Menjawab Dr Syihabuddin berkenaan dos ivermectin

(I am reproducing here my Facebook post, with some reformatting and hyperlinks).

Merujuk kepada posting Facebook saya bertajuk “IS IT TRUE HIGH DOSAGE OF IVERMECTIN IS REQUIRED FOR EFFECTIVENESS?”,

Dr Syihabuddin telah memberi respons – rujuk Gambarajah pertama.

https://www.facebook.com/permalink.php?story_fbid=1465924820445820&id=100010849486771

Firstly, I am disappointed with Dr Syihabuddin’s dishonesty whereby he claims I have blocked him. Secondly beliau tidak menjawab persoalan yang saya highlight. Thirdly, he is still barking up the wrong tree.

Dr Syihabuddin kata: “Saya diberitahu oleh rakan saya tentang satu post FB yang mengkritik pandangan saya tentang ivermectin, terima kasih kerana kritikan, saya kira satu kritikan yang baik dan ini yang kita perlukan. Tetapi saya tak boleh membuka post tersebut, mungkin saya telah di block oleh beliau, saya tak pasti. Jika benar, ini bukanlah satu ketelusan dalam dunia ilmu, awak kritik orang, benarkan orang tu baca kritikan awak, mungkin awak betul dan mungkin awak masih salah faham.”

Beliau bermain dengan kata2 “Jika benar” untuk elak dari dituduh memfitnah but that is the standard disclaimer to avoid being accused of lying. Kadang2 pemfitnah juga suka letak “?” kat hujung ayat, seolah bertanya tapi tujuan untuk memfitnah.

Adalah tidak benar saya block beliau. Ini adalah satu pembohongan. I don’t even know his Facebook profile/name. My postings are public (i.e. anyone can view) although only friends of this account and my other two accounts (Azmi Arshad II & Azmi Arshad III, which I tag to this post) can comment. I have never received a friend request from Dr Syihabuddin. Hanya friends boleh komen is to ensure we can have orderly discussions and avoid spam daripada troll yang bodoh dan biadap and so far it has been quite effective.

Anyway, let’s move on.

Hairan betul macam mana Dr Syihabuddin boleh dakwa:

“tidak ada scientific rationale yang boleh menjawab isu masalah dos tersebut”

Saya rasa mungkin sebab Dr Syihabuddin’s understanding is the same as Dr Harith Kamal, who said:

“lni hanya berjaya dicapai dengan menggunakan dos sebanyak 1700μg/kg (lebih kurang 9 kali lebih tinggi dari dos selamat yang dicadangkan oleh FDA). Secara mudahnya, ini boleh diibaratkan seperti melemaskan bakteria di dalam piring petri dengan sesudu alkohol dalam kepekatan yang tinggi, atau menelan pencuci tangan beralkohol seperti yang dicadangkan oleh Presiden Trump” – Dr Harith Kamal

Just to be clear, yang dicadangkan oleh Presiden Trump adalah berkaitan hydroxychloroquine (HCQ). Dr Harith Kamal and Dr Syihabuddin are confused in thinking that the mechanics of IVM and HCQ are similar.

Sebab itu saya kata Dr Syihabuddin tak baca response Caly et al kenapa tidak perlu 32x dos untuk manusia. Kalau nak ‘melemaskan virus’, of course perlu dos yang tinggi atau lebih dari 1:1 drug:virus ratio. But IVM merely needs to bind to only parts of the virus i.e. not “drown” the virus in whole and, furthermore, it also has other inhibiting functions. (Rujuk Gambarajah 2).

For example, you can kill a person by drowning him in a bath tub but you can also drown him by pouring water into his nose and mouth, where the amount of water required will be much less than the water in the bath tub. The point is that you target the nose/mouth and not the whole body. (Google ‘water torture’ if you still don’t understand what I mean).

Compare the mechanism of HCQ (Gambarajah 1 dan 1a) vs IVM (Gambarajah 2, 2a, 2b, 2c). Nampak perbezaan dan nampak macam mana IVM lagi hebat?

Kita rujuk balik apa Caly et al (team headed by Dr Kylie Wagstaff) kata dalam kertas kajian asal (April 2020):

“Ivermectin binds to and destabilises the Impα/β1 heterodimer thereby preventing Impα/β1 from binding to the viral protein (bottom) and preventing it from entering the nucleus. This likely results in reduced inhibition of the antiviral responses, leading to a normal, more efficient antiviral response.” Caly et al

Impα/β1 is the virus interface. In this respect, ivermectin TARGETS THIS INTERFACE of the virus. Ivermectin bukan cuba melemaskan virus dengan kuantiti yang tinggi sebagaimana disalaherti oleh Dr Harith dan saya tak pasti samada Dr Syihabuddin and Dr Harith are on the same page.

Nonetheless, since people like Dr Syihabuddin questioned the dosage, the scientific rationale regarding “masalah dos” was then explained by Dr Kylie Wagstaff in this video: Ivermectin for Covid Summit webinar, 23rd May 2021). This basically rationalises why Dr Syihabuddin’s prediction of 32x for in vivo is a fallacy (fast forward video to 1hr32m).

Dr Wagstaff said:

…utilising this In vitro study to determine the effective dose for ivermectin in vivo is a fallacy… the concentration required for ivermectin is probably very unlikely to be an issue.”

Dr Syihabuddin perlu faham bahawa eksperimen in vitro Caly et al tersebut di buat pada bulan Jan/Feb tahun lepas. As explained by Dr Wagstaff, at that time the covid virus had only been isolated once, which was only a few days before they did the study so they had no choice but to use Vero/hSLAM cells (green monkey kidney cells) instead of lung cells. Therefore the IC50 based on Caly et al’s in vitro study is not the relevant IC50 for human lung cells. Maksudnya pengiraan Dr Syihabuddin yang menghasilkan angka 32x tak boleh pakai untuk menentukan dos bagi manusia. Mekanisma ivermectin dalam kidney cell monyet dan paru2 manusia jauh berbeza and, in addition, the immune system also kicks in while ivermectin inhibits the docking and replication of the virus.

Dr Syihabuddin kata:

“Tuan Azmi mendakwa kenyataan saya salah berkenaan dos ivermectin dalam ujian makmal. Pertama sekali saya memang tersilap, bukan 10 kali ganda seperti dalam forum UiTM, tetapi 32 kali ganda lebih tinggi daripada dos paling tinggi pernah diambil manusia, saya sudah jelaskan dalam pos saya sebelum ini dan saya sudah quote 32 kali ganda ini dalam forum-forum yang lain.”

Dr Syihabuddin keliru. Cuba baca balik apa yang saya tulis. Tiada langsung perkataan “salah” atau “betul” berkenaan pengiraan ikut model simulasi yang diguna oleh beliau. Saya ulangi apa yang saya kata: … pendapat mereka berdasarkan kesimpulan yang dibuat oleh Yeo et al dan Virginia et al (and there could be others) yang mengkritik kajian Caly et al. Mereka membuat kesimpulan perlu dos tinggi berdasarkan simulasi mereka sendiri dalam makmal. Tapi ketiga-tiga doktor melayu kita (Dr Harith Kamal, Dr Syihabuddin dan Dr Luqman Alhakim) TIDAK PULA BACA (atau buat2 bodoh) RESPONS daripada Caly et al (before mid last year).

Isunya bukan samada Dr Syihabuddin input angka2 yang betul (atau salah) dalam model/formula simulasi. Whether the number Dr Syihabuddin comes up with is 32, 10 or 1, it still cannot be considered reliable nor relevant. Why? Because the IC50 was in relation to monkey kidney cells (Vero/hSLAM), not human lung cells or even a monkey’s lung cells.

It’s as if, as an analogy, Dr Syihabuddin is using the formula for a cube to calculate the volume of a sphere. He may get the calculation right (or wrong) for the cube but it is IRRELEVANT for the sphere.

In other words, Dr Syihabuddin started off on the wrong foot and is still barking up the wrong tree.

Dr Syihabuddin merujuk hanya kepada kajian (mathematical simulation) Virginia. Adakah Virgina buat kajian in vitro dengan virus dan sel? No, dia guna ‘population pharmacokinetic model’, a mathematical model. Adakah Virgina sebut dalam kertas kajian bahawa sebanyak 5 µM concentration IVM digunakan dan nilai IC50 2 µM adalah merujuk kepada kajian atas Vero/hSLAM dan bukannya sel paru2? No. Adakah Virginia merujuk kepada ulasan Caly et al yang menjawab dakwaan Yeo et al dan Noel? No. And yet Dr Syihabuddin still believes Virginia’s prediction is indisputable and accurate. The fact is Dr Syihabuddin did not have the whole picture.

Adakah Dr Syihabuddin sendiri merujuk kepada jawapan Caly et al yang diberi kepada Yeo et al (yang juga guna model simulasi) dan Noel tahun lepas? No.

Adakah Dr Syihabuddin menjawab response daripada Caly et al yang diberi kepada Yeo dan Noel pada April tahun lepas? No. Adakah Dr Syihabuddin merujuk kepada jawapan dari Dr Kylie Wagstaff yang diberi 4 bulan lepas dalam webinar 1st International Ivermectin for Covid Summit (May 2021)? No. Dr Syihabuddin merely re-did his calculations based on the same fundamentally flawed assumptions.

I have this quote for Dr Syihabuddin:

If the only tool you have is a hammer, you tend to see every problem as a nail.

It means an over-reliance on a familiar/favourite tool; in this instance, be it Virginia’s simulation or his own simulation model.

Rujuk Gambarajah 3 yang meringkaskan perbezaan antara sel Vero/hSLAM dan lung cell digunakan dalam kajian. Seperti Dr Wagstaff mengulas, the Vero/hSLAM cells do not produce interferons (IFN) and lack immunitive response, unlike for lung cells. IC50 of lung cells are 6 to 8 times better than for Vero/hSLAM. Mustahil Dr Syihabuddin sebagai seorang doktor tidak faham perbezaannya maka saya kata Dr Syihabuddin samada tak baca ulasan tersebut atau sengaja buat2 bodoh.

This is also explained below in writing (berkaitan Gambarajah 3). Dr Wagstaff mengulas kenapa pengiraan berdasarkan simulasi in vitro mereka (samada Yeo et al, Virginia et al atau Dr Syihabuddin) tidak boleh digunakan untuk menentukan dos yang berkesan atau kenapa tidak relevan untuk manusia.

In Vitro evidence on required concentration.

Some people claim that [Caly] shows that therapeutic concentrations are not easily reached in humans. This is incorrect. THE AUTHORS EXPLAIN WHY THEIR IN VITRO STUDY CANNOT BE USED TO DETERMINE THE EFFECTIVE DOSE IN VIVO, and state that the concentration required is very unlikely to be an issue [Wagstaff]. THE STUDY USED MONKEY KIDNEY CELLS (THE ONLY CHOICE AT THE TIME OF THE EXPERIMENTS), WHICH LACK ADAPTIVE IMMUNE RESPONSES AND DO NOT PRODUCE INTERFERON.

Authors also note that ivermectin accumulates in lung and other tissues, that subsequent experiments with lung cells show many times greater concentrations, and that the average lung concentration shown in modeling studies exceeds the effective level shown in their research.

Authors note that IVERMECTIN WORKS WITH THE IMMUNE SYSTEM AND A 1:1 RATIO OF DRUG TO VIRUS IS UNLIKELY TO BE REQUIRED.

In [Bray], author reply that “ivermectin’s KEY DIRECT TARGET in mammalian cells is a not a viral component, but a host protein important in intracellular transport; the fact that it is a host-directed agent (HDA) is almost certainly the basis of its broad-spectrum activity against a number of different RNA viruses in vitro. The way a HDA can reduce viral load is by INHIBITING A KEY CELLULAR PROCESS THAT THE VIRUS HIJACKS to enhance infection by suppressing the host antiviral response. REDUCING VIRAL LOAD BY EVEN A MODEST AMOUNT BY USING A HDA AT LOW DOSE EARLY IN INFECTION CAN BE THE KEY TO ENABLING THE BODY’S IMMUNE SYSTEM TO BEGIN TO MOUNT THE FULL ANTIVIRAL RESPONSE BEFORE THE INFECTION TAKES CONTROL.” In further research, authors note that they find efficacy for prophylactic use, and that smaller repeated doses are more effective than a single larger dose [Wagstaff].”

(source: https://ivmmeta.com/#invitro)

If the above is not a scientific rationale, I don’t know what is.

Ayat “The way HAD can reduce viral load…. before the infection takes control” adalah response Caly et al yang saya kata Dr Syihabuddin tidak baca and did not respond to. Ternyata kali ini pun Dr Syihabuddin tidak mengambil peluang untuk counter balik rasional saintifik tersebut. Instead he merely recomputed his numbers based on his original misunderstanding – dari 10x dos jadi 32 kali ganda pulak. He merely dug a deeper hole for himself.

Jangan hanya sebab Dr Syihabuddin tidak setuju maka dianggap bukan scientific rationale. Saya yang bukan ahli pun boleh faham secara dasar mechanics dan kesimpulan. Ada ruang ‘feedback’ di website tersebut sekiranya Dr Syihabuddin masih tidak puas hati dan ingin mengkritik scientific rationale tersebut. Just please make sure you write your ‘peer review’ in English.

Dr Syihabuddin kata:

“Maka saya membuat kesimpulan, ujian makmal atau preclinical adalah kekurangan data untuk membuktikan keberkesanan ivermectin pada dos yang biasa atau dos yang dibenarkan.”

Pelik betul Dr Syihabuddin, a qualified doctor and academician, seolah tidak faham tujuan kajian in vitro Caly et al. Tujuan kajian in vitro tersebut bukan untuk menentukan tahap dos yang diperlukan tapi untuk “proof of concept” iaitu untuk menentukan samada/atau (to some extent) bagaimana ivermectin menghalang (bukan membunuh secara langsung) virus covid dari menguasai atau menjangkiti sel. Itu sahaja. Simple.

Seperti dinyatakan dalam abstract kertas Caly et al:

“Although several clinical trials are now underway to test possible therapies, the worldwide response to the COVID-19 outbreak has been largely limited to monitoring/containment. We report here that Ivermectin, an FDA-approved anti-parasitic previously shown to have broad-spectrum anti-viral activity in vitro, is an inhibitor of the causative virus (SARS-CoV-2), with a single addition to Vero-hSLAM cells 2 h post infection with SARS-CoV-2 able to effect ~5000-fold reduction in viral RNA at 48h. Ivermectin therefore WARRANTS FURTHER INVESTIGATION for possible benefits in humans.”

Nampak kan…. “warrants further investigation for possible benefits in humans”. Bukan untuk membuktikan dos biasa atau hanya dengan dos tinggi ivermectin akan berkesan.

“The in vitro potency of ivermectin against Covid-19 virus is a testimony that this drug can be utilized to manage those patients who have been infected with SARS-CoV-2. Since the conditions in which the virus replicates and infects the cells in vivo and in vitro DIFFERS, a DECISIVE COMMENT about how ivermectin may prove to be beneficial to the patients CANNOT BE CONSTRUCTED YET.” — Dhyuti Gupta, Ajaya Kumar Sahoo, Alok Singh, Department of Pharmacology, All India Institute of Medical Sciences,Raipur, Chhattisgarh, India.

Ivermectin: potential candidate for the treatment of Covid 19, Brazilian Journal of Infectious Diseases

Maksudnya tidak boleh buat kesimpulan apa2 lagi samada perlu normal dose atau 10x atau 32x the normal dose. Tapi Dr Syihabuddin hebat boleh mendahului hasil kajian in vivo dan buat kesimpulan perlu 32 dos atau lebih berdasarkan pengiraan sendiri. Dr Syihabuddin juga dah ‘construct decisive comment’ dengan hanya menggunakan mathematical model. That is poor scholarship or simply biased and prejudiced.

Seperti juga diulas oleh Asiya Kamber Zaidi & Puya Dehgani-Mobaraki on the understanding of Caly et al’s in vitro study:

“As per the authors, using Vero/hSLAM cells, the antiviral activity of the test drug was reliably measured and the sensitivity of the IC50 = 2 µM set by them was appropriate as neither false positives nor false negatives occurred. Therefore, the study by Caly et al MERELY INDICATED that IVERMECTIN was FOUND TO HAVE anti-SARS-CoV-2 ACTIVITY in vitro — NO MORE, NO LESS. Also, the fact that there are in vivo infection experiments that could be used to connect in vitro experiments to clinical studies”.

Source: The mechanisms of action of Ivermectin against SARS-CoV-2: An evidence-based clinical review article, May 2021, The Journal of Antibiotics

I think the conclusion is easy enough to understand. Itu pada tahun lepas dan sejak kajian in vitro Caly et al diterbitkan, banyak kajian in vivo telah dibuat berdasarkan dos yang selamat yang memerlukan hanya sekitar 200µg- 400µg /kg/dos. Therefore, Dr Syihabuddin’s calculation is not only irrelevant but obsolete because subsequent to the in vitro study, in vivo studies have also already been done. Cuma samada Dr Syihabuddin terima atau menolak scientific rationale dan kajian2 in vivo tersebut.

Berkenaan kajian2 in vivo pula, sebagaimana yang saya beberapa kali kata, golongan taksub WHO/vaksin akan mencari salah dan kelemahan tiap2 kajian ivermectin dengan pelbagai alasan. Saya ulang apa yang saya kata: Doktor2 KKM dan pentaksub mereka akan dakwa kajian2 tersebut tak ikut Cochrane standard, tak cukup bilangan pesakit dalam kajian, ada plagiarism, falsified data, takde RCT, kajian cacat, kajian ditarik balik etc etc. That is their standard rhetoric. Responses have been given on the removal of the Elgazzar study by Research Square (without first clarifying with the authors). 40 doctors/scientists also responded to the biased systematic review by a group, published by Oxford University Press on behalf of CDC. The fault-finding attacks won’t stop.

And true enough, apa yang Dr Syihabuddin jawab?

Berkenaan dengan kajian klinikal tentang ivermectin, saya mengulas kajian-kajian klinikal bukan sekadar masalah bias, kajian tipu data, salah perbandingan dan penggabungan, tetapi ada beberapa data statistik yang salah terutamanya dalam ivmmeta dan data daripada FLCCC, begitu juga dengan meta analysis Bryant. Tuan Azmi kena faham basic dalam sesebuah systematic review and meta analysis, sistem penapisan bias seperti Cochrane Risk of Bias Tool 2, sistem GRADE adalah amat penting untuk memberi panduan kualiti data. Bagi kajian observational dan sebahagian statistic serta sebagainya kita menggunakan parameter seperti P value untuk mengetahui data significance, RCT banyak menggunakan confidence interval. Meta analysis menggunakan confidence interval dll dan tambahan adalah CRoB dan GRADE. Bukan sekadar mengulas, bukan saya taasub Cochrane, tetapi dalam mana-mana ubat pun beginilah kaedahnya. Tuan Azmi boleh rujuk Cochrane Handbook untuk systematic review and meta analysis, WHO pun ada.”

Very predictable. Kan saya kata beliau taksub dengan WHO. Apa response saintist2 komen berkenaan analisa WHO? Rujuk Gambarajah 4. Boleh juga baca di: https://ivmmeta.com/#who

Ya, saya faham pasal probability, bias, confidence interval etc (standard deviation, normal distribution, poisson distribution, binomial theory blah blah blah pun saya tahu). Saya pun belajar Statistics as an A-level subject dan di universiti. I also understand the P value vis-a-vis correlation and causation. Masalahnya, Dr Syihabuddin cannot see the forest for the trees. Dr Syihabuddin tidak dapat lihat atau tidak menilai kajian2 tersebut secara kesuluruhan (in totality) atau sengaja pejam mata.

“All clinical trials suffer from risks of bias in their design and conduct, as assessed by the Cochrane Risk of Bias 2.0 tool that assesses trial biases with the grades of “some concern, low, moderate, high, or serious”. Although one group of authors has assessed many of the trials as having moderate to severe risks of bias, performing meta-analyses of these trials can more accurately detect the true effects despite individual trial biases. Multiple groups, including ours, have performed meta-analyses of these trials, with all groups finding CONSISTENT BENEFITS amongst the trials. In fact, the CONSISTENCY of trial results from both sets of randomized and observational controlled trials from varied centers and countries and trial sizes and disease phases LEND EVEN MORE VALIDITY to the estimates of benefit.” – FLCCC Alliance

Baca FAQ: https://covid19criticalcare.com/iverme…/faq-on-ivermectin/

Fikirlah elok2 dan sedalam-dalamnya, macam mana banyak sangat studies semuanya pentaksub (atau ‘Ivermectin Deniers’) mendakwa tak boleh pakai. Apakah ramai saintist berkonspirasi from all over the world untuk recommend ubat yang tidak menguntungkan mereka? And of course % effectiveness will be different depending on whether for prophylaxis, treatments for different stages, late treatment and ICU and if patients have different comorbidities. Those studies also corroborate or are consistent with observations such as comparing countries/states that use ivermectin (in multi-drug protocol) vs vaccine only. Then we also hear doctors who have successfully treated their patients with IVM based protocol – are they lying? Doktor2 Jepun pun menipu?

Jelas sekali Dr Syihabuddin termasuk dalam golongan Ivermectin Deniers. (Rujuk Gambarajah 5).

Last but not least, in my previous posting, saya kata: Mereka membuat kesimpulan perlu dos tinggi berdasarkan simulasi in vitro mereka sendiri dalam makmal. Tapi ketiga-tiga doktor melayu kita (Dr Harith Kamal, Dr Syihabuddin dan Dr Luqman Alhakim) tidak pula baca (atau buat2 bodoh) respons daripada Caly et al (before mid last year).

Dr Syihabuddin menjawab:

“Tuan Azmi sama juga tidak mengulas dapatan kajian Virginia Smicthz dengan lengkap.”

Kenapa saya pula perlu mengulas dapatan Virginia D. Schmith? Dr Syihabuddin cuba mengelirukan pembaca. Ia begini:

April 2020 – Kajian in vitro Caly et al is published. (Kajian dibuat Jan/Feb 2020)

May 2020 – Kajian in vitro Yeo et al (dan persoalan oleh Noel) is published. Dia buat kesimpulan perlu dos tinggi untuk manusia.

May 2020 – Caly et al (David A. Jans & Kylie M. Wagstaff) menjawab dan mengulas kenapa dos rendah/biasa cukup untuk manusia. (See above).

Oct 2020 – Kajian in vitro Virgina et al is published. Dia buat kesimpulan perlu dos tinggi untuk manusia. Namun Dr Virgina hanya merujuk kepada kertas kajian Caly et al. Virgina tidak rujuk langsung kepada kertas kajian Yeo et al dan response Caly et al kenapa dos rendah cukup untuk manusia. Bermakna Virgina tidak tahu atau buat2 bodoh telah ada response daripada Caly et al.

May 2021 – Dr Kylie Wagstaff sekali lagi menjawab dan mengulas persoalan dos dengan lebih terperinci.

June 2021 – Dr Pierre Kory pun menjawab persoalan dos (video interview – Dr Erin Stair, Dr Pierre Kory and Dr Luis Garegnani). Fast forward to 7:00m. Dr Pierre mengulas (i) Doses used in cell culture and doses used in humans are different (ii) That was a monkey kidney cell model. Kidney cells ok. There’s not a lot of high concentration in kidney cells. When they repeated the experiment in lung alveolar cells, they have achieved inhibitory concentrations in alveolar lung cell models easily. Article is under peer review. (iii) If we couldn’t achieve effective concentration, we wouldn’t be sitting here today. We wouldn’t be debating all of the efficacy and all of these trials.

Kenapa artikel Yeo et al penting sebagai rujukan? Sebab di situ lah terkandung response daripada Caly et al berkenaan isu dos. Dalam artikel yang ditulis oleh Dr Syihabuddin pula, beliau hanya merujuk kepada kajian Virgina. (Rujuk Gambarajah 6).

Therefore, he was telling only one side of the story. Tiada rujukan kepada artikel Yeo et al dan response dari Caly et al. Kertas kajian Virginia bukan sahaja langsung tidak sebut pasal response Caly et al tapi juga tidak menyatakan (atau sengaja menyembunyi fakta) IC50=2µM dari kajian Caly et al adalah merujuk kepada sel Vero/hSLAM dan bukannya sel paru2. Dr Syihabuddin pun sama. Kenapa Dr Syihabuddin masih tidak menjawab ulasan yang diberi oleh Dr Kylie Wagstaff pada May 2020 dan pada May 2021 dan juga ulasan Dr Pierre Kory pada Jun 2021? Kenapa asyik mengulangi dapatan Virginia yang telah dibalas dan mengulangi pengiraan sendiri sahaja?

That is called intellectual dishonesty.

Hanya Dr Syihabuddin sendiri tahu samada dia terlepas pandang artikel Yeo et al atau sengaja mengabaikan response Caly, Dr Wagstaff dan Dr Kory yang menjawab kenapa dos biasa secara oral cukup untuk manusia. Apa pun, the point is persoalan dos TELAH DIJAWAB WITH SCIENTIFIC RATIONALE. Dan sebab itu saya kata sepatutnya Dr Syihabuddin menjawab balik scientific rationale yang telah diberi oleh Caly/Dr Wagstaff. Beliau langsung tidak menjawab balik tapi sebaliknya mengulangi kesilapan beliau berdasarkan salahfaham antiviral activity of ivermectin or the mechanics/process of how ivermectin works against the virus seperti dikiaskan oleh Dr Harith Kamal.

At the end of the day, how many people have been infected, hospitalised or died of covid after having taken ivermectin? It’s no coincidence that countries/states (di Africa, di India e.g. Uttar Pradesh and Uttarakhand, Zimbabwe, Indonesia, Slovakia, Mexico, Peru, Argentina etc) that use ivermectin-based protocols show drastically lower number of such cases compared to those who don’t. Bandingkan dengan negara2 yang tidak guna ivermectin. Compare that to countless number of people who relied only on vaccination, whether 1, 2 or 3 doses. Tengok Israel macam mana.

Nak suruh orang ambil vaksin, silakan, but laser-target mereka yang berisiko tinggi. And tell the truth about both vaccines and ivermectin – pros vs cons, risk vs benefits. Jangan membohong dan menyembunyi fakta. Jangan mengharamkan ivermectin dan memaksa orang ambil vaksin samada dengan mewajibkan atau secara tidak langsung atau secara halus. Tak perlu menghina mereka yang menolak vaksin kerana was-was atau sebab tak perlu. Banyak persoalan and uncertainties belum dijawab dengan sempurna. Also, jangan kelentong pasal ivermectin.

At least Dr Syihabuddin dan Dr Harith Kamal tak lah kata ivermectin hanya untuk haiwan. Syabas.

– AA –

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