Thread by @alexandrosM

The TOGETHER trial on ivermectin is finally published, only 7 months after its completion. 🧵 nejm.org/doi/full/10.10…

Impossible as it may sound, the investigators did not check at all if the patients in the study had taken ivermectin recently. In the paper we see no mention of ivermectin in the exclusion criteria:

However the paper refers us to the previously published trial protocol for more inclusion/exclusion criteria. Is it there? No.

Perhaps ivermectin was not something used commonly in that area at the time? Sounds like a reasonable explanation. Except for 3 facts:

1. Ivermectin is available over the counter in Brazil.

https://twitter.com/ColombianRoast/status/1429452050702684175?s=20&t=4v-rbFZY6UAhZn-Z3-xTIA

2. The Brazilian government was recommending it as a COVID treatment, as part of its early treatment kit:

https://twitter.com/AAPSonline/status/1309964665577848832?s=20&t=4v-rbFZY6UAhZn-Z3-xTIA

3. As a result, sales of ivermectin in the area where the trial was taking place were NINE TIMES higher than normal. (screenshot via Google translate)
otempo.com.br/interessa/vend…

In brief, I have no idea how this trial was even published, lacking the most important exclusion criterion. Without it, we don't know if people in the control group (the one that isn't supposed to be taking the drug) were actually taking the drug. What am I missing?

I've written in a lot more detail about the trial and what the issues with it were, though I'll go through the paper and see if the criticisms hold now that we have a manuscript.
doyourownresearch.substack.com/p/what-went-wr…

Honestly though, I don't think we need to look beyond the exclusion criteria to approach this study with extreme skepticism. Studies have been discarded for much less, and yet the usual suspects are salivating all over the manuscript with no mention of this fundamental error.

It should be noted, however, that this fatally flawed study has been used to drive not one but three separate waves of "ivermectin doesn't work" publicity in the press.

First in August when they published a single slide:

Then again a few weeks ago: archive.ph/QZzU7

And now again finally with the publication of the paper, where inevitably a wave of headlines are already out there. medpagetoday.com/infectiousdise…

It may not be useful as a study of ivm, but it certainly has delivered a masterclass in how certain messages receive top billing in the press over and over again, with no real new information being released whatsoever, while many other studies with opposite results get ignored.

Gathering data anomalies as they get observed here. Something is extremely odd with this trial.

https://twitter.com/alexandrosM/status/1509529207109345280?t=NBRfcs1W0NtNSDGFFfR4OQ&s=19