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There is very little if any evidence of people "taking megadoses and getting sick". There have been trials testing very large doses, far larger than those recommended by FLCCC, which are already much larger than standard antiparasitic doses, that have shown very little in terms of adverse effects, all of it transient. There is even a pre-pandemic case of a woman taking hundreds the time the recommended dose in an attempted suicide, and she walked out of the hospital 4 days later with no sign of lasting issues whatsoever. I'm not saying that people should go and take 100x doses. Only that ivermectin is one of the safest drugs we have, and even its most ardent opponents don't bother to make the case for a biologically-based downside anymore. I will steelman the opposing argument by saying that we don't know what its effects on the microbiome are, and I wouldn't feel comfortable taking large doses on an ongoing basis, but in terms of early treatment or post-exposure prophylaxis we have more than enough data to be incredibly comfortable with broad administration. Afterall, there's a reason it's available over the counter in many countries across the world. The potential for abuse is infinitesimal.

If you're interested in the deepest of deep dives on the topic, this is a good place to start: https://youtube.com/watch?v=ATiX0-2PEr4

As for the waters being muddied, one of the authors of an early and very influential meta-analysis has been caught on video admitting that he phrased his conclusions in a particularly cautious manner, recommending more studies needed to be performed, on the insistence of his funders, UNITAID. Of course, writing a conclusion you don't believe in because of the influence of third-party unnamed authors who control funding for the work is the definition of academic misconduct, but said academic is still respected and is now dedicating his time proving ivermectin results are explained by "fraud" (they're not).