Kyle: Dr. Patrick, what are your thoughts on this question?

Dr. Patrick: Well, I do have many thoughts particularly with the ivermectin being as good as vaccines statement that is very sensationalized and I think is doing a lot of harm because, as Dr. Seheult pointed out, you know, we should study any type of therapeutic that is repurposed, anything we know is safe in humans, and anything that could have even the slightest positive effect on the SARS-CoV-2 virus and COVID-19 illness because we need everything that we can to fight this. We need multiple therapeutics. We need vaccines. We need everything. And so, I think, when you sensationalize something more than the data suggests it deserves, then you have a couple of problems. One, you're misleading people, and that's a big problem. And two, you're getting a sort of knee-jerk reaction from researchers, scientists, from physicians that are going, "Whoa, wait a minute. Something feels a little, you know, off." And so you kind of put off those people that otherwise may be more open to looking at that therapeutic if they otherwise didn't hear a very sensationalistic claim like ivermectin is just as good as vaccines at protecting against COVID-19. And so meta-analysis, Dr. Seheult mentioned a very popular one that was a systematic review and did show some conclusions that were positive generally speaking. But when you actually go down and look at the individual studies within that meta-analysis and other types of analysis that are aggregating a bunch of data, what you'll often find is a common set of problems. And these problems are manifold. One, they include the co-treatments, and the treatments are very different with each of these studies. So, for example, sometimes you'll have ivermectin alone. Sometimes you'll have ivermectin plus azithromycin. Sometimes you'll have ivermectin plus some kind of nose spray. Sometimes you'll have ivermectin plus vitamin C and zinc and blood thinners and azithromycin in the kitchen sink basically. Then you'll compare that to sometimes placebo, sometimes hydroxychloroquine, sometimes hydroxychloroquine and azithromycin, sometimes doxycycline. There's so many variables here that you can't look at just one of the variables and say ivermectin is doing this when you have ivermectin plus the kitchen sink, or you have ivermectin plus something else compared to the kitchen sink or compared to...you know, so there's a lot of variables that are just being aggregated together that are very different.

The second major problem with a lot of these studies is that they are small sample sizes, and so at the end of the day, when you're looking at a clinical endpoint, for example, hospitalization, when you have 50 people in a group, you know, then if 2 people end up in the hospital, so you have 2 people in the control group end up in the hospital, but out of the other 50 people, you have zero end up in the hospital, so let's say in the ivermectin group because you'll find studies like this, it's such a low sample size that the risk of that event happening, the certainty of that event happening being actually, you know, causal by that treatment is so low. Like you can't make a definitive statement about that. And so what you'll see happening is that more and more studies will be pulled together so that you now have larger sample sizes when you pull them all together, and then your certainty becomes a little bit better. But then you have to ask yourself, well, is that really true? When you have such a low sample size within that individual study, pulling them together is kind of a statistical way of manipulating the data in a way saying, well, look, there's statistical significance when you pull it all together. I think that's really important to keep in mind when you're looking at some of these meta-analysis with ivermectin.

And then you also have the clinical endpoints varying. So you have people looking at hospitalization. You'll have research groups looking at deaths. You'll have research groups looking at viral clearance time to a negative PCR. And in some cases, they're all being aggregated together, and it's like clinical benefit is the end point. And it's like, well, geez, these are vastly different clinical endpoints. So, you really need to be careful when looking at aggregated data. Certainly, there's a number of websites out there that are doing this. And I can tell you that I've looked at these individual studies, and in many cases, I mean, it's everything I just mentioned and worse. It's where you can't even find the numbers that they're coming up with.

But sticking to just the scientific literature, you know, even that systematic meta-analysis that Dr. Seheult mentioned, you know, if you look at all the different studies, and a lot of them were pre-prints that they included, the only real consistent finding that was found, consistent meaning every study showed it, was basically time to a negative PCR, in other words, an ivermectin plus the kitchen sink or ivermectin plus whatever, it seemed to lead to a faster viral clearance to some degree. And again, it might be that it takes ivermectin plus the kitchen sink to do it, but that ivermectin plays a small role. We don't really know. And when you take ivermectin plus the kitchen sink, you can't pinpoint it and say it's ivermectin doing it. You just can't do that unless you give the kitchen sink without ivermectin to the control group. And then you can say, well, look, they were given the exact other, you know, array of therapeutics, and they didn't have the same improvement as the other group with the array of therapeutic treatments plus the ivermectin. So, there's a lot of nuance to this. And I think that at the end of the day, there is a little bit of a signal. There is something that seems to be going on with ivermectin, whether or not it's in combination with all these other things or by itself. It's unclear. What is clear is that we definitely do need more data. We need more high quality data. We need more data from, you know, states that...or from countries that don't have a really high background of parasitic disease as Dr. Seheult pointed out. It's a very big confounding factor. But also we need to not sensationalize something and, you know, speak about things that are not true. Like there's just no evidence that ivermectin is going to protect you from infection and from severe disease as well as a vaccine. There's no evidence of that, and so don't make that claim. Make the claim for what the data speaks to. There may be an effect. There may be an effect particularly on viral clearance. If people would tone it down and not make these grandiose claims, there would be a lot more interest in ivermectin and studying ivermectin.

And, you know, the other thing to keep in mind is that there's been a lot of people that have now sought out a veterinary form of it because it is something that in addition to being used in humans for parasitic diseases and helminths and also scabies and lice and things like that, it's also used in like...you know, people are calling it horse dewormer, which, you know, it's just...it's not a good idea to go and get a veterinary type of medication and try to treat yourself because there's vastly, you know, different doses involved. I mean, you know, horses are much larger than humans. It's very dangerous to do something like that. And I think people have sort of heard these sensational claims and sort of taking their own action trying to get some form of ivermectin, and really, that could be quite dangerous. I agree with Dr. Seheult that we should be studying these repurposed therapeutics. There is a potential for ivermectin. At least in my opinion at the very least, it seems as though it's pretty consistently involved in speeding up the viral clearance to some degree. It's not like a huge, huge effect, but there is an effect, and it's consistent with pretty much all the studies that I've personally looked at. So, I think that, you know, we should really go after that and try to see if that's real. That's pretty much my thought.

Kyle: Excellent. And speaking of those studies that you both talked about and these meta-analyses, one argument I've heard for ivermectin is some of these population-based studies where certain countries have decided to give ivermectin on a large scale. And you can understand, you know, potentially their motivation. They want to protect their population and prevent COVID-19 if they can, and they're going to use whatever resources they think they have to do that. What are some problems with these population-based studies for people who aren't familiar with what those are?

Dr. Patrick: So basically, they're known as ecological studies. They're great to look at. They're hypothesis generating. You don't rely on hypothesis generating studies to determine whether or not somebody gets a medication. So first off, you know, all the disclaimers, don't take this as medical advice, talk to your doctor, see if it's right for you, and don't get your ivermectin from the feed store are some reasonable advice to take. But in terms of the studies, what you need to be able to reach the point where you're able to prescribe someone something is what the FDA requires, which is a randomized placebo-controlled trial that's usually multi-centered, and it's very large. And that's what you have to do to be able to say this is the medicine that's indicated for this condition. And we just haven't had that yet here in the United States.

Dr. Patrick: And to sort of add to that, Dr. Seheult, I mean, you know, even going back to the original clinical trials with our mRNA vaccines, there were 75,000 people originally in that randomized controlled trial where, you know, half the population was getting the treatment, which were the vaccines, and the other half was getting the placebo. And then on top of that...so that's a large number of people. The sample sizes with this ivermectin is a fraction of that, I mean, a fraction. And on top of that, we now have all this real world data where we've got billions of people worldwide who have had a COVID-19 vaccine, and they are protecting from severe disease, and to some degree they're also protecting against even getting infected depending on which, you know, vaccine a person has gotten. So, we know they're effective. We know from large, large, large numbers. And to sort of even add on to that, everything has changed since the Delta variant. We have had to sort of start again and look at...aggregate new data because this is a new variant where our vaccines are not as effective at preventing infection. And, you know, the reality is, is all these meta-analysis and all this data we just talked about with ivermectin, this was not when Delta was the dominant variant. We don't really know what ivermectin even does with, you know, the Delta variant. I haven't seen data really showing how ivermectin, you know, affects Delta variant. So I think that's also something to consider as well.

Dr. Seheult: Yeah. That's a great point. And, you know, FoundMyFitness even more than MedCram, we've been talking about things that you can do, things that are easy for you to do like sleep. We talked about vitamin D. We're not opposed...I mean, look at our video histories, our respective video histories, we are all in for trying to take control of your health care, take control of your life, and to do this. So let's just take the 3,000 foot level here or the 30,000 foot level. This vaccine is indicated for this particular virus. I mean, I'm not naive to believe that this is the only pandemic that we're ever going to see in our lifetime. It's not the only illness that we're ever going to have to deal with. Some of those other things that we talked about with vitamin D, with sleep, with exercise, stress reduction, fresh air, sunlight, these things have enormous benefits, not just with COVID-19, but every other aspect of our life. And so again, it's the Swiss cheese model. The more slices you have in there, the better.

Dr. Patrick: 100%. I mean, the low hanging fruit is obviously the things that you can do to improve your lifestyle, making sure your vitamin D levels are high enough, you know, trying to be metabolically healthy, you know, eating the best diet or losing weight if you're overweight or obese, getting good enough sleep. All these things are hugely important for overall health and certainly for immunity.