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UKZN professor challenges Ivermectin expose

Professor Colleen Aldous of the medical school at the University of KwaZulu-Natal, objects to a media “hit piece” on Ivermectin and the politicisation of a drug that “could be a tool in the fight against COVID-19”.

Aldous writes:

In response to your article in MedicalBrief on 21 July 2021, entitled “Study supporting Ivermectin for COVID-19 withdrawn over ethical concerns”.

Before I am dismissed as a lobbyist let me introduce myself.

I am not a pro-Ivermectin anti-vaxxer. I am a scientist trained in the natural sciences to look at totality of evidence. This is in contrast to clinician scientists who have a narrower definition of scientific proof.

I do not agree with the pro-Ivermectin lobby that Ivermectin on its own will end the pandemic. And I disagree with the anti-Ivermectin lobby that there is insufficient evidence. I have a bibliography of over 170 papers that include RCTs, observational studies, mechanism of action studies, in vitro studies etc, and my conclusions are that there is evidence pointing to the fact that Ivermectin can be an effective tool in the fight against COVID-19. And I believe vaccines are essential.

The Elgazzar paper was sensationalised across the media. But when a 15 July 2021 article in the United Kingdom-based publication The Guardian threw right-wing politics into the mix and introduced a journalist who is studying biomedical sciences as a ‘medical student’, I realised this was a hit piece on the Ivermectin debate and I prepared the following response, that wasn’t picked up by any media.

The ‘success’ of this story is  proof that “Every up-coming boot shining scientist is pouring through the data looking for flaws and every journalist wants to write a story on the ‘conspiracy theory’ debunked.” (Quote Tim Ayers)

Which side of ethics do you want to be on?

A ‘medical student’ has apparently exposed the Elgazzar Ivermectin study as being fraudulent. This medical student happens to be Jack Lawrence, an independent journalist who founded the mis/disinformation news site GRFTR [See the url link below]. Why did The Guardian need to create credibility for their article by posing a fellow journalist as a medical student?

The Guardian newspaper has used this as a journalistic opportunity to attack the Ivermectin debate, beginning with pushing Ivermectin into the realm of right-wing politics by stating: “The efficacy of a drug being promoted by right-wing political figures worldwide.”

I have been completely unaware of any political affiliations of any colleagues across the globe who are researching Ivermectin for treatment and prophylaxis of COVID-19. It’s a dangerous ploy to politicise a drug of any ilk, particularly one where the science has only shown promise, even in studies showing low efficacy or no statistical significance.

If indeed Elgazzar is guilty of academic fraud, the seriousness of the situation lies with the lack of scientific integrity of the researchers behind the study, not with the existing and continuing increase in data showing Ivermectin’s potential value in the COVID-19 pandemic.

Elgazzar has come out vehemently in defence of his work. He found the requests to respond from The Guardian in his junk mail after he was made aware of the article, which explained his silence. He has also stated that the data that was accessed by Lawrence by guessing the password of a password protected file, was not his working data set. I reserve my judgement on him until more information becomes available.

The Elgazzar study on Ivermectin, which was one of the earliest and largest studies showing Ivermectin’s efficacy in both treatment and prophylaxis, has been withdrawn from the pe-print site Research Square. This study was not yet peer reviewed and published.

The scientific community exposed it before it could get that far; unlike the Mehra et al hydrochloroquin study in The Lancet, which went through peer review and got published in one of the world’s leading medical journals and then had to be retracted.

The purpose of the preprint sites is to satisfy the request by the World Health Organization during the 2014-2016 Ebola epidemic to make data quickly available. People are encouraged to provide peer review on the sites. The Elgazzar study had been on the preprint site for seven months and had no peer-review.

The problem with the Elgazzar study, is that the data from this study was used in the meta-analyses. The Ivermectin studies so far have been clinician-driven small studies which in isolation do not provide adequate power for decision makers.

Meta-analysis involves pooling these data in order to evaluate the larger data set. Whilst there are rigorous methods to evaluate, score and weight data for meta-analysis, there are still some people who do not fully understand the methods, who bluntly reject the Ivermectin meta-analyses as rubbish-in-rubbish-out.

One of the largest living meta-analyses has already removed the Elgazzar data and there isn’t a dent in the final outcome. The updated review by Hill et al with their leave one out sensitivity analysis demonstrates this and the Bayesian results in the another review were strong. Ivermectin is still shown to be effective.

In the Bryant et al meta-analysis, the trial sequential analysis suggested that there is already sufficient evidence in this area, and with the results of more batches of ongoing trials available soon, the omission of the Elgazzar trial should ultimately have little impact on the overall conclusions.

Meta-analyses teams have rerun their data without the Elgazzar data and have not had different results, showing that The Guardian’s assertion that the results are reversed is false. And there is a good reason for that.

The Elgazzar study is one of many studies contributing to the current body of knowledge. It was posted for the first time in November 2020, and since then there have been dozens of studies published on pre-print sites as well as in peer-reviewed journals showing Ivermectin’s efficacy, as well as low efficacy, adding to the body of research that should be carefully analysed.

Accusing the authors of plagiarism is a serious matter. I have also picked up that there are tracts in the introduction that are plagiarised. This infringement of publication ethics is serious but can be corrected.

I wonder if Nick Brown’s “comprehensive document uncovering numerous data errors” could not be used to improve the paper rather than get it squashed as fraudulent. The “obvious clones of other records” are very worrying, but we need to see how that is justified.

The Guardian article goes on to use the Roman et al meta-analysis to support its argument. The problem with so many meta-analyses that have reached print is that the selection bias can range from subtle to obvious. The Roman et al study was shown to be deeply flawed and an open letter to the editor of the journal Clinical Infectious Diseases signed by more than 40 clinicians and scientists requested its retraction [see link below].

Bad Science happens. And if further investigation proves Elgazzar et al to be bad scientists, then so be it.

I am saddened that Lawrence and Brown did not offer their criticisms as peer review on the preprint site instead of creating international sensationalism in the media. However, bad journalism also happens, and the clear bias shown by The Guardian should also be exposed.

Yours faithfully

Professor Colleen Aldous

Professor and Health Care Researcher in the School of Clinical Medicine, College of Health Sciences, at the University of KwaZulu-Natal.

Research Gate profile

 

The Guardian story – Huge study supporting ivermectin as Covid treatment withdrawn over ethical concerns (Open access)

 

Letter to the editor of Clinical Infectious Diseases. As posted on the British Ivermectin Recommendation Development Group (BIRD) website (Open access)

 

The GRFTR website

 

See also from the MedicalBrief archives

 

Study supporting Ivermectin for COVID withdrawn over ethical concerns

 

Ivermectin: ‘Pitting frontline doctors against bureaucrat academic clinicians’

 

Pressure on SA regulator to authorise Ivermectin for immediate use

 

 

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