Help me help someone with ivermectin

[Lashler9054]

Anesthesiologist here. Fully vaccinated for Covid and boosted. So are all eligible people in my family (I have children too young for vaccine). My mother in law is also vaccinated. However, she sent me this meta analysis on ivermectin. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines

Her question, which is reasonable, is why this data wasn’t entirely accepted. I know one of the studies included in meta analysis was retracted. Here is guardian article on its flaws. Huge study supporting ivermectin as Covid treatment withdrawn over ethical concerns

However, another physician (from Malaysia) refuted the guardian article as seen here: Malaysia: Doctor Review of withdrawn Ivermectin study.

How do we answer my mother in laws original question with this data? Seems like there’s two conflicting views. Help me use objective mind to decide what to tell her.

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[epidural man]

Anesthesiologist here. Fully vaccinated for Covid and boosted. So are all eligible people in my family (I have children too young for vaccine). My mother in law is also vaccinated. However, she sent me this meta analysis on ivermectin. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines

Her question, which is reasonable, is why this data wasn’t entirely accepted. I know one of the studies included in meta analysis was retracted. Here is guardian article on its flaws. Huge study supporting ivermectin as Covid treatment withdrawn over ethical concerns

However, another physician (from Malaysia) refuted the guardian article as seen here: Malaysia: Doctor Review of withdrawn Ivermectin study.

How do we answer my mother in laws original question with this data? Seems like there’s two conflicting views. Help me use objective mind to decide what to tell her.

A few things to say:

1. No one (well no one who knows any better) thinks that Meta-analysis are even worth looking at.
2. To really get a good understanding of the literature, a person would need to read each of the papers quoted in the meta-analysis and look at each individual paper's statistics and methods. It is IMPOSSIBLE to combine studies and make any meaningful conclusion from it. Why the scientific world has gone gaga over meta-analysis is beyond me. Also, I haven't looked at this one, but most of the meta-crap that has come out about Ivermectin has left out the negative papers. I assume this is done on purpose. They use the excuse that the negative papers are low quality, but then they include low quality positive studies
3. There isn't a single ID doctor (maybe true?) that claims Ivermectin has a positive benefit/harm ratio.
4. Let them know that several of the meta-analysis already done have been retracted because of dishonest reporting of some of the articles used in the analysis that have subsequently been withdrawn. This type of shenanigan behavior throws a lot of doubt to ANY of the positive studies.
5. Maybe it works. ??

 

[GassYous]

garbage in garbage out

I don't know what this obsession is with non vaccine treatments when vaccines work just fine

 

[NICMAN]

I also wonder why people are obsessed with potentially harmful pharmacologic treatments for COVID when very low risk vaccines are available.

Here let me do 5 minutes of google searching for an updated meta-analysis so you don't have to:

"Based on the current very low‐ to low‐certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID‐19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use of ivermectin for treatment or prevention of COVID‐19 outside of well‐designed randomized trials."

Just quote her that and you should be fine.

Ivermectin for preventing and treating COVID‐19

Ivermectin, an antiparasitic agent used to treat parasitic infestations, inhibits the replication of viruses in vitro. The molecular hypothesis of ivermectin's antiviral mode of action suggests an inhibitory effect on severe acute respiratory syndrome ...

www.ncbi.nlm.nih.gov

 

[PainDrain]

From purely mechanistic perspective, how the h@ll do all these people think HCQ and ivermectin actually inhibit the virus? What is the mechanism here folks? I know why chemo works mechanistically and it is simple. I know how antibiotics work. These mor@ns have no explanation why these drugs should work.

 

[pgg]

Just quote her that and you should be fine.

People who don't believe the science aren't going to listen to a scientific explanation. It's the insurmountable impasse that has been the core problem of the pandemic response for two years now.

They've done their own research and you should too, you sheep.

 

[Lashler9054]

garbage in garbage out

I don't know what this obsession is with non vaccine treatments when vaccines work just fine

OK. so how would you take that specific meta analysis and specifically argue it's garbage? i'm aware of what others have said about ivermectin, but does anyone on this forum have the ability to take on that Malaysian doctor and successfully argue why at least one of the studies included in that meta analysis is garbabe?

 

[maxxor]

Scot Alexander (psychiatrist and philosophy blogger; slatestarcodex now astralcodexten) went very very deep into the ivermectin studies.

Ivermectin: Much More Than You Wanted To Know

...

astralcodexten.substack.com

He goes over Elgazzar first. To quote:

Elgazzar et al: This one isn’t on the table above, but we can’t start talking about the others until we get it out of the way. 600 Egyptian patients were randomized into six groups, including three that got ivermectin. The ivermectin groups did substantially better: for example, 2 vs. 20 deaths in ivermectin group 3 vs. non-ivermectin group 4. There were various other equally impressive outcomes.

Unfortunately, it’s all false. Some epidemiologists and reporters were able to obtain the raw data (it was password-protected, but the password was “1234”), and it was pretty bizarre. Some patients appeared to have died before the trial started; others were arranged in groups of four such that it seemed like the authors had just copy-pasted the same four patients again and again. Probably either the study never happened, or at least the data were heavily edited afterwards. You can read more here. A lot of the apparent benefit of ivermectin in meta-analyses disappeared after taking out this paper (though remember, this isn’t even on the table at the top of the post, so it doesn’t directly affect that).

Since the Elgazzar debacle, a group of researchers including Gideon Meyerowitz-Katz, Kyle Sheldrake, James Heathers, Nick Brown, Jack Lawrence, etc, have been trying to double-check as many other ivermectin studies as possible. At least three others - Samaha, Carvallo, and Niaee - have similar problems and have been retracted.

Those studies were all removed before I screenshotted the table above, and they’re not on there. But everybody is pretty paranoid right now and looking for fraud a lot harder than they might be in normal situations. Moving on:

 

[vector2]

From purely mechanistic perspective, how the h@ll do all these people think HCQ and ivermectin actually inhibit the virus? What is the mechanism here folks? I know why chemo works mechanistically and it is simple. I know how antibiotics work. These mor@ns have no explanation why these drugs should work.

Ivermectin (and some other meds), in in vitro studies, inhibit 3-chymotrypsin like protease, which is necessary for viral replication. Same mechanism as Pfizer's upcoming oral med

Obviously there's a big difference between in vitro effect and whether it's effective in vivo

Identification of 3-chymotrypsin like protease (3CLPro) inhibitors as potential anti-SARS-CoV-2 agents - Communications Biology

Here, the authors identify potential drugs that target 3-chymotrypsin like protease (3CLpro), which is a pivotal protease for the replication of SARS-CoV-2. They found that off-target inhibitors such as ivermectin and micafungin inhibit 3CLpro enzyme activity, suggesting that these molecules...

www.nature.com

 

[deleted875186]

Anesthesiologist here. Fully vaccinated for Covid and boosted. So are all eligible people in my family (I have children too young for vaccine). My mother in law is also vaccinated. However, she sent me this meta analysis on ivermectin. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines

Her question, which is reasonable, is why this data wasn’t entirely accepted. I know one of the studies included in meta analysis was retracted. Here is guardian article on its flaws. Huge study supporting ivermectin as Covid treatment withdrawn over ethical concerns

However, another physician (from Malaysia) refuted the guardian article as seen here: Malaysia: Doctor Review of withdrawn Ivermectin study.

How do we answer my mother in laws original question with this data? Seems like there’s two conflicting views. Help me use objective mind to decide what to tell her.

Why even try to argue with people that believe this s**t. As stated above, the meta analysis is only as good as the studies they include, and biased by the studies the exclude for sometimes crappy and biased reasons. Unless your going to read all the individual studies it’s just a waste of time.

Hence why we should listen to experts that we trust have read all this stuff.

 

[chessknt]

People are so desperate for something to work (in addition to the obvious panacea of prayer) that there just has to be some sort of drug that exists that will obviously render this virus impotent that for some inexplicable reason is being ignored by the ‘elites.’

The same **** is true for climate denial. We have science showing us our future and we just keep marching toward it in absolute denial even as the evidence reaps chaos all around us. We have collectively regressed hundreds of years in a second dark age thanks to social media except Instead of the king or the pope telling us what to believe it is ****ing random internet troll bots created by foreign intelligence agencies or, even worse, some alt right libertarian neckbeard who doesn’t even believe the crap he is posting.

 

[Stank811]

For those who are unwilling to use Ivermectin what do you recommend using to treat a patient who has symptoms for a couple days and seems to be getting worse? And can you show me evidence that Ivermectin makes COViD progression worse?

Bc from what I read Ivermectin has some benefit in early treatment along with monoclonal antibodies, steroids, anticoagulants etc.

We don’t have a silver bullet for treatment so the current regimen is multi drug but currently in my opinion early treatment should include ivermectin along with the above mentioned modalities.

 

[PainDrain]

For those who are unwilling to use Ivermectin what do you recommend using to treat a patient who has symptoms for a couple days and seems to be getting worse? And can you show me evidence that Ivermectin makes COViD progression worse?

Bc from what I read Ivermectin has some benefit in early treatment along with monoclonal antibodies, steroids, anticoagulants etc.

We don’t have a silver bullet for treatment so the current regimen is multi drug but currently in my opinion early treatment should include ivermectin along with the above mentioned modalities.

Are you a physician? Have you been following things? Serious question because there appears to be benefit from monoclonal Ab and dexamethasone in early symptomatic patients. I’m not as sold by remdesivir. My practice doesn’t even involve caring for covid patients much anymore and even I have seen these studies. As shown above the ivermectin stuff is garbage and (as posted in another thread) one of the “studies” showing benefit was exposed as fairly glaring data manipulation.

 

[PainDrain]

Ivermectin (and some other meds), in in vitro studies, inhibit 3-chymotrypsin like protease, which is necessary for viral replication. Same mechanism as Pfizer's upcoming oral med

Obviously there's a big difference between in vitro effect and whether it's effective in vivo

Identification of 3-chymotrypsin like protease (3CLPro) inhibitors as potential anti-SARS-CoV-2 agents - Communications Biology

Here, the authors identify potential drugs that target 3-chymotrypsin like protease (3CLpro), which is a pivotal protease for the replication of SARS-CoV-2. They found that off-target inhibitors such as ivermectin and micafungin inhibit 3CLpro enzyme activity, suggesting that these molecules...

www.nature.com

This is interesting and I had not seen this before. As you point out though, in vitro and in vivo are worlds apart. I am not sure what a 50uM would translates to at a tissue level and I am not even sure that could be extrapolated and applied accurately in this case.

 

[Stank811]

Are you a physician? Have you been following things? Serious question because there appears to be benefit from monoclonal Ab and dexamethasone in early symptomatic patients. I’m not as sold by remdesivir. My practice doesn’t even involve caring for covid patients much anymore and even I have seen these studies. As shown above the ivermectin stuff is garbage and (as posted in another thread) one of the “studies” showing benefit was exposed as fairly glaring data manipulation.

In my post I mentioned a multi drug regimen should include steroids, monoclonal antibodies, anticoagulation, and also a drug that inhibits viral replication which in my area is ivermectin. All patients should be encouraged to be tested early and treated early…if they make it to the hospital it is to late.

 

[PainDrain]

In my post I mentioned a multi drug regimen should include steroids, monoclonal antibodies, anticoagulation, and also a drug that inhibits viral replication which in my area is ivermectin. All patients should be encouraged to be tested early and treated early…if they make it to the hospital it is to late.

So again there is scant evidence of ivermectin actually showing clinical benefit; it is a stretch to say it inhibits viral replication. The study Vector posted is a drug screening analysis; no actual proof of in vivo inhibition.

Where do you practice? “If they make it to the hospital it is to late.” What are you talking about?

 

[Stank811]

So again there is scant evidence of ivermectin actually showing clinical benefit; it is a stretch to say it inhibits viral replication. The study Vector posted is a drug screening analysis; no actual proof of in vivo inhibition.

Where do you practice? “If they make it to the hospital it is to late.” What are you talking about?

If someone is hospitalized from COViD they are far into the disease and a lot of the damage has been done already to the body via the cytokine storm and micro emboli and at that point it becomes supportive care…we still use a lot of the similar medications mentioned above but my point the same medications should be used as early as possible in the disease profession.

My practice location is not material to the current discussion.

 

[deleted875186]

In my post I mentioned a multi drug regimen should include steroids, monoclonal antibodies, anticoagulation, and also a drug that inhibits viral replication which in my area is ivermectin. All patients should be encouraged to be tested early and treated early…if they make it to the hospital it is to late.

I understand your point of view, go ahead and prescribe ivermectin if you’d like, I personally would not because I see little good evidence that it helps. If a patient otherwise has no contraindications, I would document the risk benefit discussion, make a clear recommendation that it is unlikely to alter their clinical trajectory, and to not delay care in the hosptial if worsening by taking this medicine akin to snake oil.

Again, people need to be vaccinated. Steroids have shown some benefit, some of the new oral antivirals coming out appear to perhaps show some benefit. I am not up on the data behind monoclonal antibodies.

 

[Stank811]

The big take home point that needs to be talked about more is the earlier the better for all the above treatments. So many patients are reluctant to get tested bc of the stigma behind being diagnosed with COViD. If you have a HA, stuffy nose etc just get a test and seek early treatment.

 

[PainDrain]

My practice location is not material to the current discussion.

I ask because in the US these things are not being given on an outpatient basis. At least not in my area or any that I know of.

 

[greatnt249]

And can you show me evidence that Ivermectin makes COViD progression worse?

This is not the standard by which we should determine whether to administer a medical treatment or not. If it's not effective, it doesn't matter if it's "generally harmless"; we shouldn't be recommending it as a treatment.

 

[MirrorTodd]

The big take home point that needs to be talked about more is the earlier the better for all the above treatments. So many patients are reluctant to get tested bc of the stigma behind being diagnosed with COViD. If you have a HA, stuffy nose etc just get a test and seek early treatment.

This is not the standard by which we should determine whether to administer a medical treatment or not. If it's not effective, it doesn't matter if it's "generally harmless"; we shouldn't be recommending it as a treatment.

Exactly what greatnt249 said. You need to drive it through your skull that ivermextin DOES NOT HELP. These other docs are actually being pretty darn patient with you. A lot more patient than I am willing to be. You are doing your practice, this profession and most importantly your patients a DISSERVICE by continuing to even attempt to have a discussion on the merits of ivermectin as a treatment for covid. People like you are ****ing the physicians of this world over. Todd out.

 

[Stank811]

I ask because in the US these things are not being given on an outpatient basis. At least not in my area or any that I know of.

Very common to have patients treated as outpatients in US. Majority if monoclonal abx infusions are given as outpatients so not sure why your are not seeing that in your location…my guess it is occurring you just are not aware of it which I guess illustrates my point in our messaging as a community

 

[Stank811]

Exactly what greatness said. You need to drive it through your skull that ivermextin DOES NOT HELP. These other docs are actually being pretty darn patient with you. A lot more patient than I am willing to be. You are doing your practice, this profession and most importantly your patients a DISSERVICE by continuing to even attempt to have a discussion on the merits of ivermectin as a treatment for covid. People like you are ****ing the physicians of this world over. Todd out.

I disagree…Ivermectin shows some benefit in early administration. I guess I was looking to understand why so many in this forum think it can cause serious side effects or harm.

 

[PainDrain]

Very common to have patients treated as outpatients in US. Majority if monoclonal abx infusions are given as outpatients so not sure why your are not seeing that in your location…my guess it is occurring you just are not aware of it which I guess illustrates my point in our messaging as a community

I should have been more clear before. Your statement “if they make it to the hospital it’s to late” is suspect. Outpatient through hospital yes; not through your average family practitioner.

 

[Stank811]

Calm down is it really that painful to engage in a conversation that may have a view point that doesn’t agree with your current thought process.

 

[Stank811]

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

Among patients with non-severe COVID-19 and no risk factors for severe disease receiving a single 400 mcg/kg dose of ivermectin within 72 h of fever or cough onset there was no difference in the proportion of PCR positives. There was however a marked reduction of self-reported anosmia/hyposmia...

www.thelancet.com

 

[MirrorTodd]

Calm down is it really that painful to engage in a conversation that may have a view point that doesn’t agree with your current thought process.

Sorry, I know I was over the top, but JFC I feel like I'm taking crazy pills. You wanna find evidence, do a study yourself.

 

[chessknt]

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

Among patients with non-severe COVID-19 and no risk factors for severe disease receiving a single 400 mcg/kg dose of ivermectin within 72 h of fever or cough onset there was no difference in the proportion of PCR positives. There was however a marked reduction of self-reported anosmia/hyposmia...

www.thelancet.com

Assuming you even are a physician did you get any training on interpreting research data? Can you humor us with this education and describe some of the weaknesses of this study you felt you should link to support your argument that there is clinical benefit to Ivermectin?

 

[maxxor]

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

Among patients with non-severe COVID-19 and no risk factors for severe disease receiving a single 400 mcg/kg dose of ivermectin within 72 h of fever or cough onset there was no difference in the proportion of PCR positives. There was however a marked reduction of self-reported anosmia/hyposmia...

www.thelancet.com

As better written by Astral codex ten -

Chaccour et al: 24 patients in Spain were randomized to receive either medium-dose ivermectin or placebo. The primary outcome was percent of patients with negative PCR at day 7; secondary outcomes were viral load and symptoms. The primary endpoint ended up being kind of a wash - everyone still PCR positive by day 7 so it was impossible to compare groups. Ivermectin trended toward lower viral load but never reached significance. Weirdly, ivermectin did seem to help symptoms, but only anosmia and cough towards the end (p = 0.03), which you would usually think of as lingering post-COVID problems. The paper says:

Given these findings, consideration could be given to alternative mechanisms of action different from a direct antiviral effect. One alternative explanation might be a positive allosteric modulation of the nicotinic acetylcholine receptor caused by ivermectin and leading to a downregulation of the ACE-2 receptor and viral entry into the cells of the respiratory epithelium and olfactory bulb. Another mechanism through which ivermectin might influence the reversal of anosmia is by inhibiting the activation of pro-inflammatory pathways in the olfactory epithelium. Inflammation of the olfactory mucosa is thought to play a key role in the development of anosmia in SARS-CoV-2 infection

This seems kind of hedge-y. If you’re wondering where things went from there, Dr. Chaccour is now a passionate anti-ivermectin activist.

 

[Stank811]

A five-day course of ivermectin for the treatment of COVID-19 may reduce the duration of illness

Ivermectin, a US Food and Drug Administration-approved anti-parasitic agent, was found to inhibit severe acute respiratory syndrome coronavirus 2 (SAR…

www.sciencedirect.com

 

[Stank811]

Assuming you even are a physician did you get any training on interpreting research data? Can you humor us with this education and describe some of the weaknesses of this study you felt you should link to support your argument that there is clinical benefit to

Assuming you even are a physician did you get any training on interpreting research data? Can you humor us with this education and describe some of the weaknesses of this study you felt you should link to support your argument that there is clinical benefit to Ivermectin?

I have zero interest in discussing strengths and weaknesses of studies on an online forum. Really just interested in gauging the audience.

 

[Stank811]

As better written by Astral codex ten -

Chaccour et al: 24 patients in Spain were randomized to receive either medium-dose ivermectin or placebo. The primary outcome was percent of patients with negative PCR at day 7; secondary outcomes were viral load and symptoms. The primary endpoint ended up being kind of a wash - everyone still PCR positive by day 7 so it was impossible to compare groups. Ivermectin trended toward lower viral load but never reached significance. Weirdly, ivermectin did seem to help symptoms, but only anosmia and cough towards the end (p = 0.03), which you would usually think of as lingering post-COVID problems. The paper says:


This seems kind of hedge-y. If you’re wondering where things went from there, Dr. Chaccour is now a passionate anti-ivermectin activist.

I wasn’t aware of that…what does Dr Chaccour currently recommend for early treatment?

 

[chessknt]

I have zero interest in discussing strengths and weaknesses of studies on an online forum. Really just interested in gauging the audience.

Ridiculous response. 15 years of membership and this looks like trolling. Why post at all? Why link the study?

 

[greatnt249]

I have zero interest in discussing strengths and weaknesses of studies on an online forum. Really just interested in gauging the audience.

I interpret this as you having zero interest in actually having a reasonable discussion.

 

[PainDrain]

I interpret this as you having zero interest in having actually having a reasonable discussion.

Or as having preconceived opinions based on “feels” with no opening for honest debate even when confronted with evidence to the contrary.

 

[maxxor]

I wasn’t aware of that…what does Dr Chaccour currently recommend for early treatment?

He’s on Twitter. Just ask him.

 

[Stank811]

Or as having preconceived opinions based on “feels” with no opening for honest debate even when confronted with evidence to the contrary.

No I was a originally a remdesivir, decadron, monoclonal abx, heparin, prone individual (hospital based care). Remdesivir ran into some liver kidney issues so know I added Ivermectin….snake oil (maybe) but haven’t noticed any downside yet.

I don’t think I am trolling…just gauging the forum…the amount of animosity directed towards certain topics and ideas over the last couple years on this forum is incredible…a forum that use to be fun a useful (primarily to younger residents and attending) know is full of individuals that attack and belittle those who have a different opinion. Such behavior towards your colleagues should be saved for political and religious debates and a more civil conversation should attempted to be made when discussing clinical care for our patients.

I apologize to those who I feel attempted to engage in reasonable debate over a treatment but there are just to many poster on the forum currently who over take the conversation with aggressive dialogue so maybe I will check back in next year.

 

[OneFellSwoop]

No I was a originally a remdesivir, decadron, monoclonal abx, heparin, prone individual (hospital based care). Remdesivir ran into some liver kidney issues so know I added Ivermectin….snake oil (maybe) but haven’t noticed any downside yet.

I don’t think I am trolling…just gauging the forum…the amount of animosity directed towards certain topics and ideas over the last couple years on this forum is incredible…a forum that use to be fun a useful (primarily to younger residents and attending) know is full of individuals that attack and belittle those who have a different opinion. Such behavior towards your colleagues should be saved for political and religious debates and a more civil conversation should attempted to be made when discussing clinical care for our patients.

I apologize to those who I feel attempted to engage in reasonable debate over a treatment but there are just to many poster on the forum currently who over take the conversation with aggressive dialogue so maybe I will check back in next year.

Most disagree with ivermectin simply because the data is poor and supply is low. So while the harm risk is probably extremely low to the individual patient, by prescribing it to the millions of patients who have early symptoms you are robbing it from those who truly need it for other conditions in which it is well proven for. Increasing supply would be an option, however it would take government action and tax dollars. Because the evidence is so poor, that would be a waste of money for almost no benefit. Hope that helps!

 

[greatnt249]

I apologize to those who I feel attempted to engage in reasonable debate over a treatment but there are just to many poster on the forum currently who over take the conversation with aggressive dialogue so maybe I will check back in next year.

Reasonable debate includes the notion of you being willing to reconsider your stance in the absence of evidence to support your case.

 

[pgg]

Calm down is it really that painful to engage in a conversation that may have a view point that doesn’t agree with your current thought process.

You're on a forum full of physicians and scientists who've been having this conversation in one form or another for close to two years now. We've had effective vaccines for an entire year. First it was hydroxychloroquine. Now we're on the Nth iteration of the garbage magical-thinking Wonder Drug of the moment that *****s the world over are desperately clutching at to avoid getting one of several safe vaccines that essentially eliminate the risk of severe disease.

I think everyone's remarkably calm and patient with another thread of ivermectin bull****, all things considered.

I have zero interest in discussing strengths and weaknesses of studies on an online forum. Really just interested in gauging the audience.

Sooooo .... you want to discuss ivermectin but you don't want to discuss any of the studies that have evaluated it. What'd you pick this forum for then?

 

[GassYous]

No I was a originally a remdesivir, decadron, monoclonal abx, heparin, prone individual (hospital based care). Remdesivir ran into some liver kidney issues so know I added Ivermectin….snake oil (maybe) but haven’t noticed any downside yet.

I don’t think I am trolling…just gauging the forum…the amount of animosity directed towards certain topics and ideas over the last couple years on this forum is incredible…a forum that use to be fun a useful (primarily to younger residents and attending) know is full of individuals that attack and belittle those who have a different opinion. Such behavior towards your colleagues should be saved for political and religious debates and a more civil conversation should attempted to be made when discussing clinical care for our patients.

I apologize to those who I feel attempted to engage in reasonable debate over a treatment but there are just to many poster on the forum currently who over take the conversation with aggressive dialogue so maybe I will check back in next year.

Maybe if people stopped wasting time on nonsense pulled from nowhere we could have a reasonable debate.

Thus far, the only thing that all these useless fad "treatments" have done is make billions of dollars for pharmaceutical companies while affecting my livelihood by decreasing the number of patients able to get elective surgery because these antivaxxers keep taking up our hospital beds. If there was an inkling of hope that some random medication actually helped any patients, I would be all for it. But there are hundreds of thousands of dead people out there with huge medical bills and orphaned children because of the mountains of misinformation being peddled by the talking heads. Who will pay for their care? Who shoulders the heaviest burden of taxation? High earning professionals like us.

Basically, increased personal risk for us, decreased reimbursement and increased taxation because a bunch of dopes don't want a 2 second jab in the arm.

 

[Stank811]

You're on a forum full of physicians and scientists who've been having this conversation in one form or another for close to two years now. We've had effective vaccines for an entire year. First it was hydroxychloroquine. Now we're on the Nth iteration of the garbage magical-thinking Wonder Drug of the moment that *****s the world over are desperately clutching at to avoid getting one of several safe vaccines that essentially eliminate the risk of severe disease.

I think everyone's remarkably calm and patient with another thread of ivermectin bull****, all things considered.




Sooooo .... you want to discuss ivermectin but you don't want to discuss any of the studies that have evaluated it. What'd you pick this forum for then?

Pgg I have always respected your post in the past but lately I think the pandemic has gotten to you. I agree current evidence that is there isn’t strong but there is evidence for both hydroxy and ivermectin to suggest that it does have antiviral properties and that it may show benefit but as always needs larger trials which likely won’t occur bc COViD is no longer treated with just a single drug as touched on above. So I am not saying this is a magical drug but it isn’t poison either and has anti viral properties. In the same breadth the negative side effects are minimal and well documented. I mean I still see ranitidine and metoclopramide given 10 min before a knee scope for PONV…snake oil…probably, but I don’t walk around dropping f bombs and such over that practice.

I am pro vaccination but vaccines don’t treat a pt that come to the clinic or hospital with COViD (vaccinated or unvaccinated) So yes vaccination should be part of the solution but we are talking about those who present with symptomatic COViD (vaccinated or not)

 

[greatnt249]

So I am not saying this is a magical drug but it isn’t poison either and has any viral properties. In the same breadth the negative side effects are minimal and well documented.

This sounds remarkably similar to the language those supplements on TV use to get around false advertising, like "clinically-tested ingredients."

I mean I still see ranitidine and metoclopramide given 10 min before a knee scope for PONV…snake oil…probably, but I don’t walk around dropping f bombs and such over that practice.

Last I checked, postoperative nausea and vomiting wasn't a worldwide health crisis.

 

[maxxor]

Pgg I have always respected your post in the past but lately I think the pandemic has gotten to you. I agree current evidence that is there isn’t strong but there is evidence for both hydroxy and ivermectin to suggest that it does have antiviral properties and that it may show benefit but as always needs larger trials which likely won’t occur bc COViD is no longer treated with just a single drug as touched on above. So I am not saying this is a magical drug but it isn’t poison either and has anti viral properties. In the same breadth the negative side effects are minimal and well documented. I mean I still see ranitidine and metoclopramide given 10 min before a knee scope for PONV…snake oil…probably, but I don’t walk around dropping f bombs and such over that practice.

I am pro vaccination but vaccines don’t treat a pt that come to the clinic or hospital with COViD (vaccinated or unvaccinated) So yes vaccination should be part of the solution but we are talking about those who present with symptomatic COViD (vaccinated or not)

I think by this point in the pandemic, if hcq/ivermectin worked, they would be widely used. They don’t.

I am hopeful the 2 oral drugs that have applied for EUA actually work as they are bound to be cheaper than mAbs

 

[Stank811]

I think by this point in the pandemic, if hcq/ivermectin worked, they would be widely used. They don’t.

I am hopeful the 2 oral drugs that have applied for EUA actually work as they are bound to be cheaper than mAbs

Agreed

 

[Stank811]

When the pfizer pill gets EUA I hope to see the same level of push back over the study submitted bc it isn’t a strong study. But you can count on me to try it for those that need it.

 

[epidural man]

I guess I can’t be against someone using ivermectin. It is low risk.

I mean…I still take vitamin C when I have a cold.

 

[MirrorTodd]

I guess I can’t be against someone using ivermectin. It is low risk.

I mean…I still take vitamin C when I have a cold.

I can. Any sort of credence given to Ivermectin by any medical professional is going to be used as proof for more idiots to keep eating horse paste. Like ****ing come on already (not directed at you EM)

 

[chessknt]

I guess I can’t be against someone using ivermectin. It is low risk.

I mean…I still take vitamin C when I have a cold.

At this point with the misinformation machine running full force you absolutely should be. We used to have some nuance in the practice of medicine but that was back before every sub-GED buffoon became an internet expert who could do their own research. Now I view any C19 therapy that does not have strong RCT and professional guideline-level evidence as something that cannot be offered to avoid the slippery slope that accompanies this disease because almost every patient in the hospital chose not to get vaccinated at this point which means they are reading conspiracy bull**** and dont believe in modern medicine. By the time they get admitted that means they have to agree to modern medicine practices which I have been implementing in a militarized formulaic fashion to avoid any appearance of flexibility that might allow for any more of their bull**** conspiracy crap to be incorporated in to their care. They had their chance with that outside the hospital when their church's private conspiracy facebook group was running their care but once they come to the hospital it is time for a different strategy.