Based on the clinical evidence from the 93 trials that ivermectin reduced mortality by an average of 51 percent, and on the estimated infection fatality rate of COVID-19, about 400 infected Americans aged 60-69 would need to be treated with ivermectin to statistically prevent one death in that group. The total cost of the ivermectin to prevent that one death: $40,000. (Based on the GoodRx website, a generic prescription for ivermectin is priced at approximately $40. Roughly 2.5 prescriptions would be needed per person to receive the average dose of 150 mg per patient.)
How much is your life worth? We’re betting it’s worth far more than $40,000.
When the next pandemic strikes, by necessity we’ll rely on older drugs because newer ones require years of development. Ivermectin is a repurposed drug that helps, and could have helped so much more. It deserves recognition, not disparagement. What we really need, however, is a way to inoculate ourselves against the lies and misrepresentations of powerful public figures, organizations, and drug companies. Sadly, there are no such vaccines for that contagion.
These are the closing paragraphs of Charles L. Hooper and David R. Henderson, “Setting the Record Straight on Ivermectin,” Brownstone Institute, December 14, 2022.
Read the whole thing, which is not long.
READER COMMENTS
Mactoul
Dec 15 2022 at 8:22pm
Lies and misrepresentation of organizations and pharma companies are not limited to ivermectin. Statins were shown to be useless for all groups except men under 65 who had a previous heart attack. But they are prescribed to all and sundry and your esteemed co-author was unable to credit the evidence of pharma misdoings since at that time the intention was to argue against drug price restrictions.
Mactoul
Dec 15 2022 at 8:35pm
Covid era is infamous for multitude of hasty, underpowered, inconclusive studies. Not to mention the entanglement with American politics that led division into ivermectin-deniers and vaccine-denier camps.
A well-conducted single study would have done better than 93 underpowered studies.
john hare
Dec 16 2022 at 3:45am
This leads to a question. Would it be possible to set up an organization to promote truth in drug utility without conflict of interest as in the FDA and involved drug companies? And that organization have the wide respect to be taken seriously? And how would it be funded?
David Seltzer
Dec 16 2022 at 4:46pm
John, that seems an incentive to create an independent enterprise to provide one with independent and unbiased drug utility reviews one can trust. I suspect that undertaking of due diligence would obtain for entrepreneurs if marginal costs were less than marginal revenue. It seems David and with Charley Hooper’s research yielded public information about Ivermectin with relatively low opportunity costs. Of course, I could be wrong.
Dylan
Dec 16 2022 at 8:34am
I don’t know why you insist on continuing to beat this dead horse. In previous pieces on the topic, plenty of commentators have told you why you can’t do simple meta analysis to get to the numbers you’re getting. And, the focus on off label promotion is a bit of a red hearing. At the beginning of the pandemic, almost everything we were looking at were repurposed drugs that would be used off label. And Remdesivir got an EUA and then eventual approval for the treatment of Covid, even though the efficacy is fairly modest, so it isn’t as if the FDA is against all repurposing.
David Henderson
Dec 18 2022 at 11:08pm
You write:
Really, Dylan? I thought the answer was obvious. We don’t think it’s a dead horse.
Dylan
Dec 19 2022 at 8:22am
I should have said, I don’t think you’re doing a good job of steelmanning the other side of the debate. On previous posts on the topic I’ve linked to posts by Derek Lowe, who’s looked at the data in detail. Others have linked to this post by Scott Alexander, which goes into the topic in depth. I know you and Charlie responded in the comments on this one, but focused on his joking comment about being cast out of polite society, and didn’t really address the bulk of his analysis. And, nothing in any of the articles I’ve read from you on this topic has really “shown your work” in terms of exactly how you’ve done the meta analysis, what’s your criteria for including a study, how did you add up endpoints, etc…
Charley Hooper
Dec 20 2022 at 1:12pm
We’ve been referencing and digging into the information presented at https://c19early.org/
nobody.really
Dec 19 2022 at 3:46pm
Scott Adams, The Dilbert Principle (1996).
nobody.really
Dec 16 2022 at 4:20pm
Henderson’s analysis seems to assume that the price of ivermectin would remain constant, regardless of a massive, abrupt increase in demand.
I can still remember when this was an econ blog.
Charley Hooper
Dec 20 2022 at 1:13pm
How would you suggest that we deal with this issue?
Douglas Cox
Dec 16 2022 at 7:49pm
What 93 trials are you referring to? Many of the trials Dr. Pierre Kory has pushed, have been shown to be flawed or outright BS. Dr. Kory, the FLCCC and the Ivermectin crowd try to give Ivermectin credit for reducing Covid outbreaks and deaths without looking at a multitude of other factors affecting the outcome. Can you provide a link to everything that was wrong with The Together Trial? The people still pushing the Ivermectin cure will continue to do so. Getting them to admit that the drug doesn’t work, would be like getting the Pope to admit there’s no god.
artifex
Dec 18 2022 at 12:33am
They either made a mistake or are writing sloppily. The mortality results are from only 48 studies. I don’t know why they wrote “Based on the clinical evidence from the 93 trials that ivermectin reduced mortality by an average of 51 percent”. Some of the studies aren’t even interventional.
Charley Hooper
Dec 20 2022 at 1:15pm
artifex is correct. There have been 48 clinical trials of ivermectin that have measured its affect on mortality.
Charley Hooper
Dec 20 2022 at 2:51pm
The 93 trials we’re referring to are covered in great detail here: https://c19ivm.org/
Jon Murphy
Dec 17 2022 at 8:13am
I like this line a lot. I try to stress two things with my students:
First: Sunk costs are sunk
Second: Time makes everything more elastic
My first point (sunk costs are sunk) gets to the problem of regulation you discuss. Regulation seeks to “lock-in” certain ways of doing things; regulation focuses on sunk costs. But economic decision-making takes place in the future. We are trying to decide future courses of action. Thus, regulation does not really help when new and novel situations arise. In fact, regulation can hinder because it focuses so much on preserving sunk costs. Note that the area where government action excelled during this pandemic (vaccine development) was where the government removed and reduced regulations. And, as I show in my forthcoming paper Cascading Expert Failure, where the government did much harm was when it enforced and increased regulation.
My second point (time makes everything more elastic) is the importance of flexibility. Ivermectin, in the short run, may be one of many tools we could use to combat COVID and other disease. In the long run, more effective means would be developed as we learn more and as people adapt. In any novel event we encounter, our initial tools will be relatively less effective simply because of the novelty. Comparing the current tools to hypothetical perfect future tools is both the Nirvana Fallacy and a time-mismatch error.
David Seltzer
Dec 17 2022 at 6:27pm
Jon, brilliant examples of sunk costs, deriving no further benefit, and longer term increase in elasticity. The classic example, short term inelasticity for oil. Over time the elasticity of demand for oil tends to increase. I wonder how just increasing nuclear power production would make the demand for oil more elastic with respect to price.
Charley Hooper
Dec 20 2022 at 1:54pm
Jon,
I know you’re talking about how to think about these situations…
…but it’s interesting in this example how some of the initial tools, such as ivermectin, are still better than any of the newer tools.
Joseph Sleckman
Dec 17 2022 at 11:14am
As a retired physician, I would welcome any medication, such as ivermectin, that would help treat Covid-19. Unfortunately, the studies that I’ve seen in the major medical journals have failed to find this medication beneficial in treating or preventing Covid-19. The over-all consensus of the medical community is in agreement with this.
The TOGETHER Study, recently published in New England Journal of Medicine, failed to find evidence of a benefit to the use of ivermectin in the treatment of Covid-19. There was a post on this blog a couple of months ago that was highly critical of this study. I read the post. It contained numerous flaws, which I won’t go into this here.
I don’t see any problems with the FDA website with respect to ivermectin. They are basically saying that one should not take a medication that is not approved for a certain indication, and if insufficient evidence exists for this indication, and if there is a risk of harm. They warn against taking ivermectin formulations used for animals (people have actually done this), and the risk of an overdose, which could produce many of these alarming symptoms.
A study published in the New England Journal of Medicine last December came from the Oregon Poison Control Center. They reported an increase in calls regarding ivermectin toxicity. They reported 21 hospitalizations, including 4 admissions to intensive care. One patient had seizures, and two had hypotension. Other symptoms reported were confusion, ataxia and gastrointestinal problems. Aside from this article, there were two reported deaths in New Mexico possibly related to use of ivermectin. But given the widespread use of ivermectin as an anti-helminthic medication, I would not characterize it as an inherently “dangerous drug”. However, many drugs can be dangerous if used incorrectly or recklessly.
David Henderson
Dec 18 2022 at 11:20pm
You write:
I don’t know how many studies you’ve read so there’s no point in my commenting.
You write:
Two points. First, as I’m sure you know as a doctor, we don’t find truth by consensus. Second, what is your evidence that there’s such a consensus? Please give cites.
You write:
Actually, that’s false. Charley and I addressed that here.
You write:
I bet you won’t. I’ll point out to readers that you sent a detailed critique by email, Charley and I responded point by point, you responded to our response, and we responded to that. Then you said that we should stop corresponding and should instead talk about it in person.
Charley Hooper
Dec 20 2022 at 2:49pm
If other readers are interested, we can summarize the points here.
steve
Dec 17 2022 at 8:12pm
This is so wrong. The data that is of any good quality does not support that Ivermectin works. We knew that we should expect that from lab studies showing that we would need to use toxic levels of the drug to work. What we did learn is that for pts with a co-existing parasitic infection it could help, but not because of its effects on covid.
As anyone in medicine knows a drug that works/cures 51% of the time is pretty much a miracle drug. Ivermectin was widely used by many US doctors early on since we didnt know what would work. We used it at my institution for several months, as did most others in my area and at places with which we were in communication. If it had reduced mortality 51% we would have noticed. We would have noticed 5% or 10%, we were desperate. We saw no effects, just like everyone else.
Steve
Charley Hooper
Dec 20 2022 at 2:56pm
Do you have any results of your trial of ivermectin that you can share? How did you test it? What did you measure?
Maybe you didn’t notice any difference, but many others have. If you have the patience, I’d be willing to go through the 93 clinical trials one by one and talk about their results, strengths, and weaknesses.
Joseph Sleckman
Dec 20 2022 at 3:19pm
Consensus opinions: Check out the editorial on the TOGETHER Trial in that same issue of the NEJM. I would also recommend checking the opinion of the FDA, Alberta Department of Health, and the World Health Organization. There’s an article from JAMA Internal Medicine 182[4]:426-435[2022]. “Efficacy of Ivermectin Treatment on Disease Progression Among Adults with Mild to Moderate Covid-19 and Comorbidities” by Stephen Chee Loon Lim et al. You cite it in your article, but their conclusion was that their study failed to show evidence of benefit of ivermectin.
Charley Hooper
Dec 20 2022 at 3:44pm
David and I have dissected the TOGETHER Trial in detail here. It’s really a sloppy study and no one should reference it without being aware of its substantial weaknesses.
The opinion of the FDA was addressed in the article this blog post is about.
The Alberta Department of Health is essentially just repeating the opinions of other government agencies.
We referenced the Stephen Chee Loon Lim study to draw attention to the TOGETHER Trial’s questionably low incidence of gastrointestinal disorders among patients using ivermectin. In the Stephen Chee Loon Lim study, there was 3.6 times the incidence of diarrhea among patients given ivermectin and this has been seen elsewhere. However, in the TOGETHER Trial, the incidence of GI problems among the patients on ivermectin was lower than for those on placebo. That result questions whether those patients were really on ivermectin and the other patients were really on a placebo. Or whether the results were collected and analyzed correctly.
Joseph Sleckman
Dec 22 2022 at 1:10pm
The Stephen Chee Loon Lim study showed a much higher incidence of diarrhea, but the total dose was higher – 3 days vs. 5 days. And the irony is that although you referenced the study, they concluded that ivermectin did not show any benefit. You also might check out studies done by Susanna Naggie.
It looks like the people at the Alberta Health Services analyzed the data on it’s own. Of course they also reviewed the conclusions of other agencies. They were thorough. That’s the way Canadians are.
Could you give me the names of a couple of studies that support the benefit of ivermectin in Covid-19? It should be of the level of quality to be found on PubMed. Thanks
Charley Hooper
Dec 22 2022 at 7:23pm
I don’t know if these studies match the level of quality you’ve specified.
Mayer et al.: https://www.frontiersin.org/articles/10.3389/fpubh.2022.813378/full
de Jesús Ascencio-Montiel et al.: https://www.sciencedirect.com/science/article/pii/S0188440922000029
Chowdhury et al.: https://www.ejmo.org/10.14744/ejmo.2021.16263/
Mahmud et al.: https://journals.sagepub.com/doi/10.1177/03000605211013550
Ahmed et al.: https://www.sciencedirect.com/science/article/pii/S1201971220325066
Bukhari et al.: https://www.medrxiv.org/content/10.1101/2021.02.02.21250840v1
Faisal et al.: http://theprofesional.com/index.php/tpmj/article/view/5867
Mirahmadizadeh et al.: https://onlinelibrary.wiley.com/doi/10.1111/resp.14318
Lima-Morales: https://www.sciencedirect.com/science/article/pii/S1201971221001004
Ahsan et al.: https://www.cureus.com/articles/56545-clinical-variants-characteristics-and-outcomes-among-covid-19-patients-a-case-series-analysis-at-a-tertiary-care-hospital-in-karachi-pakistan
Shouman et al.: https://www.jcdr.net/articles/PDF/14529/46795_CE%5BRa%5D_F(Sh)_PF1(SY_OM)_PFA_(OM)_PN(KM).pdf
Chahla et al.: https://journals.lww.com/10.1097/MJT.0000000000001433
Joseph Sleckman
Jan 2 2023 at 12:29pm
Charley
I reviewed the papers from links you gave on the blog post. I don’t see that any of them would qualify as showing a high level of evidence in favor of ivermectin. Problems I noted included less rigor, such as observational studies, bundling the ivermectin with another drug (most of the time tetracycline or doxycycline), head-to-head studies with another drug, and lack of clarity as to who was getting what drug.
The Mayer study looked good, but it was observational. The controls were people in that province of Argentina that were not on ivermectin for Covid. Much was left to the discretion of the local physician. The investigators discussed this, and their concluding statement was that their study “highlights the importance of performing adequately powered randomized control studies to confirm our findings”. One useful finding was related to side effects. They used the highest dose that I’ve seen in these studies: 0.6 mg/kg. They also encouraged the patients to take the medication with a high fat meal. The incidence of diarrhea was almost 6%. If you add anorexia, abdominal pain, nausea, and vomiting, it comes to 14%. So this dose may be too high.
One link was “file not found. Another link (Mirahmadizadah et.al.) actually concluded that ivermectin did not show any benefit. Another study (Morales et al) stated that in the treated group 2.71% were taking NSAIDs, while the control group was taking 61%, plus 14% reported taking antibiotic plus NSAIDs or corticosteroids.
I would conclude that these studies, taken as a body of evidence, would of themselves be insufficient to get any kind of approval to bring ivermectin to market in the United States. Respectfully, J. Sleckman
Charley Hooper
Jan 2 2023 at 5:48pm
Thanks for looking at these studies. I’ll provide more detailed feedback in a bit. In the meantime, the “file not found” was due to the hyperlink not including all the characters. Try this one: https://www.jcdr.net/articles/PDF/14529/46795_CE%5BRa%5D_F(Sh)_PF1(SY_OM)_PFA_(OM)_PN(KM).pdf
Charley Hooper
Jan 2 2023 at 5:50pm
Actually, just copy and paste the following into your browser.
https://www.jcdr.net/articles/PDF/14529/46795_CE%5BRa%5D_F(Sh)_PF1(SY_OM)_PFA_(OM)_PN(KM).pdf
Charley Hooper
Jan 4 2023 at 3:09pm
I can provide many more studies for you to review, but I don’t want to waste your time if you aren’t interested. I do have a question for you. You said:
If the criterion weren’t FDA approval but the potential for use among those you know, would your conclusion change? In other words, if you or someone you loved contracted COVID, would you want access to ivermectin?
Joseph Sleckman
Jan 6 2023 at 6:54pm
I can probably access ivermectin, but I would not take it for Covid-19 nor would I recommend it to a loved one. There are side effects, like any medication, and I am not convinced that it helps. We now have at least some tools to treat this disease, such as Paxlovid, Dexamethasone, and of course the vaccines. I’ve gotten the vaccines and all the boosters and will continue to do so, and will continue to wear a mask in stores and other indoor locations.
I worry about drug access with respect to those already in use. Issues include excessive costs, changing insurance drug formularies, gaps in coverage, and outright drug shortages. It’s a big problems
Charley Hooper
Jan 10 2023 at 7:29pm
Two comments:
(WSJ op-ed from yesterday)
2: Some studies have shown that the more mRNA vaccinations you had the more likely you are to become infected with SARS-CoV-2.
See Figure 2 in: https://www.medrxiv.org/content/10.1101/2022.12.17.22283625v1
See also: https://doi.org/10.2105/AJPH.2022.307112
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