Talk:COVID-19 drug repurposing research

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RfC about the summary of a review article in the Ivermectin section

The following discussion is an archived record of a request for comment. Please do not modify it. No further edits should be made to this discussion. A summary of the conclusions reached follows.

I am agreeing to the request from other editors who asked for this RfC to be closed pending discussions. --Vrtlsclpl (talk) 04:36, 15 January 2021 (UTC)

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Two editors differ on the best way to summarize a review article on a novel treatment for COVID-19. Should they just take a direct quote from the review article itself? Here are the two version of the article.--Vrtlsclpl (talk) 19:59, 14 January 2021 (UTC)

Proposals

Remove the December 2020 and January 2021 review notes. New NIH guidelinespublished today supersede those sources, in my opinion. A summary from this source is already in the article as of 14 Jan 2021 (thanks Tvaughan1!). Jdphenix (talk) 00:20, 15 January 2021 (UTC)

References

Why are you not proposing to also remove the review note, "There is only very weak evidence of ivermectin's benefit when used as an add-on therapy for people with non-severe COVID-19."? Seems biased to me. Especially since this sentence fails to conform to the format of the two previous review notes that clearly indicate that the comment is specifically related to a particular piece of research.

I suggest leaving the two research notes, and changing the other to read, "In November 2020, a review was published that demonstrated that there is only very weak evidence of ivermectin's benefit when used as an add-on therapy for people with non-severe COVID-19." AussiePete56 (talk) 01:05, 15 January 2021 (UTC)

Do we still need to keep paragraphs 1-3 in the Ivermectin section? I think there will be significantly less interest in those preliminaries now that they are moving towards large-scale clinical trials.--Vrtlsclpl (talk) 02:57, 15 January 2021 (UTC)

This is just a purely conversational point but re-reading the recommendations - that may actually be the green light for the use of Ivermectin - others may know better.--Vrtlsclpl (talk) 03:10, 15 January 2021 (UTC)

I say that because in an interview I heard Peter McCullough - a fairly influential physician/researcher - suggest that all that was needed from the NIH was a neutral recommendation. That was in the context of the hydroxychloroquine discussion but it applies equally well to Ivermectin.--Vrtlsclpl (talk) 03:17, 15 January 2021 (UTC)

I think the tone of the recommendation is just for face-saving since they have been MIA in this field. --Vrtlsclpl (talk) 03:55, 15 January 2021 (UTC)

Discussion

A second RfC on the specific wording on research of ivermectin? While one is still open? Please close this. It's premature. Jdphenix (talk) 20:15, 14 January 2021 (UTC)

• Agree with above, this is premature with no discussion and (per Talk at ivermectin) several newer/better sources available. Should be closed pending further discussion and reading of new sources. Alexbrn (talk) 21:08, 14 January 2021 (UTC)

A similar discussion about how to describe this article did already take place at Talk at ivermectin that involved Alexbrn, Adriaandh and AussiePete56. I don't really see the harm in getting community input on this discussion at this point. Can either of you provide reasonable alternative language and we can just settle this? Could we just quote directly from the authors conclusion and remove the original text? --Vrtlsclpl (talk) 22:06, 14 January 2021 (UTC)

Yes, stand by. Jdphenix (talk) 00:14, 15 January 2021 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Mccullough et al.

Over at Talk:Ivermectin, Vrtlsclpl (talk · contribs) called for further editors - especially those with more hard-core clinical expertise to comment. I have been a member of the Medicine project for over a decade, am one of the original developers of WP:MEDMOS and WP:MEDRS, and one of the founders of the Pharmacology project. I hope that's enough in the way of expertise. As the RfC has been closed, I am adding my comments here.

The article currently has a direct quotation from the Mccullough et al. review:

there are a number of randomized and prospective studies [of Ivermectin for treatment of COVID-19] and all have shown efficacy in clinical out-comes at the time [of publication].

Unfortunately, this quote is itself a misrepresentation. Of the five cited studies (Alam, Chowdhury, Gorial, Khan, Nunez), only one was randomized and none placebo-controlled. The others are case series and observational research; two are in non-indexed journals, and one a preprint. All—every single one—would fail WP:MEDRS. Not exactly "a number"—well, I guess one is a number (the loneliest number, as the song goes). Presenting the review authors' incorrect, editorialized summary of the state of the research uncritically in the article simply because it is a "review" and is thus high-quality evidence (it isn't; it is a narrative, unsystematic review) is a misinterpretation of WP:MEDRS, and is not productive. Fvasconcellos (t·c) 07:08, 16 January 2021 (UTC)

Further misrepresentation

Talking of misrepresentation, this[1] edit by Vrtlsclpl seems to fail WP:V, and goes against the emergent consensus at ivermectin not to add dates to NIH statements. Alexbrn (talk) 07:40, 16 January 2021 (UTC)

How so? In NIH COVID-19 Treatment Guidelines updated on August 17. 2020:

"The COVID-19 Treatment Guidelines Panel recommends against the use of ivermectin for the treatment of COVID-19, except in a clinical trial (AIII)."

In the the NIH COVID-19 Treatment Guidelines updated on January 14, 2021:

"The COVID-19 Treatment Guidelines Panel (the Panel) has determined that currently there are insufficient data to recommend either for or against the use of ivermectin for the treatment of COVID-19."

The statement "...recommends against ..." statement in the earlier recommendation has been removed in the latter. More to the point, the recommendations are boiler-plate language. For interpretation see:( [2], p.17). It is clear from that that the drug is one step closer to full-blown NIH endorsement in COVID-19. --Vrtlsclpl (talk) 15:25, 16 January 2021 (UTC)

You are imposing a non-scientific narrative framework onto this not supported by the sources. This is not a progression that has some pre-ordained plan: the next "step" could as well be that better evidence shows the drug useful or useless for example. In the absence of this better we just don't know (as the good sources say). Please also see WP:SYNTH for why we avoid editorializing text that comes from combining different sources. Test should be WP:Verfified by the sources cites. Alexbrn (talk) 16:35, 16 January 2021 (UTC)

I never used the phrase "...one step closer ..." in the text of the article. I simply stated that the negative recommendation was removed in the update to the NIH treatment guidelines. Are we at a logjam on this language?--Vrtlsclpl (talk) 17:35, 16 January 2021 (UTC)

The current text[3] as tidied by Fvasconcellos is good, with the correct professional WP:TONE. Alexbrn (talk) 17:41, 16 January 2021 (UTC)

I have slightly adjusted the tone in favor of clarity around the dose size. Most people don't understand that "10⁴ dose" means "ten thousand times the normal amount". That means 10,000 pills per day. At an average rate of 60 pills per minute, you'd spend three hours a day swallowing pills. (You would also probably die from the side effects.) If the people advocating for this on the internet can't do math or if they have decided that 1/10000th the amount that worked in that one lab test (the very lab test they're saying proves that it works) will have the same effect as the amount that actually worked in the lab – well, that's not my fault, and I additionally encourage them to watch out for people trying to sell them homeopathy "drugs", too. WhatamIdoing (talk) 19:44, 16 January 2021 (UTC)

This focus on the drug quantities involved in the original research is pointless. Nowhere was it claimed by the original researchers that the quantities used were the minimum required to achieve their result. The leader of the Monash Biomedicine Discovery Institute Dr Wagstaff said at the time, "“Ivermectin is very widely used and seen as a safe drug. We need to figure out now whether the dosage you can use it at in humans will be effective – that’s the next step,” [[4]] Since April there have been dozens of studies which confirm that a normal dose of 200 micrograms/kg of bodyweight is effective against Covid 19, so perhaps its time to retire these references to the quantities used in the original in vitro studies. AussiePete56 (talk) 06:53, 22 January 2021 (UTC)

Where does Vitamin-D fit in?

I am trying to figure out why Vitamin-D is not featured on this page on the other similar one COVID-19 drug development.

There is a surprising amount of research on the go with trials and published papers. Safety at physiological doses is well proven yet widespread deficiencies remain uncorrected. Demonstrated benefits and learned consensus keeps telling us that it should be on the front line as a prophylactic to minimise severity even it it does nothing else.

Here is a secondary source of sorts that has valuable information in the conclusion. Vitamin D and COVID-19: evidence and recommendations for supplementation

Here are some of the published study results Vitamin D is effective for COVID-19: real-time meta analysis of 37 studies

Has this simply been forgotten or what is the reason it is a second class citizen to new drugs that have still to be invented?

Idyllic press (talk) 21:18, 17 January 2021 (UTC)

There's a whole section on vitamin D in the article. Fvasconcellos (t·c) 07:00, 18 January 2021 (UTC)

200 scientists and doctors agree with you... [[5]] AussiePete56 (talk) 06:28, 22 January 2021 (UTC)

AussiePete56, there's content already here. What do you think needs to change? Jdphenix (talk) 06:37, 22 January 2021 (UTC)

Thanks for that Jdphenix. Apologies - I actually misread the above - I thought it was all written by Fvasconcellos and that he was saying that there was no mention of vitamin D in the "drug repurposing" article. What's actually there is not bad AussiePete56 (talk) 07:09, 22 January 2021 (UTC)

Repurposing psychotropic drugs for treatment of COVID-19

We need a section on repurposing psychotropic drugs. Especially Fluvoxamine, other SSRI inhibitors, and successful amantadine use in Poland (adamantanes in general). — Preceding unsigned comment added by 94.254.144.208 (talk) 19:21, 23 January 2021 (UTC)

Brings sources and discuss. Sounds interesting! Jdphenix (talk) 12:21, 25 January 2021 (UTC)