The Ivermectin Cautionary Tale
Anand Swaminathan and Gideon Meyerowitz-Katz
- Falsified Data Issues
- Surgisphere is a healthcare analytics company with a very questionable past. They created data sets that were used by researchers to do preliminary COVID work.
- These studies were published in the Lancet and New England Journal of Medicine but later had to be retracted. It is not clear if these data sets were completely fabricated.
- One study based on this data set suggested a benefit to Ivermectin; it was almost certainly false but many people and countries had already instituted its use.
- A number of meta-analyses have included these papers and have found a benefit to ivermectin.
- The Observational Data
- Comparing the rates of COVID-19 in two countries and inferring a benefit of ivermectin due to lower rates in countries administering the drug as part of a mass drug administration program (eg, for river blindness) is extremely dangerous and open to enormous bias.
- In some developing countries where this occurs, almost no COVID-19 testing is done so it appears that there are very few COVID-19 cases when there are in fact huge numbers.
- For example, Tanzania has been part of a mass drug administration with ivermectin but officially reported zero cases of COVID.
- In Zambia, a morgue study noted a death rate from COVID-19 ten times the officially reported number.
- During the COVID-19 pandemic, most ivermectin mass drug administration had ceased in these countries.
- The Retracted “Elgazzar” Study
- This was an Egyptian study of health care workers which was retracted while still in pre-print form without a defense of the data presented.
- The study contained a plagiarized introduction and methods section, used incorrect statistics, and the data presented was full of inconsistencies that strongly suggest that it was falsified.
- The TOGETHER Study
- This study of 1300 patients found no reduction in admission and no statistical reduction in death.
- The “Zoni” Group
- This study showed no benefit in a 500 patient randomized prevention study.
- Malaysia Health Study group
- This was a 500 patient randomized trial that showed no benefit.
- The best evidence is that ivermectin does not work against COVID-19. More studies are ongoing.
The Bryant Meta Analysis: https://pubmed.ncbi.nlm.nih.gov/34145166/
Tanzanian Present COVID death: https://www.bbc.com/news/world-africa-56437852
Zambia Morgue Study: https://www.bmj.com/content/372/bmj.n334
The Retracted Elgazzar study: https://assets.researchsquare.com/files/rs-100956/v2/c11416a2-d0bd-494f-abc8-3cbf8c605b10.pdf?c=1631861037
The retracted “Samha Study”: https://www.mdpi.com/1999-4915/13/6/989
The retrated Kory study: “ Kory P, Meduri GU, Iglesias J, Varon J, & Marik PE. Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19. J Intensive Care Med. 2021:36;135-156. 10.1177/0885066620973585
The Together Trial: https://c19ivermectin.com/togetherivm.html
The “Zoni” Group: https://pubmed.ncbi.nlm.nih.gov/34215210/
The Malaysian Study: http://outbreaknewstoday.com/ivermectin-does-not-reduce-risk-of-severe-illness-from-covid-19-malaysia-study-50379/
Brian D. - January 26, 2022 12:29 AM
This was arguably one of the best EMRAP presentations I have heard. Great back and forth on the limitations of the medical literature in the era of COVID. Great lessons for all of us. Keep up the good work!
Gideon Meyerowitz-Katz is a very clever individual and a great speaker. It would be fantastic to hear from him again!
Marcel C. - February 6, 2022 8:55 AM
Please comment on the Brazil study published this month with 223,128 subjects testing Ivermectin prophylaxis.
Anand S. - February 6, 2022 10:38 AM
Marcel - thanks for raising this.
My initial thoughts: methodology is weak, unclear if patients assigned given ivermectin actually took it, serious COI from the authors, selection bias in terms of who got IVM and who didn't. They don't take into account whether patients were already taking ivermectin prior to the study. The follow up is a bit weak as well based on design. I also find it strange that the data was collected in December 2020 but not published for 13 months.
Finally, there are some issues in data reporting like the fact that there were no deaths in those < 30 before propensity matching but then there were deaths after propensity matching which is nonsensical.
Gideon has commented on this elsewhere:
Gideon Meyerowitz-Katz, an epidemiologist and Ph.D student from the University of Wollongong in Australia who often writes about COVID-19, said the research lacks critical information about the study’s participants, including how many Itajaí residents were already taking ivermectin before the program began and how many continued to take the full doses of the drug as prescribed.
"This sort of epidemiological study is very prone to biases resulting from characteristics that are inherently different between the intervention and control groups," Meyerowitz-Katz said. "There is essentially no information on how many people in either the intervention or control group actually took ivermectin, which is a fairly important consideration if that's what the authors were trying to investigate."
Also, here's a longer twitter thread from Gideon on the study: https://twitter.com/GidMK/status/1471320851156910083?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1471320851156910083%7Ctwgr%5E%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fhealthfeedback.org%2Fclaimreview%2Fivermectin-study-itajai-contains-methodological-weaknesses-questionable-conclusions%2F