On withdrawing “Ivermectin and the odds of hospitalization due to COVID-19,” by Merino et al

On withdrawing “Ivermectin and the odds of hospitalization due to COVID-19,” by Merino et al.

4 February 2022

Preamble by Philip N. Cohen, director of SocArXiv

SocArXiv’s steering committee has decided to withdraw the paper, “Ivermectin and the odds of hospitalization due to COVID-19: evidence from a quasi-experimental analysis based on a public intervention in Mexico City,” by Jose Merino, Victor Hugo Borja, Oliva Lopez, José Alfredo Ochoa, Eduardo Clark, Lila Petersen, and Saul Caballero. [10.31235/osf.io/r93g4]

The paper is a report on a program in Mexico City that gave people medical kits when they tested positive for COVID-19, containing, among other things, ivermectin tablets. The conclusion of the paper is, “The study supports ivermectin-based interventions to assuage the effects of the COVID-19 pandemic on the health system.”

The lead author of the paper, José Merino, head of the Digital Agency for Public Innovation (DAPI), a government agency in Mexico City, tweeted about the paper: “Es una GRAN noticia poder validar una política pública que permitió reducir impactos en salud por covid19” (translation: “It is GREAT news to be able to validate a public policy that allowed reducing health impacts from covid19”). The other authors are officials at the Mexican Social Security Institute and the Mexico City Ministry of Health, and employees at the DAPI.

We have written about this paper previously. We wrote, in part:

“Depending on which critique you prefer, the paper is either very poor quality or else deliberately false and misleading. PolitiFact debunked it here, partly based on this factcheck in Portuguese. We do not believe it provides reliable or useful information, and we are disappointed that it has been very popular (downloaded almost 10,000 times so far). … We do not have a policy to remove papers like this from our service, which meet submission criteria when we post them but turn out to be harmful. However, we could develop one, such as a petition process or some other review trigger. This is an open discussion.”

The paper has now been downloaded more than 11,000 times, among our most-read papers of the past year. Since we posted that statement, the paper has received more attention. In particular, an article in Animal Politico in Mexico reported that the government of Mexico City has spent hundreds of thousands of dollars on ivermectin, which it still distributes (as of January 2022) to people who test positive for COVID-19. In response, University of California-San Diego sociology professor Juan Pablo Pardo-Guerra posted an appeal to SocArXiv asking us to remove the “deeply problematic and unethical” paper and ban its authors from our platform. The appeal, in a widely shared Twitter thread, argued that the authors, through their agency dispensing the medication, unethically recruited experimental subjects, apparently without informed consent, and thus the study is an unethical study; they did not declare a conflict of interest, although they are employees of agencies that carried out the policy. The thread was shared or liked by thousands of people. The article and response to the article prompted us to revisit this paper. On February 1, I promised to bring the issue to our Steering Committee for further discussion.

I am not a medical researcher, although I am a social scientist reasonably well-versed in public health research. I won’t provide a scholarly review of research on ivermectin. However, it is clear from the record of authoritative statements by global and national public health agencies that, at present, ivermectin should not be used as a treatment or preventative for COVID-19 outside of carefully controlled clinical studies, which this clearly was not. These are some of those statements, reflecting current guidance as of 3 February 2022.

  • World Health Organization: “We recommend not to use ivermectin, except in the context of a clinical trial.”
  • US Centers for Disease Control and Prevention: “ivermectin has not been proven as a way to prevent or treat COVID-19.”
  • US National Institutes of Health: “There is insufficient evidence for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of ivermectin for the treatment of COVID-19.”
  • European Medicines Agency: “use of ivermectin for prevention or treatment of COVID-19 cannot currently be recommended outside controlled clinical trials.”
  • US Food and Drug Administration: “The FDA has not authorized or approved ivermectin for use in preventing or treating COVID-19 in humans or animals. … Currently available data do not show ivermectin is effective against COVID-19.”

For reference,  the scientific flaws in the paper are enumerated  at the links above from PolitiFact, partly based on this factcheck from Estado in Portuguese, which included expert consultation. I also found this thread from Omar Yaxmehen Bello-Chavolla useful.

In light of this review, a program to publicly distribute ivermectin to people infected with COVID-19, outside of a controlled study, seems unethical. The paper is part of such a program, and currently serves as part of its justification.

To summarize, there remains insufficient evidence that ivermectin is effective in treating COVID-19; the study is of minimal scientific value at best; the paper is part of an unethical program by the government of Mexico City to dispense hundreds of thousands of doses of an inappropriate medication to people who were sick with COVID-19, which possibly continues to the present; the authors of the paper have promoted it as evidence that their medical intervention is effective. This review is intended to help the SocArXiv Steering Committee reach a decision on the request to remove the paper (we set aside the question of banning the authors from future submissions, which is reserved for people who repeatedly violate our rules). The statement below followed from this review.

SocArXiv Steering Committee statement on withdrawing the paper by Merino et al. (10.31235/osf.io/r93g4).

This is the first time we have used our prerogative as service administrators to withdraw a paper from SocArXiv. Although we reject many papers, according to our moderation policy, we don’t have a policy for unilaterally withdrawing papers after they have been posted. We don’t want to make policy around a single case, but we do want to respond to this situation.

We are withdrawing the paper, and replacing it with a “tombstone” that includes the paper’s metadata. We are doing this to prevent the paper from causing additional harm, and taking this incident as an impetus to develop a more comprehensive policy for future situations. The metadata will serve as a reference for people who follow citations to the paper to our site.

Our grounds for this decision are several:

  1. The paper is spreading misinformation, promoting an unproved medical treatment in the midst of a global pandemic.
  2. The paper is part of, and justification for, a government program that unethically dispenses (or did dispense) unproven medication apparently without proper consent or appropriate ethical protections according to the standards of human subjects research.
  3. The paper is medical research – purporting to study the effects of a medication on a disease outcome – and is not properly within the subject scope of SocArXiv.
  4. The authors did not properly disclose their conflicts of interest.

We appreciate that of the thousands of papers we have accepted and now host on our platform, there may be others that have serious flaws as well.

We are taking this unprecedented action because this particular bad paper appears to be more important, and therefore potentially more harmful, than other flawed work. In administering SocArXiv, we generally err on the side of inclusivity, and do not provide peer review or substantive vetting of the papers we host. Taking such an approach suits us philosophically, and also practically, since we don’t have staff to review every paper fully. But this approach comes with the responsibility to respond when something truly harmful gets through. In light of demonstrable harms like those associated with this paper, and in response to a community groundswell beseeching us to act, we are withdrawing this paper.

We reiterate that our moderation process does not involve peer review, or substantive evaluation, of the research papers that we host. Our moderation policy confirms only that papers are (1) scholarly, (2) in research areas that we support, (3) are plausibly categorized, (4) are correctly attributed, (5) are in languages that we moderate, and (6) are in text-searchable formats. Posting a paper on SocArXiv is not in itself an indication of good quality – but it is often a sign that researchers are acting in good faith and practicing open scholarship for the public good. We urge readers to consider this incident in the context of the greater good that open science and preprints in general, and our service in particular, do for researchers and the communities they serve.

We welcome comments and suggestions from readers, researchers, and the public. Feel free to email us at socarxiv@gmail.com, or contact us on our social media accounts at Twitter or Facebook.

51 thoughts on “On withdrawing “Ivermectin and the odds of hospitalization due to COVID-19,” by Merino et al

  1. Es increíble que autoridades sanitarias de alto rango se hayan prestado a ésta farsa, además del gasto al erario, han puesto en riesgo de muerte a muchos seres humanos. Tiene que haber un castigo ejemplar, no lo pedimos, lo exigimos!!!

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    1. Lo que es increíble es la censura por este sitio. Si el estudio fue “una farsa” como afirmas, qué importa? El propósito de este sitio es hacer disponible trabajos como este, dejando al publico la oportunidad examinar sus hipótesis y debatir sus méritos (o la falta de estos). Ahora, gracias a la corupción extraordinaria este sitio, no se puede tener este debate.

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      1. Claro que importa el estar haciendo recomendaciones erroneas basados en “artículos” deficientes en todo aspecto e importa mas como esos funcionarios de escritorio que jamás atendieron a un enfermo personalmente, ponen en riesgo la ya mermada salud de los enfermos con covid

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      2. Es evidente que usted no tiene ninguna experiencia en investigación. Todo trabajo que involucre pacientes debe pasar por un comité de ética. Por otra parte ya leí el trabajo y es muy evidente que no sería aprobado en una revisión por pares. Eso no es corrupción, sino simplemente tener responsabilidad. Los preprints no están dirigidos al público general, sino a los pares que evaluán la investigación, esa es una diferencia importante. El público no puede juzgar sobre los méritos de una investigación, tiene que esperar a la opinión de los pares.

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    2. Ariel. ¿Revisaste el artículo con rigor científico? Si es así, sería extraordinario que postearas aqui te revisión. Los que no somos expertos aprenderíamos y podríamos opinar de manera más sólida.

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    3. How have they “put at risk of death many human beings” by giving them one of the safest medications known as part of an attempt to treat a disease that has killed millions of people? It might also be worth considering that, in a place like Mexico where parasitic infections are fairly common, the side effects of giving ivermectin, an established anti-parasitic medication, in an attempt to treat another kind of disease are more likely to be beneficial than harmful.

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  2. Outrageous and extraordinarily corrupt act of censorship.

    Good science requires open access to all available information, freedom to consider and propose any reasonable hypothesis and the liberty to have an open debate. By withdrawing this paper, you have denied the users of this space all of this.

    Despicable.

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  3. El gobierno mexicano y las instituciones de salud jamás han apostado a la verdadera investigación y prefieren consultar expertos de escritorio que para nada son expertos en el area y crean propuestas erroneas como el famoso kit covid que por fortuna ya desmantelaron, los integrantes del kit ya habian sido desechados por estudios como los Recovery y seguian dando esos medicamentos sin evidencia y exponiendo la salud de los ya enfermos por covid
    Existen actualmente retractación en algunos documentos erróneos y eso fue lo que paso se retractaron por no haber evidencia

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    1. Has leido este artículo? En tu respuesta a mi comentario, hablas de ” ‘artículos’ deficientes ” hechos por “funcionarios de escritorio”. Podrías proporcionar un crítica detallada del artículo y sus métodos, que muestra exactamente en que sentido es “deficiente”, en lugar de lanzar ataques ad hominem en contra los autores?

      De hecho, el artículo consiste de un análisis estadistico sofisticado de los datos generados por el amplio programa de tratamiento por Ivermectina en la CDMX durante la pandemia de COVID-19. Uno pensaría que un tal estudio seria bienvenido y de alto interés, en consideración de la urgente necesidad para terapias eficientes en contra COVID-19. Me imagino que ni siquiera tienes la formación necesaria en estadistica para entender un tal estudio.

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      1. Si lo vi y no estaba publicado en ninguna revista de peso solo en un repositario como preprint (al menos cuando lo vi) y no puedes basar una recomendacion de un gran instituto solo en un estudio, y ademas ante la evidencia actual es una crimen de lesa humanidad obligar a los medicos familiares indicarlo hasta finales de 2021 en donde por fortuna el famoso kit covid se fue desintegrando por su pobre eficacia, esos expertos que los recomiendan no se de donde son expertos, en fin…
        Soy investigador puedes consultar mi produccion en donde gustes (publons, pubmed, sciencedirect, ResearchGate, web of science, etc etc) ademas de que he participado en congresos mundiales como la IDweek de la IDSA por decir uno
        Saludos

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      2. Viendo que retractaron su trabajo
        No puedo verlo completo
        Pero no puedes basar una recomendación en datos administrativos de hospitales sin ver directamente a los enfermos y sus características clinicas y paraclinicas
        Por otro lado utilizaron regresión logistica simple? Multiple?

        Ademas de autor y coautor soy revisor para publons de la web of Science con mas de 190 revisiones la mayoria en revistas con FI

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      1. No es mi intención hacer una review de un paper que ni siquiera paso por un proceso de revisión formal y ya fue retractado
        Solo diré que para poder hablar de la eficacia de un fármaco experimental hay que realizar un estudio controlado aleatorizado comparado con placebo, de lo contrario NO se puede hablar categóricamente de la eficacia de un fármaco y mucho menos basados en estadísticas hospitalarias administrativas
        Supongo ud y temo estan involucrados en este estudio y en el despilfarro al comprar millones de ivermectina, solo dire que pudieron haber probado otros farmacos como antivirales o para los complicados estudiar a los jakinibs por ejemplo; y no debieron instar al uso de la ya rechazada ivermectina hasta finales de 2021
        Saludos

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      2. Alfonso
        Es otro preprint sin revisión por pares, no puedes basarte en un documento así
        y además ustedes pretenden estar por encima de instituciones como la FDA, OMS, entre otras que ya han dado un punto de vista experto y recomendaciones sobre el uso de ivermectina
        seguir en esta discusión es lo que coloquialmente se conoce como “patadas de ahogado”, creo deberían de aceptar que aunque hicieron un análisis estadístico detallado, el error fue basarse en estadísticas hospitalarias y no en pacientes
        Les dejo la guía de la OPS (espero no piensen que están por encima de esa guía) chequen la pagina 14
        https://iris.paho.org/handle/10665.2/52719

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      3. ¿Revisaste el artículo con rigor científico? Si es así, sería extraordinario que postearas aqui te revisión. Los que no somos expertos aprenderíamos y podríamos opinar de manera más sólida.

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  4. No estoy aqui para dar clases
    Mi perfil publons de la Web of Science me avala
    Estoy aqui para recalcarles que ivermectina no sirve y eso lo sabemos desde finales de 2020, es un grave error seguir indicandola a estas alturas y es un error seguir ensimismado en que si funciona llendo contra grandes recomendaciones de grandes instituciones y no hablo del IMSS por ejemplo
    En fin… no hay mas que hablar
    Saludos y no gasten en medicamentos innecesarios y sin ninguna evidencia científica, deberian estar ya importando Paxlovid o molnupiravir en lugar de defender a ivermectina y gastar recursos en vano

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  5. Gracias por “recalcar” que están un un grave error, supongo que las autoridades que toman esas decisiones. Ojalá te tomen en cuenta. Yo solo defiendo la libertad de expresión porque me parece lamentable que un sitio como SocArXiv, baje un articulo independientemente de su calidad e impidan con esto, que los científicos opinen sobre el mismo . Saludos Luis.

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  6. Desafortunadamente esta pandemia ha traido de todo, y un aspecto es la retractación científica en la era covid, asi se titula un artículo de opinion de mi autoria
    Buscalo si gustas leerlo y este paper no es el primero ni el ultimo que sera retractado en esta pandemia

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  7. Long criticism based on “fact checkers” but no opportunity to allow the authors to respond. That is just censorship not scholarship. Which pharma company put you up to this.

    Liked by 1 person

      1. Dear Philip, your cynism is immense (please do not be offended. This is the meaning of cynicism: an inclination to believe that people are motivated purely by self-interest.

        Since when government has prohibition to publish?. Just in case, for your information. The counterpart done in the IMSS (Mexican institute of Social Security) just published their Study. Check it out. They had the luck to be peer-reviewed.
        Archives of Medical Research
        Available online 24 January 2022
        In Press, Corrected ProofWhat are Corrected Proof articles?
        Archives of Medical Research
        ORIGINAL ARTICLE
        A Multimodal Strategy to Reduce the Risk of Hospitalization/death in Ambulatory Patients with COVID-19

        Author links open overlay panelIván de JesúsAscencio-MontielaJuan CarlosTomás-LópezbVerónicaÁlvarez-MedinabLuisa EstelaGil-VelázquezbHortensiaVega-VegabHéctor RaúlVargas-SánchezbManuelCervantes-OcampocMiguel ÁngelVillasís-KeeverdCesar RaúlGonzález-BonilladeCélidaDuque-Molinaf

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      2. Im sorry not to replay about Philip. It is not about ivermectin whether it is useful or not. It is about Censorship. One may ask who pays the factchekers?.

        Liked by 1 person

      3. That is the problem with scoffers. You didn’t answer the question as to your conflicts of interest. You didn’t give the authors the ability to respond to your assertions, and there is only one reason: you know that they can respond adequately. People who censor do so because they have inadequate counter-arguments. That is You.

        Liked by 1 person

  8. Ivermectin BAD, Vaccine GOOD (to misquote Animal Farm).
    Amazing how Ivermectin (a drug so safe and effective the inventor won a Nobel Prize) gets slammed every time a positive study is published. Yet the numerous injuries and deaths from the Covid (so-called) vaccines get swept under the rug.

    Liked by 2 people

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