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Ivermectin, redux

Summary:
The conceit of the article on ivermectin by Hooper and Henderson I discussed in my prior post is that medical authorities – mostly the FDA, but also Merck, the maker of ivermectin – are wrongly denying that ivermectin is an effective treatment for COVID.  They raise some issues that are worth discussing.  For example, they talk about the lack of incentive for companies to do clinical trials on existing, off-patent drugs, and about the way FDA uses statistical significance in its decision making.  These are subjects that are worth debating when we think about reform, but raising reasonable issues can be a cover for bad faith argument.  To illustrate, here is a methodological issue they ignore:  it makes no sense to make treatment decisions for

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The conceit of the article on ivermectin by Hooper and Henderson I discussed in my prior post is that medical authorities – mostly the FDA, but also Merck, the maker of ivermectin – are wrongly denying that ivermectin is an effective treatment for COVID. 

They raise some issues that are worth discussing.  For example, they talk about the lack of incentive for companies to do clinical trials on existing, off-patent drugs, and about the way FDA uses statistical significance in its decision making. 

These are subjects that are worth debating when we think about reform, but raising reasonable issues can be a cover for bad faith argument.  To illustrate, here is a methodological issue they ignore:  it makes no sense to make treatment decisions for COVID patients based on placebo-controlled trials when *very* effective treatments like Paxlovid are available.  No sense at all.  Ivermectin should only be considered as a treatment for COVID if it outperforms other available treatments.  Yet the two studies they single out for discussion were, in fact, placebo-controlled trials in unvaccinated patients.  Talking about statistical significance or incentives to do trials on drugs out of patent in this context is just misdirection.

They also ignore the fact that ivermectin is being used and often abused without medical supervision (e.g., animal formulations are being used by people, some people may be taking doses that are dangerous; ivermectin does have serious side effects).  They could argue that if the FDA approved ivermectin, then people could take appropriate human dosage forms under proper medical supervision.  But in fact, no one would, because no competent doctor would prescribe ivermectin based on the now-available evidence.

Under these circumstances, writing an article that suggests that ivermectin is effective at preventing serious COVID and criticizing the FDA for withholding approval is disgraceful.  It will just get people killed.

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