Talk:Ivermectin/Archive 2

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Ivermectin as a medical treatment for Covid-19, Goa, India, May 2021

I added this to the paragraph Medical Use:

=== Covid-19 ===

Vishwajit Rane, Minister of Health of the Government of the State of Goa, India, announced on May 10, 2021, the Government's decision to administer Ivermectin 12 mg, for five days, to all above 18 as a prophylaxis treatment against Covid-19.

but user:Alexbrn reverted 6 minutes later with comment “fringe/pseudoscience without context, failing WP:GEVAL”

I am okay with the usefulness for someone else to add context in order to avoid WP:GEVAL, but not with the plain revert of this information about an official medical use of Ivermectin as a treatment for Covid-19, be it fringe/pseudoscience or not. It is official in one State. Would someone else transform this information in a acceptable way for all?

Ceveris (talk) 09:41, 28 May 2021 (UTC)

Politicians decide what is allowed and what is not allowed within their jurisdiction. They do not tell Wikipedia what is true and what is false. Reliable scientific sources do. --Hob Gadling (talk) 09:47, 28 May 2021 (UTC)

A Medical treatment is a “ the attempted remediation of a health problem”. Is it efficient? True or false, this is the topic that “reliable scientific sources” will clarify. In that Goa case, Ivermectin IS a medical treatment for Covid-19. We could add, in order to comply with WP:GEVAL:

In Uttar Pradesh, the most populous state of India, with a high density of population, “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“

Those individual governments decisions to use Ivermectin as a treatment for Covid-19 don't comply with WHO's March 31, 2021 recommendation “that ivermectin only be used to treat COVID-19 within clinical trials”.

Any objections?

Ceveris (talk) 13:24, 28 May 2021 (UTC)

Yeah that Indian Express source is utter quackery and shouldn't be used. There's some at least sane secondary commentary here - but really this is just part of the terrible story of how quackery has compromised India's COVID response. It may be due to mention in that light at COVID-19 pandemic in India‎, but this page shouldn't become a directory of every region on the planet that's authorized a drug (even if it were a good decision). We just don't do that for drug articles. Alexbrn (talk) 13:36, 28 May 2021 (UTC)

Until we set clear criteria what belongs to the article, I don't see why this information is less relevant than the information about other countries which is already included. I'd be happy to remove or leave it based on the results of the RfC above. "Terrible response" is noteworthy and notable. Alaexis_¿question? 14:23, 28 May 2021 (UTC)

Ceveris, Hob Gadling please note that I've opened a RfC about the notability of various uses of ivermectin. Please leave a comment there, I think the article would benefit from clear criteria. Alaexis_¿question? 14:27, 28 May 2021 (UTC)

Alexbrn the RfC above clearly shows that the use of Ivermectin is notable, irrespective of its effectiveness against Covid. I'm happy to discuss how this information should be presented in the article to avoid making it look like an endorsement by Wikipedia. Refusing to mention it in any way against the position of the majority of other editors is disruptive. Alaexis_¿question? 18:09, 29 May 2021 (UTC)

The RfC is still running. We're not going to do a shopping list of nations/regions/governments with daft policies, as it is of no encyclopedic worth. You are now aware of the sanctions for this topic (which you are in breach of, by restoring disputed content). Alexbrn (talk) 19:08, 29 May 2021 (UTC)

India, population 1.38 Billion, with official (not draft) policy on a “shopping list”. You make my day! The content is most official and undisputed. Ceveris (talk) 19:21, 29 May 2021 (UTC)

@Alaexis: to say that India is endorsing this pseudo-scientific treatment, it is not necessary to inform the dosage and duration of the treatment. This is an incentive to self-medication. Do not use Wikipedia to promote this treatment. --Fernando Trebien (talk) 21:39, 29 May 2021 (UTC)

@Alexbrn: Totally dishonest to ignore the recommendation to the public by the Ministry of Health of the Government of India (version for the public) (pop. 1,380 M) but leave those of US (pop. 332 M) FDA and EU (pop. 513 M) EMA.

You banned it under the pretext it is “irrelevant to "research" - the topic of this article”. This is hypocrisy because such recommendations to the public by health authorities (the Indian one as well as the US and European ones) about a drug are made after consideration of research. — Preceding unsigned comment added by Ceveris (talk • contribs) 21:54, 29 May 2021 (UTC)

— Ceveris (talk • contribs) has made few or no other edits outside this topic.

And the consensus of relevant credentialed qualified health experts does not support that recommendation. That's why it's irrelevant and adding a WP:LAUNDRY.--Shibbolethink ^{(♔ ♕)} 23:14, 29 May 2021 (UTC)

@Ceveris: do not use Wikipedia to promote this treatment. When writing about it, you should also say that the Indian government is using it against international consensus. This last part is very important. --Fernando Trebien (talk) 23:27, 29 May 2021 (UTC)

I agree with that. It's kind of obvious if we mention it right after saying that the WHO, CDC and EMA do not recommend it, but we can say it explicitly too. Alaexis_¿question? 05:32, 30 May 2021 (UTC)

Agree too. No problem!

Alexbrn reverted my last edit ¯\(°_°)/¯

His series of reverts is the cause of this ongoing discussion:

We have to find an acceptable presentation of that Indian decision… (Be it good or bad, what is Wikipedia to judge?) Ceveris (talk) 17:22, 30 May 2021 (UTC)

It seems like India's High Court will block the prophylactic use of ivermectin. I think the best we can do right now is something along these lines:

In May 2021, with hospitals overrun with critically ill COVID-19 patients, the Indian states of Goa and Uttarakhand announced plans to use ivermectin to treat mild cases of COVID-19. The Indian Council of Medical Research issued the recommendation to doctors while warning that the decision was based on low certainty of evidence. WHO chief scientist Soumya Swaminathan reiterated that the WHO does not recommend the use of ivermectin for COVID-19, except in clinical trials, citing the statement by the manufacturer and developer of ivermectin Merck against off-label use.

I'm not sure where this should be placed. Please wait a while for opinions before adding this to the article. --Fernando Trebien (talk) 20:12, 30 May 2021 (UTC)

Maybe add a new first-level section on covid and put everything related to it there (research, actual usage and misinformation)? Alaexis_¿question? 06:58, 31 May 2021 (UTC)

I think we've already got enough (too much) on this fringe aspect of what is otherwise a useful drug. Need to be wary of WP:UNDUE and giving too much attention to a fringe sideshow. Alexbrn (talk) 07:07, 31 May 2021 (UTC)

Alexbrn please next time notify other editors when you solicit feedback at the Fringe_theories dashboard. Alaexis_¿question? 08:50, 31 May 2021 (UTC)

There's no need. Alexbrn (talk) 09:06, 31 May 2021 (UTC)

Alexbrn You misrepresent WP:UNDUE. Fact that ivermectin is, since April 28, 2021, part of the treatment proposed by Indian health authorities for mild/asymptotic covid-19 patients is no “views of tiny minorities”, whose representation is the topic of WP:UNDUE. It is not a “view”. It is a fact. The “view” that ivermectin is efficient as a treatment for Covid-19, although shared by more than “a tiny minority”, is only presented by Wikipedia as “misinformation”. Ceveris (talk) 08:37, 31 May 2021 (UTC)

No, it would be a WP:FALSEBALANCE to give attention to some confused politicians who gave some dumb advice in one part of the world for a few weeks, for a drug which is actually changing the world for the better because of the work of informed policy makers and scientists. We already mention some misguided countries/regions. How does it help convey knowledge to add more? Anyway, you can add your view to the RfC and we'll see where things stand in a month or so. Alexbrn (talk) 08:59, 31 May 2021 (UTC)

Again, (as usual,) you misrepresent the subject. We are not talking about any “confused politician”, but about the “REVISED GUIDELINES FOR HOME ISOLATION OF MILD/ASYMPTOMATIC COVID-19 CASES” published on April 28, 2021 by the Ministry of Health & Family Welfare of the Government of India, directly accessible (one clic) from this page: https://www.mohfw.gov.in/

Presented by the press: Govt issues new guidelines for home isolation of mild, asymptomatic COVID-19 cases, BusinessToday.In, April 29, 2021.

This is notable information for the article about Ivermectin. Ceveris (talk) 09:49, 31 May 2021 (UTC)

PS: thank you Alaexis to let us know about that mean Alexbrn conspiring behind our backs… Ceveris (talk) 09:49, 31 May 2021 (UTC)

I’m not sure that the Indian government is a particularly good authority on medical issues. On the same ministry website, for example, you can find recommendations for using Ayurveda to prevent COVID, and the government has also issued guidance on the use of homeopathy for prevention and treatment of COVID symptoms. They have an entire ministry devoted to this sort of thing. Brunton (talk) 13:46, 31 May 2021 (UTC)

We are not providing medical advice here. Wrong decisions can be notable and should be covered by Wikipedia. Alaexis_¿question? 14:07, 31 May 2021 (UTC)

Better to have sources on the "wrong decisions" then, rather than letting it somehow be implied. We already know, and say, some countries have made wrong decisions - if you must, put this India stuff in that country's COVID article. This is an article focused on an anti-parasitic drug. Look at the weight of serious sourcing on that (800+ scholarly secondary sources). Next to that, piling up a list of tittle tattle about how it doesn't work - which we already cover - is undue. Alexbrn (talk) 14:19, 31 May 2021 (UTC)

Correct. There are loads of references in the article saying ivermectin doesn't work for covid. This balances the Indian choice to have it as a treatment. This choice is a notable information about IVERMECTIN, has its place in Ivermectin.

I put the info as you propose into COVID-19 pandemic in Goa but your accomplice Brunton reverted, instead of WP:FIXTHEPROBLEM! Ceveris (talk) 15:30, 31 May 2021 (UTC)

This piece of random trivia doesn't belong in this article. If we put every crackpot medical idea that the Indian Government has in the individual treatment article, they would be an incredible mess. WP:FRINGE applies here, because that's exactly the Indian Government's approach to medical issues. Black Kite (talk) 16:18, 31 May 2021 (UTC)

WP:FRINGE is Wikipedia:Fringe theories, don't apply:

You confuse the ideas, the “theories”, with the events.

The publication by the Indian Government, 28 April, of a revised guidance for covid with “Treatment for patients with mild/asymptomatic disease in home isolation”, containing Ivermectin, and the decisions taken in such states as Goa (10 May), Karnataka (11 May) and Uttarakhand (12 May), (not talking about Uttar Pradesh) to distribute ivermectin tablets to their population are not ideas or theories (fringe or not)! Ceveris (talk) 16:57, 31 May 2021 (UTC)

The distinction is really simple. Flat Earth is a fringe idea - to put it mildly. Still we mention that it was the dominant theory in the past in the Earth article. Alaexis_¿question? 18:25, 31 May 2021 (UTC)

Ftrebien, thanks for improving the article and incorporating the information about India. Alaexis_¿question? 20:13, 31 May 2021 (UTC)

I hope this settles the controversy a bit. I only disagree about the direct link to the national guidelines, as it can be an incentive to self-medication because it contains usage instructions. It is ok to link to news articles that puts this in the adequate context. I understand that the High Court will block Goa's intention to use it prophylactically, and the national guidelines are only for people with mild symptoms, not prophylactically. --Fernando Trebien (talk) 20:51, 31 May 2021 (UTC)

I don't have a strong opinion on the inclusion of the guidelines themselves, I think it's fine the way it is now. Alaexis_¿question? 06:51, 1 June 2021 (UTC)

So far Ftrebien “improving of the article and incorporating the information about India” as Alaexis thanks him for is sleeping on this talk page.

So, were are we going to put that information that, since April 29, 2021, Ivermectin is included in India’s “revised national COVID-19 treatment protocol for people with mild infection” Times of India, 30 April Ministry of Health? In a new sub chapter Medical uses/Covid-19? In the existing chapter Research/COVID-19? Ceveris (talk) 10:43, 5 June 2021 (UTC)

It's already written that some countries, including India, authorised its use for Covid. What exactly do you propose to add/change? Alaexis_¿question? 12:05, 5 June 2021 (UTC)

It is written that India, among others “allowed its off-label use.” But inclusion in the official protocol is more than allowing off-label use, it is promoting it. This is stronger. So I would suggest to add: “India even included ivermectin in its revised national COVID-19 treatment protocol for people with mild infection, published April 29 2021.” With the 2 references above: The Times of India, 30 April Ministry of Health, Government of India. Ceveris (talk) 12:32, 5 June 2021 (UTC)

I see. In the same paragraph, the text can distinguish between off-label use (prescribed by physicians) and official guidelines for home isolation, which can be understood as some kind of endorsement. I still think we should not link directly to the guidelines, this can lead to self-medication and is unnecessary to support the claim. The USA Today article used as a reference already provides enough support. Times of India is considered to have a pro-government bias. --Fernando Trebien (talk) 13:09, 5 June 2021 (UTC)

Thank you for your answer. You can dump that direct link to the recommendations, but I do like direct link to the original sources the press is only commenting about (like Mercks, WHO, FDA, NIH statements…) I proposed The Times of India (“the largest selling English-language daily in the world“) to please Alexbrn who wrote “that Indian Express source is utter quackery and shouldn't be used.” I am okay with a journal “considered to have a pro-government bias”. At least this would mean that it is not misrepresenting the government initiative. Ceveris (talk) 13:41, 5 June 2021 (UTC)

Oh, I read in your link WP:INDIANEXP that “The Indian Express is considered generally reliable under the news organizations guideline.” So Alexbrn has a strong disagreement with Wikipedia!!! A go for Indian Express source, then? Like this April 30 article. Ceveris (talk) 14:16, 5 June 2021 (UTC)

I think Alexbrn was referring to another article. Anyway, as a news source, the Indian Express is considered reliable. But care must be taken not to express the information as a biomedical claim, only as news, we should follow WP:PSMED#Writing for the right audience and WP:NPOVFAQ#Writing for the opponent. The Indian Express says The guidelines suggest further that the doctor consider ivermectin tablets, which is accurate, and the highlighted parts are important to ensure neutrality. We cannot write that the guidelines recommend it, or that the doctor should prescribe it. --Fernando Trebien (talk) 14:44, 5 June 2021 (UTC)

It would be undue, and take us into laundry-list territory. We can't mention Indian quackery without a source contextualizing that quackery per WP:GEVAL, otherwise it gives the impression it's rational. Alexbrn (talk) 16:01, 5 June 2021 (UTC)

Quackery “often synonymous with health fraud”, “promotion of fraudulent or ignorant medical practices.” is highly disparaging applied to India's Public Health Policy. Especially applied to its policy toward covid-19 (Death/1M Pop: UK/USA/India: 1,874/1,840/249/ - source: https://www.worldometers.info/coronavirus/)

Considering that the whole article is biased against the use of Ivermectin for Covid-19, presenting its advocacy as a “misinformation”, reporting not one study or evaluation in favor of its use, adding the info about the Indian guideline stating: “Consider Tab Ivermectin” as a treatment would not break WP:GEVAL. Ceveris (talk) 16:30, 5 June 2021 (UTC)

I don't think the Indian government is advocating the drug. If that were the case, it would have promoted the drug earlier, as some other governments have done. I think it's succumbing to pressure. As for reporting favorable studies, it would be WP:FALSEBALANCE as they are generally considered poorly executed.--Fernando Trebien (talk) 16:51, 5 June 2021 (UTC)

I agree. We should prefer a reference that provides the appropriate context. So, even if the Indian Express is accurately reporting what the Indian government is doing, it has failed to mention that it goes against international consensus. The USA Today article does both and is therefore a good source. The point that remains is whether to simply write that the Indian government is allowing off-label use or explicitly state that this is now part of a national guideline for caregivers. --Fernando Trebien (talk) 16:51, 5 June 2021 (UTC)

New section

Came to this talk page to say that the sections on "misinformation and covid" and "research on covid" are written in a way that violates NPOV. Including the very title of the misinfo section. Can it pls be rewritten in a way that highlights controversy without taking a position, and in fact uses words like "controversy" and "disagreement" instead of "misinformation"? I've long appreciated Wikipedia's entries on biochemistry, drugs, etc. and really don't like seeing them become politicized. Frankly, that begins with avoiding terms like "misinformation" and "conspiracy theory". 104.247.238.179 (talk) 19:01, 5 June 2021 (UTC)

What you're requesting is to violate WP:GEVAL, which is part of NPOV policy. NPOV means we illustrate the mainstream view, especially in science topics, and call out WP:FRINGE theories as such. It's very similar to how climate change denial can be political, but we don't step back from the mainstream position. The beginning of WP:LUNATICS gives some guidance on this. KoA (talk) 19:49, 5 June 2021 (UTC)

Why is revision history on this page inconsistent with Wayback Machine / Internet Archive?

Yesterday an addition to the COVID-19 research section was proposed to include the NIH ACTIV-6 trial: https://en.wiki.x.io/wiki/Talk:Ivermectin#NIH_Running_Phase_III_Trial_of_Ivermectin:_ACTIV-6 this was added to the main article.

Previous content: "To resolve uncertainties from previous small or poor quality studies, a large scale trial being run by Oxford University, named PRINCIPLE, began recruiting test subjects in June 2021." https://web.archive.org/web/20210624211205/https://en.wiki.x.io/wiki/Ivermectin#COVID-19

Current content: "To resolve uncertainties from previous small or poor-quality studies, as of June 2021 large scale trials were underway in the United States and United Kingdom."

If I go to "View history" for the article no revisions show up on the 27th of June, and previous revisions for the page, even as far back as the 22nd, show the new version of the content: see version from June 22nd: https://en.wiki.x.io/w/index.php?title=Ivermectin&oldid=1029907834 Why is Wikipedia's revision history inconsistent with the archived versions, implying a new edit has been part of the page all along? Caprilyc (talk) 12:44, 28 June 2021 (UTC)

Some content here is transcluded from other articles. Alexbrn (talk) 12:48, 28 June 2021 (UTC)

I see. The edits show up in https://en.wiki.x.io/wiki/COVID-19_drug_repurposing_research#Ivermectin and are visible in the corresponding history: https://en.wiki.x.io/w/index.php?title=COVID-19_drug_repurposing_research&action=history Thanks for clarifying. Apologies for being new to this. Caprilyc (talk) 12:52, 28 June 2021 (UTC)

Malaysia, Philippines COVID studies

Malaysia recently started studying the use of IVM for COVID treatment. The Philippines did something similar back in April. For your consideration:

https://www.freemalaysiatoday.com/category/bahasa/tempatan/2021/06/06/kkm-mula-uji-ivermectin-ke-atas-pesakit-covid-19-berisiko-tinggi/

https://www.malaymail.com/news/malaysia/2021/06/05/dr-noor-hisham-health-ministry-starts-ivermectin-trial-for-high-risk-covid/1979924

https://www.thestar.com.my/news/nation/2021/06/05/dr-noor-hisham-health-ministry-has-begun-ivermectin-trial-for-high-risk-covid-19-patients

https://www.reuters.com/business/healthcare-pharmaceuticals/philippines-start-clinical-trials-ivermectin-other-drugs-covid-19-2021-04-20/

-SmolBrane (talk) 05:28, 7 June 2021 (UTC)

Biased not misinformation re Covid 19

Invermectin has been shown to be affective against Covid 19. Doctors in the field have used it and reported success. Watch Kory Pierre interview with Bert Weinstein on You Tube. Kory Pierre is no quack, he is a leading physician in treating Covid 19. Also Australian Doctors back the use of Invermectin in treating Covid 19. — Preceding unsigned comment added by 150.143.179.116 (talk • contribs) 09:50, 5 June 2021 (UTC)

That is your opinion. Reliable sources disagree with you. Reliable sources win.

Also, you should sign your contributions on Talk pages, and new contributions go to the bottom. I rectified both for you. --Hob Gadling (talk) 19:57, 5 June 2021 (UTC)

At this point, the true misinformation on Ivermectin is this Wikipedia article. India is crushing Covid with Ivermectin protocols. Mexico has crushed Covid with Ivermectin, in spite of the misinformation campaign by 'big tech' and the US Medical Establishment, which has not provided a treatement protocol for an eminently treatable illness, and instead tells people to stay home and get sicker and sicker until they go to the hospital to die alone. It's not longer about having data, or the science. It's a suppression campaign.

— Preceding unsigned comment added by 2601:603:4a80:5870:6c38:9241:2cc8:9b8d (talk • contribs) 18:01, 6 June 2021 (UTC)

Correlation does not imply causation and none of those sources can be trusted. No other source confirms there was any legal notice against that scientist. Go away. --Fernando Trebien (talk) 23:31, 6 June 2021 (UTC)

Another source: WHO scientist in dock for opposing Ivermectin’s use for Covid-19 cure. Ceveris (talk) 00:19, 7 June 2021 (UTC)

Can this source be trusted? --Fernando Trebien (talk) 11:01, 7 June 2021 (UTC)

Good question: is the information true or not? Third secondary source, for your information, heraldgoa.in, a “primary” source: Blog Indian Bar Association. Ceveris (talk) 15:18, 7 June 2021 (UTC)

Second “primary” source: Indian Bar Association Press Release, May 26, 2021. Ceveris (talk) 15:25, 7 June 2021 (UTC)

Even if that is true, it only shows that the quackery pushers who are in power in India legally harrass people for disagreeing with them. That says nothing about whether the stuff works. Pure argumentum ad baculum. --Hob Gadling (talk) 15:28, 7 June 2021 (UTC)

Quite, and even if this gets coverage it tells us nothing about ivermectin, but plenty about India - so it may be due in COVID-19 pandemic in India. But not here. Alexbrn (talk) 15:33, 7 June 2021 (UTC)

My Friend’s uncle in India was saved from severe hospitalized Covid by Ivermectin prescription. Anyone who denies Ivermectin as an effective treatment for Covid 19, is either looking at old facts or blind. — Preceding unsigned comment added by 150.143.179.120 (talk) 01:09, 7 June 2021 (UTC)

I suppose he was saved by a combination of complex clinical care and various drugs, carefully administered, while monitoring his vital signs, right? --Fernando Trebien (talk) 03:47, 7 June 2021 (UTC)

That is what it has come to? Anecdotes? What next? Homeopathy helped your aunt? Faith healing helped your uncle?

Please inform yourself on the requirements for Wikipedia sourcing. --Hob Gadling (talk) 06:35, 7 June 2021 (UTC)

Proposal - added context for Merck's statement on Ivermectin/Covid

As reported by PBS, Merck is developing a novel drug for treating Covid. From the linked article:

"Another existing drug, ivermectin, may also have potential against SARS-CoV-2. A May meta-analysis suggests it could speed recovery and reduce mortality from COVID-19. The idea is controversial; some experts are unconvinced while proponents are eager to put it to use as a cheap, effective treatment. The anti-parasitic, developed by Merck in the 1980s, is no longer under patent. The company has contended there is not sufficient evidence for its use against COVID. Merck declined to respond to PBS NewHour’s request for comment."

Merck's position creates a potential conflict of interest that means proper context needs to be provided when citing their statement on ivermectin. Given that Merck would stand to make far more money through a novel treatment than they would on a generic. The danger with the current text of the article is that it veers from a WP:NPOV and adopts Merck's framing of ivermectin's effectiveness (or lack thereof) without fully disclosing what incentives they may have had to make that statement.

I propose including additional text, using the neutral language provided by WP:RS PBS in the above linked story as a reference. 2600:1700:7CC0:4770:1905:B5EA:593B:F994 (talk) 19:36, 2 June 2021 (UTC)

 Not done Silly news piece, not WP:MEDRS. Merck's position is reported correctly, satisfying WP:NPOV. Alexbrn (talk) 19:38, 2 June 2021 (UTC)

What is "silly" about a report that Merck is developing a novel drug for treatment of Covid? Surely you are not questioning the underlying facts, or their potential for creating a conflict of interest?2600:1700:7CC0:4770:1905:B5EA:593B:F994 (talk) 19:43, 2 June 2021 (UTC)

News about Merck & Co.'s drug development would belong at their article. We're not going to spout moronic conspiracy theories. Alexbrn (talk) 19:51, 2 June 2021 (UTC)

This is not the first time you have been incredibly disrespectful with your comments, and I wonder what the point of it is? Please dial it back.2600:1700:7CC0:4770:1905:B5EA:593B:F994 (talk) 19:55, 2 June 2021 (UTC)

Please WP:FOC. --Hipal (talk) 20:21, 2 June 2021 (UTC)

I agree, let's redirect the conversation to what is or isn't substantively wrong with my proposal, and not use words like "silly" and "moronic" to dismiss it out of hand.2600:1700:7CC0:4770:1905:B5EA:593B:F994 (talk) 20:24, 2 June 2021 (UTC)

Make a new request. You may want to review relevant policy before you do. --Hipal (talk) 21:25, 2 June 2021 (UTC)

I believe I cited good policy. Simply repeating Merck's statement is not NPOV, as Alexbrn suggests. They are not an uninterested third party or authoritative secondary source - they have a source bias as an interested party in this matter. Presumably their statement was included to show that "even the big pharma company who would stand to gain from ivermectin says it doesn't work." This is an educated guess, as the statement does not appear to be relevant on its face, and this argument has been posited by sources previously linked by Alexbrn. Of course, this argument falls down if the full context provided by PBS is taken into consideration. If Merck's statement is to be included in this article then balance is very much needed to fulfill NPOV. 2600:1700:7CC0:4770:1905:B5EA:593B:F994 (talk) 21:27, 2 June 2021 (UTC)

Yeah, we get it. You don't like the facts, so you are digging to disqualify the people who supply the facts. Business as usual, in short.

Merck is selling Ivermectin now, and they could sell more of it now if they said it works against COVID. And you are saying that it does work, but they will not admit it because they do not want that money now, they prefer hypothetical money at some time in the future when they are finished developing something that actually works against COVID (although ivermectin already does that)? That does not make sense in this universe or any parallel ones I know. Even if it did, this is Wikipedia, and you will not convince anyone it makes sense.

So, disqualifying Merck as a source based on that article only works if we follow your contorted ideas.

Go away, you are not here to build an encyclopedia. --Hob Gadling (talk) 07:02, 4 June 2021 (UTC)

Not to mention the idea that a company would tell a blatant lie to conceal its drug's effects, to prolong a global pandemic for its possible future advantage, is one of the more extreme instances of a Big Pharma conspiracy theory one's ever likely to encounter! If it were Merck alone saying this then maybe we'd have an issue, but since their view is aligned with every decent medical source on the planet, we're good, and it's added extra knowledge that even the drug company are saying this. Alexbrn (talk) 07:14, 4 June 2021 (UTC)

In order to erase a link in this article to the neutral NIH recommendation about Ivermectin telling “There are insufficient data for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of ivermectin for the treatment of COVID-19” for this article, Alexbrn says: “Please don't bring press releases to Wikipedia, they are nearly always useless for the encyclopedia.

And here, he battles to keep as only source about Merck's position about Ivermectin, its own press release, and refuses a respected secondary source contextualizing Merck's position.

This not coherent and not NPOV. Ceveris (talk) 09:56, 4 June 2021 (UTC)

Hob Gadling: “That does not make sense in this universe or any parallel ones I know,” “your contorted ideas”, “Go away, you are not here to build an encyclopedia” :these are blatant personal attacks. Does not respect Wikipedia's policy WP:NOPA. Does not respect also WP:OWN: “No one, no matter how skilled, or how high-standing in the community, has the right to act as though they are the owner of a particular article.” Ceveris (talk) 10:16, 4 June 2021 (UTC)

Except, the Merck source is a "Company Statement", a type of document they distinguish from their "News Releases". There is plenty of secondary coverage of the statement too, if adding it would help. (Update: I added something secodnary from SBM, a premium source for coverage of medical BS. They lend some "context" to the statement too: "The pharmaceutical company that has the most to gain from the sale of ivermectin is actively discouraging its use to treat COVID-19". Probably undue, mind.) Alexbrn (talk) 10:33, 4 June 2021 (UTC); updated 10:50, 4 June 2021 (UTC)

these are blatant personal attacks Bullshit bullshit bullshit. These are very, very blatant attacks on the IP's abysmal reasoning, and just as blatantly not on their person. Go read WP:PA, and while you are at it, Argumentum ad hominem. And neither does it have anything to do with ownership of articles. Bad reasoning can and must be criticized and debunked as bad reasoning. That "ownership" nonsense is just a red herring. --Hob Gadling (talk) 11:40, 4 June 2021 (UTC)

These are very, very blatant attacks on the IP's abysmal reasoning What aspect of my reasoning is abysmal exactly? There is a whole lot of nonsense argument being falsely attributed to me that is not close to accurate (RE: conspiracy theorizing as to whether Merck is intentionally prolonging the pandemic knowing of Ivermectin's effectiveness, etc). If you are going to claim my reasoning is abysmal please specify which part of my argument you are specifically talking about and I can respond appropriately. To once again redirect the discussion to the substance of the proposal, (1) is simply restating the claim of an interested party with no context appropriate RE WP:NPOV, and (2) is the statement even relevant or appropriately included given that WP:MEDRS was given as a reason not to include PBS's report (surely Merck does not fulfill the same criteria).2600:1700:7CC0:4770:9809:7234:5739:83B1 (talk) 22:02, 4 June 2021 (UTC)

falsely attributed to me So you are the same person as some of the other IPs posting here. We cannot really tell, you see, unless you tell us. If you used an account, it would be easier to answer your questions about what is bad about what you said - we quite literally do not know what you said. I am not interested in discussing someone who makes it intentionally difficult. My last contribution was just a response to Ceveris' bullshit and does not concern you. But maybe Ceveris is also you? --Hob Gadling (talk) 05:35, 5 June 2021 (UTC)

Let's WP:FOC and please redirect discussion to my proposal. There have been several comments presumably opposed to my proposal but none are addressing the arguments made in support of it. And yes, this is the same user who has a similar IP address over and over (it changing is not due to any action on my part.)2600:1700:7CC0:4770:E4FE:3D16:8E4A:A766 (talk) 06:02, 5 June 2021 (UTC)

The article cannot include material implying that Merck is suppressing the effectiveness of ivermectin unless you can produce reliable sources supporting this, per (at the very least) WP:OR and WP:BLP. Brunton (talk) 07:35, 5 June 2021 (UTC)

Thanks for your reply. I would just question what merits Merck's statement as it currently stands? As argued above, their statement would seem to fail both NPOV and MEDRS. 2600:1700:7CC0:4770:C1A5:72C2:D47E:72F7 (talk) 22:03, 5 June 2021 (UTC)

The statement is singled-out as significant by secondary sources (one such is cited), so NPOV would point to its inclusion. What Merck's statement says is not, strictly, biomedical information but it could imply it. However, since any implication is aligned with our golden sources (FDA, etc) there is no issue of this being "wrong". Alexbrn (talk) 03:38, 6 June 2021 (UTC)

Are you referring to Science Based Medicine? This appears to be a Patreon-funded blog. Are you claiming this is more of a WP:RS than PBS, whose reliability you previously rejected?2600:1700:7CC0:4770:897E:7CCD:13A6:E14A (talk) 19:43, 6 June 2021 (UTC)

Science-Based Medicine is a good source for fringe topics, per WP:PARITY. Alexbrn (talk) 19:47, 6 June 2021 (UTC)

Epicycles 2600:1700:7CC0:4770:897E:7CCD:13A6:E14A (talk) 00:25, 7 June 2021 (UTC)

Galileo gambit --Hob Gadling (talk) 06:35, 7 June 2021 (UTC)

Again, the PBS article points to a meta-analysis published in a journal that does not score well in SCImago at the time of publication. Simple check to avoid unnecessary headaches. --Fernando Trebien (talk) 20:19, 4 June 2021 (UTC)

---

The existence of a conflict of interest does not constitute medical information and thus doesn't require MEDRS. Alaexis_¿question? 14:59, 5 June 2021 (UTC)

The insinuation of a conspiracy to suppress the use of ivermectin comes under BLP and thus requires RS. Brunton (talk) 16:11, 5 June 2021 (UTC)

How is BLP relevant if I'm talking about a company? We don't have corporate personhood here. Alaexis_¿question? 05:19, 6 June 2021 (UTC)

Companies are controlled by living people. Brunton (talk) 11:12, 6 June 2021 (UTC)

Yes, but BLP as a policy does not normally apply to companies, see WP:BLPGROUP. Alaexis_¿question? 13:11, 6 June 2021 (UTC)

The insinuation of a conspiracy [...] requires RS Beyond the point made by User:Alaexis RE WP:BLPGROUP which I believe is correct, my proposal is to add context based on wording provided by WP:RS PBS. I believe that fulfills the criteria you set forth. 2600:1700:7CC0:4770:897E:7CCD:13A6:E14A (talk) 19:39, 6 June 2021 (UTC)

"Context based on wording" sounds like WP:OR. What exact words are you proposing? Alexbrn (talk) 19:45, 6 June 2021 (UTC)

It sounds like WP:OR? To me it sounds like sourcing from an actually widely known secondary source, PBS (not a Patreon-funded blog you consider reliable because it shares your viewpoint). 2600:1700:7CC0:4770:897E:7CCD:13A6:E14A (talk) 00:27, 7 June 2021 (UTC)

As a news source, PBS can make incorrect biomedical claims if its sources are not good. Good thing someone read the article paying attention. --Fernando Trebien (talk) 03:47, 7 June 2021 (UTC)

Good thing someone read the article paying attention sounds like WP:OR to me 2600:1700:7CC0:4770:897E:7CCD:13A6:E14A (talk) 06:35, 7 June 2021 (UTC)

When you cannot think of a response, use the one your opponent used on you, regardless of whether it works in the context? What is this, kindergarten?

SBM is a far more reliable source on medical subjects than any journalistic source. --Hob Gadling (talk) 06:51, 7 June 2021 (UTC)

PBS do not explicitly say that Merck have a conflict of interest in that article so saying it would be OR. There is one article from generally reliable The Wire that says that it might be the case [1] but I think it's worth waiting until we have more reliable sources explicitly writing about it. Alaexis_¿question? 06:02, 7 June 2021 (UTC)

Yes, and in the The Wire it's (correctly) characterized as a conspiracy theory. Alexbrn (talk) 06:14, 7 June 2021 (UTC)

No, the statement "pharma companies are blocking ivermectin’s entry into the market so that vaccines remain profitable" is described as a conspiracy theory. There is a big difference between a conflict of interest and blocking. Alaexis_¿question? 10:08, 7 June 2021 (UTC)

Not really, because the conspiracy theorists want to state or imply the "conflict of interest" taints Merck's statement. Wikipedia isn't going to play that game. Alexbrn (talk) 14:38, 7 June 2021 (UTC)

So we should eschew WP:NPOV and pretend the conflict of interest doesn't exist?2600:1700:7CC0:4770:FC9A:A677:BAAD:FDFC (talk) 20:47, 7 June 2021 (UTC)

The opposite. We adhere to WP:NPOV by reporting what's in good sources, rather than including conspiracy theories made up by Wikipedia editors. Alexbrn (talk) 09:22, 8 June 2021 (UTC)

The lede should mention COVID trials

(I saw the discussion at “crusades”, above, but there appears to be a broken archive tag there, so I'm starting a new section). We currently have a statement on misinformation, and a statement that no evidence exists for treatment or prevention, but we do not mention that many trials have occurred or are still in progress. This misleads the reader into thinking that no application is being investigated. The lede should more accurately reflect the body of the article and include such a statement, such as:

No reliable evidence exists to back up such claims, although many studies are still underway.

-SmolBrane (talk) 23:46, 7 June 2021 (UTC)

Simply being in trials or studies generally isn't something worth mentioning before publication (and WP:MEDRS is pretty clear on more details related to primary literature even after publication). Such information on "studies underway" is typically not encyclopedic, much less something that would be even mentioned in primary sources. Even in the latter, if something isn't published yet, it's like it doesn't exist yet, which is where WP:CRYSTAL comes in. KoA (talk) 00:16, 8 June 2021 (UTC)

The COVID excerpt under Research says “At least 45 such trials were listed as of January 2021.[77]”, which is the source and the basis for my suggested addition. The excerpt also contains the following statements:

After reviewing the evidence on ivermectin, the EMA said that "the available data do not support its use for COVID-19 outside well-designed clinical trials".

The WHO also said that ivermectin should not be used to treat COVID-19 except in a clinical trial.

So I think the ongoing trials are due. Perhaps an addition could be more appropriately phrased. I find it odd that the Research excerpt is 3500 characters and the COVID misinformation section is 800 characters, yet we only mention the misinformation in the lead. -SmolBrane (talk) 03:22, 8 June 2021 (UTC)

Like any drug there are many trials underway or recently completed for ivermectin, for applications as diverse as cancer therapy to underwear treatment. We would need to stick to secondary coverage, and looking at them, about the only thing of note about the COVID research is that is has generally been of very poor quality and/or mis-sold to a gullible fan base as part of a misinformation campaign. This is why the misinformation aspect is more weighty. Alexbrn (talk) 08:32, 8 June 2021 (UTC)

The first paragraph at WP:MEDPOP states “The popular press is generally not a reliable source for scientific and medical information in articles. Most medical news articles fail to discuss important issues such as evidence quality,[28] costs, and risks versus benefits,[29] and news articles too often convey wrong or misleading information about health care.[30]“ I think editors are doing a good job here.

However, the second paragraph states “Conversely, the high-quality popular press can be a good source for social, biographical, current-affairs, financial, and historical information in a medical article.“ I am concerned that the second paragraph is being ignored. Obviously potential treatments or preventions for COVID are important for the social, current-affairs and possibly historical context. The nature of a pandemic makes this all the more relevant—this is not a simple medical article. “Like any drug” is not persuasive to me. If we have a great Reuters source saying that the Philippines is studying ivm for COVID, perhaps it would be worth mentioning on that basis. It can be argued that it is undue, certainly, but it's not unverifiable, it's not a bad source, and it's not misinformation. -SmolBrane (talk) 15:14, 8 June 2021 (UTC)

It's just a factoid, not the kind of knowledge Wikipedia wants to deal in. Are you going to go to each of the articles on methylprednisolone, melatonin, tawa-tawa, and coconut oil and demand that we record the factoid of a COVID clinical trial? If every trial for every substance was worth mentioning on Wikipedia we'd have a almighty WP:LAUNDRY mess. We already say there are some trials. That's enough here. Alexbrn (talk) 15:31, 8 June 2021 (UTC)

Those are good points. I'm not "demanding" anything, I would encourage you to remain civil. I still believe the lead would be better served by acknowledging that ivermectin has, and continues to be investigated as a treatment option for COVID, if we are going to include a statement on COVID misinformation. Perhaps we could say something like:

While at least 45 studies are currently ongoing or completed, No reliable evidence exists to back up such claims.

Additionally, the article fails to acknowledge that India DID use ivermectin as a treatment, not that it was simply being “allowed”, as the wiki article currently states:

Despite the absence of high-quality evidence to suggest any efficacy and advice to the contrary, some governments have allowed its off-label use, including Czech Republic,[89]Slovakia,[89] Peru (later rescinded despite continuing use),[90][91] and India.[92][93]

What the source actually says:

The state of Goa, a major tourist haven, said earlier this week it plans to give ivermectin to all those older than 18, while the Himalayan state of Uttarakhand announced plans on Wednesday to distribute the tablets to any person over the age of two, except for pregnant and lactating women.

The characterization of the sources on Czech Republic and Slovakia seem correct to say “allowed”, although the Peruvian source seems to suggest that usage was closer to a recommendation, from the source(translated):

In the framework of the second wave of COVID-19 , the Ministry of Health (Minsa) and EsSalud once again included ivermectin in the new kit for the outpatient treatment of patients with this disease, despite being withdrawn last year.

-SmolBrane (talk) 16:11, 8 June 2021 (UTC)

The country stuff would be better covered in the misinformation article, where there's already some content about how the misinformation has caused some bad policy decisions. Alexbrn (talk) 16:15, 8 June 2021 (UTC)

I'll address the "country stuff" in the RfC above so we can stop discussing it here. Anyway I still think the lead would more accurately reflect the rest of the page if we mentioned that COVID-related studies are ongoing, or that many occurred. Possible therapies for an ongoing pandemic that has limited therapies has relevance beyond the medical and scientific context; it has affected government policies. Inclusion won't diminish the current statement or mislead anyone, indeed the current lead seems to suggest that only misinformation surrounding ivm and COVID exists. There are many sources that suggest a possible therapy on the basis that ivm has anti-viral uses elsewhere. The investigation of such possibilities should be discerned from the misinformation for the benefit of the reader, if we are going to include such commentary in the lead at all. -SmolBrane (talk) 17:45, 8 June 2021 (UTC)

Compare with Thalidomide, which has an entire section entitled "Society and Culture". SmolBrane (talk) 18:22, 8 June 2021 (UTC)

I'm not sure how that's relevant. As the acknowledged cause of one of the biggest drug scandals in human history, with huge human consequences documented, that would be expected. OTOH, we don't mention current clinical trials for thalidomide in that article's lede, despite the fact there are more of them than for ivermectin. Alexbrn (talk) 18:34, 8 June 2021 (UTC)

Useful studies?

• Carvallo et al 2020. Study of the efficacy and safety of topical ivermectin+ iota-carrageenan in the prophylaxis against COVID-19 in health personnel. J. Biomed. Res. Clin. Investig., 2.

• Cobos-Campos et al 2021.Potential use of ivermectin for the treatment and prophylaxis of SARS-CoV-2 infection: Efficacy of ivermectin for SARS-CoV-2. Clin Res Trials, 7: 1-5.

• Database of all ivermectin COVID-19 studies. 93 studies, 55 peer reviewed, 56 with results comparing treatment and control groups.

• Karale et al 2021. A Meta-analysis of Mortality, Need for ICU admission, Use of Mechanical Ventilation and Adverse Effects with Ivermectin Use in COVID-19 Patients. medRxiv.

• Kory et al 2021. Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19. American Journal of Therapeutics, 28(3): e299.

• Nardelli et al 2021. Crying wolf in time of Corona: the strange case of ivermectin and hydroxychloroquine. Is the fear of failure withholding potential life-saving treatment from clinical use?. Signa Vitae, 1: 2.

• Yagisawa et al 2021. Global trends in clinical studies of ivermectin in COVID-19. The Japanese Journal of Antibiotics, 74: 1.--193.152.127.203 (talk) 10:35, 16 June 2021 (UTC)

See WP:MEDRS for what constitutes a reliable source for biomedical content on Wikipedia. The only one here which gets in sniffing distance is the review in American Journal of Therapeutics, but as has been previously discussed this is a low quality journal harbouring a discredited paper, so not usable. We do, on the other hand, have some excellent high-quality sources from the European Medicines Agency, FDA, the BMJ and so on. Alexbrn (talk) 09:03, 16 June 2021 (UTC)

I assume you have read them. By the way, WP:TALKO.--193.152.127.203 (talk) 10:35, 16 June 2021 (UTC)

Whatever for! Why read crap sources when good ones are available? That's a recipe for a wasted life and a head full of learned lumber. Alexbrn (talk) 10:57, 16 June 2021 (UTC)

I suggest you give the WP:SECTIONHEADINGOWN part of WP:TALKO a more careful read. You do not own this section, we all do, together. It is appropriate for others besides the section creator to edit section headings. See also this relevant quote: "Because threads are shared by multiple editors (regardless of how many have posted so far), no one, including the original poster, "owns" a talk page discussion or its heading. It is generally acceptable to change headings when a better heading is appropriate, e.g., one more accurately describing the content of the discussion or the issue discussed, less one-sided, more appropriate for accessibility reasons, etc."--Shibbolethink ^{(♔ ♕)} 13:21, 16 June 2021 (UTC)

Semi-protected edit request on 8 June 2021

The claim that there is no evidence of Ivermectin being effective as prophylaxis and treatment for COVID-19 is false. Ivermectin has shown efficacy in fighting viruses of multiple types in vitro and in vivo. There are multiple peer reviewed observational and RCT studies, as well as review papers discussing this. I suggest you remove this false statement about Ivermectin and COVID-19 entirely. And replace it with a more accurate articulation describing that it is highly disputed amongst scientists and practitioners and there is not a consensus regarding its efficacy in the case of preventing and treating COVID-19. Kwall926 (talk) 02:45, 8 June 2021 (UTC)

 Not done. Wikipedia reflects accepted knowledge as published in reliable sources. Alexbrn (talk) 08:34, 8 June 2021 (UTC)

"No evidence" is shorthand for "no evidence except the sort of useless, weak or crappy evidence you will get when something does not work but there are a lot of people trying to prove it does". --Hob Gadling (talk) 11:40, 8 June 2021 (UTC)

Kwall926, the burden is on you to provide the studies you mentioned. Then we can discuss if they are reliable or not for medical claims. Alaexis_¿question? 11:52, 8 June 2021 (UTC)

There are reliable sources that claim that ivermectine could be used to treat covid, those are already cited and references, hiding the conflict helps no one, treating scientific reaserch as misinformation is clearly a violation of WP:IMPARTIAL. Eloyesp (talk) 22:13, 11 June 2021 (UTC)

Those reliable sources are? --Hipal (talk) 23:50, 11 June 2021 (UTC)

"Laboratory studies found that ivermectin could block replication of SARS-CoV-2 (the virus that causes COVID-19), but at much higher ivermectin concentrations than those achieved with the currently authorised doses. Results from clinical studies were varied, with some studies showing no benefit and others reporting a potential benefit. Most studies EMA reviewed were small and had additional limitations, including different dosing regimens and use of concomitant medications."

"The NIH in February said that some clinical studies showed no benefits or worsening of disease after ivermectin use; other studies suggested using ivermectin had some benefits. "However, most of these studies had incomplete information and significant methodological limitations, which make it difficult to exclude common causes of bias," the NIH said."

A large majority of randomized and observational controlled trials of ivermectin are reporting repeated, large magnitude improvements in clinical outcomes. Numerous prophylaxis trials demonstrate that regular ivermectin use leads to large reductions in transmission. Multiple, large “natural experiments” occurred in regions that initiated “ivermectin distribution” campaigns followed by tight, reproducible, temporally associated decreases in case counts and case fatality rates compared with nearby regions without such campaigns.

Those references seems to make it clear that there exist "reliable sources that claim that ivermectine could be used to treat covid", on the other hand, most of them make it clear that there is still uncertainty about the effectiveness and the security of such a treatment, and that it is not yet recommended, but those already referenced sources do never claim something like "there is no reliable source for that claim". Eloyesp (talk) 02:08, 12 June 2021 (UTC)

"Natural experiments" are especially not WP:MEDRSes, and MEDRSes are the standard of evidence necessary to put a claim into this article. I am sorry but that article you cited from Pierre Korry conflicts with many other sources, and it itself is not a systematic review or meta-analysis. Which are the standard of evidence necessary to make such a claim. It is putting forth the same shoddy evidence standard Dr. Korry has put forth for ivermectin for many months now. And no matter how much lipstick you put on a pig, it will never be prom queen. The evidence is poor quality, it has poor controls, the control groups are not well-matched, it includes many different studies with different standards in the same group of analysis... all of which are fundamentally bad scientific practices. Until we can determine that a consensus of MEDRS publications supports the claims you're making, they should not be included in this article.--Shibbolethink ^{(♔ ♕)} 03:00, 12 June 2021 (UTC)

@Eloyesp: The American Journal of Therapeutics does not look good on SCImago, so WP:RSUW. As for the other two you mentioned, your emphasis is WP:UNDUE. See:

Laboratory studies found that ivermectin could block replication of SARS-CoV-2 (the virus that causes COVID-19), but at much higher ivermectin concentrations than those achieved with the currently authorised doses. Already in the first paragraph of Ivermectin#COVID-19. Results from clinical studies were varied, with some studies showing no benefit and others reporting a potential benefit. Most studies EMA reviewed were small and had additional limitations, including different dosing regimens and use of concomitant medications.

The NIH in February said that some clinical studies showed no benefits or worsening of disease after ivermectin use; other studies suggested using ivermectin had some benefits. "However, most of these studies had incomplete information and significant methodological limitations, which make it difficult to exclude common causes of bias," the NIH said.

EMA and NIH have already done the work of assessing evidence quality (WP:MEDASSESS). --Fernando Trebien (talk) 11:51, 12 June 2021 (UTC)

Clearly both quotes say that most of the studies had "limitations", thus they clearly state that some studies do not match with that criteria, so the article cannot read: "No reliable evidence exists". --Eloyesp (talk) 15:03, 12 June 2021 (UTC)

Maybe out of an abundance of scrupulousness, I have re-worded this to "Such claims are not backed by good evidence". Everybody should be happy now. Alexbrn (talk) 15:45, 12 June 2021 (UTC)

Thanks for the change, it is not the wording I would chose, but it at least makes clear your intentions are not bad.--Eloyesp (talk) 19:11, 12 June 2021 (UTC)

You are right to think that some of them had no such methodological limitations, but wrong to believe that this means they found some benefit. Therefore, there is still no reliable evidence. --Fernando Trebien (talk) 16:44, 12 June 2021 (UTC)

Same mistake again, I do not need to "believe they found some benefit", the burden is on you to provide prove that they found NO study that show a benefit.--Eloyesp (talk) 19:11, 12 June 2021 (UTC)

Absence of evidence ("None of these claims is supported by science") is different from evidence of absence ("Scientific studies have shown that these claims are false"). --Fernando Trebien (talk) 00:51, 13 June 2021 (UTC)

Please read carefully my words, I'm not doing any research myself, I do not claim that there is "absence of evidence", nor that there is "evidence of absence", I DO claim that the referenced sources do not support the claims written on the wikipedia article. What is made evident on your comment, is that you feel that your research on supporting evidence is what actually do support such claims, so you do not need that the actual references say exactly that, so the misrepresentation of the sources is actually just hiding a violation of WP:NOR.--Eloyesp (talk) 14:06, 16 June 2021 (UTC)

This is bizarre, to the extent I wonder if there is a language problem. Eloyesp's statement ("the burden is on you to provide prove that they found NO study that show a benefit") is wrong, to support the claim that "there is no good evidence". That is a fair summary, amply supported by excellent sources throughout the article. Alexbrn (talk) 14:11, 16 June 2021 (UTC)

Sorry Alexbrn, I do not discard a language problem. When I say "the burden is on you to provide prove that they found NO study that show a benefit" I mean that instead of saying some generic statement like "amply supported by excellent sources throughout the article" there might be a quote of one of such excellent sources that make clear that point. On the quotes that were already made from the excellent sources that are referenced in the article the wording used was less strong than the used on the "fair summary" (specially the original one, the new one is much better, thanks for that). But, as already explained, English is not my first language so the difference I observe between the referenced articles and the summary, when one sounds like a humble scientific thinking ("most of the studies where...") and the later as a newspaper headline ("there is no good evidence"), might not be that for an English reader.--Eloyesp (talk) 14:55, 16 June 2021 (UTC)

Many sources. For example the first says "the available data do not support its use for COVID-19 outside well-designed clinical trials"; when we say there is "no good evidence" to support its (assumed clinical) use, that is a fair reflection of that. Evidence needs to be "good" for something to be considered a viable treatment. Alexbrn (talk) 15:01, 16 June 2021 (UTC)

You seems to misunderstand my point, I'm not making a claim like "there is clear evidence that ivermectine do magic", that is not the case. If that were the case, I would be forced to prove that point, but I'm not.

I'm saying that the article makes a claim that is not sourced, adding references that do not prove the point, misrepresenting the referenced sources to make they say what they do not.

The article reads: "No reliable evidence exists to back up such claims." and references three articles that do not say that, forcing the sources to make the claim. If you find a source to support such a claim, please add that as a reference, but those three articles do not do it.

If your conclusion as an expert is that after reviewing multiple papers and a lot of research you have found not "reliable evidence to back up such claims" then write a paper about it and reference that paper on the article, but WP:NOR.

So I do not have to prove that there are reliable evidence (I'm not writing that on the article), but you need to reference the opposite or remove it.

Just to add a little of context: my last edit changed that very phrase for "The EMA and the FDA advises against this use because the available data do not support it" and that phrase is supported by the references given. Eloyesp (talk) 03:37, 12 June 2021 (UTC)

What we say is a good summary of what the EMA says ("the available data do not support it") along with all the other high-quality sources. Per WP:YESPOV this needn't be attributed as it's not in serious dispute. Alexbrn (talk) 06:09, 12 June 2021 (UTC)

Let me disagree with that, the phrase "No reliable evidence exists to back up such claims" is not a good summary for the "the available data do not support it", given that, the second one does not make clear who makes that claims and the context is also different. In the sourced article "it" refers to "an authorized and promoted treatment" while the wikipedia article is talking about ivermectin being beneficial on the treatment and prevention. While that might sound like a subtle difference I think it is not. --Eloyesp (talk) 15:03, 12 June 2021 (UTC)

For that to be a meaningful difference, you'd have to believe it was effective but that multiple health authorities still didn't approve it. That sounds like a conspiracy theory. Wikipedia likes to align itself with reputable sources like health authorities, and by that token Wikipedia's standard for what it "reliable evidence" or not is that same as those bodies have. Alexbrn (talk) 15:38, 12 June 2021 (UTC)

I'm going to remove the dispute tag on this, because now we are quibbling about one specific phrase. I get why it's contentious to some editors, but I believe the consensus is in favor of the current language, not only based on what's been said above, but also based on what has been said several times before on this talk page about this exact question. A dispute about a single phrase that is already arguing between "This is not supported by the evidence" and "there is no evidence to support" is truly not enough for a disputed tag in my humble opinion. If we can get a consensus on this talk page (or elsewhere) that this is actually disputed in credible articles published in journals worth reading (which this one is not), then I will personally add the tag back.--Shibbolethink ^{(♔ ♕)} 15:49, 12 June 2021 (UTC)

I think that is it not good for an encyclopedia to hide disputes and to force confidence. If there is some doubt on the scientific community it is always better to make clear what the positions are. It is clear in those referenced articles that they chosen to be very cautious with the wording they used (for example they used "most of the", instead of "none of the"). That kind of caution or openness to being wrong is very important on the scientific way of think. On the other hand, the language used on the wikipedia article seems to be much stronger and determinant (read less scientific). It is not the type of encyclopedia that I would like to build, I don't know how many of you value the clarity of strong language over the humble language of scientific thinking. At the very end, it seems that it is just another conflict of visions.

I'm over here, I made clear my point and I have no more energy, I'm very sad for this situation. I would like to ask for pardon if I offended someone, it was never my intention, and sorry for my English, it is not my first language.--Eloyesp (talk) 19:11, 12 June 2021 (UTC)

What are you talking about? The article says in the lede, "Such claims are not backed by good evidence." Is something wrong with that? The article say a lot more, but if you wnat to change parts of it, you need to be specific. Unspecific wailing and waving of hands will get you nowhere. --Hob Gadling (talk) 06:12, 15 June 2021 (UTC)

References

A preprint

I intend to post some relevant articles here:

• Biber, Asaf; et al. (31 May 2021). "Favorable outcome on viral load and culture viability using Ivermectin in early treatment of non-hospitalized patients with mild COVID-19 – A double-blind, randomized placebo-controlled trial" (Preprint). medRxiv. Sheba Medical Center, Israel. doi:10.1101/2021.05.31.21258081. Retrieved 19 June 2021. Seligne (talk) 20:54, 19 June 2021 (UTC)

It's a preprint. Editors trying to use preprints for COVID-19 can expect to get sanctioned, so why propose it? Alexbrn (talk) 04:55, 20 June 2021 (UTC)

Bryant, Lawrie, et al again

This Studie was Published in American Journal of Therapeutics: June 17, 2021 - Volume Publish Ahead of Print The Study is downloadable for Free. It finds an Average reduction in death of 62% with moderate-certainty evidence and an Average reduction of infection when used as a profilactic of 86% with low-certainty evidence (due to study design limitations and few included trials)

Here is a video by Dr John Campbell introducing the findings

Please excuse my "messy" talkpoint, but i am rather new to wiki-editing.

Please review this Information for acceptance in the main article.

 Not done not a good source, as discussed above in at least two sections. Alexbrn (talk) 06:44, 25 June 2021 (UTC)

After reading this Wikipedia article again, I fail to see why the above publication is not relevant in the covid misinformation section. The article reads as though no journal has peer reviewed and accepted meta analysis which suggests efficacy of Ivermectin against Covid. The section mentions "misleading websites" and a publication that was provisionally accepted and then rejected. If obviously low quality (qua scientific sources) sources such as "misleading websites" are relevant for context here, and I believe they are, so is a peer-review journal like the American Journal of Therapeutics, whose editorial board largely consists of faculty of an accredited, and arguably respected research university (see above). If a peer reviewed article that was ultimately rejected is relevant, a similar one that was published (or the fact that the same article was ultimately published) is important context, because an obvious question arises for anyone trying to assess whether such claims have been peer-reviewed, and the result of such review: Have the claims been ultimately published? It is counter-intuitive that an article being published would make it ineligible for inclusion on the page, whereas prior to having been published it would be eligible for inclusion (as evidence of misinformation). If the article had been rejected, it seems that that event would have been included in this section. I think the best course of action is to add the citation to the Covid Misinformation section to provide context, and to clearly state the caveats about the quality of the work, as discussed on this talk page. To be clear: I am not saying that the American Journal of Therapeutics articles should be cited as evidence for a claim like "Ivermectin is an effective treatment for Covid", in the Medical Uses section, which would require a much higher bar based on the standards discussed above. However, this is a section about the controversy itself, and if information deemed misinformation was published in a peer reviewed journal that is relevant to understanding the issue at hand. Tcx64 (talk) 14:15, 25 June 2021 (UTC)

This Covid Misinformation section looks to be at serious risk of violating Wikipedia:Neutral_point_of_view. Not the existence of the section, to be clear. But, for example, the use of the term "misleading", which is based on a paper from the journal One Health. The paper is classified as "Editorial Commentary", so it is not clear whether it was peer reviewed. It reads like an opinion piece. That's not an attempt on my part to smear the piece. However, "Editorial Commentary" is not a standard article type described on the Elsevier Site. One Health's website does not say either way as I can see.Tcx64 (talk) 14:15, 25 June 2021 (UTC)

Per WP:PARITY fringe claims and pseudoscience can be effectively debunked by lower quality sources (not that these - the BMJ in particular, are low quality). We could go into the weeds using Science-Based Medicine for commentary on the Bryant paper and its questionable nature, but this is would be undue I think. This is an article about an actually useful drug that is incredibly important in its legitimate use; there's a danger we pay too much attention to the ivermectin/COVID nonsense. There are over 700 secondary papers on non-COVID aspects of Ivermectin[2] vs. well, hardly any high-quality secondary publications ever on Ivermectin/COVID (because there's no high-quality research). All we have to discuss is the misinformation, and we're already at risk of overbalancing. Alexbrn (talk) 14:27, 25 June 2021 (UTC)

Your point about parity is well taken. I think your argument mostly points to addressing the issues I pointed out in here instead, where concerns aboutWP:PARITY wouldn't apply. However, that section basically mirrors the one in this page. Therefore the right approach may be to decouple these sections, making the misinformation section on this page much shorter. Tcx64 (talk) 14:52, 25 June 2021 (UTC)

Bryant, Lawrie, et al, yet again

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

The COVID-19 section does not provide a balanced view of Ivermectin's efficacy when used as a treatment for sars-cov-2. https://pubmed.ncbi.nlm.nih.gov/34145166/ states "Conclusions: Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally."

I would request the conclusion of the above meta-analysis is sighted and included in this section. — Preceding unsigned comment added by Brnn8r (talk • contribs) 06:53, 26 June 2021 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Bryant, Lawrie, et al

• Bryant, Andrew et al. (June 17, 2021) - Ivermectin for Prevention and Treatment of COVID-19 Infection (American Journal of Therapeutics) doi: 10.1097/MJT.0000000000001402

Conclusions: "Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally."--193.152.127.23 (talk) 21:47, 19 June 2021 (UTC)

@Alexbrn: Is this also a crap source?--193.152.127.23 (talk) 21:47, 19 June 2021 (UTC)

It's a low quality-journal (also the one Kory and Marik eventually got to accept their paper). So not useful, especially considering the WP:REDFLAG for this subject area. Alexbrn (talk) 04:54, 20 June 2021 (UTC)

@Alexbrn: Are you using any quantifiable metric to call the journal low quality? I see H Index of 62 (compared with over 1000 for Nature, Science, JAMA), so clearly it's not a top journal. I believe the relavent guideline you're using (including the WP:REDFLAG allusion) is "exceptional claims require exceptional sources", which states that multiple high quality sources are required for an exceptional claim.

In looking for a definition of or rubric with which to assess source quality, I can find the reliable sources guidelines, which states, "If you are unsure about the quality of a journal, check that the editorial board is based in a respected accredited university, and that it is included in the relevant high-quality citation index—be wary of indexes that merely list almost all publications, and do not vet the journals they list." Do you have a good idea of which citation index is a good reference for "high quality" in this case? As for the editorial board of the American Journal of Therapeutics, I checked the editor in chief and a few others and they appear to be from the Zucker School of Medicine, which is quite small, but is fully accredited as of 2015, and is ranked #66 by US News and World Report in the Best Medical Schools: Research category

Given the above, I think the journal checks at least one of the two boxes for being considered high-quality: editorial board based on well respected and accredited university, and journal being present in a high-quality citation index. I don't see any guidance indicating high quality implies high impact (e.g. as measured by H index). Again, I don't know about whether the journal appears in a citation index which would only include high-quality journals, but if you have evaluated the journal as low-quality, I can only assume you were not able to find it in one such index. Can you please elaborate? — Preceding unsigned comment added by Tcx64 (talk • contribs) 02:08, 21 June 2021 (UTC)

The previous discussion was at Talk:Ivermectin/Archive 2#Semi-protected edit request on 8 June 2021. One can use various metrics (an impact factor below 2 is sometimes invoked as a bright line, e.g.) but ultimately WP:CONTEXTMATTERS. For an area with known research fraud, and in which we have multiple unimpeachable medical sources pointing in one direction, an outlier low-quality journal (which has already published one discredited ivermectin paper) isn't going to cut it. As you say, WP:EXCEPTIONAL applies. (Update: the paper is discussed in some detail here and the concerns raised: questionable methodology and undisclosed conflicts of interest, further confirm that this source is not suitable for Wikipedia's purposes). Alexbrn (talk) 06:43, 21 June 2021 (UTC)

Interestingly, the author of that Science Based Medicine piece, David H. Gorsky, is listed as being on the editorial board of the American Journal of Therapeutics. The journal itself doesn't have great impact scores, but Wikipedia guidelines don't require "top-tier", nor should they. I cannot find guidelines supporting calling the Journal low-quality (though I am still unsure about which citation index should be used, I haven't yet found evidence it is predatory, at the very least). In light of the above, WP:CONTEXTMATTERS is in my opinion the more salient guideline here, pertaining to this particular paper. Not the journal as a whole. It seems that Gorski himself might agree. If Gorski is indeed on the editorial board, the fact that he would remain so and yet speak out against the paper is at least worth looking into. Gorski also appears to mock the journal for having published what he deems a hilarious argument made by Kory et. al. i.e. the ecological argument that regions where Ivermectin is used have better Covid outcomes. While I don't think this is nearly as hilarious or fallacious as does Gorski, I think this supports the idea the paper is more controversial than the journal itself. I do find it odd that he fails to mention he is on the board as an associate editor (though for all I know that editorial board list is out-dated).

The reason I'm carrying on about the quality of the journal is that the guidelines require evidence from multiple high-quality sources, which in the case of medical research would most likely be journals. If another paper is published at a journal that meets Wikipedia's standards for high quality, namely being listed on a reputable citation index and having a reputable editorial board, I think it would be quite difficult to argue for not including the claim that there exists evidence that Ivermectin is at least somewhat effective against Covid19. At a certain point defending keeping that claim off the page because WP:CONTEXTMATTERS, based on claims that aren't peer reviewed (albeit from experts like Gorski with high notoriety), starts to feel like a form of original research. — Preceding unsigned comment added by Tcx64 (talk • contribs) 14:25, 21 June 2021 (UTC)

On Wikipedia the position statements of major medical bodies and clinical guidelines are at the top of the tree alongside secondary sources in prestigious medical journals. We have several good sources on Ivermectin/COVID so there's no need to scrape the barrel with something in a minor journal that provokes hilarity in a source which is well-regarded for its coverage of fringe medicine. The "claims on the page" here flow from the WP:BESTSOURCES as they should. Alexbrn (talk) 13:40, 21 June 2021 (UTC)

In order to see how funny the reasoning regions where Ivermectin is used have better Covid outcomes is, you would have to be familiar with the unreliability of that method. Gorski explains further in the other article he links: [3], starting with "But let’s get back to what this trial really is". Also, you did not sign your badly indented contribution. --Hob Gadling (talk) 16:14, 21 June 2021 (UTC)

@Hob Gadling: I understand the argument about ecological analysis, and I'm not going to debate it here, but my disagreement lies in the magnitude of the doubt cast, not that doubt shouldn't be cast at all (in general I mean; perhaps this particular ecological analysis is particularly bad). Instead of merely assigning a judgment to my formatting, why not take a second to explain, or at least link to something useful? Obviously I'm not an experienced Wikipedia editor. Did I indent too many times? Anyway, I like Wikipedia and have used it as data for academic research for years, and have a vested interest in its credibility. I am not attempting to "go rogue" and edit a page where I don't have a strong understanding of the material. Alexbrn My concern is that if a result published in a prestigious journal is contradicted by a result in a not very prestigious journal, it will be thereby disallowed. I think you can see how this could be counter-productive. But if as you say, the American Journal of Therapeutics is well-regarded for its coverage of fringe medicine, and that is the reason for not including its articles as a source for a minority viewpoint, I think that evidence should be provided. When that documentation comes from an associate editor of the journal itself (i.e. Gorski), perhaps that makes the documentation even more credible! But it's not clear to me that Gorski meant to generalize beyond the papers in question to the journal as a whole. Please don't interpret my concern as suggesting foul play, because I'm not. It is pretty clear to me that there is a group of people who very much want to write on this page that Ivermectin is a promising Covid treatment, and there is a group of people that believe this would be highly irresponsible and based on terrible arguments. Not sure if you're doing so, but you would be wrong to interpret my concern as being in the former camp. I am getting the sense, however, that the latter camp is growing increasingly annoyed and as a result dismissive - perhaps for good reason. I appreciate the work people are doing to uphold Wikipedia's standards. Covid and it's treatment is a hugely important issue and more than anything I want to understand the reasoning behind decisions that are being made about how information is disseminated and controlled. I don't think I am alone in that desire.Tcx64 (talk) 17:03, 21 June 2021 (UTC)

I meant Science-Based Medicine is well-regarded for covering fringe medicine. In general, weak sources are not used to "undercut" strong ones but obviously much depends on context, the relative repute of the sources and so on. As always, if we stick to faithfully summarizing high-quality sources all shall be well. Alexbrn (talk) 17:10, 21 June 2021 (UTC)

Got it, I misinterpreted.Tcx64 (talk) 17:20, 21 June 2021 (UTC)

"Lab leak" cruft

The latest article in Science-Based Medicine on Ivermectin refers to the lab leak hypothesis as a conspiracy theory - this is in late June of 2021. I struggle to understand what is science-based about the author's viewpoint. 2600:1700:7CC0:4770:D24:AEA:246F:F713 (talk) 19:11, 23 June 2021 (UTC) No, it doesn’t. Brunton (talk) 10:03, 24 June 2021 (UTC) OK, it uses the word "disinformation" and not "conspiracy theory," which is actually even less defensible since "conspiracy theory" is merely negatively connoted, whereas "disinformation" actually passes factual judgment on both the claim and the intent of the individual making the claim. In any case it is revealing of clear bias on the part of the writer. 2600:1700:7CC0:4770:1905:B5EA:593B:F994 (talk) 04:40, 27 June 2021 (UTC) Not this article, but this one.--95.127.186.178 (talk) 08:00, 25 June 2021 (UTC) This article is about Covid Origins, not Ivermectine.Tcx64 (talk) 13:28, 25 June 2021 (UTC)

• Editors are reminded this page is for discussion of improvements to the article, and that this topic is under WP:Discretionary sanctions. Discussions about the lab leak/conspiracy theories are already derailing multiple pages on Wikipedia and are inappropriate here. Alexbrn (talk) 08:27, 25 June 2021 (UTC)

Ivermectin to be investigated as a possible treatment for COVID-19 in Oxford’s PRINCIPLE trial

Sorry, I didn't realize the paper I posted had been discussed already.

Perhaps some balance to the Ivermectin/COVID-19 discussion section could be achieved by stating it is being studied by reputable organizations, such as Oxford. https://www.ox.ac.uk/news/2021-06-23-ivermectin-be-investigated-possible-treatment-covid-19-oxford-s-principle-trial

The current impression given by the section is that Ivermectin's usage in treating COVID-19 is only supported by far-right conspiracy theorists. — Preceding unsigned comment added by 124.197.38.58 (talk • contribs) 07:26, 27 June 2021 (UTC)

Yes, the article already says "To resolve uncertainties from previous small or poor quality studies, a large scale trial being run by Oxford University, named PRINCIPLE, began recruiting test subjects in June 2021" and cites news coverage of that trial. Alexbrn (talk) 07:33, 27 June 2021 (UTC)

 Done

Toxicity Update

"Self-medication with a highly concentrated formula intended for horses has led to multiple hospitalizations, and overdose can lead to death, possibly due to interaction with other medications." -> this does not belong in the COVID research section but more in the toxicity section; additionally, further citations would be helpful for hospitalizations - the provided FDA source provides a minimal level of detail

"Ivermectin was generally well tolerated, with no indication of associated CNS toxicity for doses up to 10 times the highest FDA-approved dose of 200 μg/kg."Caprilyc (talk) 11:49, 27 June 2021 (UTC)

pmid:12362927 is a primary source failing WP:MEDRS. The FDA (which we cite) is by contrast an excellent source. I notice some concern from Braziliam medical organisations also.[4]. For obvious reasons, sourcing on this topic needs to be impeccable. Alexbrn (talk) 11:58, 27 June 2021 (UTC)

May be worth adding section on potential neurological side effects - here is a review of adverse events in cases treated for parasitic infection. Based on 1668 cases of adverse events: "The most commonly reported adverse events for ivermectin were pruritus (25.3%), headache (13.9%), and dizziness (7.5%)." 28 were associated with serious neurological adverse events likely unrelated to the underlying parasitic infection; 20 of these were associated with usage of concomitant medications. Caprilyc (talk) 12:09, 27 June 2021 (UTC)

Research: Cancer

A review of the antitumor effects of ivermectin that details several possible mechanisms of action, as well as cell culture and animal studies. "the in vitro and in vivo antitumor activities of ivermectin are achieved at concentrations that can be clinically reachable based on the human pharmacokinetic studies done in healthy and parasited patients."

References

Not a great source. Per WP:REDFLAG a better quality journal would I think be needed. Alexbrn (talk) 13:02, 27 June 2021 (UTC)

How about this review which also summarizes mechanisms and applicable preclinical evidence: "Many studies have proven that ivermectin exerts antitumour effects and might thus benefit patients with cancer after sufficient clinical trials." Caprilyc (talk) 13:18, 27 June 2021 (UTC)

References

Chinese research in a Dove Medical Press journal doesn't inspire the greatest confidence, but on the other hand the nothingburger of its conclusion ("The role of ivermectin in cancer remains to be discovered") is harmless enough to include, though I'm not sure it conveys much knowledge. Alexbrn (talk) 13:26, 27 June 2021 (UTC)

What is misinformation?

"Misinformation" should only be used to refer to a claim that has been falsified. As argued above, the use of the word "misinformation" appears to be a subjective conclusion reached by Wikipedia editors and not by a trusted secondary source. Ivermectin's potential for treating Covid is actively being studied by Oxford and others. While it is certainly possible that misinformation about ivermectin's effects have been spread, without specifying what this misinformation is, and how it has been falsified, its use in the introductory paragraph is itself bordering on misinformation.

Since the discussion above RE subjectivity has fizzled out with no action, and the editors have been warned not to "free talk" on this page, I am lodging my previously expressed concerns in the form of a clearly actionable proposal. 2600:1700:7CC0:4770:4C3B:1AF9:643D:6055 (talk) 23:22, 25 May 2021 (UTC)

• Disagree. Header sections are meant to be brief and summarize the content of the article. Not go into in depth definitions of what counts as "misinformation" and what does not. The body of the article should do that. The relevant style guide would be MOS:LEAD.--Shibbolethink ^{(♔ ♕)} 23:38, 25 May 2021 (UTC)

But it looks like the body of the article doesn't say what you say it should. ????--TMCk (talk) 23:47, 25 May 2021 (UTC)

Wikipedia is a work in progress. Let's do everything we can to not make it worse.--Shibbolethink ^{(♔ ♕)} 00:11, 26 May 2021 (UTC)

Well. That was a clear non response.--TMCk (talk) 00:16, 26 May 2021 (UTC)

In other words, I think we should add elaboration to the body, not the lead. That's what MOS:LEAD would tell us to do.--Shibbolethink ^{(♔ ♕)} 00:30, 26 May 2021 (UTC)

I'm not sure the guidelines would prescribe your solution vs. mine. What they certainly do establish is that the current lead is poorly matched to the body of the article.2600:1700:7CC0:4770:4C3B:1AF9:643D:6055 (talk) 00:40, 26 May 2021 (UTC)

Per WP:MOSLEAD as linked by User:Shibbolethink, "...the emphasis given to material in the lead should roughly reflect its importance to the topic, according to reliable, published sources. Apart from basic facts, significant information should not appear in the lead if it is not covered in the remainder of the article." The use of "misinformation" fails this criteria on multiple fronts. First, it is not elaborated in the body of the article, suggesting it should not appear in the lead. Second, the requisite importance of "misinformation" necessary to establish "lead" status, has to my knowledge not been established by reliable secondary sources (in fact, the term "misinformation" has not been used by reliable sources to my knowledge).2600:1700:7CC0:4770:4C3B:1AF9:643D:6055 (talk) 00:19, 26 May 2021 (UTC)

To further respond to User:Shibbolethink - "Header sections are meant to be brief and summarize the content of the article. Not go into in depth definitions of what counts as 'misinformation.'" At no point did I suggest the lead section should discuss definitions of "misinformation," as I agree that would be wildly inappropriate. Rather, the concern is that "misinformation" is not being directed at a specific target. Please be careful to respond to the actual proposal and not to mischaracterize what is being requested. 2600:1700:7CC0:4770:4C3B:1AF9:643D:6055 (talk) 00:23, 26 May 2021 (UTC)

My overall ask of you would be "Why don't we elaborate on it in the body instead of changing the lead?" Seems a much better and more justifiable approach in my opinion. And per my reading of the article, there actually is some elaboration on it. Could be more. Specifically under "Ivermectin#COVID-19_misinformation." You asked for the introductory sentence to be changed, I think it would be more appropriate to add more content about misinformation in the body.--Shibbolethink ^{(♔ ♕)} 00:30, 26 May 2021 (UTC)

If the article gave me a clear understanding of what justified the term, I would be more willing to adopt your approach. Unfortunately, I am still unclear on what "misinformation" in the lead is intended to refer to. As I described above in this talk page, I believe it to be a wholly inaccurate descriptor RE potential treatment of Covid. As highly reputable secondary sources report, its potential benefits are currently under study by Oxford and others, and by no means a settled question. If instead, "misinformation" refers to specific falsifiable claims such as "miracle cure," its usage would be more justifiable, though I would question its inclusion in the introductory section on a relevance basis. Nevertheless, until the claim is more clearly articulated in the header, and fully substantiated in the body with reliable secondary sources cited, I struggle to understand what merits its current usage.2600:1700:7CC0:4770:4C3B:1AF9:643D:6055 (talk) 00:38, 26 May 2021 (UTC)

Here are several RSes that use the term "misinformation" about ivermectin and COVID. I'll integrate them into the article when I get a chance. As for now they are a reliable source for the fact that the term "misinformation" has been applied to the use of ivermectin to treat COVID-19. We don't need MEDRS for that, by the way, since it's a matter of "are people saying X" not "is X a medical fact." Small distinction, but an important one. MEDRS would be better, but RS will do.--Shibbolethink ^{(♔ ♕)} 00:40, 26 May 2021 (UTC)

• Sorry, why's this hard? The misinformation is that ivermectin is a safe & effective COVID-19 treatment (or even a "miracle cure"!) peddled all over the web. We have a whole section about it at COVID-19 misinformation#Ivermectin which is linked. Alexbrn (talk) 03:47, 26 May 2021 (UTC)

comment - We have to follow WP:LEAD. It's bad idea to ignore misinformation around the drug. We know that it's under investigation currently. AXONOV (talk) ⚑ 18:46, 26 May 2021 (UTC)

comment - How is Polifact a reliable medical science source? Be specific.

References

Yes, the word "misinformation" should be omitted. To use it in this context is ... misinformation. No long term study has been done on Ivermectin's efficacy as a treatment for Covid, but many respected clinicians and scientists have suggested that there is empirical evidence that it could be an effective treatment.

This is a perfect example of a wikipedia article where the "talk" section is far more interesting and informative than the main page. The way in which so many wikipedia pages (like this one) are hijacked by vested interests pushing their agendas is incredibly disappointing. Pages should always be written in encyclopaedic format, with objective fact clearly separated from subjective opinion. Subjective opinion is still subjective opinion even if you can reference it! John2o2o2o (talk) 23:29, 26 May 2021 (UTC)

many respected clinicians and scientists - how many is "many"? how "respected" are they? - uttered a subjective opinion containing words like "suggested" and "could", which is is still subjective opinion, according to you, and suggesting that there is solid evidence for their opinion is misinformation.

Your claims of hijacking and vested interests are not appreciated either. They just show that your thinking runs on conspiracy theories rather than actual evidence. --Hob Gadling (talk) 11:03, 27 May 2021 (UTC)

Setting aside claims of hijacking, etc. Here are some high quality papers that show significant benefits of ivermectin in treatment of Covid. This paper which was previously included in the Wiki article, until it was removed when I pointed out the article was mischaracterizing it in a number of ways. And this paper, which I haven't seen any discussion of here. Caveat that I understand secondary sources take precedent over individual papers. But let's not act as though ivermectin's potential benefits could only possibly be a fringe belief that no "respected" clinician would support. Evidence exists to clearly contradict that, in my view.2600:1700:7CC0:4770:E5BA:10D5:B084:E7DA (talk) 23:01, 28 May 2021 (UTC)

Two broken links. The issue is not whether ivermectin has "potential benefits". The quacks boosting it are saying is has actual benefits which Big Pharma is concealing from you, and that it is a "miracle cure". Alexbrn (talk) 06:58, 29 May 2021 (UTC)

Two repaired links (Was easy, why didn't you do it?):

1) Carlos Chaccour, Aina Casellas, Andrés Blanco-Di Matteo, Iñigo Pineda, Alejandro Fernandez-Montero, Paula Ruiz-Castillo, et al., The effect of early treatment with ivermectin on viral load, symptoms and humoral response in patients with non-severe COVID-19: A pilot, double-blind, placebo-controlled, randomized clinical trial, EClinicalMedecine, Published by The Lancet, Volume 32, 100720, February 01, 2021 https://doi.org/10.1016/j.eclinm.2020.100720

12 patients of 24, were given high doses of Ivermectin (400 μg/kg i.e 28 mg for a 70 kg patient) in summer 2020.

Conclusion: “The positive signal found in this pilot warrants the conduction of larger trials using ivermectin for the early treatment of COVID-19. Such trials should include patients with risk factors for severe disease as well as patients with pneumonia. The potential for a mechanism of action different to direct antiviral effect also opens the door for pre-exposure prophylaxis in high-risk groups.”

2) O E Babalola, C O Bode, A A Ajayi, F M Alakaloko, I E Akase, E Otrofanowei, O B Salu, W L Adeyemo, A O Ademuyiwa, S Omilabu, Ivermectin shows clinical benefits in mild to moderate COVID19: a randomized controlled double-blind, dose-response study in Lagos, QJM: An International Journal of Medicine, 2021;, hcab035, https://doi.org/10.1093/qjmed/hcab035

3 groups totaling 60 patients: (IV: Ivermectin)

“Conclusions: 12mg IV regime given twice a week may have superior efficacy over 6mg IV given twice a week, and certainly over the non IV arm of the study. IV should be considered for use in clinical management of SARS-COV2, and may find applications in prophylaxis in high risk areas.”

From those two article one cannot conclude that saying (as now written in the intro of the article) that “claiming that ivermectin was beneficial for treating and preventing COVID-19” is “misinformation”! Ceveris (talk) 12:09, 29 May 2021 (UTC)

Study (1): The positive signal found in this pilot warrants the conduction of larger trials using ivermectin for the early treatment of COVID-19 This does not mean that it works. This means that more research is needed. The article also says that The ivermectin group had non-statistically significant lower viral loads (one cannot conclude much from that), as well as lower IgG (perhaps a good sign, but these are not neutralizing antibodies), Patients in the ivermectin group recovered earlier from hyposmia/anosmia (looks similar to favipiravir, which shortens disease length but has no effect in reducing mortality; more research is needed). In any case, a sample size of 24 participants is too small.

Study (2): QJM is not a good source, check SCImago.

From those two article one cannot conclude that saying (as now written in the intro of the article) that “claiming that ivermectin was beneficial for treating and preventing COVID-19” is “misinformation” Promoting this treatment to the lay public is misinformation until a benefit is demonstrated through serious research. Ivermectin is mildly hepatotoxic and prolonged use may cause liver damage. On a large scale, this in itself can do a lot of harm, and the illusion of protection will likely lead to risk compensation which will increase transmission rates of the new coronavirus.

Speaking of sample sizes, the EPIC trial had 398 participants. Its conclusion is that ivermectin did not significantly improve the time to resolution of symptoms. and that ivermectin does not significantly affect the course of early COVID-19, consistent with pharmacokinetic models showing that plasma total and unbound ivermectin levels do not reach the concentration resulting in 50% of viral inhibition even for a dose level 10-times higher than the approved dose. --Fernando Trebien (talk) 03:16, 30 May 2021 (UTC)

Yeah, two unreliable sources failing WP:MEDRS. For a source to be admissible it needs to be a secondary source (like if this systematic review ever got reputably published - it's a preprint now so unusable). Until then we know from the WP:BESTSOURCES that there's no good evidence of benefit, some risk of harm, and that despite this a number of quacks and conspiracy theorists are spreading misinformation that "#ivermectinworks". Alexbrn (talk) 04:55, 30 May 2021 (UTC)

I think the sources in the article clearly support the advice against indiscriminate use. But I hope this gets reviewed and published soon. --Fernando Trebien (talk) 21:01, 31 May 2021 (UTC)

"Study (2): QJM is not a good source, check SCImago." *checks SCImago* "QJM is a long-established, leading general medical journal" 2600:1700:7CC0:4770:49D9:257:F3AA:50DD (talk) 23:12, 31 May 2021 (UTC)

Look at the quartiles. Once reputable journals may decline. --Fernando Trebien (talk) 20:02, 4 June 2021 (UTC)

To further defend my post you are replying to, while the sample is small in the first study, they found a symptom reduction result with a < 0.001 p value. I of course would like to see that result replicated, but they themselves report this as a significant benefit. You are correct that they found non-significant viral load reduction on top of that result, which the study was not properly powered to detect, unlike the symptom reduction finding (sample size). Note also that I am not trying to claim that "it works," just that some respected scientists (not fringy nuts) have performed studies showing significant benefits. These claims are somewhat different. In order to be sure that "it works," I would agree that I would like to see replication and larger sample sizes. Note that the study you cite with 398 participants was subject to a number of procedural errors and post-hoc modifications. 2600:1700:7CC0:4770:49D9:257:F3AA:50DD (talk) 23:26, 31 May 2021 (UTC)

Amateurs who think that reliability of sources is a yes-no question are a scourge of Wikipedia.

Something which was published in a "leading general medical journal" is still not necessarily a source we can use on Wikipedia. If it is a primary source about one study, as this one, it definitely is not. Read WP:MEDRS and WP:WHYMEDRS. --Hob Gadling (talk) 07:08, 4 June 2021 (UTC)

If the "evidence" is that thin, then considering the size of the controversy around it, there is an even stronger reason to wait for systematic reviews published in reliable sources. And yes, that study has some known flaws and maybe it is better to remove the reference, as long as we do not replace it by another study that is even more flawed. --Fernando Trebien (talk) 20:02, 4 June 2021 (UTC)

Wow, it appears as though the exactly wrong approach has been taken with this article since my original comment. "Misinformation" has been clarified...but to refer to things that are specifically not misinformation. It seems this article becomes more opinionated and biased against the evidence, as more evidence comes out. Really fascinating. 2600:1700:7CC0:4770:D24:AEA:246F:F713 (talk) 19:07, 23 June 2021 (UTC)

Since there is no solid evidence that "ivermectin was beneficial for treating and preventing COVID-19", claiming that there is such solid evidence is misinformation. Pretty simple. --Hob Gadling (talk) 13:22, 24 June 2021 (UTC)

Disagree. Even official sources like WHO, NIH at most claim that there is low certainty of evidence in favor of ivermectin and more research is needed. They do not claim evidence of no effect, or evidence of harm. NIH is running Phase III trials. Claiming "misinformation" about benefit implies high certainty of no benefit, not low certainty of benefit. Caprilyc (talk) 13:57, 27 June 2021 (UTC)

"Evidence of no effect" is a curious concept. The assumption is that a drug is ineffective unless good evidence shows otherwise. There is concern about harm, and from reliable sources. Given the state of the evidence, an unqualified assertion (as has been made by Pierre Kory for example) that "[ivermectin] basically obliterates transmission of this virus. If you take it, you will not get sick" is in-your-face misinformation, unless in thrall to the fallacy of future vindication. Alexbrn (talk) 14:46, 27 June 2021 (UTC)

I saw what you did there. Nobody said "Evidence of no effect", it was always about "no evidence of any effect". --Hob Gadling (talk) 15:14, 27 June 2021 (UTC)

WHO / COVID-19

The official WHO literature review summarizing the available research shows improvements in 7 outcomes: lower mortality, lower need for mechanical ventilation, higher viral clearance and lower time to viral clearance, lower hospital admission, lower time to clinical improvement, and shorter duration of hospitalization, though the certainty of the evidence on both benefits and frequency of adverse events is rated as low. Last update published on 3/15/21. Point being even official WHO lit review with strict exclusion criteria for the studies included shows positive effect of ivermectin treatment and calls for further research. Caprilyc (talk) 13:43, 27 June 2021 (UTC)

References

No good evidence of benefit, so recommend against clinical use. Same story as it's been for a long time. The big trials underway should paint a clearer picture. Alexbrn (talk) 13:50, 27 June 2021 (UTC)

Nit pick. "No good evidence" does not mean the same thing "insufficient high quality evidence." There is a meaningful difference between quality and certainty. The fact that WHO has issued recommendations based on 8 studies with outcomes summarized in their living recommendation implies there is some high quality evidence, but it does not meet the threshold of sufficient certainty to advocate widespread use. Caprilyc (talk) 17:06, 27 June 2021 (UTC)

The WHO assessment is that all the evidence is poor. There is no good evidence. We need to stick to the sources rather than inventing things about "implications". Alexbrn (talk) 17:26, 27 June 2021 (UTC)

NIH Running Phase III Trial of Ivermectin: ACTIV-6

"ACTIV-6: COVID-19 Outpatient Randomized Trial to Evaluate Efficacy of Repurposed Medications" currently recruiting 15000 participants for a double-blind, placebo-controlled, RCT investigating ivermectin as a treatment for COVID-19. Caprilyc (talk) 13:02, 27 June 2021 (UTC)

References

 Done

@Alexbrn Thanks for adding ref to NIH trial to main article. I think it is important to paint a clearer picture of how seriously official sources are considering this as a potential treatment. Consider rephrasing "Such claims are not backed by sound evidence" in intro to "Promising initial research showing benefit suffered from methodological limitations and was insufficient to issue recommendations for treatment. Larger randomized controlled trials to assess efficacy and safety are currently in progress in both the US and UK." WP:NPOV There's a difference between a completely unproven fringe treatment and something that is promising enough to be considered for trials at this scale. Caprilyc (talk) 14:11, 27 June 2021 (UTC)

Clinically there's not. The respectable position is this is not to be used (but research is okay) because there is no good evidence (but lots of crap). Meanwhile ivermectin quackery/conspiracism/antivax talking points are rampant. The result of the research could of course show this drug is useless or worse for COVID. Alexbrn (talk) 14:23, 27 June 2021 (UTC)

Respectfully disagree. The respectable position is that this is not to be recommended (but research is okay) because there is a small amount of good evidence (and also lots of crap). I completely agree that more research is needed, but conflating the misinformation that is out there with a complete lack of good quality evidence in favor of benefit is also not constructive to the discussion, or an accurate representation of the current literature. Caprilyc (talk) 14:46, 27 June 2021 (UTC)

Well fortunately we do not need to decide as editors what is misleading, as it is covered in good sources which we cite. It is rife, from the research through to social media pundits. Alexbrn (talk) 14:59, 27 June 2021 (UTC)

I can respect the emphasis on maintaining rigor. What level of evidence in favor of ivermectin would be sufficient to remove the wording about claims about its benefit equaling misinformation? Positive outcomes from the currently in progress large scale RCTs? A favorable meta-analysis published in a high quality medical journal? Caprilyc (talk) 17:10, 27 June 2021 (UTC)

You're wanting to venture into the realms of WP:Original research. Sources describe the quackery/disinformation/misinformation etc. Wikipedia reflects that. That is the purpose of an encyclopedia. It's not our job to re-legislate the topic. Alexbrn (talk) 17:31, 27 June 2021 (UTC)

If I understand correctly you mean to indicate that having a public health authority at the level of WHO/FDA/CDC/NIH/EMA legislate or advocate ivermectin as an approved, or emergency authorized treatment for COVID, would be sufficient evidence to remove the description "misinformation." Is that accurate? Caprilyc (talk) 17:49, 27 June 2021 (UTC)

No. Just follow the sources. Alexbrn (talk) 17:51, 27 June 2021 (UTC)

Sorry @Alexbrn I'm not sure I follow. What do you mean by "follow the sources?" Per WP:MEDRS: "Ideal sources for biomedical information include: review articles (especially systematic reviews) published in reputable medical journals; academic and professional books written by experts in the relevant fields and from respected publishers; and guidelines or position statements from national or international expert bodies." I am just trying to understand better what the criterion of evidence would have to be to reclassify favorable results as not simple misinformation. Caprilyc (talk) 18:00, 27 June 2021 (UTC)

Misinformation is more a socio-political phenomenon covered in non-WP:MEDRS sources - although obviously there is some overlap with biomedicine. If Wikipedia needs to cover the antics of the ivermectin propagandists, as mentioned in good sources, those sources are unlikely to be WP:MEDRS ones. It is not up to Wikipedia editors to "reclassify" things; we follow sources. In the event ivermectin turns out to be a miracle cure, no doubt some sources will appear saying how various pundits luckily guessed right beforehand. Wikipedia would then report what those sources said. Alexbrn (talk) 18:08, 27 June 2021 (UTC)

To circle back around "misinformation" is fundamentally related to the assumption "Such claims are not backed by sound evidence" as it's obviously not misinformation to advocate for something that is proven to work. I think there are three issues at play here: (1) the quality of the scientific evidence for or against ivermectin as a treatment for COVID (2) the simple legal status of ivermectin approval for a particular indication, in this case COVID (3) the representation of the effectiveness of ivermectin as a treatment in media and social media. So if I understand correctly, the label "misinformation" is primarily related to (3) above. If higher quality data in favor of ivermectin as a treatment emerges, would the summary of (1) be updated to reflect the emerging evidence before (2) changes? I ask because there is a meaningful difference between drugs having a scientifically proven effect, and their approval for treatment for any particular indication. I assume if we get to the point where for example WHO approves it, it is because the sum total of the evidence is in favor. But in this hypothetical there would be some period of time after new research has emerged before the guidelines are updated. Caprilyc (talk) 18:27, 27 June 2021 (UTC)

Again, you're fundamentally mistaken in thinking that Wikipedia is based on some kind of internally-agreed editorial narrative. It just reflects sources. If the sources changes, Wikipedia follows. Trying to speculate about how that might happen is fruitless. We are where we are: there's no good evidence ivermectin is useful for COVID-19, but some charlatans are pumping out misinformation to the contrary. Wikipedia can't fix reality as reported in WP:RS, only reflect it. Alexbrn (talk) 18:34, 27 June 2021 (UTC)

I am primarily trying to understand better what is considered a reliable source. I don't want to waste your time (or mine!) by bring in low quality research from questionable journals so I would like to know what level of future evidence would meet the threshold of a source changing. I am not trying to change your mind about the current level of evidence, but can you please describe what criteria would need to be met for this article to reflect a changed reality? Per WP:MEDRS I would deduce that favorable recommendation or licensure from large-scale public health authorities like EMA/CDC/NIH/WHO/FDA and/or a favorable meta-analysis in something reputable like BMJ or some other Abridged Index Medicus journal. Would that be sufficient? Caprilyc (talk) 18:50, 27 June 2021 (UTC)

It would depend. WP:CONTEXTMATTERS and there's a lot of context in this topic area. If you want to understand how Wikipedia works, start at WP:5P. 18:54, 27 June 2021 (UTC)

Thank you! Will take a look. Caprilyc (talk) 19:18, 27 June 2021 (UTC)

Increase in Outpatient Ivermectin Dispensing in US During Pandemic

I think this is cool and worth adding to the COVID research section - unrelated to clinical efficacy for treatment, but showing an increase of number of ivermectin prescriptions dispensed in the US markedly increased. "During March 16, 2019–April 2, 2021, national estimates of ivermectin dispensed from outpatient retail pharmacies increased from an average of 3589 prescriptions per week at the pre-pandemic baseline to a peak of 39,102 prescriptions in the week ending on January 8, 2021 (989% relative percent increase)" and "the increase in the number of outpatients who received ivermectin from retail pharmacies observed during the pandemic followed publication of the previously mentioned in vitro study" Caprilyc (talk) 19:29, 27 June 2021 (UTC)

References

It's not research and "cool" is not a good reason to add anything to Wikipedia. We'd need some secondary sourcing on this to make sense of it. Alexbrn (talk) 19:34, 27 June 2021 (UTC)

Here is a related review with similar conclusions. "Although the National Institutes of Health COVID-19 Treatment Guidelines Panel has not recommended outpatient use of ivermectin, zinc, or dexamethasone for treatment or prevention of COVID-19, increased dispensing of each of these products has coincided with a national increase in COVID-19 cases beginning in July 2020 and another national increase in the fall which continued into December 2020." I think it is relevant information to add to the research section because it is in line with the "Self-medication with a highly concentrated formula intended for horses has led to multiple hospitalizations, and overdose can lead to death, possibly due to interaction with other medications" - it points to the fact that there has been widespread usage of both DIY self-medication via animal products, as well as widespread off-label usage of the actual prescription medicine. Caprilyc (talk) 19:55, 27 June 2021 (UTC)

References

National guidelines

Currently the article contains the positions of the WHO, CDC, European Medical Agency (EMA) whose consensus is that ivermectin should not be used for treating covid until clinical trials are done. Also, the usage of ivermectin in a number of countries in Latin America is mentioned, together with the recommendations of the relevant bodies. Recently India's health ministry has published guidelines recommending the use of ivermectin for treating some Covid patients. The questions are

1. Should the positions of national public health agencies on ivermectin be mentioned in this article?
2. If yes, which public health agencies? Only CDC and EMA or also of other major countries?
3. If no, does this information belong to another article? Alaexis_¿question? 19:54, 25 May 2021 (UTC)

To be clear, the question is not about the effectiveness of ivermectin against COVID (as far as I can see the consensus is that there is no proof that it works) but about the notability of the recommendations issues by various national and supra-national bodies. Alaexis_¿question? 19:57, 25 May 2021 (UTC)

Survey

• Nonsensical question. EMA and CDC are not "countries". Does the OP envisage a list of countries and if so how many? 30? 40? 50? Alexbrn (talk) 19:57, 25 May 2021 (UTC)

  CDC is a public health agency of the US, while the EMA is the EU's agency in charge of evaluating medicinal products. This is exactly what I meant by national and supra-national public health agencies. Alaexis_¿question? 20:01, 25 May 2021 (UTC)

  Just saw that I didn't answer the question. If and when all the countries in the world publish their official guidelines, I would summarise it "The position of the CDC and EMA and X other countries, including BigCountry1, BigCountry2, is A; the position of health agencies of Y other countries, including BigCountry3, BigCountry4, is B." If X >> Y and the minority position is not held by major countries, we can ignore it and only write about the mainstream one per WP:FALSEBALANCE. But it's very hypothetical, now we only have a handful of countries and we can easily deal with new information when it comes. Alaexis_¿question? 12:24, 27 May 2021 (UTC)

• Another pointless endeavor. Just give up already, only one view can be reflected on this topic. Adriaandh (talk) 09:17, 27 May 2021 (UTC)

  I understand you are in favour of mentioning the positions of health agencies of major countries even if it's different from the mainstream view? Alaexis_¿question? 12:24, 27 May 2021 (UTC)

I'm in favor of an unbiased reporting on the evidence in favor and against the efficacy of ivermectin and I am in favor of classifying peer reviewed scientific studies as higher quality than APNews fact checks. I am also in favor of reporting all the facts and not just the ones that fit with a specific narrative. I am in favor of free speech and objective media/journalism that does not merely report what a certain government institution mandates. Indeed, I consider the government guidelines of a huge country such as India, which incidentally has a very strong pharmaceutical sector, to be noteworthy if not of equal importance to that of the agencies in the United States, especially considering the country has a population of about 4 times that of the USA, thus their policies affect 4 times the amount of lives. All of this is irrelevant since no amount of voting is going to change this section. Adriaandh (talk) 01:17, 28 May 2021 (UTC)

• Yes. Recommendations from any Public Health Agency or Government could be referred to, not restrained to CDC and EMA. (I was just trying to add a paragraph about the use of Ivermectin as a treatment for Covid-19 based on the decision of the Government of Goa and the Government of Uttar Pradesh.) With respect of WP:GEVAL. It could be presented the way it is in fr.wikipedia. Ceveris (talk) 19:23, 28 May 2021 (UTC)

Discussion

• By convention, CDC, WHO, and EMA set the standards everybody else follows. That's why CDC has investigators in multiple other countries while other countries usually do not. They did it first, and have, so far, done it best (with a few hiccups). What we have so far about other countries' use of Ivermectin makes sense, because listing a few of the countries that are doing it anyway is clearly notable. But anything further would be undue weight, and an excessively long list would be WP:LISTCRUFT. I think having an entire section on India is clearly and evidently excessive. It would be filled with non-MEDRS, as Alexbrn has already stated the India public health agency has a lot of problems with pseudoscience.--Shibbolethink ^{(♔ ♕)} 21:27, 25 May 2021 (UTC)

  So you are saying that we need to have WHO, CDC and EMA as they are most reliable and notable cases of countries straying from these recommendations, is it a fair summary? I'm not proposing a section on India, more like a sentence, or even having one sentence about countries that are doing it anyway contrary to the WHO recommendations which would include both India and the Latin American countries that are already mentioned. Alaexis_¿question? 05:23, 26 May 2021 (UTC)

  As a bit of background here, there was a time when certain ivermectin advocates were pushing to include countries that seemed to endorse Ivermectin (Belize IIRC!) but downplay those that didn't, and it was a rapidly changing scene. Rather than try to have a "dashboard" of national positions it was probably better to skim off the most reputable MEDRS. The wider context here is that in the real world (of medical sources too) ivermectin is a very important drug for its antiparasitic properties, and all this COVID stuff is just a fringe shitshow on the side, which we're in danger of giving too much attention to already. Alexbrn (talk) 05:31, 26 May 2021 (UTC)

  Wrong decisions are also notable, if it's the country the size of India that makes it. The statement that ivermectin cures COVID can be described as a fringe position. But it's not the question that is asked here! Alaexis_¿question? 08:28, 26 May 2021 (UTC)

  The fringe-iness is relevant, because per WP:GEVAL we aren't meant to air fringe ideas (like India's wrt ivermectib) without mainstream context. Hence we would need good secondary commentary. Alexbrn (talk) 08:36, 26 May 2021 (UTC)

  That's a wrong interpretation of policy. Treating dental pain with cocaine is a terrible idea but we mention it in the article about cocaine as it actually happened. Alaexis_¿question? 09:44, 26 May 2021 (UTC)

  It's not an "interpretation" of policy, it is policy itself. We don't bother with obviously historical but if some idea took hold today that cocaine was a great dental pain treatment then yes, it would be governed by WP:FRINGE (assuming it was not mainstream too!) Alexbrn (talk) 09:50, 26 May 2021 (UTC)

  Now you are inventing the distinction between historical and current ideas which is not based on any policy whatsoever. Alaexis_¿question? 10:52, 26 May 2021 (UTC)

Well no, Wikipedia in general doesn't attempt to legislate WP:CLUE. As it happens, in this case, there is some specific supplemental guidance on medical history given at WP:BMI. But if you are concerned the description of an 1879 cocaine experiment represents the undue promotion of a WP:FRINGE theory, then you know how it goes (but maybe expect pushback). Why stop there though? You could progress, say, to Cucking stool and demand that Wikipedia clarifies that witches don't really exist as this is a WP:FRINGE notion! Alexbrn (talk) 12:08, 26 May 2021 (UTC)

Can Wikipedia say that the Indian government is officially using it? Yes, it's a relevant fact. Can Wikipedia suggest that it prevents COVID-19? No, the justification used by Goa was based on a scientific article published in a journal with poor indicators. Can Wikipedia suggest that the Indian health agency must be right and that CDC, WHO and EMA are all wrong? Not as a biomedical claim. Can Wikipedia suggest that the CDC, WHO and EMA are involved in some sort of conspiracy against ivermectin? No, but it could describe the controversy in a neutral way, but this article is not the right place. Here, the tone must be appropriate for the lay reader, writing that India's use of ivermectin goes against international consensus and at a time of despair. In addition, "to keep positivity" (as The Indian Express says) makes the political intention quite obvious. I suggest reading this article in Politico for context. --Fernando Trebien (talk) 00:45, 29 May 2021 (UTC)

Can Wikipedia say that the Indian government is officially using it? Well, maybe. But the important question is, should Wikipedia say this? And the answer to that, per GEVAL and FRINGE, is “no”. Brunton (talk) 09:28, 29 May 2021 (UTC)

I believe that I am as concerned about the bad consequences of this as you are. But the way I understand WP:GEVAL and WP:FRINGE is that they prohibit stating things like "ivermectin works" and then citing the Indian government as a source to support such claims. Saying who did what would not really violate these policies, especially if accompanied by sourced expert criticism. To some extent, this has already been done for other instances in COVID-19 misinformation#Ivermectin and Ivermectin#COVID-19 misinformation. --Fernando Trebien (talk) 12:46, 29 May 2021 (UTC)

In addition to Politico (which presents the political side of the issue), I also recommend reading this BMJ article which provides the scientific side. --Fernando Trebien (talk) 13:00, 29 May 2021 (UTC)

That's right, we are not stating that "ivermectin treats covid" but rather "Indian health ministry recommends it as a covid treatment."I think the relevant policy here is WP:BALASP:

“ An article should not give undue weight to minor aspects of its subject, but should strive to treat each aspect with a weight proportional to its treatment in the body of reliable, published material on the subject. For example, discussion of isolated events, criticisms, or news reports about a subject may be verifiable and impartial, but still disproportionate to their overall significance to the article topic. ”

Applying this to the endorsements by national health agencies, the position of WHO, CDC and EMA should be mentioned first and more prominently that that of Indian health ministry. Alaexis_¿question? 18:34, 29 May 2021 (UTC)

Now inevitably, this.[5] Further evidence of why Wikipedia shouldn't attempt to be some kind of news tracker based on transient information in weak sources. Alexbrn (talk) 14:41, 7 June 2021 (UTC)

Zein et al: Ivermectin and mortality in patients with COVID-19

Another systematic review and meta-analysis. "Ivermectin was associated with decreased mortality in COVID-19 with a low certainty of evidence. Further adequately powered double-blinded placebo-controlled RCTs are required for definite conclusion." Caprilyc (talk) 02:35, 3 July 2021 (UTC)

References

Comparing with the OUP review -

Ravikitri 2021, Niaee 2020, and Lopez-Medina 2021 are common to both.

Elgazzar 2020, Galan 2021, Gonzalez 2021, Hashim 2020, NCT04523831, and NCT04646109 are unique to Zein et al.

Chachar 2020, Krolewiecki 2020, Podder 2020, Ahmed 2021, Beltran 2021, Karamat 2021, and Chaccour 2021 are unique to Roman et al.

Roman et al neither searched the "Clinicaltrials.gov" database nor enlisted studies which had anything other than SoC/Placebo as control. Hashim 2020 had Dox in combination. That explains the relative exclusions except Gonzalez 2021, which would have only reinforced their assessment.

I cannot explain the relative exclusions of Zein et al. TrangaBellam (talk) 05:42, 3 July 2021 (UTC)

This is a diabetes journal, which is a warning flag. Alexbrn (talk) 06:07, 3 July 2021 (UTC)

(edit conflict)Thanks. How did I miss that. Overall, an inferior review. TrangaBellam (talk) 11:47, 4 July 2021 (UTC)

They were specifically looking at how diabetes, hypertension, and coronary artery disease affect outcomes: "The data of interest for this systematic review were the first author, study design, ivermectin dose, sample size, percentage of severe COVID-19, age, sex, diabetes, hypertension, coronary artery disease, and mortality." Caprilyc (talk) 11:45, 4 July 2021 (UTC)

The greater issue is why were studies having anything other than SoC/Placebo as control entertained? Elgazzar 2020, Galan 2021, and NCT04646109. I guess that you understand the obvious lacunae with using such studies.

And, why were the studies unique to Roman et al. ignored? TrangaBellam (talk) 13:04, 4 July 2021 (UTC)

@TrangaBellam Per WP:MEDRS "Respect the levels of evidence: Do not reject a high-level type of source (e.g., a meta-analysis) in favor of a source from lower levels of evidence (e.g., any primary source) because of personal objections to the inclusion criteria, references, funding sources, or conclusions in the higher-level source. Editors should not perform detailed academic peer review." Caprilyc (talk) 13:42, 4 July 2021 (UTC)

Do not be ridiculous that all journals are of an equal standard. TrangaBellam (talk) 15:40, 4 July 2021 (UTC)

Hariyanto et at: Ivermectin and outcomes from Covid-19 pneumonia

Another favorable meta-analysis published in Reviews in Medical Virology:

We systematically searched the PubMed, Europe PMC and ClinicalTrials.gov database using specific keywords related to our aims until 10th May 2021. All published randomized clinical trial studies on Covid‐19 and ivermectin were retrieved. The quality of the study was assessed using Jadad scale assessment tool for clinical trial studies. Statistical analysis was done using Review Manager 5.4 software. A total of 19 studies with 2768 Covid‐19 patients were included in this meta‐analysis. This meta‐analysis showed that ivermectin was associated with reduction in severity of Covid‐19 (RR 0.43 [95% CI 0.23–0.81], p = 0.008), reduction of mortality (RR 0.31 [95% CI 0.15–0.62], p = 0.001), higher negative RT‐PCR test results rate (RR 1.23 [95% CI 1.01–1.51], p = 0.04), shorter time to negative RT‐PCR test results (mean difference [MD] −3.29 [95% CI −5.69, −0.89], p = 0.007), higher symptoms alleviations rate (RR 1.23 [95% CI 1.03−1.46], p = 0.02), shorter time to symptoms alleviations (MD −0.68 [95% CI −1.07, −0.29], p = 0.0007) and shorter time to hospital discharge (MD −2.66 [95% CI −4.49, −0.82], p = 0.004). Our study suggests that ivermectin may offer beneficial effects towards Covid‐19 outcomes.

Caprilyc (talk) 22:06, 3 July 2021 (UTC)

References

Caprilyc, Extremely low quality meta-analysis, given that they included every single trial regardless of outcome measure, control group, blinding, etc. Would not rate very highly on the Cochrane Collab's scale [6].--Shibbolethink ^{(♔ ♕)} 01:13, 4 July 2021 (UTC)

Shibbolethink can you be more specific about this? In the section discussion selection criteria they say:

"Among the 95 evaluated full‐text articles for its eligibility, 47 articles were excluded due to unposted results (still recruiting or withdrawn), 20 articles because the study designs are not randomized clinical trial study (non‐randomized clinical trial, cross‐sectional, observational studies, case‐series), 5 articles because of no control/comparison group in the studies, 3 articles because of they do not mention the criteria of our outcome of interest and 1 article because the article was not in English. At last, the meta‐analysis included 19 randomized clinical trial studies with a total of 2768 Covid‐19 patients. Amongst them, 10 were open‐label randomized clinical trial studies, while the rest nine studies were double‐blind randomized clinical trial studies."

are you referring to the fact that the review is looking a more than just double-blind studies? All have control groups. And why is considering more than one outcome measure a bad thing? Caprilyc (talk) 01:33, 4 July 2021 (UTC)

Caprilyc, A) should be double blind. The fact that they included both blinded and unblinded trials means their results are worthlessof a heavily reduced value. Systematic meta-analyses should be based on the best available evidence not all available evidence, B) need to have very specific criteria for when and how a patient is excluded. If they exclude every patient who gets worse, then how is that a fair comparison? (this was a cardinal sin committed by Didier Raoult in his first few studies, for example), C) was the control group really a control? (they allowed control groups who were given a different non-standard of care drug, which could have made patients worse), D) It doesn't matter that they used more than one outcome, that's great. What matters is that they didn't, as far as I can tell, make sure that each outcome measure was measured the same way. That's another cardinal sin in systematic reviews. You have to make sure everybody's on a level playing field. This, to me, looks like a plug and play meta-analysis, and that's not what will be useful for our purposes here.--Shibbolethink ^{(♔ ♕)} 01:37, 4 July 2021 (UTC) (edited 02:44, 4 July 2021 (UTC))

Shibbolethink Re: (A) I am not sure I follow how including unblinded trials makes the results worthless. Obviously blinding is preferable but after reading the Cochrane handbook section if the groups are randomized I'm not sure I understand why it would make a difference: "Lack of blinding of participants, carers or people delivering the interventions may cause bias if it leads to deviations from intended interventions." Lack of blinding increases risk of bias somewhat but this is factored into the meta-analysis when assigning weights to different trials. (B) not sure what you are referring to here on excluding patients who get worse - please elaborate? for (C) I am curious to know what the gold standard would be in your view. Obviously in an ideal world we would have a comparison of ivermectin against either placebo or identical SOC but in practice SOC varies both over time and geographically. I know the Oxford PRINCIPLE trial is comparing ivermectin to SOC whereas the NIH ACTIV trial is comparing to placebo; based on these discrepancies are there any currently available meta-analyses/systematic reviews of ivermectin that do not suffer from these drawbacks? (D) Not sure what you mean. I agree symptoms severity/alleviation is dicey. Mortality however is a binary measurement - there is only one way of measuring whether or not people die. Negative PCR rate, time to negative PCR, time to hospital discharge all seem like variables that can only be measured one way. Caprilyc (talk) 02:24, 4 July 2021 (UTC)

Caprilyc, sorry, I was exaggerating. Worthless is probably too extreme a phrase, but yes it significantly reduces the ability to interpret the results, to the point where I wouldn't let it influence whether I personally prescribed the drug outside of a clinical trial. That's the most accurate way I can describe it to you. And I would be surprised if any professional organizations or government agencies' guidelines changed based on this publication. --Shibbolethink ^{(♔ ♕)} 02:42, 4 July 2021 (UTC)

I am trying to find a source for why an open label design would be as significant a reduction in the ability to interpret results. My understanding was that a standard part of the meta-analysis process was to assign weights to different studies based on measures of quality including level of blinding, so that is factored into the overall assessment. The authors explicitly list their assessment of the level of quality of the included trials and assign up to 2 points for blinding contributing to a total score which ranges between 3 and 7 for the included trials. If I understand correctly that means the authors agree with you that lack of blinding reduces the certainty of the outcomes, and that is already factored into the analysis. Caprilyc (talk) 11:17, 4 July 2021 (UTC)

Shibbolethink are there any currently available meta-analyses/systematic reviews of ivermectin you are familiar with that do not suffer from the drawbacks you point out? Caprilyc (talk) 11:13, 4 July 2021 (UTC)

Also per WP:MEDRS "Respect the levels of evidence: Do not reject a high-level type of source (e.g., a meta-analysis) in favor of a source from lower levels of evidence (e.g., any primary source) because of personal objections to the inclusion criteria, references, funding sources, or conclusions in the higher-level source. Editors should not perform detailed academic peer review." Caprilyc (talk) 13:43, 4 July 2021 (UTC)

Caprilyc, The Roman et al source is the best available so far. It actually filters out the RCTs based on which ones are worth including and which ones actually follow the Cochrane Collab standards. Indiscriminate inclusion of every study only muddies the waters further.

As an aside, I'm going on a long wikibreak, because I'm about to enter the phase of medical school where I'll be spending 70-80 hours per week (essentially every waking minute) either in the hospital or studying, in order to figure out which kind of physician I'd like to become. Wiki, though I love it dearly, will unfortunately only get in the way of this process.

Please help me maintain that wiki break and do not tag me any further, I won't be able to respond. There are many wonderful users around here who can answer any questions (Alexbrn most of all!) I leave you in their very capable hands.--Shibbolethink ^{(♔ ♕)} 20:51, 5 July 2021 (UTC)

• Interesting comment on PubPeer. Alexbrn (talk) 02:52, 4 July 2021 (UTC)

Semi-protected edit request on 7 July 2021

Collapse WP:MWOT. Alexbrn (talk) 06:29, 7 July 2021 (UTC)

I provide the corrections required, a summary of the supporting background information plus context, as well as the sources. If you don't correct this wikipedia will become an institution as trusted and respected as the new York times or fox news. Aka propaganda and disinformation outlet. No one will ever donate again. The section on Ivermectin spreads antiscientific medical misinformation: False stament on page: There is no reliable evidence of benefit from ivermectin in preventing or treating COVID-19. Furthermore, the sources that were cited are low quality not reliable and contradict the extensive indepemdent scientific literature documented below. Giving the benefit of the douht to this wiki, the author is at best guilty of cherry picking the data. The actual CREDIBLE literature available on this topic is extensive, peer reviewed, free from financial coflicts of interest, high quality, internally consistent, consistent with our current understanding of biology, biochemistry, medicine, immunology, and virology, as well as providing results that were independently and repeatedly REPLICATED, bringing me to me the main point. To correct previously inaccurate statements circulating online it is important to state that the available scientific evidence clearly and overwhealmingly demonstrates that Ivermectin is a safe and effective treatment for covid. This statement is consistent with the WHO's published data on the subject and 7 other meta analyses examining over 60 studies using Cochrane methodology and along with luvox ivermectin is recognized to be the standard of care by the world's leading independent physicians treating acute covid. [1], [2],...,[125],[126] Rationale supporting the above changes: Currently all statements about Ivermectin in the context of covid treatment in this article are flagrantly innaccurate and fundamentally antiscientific and actively promote medical misinformation, as there's a mountain of high quality evidence including 36 randomized controlled studies 32 peer reviewed articles covering over 18,000 participants all demonstrating that Ivermectin is effective along with dozens more establishing its mechanism of action and likely impact on the pandemic if widely adopted. [1],[2],...,[125],[126]. The science here is NOT CONTROVERSIAL. To see the current state of the science on Ivetmectin see the meta analysis published at ivmmeta.com as well as 8 other meta analyses they systematically review that are comsistent with their findings (including the results published by the WHO[OR]). Their analysis covers over 60 studies with more than 18,000 total participants meet the exclusion criteria for a Cochrane meta analysis that shows Ivetmectin performs as well if not better than the vaccine as prophylaxis, has a SIGNIFICANTLY superior safety profile to the vaccines, provides instant reliable protection (vs a wait for of up to 6 weeks for full immunity in the case of vaccines), and reduces mortality by 96% in those who are treated AFTER being infected. The probability that an ineffective treatment generated results as positive as the 61 studies to date is estimated to be 1 in 354 billion (p = 0.0000000000028) The WHO meta analysis cited above clearly establishes the effectiveness of Ivetmectin demonstrating an 81% improvement over control in the data they examined. The WHO position that references this report was formulated by a heavily politicized committee consisting of individuals with industry conflicts who claim there's insufficient evidence. Agian the WHO position INCONSISTENT with the numbers the WHO cites to justify their recommendations. These recommendations contradict those recently issued by another committee CORRECTLY recommending the approval of Ivermectin as a safe treatment for scabies on an order of magnitude less evidence (10 small trials with less than 900 total participants and less over all effectiveness). Sources: 1. Abd-Elsalam et al., Journal of Medical Virology, doi:10.1002/jmv.27122, Clinical Study Evaluating the Efficacy of Ivermectin in COVID-19 Treatment: A Randomized Controlled Study, https://onlinelibrary.wiley.com/doi/10.1002/jmv.27122. 2. Adams, B., Fierce Biotech, Merck must do a new trial for faltering $425M COVID-19 drug the U.S. government asked it to buy, https://www.fiercebiotech.com/biot..rug-u-s-government-asked-it-to-buy. 3. 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Is the fear of failure withholding potential life-saving treatment from clinical use?, https://www.signavitae.com/articles/10.22514/sv.2021.043. 90. Niaee et al., Asian Pacific Journal of Tropical Medicine, doi:10.4103/1995-7645.318304 (preprint 11/24/20), Ivermectin as an adjunct treatment for hospitalized adult COVID-19 patients: A randomized multi-center clinical trial, https://www.apjtm.org/article.asp?..66;epage=273;aulast=Shakhsi;type=0. 91. Nichol et al., Injury, 2010, doi: 10.1016/j.injury.2010.03.033, Challenging issues in randomised controlled trials, https://www.injuryjournal.com/article/S0020-1383(10)00233-0/fulltext. 92. Okumuş et al., BMC Infectious Diseases, doi:10.1186/s12879-021-06104-9 (preprint 1/12), Evaluation of the Effectiveness and Safety of Adding Ivermectin to Treatment in Severe COVID-19 Patients, https://bmcinfectdis.biomedcentral..rticles/10.1186/s12879-021-06104-9. 93. 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Rajter et al., Chest, doi:10.1016/j.chest.2020.10.009, Use of Ivermectin is Associated with Lower Mortality in Hospitalized Patients with COVID-19 (ICON study), https://www.sciencedirect.com/science/article/pii/S0012369220348984. 98. Ravikirti et al., medRxiv, doi:10.1101/2021.01.05.21249310, Ivermectin as a potential treatment for mild to moderate COVID-19: A double blind randomized placebo-controlled trial, https://www.medrxiv.org/content/10.1101/2021.01.05.21249310v1. 99. Reuters, WHO joins Europe, Merck in recommending against ivermectin for COVID-19, https://news.trust.org/item/20210331135538-tajza/. 100. Rochwerg et al., BMJ, doi:10.1136/bmj.m2924 , Remdesivir for severe covid-19: a clinical practice guideline, https://www.bmj.com/content/370/bmj.m2924. 101. 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 Not done WP:PROFRINGE based on weak sources and weaker reasoning. Alexbrn (talk) 06:29, 7 July 2021 (UTC)

To elucidate: The first source is a WP:PRIMARY source, a single study, something which is not used on Wikipedia for scientific subjects. @IP: Read WP:RS and WP:MEDRS to find out which sources are acceptable. In this case, it is the ones that are already used in the article: mainly systematic reviews. You probably put a lot of work in this useless attempt to turn the article around without first getting information about Wikipedia sourcing rules, and now you are posting this everywhere, so you should also read Sunk cost. --Hob Gadling (talk) 06:20, 8 July 2021 (UTC)

Extended-confirmed-protected edit request on 16 July 2021

I feel the article is skewed against Ivermectin as a possible treatment for COVID-19 when in fact, The National Institute of Health is withholding judgement until further testing is done. The case against is politically motivated.

This is the last paragraph of the current intro: During the COVID-19 pandemic, misinformation was widely spread claiming that ivermectin was beneficial for treating and preventing COVID-19.[14] Such claims are not backed by sound evidence.[15][16][17][18][19]

I would like to add this immediately afterward: However, from the US government National Institute of Health: "There are insufficient data for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of ivermectin for the treatment of COVID-19. Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin in the treatment of COVID-19." The source is: https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ivermectin/ 83Gulf (talk) 01:14, 16 July 2021 (UTC)

 Not done for now: please establish a consensus for this alteration before using the {{edit extended-protected}} template. ScottishFinnishRadish (talk) 01:58, 16 July 2021 (UTC)

Extended-confirmed-protected edit request on 13 July 2021

Paragraph 4 entire section. Ref 14 to 19. New studies published by the lancet in EclinincalMedicine https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00239-X/fulltext show it "has shown potent activity against SARS-CoV-2 in vitro". Further studies are now underway to ascertain it's use in treating Covid-19 https://www.reuters.com/world/uk/oxford-university-explores-anti-parasitic-drug-ivermectin-covid-19-treatment-2021-06-22/ CosmosGRL (talk) 09:28, 13 July 2021 (UTC)

 Not done. Primary research failing WP:MEDRS. And in any case this point is already made in the article. Alexbrn (talk) 09:30, 13 July 2021 (UTC)

Why BMJ is an accepted source while the American Journal of Therapeutics is not?

When trying to add a source about the research on Ivermectine as COVID treatment, the article Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19 (and I understand that it will also apply to: Ivermectin for Prevention and Treatment of COVID-19 Infection A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines it was discarded with the comment by @Ftrebien: that reads:

(...) The American Journal of Therapeutics does not look good on SCImago, so WP:RSUW. (...)

I do not understand at full that comment, but then I found that a new source was added to that problematic comment: Misleading clinical evidence and systematic reviews on ivermectin for COVID-19 that is not even a paper, but an opinion note published as far as I understand on the BMJ Evidence-Based Medicine, that looks worst on Scimago, at least based on the H-index of 11, against the 62 of the American Journal of Therapeutics. Is there anything I'm missing here? --Eloyesp (talk) 01:41, 28 June 2021 (UTC)

Agree. That is an opinion piece not a review. Per the EMB journal itself: "EBM opinion and debate articles express a highly readable and compelling perspective or opinion on current issues related to evidence-based medicine, health care and research. The best opinion pieces make a single robust, novel, and well-argued point. These articles do not include primary data nor evidence synthesis." Caprilyc (talk) 02:06, 28 June 2021 (UTC)

A piece on misinformation from a prestigious journal is a golden source, and its content is entirely unsurprising (except maybe for anybody who believes those ludicrous websites it is highlighting). So, considering the WP:PARITY lenience for sources debunking fringe ideas, it is over-strength for the claims made. Alexbrn (talk) 06:02, 28 June 2021 (UTC)

• Alexbrn seems to argue that the article should violate WP:MEDRS. MEDRS says "Ideal sources for biomedical information include: review articles (especially systematic reviews) published in reputable medical journals; academic and professional books written by experts in the relevant fields and from respected publishers; and guidelines or position statements from national or international expert bodies. " This doesn't list opinion pieces published in prestigious journals. Wikipedia is supposed to use neutral sources and opinion pieces are per definition about someones opinion and not neutral.

The American Journal of Therapeutics is a reputable journal and thus an ideal source according to MEDRS.

As a criteria about what articles to include in Wikipedia for COVID-19 and ivermectin, I suggest "meta-analysis in journals with impact factor>1 and published in 2021". I don't see any reason to leave out any study that fulfills that criteria.

When there are multiple opinions Wikipedia doesn't exist to take a side but to provide the reader with both sides of the debate. One side writting opinion pieces about how the other is misinformation doesn't change anything about Wikipedia's goal of being neutral and providing both sides.

Besides impact factor the American Journal of Therapeutics is part of the Index Medicus which is a curated list of medical journals. If you want to argue that journals in the Index Medicus shouldn't be seens as reputable, please make that argumetn explicitely. ChristianKl ❪✉❫ 09:59, 28 June 2021 (UTC)

The issue is WP:REDFLAG. With every major medical body pointing in one direction, a review in a low-quality journal which has been criticized by a reputable source for fringe science[7] is simply something that cannot be used for its extraordinary claim. If in doubt, raise a query at WT:MED. 11:49, 28 June 2021 (UTC)

I don't see how a blog article primarily drawing on Twitter criticisms is a better source than a peer reviewed scientific journal, especially if the main criticism of the journal in question comes from said blog article. Need a more substantive source to discredit American Journal of Therapeutics than a blog. Caprilyc (talk) 13:12, 28 June 2021 (UTC)7

If you don't see that, can you at least see With every major medical body pointing in one direction, a review in a low-quality journal?

That David Gorski, a well-known expert, finds mistakes in your source, is a red flag. It does not mean that blog articles in general are better sources than peer reviewed scientific journals in general, only that this specific article in this specific peer reviewed scientific journal needs to be handled with care. Please peruse WP:CIR: Wikipedia editors are not robots running a simple algorithm, putting sources on a predefined reliability scale and using them or not using them as a function of the measured value. They need to judge if the source is good enough, based on several factors, such as reception, impact factor, extraordinariness of content, and so on. Alexbrn, who has been doing this since 2007, is way ahead of you in the ability of judging medical sources. You have been editing since yesterday, and it is not surprising that you do not know yet how to do this. --Hob Gadling (talk) 13:50, 28 June 2021 (UTC)

Point taken. I reread the Science Based Evidence blog article and agree there are valid scientific criticisms raised in it. My initial glance at it was colored by the mixing in of Twitter commentary in a way that appeared biased. Caprilyc (talk) 14:31, 28 June 2021 (UTC)

If you want to advocate a general principle that BJM criticism should be featured in Wikipedia, how about integrating into Wikipedia articles like "Covid-19, trust, and Wellcome: how charity’s pharma investments overlap with its research efforts" which is about undisclosed financial conflicts of the organization, who's chairman Fauci called on 31. January when he was told that SARS-CoV-2 likely escaped from a lab? ChristianKl ❪✉❫ 12:41, 28 June 2021 (UTC)

Please WP:FOC. Quality control is a valid concern. I agree that American Journal of Therapeutics is an appropriate source to include here but bringing in generalizations about pharma industry and Fauci is not directly relevant to that discussion or making a strong argument. Caprilyc (talk) 13:05, 28 June 2021 (UTC)

There seems to be a misunderstanding that entire journals are somehow "reliable" or "unreliable". The issue here is two particular articles in the American Journal of Therapeutics which make WP:EXCEPTIONAL claims at odds with top-level WP:MEDRS sources and about which concerns have been raised in independent, reputable sources. Wikipedia's mission is to reflect accepted knowledge about topics, and the only accepted knowledge we have in relation to these articles is that they are suspicious outliers. As I say, for more input raise a query at WT:MED. Alexbrn (talk) 13:19, 28 June 2021 (UTC)

You have repeatedly dismissed the journal as "a low-quality journal" which may have added to the misunderstanding. The point in this discussion is that two published, peer-reviewed meta-analyses contradict an opinion piece in BMJ and a blog article, which are being presented as more reputable sources. Caprilyc (talk) 13:47, 28 June 2021 (UTC)

The BMJ piece has nothing to do with it, but is focussed on some misleading web sites. Alexbrn (talk) 13:52, 28 June 2021 (UTC)

The BMJ piece is part of this discussion - the whole section is about why a BMJ EBM opinion piece as a reputable source, and the American Journal of Therapeutics meta-analyses are not. The main other source you draw upon, in your words "a reputable source for fringe science"[8] is a blog article which heavily draws on Twitter criticisms and has no actual scientific references, including a clearly biased Twitter account called the "Ivermectin Research Alliance" whose bio states "I research the corrupt physicians, narcissistic tech entrepreneurs, and social media grifters who promote ivermectin. Delicious apple flavor."[9] and is full of ad hominem attacks and memes. I am all in favor of being stringent in quality control, but that applies to both sides of this discussion. This is not a reputable source. Caprilyc (talk) 14:03, 28 June 2021 (UTC)

We're back to the misunderstanding. To repeat: the BMJ EBM source is reliable for commenting on some shit websites; the AJT source is not reliable for something that would overturn the global medical consensus. WP:CONTEXTMATTERS folks. Sheesh. Science-Based Medicine is a reputable source, particularly for fringe medicine. Alexbrn (talk) 14:07, 28 June 2021 (UTC)

Here's something a lot of people are missing in the above discussion: Am J Ther may be a reputable journal for some things, but it is not a reputable journal for the extremely controversial topic of Ivermectin in COVID-19. In the context of the scientific landscape, the best thing we have is the consensus statements from places like the FDA [10], Infectious Disease Society of America [11], CDC [12], NIH [13], and dedicated experts with excellent standing in their field like MGH's FLARE [14]. These neutral bodies which are comprised of many experts in these topics have spent hours and hours reviewing the clinical research evidence, so that we don't have to. We are meant to reflect the consensus of the science. And that consensus is reflected in these statements from professional bodies and organizations. Physicians respect these institutions, so we should too. We cannot mislead the public and attempt to circumvent the most reliable medical reviews of the literature around, just because a very loud minority of scientists or researchers or internet sleuths or armchair scientists believe X thing. We have to follow the state of the evidence. See WP:V. When these consensus-generating professional bodies change, we can as well. Until then, no dice.--Shibbolethink ^{(♔ ♕)} 14:14, 28 June 2021 (UTC)

Exactly. --Fernando Trebien (talk) 11:58, 29 June 2021 (UTC)

While we wait for solid evidence, we can point to expert opinion, see WP:MEDASSESS. The BMJ is a core journal. As for SCImago, look at the quartiles (current and past) and the SJR index at the bottom of the page. --Fernando Trebien (talk) 11:58, 29 June 2021 (UTC)

@Caprilyc: your account was created 2 days ago exclusively for editing on ivermectin? Are you a paid editor? In that case, your user page must disclose this. --Fernando Trebien (talk) 11:58, 29 June 2021 (UTC)

Not a paid editor, just curious about the topic. I have spent a large amount of personal time researching ivermectin and thought I could contribute by adding relevant parts. My only disclosure is that based on the available evidence I suspect ivermectin is likely to be an effective treatment for COVID, though I understand that is not a sufficient reason to rewrite the article in favor before a medical consensus is established on the topic. I am new to editing Wikipedia and apologize if some of my responses have seemed inappropriately biased. I am only trying to add information as appropriate, and include relevant, neutral stuff like the fact that the number of ivermectin prescriptions in the US has increased (with supporting sources), the fact that NIH is actively running an RCT to investigate ivermectin, and the role of ivermectin in cancer. Caprilyc (talk) 12:59, 29 June 2021 (UTC)

• The idea that non-peer reviewed sources should be preferred over peer-reviewed sources for a scientific topic is really strange. Organizations like the CDC had no problem lying about the effectiveness of masks early in the pandemic and spend a long time being in denail about COVID-19 being airbone. They are political institutions. It's worth noting the position of institutions like the CDC in a Wikipedia article but there's no reason to avoid peer reviewed sources just because they are not in agreement with the CDC or other non-peer-reviewed policy documents.

Even as far as government institutions go there's no consensus with countries like Mexico using it.

The idea that the Am J Ther article is the only meta-study that's supporting of Ivermectin is wrong. Reviews in Medical Virology: "Our study suggests that ivermectin may offer beneficial effects towards Covid-19 outcomes." Science is not about pretending that there's consensus when there isn't a scientific consensus. The mission of Wikipedia is to be neutral and offer both sides of an argument.

If you look at all the peer reviwed published meta analysis there's nothing expectional about the position laid out in the Am J Ther article. ChristianKl ❪✉❫ 22:02, 29 June 2021 (UTC)

ChristianKl, in WP:MEDRS, it prescribes that we...

present prevailing medical or scientific consensus, which can be found in recent, authoritative review articles, in statements and practice guidelines issued by major professional medical or scientific societies (for example, the European Society of Cardiology or the Infectious Disease Society of America) and widely respected governmental and quasi-governmental health authorities (for example, AHRQ, USPSTF, NICE, and WHO), in textbooks, or in scholarly monographs.

My understanding is that you think we should prefer the non-notable review articles published in low quality journals (for this purpose) over the recommendations of these "political institutions." Unfortunately, when there is disagreement among different review articles (which there is in this case), then we default to using professional organizations for determining the scientific consensus. The gold standard isn't "review articles" or "systematic reviews" for our purposes. The gold standard is "what's the scientific consensus?" Which is not that ivermectin should not be used, but rather that it is still under investigation, and should be used only in the confines of clinical trials. Because at this point, risk may outweigh any benefit for many patients. It matters not only if Ivermectin is used, but how and for whom. These are the questions that well-designed RCTs answer.

Does that make sense?

If it's any consolation, there are several systematic reviews coming out soon that assess the results of the newest and most robust RCTs, and appear to show negative results. As in the section just below this one. Given that, this will not be a debate for much longer.--Shibbolethink ^{(♔ ♕)} 22:15, 29 June 2021 (UTC)

@Shibbolethink:First the study below (the one in Clinical Infectious Diseases) explicitely didn't include the newest trials. The claim that it did is just factually wrong. The pro-Ivermectin studies I mentioned include more then a month more data and they were published earlier.

There are reviews that do that but if you take the example of the last one that was mentioned, it's a very low quality document that did things like switching placebo and control group for one group in a way that makes Ivermectin look worse. It obviously didn't went through real peer review because any competent reviewer who knows the subject well should know the outcome of the trial in question and catched the error and that isn't the only issue with it. Pubpeer is a good neutral source if you are interested in the details of how data was maltreated.

Wikipedia's core policy is about not taking sides in conflicts. There are two sides here within respectable sources. Wikipedia's job is it to present both sides and be neutral. ChristianKl ❪✉❫ 16:05, 5 July 2021 (UTC)

ChristianKl, Alexbrn is correct. Our role here is not to evaluate this study as peer reviewers, it is to trust in the verifiability of what professional organizations have concluded. Worth saying, though, that you have linked to a pubpeer page based on the preprint version of this article, not the published version. The published version corrects the mistakes you've referenced, but these corrections do not ultimately alter the conclusion: [15]

As an aside, I'm taking a long wikibreak because I'm entering the phase of medical school where I will spend 70-80 hours per week in the hospital/studying, in order to figure out what kind of physician I'd like to become. Wiki will only get in the way of that process, unfortunately! So please help me maintain my wikibreak, and do not tag me from now on. There are plenty of other users who are more than capable of answering any questions (including Alexbrn)! I leave you in their very capable hands.--Shibbolethink ^{(♔ ♕)} 20:42, 5 July 2021 (UTC)

There aren't "two sides". There's delusion and advocacy about miracle cures on one side, and on the other a consensus that there it no good evidence of benefit. Wikipedia avoids WP:GEVAL. If the EMA, WHO, etc. start changing position, then we'll know things are changing .Alexbrn (talk) 16:12, 5 July 2021 (UTC)

@Alexbrn: There are multiple peer reviewed studies and multiple jurisdictions with >100 million citizens on the other side. Calling journals like American Journal of Therapeutics and Reviews in Medical Virology delusion and advocacy is a simple rejection as peer reviewing mattering as a basis for clinical decision making. It's extremely hypocritical to evaluate both of those respectable journals as delusion and advocacy while arguing that it's not Wikipedia's role to evaluate studies as peer reviewers. If it isn't just include the meta-reviews in the Wikipedia article and don't treat them as delusional. ChristianKl ❪✉❫ 13:58, 13 July 2021 (UTC)

The concerns about the studies are from RS. It is you who has decided "delusional" specifically applies to the journals, because nobody else said any such thing. But you can see of course that ivermectin does have its delusional advocates. Fraudulent research gets routinely published, even in respectable journals. Alexbrn (talk) 14:14, 13 July 2021 (UTC)

Pricing: Extremely Low Cost use in general and for the treatment and prevention of Covid-19

User was blocked, no consensus for edit. Alexbrn (talk) 20:12, 9 July 2021 (UTC)

There is inadequate information on costs. 1. There has been a lot of reporting on the extremely low cost of ivermectin, including in the peer-reviewed medical literature. The article should reflect that. Anyone dispute that there should be some mention of its extremely low cost? 2. Instead, the section starts with info that belongs in the History section, and never gets to bulk or LMIC pricing. 3.It also slightly deceptively reports that two 3 mg tablets (lice in children, 1 treatment) cost about $10 US, when 3.1 the source says they cost $9.30, and 3.2 GoodRx has that dose for $6 and about $1/pill if >20 pills are ordered. Per Wikipedia:Prices, "Wikipedia has no specific policy on presenting prices of products." until it was overrun, I presume because: Some old quotes: We know that the pharmaceutical industry is trying really hard to hide medication prices with ongoing legal cases in the United States.[16] Many NGOs including Doctors Without Borders and UNICEF struggle with the lack of transparency around medication and vaccine prices.[17] WP:NOTCENSORED applies here. Doc James (talk · contribs · email) 18:36, 30 September 2019 (UTC) [...M]ajor medical organizations that state that they consider prices to be notable. Here is a link to MSF [18] Transparency around prices is critical to global public health.[19] Doc James (talk · contribs · email) 18:45, 30 September 2019 (UTC) 4. Ivermectin is officially approved for use in the prevention and treatment of covid-19 in multiple nations and available for such use in many more. Anyone dispute that? 5. In some nations, Ivermectin is officially supplied at no cost for use in the prevention and treatment of covid-19. Anyone dispute that? 6. WP:NOTCENSORED applies to this use. Anyone dispute that? 7. WP:V states, "If reliable sources disagree, then maintain a neutral point of view and present what the various sources say, giving each side its due weight." and we're not doing that. Anyone dispute that? For now, I just request correction per 3, 3.1, above: Replace 10 with 9, as $9.30 rounds to 9.--50.201.195.170 (talk) 23:21, 7 July 2021 (UTC) Not done for now. Get consensus or find better sources. This is a lot of words to ask for "about $10" to be changed to "about $9". The source says $9.30, which is about $10. – Jonesey95 (talk) 15:27, 13 July 2021 (UTC)

Bryant, Lawrie et al (again v6)

It seems that the introductory conclusion... "During the COVID-19 pandemic, misinformation was widely spread claiming that ivermectin was beneficial for treating and preventing COVID-19.[14] Such claims are not backed by sound evidence.[15][16][17][18][19]"... is disputed here in a peer-reviewed publication: https://journals.lww.com/americantherapeutics/Fulltext/2021/06000/Review_of_the_Emerging_Evidence_Demonstrating_the.4.aspx

<a href="/wiki/User:jim_hoerner" title="User:jim_hoerner">jim_hoerner</a>

22:36, 13 July 2021 (UTC) Hi Jim hoerner, please see the several other discussions about this source already on this talk page. Search the archives as well. If you believe you have new evidence or reasons to bring up that in some way contradict the consensus on this talk page, that would be appropriate. But please don't make us reinvent the wheel again. --Shibbolethink ^{(♔ ♕)} 13:58, 13 July 2021 (UTC)

Hi. I don't care if the study is disputed. I am sure it is. Fact is, it was published in a peer-reviewed journal, and the Wikipedia page is incorrect the way it is currently written. I thought Wiki was supposed to be a reliable source of information. I was surprised when I came to the Ivermectin page and read that there is no sound evidence supporting the effectiveness of treatment. I make no judgement about the paper, as I am an engineer, not an epidemiologist. Does the person who locked the page have appropriate qualifications to prevent factual contrary peer-reviewed studies from even being mentioned?

<a href="/wiki/User:jim_hoerner" title="User:jim_hoerner">jim_hoerner</a>

22:32, 13 July 2021 (UTC)

New stuff goes to the bottom. If you respond to a contribution which has already been responded to, you either put the second response below the first one (and below the responses to it), or you add one more indentation. I corrected that for you.

I don't care if the study is disputed. See, this is why WP:CIR. If you had read WP:MEDRS, you would know that being "published in a peer-reviewed journal" is a ridiculously low standard. Lots of crap gets "published in a peer-reviewed journal", and lots of weak and inconclusive stuff gets "published in a peer-reviewed journal". Bad studies typically get disputed more than good ones. All these things are very basic facts about medical science. For other sciences, you still have WP:RS.

I will never understand how people can be aware of their own incompetence in a field (I am an engineer, not an epidemiologist) and at the same time behave as if they understand it much better than those who make their living in that field. --Hob Gadling (talk) 05:02, 14 July 2021 (UTC)

So, what actually is your argument that this paper is not a valid source? I dare you to refute it.

I dare you to rollback everything I write. That will prove that you are correct. Thepigdog (talk) 15:01, 13 July 2021 (UTC)

Thepigdog, I would advise you to read WP:USTHEM. "Daring" me to do something is not conducive to editors working together collaboratively. As an aside, I don't believe I've personally rolled back anything you've written here, though other users have. As to my thoughts about this source, you can check out at least one of the aforementioned discussions here. Here are several other discussions about this source as well: 1, 2, 3, 4. Please engage in one of those instead of reinventing the wheel.--Shibbolethink ^{(♔ ♕)} 15:16, 13 July 2021 (UTC)

Alexbrn rolled back what I wrote, without asking for clarification. Is this the way you conduct a discussion on the talk page?

The arguments given previously were based on the assumption that there are good citations, and bad citations, and that Alexbrn has some magic formula to distinguish which is which, even in published papers. I ask you to humour me, and actually give your argument in simple form why this paper does not refute what I regard to be an egrecious line in this wikipedia entry.

I ask again, if you do not wish to play fair, please tell me and I will stop wasting my time. Thepigdog (talk) 15:27, 13 July 2021 (UTC)

No one is stopping you from participating in this discussion in the many multiple venues that are already on this talk page to have it. Continuing to have it in 6 different places just makes this more difficult for everyone.--Shibbolethink ^{(♔ ♕)} 15:41, 13 July 2021 (UTC)

Alexbrn rolling back my posts is not interference?

"During the COVID-19 pandemic, misinformation was widely spread claiming that ivermectin was beneficial for treating and preventing COVID-19.[14] Such claims are not backed by sound evidence.[15][16][17][18][19]"

This is offensive to all the people that believe (rightly or not) that Ivermectin may be a part of a treatment for Covid 19. I ask for it to be replaced by.

Some sources suggest that during the COVID-19 pandemic, misinformation was widely spread claiming that ivermectin was beneficial for treating and preventing COVID-19 [14] and that such claims are not backed by sound evidence.[15][16][17][18][19] Other sources (give references) contest that ivermectin may be a part of a valid treatment plan. There is an ongoing debate in the scientific community, and more research is needed to make a firm conclusion.

Would this be an acceptable and balanced way forward? Thepigdog (talk) 15:55, 13 July 2021 (UTC)

Thepigdog, rolling back comments that are not related to the discussion is not interfering with your ability to participate in the discussion. it is telling you that you should keep your comments focused on the points of the discussion themselves and not about other articles/controversies. This page is only for discussion of the wikipedia article on Ivermectin. Not the lab leak, not alleged conspiracies about Fauci, etc. etc.

It does not matter if the content on wikipedia is "offensive" to anyone, as long as it is sourced to high quality WP:MEDRSes, which this sentence is. Checking those sources, it is indeed a correct interpretation of the sources.

We do not trust meta-analyses of a few dozen or a few hundred patients published in not very reputable journals over the published guidelines from reputable government agencies and medical bodies. That's WP:MEDRS for you. See the discussion above started by 力.--Shibbolethink ^{(♔ ♕)} 16:02, 13 July 2021 (UTC)

Why is the American Journal of Therapeutics any less reputable than Nature. Nature fast-tracked what appears to be a corrupt paper, written by people that a few days before espoused a different point of view in private. In light of Fauci's emails, please explain why Nature is more reputable than "The American Journal of Therapeutics" in this matter. Thepigdog (talk) 16:23, 13 July 2021 (UTC)

Seriously, guys, is that the way you argue. Just roll back posts that you don't agree with? Are you that corrupt? Thepigdog (talk) 16:28, 13 July 2021 (UTC)

I am somewhat shocked that Wikipedia editors are preventing peer-reviewed papers from even being mentioned. This does not seem to be consistent with what I always though the spirit of Wiki is. The appropriate course of action would be not to prevent the study from being mentioned, but to criticize it with other reliable sources.

<a href="/wiki/User:jim_hoerner" title="User:jim_hoerner">jim_hoerner</a>

23:20, 13 July 2021 (UTC)

See my response above. Instead of being "shocked" that people think differently from you, you should listen to their explanations of why they think that way. But I guess you are not here to learn anything, but to lecture those who understand the situation far better than you. --Hob Gadling (talk) 05:02, 14 July 2021 (UTC)

Thepigdog, AJT had a 2019 impact factor of 1.955 [20]. Nature had a 2019 impact factor of 42.778 [21].

Scimago ranks AJT in the 3rd quartile of medical journals [22], whereas it ranks Nature in Q1 [23]. --Shibbolethink ^{(♔ ♕)} 16:30, 13 July 2021 (UTC)

But Nature is directly implicated in a corrupt paper on the subject of SARS-COV-2. How are they more believeable? Thepigdog (talk) 16:34, 13 July 2021 (UTC)

Thepigdog, I'm not really sure what you're talking about. What "corrupt paper?" And can you provide reliable secondary WP:RSes or WP:MEDRSes which describe this paper as "corrupt" and Nature as somehow "flawed" in its coverage? Keep in mind, fringe sources aren't really helpful in this regard.--Shibbolethink ^{(♔ ♕)} 16:38, 13 July 2021 (UTC)

Regarding the lede; the most "sympathetic" language possible is to explicitly quote the WHO as saying data is inconclusive; the various "some people say it is effective" statements simply aren't acceptable. The most glaringly missing material in this article is the lack of discussion regarding usage statistics of Ivermectin in third-world countries. There are suggestions that a substantial part of the population in Latin America and India are taking it (either prophylactically or as treatment) but I haven't found any reliable sources that quantify that use to add it. User:力 (power~enwiki, π, ν) 16:11, 13 July 2021 (UTC)

Meta-commentary on meta-analyses

There are a lot of sections about meta-analyses, rather than pick one I make a new section for this.

The emphasis I see on other forums about how meta-analyses are the "best" type of evidence is largely crap. Most of the meta-analyses I've seen on Ivermectin (some promoted by people claiming it is a miracle cure, others promoted by people saying it does nothing) are garbage-in, garbage-out. Doing a meta-analysis on 5-10 studies, each of which has 400 people or less, is still not going to give you good results.

By comparison, take Hydroxychloroquine (HCQ). There are a lot of bad meta-analyses about that as well. But it doesn't matter. We have one good study (by Oxford) with conclusive results, and that was it. Even Donald Trump stopped harping about it.

In conclusion: please can we have less of the meta-analysis talk here? User:力 (power~enwiki, π, ν) 18:49, 6 July 2021 (UTC)

I think it's good we've got some major medical bodies we can cite without having to go "down" to meta-analyses. Alexbrn (talk) 18:51, 6 July 2021 (UTC)

"The current evidence on the use of ivermectin to treat COVID-19 patients is inconclusive." (from the WHO) is really all there is to be said on Wikipedia based on the data available. Well, that, and that it is not as effective as Bret Weinstein claims on his podcast. User:力 (power~enwiki, π, ν) 18:55, 6 July 2021 (UTC)

The editor logic on this page is very confusing, and seems to me to be contradicting itself when convenient. First we are told "Sources can only be questioned when there is some sourced legitimate basis for doing so. Alexbrn (talk) 13:10, 30 June 2021 (UTC)" But then later we are told that sources that are from "an ivermectin advocate" should be questioned (even when it is a meta-analysis published in a peer reviewed journal). Then we are referred to the WP page on assessing medical evidence, where we're told "Studies can be categorized into levels of evidence, and editors should rely on high-level evidence, such as systematic reviews." This is followed by an image of a pyramid showing Meta-Analysis, Systematic Review" at the top of the pyramid, above RCTs. And now we're told we "shouldn't have to go 'down' to meta-analysis," but rather rely on political and bureaucratic major medical bodies for direction on what gets posted on WP? Can you folks understand why so many of keep pushing back? The guidance is not coherent. User:DavidM

Use the WP:BESTSOURCES and be wary of WP:EXCEPTIONAL claims. All the "meta-analyses" for ivermectin are relatively low-quality and there are documented third-party concerns for them and their underlying data. The best quality secondary review is Roman et al which is negative. But there is no need to use any of these where there is a strong international consensus from all the major medical organizations. The situation may change when some quality RCT outcomes are reported. Until then, there's WP:NODEADLINE. Alexbrn (talk) 07:13, 12 July 2021 (UTC)

There are four meta-analysis published studies that I am aware of. Three of the four demonstrate a consensus that ivermectin shows promise of benefit, with "Roman, et al" as the outlier. Hence my thinking that we should consider WP:BALANCE. How was "Roman et al" determined to be the best quality secondary review? There have been numerous documented third party concerns on this paper noting significant multiple errors, including an open letter signed by 40 medical professionals. The most egregious error was that treatment arms in the study of Niaee1 were reversed, protested by Dr. Niaee himself. This error was corrected in the revised version, but with no change to the conclusion in spite of dramatic change in the evidence. The correction shows a >60% mortality reduction in those that took ivermectin. I know of no third party concerns about the "Hill, et al" study (perhaps I've missed them). Unless I'm made aware of legitimate strong critiques of the recently published (June 28) study by Hill, this one seems to me to be the best quality secondary review (not to be confused with the earlier study Hill prepared for the WHO). The accompanying editorial by Mark J. Siedner (Harvard Medical School) seems to me to strike the correct tone of how ivermectin should be discussed on WP (see WP:IMPARTIAL), i.e. "There are arguments to be made both in support and against a potential benefit of ivermectin for COVID-19 treatment..."DavidM58 (talk) 21:02, 12 July 2021 (UTC)

That would be classic WP:GEVAL. We're not going to "balance" the EMA/WHO/FDA/etc against a few dodgy sources. There has so far as I am aware been no documented concerns about the Roman paper in any RS. We would never normally use a lower-quality source like Hill (i.e. not MEDLINE indexed) for anything, but in the current circumstances the needed is maxxed into the red for claims about Ivermectin. Things will be clearer soon as the quality RCTs start reporting. Alexbrn (talk) 21:10, 12 July 2021 (UTC)

I don't see it as classic WP:GEVAL. This is not equivalent to Flat Earth theory, and peer reviewed Open Forum Infections Diseases or Journal of American Therapeutics are not dodgy sources, nor are the authors (both Hill and Lawrie) who have in the past been contracted with the WHO itself to do this kind of work. What is in question here is what weight to give governmental agencies vs. peer reviewed, published science? I am probably wrong, but I thought WP favors science over governmental agencies who might very well be motivated by the politics of the day. Can you point me to a WP statement telling us to give more weight to the CDC/FDA/WHO than we would to peer reviewed published science? At any rate, all I'm asking for is for WP to convey something more akin to what the NIH (doesn't recommend for or against) and the WHO are saying - we are waiting for more data. That's very different than casting aspersion with words like "misinformation" and "not backed by sound evidence" with reference to dodgy sources, such as a Politi-Fact checker with no known experience in medicine and a physical therapist who wrote an opinion piece (Garegnani). We should instead strive to "summarize and present the arguments in an impartial tone." WP:IMPARTIAL --DavidM58 (talk) 01:32, 13 July 2021 (UTC)

DavidM58, WP:MEDRS would likely be the policy you're asking for. And, likewise, we value consensus statements from medical bodies like the WHO and government agencies like the FDA above small-scale low-sample size meta-analyses or meta-analyses which have been questioned and criticized in open peer review. There have been numerous discussions about this already on this talk page, discussing the problems with the meta analyses you're referencing. I would suggest addressing those discussions instead of rehashing them here. Let us please not reinvent the wheel whenever possible. Thank you.--Shibbolethink ^{(♔ ♕)} 01:58, 13 July 2021 (UTC)

We also have quite a few high quality RSes describing the misinformation connected to Ivermectin. See these for example: [24] [25] [26] [27] [28] [29] [30] --Shibbolethink ^{(♔ ♕)} 02:06, 13 July 2021 (UTC)

You offer seven links to opinion pieces that in most instances have very little to say about ivermectin itself, and with scant actual science. I guess we have very different ideas about high quality RSes. --DavidM58 (talk) 04:22, 14 July 2021 (UTC)

I looked at the first one, and it says it is "news", not "opinion". If your idea of high quality sources consists of labeling those you do not like "opinion pieces", having a different idea is, well, a good idea. Why don't you have a look at WP:MEDRS? --Hob Gadling (talk) 05:02, 14 July 2021 (UTC)

OK, if you insist. [WP:MEDRS] "Respect the levels of evidence: Do not reject a high-level type of source (e.g., a meta-analysis) in favor of a source from lower levels of evidence" (e.g.,"news" masquerading as high quality RS).--DavidM58 (talk) 05:16, 14 July 2021 (UTC)

This is not ""news" masquerading as high quality RS", it is actual news, in the British Medical Journal, based itself on secondary sources. First you tried to pass it off as an "opinion piece", which it is not, now you try to pass it off as "masquerading as" something else, which it is not. Why do you have to add untruths to everything you say? --Hob Gadling (talk) 05:57, 14 July 2021 (UTC)