The Great Ivermectin Debate

Via Google, Covid is now virtually nonexistent in the Indian state of Uttar Pradesh:

Uttar Pradesh is the largest state in India and home to some 232 million people. It is currently averaging about 13 new Covid cases per day, and has been averaging fewer than 100 new cases a day since mid-July.

This is quite a big deal. If Uttar Pradesh were its own country, it would rank as the 5th-most populous in the world.

It would appear that Uttar Pradesh has, for all intents and purposes, beaten Covid.

Now, Google does not have vaccination data for the individual states in India, but the entire nation of India is only about 35% fully vaccinated:

In mid-July, once new cases dropped below an average of 100 per day, the whole country of India was only 6.2% fully vaccinated, meaning that cases in Uttar Pradesh were already virtually nonexistent when only a tiny sliver of the population was fully vaccinated.

Again, Google doesn’t have vaccination data for Uttar Pradesh specifically, but if the entire nation of India was only 6.2% fully vaccinated, and we can reasonably assume that those vaccinations were spread out over the whole country and not just in Uttarh Pradesh, the vaccination rate in Uttar Pradesh could not have been very high at all.

There were only about 83 million people fully vaccinated in India as of July 18, so even if they were all in Uttar Pradesh (which they weren’t), that would only be a 35.7% fully vaccinated rate in the state.

What is interesting is that India does not use any of the American-made vaccines. According to the BBC, India uses three vaccines: one made by British pharma giant AstraZeneca (Covishield), one made by Indian firm Bharat Biotech (called Covaxin), and the Russian-made Sputnik V.

It’s possible that those vaccines, unlike the American vaccines, actually work, and that this is why Covid cases have practically vanished in Uttar Pradesh. But then again, the vaccination rate in India overall is still relatively low so it’s hard to credit the vaccines.

India’s third-most populous state, Bihar, with a population of 105 million, has also been largely Covid-free since July:

They are now averaging 4 new cases per day in Bihar.

Maharashtra, the second-most populous state in India, is not quite seeing the sustained success of Uttar Pradesh and Bihar, but they are still only seeing about 620 new cases on average there right now, and the number has been falling for a while:

If we just look at Uttar Pradesh and Bihar, combined they have a population greater than the whole United States, yet virtually no new Covid cases anymore.

So what is the reason for these major Indian states being so successful against Covid-19?

I Immediately Regret This Decision

When I first started this article over a week ago, I was going to just bring attention to the low number of Covid cases in Uttar Pradesh and be done with it.

But I just had to ask, “Why?” didn’t I.

Asking the simple question of Why Uttar Pradesh is Covid Free turned this short blog post into a full-blown essay that I’ve now been working on for almost a week.

Several times I’ve come close to scrapping this post altogether, as it was not easy to string all these different subjects together into one coherent essay (and it may yet be incoherent and unreadable anyway).

But I also wanted to see it through to the end and really dig deep into the Ivermectin debate. I wanted to be thorough. (It could also be that I fell victim to the sunk cost fallacy).

Anyway, away we go into the nerd battle royale that is the Ivermectin debate.

A quick Google search for “uttar pradesh covid free” returns some predictable results. You don’t even have to type in the word “ivermectin” and already Google will be shoving down your throat “Fact Checks” about how Ivermectin isn’t the reason for the success against Covid.

But let’s take a look at this article on PolitiFact claiming there is “No scientific basis for claims of Ivermectin’s success in Uttar Pradesh.”

The author starts by citing a few articles that claim Ivermectin eliminated Covid in India, but then goes on with this:

Claims regarding the supposed success of ivermectin in preventing COVID-19 in India have been around for months, and have recently popped up again as India’s case numbers subside. India stopped recommending the use of ivermectin for management of the virus in September, citing a lack of scientific evidence of its benefits.

But by this article’s own admission, the Indian Government was recommending Ivermectin to treat Covid prior to September. And cases were already down to almost nonexistent levels by September.

By no means is this proof that Ivermectin is a miracle drug that eradicated Covid in Uttar Pradesh, but it’s at least relevant, no?

I went to the link provided regarding the Indian government’s decision to no longer recommend Ivermectin. The exact language used in the report was as follows: “It was recommended that these medicines [Ivermectin and Hydroxychloroquine] may be removed from the guidance document after reviewing the current evidence.”

Now this is somewhat confusing wording. They are recommending that those medicines “may be removed” from the guidance? That doesn’t make a lot of sense, maybe due to a faulty translation to English. It sounds more like the Indian government is giving state governments permission to remove those medicines rather than recommending they be removed from the guidelines.

I’ll briefly summarize the reasons India provided for recommending (or perhaps permitting? Again, the wording isn’t very clear) the removal of Ivermectin:

Many ongoing clinical trials (n=62, 16 complete)

13 Systematic reviews and meta-analysis since Jan 2021 were included in this review. 7/13 showed mortality benefit, 4/13 no mortality benefit, 2/13 inconclusive/unclear.

Other outcomes— no effect on length of stay (1), no effect on clinical recovery (1), no difference in ADE (1) [antibody-dependent enhancement, which basically means that the antibodies your immune system generates in response to an infection are able to bind to a pathogen, but not prevent infection. ADE is a bad thing because it allows the virus to spread throughout your body as it is bound to your antibodies. ADE could also mean Adverse Drug Event. The paper does not clearly specify which acronym it is using here.]

Okay, well it doesn’t sound like these are bad results for Ivermectin, so why remove it from the recommendation?

Risk of bias–high risk of bias in many studies (especially with the ones showing benefit), level of certainty for mortality benefit is low.

Well there you have it. Although the studies do appear to have positive results, the Indian government concluded that those studies had a high risk of bias. They don’t really get into detail, though.

Here is the wording of the recommendation:

Recommendation: Ivermectin may be considered for removal from the guideline, with recommendation to use only in clinical trial setting until warranted by more conclusive large-scale randomized controlled trials due to the following reasons: Many studies show mortality benefit and no evidence for increased mortality. High risk of bias in many studies (especially with the ones showing benefits), level of certainty for mortality benefit is low.

So really it’s just inconclusive about Ivermectin. The Indian government says that while there’s no evidence at all it increases mortality, there’s also not enough evidence showing benefit.

I also want to point out what the Indian government said about HCQ, because I think people might be happy to be informed about it:

“The summary of the evidence that led to recommendation of removal of Hydroxychloroquine is given below:

Many ongoing clinical trials (n=339)

13 systematic reviews and meta-analysis since Jan 2021 were discussed during the meeting: 2/13 mortality benefit (in severe cases and low dose), 10/13 no mortality benefit or increases in mortality, 3/13 increases in mortality when co-administered with Azithromycin.

Other outcomes— faster viral clearance (1/13), no faster viral clearance (2/13), non-progression to severe disease (2/13), no benefit (1/13), adverse events (6/13), no increased ADE (1/13) [again, it is unclear here whether the paper means by ADE antibody-dependent enhancement, or adverse drug effects. Based on the context, I would assume it’s the latter, but it’s possible it is not.

Risk of bias — many of the studies showed moderate-high risk of bias and moderate-high certainty of evidence.

The one thing I wanted to highlight is that 6/13 studies on HCQ reported adverse events, and 3/13 reported increases in mortality when co-administered with Azithromycin.

I guess I would say just to use caution with HCQ. I felt that having read the report myself and seeing that, I had to share with you here. I had to mention it, it would’ve been wrong not to.

Anyway, let’s get back to the “Fact Check” article:

Uttar Pradesh, which is India’s most populous state, with more than 200 million people, reported on Nov. 7 that it had just 85 active COVID cases, according to the Times of India. More than 67% of the eligible population had received at least one dose of the vaccine, and 22% were fully vaccinated. The government has credited its success to using ivermectin as a preventive measure, according to an article in the Indian Express in May.   

I wrote about Uttar Pradesh some time ago and noted that article linked above from May. The government of Uttar Pradesh itself credited Ivermectin for its success against Covid, and it’s not immediately clear what incentive they’d have for falsely crediting Ivermectin. At least I can’t think of one.

Here comes a questionable part of the article: PolitiFact, instead of talking to doctors and authorities in India, talks to an American doctor:

We spoke with Dr. Lee Riley, a professor of infectious diseases at the University of California Berkeley, who said that there is no peer-reviewed randomized control study that shows that ivermectin is the reason why cases are going down in Uttar Pradesh. Any study would have to include a placebo group, and control for other measures, such as use of masks and social distancing, which Uttar Pradesh was using, he said. 

Sure, let’s take an American professor’s word as the ultimate authority on why India is succeeding against Covid. Has Lee Riley been on the ground in India during Covid? Is he working on the front lines there? How is he qualified to talk about Covid cases in India? Has he conducted any studies on the use of Ivermectin to treat Covid?

No. But he’s an Expert™, so just trust him anyway.

Fair enough, I guess. We shouldn’t just assume he’s a hack off the bat. He could have some good points to make.

But of course, he had to bring up the lack of randomized control studies on Ivermectin.

I posted a while back on a great Twitter thread on why RCTs are not the be-all, end-all of scientific studies, and in fact are actually flawed in a lot of ways, one of which is that they are structurally biased against generic medicines, according to Alexandros Marinos.

RCTs are also how Big Pharma acts as gatekeeper on Ivermectin. The government and the WHO only accept RCTs, and this is not because RCTs are the only legitimate way of conducting a study. It’s because they’re expensive, time-consuming and generally can only be undertaken by deep-pocketed pharmaceutical companies. Independent doctors and scientists cannot easily conduct RCTs.

If Big Pharma doesn’t want to undertake an RCT regarding Ivermectin’s effectiveness against Covid, chances are we’re not going to get any. There even are some foreign RCTs on Ivermectin, but they’re rejected by the Scientific Establishment™ for whatever reason (we’ll get into this shortly).

Anyway, look at this other line from Lee Riley: “Any study would have to include a placebo group, and control for other measures, such as use of masks and social distancing, which Uttar Pradesh was using, he said.”

He’s trying to imply that perhaps it’s masks and social distancing that are the reason Uttar Pradesh is Covid-free. If that were true, then why haven’t masks and social distancing stopped the spread of Covid anywhere else?

If anything, masks and social distancing are the placebo group.

Confirmed COVID cases are down in India, and in other places,

Which other places?

Riley said, but he questioned how widely Uttar Pradesh is testing. If there are fewer tests, there will be fewer recorded cases. 

Okay, but even if testing isn’t very prevalent, if people are still getting sick and going to the hospital, they will be tested, and that will show up in the data. He can’t just dismiss the lack of Covid cases in Uttar Pradesh as a simple result of low levels of testing. I’m also not sure how much Lee Riley is familiar with how India deals with Covid, but they send people door-to-door to administer tests.

From what I gather, it seems like India proactively goes out and tests as many people as they can, rather than letting people come to the testing sites when they please. Data shows that India has carried out about 652 million Covid tests, which is admittedly a smaller number than the US’s 770 million tests, as well as a much smaller number of tests per 1 million (2.3 million per 1 million in the US, 465k per million in India).

But despite this testing disparity, for reasons I just stated above, it’s possible that India may have a higher percentage of its population having been tested than the US. I know tons of people who have never been tested for Covid. I also know some people who get tested on a daily basis for work. This is why I don’t think it’s fair to assume that the number of tests a nation does–or even the number of tests per capita–gives us a clear picture of how well a nation is tracking its Covid cases.

Testing efficiently is more important than testing frequently.

Asked about claims that Uttar Pradesh’s low case numbers were due to ivermectin, Riley said said that there would be no biological reason why the drug would be effective at preventing the disease, but not in treating it, as studies have shown. No other place in the world has shown that ivermectin is effective at preventing COVID-19, Riley said.  

So he does admit that there have been studies done in India that have shown Ivermectin was effective at preventing Covid.

The one other point the article makes, which I think is actually a good point, is that Uttar Pradesh had been using Ivermectin against Covid since August of 2020, and it did not prevent the big spike in cases they had over the summer of this year.

Dr. Nick Mark, who works with critical care and pulmonary patients at Swedish Medical Center in Seattle, has examined claims that ivermectin has had dramatic success in Uttar Pradesh. 

“This is not even remotely the case,” he said during a lecture with other doctors on Oct. 15. While there are claims that the state began using ivermectin in May 2021, during the height of India’s COVID-19 crisis, the government actually said it began giving the drug in August 2020. 

“Not only did it not hasten the end of that alpha wave, but it didn’t prevent the delta wave,” Mark said.

This is a fair point, in my view.

The thing is, the impression I’ve gotten over the past several months has never been that Ivermectin prevents Covid, only that it somehow cures, or at least helps to cure, Covid.

The studies that Riley is referring to seem to conclude the exact opposite. This just feels like a big mess right now, frankly.

When I began this article, I did not set out to prove that Ivermectin Is The Reason There’s No More Covid in Uttar Pradesh. I didn’t even believe that was the case. I kind of just got sucked into the whole Ivermectin debate through this PolitiFact article.

But now that we’re balls-deep in the Ivermectin debate, might as well keep going, right?

The main reason I’ve always given Ivermectin the benefit of the doubt is this: because the Authorities™ are so rigid and intransigent against even exploring the possibility that something other than their precious fucking vaccine might be effective against this virus and are so fixated on jabbing as many people as possible to the point where you have to wonder if it’s even about Covid anymore, or if it’s only about jabbing people. The jab clearly doesn’t prevent Covid from spreading.

I have favorable views on Ivermectin mainly because these people are so viciously and desperately intolerant of anything other than the vaccine.

I mean, if people found out that sunlight helped against Covid, I have no doubt the Health & Scientific Authorities™ would immediately begin banning people from going outdoors.

Oh, wait, they’ve already done that.

And also, your average Expert Truster™ on social media scoffing at Ivermectin hasn’t actually done any research on the matter. They’re just blindly trusting Fauci and the media, and not only about Ivermectin, but virtually everything else. And I doubt they’ve actually reviewed the work of independent scientists and researchers that have looked into the studies on Ivermectin, both on the pro side and the con side.

The Expert Trusters™ may be right about Ivermectin, but if they are, they’re right for all the wrong reasons.

If these people are reflexively against Ivermectin because Fauci & Co. are, then I’m reflexively for it until I find a reason not to be.

Ivermectin is safe. It has been administered billions of times in the world over the past 40 years. It is extremely safe. And it has antiviral properties. What harm could it do to someone with Covid who is in the hospital, on a ventilator, and basically waiting to die? None.

I’m not saying people should be popping Ivermectin left and right as a preventative, because I’ve never really totally bought into the idea that Ivermectin prevents Covid. It’s an anti-parasitic and an anti-viral medicine; it’s not an immune-booster. To prevent Covid, you should be eating healthy, exercising regularly (the Experts™ also banned that for much of 2020), getting good sleep, getting plenty of Vitamin D, and making sure your Vitamin C levels are in good shape.

But I am at least open to the idea that maybe Ivermectin does prevent Covid, even if my initial assumption is to doubt it.

Anyway, about this claim that there are no studies from other countries showing Ivermectin’s effectiveness at preventing Covid: well there is in fact a database full of studies about Ivermectin as a treatment for Covid, and they’re from all around the world.

You can find it here: https://ivmmeta.com/

That website has several dozen studies on Ivermectin, and they show very promising results.

However, if you check out this post by Scott Alexander (a really great blogger who actually went through all the studies one-by-one to separate the wheat from the chaff), he said this:

“the trends really are in ivermectin’s favor, but once you eliminate all the questionable studies there are too few studies left to have enough statistical power to reach significance.”

Out of the 29 Ivermectin studies he looked at, he and another researcher named Gideon Meyerowitz-Katz concluded that only 11 should be considered legitimate.

These are the studies he looked at:

Both the Mahmud and Ahmed studies were conducted in Bangladesh, Chaccour was in Spain, Ravikirti and Mohan are from India, Bukhari was in Pakistan, Lopez-Medina is in Colombia, Krolewiecki and Vallejos are in Argentina, the Together study is from Brazil, and Bounfrate is from Italy.

Only two of the studies took place in Europe, and not a single one took place in North America. Hold this thought, though, because we’ll return to it shortly.

Alexander goes on to conclude–or rather, theorize–that basically the reason a lot of these Ivermectin studies are coming back with such promising results is because they also come from places where there is a high prevalence of parasitic worms, like Bangladesh and Colombia.

The presence of parasitic worms in a person mean Covid will hit them harder, generally speaking. If someone has both a parasitic worm infection and Covid, by giving them Ivermectin to clear out the worms, it will enable their body to better fight off Covid.

Thus, we might be seeing positive results against Covid in people who take Ivermectin because Ivermectin gets rid of the worms, which frees up these patients’ immune systems to fight off the Covid.

At least that’s the theory being proposed.

The takeaway, then, is that Ivermectin absolutely should be used on Covid patients in countries with high rates of parasitic worms. How could you conclude anything else?

Additionally, it’s unclear whether Ivermectin would actually help against Covid in countries without a high prevalence of parasitic worms. Alexander points out:

“The good ivermectin trials in areas with low Strongyloides [a type of parasitic threadworm] prevalence, like Vallejos in Argentina, are mostly negative. The good ivermectin trials in areas with high Strongyloides prevalence, like Mahmud in Bangladesh, are mostly positive.”

The inference is that America, which like Argentina does not have a high prevalence of parasitic worms, would not benefit from Ivermectin in treating Covid.

I think there are a few important points to make here:

1. Scott Alexander is the only Ivermectin “skeptic” I actually trust to be operating in good faith. He’s done a lot of great work over the years, and I see him as a guy who genuinely just wants to separate fact and fiction. I do not question his motives.
2. However, this theory that Ivermectin only appears to help with Covid because it’s eliminating parasites is just that–a theory.
3. We have no studies on the effectiveness of Ivermectin from America and Europe. So we don’t actually know if Ivermectin is only helpful against Covid in places with a high prevalence of parasitic worms.
4. It’s still possible that the simplest explanation holds up: Ivermectin works against Covid because it works against Covid, not because it gets rid of parasites.
5. At the end of the day, 8 studies Alexander cites do show that Ivermectin is effective against Covid. The whole part about “it’s only because of worms” is Alexander’s theory. That part hasn’t been studied.
6. It’s awful funny to see how fast people went from “Ivermectin doesn’t work against Covid at all!” to “Ivermectin only works against Covid because of the roundworms!”

Again, I don’t know one way or the other. But I do know that Scott Alexander is probably the only person out there who could actually convince me that Ivermectin doesn’t work, just because I don’t question his motives. I think he’s an honest person. I’m not fully convinced by his arguments, but he does bring up a lot of great points.

Is Scott Alexander Correct?

However, I wanted to look at bit more into this parasitic worm theory myself and not just take Alexander at his word. Because, again, the data in most of the 11 studies that Alexander gave his stamp of approval to did show that Ivermectin was effective against Covid. They didn’t say anything about parasitic worms. That’s Alexander’s conclusion, not any of the studies’ conclusions.

He shares with us this map of countries by their prevalence of roundworm infections:

And then writes the following:

Here’s the prevalence of roundworm infections by country (source). But alongside roundworms, there are threadworms, hookworms, blood flukes, liver flukes, nematodes, trematodes, all sorts of worms. Add them all up and somewhere between half and a quarter of people in the developing world have at least one parasitic worm in their body.

Next he pulls a quote from a study (Gluchowska 2021) that says “treatment and prevention of helminth infections [parasitic worms] might reduce the negative effect of Covid-19.”

Might.

I wanted to take a look at that study for myself. I actually found some very interesting stuff in the study. Now, I might be wrong, and I might just not fully understand what I’m reading (after all, I am not a scientist or a doctor, and Alexander is, although admittedly he’s a psychiatrist, which many consider a quack field).

But while, sure, there are some big medical words in these studies that I don’t understand, for the most part, they’re not that hard to read. I feel like I’m able to understand most of what these studies are saying.

It seems to me that Alexander, whether intentionally or not, misrepresented the results of this Gluchowska study pretty badly. Again, I could very well be the one misunderstanding it, not Alexander, but I think this study is pretty straightforward in its conclusion. See for yourself:

Research indicates that helminth co-infection can have a synergistic or antagonistic effect on the course of COVID-19; however, using the current state of knowledge and the small number of described co-infections, it is difficult to clearly define the influence of parasite infection on COVID-19

This is from the conclusion of the Gluchowska study. Correct me if I’m wrong, but I don’t see any sort of definitive assessment that parasitic worms exacerbate the severity of Covid. The study says there is a “small number of described co-infections,” which means there’s nowhere near enough data to conclusively say parasitic worms exacerbate Covid.

The study also says it is “difficult to clearly define the influence of parasite infection on Covid-19.”

Again, far from conclusive. In my view.

The most interesting part of the Gluchowska study’s conclusion, though, is the first part, because it says that “helminth co-infection can have a synergistic or antagonistic effect on the course of Covid-19.”

In other words, parasitic worms might exacerbate the effects of Covid and make cases more severe. But they also might make Covid less severe. In other words, the worms might actually help people fight off Covid. And if this is true, it completely debunks Alexander’s worm theory.

It would mean that Ivermectin does not help people better fight off Covid by getting rid of the worms that are weighing down their immune systems, because those worms might actually be helping that person fight off Covid.

But that’s not all: because there are at least 8 randomized control tests that show Ivermectin has a positive effect on fighting Covid. Alexander has written those studies off on account of the worm thing, but if the worm thing isn’t true, then you’re left with 8 quality studies (as judged by Alexander himself and his buddy Meyerowitz-Katz) that show that Ivermectin does have a positive effect on Covid patients.

It’s possible that Ivermectin fights off both parasitic worms and Covid. And that makes sense because Ivermectin is an anti-parasitic as well as an anti-viral medication.

There is an entire section of this Gluchowska study entitled “Can Parasites Protect Us From Covid-19?”

Take a look at this:

The low incidence rates of COVID-19 in Africa [74,77,78,79] are of high interest to scientists and WHO authorities, and it has been hypothesized that this could be a result of the increased exposure to parasites in less developed countries: the populations of Africa and Latin America are much more likely to suffer from parasitic diseases than those of more highly developed countries.

Helminth infection entails various forms of immunomodulation, resulting in an increased susceptibility to some infections, a decreased susceptibility to others, and changes in the intensity of allergic, autoimmune and inflammatory diseases; it has also been proposed that infection may account for inadequate responses to vaccines and, possibly, better tolerance of SARS-CoV-2 infection [5,80,81].

Okay, so this part might directly contradict Alexander’s theory. But he cited this study to bolster his theory.

Did he even read the whole thing?

It has been suggested that helminths could enhance antiviral mechanisms, leading to a better control of viral load [5]. During helminth infection, IL-4 can increase and condition virtual memory CD8+ T cells (TVM cells) for more rapid CD8 responses against a subsequent cognate antigen encounter. Most probably, helminth infection has forced the human immune response to evolve a safety mechanism based on the induction of highly responsive TVM cells; this would counterbalance the anti-inflammatory effects related to type 2 immunity and thus result in more effective antiviral responses [5]. The low lethality of COVID-19 in Sub-Saharan Africa may be also related to the inhibition of inflammatory processes by immunomodulatory molecules released by helminths. Indeed, the COVID-19 and Middle East respiratory syndrome-CoV epidemics also caused very limited health problems in the Sub-Saharan region [5].

This study that Alexander is citing appears to disprove his point, and also suggests that maybe even the opposite of what Alexander is saying is true: that the helminths might actually help fight off Covid, not make it worse. The study makes no definitive conclusion, however.

I want to highlight one final point here in the study:

Despite being a potentially fatal disease, COVID-19 remains poorly understood. Due to its novelty, it can often be misdiagnosed as other infections affecting the pulmonary system, including parasitic diseases such as malaria, leishmaniasis, shistosomiasis, parogonimiasis, alveococcosis, strongyloidiasis, and trichinellosis.

So apparently Covid and parasitic infections display similar symptoms, causing both to be frequently misdiagnosed. Is it possible that people are being misdiagnosed with Covid when they really have a parasitic infection, are being prescribed Ivermectin, are getting cured of that parasitic disease, but because the parasitic disease was misdiagnosed as Covid, people wrongly conclude that Ivermectin cures Covid, when in fact it only cured the parasitic infection?

That’s an interesting theory.

But I really want to focus on this idea that it’s possible parasites can help the body fight off Covid. I don’t know how or why Alexander wouldn’t mention this. It’s part of the conclusion of a study he himself cited.

Now I’m starting to wonder if maybe I was wrong to trust this guy.

And I’m also wondering what else he was wrong (or lying) about.

Well, it just so happens that I stumbled across a video on YouTube entitled “Debunking the BBC debunk of Ivermectin,” by Dr. John Campbell.

Dr. John Campbell is a great source medical of information on YouTube. He’s a British doctor who says he is pro-vaccine but is also pro-anything else that could help people, meaning he’s not pro-only vaccines, like so many Experts out there these days. He follows the data, uses his many years’ experience as a doctor to evaluate studies and articles, and walks us, the viewers, through his whole thought process. His videos are highly informative, he’s quite thorough and overall, he just seems like a kind, honest and decent man.

So I saw this video of his, and coincidentally the Ivermectin “debunk” BBC article Campbell is dissecting relies heavily on an article co-authored by none other than Alexander’s buddy Gideon Meyerowitz-Katz. I am already sick of typing out that long name so from now on it will be GMK.

If you read through Alexander’s post, he defers to GMK quite a bit in his process of going through all the Ivermectin studies and throwing out all the bogus ones. Apparently GMK is a big Ivermectin debunker, and clearly a biased actor:

Waaaaait a minute.

Enhance.

This dude is the DEBOONKER meme:

The meme is him. He’s the meme!

This is too funny.

(He also has pronouns in his Twitter bio, so I’m inclined to disregard everything he says based on that alone. But I’ll be nice here.)

Dr. Campbell raised some serious issues about GMK’s methods and reasons for supposedly “debunking” these Ivermectin studies. The article in question is a letter to the editor of Nature Medicine entitled “The lesson of Ivermectin: meta-analyses based on summary data alone are inherently unreliable.”

Real quickly: a meta-analysis is like a study of studies. People who conduct meta-analyses basically compile a bunch of studies on a particular subject, and then go through all the studies one-by-one, reviewing and critiquing them to try to establish some sort of consensus among all the studies. A person who reviews one individual study can say, “This is what this study has found.” A person who conducts a meta-analysis can say, “This is what all these studies have found.”

You can watch the full video above if you wish, but I will quote some of the most relevant bits of the video here.

One of the major points the article makes is that they “recommend that meta-analysts who study interventions for COVID-19 should request and personally review independent patient data (IPD) in all cases.”

Campbell responds:

“I think that’s a brilliant idea. The point is this data is simply not published; this is not possible. This is not done in any studies I’ve ever come across in my life. So, they’re asking for something, in my experience–and I’ve been reading meta-analyses for about 30 years now–that I really have never come across before, where this has been reduced to individualized patient data. It’s not the way meta-analyses work, in my experience.”

Campbell adds that he agrees that the IPD should be made available in all studies, and that it’s a great idea in theory, but it’s not the reality of how meta-analyses work. Publishing the IPD often breaches patient confidentiality, and it’s not often possible.

The Nature article then says:

“Any study for which authors are not able or not willing to provide suitably anonymized IPD should be considered at high risk of bias for incomplete reporting and/or excluded entirely from meta-synthesis.”

But as Dr. Campbell explained, this is just not the way this stuff works. Campbell says that if this is the new standard–as GMK and his associates are demanding–then it means basically every meta-analysis conducted in the past is now considered bunk because of a “high risk of bias.” Campbell says none of the meta-analyses he’s reviewed over the past 30 years have provided IPD.

He pulls another quote from the Nature piece:

“We recognize that this is a change to long-accepted practice and is substantially more rigorous than the standards that are typically currently applied.”

All of the sudden, right now, we need to change the way meta-analyses are conducted. We need to upend the whole process, say GMK and his pals. Interesting timing.

Campbell says they live in an “idealized world.”

One gets the impression here that GMK and his pals are trying to undermine confidence in the Ivermectin studies that they were unable to legitimately debunk. “The study showed that Ivermectin works, but since we don’t want to admit that let’s talk about how the real problem is that meta-analyses are flawed in nature!”

It reminds me of mean, petty children, who set up their own secret club and exclude another child. “You don’t know the password, you’re not allowed in the club!” When the excluded child finally figures out the password, they still won’t let him in the club. “Wrong! That’s the OLD password! There’s a new password now!”

They’re simply changing the rules so that their side always wins no matter what. If they don’t win, then the rules must be changed.

“Ivermectin doesn’t work. Watch, we’ll debunk the studies.”

“Oh. We couldn’t debunk the studies…… Well, it’s clear that the way we conduct studies is fundamentally broken! It must be changed!“

Rather than admitting Ivermectin works, these sore losers are now determined to come up with an entirely new standard for meta-analyses: one that will ensure that Ivermectin studies flunk.

Campbell wraps it up:

“A large part of the problem is, yes, a lot of the studies that have been done on Ivermectin have been done by clinicians. Yes, there’s been some fraud in some of the cases, it would appear.

But most of the research has been done by clinicians, the doctors and staff, the pharmacists, all themselves. They’re not full-time researchers. They’re busy with day jobs anyway. And they’re not professional researchers, necessarily, so it’s very hard for them to do these studies.

Whereas near-perfect randomized control trials–like we had for the vaccine–they’re conducted by Big Pharma, multimillion dollar budgets. So really, to compare one to the other is just not fair.”

And we already know how screwed up Pfizer’s vaccine trials were, so we shouldn’t even assume Big Pharma trials are flawless, either.

But Dr. Campbell brings up a great point: randomized control tests are arduous and expensive, and it’s very hard for people who don’t have a Big Pharma Budget to conduct them.

Maybe the studies aren’t perfect, but they’re also being conducted by independent scientists who don’t have the financial incentive to “prove” a predetermined outcome, like many Big Pharma and government studies do. Smaller studies are, in my view, have inherently more integrity than Big Pharma studies. Even if the smaller studies aren’t perfect.

It is truly bizarre that GMK and his friends are deeply suspicious of “fraud” and “bias” when looking at these small studies about Ivermectin, when the real incentive for fraud is way more likely to come from a gigantic corporation that has billions of dollars at stake in each study.

I mean, what does a doctor in Bangladesh have to gain from faking a study showing that Ivermectin works? There’s no financial incentive. Ivermectin is cheap and widely available. So this whole “high risk of bias,” it just seems ridiculously unfair, and also illogical.

If there is any “high risk of bias,” it’s in studies conducted by Pfizer, a company that has a $36 billion gravy train running at full steam due to its mRNA vaccine. Any admitted or acknowledged proof that Ivermectin works could derail the whole thing.

But no, GMK and Co. are more concerned with finding “bias” in studies conducted by doctors in India and Bangladesh and Colombia.

The point is, now that we know this about GMK–and Alexander was relying heavily on GMK in evaluating the Ivermectin studies and throwing out the bad ones–how can we trust that he was actually fairly reviewing the Ivermectin studies? He literally invented a new standard for meta-analyses that they had to meet or else they’d be discarded due to a “high risk of bias,” but this is a standard that no study has ever been held to in the past.

In Alexander’s initial review of the 29 Ivermectin RCTs, he initially threw out 13 of the studies, leaving 16 remaining. But GMK wanted to throw out an additional 5 studies, and Alexander obliged, which is how he came to the final number of 11 quality Ivermectin studies.

Other than this quote, Alexander doesn’t really get into the specifics on why GMK wanted to throw out the additional studies:

I asked him about his decision-making, and he listed a combination of serious statistical errors and small red flags adding up. I was pretty uncomfortable with most of these studies myself, so I will err on the side of severity, and remove all studies that either I or Meyerowitz-Katz disliked.

But while Alexander claims he was “uncomfortable” with the studies GMK removed, Alexander ultimately didn’t remove them until consulting with GMK.

As we know about GMK, he’s holding these Ivermectin tests up to an almost impossibly high standard–a standard that no study in the past has ever had to live up to at that.

Alexandros Marinos’ Response

Alexandros Marinos raised some of the same questions I did about Scott Alexander’s deference to this guy GMK, plus a few other things. Marinos wrote his own in-depth post on Substack about the matter:

Reading the article, I was surprised (but not really) by the central role Gideon Meyerowitz-Katz (henceforth GidMK as is his much shorter Twitter handle) had played in the analysis. The man has a way to apparate wherever a person of influence takes a position on ivermectin. This is at least the third time I’ve observed the same sequence of events.

In particular, while Scott’s exclusions look reasonable and even-handed, the 5 papers that Scott excluded *because* of GidMK look to be either big and positive studies, or small and *very* positive. Being highly suspicious that these exclusions by GidMK had shifted the analysis entirely, but not wanting to let that prevent me from seeing something that was true, I decided to tie myself to the mast. I actually declared my intention to do a triple exclusion analysis, to see what the studies accepted by Scott Alexander, GidMK, and ivmmeta.com show, as a consensus set of three opinions that come from very different places.

The next morning, I added more details about the experiment I was intending to run. I wanted to see what Scott’s exclusions would do on their own, what GidMK’s exclusions did when added to Scott’s exclusions, and what the ivmmeta.com exclusions would do when added to Scott’s exclusions, as well as when added to Scott’s and GidMK’s exclusions. That last one was the originally promised “triple exclusion” analysis. In short, I wanted to see these 5 analyses:

So just to clarify matters here, Alexander himself wanted to exclude 16 studies. GMK wanted to exclude a further 5, and Alexander obliged. The website ivmmeta wanted to exclude 2 studies (TOGETHER and Lopez-Medina), but Alexander and GMK included those studies in their analysis, giving them the stamp of approval (incidentally, those were two studies that did not show positive results for Ivermectin).

I pulled some favors, and I have fascinating results to share.

To start, here’s the complete set of [all 29] early treatment ivermectin studies as presented at ivmmeta.com, coming to roughly the same result. Early treatment with ivermectin produces 67% improvement, or, as RevMan outputs it, has a risk ratio (RR) of 0.33 with a confidence interval (CI) of 0.23-0.47.

We then move on to the set of studies after Scott’s exclusions [16 studies]. Notice that the risk ratio (RR) barely moves (0.36 or 64% improvement), though the confidence interval widens, if only a bit.

For brevity I’ll spare you the third analysis which I will summarize below, and move on to the fourth. Let’s see what happens when we remove the studies recommended for exclusion by GidMK.

The difference is far larger than the one caused by Scott Alexander’s exclusions. The risk ratio moves to 0.45 (or, 55% improvement). About 9% of the effect of ivermectin evaporates, and the CI is stretched all the way to 0.94. For those of you into P-values (which don’t mean what the vast majority thinks they mean), we go from P<0.0001 without GidMK’s exclusions to P<0.03 with them. In other words, the exclusions recommended only by GidMK make the analysis on the remaining set of studies far more uncertain, though it does stay firmly within what is considered “statistically significant” territory. I’m not sure how Scott ended up with a P<0.15 but the difference is large enough to make me suspect a mathematical error somewhere.

In addition, if we remove the 2 studies in this set that ivmmeta.com  excludes (Lopez-Medina and Together), we are left with the originally promised triple exclusion analysis. The remaining studies are accepted by Scott Alexander, GidMK, and ivmmeta.com.

The resulting Risk Ratio is 0.38 (or 62% improvement), somewhere between the one we started with, and what it was after the GidMK exclusions While the CI has widened, it is remarkable that we are still within the bounds of “statistical significance”.

Overall, the 5 pre-announced analyses put together, end up looking something like this:

The way to read this chart, in brief, is that smaller intervals are better, and being more to the left is better. The Risk Ratio, very briefly, is how much better a patient taking the intervention (in this case ivermectin) does at whatever the relevant objective is than the control group. So a RR of 0.33 indicates that the intervention group does 3x better than the control group. ivmmeta.com chooses the most serious endpoint they can find in each study, which I find to be a pragmatic compromise for the kind of bottom-up dataset we’re looking at.

It is incredibly clear that Scott’s own analysis doesn’t actually move the conclusion much from what ivmmeta.com shows even though he excluded almost half the studies, but his trust in GidMK waters down the power of the dataset to the point where the effect starts to look uncertain, even if ivermectin still looks more likely than not to have a significant effect.

When you torture a dataset this much, and it still doesn’t tell you what you want to hear, well, you have to start wondering if maybe the poor dataset *really* believes what it’s telling you. I must admit that I did not expect that after all the exclusions we would still be in commonly accepted as “significant” territory, but them’s the maths.

Nevertheless, none of this should be taken to be an official meta-analysis, or even particularly scientific. What I intended to show, and I think this exercise makes clear, is that Scott’s conclusions are very much dominated by what he excluded because of GidMK. Had he not done so, the conclusion of his analysis would have been very different.

And that’s the bottom line here. GMK convinced Scott Alexander to exclude the ivermectin studies that had the most positive conclusions.

More from Marinos:

I wanted to avoid focusing on GidMK himself, but the way the analysis comes out, this won’t be possible. I’ll try to keep things as dispassionate as possible without being fake, but I beseech the reader to understand that this isn’t your standard “Ad Hominem” argument. If Scott’s analysis depends on his trust on GidMK, it is paramount that I demonstrate that GidMK’s track record is not one deserving of that trust.

…

I’ve had prior run-ins with GidMK on Twitter and have found him so reliable at repeating the prevailing “respectable” opinion, that the best way I have to know what that respectable opinion is at any given moment, is to find what GidMK thinks about any given topic. I literally predicted the opinion he would hold at different times based on what I knew the establishment position was at the time, and had basically 100% success. Lab leak? Check. Aerosol transmission? Check. I’m not kidding, try it and see for yourself. I don’t know why this is, but I do know it sets up a win-win. If one does this and is right, they get to claim credit, and if they’re wrong, they get to diffuse responsibility to the unnamed “experts”, never taking a hit to their own credibility.

More importantly, he has judged his conclusion on ivermectin far before most of the studies we have today were available, or any of the junk science results he and his colleagues have unearthed and are using today to justify their position. To frame a new promising treatment as something the “COVID cranks” are looking at, and “something else to debunk” back in December 2020, before the work is even really started, puts any trust in his judgement far into forbidden territory. I will still look at any evidence he brings up, and as a dedicated adversary sometimes he finds valid points to make, but that’s as much as I can possibly do.

Marinos then tackles the “worms” theory:

So here’s where we are in this debate: Initially, when the Hill and Lawrie meta-analyses were showing positive results for ivermectin, almost nobody paid attention. Then, GidMK and his colleagues started finding fraudulent studies. Some of them show solid evidence of fraud, others sloppiness. I’ll call them “junk studies” for the moment, because I am uncomfortable with the blanket attribution of intent to the researchers. Crucially, as I’ve pointed out to the interested parties, the amount of junk [ivermectin] studies found do not exceed the expected baseline for such studies anywhere else in the medical literature.

Despite this, GidMK and his colleagues have consistently made statements that indicate that the ivermectin literature is uniquely fraudulent.

And wouldn’t you know it, the link to his essay in Nature that Dr. John Campbell dismantled above.

Again, GMK and his friends were unable to discredit Ivermectin, so their response was not to admit that Ivermectin might work, but to demand “systematic change” in the field of meta-analysis.

Marinos:

When they are pushed on it, they retreat back to the claim that “we have simply found fraudulent papers” but when speaking freely they make their claim plain: The ivermectin literature is uniquely fraudulent and is not to be trusted as a whole. What Scott has popularized as the motte and bailey doctrine. It is extremely important that we separate the two claims, because I do not challenge that several studies are junk, only that they don’t exceed what we would expect to see.

Marinos references a BMJ editorial that proposes we assume a baseline assumption that around 20% of all studies are garbage, in any field.

This jibes pretty closely to what I’ve said in the past. In a long article I wrote a few months ago, I noted a 2009 poll that found 14% of scientists admitted they personally knew other scientists who had falsified studies.

What Marinos is saying is that the “junk rate” in Ivermectin studies is no higher than what you would typically expect in any other area of study.

So after all this back and forth, with the “anti” side never yielding to the fact that there is, indeed, a real signal of effectiveness and that ivermectin should be administered to COVID patients, it is a bit odd to see a study appear that indicates that well, yes, there is a signal, but it is because of mediation by roundworms.

Having been this careful and strict with all the studies Scott has rejected this far in his analysis, I don’t really understand why he jumps onto this conjecture. There are several hypothesized confounders of this analysis, including timing, dosage, background use of ivermectin in the control population (a concern for both the Together trial that did not include ivermectin in its exclusion criteria, and the Lopez-Medina trial that showed blurred vision in the control group in an area of exceedingly high ivermectin use).

In order to check my thinking, I did some basic investigation into the Mahmud trial, and what I saw isn’t that compelling. Serological evidence of Strongyloides stercoralis in city and slum populations in Dhaka, where the trial took place, were at 5% and 22% respectively, and in general serological evidence may indicate past, not present infection. Let’s say 10% of study participants (20/200) had a relevant infection. How many of these 20 made it to the ICU, and what is the likelihood that in any of them lethal worm hyperinfection was the cause of death that would have been otherwise avoided? I also note that this would involve local doctors not knowing this and incorrectly administering steroids in an area where roundworm infection is common, a mistake I would not expect them to have made.

Now, I’m not saying that the [worm] hypothesis is false. What I *am* saying is that it is too new, and that there are way too many questions to be latching onto it as the be-all end-all explanation.

Marinos didn’t even bring up the fact that the Gluchowska study raised the possibility that parasitic worms help, rather than hamper, the body’s ability to fight off Covid.

Scott Alexander, however, did bring up this possibility in a follow-up post, but only briefly, and he referenced a different study:

On the other hand, there’s some speculation that having some kinds of parasitic worms might help COVID. Remember, a lot of COVID deaths are because your immune system over-reacts and causes too much collateral damage; this is why immunosuppressants like corticosteroids are so useful. But parasitic worms are constantly trying to sabotage your immune system to prevent it from killing them, so people with chronic worm infections are already a little immunosuppressed, which is probably good for them. Probably the exact good/bad balance depends on the specific worm, infection, and person involved.

I don’t know why he didn’t say more on this. This hypothesis has just as much proof behind it as the hypothesis that parasitic worms make it harder to fight off Covid. But this was all Scott said on the matter.

Back to Marinos:

Here’s how I process the state of the evidence [on Ivermectin]. There are several different lines of evidence pointing us in the direction that ivermectin helps significantly with COVID. Any of those being true is sufficient, and several of them could be wrong, but the conclusion would still hold. This is how I like my theses, supported by multiple independent lines of evidence.

The way I understand the counterargument is this: focus on the most “prestigious” signal and work hard to chip away at it. First, remove several studies because of form or style issues. Then, trust GidMK and remove even more studies. Then, indicate that there is *unusual* levels of fraud in the findings that *are* significant (a mistake Scott hasn’t made, but others constantly do). Then, explain away what’s left with a brand new hypothesis about worms. Then, explain away viral replication results with an ad-hoc analysis indicating publication bias. Then, explain away what’s left after *that*, as *not statistically significant*. Finally, somehow use the tower of arguments you’ve constructed, to indicate that all other lines of evidence are similarly suspect and should be discarded.

Notice something though: This settles into a *tower* of arguments. Many of them initially attempted to be the complete answer, but by now are all coming together to form a single, composite explanation. All of them, or almost all of them, have to work to explain away the signal. It’s not enough for a couple of them to be right, because then there’s just too much signal to explain away. And while I give some of those arguments plausibility, others have very compelling counter-arguments, ones that don’t seem to be getting evaluated properly.

In short, I like support for my positions to be linked mostly with “OR” operators, and am suspicious of arguments held together by “AND” operators. Consider this a rephrasing of Occam’s Razor. This is probably where I should detail the various arguments in favor of ivermectin, but for one, this article has gone on long enough, and for another, I’m probably not the best person to write it.

What Marinos means by “or” operators is: “The case for Ivermectin can be made by the RCTs, or the observational trials, or the case studies, or the physician testimonies.” Not all of these things have to be true for Ivermectin to be proven effective. Only one or two of them have to be true and it still shows Ivermectin works against Covid.

His criticism of the anti-Ivermectin case as a “tower of arguments” is that it relies on like 7 different things to all be true, and all of them are only true if the preceding hypotheses remain true. If any one of them is false, the whole case against Ivermectin falls apart.

So for example, if it is shown that there are not atypical levels of fraud in the ivermectin literature, and that the parasitic worms theory isn’t valid (and also that GMK is a biased actor who is not to be trusted in his evaluation of studies on Ivermectin), then the whole case against Ivermectin basically crumbles.

As you can see, we have waded deeply into a major debate here. While you and I may not fully understand quite everything that was said above, I think we got the gist of it, right? It should be clear at this point that the scientific community is by no means monolithic and united around a consensus, nor are all participants in the scientific field honest, truth-seeking and trustworthy. Blind trust in “science” and “experts” is foolish.

There were a few great comments on Marinos’ article:

And we do need studies on ivermectin conducted in America, because if we look at the studies from above, the results are different from country to country. Now while it might be possible that the differences are caused by the prevalence of parasitic worms in some countries, we don’t know this for sure. There might be another variable that explains the different results of the studies.

Isn’t it a little odd that of all the most credible studies done on Ivermectin, none of happened in America? Or the UK? Or France? Or Germany?

And yet it is the authorities in those very countries who are screaming the loudest: IVERMECTIN DOESN’T WORK, DAMNIT!!!!!!

They just keep saying “There are no studies that show Ivermectin is effective.” Well, yeah, because you (the people who can actually afford to do the studies in this country) haven’t done them.

And also, they’re simply ignoring the studies that do show Ivermectin works against Covid.

There must be a reason no one in the US is even studying the use of Ivermectin against Covid.

We hear the word Science thrown around constantly in the US. Science, science, science. It’s all about Science.

But it doesn’t seem very scientific to angrily shout down Ivermectin proponents while never having conducted any studies on Ivermectin used against Covid.

At least Scott Alexander and GMK were trying to engage with the data and partake in intellectual debate (more so Scott Alexander, less so GMK).

There’s got to be something behind the pharmaceutical industry and the government being so angrily opposed to Ivermectin. If that doesn’t set off your B.S. detector, your B.S. detector may be faulty.

Alexander talks about this in his conclusion while that he doesn’t believe, based on the studies he looked at, that Ivermectin works against Covid, he totally understands why people believe it does:

[Ivermectin proponents] have a very reasonable-sounding belief, which is that if dozens of studies all say a drug works really well, then it probably works really well. When they see dozens of studies saying a drug works really well, and the elites saying “no don’t take it!”, their extremely natural conclusion is that it works really well but the elites are covering it up.

Sometimes these people even have a specific theory for why elites are covering up ivermectin, like that pharma companies want you to use more expensive patented drugs instead. This theory is extremely plausible. Pharma companies are always trying to convince people to use expensive patented drugs instead of equally good generic alternatives. Ivermectin believers probably heard about this from the many, many good articles by responsible news outlets, discussing the many, many times pharma companies have tried to trick people into using more expensive patented medications. Like this ACSH article about Nexium. Or my article on esketamine. Given that dozens of studies said a drug worked, and elites continued to deny it worked, and there are well-known times where elites lie about drugs in order to make money, it was an incredibly reasonable inference that this was one of those times.

The greedy, frequently lying and settlement-paying pharmaceutical companies do not deserve our trust whatsoever.

I wouldn’t take the vaccine even if I was 100% certain it was 100% safe and effective, because, Fuck Big Pharma and Fuck Anthony Fauci (and because I have about the same chance of being killed by a loose airplane part falling out of the sky and striking me than I do dying of Covid.)

And a lot of people feel the same way.

And we’re not the bad people for not trusting the Authorities. The so-called Experts and Authorities are the ones who have to earn our trust.

That’s the way it works in a democracy.

If we don’t want to take a vaccine from them, then that reflects poorly on them, not us.

How do so many people not realize this?

Well, there are a lot of people–mainly libs, but also plenty of people on the right as well–who have a “subject” mindset, where they think they are subjects of the government instead of the other way around. They do not view themselves as free people who make their own decisions about their lives; they simply do what they’re told.

It’s also because the government and the media are excoriating people for not getting the vaccine and vilifying them as terrible people. Biden said his “patience was wearing thin” with those stubborn vaccine holdouts, completely dispensing with the notion that America is a free country where a man’s decision to get or reject the vaccine is his and his alone, not a politician’s.

The absolute audacity of this asshole to take the “You unvaccinated people are letting me down” attitude.

That is not how it works around here, chief. We don’t work for you.

There are many countries around the world where vaccination rates are way higher than in America:

The US ranks 53rd in the world in vaccinations per capita.

That’s because lots of people don’t trust the government, and they don’t trust Big Pharma, either.

It is the ruling class’s fault–and the ruling class’s fault alone–that people remain skeptical of the vaccine. The ruling class does not deserve the people’s trust. Alexander:

So “believe experts”? That would have been better advice in this case. But the experts have beclowned themselves again and again throughout this pandemic, from the first stirrings of “anyone who worries about coronavirus reaching the US is dog-whistling anti-Chinese racism”, to the Surgeon-General tweeting “Don’t wear a face mask”, to government campaigns focusing entirely on hand-washing (HEPA filters? What are those?) Not only would a recommendation to trust experts be misleading, I don’t even think you could make it work. People would notice how often the experts were wrong, and your public awareness campaign would come to naught.

These people said the vaccine would allow us to go back to normal.

That was a lie.

Then they said the booster shot was needed.

Well, we know that was a lie, too. Pfizer’s CEO has already said that “fourth Covid vaccine doses may be needed sooner than expected due to omicron.”

Now the head of BioNTech (the German company that partnered with Pfizer on the vaccine) just recently said that the Omicron variant will require an entirely new vaccine, which will also be a three-shot process, meaning now it’s up to SIX shots.

Why on earth should we trust these people at all?

And, more to the point, how are we the bad ones for not trusting these Experts and Leaders, who have repeatedly lied to our faces?

Okay, I had to get that all out of my system.

More than Just Ivermectin?

Let’s get back to the topic at hand.

While there is considerable debate currently taking place over ivermectin, is it possible we’re asking the wrong questions?

What if this focus on Ivermectin is sort of missing the point? After all, the prominent figures in the US most associated with Ivermectin (Joe Rogan, Aaron Rodgers) never claimed that Ivermectin alone cured their Covid. They took Ivermectin along with other medications and vitamin supplements: monoclonal antibodies, zinc, vitamin D, vitamin C, etc.

They said that whole cocktail was what got them better so quickly. Not just Ivermectin alone.

And in Uttar Pradesh, they were not just using Ivermectin alone, either. Dr. John Campbell has another video in which he goes over what, exactly, India uses in its “Covid kits”:

He goes over the specifics from Uttar Pradesh.

–Targeted testing of specific groups (While they didn’t have as much testing per capita as places like the US or the UK, they targeted the testing effectively. In other words, they were efficient with it. In the US at least, we have people who literally take Covid tests every day for work. So many of these tests are just wasted. Simply doing a ton of tests doesn’t automatically mean you’re testing smartly.)

–Early detection

–Contact tracing

–Isolation

–Free and timely provision of medicine kits and treatment of the rural populace. Basically they went to people’s homes and tested them, and if someone tested positive, they came back that day with the medicine kits to administer them and begin treatment.

–Cost: $2.65 per person.

There is no way this would be possible in the US. Nobody trusts the government to go door-to-door testing people and administering treatments. But it worked in India, apparently.

And the price is another big sticking point here: if India only had to spend $2.65 a person on its Covid detection and treatment plan, sure, that’s a lot of money in a nation of about 1.4 billion, but not nearly enough for a Big Pharma company in America. That’s way too small a sum of money for them. Why take care of Covid for $2.65 a person when you can make profits of $36 billion off the vaccines?

Now let’s get into the treatment kit that was used in Uttar Pradesh starting in August 2020:

• Ivermectin
• Doxycycline (this is an antibiotic and antibacterial typically used to treat pneumonia, chlamydia, Lyme disease, cholera, typhus and even syphilis. It is also used to prevent malaria.)
• Vitamin D
• Vitamin C
• Vitamin B
• Zinc
• Paracetamol (this is acetaminophen, a fever reducer and mild pain reliever)

So it wasn’t just Ivermectin. I’d really recommend watching the video above, Campbell does a great job of going in-depth on exactly how India decided to attack Covid.

The common denominator of everything in that treatment kit, however, is that it’s all dirt cheap and widely available.

But there’s another part at about the 12:30 mark of the video where he pulls up a chart of Covid cases in the Indian state of Uttarakhand and it shows what Campbell calls an “interesting correlation”:

He says that on April 20, 2021, Ivermectin was added to the Indian Covid protocols. It began on April 20, but did took a while to become widely implemented. Campbell says May 11 was the day it really became widely implemented, which I tried to mark on the chart as best I could with the red arrow (I’m assuming each bar is one day).

Now, you could certainly argue that cases were already starting to drop off by May 11, but keep in mind Ivermectin was being used prior to May 11, it just wasn’t at a level that could be classified as “widespread” use. Campbell said it was a “temporal correlation,” although he made sure to note that it doesn’t prove causality.

Still, pretty interesting, I’d say.

There’s a reason that people–both pro and con–are focusing in Ivermectin specifically.

However, before we get into the home stretch on Ivermectin and Covid, let’s briefly discuss a few other theories on why Uttar Pradesh is doing so well against Covid.

Faulty Data in India?

Let’s go back to that idea that lower testing rates in India could be misleading us into believing Covid is nonexistent in many of India’s states when in fact it really is not nonexistent.

This, to me, is little more than a cop-out. If Uttar Pradesh were 80% vaccinated and the Experts were touting it as a vaccine success story, and we started questioning whether the data on Covid coming out of India was really all that accurate, they’d call us conspiracy theorists and boot us off of social media.

The reason they are questioning the accuracy of the numbers in India is because it doesn’t support their Vaccine™ push.

Personally, I’m going to take the data from Uttar Pradesh at face value and attempt to figure out why they have seemingly been able to beat Covid without widespread Pfizer Vaccinations™.

These scientists in the PolitiFact article may dismiss the numbers in India, but the World Health Organization didn’t. Back in May, they wrote an article on their website applauding health authorities in Uttar Pradesh for their proactive approach to getting Covid under control. The WHO wrote:

UTTAR PRADESH Going the last mile to stop COVID-19

The Uttar Pradesh state government has initiated house-to-house active case finding of COVID-19 in rural areas to contain transmission by testing people with symptoms for rapid isolation, disease management and contact tracing.  

Government teams are moving across 97,941 villages in 75 districts over five days for this activity, which began on 5 May in India’s most populous state with a population of 230 million.

Each monitoring team has two members, who visit homes in villages and remote hamlets to test everyone with symptoms of COVID-19 using Rapid Antigen Tests (RAT) kits. Those who test positive are quickly isolated and given a medicine kit with advice on disease management. All the contacts of those who test positive are quarantined and tested using an RT-PCR at home by a rapid response team.

Two mobile vans have been allocated to each Block within a District in the state to test people with symptoms, even as routine sample collection and testing continues in Community Health Centres.

The state government has deployed 141,610 teams and 21,242 supervisors from the state health department for this activity to ensure all rural areas are covered.

WHO, which supported Uttar Pradesh government in training and micro planning for the activity, now has field officers on the ground to monitor and share real-time feedback with the government for immediate corrective action to ensure quality. On the inaugural day, WHO field officers monitored over 2,000 government teams and visited at least 10,000 households. WHO will also support the Uttar Pradesh government on the compilation of the final reports.

It seems like Uttar Pradesh was extremely thorough. And the WHO assisted them in the process. I’d say it’s pretty ridiculous to just outright dismiss the Covid data from Uttar Pradesh. They seem to be taking it very seriously–a lot more seriously than we are in the US, honestly. It’s not like they have a history of sweeping Covid data under the rug.

The WHO seems to have given the seal of approval to Utter Pradesh’s Covid testing and treating policies. But apparently that’s not enough for these scientists cited by PolitiFact.

Now, I want to get one thing straight here: by no means am I saying India’s Covid numbers are 100% accurate. No country in the world, including the US, has accurate Covid numbers. I’ve written on this site about how the true number of Covid cases in the US is probably at least 5-6x higher than the official numbers show.

This is probably true to an even greater extent in India. They might be under-counting cases by 10x.

But just because countries don’t have fully accurate figures does not mean it’s reasonable to imagine a scenario where the official case numbers are averaging, say, 15 per day (like in Uttar Pradesh), but the real number is something like 15,000 per day. It’s not as if official data would be showing nearly non-existent cases when in reality new cases are skyrocketing and in the tens of thousands.

The rule I use is more to just take whatever the reported new case number is and multiply it by, say 4 or 5 or 10, or whatever ratio you’ve come up with to estimate how much cases are being under-counted.

All I’m saying is that the true case number in a given country is several times higher than the official number.

What the scientists in the Fact Check article are implying is that it’s possible cases of Covid in India are in reality skyrocketing even though the official figures show virtually no new cases per day.

See the difference? There’s a massive difference.

Let me show what I’m talking about with a crude illustration:

What I’m saying is that, when the official case numbers look like the blue line, the real number of cases probably looks more like the red line, because of simple under-counting.

I’m not saying the official number is fake, I’m just saying it’s under-counting the true number of cases.

But what the Fact Checkers are suggesting is something like this:

Again, the blue line is the official number, the red line is the theorized “true” number of new cases.

That’s basically what the people in the Fact Check article are suggesting: that the real case number is potentially skyrocketing even as official figures say it’s almost non-existent.

Let’s face it: the Fact Checkers are conspiracy theorists. All I’m saying is that the cases are being undercounted. They’re saying the case numbers are completely wrong and fake.

This would be more believable if the entire country of India was reporting virtually no new Covid cases, but that’s not the case. There are other states in India where Covid is still active.

The country itself is still reporting around 8,000 new cases a day on average right now:

Most states are looking like Uttar Pradesh in terms of cases flatlining, but not all of them. Mizoram’s cases are declining, but not yet flatlined:

Cases are still spreading in Kerala:

So clearly there are some places in India where cases are still spreading. It’s not as if there’s no data at all coming out of India and they’re no longer tracking new Covid cases in the country.

Now, I guess you could argue that the data in Uttar Pradesh specifically is unreliable and untrustworthy, but Uttar Pradesh isn’t the only state in India where cases have essentially flatlined.

Cases have flatlined in Delhi:

And in Karnataka as well:

I think you get the picture. If Uttar Pradesh was the only state in India where cases appear to have flat-lined, then I could see not believing the numbers from there. But Uttar Pradesh is far from the only state where the numbers of new Covid cases have flatlined.

I don’t think we should just dismiss the data in India, personally. I think we should engage with it under the assumption that it is generally accurate (even if it’s understated), and try to figure out why the data is showing what it is showing.

If we can’t find a good or satisfactory answer, then we may have to conclude that the data is faulty. But not yet.

Vaccines and/or Herd Immunity Achieved?

Could it be that the vaccines they’re using in India actually work, while ours do not?

Well, it can’t be the vaccines–no matter which vaccines they’re using. At least if we go by what the Experts have told us.

As I’ve previously asserted on this site, the herd immunity threshold for Covid, at least the Delta variant, is at least 81% of the population. This Cleveland Clinic article from May of this year said between 70-85% of the population need to be fully vaccinated to reach herd immunity.

India is nowhere near 70-85%. They’re at 35% vaccinated. They’re barely halfway to the low-end estimates for the herd immunity threshold.

So there’s no way India has beaten Covid with the vaccines.

Is it herd immunity? Has India reached natural herd immunity?

I don’t think this is it, either.

The herd immunity threshold is, again, between 70-85%. I’ve calculated it to be 81% for Delta variant, but let’s just defer to the Experts here.

India has a population of 1.4 billion. If the herd immunity threshold is 70% (and I don’t think it is, but whatever we’ll go with it here), then that would mean 980 million people in India would have to have natural immunity.

If the herd immunity threshold is 81%, that would mean 1.13 billion people would have to have natural immunity in India.

If herd immunity is 85%, then that would mean 1.19 billion is the magic number.

India only has 34.1 million recoveries from Covid, according to official figures.

In order for India to have hit 70% natural immunity, it would mean the true number of Covid cases would have to be at the very least 28.7x higher than the official numbers.

If India has actually hit the 81% natural immunity number, it would mean the true number of cases is 33x higher than official figures.

It’s certainly possible that true case numbers in India are between 28-33x higher than official figures.

But I’m not so sure about that. I don’t think they’ve hit herd immunity yet.

The New York Times, in May, attempted to estimate the true number of Covid cases and deaths in India, and these are the estimates they came up with:

So basically NYT was estimating that India’s true Covid case number was anywhere between 15-26x higher than official numbers, with the likely figure being about 20x higher than the official count. Deaths were estimated to be anywhere from twice as high as official number to 13.6x higher, but the more likely scenario estimate was about 5.2x higher.

Even if the worst-case scenario number for total cases is correct, and India is under-counting Covid cases by 26x still to this day, it would mean that today about 902 million people in India have had Covid.

That still doesn’t put them above 70% natural immunity, meaning even in the most drastic scenario, they don’t have enough people recovered to have hit the herd immunity point.

So it could well be Ivermectin that is the reason India appears to be done with Covid-19.

I’m not saying that’s certain, but it’s hard to come up with other explanations.

Ivermectin Elsewhere

What is happening in other countries that have a high prevalence of Ivermectin use? I think before we conclude that Ivermectin is the reason India beat Covid, we should talk about other countries, right?

Well, the good news is that ivmmeta has data on this–lots of data, actually.

The darker green your country is, the more widespread its use of Ivermectin for Covid.

The largest countries we have:

1. Bangladesh
2. India
3. Egypt
4. Nigeria
5. Zimbabwe
6. Bolivia
7. Bulgaria
8. Cambodia
9. Colombia
10. Venezuela

There are some others. We’ll focus on the countries that according to the website have the highest rates of ivermectin use.

It should be a pretty simple matter. We just look up these countries’ Covid data and see how well they’re doing to see if the Ivermectin countries are doing better than the non-ivermectin countries.

It’s easier to do present the data in table format:

I included the US as a control group. But the odd thing is that the website says Ivermectin use is in “some regions” in the US. This is not the the case, as far as I know. Ivermectin use is actively, officially and widely discouraged against in the US. You have to go to court and fight for months to be allowed to use it even if you’re on the verge of dying, and even then, the hospitals fight you tooth and nail on it.

So, this makes me wonder what “some regions” means for Brazil. Is it really used in like 30-50% of the regions of the country, as “some regions” would indicate? It’s hard to tell.

This is why I mainly focused on countries that were classified as “country-wide” adoption of Ivermectin or “many regions.”

What does the data show us? Well, countries with widespread ivermectin use seem to be doing pretty well in terms of average cases per million and average deaths per million, but then you have a country like Bulgaria which has the second-highest official Covid death rate in the world behind only Peru.

It’s just hard to draw a correlation here. Some countries that have widespread use of ivermectin are doing great against Covid, but then again, one of them, Cambodia, is 81% vaccinated, while the others are generally below 50%.

I don’t know. I’d say it’s pretty promising, though.

I would mainly point to India, Bangladesh, Egypt and Nigeria: big countries, very low Covid rates, very low death rates, very low vaccinated rate, widespread use of Ivermectin.

Obviously, Bulgaria is the exception to the rule, though Bulgaria is only a nation of about 6.8 million. I have no idea why Bulgaria has such a high Covid death rate. I googled it, and the only articles I could find were saying that it is because Bulgaria has low vaccination rates.

While Bulgaria does have low vaccination rates, so do a lot of the other countries in the table as well, and none of them are even close to Bulgaria in terms of death rate.

It’s not easy to find any clear trends here. Most countries that have widespread ivermectin usage are doing quite well, but Bulgaria is a glaring exception.

But at the end of the day, and this is what I’ve been saying since I first heard about Ivermectin, it’s safe, cheap and widely available. So why not try it? It’s so low risk, how could you really even be against it? It’s not like it’s going to hurt you.

Ivermectin can only either help you or do nothing beneficial for you. It’s either beneficial or placebo. It’s not like there’s much of a downside.

For patients, that is.

Because there’s a good reason that, despite Ivermectin’s apparent effectiveness, it’s not being widely used and promoted here in the US.

Why Suppress Ivermectin?

I want to make a larger point here on the opposition to Ivermectin, and any other non-Vaccine™ answer to Covid, that starts at the top. There was a similar situation in the 1980s with AIDs and the NIH’s approval of treatments to fight that virus:

In a new video on The Hill’s “Rising,” political commentator Kim Iversen analyzes Dr. Anthony Fauci’s support for azidothymidine (AZT) to treat HIV/AIDS and compares it to his current support for COVID mRNA vaccines.

Fauci, named head of the National Institute of Allergy and Infectious Diseases in 1984… and his team of scientists went full speed ahead on developing a vaccine for AIDS. However, despite promises from the U.S. Department of Health and Human Services that it would roll out an AIDS/HIV vaccine, Iversen says that never happened.

Realizing the potential to earn big profits, Iversen says pharmaceutical companies soon began developing treatments for AIDS.

The British drug company, Burroughs Wellcome & Co., said its failed cancer drug AZT could be used to treat AIDS.

I can just imagine that conversation: “Hey, we’ve sunk all this time and money into this cancer drug that ultimately failed, but what if we simply repurpose it and rebrand it as an AIDS drug?”

Few studies were done, said Iversen, and the long-term side effects were unknown. But in March 1987, the U.S. Food and Drug Administration approved AZT, claiming the benefits outweighed the risks.

Celia Farber, who in 1989 reported on the approval of AZT and its potential health risks, wrote at the time: “The majority of those in the AIDS-afflicted and medical communities held the drug up as the first breakthrough on AIDS. For better or worse, AZT had been approved faster than any drug in FDA history, and activists considered it a victory. The price paid for the victory, however, was that almost all government drug trials, from then on, focused on AZT — while over 100 other promising drugs were left uninvestigated.”

The government closed ranks around AZT, promoting only it and excluding any and all alternatives.

The drug was “one of the most toxic, expensive and controversial drugs in the history of medicine,” Farber wrote.

In 1989, Iversen said Fauci started promoting the drug not only for critically ill AIDS patients, but for anyone who tested positive for HIV, including those who were asymptomatic and showed no sign of the disease.

“Those patients included hospital workers, pregnant women and even children,” said Iversen. “Doctors were stunned.”

Despite limited data, the NIH went all in on AZT, ignoring evidence that the drug was toxic, caused liver damage and destroyed white blood cells, Iversen said.

“The drug continued to be used for years,” she explained.

As Children’s Health Defense Chairman Robert F. Kennedy, Jr. notes in his upcoming book, “The Real Anthony Fauci,” Fauci sabotaged safe and effective off-patent therapeutic treatments for AIDS while promoting deadly chemotherapy drugs that almost certainly caused more deaths than HIV.

Iversen made the same observation: “As Fauci and the NIH focused on vaccines and AZT for the treatment of AIDS, hundreds of drugs went unstudied.”

Iversen said that while many hoped the vaccine would eliminate COVID, like AIDS, the virus appears to mutate too rapidly.

“The same way Fauci discouraged and prevented inexpensive treatments from being talked about, researched and prescribed” in the 1980s is the “same thing that’s happening today,” said Iversen.

Governments should be exploring every possible option to treat COVID, Iversen said, including inexpensive treatments, and treatments that aren’t so profitable for the pharmaceutical industry.

“Everything should be studied,” Iversen said, “but just like what happened during the AIDS epidemic that just doesn’t seem to be happening.”

Fauci has a history of suppressing research on inexpensive drugs and treatment. Fauci’s job first and foremost is to ensure that drugs and treatments are monopolized and highly expensive.

Given his track record of malfeasance during the AIDS epidemic in the 1980s, is it any wonder that Health Authorities™ are strongly opposing Ivermectin?

And this is why people believe in Ivermectin, and will continue to believe in Ivermectin, regardless of what the Authorities say, and regardless of how many “Debunkers” try to dismiss it.