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Should I Prescribe Ivermectin for COVID? 

By  Dr. Mike Hansen

Ivermectin is a cheap and widely available drug that is getting many buzzes right now, with its potential to prevent and treat COVID, which I’m cautiously optimistic about. We’ve seen the hype before with different drugs that ultimately did not pan out. The buzz ivermectin for covid started when researchers in Australia showed that in vitro, meaning in a test tube, SARS-CoV-2 replication was reduced about ~5000-fold over a 48 h period.
In April, I made a video about this (Ivermectin for COVID), and I explained how this drug is thought to inhibit viral replication. And is also widely believed to have anti-inflammatory properties.

Ivermectin for COVID

Since April, I’ve come thru multiple studies, as scientists worldwide have been looking at ivermectin, and so far, 14 studies have been completed. But these studies are not without their flaws. There are retrospective studies that introduce bias, and most of the studies have small numbers, and some are published as preprints before a thorough peer-review process can be completed.

The benefit of pre-print studies being published is that knowledge can be quickly shared worldwide. The hope is that prospective randomized studies will follow these observational or anecdotal studies. The drawback is that studies are frequently published and retracted once they are more critically reviewed. For example, I was able to find 3 ivermectin pre-print studies that have since been abandoned. But I need to know, should I be prescribing ivermectin for COVID? If so, at what dose and for how long? Well, in this video, I’m going to break these studies down objectively.

The gold standard for a scientific trial is a prospective study that is double-blind and randomized with a treatment and control group, and it should be well-matched in as many variables as possible to reduce the risk that unforeseen factors, and not the medication’s action, are causing the effect that researchers are studying.

A prospective study enrolls participants to evaluate a treatment protocol, follows them for side effects, and evaluates the results. A double-blind study is one in which neither the investigators nor the treatment recipients know whether they have received the treatment or a placebo. Amid a pandemic, decision-makers have been trying to balance the need for evidence-based medicine and good clinical practice with the urgent need for safe and effective treatments for COVID.

Advocates who are on the side of pushing more treatment protocols through this process, even on sub-standard clinical evidence, will argue that the death rate continues to increase and that there is not enough time to justify a complete prospective study that can take months. They also note that the medications they are choosing, ivermectin for COVID, have been FDA approved for other uses and, therefore, are considered safe, even if they have not been tested to verify the safety and efficacy COVID.

Ivermectin is sold over-the-counter in many countries to treat people and animals for parasitic worm infections. In countries in Latin America such as Peru, Guatemala, and Bolivia, it’s been in great demand as people believe that it protects them from COVID; they are also choosing ivermectin for covid. Researchers in Latin America point out that the evidence is scant that ivermectin protects against COVID. However, they have difficulty recruiting participants to run a clinical trial and test their hypothesis because nearly everyone has taken the drug.

Bias can lead to beliefs that become difficult to dislodge and question. If people believe medication will work, it can become challenging to get them to challenge this belief. Many will justify using unproven remedies by saying that it has a good safety profile and will not hurt even if it does not work. A zealous belief that medication will cure can lead to users ignoring side effects, a confirmation bias.

Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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