Ivermectin: Wonder drug or instant death?

Hey guess what there's an old drug that's super cheap and works on lots of things and might work on COVID-19 but you wouldn't know that from the news.

Yep, it’s low budget horror. They’re probably all gonna die.

Let’s talk about Ivermectin!

Can it cure Covid? I don’t know.

Is there at least a reason to think it might? Yes. Several reasons, in fact.

Is it super dangerous? No.

Is CNN contributor Dr. Sanjay Gupta a douchebag? Yes.

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[As promised, today we are watching a terrible film on Netflix. This one is called Demonic and it can be found in the category Horror Films With Casts of Attractive Young People All of Whom Will Die Horribly. This is normally one of my favorite categories but we are just past the credits and I already regret my choice. They’e doing “shaky cam” for exposition dialogue and that’s two types of bad film making at the same time.]

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Bad films aside, why are we talking about a drug no one had heard of a year ago? One reason is the FDA, who made themselves temporarily Twitter famous with this post:

Your tax dollars at work. I think that CDC intern who did the webpage on masks is now working full time at the FDA.

Notice how this is worded, by the way. Using Ivermectin to treat Covid could be “dangerous and even lethal” and hasn’t been approved “for that purpose.” You’re not a horse, “y’all.”

In another example, Joe Rogan, prominent patient podcaster (interviews can take three hours) recently mentioned he was diagnosed with the Rona and his doctor prescribed Ivermectin (among other things). Rogan was roasted in the media for taking the “horse de-wormer” which is clearly stupid since he’s not a horse. One of those useless talking heads was the aforementioned Dr. Sanjay Gupta, who was later confronted about this on Rogan’s podcast and admitted that Joe Rogan wasn’t killed by Ivermectin and is, indeed, not a horse.

However, people who aren’t being snarky about it have (reasonably) pointed out that, horse de-worming aside, it’s classified as an anti-parasitic drug and SARS-CoV-2 is a virus. This of course begs the question: then why have doctors prescribed it for COVID-19?

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[Oh god the movie is doing ‘found footage’ - please make them stop. Found Footage Shaky Cam Exposition Dump should be its own category at whatever the opposite of The Oscars is.]

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What is Ivermectin and why do people get Nobel Prizes for killing horse worms?

The famously far-right wing magazine Mother Jones (that's sarcasm, if you're unfamiliar with Mother Jones) published a nifty little article¹ about it back in 2015. Here’s the abbreviated version:

In the late 1970s a guy named Satoshi Omura found, in some soil in Japan, some bacteria that ate parasites. He sent samples to his pen pal William Campbell (who worked at Merck) and Campbell made Ivermectin. I skipped a lot of steps but that’s the tl;dr² version.

The new drug was great at killing small parasites that are common in African and South Asian countries and cause things like river blindness, which has blinded hundreds of thousands of people.

Bad news though - these diseases are rare in countries that can afford expensive drugs and common in countries that can’t. The good news - Ivermectin is really, really cheap to manufacture. So rather than trying to make money on the drug, Merck partnered with the WHO and gave it out for free. Those two swell guys, Omura and Campbell, were later forced to buy tuxedos so they could accept the Nobel Prize in 2015.

So this is a success story, and Merck and the WHO come out as good guys, which probably reduced their future time in purgatory by about twenty minutes each.

Animals also get parasites, and nowadays there are lots of versions of this and related drugs for pets and livestock. Nobody really cares because the patents expired forever ago and no one is buying a yacht or small island with the profits.

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[Update: Our movie characters have found a big circle thing on the floor and the girl with the handheld light meter that the cast is pretending detects something ghost related says it’s “maxed out” whatever that means.]

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But is it safe? Someone on Facespace told me I’d wind up getting my stomach pumped just from sniffing the cork

Here’s what the FDA says on their page titled Why You Should Not Use Ivermectin to Treat or Prevent COVID-19³:

One of the FDA’s jobs is to carefully evaluate the scientific data on a drug to be sure that it is both safe and effective for a particular use. In some instances, it can be highly dangerous to use a medicine for the prevention or treatment of COVID-19 that has not been approved by or has not received emergency use authorization from the FDA.

The page is full of dire warnings about overdoses, drugs intended for animals blah blah blah - then they also admit there are human versions that are approved for parasitic infections. (Oh, so humans can take it and not die?)

This is your FDA: they’ll issue an Emergency Use Authorization for a new messenger RNA drug that’s never been used on humans before, but the thing that’s been around since the 1980s and has been given to millions of children in Africa is waaaay too dangerous.

It’s even listed on their own table of Characteristics of Antiviral Agents That Are Approved or Under Evaluation for the Treatment of COVID-19⁴ right under Remdesivir, a drug with many more listed side effects. So Ivermectin is under evaluation, which means people are using it right now. Just not you because your pharmacy decided to stop filling prescriptions from medical doctors.

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[Oh great now the tech guy has a thingy that can hear all the heartbeats in the room and there’s too many of them because ghosts apparently have heartbeats.]

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Enough about the FDA, what do people who work for a living think?

There are quite a few papers discussing the potential for Ivermectin and many of them talk about its relative safety. For example:

Ivermectin: a multifaceted drug of Nobel prize-honoured distinction with indicated efficacy against a new global scourge, COVID-19 (Santin et al. 2021⁵)

IVM has been safely used in 3.7 billion doses since 1987, well tolerated even at much greater than standard doses and used without serious AEs in the three high-dose COVID-19 treatment studies noted above.

Did you see that part about 3.7 billion doses and “well tolerated”? That means it’s been safely used on a shit ton of people. (AEs are adverse events.)

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You know who also thinks it might be a viable, safe treatment? Per an article at MSN⁶ the state of Uttar Pradesh in India (population ‘really huge’) does. They’ve been using it for over a year. Here's a quote from the MSN article:

The state Health Department introduced Ivermectin as prophylaxis for close contacts of Covid patients, health workers as well as for the treatment of the patients themselves through a government order on August 6, 2020, after a committee headed by the Director General, Medical and Health Services, gave it the go ahead.

Regardless of whether it works on Covid, If Ivermectin were super dangerous I think we would have heard something from these folks by now.

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[Someone blew out the movie’s special effects budget so now they’re just flashing the lights on and off to create mood. They are really making it hard to like them.]

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Okay so maybe it’s not going to kill me but why would I think it works on a virus?

Well, the world is filled with real go-getters and some of those folks have tried Ivermectin on other things (like viruses).

Warning: way too much discussion of mosquitoes.

Antivirus effectiveness of ivermectin on dengue virus type 2 in Aedes albopictus (Xu et al. 2018⁷)

Xu and pals tested it on dengue. From the authors:

Dengue fever is the most rapidly spreading mosquito-borne viral disease over the past 50 years, with a 30-fold increase in global incidence.

The focus of this study was not to use it on people but rather on the mosquitoes that carry it. So they birthed a herd of skeeters, pulled on their galoshes and went out and fed the little buggers human blood infected with dengue virus (DENV-2) and varying amounts of Ivermectin (with one group getting zero Ivermectin).

And guess what - the higher the concentration of Ivermectin, the lower the rate of infection with DENV-2.

The average of infection rates in the seven groups treated with 0, 2, 4, 8, 16, 32 and 64 ng/ml ivermectin from 4 to 10 days post ingesting infectious blood were 84.62%, 85.29%, 82.54%, 74.24%, 63.33%, 54.29% and 42.62%, respectively, And the average of infection rates in historical control group was 81.67%.

So 84% of the untreated skeeters developed infection but only 42% of the ones in the highest dosage group did (so half as many). The Ivermectin clearly did something to limit growth of the dengue virus.

Someone else tried it on yellow fever:

Ivermectin is a potent inhibitor of flavivirus replication specifically targeting NS3 helicase activity: new prospects for an old drug (Mastrangelo et al. 2012⁸)

This one is extremely technical so I’m just going to stick to the point relevant to this rant.

Ivermectin, a broadly used anti-helminthic drug, proved to be a highly potent inhibitor of YFV replication (EC 50 values in the sub-nanomolar range). Moreover, ivermectin inhibited, although less efficiently, the replication of several other flaviviruses, i.e. dengue fever, Japanese encephalitis and tick- borne encephalitis viruses.

(YFV is Yellow Fever Virus.)

So the authors have noted that Ivermectin inhibits replication in several viruses, and in their conclusion they tell us how easy it might be to find real-world data on its impact against some of those viruses.

Considering that ivermectin has been used for the treatment of a variety of parasitic disease in man for >20 years, assessing its potential for the treatment of life-threatening flavivirus infections in clinical trials may require a minimum effort. Mining of epidemiological records in tropical regions where flaviviruses are endemic and where ivermectin has been administered for decades during population-wide onchocerciasis eradication programmes may offer first insights into the protective roles offered by the new application of this old drug.

“Mining of epidemiological records… may offer first insights into the protective roles offered by the new application of this old drug” So why don’t we do that? Hey CDC, can you look into this? What do we pay you for? Can you at least clean your room and take out the garbage?

It looks like lots of scientists have found reasons to think Ivermectin might work against viruses, so clearly trying it on SARS-CoV-2 is not crazy talk.

In fact, another paper provided a laundry list of potential uses.

Ivermectin, a potential anticancer drug derived from an antiparasitic drug (Tang et al. 2021⁹)

IVM not only has strong effects on parasites but also has potential antiviral effects. IVM can inhibit the replication of flavivirus by targeting the NS3 helicase; it also blocks the nuclear transport of viral pro­teins by acting on α /β-mediated nuclear transport and exerts antiviral activity against the HIV-1 and dengue viruses. Recent studies have also pointed out that it has a promising inhibitory effect on the SARS-CoV-2 virus, which has caused a global outbreak in 2020. In addition, IVM shows potential for clinical application in asthma and neurological diseases. Recently scientists have discovered that IVM has a strong anticancer effect.

So lots of people have looked at using Ivermectin to treat viral infections as well as other things, and thinking it might be useful against a new virus is completely reasonable.

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Summary for recovering CNN viewers who would like to know something useful for a change

What is it? Ivermectin is a Nobel Prize winning drug that is cheap and effective at curing several parasitic diseases in humans, and has versions used very commonly on pets and livestock.

Is it super dangerous? Per the scientific literature the drug has been given to millions of people and is well tolerated, with few adverse effects.

Can it cure COVID? We don’t yet know. According to researchers it has potential for use against viral diseases (and other things) so it’s definitely possible. The drug is currently being used in countries other than the U.S. to treat COVID-19 so we are getting more data every day.

Also, Sanjay Gupta is a douchebag. We covered that already but it’s worth repeating.

So why all the negative press, the dire FDA warnings, dumb FDA tweets, and talk about Joe Rogan’s treatment regimen? I have a personal Theory on Regulatory Oversight that might explain all this, so if you’re curious then go take a look.

For a more academic explanation, I’m going to remind you of my post about regulatory capture. I have a sneaking suspicion there’s a connection between that concept and some of the responses to Ivermectin.

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[The dumb movie has a plot twist (of course!) so I can’t go into details because I would never deprive you of the joy of experiencing this for yourself. At least most of the characters die horribly so that’s something you can look forward to.]

1. Mother Jones article about Ivermectin:
https://www.motherjones.com/environment/2015/10/story-behind-drug-just-won-nobel-prize-medecine-mectizan-ivermectin-william-campbell-satoshi-omura/
Archived copy:
https://web.archive.org/web/20170630063654/http://www.motherjones.com/environment/2015/10/story-behind-drug-just-won-nobel-prize-medecine-mectizan-ivermectin-william-campbell-satoshi-omura/

2. Too Long, Didn’t Read

3. FDA page on Ivermectin:
https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19
Archived copy:
https://web.archive.org/web/20211117062156/https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19

4. FDA page on treatments for COVID-19:
https://www.covid19treatmentguidelines.nih.gov/tables/table-2e/
Archived copy:
https://web.archive.org/web/20211117104533/https://www.covid19treatmentguidelines.nih.gov/tables/table-2e/

5. Santin AD, Scheim DE, McCullough PA, Yagisawa M, Borody TJ. Ivermectin: a multifaceted drug of Nobel prize-honoured distinction with indicated efficacy against a new global scourge, COVID-19. New Microbes New Infect. 2021 Aug 3;43:100924. doi: 10.1016/j.nmni.2021.100924. PMID: 34466270; PMCID: PMC8383101.
https://pubmed.ncbi.nlm.nih.gov/34466270/

6. Article about Uttar Pradesh:
https://www.msn.com/en-in/news/other/uttar-pradesh-government-says-early-use-of-ivermectin-helped-to-keep-positivity-deaths-low/ar-BB1gDp5U
Archived copy:
https://web.archive.org/web/20211028023800/https://www.msn.com/en-in/news/other/uttar-pradesh-government-says-early-use-of-ivermectin-helped-to-keep-positivity-deaths-low/ar-BB1gDp5U

7. Xu TL, Han Y, Liu W, Pang XY, Zheng B, Zhang Y, Zhou XN. Antivirus effectiveness of ivermectin on dengue virus type 2 in Aedes albopictus. PLoS Negl Trop Dis. 2018 Nov 19;12(11):e0006934. doi: 10.1371/journal.pntd.0006934. PMID: 30452439; PMCID: PMC6277121.
https://pubmed.ncbi.nlm.nih.gov/30452439/

8. Mastrangelo E, Pezzullo M, De Burghgraeve T, Kaptein S, Pastorino B, Dallmeier K, de Lamballerie X, Neyts J, Hanson AM, Frick DN, Bolognesi M, Milani M. Ivermectin is a potent inhibitor of flavivirus replication specifically targeting NS3 helicase activity: new prospects for an old drug. J Antimicrob Chemother. 2012 Aug;67(8):1884-94. doi: 10.1093/jac/dks147. Epub 2012 Apr 25. PMID: 22535622; PMCID: PMC3888155.
https://pubmed.ncbi.nlm.nih.gov/22535622/

9. Tang M, Hu X, Wang Y, et al. Ivermectin, a potential anticancer drug derived from an antiparasitic drug. Pharmacol Res. 2021;163:105207. doi:10.1016/j.phrs.2020.105207
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505114/