Dr Carlos Chaccour was in trouble when he and his colleagues started recruiting patients in Peru to study the effects of daily ivermectin doses on Covid-19-infected people.
We would call the patient to inform him that he has just been diagnosed as Covid. He is eligible for this study. He asks if you are taking ivermectin.
They would reply, "Of course."
Patricia Garca, the former Peruvian health minister and the leader of the study, stated that of approximately 10 people who visit the hospital, eight have taken ivermectin. She cannot take part in the study.
Ivermectin is not proven to be an effective Covid treatment. Studies that claimed it were have either been poorly done, too small to apply their findings more widely, or simply been fabricated. However, the drug's popularity has increased.
Just a few months after the outbreak, a fraudulent study on ivermectin was published. This was before the drug was widely promoted or used to treat the disease. The study showed that ivermectin led to a reduction in mortality among hospitalized Covid-19 patients. After the paper's data were falsified, and the patients missing, the medical journal published it.
The damage was done. The Peruvian government had included ivermectin before the retraction. Their advice was partly based on the ivermectin papers.
Another study found that ivermectin does not have a significant effect on Covid-19 viral load. Further, larger studies are required to assess the impact of ivermectin. The drug is still being promoted as a viable treatment for Covid-19 by celebrities, doctors, and even scientists.
Chaccour has been studying ivermectin's ability to control tropical disease for over 15 years. He says it is easy to understand why people are dying in waiting rooms, and that there is not enough Covid-19 vaccines.
People have tried to get ivermectin from countries that have readily available vaccines such as the UK, USA, and Australia. Some even attempted to take formulations meant to treat parasites in animals. In some cases, general practitioners will gladly prescribe it. It is often tweeted by controversial researchers and politicians who claim to support its use.
However, more of these studies are becoming problematic.
Guardian Australia announced in July that results from an Egyptian randomised controlled trial were withdrawn after serious ethical concerns and questions about the data.
Buzzfeed News reported in September that an influential study claiming that ivermectin could prevent Covid-19 from happening 100% of the times contained suspect data, and was based upon flawed methodology.
Asking questions
A control group in research is the group of participants who don't receive the intervention, in this instance ivermectin. It is essential to a reliable study. A clinical trial cannot be conducted if the majority of people already take the drug being studied.
To increase the chance that the intervention is responsible for any effect observed in the experiment, the control and experiment groups should be identical in every other way, including gender split, age ranges and severity of Covid.
These are called randomised control trials (RCTs). They are double-blind, so neither the researchers nor participants can see which patients are being treated with the intervention or the placebo. The treatment is typically a sugar pill, or in vaccine trials, a solution containing saline.
It is not clear why ivermectin was promoted as a mass treatment for Covid-19.
RCTs are crucial in fighting Covid-19 due to their strength. RCTs are more effective if there are more participants. This makes it more likely that the results will be repeated in future studies. To make decisions about the drugs to approve, governments and regulators heavily rely on RCT findings.
The prestigious medical journal Nature Medicine published a Thursday article by concerned epidemiologists who had conducted research on ivermectin.
The authors stated that ivermectin has been administered to tens of thousands of patients, based on evidence that had substantially disappeared under close scrutiny.
Many studies that claim clinical benefits for ivermectin have similar problems. They contain unimaginable numbers, unexplained mismatches between published patient demographics and trial registry updates, purported timelines that do not align with the veracity and validity of data collection, as well as significant methodological weaknesses.
Sky News' Chris Kenny is one of those who has promoted the use ivermectin for Covid-19 treatment despite the fact that studies have disproved its efficacy.
Gideon MeyerowitzKatz, an epidemiologist at the University of Wollongong, New South Wales, is co-author of the Nature Medicine article. He and his colleagues reviewed more than a dozen studies that claimed ivermectin was beneficial as either a preventive or treatment of Covid-19.
We are concerned about four of those studies and we are still looking into several others.
Meyerowitz-Katz states that some authors have not shared data from their research. This is a worrying sign.
He says that there has been only one retraction so far. But, I suspect there will be many more.
Conspiracy theories fuelled by misinformation
He answers questions about why researchers make so many errors or worse, intentionally misrepresent, falsify, and mislead data.
Chaccour believes that academic pressure plays a part.
Many people work at entry-level and PhD levels, working 120 hours per week for less than the minimum wage. You will be closer to a stable lifestyle and greater career recognition if you publish more papers and get more recognition from the journals that publish them.
Researchers that cite papers have helped ivermectin to be recognized. This has helped the papers rise in academic rankings and given prominence to the websites or journals where they were published. The findings are promoted by journalists, politicians, and celebrities.
There are many websites that publish treatment protocols for Ivermectin. Many sell merchandise, including Tshirts with the slogan "Covid kills, but ivermectin spares lives."
Chaccour said that he watched in despair as journalists started to attribute a decrease in Covid-19 levels in Peru to ivermectin, rather than strict lockdown measures which were put in place before the disease rate fell. This misinformation was fueling conspiracy theories that the medical establishment was hiding ivermectin, since the drug is not only affordable, but has been around for decades.
Chaccour claims that the profits of chemical companies producing ivermectin ingredients have soared. Meyerowitz-Katz claims that even though ivermectin has been granted an exemption from patent, which allows rival pharmaceutical companies to produce cheaper generic versions of the drug, the stock prices for the two companies that manufacture patented ivermectin have skyrocketed.
Chaccour says he doesn't believe these companies are behind ivermectin promotion, but he believes it is wrong for people promoting ivermectin not to claim that the drug was being downplayed as it was less profitable than new, patented drugs.
He believes that those who promote ivermectin are ignorant and lacking in education. There is also mistrust in government and distrust of science. And there is a level where he does his own research, which he claims gives him pride.
The Australian National Covid-19 Clinical Evidence Taskforce creates Covid-19 recommendations to clinicians. These recommendations are based on the strongest evidence available. This group doesn't recommend that ivermectin is used in any other than randomised controlled trials. The methodology behind their recommendations are made public.
Assoc Prof Tari Turn, director of taskforces, says that she and the other members of taskforces are often criticised for not supporting certain ivermectin research findings in their recommendations.
Turner stated that she wasn't sure why people still considered ivermectin a miracle-drug despite the fact that it was not supported by any evidence.
She says that the taskforce's mission is to gather evidence that will allow us to evaluate the efficacy of ivermectin or other treatments. It seems that advocates of ivermectin and hydroxychloroquine are looking for evidence to support their effectiveness.
