I don’t think Ivermectin should be used outside of randomized trials for the treatment of COVID19, and I would not prescribe it for COVID19 until I see RCT data. As a general rule, I almost never think a drug product should be used off protocol (outside of trials), until RCTs have proven benefit. The reason why is detailed in my book Ending Medical Reversal. But the short answer is that the pretest probability any drug works without good trials borders zero percent. (see video below)
Simultaneously, I think we must encourage and complete the randomized controlled trials open on this topic (ivermectin/covid)—and there are several ongoing trials. This means being careful to not demonize the product and poison ongoing equipoise for those RCTs. Indeed, with HCQ, we swung from the extreme poll of prescribing it off protocol (bad idea) to it-is -so- toxic-we-should-not-ever-give-it (poisoning enrollment in the ongoing RCTs)—also a bad idea.
Like many, I find the CNN/ Joe Rogan/ Sanjay Gupta discussion fascinating.
Bottom line: In my mind, it is clear that CNN lied.
CNN lied by claiming that Mr Rogan consumed horse dewormer—a veterinary grade product. He did in fact consume human ivermectin.
Should Joe Rogan have consumed human ivermectin? As mentioned above, I would not advise it outside of an ongoing randomized trial. But as a simple matter of fact, he did not consume the veterinary product.
So, why did CNN lie? While many have claimed it is about money—ivermectin is generic—I personally doubt this is the reason. Others argue it is about power—and again, I have my doubts. Instead, I think the simplest explanation is that CNN, like so many covid pundits, are levering the culture war. If you ignite the culture war, you get massive views.
By calling it horse de-wormer, CNN further pushed the cultural and political divides that plagues our country. Strangely this drug has taken on a left/ right political dimension, and CNN knows that disparaging it will excite one side, and anger the other. That fuels ratings and views and clicks.
Ironically, I note some academics repeatedly point out that Ivermectin has no good RCTs and only poor quality observational studies with glee on twitter (I agree!), while simultaneously not mentioning that other interventions oft touted by their side are supported by no better data. ;)
One person said something like, “we should not adopt interventions (or keep doing them for years) until we have good RCTs.” I agree! But, sit down now, are you ready to hear the full list?
This is how science has been destroyed, in my opinion. Uncontrolled, quasi experimental and bad RCTs are not suitable for practice and policy. That is true for pills and many other interventions that people false claim are “proven.” You cannot just make this point for interventions the other side likes, while ignoring it for interventions your side craves. It applies equally to all.
A colleague of mine told me that they will have less faith in CNN after this episode. I admit that made me laugh. I don’t think I have watched television news to learn facts for more than a decade now. It is a farce. The entire episode won’t change that. It just confirms what I have known for years.
My video on this topic
My 2 c on Ivermectin
Prasad and Damania
My op ed
Oh, and by RCT data, I mean adequately powered RCTs measuring clinical endpoints with robust reporting and no hint of fraud -- but I didn't say all that b/c it is just plain obvious to me.
Enjoying your substack/youtube immensely. But admit I miss your wit ( hence my joy and laughter) on your twitter threads. Hopefully we’ll see you back soon. 😊