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This is an old revision of this page, as edited by 49.195.100.179 (talk) at 03:52, 23 December 2021 (→‎Wikipedia:NPOV: new section). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

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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)

Misinformation

"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]
Buts and maybes? How do you get "a lot of buts and maybes" from the citation of multiple scientific papers demonstrating the claim that the conclusion of those studies is "not backed by credible scientific evidence"? This makes absolutely no sense. — Preceding unsigned comment added by 2601:280:c081:9220:f570:6e02:44a7:32e4 (talk) 22:38, 19 October 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]

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. — Preceding unsigned comment added by 2601:280:C081:9220:F570:6E02:44A7:32E4 (talk) 22:35, 19 October 2021 (UTC)[reply]

@AlexBrn reverted my edit to the Ivermectin article which provided three references, available from NIH, on the ability of Ivermectin to bind to the COVID-19 spike protein, indicating that it may be useful for treatment of the disease. Clinical trials are ongoing, and it is certainly not yet approved by the various agencies, but I think this information is useful. I think peer-reviewed articles from respectable journals, available at the National Institute of Health website do not qualify as "unreliable/misinformation". Here are the articles: [1][2][3] Please let me know if this changes your opinion. PAR (talk) 20:47, 11 November 2021 (UTC)[reply]

It's actually more an issue of WP:MEDPRIMARY and WP:MEDASSESS. What you are making is a medical claim: "it may be useful for treatment of the disease." But what you have brought are not WP:MEDRS sources. They are A) primary sources (not secondary narrative review articles), B) from pretty low impact and not well regarded journals, and C) extremely low on the totem pole of evidence around here. This is also an example of WP:OR given that these are primary sources, we would need high quality secondary sources to say this even if it wasn't a medical claim. The fact that it's a medical claim raises the bar even higher. — Shibbolethink (♔ ♕) 03:56, 12 November 2021 (UTC)[reply]

OK, I read the American Journal of Therapeutics review by Korey. Korey says that the largest double-blinded RCT was by Mahmud in J Int Med Res [1]. In other words, that's their best case. This was a 400-patient trial, 200 placebo and 200 treatment. Primary outcome was time to clinical recovery. Secondary outcomes were disease progression and RT-PCR positivity, which reached statistical significance. A secondary outcome, survival, was 3 deaths in the placebo group and 0 deaths in the treatment group -- which they say is statistically significant at p = 0.016. They published it in a peer-reviewed journal on PubMed. You can't change clinical practice on the basis of one study, but they checked all the boxes. It may be that this was just a statistical anomaly. It may be that multiple other studies failed to replicate their result. I'd like to see letters commenting on this study. But otherwise I don't see how we can dismiss a published RCT like this, and/or the review by Korey.

I'm an ivermectin skeptic, and I'd be happy to find well-designed studies debunking it. (That's what I came here for.) But I learned that in science, you have to give all the information supporting your position, and all the information opposing your position. (I just heard Daniel Griffin say that again on TWIV.) Do we all agree on that? --Nbauman (talk) 20:30, 11 December 2021 (UTC)[reply]

"all the information opposing your position" ← no, sounds intellectually incompetent, and falls right into the trap of the quacks and grifters. In any case, see the top of this page for the consensus from reliable sources. We're not going to be undercutting high-quality sources with obvious crap like the Kory review. Alexbrn (talk) 20:40, 11 December 2021 (UTC)[reply]
Okay, this is a fair idea, to think that we must consider all available evidence before making a decision. But we must also weight all of this evidence in proportion to the quality of the evidence. This review cites this trial uncritically, without considering the many well-known criticisms of the Mahmud RCT. To count just a few:
  1. "Group assignment was not stratified according to disease severity". This means it is possible that the placebo group could have, by chance, received a slightly sicker set of patients. Well-designed trials overcome this weakness by using a rolling basis model, and assigning patients to the different treatment groups based on maintaining an even proportion of severity, age, comorbidities, etc. in the two groups. So that we can be sure we have removed the influence of these other factors on the outcome.
  2. Severity in particular was probably comparable between the two (see their Table 1). But the placebo group was A) older, B) had worse comorbidities, and C) more severe symptoms than the treatment group.
  3. "The trial was registered retrospectively" Meaning they could have run this study as many times or ways as they liked, and registered only the ones that worked.
  4. Randomization was conducted by the head of the dept of Medicine, not by an independent agency. This means that dept head could have fudged the results by deciding which patients were randomized into which group. This is technically double-blind because the treating physicians didn't know the code. But it is also nowhere near as ethical or ideal as having an independent agency do the randomization.
  5. Typically we judge the chosen outcomes of a study by "clinical utility." Does it actually matter to the patient or the provider if they recover 1.5-2 days earlier? Especially when the two groups overlap in this measure by something like 87%... Does it actually matter? If the mortality benefit is minimal? I would say it does not.
  6. This study is underpowered to find the differences they claim to have found.
  7. A lot of the evidence for their conclusions is based in surrogate or post-hoc measures, which are known to be tainted by experimenter bias. (e.g. "Increase in stage of severity" is an outcome measure they did not decide on from the outset.)
For all of the above reasons, one must consider how much weight to give this study in comparison to the much larger and better-designed trials which have found no effect. Importantly, Wikipedia does not consider single RCTs to be very much evidence worthy of mentioning. We prefer systematic reviews and meta-analyses. Such analyses have found that this study is not consistent with the prevailing evidence that demonstrates a lack of efficacy in these candidate treatments.
And perhaps that is the most important point in this consideration. Wikipedians should not be engaging in peer review. We should be trusting the conclusions of the prevailing scientific community in these controversies. That prevailing consensus is that ivermectin and HCQ do not work. — Shibbolethink (♔ ♕) 21:05, 11 December 2021 (UTC)[reply]

User:Alexbrn, Daniel Griffin, MD, PhD, and Vincent Racaniello, PhD, are "intellectually incompetent" because they say that a scientist has to give all the information supporting his position, and all the information opposing his position? Do you want to think that over? Nbauman (talk) 23:46, 11 December 2021 (UTC)[reply]

User talk:Shibbolethink Thanks for your detailed answer. But that's your answer. If there are many well-known criticisms of the Mahmud RCT, where have they been published? --Nbauman (talk) 23:54, 11 December 2021 (UTC)[reply]
Among other places, here: [2] [3] [4] (these are some of the best available sources on this question)
Those sources additionally criticized the intervention schema, for altering the "standard of care" between the two groups even when setting Ivermectin aside. This could have had significant influence on the results, and is part of why this study fails the "Cochrane risk of bias tool 2" (RoB 2) [5]
And here are some other secondary reviews which do not directly discuss this study, but still demonstrate that the landscape of the evidence is currently against the conclusions of Mahmoud et al. [6] [7]. — Shibbolethink (♔ ♕) 01:35, 12 December 2021 (UTC)[reply]
Yup, Mahmoud et al. is a primary source failing WP:MEDRS and of no consequence here. Knowledge is not based on "all the information" for or against "positions", but only on the relevant high-quality evidence. Luckily our decent sources do that sifting so we don't have to. It is in fact a hallmark of junk sources that they don't sift and use "all the information" - see ivmmeta.com. (It's also a bit odd to think that there should be evidence "opposing" a drug; except in cases where it's positively unsafe the tell of an ineffective drug is a lack of good evidence of effect, not evidence "opposing" effect, an illogical concept).
Incidentally, Cochrane's living systematic review, PMID:34318930 is an example of how this should be done. It systematically reduces > 300 initial records ("all the information") to just 13 for consideration, so as to ensure only high-quality evidence is used. Mahmud et al is one of the RCTs that doesn't make the cut, because it "evaluated a combination of ivermectin with other treatments that were different between groups". And as MEDRS says: "cite reviews, don't write reviews". Alexbrn (talk) 05:39, 12 December 2021 (UTC)[reply]

Several new studies are linked in this article on horse medicine that might suggest some updates to this page: — Preceding unsigned comment added by Dougransom (talk • contribs) 16:02, 13 December 2021 (UTC)[reply]

This does not pass wp:medrs.Slatersteven (talk) 16:09, 13 December 2021 (UTC)[reply]
Zerohedge is deprecated on Wikipedia. Firefangledfeathers 16:09, 13 December 2021 (UTC)[reply]

Hoping, and a call for a tiny little just a smidge of neutral language in the lead

Nothing more to discuss here. If MEDRS-compliant sourcing to support the proposed change is found, it may be WP:BOLDly added to the article or proposed in a new section. –dlthewave ☎ 02:50, 27 November 2021 (UTC)[reply]

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.

Let's just hope that if (more likely when) Ivermectin is accepted in the U.S. as effective in treating Covid-19, before or after catching a case, that there has not been even one desperate reader who has actually taken Wikipedia as their main source and given up on seeking out the medicine. No neutral wording has been allowed to stay in the lead, even simple language like "no benefit, which has been disputed..." would be much better. So please add a few words of neutrality. Don't cage this section for awhile, would like to read some comments. Feeling I have to write this, and make an attempt rather than sit by and not at least try, for myself and for the benefit of editors who won't allow it and will have to live with their stance, just as U.S. media, medical personnel, and politicians will have to live with what they've done in their realms of influence. As this page is read worldwide, even in countries where Ivermectin is successfully used for Covid-19 prevention and treatment, the lead violates WP international and reflects a U.S. and other western nation bias. Randy Kryn (talk) 12:40, 26 November 2021 (UTC)[reply]

When (and if) it is accepted as a treatment we will reflect this. But being a (say) an aid to recovery does not mean it is (for example) a cure (or a preventative), thus that would still be misinformation. But at this time that is not the case, and the medical consensus is it is not an effective treatment, and that is what (at this time) we must reflect.Slatersteven (talk) 12:43, 26 November 2021 (UTC)[reply]
No, that's a US centered approach and so isn't neutral language concerning, say, India and Japan. This page is read worldwide, not just in North America and Europe. Randy Kryn (talk) 12:45, 26 November 2021 (UTC)[reply]
There's no evidence ivermectin is an effective drug against COVID, and no reason to suppose it could be. This is well established in multiple solid RS. Messages to the contrary all either ignorant or active misinformation. Randy Kryn is pushing a WP:PROFRINGE POV. Alexbrn (talk) 12:47, 26 November 2021 (UTC)[reply]
OK, what countries have licensed its use as a Covid treatment?Slatersteven (talk) 12:48, 26 November 2021 (UTC)[reply]
And how do you that Ivermectin is successfully used for Covid-19 prevention and treatment? Are there any WP:MEDRS sources for that? --Hob Gadling (talk) 12:51, 26 November 2021 (UTC)[reply]
Calls for doing so have been issued (just one example, this is worldwide and many physicians have spoken out, as we all know. Adding just a few neural words, just a sentence fragment. This seems surely a WP:IAR issue, maybe its most important use yet. Randy Kryn (talk) 12:56, 26 November 2021 (UTC)[reply]
This is why we can't [8], it has not been licensed as a treatment, so we can't say it might work based upon a few (often falsified) reports or studies. So when it becomes a formally recognized treatment we can revisit this, until then it's not.Slatersteven (talk) 13:03, 26 November 2021 (UTC)[reply]
Then use WP:IAR to add just a few words. As most here know, if another treatment is officially recognized then that would automatically change some of the present US policies. Even the Japanese statement linked above could justify "which has been disputed". Randy Kryn (talk) 13:08, 26 November 2021 (UTC)[reply]
IAR is involved when rules stop us from making the site better, this does not. It will push Covid misinformation (and for that reason I invoke IAR, we can't allow our readers to be mistaken into thinking this is an effective treatment when at best it seems to just aid recovery, not provide any kind of protection (which is how it is being touted)). When and if the scientific consensus changes, and when and if it is licensed for use as a treatment we will know what it is being used for. Until then we do not even imply it is an effective treatment, as people's lives are at stake..Slatersteven (talk) 13:13, 26 November 2021 (UTC)[reply]
IAR cannot be invoked to override NPOV. Randy Kryn should know blogs are not reliable sources, and the fact that the chair of some doctors' group in Tokyo gave (yet another) whacky press conference means nothing, despite how it's been lapped-up and twisted in in the crank-o-sphere. Alexbrn (talk) 13:19, 26 November 2021 (UTC)[reply]
@Randy Kryn in most of the world, we practice evidence-based medicine, not eminence-based medicine. The opinion of a famous doctor does not override the conclusions of the rest of the medical research community. — Shibbolethink (♔ ♕) 13:37, 26 November 2021 (UTC)[reply]
Just wanted to try to get the tiniest amount of neutrality, as many have before and I tried a small amount with one post awhile ago. Not saying the other editors are acting other than in good faith here, sticking to the exact language which allows not even small disagreement in the lead of just a clarifying word or two. This is my last post in this section, and still ask that it be left open so other editors can address the issue without the locked-section wall, thanks. Randy Kryn (talk) 15:48, 26 November 2021 (UTC)[reply]
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.

This article has multiple issues.

Nothing more to discuss here. If MEDRS-compliant sourcing to support the proposed change is found, it may be WP:BOLDly added to the article or proposed in a new section. –dlthewave ☎ 02:51, 27 November 2021 (UTC)[reply]

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.

This article needs more medical references for verification or relies too heavily on primary sources.

Omission bias over Japan success using the treatment. Country not mentioned at all

Omission bias over India success using the treatment. Country not mentioned at all

Omission bias over several countries success on using the treatment. — Preceding unsigned comment added by 2804:128:856B:D500:7CA5:29AB:2D67:4857 (talk) 17:46, 26 November 2021 (UTC)[reply]

Lets have some sources that say (see wp:medrs) this.Slatersteven (talk) 17:49, 26 November 2021 (UTC)[reply]
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.

Wikipedia:NPOV

This article violates NPOV. From Impartial Tone:

“ Wikipedia describes disputes. Wikipedia does not engage in disputes. A neutral characterization of disputes requires presenting viewpoints with a consistently impartial tone; otherwise, articles end up as partisan commentaries even while presenting all relevant points of view. Even where a topic is presented in terms of facts rather than opinions, inappropriate tones can be introduced through how facts are selected, presented, or organized. Neutral articles are written with a tone that provides an unbiased, accurate, and proportionate representation of all positions included in the article.

The tone of Wikipedia articles should be impartial, neither endorsing nor rejecting a particular point of view.”

Presenting the conversation surrounding Ivermectin as “misinformation” is clearly attempting to characterize opposing/contentious viewpoints as “lies” which is incredibly problematic and antithetical to Wikipedia’s values.

Consider changing the article to present both sides of the debate without attempting to authenticate either side. No definite scientific consensus has been reached and it is dishonest for Wikipedia to suggest otherwise. 49.195.100.179 (talk) 03:52, 23 December 2021 (UTC)[reply]

  1. ^ Lehrer, Steven; Rheinstein, Peter H. (Sep–Oct 2020). "Ivermectin Docks to the SARS-CoV-2 Spike Receptor-binding Domain Attached to ACE2". In Vivo. 34 (5). doi:10.21873/invivo.12134. Retrieved Nov 11, 2021.{{cite journal}}: CS1 maint: date format (link)
  2. ^ Saha, J.; Raihan, M. (2021). "The binding mechanism of ivermectin and levosalbutamol with spike protein of SARS-CoV-2". Structural Chemistry. doi:10.1007/s11224-021-01776-0. Retrieved Nov 11, 2021.
  3. ^ Eweas, A.; Alhossary, A.; Abdel-Moneim, A. (25 Jan, 2021). "Molecular docking reveals ivermectin and remdesivir as potential repurposed drugs against SARS-CoV-2". Front. Microbiol. 11:592908. doi:10.3389/fmicb.2020.592908. Retrieved Nov 11, 2021. {{cite journal}}: Check date values in: |date= (help)CS1 maint: unflagged free DOI (link)
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