This week in class we were asked for “additional quality factors” that could “be employed to ensure the average healthcare customer is getting information that [is] both accurate and can be interpreted correctly.”
Someone suggested that criteria from a JAMA article (1997) should be enforced that required an author to publish their name, affiliation, credentials, conflicts of interest, and to properly cite research which supports their claims. Additionally this classmate suggested adhering to Health on the Net (HON) codes and to secure third-party accreditation from a body like the Utilization Review Accreditation Commission (URAC).
Interestingly in 2018, there was a review which discussed a weak correlation between HONcode certification and the degree of quality of health information found on a website (O'Mathúna, 2018). The same review outed health care institution websites as being more likely to have inaccurate information and contain at least one recommendation contradicting evidence-based guidelines (O'Mathúna, 2018).
I responded that there are some problems with determining what information can be considered credible and trusted. Currently the largest randomized controlled trials can only be run by pharmaceutical companies who have the money to fund them. An excellent example of how this can be problematic is Ivermectin. There were 26 randomized controlled trials on Ivermectin with promise in prophylactic and active treatment for COVID-19 according to Dr. Pierre Kory last month in June (TrialSite News, 2021). According to a website maintained by research volunteers, there's now currently 30 RCTs (c19ivermectin.com, 2021). The latest published meta-analysis on Ivermectin (highest level of research evidence) from this month, July, concluded:
"there is overwhelming evidence to support a causal link between ivermectin, Covid-19 severity and mortality, and: i) for severe Covid-19 there is a 90.7% probability the risk ratio favours ivermectin; ii) for mild/moderate Covid-19 there is an 84.1% probability the risk ratio favours ivermectin. Also, from the Bayesian meta-analysis for patients with severe Covid-19, the mean probability of death without ivermectin treatment is 22.9%, whilst with the application of ivermectin treatment it is 11.7%" (Neil, 2021).
What do the critics of Ivermectin say? They say that the evidence is not rigorous enough because there hasn't been a large Randomized Controlled Trial (only many small ones). There is no funding for such a trial because Ivermectin is no longer under patent and no drug company would make money on it.
There has been a tremendous amount of research which overwhelmingly (57 out of 60 trials and all 30 which were RCT) shows positive effects against Covid-19. According to Dr. Kory, Ivermectin has been taken by 4 billion people around the world for the last 40 years including pregnant people and children with very few side effects reported. Please check out c19ivermectin.com to get a list and summary of all the research results on ivermectin for Covid. Dr. Kory who has personally treated hundreds of Covid patients said he could never participate in any research involving ivermectin, because he believes a placebo arm (which would not be provided with ivermectin) would not be ethical.
I bring up ivermectin, because it is a Covid treatment option that the government is saying social media must censor. Regulatory agencies like WHO and the NIH say evidence on ivermectin is not robust enough.
WHO: The current evidence on the use of ivermectin to treat COVID-19 patients is inconclusive. Until more data is available, WHO recommends that the drug only be used within clinical trials.This recommendation, which applies to patients with COVID-19 of any disease severity, is now part of WHO’s guidelines on COVID-19 treatments. https://www.who.int/news-room/feature-stories/detail/who-advises-that-ivermectin-only-be-used-to-treat-covid-19-within-clinical-trials
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NIH: "There are insufficient data for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of ivermectin for the treatment of COVID-19. Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin in the treatment of COVID-19." NIH updated these treatment guidelines (from "against" to "neither for nor against") on January 14, 2021 in response to Dr. Paul Marik, Dr. Pierre Kory, and Dr. Andrew Hill's testimony in support of Ivermectin https://www.newswise.com/coronavirus/nih-revises-treatment-guidelines-for-ivermectin-for-the-treatment-of-covid-19
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FDA: The FDA has not reviewed data to support use of ivermectin in COVID-19 patients to treat or to prevent COVID-19; however, some initial research is underway. Taking a drug for an unapproved use can be very dangerous. This is true of ivermectin, too. https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19
Freedom of Information Act (FOIA) requests to the NIH and emails to panel members yielded no answer as to how the committee reached a decision on ivermectin or even whether a vote was ever held on the ivermectin recommendation (Yim, 2021). The NIH did provide 2 names of Panel members (the others were redacted). One of the two was later revealed to be the principal investigator of a clinical trial the NIH had announced $155 million of funding in initial investment (Yim, 2021). More details from Yim on what appears to be a large conflict of interest that is having difficulties being disclosed here: https://trialsitenews.com/controversial-ivermectin-researcher-failed-to-report-massive-conflict-of-interest/
The researchers hosting and populating c19ivermectin.com do so anonymously. On their FAQs page they've written:
We are PhD researchers, scientists, people who hope to make a contribution, even if it is only very minor. You can find our research in journals like Science and Nature. For examples of why we can't be more specific, search for "raoult death threats" or "simone gold fired". We have little interest in adding to our publication lists, being in the news, or being on TV (we have done all of these things before but feel there are more important things in life now).
Posting about research on a topic by qualified professionals is now an act of bravery? Professionals who support a view on a scientific topic that isn't supported by the establishment are afraid to identify themselves due to fear of character assassination and loss of income?
There are disinformation attacks on scientists who are presenting data that runs counter to the establishment narrative:
Dr Tess Lawrie and BiRD responded to the mainstream press reports misrepresenting the meta analysis on ivermectin here https://bird-group.org/meta-analysis-paper/ Dr Lawrie, as you will see after reading, is another researcher who believes any further experimental trials with ivermectin would be unethical (because the placebo arm wouldn’t get the drug). Dr. Tess Lawrie is the Director of E-BMC Ltd, and EbMCsquared, a community interest research company. Dr. Lawrie is committed to improving the quality of healthcare through rigorous research. Her range of research expertise, based on research experience in both developing and developed countries, uniquely positions her to evaluate and design research for a variety of healthcare settings. Dr. Lawrie is a frequent member of technical teams responsible for developing international guidelines. Her peer-reviewed publications have received in excess of 3000 citations and her ResearchGate score is among the top 5% of ResearchGate members https://bird-group.org/who-are-bird/
More researchers who've been contributing to the pro-Ivermectin discussion include:
Dr. Peter McCullough: Dr. McCullough is a practicing internist, cardiologist, epidemiologist and Professor of Medicine at Texas A & M College of Medicine, Baylor Dallas campus. Dr. McCullough is broadly published on a range of topics >1000 publications and >600 citations in the National Library of Medicine. https://trialsitenews.com/about-us/
Dr. Robert Malone: The inventor of mRNA vaccines and RNA transfection, Dr. Malone has extensive research and development experience in the areas of pre-clinical discovery research, clinical trials, vaccines, gene therapy, bio-defense, and immunology. https://trialsitenews.com/about-us/
Paul E. Marik, M.D., FCCM, FCCP: Endowed Professor of Medicine; Chief, Div. of Pulmonary & Critical Care Medicine, Eastern Virginia Medical School Norfolk, Virginia Dr. Marik has special knowledge and training in a diverse set of medical fields, with specific training in Internal Medicine, Critical Care, Neurocritical Care, Pharmacology, Anesthesia, Nutrition, and Tropical Medicine and Hygiene. Dr. Marik is currently a tenured Professor of Medicine and Chief of the Division of Pulmonary and Critical Care Medicine at Eastern Virginia Medical School in Norfolk, Virginia. Dr. Marik has written over 500 peer-reviewed journal articles, 80 book chapters and authored four critical care books. He has been cited over 43,000 times in peer-reviewed publications and has an H-index of 77. He has delivered over 350 lectures at international conferences and visiting professorships. He has received numerous teaching awards, including the National Teacher of the Year award by the American College of Physicians in 2017. He is the 2nd most published critical care physician in the world ever, and is a world renowned expert in the management of sepsis – his contributions to the understanding and management of the hemodynamic, fluid, nutritional, and supportive care practices in sepsis have transformed the care of patients throughout the world. He also led the Society of Critical Care Medicine task force on corticosteroids in sepsis. He has already co-authored 10 papers on many therapeutic aspects of COVID-19. https://covid19criticalcare.com/wp-content/uploads/2021/01/FLCCC-Alliance-member-CV-Marik.pdf
Pierre Kory, M.D., M.P.A.:
Pierre Kory is the former Chief of the Critical Care Service and Medical Director of the Trauma and Life Support Center at the University of Wisconsin. He is considered one of the world pioneers in the use of ultrasound by physicians in the diagnosis and treatment of critically ill patients. He helped develop and run the first national courses in Critical Care Ultrasonography in the U.S., and served as a Director of these courses with the American College of Chest Physicians for several years. He is also the senior editor of the most popular textbook in the field titled “Point of Care Ultrasound,” a book that is now in its 2nd edition and that has been translated into 7 languages worldwide. He has led over 100 courses nationally and internationally teaching physicians this now-standard skill in his specialty. Dr. Kory was also one of the pioneers in the United States in the research, development, and teaching of performing therapeutic hypothermia to treat post-cardiac arrest patients. In 2005, his hospital was the first in New York City to begin regularly treating patients with therapeutic hypothermia. He then served as an expert panel member for New York City’s Project Hypothermia, a collaborative project between the Fire Department of New York and Emergency Medical Services that created cooling protocols within a network of 44 regional hospitals along with a triage and transport system that directed patients to centers of excellence in hypothermia treatment, of which his hospital was one of the first. Known as a Master Educator, Dr. Kory has won numerous departmental and divisional teaching awards in every hospital he has worked and has delivered hundreds of courses and invited lectures throughout his career. In collaboration with Dr. Paul Marik, Dr. Kory pioneered the research and treatment of septic shock patients with high doses of intravenous ascorbic acid. His work was the first to identify the critical relationship between the time of initiation of therapy and survival in septic shock patients, an aspect of the therapy that led to understanding all the failed randomized controlled trials that employed delayed therapy. Dr. Kory has led ICU’s in multiple COVID-19 hotspots throughout the pandemic, having led his old ICU in New York City during their initial surge in May for 5 straight weeks, he then travelled to other COVID-19 hotspots to run COVID ICU’s in Greenville, South Carolina and Milwaukee, WI during their surges. He has co-authored 5 influential papers on COVID-19 with the most impactful being a paper that was the first to support the diagnosis of early COVID-19 respiratory disease as an organizing pneumonia, thus explaining the critical response of the disease to corticosteroids. https://covid19criticalcare.com/wp-content/uploads/2021/01/FLCCC-Alliance-member-CV-Kory.pdf
All these researchers’ information about ivermectin is being censored by social media. Dr. Peter McCullough testified to Texas Senate HHS Committee concerning censorship by social media: “there was a near total block on any information of treatment to patients”
Why has social media been given the power to censor these amazing doctors and researchers? Why is the government allowed to tell them who to censor? Many in government are in office thanks to funding from industry, giving them also conflicts of interest.
I've already spoken about the myriad conflicts of interest reported for decades within the WHO, FDA, NIH, HHS & CDC.
Dr. Malcolm Kendrick does a fantastic job in his latest post summarizing the crisis we have of science currently. https://drmalcolmkendrick.org/2021/06/28/covid19-the-final-nail-in-coffin-of-medical-research/ I quote his article here:
Marcia Angell, who edited the New England Journal of Medicine for twenty years, wrote the following. "It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgement of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the New England Journal of Medicine."
Peter Gotzsche, who set up the Nordic Cochrane Collaboration, and who was booted out of said Cochrane collaboration for questioning [use of ONE vaccine - not other vaccines] wrote the book. ‘Deadly Medicine and Organised Crime. [How big pharma has corrupted healthcare]’. The book cover states… ‘The main reason we take so many drugs is that drug companies don’t sell drugs, they sell lies about drugs… virtually everything we know about drugs is what the companies have chosen to tell us and our doctors… if you don’t believe the system is out of control, please e-mail me and explain why drugs are the third leading cause of death...’
Richard Smith edited the British Medical Journal (BMJ) for many years. He now writes a blog, amongst other things. A few years ago, he commented: "Twenty years ago this week, the statistician Doug Altman published an editorial in the BMJ arguing that much medical research was of poor quality and misleading. In his editorial entitled ‘The scandal of Poor Medical Research.’ Altman wrote that much research was seriously flawed through the use of inappropriate designs, unrepresentative sample, small sample, incorrect methods of analysis and faulty interpretation… Twenty years later, I feel that things are not better, but worse…In 2002 I spent eight marvellous weeks in a 15th palazzo in Venice writing a book on medical journals, the major outlets for medical research, and the dismal conclusion that things were badly wrong with journals and the research they published. My confidence that ‘things can only get better’ has largely drained away..."
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Dr. Malcolm Kendrick concludes: "Essentially, medical research has inexorably turned into an industry. A very lucrative industry. Many medical journals now charge authors thousands of dollars to publish their research. This ensures that it is very difficult for any researcher, not supported by a university, or a pharmaceutical company, to afford to publish anything, unless they are independently wealthy. The journals then have the cheek to claim copyright, and charge money to anyone who actually wants to read, or download the full paper. Fifty dollars for a few on-line pages! They then bill for reprints, they charge for advertising. Those who had the temerity to write the article get nothing – and nor do the peer reviewers...Driven by financial imperative, the research itself has also, inevitably, become biased. He who pays the paper calls the tune. Pharmaceutical companies, food manufacturers and suchlike. They can certainly afford the publication fees..."
The answer is not censoring. The answer is open research. The answer is transparent research. The answer is active debate encouraged by legitimate researchers on all sides of controversial issues. Not a one-sided “establishment approved” presentation of issues. "Independent" panels, like supposedly the "NIH COVID-19 Treatment Guidelines Panel" was, can be bought. And have been bought. Cochrane has fallen:
During his tenure with Cochrane, Gøtzsche fought to uphold Cochrane’s original values of transparency, scientific rigor, free scientific debate, and collaboration. However, in spite of its charter, when Gøtzsche attempted to correct the path of consensus science or point to industry-related bias, Cochrane sought to censor him. He was eventually expelled from the organization in 2018 after what he calls a Kafkaesque “show trial.” Gøtzsche’s expulsion created rifts in the medical and scientific communities. John Ioannidis, a famed professor and medical researcher at Stanford, wrote a letter to the Danish Minister of Health condemning Gøtzsche’s dismissal from the Nordic Cochrane Centre. “Peter is undoubtedly a giant, one of the greatest scientists of our times … I believe that basic respect for scientific discourse requires that you do not eliminate your opponents through administrative machinations,” he wrote. Additionally, 3,500 scientists and health-care professionals signed a letter in protest of Gøtzsche’s treatment… https://www.crossfit.com/health/dr-peter-gotzsche
There is nothing more integral to democracy than freedom of information, and currently we all have a front-row seat witnessing its astonishingly quick deterioration. Liberty and free speech is something that must be cherished and fought for without compromise. Some other countries are seeing their right to information, free movement and free choice restricted much faster than in America, all in the name of establishment-approved science. As Health Science graduates we will be responsible for researching issues from all sides and for calling out discrepancies when we see them.
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Reference List:
1. C19ivermectin.com (2021). FAQ page link here: https://c19early.com/faq.html
2. Front Line COVID Critical Care Alliance (FLCCC). (2021). The FLCCC Physicians. FLCCC Website: https://covid19criticalcare.com/about/the-flccc-physicians/
3. Neil, M., & Fenton, N. (2021). Bayesian Meta Analysis of Ivermectin Effectiveness in Treating Covid-19 Disease. https://www.researchgate.net/profile/Norman-Fenton/publication/353195913_Bayesian_Meta_Analysis_of_Ivermectin_Effectiveness_in_Treating_Covid-19_Disease/links/60eca76cfb568a7098a6688a/Bayesian-Meta-Analysis-of-Ivermectin-Effectiveness-in-Treating-Covid-19-Disease.pdf
4. O'Mathúna, DP (2018). How should clinicians engage with online health information ?. AMA journal of ethics , 20 (11), 1059-1066. https://journalofethics.ama-assn.org/article/how-should-clinicians-engage-online-health-information/2018-11
5. TrialSite News (2021, June 26). Ivermectin: Pros vs Cons. Dr. Luis Garegnani and Dr. Pierre Kory Debate the Issue. TrialSite News YouTube channel:
6. Yim, P. (2021, July 15). NIH COVID-19 Panel member received massive windfall from ivermectin non-recommendation. TrialSite News website: https://trialsitenews.com/nih-covid-19-panel-member-received-massive-windfall-from-ivermectin-recommendation/