[Joking_Phantom]

Love the final explanation for how ivermectin can be incidentally good for COVID-19 patients, even if it does nothing to COVID-19 directly.

In fact, as the author cites from another researcher, the trials are a strong piece of evidence for "add[ing] ivermectin to mass drug administration programs." In other words, global medical welfare, where we just give everyone a bunch of a cheap and effective medications to counteract the most prolific diseases. In addition to reducing mortality from diseases targeted by the medication, it will probably reduce incidental mortality when people contract multiple conditions at once. I.e. getting ivermectin for a detected COVID-19 infection has a 10% chance of helping you, because you have a 10% chance of having an undetected worm infection that will kill you if your immune system is suppressed by drugs that are used to prevent COVID-19 from killing you.

I do think the ending political metaphor doesn't quite fit, however. I see more parallels with workplace politics than an alien invasion, for why our societies have become so divided on relatively meaningless issues. Uniting disparate factions to work towards a common goal is an uphill battle that sees more failure than success, most often in our workplaces. To me, the ivermectin drama was just another example of an emergent situation that wasn't optimally handled by a collection of random individuals, who despite the best intentions, were unable to unite a group. Doesn't make them bad people, or mean they have the wrong approach. Just means they weren't ready to tackle such a difficult challenge. Positive outcomes take dedicated effort, they don't come automatically because we assume the status quo is good enough to us immune to random chance.

[DoreenMichele]

In fact, as the author cites from another researcher, the trials are a strong piece of evidence for "add[ing] ivermectin to mass drug administration programs." In other words, global medical welfare, where we just give everyone a bunch of a cheap and effective medications to counteract the most prolific diseases.

When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections.

Medical stuff doesn't work the way most people would like to imagine it does. This sounds like a terrible thing to conclude. I'm rather unsettled to see it lauded here on HN.

[darrenf]

> When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections.

> Medical stuff doesn't work the way most people would like to imagine it does. This sounds like a terrible thing to conclude. I'm rather unsettled to see it lauded here on HN.

Indeed, this exact thing is headline news in the UK today from our Health Security Agency - don't take antibiotics unless you definitely have something treatable by them: https://www.bbc.co.uk/news/health-59310099

[DoreenMichele]

Parasites are notoriously hard to treat. They are harder to treat than bacterial infection.

Places with lots of parasitic infections need better infrastructure and general hygiene to prevent infection. They don't need all the locals actively breeding drug-resistant parasites. Parasites are enough of a nightmare without cavalierly passing out drugs for funsies.

[yorwba]

The WHO's guideline for "preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups" https://apps.who.int/iris/handle/10665/258983 isn't about "passing out drugs for funsies". They recommend mass drug administration for at-risk groups because hundreds of millions of people are suffering from parasitic worm infections that can easily be treated with a single dose of a cheap anthelmintic drug, but diagnosing every single case beforehand would be much more expensive.

Of course improving hygiene to prevent infection is important (that's also stressed in the guideline), but that will take much longer, while mass drug administration has immediate benefits.

Fear of drug resistance isn't a good reason to withhold treatment from people who really need it. The WHO's much more sensible strategy is to encourage research into alternative drugs in case drug resistance becomes a significant concern.

[mrow84]

I’m certainly no expert but isn’t the evolutionary timescale for parasites considerably longer than for bacteria? That would presumably lead to quite different consequences (though of course the evolutionary pressure, and thus the risk, is still there).

[dkga]

Veterinarian here, used to ivermectin as it should be used - as an anti parasitic.

I fully agree with this view above.

[WithinReason]

You mean you believe that a widespread administration of ivermectin would lead to development of ivermectin resistance in parasites?

[crazyjncsu]

That’s certainly already the case. Ivermectin has lost effectiveness against particularly insidious parasites such as Haemonchus Contortus (barber pole worm). We’ve resorted to other treatments such as Moxidectin, Levamisole, etc, all of which are more expensive and harder to dose safely and effectively.

I can totally understand how Ivermectin got its following— it’s an amazing general purpose medicine around the farm. I generally use it responsibly by verifying the presence of parasites before administering (which can be literally any animal on the farm with almost any parasite) … but then there are times such as when my daughter had a single pet chicken (among many healthy ones) that wasn’t looking so hot … Whereas previously I’d just dispatch the animal and be done with it, now I give a dose of Ivermectin and isolate for a few days before calling in the grim reaper. So far the success rate is something like 90% where now my 9 year old daughter administers it herself. While I acknowledge this isn’t the most responsible, I can imagine others have had similar experiences which explain some of the popularity of Ivermectin with rural folk.

[WithinReason]

What's the downside of giving Ivermectin to livestock that don't have parasites?

[mumblemumble]

Ivermectin stops working.

[h2odragon]

There's an issue with collies and collie-derived dog breeds; used to be warnings (even mentioned in an episode of "House"). But. Most of the lines running around today are the ones that weren't sensitive and didn't die from ivermectin. So it's no longer such an issue.

[marcosdumay]

Widespread administration does lead to the development of resistant parasites. That's not an hypothetical, that's what you see on any farm if you prolong the treatment for too long.

It's always recommended that you cycle through different anti-parasite treatments.

[imwillofficial]

Why would I take human medical advice from you? Are you saying there are no human uses beyond an anti parasitic?

[blitzar]

I guess in theory you could use the topical cream form as a moisturiser. Perhaps even use the tube as a doorstop in a pinch.

[HelloNurse]

Wouldn't we risk force-evolving ivermectine resistant parasites with the same mechanism as antibiotic resistant bacteria?

[toolz]

The CDC estimates that _at least_ 30% of all anti-biotic prescriptions are inappropriately prescribed. I'd wager an over-prescription of Ivermectin (that by some unknown characteristic appears it would save massive numbers of lives) isn't likely to evolve parasites (which evolve much more slowly than bacteria to begin with) to be resistant in a dangerously meaningful way given what we see with bacteria resistance.

This is of course just a gut feeling and not a studied understanding.

[PaulDavisThe1st]

>This is of course just a gut feeling

I see what you did there.

[MissionInfl]

I'm curious whether a similar mechanism would apply to the COVID vaccines? Can someone with some expertise in the area help clarify if this is the case? Are we accidentally creating vaccine resistant COVID strains with mass vaccination similar to how mass ivermectin creates ivermectin resistant parasites?

[LordDragonfang]

>When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections.

I think this is an extremely jaded take, resulting from growing up in a post-antibiotics society. The risk factor for those "scary antibiotic-resistant infections" is still an order of magnitude less than the class of diseases antibiotics almost totally eliminated. In the 30 years following penicillin's discovery, deaths from bacterial infection dropped from accounting for over 22% of all deaths to just 6% [1] (MRSA deaths, by comparison, currently represent less than half a percent). "End of disease" may be hyperbole, but between antibiotics and vaccines, infectious diseases were almost totally knocked off the leading causes of death.

The only reason why we even have antibiotic resistant bacteria is because they keep getting prescribed, because they're so damn useful. "Medical stuff" does, in fact, work like that, to some extent.

[1] https://dash.harvard.edu/bitstream/handle/1/8889467/Gottfrie...

[adrianN]

The major reason why we have antibiotic resistant bacteria is because we use literal tons of the stuff for meat production and too many countries have too lax controls for antibiotic use in humans, which means they are taken for things were they don't help, or are not necessary, and are taken in the wrong dosage and for the wrong duration.

[jacquesm]

Exactly, if we only used it when there was a chance of it being effective that would be that, but instead your average cow is a walking antibiotic laboratory.

[ncmncm]

Malaria seems to develop resistance pretty fast. Are farm animals getting those treatments in their feed?

[adrianN]

https://en.wikipedia.org/wiki/Antibiotic_use_in_livestock

[ncmncm]

You will notice that the word "malaria" does not appear in the article cited. It is, thus, non-responsive, and no better than noise.

Anti-malarial medications are not antibiotics. Malaria has never responded to any antibiotic, to my knowledge. Maybe you don't know what malaria is?

[pjc50]

> infectious diseases were almost totally knocked off the leading causes of death.

Well, until 2020. Then we had another infectious disease. Which is why we're having this conversation.

[BurningFrog]

You have a valid point.

But note that it's a much easier point to make from a region where parasitic worms don't exist.

[WhompingWindows]

I think you should clarify that Ivermectin works better in higher-worm-prevalence areas. It's not remotely true that 10% of Americans have undetected worms. The praised study in the post highlights 12.5% as "high" prevalence, so 10% would be nearly high -- not true in the developed world.

[Joking_Phantom]

10% is a token number for argument's sake, not any rate based on reality

[naasking]

According to the CDC, 3.7 million people in the US are infected with Trichomoniasis. That's at least 10%.

https://www.cdc.gov/media/releases/2014/p0508-npi.html

[Jefenry]

I think you missed a decimal place. There's very nearly 333 million people in the US, so 3.7 million infected is 1.1%

[blitzar]

3.7/329.5 != 10%

[naasking]

Haha, math fail.

[jacquesm]

That depends on the side effects and the dose required+. So no, you can't just draw that conclusion.

+ edit: , etc...

Thanks Cthulhu_.

[Cthulhu_]

And of course whether parasites can adapt to become resistant (?) to the treatments.

[jacquesm]

There are probably many other factors that I should have listed there, my bad, I did not mean to make an exhaustive list, in fact the opposite, that's the first two things that came to mind.

[Veelox]

> I do think the ending political metaphor doesn't quite fit, however.

Literally none of my immediate family has gotten the vaccine. I know several more people who haven't gotten it. I have been reading Scott since around 2015. I would say I sit in an interesting intersection of worlds for this issue.

While the facts of the metaphor are slightly off, I think Scott got the emotional feeling exactly correct. There are hostile aliens who actively gone against my interests in the past, they have been wrong before, their is a good chance they could use this for their own gain. That is exactly how my parents feel.

[nisegami]

I have unironically been advocating for this approach with Metformin in my country. I think it'd have incredible positive effects.

[vmception]

This is interesting, it is similar to how doctors just include gonorrhea treatment for women that expect to bear children. Instead of embarrassing any particular woman who would suddenly have something to explain to the partner, they just give it to many amongst the cocktail of various other obscure sounding drugs.

[raverbashing]

For real, prophylaxis of enteral worms should have been more popular in developed countries.

It's amazing how hygiene practices are sometimes poor and tropical diseases are unknown in developed countries

But then you go visit somewhere and/or some animal product is imported in questionable ways and you get a worm. Which for 95% of people will be mildly inconsequential but it might also cause problems.

[jacquesm]

This is the basis for many religious food taboos.