Sunday, June 27, 2021

The Irrepairably Broken Trust/Distrust Axis In Science And Medicine

taibbi  |  Telescope out a little further, however, and the ivermectin debate becomes more complicated, reaching into a series of thorny controversies, some ridiculous, some quite serious.

The ridiculous side involves the front end of Lorigo’s story, the same story detailed on this site last week: the censorship of ivermectin news that, no matter what one thinks about the evidence for or against, is clearly in the public interest.

Anyone running a basic internet search on the topic will get a jumble of confusing results. YouTube’s policies are beyond uneven. It’s been aggressive in taking down videos containing interviews with people like Kory and doling out strikes to independent media figures like Bret Weinstein, but an interview with Lorigo on TrialSite News containing basically all of the same information is still up, as are clips from a just-taped episode of the Joe Rogan Experience that feature both Weinstein and Kory. Moreover, all sorts of statements at least as provocative as Kory’s “miraculous” formulation in the Senate still litter the Internet, many in reputable research journals. Take, for instance, this passage from the March issue of the Japanese Journal of Antibiotics:

When the effectiveness of ivermectin for the COVID-19 pandemic is confirmed with the cooperation of researchers around the world and its clinical use is achieved on a global scale, it could prove to be of great benefit to humanity. It may even turn out to be comparable to the benefits achieved from the discovery of penicillin…

There clearly is not evidence that ivermectin is the next penicillin, at least as far as its effects on Covid-19. As is noted in nearly every mainstream story about the subject, the WHO has advised against its use pending further study, there have been randomized studies showing it to be ineffective in speeding recovery, and the drug’s original manufacturer, Merck, has said there’s no “meaningful evidence” of efficacy for Covid-19 patients. However, it’s also patently untrue, as is frequently asserted, that there’s no evidence that the drug might be effective.

This past week, for instance, Oxford University announced it was launching a large-scale clinical trial. The study has already recruited more than 5,000 volunteers, and its announcement says what little is known to be true: that “small pilot studies show that early administration with ivermectin can reduce viral load and the duration of symptoms in some patients with mild COVID-19,” that it’s “a well-known medicine with a good safety profile,” and “because of the early promising results in some studies, it is already being widely used to treat COVID-19 in several countries.”

The Oxford text also says “there is little evidence from large-scale randomized controlled trials to demonstrate that it can speed up recovery from the illness or reduce hospital admission.” But to a person who might have a family member suffering from the disease, just the information about “early promising results” would probably be enough to inspire demands for a prescription, which might be the problem, of course. Unless someone was looking for that information, they likely wouldn’t find it, as mainstream news even of the Oxford study has been effectively limited to a pair of Bloomberg and Forbes stories.

Ivermectin has suffered the same fate as thousands of other news topics since Donald Trump first announced his run for the presidency nearly six years ago, cleaved in two to inhabit separate factual universes for left and right audiences. Repurposed drugs generally have had a hard time being taken seriously since Trump announced he was on hydroxychloroquine last year, and ivermectin clearly also suffers from its association with Republican Senators like Ron Johnson. Still, the drug’s publicity issues go beyond the taint of “conservative” news.

The drug has become a test case for a controversy that’s long been building in health care, about how much input patients should have in their own treatment. Well before Covid-19, the medical profession was thrust into a revolution in patient information, inspired by a combination of Google and new patients’ rights laws.

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