Dec 25, 2021
Mike Isaacson: Now when you say recommended dose…
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Whiteness is an AIDS
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Mike: Welcome to another episode of the Nazi Lies Podcast. Subscribe to our Patreon to get access to early episodes and membership in our book club and Discord. Today we are joined by Dr. Tim Geary, a pharmacoparasitologist or parasitopharmacologist… He studies parasites and makes drugs. He's a professor emeritus at McGill University and still teaches courses at Queen's University Belfast. He's here to talk to us about hydroxychloroquine, ivermectin, and why they probably won't neutralize Coronavirus. Thanks for joining us, Dr. Geary.
Tim Geary: You're welcome, Mike. Please call me Tim.
Mike: Okay, Tim. Before we get into all the science, tell our audience a little bit about what you've done professionally, because you have a very extensive list of bona fides, and I don't really know where to start. [laughs]
Tim: That’s quite all right. Yes, I have been working on the study of drugs, pharmacology, for about 45 years, and most of that time I've been working on chemotherapy of infectious diseases, primarily parasites. This includes work in Africa. Most of my career has been on veterinary parasites or human neglected tropical diseases caused by parasites. During the course of my career I have worked on malaria, and that's where chloroquine and its derivative hydroxychloroquine come from, and also ivermectin, which I have studied for many, many years, both in animals and people.
In full disclosure, Mike, I once did work for the pharmaceutical industry, the animal health arm of a company called up Upjohn that is now known as Zoetis in Kalamazoo, Michigan. [ed. It’s now part of Viatris.] I also consulted and worked with the World Health Organization, with the Bill and Melinda Gates Foundation, and with the Carter Center on various problems of tropical diseases, and I continue to be a consultant for some animal health companies. That's who I am.
Mike: Very good. All right. Now you've done some research on both hydroxychloroquine and ivermectin, correct?
Tim: I have, indeed. I worked on both how they work to kill parasites and also how parasites become resistant to them. I have studied them in clinical settings as well as in the laboratory, and I think I qualify as an expert in both medicines in the indications for which they are used, which is essentially tropical medicine and veterinary parasitology.
Mike: Very good. And you've also been following the misinformation surrounding these two drugs too, right?
Tim: I have, with great interest and concern. There aren't very many people in the world who are experts at drug discovery and drug development for these kinds of conditions. That's unfortunate. But yes, I have followed that, Mike, and I certainly have opinions about where the misinformation came from. It was not a malintention, it was just wrong interpretation and wrong design of some initial experiments that led to inappropriate conclusions in a rush to clinical use.
Mike: Okay, so let's talk about each of these medications and then we'll talk about where the rumors started. So let's start with hydroxychloroquine. Since the beginning of the pandemic almost, it was heralded as a miracle COVID cure but was quickly discovered not to be that. What were its recognised clinical uses?
Tim: So hydroxychloroquine is a derivative of a drug called chloroquine, which was also touted initially as a possible solution to COVID. Chloroquine was a miracle drug for the treatment of malaria. It saved, oh my gosh, millions and millions of lives over the course of its use. It's relatively cheap, it's reasonably safe and it was highly effective against malaria parasites until they evolved resistance to it. It's use for malaria has now diminished remarkably.
Hydroxychloroquine was thought to be a safer alternative with a better sort of safety profile. But it never was really used for malaria. It just never displaced chloroquine. Instead, it found use as kind of an immunomodulator compound for people with systemic lupus erythematosus or lupus as it's commonly known, an autoimmune condition. So hydroxychloroquine for people with lupus does help to reduce symptoms, to reduce worsening of the disease, and it is a valuable drug for that purpose.
Mike: Okay, and how safe is it to experiment with?
Tim: Not very. I mean, it does have side effects, especially when you go over recommended dosing. We'll talk, I think Mike, in a little bit about how that relates to potential uses against COVID, if you like, but it's normal use in lupus patients, it's pretty well tolerated. But the doses are quite specific for that, and as with most medicines, it's safe when used appropriately.
Mike: And what happens when it's not used appropriately? What kinds of symptoms can you...
Tim: There are a variety; hearing loss is one that kind of stands out, but you can get imbalances, a sort of dizziness, classic nausea, vomiting, things like that. It's not a drug to be taken lightly. It's not as safe as many of the medicines that we use. But again, when it's used appropriately, it's fine.
Mike: Okay, and how did the rumors start that this could be used to be COVID.
Tim: So it's a classic story, Mike. So whenever a new condition surfaces, like COVID, there's a rush to test all the– what are known as the FDA registered medicines. These are medicines that have been approved for one use or another either by the US government or by the European agencies. It's always easier to adapt an approved drug for new indication than to register a completely new medicine. It's just way cheaper, way faster. So everyone turns to “What have we already approved just to see if by some unexpected chance it would also work in this new condition?” And that's what happened here.
People can grow the SARS-CoV-2 virus in cell culture. So we grow it in cell culture and throw every compound that is registered and approved into those cultures to see, “Does any of them work?” And hydroxychloroquine and ivermectin, which we'll talk about, they came out of that effort.
There's a serious flaw with the strategy in this case. I will say, Mike, sometimes it works. Sometimes you find something you didn't expect. I don't think we'll have time to go into those exceptions but there are some. So a key-- and this is sort of basic science and I hope it's okay for everybody-- but a big factor is the kind of cell that you use to grow the virus to test it. Scientists typically use for viral diseases, a cell called the vero cell, which was derived from an African Green Monkey kidney. The reason they use this cell is because most viruses grow really well in it, so it's quite easy to adapt a new virus to that system. The problem is, it's not representative of the kinds of cells that say SARS-CoV-2, the COVID virus infect. Those would be human lung cells, if you will.
So yes, hydroxychloroquine works at relatively high concentrations against the virus in vero cells. But it turns out if you do the same experiment with cultures of human lung cells, it really doesn't work at all, because the virus enters those cells in a way that's different than how it infects vero cells. Had we done the experiment properly, which is to use cultures of human lung cells, we wouldn't be having this conversation, Mike, because no one would have advanced hydroxychloroquine as a potential cure.
I hope that answers okay, and I hope it's clear. It's not that the scientists who did this work had evil intentions, they did not. It's just that they used the wrong cell type, and people drew inappropriate conclusions from the result.
Mike: Okay, let's switch gears to ivermectin. There's actually been a lot of misinformation about ivermectin on both sides of the don't-try-this-at-home debate. So in addition to the people on one side claiming that ivermectin can cure COVID, on the other side, you have people who are reducing ivermectin to just a horse dewormer.
Tim: [laughs] Yeah. Well, ivermectin, like chloroquine is a wonder drug. Okay? First of all, ivermectin has revolutionized the treatment of parasites in animals, and we should not discount it. So maybe its primary use is actually in the prevention of heartworm infections in people's pets. It revolutionized the treatment of this.
It's an important and extremely useful drug, but it also is very useful in people. It has been donated– More than a billion doses have been donated by Merck for the treatment of individuals infected with a couple of parasites in poor areas of the world, one is onchocerciasis or river blindness and the other is lymphatic filariasis or elephantiasis.
So we have a huge history of use of the drug. It can be given once a year for these infections or twice a year. It's enormously important in tropical medicine. It is a human medicine. It is very safe as used. It's also extremely potent. So it takes very little of the drug to have a beneficial therapeutic effect.
Mike: And how safe is it to experiment with?
Tim: At the use doses, it's quite safe. There are isolated incidences which would never happen to people in the United States, for instance, or in regions that don't suffer from parasitic infections like this. It's very safe, but it can be overdosed. It's possible.
One of the things that's really important to know, and I mentioned that it's very potent, right? So you give tiny doses to people who suffer from these parasitic infections, but the solutions that we use to treat animals, because animals are so much bigger than people, like horses or cows, for instance, they contain much higher amounts of the drug. And inappropriately taking those medicines you can get an overdose that has serious lethal concentrations and lethal implications, for instance. I think there have been a couple of fatalities in the US. So it should never be taken outside of a prescription by a physician.
Mike: Okay. And where did the rumors about this one start from?
Tim: [laughs] Exactly the same place, Mike. Ivermectin works against the virus in cell cultures, in vero cell cultures. It does not work in cultures of human lung cells, so there's no basis to presume that either of these drugs act by inhibiting the virus.
I will also say that the concentrations of ivermectin that are required to be active even in the vero cells are 100 times higher than what you would see in a human dosed with a therapeutic amount of the drug. It's not even clear to me that even massive overdoses would give you enough of the drug in your blood to actually have this beneficial effect.
The other problem, of course, that happened is people said, "Well, it's doing other things,” same with hydroxychloroquine, that maybe it's not inhibiting the virus but it has an immunosuppressive or some beneficial effect on immunity to the virus.
That's unproven. I know of no real evidence that therapeutic doses of ivermectin for sure have this effect. Hydroxychloroquine is a kind of immunosuppressant and that is certainly not an effect you would like to see in acute infection, initial infection, because you need the immune system to combat the virus.
It's possible that at later stages of more serious infections, when sometimes the human immune response can be over aggressive and cause pathology. That's why dexamethasone, which is a steroid that's used to suppress the immune system, has therapeutic benefit. But there's no reason to think that hydroxychloroquine will have any benefit over and above dexamethasone. And in fact, as you know, clinical trials in hospitalized patients showed no benefit whatsoever from hydroxychloroquine.
Mike: And I would assume it's the same for ivermectin.
Tim: It is. I'm sorry. It is. It's the same for ivermectin that we have treated hundreds of millions of people and literally billions of animals with this drug. No one has ever reported an antiviral effect or an immunosuppressive effect in these individuals. So we don't really have a mechanism that would explain either one. This becomes very important. I'm going to take a segue here if you don't mind.
Mike: Hey, go for it.
Tim: So right now ivermectin is undergoing clinical trials, not because of science but because of sort of public demand. These include several trials in the United States. The problem with a clinical trial like this is we have no hypothesized mechanism. So we don't have any way to judge, “How much ivermectin should we give to these people? What dose do we use? How frequently do we give it?” We have no idea what the target plasma concentration or blood concentration of the drug should be to have a beneficial effect on COVID. This makes the trial design extremely difficult. And it's going to complicate the interpretation. Right now some people think you have to take ivermectin all the time, other people think, “No, no, you just take it when you get sick.” We don't have a theoretical or any basis in theory to account for any of these outcomes.
Mike: Okay. Switching gears again, I imagine in your relief work, you've encountered a bit of treatment and vaccine hesitancy, right?
Tim: I think, Mike, just as a citizen, not necessarily have I sought it out. [laughs] I will say I have given a couple of other interviews about this and at least one of them generated a lot of negative feedback on my character because clearly ivermectin is a lifesaver and I'm doing a disservice.
But in terms of vaccine hesitancy, I think it's coupled with enthusiasm for hydroxychloroquine or ivermectin. It's a rather bizarre demonstration of human susceptibility to anecdote and conspiracy.
I will say, look, a lot of people that advocate either one of these drugs are not evil. I think they're misguided. I'm looking forward to the results of the clinical trials on ivermectin that I hope will quell some of this over-enthusiasm. I don't believe they are malicious actors, they just are misinformed. There is no scientific rationale to advocate either of them.
Vaccine hesitancy is a bit different. It's grounded in ignorance. There's a political component to it, which is difficult for me to accept, that somehow it threatens individual liberty to require people to protect each other. I find that a bizarre and unhealthy development in our society. I suppose it’s always been there.
There is no reason to fear the vaccine. They're well-grounded in science, all of the various pipes that have been advanced. They have all been approved after regular rigorous study. None of them has nefarious intent. There is no conspiracy among major pharma companies about this.
I'm a little bit concerned that the medicines that have recently been approved, I think, one from Merck and one from Pfizer as antivirals, I think they're valuable. But it also gives people an opt-out for the vaccine to say, "Well, if I get sick I can get cured." That's unfortunate. I probably haven't answered your question, have I?
Mike: Well, I was gonna ask what you find motivates the vaccine hesitancy and what motivates the hesitancy to believe medical professionals, if you've encountered that in your personal interaction with patients.
Tim: I have. I mean, I don't treat patients. I want to be clear about that. I'm just a scientist. But of course I have lots of conversations in my life with some people who don't agree that vaccines are important. Some people don't agree that the virus is actually real. They think it's a hoax perpetrated, somehow, I don't know how.
I'm gonna-- not being a sociologist, I'm not sure how valid my opinion is, but I think one of the factors is that most people don't know any scientists. They don't really know their physicians as people. We've become a customer-client medical system. You're probably too young to remember sort of the family doctor that would sit and chat. I know there's still some GPs that do that, but a lot of this is now assembly line. You show up, you don't even get 10 minutes, and you're on to the next patient. Right?
People don't know physicians as people, they don't know scientists at all. The demise of the public school system in the US and the advance of private schools means that people who are scientifically literate often send their kids to private schools, and they don't get a chance to interact with, I’m just gonna say, non-scientists very much. They don't coach softball or baseball or football teams, they don't go to PTA meetings.
Our dependence on electronic communications, as you and I are now doing, diminishes the opportunity for interpersonal interaction or casual just to say, "Hey, I do this for a living and you shouldn't be afraid of me and the people like me." But there is a distrust, especially in the Western countries-- actually, it's global. In the so-called elite, there is this distrust of intellectual output.
I gotta tell you, just recently, the National Science Foundation released survey data of 30% of the scientists and engineers in the US are foreign born. And that's another barrier to communication; people tend to view foreigners with suspicion. So there's been a disconnect in American society between this incredible technology that drives our society and the people who benefit from it, or participate in it almost as unwitting, unwilling guinea pigs, right? That's a long winded answer, I hope it's okay.
Mike: [laughs] Well, it's a good one. So what research are you working on now?
Tim: One of the things that I have become fascinated by is how parasites manipulate their hosts. So a lot of my work is how the molecules that parasites release into their hosts affect the host response to allow them to succeed. Some of the parasites I studied live for many, many years in the host, large kind of parasites, and you’d think we should be really good at getting rid of them. And we are, in fact, really good at getting rid of almost every parasite, but some few species have figured out how to 'live long and prosper' as Mr. Spock would say, in our bodies. So I'm really curious about how they accomplish that.
The other project I'm involved with at the moment is with the Carter Center, and it's about a worm, a parasite called guinea worm in Africa, which has nearly been eradicated, but it has recently been found to not only infect people but dogs, and so we're trying to come up with a medicine that can be used to treat the parasite in dogs so that eventually we can eradicate it. This is a parasite that Jimmy Carter has said, "I hope the last guinea worm dies before I do."
Mike: And what does a guinea worm do?
Tim: Oh my gosh, you want to really get grossed out? Your listeners, go look it up. It's a parasite called Dracunculus medinensis. It's the little dragon of Medina. It lives beneath the skin. The females get to be at least half a meter long or even longer, and they burrow out of the skin, and lay their eggs basically in water. It's disfiguring. It's very painful. It's an example of a gross parasite, I will say. But it can be cured or can be prevented if you keep people from going into the water. So this is kind of a behavioral solution that the Carter Center has really promoted. Or if you use filtered straws to drink. It infects people by drinking water that's contaminated with parasites. It's a lovely story. It would be a wonderful thing to eradicate, and I hope we can do it.
Mike: Oh, really important work, Tim. Thank you so much for coming on the Nazi Lies podcast to teach us about drugs. This was fun.
Tim: It's a pleasure. I think it's important to recognise, Mike, that people involved in fighting this virus are not motivated by malicious intent. They really are working to benefit people to try to get control of the epidemic, and they want everyone to get vaccinated. But thank you for inviting me, I sincerely appreciate the opportunity.
Mike: Well, thank you so much.
Tim: And another time perhaps, my friend.
Mike: Absolutely. If you liked what you heard and want to support the Nazi Lies podcast, consider becoming a Patreon subscriber. Patrons get access to early episodes and membership in our book club. The early episodes can come in on any podcast app, and the book club is on Discord. Come join us as we read the books of our upcoming guests. It's a good conversation; your question may even end up on the show. Check us out at patreon.com/nazilies.
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