A no win situation for doctors

The Quarantine Zone
101

I mean, sure, that’s technically possible? But by that logic, we should give someone who’s sick literally every possible medicine for every condition that could be weakening the immune system, on the off chance that they have one of those conditions and it just hasn’t been diagnosed.

The fact is that there’s just no good evidence that ivermectin has any therapeutically useful effects in treating COVID. And, again, it’s technically possible that a few people were actually helped because they had undiagnosed parasitic worms, and there just weren’t enough of them to be statistically significant, but…again, at that point, just give everyone with COVID everything, because they could have something besides the SARS-COV-2 virus.

Before trying to come up with reasons why ivermectin could be useful, it would be nice to have evidence it actually is useful.

102

I’m certainly not recommending it. I’m just wondering if that may be behind some of anecdotal stories of people getting better after taking it.

103

Sure, it’s technically possible. But since there’s no good evidence that ivermectin actually has a statistically significant therapeutic effect, there’s really no particular reason to look for reasons why it “worked” in specific cases. It’s possible that some people treated with ivermectin could have also had parasitic worms just by sheer coincidence, and it’s possible that the ivermectin was effective in deworming them, and that in turn deworming them could have helped them fight off the SARS-COV-2 virus.

But it’s overwhelmingly more likely that anyone “helped” by ivermectin simply benefitted from the placebo effect, particularly regression to the mean and natural recovery.

A lot of people have recovered from COVID without ivermectin. The fact that some people have recovered from COVID after taking ivermectin doesn’t actually tell us anything useful. Anecdotes aren’t really useless, but in a situation like this, they’re not particularly useful. If there’s statistically significant evidence that treatment with ivermectin actually makes a difference in meaningful clinical outcomes, then it makes sense to figure out exactly why.

I’d personally bet that anecdotal stories of people getting better after taking ivermectin are entirely due to the fact that people sometimes get better.

104

New drugs, and new uses for drugs, are routinely found by observation and anecdote. Of course such uses should be studied before they become recommended standard treatment. And i think it’s dumb to take ivermectin for mild covid outside of a clinical study. But in the case of a guy who is going to die on the best standard treatment, i don’t think it’s crazy to try unproven treatments that are only supported by anecdotal evidence.

105

And really, the problem is that it’s not sometimes, it’s most of the time. It makes it hard to tell if something that really does have a benefit actually did anything, or if you would have recovered on your own.

Anyway, my point was not to say it should be used in case the patient has parasites, just more or less idly speculating if some doctors have fooled themselves when they have seen improvement after administering it, when the improvement came from a completely unrelated issue.

Sure, using people who are probably terminal as medical guinea pigs is practical, but I don’t know that it’s really all that ethical.

The chances that he recovers under our best standard treatment seem small. But administering drugs with no reason to help, and potential side effects could make his recovery even less likely.

As I was saying to gdave, what anecdotal evidence there is could be coming from treating an entirely unrelated problem, and as gdave rightly points out, the anecdotal evidence could be entirely bunk anyway.

I tried reading through some medical studies, and they are all over the place, but kinda consolidating them, I think he would still have around a 5-10% chance of recovery, maybe more, after being on a ventilator for over a month.

So, this also has the PR problem, in that if he does recover, then suddenly Ivermectin becomes a miracle drug, and people will count on it rather than on actual medically and scientifically backed treatment.

106

It’s a nice hypothetical, but that’s the thing - we don’t know they’ll die with the best standard treatment. The probability never gets to 100%. It’s the ticking time bomb hypothetical all over again. We developed our current system for a reason - anecdotal evidence based on random guessing really doesn’t work.

People were saying the same thing about taking a chance on HCQ, which at best did not help and at worst actually hurt patients.

So, yeah, I’m ok with the idea of off label use and trying different things but the “well, might as well try it if there’s no other option” kind of ignores lots of options. Sherlock Holmes’ adage about eliminating the impossible is well and good but there’s a nearly infinite number of possibilities.

107

It’s not about “using people as guinea pigs”, it’s about attempting to help that person. I really don’t think there are ethical problems so long as the patient (or their advocate, if they aren’t capable of consent) understand the issues and consents.

108

This is very similar to the Hydroxychloroquine debacle, and the drug actually is very similar.
There is reason to think these anti-parasitics might be effective anti-virals, they interfere with some chemical pathways that viruses use to replicate. There is a lot of theory as to why these drugs might be effective anti-virals. Theories that have consistently failed to translate as effective clinical treatments, against HIV, against flu, against other SARS viruses.

Covid is unique, but it’s not that damn unique. The fact that these anti-parasitical drugs have consistently failed as anti-viral drugs is decidedly not promising.

109

Yeah, to digress slightly, it drives me nuts that the FDA is making vaccine recommendations as if we’ve never studied any other vaccine, and they can’t possibly recommend anything but exactly a protocol that has been studied in exactly this circumstance.

So they aren’t going to approve any boosters other than another dose of the same thing (because those will be the funded studies) and they didn’t consider the UK/Canadian “get first doses out quickly” protocol when vaccines were in very short supply.

(End rant)

110

I understand, and sympathize with those people who are willing to try anything (Ivermectin, etc) when the patient’s circumstances are desparate, I do not agree with them. Which, again, seems to be similar to pretty much everyone else in the thread. But as to why they’re doing it …

https://comb.io/IEFT3B

[Futurama0 -
Look, you want false hope or not?
Only if you don’t have any real hope.

All joking aside, I disagree (immensely) with the overriding the Doctor’s advice for that of a quack without admitting privileges. My biggest issue though is that actions like this lead credence to those who aren’t in desperate circumstances and/or disregard proven techniques such as vaccines and masking. Again, false hope is only acceptable if you have no ‘real’ hope. Don’t throw out the real hope for the false.

111

Or maybe not 100%. Brazilian viper venom is showing some promise in the treatment of Covid. Since some snake venoms affect clotting, it’s not all that farfetched that they might be useful against a disease where clotting is a serious component. Will the next big trend among anti-vaxxers be getting a bite from a venomous snake?

https://thehill.com/policy/healthcare/public-global-health/570466-brazilian-viper-venom-shows-promise-as-drug-to-combat

112

Will the next big trend among anti-vaxxers be getting a bite from a venomous snake?

“Signs following.”

113

It gets worse.

There’s an ad wall so I’ll quote the most relevant text here:

It’s not just a “hail mary” strategy, it’s actively causing harm to other patients.

114

Although that would be a theory for preventing COVID infection, does it work as a theory for curing COVID hospitalization? Are people who are in ICU people who have continuing low immune response?

115

Oh jeez. I was testing the suggestion by @puzzlegal. Hey, Jane Goodall would not approve of veterinary strength ivermectin.

116

That same article includes a statement from a hospital McElyea practiced at in Sallisaw (but supposedly hasn’t seen patients there in the past two months), noting that they haven’t treated ivermectin overdose patients, and no trauma or other emergency patients have been turned away because of overcrowding.

117

The general anti-vaxxers (i.e. “Vaccines cause autism”) still quote Andrew Wakefield’s study that was published in the Lancet, even though he’s long been discredited.

118

Which, assuming it is true, does not invalidate the claims, as the doctor, as far as I can see, never said anything about that hospital.

119

It should be easy to back up the doctor’s claims with reports from other physicians, and patients who were supposedly turned away - unless one postulates a massive area-wide coverup.

120

In other words,