21st September 2021
My current position on ivermectin #2
My previous comments received a lot of pushback. So I wrote a slightly broader response, copied below:
I hear you all, and thanks for sharing your thoughts. Let me summarise why I’m far more cautious than most with such things.
First and foremost, we must not forget that we are talking about a pandemic which is *impossible* for anyone to identify in jumbled 10-year, let alone 20-year, total death-rate charts. The more one side screams “vaccine!” and the other side “ivermectin!” the more it appears to the listener that this is a huge pandemic when it is not.
The anti-covid vaccine side (rightly) insists that the data are insufficient to prove that vaccines work. They require a full-fledged 10-year trial and study. But with regard to ivermectin the same group of people insists that everyone should buy into short-duration, underpowered studies that provide preliminary evidence but by no stretch of imagination meet any of the yardsticks of a full-fledged drug trial.
Such people are not happy when I say: By all means doctors and patients should have the right to try ivermectin in moderation (it seems to cause no harm in moderation). Instead, they want me to “endorse” ivermectin.
Just as I can’t (and no one can) endorse these vaccines without full-fledged proofs – that will take many years – I won’t endorse ivermectin as the magic bullet for this modest pandemic. I have it at home (in India) and am happy to use it in moderation when necessary for my family – but I’m not clear that this drug will pass the test of full-fledged double blind RCTs. It well might but why not wait for that first?
Things get worse when people cite half-baked data from India to “prove” their case. Don’t!
I have worked for many years as a senior civil servant in India (including as a district administrator, a relatively junior position) and know how hopeless the system is. I’d personally be very cautious about any data coming out of India. And data from Uttar Pradesh – the worst governed state in India! – got to take it with a huge pinch of salt.
These are some of the facts about India/UP:
- There is massive cross-reactivity in India (the poorer and more filthy a state – and Eastern UP definitely meets these criteria), the greater the cross-reactivity of its population with other coronaviruses. And BCG also provides a trained immunity effect. (see my articles: this and this).
- The life expectancy in UP (64.1 years) is the second lowest among Indian states – https://www.niti.gov.in/content/life-expectancy. In Sweden, the death rate in 2020 for those <65 was less than the death rate for this cohort in an average year. There are virtually no people (in proportionate terms) for covid to kill in UP.
- The prior spread of covid and measured antibodies in India needs to be considered. I’d expect it to be pretty high in the highly crowded state of UP – covid would have spread like wildfire well before ivermectin was introduced. The population would have been more immune than most (except for remote pockets).
- This whole pandemic is a very minor blip.
- The same standard of quality of study should be demanded both for vaccines and drugs (not lower standard for drugs and higher for vaccines).
- Correlation does not prove causation. India’s “data” should be investigated by genuine professionals with competence in statistics, not “medical experts” *most* of whom have never been trained in statistics and have somehow got used to publishing poor quality studies in “peer reviewed” medical journals. Do read “Why Most Published Research Findings Are False”.
So don’t expect me to “holler” for ivermectin like Craig Kelly does. I prefer my science to be done properly and with great care. I also believe it is not the job of a politician (which is what I’m trying to be) to pick winners. A politicians job is to build systems – and I’d like to replace all current health regulators and with alternative, reputation-based, competitive self-regulating mechanisms – with full freedom to medical practitioners to pick the drug/ vaccine they wish to recommend to their patients AND with full freedom for their patients to decide what they put into their body.
I’m saying something simple. Let me capitalise:
– GET RID OF HEALTH REGULATORS AND OCCUPATIONAL LICENSING