Talk:Ivermectin

COVID-19

It is truly shocking the lengths taken to suppress information about this potentially life saving treatment for covid. The WHO and CDC have sat on this cheap safe potential treatment since August, meanwhile promoting an unproven expensive vaccine. Why? This is another tool in the toolbox, yet only negative articles are allowed on Wikipedia. When did Wikipedia become so politicized? Is this source good enough for mention? https://clinicaltrials.gov/ct2/show/NCT04668469 .2mg / kg is a low dosage proven to be safe, not the nonsense stated in this wiki

— Preceding unsigned comment added by 2601:603:4A80:5870:3910:DA7:2204:1AE2 (talk) 23:34, 25 December 2020 (UTC) 

Incoming edits due to https://www.news.com.au/lifestyle/health/health-problems/coronavirus-australia-ivermectin-antiparasitic-drug-kills-covid19-in-lab/news-story/615c435e56aefc4b704f4fd890bd4c2c for sure.... — Preceding unsigned comment added by 193.116.241.225 (talk) 14:15, 3 April 2020 (UTC)

Right now [48] and [78] are duplicate refs to the same COVID-19/invermectin article. Boud (talk) 23:38, 5 April 2020 (UTC)

Article incorrectly refers to SARS-COV-2 as a negative sense RNA virus. It is a positive sense RNA virus.

On December 8th 2020 Dr Pierre Kory, speaking as a representative of a group of doctors who together have published nearly 2,000 peer-reviewed publications appeared at a meeting of the Senate Homeland Security and Governmental Affairs Committee to plead that the NIH be forced to review the most recent evidence on the use of Ivermectin as a treatment and prophylactic for Sars-Cov-2 and Covid 19. He claimed that the use of Ivermectin on Covid 19 patients had a "miraculous impact", and this description was based on "mountains of evidence that has appeared in the last three months". He pointed out that the NIH's recommendation that Ivermectin not be used outside of controlled trials was made in August 2020, before the "mountains of data" that emerged subsequently. Dr. Kory presented a summary of this data, and the committee chairman Senator Ron Johnson promised to pass this on to the NIH for review.... <https://osf.io/wx3zn/> <https://www.youtube.com/watch?v=Tq8SXOBy-4w> AussiePete56 (talk) 02:46, 15 December 2020 (UTC)

It is okay to publish the truth about this drug now, and the results it has proven for Covid Treatment. Now that the marxists that control Wikipedia and all the internet have defeated Trump, the truth can come out. https://buffalonews.com/news/local/2nd-wny-hospital-ordered-to-treat-covid-19-patient-with-experimental-drug/article_f32339f0-5d01-11eb-b752-4f8966804581.html — Preceding unsigned comment added by 24.116.87.50 (talk) 11:39, 30 January 2021 (UTC)

I would delete this comment per WP:TPG, but perhaps it's instructive to leave it as an illustration of where the pro-Ivermectin boosterism is coming from. Alexbrn (talk) 11:48, 30 January 2021 (UTC)

Unreliable. Would need WP:MEDRS. Alexbrn (talk) 06:17, 15 December 2020 (UTC)

Here is some more reliable evidence on the effectiveness of Ivermectin in preventing and treating Covid-19 . https://covid19criticalcare.com/wp-content/uploads/2020/11/FLCCC-Ivermectin-in-the-prophylaxis-and-treatment-of-COVID-19.pdf .

https://c19ivermectin.com/ . AussiePete56 (talk) 05:40, 21 December 2020 (UTC)

Unreliable. Would need WP:MEDRS. Alexbrn (talk) 05:43, 21 December 2020 (UTC)

I dispute the claim of "unreliable" by Alexbrn since the two articles are secondary reviews of others' research and therefore qualify as reliable as per the WP:MEDRS guidelines. I notice that the "unreliable" tag was applied to this page three minutes after the links to the two review articles were published - three minutes isn't enough time to read even half of one of the reviews, let alone properly evaluate both. The charge of "unreliable" is therefore itself seemingly unreliable AussiePete56 (talk) 14:47, 21 December 2020 (UTC)

We need secondary sources in reputable medical journals (or medical textbooks, etc). These are obviously not that, and appear to be self-published web sites. Alexbrn (talk) 14:59, 21 December 2020 (UTC)

Using medical journals , textbooks etc is ideal, but as the guidelines state, "It is a generally accepted standard that editors should attempt to follow, though it is best treated with common sense, and occasional exceptions may apply." We are currently in a "war" with a virus which is currently killing nearly 14,000 people a day worldwide - a number which is increasing every day. Information which can save lives is desperately needed. As per guidelines, "Wikipedia's articles are not meant to provide medical advice. Nevertheless, they are widely used among those seeking health information." I maintain that this is clearly a time where an exception to the normal stringent editorial standards should apply. Ivermectin has been taken 3.7 billion times over 40 years and its safety is not in dispute - the only unknown is its efficacy. There is after all, no alternative medicine for Covid 19, and even ventilation in hospital will allow about 23% of patients to die. Surely the "mountains of evidence that Ivermectin works miraculously on Covid 19" that Dr Kory and his team refers to should be mentioned on these pages to allow access to as many medical professionals as possible the information they need to make their own assessments on how to best treat their patients. AussiePete56 (talk) 15:53, 21 December 2020 (UTC)

The current situation is all the more reason why we used the best quality sources, which is why general sanctions apply for this topic requiring WP:MEDRS, of which you have been notified. What you're proposed to add is dodgy (as the word "miraculous" should clue you in to at once). We already cite high quality WP:MEDRS: PMID 33227231. I shall not respond further unless new sources are proposed as this is a clear-cut case. Alexbrn (talk) 16:03, 21 December 2020 (UTC)

My point is that the information being presented in these reviews IS the "best quality source" available - ie, the very latest real-world studies demonstrating life-saving treatments. Alexbrn didn't even read these studies. 6% hospital deaths versus 23% are the results achieved. Some of these studies lack peer-review which typically takes months - time that these 14,000 people who are dying daily no not have. To give priority to ideological purity over thousands of daily deaths is insane and inhumane. To repeat a point that Alexbrm ignores - 3.7 billion doses of Ivermectin has been taken over 40 years. It is safe. There is only potential benefits to using it and strong and growing evidence supports such use. Allowing this information to be available, together with suitable disclaimers, is the appropriate and responsible decision. AussiePete56 (talk) 23:26, 21 December 2020 (UTC)

"In November 2020 a meta-analysis found only weak evidence of benefit.[89]"

I propose changing this vague and ambiguous sentence to, "In November 2020 a meta-analysis found a 47% reduction in mortality (statistically significant) for Ivermectin-treated Covid-19 patients, however, due to a relatively small sample size (629 patients) the evidence is considered weak. [1] AussiePete56 (talk) 05:40, 25 December 2020 (UTC)

Alexbrn The actual meta-analysis linked as reference is much more positive as to the effectiveness of Ivermectin that what is stated in this wiki: There is only very weak evidence of ivermectin's benefit when used as an add-on therapy for people with non-severe COVID-19; there is no evidence for people with severe disease.[85]

Why not just quote the conclusion of the actual meta-analysis? Ivermectin is an established drug with a long history of clinical use and with minimal safety concern. Recent observational studies have reported the effectiveness of this drug as add-on therapy in patients with COVID-19. Our meta-analysis also supports this finding and suggests the modest utility of ivermectin in reducing all-cause mortality and improving clinical outcomes. Currently, many clinical trials are on-going, and definitive evidencefor repurposing this drug for COVID-19 patients will emerge only in the future. — Preceding unsigned comment added by Adriaandh (talk • contribs) 17:48, 31 December 2020 (UTC)

}}

"The National Institutes of Health recommend against the use of ivermectin for COVID-19". In the interests of full disclosure, I propose amending this to, "The National Institutes of Health recommended against the use ivermectin for COVID-19 in August 2020". Since then, dozens of research reports on Ivermectin and Covis 19 have been released. Putting a date on the recommendation flags for the reader that it does not necessarily encompass the most recent research. AussiePete56 (talk) 17:36, 1 January 2021 (UTC)

This would be possible is it was also added "... and is still current as of 2021", because of course such guidelines are under constant review. And we wouldn't want to give the false impression that the NIH is somehow outdated, now would we? Alexbrn (talk) 17:41, 1 January 2021 (UTC)

I would accept your suggestion on a "better than nothing" basis. Do you really think that the NIH's position is not outdated Alexbrn? You always exude the attitude that conformity to authority equals virtue. Do you have any theories on why the NIH, CDC and FDA allocated zero public funds to the investigation of re-purposing existing drugs against Covid 19, and instead went "all-in" on developing novel vaccines? I'm not cynical, but cynics would say, "Because that's where the money is." Many billions of dollars. And the vaccines don't work on patients who already have the virus. And it will take about a year for 80% of first-world countries to get vaccinated, and many more years for third-world countries.

So we're up to 15,000 people per day dying from Covid 19 at the moment, most of whom could be saved on the evidence of dozens of studies that the NIH ignores.... AussiePete56 (talk) 14:37, 2 January 2021 (UTC)

Please do not use Talk pages to push conspiracy theories. As multiple editors have now advised you, WP:FOC. Alexbrn (talk) 14:46, 2 January 2021 (UTC)

We should try to avoid turning this into a discussion board, and try to focus on reporting what our sources say. Since regulatory bodies routinely change their positions, their prior positions by their own admission were outdated. Teishin (talk) 14:51, 2 January 2021 (UTC)

Alexbrn, you have repeatedly referred to the 28 studies which each independently found that Ivermectin works to alleviate Covid 19 illness as "fake" - that sounds like a conspiracy theory to me. AussiePete56 (talk) 14:50, 3 January 2021 (UTC)

Something trying to pass itself off as a journal article, when it's just a self-published web site, is a "fake" journal article. As noted, people sharing it on Facebook get banned. Maybe Wikipedia should do the same. Alexbrn (talk) 14:55, 3 January 2021 (UTC)

I have no skin in this game. I just saw this chart stating far lower cumulative deaths from COVID-19 in the Mexican state of Chiapas compared to all the others and how that correlates with it being alone amongst them in using Ivermectin: https://twitter.com/Covid19Critical/status/1347721731272830976 (That mention of Ivermectin brought me here.) The correlation may be something which can be readily verified or disproved as it claims to be from public official data and the outcome mentioned on the main page. ― Ralph Corderoy (talk) 12:08, 10 January 2021 (UTC)

I'm late for this discussion. c19early, c19study, c19legacy, c19ivermectin, ivmmeta, c19hcq, hcqmeta, and others, use grossly incorrect methodology, producing biased results with bizarre p-values. They are still being used as "evidence" by political groups in Brazil to spread medical disinformation. (talk) 01:23, 26 April 2021 (UTC)

Does the recommendation from the ministry of health of India count as a reliable source ? https://www.icmr.gov.in/pdf/covid/techdoc/COVID19_Management_Algorithm_22042021_v1.pdf I hear also IVM is used in Mexico city now https://mexicobusiness.news/health/news/ivermectin-controversial-covid-19-drug-used-mexico-city Isn't it enough to say at least that there is no consensus on efficacy? We don't live in Disneyland, health agencie's recommendations in rich countries account for billions in drug purchasing.How could there be no influence when there are choices like $1000 remdesivir vs $5 hcq or ivermectin ? In countries with lower financial resources there are also bright people, but less pressure not to reuse existing drugs.— Preceding unsigned comment added by Pweltz (talk • contribs) 15:34, 28 April 2021 (UTC)

Reliable for their view, but since the Indian govt. is a busy hive of quackery and pseudoscience not reliable for any rational assertion about reality. Alexbrn (talk) 15:50, 28 April 2021 (UTC)

Could we just remove the "misinformation" claim? "A five-day course of ivermectin for the treatment of COVID-19 may reduce the duration of illness" https://pubmed.ncbi.nlm.nih.gov/33278625/ HaraldTheBlue (talk) 23:32, 6 June 2021 (UTC)

Hospitalized patients only, says the study. Not for mild disease, at home. And it concludes with Larger trials will be needed to confirm these preliminary findings. 72 participants is quite a small sample indeed. --Fernando Trebien (talk) 03:47, 7 June 2021 (UTC)

The link shows that it isn't misinformation and the source for the 'misinformation' claim comes from a patient group on social media. The reference to 'misinformation' needs to be removed if this page is to conform to the neutrality rule.

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Note the imprecise wording of the Invermectin COVID-19 Wikipedia entry: "As of January 2021, the U.S. National Institutes of Health COVID-19 Treatment Guidelines state that the evidence for ivermectin is too limited to allow for a recommendation for or against its use." This wording does not make clear that ivermection is now a treatment option for COVID-19. In fact, the “neither for nor against” NIH classification is the "recommendation given to monoclonal antibodies and convalescent plasma, both widely used across the nation." [2] Unfortunately, this clarification can not be made because the COVID-19 section is locked down for edits even from autoconfirmed users--which is contrary to the edit notification for that section. I hope this is just a mistake and not a tragic example of "cancel culture" impacting Wikipedia. — Preceding unsigned comment added by Swisswiss (talk • contribs) 18:48, 20 January 2021 (UTC)

Concerns about reporting of study results:

This statement is false: A randomized controlled trial (RCT) of 24 patients with non-severe COVID-19 and no risk factors found no difference in PCR-positive nasal swabs nor in viral load between patients who received ivermectin and those given placebo. I quote directly from the study: the median viral load for both genes was lower at days 4 and 7 post treatment in the ivermectin group with differences increasing from 3-fold lower at day 4 (p = 0·24 for gene E; p = 0·18 for gene N) to around 18-fold lower at day 7 (p = 0·16 for gene E; p = 0·18 for gene N)

The study DID find a difference - it was just not statistically significant based on the threshold chosen. Even the PCR found a difference - RR 0·92. If you want to write something negative based on the results of this extremely small study, then write that it was underpowered to find statistically significant difference. Because every single endpoint found a difference showing benefit of Ivermectin use.Adriaandh (talk) 09:53, 10 February 2021 (UTC)

• I found the same error. It is interesting that the one paper cited in support of ivermectin's ineffectiveness actually does a pretty good job selling its beneficial effects - note that, on top of the difference in viral load that did not meet the significance threshold, it did find a significant reduction of symptoms. Whether or not the experimental design designated this as a "primary finding" would seem to me to have no bearing on the scientific merit of the finding, or its relevance to the text of this article. 2600:1700:7CC0:4770:200A:7D27:DC73:41AB (talk) 06:08, 18 May 2021 (UTC)

• • Not to worry, the editors simply deleted all mention of this study rather than reckon with their error.2600:1700:7CC0:4770:C47C:4E3C:EC7D:831 (talk) 20:34, 18 May 2021 (UTC)

The section on Covid seems to be highly subjective

The section on Covid seems to be highly subjective and possibly inaccurate. I believe it should be changed to more neutral and objective as Wikipedia standards dictate - removing the word "misinformation" and to change "no reliable evidence exists" to "no large scale studies have been done."

All research that has been performed to my knowledge has shown that ivermectin is effective at treating Covid. A meta-analysis of four papers, accessible through the NIH, shows a .02 p value that adding ivermectin to a treatment regimen leads to improved clinical outcomes.

While they do stipulate that the quality of the individual papers included in the meta-analysis is "very low," they go on to say "currently, many clinical trials are on-going, and definitive evidence for repurposing this drug for COVID-19 patients will emerge only in the future."

As far as I am aware, all subsequent papers have all found that ivermectin was effective in treating Covid. This website that performs a real time meta-analysis of all papers (as of comment, 55 studies) shows a p value of disproving the clinical results as p = 0.000000000000043.

While there are no large scale studies of ivermectin as of yet, there is nothing but positive research (again, as far as I know) that show that it is effective. Therefore, "misinformation" does not objectively apply to this situation. It should only be applied when we have reliable information that the claim is false. On the contrary, the only reliable information we do have is that the claim is true, though I grant that it is far from settled science due to lack of large scale studies.

Further, while any of the smaller studies on their own might not be considered "reliable," surely a meta-analysis of 55 studies demonstrating a remarkably small p-value, could arguably considered reliable. Notwithstanding the lack of a large scale study, the meta-analysis data should disqualify the descriptor "not reliable" from being used by an objective source such as Wikipedia. 2600:1700:7CC0:4770:3CB4:489B:79C1:24A7 (talk) 08:45, 16 May 2021 (UTC)

ivnmeta.com is not a reliable source. This article cites several reliable sources. Alexbrn (talk) 08:57, 16 May 2021 (UTC)

I believe my overall point stands even with only the first source. The authors find a statistically significant beneficial effect in their meta-analysis of 4 papers (though they stipulate the individual papers to be of very low quality) and say only time will tell when there is more of a body of evidence shown.

As others have pointed out, since the publication of that paper, many other papers have shown significant results in favor of ivermectin, even if not all 55 papers included in the website you mention are legitimate (I wonder, which aren't? I genuinely don't know).

My argument against the use of the word disinformation therefore stands, as this is an active ongoing area of research (and I might add, the overwhelming body of evidence, however inconclusive, points to its efficacy).2600:1700:7CC0:4770:3CB4:489B:79C1:24A7 (talk) 09:09, 16 May 2021 (UTC)

Things have moved on since November, but in fact we already cite that review (actually, at COVID-19 drug repurposing research#Ivermectin which is transcluded here). The line from ivermectin proponents was for a long time that high-quality evidence of benefit was just around the corner. It hasn't appeared, and ivermectin advocacy has passed into the realm of quackery, antivax, COVID denial and conspiracy theorizing.[3] There's not much more Wikipedia can do than report the caution from our best (WHO, FDA, NHS, etc.) sources and the shame of the misinformation that's been spread. Alexbrn (talk) 09:15, 16 May 2021 (UTC)

Why is science based medicine deemed reliable here and not the other websites of individual physicians? Again, I am relatively new to this issue and am trying to understand the terrain here. As for "ivermectin advocacy has passed into the realm of quackery, antivax, COVID denial and conspiracy theorizing," this again reads as highly subjective.2600:1700:7CC0:4770:3CB4:489B:79C1:24A7 (talk) 09:24, 16 May 2021 (UTC)

We don't cite that SBM article (there's no need when we have top-level WP:MEDRS), but SBM is regarded as a reliable source for fringe medical claims (see WP:RSP). I'm not sure what you mean by subjective. If you want to read about the sociological aspects of ivermectin/COVID advocacy - which Wikipedia does not really cover - there's plenty of reading to be done, starting here maybe? As far as (lack of) evidence of efficacy goes, we have unimpeachable sources already cited. Alexbrn (talk) 09:32, 16 May 2021 (UTC)

Your linked source (New Statesman) does not address any of the points I am making RE subjective use of "disinformation." It reiterates that the papers have been included in meta-analyses are low quality, and that a large scale trial at Oxford is underway. Where is the sufficient objective basis to label this issue "misinformation?" 2600:1700:7CC0:4770:3CB4:489B:79C1:24A7 (talk) 09:46, 16 May 2021 (UTC)

The subjective/objective distinction, if meaningful anywhere, is not meaningful for the purposes of reflecting what reliable sources say. By any measure the claim that ivermectin is a "miracle cure" or indeed effective at all, is misinformation. Reliable sources contain that knowledge, Wikipedia reflects it. That is the function of an encyclopedia. There is more detail on the misinformation at the COVID-19 misinformation article. Alexbrn (talk) 10:10, 16 May 2021 (UTC)

"By any measure the claim that ivermectin is a "miracle cure" or indeed effective at all, is misinformation." According to the WHO, no conclusion has been reached on this question. Certainly an investigator who finds an effect, in an ongoing worldwide clinical effort, in not spreading misinformation by reporting their finding. Certainly the WHO's own analysis that no conclusive finding has been reached, should outrank a non-SME deeming ivermectin benefits to be "misinformation." I also question why the European Medicines Agency recommending against its use, is being cited over the WHO, which does not recommend either for or against.2600:1700:7CC0:4770:D89C:66EE:D017:775B (talk) 21:06, 16 May 2021 (UTC)

From the New Statesman article linked above by Alexbrn as a reputable source - "at the moment the only scientific response is to withhold judgement." This language far more accurately describes the current state of the science as far as I can tell. I remain confused as to why "misinformation" is an accurate characterization of the potential benefits of ivermectin, and further why it should be included in a single-sentence synopsis on the topic - seems to me that something more akin to the official WHO language would serve to inform readers better, rather than arbitrarily shepherd them towards adopting a subjective opinion RE misinformation. 2600:1700:7CC0:4770:D89C:66EE:D017:775B (talk) 00:04, 17 May 2021 (UTC)

The WHO is already cited. Claims that ivermectin is an effective COVID treatment are misinformation. A statement that we should "withhold judgement" would not be; but that's not what the advocates are saying. That's the reality according to the sources. Alexbrn (talk) 05:48, 17 May 2021 (UTC)

Surely, under your definition, misinformation is spread about every drug known to humanity. The question is, what is the most informative way to present the relevant information in a one-sentence synopsis? Is it to debunk a notion that the reader may or may not have prior to reading the article, in a manner that easily could lead others to a false understanding of the scientific record - ex. "Wiki says Ivermectin being effective against Covid is misinformation, so this must mean it is not effective!" Or is it to provide a simple summary of the science - "research to ascertain effectiveness is underway"? In my opinion, the current language creates a false impression in the reader and endeavors to "correct" rather than inform. If use of "misinformation" is strictly necessary, then more specificity as to what is misinformation and what is not would seem to me to be of the utmost importance.2600:1700:7CC0:4770:8C96:D3CD:38B2:2270 (talk) 18:51, 17 May 2021 (UTC)

"There is no evidence it is effective" obviously means just that. We are not responsible for any misunderstandings by people who cannot read. There are people out there who tell you it works against COVID, and Wikipedia needs to tell you that those people pulled that information out of their own ass. I don't know what is so difficult about that. --Hob Gadling (talk) 05:39, 18 May 2021 (UTC)

That is not an accurate characterization of my argument. Allow me to point out what exactly I find misleading: "During the 2020 COVID-19 pandemic misinformation was widely spread claiming that ivermectin was beneficial for treating and preventing COVID-19. No reliable evidence exists to back up such claims." Notwithstanding the fact that a paper cited in the body of the article (deemed reliable) does offer evidence that ivermectin is beneficial in the treatment of Covid, labeling the claim "misinformation," which indicates that the information is false, could indeed lead a careful reader to conclude that the information is not simply unsubstantiated (again, I would argue against that claim as an aside) but indeed that it has been falsified (incontrovertibly not the case). The word "misinformation" in the context of this sentence simply is not merited in my view. 2600:1700:7CC0:4770:200A:7D27:DC73:41AB (talk) 05:56, 18 May 2021 (UTC)

We assume our readers are reasonably intelligent. Any reader who was provoked into imagining something nonsensical about the falsifiability of a drug's efficacy would not be a "careful reader", they'd be daft. You seem to be pursuing some kind of Truth™ but Wikipedia's purpose is to reflect reliable sources. Alexbrn (talk) 06:05, 18 May 2021 (UTC)

Nonsense. Equivalence with a placebo could be easily determined by an experiment designed towards that end. 2600:1700:7CC0:4770:200A:7D27:DC73:41AB (talk) 06:14, 18 May 2021 (UTC)

I will also repeat an argument earlier for which I have heard no response. Why should a researcher, accurately reporting their findings, deemed to be spreading "misinformation?"2600:1700:7CC0:4770:200A:7D27:DC73:41AB (talk) 06:20, 18 May 2021 (UTC)

The is good evidence, or there is not. We're in the latter circumstance. It's likely that the True Believers will always find something in any experiment that they say supports their Truth™, no matter how unencouraging it is. Anyway, without new sourcing I think we are done here. Your question has no relevance to our article text. Alexbrn (talk) 06:22, 18 May 2021 (UTC)

The article text improperly uses the word misinformation. That is the relevance of my question. As for whether there is good evidence or not, do you now believe the paper that is currently cited by the article is no longer "good evidence," now that you have been informed that it contains significant evidence of benefits of the use of ivermectin in treating Covid?2600:1700:7CC0:4770:200A:7D27:DC73:41AB (talk) 06:25, 18 May 2021 (UTC)

Per WP:GEVAL we need to make sure misinformation (e.g. "wonder drug") is properly identified. This is policy. There is no good evidence per the WP:MEDRS sources we cite; this is a the sourcing standard for biomedical information on Wikipedia. If you have a specific proposal, make it, but this is just looking like a prolonged waste of time so I shall not respond further if no concrete policy-based proposal is made. Alexbrn (talk) 06:33, 18 May 2021 (UTC)

I feel I have (more than) adequately detailed my concerns over the term "misinformation" as it is deployed currently in the summary of ivermectin vis a vis Covid. Certainly specifying what is misinformation (ex. "miracle cure" has clearly been established by the research not to be accurate) and what is not (the open prospect that it might be deployed as a beneficial treatment and/or preventative measure) would be a good way to begin addressing these concerns.2600:1700:7CC0:4770:200A:7D27:DC73:41AB (talk) 06:46, 18 May 2021 (UTC)

No, because your "open prospect" narrative is a WP:PROFRINGE one out of alignment with the way in which decent sources refer to the matter. Alexbrn (talk) 06:52, 18 May 2021 (UTC)

It aligns perfectly with the language within the paper currently cited in the article (I was not the one who deemed this paper reliable). Regardless, if the term "misinformation" must be used (I wonder why this is the case), it certainly should be directed at a specific target. What exactly is misinformation?2600:1700:7CC0:4770:200A:7D27:DC73:41AB (talk) 07:01, 18 May 2021 (UTC)

You have no idea how ironic what you're spouting is. 2402:B801:2867:E200:C5E8:96E4:1417:F9CC (talk) 09:36, 23 May 2021 (UTC)

Miracle Cure or Cruel Hoax (May 6th 2021).Moxy- 21:52, 18 May 2021 (UTC)

If the term "miracule cure" indeed is what is referred to by "misinformation" in the introductory sentence, then that should be specified. As it stands, the vague application of misinformation appears to be directed towards the idea that ivermectin is beneficial in treating covid - a conclusion which by no means is reflective of the current state of the science. Further, I would question why fact checking the "miracle cure" claim would warrant "lede" status, but I am not willing to die on that hill ;) 2600:1700:7CC0:4770:C47C:4E3C:EC7D:831 (talk) 22:14, 18 May 2021 (UTC)

MEDRS Dhama et al (2020) on Ivermectin and Covid

From p. 29 of this MEDRS in one of the best journals (Clinical Microbiology Reviews):

Recently, another FDA-approved drug, ivermectin, was reported to inhibit the in vitro replication of SARS-CoV-2. The findings from this study indicate that a single treatment of this drug was able to induce an 5,000-fold reduction in the viral RNA at 48 h in cell culture. One of the main disadvantages that limit the clinical utility of

ivermectin is its potential to cause cytotoxicity. However, altering the vehicles used in the formulations, the pharmacokinetic properties can be modified, thereby having significant control over the systemic concentration of ivermectin (338). Based on the pharmacokinetic simulation, it was also found that ivermectin may have limited therapeutic utility in managing COVID-19, since the inhibitory concentration that has to be achieved for effective anti-SARS-CoV-2 activity is far higher than the maximum plasma concentration achieved by administering the approved dose (340). However, ivermectin, being a host-directed agent, exhibits antiviral activity by targeting a critical cellular process of the mammalian cell. Therefore, the administration of ivermectin, even at

lower doses, will reduce the viral load at a minor level. This slight decrease will provide a great advantage to the immune system for mounting a large-scale antiviral response against SARS-CoV-2 (341). Further, a combination of ivermectin and hydroxychloroquine might have a synergistic effect, since ivermectin reduces viral replication, while hydroxychloroquine inhibits the entry of the virus in the host cell (339). Further, in vivo studies and randomized clinical control trials are required to understand the mechanism as well as the clinical utility of this promising drug

I propose we edit the article to acknowledge that this source says "ivermectin, even at lower doses, will reduce the viral load at a minor level.". Forich (talk) 02:40, 24 May 2021 (UTC)

[4].Moxy- 04:35, 24 May 2021 (UTC)

The source is old in comparison to later good ones, and a WP:REDFLAG flies. It does not raise confidence that the text about "immune response" is cited to a single letter, and misrepresents it (by boosting a "can" to a "will"). We already say why pre-clinical work gave rise to the notion that ivermectin might have utility as a treatment. Alexbrn (talk) 10:24, 24 May 2021 (UTC)

ivmmeta and all similar domain names linking to the same site

Tagging in user:Aaronmhamilton to this discussion about sites like ivvmeta.com. These are not MEDRS, and as has been discussed above several times, the findings on that site are not a legitimate reason for any edit on this page. To restate my reasons for this revert:

For 1, you can't change the wording and keep the same citation, that's misleading. Because the citation does not support that claim. For 2, there is actually a great deal to distrust about the website this editor linked. It is not a MEDRS. It is entirely anonymous, no one knows who runs the site or if they actually have any credentials to back up the ad-hoc analysis they're doing.

As a medical researcher and scientist, I can tell you they break a lot of the golden rules of meta-analysis. But you don't have to trust me on that, and you shouldn't, because that's not how wiki works! Trust the RS: There are peer reviewed articles (and several much more informal take-downs that themselves link to MEDRS) detailing exactly what is wrong with that website and how they do their systematic review, and where they go wrong. More than anything, they have cherry picked which outcomes to use from each study, which "informal" studies to include, which patients to include, and they have combined data that is in different settings, different types of patients, all in a way that makes the data look shiny and good for their preferred outcome. You will find that this site differs in conclusion from basically anything published in a reputable MEDRS. There's a reason for that. And it isn't a conspiracy, it's that the scientific community tends to agree on how systematic reviews are meant to be performed. this ain't it, chief. Overall it is a shame that site is so terrible in its methodology, because it has fabulous style. Style points, unfortunately, are not worth much in science. --Shibbolethink ^{(♔ ♕)} 02:15, 25 May 2021 (UTC)

When you bring an inappropriately sarcastic and derisive quip like "this ain't it chief" to the table, it is clear that it's personal to you, and honestly, that you haven't evaluated the specific claims of your citations on the matter. I guess I'll revisit this when there are more cold bodies. Aaron Muir Hamilton <aaron@correspondwith.me> (talk) 03:33, 25 May 2021 (UTC)

Hahaha, no no no, I apologize if it came off that way. I just am tongue-in-cheek about most things. I meant no harm by my comments, you are not the first and you will not be the last to find that site trustworthy, and I spend my time criticising data, not people. Like I said, it is visually very impressive. But I judge badly done science especially poorly, and that site needs some work in its understanding of the levels of evidence re: Greeenhalgh. It's particularly flawed methodology to group RCTs and non-RCTs together in a systematic review, as it degrades the quality of the conclusions you can draw from it. In evidence-based medicine, conclusions are drawn based on what the highest quality available evidence tells us, not the plurality of evidence. One million unblinded case reports do not surpass one RCT. And, as wikians, we are supposed to take what the most reliable highest quality systematic reviews of RCTs say, and restate it for the public. Anyway, when you're ready to come back and talk about it, there's always plenty of people around here to talk about it with! --Shibbolethink ^{(♔ ♕)} 05:10, 25 May 2021 (UTC)

References

Ah, yes. Saying one thing in the style of "this ain't it chief" invalidates all the solid reasoning by the same person. That way of thinking is similar to the fallacy fallacy, but not quite the same. If the way you judge an argument is that superficial, it's no wonder that you cannot tell that site is a bad source. It mimicks the style of science, and Shibbolethink did not, and style trumps content for you. Well, as Shibbolethink said, that is not how Wikipedia works. --Hob Gadling (talk) 09:04, 26 May 2021 (UTC)

Current clinicial trials

Currently there is a Principle trial being ran investigating the effectiveness of ivermectin in treating COVID in over-50s in the UK. The trial currently has over 5,000 volunteers.

It may be appropriate to include this in the lead of the article as the fact that such a large-scale study from a reliable organisation is currently taking place is very notable and will be an extremely useful and reliable source when the study publishes its results, whichever way it goes. Yeah, that's fine. (talk) 08:42, 23 June 2021 (UTC)

 Done Yes, that would seem appropriate as this is a BIG one that has gained mainstream attention. Updated at COVID-19 drug repurposing research. Alexbrn (talk) 13:42, 23 June 2021 (UTC)

National guidelines

Currently the article contains the positions of the WHO, CDC, European Medical Agency (EMA) whose consensus is that ivermectin should not be used for treating covid until clinical trials are done. Also, the usage of ivermectin in a number of countries in Latin America is mentioned, together with the recommendations of the relevant bodies. Recently India's health ministry has published guidelines recommending the use of ivermectin for treating some Covid patients. The questions are

1. Should the positions of national public health agencies on ivermectin be mentioned in this article?
2. If yes, which public health agencies? Only CDC and EMA or also of other major countries?
3. If no, does this information belong to another article? Alaexis_¿question? 19:54, 25 May 2021 (UTC)

To be clear, the question is not about the effectiveness of ivermectin against COVID (as far as I can see the consensus is that there is no proof that it works) but about the notability of the recommendations issues by various national and supra-national bodies. Alaexis_¿question? 19:57, 25 May 2021 (UTC)

Survey

• Nonsensical question. EMA and CDC are not "countries". Does the OP envisage a list of countries and if so how many? 30? 40? 50? Alexbrn (talk) 19:57, 25 May 2021 (UTC)

  CDC is a public health agency of the US, while the EMA is the EU's agency in charge of evaluating medicinal products. This is exactly what I meant by national and supra-national public health agencies. Alaexis_¿question? 20:01, 25 May 2021 (UTC)

  Just saw that I didn't answer the question. If and when all the countries in the world publish their official guidelines, I would summarise it "The position of the CDC and EMA and X other countries, including BigCountry1, BigCountry2, is A; the position of health agencies of Y other countries, including BigCountry3, BigCountry4, is B." If X >> Y and the minority position is not held by major countries, we can ignore it and only write about the mainstream one per WP:FALSEBALANCE. But it's very hypothetical, now we only have a handful of countries and we can easily deal with new information when it comes. Alaexis_¿question? 12:24, 27 May 2021 (UTC)

• Another pointless endeavor. Just give up already, only one view can be reflected on this topic. Adriaandh (talk) 09:17, 27 May 2021 (UTC)

  I understand you are in favour of mentioning the positions of health agencies of major countries even if it's different from the mainstream view? Alaexis_¿question? 12:24, 27 May 2021 (UTC)

I'm in favor of an unbiased reporting on the evidence in favor and against the efficacy of ivermectin and I am in favor of classifying peer reviewed scientific studies as higher quality than APNews fact checks. I am also in favor of reporting all the facts and not just the ones that fit with a specific narrative. I am in favor of free speech and objective media/journalism that does not merely report what a certain government institution mandates. Indeed, I consider the government guidelines of a huge country such as India, which incidentally has a very strong pharmaceutical sector, to be noteworthy if not of equal importance to that of the agencies in the United States, especially considering the country has a population of about 4 times that of the USA, thus their policies affect 4 times the amount of lives. All of this is irrelevant since no amount of voting is going to change this section. Adriaandh (talk) 01:17, 28 May 2021 (UTC)

• Yes. Recommendations from any Public Health Agency or Government could be referred to, not restrained to CDC and EMA. (I was just trying to add a paragraph about the use of Ivermectin as a treatment for Covid-19 based on the decision of the Government of Goa and the Government of Uttar Pradesh.) With respect of WP:GEVAL. It could be presented the way it is in fr.wikipedia. Ceveris (talk) 19:23, 28 May 2021 (UTC)

Discussion

• By convention, CDC, WHO, and EMA set the standards everybody else follows. That's why CDC has investigators in multiple other countries while other countries usually do not. They did it first, and have, so far, done it best (with a few hiccups). What we have so far about other countries' use of Ivermectin makes sense, because listing a few of the countries that are doing it anyway is clearly notable. But anything further would be undue weight, and an excessively long list would be WP:LISTCRUFT. I think having an entire section on India is clearly and evidently excessive. It would be filled with non-MEDRS, as Alexbrn has already stated the India public health agency has a lot of problems with pseudoscience.--Shibbolethink ^{(♔ ♕)} 21:27, 25 May 2021 (UTC)

  So you are saying that we need to have WHO, CDC and EMA as they are most reliable and notable cases of countries straying from these recommendations, is it a fair summary? I'm not proposing a section on India, more like a sentence, or even having one sentence about countries that are doing it anyway contrary to the WHO recommendations which would include both India and the Latin American countries that are already mentioned. Alaexis_¿question? 05:23, 26 May 2021 (UTC)

  As a bit of background here, there was a time when certain ivermectin advocates were pushing to include countries that seemed to endorse Ivermectin (Belize IIRC!) but downplay those that didn't, and it was a rapidly changing scene. Rather than try to have a "dashboard" of national positions it was probably better to skim off the most reputable MEDRS. The wider context here is that in the real world (of medical sources too) ivermectin is a very important drug for its antiparasitic properties, and all this COVID stuff is just a fringe shitshow on the side, which we're in danger of giving too much attention to already. Alexbrn (talk) 05:31, 26 May 2021 (UTC)

  Wrong decisions are also notable, if it's the country the size of India that makes it. The statement that ivermectin cures COVID can be described as a fringe position. But it's not the question that is asked here! Alaexis_¿question? 08:28, 26 May 2021 (UTC)

  The fringe-iness is relevant, because per WP:GEVAL we aren't meant to air fringe ideas (like India's wrt ivermectib) without mainstream context. Hence we would need good secondary commentary. Alexbrn (talk) 08:36, 26 May 2021 (UTC)

  That's a wrong interpretation of policy. Treating dental pain with cocaine is a terrible idea but we mention it in the article about cocaine as it actually happened. Alaexis_¿question? 09:44, 26 May 2021 (UTC)

  It's not an "interpretation" of policy, it is policy itself. We don't bother with obviously historical but if some idea took hold today that cocaine was a great dental pain treatment then yes, it would be governed by WP:FRINGE (assuming it was not mainstream too!) Alexbrn (talk) 09:50, 26 May 2021 (UTC)

  Now you are inventing the distinction between historical and current ideas which is not based on any policy whatsoever. Alaexis_¿question? 10:52, 26 May 2021 (UTC)

Well no, Wikipedia in general doesn't attempt to legislate WP:CLUE. As it happens, in this case, there is some specific supplemental guidance on medical history given at WP:BMI. But if you are concerned the description of an 1879 cocaine experiment represents the undue promotion of a WP:FRINGE theory, then you know how it goes (but maybe expect pushback). Why stop there though? You could progress, say, to Cucking stool and demand that Wikipedia clarifies that witches don't really exist as this is a WP:FRINGE notion! Alexbrn (talk) 12:08, 26 May 2021 (UTC)

Can Wikipedia say that the Indian government is officially using it? Yes, it's a relevant fact. Can Wikipedia suggest that it prevents COVID-19? No, the justification used by Goa was based on a scientific article published in a journal with poor indicators. Can Wikipedia suggest that the Indian health agency must be right and that CDC, WHO and EMA are all wrong? Not as a biomedical claim. Can Wikipedia suggest that the CDC, WHO and EMA are involved in some sort of conspiracy against ivermectin? No, but it could describe the controversy in a neutral way, but this article is not the right place. Here, the tone must be appropriate for the lay reader, writing that India's use of ivermectin goes against international consensus and at a time of despair. In addition, "to keep positivity" (as The Indian Express says) makes the political intention quite obvious. I suggest reading this article in Politico for context. --Fernando Trebien (talk) 00:45, 29 May 2021 (UTC)

Can Wikipedia say that the Indian government is officially using it? Well, maybe. But the important question is, should Wikipedia say this? And the answer to that, per GEVAL and FRINGE, is “no”. Brunton (talk) 09:28, 29 May 2021 (UTC)

I believe that I am as concerned about the bad consequences of this as you are. But the way I understand WP:GEVAL and WP:FRINGE is that they prohibit stating things like "ivermectin works" and then citing the Indian government as a source to support such claims. Saying who did what would not really violate these policies, especially if accompanied by sourced expert criticism. To some extent, this has already been done for other instances in COVID-19 misinformation#Ivermectin and Ivermectin#COVID-19 misinformation. --Fernando Trebien (talk) 12:46, 29 May 2021 (UTC)

In addition to Politico (which presents the political side of the issue), I also recommend reading this BMJ article which provides the scientific side. --Fernando Trebien (talk) 13:00, 29 May 2021 (UTC)

That's right, we are not stating that "ivermectin treats covid" but rather "Indian health ministry recommends it as a covid treatment."I think the relevant policy here is WP:BALASP:

“ An article should not give undue weight to minor aspects of its subject, but should strive to treat each aspect with a weight proportional to its treatment in the body of reliable, published material on the subject. For example, discussion of isolated events, criticisms, or news reports about a subject may be verifiable and impartial, but still disproportionate to their overall significance to the article topic. ”

Applying this to the endorsements by national health agencies, the position of WHO, CDC and EMA should be mentioned first and more prominently that that of Indian health ministry. Alaexis_¿question? 18:34, 29 May 2021 (UTC)

Now inevitably, this.[5] Further evidence of why Wikipedia shouldn't attempt to be some kind of news tracker based on transient information in weak sources. Alexbrn (talk) 14:41, 7 June 2021 (UTC)

What is misinformation?

"Misinformation" should only be used to refer to a claim that has been falsified. As argued above, the use of the word "misinformation" appears to be a subjective conclusion reached by Wikipedia editors and not by a trusted secondary source. Ivermectin's potential for treating Covid is actively being studied by Oxford and others. While it is certainly possible that misinformation about ivermectin's effects have been spread, without specifying what this misinformation is, and how it has been falsified, its use in the introductory paragraph is itself bordering on misinformation.

Since the discussion above RE subjectivity has fizzled out with no action, and the editors have been warned not to "free talk" on this page, I am lodging my previously expressed concerns in the form of a clearly actionable proposal. 2600:1700:7CC0:4770:4C3B:1AF9:643D:6055 (talk) 23:22, 25 May 2021 (UTC)

• Disagree. Header sections are meant to be brief and summarize the content of the article. Not go into in depth definitions of what counts as "misinformation" and what does not. The body of the article should do that. The relevant style guide would be MOS:LEAD.--Shibbolethink ^{(♔ ♕)} 23:38, 25 May 2021 (UTC)

But it looks like the body of the article doesn't say what you say it should. ????--TMCk (talk) 23:47, 25 May 2021 (UTC)

Wikipedia is a work in progress. Let's do everything we can to not make it worse.--Shibbolethink ^{(♔ ♕)} 00:11, 26 May 2021 (UTC)

Well. That was a clear non response.--TMCk (talk) 00:16, 26 May 2021 (UTC)

In other words, I think we should add elaboration to the body, not the lead. That's what MOS:LEAD would tell us to do.--Shibbolethink ^{(♔ ♕)} 00:30, 26 May 2021 (UTC)

I'm not sure the guidelines would prescribe your solution vs. mine. What they certainly do establish is that the current lead is poorly matched to the body of the article.2600:1700:7CC0:4770:4C3B:1AF9:643D:6055 (talk) 00:40, 26 May 2021 (UTC)

Per WP:MOSLEAD as linked by User:Shibbolethink, "...the emphasis given to material in the lead should roughly reflect its importance to the topic, according to reliable, published sources. Apart from basic facts, significant information should not appear in the lead if it is not covered in the remainder of the article." The use of "misinformation" fails this criteria on multiple fronts. First, it is not elaborated in the body of the article, suggesting it should not appear in the lead. Second, the requisite importance of "misinformation" necessary to establish "lead" status, has to my knowledge not been established by reliable secondary sources (in fact, the term "misinformation" has not been used by reliable sources to my knowledge).2600:1700:7CC0:4770:4C3B:1AF9:643D:6055 (talk) 00:19, 26 May 2021 (UTC)

To further respond to User:Shibbolethink - "Header sections are meant to be brief and summarize the content of the article. Not go into in depth definitions of what counts as 'misinformation.'" At no point did I suggest the lead section should discuss definitions of "misinformation," as I agree that would be wildly inappropriate. Rather, the concern is that "misinformation" is not being directed at a specific target. Please be careful to respond to the actual proposal and not to mischaracterize what is being requested. 2600:1700:7CC0:4770:4C3B:1AF9:643D:6055 (talk) 00:23, 26 May 2021 (UTC)

My overall ask of you would be "Why don't we elaborate on it in the body instead of changing the lead?" Seems a much better and more justifiable approach in my opinion. And per my reading of the article, there actually is some elaboration on it. Could be more. Specifically under "Ivermectin#COVID-19_misinformation." You asked for the introductory sentence to be changed, I think it would be more appropriate to add more content about misinformation in the body.--Shibbolethink ^{(♔ ♕)} 00:30, 26 May 2021 (UTC)

If the article gave me a clear understanding of what justified the term, I would be more willing to adopt your approach. Unfortunately, I am still unclear on what "misinformation" in the lead is intended to refer to. As I described above in this talk page, I believe it to be a wholly inaccurate descriptor RE potential treatment of Covid. As highly reputable secondary sources report, its potential benefits are currently under study by Oxford and others, and by no means a settled question. If instead, "misinformation" refers to specific falsifiable claims such as "miracle cure," its usage would be more justifiable, though I would question its inclusion in the introductory section on a relevance basis. Nevertheless, until the claim is more clearly articulated in the header, and fully substantiated in the body with reliable secondary sources cited, I struggle to understand what merits its current usage.2600:1700:7CC0:4770:4C3B:1AF9:643D:6055 (talk) 00:38, 26 May 2021 (UTC)

Here are several RSes that use the term "misinformation" about ivermectin and COVID. I'll integrate them into the article when I get a chance. As for now they are a reliable source for the fact that the term "misinformation" has been applied to the use of ivermectin to treat COVID-19. We don't need MEDRS for that, by the way, since it's a matter of "are people saying X" not "is X a medical fact." Small distinction, but an important one. MEDRS would be better, but RS will do.--Shibbolethink ^{(♔ ♕)} 00:40, 26 May 2021 (UTC)

• Sorry, why's this hard? The misinformation is that ivermectin is a safe & effective COVID-19 treatment (or even a "miracle cure"!) peddled all over the web. We have a whole section about it at COVID-19 misinformation#Ivermectin which is linked. Alexbrn (talk) 03:47, 26 May 2021 (UTC)

comment - We have to follow WP:LEAD. It's bad idea to ignore misinformation around the drug. We know that it's under investigation currently. AXONOV (talk) ⚑ 18:46, 26 May 2021 (UTC)

comment - How is Polifact a reliable medical science source? Be specific.

References

Yes, the word "misinformation" should be omitted. To use it in this context is ... misinformation. No long term study has been done on Ivermectin's efficacy as a treatment for Covid, but many respected clinicians and scientists have suggested that there is empirical evidence that it could be an effective treatment.

This is a perfect example of a wikipedia article where the "talk" section is far more interesting and informative than the main page. The way in which so many wikipedia pages (like this one) are hijacked by vested interests pushing their agendas is incredibly disappointing. Pages should always be written in encyclopaedic format, with objective fact clearly separated from subjective opinion. Subjective opinion is still subjective opinion even if you can reference it! John2o2o2o (talk) 23:29, 26 May 2021 (UTC)

many respected clinicians and scientists - how many is "many"? how "respected" are they? - uttered a subjective opinion containing words like "suggested" and "could", which is is still subjective opinion, according to you, and suggesting that there is solid evidence for their opinion is misinformation.

Your claims of hijacking and vested interests are not appreciated either. They just show that your thinking runs on conspiracy theories rather than actual evidence. --Hob Gadling (talk) 11:03, 27 May 2021 (UTC)

Setting aside claims of hijacking, etc. Here are some high quality papers that show significant benefits of ivermectin in treatment of Covid. This paper which was previously included in the Wiki article, until it was removed when I pointed out the article was mischaracterizing it in a number of ways. And this paper, which I haven't seen any discussion of here. Caveat that I understand secondary sources take precedent over individual papers. But let's not act as though ivermectin's potential benefits could only possibly be a fringe belief that no "respected" clinician would support. Evidence exists to clearly contradict that, in my view.2600:1700:7CC0:4770:E5BA:10D5:B084:E7DA (talk) 23:01, 28 May 2021 (UTC)

Two broken links. The issue is not whether ivermectin has "potential benefits". The quacks boosting it are saying is has actual benefits which Big Pharma is concealing from you, and that it is a "miracle cure". Alexbrn (talk) 06:58, 29 May 2021 (UTC)

Two repaired links (Was easy, why didn't you do it?):

1) Carlos Chaccour, Aina Casellas, Andrés Blanco-Di Matteo, Iñigo Pineda, Alejandro Fernandez-Montero, Paula Ruiz-Castillo, et al., The effect of early treatment with ivermectin on viral load, symptoms and humoral response in patients with non-severe COVID-19: A pilot, double-blind, placebo-controlled, randomized clinical trial, EClinicalMedecine, Published by The Lancet, Volume 32, 100720, February 01, 2021 https://doi.org/10.1016/j.eclinm.2020.100720

12 patients of 24, were given high doses of Ivermectin (400 μg/kg i.e 28 mg for a 70 kg patient) in summer 2020.

Conclusion: “The positive signal found in this pilot warrants the conduction of larger trials using ivermectin for the early treatment of COVID-19. Such trials should include patients with risk factors for severe disease as well as patients with pneumonia. The potential for a mechanism of action different to direct antiviral effect also opens the door for pre-exposure prophylaxis in high-risk groups.”

2) O E Babalola, C O Bode, A A Ajayi, F M Alakaloko, I E Akase, E Otrofanowei, O B Salu, W L Adeyemo, A O Ademuyiwa, S Omilabu, Ivermectin shows clinical benefits in mild to moderate COVID19: a randomized controlled double-blind, dose-response study in Lagos, QJM: An International Journal of Medicine, 2021;, hcab035, https://doi.org/10.1093/qjmed/hcab035

3 groups totaling 60 patients: (IV: Ivermectin)

“Conclusions: 12mg IV regime given twice a week may have superior efficacy over 6mg IV given twice a week, and certainly over the non IV arm of the study. IV should be considered for use in clinical management of SARS-COV2, and may find applications in prophylaxis in high risk areas.”

From those two article one cannot conclude that saying (as now written in the intro of the article) that “claiming that ivermectin was beneficial for treating and preventing COVID-19” is “misinformation”! Ceveris (talk) 12:09, 29 May 2021 (UTC)

Study (1): The positive signal found in this pilot warrants the conduction of larger trials using ivermectin for the early treatment of COVID-19 This does not mean that it works. This means that more research is needed. The article also says that The ivermectin group had non-statistically significant lower viral loads (one cannot conclude much from that), as well as lower IgG (perhaps a good sign, but these are not neutralizing antibodies), Patients in the ivermectin group recovered earlier from hyposmia/anosmia (looks similar to favipiravir, which shortens disease length but has no effect in reducing mortality; more research is needed). In any case, a sample size of 24 participants is too small.

Study (2): QJM is not a good source, check SCImago.

From those two article one cannot conclude that saying (as now written in the intro of the article) that “claiming that ivermectin was beneficial for treating and preventing COVID-19” is “misinformation” Promoting this treatment to the lay public is misinformation until a benefit is demonstrated through serious research. Ivermectin is mildly hepatotoxic and prolonged use may cause liver damage. On a large scale, this in itself can do a lot of harm, and the illusion of protection will likely lead to risk compensation which will increase transmission rates of the new coronavirus.

Speaking of sample sizes, the EPIC trial had 398 participants. Its conclusion is that ivermectin did not significantly improve the time to resolution of symptoms. and that ivermectin does not significantly affect the course of early COVID-19, consistent with pharmacokinetic models showing that plasma total and unbound ivermectin levels do not reach the concentration resulting in 50% of viral inhibition even for a dose level 10-times higher than the approved dose. --Fernando Trebien (talk) 03:16, 30 May 2021 (UTC)

Yeah, two unreliable sources failing WP:MEDRS. For a source to be admissible it needs to be a secondary source (like if this systematic review ever got reputably published - it's a preprint now so unusable). Until then we know from the WP:BESTSOURCES that there's no good evidence of benefit, some risk of harm, and that despite this a number of quacks and conspiracy theorists are spreading misinformation that "#ivermectinworks". Alexbrn (talk) 04:55, 30 May 2021 (UTC)

I think the sources in the article clearly support the advice against indiscriminate use. But I hope this gets reviewed and published soon. --Fernando Trebien (talk) 21:01, 31 May 2021 (UTC)

"Study (2): QJM is not a good source, check SCImago." *checks SCImago* "QJM is a long-established, leading general medical journal" 2600:1700:7CC0:4770:49D9:257:F3AA:50DD (talk) 23:12, 31 May 2021 (UTC)

Look at the quartiles. Once reputable journals may decline. --Fernando Trebien (talk) 20:02, 4 June 2021 (UTC)

To further defend my post you are replying to, while the sample is small in the first study, they found a symptom reduction result with a < 0.001 p value. I of course would like to see that result replicated, but they themselves report this as a significant benefit. You are correct that they found non-significant viral load reduction on top of that result, which the study was not properly powered to detect, unlike the symptom reduction finding (sample size). Note also that I am not trying to claim that "it works," just that some respected scientists (not fringy nuts) have performed studies showing significant benefits. These claims are somewhat different. In order to be sure that "it works," I would agree that I would like to see replication and larger sample sizes. Note that the study you cite with 398 participants was subject to a number of procedural errors and post-hoc modifications. 2600:1700:7CC0:4770:49D9:257:F3AA:50DD (talk) 23:26, 31 May 2021 (UTC)

Amateurs who think that reliability of sources is a yes-no question are a scourge of Wikipedia.

Something which was published in a "leading general medical journal" is still not necessarily a source we can use on Wikipedia. If it is a primary source about one study, as this one, it definitely is not. Read WP:MEDRS and WP:WHYMEDRS. --Hob Gadling (talk) 07:08, 4 June 2021 (UTC)

If the "evidence" is that thin, then considering the size of the controversy around it, there is an even stronger reason to wait for systematic reviews published in reliable sources. And yes, that study has some known flaws and maybe it is better to remove the reference, as long as we do not replace it by another study that is even more flawed. --Fernando Trebien (talk) 20:02, 4 June 2021 (UTC)

Wow, it appears as though the exactly wrong approach has been taken with this article since my original comment. "Misinformation" has been clarified...but to refer to things that are specifically not misinformation. It seems this article becomes more opinionated and biased against the evidence, as more evidence comes out. Really fascinating. 2600:1700:7CC0:4770:D24:AEA:246F:F713 (talk) 19:07, 23 June 2021 (UTC)

Since there is no solid evidence that "ivermectin was beneficial for treating and preventing COVID-19", claiming that there is such solid evidence is misinformation. Pretty simple. --Hob Gadling (talk) 13:22, 24 June 2021 (UTC)

Disagree. Even official sources like WHO, NIH at most claim that there is low certainty of evidence in favor of ivermectin and more research is needed. They do not claim evidence of no effect, or evidence of harm. NIH is running Phase III trials. Claiming "misinformation" about benefit implies high certainty of no benefit, not low certainty of benefit. Caprilyc (talk) 13:57, 27 June 2021 (UTC)

"Evidence of no effect" is a curious concept. The assumption is that a drug is ineffective unless good evidence shows otherwise. There is concern about harm, and from reliable sources. Given the state of the evidence, an unqualified assertion (as has been made by Pierre Kory for example) that "[ivermectin] basically obliterates transmission of this virus. If you take it, you will not get sick" is in-your-face misinformation, unless in thrall to the fallacy of future vindication. Alexbrn (talk) 14:46, 27 June 2021 (UTC)

I saw what you did there. Nobody said "Evidence of no effect", it was always about "no evidence of any effect". --Hob Gadling (talk) 15:14, 27 June 2021 (UTC)

Semi-protected edit request on 8 June 2021

The claim that there is no evidence of Ivermectin being effective as prophylaxis and treatment for COVID-19 is false. Ivermectin has shown efficacy in fighting viruses of multiple types in vitro and in vivo. There are multiple peer reviewed observational and RCT studies, as well as review papers discussing this. I suggest you remove this false statement about Ivermectin and COVID-19 entirely. And replace it with a more accurate articulation describing that it is highly disputed amongst scientists and practitioners and there is not a consensus regarding its efficacy in the case of preventing and treating COVID-19. Kwall926 (talk) 02:45, 8 June 2021 (UTC)

 Not done. Wikipedia reflects accepted knowledge as published in reliable sources. Alexbrn (talk) 08:34, 8 June 2021 (UTC)

"No evidence" is shorthand for "no evidence except the sort of useless, weak or crappy evidence you will get when something does not work but there are a lot of people trying to prove it does". --Hob Gadling (talk) 11:40, 8 June 2021 (UTC)

Kwall926, the burden is on you to provide the studies you mentioned. Then we can discuss if they are reliable or not for medical claims. Alaexis_¿question? 11:52, 8 June 2021 (UTC)

There are reliable sources that claim that ivermectine could be used to treat covid, those are already cited and references, hiding the conflict helps no one, treating scientific reaserch as misinformation is clearly a violation of WP:IMPARTIAL. Eloyesp (talk) 22:13, 11 June 2021 (UTC)

Those reliable sources are? --Hipal (talk) 23:50, 11 June 2021 (UTC)

"Laboratory studies found that ivermectin could block replication of SARS-CoV-2 (the virus that causes COVID-19), but at much higher ivermectin concentrations than those achieved with the currently authorised doses. Results from clinical studies were varied, with some studies showing no benefit and others reporting a potential benefit. Most studies EMA reviewed were small and had additional limitations, including different dosing regimens and use of concomitant medications."

"The NIH in February said that some clinical studies showed no benefits or worsening of disease after ivermectin use; other studies suggested using ivermectin had some benefits. "However, most of these studies had incomplete information and significant methodological limitations, which make it difficult to exclude common causes of bias," the NIH said."

A large majority of randomized and observational controlled trials of ivermectin are reporting repeated, large magnitude improvements in clinical outcomes. Numerous prophylaxis trials demonstrate that regular ivermectin use leads to large reductions in transmission. Multiple, large “natural experiments” occurred in regions that initiated “ivermectin distribution” campaigns followed by tight, reproducible, temporally associated decreases in case counts and case fatality rates compared with nearby regions without such campaigns.

Those references seems to make it clear that there exist "reliable sources that claim that ivermectine could be used to treat covid", on the other hand, most of them make it clear that there is still uncertainty about the effectiveness and the security of such a treatment, and that it is not yet recommended, but those already referenced sources do never claim something like "there is no reliable source for that claim". Eloyesp (talk) 02:08, 12 June 2021 (UTC)

"Natural experiments" are especially not WP:MEDRSes, and MEDRSes are the standard of evidence necessary to put a claim into this article. I am sorry but that article you cited from Pierre Korry conflicts with many other sources, and it itself is not a systematic review or meta-analysis. Which are the standard of evidence necessary to make such a claim. It is putting forth the same shoddy evidence standard Dr. Korry has put forth for ivermectin for many months now. And no matter how much lipstick you put on a pig, it will never be prom queen. The evidence is poor quality, it has poor controls, the control groups are not well-matched, it includes many different studies with different standards in the same group of analysis... all of which are fundamentally bad scientific practices. Until we can determine that a consensus of MEDRS publications supports the claims you're making, they should not be included in this article.--Shibbolethink ^{(♔ ♕)} 03:00, 12 June 2021 (UTC)

@Eloyesp: The American Journal of Therapeutics does not look good on SCImago, so WP:RSUW. As for the other two you mentioned, your emphasis is WP:UNDUE. See:

Laboratory studies found that ivermectin could block replication of SARS-CoV-2 (the virus that causes COVID-19), but at much higher ivermectin concentrations than those achieved with the currently authorised doses. Already in the first paragraph of Ivermectin#COVID-19. Results from clinical studies were varied, with some studies showing no benefit and others reporting a potential benefit. Most studies EMA reviewed were small and had additional limitations, including different dosing regimens and use of concomitant medications.

The NIH in February said that some clinical studies showed no benefits or worsening of disease after ivermectin use; other studies suggested using ivermectin had some benefits. "However, most of these studies had incomplete information and significant methodological limitations, which make it difficult to exclude common causes of bias," the NIH said.

EMA and NIH have already done the work of assessing evidence quality (WP:MEDASSESS). --Fernando Trebien (talk) 11:51, 12 June 2021 (UTC)

Clearly both quotes say that most of the studies had "limitations", thus they clearly state that some studies do not match with that criteria, so the article cannot read: "No reliable evidence exists". --Eloyesp (talk) 15:03, 12 June 2021 (UTC)

Maybe out of an abundance of scrupulousness, I have re-worded this to "Such claims are not backed by good evidence". Everybody should be happy now. Alexbrn (talk) 15:45, 12 June 2021 (UTC)

Thanks for the change, it is not the wording I would chose, but it at least makes clear your intentions are not bad.--Eloyesp (talk) 19:11, 12 June 2021 (UTC)

You are right to think that some of them had no such methodological limitations, but wrong to believe that this means they found some benefit. Therefore, there is still no reliable evidence. --Fernando Trebien (talk) 16:44, 12 June 2021 (UTC)

Same mistake again, I do not need to "believe they found some benefit", the burden is on you to provide prove that they found NO study that show a benefit.--Eloyesp (talk) 19:11, 12 June 2021 (UTC)

Absence of evidence ("None of these claims is supported by science") is different from evidence of absence ("Scientific studies have shown that these claims are false"). --Fernando Trebien (talk) 00:51, 13 June 2021 (UTC)

Please read carefully my words, I'm not doing any research myself, I do not claim that there is "absence of evidence", nor that there is "evidence of absence", I DO claim that the referenced sources do not support the claims written on the wikipedia article. What is made evident on your comment, is that you feel that your research on supporting evidence is what actually do support such claims, so you do not need that the actual references say exactly that, so the misrepresentation of the sources is actually just hiding a violation of WP:NOR.--Eloyesp (talk) 14:06, 16 June 2021 (UTC)

This is bizarre, to the extent I wonder if there is a language problem. Eloyesp's statement ("the burden is on you to provide prove that they found NO study that show a benefit") is wrong, to support the claim that "there is no good evidence". That is a fair summary, amply supported by excellent sources throughout the article. Alexbrn (talk) 14:11, 16 June 2021 (UTC)

Sorry Alexbrn, I do not discard a language problem. When I say "the burden is on you to provide prove that they found NO study that show a benefit" I mean that instead of saying some generic statement like "amply supported by excellent sources throughout the article" there might be a quote of one of such excellent sources that make clear that point. On the quotes that were already made from the excellent sources that are referenced in the article the wording used was less strong than the used on the "fair summary" (specially the original one, the new one is much better, thanks for that). But, as already explained, English is not my first language so the difference I observe between the referenced articles and the summary, when one sounds like a humble scientific thinking ("most of the studies where...") and the later as a newspaper headline ("there is no good evidence"), might not be that for an English reader.--Eloyesp (talk) 14:55, 16 June 2021 (UTC)

Many sources. For example the first says "the available data do not support its use for COVID-19 outside well-designed clinical trials"; when we say there is "no good evidence" to support its (assumed clinical) use, that is a fair reflection of that. Evidence needs to be "good" for something to be considered a viable treatment. Alexbrn (talk) 15:01, 16 June 2021 (UTC)

You seems to misunderstand my point, I'm not making a claim like "there is clear evidence that ivermectine do magic", that is not the case. If that were the case, I would be forced to prove that point, but I'm not.

I'm saying that the article makes a claim that is not sourced, adding references that do not prove the point, misrepresenting the referenced sources to make they say what they do not.

The article reads: "No reliable evidence exists to back up such claims." and references three articles that do not say that, forcing the sources to make the claim. If you find a source to support such a claim, please add that as a reference, but those three articles do not do it.

If your conclusion as an expert is that after reviewing multiple papers and a lot of research you have found not "reliable evidence to back up such claims" then write a paper about it and reference that paper on the article, but WP:NOR.

So I do not have to prove that there are reliable evidence (I'm not writing that on the article), but you need to reference the opposite or remove it.

Just to add a little of context: my last edit changed that very phrase for "The EMA and the FDA advises against this use because the available data do not support it" and that phrase is supported by the references given. Eloyesp (talk) 03:37, 12 June 2021 (UTC)

What we say is a good summary of what the EMA says ("the available data do not support it") along with all the other high-quality sources. Per WP:YESPOV this needn't be attributed as it's not in serious dispute. Alexbrn (talk) 06:09, 12 June 2021 (UTC)

Let me disagree with that, the phrase "No reliable evidence exists to back up such claims" is not a good summary for the "the available data do not support it", given that, the second one does not make clear who makes that claims and the context is also different. In the sourced article "it" refers to "an authorized and promoted treatment" while the wikipedia article is talking about ivermectin being beneficial on the treatment and prevention. While that might sound like a subtle difference I think it is not. --Eloyesp (talk) 15:03, 12 June 2021 (UTC)

For that to be a meaningful difference, you'd have to believe it was effective but that multiple health authorities still didn't approve it. That sounds like a conspiracy theory. Wikipedia likes to align itself with reputable sources like health authorities, and by that token Wikipedia's standard for what it "reliable evidence" or not is that same as those bodies have. Alexbrn (talk) 15:38, 12 June 2021 (UTC)

I'm going to remove the dispute tag on this, because now we are quibbling about one specific phrase. I get why it's contentious to some editors, but I believe the consensus is in favor of the current language, not only based on what's been said above, but also based on what has been said several times before on this talk page about this exact question. A dispute about a single phrase that is already arguing between "This is not supported by the evidence" and "there is no evidence to support" is truly not enough for a disputed tag in my humble opinion. If we can get a consensus on this talk page (or elsewhere) that this is actually disputed in credible articles published in journals worth reading (which this one is not), then I will personally add the tag back.--Shibbolethink ^{(♔ ♕)} 15:49, 12 June 2021 (UTC)

I think that is it not good for an encyclopedia to hide disputes and to force confidence. If there is some doubt on the scientific community it is always better to make clear what the positions are. It is clear in those referenced articles that they chosen to be very cautious with the wording they used (for example they used "most of the", instead of "none of the"). That kind of caution or openness to being wrong is very important on the scientific way of think. On the other hand, the language used on the wikipedia article seems to be much stronger and determinant (read less scientific). It is not the type of encyclopedia that I would like to build, I don't know how many of you value the clarity of strong language over the humble language of scientific thinking. At the very end, it seems that it is just another conflict of visions.

I'm over here, I made clear my point and I have no more energy, I'm very sad for this situation. I would like to ask for pardon if I offended someone, it was never my intention, and sorry for my English, it is not my first language.--Eloyesp (talk) 19:11, 12 June 2021 (UTC)

What are you talking about? The article says in the lede, "Such claims are not backed by good evidence." Is something wrong with that? The article say a lot more, but if you wnat to change parts of it, you need to be specific. Unspecific wailing and waving of hands will get you nowhere. --Hob Gadling (talk) 06:12, 15 June 2021 (UTC)

References

Useful studies?

• Carvallo et al 2020. Study of the efficacy and safety of topical ivermectin+ iota-carrageenan in the prophylaxis against COVID-19 in health personnel. J. Biomed. Res. Clin. Investig., 2.

• Cobos-Campos et al 2021.Potential use of ivermectin for the treatment and prophylaxis of SARS-CoV-2 infection: Efficacy of ivermectin for SARS-CoV-2. Clin Res Trials, 7: 1-5.

• Database of all ivermectin COVID-19 studies. 93 studies, 55 peer reviewed, 56 with results comparing treatment and control groups.

• Karale et al 2021. A Meta-analysis of Mortality, Need for ICU admission, Use of Mechanical Ventilation and Adverse Effects with Ivermectin Use in COVID-19 Patients. medRxiv.

• Kory et al 2021. Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19. American Journal of Therapeutics, 28(3): e299.

• Nardelli et al 2021. Crying wolf in time of Corona: the strange case of ivermectin and hydroxychloroquine. Is the fear of failure withholding potential life-saving treatment from clinical use?. Signa Vitae, 1: 2.

• Yagisawa et al 2021. Global trends in clinical studies of ivermectin in COVID-19. The Japanese Journal of Antibiotics, 74: 1.--193.152.127.203 (talk) 10:35, 16 June 2021 (UTC)

See WP:MEDRS for what constitutes a reliable source for biomedical content on Wikipedia. The only one here which gets in sniffing distance is the review in American Journal of Therapeutics, but as has been previously discussed this is a low quality journal harbouring a discredited paper, so not usable. We do, on the other hand, have some excellent high-quality sources from the European Medicines Agency, FDA, the BMJ and so on. Alexbrn (talk) 09:03, 16 June 2021 (UTC)

I assume you have read them. By the way, WP:TALKO.--193.152.127.203 (talk) 10:35, 16 June 2021 (UTC)

Whatever for! Why read crap sources when good ones are available? That's a recipe for a wasted life and a head full of learned lumber. Alexbrn (talk) 10:57, 16 June 2021 (UTC)

I suggest you give the WP:SECTIONHEADINGOWN part of WP:TALKO a more careful read. You do not own this section, we all do, together. It is appropriate for others besides the section creator to edit section headings. See also this relevant quote: "Because threads are shared by multiple editors (regardless of how many have posted so far), no one, including the original poster, "owns" a talk page discussion or its heading. It is generally acceptable to change headings when a better heading is appropriate, e.g., one more accurately describing the content of the discussion or the issue discussed, less one-sided, more appropriate for accessibility reasons, etc."--Shibbolethink ^{(♔ ♕)} 13:21, 16 June 2021 (UTC)

A preprint

I intend to post some relevant articles here:

• Biber, Asaf; et al. (31 May 2021). "Favorable outcome on viral load and culture viability using Ivermectin in early treatment of non-hospitalized patients with mild COVID-19 – A double-blind, randomized placebo-controlled trial" (Preprint). medRxiv. Sheba Medical Center, Israel. doi:10.1101/2021.05.31.21258081. Retrieved 19 June 2021. Seligne (talk) 20:54, 19 June 2021 (UTC)

It's a preprint. Editors trying to use preprints for COVID-19 can expect to get sanctioned, so why propose it? Alexbrn (talk) 04:55, 20 June 2021 (UTC)

Bryant, Lawrie, et al

• Bryant, Andrew et al. (June 17, 2021) - Ivermectin for Prevention and Treatment of COVID-19 Infection (American Journal of Therapeutics) doi: 10.1097/MJT.0000000000001402

Conclusions: "Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally."--193.152.127.23 (talk) 21:47, 19 June 2021 (UTC)

@Alexbrn: Is this also a crap source?--193.152.127.23 (talk) 21:47, 19 June 2021 (UTC)

It's a low quality-journal (also the one Kory and Marik eventually got to accept their paper). So not useful, especially considering the WP:REDFLAG for this subject area. Alexbrn (talk) 04:54, 20 June 2021 (UTC)

@Alexbrn: Are you using any quantifiable metric to call the journal low quality? I see H Index of 62 (compared with over 1000 for Nature, Science, JAMA), so clearly it's not a top journal. I believe the relavent guideline you're using (including the WP:REDFLAG allusion) is "exceptional claims require exceptional sources", which states that multiple high quality sources are required for an exceptional claim.

In looking for a definition of or rubric with which to assess source quality, I can find the reliable sources guidelines, which states, "If you are unsure about the quality of a journal, check that the editorial board is based in a respected accredited university, and that it is included in the relevant high-quality citation index—be wary of indexes that merely list almost all publications, and do not vet the journals they list." Do you have a good idea of which citation index is a good reference for "high quality" in this case? As for the editorial board of the American Journal of Therapeutics, I checked the editor in chief and a few others and they appear to be from the Zucker School of Medicine, which is quite small, but is fully accredited as of 2015, and is ranked #66 by US News and World Report in the Best Medical Schools: Research category

Given the above, I think the journal checks at least one of the two boxes for being considered high-quality: editorial board based on well respected and accredited university, and journal being present in a high-quality citation index. I don't see any guidance indicating high quality implies high impact (e.g. as measured by H index). Again, I don't know about whether the journal appears in a citation index which would only include high-quality journals, but if you have evaluated the journal as low-quality, I can only assume you were not able to find it in one such index. Can you please elaborate? — Preceding unsigned comment added by Tcx64 (talk • contribs) 02:08, 21 June 2021 (UTC)

The previous discussion was at #Semi-protected edit request on 8 June 2021. One can use various metrics (an impact factor below 2 is sometimes invoked as a bright line, e.g.) but ultimately WP:CONTEXTMATTERS. For an area with known research fraud, and in which we have multiple unimpeachable medical sources pointing in one direction, an outlier low-quality journal (which has already published one discredited ivermectin paper) isn't going to cut it. As you say, WP:EXCEPTIONAL applies. (Update: the paper is discussed in some detail here and the concerns raised: questionable methodology and undisclosed conflicts of interest, further confirm that this source is not suitable for Wikipedia's purposes). Alexbrn (talk) 06:43, 21 June 2021 (UTC)

Interestingly, the author of that Science Based Medicine piece, David H. Gorsky, is listed as being on the editorial board of the American Journal of Therapeutics. The journal itself doesn't have great impact scores, but Wikipedia guidelines don't require "top-tier", nor should they. I cannot find guidelines supporting calling the Journal low-quality (though I am still unsure about which citation index should be used, I haven't yet found evidence it is predatory, at the very least). In light of the above, WP:CONTEXTMATTERS is in my opinion the more salient guideline here, pertaining to this particular paper. Not the journal as a whole. It seems that Gorski himself might agree. If Gorski is indeed on the editorial board, the fact that he would remain so and yet speak out against the paper is at least worth looking into. Gorski also appears to mock the journal for having published what he deems a hilarious argument made by Kory et. al. i.e. the ecological argument that regions where Ivermectin is used have better Covid outcomes. While I don't think this is nearly as hilarious or fallacious as does Gorski, I think this supports the idea the paper is more controversial than the journal itself. I do find it odd that he fails to mention he is on the board as an associate editor (though for all I know that editorial board list is out-dated).

The reason I'm carrying on about the quality of the journal is that the guidelines require evidence from multiple high-quality sources, which in the case of medical research would most likely be journals. If another paper is published at a journal that meets Wikipedia's standards for high quality, namely being listed on a reputable citation index and having a reputable editorial board, I think it would be quite difficult to argue for not including the claim that there exists evidence that Ivermectin is at least somewhat effective against Covid19. At a certain point defending keeping that claim off the page because WP:CONTEXTMATTERS, based on claims that aren't peer reviewed (albeit from experts like Gorski with high notoriety), starts to feel like a form of original research. — Preceding unsigned comment added by Tcx64 (talk • contribs) 14:25, 21 June 2021 (UTC)

On Wikipedia the position statements of major medical bodies and clinical guidelines are at the top of the tree alongside secondary sources in prestigious medical journals. We have several good sources on Ivermectin/COVID so there's no need to scrape the barrel with something in a minor journal that provokes hilarity in a source which is well-regarded for its coverage of fringe medicine. The "claims on the page" here flow from the WP:BESTSOURCES as they should. Alexbrn (talk) 13:40, 21 June 2021 (UTC)

In order to see how funny the reasoning regions where Ivermectin is used have better Covid outcomes is, you would have to be familiar with the unreliability of that method. Gorski explains further in the other article he links: [6], starting with "But let’s get back to what this trial really is". Also, you did not sign your badly indented contribution. --Hob Gadling (talk) 16:14, 21 June 2021 (UTC)

@Hob Gadling: I understand the argument about ecological analysis, and I'm not going to debate it here, but my disagreement lies in the magnitude of the doubt cast, not that doubt shouldn't be cast at all (in general I mean; perhaps this particular ecological analysis is particularly bad). Instead of merely assigning a judgment to my formatting, why not take a second to explain, or at least link to something useful? Obviously I'm not an experienced Wikipedia editor. Did I indent too many times? Anyway, I like Wikipedia and have used it as data for academic research for years, and have a vested interest in its credibility. I am not attempting to "go rogue" and edit a page where I don't have a strong understanding of the material. Alexbrn My concern is that if a result published in a prestigious journal is contradicted by a result in a not very prestigious journal, it will be thereby disallowed. I think you can see how this could be counter-productive. But if as you say, the American Journal of Therapeutics is well-regarded for its coverage of fringe medicine, and that is the reason for not including its articles as a source for a minority viewpoint, I think that evidence should be provided. When that documentation comes from an associate editor of the journal itself (i.e. Gorski), perhaps that makes the documentation even more credible! But it's not clear to me that Gorski meant to generalize beyond the papers in question to the journal as a whole. Please don't interpret my concern as suggesting foul play, because I'm not. It is pretty clear to me that there is a group of people who very much want to write on this page that Ivermectin is a promising Covid treatment, and there is a group of people that believe this would be highly irresponsible and based on terrible arguments. Not sure if you're doing so, but you would be wrong to interpret my concern as being in the former camp. I am getting the sense, however, that the latter camp is growing increasingly annoyed and as a result dismissive - perhaps for good reason. I appreciate the work people are doing to uphold Wikipedia's standards. Covid and it's treatment is a hugely important issue and more than anything I want to understand the reasoning behind decisions that are being made about how information is disseminated and controlled. I don't think I am alone in that desire.Tcx64 (talk) 17:03, 21 June 2021 (UTC)

I meant Science-Based Medicine is well-regarded for covering fringe medicine. In general, weak sources are not used to "undercut" strong ones but obviously much depends on context, the relative repute of the sources and so on. As always, if we stick to faithfully summarizing high-quality sources all shall be well. Alexbrn (talk) 17:10, 21 June 2021 (UTC)

Got it, I misinterpreted.Tcx64 (talk) 17:20, 21 June 2021 (UTC)

"Lab leak" cruft

The latest article in Science-Based Medicine on Ivermectin refers to the lab leak hypothesis as a conspiracy theory - this is in late June of 2021. I struggle to understand what is science-based about the author's viewpoint. 2600:1700:7CC0:4770:D24:AEA:246F:F713 (talk) 19:11, 23 June 2021 (UTC) No, it doesn’t. Brunton (talk) 10:03, 24 June 2021 (UTC) OK, it uses the word "disinformation" and not "conspiracy theory," which is actually even less defensible since "conspiracy theory" is merely negatively connoted, whereas "disinformation" actually passes factual judgment on both the claim and the intent of the individual making the claim. In any case it is revealing of clear bias on the part of the writer. 2600:1700:7CC0:4770:1905:B5EA:593B:F994 (talk) 04:40, 27 June 2021 (UTC) Not this article, but this one.--95.127.186.178 (talk) 08:00, 25 June 2021 (UTC) This article is about Covid Origins, not Ivermectine.Tcx64 (talk) 13:28, 25 June 2021 (UTC)

• Editors are reminded this page is for discussion of improvements to the article, and that this topic is under WP:Discretionary sanctions. Discussions about the lab leak/conspiracy theories are already derailing multiple pages on Wikipedia and are inappropriate here. Alexbrn (talk) 08:27, 25 June 2021 (UTC)

Bryant, Lawrie, et al again

This Studie was Published in American Journal of Therapeutics: June 17, 2021 - Volume Publish Ahead of Print The Study is downloadable for Free. It finds an Average reduction in death of 62% with moderate-certainty evidence and an Average reduction of infection when used as a profilactic of 86% with low-certainty evidence (due to study design limitations and few included trials)

Here is a video by Dr John Campbell introducing the findings

Please excuse my "messy" talkpoint, but i am rather new to wiki-editing.

Please review this Information for acceptance in the main article.

 Not done not a good source, as discussed above in at least two sections. Alexbrn (talk) 06:44, 25 June 2021 (UTC)

After reading this Wikipedia article again, I fail to see why the above publication is not relevant in the covid misinformation section. The article reads as though no journal has peer reviewed and accepted meta analysis which suggests efficacy of Ivermectin against Covid. The section mentions "misleading websites" and a publication that was provisionally accepted and then rejected. If obviously low quality (qua scientific sources) sources such as "misleading websites" are relevant for context here, and I believe they are, so is a peer-review journal like the American Journal of Therapeutics, whose editorial board largely consists of faculty of an accredited, and arguably respected research university (see above). If a peer reviewed article that was ultimately rejected is relevant, a similar one that was published (or the fact that the same article was ultimately published) is important context, because an obvious question arises for anyone trying to assess whether such claims have been peer-reviewed, and the result of such review: Have the claims been ultimately published? It is counter-intuitive that an article being published would make it ineligible for inclusion on the page, whereas prior to having been published it would be eligible for inclusion (as evidence of misinformation). If the article had been rejected, it seems that that event would have been included in this section. I think the best course of action is to add the citation to the Covid Misinformation section to provide context, and to clearly state the caveats about the quality of the work, as discussed on this talk page. To be clear: I am not saying that the American Journal of Therapeutics articles should be cited as evidence for a claim like "Ivermectin is an effective treatment for Covid", in the Medical Uses section, which would require a much higher bar based on the standards discussed above. However, this is a section about the controversy itself, and if information deemed misinformation was published in a peer reviewed journal that is relevant to understanding the issue at hand. Tcx64 (talk) 14:15, 25 June 2021 (UTC)

This Covid Misinformation section looks to be at serious risk of violating Wikipedia:Neutral_point_of_view. Not the existence of the section, to be clear. But, for example, the use of the term "misleading", which is based on a paper from the journal One Health. The paper is classified as "Editorial Commentary", so it is not clear whether it was peer reviewed. It reads like an opinion piece. That's not an attempt on my part to smear the piece. However, "Editorial Commentary" is not a standard article type described on the Elsevier Site. One Health's website does not say either way as I can see.Tcx64 (talk) 14:15, 25 June 2021 (UTC)

Per WP:PARITY fringe claims and pseudoscience can be effectively debunked by lower quality sources (not that these - the BMJ in particular, are low quality). We could go into the weeds using Science-Based Medicine for commentary on the Bryant paper and its questionable nature, but this is would be undue I think. This is an article about an actually useful drug that is incredibly important in its legitimate use; there's a danger we pay too much attention to the ivermectin/COVID nonsense. There are over 700 secondary papers on non-COVID aspects of Ivermectin[7] vs. well, hardly any high-quality secondary publications ever on Ivermectin/COVID (because there's no high-quality research). All we have to discuss is the misinformation, and we're already at risk of overbalancing. Alexbrn (talk) 14:27, 25 June 2021 (UTC)

Your point about parity is well taken. I think your argument mostly points to addressing the issues I pointed out in here instead, where concerns aboutWP:PARITY wouldn't apply. However, that section basically mirrors the one in this page. Therefore the right approach may be to decouple these sections, making the misinformation section on this page much shorter. Tcx64 (talk) 14:52, 25 June 2021 (UTC)

Bryant, Lawrie, et al, yet again

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.

---

The COVID-19 section does not provide a balanced view of Ivermectin's efficacy when used as a treatment for sars-cov-2. https://pubmed.ncbi.nlm.nih.gov/34145166/ states "Conclusions: Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally."

I would request the conclusion of the above meta-analysis is sighted and included in this section. — Preceding unsigned comment added by Brnn8r (talk • contribs) 06:53, 26 June 2021 (UTC)

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.

Ivermectin to be investigated as a possible treatment for COVID-19 in Oxford’s PRINCIPLE trial

Sorry, I didn't realize the paper I posted had been discussed already.

Perhaps some balance to the Ivermectin/COVID-19 discussion section could be achieved by stating it is being studied by reputable organizations, such as Oxford. https://www.ox.ac.uk/news/2021-06-23-ivermectin-be-investigated-possible-treatment-covid-19-oxford-s-principle-trial

The current impression given by the section is that Ivermectin's usage in treating COVID-19 is only supported by far-right conspiracy theorists. — Preceding unsigned comment added by 124.197.38.58 (talk • contribs) 07:26, 27 June 2021 (UTC)

Yes, the article already says "To resolve uncertainties from previous small or poor quality studies, a large scale trial being run by Oxford University, named PRINCIPLE, began recruiting test subjects in June 2021" and cites news coverage of that trial. Alexbrn (talk) 07:33, 27 June 2021 (UTC)

 Done

Toxicity Update

"Self-medication with a highly concentrated formula intended for horses has led to multiple hospitalizations, and overdose can lead to death, possibly due to interaction with other medications." -> this does not belong in the COVID research section but more in the toxicity section; additionally, further citations would be helpful for hospitalizations - the provided FDA source provides a minimal level of detail

"Ivermectin was generally well tolerated, with no indication of associated CNS toxicity for doses up to 10 times the highest FDA-approved dose of 200 μg/kg."Caprilyc (talk) 11:49, 27 June 2021 (UTC)

pmid:12362927 is a primary source failing WP:MEDRS. The FDA (which we cite) is by contrast an excellent source. I notice some concern from Braziliam medical organisations also.[8]. For obvious reasons, sourcing on this topic needs to be impeccable. Alexbrn (talk) 11:58, 27 June 2021 (UTC)

May be worth adding section on potential neurological side effects - here is a review of adverse events in cases treated for parasitic infection. Based on 1668 cases of adverse events: "The most commonly reported adverse events for ivermectin were pruritus (25.3%), headache (13.9%), and dizziness (7.5%)." 28 were associated with serious neurological adverse events likely unrelated to the underlying parasitic infection; 20 of these were associated with usage of concomitant medications. Caprilyc (talk) 12:09, 27 June 2021 (UTC)

Research: Cancer

A review of the antitumor effects of ivermectin that details several possible mechanisms of action, as well as cell culture and animal studies. "the in vitro and in vivo antitumor activities of ivermectin are achieved at concentrations that can be clinically reachable based on the human pharmacokinetic studies done in healthy and parasited patients."

References

Not a great source. Per WP:REDFLAG a better quality journal would I think be needed. Alexbrn (talk) 13:02, 27 June 2021 (UTC)

How about this review which also summarizes mechanisms and applicable preclinical evidence: "Many studies have proven that ivermectin exerts antitumour effects and might thus benefit patients with cancer after sufficient clinical trials." Caprilyc (talk) 13:18, 27 June 2021 (UTC)

References

Chinese research in a Dove Medical Press journal doesn't inspire the greatest confidence, but on the other hand the nothingburger of its conclusion ("The role of ivermectin in cancer remains to be discovered") is harmless enough to include, though I'm not sure it conveys much knowledge. Alexbrn (talk) 13:26, 27 June 2021 (UTC)

NIH Running Phase III Trial of Ivermectin: ACTIV-6

"ACTIV-6: COVID-19 Outpatient Randomized Trial to Evaluate Efficacy of Repurposed Medications" currently recruiting 15000 participants for a double-blind, placebo-controlled, RCT investigating ivermectin as a treatment for COVID-19. Caprilyc (talk) 13:02, 27 June 2021 (UTC)

References

 Done

@Alexbrn Thanks for adding ref to NIH trial to main article. I think it is important to paint a clearer picture of how seriously official sources are considering this as a potential treatment. Consider rephrasing "Such claims are not backed by sound evidence" in intro to "Promising initial research showing benefit suffered from methodological limitations and was insufficient to issue recommendations for treatment. Larger randomized controlled trials to assess efficacy and safety are currently in progress in both the US and UK." WP:NPOV There's a difference between a completely unproven fringe treatment and something that is promising enough to be considered for trials at this scale. Caprilyc (talk) 14:11, 27 June 2021 (UTC)

Clinically there's not. The respectable position is this is not to be used (but research is okay) because there is no good evidence (but lots of crap). Meanwhile ivermectin quackery/conspiracism/antivax talking points are rampant. The result of the research could of course show this drug is useless or worse for COVID. Alexbrn (talk) 14:23, 27 June 2021 (UTC)

Respectfully disagree. The respectable position is that this is not to be recommended (but research is okay) because there is a small amount of good evidence (and also lots of crap). I completely agree that more research is needed, but conflating the misinformation that is out there with a complete lack of good quality evidence in favor of benefit is also not constructive to the discussion, or an accurate representation of the current literature. Caprilyc (talk) 14:46, 27 June 2021 (UTC)

Well fortunately we do not need to decide as editors what is misleading, as it is covered in good sources which we cite. It is rife, from the research through to social media pundits. Alexbrn (talk) 14:59, 27 June 2021 (UTC)

I can respect the emphasis on maintaining rigor. What level of evidence in favor of ivermectin would be sufficient to remove the wording about claims about its benefit equaling misinformation? Positive outcomes from the currently in progress large scale RCTs? A favorable meta-analysis published in a high quality medical journal? Caprilyc (talk) 17:10, 27 June 2021 (UTC)

You're wanting to venture into the realms of WP:Original research. Sources describe the quackery/disinformation/misinformation etc. Wikipedia reflects that. That is the purpose of an encyclopedia. It's not our job to re-legislate the topic. Alexbrn (talk) 17:31, 27 June 2021 (UTC)

If I understand correctly you mean to indicate that having a public health authority at the level of WHO/FDA/CDC/NIH/EMA legislate or advocate ivermectin as an approved, or emergency authorized treatment for COVID, would be sufficient evidence to remove the description "misinformation." Is that accurate? Caprilyc (talk) 17:49, 27 June 2021 (UTC)

No. Just follow the sources. Alexbrn (talk) 17:51, 27 June 2021 (UTC)

Sorry @Alexbrn I'm not sure I follow. What do you mean by "follow the sources?" Per WP:MEDRS: "Ideal sources for biomedical information include: review articles (especially systematic reviews) published in reputable medical journals; academic and professional books written by experts in the relevant fields and from respected publishers; and guidelines or position statements from national or international expert bodies." I am just trying to understand better what the criterion of evidence would have to be to reclassify favorable results as not simple misinformation. Caprilyc (talk) 18:00, 27 June 2021 (UTC)

Misinformation is more a socio-political phenomenon covered in non-WP:MEDRS sources - although obviously there is some overlap with biomedicine. If Wikipedia needs to cover the antics of the ivermectin propagandists, as mentioned in good sources, those sources are unlikely to be WP:MEDRS ones. It is not up to Wikipedia editors to "reclassify" things; we follow sources. In the event ivermectin turns out to be a miracle cure, no doubt some sources will appear saying how various pundits luckily guessed right beforehand. Wikipedia would then report what those sources said. Alexbrn (talk) 18:08, 27 June 2021 (UTC)

To circle back around "misinformation" is fundamentally related to the assumption "Such claims are not backed by sound evidence" as it's obviously not misinformation to advocate for something that is proven to work. I think there are three issues at play here: (1) the quality of the scientific evidence for or against ivermectin as a treatment for COVID (2) the simple legal status of ivermectin approval for a particular indication, in this case COVID (3) the representation of the effectiveness of ivermectin as a treatment in media and social media. So if I understand correctly, the label "misinformation" is primarily related to (3) above. If higher quality data in favor of ivermectin as a treatment emerges, would the summary of (1) be updated to reflect the emerging evidence before (2) changes? I ask because there is a meaningful difference between drugs having a scientifically proven effect, and their approval for treatment for any particular indication. I assume if we get to the point where for example WHO approves it, it is because the sum total of the evidence is in favor. But in this hypothetical there would be some period of time after new research has emerged before the guidelines are updated. Caprilyc (talk) 18:27, 27 June 2021 (UTC)

Again, you're fundamentally mistaken in thinking that Wikipedia is based on some kind of internally-agreed editorial narrative. It just reflects sources. If the sources changes, Wikipedia follows. Trying to speculate about how that might happen is fruitless. We are where we are: there's no good evidence ivermectin is useful for COVID-19, but some charlatans are pumping out misinformation to the contrary. Wikipedia can't fix reality as reported in WP:RS, only reflect it. Alexbrn (talk) 18:34, 27 June 2021 (UTC)

I am primarily trying to understand better what is considered a reliable source. I don't want to waste your time (or mine!) by bring in low quality research from questionable journals so I would like to know what level of future evidence would meet the threshold of a source changing. I am not trying to change your mind about the current level of evidence, but can you please describe what criteria would need to be met for this article to reflect a changed reality? Per WP:MEDRS I would deduce that favorable recommendation or licensure from large-scale public health authorities like EMA/CDC/NIH/WHO/FDA and/or a favorable meta-analysis in something reputable like BMJ or some other Abridged Index Medicus journal. Would that be sufficient? Caprilyc (talk) 18:50, 27 June 2021 (UTC)

It would depend. WP:CONTEXTMATTERS and there's a lot of context in this topic area. If you want to understand how Wikipedia works, start at WP:5P. 18:54, 27 June 2021 (UTC)

Thank you! Will take a look. Caprilyc (talk) 19:18, 27 June 2021 (UTC)

WHO / COVID-19

The official WHO literature review summarizing the available research shows improvements in 7 outcomes: lower mortality, lower need for mechanical ventilation, higher viral clearance and lower time to viral clearance, lower hospital admission, lower time to clinical improvement, and shorter duration of hospitalization, though the certainty of the evidence on both benefits and frequency of adverse events is rated as low. Last update published on 3/15/21. Point being even official WHO lit review with strict exclusion criteria for the studies included shows positive effect of ivermectin treatment and calls for further research. Caprilyc (talk) 13:43, 27 June 2021 (UTC)

References

No good evidence of benefit, so recommend against clinical use. Same story as it's been for a long time. The big trials underway should paint a clearer picture. Alexbrn (talk) 13:50, 27 June 2021 (UTC)

Nit pick. "No good evidence" does not mean the same thing "insufficient high quality evidence." There is a meaningful difference between quality and certainty. The fact that WHO has issued recommendations based on 8 studies with outcomes summarized in their living recommendation implies there is some high quality evidence, but it does not meet the threshold of sufficient certainty to advocate widespread use. Caprilyc (talk) 17:06, 27 June 2021 (UTC)

The WHO assessment is that all the evidence is poor. There is no good evidence. We need to stick to the sources rather than inventing things about "implications". Alexbrn (talk) 17:26, 27 June 2021 (UTC)

Increase in Outpatient Ivermectin Dispensing in US During Pandemic

I think this is cool and worth adding to the COVID research section - unrelated to clinical efficacy for treatment, but showing an increase of number of ivermectin prescriptions dispensed in the US markedly increased. "During March 16, 2019–April 2, 2021, national estimates of ivermectin dispensed from outpatient retail pharmacies increased from an average of 3589 prescriptions per week at the pre-pandemic baseline to a peak of 39,102 prescriptions in the week ending on January 8, 2021 (989% relative percent increase)" and "the increase in the number of outpatients who received ivermectin from retail pharmacies observed during the pandemic followed publication of the previously mentioned in vitro study" Caprilyc (talk) 19:29, 27 June 2021 (UTC)

References

It's not research and "cool" is not a good reason to add anything to Wikipedia. We'd need some secondary sourcing on this to make sense of it. Alexbrn (talk) 19:34, 27 June 2021 (UTC)

Here is a related review with similar conclusions. "Although the National Institutes of Health COVID-19 Treatment Guidelines Panel has not recommended outpatient use of ivermectin, zinc, or dexamethasone for treatment or prevention of COVID-19, increased dispensing of each of these products has coincided with a national increase in COVID-19 cases beginning in July 2020 and another national increase in the fall which continued into December 2020." I think it is relevant information to add to the research section because it is in line with the "Self-medication with a highly concentrated formula intended for horses has led to multiple hospitalizations, and overdose can lead to death, possibly due to interaction with other medications" - it points to the fact that there has been widespread usage of both DIY self-medication via animal products, as well as widespread off-label usage of the actual prescription medicine. Caprilyc (talk) 19:55, 27 June 2021 (UTC)

References

Why BMJ is an accepted source while the American Journal of Therapeutics is not?

When trying to add a source about the research on Ivermectine as COVID treatment, the article Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19 (and I understand that it will also apply to: Ivermectin for Prevention and Treatment of COVID-19 Infection A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines it was discarded with the comment by @Ftrebien: that reads:

(...) The American Journal of Therapeutics does not look good on SCImago, so WP:RSUW. (...)

I do not understand at full that comment, but then I found that a new source was added to that problematic comment: Misleading clinical evidence and systematic reviews on ivermectin for COVID-19 that is not even a paper, but an opinion note published as far as I understand on the BMJ Evidence-Based Medicine, that looks worst on Scimago, at least based on the H-index of 11, against the 62 of the American Journal of Therapeutics. Is there anything I'm missing here? --Eloyesp (talk) 01:41, 28 June 2021 (UTC)

Agree. That is an opinion piece not a review. Per the EMB journal itself: "EBM opinion and debate articles express a highly readable and compelling perspective or opinion on current issues related to evidence-based medicine, health care and research. The best opinion pieces make a single robust, novel, and well-argued point. These articles do not include primary data nor evidence synthesis." Caprilyc (talk) 02:06, 28 June 2021 (UTC)

A piece on misinformation from a prestigious journal is a golden source, and its content is entirely unsurprising (except maybe for anybody who believes those ludicrous websites it is highlighting). So, considering the WP:PARITY lenience for sources debunking fringe ideas, it is over-strength for the claims made. Alexbrn (talk) 06:02, 28 June 2021 (UTC)

• Alexbrn seems to argue that the article should violate WP:MEDRS. MEDRS says "Ideal sources for biomedical information include: review articles (especially systematic reviews) published in reputable medical journals; academic and professional books written by experts in the relevant fields and from respected publishers; and guidelines or position statements from national or international expert bodies. " This doesn't list opinion pieces published in prestigious journals. Wikipedia is supposed to use neutral sources and opinion pieces are per definition about someones opinion and not neutral.

The American Journal of Therapeutics is a reputable journal and thus an ideal source according to MEDRS.

As a criteria about what articles to include in Wikipedia for COVID-19 and ivermectin, I suggest "meta-analysis in journals with impact factor>1 and published in 2021". I don't see any reason to leave out any study that fulfills that criteria.

When there are multiple opinions Wikipedia doesn't exist to take a side but to provide the reader with both sides of the debate. One side writting opinion pieces about how the other is misinformation doesn't change anything about Wikipedia's goal of being neutral and providing both sides.

Besides impact factor the American Journal of Therapeutics is part of the Index Medicus which is a curated list of medical journals. If you want to argue that journals in the Index Medicus shouldn't be seens as reputable, please make that argumetn explicitely. ChristianKl ❪✉❫ 09:59, 28 June 2021 (UTC)

The issue is WP:REDFLAG. With every major medical body pointing in one direction, a review in a low-quality journal which has been criticized by a reputable source for fringe science[9] is simply something that cannot be used for its extraordinary claim. If in doubt, raise a query at WT:MED. 11:49, 28 June 2021 (UTC)

I don't see how a blog article primarily drawing on Twitter criticisms is a better source than a peer reviewed scientific journal, especially if the main criticism of the journal in question comes from said blog article. Need a more substantive source to discredit American Journal of Therapeutics than a blog. Caprilyc (talk) 13:12, 28 June 2021 (UTC)7

If you don't see that, can you at least see With every major medical body pointing in one direction, a review in a low-quality journal?

That David Gorski, a well-known expert, finds mistakes in your source, is a red flag. It does not mean that blog articles in general are better sources than peer reviewed scientific journals in general, only that this specific article in this specific peer reviewed scientific journal needs to be handled with care. Please peruse WP:CIR: Wikipedia editors are not robots running a simple algorithm, putting sources on a predefined reliability scale and using them or not using them as a function of the measured value. They need to judge if the source is good enough, based on several factors, such as reception, impact factor, extraordinariness of content, and so on. Alexbrn, who has been doing this since 2007, is way ahead of you in the ability of judging medical sources. You have been editing since yesterday, and it is not surprising that you do not know yet how to do this. --Hob Gadling (talk) 13:50, 28 June 2021 (UTC)

Point taken. I reread the Science Based Evidence blog article and agree there are valid scientific criticisms raised in it. My initial glance at it was colored by the mixing in of Twitter commentary in a way that appeared biased. Caprilyc (talk) 14:31, 28 June 2021 (UTC)

If you want to advocate a general principle that BJM criticism should be featured in Wikipedia, how about integrating into Wikipedia articles like "Covid-19, trust, and Wellcome: how charity’s pharma investments overlap with its research efforts" which is about undisclosed financial conflicts of the organization, who's chairman Fauci called on 31. January when he was told that SARS-CoV-2 likely escaped from a lab? ChristianKl ❪✉❫ 12:41, 28 June 2021 (UTC)

Please WP:FOC. Quality control is a valid concern. I agree that American Journal of Therapeutics is an appropriate source to include here but bringing in generalizations about pharma industry and Fauci is not directly relevant to that discussion or making a strong argument. Caprilyc (talk) 13:05, 28 June 2021 (UTC)

There seems to be a misunderstanding that entire journals are somehow "reliable" or "unreliable". The issue here is two particular articles in the American Journal of Therapeutics which make WP:EXCEPTIONAL claims at odds with top-level WP:MEDRS sources and about which concerns have been raised in independent, reputable sources. Wikipedia's mission is to reflect accepted knowledge about topics, and the only accepted knowledge we have in relation to these articles is that they are suspicious outliers. As I say, for more input raise a query at WT:MED. Alexbrn (talk) 13:19, 28 June 2021 (UTC)

You have repeatedly dismissed the journal as "a low-quality journal" which may have added to the misunderstanding. The point in this discussion is that two published, peer-reviewed meta-analyses contradict an opinion piece in BMJ and a blog article, which are being presented as more reputable sources. Caprilyc (talk) 13:47, 28 June 2021 (UTC)

The BMJ piece has nothing to do with it, but is focussed on some misleading web sites. Alexbrn (talk) 13:52, 28 June 2021 (UTC)

The BMJ piece is part of this discussion - the whole section is about why a BMJ EBM opinion piece as a reputable source, and the American Journal of Therapeutics meta-analyses are not. The main other source you draw upon, in your words "a reputable source for fringe science"[10] is a blog article which heavily draws on Twitter criticisms and has no actual scientific references, including a clearly biased Twitter account called the "Ivermectin Research Alliance" whose bio states "I research the corrupt physicians, narcissistic tech entrepreneurs, and social media grifters who promote ivermectin. Delicious apple flavor."[11] and is full of ad hominem attacks and memes. I am all in favor of being stringent in quality control, but that applies to both sides of this discussion. This is not a reputable source. Caprilyc (talk) 14:03, 28 June 2021 (UTC)

We're back to the misunderstanding. To repeat: the BMJ EBM source is reliable for commenting on some shit websites; the AJT source is not reliable for something that would overturn the global medical consensus. WP:CONTEXTMATTERS folks. Sheesh. Science-Based Medicine is a reputable source, particularly for fringe medicine. Alexbrn (talk) 14:07, 28 June 2021 (UTC)

Here's something a lot of people are missing in the above discussion: Am J Ther may be a reputable journal for some things, but it is not a reputable journal for the extremely controversial topic of Ivermectin in COVID-19. In the context of the scientific landscape, the best thing we have is the consensus statements from places like the FDA [12], Infectious Disease Society of America [13], CDC [14], NIH [15], and dedicated experts with excellent standing in their field like MGH's FLARE [16]. These neutral bodies which are comprised of many experts in these topics have spent hours and hours reviewing the clinical research evidence, so that we don't have to. We are meant to reflect the consensus of the science. And that consensus is reflected in these statements from professional bodies and organizations. Physicians respect these institutions, so we should too. We cannot mislead the public and attempt to circumvent the most reliable medical reviews of the literature around, just because a very loud minority of scientists or researchers or internet sleuths or armchair scientists believe X thing. We have to follow the state of the evidence. See WP:V. When these consensus-generating professional bodies change, we can as well. Until then, no dice.--Shibbolethink ^{(♔ ♕)} 14:14, 28 June 2021 (UTC)

Exactly. --Fernando Trebien (talk) 11:58, 29 June 2021 (UTC)

While we wait for solid evidence, we can point to expert opinion, see WP:MEDASSESS. The BMJ is a core journal. As for SCImago, look at the quartiles (current and past) and the SJR index at the bottom of the page. --Fernando Trebien (talk) 11:58, 29 June 2021 (UTC)

@Caprilyc: your account was created 2 days ago exclusively for editing on ivermectin? Are you a paid editor? In that case, your user page must disclose this. --Fernando Trebien (talk) 11:58, 29 June 2021 (UTC)

Not a paid editor, just curious about the topic. I have spent a large amount of personal time researching ivermectin and thought I could contribute by adding relevant parts. My only disclosure is that based on the available evidence I suspect ivermectin is likely to be an effective treatment for COVID, though I understand that is not a sufficient reason to rewrite the article in favor before a medical consensus is established on the topic. I am new to editing Wikipedia and apologize if some of my responses have seemed inappropriately biased. I am only trying to add information as appropriate, and include relevant, neutral stuff like the fact that the number of ivermectin prescriptions in the US has increased (with supporting sources), the fact that NIH is actively running an RCT to investigate ivermectin, and the role of ivermectin in cancer. Caprilyc (talk) 12:59, 29 June 2021 (UTC)

• The idea that non-peer reviewed sources should be preferred over peer-reviewed sources for a scientific topic is really strange. Organizations like the CDC had no problem lying about the effectiveness of masks early in the pandemic and spend a long time being in denail about COVID-19 being airbone. They are political institutions. It's worth noting the position of institutions like the CDC in a Wikipedia article but there's no reason to avoid peer reviewed sources just because they are not in agreement with the CDC or other non-peer-reviewed policy documents.

Even as far as government institutions go there's no consensus with countries like Mexico using it.

The idea that the Am J Ther article is the only meta-study that's supporting of Ivermectin is wrong. Reviews in Medical Virology: "Our study suggests that ivermectin may offer beneficial effects towards Covid-19 outcomes." Science is not about pretending that there's consensus when there isn't a scientific consensus. The mission of Wikipedia is to be neutral and offer both sides of an argument.

If you look at all the peer reviwed published meta analysis there's nothing expectional about the position laid out in the Am J Ther article. ChristianKl ❪✉❫ 22:02, 29 June 2021 (UTC)

ChristianKl, in WP:MEDRS, it prescribes that we...

present prevailing medical or scientific consensus, which can be found in recent, authoritative review articles, in statements and practice guidelines issued by major professional medical or scientific societies (for example, the European Society of Cardiology or the Infectious Disease Society of America) and widely respected governmental and quasi-governmental health authorities (for example, AHRQ, USPSTF, NICE, and WHO), in textbooks, or in scholarly monographs.

My understanding is that you think we should prefer the non-notable review articles published in low quality journals (for this purpose) over the recommendations of these "political institutions." Unfortunately, when there is disagreement among different review articles (which there is in this case), then we default to using professional organizations for determining the scientific consensus. The gold standard isn't "review articles" or "systematic reviews" for our purposes. The gold standard is "what's the scientific consensus?" Which is not that ivermectin should not be used, but rather that it is still under investigation, and should be used only in the confines of clinical trials. Because at this point, risk may outweigh any benefit for many patients. It matters not only if Ivermectin is used, but how and for whom. These are the questions that well-designed RCTs answer.

Does that make sense?

If it's any consolation, there are several systematic reviews coming out soon that assess the results of the newest and most robust RCTs, and appear to show negative results. As in the section just below this one. Given that, this will not be a debate for much longer.--Shibbolethink ^{(♔ ♕)} 22:15, 29 June 2021 (UTC)

@Shibbolethink:First the study below (the one in Clinical Infectious Diseases) explicitely didn't include the newest trials. The claim that it did is just factually wrong. The pro-Ivermectin studies I mentioned include more then a month more data and they were published earlier.

There are reviews that do that but if you take the example of the last one that was mentioned, it's a very low quality document that did things like switching placebo and control group for one group in a way that makes Ivermectin look worse. It obviously didn't went through real peer review because any competent reviewer who knows the subject well should know the outcome of the trial in question and catched the error and that isn't the only issue with it. Pubpeer is a good neutral source if you are interested in the details of how data was maltreated.

Wikipedia's core policy is about not taking sides in conflicts. There are two sides here within respectable sources. Wikipedia's job is it to present both sides and be neutral. ChristianKl ❪✉❫ 16:05, 5 July 2021 (UTC)

ChristianKl, Alexbrn is correct. Our role here is not to evaluate this study as peer reviewers, it is to trust in the verifiability of what professional organizations have concluded. Worth saying, though, that you have linked to a pubpeer page based on the preprint version of this article, not the published version. The published version corrects the mistakes you've referenced, but these corrections do not ultimately alter the conclusion: [17]

As an aside, I'm taking a long wikibreak because I'm entering the phase of medical school where I will spend 70-80 hours per week in the hospital/studying, in order to figure out what kind of physician I'd like to become. Wiki will only get in the way of that process, unfortunately! So please help me maintain my wikibreak, and do not tag me from now on. There are plenty of other users who are more than capable of answering any questions (including Alexbrn)! I leave you in their very capable hands.--Shibbolethink ^{(♔ ♕)} 20:42, 5 July 2021 (UTC)

There aren't "two sides". There's delusion and advocacy about miracle cures on one side, and on the other a consensus that there it no good evidence of benefit. Wikipedia avoids WP:GEVAL. If the EMA, WHO, etc. start changing position, then we'll know things are changing .Alexbrn (talk) 16:12, 5 July 2021 (UTC)

New source forthcoming (COVID)

• Roman YM, Burela PA, Pasupuleti V, Piscoya A, Vidal JE, Hernandez AV (28 June 2021). "Ivermectin for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials". Clinical Infectious Diseases. doi:10.1093/cid/ciab591. ISSN 1058-4838. PMID 34181716.

Should be useful, at least until the big trials are complete and their results incorporated in newer reviews. Alexbrn (talk) 06:07, 29 June 2021 (UTC)

The new serious paper that discard ivermectine is from Clinical Infectious Diseases published by Oxford University Press, that is in no way linked to the Oxford–AstraZeneca_COVID-19_vaccine. Obviously his is not a WP:COI because the paper is not part of wikipedia, so I will take it as a joke. --Eloyesp (talk) 02:14, 30 June 2021 (UTC)

...huh? Are you saying that if we were to use this WP:BESTSOURCES systematic review in the article, you would consider it a COI? I'm sorry I'm just confused by the wording of your comment. You do think it's a COI? or not?--Shibbolethink ^{(♔ ♕)} 02:27, 30 June 2021 (UTC)

I'm just saying that ignoring that Oxford is one of the interested parties on a conflicting subject and treating it as "unbiased research" (quoted from WP:BESTSOURCES) does not makes any sense. As far as I understand Oxford University depends on Ivermectine not being an accepted treatment on Covid to continue selling the Vaccine (as the emergency approval can only be allowed when there is no alternative treatment). As always, I may be missing something.

Just to clarify, I didn't know about WP:BESTSOURCES, but clearly an Oxford published paper on Ivermectine is not one (just as a paper on their vaccine is not or a company paper about his product is not).--Eloyesp (talk) 02:59, 30 June 2021 (UTC)

The authors ≠ Infectious Diseases Society of America ≠ Oxford University Press ≠ Oxford/Astrazeneca. This objection has to be one of the most ignorant pieces of tinfoilery I've yet seen on Wikipedia. As a reminder, some basic level of competence is required to edit Wikipedia. Alexbrn (talk) 06:23, 30 June 2021 (UTC)

I would like to hear more voices, as you may be the one lack the social skills here as I feel you are making exceptions to WP:DNB on a regular basis. I feel that, while your Good Faith is clear, you might lack some social skills for dispute resolution like empathy and humility. --Eloyesp (talk) 11:49, 30 June 2021 (UTC)

You need to WP:FOC. It helps nobody to indulge idiotic arguments. Alexbrn (talk) 11:52, 30 June 2021 (UTC)

I forgot about civility on the list. I will refrain for more edits until next week to prevent WP:EUI, as I feel a little bit offended by your personal attacks and I think it is better to calm down a bit. Regards. --Eloyesp (talk)

personally I agree that asserting this as a legitimate COI makes me question whether Eloyesp is WP:HERE. That's why I asked for clarification, because I didn't believe it at first. It's just obvious baloney. Have you read WP:FLAT? What were your thoughts?--Shibbolethink ^{(♔ ♕)} 12:21, 30 June 2021 (UTC)

I think the broader concern of conflicts of interest in research, especially in biomedical research, is a valid overall concern, and especially so for a topic as controversial as ivermectin. However the above connection via Oxford University Press publisher is questionable at best. A more appropriate example of potential COI would be the Lopez-Medina RCT Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19 widely cited as an example of ivermectin's inefficacy for treatment, with disclosures of funding directly from pharmacautical companies: "Dr López-Medina reported receiving grants from Sanofi Pasteur, GlaxoSmithKline, and Janssen and personal fees from Sanofi Pasteur during the conduct of the study. Dr López reported receiving grants from Sanofi Pasteur, GlaxoSmithKline, and Janssen and personal fees from Sanofi Pasteur during the conduct of the study. Dr Oñate reported receiving grants from Janssen and personal fees from Merck Sharp & Dohme and Gilead outside the submitted work." Caprilyc (talk) 13:05, 30 June 2021 (UTC)

As MEDRS says: "Do not reject a high-level type of source ... because of personal objections to the inclusion criteria, references, funding sources, or conclusions ..." Sources can only be questioned when there is some sourced legitimate basis for doing so. Alexbrn (talk) 13:10, 30 June 2021 (UTC)

I don't think questioning a high-level source which openly discloses being funded by a Merck subsidiary as a potential conflict of interest is a stretch, or counts as a "personal objection." I didn't feel strongly enough to start up a thread about it in the first place, but as far as conflicts of interest go, that seems like a legitimate basis. If you disagree please elaborate on why you believe the authors of this study receiving funding from a Merck subsidiary does not represent a conflict of interest. Caprilyc (talk) 13:33, 30 June 2021 (UTC)

It's a personal objection. Journals have editorial processes, require conflict of interest transparency, and use independent peer review to validate research, and are not discounted just because some random Wikipedia editor thinks their conspiracy-theory-fuelled sleuthing trumps all that; some external expression of concern are needed. The JAMA article is a primary source in any case and not usable here, so the question is moot. The objections to the Clinical Infectious Diseases are also personal objections, and absurd ones at that. Alexbrn (talk) 13:39, 30 June 2021 (UTC)

I agree that the Clinical Infectious Diseases objections are dubious and that the Merck/Lopez-Medina connection would need further sources to be included. My point was that that is a direct connection not an extremely hypothetical chain for a possible COI. Caprilyc (talk) 13:48, 30 June 2021 (UTC)

Conflicts of interest happen all the time, and are not necessarily a bad thing - in some sense they are inevitable because of the nature of specialism and expertise. What is bad is undisclosed and so unmanaged conflicts of interest that can taint work. Basically, you are indulging in a conspiracy theory with zero documentary support. Alexbrn (talk) 13:59, 30 June 2021 (UTC)

I'm sorry can you elaborate on the exact conspiracy theory I am indulging? I am merely pointing out an openly disclosed potential conflict of interest. I don't see how this equates to indulging a conspiracy theory. As I stated above I believe that "Merck/Lopez-Medina connection would need further sources to be included." Caprilyc (talk) 14:12, 30 June 2021 (UTC)

The conspiracy theory is that in some unspecified way pharma companies were responsible for results which are not reliable. Curious about this, I looked around a bit and see the ivermectin yahoos on the web have been trying very hard to discredit this research. Have you been drinking their koolaid? I notice an entire domain devoted to a letter (jamaletter.com) rejected by JAMA, and containing some of the usual suspects among the signatories, including Pierre Kory and Paul E. Marik, and spot checking another name at random it's the executive director of the Association of American Physicians and Surgeons - which shows we're entering the orbit of planet quackery here. Alexbrn (talk) 14:19, 30 June 2021 (UTC)

I've seen the articles you linked to, and don't think any of them would count as a reputable source by Wikipedia standards. As I have said repeatedly I'm not certain that the connection between Merck and Lopez-Medina is conclusive enough to warrant further discussion unless it gets confirmed by other sources. But there are many well-documented cases of similar conflicts of interest with pharmaceutical industry and medical research in the past, for further on the reading see: Hidden conflicts? Pharma payments to FDA advisers after drug approvals spark ethical concerns, Merck Manipulated the Science about the Drug Vioxx, Academic Medical Center Leadership on Pharmaceutical Company Boards of Directors, Memorial Sloan Kettering Curbs Executives’ Ties to Industry After Conflict-of-Interest Scandals, Harvard Medical School in Ethics Quandary I don't think any of these sources count as conspiracy theorist or trying to promote a particular agenda. Caprilyc (talk) 15:33, 30 June 2021 (UTC)

Yes, hidden conflicts of interest, as the Science piece points out, are unethical and problematic. But that is not the situation with the JAMA article which has COI disclosure. Ironically, the only documented hidden conflict of interest in this topic area is that SBM piece raises about the Bryant, Lawrie et al paper, which the ivermectin boosters are so incuriously keen on. Alexbrn (talk) 15:45, 30 June 2021 (UTC)

Even non-hidden conflicts of interests can have effects... Per Pharmaceutical_industry#Controversies: "Meta-analyses have shown that psychiatric studies sponsored by pharmaceutical companies are several times more likely to report positive results, and if a drug company employee is involved the effect is even larger." Caprilyc (talk) 15:48, 30 June 2021 (UTC)

Yes, and is precisely what the publication process and peer-review seek to deal with. Wikipedia follows reliable, published, reputable sources for this reason. If there's documented cause for concern that is one thing, but editors with a POV not liking something cannot be allowed to influence source choice, for obvious reasons. Alexbrn (talk) 15:54, 30 June 2021 (UTC)

Wholeheartedly agree! Caprilyc (talk) 16:13, 30 June 2021 (UTC)

also, wanted to say, it's important to identify when someone is attacking us, vs our arguments. and if multiple people think our argument is baloney, maybe it's time to reassess that argument and admit we were wrong. --Shibbolethink ^{(♔ ♕)} 12:23, 30 June 2021 (UTC)

@Eloyesp: @Caprilyc: Someone stands to benefit from the continued instigation of such a conspiracy. If you follow the money, you can easily tell who it is; after all, its sale soared. Ivermectin has been tested at various locations by various healthcare professionals at various times during the last 15 months. Being cheap, if it really worked, governments would be scrambling to distribute it, as that would end the pandemic and save trillions of dollars. We don't see that happening, so clearly there is no basis for the claim that any of the existing studies supporting it are proving anything. Do you really think the UK government would be so stupid to let AstraZeneca make money at their expense? What about the US government? Are 600 thousand deaths and a recession worth the profit of some national big pharma company? What we do see rich countries investing in is lockdowns and monoclonal antibodies, the latter being too expensive for large scale use in developing countries. Ivermectin was used in India during last month's peak due to despair but not before that, and it is used in Brazil which is in the middle of a Senate inquiry to investigate corruption while handling the crisis. While ivermectin continues to be used in Brazil for that purpose, you can see in the data there is no significant effect in preventing deaths. --Fernando Trebien (talk) 17:41, 30 June 2021 (UTC)

"Someone stands benefit from the continued instigation of such a conspiracy. If you follow the money, you can easily tell who it is; after all, its sale soared." - by this are you implying Merck would financially benefit if ivermectin was proven an effective treatment for COVID? As far as I am aware the drug is off-patent at this point. Were you implying Merck is promoting misinformation about effectiveness of ivermectin, in order to sell more of it? Caprilyc (talk) 17:54, 30 June 2021 (UTC)

If it is off-patent, who is making money from the sales? Think. It's a group of manufacturers. --Fernando Trebien (talk) 18:33, 30 June 2021 (UTC)

I read the fulltext Roman et al. paper and I am not sure I understand how their conclusions follow from the data. For all cause mortality they report risk with ivermectin 2 per 100 vs 6 per 100 with control; RR 0.37 (0.12 to 1.13) with very low certainty of evidence. This contradicts an earlier version of the paper where all-cause mortality was reported as RR 1.11 (0.16 to 7.65) - their conclusion of "IVM did not reduce all-cause mortality vs. controls (RR 1.11, 95%CI 0.16-7.65, very low QoE)" makes sense for the earlier version but the latest revision just does not make sense. "IVM did not reduce all-cause mortality vs. controls (RR 0.37, 95%CI 0.12 to 1.13, very low QoE)" Can someone please explain how a RR of 0.37 for all-cause mortality is not a reduction? I understand that the confidence interval is wide but based on my reading of the data they present, their conclusions do not follow from the data they present. Caprilyc (talk) 13:53, 6 July 2021 (UTC)

Zein et al: Ivermectin and mortality in patients with COVID-19

Another systematic review and meta-analysis. "Ivermectin was associated with decreased mortality in COVID-19 with a low certainty of evidence. Further adequately powered double-blinded placebo-controlled RCTs are required for definite conclusion." Caprilyc (talk) 02:35, 3 July 2021 (UTC)

References

Comparing with the OUP review -

Ravikitri 2021, Niaee 2020, and Lopez-Medina 2021 are common to both.

Elgazzar 2020, Galan 2021, Gonzalez 2021, Hashim 2020, NCT04523831, and NCT04646109 are unique to Zein et al.

Chachar 2020, Krolewiecki 2020, Podder 2020, Ahmed 2021, Beltran 2021, Karamat 2021, and Chaccour 2021 are unique to Roman et al.

Roman et al neither searched the "Clinicaltrials.gov" database nor enlisted studies which had anything other than SoC/Placebo as control. Hashim 2020 had Dox in combination. That explains the relative exclusions except Gonzalez 2021, which would have only reinforced their assessment.

I cannot explain the relative exclusions of Zein et al. TrangaBellam (talk) 05:42, 3 July 2021 (UTC)

This is a diabetes journal, which is a warning flag. Alexbrn (talk) 06:07, 3 July 2021 (UTC)

(edit conflict)Thanks. How did I miss that. Overall, an inferior review. TrangaBellam (talk) 11:47, 4 July 2021 (UTC)

They were specifically looking at how diabetes, hypertension, and coronary artery disease affect outcomes: "The data of interest for this systematic review were the first author, study design, ivermectin dose, sample size, percentage of severe COVID-19, age, sex, diabetes, hypertension, coronary artery disease, and mortality." Caprilyc (talk) 11:45, 4 July 2021 (UTC)

The greater issue is why were studies having anything other than SoC/Placebo as control entertained? Elgazzar 2020, Galan 2021, and NCT04646109. I guess that you understand the obvious lacunae with using such studies.

And, why were the studies unique to Roman et al. ignored? TrangaBellam (talk) 13:04, 4 July 2021 (UTC)

@TrangaBellam Per WP:MEDRS "Respect the levels of evidence: Do not reject a high-level type of source (e.g., a meta-analysis) in favor of a source from lower levels of evidence (e.g., any primary source) because of personal objections to the inclusion criteria, references, funding sources, or conclusions in the higher-level source. Editors should not perform detailed academic peer review." Caprilyc (talk) 13:42, 4 July 2021 (UTC)

Do not be ridiculous that all journals are of an equal standard. TrangaBellam (talk) 15:40, 4 July 2021 (UTC)

Hariyanto et at: Ivermectin and outcomes from Covid-19 pneumonia

Another favorable meta-analysis published in Reviews in Medical Virology:

We systematically searched the PubMed, Europe PMC and ClinicalTrials.gov database using specific keywords related to our aims until 10th May 2021. All published randomized clinical trial studies on Covid‐19 and ivermectin were retrieved. The quality of the study was assessed using Jadad scale assessment tool for clinical trial studies. Statistical analysis was done using Review Manager 5.4 software. A total of 19 studies with 2768 Covid‐19 patients were included in this meta‐analysis. This meta‐analysis showed that ivermectin was associated with reduction in severity of Covid‐19 (RR 0.43 [95% CI 0.23–0.81], p = 0.008), reduction of mortality (RR 0.31 [95% CI 0.15–0.62], p = 0.001), higher negative RT‐PCR test results rate (RR 1.23 [95% CI 1.01–1.51], p = 0.04), shorter time to negative RT‐PCR test results (mean difference [MD] −3.29 [95% CI −5.69, −0.89], p = 0.007), higher symptoms alleviations rate (RR 1.23 [95% CI 1.03−1.46], p = 0.02), shorter time to symptoms alleviations (MD −0.68 [95% CI −1.07, −0.29], p = 0.0007) and shorter time to hospital discharge (MD −2.66 [95% CI −4.49, −0.82], p = 0.004). Our study suggests that ivermectin may offer beneficial effects towards Covid‐19 outcomes.

Caprilyc (talk) 22:06, 3 July 2021 (UTC)

References

Caprilyc, Extremely low quality meta-analysis, given that they included every single trial regardless of outcome measure, control group, blinding, etc. Would not rate very highly on the Cochrane Collab's scale [18].--Shibbolethink ^{(♔ ♕)} 01:13, 4 July 2021 (UTC)

Shibbolethink can you be more specific about this? In the section discussion selection criteria they say:

"Among the 95 evaluated full‐text articles for its eligibility, 47 articles were excluded due to unposted results (still recruiting or withdrawn), 20 articles because the study designs are not randomized clinical trial study (non‐randomized clinical trial, cross‐sectional, observational studies, case‐series), 5 articles because of no control/comparison group in the studies, 3 articles because of they do not mention the criteria of our outcome of interest and 1 article because the article was not in English. At last, the meta‐analysis included 19 randomized clinical trial studies with a total of 2768 Covid‐19 patients. Amongst them, 10 were open‐label randomized clinical trial studies, while the rest nine studies were double‐blind randomized clinical trial studies."

are you referring to the fact that the review is looking a more than just double-blind studies? All have control groups. And why is considering more than one outcome measure a bad thing? Caprilyc (talk) 01:33, 4 July 2021 (UTC)

Caprilyc, A) should be double blind. The fact that they included both blinded and unblinded trials means their results are worthlessof a heavily reduced value. Systematic meta-analyses should be based on the best available evidence not all available evidence, B) need to have very specific criteria for when and how a patient is excluded. If they exclude every patient who gets worse, then how is that a fair comparison? (this was a cardinal sin committed by Didier Raoult in his first few studies, for example), C) was the control group really a control? (they allowed control groups who were given a different non-standard of care drug, which could have made patients worse), D) It doesn't matter that they used more than one outcome, that's great. What matters is that they didn't, as far as I can tell, make sure that each outcome measure was measured the same way. That's another cardinal sin in systematic reviews. You have to make sure everybody's on a level playing field. This, to me, looks like a plug and play meta-analysis, and that's not what will be useful for our purposes here.--Shibbolethink ^{(♔ ♕)} 01:37, 4 July 2021 (UTC) (edited 02:44, 4 July 2021 (UTC))

Shibbolethink Re: (A) I am not sure I follow how including unblinded trials makes the results worthless. Obviously blinding is preferable but after reading the Cochrane handbook section if the groups are randomized I'm not sure I understand why it would make a difference: "Lack of blinding of participants, carers or people delivering the interventions may cause bias if it leads to deviations from intended interventions." Lack of blinding increases risk of bias somewhat but this is factored into the meta-analysis when assigning weights to different trials. (B) not sure what you are referring to here on excluding patients who get worse - please elaborate? for (C) I am curious to know what the gold standard would be in your view. Obviously in an ideal world we would have a comparison of ivermectin against either placebo or identical SOC but in practice SOC varies both over time and geographically. I know the Oxford PRINCIPLE trial is comparing ivermectin to SOC whereas the NIH ACTIV trial is comparing to placebo; based on these discrepancies are there any currently available meta-analyses/systematic reviews of ivermectin that do not suffer from these drawbacks? (D) Not sure what you mean. I agree symptoms severity/alleviation is dicey. Mortality however is a binary measurement - there is only one way of measuring whether or not people die. Negative PCR rate, time to negative PCR, time to hospital discharge all seem like variables that can only be measured one way. Caprilyc (talk) 02:24, 4 July 2021 (UTC)

Caprilyc, sorry, I was exaggerating. Worthless is probably too extreme a phrase, but yes it significantly reduces the ability to interpret the results, to the point where I wouldn't let it influence whether I personally prescribed the drug outside of a clinical trial. That's the most accurate way I can describe it to you. And I would be surprised if any professional organizations or government agencies' guidelines changed based on this publication. --Shibbolethink ^{(♔ ♕)} 02:42, 4 July 2021 (UTC)

I am trying to find a source for why an open label design would be as significant a reduction in the ability to interpret results. My understanding was that a standard part of the meta-analysis process was to assign weights to different studies based on measures of quality including level of blinding, so that is factored into the overall assessment. The authors explicitly list their assessment of the level of quality of the included trials and assign up to 2 points for blinding contributing to a total score which ranges between 3 and 7 for the included trials. If I understand correctly that means the authors agree with you that lack of blinding reduces the certainty of the outcomes, and that is already factored into the analysis. Caprilyc (talk) 11:17, 4 July 2021 (UTC)

Shibbolethink are there any currently available meta-analyses/systematic reviews of ivermectin you are familiar with that do not suffer from the drawbacks you point out? Caprilyc (talk) 11:13, 4 July 2021 (UTC)

Also per WP:MEDRS "Respect the levels of evidence: Do not reject a high-level type of source (e.g., a meta-analysis) in favor of a source from lower levels of evidence (e.g., any primary source) because of personal objections to the inclusion criteria, references, funding sources, or conclusions in the higher-level source. Editors should not perform detailed academic peer review." Caprilyc (talk) 13:43, 4 July 2021 (UTC)

Caprilyc, The Roman et al source is the best available so far. It actually filters out the RCTs based on which ones are worth including and which ones actually follow the Cochrane Collab standards. Indiscriminate inclusion of every study only muddies the waters further.

As an aside, I'm going on a long wikibreak, because I'm about to enter the phase of medical school where I'll be spending 70-80 hours per week (essentially every waking minute) either in the hospital or studying, in order to figure out which kind of physician I'd like to become. Wiki, though I love it dearly, will unfortunately only get in the way of this process.

Please help me maintain that wiki break and do not tag me any further, I won't be able to respond. There are many wonderful users around here who can answer any questions (Alexbrn most of all!) I leave you in their very capable hands.--Shibbolethink ^{(♔ ♕)} 20:51, 5 July 2021 (UTC)

• Interesting comment on PubPeer. Alexbrn (talk) 02:52, 4 July 2021 (UTC)