
“unethical to do RCTs”
Any negative study must be “designed to fail”
3/
Read 4 tweets
23 Oct
A new paper is circulating, leading to a new & improbable claim that "ivermectin treats staph aureus."

There is absolutely no evidence that this is true.

A short thread about pharmacology (MICs, IC50s, and Cmax) explaining why this claim is so unlikely.
1/ ImageImage
This paper by Ashraf et al is an in vitro study of repurposed meds on MRSA & MSSA.

Right off the bat, there are weird things going on. They grew 21 strains and report results for...2

And when they treated those strains with ivermectin, they used some insanely high doses...
2/
How high?
They found the minimum inhibitor conc (MIC) to kill MSSA was 12.5 ug/mL
How high is that? Let's do some math:
Ivermectin has two forms B1a & B1b. The average MW is 868 g/mol.Converting 12.5 ug/mL mass concentration to molar concentration we get 14 uM! Yikes!
3/ ImageImage
Read 6 tweets
7 Oct
To the ivermectin die hards asking "What about Uttar Pradesh?!?" Perhaps you can answer the question "Why *ONLY* Uttar Pradesh?"
You realize that IVM was tried and failed in Peru, Brazil, & elsewhere. Why have the benefits of IVM *never* been seen in RCTs or other countries?
1/
Alternatively, perhaps the "Uttar Pradesh Miracle" has to do with proven interventions: lockdown, curfew, mask mandate, testing/quarantine, & vaccines.

There's also major under-reporting in UP. (Unless you think IVM has decreased deaths from car accidents & cancer too).
2/ From https://www.nature.com/articles/s41562-020-01009-0 Source: https://www.medrxiv.org/content/10.1101/2021.08.04.2
To those saying UP "was only 5% vaccinated" when cases started to drop, realize that vaccinating frontline people can/does reduce transmission & vaccinating high risk people reduces mortality.

If you are looking for why cases REMAIN low, UP is >50% partially vaxxed right now
3/
Read 6 tweets
7 Oct
Here’s an interesting ventilator waveform; can anyone explain what’s going on during this inspiratory hold maneuver?
Another clue:
Y’all nailed it! This is a large bronchopleural fistula (BPF) causing air leak.

See how airway pressure drops with inspiration hold?

The ventilator measures exhaled (or “returned”) volumes and is alarming “Low MV” b/c most of the air is going out the chest tubes not the ETT
1/
Read 4 tweets
6 Oct
Yesterday I shared a fun fact that black coffee cools faster than coffee with milk/cream.

Today I woke up early and decided to do an experiment. What followed was interesting & more than a little messy (🤷 that’s science!)

A short 🧵 on ☕️ science
1/
First some background:

Supposedly black coffee ☕️ cools faster for two reasons:
1. Black coffee radiates more heat because black objects have greater emissivity (due to Stefan Boltzmann)
2. Milk 🥛 increases viscosity & decrease evaporative cooling

Should be easy to test?
2/
Methods:
I made coffee & (tried to) warm the 🥛 to the same temperature as the ☕️.

I aliquoted the coffee and combined w/ or w/o 50 ml milk, bringing to the same volume (250ml).

Then I tried to pour both simultaneously into identical cups but managed to make a big mess. 🙊
3/ ImageImageImageImage
Read 7 tweets

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