Chris Heimerdinger responds to critics

[Dr Exiled]

Here are some articles to consider about the practice of medicine, malpractice, and off label drug use.

The first one is about medical malpractice: https://www.standardsofcare.org/medical-malpractice/

Medical malpractice occurs when a patient is harmed and suffers as a result of a professional medical caregiver failing to provide care that measures up to accepted standards of care. In other words, when a doctor or other caregiver makes a mistake or fails to provide the right care, a patient can be harmed or even killed, and this is medical malpractice.

Here is one about off label drug use: https://www.policymed.com/2010/05/fda-o ... label.html

The FDA approves drugs for a specific use and once approved, doctors can prescribe the approved drug for an unapproved use or off label use. Doctors can be held liable if they know an off label drug could help a patient yet refuse to prescribe it. Hospitals endanger having a lawsuit against them for prevention of a possible remedy without any just cause to prevent its use.

From the policy med article:

In addition, the American Medical Association (AMA) believes that “physicians have the training and experience necessary to determine the best or preferred method of treatment,” including off-label prescribing, which is often be considered “reasonable and necessary medical care, irrespective of labeling.” In fact, doctors can be subject to malpractice liability if they do not use drugs for off-label indications when doing so constitutes the standard of care.

In the case of HCQ, ivermectin, fluvoxamine, and other approved FDA drugs, a doctor or hospital could be held liable for not trying these drugs if in the case where nothing else is working. However, in the case where there are alternatives, my guess at this point, without researching further, that a hospital could refuse certain treatments under its roof. However, why would it refuse an off label treatment if the proposed treatment is proven to not harm at the prescribed dosage? There isn't any harm in trying the off label treatment and trying might save the patient. This is what has me wondering what the motivation is in preventing these already approved drugs from being used to treat covid. Why not let the doctors make the attempt if the patient is informed and consents?

[Dr Exiled]

What prevented him from finding a hospital that did have medical providers prescribing that? Also, why wasn't he already taking it on his own before this if he believed in it so much?

Exactly. No hospital is preventing anyone from doing anything they want with their own body. But these lunatics want to force doctors to prescribe medicines for ideological (anti-vaccine) reasons. It's not about effective treatment, it's about politics. And maybe he makes some money off donations and lawsuits along the way...

Of course, a doctor shouldn't be forced to prescribe something he/she doesn't believe will be effective, just because some idiot wants to make a political point. However, I think the prudent approach is to not refuse possible treatments due to politics either.

[Doctor CamNC4Me]

Wiki:

Subsequent research failed to confirm the utility of ivermectin for COVID-19, and in 2021 it emerged that much of the research finding benefit was faulty, misleading, or fraudulent.

[drumdude]

Exactly. No hospital is preventing anyone from doing anything they want with their own body. But these lunatics want to force doctors to prescribe medicines for ideological (anti-vaccine) reasons. It's not about effective treatment, it's about politics. And maybe he makes some money off donations and lawsuits along the way...

Of course, a doctor shouldn't be forced to prescribe something he/she doesn't believe will be effective, just because some idiot wants to make a political point. However, I think the prudent approach is to not refuse possible treatments due to politics either.

Which doctors are refusing it due to politics? You're implying that doctors are willingly letting people die because they haven't thought to walk the 10 feet over to the pharmacy and prescribe something that has been there for decades.

If ivermectin worked in emergency rooms and intensive care units, they would be using it! They have tried it, for 2 years now, and they have watched the patients die at the same rate as everyone else.

I know it's human psychology to think that there's this one neat trick that a soccer mom found to beat covid. It's why there are so many clickbait articles with those titles. But it's all wishful thinking. And when it doesn't work, it's "you didn't take enough zinc. You didn't take enough vitamin C. You didn't get enough sun/vitamin D." On and on and on to justify this ivermectin cult.

[sock puppet]

Why stop at HCQ and IVM? He could also sue them for not having healing crystals, consecrated Malchezedic Priesthood oil, Wolf's Bane 200C, and the thoughts and prayers of a few thousand Facebook followers.

He could have just stayed home, drank a tumbler of Clorox and voila! healed.

[Dr Exiled]

Of course, a doctor shouldn't be forced to prescribe something he/she doesn't believe will be effective, just because some idiot wants to make a political point. However, I think the prudent approach is to not refuse possible treatments due to politics either.

Which doctors are refusing it due to politics? You're implying that doctors are willingly letting people die because they haven't thought to walk the 10 feet over to the pharmacy and prescribe something that has been there for decades.

If ivermectin worked in emergency rooms and intensive care units, they would be using it! They have tried it, for 2 years now, and they have watched the patients die at the same rate as everyone else.

I know it's human psychology to think that there's this one neat trick that a soccer mom found to beat covid. It's why there are so many clickbait articles with those titles. But it's all wishful thinking. And when it doesn't work, it's "you didn't take enough zinc. You didn't take enough vitamin C. You didn't get enough sun/vitamin D." On and on and on to justify this ivermectin cult.

Maybe talk to these doctors/scientists who did a meta analysis and found ivermectin to be effective in treating sars-cov-2. I am sure they are cult members like you say and need saving from themselves. I just can't see it but am open to further proof. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248252/

Here is a study out of mexico that says a regimen that includes ivermectin worked: https://pubmed.ncbi.nlm.nih.gov/33578014/ Pretty culty people involved.

However, you do not need to take it if you are sick of course. Do you think it should be outlawed as a treatment? And if so, why? It has been proven safe and effective in treating river blindness, why not other uses if there is informed consent?

[drumdude]

Proving ivermectin effective has become a cottage industry in labs across the world. Here are the results, after examining them critically instead of taking them at face value:


https://www.nature.com/articles/s41591-021-01535-y

The global demand for prophylactic and treatment options for COVID-19 has in turn created a demand for both randomized clinical trials, and the synthesis of those trials into meta-analyses by systematic review. This process has been fraught, and has demonstrated the inherent risks in current approaches and accepted standards of quantitative evidence synthesis when dealing with high volumes of recent, often unpublished trial data of variable quality.

Research into the use of ivermectin (a drug that has an established safety and efficacy record in many parasitic diseases) for the treatment and/or prophylaxis of COVID-19 has illustrated this problem well. Recently, we described flaws in one randomized control trial of ivermectin1, the results of which represented more than 10% of the overall effect in at least two major meta-analyses2,3. We described several irregularities in the data that could not be consistent with them being experimentally derived4. That study has now been withdrawn by the preprint server5 on which it was hosted. We also raised concerns about unexpected stratification across baseline variables in another randomized controlled trial for ivermectin6, which were highly suggestive of randomization failure. We have requested data from the authors but, as of 6 September 2021, have not yet received a response. This second ivermectin study has now been published6, and there is still no response from the authors in a request for data.

The authors of one recently published meta-analysis of ivermectin for COVID-193 have publicly stated that they will now reanalyze and republish their now-retracted meta-analysis and will no longer include either of the two papers just mentioned. As these two papers were the only studies included in that meta-analysis to demonstrate an independently significant reduction in mortality, the revision will probably show no mortality benefit for ivermectin.

Ivermectin is an antiparasitic drug being investigated for repurposing against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Ivermectin showed in vitro activity against SARS-COV-2, but only at high concentrations. This meta-analysis investigated ivermectin in 23 randomized clinical trials (3349 patients) identified through systematic searches of PUBMED, EMBASE, MedRxiv, and trial registries. The primary meta-analysis was carried out by excluding studies at a high risk of bias. Ivermectin did not show a statistically significant effect on survival (risk ratio [RR], 0.90; 95% CI, 0.57 to 1.42; P = .66) or hospitalizations (RR, 0.63; 95% CI, 0.36 to 1.11; P = .11). Ivermectin displayed a borderline significant effect on duration of hospitalization in comparison with standard of care (mean difference, –1.14 days; 95% CI, –2.27 to –0.00; P = .05). There was no significant effect of ivermectin on time to clinical recovery (mean difference, –0.57 days; 95% CI, –1.31 to 0.17; P = .13) or binary clinical recovery (RR, 1.19; 95% CI, 0.94 to 1.50; P = .15). Currently, the World Health Organization recommends the use of ivermectin only inside clinical trials. A network of large clinical trials is in progress to validate the results seen to date.

https://academic.oup.com/ofid/article/8 ... 58/6316214

[Doctor Steuss]

Some quick notes on the shared studies (and others that have shown promise).

They are almost exclusively retroactive observational studies (ROS from here on out for brevity). These types of studies are useful for ascertaining the potential of given therapeutics, but they are prone to conflate correlation and causation -- particularly because of their complete lack of controls.

This was something that occurred with the myriad of HCQ ROS. The majority of them indicated efficacy, and were exceptionally promising. However, once placebo-based double-blind studies started to be conducted, every single such study showed no efficacy. There was a level of efficacy demonstrated for the HCQ/Azithromycin studies, but it was for people remaining off ventilators, and had no statistical effect on deaths. So, if the HCQ studies showed the efficacy of anything, it was predominantly that combatting the susceptibility for secondary bacterial infections was advantageous.

The first study shared above is an ROS. The second study included administration of an antileukotriene, aspirin, and azithromycin. As noted above, azithromycin has been shown efficacy in reducing chances of ending up on a ventilator. Antileukotrienes are used to reduce inflammation in the lungs, and are a somewhat common type of asthma medication.

So, given the above, why should the assumption be that an antiparasitic was the determining factor for successful management of adverse outcomes from an upper respiratory viral infection? Instead of something that directly treats a symptomatic aspect of said infection, or something that has shown tentative efficacy? They also don’t mention what the other patients were treated with, and there was no true placebo control group.

It's kind of like me getting a headache, and taking a Tylenol, a Benadryl, a Prozac and a Tums, and deciding it must have been the Tums that got rid of the headache (gastric headaches are a thing, after all).

[Rivendale]

Some quick notes on the shared studies (and others that have shown promise).

They are almost exclusively retroactive observational studies (ROS from here on out for brevity). These types of studies are useful for ascertaining the potential of given therapeutics, but they are prone to conflate correlation and causation -- particularly because of their complete lack of controls.

This was something that occurred with the myriad of HCQ ROS. The majority of them indicated efficacy, and were exceptionally promising. However, once placebo-based double-blind studies started to be conducted, every single such study showed no efficacy. There was a level of efficacy demonstrated for the HCQ/Azithromycin studies, but it was for people remaining off ventilators, and had no statistical effect on deaths. So, if the HCQ studies showed the efficacy of anything, it was predominantly that combatting the susceptibility for secondary bacterial infections was advantageous.

The first study shared above is an ROS. The second study included administration of an antileukotriene, aspirin, and azithromycin. As noted above, azithromycin has been shown efficacy in reducing chances of ending up on a ventilator. Antileukotrienes are used to reduce inflammation in the lungs, and are a somewhat common type of asthma medication.

So, given the above, why should the assumption be that an antiparasitic was the determining factor for successful management of adverse outcomes from an upper respiratory viral infection? Instead of something that directly treats a symptomatic aspect of said infection, or something that has shown tentative efficacy? They also don’t mention what the other patients were treated with, and there was no true placebo control group.

It's kind of like me getting a headache, and taking a Tylenol, a Benadryl, a Prozac and a Tums, and deciding it must have been the Tums that got rid of the headache (gastric headaches are a thing, after all).

Here is another study back in 2003. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7128816/

[Doctor Steuss]

Here is another study back in 2003. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7128816/

Thank you. I had forgotten that prior to the ROS studies, there were In vitro studies that lead to the hypothesis for use against SARS-CoV-1 (which inevitably lead to the ROS studies for SARS-CoV-2).

Unfortunately, in vivo placebo-based double-blind studies didn't support the hypothesis. Our bodies, nasties, and drugs are weird when all of the moving parts and variables come together.