On Ivermectin and the Importance of Checking Your Sources

 Earlier this evening I stumbled upon this meme claiming that Ivermectin - the latest alleged "miracle drug" of the COVID-19 conspiracy theorists - causes low sperm counts in human males. I already knew that COVID-19 can cause Erectile Dysfunction, and frankly, the idea that these Anti-vax idiots might get COVID and then "treat" themselves with horse de-wormer, thereby giving themselves both ED and low sperm count, and making them two-time winners of the Darwin Awards for taking themselves out of the gene pool... it led to a good solid facepalm.

Nevertheless, I didn't want to simply take this meme at face value. I wanted to see the study for myself. After a bit of poking around on Google, I was having surprising difficulty locating this article. There are several showing that Ivermectin causes infertility in rats and other animals, but this meme seems to be referencing human infertility.

Noticing that the meme claims that this article was found on "ScholarsResearchLibrary.com", I tried going to that site directly to see if I could perhaps find the article that way. I must say, the Scholars Research Library home page gave me some cause for doubt. First of all, the home page has several instances of questionable grammar. That said, not everyone speaks English as a first language, it's possible that this website is hosted in a foreign country, and this was their best translation job. 

However, scrolling down a little, I noticed that the home page suddenly became a several paragraph advertisement for CBD oil. So, between the poor grammar and the lengthy advertisement for a product with questionable scientific backing, I was beginning to worry about the credibility of the information I might find here. Nevertheless, I recognized that it was possible for a good piece of research to be hosted on a bad site, so I resumed my efforts to hunt down the actual article. Unfortunately, the site itself appeared to be having issues. Numerous 404 errors and difficulties with loading made it impossible for me to locate the article I wanted through their search box.

I was beginning to suspect that the meme I had seen may have be a doctored image and that there may be no such study, but I tried a new tactic: I Googled: Ivermectin "Significant reduction in the sperm counts"

The first thing I noticed was three absolutely identical news stories by three different rightwing crackpot "news" sites. (It's amazing how right wingers claim to be "critical thinkers" and that all others are "sheeple", and yet their #1 export is plagiarized blog posts... almost as though they don't have an original thought in their heads... but I digress.)

Against my better judgement, I opened up "The Liberty Beacon" to see if they had some source for this claim that Ivermectin leads to low sperm counts, and - against all probability - they actually did. I'm going to come back to The Liberty Beacon later, because there's more on that site that's worth discussing here. But first, since I finally found it, let's talk about this paper.

The full title of the paper is "Effects of Ivermectin therapy on the sperm functions of Nigerian onchocerciasis patients". Onchocerciasis, also called "river blindness", is a disease caused by infection with the parasitic worm Onchocerca volvulus. Essentially it's a possible hazard from drinking unpurified water (hence the name "river blindness").

The study screened 385 Onchocerciasis patients, but only selected 37 to participate in the study, as the others either already had "very low sperm counts", or were deemed too sickly to participate. The 37 participants were given 150 micrograms of Ivermectin per kilogram of body weight for 11 months, and at the end of that time all 37 showed reduced sperm count, and all but one showed reduced motility.

There are a few issues here right off the bat:

1) The sample size was only 37 people. Now, for some studies 37 people is sufficient, for others it's not. If I want to get an idea of the political leanings of Green Bay WI (Population 107,395) I don't need to ask nearly as many people as I would if I wanted to get an idea of the political leanings of New York City (Population 8,804,190). To determine if the sample size is adequate in this instance, we would want to discuss the appropriate margins of error, confidence levels, standard deviations, etc. which would require diving into statistics, and it's not my purpose in writing this post to give a statistics lesson. Suffice to say that - according to sample size calculators available online - these researchers would have wanted to conduct the research on at least 385 participants to ensure a representative sample. So the 37 participants that they actually had is woefully insufficient to draw any meaningful conclusions. (The fact that they screened exactly 385 people tells me that they likely ran the math and reached the same results.)

2) They never say how much Ivermectin is administered or how often. Is that "150 micrograms of Ivermectin, per kilogram of body weight" once per day? Twice per day? Once per week? Was that amount spread out over the course of 11 months? We have no idea how much Ivermectin was received.

3) There is no control group. Ideally they would've wanted to pair each participant with a control participant, matched for initial sperm count, and would've likely also wanted to try to match them based on the area where they live and/or socioeconomic status, to help control for differences in lifestyle, nutrition, etc., that may explain variation in sperm count. The paper gives no indication that the researchers took any measures to rule out other possible causes of decreased sperm count.

4) In the same vein as point 3, if 90% of your intended participants were deemed unable to participate in the study because they already had a very low sperm count and/or were too sickly to participate, is a low sperm count already endemic to the region? Why were so many people already exhibiting a low sperm count before they even started? In addition to the lack of controls for the possible confounding variables mentioned in point 3, the authors made specific mention of this possible confounding variable, and then made no attempt to control for it or otherwise explain it.

Ultimately, this is a somewhat ok "pilot study". It's the sort of thing where some researcher down the road could look at this, and possibly write a grant proposal saying "These researchers found a possible link, but their methodology is questionable at best. Please fund my study so I can see if they were on to something."

In short: There is evidence that Ivermectin causes some decrease in sperm count in some animals, and this study provides just the barest thread of evidence that it may do so in humans as well.

Jumping back a minute, let's talk about that article I found in "The Liberty Beacon" (Don't worry, I will post screenshots. I ruined my ad algorithm by visiting this site, so you don't have to!)

First of all, what is "The Liberty Beacon"? The RationalWiki describes it as "a fringe online news source that promotes vaccine hysteria, chemtrail conspiracy theories... the international Jewish conspiracy and other far-right survivalist bullshit." Having now spent... about a half-hour perusing, I can confidently say that RationalWiki has hit the nail on the head.

So why am I doubling back to this cesspool of tinfoil-hattery? Well, because in 2016, this rag was one of several right-wing "news" sources insisting that Ivermectin was secretly a "Depopulation" drug that was intended to sterilize millions of other-wise healthy adults, as a form of covert genocide.

That's right, only five years ago, the right wing conspiracy theorists were decrying their darling miracle drug as a secret tool of mass sterilization and genocide.

But now it appears that they've forgotten the alleged "secret mass genocide", and believe that Ivermectin is the Real Cure for COVID that "They" (whoever this diabolical "They" happens to be this week) don't want you to know about.

Right-wing "news" sources like "Restoring Liberty" are outraged that it has become increasingly difficult for Americans to get their hands on Ivermectin, and yet the CDC recommended Ivermectin be administered to all refugees from Afghanistan. Of course, a simple search of the CDC website indicates that the CDC is recommending that Afghani refugees be given Ivermectin to treat for possible intestinal parasites, as refugees often do not have the luxury of easy access to clean drinking water, while they're busy fleeing a theocratic regime.

Meanwhile at least one conspiracy theorist on Reddit has heard that Ivermectin causes sterility, and is now positing that the "Deep State" basically just used "reverse psychology" on all the anti-vaxxers to get them to use Ivermectin and inadvertently self-sterilize (because the alternate explanation - that they're morons who took horse dewormer despite everyone telling them not to, because the same company that told them to take hydroxychloroquine also told them that Ivermectin was the best way to "own the libs" - is apparently too much for their brains to process).

In summary, the original meme's claim that Ivermectin causes sterility in humans, is presently unsupported by evidence. There's the barest thread of evidence that low sperm count might be a side effect, but that's hardly a "smoking gun". Meanwhile, the right wing, in their anti-science hysteria, have gone from seeing Ivermectin as a tool of secret genocide, to a secret miracle drug in only a handful of years.

In all of these cases, the misinformation could have been easily be avoided by simply checking the source and assessing its strengths and flaws, all while maintaining a steadfast commitment to intellectual honesty.