Coronavirus

Craig Kelly and Covid-19 treatments

Craig Kelly has posted numerous reports on alternative treatments for Covid-19, where he claims that governments and medical experts are denying effective treatment for murky reasons.

I am a total layperson, I have no medical knowledge. But I wanted to try to understand why medical science has so far rejected the treatments he has recommended. Here is what I have found.

(If you know something I have written here is wrong, please let me know. I have edited this page since it was first posted in response to comments and further information .)

In brief …..

Mr Kelly’s insistence that first hydroxychloroquine (HCQ), and then ivermectin (IVM) should be made available for treating Covid-19 is based, I think, on six mistaken ideas:

  1. He makes judgments on medical matters far too complex for a layperson and doesn’t trust the real experts.
  2. He cherry picks the reports to find those that support this use while ignoring the majority that don’t.
  3. He often references poor quality studies and reports and claims more than they actually show.
  4. He claims certainty about matters that the experts haven’t resolved as well as matters where they disagree with him.
  5. He ignores the documented dangers of the treatments he recommends and the need for these treatments to be properly tested. This is irresponsible.
  6. He imputes improbable motives to the experts he rejects.

Covid-19 treatments are still under investigation and there are still uncertainties. The experts have made their recommendations based on good reasons. They may not always be right, but the best evidence appears to be on their side.


Background

As we all know, the Covid -19 virus has led to almost 2 million deaths worldwide in the past year. Vaccines have only recently become available and will take months, possible a year or more, for vaccinations to be given to all who want them. Some people who are opposed to vaccinations are expected to refuse them.

Meanwhile, alternative treatments have been trialled, and generally rejected by the World Health Organisation (WHO) and first world governments. Yet they have been supported by some, including Mr Kelly. Over the past year or so, Mr Kelly has supported:

Typically, Mr Kelly’s Facebook posts reference a study which has found a positive result in the use of one of these treatments, accompanied by the claim that this study demonstrates or proves without doubt the effectiveness of the treatment. Often he makes adverse comments about the “scandal” or the obduracy or motives of those who refuse to endorse the treatment. In at least one case (6 July), Facebook has added a note that “Independent fact-checkers say that this information has no basis in fact.”

Australia’s government medical officers have many times indicated that Mr Kelly’s facts and conclusions are wrong (e.g. August 2020 and January 2021).

Wide differences

This situation is confusing to a layperson wanting to check the facts.

There are many studies which indicate that hydroxychloroquine is effective in treating Covid-19, especially if administered with another drug (azithromycin) and zinc as a preventative. Yet many other studies show it is ineffective or even dangerous. The experts in WHO and most western countries say it is ineffective and recommend against its use.

The situation with ivermectin is much less clear, as (1) there appear to have been too few useful trial results so far to allow a proper determination, and (2) results are mixed. So despite Mr Kelly’s endorsement, it isn’t currently recommended by medical authorities though this could possibly change.

In this review I have focused mostly on hydroxychloroquine (HCQ) because it appears to have been much more widely tested. But the lessons we can learn from HCQ can be applied to ivermectin and other treatments.

The consensus view

As far as I can ascertain, this is the consensus view of medical experts at the time of writing.

Safety vs speed

New medications shouldn’t be used until all side effects have been evaluated through comprehensive clinical trials. HCQ and IVM are not new, and HCQ “has multiple effects in the body that aren’t fully understood”. Since they are being re-purposed to treat Covid-19 they require testing for this purpose. Some processes have been speeded up because of the urgency, but safety is important.

Hydroxychloroquine

The experts say that hydroxychloroquine has no benefit when used to treat patients who have contracted Covid-19. Its possible benefits (or not) as a preventative haven’t yet been properly established. Seriously harmful side effects are possible. Its use isn’t recommended.

Ivermectin

Ivermectin shows some promise as a possible treatment, but this hasn’t yet been properly established. It shouldn’t be used yet, while proper trials continue, although emergency use may be acceptable.

Remdesivir

Remdesivir is “a broad-spectrum antiviral medication” that has been used with Covid-19 patients. There is some evidence that it may be useful (e.g. it was given to President Donald Trump), although WHO recommends against its use. In a Parliamentary speech on 2 December, Mr Kelly didn’t recommend this medication, so I haven’t discussed it further here.

Vaccination

Vaccination with one of at least three vaccines now available is the recommended treatment. Australian vaccinations are proposed to begin in March. The availability of proven and safe vaccines makes the use of questionable alternative treatments unnecessary.

Mr Kelly’s seven mistakes

1. Overestimating a layperson’s abilities

I have no training in medical science. I wouldn’t pretend to be able to make an informed judgment based on my own knowledge. I have read many medical papers and reports while preparing this post, but most of them discuss matters way beyond my knowledge. Treatment for Covid-19 is definitely something I need to leave to the experts.

Mr Kelly is surely in a similar situation. He seems unaware of the folly of a layperson making such pronouncements.

2. Cherry picking

I have accessed literally scores of reports on alternative Covid-19 treatments, and seen lists and summaries of scores more. Many support the use of HCQ or other treatments, but more found alternative treatments were not beneficial, and a few found them dangerous.

I have not tried to count the number of studies in each category (it would be impossible to know if studies are included in more than one review), but my impression is that reliable studies concluding that hydroxychloroquine should not be used were a significant majority.

I found far less studies of ivermectin, and the outcomes seem more positive than for HCQ. It certainly seems that it warrants further urgent testing for use where vaccines are not available.

These two identical review sites (https://hcqmeta.com and c19study.com) support the use of HCQ for Covid-19 but the sites are anonymous and don’t score well on scam assessment sites. This site by Victorian doctors supports these two sites, but it suggests an anti-Trump conspiracy is the cause of non-acceptance of HCQ, which makes me very doubtful of the reliability of these three sites.

I conclude than that the efficacy and safety of these two drugs is still uncertain.

But Mr Kelly only ever (to my knowledge) references studies which he thinks support alternative treatments, and ignores (or is unaware of) the many that oppose their use.

This is dishonest. It is called cherry picking, and it presents a false view. (This isn’t unexpected, for fact checks show he often cherry picks climate data too.)

3. Not all studies are equal

Medical science, like all the sciences, relies on competent researchers following certain processes, such as:

  • conducting their study competently, for example:
    • a significant number of cases to allow reliable conclusions,
    • randomised “double blind” trials where neither doctor nor patient know whether the trial treatment or an alternative or a placebo are being used, are preferred to observational studies where actual treatments are reported without any control group;
    • proper statistical analysis;
  • publishing their results in respected journals where the paper is peer-reviewed before being accepted for publication; and
  • clearly stating any conflicts of interest.

It turns out that, perhaps due to the rush to find a treatment for coronavirus, too many papers fall well short of these standards – and too often it seems to be the papers which support alternative treatments.

For example, one examination of 24 studies found that all the clinical trials showed negative results for the use of hydroxychloroquine or chloroquine, whereas a number of the less rigorous observational studies showed positive results.

Medical Practitioner Dr Sara Marzouk reviewed a bunch of papers supporting the use of ivermectin, and found half a dozen “embarrassing” problems with their methodology. NSW Health summarises the available information on ivermectin and says: “most of the available evidence is of low quality.” One review quoted there concluded that “studies on ivermectin were found to have a high risk of bias, very low certainty of the evidence”.

Mr Kelly references papers as if all are of equal quality and appears unaware of the possibility that some are dangerously unreliable.

4. Claiming certainty

During the period when he was supporting the use of hydroxychloroquine, Mr Kelly seemed absolutely certain of its efficacy, so much so that he accused those opposing its use of base motives. Yet only months after saying that those who opposed use of HCQ “will stand condemned by history forever”, he moved on to support the use of ivermectin instead. yet the reality is that there are many studies recommending against using HCQ for Covid-19 treatment.

He has shown the same certainty about ivermectin. For example, he claimed on 12 January 2021 that “100% of all published studies to date report positive effects”. This isn’t accurate. This statement by NSW Health lists about 40 studies, with more positive results but some negative also. Most studies are considered unreliable or preliminary, and require further testing before the drug is used against Covid-19 (a few examples are listed below). NSW Health concludes: “The evidence on ivermectin is still emerging”.

Thus his impression of certainty is quite contrary to the evidence where:

  • the majority opinion on HCQ is different to his, and
  • there is considerable uncertainty about IVM and most current studies are not reliable indicators of effectiveness.

5. Ignoring the dangers

You don’t need me to tell you that government authorities are very cautious about allowing new drug treatments. The disastrous effect of thalidomide on unborn babies in the late 1950s highlighted the potential dangers of drugs that aren’t fully tested.

Hydroxychloroquine and ivermectin have been around for years, and so some of their side-effects are well-known, but apparently they haven’t been fully tested. So before they are used in such large numbers as a different treatment, they require thorough testing.

While many studies find the use of hydroxychloroquine to be safe, a significant number find some serious side effects including heart problems. I cannot recall seeing any post where Mr Kelly has clarified the dangers of the treatments he recommends. This is irresponsible. Given the low Covid-19 fatality rate in Australia (only 5 deaths in the last 3 months), his recommended treatment might give a worse result.

6. Imputing improbable motives

Again and again, Mr Kelly imputes nefarious motives to those opposing his preferred treatments, whether hydroxychloroquine (originally) or now ivermectin. For example:

  • On July 6 he wrote: “The left’s war on Hydroxychloroquine is one of the greatest scandals of our time. Everyone that attempted to demonise this drug has blood on their hands.”
  • On 10 September he accused opposition to the use of hydroxychloroquine a “sham” to make its use “politically incorrect”. He said they’d bear the responsibility for “unnecessary deaths of hundreds of thousands and the destruction of economies”.

Mr Kelly seems to think that Covid-19 treatment is a political matter, and he blames “the left”, “the Labor Caucus” and “health bureaucrats”. As I’ve written elsewhere, overstatement and attributing evil motives are typical of conspiracy theorists as they try to explain why the experts have got it wrong and only they have got it right.

We are justified in questioning Mr Kelly’s motives before we question Australia’s chief medical officers, the WHO and experts around the world.

Conclusions

  1. The refusal of medical authorities to authorise hydroxychloroquine as a treatment for Covid-19 (on its own or in combination with other medications) is based, as far as a layperson can tell, on the best information from numerous trials. Some trials support its use, but there are more that oppose it and a significant number that suggest it can be dangerous.
  2. Mr Kelly’s enthusiastic support for HCQ use was based on lack of expertise, selective (cherry picked) information and conspiracy theories about medical authorities. It was foolish and potentially dangerous. His early strong opinions proved to be unjustified and mistaken. It is pleasing that he seems to have moved on from this support, but there are lessons he could learn from this.
  3. The lack of authorisation for ivermectin is based on mixed results and incomplete trials (according to NSW Health). It may or may not yet prove to be effective in treating Covid-19, but it is irresponsible to support its use until properly tested (except maybe in emergency cases). It is foolish to claim this thorough testing is a war on ivermectin as Mr Kelly sometimes does, though it may be right that testing should be completed with some urgency.
  4. Both HCQ and IVM have been used in some countries, apparently with some success, although this isn’t considered to be reliably documented.
  5. Several effective vaccines have been produced and will be available in Australia with 2 months. These should be preferable to alternative treatments.
  6. Australia has one of the lowest fatality rates from Covid-19 in the world. This is doubtless due to Australia’s policies of border controls, lockdowns, extensive testing, contact tracing, isolation, social distancing and mask wearing. It seems certain that these measures have prevented more deaths than hydroxychloroquine could have, even if it was effective as first claimed. Craig Kelly would have served us all better if he had supported these measures instead of undermining several of them (e.g. Victoria’s lockdowns, mask wearing).
  7. Facts about Covid-19 treatments should be obtained from NSW Health and the World Health Organisation (Coronavirus disease (COVID-19) advice for the public: Mythbusters) rather than from Mr Kelly.

References

I don’t suggest the following references are definitive. They are provided as illustrative of the hundreds of studies and reports that are available on the internet. It is foolish for any non-expert to think that reading a few studies allows them to make a judgment on the effectiveness of these treatments. I have relied on Australia’s and the world’s medical experts for my conclusions.

Expert conclusions
Examples of studies supporting use of alternative treatments for Covid-19
Examples of studies opposing these treatments
Examples of studies recommending further testing

Graphic: Transmission electron microscope image of the virus that causes COVID-19, by NIAID on Wikipedia.

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