Richard Thrasher Profile picture
Otolaryngologist/Head & Neck Surgeon. Managing Partner of The ENT & Allergy Centers of TX. Decent photographer. Poor athlete. Cryptocurrency nerd.
Jun 4, 2025 22 tweets 21 min read
Hello Dr. Bowden. I've decided to take you up on the offer. I'll post my developing results here. After I go through the 105 studies, I think I'll take you up on the offer to discuss on your podcast. By that time I feel I will have had the opportunity and hours to discuss in a meaningful way so that the discussion could be productive. I will post my ongoing review of these studies so you are not blindsided by my findings. I think full transparency is the best way to approach science. To that end, here is a summary of the first 15 studies. I apologize for the time it will take for all 105 as I am an active clinician, husband, and father. Additionally, I want to dedicate the needed time to understand the nuances coming into the lion's den to discuss. Not looking good so far after 15 studies for IVM, however.

1 - Qureshi 2024. Pakistan. N= 200. EBM Level II. Documents reduction in mortality of 12% to 4% using Ivermectin + SOC vs SOC alone. Publication rejected for poor methodology. No blinding. No description of what SOC was.
2 - Chowdhury 2023. Bangladesh. Double blind RCT Ivermectin vs placebo. EBM Level II. N=116. Documents median time to PCR negativity from 10 days to 6 days. Clinical significance not documented. Methodology good, but clinical benefit unclear.
3 - Hashim 2021. Iraq. RCT w/ 3 groups IVM + doxy, IVM only, SOC. N=140. Documents mortality 22% in SOC vs 2% in IVM group. Not peer-reviewed. No randomization described. Not registered. Selection bias likely with 10x mortality in SOC group. 2% mortality in treated group consistent with normal mortality at this time during pandemic.
4 - Elgazzar 2020. Egypt. Preprint. N=200. Study retracted due to documented data manipulation and plagiarism.
5 - Okumus 201. Turkey. Prospective RCT. EBM Level II. N=66. IVM + SOC vs SOC alone. Documents no statistical significance between groups. Peer-reviewed. Low N but otherwise good study refuting benefit of IVM.
6 - Krolewiecki 2021. Argentina. RCT. EBM Level II. IVM vs SOC. Documents drop in viral load in treated group with no change in clinical outcomes. No placebo group. No clinical benefit found for IVM despite drop in viral load.
7 - Rajter 2020. USA. EBM III. N = 280. IVM vs SOC. 25% mortality lowered to 15% mortality. Large study, but observational, non-randomized. Treatment allocation not standardized. Causality cannot be established. Worthy of additional investigation.
8 - Kirti 2021. India. Double-blind Placebo-controlled RCT. EBM II. N =112. IVM + SOC vs SOC alone. Documents no significant difference in symptom resolution or mortality. Well-done trial but no benefit from IVM.
9 - Mahmud 2021. Bangladesh. Randomized, placebo controlled. EBM II. IVM + doxy vs placebo. N = 400. Documents faster symptom resolution and drop in hospitalizations from 10% to 2%. Problem is patients registered in trial after treatment begun. Not blinded. High risk of bias, but better design trial is worth investigation.
10 - Carvallo 2020. Argentina. Observational. EBM V. N=1195. IVM + ASA + enoxaparin + steroids. Documents mortality of 0.59%. No control. Not randomized. Not peer-reviewed in publication. No conclusions can be drawn.
11 - Lopez-Medina 2021. Colombia. Double blind placebo-controlled RCT. EBM I. N = 476. Documents no significant difference in duration of symptoms or clinical deterioration in IVM treatment arm. Excellent study, peer-reviewed in JAMA.
12 - Ahmed 2021. Bangladesh. Double-blind RCT. EBM II. N=72. IVM vs IVM +doxy vs Placebo. Documents median viral clearance was 5.9 in treatment groups. Good study, but showed no clinical difference in arms. Unclear benefit.
13 - Bukhari 2021. Pakistan. RCT. EBM II. N=86. IVM + SOC vs SOC alone. Documents 5 day faster recovery in IVM arm. Randomization not documented, not blinded. Not peer-reviewed. Rejected for publication due to poor study design.
14 - Beltran-Gonzalez 2021. Double-blind placebo-controlled RCT. EBM II. N=72. No statistical difference in viral load reduction or symptom resolution between IVM and SOC groups. Well done study without demonstration of benefit.
15 - Morgenstern 2021. Dominican Republic. Retrospective observation. EBM IV. IVM + azithromycin + ASA + steroids. N=3099. 0.59% hospitalization rate. 0.04% mortality. Not randomized. No control. Confounded by multimodality tx. Had a little break at lunch. Here are studies 15-20.

So far, no high quality study has been shown among the first 20 that demonstrate IVM with clear clinical benefit except for some slight improvement in symptom resolution. Worse, all the well-structured studies that are indeed double-blinded placebo controlled RCT have stated no difference in treatment with IVM compared to standard of care. This continues to bode poorly for your claim. I will finish all 105 because it's intriguing. Why the very list of studies you would recommend using would include studies contradicting your claim is unclear to me. Either you didn't actually evaluate these or your intellectual integrity is better than I thought, but that also requires that you don't understand what "works" actually means or your are exaggerating the results of the studies. Nevertheless 15-20. . .

16 - Kishoria 2021. India. Open Label RCT. EBM II. N =100. IVM + SOC vs SOC alone. Documents faster resolution of fever in IVM, no difference in mortality. Not blinded. No description of what their SOC protocol was so hard to tell if standardized. Fever improvement but no other demonstrated clinical benefit in IVM.
17 - Pott-Junior. Brazil. Double Blind placebo controlled RCT. EBM II. N=72. Documents no difference between IVM and placebo. Peer-reviewed. Well done study.
18 - Mahmud 2021. Bangladesh. RCT. EMB II. IVM + doxycycline vs placebo. N = 400. Just a repeat listing of study #9. Just a duplicate.
19 - Shahbaznejad 2021. Iran. Double blind placed controlled RCT. EBM II. N=69. Documents not statistically significant differences in resolution of fever, cough, dyspnea, or hospitalization. Peer-reviewed. Decent design.
20 - Khan 2020. Bangladesh. Open Label RCT. EBM II. IVM vs Placebo. N=400. Recovery time shorter in IVM group by about 2.5 days. No other benefit found. Not blinded, randomization not documented, not peer reviewed. Rejected for publication due to poor study design/documentation.
Nov 8, 2021 11 tweets 3 min read
Regarding Crypto, I've spent about 1800 hours or so now studying this stuff. Granted, I spent 5200 hours studying medicine over the same length of time back in the day, but there's more to learn in medicine and more at risk there. But here's what I've learned along the way: 1 - Every "expert" is guessing to some degree what's going to happen. Not a single person "knows" and if they claim they do, they're wrong more often than right. I keep a spreadsheet on predictions of the gurus I follow--no one has beat >40% accuracy in the last 14 months