“The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge” Stephen Hawking.
Whilst I congratulate The Daily Friend for keeping up to date with the latest research, I’m dismayed at how the writer of the article “Ivermectin doesn’t work – study, 22 March 2022” is swayed by the conclusions of the abstract without bothering to read the rest of the results contained in the abstract or to peruse the data in the tables. In my scientific review of the data, I conclude that this study has rendered data that shows good efficacy for ivermectin.*
By looking only at the results presented in abstract, it is evident that for the secondary outcomes selected by the researchers, ivermectin is effective against death, with three deaths in the ivermectin arm and 10 in the control arm. While the researchers conclude that this outcome is an insignificant finding, I do not. Whilst it may be statistically non-significant using the statistical test selected by the data analysts of this study, a much lower death rate to most people is meaningful. The efficacy of ivermectin in reducing human suffering is shown further with fewer participants requiring mechanical ventilation (4 vs 10), and intensive care admission (6 vs 8). This highlights the stark contrast between statistical significance versus clinical significance in clinical practice.
On perusing the tables in the content of the paper, it appears that there were more participants who were sicker with co-morbid illnesses in the ivermectin arm. The two arms are very well matched for gender, ethnicity, age, BMI, vaccination, but there were almost twice as many smokers and people with cardiovascular problems in the ivermectin group. With regards to presenting symptoms, there were many more people with myalgia and loss of taste in the ivermectin group, which begs the question if they were more advanced in their Covid-19 illness.
A further confounder was the open-label design of the trial, which could have resulted in an intentional or unintentional allocation of ivermectin to patients with moderate disease as opposed to mild disease. Almost three times as many participants in the ivermectin arm had received antibiotics in the seven days prior to enrolling in the trial. This could result in drug to drug interactions that could possibly lower the minimum effective concentration of ivermectin in Covid-19 illness.
The measure for severe illness was a blood oxygen saturation below 95%, which coincides with the WHO definition of severe illness. If the ivermectin arm had more sick patients, it stands to reason that more patients would have had oxygen saturation levels below 95%.
As far as “potentially overestimating the effect of the drug,” because of the open label study design, I ask how do you underestimate deaths, ventilations and ICU admissions? These can only be objectively reported.
A valid criticism would be that the source and brand of ivermectin used in the study is not declared. This should have been reported and available for critical scrutiny under peer review. This paper cleverly manipulates the data by reporting a self-selected main outcome in stage lights while downplaying the secondary outcomes, which most laypeople consider more important. In summary the statistical analysis seems partisan while the conclusion remains spurious.
Any study that purports to find ivermectin doesn’t work is presented with a flourish and a drum roll, no matter how debatable the study design and execution. The Malaysian trial covered by the Daily Friend, whilst being well designed, is no exception. Conversely a recent, large Brazilian peer-reviewed study which shows decisively that ivermectin works has been inexplicably ignored. Whilst not flawless, this study used Propensity Score Matching, a robust scientific method which is a good alternative to randomised control trials, and included records of over 200 000 participants, the largest study yet. This study was published in a PubMed indexed journal, after independent review and 3-step editor evaluation.
Invariably the coverage of the ivermectin studies purporting to show that ivermectin doesn’t work is presented in a vacuum, devoid of all context, showing unabashed prejudice. The totality of all the evidence is missing. There is no reference to mechanisms of action, meta-analysis and other RCT trials which show that ivermectin works. At the beginning of March 2022 there were 247 published articles on ivermectin use in Covid-19, including all levels of evidence-based medicine. Less than 10% show negative outcomes. There has been no attempt to weigh up the bias presented in the form of research design; to evaluate the truth in the data and take cognisance of the context within which the research is carried out, or to weigh up conflicts of interest.
The authors of the Malaysian study conclude by saying “The study findings do not support the use of ivermectin for patients with Covid-19.” Would those of us who have studied their data agree? I was trained as a natural scientist, to look at all the evidence from every angle, and most importantly to distinguish science from prejudice.
*The reference to ivermectin was not made in an article by any of the Daily Friend’s writers, but was the subject of a news item taken from an article in the main stream media. The contents were not an expression of any writers’ opinions.
Reference:
Lim SC, Hor CP, Tay KH, Jelani AM, Tan WH, Ker HB, Chow TS, Zaid M, Cheah WK, Lim HH, Khalid KE. Efficacy of Ivermectin Treatment on Disease Progression Among Adults With Mild to Moderate COVID-19 and Comorbidities: The I-TECH Randomized Clinical Trial. JAMA Internal Medicine. 2022 Feb 18.
*The reference to ivermectin was not made in an article by any of the Daily Friend’s writers, but was the subject of a news item taken from an article in the main stream media. The contents were not an expression of any writers’ opinions.
The views of the writer are not necessarily the views of the Daily Friend or the IRR
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