Malaysian study says ivermectin doesn’t work in COVID-19. Patients were 50 or older and considered to be at high risk of severe disease. The dose of ivermectin was reasonable.
There are really three main problems with this study and its aftermath;
1) Publication Bias: given my personal knowledge of a number of researchers whose profoundly positive ivermectin studies were rejected by JAMA [Journal of the American Medical Association], they, for the second time in a row, reveal a profound publication bias. It is a well-known disinformation tactic for high impact journals like JAMA to somehow only publish studies without “statistically significant benefits” for medicines that Pharma does not want to see in play (generally generic medicines), as they similarly avoid publishing studies of “harms” associated with Pharma favored products (i.e tobacco studies last century and/or vaccine studies this one). What is fascinating is that JAMA’s (“PHAMA’s”) ivermectin papers actually all report important benefits, but most importantly for JAMA, none that reach “statistical significance.”
2) Study Conclusion: JAMA saw fit to ensure inclusion of this phrase at the end of the conclusion, “the findings do not support the use of ivermectin for treatment of mild COVID-19,” despite what could arguably be called a compellingly supportive study based on a number of important, near statistically significant reductions in secondary outcomes like death. An absurdly obvious reason why statistical significance was not reached was that, in this population of patients, like many other upcoming trials (NIH’ ACTIV-6, U Minnesota’s COVID-OUT, Oxford’s Principle trial etc) they allowed patients to enter the trial up to 7 days from first symptoms. It is well known anti-virals efficacy is strongest.. earlier. In this trial, the average time from first symptoms was 5.1 days with a confidence interval of 1.3, meaning, pretty much nobody got treatment within 3 days of symptoms. Yet, this critical feature of this trial gets ignored in the conclusion (many conclusions will include important limitations of the study’s findings, unsurprisingly, not this one).
JAMA, per their strict criteria, also consistently avoids mention in conclusion statements of large differences in massively important secondary outcomes. Best example of this behavior by JAMA was the IV Vitamin C in ARDS trial. Read the conclusion. Then read the paper, and look at Table 2 and Figure 3… you find a massive, statistically significant reduction in mortality in those treated with IV Vitamin C. Hard to find.. but it is there. If JAMA wouldn’t allow those authors to mention it in that paper’s abstract conclusion, no surprise they did it again here.
3) the masses of doctors and media who simply propagate and disseminate that sentence and abstract without reading the actual study or reviewing the actual data while ignorant of the findings from the highest level of medical evidence.. the “meta-analyses” of ivermectin (summary analyses of all trials).
Now that Vladimir Putin has cured COVID-19, I’ll be posting less about it.
Steve Parker, M.D.