In Practice

Meta-analytic magic, ivermectin, and socially responsible reporting

A G Parrish, M Blockman, K Cohen, H Dawood, R de Waal, A L Gray, T Kredo, T D Leong, J Nel, H Rees, G Reubenson

Abstract


Some clinicians prescribe ivermectin for COVID-19 despite a lack of support from any credible South African professional body. They argue that when faced by clinical urgency, weak signals of efficacy should trigger action if harm is unlikely. Several recent reviews found an apparent mortality benefit by including studies at high risk of bias and with active rather than placebo controls. If these studies are discounted, the pooled mortality effect is no longer statistically significant, and evidence of benefit is very weak. Relying on this evidence could cause clinical harm if used to justify vaccine hesitancy. Clinicians remain responsible for ensuring that guidance they follow is both legitimate and reliable. In the ivermectin debate, evidence-based medicine (EBM) principles have largely been ignored under the guise that
in a pandemic the ‘rules are different’, probably to the detriment of vulnerable patients and certainly to the detriment of the profession’s image. Medical schools and professional interest groups are responsible for transforming EBM from a taught but seldom-used tool into a process of lifelong learning, promoting a consistent call for evidence-based and unconflicted debate integral to clinical practice.


Authors' affiliations

A G Parrish, Chair, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Department of Internal Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa; Frere and Cecilia Makiwane hospitals, East London, South Africa

M Blockman, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

K Cohen, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

H Dawood, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Department of Medicine, Grey’s Hospital, Pietermaritzburg, KwaZulu-Natal, South Africa; CAPRISA (Centre for the AIDS Programme of Research in South Africa), University of KwaZulu-Natal, Durban, South Africa

R de Waal, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

A L Gray, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Division of Pharmacology, Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

T Kredo, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa – GRADE Network South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa

T D Leong, Essential Drugs Programme, Affordable Medicines Directorate, National Department of Health, Pretoria, South Africa

J Nel, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

H Rees, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

G Reubenson, Vice-Chair, National Essential Medicines List COVID-19 subcommittee, National Department of Health, Pretoria, South Africa; Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa

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Keywords

COVID-19; Ivermectin; Medical professionalism; EBM; Evidence-based medicine; Meta-analysis; Systematic review

Cite this article

South African Medical Journal 2021;111(10):934-937. DOI:10.7196/SAMJ.2021.v111i10.16021

Article History

Date submitted: 2021-08-17
Date published: 2021-08-17

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