Monday, January 24, 2022

Reposting. Ivermectin Suppression: Hydroxychloroquine Redux

Sunday, September 12, 2021

First, access to hydroxychloroquine and chloroquine was restricted.  The chloroquine drugs only work during active viral replication. While extremely safe at prescribed doses, and used daily for years by hundreds of thousands of patients with rheumatoid arthritis or lupus, overdose can be fatal.

Awareness of these facts led to the FDA restricting the use of EUA hydroxychloroquine to only hospitalized patients, in whom it would no longer be effective. Three large multicenter, multination clinical trials were designed to give patients excessive amounts of hydroxychloroquine, leading to predictably increased arrhythmias and deaths.  Most of the early and large clinical trials were deliberately flawed, by either giving the drug too late or using too much. That's how the initial literature on hydroxychloroquine was contrived to make it appear ineffective and dangerous for Covid. Later studies that used appropriate doses, and gave the drug to patients during the first week of illness, showed almost uniformly excellent results.

While the HCQ research was being controlled early in 2020, FDA and about 30 states imposed other restrictions on its use.  Maine has one of the least severe restrictions, but the restriction is still unacceptable.  I can prescribe HCQ for early treatment but not for prophylaxis, even though the prophylactic dose is only about 1/6 of the treatment dose for lupus, and therefore extremely safe.

Like hydroxychloroquine, ivermectin is also a licensed drug in the United States which physicians can (supposedly) prescribe freely. Fortunately, unlike HCQ, it is not toxic when given much more frequently than is necessary for parasites--which often require only one dose. It has been used over 3 billion times since 1987, without a prescription, for parasitic diseases. It is derived from a streptomycetes soil bacterium.  According to Wikipedia:

Streptomycetes... produce over two-thirds of the clinically useful antibiotics of natural origin, e.g., neomycincypemycingrisemycinbottromycins and chloramphenicol. The antibiotic streptomycin takes its name directly from Streptomyces. 

Ivermectin not only works during viral replication, but also is effective later in the illness.  This meant that the tricks that had been used to make hydroxychloroquine look bad would not be effective for ivermectin.  Furthermore, there have been dozens of independent studies showing the drug's safety and effectiveness for Covid.  The powers that be had not gotten into the game early with fake studies and fake publications.  

There have now been several metanalyses showing how well the drug works for Covid. I have previously linked to a metanalysis by Bryant, Lawrie et al., and another by Pierre Kory et al.

I suspect the powers that be were also gun-shy about repeating their tricks to stop the public getting effective treatment for Covid.  Would they be outed by media this time around?

As more and more people began to obtain ivermectin, and thereby were able to discard their fear of Covid, also perhaps discarding their need for vaccination, the bad guys apparently decided that despite the risk, they had to act.

This time a very concerted movement of FDA, CDC, Pharmacy chains, state medical boards, and drug wholesalers occurred together, beginning around August 25, 2021.  I wrote about this earlier in a piece titled "The Mess Media."  Let me lay out and expand on what happened.

At least 4 doctors in 3 states were suddenly publicly charged by their medical boards for prescribing ivermectin for Covid, and this made national news.  Immediately thereafter the CDC sent out an Emergency memo titled Severe Illness Associated with...Ivermectin. However the 4 pages of the memo said absolutely nothing about any adverse reactions to ivermectin prescribed by doctors.  Instead, it was claimed that one internet purchaser and one consumer of veterinary ivermectin developed neurologic symptoms and were hospitalized. The strategy was to paint ivermectin as an animal dewormer, and dangerous to boot.

FDA produced a famous tweet: "You are not a horse. You are not a cow" about people taking ivermectin, and put up a warning on its website.  However, the FDA has yet to acknowledge reviewing the literature on ivermectin for the human treatment of Covid.  Instead, FDA pretends that 31 randomized clinical trials do not exist, stating

Any use of ivermectin for the prevention or treatment of COVID-19 should be avoided as its benefits and safety for these purposes have not been established. Data from clinical trials are necessary for us to determine whether ivermectin is safe and effective in treating or preventing COVID-19.

The NY Times reported on August 30, 

Demand Surges for Deworming Drug for Covid, Despite Scant Evidence It Works

Prescriptions for ivermectin have jumped to more than 88,000 per week, some pharmacists are reporting shortages and people are overdosing on forms of the drug meant for horses.

It was right around this time that the drug started to be unavailable.  Pharmacists began refusing to dispense it, and two told me they were afraid for their licenses.  

On September 1, The American Medical Association and the American Pharmacists Association issued a joint press release condemning the use of ivermectin for Covid. 

Then lies about a huge number of calls to poison control centers were disseminated nationally.  The Associated Press reported that 70% of calls to Mississippi's poison center were for ivermectin.  Soon the AP corrected itself, when Mississippi's chief epidemiologist said it was only "about 2%." 

An actual Oklahoma doctor was interviewed by a TV station and somehow claimed that there were so many ivermectin overdoses coming to ERs that people arriving with gunshot wounds were having to wait.  This story made the international news, was covered by tweets from Rachel Maddow, and Rolling Stone did a big story about it: 

Gunshot Victims Left Waiting as Horse Dewormer Overdoses Overwhelm Oklahoma Hospitals, Doctor Says"

--using a photo of a long line of patients, allegedly waiting to be seen in an ER.

This story apparently had too many legs.  One hospital where the doctor worked issued a statement that it had seen absolutely zero ivermectin overdoses, and there were no lines of patients waiting for care.  The story was a complete fabrication, harking back to the Lancet paper on the dangers of the chloroquine drugs.

Within a few days, Walgreens' and CVS' corporate offices told their staff to stop filling ivermectin scripts.  Cardinal Health, a distributor for many pharmacies, told those pharmacies (including my local Hannaford's) the drug was on backorder and Cardinal had no idea when it would be available.  Cardinal formed a business relationship with CVS in 2014.  I do not know if that is relevant or not.

Amerisource-Bergen and McKesson are the two other large drug wholesaler-distributors in the US.  In 2018 these three companies controlled 95% of the US market.

I bit the bullet and drove around town surveying the local pharmacists, which is how I got this information.  McKesson is not making ivermectin available to Osco or Walmart pharmacies. No one local obtains ivermectin through Amerisource.

So, I can prescribe it, but the supply has been shut off. 

Tomorrow I will call the compounding pharmacies and see what their situation is.

UPDATE September 13:  From Boise Idaho:

BOISE — Since the U.S. Centers for Disease Control issued an official health advisory Aug. 26 against using ivermectin, an anti-parasite drug, to prevent or treat COVID-19, Idaho has seen warnings from officials, but no new rules about prescribing or using the controversial drug.

However, a nationwide shortage of the drug over the past two weeks has stopped many Treasure Valley pharmacies from filling invermectin prescriptions at all. “We haven’t been able to buy any ivermectin for a couple of weeks,” Travis Walthall, pharmacist and manager of Custom RX Pharmacy in Kuna, said Friday. “So we have not filled one in weeks or more.”

Walthall said prior to the COVID-19 pandemic, he filled maybe one ivermectin prescription a year. By mid-August, his pharmacy was filling four or five a week...

I have spoken to two compounding pharmacies this morning, and they still have a supply of the medicine. They do not obtain it through the big three wholesalers, and can dispense it for cash/credit card payments, because compounded meds are generally not covered by insurance. I think compounding pharmacists are more accustomed to dealing with controversial drugs, and so they have not succumbed to the propaganda.  They know they cannot get into trouble for filling a legal prescription.

If you want some, I suggest you not hesitate obtaining it, as we do not know what will happen next.


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Anonymous said...

Some states still pushing ineffective Covid antibody treatments - MedCity News

Remdesivir and Mortality in Patients With Coronavirus Disease 2019 | Clinical Infectious Diseases | Oxford Academic

During cohort follow-up, death occurred in 206 of 1138 persons (18.1%), with 169 deaths occurring in the hospital, 182 by 30 days, and 195 by 60 days after T0. Among treatment groups, death during follow-up occurred in 33 of 286 persons receiving RDV, 78 of 400 receiving HCQ, and 95 of 452 of receiving supportive care alone. The unadjusted Kaplan-Meier survival rates were 89.8% (RDV), 78.9% (HCQ), 79.8% (supportive care alone) at 30 days, and 87.3% (RDV), 77.8% (HCQ), and 78.0% (supportive care alone) at 60 days (Figure 3).

Survival Outcomes
During cohort follow-up, death occurred in 206 of 1138 persons (18.1%), with 169 deaths occurring in the hospital, 182 by 30 days, and 195 by 60 days after T0. Among treatment groups, death during follow-up occurred in 33 of 286 persons receiving RDV, 78 of 400 receiving HCQ, and 95 of 452 of receiving supportive care alone. The unadjusted Kaplan-Meier survival rates were 89.8% (RDV), 78.9% (HCQ), 79.8% (supportive care alone) at 30 days, and 87.3% (RDV), 77.8% (HCQ), and 78.0% (supportive care alone) at 60 days (Figure 3).

The HR (95% CI) for death in RDV group compared with the BSC group was 0.42 (.28–.64; P < .001) in univariate analysis and 0.58 (.38–.90; P = .02) in the risk-adjusted model.