Level of Evidence and Washington Post's Claims of Ivermectin Toxicity

A letter to the editor of NEJM is cited as providing evidence of a host of toxic side effects... but in tracking down the reference, the evidence falls far short of "toxic" and "causal".

The Washington Post’s article, “Online archives where scientists post their research spark information revolution” writes about a non-peer-reviewed study on Ivermectin was “retracted” by a pre-print server (technically, an impossible feat given that preprint servers do not technically “publish” studies, because the works are not peer-reviewed).

They also throw in this sentence:

“not to mention contributed to a host of serious side effects among those who ingested ivermectin with no proven benefit against covid-19.”

That reads as if the study found a host of serious side effects, but the WashPo article linked to a letter to the editor of the New England Journal of Medicine.

Was this letter a peer-reviewed study that demonstrated causality of the alleged stide effects WashPo claims the study has “contributed to”?

No. It was not. The letter merely described 21 reported sets of symptoms following Ivermectin use based on phone calls to a poison control center:

“Of the 21 persons who called in August, 11 were men, and most were older than 60 years of age (median age, 64; range, 20 to 81). Approximately half (11 persons) were reported to have used ivermectin to prevent Covid-19, and the remaining persons had been using the drug to treat Covid-19 symptoms. Three persons had received prescriptions from physicians or veterinarians, and 17 had purchased veterinary formulations; the source of ivermectin for the remaining person was not confirmed. Symptoms had developed in most persons within 2 hours after a large, single, first-time dose. In 6 persons, symptoms had developed gradually after several days to weeks of repeated doses taken every other day or twice weekly. One person had also been taking vitamin D to treat or prevent Covid-19. Reported doses ingested by the persons who had been using veterinary products ranged from 6.8 mg to 125 mg of 1.87% paste and 20 to 50 mg of the 1% solution. The dose of the human-use tablets was 21 mg per dose twice weekly for prevention.

Six of the 21 persons were hospitalized for toxic effects from ivermectin use; all 6 reported preventive use, including the 3 who had obtained the drug by prescription. Four received care in an intensive care unit, and none died. Symptoms were gastrointestinal distress in 4 persons, confusion in 3, ataxia and weakness in 2, hypotension in 2, and seizures in 1. Of the persons who were not admitted to a hospital, most had gastrointestinal distress, dizziness, confusion, vision symptoms, or rash.

These cases illustrate the potential toxic effects of ivermectin..”

The question for the WashPo article author, and WashPo, is how is this “a host of serious side effects” when

(1) Frequency data are not available (we don’t know how many people were using Ivermectin. Is 21 a lot? A little? 1 in 1,000? 1 in 1,000,000?

(2) Causality has not been determined (calls from poison control are not clinical study-level evidence). GI issues, ataxia and hypotension also happen in people taking any number of over-the-counter drugs, prescription drugs and vaccines.

(3) None of these events are considered “serious” (Seizures following vaccination are not considered “serious”).

Imagine if Ivermectin were a vaccine… and 21 phone calls laters, the reported outcomes were reported as “caused by” and “serious”.

It seems that the level of evidence need to bury an inexpensive treatment is far, far less than needed to determine causality of vaccine injury.

With this type of loose “reporting”, the legacy press loses yet another point on the credibility scale.

Make that four points (-4).

Actually, make it five: WashPo fails to report the 77 other studies on Ivermectin.

This is why people who read the news need to check the references and see for themselves whether their news source is accurately representing what’s going on.

And it’s time we start holding such “news” outlets accountable for their abuse of the public trust and of scientific evidence.