J, I notice that web searches turn up multiple instances of the argument you’re making along with the same references, most commonly on sites with an extreme rightwing bias (examples below). It’s obvious where you’re sourcing them from, and I would caution that those sites are not renowned for rigorous self-criticism.
There are of course two sides to this controversy, and Clark is correct that you’re conveniently overlooking counterarguments that could undermine your position – which is a reasonable strategy in a debate, after all: you’re staking a claim and trying to defend it. With the adversarial way you’ve kicked off the discussion, you leave it up to others to attempt to undermine your firm position. Fine. Challenge accepted.
To cut to the chase, this spat is essentially going to boil down to “My sources are more reliable than your sources” like some kind of playground taunting game. I’ll set out my argument that your sources are very dubious and lack credibility, whereas the sources I’ll cite which comment on the same phenomena have a superior reputation for objective reporting. Your next logical move would be to try to undermine their good reputation with allusions to high-level conspiracies between official agencies. Just so we know we’re going. So, on with the game …
Your first reference (from the Indian Express) suffers from the same flaw as the report you mentioned previously in Point 1: it was published on May 12, well before the Indian observational study concluded. In effect, it simply reiterates some people’s attribution of the relatively low incidence of Covid last year to Ivermectin, together with their confidence that the observational study will show that it was effective. So what? Well, for one thing that expression of faith alludes to their motives in conducting the study – which could be quite relevant to consideration of confirmation bias in their subsequent conclusions.
Your next reference is to an article on the Gateway Pundit (which is hardly noted as a reliable source of truth – indeed it’s one of those “extreme right” loon sites mentioned earlier: https://mediabiasfactcheck.com/the-gateway-pundit/ https://www.allsides.com/news-source/gateway-pundit ). It summarises the argument for Ivermectin thus: the state of Uttar Pradesh is now Covid-free, and the government of UP issued a recommendation for the use of Ivermectin in August 2020, so there must be a link between them (mustn’t there, ey?). Post hoc ergo propter hoc. The first major flaw is that the observation they regard as ‘post hoc’ is very dubious indeed (as explained in the quote directly below). The second major flaw is that there was a myriad of different factors at play, and there is no reliable statistical method to trace the likely cause to an antecedent drug.
The counterarguments are set out in a review of the evidence for the efficacy of Ivermectin produced by the Alberta Health Services Covid-19 Scientific Advisory Group (SAG):
2. Commentary on Ivermectin Use in Uttar Pradesh, India
Multiple social media sources have also reported that ivermectin might have been responsible for reducing COVID-19 cases in Uttar Pradesh, India, with claims that the low rate of new cases in spite of low vaccination rates in this region is related to distribution of ivermectin-containing medication kits. There are several potential issues with these lines of reasoning, including:
- Both observational trial data and “real world” data sources need careful evaluation using these key principles of review: expert peer review of evidence, assessment of errors in reporting, assessment of due scientific diligence, and careful consideration of confounders. These principles have not been applied to this data.
- This observational data is much lower quality evidence compared with randomized trials (which also can vary in quality and require assessment). There is variability in assessment of infection rates and outcome reporting at a population level, as well as confounding.
- Multiple sources suggest the infection rate and death toll of COVID-19 in India in general, and Uttar Pradesh in particular, has been underestimated and current transmission is likely lower because of post infection immunity in survivors given prior waves of the pandemic:
- India’s death toll (and associated case counts) is estimated to be at least 7-13X higher than reported, suggesting actual population infection rates have been 6070%, confirmed by seroprevalence data. Multiple resources indicate that cremations outstripped official death estimates considerably in this area.
- A preprint analysis of excess mortality for India related to COVID-19 (which found up to 2% of the population died up to June, 2021) had to omit data from Uttar Pradesh because of significant reporting irregularities (including districts that reported NO deaths for months)
- Public health seroprevalence data reported by the Center for Global Development suggested extreme underreporting of cases and deaths in Uttar Pradesh, and Indian Council of Medical Research data (reported by press release) showed 71% seroprevalence in Uttar Pradesh in spite of only 29% initial dose vaccinated in July.
It is also noted that many districts in India used ivermectin over a period in which the evidence was less clear, based on national guidelines, so regions cannot be compared based on use or non-use. Ivermectin and hydroxychloroquine have recently been removed from the national COVID-19 guidelines in India for lack of efficacy.
In summary, this would suggest Uttar Pradesh had a devastating prior COVID-19 surge with high case rates and significant uncounted mortality, with current evidence of partial population immunity in people who survived COVID-19 infection and increasing numbers of vaccinated people.
You may or may not find those counterpoints and alternative explanations persuasive. Anyway, the excerpt does at least demonstrate that the observational reports from UP are considered too unreliable to be taken seriously by this medical review panel. And of course the WHO itself, not to mention India’s own government, holds the same position.
Your next reference is just a letter to the editor of the Desert Review, which is described by Media Bias Fact Check as (would you believe it?) a rightwing conspiracy theory site “based on the frequent promotion of pseudoscience, conspiracy theories, and misinformation regarding covid-19”. It doesn’t say much for the credibility of your sources, does it? The letter itself contains a number of false assertions, such as that the ICMR added Ivermectin to their treatment protocol (which the ICMR has strongly refuted: https://news.abplive.com/health/fact-check-icmr-did-not-prescribe-any-drug-to-prevent-covid-19-1337718 ). Anyway, it’s only a letter to the editor, so neither the publication nor the author face any real-world consequences for spreading such misinformation.
There are further good reasons to be suspicious of the integrity of the purported UP study conclusions. If Ivermectin was found to be effective there, then studies conducted elsewhere should demonstrate the same result … which brings us neatly onto the meta-analysis question.
You provide a link to a meta-analysis study hosted on a truther site called “ivmmeta” which was set up precisely for the purpose of disseminating that material. It wasn’t peer reviewed or published by an independent editorial board. So, in poker-playing terms, I ‘see’ your questionable meta-analysis, and raise you a proper one (link: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full ) by the Cochrane Collaboration (which as I’m sure you know is the leading authority of scientific meta-analyses and systematic reviews). It raises some complex issues, so here’s a helpful summary (from the AHS review cited earlier):
1. Guidelines and Evidence Review Update: Fraudulent Data Withdrawn
A recent Cochrane systematic review by Popp et al. (July 2021) is in alignment with AHS and other jurisdictions (including the US National Institutes of Health, the World Health Organization and the US Food & Drug Administration). It concludes that the reliable evidence available to date does not support the use of ivermectin for treatment or prevention of COVID19 (outside of well-designed randomized trials). The authors found that the available studies varied widely in the dosages used, the other medications included as comparators, and the outcomes examined, and that many of the studies were at high risk of bias (meaning any differences noted across groups were likely due to other factors).
This Cochrane review excluded a study (Elgazzar et al.) that contributes to the positive findings noted in some other meta-analyses. It should be noted that the Elgazzar et al. RCT, which reported results that were very favorable to ivermectin, has been withdrawn from the preprint server for possible data fraud, so any reviews or meta-analyses that include it are not valid. For details on the issues identified in the Elgazzar et al. study, please see the article published in Nature (some of the issues include duplicated patient records, patients whose records indicate they died before the study started, and phrases that were identical to other published work).
The SAG is aware that there has been considerable social media attention related to ivermectin as an effective therapy for COVID-19, in part due to the study by Elgazzar and meta-analyses using that study as well as other lesser quality observational trials with significant data issues including impossible numbers, unexplainable mismatches between trial registry updates and published patient demographics, and nonfeasible timelines. Given the ongoing investigation of these studies, more may be withdrawn over the coming months.
Concerns regarding the lack of assessment of quality of these studies have been published, stating that
“relying on low-quality or questionable studies in the current global climate presents severe and immediate harms. The enormous impact of COVID-19 and the consequent urgent need to demonstrate the clinical efficacy of new therapeutic options provides fertile ground for even poorly evidenced claims of efficacy to be amplified, both in the scientific literature and on social media. This context can lead to the rapid translation of almost any apparently favorable conclusion from a relatively weak trial or set of trials into widespread clinical practice and public policy.”
Is that enough refutation for you, or do you want more? Maybe we could go on to examine the credibility of the Tyson & Fareed OP (nb: it’s definitely not an objective “study”) – which once again is published (in line with their self-described “battle for truth”) on the rightwing CT site Desert Review. But for the moment I’ll leave it to others to peruse that laughable propaganda piece and form their own impression.
Credible sources? Pah! Go and find something that’ll stand up to some scrutiny.