Got a tip for us?
Let us know
Become a MacRumors Supporter for $50/year with no ads, ability to filter front page stories, and private forums.
Coronavirus (Covid-19) informational thread
- Thread starter yaxomoxay
- Start date
- Sort by reaction score
Definitely an interesting post. However, reference the bolded, I’d be curious to know how do you know that and/or derived “That boosters train the immune response better against mutations.”
If you have a source, that would be great.
Probably still WAY too early to draw a conclusion, but a couple of early reports from different countries are that Omicron seems to produce relatively mild symptoms
www.japantimes.co.jp
www.wsj.com
Stopping the spread of this beast completely would be the best thing, but at this point it seems as though mutations may actually be moving at least in a(somewhat perversely) good direction.
The first article I linked here also states that Omicron is becoming the dominant strain over Delta in South Africa, and the number being thrown around is that it is 2x as transmissible.
If we have reached a mutation where we have a wildly contagious virus that basically acts like other Coronaviruses and just causes cold-like symptoms but no other serious issues(again WAY too early to actually conclude that, but early data shows promise) we may, two years later, be at the point where the end of the pandemic is in sight-an endemic virus that is not of concern.
Not advocating throwing caution to the wind, yet, and if an Omicron-specific booster is offered I will certainly be in line to take it, but again if the trends continue I'm perversely optimistic about this variant.
Article expired
News on Japan, Business News, Opinion, Sports, Entertainment and More
U.S. Plans to Fast-Track Revamped Covid-19 Vaccines
Federal regulators said cases have been identified in 16 states and that the Food and Drug Administration is already in conversations about streamlining authorization for revamped vaccines.
www.wsj.com
Stopping the spread of this beast completely would be the best thing, but at this point it seems as though mutations may actually be moving at least in a(somewhat perversely) good direction.
The first article I linked here also states that Omicron is becoming the dominant strain over Delta in South Africa, and the number being thrown around is that it is 2x as transmissible.
If we have reached a mutation where we have a wildly contagious virus that basically acts like other Coronaviruses and just causes cold-like symptoms but no other serious issues(again WAY too early to actually conclude that, but early data shows promise) we may, two years later, be at the point where the end of the pandemic is in sight-an endemic virus that is not of concern.
Not advocating throwing caution to the wind, yet, and if an Omicron-specific booster is offered I will certainly be in line to take it, but again if the trends continue I'm perversely optimistic about this variant.
As you say very early days, but Dr John Cambell's latest vid where he's started to get and then look carefully at some SA info doesn't look as bad as we might have feared (in terms of severity of disease). Let's hope...
(Just a reminder the "Dr." is not a medical doctor but a retired nurse with a PhD in teaching nursing. I saw him on German TV the other day and they introduced him as "medical expert Dr. Campbell" with no qualification which I think is really misleading.)
Some preliminary analysis of South African data has the Rt for Omicron at 3 to 3.5. The initial Delta wave was 1.5:
Thread by @trvrb on Thread Reader App
@trvrb: As the Omicron epidemic continues to expand in South Africa and as case counts and sequencing data continues to come in, we can better estimate the current transmission rate of Omicron. 1/19 Here, I am focuse...…
threadreaderapp.com
(Just a reminder the "Dr." is not a medical doctor but a retired nurse with a PhD in teaching nursing. I saw him on German TV the other day and they introduced him as "medical expert Dr. Campbell" with no qualification which I think is really misleading.)
Some preliminary analysis of South African data has the Rt for Omicron at 3 to 3.5. The initial Delta wave was 1.5:
Thread by @trvrb on Thread Reader App
@trvrb: As the Omicron epidemic continues to expand in South Africa and as case counts and sequencing data continues to come in, we can better estimate the current transmission rate of Omicron. 1/19 Here, I am focuse...…
He knows how to find and read research papers and spends a lot of time doing this. He also provides his sources and he does a lot of interesting interviews with people around the world. You don't have to be a medical doctor to do what he does but it's pretty obvious that he has a decent bio background. If you want to challenge him, he'll accept but you're basically criticizing research papers or his analysis. If he's proven wrong, he'll admit it.
Look I'm not knocking the guy particularly. I find him a good resource for summarizing the latest COVID findings if I miss the news for a few days (although I wish I could play him at 2x-speed since I find his pace painfully slow at times).
I just think he should label himself "John Campbell PhD". How many of his 1.75 million subscribers think he is a medical doctor? And the thing is he is pushing his own theories that are not mainstream COVID-medicide (e.g. Ivermectin [!], vitamins, aspiration). A viewer might take the theories differently coming from a nurse than a doctor.
Coming from a family of PhDs I don't even knock him calling himself "Dr.", I just think in the context of medicine it is dubious. Especially since the PhD isn't even in biology or a hard-science field.
I never thought that he was a practicing doctor as I couldn't see how he would have the time to do his research, interviews and video production.
He made a case for Ivermectin in that it's a protease-inhibitor and provides research papers to back up his comments. If you have a problem on his views, then take it up with his research sources.
Probably still WAY too early to draw a conclusion, but a couple of early reports from different countries are that Omicron seems to produce relatively mild symptoms
Article expired
News on Japan, Business News, Opinion, Sports, Entertainment and MoreU.S. Plans to Fast-Track Revamped Covid-19 Vaccines
Federal regulators said cases have been identified in 16 states and that the Food and Drug Administration is already in conversations about streamlining authorization for revamped vaccines.
Stopping the spread of this beast completely would be the best thing, but at this point it seems as though mutations may actually be moving at least in a(somewhat perversely) good direction.
The first article I linked here also states that Omicron is becoming the dominant strain over Delta in South Africa, and the number being thrown around is that it is 2x as transmissible.
If we have reached a mutation where we have a wildly contagious virus that basically acts like other Coronaviruses and just causes cold-like symptoms but no other serious issues(again WAY too early to actually conclude that, but early data shows promise) we may, two years later, be at the point where the end of the pandemic is in sight-an endemic virus that is not of concern.
Not advocating throwing caution to the wind, yet, and if an Omicron-specific booster is offered I will certainly be in line to take it, but again if the trends continue I'm perversely optimistic about this variant.
I think it’s hard to make any sweeping assumptions at this point. In South Africa the majority of cases appear to be mild and occurring in younger people, particularly those who are unvaccinated- which is a significant proportion of their younger population. Younger people have a low risk of complications and death with the previous variants. Older people are more likely to be vaccinated and most scientists suspect, including myself, the existing vaccines will not be completely useless.
Through the pandemic, SA has faired statistically quite a bit better than similarly sized nations (ie the UK). This may have something do to with the average life expectancy in South Africa being 64 years. The average age of death caused by COVID-19 in the US is 79. So I suspect the younger age of the population and skewed age-related distribution of vaccinations could potentially be throwing off expectations.
Israel’s preliminary data suggests very contagious, but mild cases, particuarly in people under 50. Israel had a big push early on to vaccinate its population and 70% is fully vaccinated. That said, Israel was also one of the fjrst, if not the first to notice waning immunity. 45% of the population is boosted, presumably a lot of that being older individuals and essential workers. So younger people would be most likely to be boosted and have milder symptoms.
As I mentioned earlier, I’m also a little suspicious of the South Africa doctor presenting the new variant, foreign countries locking down travel, the SA government having a conniption over the travel bans, and the next day said doctor all over the news trying to downplay concerns with very little data to go off of. It seemed like there was political pressure for her to do so.
In all other countries there’s so few cases it’s hard to draw conclusions at this point. It’s difficult to base predictions off at most couple hundred known cases that you’ve only been aware of for several days.
I think it is clear omicron is spreading faster than delta. The cases seem to be exploding exponentially. If the variant is less deadly, that could be a good thing- assuming it doesn’t morph into something more dangerous down the road. Typically that’s not the case, but it’s not impossible. I think the world needs to come to grips 100% containment is not possible (and never was) and this is likely going to be endemic.
It’ll be interesting to see what happens with the vaccines. Pfizer, Moderna, etc scrambled to create a delta booster only to find out the existing vaccines worked well enough. Given the speed omicron seems to be blowing up at, I question if a omicron specific booster was deemed necessary if it could be on the market before the virus has wiped through society. Pfizer said it would take 2 months before they can start clinical trials and March before the product is available, which seems very optimistic. Between the clinical trials, potential delays/safety reviews, the FDA approval process, getting manufacturing online, and putting out enough doses to affect a sizable degree of the population (or at least those most volnerable), a little over 3 months sounds insanely fast- even if production begins before it’s approved.
All that said, I’m optimistic that omicron will be manageable. I don’t think it’s right to make predictions off preliminary findings in limited context. At the same time, I can’t stand the hype the media has played up over the past week. At the end of the day it is what it is and there is only so much that can be done. But we’re in a much better place than we were year ago or March 2020 to combat another wave.
Seems contrary to your previous post.
Just to be clear, the CDC, NIH, FDA and WHO current guidance is Ivermectin has not shown to be effective against COVID in practice and could even be dangerous.
That was before I saw how much volume he put out and knew how much time he spent reading research papers.
I'm aware of the guidance on Ivermectin. We don't have drug companies doing clinical trials on it so we're not really going to get it approved, even if it does work. There is a paper on how it works, and it's in a similar class to one of the new therapies against COVID. If the drug companies decide not to try clinical trials, then it's not going to get approved. They have no financial interest to do so.
Again, if you want to complain, complain against the research already done.
I should also mention Merck’s new COVID-19 oral antiviral therapeutic drug was reviewed by the FDA’s Drug Advisory Committee and just squeaked by 13 approved, 10 opposed. Ultimately though the FDA decides to approve or deny, not the advisory committee.
Apparently despite Merck’s interim report stating their drug offered a 50% reduction in hospitalizations and death, apparently in the final analysis the number was actually 30%. While 30% is significant, the 70% failure rate opens a big door for promotion of mutation, which was also observed in studies. That of course is problematic and could easily lead to a strain that’s entirely resistant to Molnupiravir. It was also found to be highly teratogenic (toxic to fetuses) which is a problem. Therefore it’s also likely not going to be approved for children. Many other highly teratogenic drugs (ie accutane) are highly controlled with all sorts of measures, including things like pregnancy tests and mandatory birth control. It could make prescribing and dispensing difficult if similar precautions are taken.
In the case of a lot of viruses (ie HIV), using a single antiviral even in the best cases is bound for eventual failure and resistant mutation for one of a number of reasons. That’s why most HIV regimens are at least 2 or 3 drugs in combination. The chance of resistance formation is greatly reduced (though HIV mutates far faster than SARS-CoV-2.
Pfizers upcoming COVID-19 antiviral allegedly has 90%+ efficacy. Not sure if that will turn out to be the case in the real world (such studies tend to be designed to optimize positive outcomes and minimize negative ones), but it does use two antivirals which will potentially lead to less risk of treatment failure and viral mutation and resistance. It does contain rotonivir which interacts with almost every other drug under the sun which is a problem, but that can usually be managed. Especially considering the short course of treatment.
Both drugs are seeking EUAs and not studies have been published so we’ll see what happens.
Apparently despite Merck’s interim report stating their drug offered a 50% reduction in hospitalizations and death, apparently in the final analysis the number was actually 30%. While 30% is significant, the 70% failure rate opens a big door for promotion of mutation, which was also observed in studies. That of course is problematic and could easily lead to a strain that’s entirely resistant to Molnupiravir. It was also found to be highly teratogenic (toxic to fetuses) which is a problem. Therefore it’s also likely not going to be approved for children. Many other highly teratogenic drugs (ie accutane) are highly controlled with all sorts of measures, including things like pregnancy tests and mandatory birth control. It could make prescribing and dispensing difficult if similar precautions are taken.
In the case of a lot of viruses (ie HIV), using a single antiviral even in the best cases is bound for eventual failure and resistant mutation for one of a number of reasons. That’s why most HIV regimens are at least 2 or 3 drugs in combination. The chance of resistance formation is greatly reduced (though HIV mutates far faster than SARS-CoV-2.
Pfizers upcoming COVID-19 antiviral allegedly has 90%+ efficacy. Not sure if that will turn out to be the case in the real world (such studies tend to be designed to optimize positive outcomes and minimize negative ones), but it does use two antivirals which will potentially lead to less risk of treatment failure and viral mutation and resistance. It does contain rotonivir which interacts with almost every other drug under the sun which is a problem, but that can usually be managed. Especially considering the short course of treatment.
Both drugs are seeking EUAs and not studies have been published so we’ll see what happens.
I saw a video on this over the weekend and I was surprised at the low the efficacy rate was on this. We have several therapies already and I wonder why a doctor would use this one. I could see combining them. I imagine Merck's drug is expensive like the other drugs. The important thing about the therapies is that patients get them as early as possible. They don't seem to be effective once severe disease sets in.
An interesting place to see the progression of disease is r/HermanCainAward. I am somewhat amazed at the number of people dying with pretty good descriptions from their relatives of the process. There are crossposts from r/nursing as well so you can get an idea of what the nurses are going through and how they are feeling. COVID treatment is out-of-sight for most people. It seems like a long period of agony in the process of dying. Cancer treatment is similar - the images or videos of the treatment don't really give you much of an idea as to the process, feelings or damage done. Most people are far more scared of cancer because it used to be a death sentence. COVID seems that way for a lot of people too but I think that most don't realize it even though they could probably make a determination by looking in the mirror or stepping on a scale.
Last edited:
I’m not particularly surprised. If you look at other antivirals for respiratory infections the results are pretty modest. You have to initiate treatment within 24-48hrs of symptoms. It’s not common for most people to feel sick, go to the doctor, and get confirmation they have or might have the flu within 24-48hrs. Rapid flu diagnostic tests reliability is all over the place. If started within the 2 day window, it may shorten the duration of illness by 24-48hrs. It can reduce “complications” (which range from ear infection to hospitalization) by 40%. The suggested populations’ recommended for its use is limited too- basically high risk patients.
I think I saw Merck is charging around ~$700 per course (5 days). Not cheap, but a lot cheaper than many other drugs. The reason it would be used is because it’s a targeted therapy against preventing viral replication. Monoclonal antibodies would help target viral cells for destruction*. Steroids such as dexamethasone tamp down the body’s inflammatory response that causes collateral damage to its own organs. Interleukin 6 and 1 inhibitors have a similar effect, though through a different mechanism of action and are actually monoclonal antibodies… and thus cost way more than dexamethasone. IL-6 inhibitors reduce deaths by 12%. As with most conditions, especially severe ones, you want to take a multifaceted approach and attack the problem from multiple angles.
Remdesivir is also antiviral, allegedly “broad spectrum”. As you may know it was developed to treat Ebola. While initial studies suggested high utility, studies quickly became contradictory, and at this point the overwhelming evidence suggests it’s not useful at all. Here’s a meta analysis from Cochrane, who is basically the king of meta analyses. https://www.cochrane.org/news/remdesivir-treatment-covid-19
Their key findings:
- “For adults hospitalised with COVID-19, remdesivir probably has little or no effect on deaths from any cause up to 28 days after treatment compared with placebo (sham treatment) or usual care.”
- “The review authors are uncertain whether remdesivir improves or worsens patients’ condition, based on whether they needed more or less help with breathing.”
There have been, and there are many ongoing, clinical trials of Ivermectin's effect on COVID:
ClinicalTrials.gov
www.clinicaltrials.gov
There has also been meta-analysis of the research:
The consensus on Ivermectin is based on all research to date. A single individual who cherry-picks out some contrary information is not a scientist -- in fact it's a sign of lack of scientific-sophisitication. Which is why I emphasize he is not a doctor.
There have been, and there are many ongoing, clinical trials of Ivermectin's effect on COVID:
ClinicalTrials.gov
There has also been meta-analysis of the research:
The consensus on Ivermectin is based on all research to date. A single individual who cherry-picks out some contrary information is not a scientist -- in fact it's a sign of lack of scientific-sophisitication. Which is why I emphasize he is not a doctor.
Based on the current very low‐ to low‐certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID‐19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use of ivermectin for treatment or prevention of COVID‐19 outside of well‐designed randomized trials.
Basically what I said.
I'm not saying that it works. What I got is that that the mechanism works In Vitro. One of your papers said the same thing.
I'm saying that there isn't enough research to support that it works. But there's nothing out there that disproves that it works.
There are just no financial incentives to do clinical trials.
Do you know anything about side effects with these sorts of drugs (beyond pregnancy)? I saw something in passing (forget where) which said they can be significant with these family of drugs. I ask because it seems problematic to me that you need to take it early when your symptoms would probably be mild (if you even knew you had COVID). Trying to balance the risks between taking it and not taking it might be difficult.
Yeah which makes it interesting. But it also kills HIV in vitro too. In fact it kills a lot of things in vitro but is useless in a human.
I listed over 60 clinical trials looking at ivermectin and COVID. It seems to me if it worked, Merck (original patent holder) could combine it with something else and re-patent it. The drug companies are very good at that.
If it were proven in a clinical trial, then the drug would get repurposed. Yeah, they could combine it with something else but that doesn't mean that doctors would have to use the combination.
There’s not a lot of information publicly available about these new antivirals at this point.
Regarding molnupiravir, Merck issued a preliminary report stating the results of two individual combined phase 2/3 studies. The two studies differed in the timing of intervention and one studied non-hospitalized patients and the other hospitalized patients. Each only had about 300 participants who were divided into 4 treatment groups- 200mg, 400mg, 800mg, and placebo BID x5 days. In reality, that’s a pretty small sample size. There is also no data on the ages (other than 18+), condition, or preexisting conditions of the participants.
Merck claims in the outpatient study there was no statistical significant between the intervention groups and the placebo (6.8%). In the inpatient study the intervention groups had 11% had adverse effects while 21% in the placebo group had side effects. None were considered serious and no one dropped out the study due to side effects. No one died either (which may suggest these people weren’t seriously ill to begin with, which is often the case in many clinical trials). They provide no information on what these side effects were.
I would expect nausea, vomiting, diarrhea and headache would be the most common side effect being an antiviral and oral medication. As mentioned there are serious concerns about it’s mutagenic properties against SARS-CoV-2 itself. A similar antiviral called favipiravir was created long ago to treat influenza (and was also investigated for SARS-CoV-2 early in the pandemic), but was never approved anywhere except Japan where it’s not really used. For one reason because it was highly mutagenic/teratogenic. It turns out molnupiravir is significantly more mutagenic than favipiravir.
Antiviral medications as a class many different mechanisms of action. Favipiravir’s is most similar to molnupiravir. There’s not a ton of information on Favipiravir given it never left Japan and isn’t used, but it appears to have some significant side effects beyond the N/V/D, headache found with most all drugs- muscle pain, elevated liver enzymes and tachycardia occurred frequently. It has also been linked to liver and cardiac dysfunctions as well as lympathic and blood abnormalities.
That’s not to say those adverse effects will happen with molnupiravir, but it’s something to consider. As a disclaimer, all adverse effects must be reported and may be caused/related to the illness being treated.
So not only can molnupiravir cause mutations in fetuses, it’s also possible it may cause mutations in sperm and ovum, negatively developing children, babies who are breastfed by a mother taking the medication, and perhaps even cause cancer in adults. But these potential issues have not been explored.
Pfizer’s Paxlovid also has very little public information. It’s a combination of an experimental protease inhibitor (called PF-07321332) and Ritonavir (also a protease inhibitor) long used in HIV treatment. Ritonavir’s primary function is actually to slow the metabolism of the the protease inhibitor so it’s ability to circulate and duration of action is longer than it otherwise would be.
Unlike Merck’s two studies, Pfizer’s study designs only investigated subjects who were not hospitalized to begin with. In one study, subjects were given drug or placebo within 3 days after were symptoms developed. 0.8% (3 of 389) subjects receiving Paxlovid required hospitalization versus 7% (27/385) in the placebo group. 0 people died in the Paxlovid group vs. 7 in the placebo. A second study provided the drug or placebo within 5 days of symptom onset. Results were similar- 1% (6/607) given Paxlovid were hospitalized, with 0 fatalities while 6.7% (41/612) were hospitalized and 10 dying.
I would consider we don’t know how well these groups are matched (age, health status, etc). I am also a little uncomfortable with the term “within 3/5 days of symptom onset”. 1 day can be within 5 days. So can 5 days. I’m curious to know the average time of symptom onset to hospitalization in these groups. This study took place in many different countries, so I’m curious if location affected outcomes (due to cultural health factors, what other treatments were given/available, etc). I will say this study design seems to have a bit more integrity than Merck. That said, both lack information necessary to truly assess their value.
Pfizer also provides very little safety data. ~20% of both intervention and placebo group experienced adverse effects. Serious side effects occured 1.7% vs 6.6% respectively, more in the placebo. Drop out was about 2% Paxlovid vs 4% Placebo.
In that the PF-07321332 and Ritonavir are both protease inhibitors, common class side effects are hyperlipidemia, T2 diabetes, kidney stones, and loss of body fat. Ritonavir is well known for causing lethargy, GI effects (N/V/D), dizziness/headache, insomnia. Ritonavir has profound effects on metabolic enzymes including inhibiting CYPs 3A4 and 2D6 metabolic enzymes. 3A4 and 2D6 are responsible for metabolizing many, many drugs in the world, thus increases their effects (which is why it is in Paxlovid, to boost the other protease inhibitor. This is also why it’s found in many HIV antiretroviral cocktails). This can cause complications when trying to treat other conditions with other drugs.
It’s important to say however these drug-drug interactions can be managed, usually by reducing doses of the affected medications or withholding them. It’s a lot easier to deal with this problem when the course of treatment is 5 days with Paxlovid versus in HIV which requires lifelong treatment.
It’s also worth noting many adverse effects are not discovered until post-market research.
And to be clear, the mechanism of action of antivirals is very diverse. So to assume the serious side effects of oseltamivir aka Tamiflu (liver inflammation, altered mental state, pediatric seizures, etc) would automatically apply to these other antivirals would not be appropriate.
It will be interesting to see what the FDA decides to do with Merck. The FDA and advisory comittee usually agree 80% of the time. When they don’t, 75% of the time the FDA takes more restrictive measures. They obviously have all the data to look at and can ask questions, but I’d like to see more safety information. I think it’s important the FDA not hastily approve a drug influenced by the misconception we direly need another COVID treatment (while overlooking study flaws/shortcomings and potential risks). This kind of happened with Remdesivir and that Alzheimer’s drug (it’s name is eluding me). Along the same lines, I’d like to see more specific data from the Paxlovid studies, though it sounds more promising in its practicality and functionality.
I suspect if molnupiravir gets an EUA it will be restricted to people not of child beating age, who are at most at risk as it is. But assuming both candidate drugs studies are 100% representative of the real world, molnupiravir probably wouldn’t receive much use if Paxlovid is 3x more effective.
I should also say all drugs have side effects of varying degrees. Even Aspirin can be dangerous in the wrong situation. The benefits have to be weighed against the potential risks with everything. Chemotherapy is extremely toxic and has significant risks, including long term effects, but those risks outweigh the alternative of almost certain death.
Anyways, this is far too much writing for one post.
The fact that ivermectin is generic does not mean that it would not be “indicated” for COVID-19 if it was indeed effective. Dexamethasone is generic and dirt cheap, yet is a standard of treatment in severe cases. Drugs are used off-label all the time and it’s approval status, so long as it’s FDA approved to begin with, is irrelevant.
It’s true that pharmaceutical companies have an incentive to come out with shiny new expensive treatments. But there are also incentives among hospitals as well as governments who fund any amount of public healthcare to find effective treatments at the lowest cost. Most reimbursement these days is capitation rather than fee-for-service, meaning the hospital gets paid a X amount of money to treat Y condition rather than paying an itemized invoice for each service provided.
I’m throwing out costs and oversimplifying for the sake of example here: let’s say an insurer pays $30,000 for 2 weeks of inpatient psych treatment to treat a patient’s bipolar mania. The hospital could spend $3000 on meds using the newest brand name drugs or $50 using generics that have been around for decades. Why throw away $3000 when you could get the same outcome for $50 and keep the extra $2950?
If healthcare can get the same outcome for less, they will take that opportunity- and seek out ways to do so. Sometimes it’s almost hard to laugh when drug reps come in trying to sell some new $2000/month drug that really has no meaningful benefit over an older drug that costs $2/month. Or some new combination of two existing drugs that cost $300/month while the two drugs independently cost $15 each. Or levothyroxine (normally $5/month, $40 for brand name Synthroid) that costs $250 because it comes in a capsule instead of a tablet. The best might have been this a $7,000 naloxone (Narcan) auto-injector called Evzio. Alternatively a vial of naloxone and a syringe is probably $11. (Not surprisingly, Evzio no longer is on the market).
You should also understand that if you take an existing generic drug, change the dose or dosage form, do expensive clinical trials, go through the approval process, you can patent it and sell it as a brand name drug. For example, in 1992 finasteride aka Proscar was approved. It comes in a single dose (5mg) and is used to treat enlarged prostates. In 1997, finasteride 1mg was approved for male pattern baldness, aka Propecia, which got its own patent. And while Propecia cost $100/month and wasn’t covered by insurance, generic finasteride 5mg cost several dollars per month.
Another example, ~10 years ago some of the manufacturers of albuterol inhalers and lobbied the government to ban CFC’s in inhalers, which was the propellant everyone used. This was done under the guise of environmentalism despite the amount CFCs being very small. This way a few companies could corner the market getting non-CFC inhalers approved while others opted not to make such a large investment. Because they used a new propellant, a new approval process was necessary despite it being the exact same drug. This allowed them to charge $40/inhaler instead of $5
If a drug is truly effective, pharmaceutical companies will find a way to patent it and make money.
There have been a number of meta analyses done on ivermectin and COVID-19. Many studies are small, of poor quality, and or flawed in procedure or calculations. Additionally, investigating the raw data, a number of studies are believed to be fraudulent / have manufactured results.
At the end of the day do I care if people want to take it? Not really, it’s quite benign in terms of risks, provided the correct dose is taken. Do I recommend it, no. What I do care about is people buying up the world supply of it preventing people who legitimately need it from being able to get it. In reality, millions of people take homeopathic treatments everyday that have zero clinical evidence of working. So it’s really nothing new and just part of the wild we live in.
I haven’t thoroughly read many of the ivermectin studies, but I did the hydroxychloroquine research. The HQC studies were so poorly designed and absurd I was astonished anyone, especially in healthcare, would find the results in any way meaningful. HCQ while a generally safe drug does have some significant risks if not doses and monitored appropriately. But me, my wife, and some of my colleagues all endured tantrums and threats (death threats if your my wife) from patients and family members who demanded HQC. Talk about insanity.