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This is an old revision of this page, as edited by 2601:280:c081:9220:f570:6e02:44a7:32e4 (talk) at 22:35, 19 October 2021. The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Template:Vital article


Treatments for COVID-19: Current consensus

A note on WP:MEDRS: Per this Wikipedia policy, we must rely on the highest quality secondary sources and the recommendations of professional organizations and government bodies when determining the scientific consensus about medical treatments.

  1. Ivermectin: The highest quality sources (1 2 3 4) suggest Ivermectin is not an effective treatment for COVID-19. In all likelihood, ivermectin does not reduce all-cause mortality (moderate certainty) or improve quality of life (high certainty) when used to treat COVID-19 in the outpatient setting (4). Recommendations from relevant organizations can be summarized as: Evidence of efficacy for ivermectin is inconclusive. It should not be used outside of clinical trials. (May 2021, June 2021, June 2021, July 2021, July 2021) (WHO, FDA, IDSA, ASHP, CDC, NIH)
  2. Chloroquine & hydroxychloroquine: The highest quality sources (1 2 3 4) demonstrate that neither is effective for treating COVID-19. These analyses accounted for use both alone and in combination with azithromycin. Some data suggest their usage may worsen outcomes. Recommendations from relevant organizations can be summarized: Neither hydroxychloroquine nor chloroquine should be used, either alone or in combination with azithromycin, in inpatient or outpatient settings. (July 2020, Aug 2020, Sep 2020, May 2021) (WHO, FDA, IDSA, ASHP, NIH)
  3. Ivmmeta.com, c19ivermectin.com, c19hcq.com, hcqmeta.com, trialsitenews.com, etc: These sites are not reliable. The authors are pseudonymous. The findings have not been subject to peer review. We must rely on expert opinion, which describes these sites as unreliable. From published criticisms (1 2 3 4 5), it is clear that these analyses violate basic methodological norms which are known to cause spurious or false conclusions. These analyses include studies which have very small sample sizes, widely different dosages of treatment, open-label designs, different incompatible outcome measures, poor-quality control groups, and ad-hoc un-published trials which themselves did not undergo peer-review. (Dec 2020, Jan 2021, Feb 2021)

Last updated (diff) on 27 February 2023 by Sumanuil (t · c)

Stromectol?

Why does "Stromectol" get top billing at the top of the article? Is this not pure commercial promotion?

200.68.169.188 (talk) 18:16, 24 August 2021 (UTC) baden k.[reply]

I think it is because in pharmacology text book like lippincott that brand is given as an example. Who ever made this may have simply copied it, I do not think there was any malicious intent.— Preceding unsigned comment added by 116.68.96.247 (talk) 20:38, 19 September 2021 (UTC)[reply]

Misinformation

Missing anti-viral properties as primary description. Ivermectin has known anti-viral properties as well as anti-parasitic properties. Failing to mention it's anti-viral properties in the first paragraph is noteworthy, and is obviously due to the controversy about it's efficacy with the coronavirus that causes COVID-19. Regardless of whether this article cites the potential of Ivermectin to treat COVID, the anti-viral properties of Ivermectin are well-established and obvious, as the vast majority of the citations in this article testify to. The first sentence should read "Ivermectin is a medication used to treat parasitic and viral infections". To do otherwise violates Nuetrality.

"During the COVID-19 pandemic, misinformation has been widely spread claiming that ivermectin is beneficial for treating and preventing COVID-19.[18][19] Such claims are not backed by credible scientific evidence.[20][21]

Not true. There's over 40 credible scientific papers by top research scientists stating it is beneficial, including a Monash University study revealing Ivermectin kills COVID within 48 hrs, paper snippet here and National Library of Medicine here which indicates a five day treatment is effective. The media is lying and trying to make Ivermectin look like a controversial medicine when it is even on the WHO list of essential medicines and is considered safe for human use. † Encyclopædius 08:06, 7 September 2021 (UTC)[reply]

That is a lot of ifs buts and maybes. When you have a source that says it is beneficial we can change the wording.Slatersteven (talk) 12:07, 7 September 2021 (UTC)[reply]
What about this article from the American Journal of Therapeutics? It is a reputable, peer-reviewed journal. (Justus R. Hope mentioned this same article, but it was subsequently removed from this Wikipedia page.) Sdekk (talk) 18:32, 20 September 2021 (UTC)[reply]

You can check https://osf.io/preprints/socarxiv/r93g4/ and https://osf.io/9egh4 among others for scientific published evidence of the EFFECTIVENESS of Ivermectin against covid19. The statement is not true.

Due to the wave of reporting that ivermectin is only used to treat heart worms in horses, often from sources or in the same articles correctly identifying that ivermectin is not approved for covid treatment, I think this section should have it noted that it is erroneous that ivermectin is not suitable for any human application. — Preceding unsigned comment added by 75.164.76.179 (talk) 14:14, 12 September 2021 (UTC)[reply]

We require higher quality sources for medical claims on wikipedia. These preprints do not apply. — Shibbolethink (♔ ♕) 14:20, 12 September 2021 (UTC)[reply]

I have a question about this: does the article in the American Journal of Therapeutics not comply with the criteria of "Higher Quality Resources for medical claims"? The article appears to be a peer reviewed secondary source within the Wikipedia definition of secondary sources. It appears to be a review article and meta analysis of peer reviewed primary sources. Please can somebody explain. Robscovell (talk) 01:47, 4 October 2021 (UTC)[reply]

See WP:REDFLAG and past discussion on this topic in the archives. Firefangledfeathers (talk) 02:08, 4 October 2021 (UTC)[reply]

I think it would be educational to explain why the article in the American Journal of Therapeutics meets the "Red Flag" criteria listed in WP:REDFLAG. On the face of it it appears to be a valid meta-analysis in a reputable peer-reviewed medical journal. I have reviewed the past discussion on the topic in the archives and I haven't found a detailed critique of the article yet. It would help me, and others, if there could be a detailed explanation of the inadequacy of the article.Robscovell (talk) 00:32, 10 October 2021 (UTC)[reply]

The specific REDFLAG criterion for me is "Claims that are contradicted by the prevailing view within the relevant community or that would significantly alter mainstream assumptions—especially in science, medicine, history, politics, and biographies of living and recently dead people. This is especially true when proponents say there is a conspiracy to silence them." Firefangledfeathers (talk) 00:41, 10 October 2021 (UTC)[reply]

I still think it would be highly instructive, from a science education point of view, to provide a critique of the article in the American Journal of Therapeutics by members of the relevant community (who are they?) and in the context of mainstream assumptions (what are the relevant assumptions?). That would help reader to understand the AMA's decision and would also help provide clarity as to the dangers of Ivermectin. Of course, there is a meta-question here: who decides what is the 'relevant community' and what the 'mainstream assumptions' are? Robscovell (talk) 01:19, 10 October 2021 (UTC)[reply]

WP:REDFLAG applies to claims, not (merely) to sources. If one article in a minor journal makes claims which contradict what every major medical organization is saying, and has been criticized for its undisclosed conflicts of interest by reliable sources, then it's safe to say it is suspect and does not reflect accepted knowledge. As to "who decides", Wikipedia operates according to consensus, as rooted in the WP:PAGs. As it's turned out, Wikipedia has been entirely right to take this stance as the pro-ivermectin/COVID research has all turned out to be dodgy and the ivermectin boosters, quacks. Alexbrn (talk) 01:28, 10 October 2021 (UTC)[reply]

In that case, this leads naturally to questions about whether or not Wikipedia's approach is valid or not, which is obviously a much broader topic beyond the limit of this discussion, so I won't pursue it here. It is true that the consensus opinion of major medical organisations is that pro-Ivermectin/COVID research is flawed, so I will leave it there, because that is the highest claim that Wikipedia is constitutionally able to make. Robscovell (talk) 03:21, 10 October 2021 (UTC)[reply]

The research fraud and quackery is just the reality (something the pro-ivermectin crank-o-sphere has trouble with) and Wikipedia likes to contextualize WP:FRINGE views properly: historically WP:QUACKS have disliked this but, as an encyclopedia, Wikipedia is only meant to offer a handy summary of accepted knowledge as published in high-quality sources. Alexbrn (talk) 03:33, 10 October 2021 (UTC)[reply]

Extended-confirmed-protected edit request on 20 September 2021

the claim is made that the use of ivermectin to treat covid is misinformation and theirs no data to backup the claim that ivermectin can be used to treat covid Because of the mechanism of action of ivermectin we know that it will be beneficial to symptoms and certain mechanisms of covid 19 and SARS-CoV-2 Ivermectin acts by inhibiting the host importin alpha/beta-1 nuclear transport proteins, which are part of a key intracellular transport process that viruses hijack to enhance infection by suppressing the host’s antiviral response.In addition, ivermectin docking may interfere with the attachment of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein to the human cell membrane. Not to mention a study from the American journal of therapeutics Witch concluded that Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248252/ I would like for the the page to be edited to remove the claim that misformation about the effectiveness of ivermectin was spread with no studies to back the claim Their is many studies that show the effectiveness of ivermectin thou as stated above not enough conclusive data for the approval of ivermectin as a covid 19 medication

Thank you for your time and I hope you will view the information given and actually check the relevant information instead of spreading deliberate misinformation 166.182.252.190 (talk) 20:29, 20 September 2021 (UTC)[reply]

 Not done for now: please establish a consensus for this alteration before using the {{edit extended-protected}} template. It will help to bring more reliable sources. Please also review the talk page archives for prior discussion about the American Journal of Therapeutics source. Firefangledfeathers (talk) 20:36, 20 September 2021 (UTC)[reply]

Reason why the page has not been updated with relevant info?

Is there a reason why these studies are excluded from the consensus and what about the FLCCC Alliance? 41.13.254.135 (talk) 07:29, 22 September 2021 (UTC)[reply]

Yes. Wikipedia requires reliable sources. See WP:MEDRS and WP:EXCEPTIONAL and review the statement at the head of this page. Alexbrn (talk) 07:36, 22 September 2021 (UTC)[reply]
And to add, we need new studies of proper clinical trials. Not analysis of anecdotal data from a few months ago.Slatersteven (talk) 10:57, 22 September 2021 (UTC)[reply]

Living organism...

Hi @Al-Andalus: just a note here because I reverted your edits and the rollback tool doesn't allow an edit summary. If I understand correctly, I think you were trying to make clearer the distinction between what ivermectin is approved and widely used for (treating worms and mites) vs. what it is not approved for (treating viruses), since we currently use the word "parasite" which could encompass both? Is that correct? If so, I think we could make that clearer in the article with less clunky wording. Maybe something like "Ivermectin is a medication used to treat worm and arthropod infections in humans and animals"? Though I suppose arthropod is also somewhat jargony... Anyway happy to hear others' thoughts on AA's proposed wording and/or on the idea of "parasite" being imprecise here. Ajpolino (talk) 13:53, 25 September 2021 (UTC)[reply]

Maybe add "and not for treating viral infections"?.Slatersteven (talk) 13:55, 25 September 2021 (UTC)[reply]
AA's attempt was much too wordy. If it can be done pithily to summarize something in the body, then - good. Alexbrn (talk) 13:57, 25 September 2021 (UTC)[reply]

Extended-confirmed-protected edit request on 26 September 2021

Add:

As of September 26, 2021, there is 79 clinical studies of Ivermectin as listed at the clinicaltrials.gov website.

https://clinicaltrials.gov/ct2/results?term=ivermectin&cond=covid%2C+covid19%2C+covid+19&Search=Apply&age_v=&gndr=&type=&rslt= Shawn.rsa (talk) 12:54, 26 September 2021 (UTC)[reply]

 Not done Undue/meaningless without secondary sourcing. Alexbrn (talk) 12:56, 26 September 2021 (UTC)[reply]
Also it does not matter hoe many there are. What matters is what they say, and if they have been rejected/withdrawn from publication.Slatersteven (talk) 14:00, 26 September 2021 (UTC)[reply]

Extended-confirmed-protected edit request on 1 October 2021

Your information on Ivermectin efficacy for early treatment of covid is not factual. See Uttar Pradesh and how they have contained the virus and reduced hospitalizations. When most of the world does not have vaccines or monoclonal antibodies you do the world a disservice by promoting misinformation due to the influence of for-profit pharmaceutical companies. These companies are coming out with their own new early treatments. Some are very similar in chemical composition to Ivermectin. 47.183.226.192 (talk) 03:29, 1 October 2021 (UTC)[reply]

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. Firefangledfeathers (talk) 03:33, 1 October 2021 (UTC)[reply]
Additionally, this change would need reliable sources and consensus from other editors. Firefangledfeathers (talk) 03:34, 1 October 2021 (UTC)[reply]

Extended-confirmed-protected edit request on 1 October 2021 (2)

"Ivermectin has been pushed by right-wing politicians and activists promoting it as a supposed COVID treatment." This passage needs to strike the partisan political editorial content. People from across the political spectrum have "pushed" this drug. Putting this kind of partisan political editorializing into this article ruins the credibility of this site and feeds conspiracy theories. DanBoomerman (talk) 15:32, 1 October 2021 (UTC) DanBoomerman (talk) 15:32, 1 October 2021 (UTC)[reply]

See the upteen talk page threads about this.Slatersteven (talk) 15:38, 1 October 2021 (UTC)[reply]

Misleading Mechanism of Action

The page currently states: 

   In mammals, however, glutamate-gated chloride channels only occur in the brain and spinal cord and avermectins cannot cross the blood-brain barrier.

This "cannot" should be changed to "does not usually". The claim that it cannot is misleading, inconsistent with the cited paper, and underplays the risks associated with this drug.

Wyatt Childers (talk) 18:31, 3 October 2021 (UTC)[reply]

 Done Zetana (talk) 21:22, 3 October 2021 (UTC)[reply]
Thanks for the catch, I've additionally partially rewritten that section to better reflect what the cited sources are saying. Zetana (talk) 21:35, 3 October 2021 (UTC)[reply]

Extended-confirmed-protected edit request on 8 October 2021

Ivermectin must be capitalized. Below and other places it is not.

"Despite the absence of high-quality evidence to suggest any efficacy and advice to the contrary, some governments have allowed its off-label use for prevention and treatment of COVID-19. Countries that have granted such official approval for ivermectin include the Czech Republic,[120] Slovakia,[120] Mexico,[121] Peru (later rescinded),[122][123] and India[124][125] (later rescinded).[126]" 2600:6C4E:200:BFE0:F8CF:7219:C5CA:756F (talk) 04:52, 8 October 2021 (UTC)[reply]

 Not done per WP:NCMED. Alexbrn (talk) 06:45, 8 October 2021 (UTC)[reply]

Extended-confirmed-protected edit request on 10 October 2021

Ivermectin is used globally as a broad base antiparasitic, antibacterial, and antiviral medicine based on its cell replication inhibition properties. With respect to SARS-CoV2 (COVID-19) Ivermectin has been shown to be absorbed into the lung tissue for long duration (half-life between 81-91 hours) which allows longer duration antiviral activity which can help reduce respiratory disease duration and patient recovery. The developing and third world areas have the highest use of Ivermectin based on its low cost (5 day course is US$0.60 to US$1.80) and high safety levels for humans with over 3.7 million human patients treated with with 5693 adverse reactions when administered for the various diseases it can be used to treat.[1][2][3][4][5][6]. Cschlise (talk) 23:49, 10 October 2021 (UTC)[reply]

References

  1. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996102/
  2. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8383101/
  3. ^ https://pubmed.ncbi.nlm.nih.gov/33278625/
  4. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043740/
  5. ^ https://www.who.int/selection_medicines/committees/expert/21/reviews/Ivermectin_Review1.pdf
  6. ^ http://www.vigiaccess.org
 Not done please see the consensus banner at the top of this page.— Shibbolethink (♔ ♕) 00:00, 11 October 2021 (UTC)[reply]

Extended-confirmed-protected edit request on 16 October 2021

  • Under 'COVID-19 Misinformation': "Public discussion over ivermectin has been characterized by wrong attitudes regarding the interpretation of the evidence.[86]"; should either be supported with new evidence, or removed.
  • Reason: The article linked is to an opinion piece, which in turn gives some examples or experts disagreeing with parts of public discussion. This is anecdotal at best. There should at least be and indication of 'characterized by whom'. If we mean only 'characterized by _someone_', then it has presumably been characterized differently by all sorts of people, as evidenced by how controversial this topic has become.

We risk losing neutral tone without being more careful with our words here. ErrantPhilosopher (talk) 13:59, 16 October 2021 (UTC)[reply]

 Done I removed this sentence because it doesn't really make sense (it reads like a bad translation). This is without prejudice to something sane being added sourced to the same source. Alexbrn (talk) 20:23, 16 October 2021 (UTC)[reply]

Is ivermectin diverse?

A few weeks ago I inserted an edit that said: It is considered a very diverse biopharmaceutical product.. Another editor reverted it with this summary: undue without explaining this is an oldish piece by Ivermectin's inventor, in the context of a parasitology journal which is not reliable for exceptional claims of general use. During a quick review of the literature I have found a few different and significant mentions of ivermectin being "diverse". For instance, some sources say that it is "broad spectrum", "versatile", or "an old drug with new tricks".

I propose we discuss here the precise meaning of this diversity. Is it:

  1. Diverse among antiparasitic medications (i.e. it combats a more-diverse than usual range of parasitic diseases)
  2. Diverse because it is both an antiparasitic and a drug "studied as a potential antiviral agent against chikungunya"
  3. Diverse because it has a tradition of off-label prescriptions by physicians to treat not only parasites, but a diverse range of diseases

There is a danger in numerals 2 and 3 above. They can imply that it is normalized to consider ivermectin for treatment of diseases other than parasites. This implication can open the door for POV and fringy views that ivermectin is effective as a prophylactic for COVID-19. So, although the diversity deserves a mention, wording has to be extra careful here to keep things NPOV. Forich (talk) 03:39, 18 October 2021 (UTC)[reply]

Or does "diverse" mean it is used for lots of different animals? Or that it can be a oral medication, a sheep dip, or an ointment? Having "It is considered a very diverse biopharmaceutical product" was not good. Alexbrn (talk) 04:30, 18 October 2021 (UTC)[reply]
I requested help from the guys at Wikiproject Pharmacology, this is too technical for me. I suspect that it being used in lots of different animals is not the connotative meaning, though. Forich (talk) 04:41, 18 October 2021 (UTC)[reply]
Here is another synonym used: "multifaceted". It is so notable that they use it in the title.Forich (talk) 04:44, 18 October 2021 (UTC)[reply]
That is drivel. It's about as meaningful as saying the drug is "enigmatic". Alexbrn (talk) 04:50, 18 October 2021 (UTC)[reply]
Yeah... Wikipedia is written for the lay public, and any use of language which is technically correct but confusing is misunderstanding the purpose here. This sentence adds very little to popular understanding of the drug. — Shibbolethink (♔ ♕) 09:33, 18 October 2021 (UTC)[reply]
Let's go with the best MEDRS out there for a second. If we follow Heidari and Gharebaghi (2020), their first description of ivermectin in the introduction, which is the most appropiate place to find an NPOV summary of the drug, reads: Ivermectin has been used for several years to treat many infectious diseases in mammals.. (By the way, the section that opens the introduction is titled: "Ivermectin: a multifaceted medication" keep that in mind for my point below). This description is very different from the current one we are using, which says Ivermectin is a medication used to treat parasite infestations..
To make my case clearer, let me use an analogy. Suppose we were dicussing the description in the lead for Mark Allen (triathlete). The fact that Allen is a thriatlete, that is, an athlete that competes in many diverse sports is the equivalent of the multifaceted property of ivermectin that I am trying to include as an edit. Our current entry in Ivermectin omits this fact, which is the equivalent of saying of Mark Allen: "Mark Allen is a swimmer." coupled with information in the body of the article saying that he also does biking and running.
The analogy is not perfect, because in our current political climate it is risky to say that ivermectin is multifaceted. However, we can repeat Heidari and Gharebhaghi (2020) wording, because the "many diseases" implies multifacets, and the mammals implies (humans, livestock, horses, dogs, and many other animals), (CNN just misinformed saying that it is a horse dewormer, an error we should not repeat).
So, to sum up my recommendation: i) Open with the same wording as in the best MEDRS we have Ivermectin has been used to treat many infectious diseases in mammals. and ii) Inmediately make the distinction between FDA approved uses in humans (this part is not multifaceted) vs the medication's "properties", which pertain to inhibiting diseases in vitro, and include:
  1. anti-parasitic
  2. anti-viral (in vitro)
  3. inhibiting the proliferation of cancer cells (in vitro)
  4. regulating glucose and cholesterol in animals (in vitro and in vivo)
I disagree with Shibbolethink and Alexbrn's position to continue omiting the multifaceting property. Alex says it is nonsense (wrong, as proved by the MEDRS I showed) and Shibbolethink says it is too confusing for a lay reader. Perhaps after reading this longer explanation my point of introducing implicitly the multifaceted property by opening with "many diseases"+ inmediate distinction of FDA-approved uses and experimental properties may change your mind. Please comment, the article state is not optimal, as if would be the case if the entry on Mark Allen said that he was a swimmer instead of a thriatlete, in my opinion. Forich (talk) 03:02, 19 October 2021 (UTC)[reply]
The "MEDRS" also says ivermectin is "enigmatic". Scientists do write some crap sometimes. What you seem to want to do is cherry-pick the most imprecise and meaningless wording out of sources to water-down the meaningful knowledge that we precisely convey already, while also introducing a misleading slant about ivermectin somehow being a "drug" for cancer and so on. Writing a Wikipedia article means understanding and summarizing sources, not creating a collage of words from them. Alexbrn (talk) 03:44, 19 October 2021 (UTC)[reply]
To take your analogy to its logical extent... Mark Allen would only be a triathlete if he competed professionally with sponsorships in all 3 sports. Not if he competed professionally only as a runner, and then did some practice small-town bike and swim races on his off-weekends. Ivermectin is not approved or used widely in any evidence-based sense to treat these other things. So for our purposes, it's mainly an anti-parasitic, and then some people think it might be useful for other stuff, despite mostly negative clinical evidence.
It's still confusing and unnecessarily detailed for the purposes of this article. There's a reason we don't often go into the minutiae of in vitro vs in vivo uses, and it's because it runs afoul of WP:MEDRS sourcing for what counts as a "treatment." If anti-parasitic is the only indication for which it is actually clinically used in any meaningful evidence-based sense per our sources, then the most accurate and policy-compliant interpretation of "treatment of many diseases" is "treatment of many different parasites." See WP:MEDANIMAL and weigh the overall clinical evidence for the drug in these contexts vs this one review. It just isn't there, and we accurately describe the level of evidence already.
BTW, ivermectin really is a medication used to treat worms in horses.
Including: Red flukes (small strongyles) [1][2], Hairworms [3], Blood flukes (large strongyles) [4], Botworms/Botflies [5]. Intestinal Roundworms (Ascarids) [6], Intestinal threadworms [7], Pinworms (Oxyuris) [8], Lungworms (Dictyocaulus) [9], and Stomach worms (Habronema) [10].
It is literally a dewormer used in horses. That is not misinformation in any sense of the word. — Shibbolethink (♔ ♕) 03:58, 19 October 2021 (UTC)[reply]
@Alexbrn:, you said What you seem to want to do is cherry-pick the most imprecise and meaningless wording out of sources. To be clear and transparent, if one uses as a google-scholar-search-strategy the terms "allintitle: ivermectin review" and pick the first three results that come up, which the algorithm tends to show the one with most cites, we get these results:
  1. Navarro et al (2020), describe ivermectin as: Anthelmintics available through drug donations are being used according to manufacturer recommendations and a large body of experience and knowledge has been gained through their use in millions of individuals. Ivermectin is probably the most remarkable anthelmintic drug owing to its impact on onchocerciasis and LF, with an efficacy and safety that have made it the most relevant tool for the control of those diseases..
  2. Gonzalez et al (2008), use this wording on their first description of ivermectin in the introduction: Ivermectin is a semisynthetic derivative of avermectin B1 and consists of an 80:20 mixture of the equipotent homologous dehydro B1a and B1b. This antiparasitic agent, developed by Merck & Co., is frequently used in veterinary medicine, due to its broad spectrum of activity, high efficacy and wide margin of safety.
  3. Heidari and Gharebhaghi (2020), describe ivermectin as: Ivermectin has been used for several years to treat many infectious diseases in mammals. It has a good safety profile with low adverse effects when orally prescribed. Ivermectin was identified in late 1970s and first approved for animal use in 1981. Its potential use in humans was confirmed a few years later. Subsequently, William C. Campbell and Satoshi Ōmura who discovered and developed this medication received the 2015 Nobel Prize in Physiology or Medicine. Studies revealed that ivermectin as a broad-spectrum drug with high lipid solubility possesses numerous effects on parasites, nematodes, arthropods, flavivirus, mycobacteria, and mammals through a variety of mechanisms. In addition to having antiparasitic and antiviral effects, this drug also causes immunomodulation in the host. Studies have shown its effect on inhibiting the proliferation of cancer cells, as well as regulating glucose and cholesterol in animals. Despite diverse effects of this medication, many of its underlying mechanisms are not yet known. Of note, some of these effects may be secondary to toxic effects on cells.
I purposefully quoted whole paragraphs from these papers to avoid the accusation of cherry-picking, so please aknowledge that I'm putting the effort to avoid selective editing. Let's keep this discussion productive. Forich (talk) 05:14, 19 October 2021 (UTC)[reply]
@Shibbolethink:, you said So for our purposes, it's mainly an anti-parasitic. Are you aware that our wording does not include the word "mainly"? I can compromise to including it, seems a fair description. Forich (talk) 05:17, 19 October 2021 (UTC)[reply]
To be honest I don't understand what you're doing, but it seems you somehow think the connotations of general words override specific meanings in texts. Is there a language problem maybe - are you a native English speaker? Alexbrn (talk) 05:20, 19 October 2021 (UTC)[reply]
@Alexbrn:, you said it seems you somehow think the connotations of general words override specific meanings in texts. I made this proposed wording for the lead: "Ivermectin has been used to treat many infectious diseases in mammals." I apologize if it wasn't clear that this is what I am recommending to include in the article. If you think I am pushing for a general word (I did mention "multifaceted", but not in the proposed text), let me make clear that I understand that including the word "multifaceted" or a similar term in the lead is too general and imprecise and, for that reason, it was not in my proposed text. So to answer directly your comment, I do not think that the connotation of general words should override specific meaning in texts, as my proposal to use the specific meaning "Ivermectin has been used to treat many infectious diseases in mammals." shows. My wording says many infectious diseases, the current text says "parasite infestations" so in this instance mine is more precise. My text says "in mammals" whereas the current words do not specify subjects of treatment, which to me seems like my proposal is more precise. I am not an english native speaker, perhaps that is influencing your perception of me being unclear. You do seem to speak english very well but I don´t mind collaborating with you even if you are not a native speaker. If that becomes a problem I can always ask a native speaker to proof-read my texts, just let me know. Forich (talk) 05:43, 19 October 2021 (UTC)[reply]
I suspected from your approach to language you might not be a native English speaker. Saying in the lede that ivermectin "has been used to treat many infectious diseases" would be misleading, ironically for exactly the same reason that calling ivermectin simply a "horse dewormer" would be. Such statements omit necessary precision and offer a technically correct but vague general statement that implies false things. Ivermectin can apparently be used to de-worm (some) reptiles, as well as mammals. Alexbrn (talk) 05:59, 19 October 2021 (UTC)[reply]
@Shibbolethink:, this also deserves quick response: Ivermectin is not approved or used widely in any evidence-based sense to treat these other things. Can you comment what part of my interventions led you to think that I want to edit the article to conform to Ivermectin being approved or used widely in other things than parasites? My request to have a secondary sentence following the opening description in which we make an explicit distinction between the FDA approved uses and the other properties seems to fail to make across the point that I understand the distinction exists and should be clear. I believe this back and forth is revealing where is our main point of miscommunication, please bear with me and you'll see where I'm going, we are getting closer I think. Forich (talk) 06:05, 19 October 2021 (UTC)[reply]

I feel an overall lesson of this discussion is that the three of us value the FDA approved uses to come across as the most important message to convey in Wikipedia. I would go as far to say that I do not mind to comply to a wikipolicy that enforces us to use in the first sentence of a drug entry exclusively the FDA approved uses of the drug in the United States. But we should be honest and admit that is the goal guiding us. If I get some time I will look at the articles for other drugs with notable off-label prescriptions to see what do their lead sections look like, maybe it is a de facto pattern to include the FDA-approved uses as the main descriptor and I have missed it. Forich (talk) 06:15, 19 October 2021 (UTC)[reply]

No, I think any text which says “many infectious diseases” or “many uses” or “diverse uses” is unnecessarily vague and imprecise. For our purposes, the most important thing is that we do not reference its unapproved uses in the same breath as its approved ones. Ever. That’s how we create a false equivalence. Even if we explain it immediately after, it still makes the article worse by unnecessary generalization. I have no interest in changing the current wording to one that changes “anti parasitic” or “treat parasitic diseases” to something that is not parasite specific. The difference in depth of use and context between A) its actual efficacious uses in veterinary medicine and human allopathic medicine versus B) its off label uses and infant research ideas means we should not use generalizing language to refer to both together… — Shibbolethink (♔ ♕) 10:02, 19 October 2021 (UTC)[reply]

Further, the review sources support this. All 3 of those sources you cited put its parasitic uses first. One, the last one, uses vague language which is the result of writing a review about its in vitro data as well. Unlike us, this review is for content experts, so they can get away with this sleight of hand. We cannot. — Shibbolethink (♔ ♕) 10:05, 19 October 2021 (UTC)[reply]

Pharmacokinetics

Can someone confirm that this source also covers the text of the section after the citation? I cannot access it and its placement should likely be adjusted, or a citation-needed tag added... Thanks, —PaleoNeonate – 10:54, 19 October 2021 (UTC)[reply]

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