I heard about Ivermectin for the first time this week and was shocked how much it seemed that I had stepped into conspiracy theory land. There seemed to be an overwhelming amount of evidence over the last year that this repurposed drug is effective at treating Covid during a variety of stages (preventative, first positive test, ICU admittance, and even long haul). But since there hadn't been a randomized trial the drug had, not only been dismissed, but heavily censored over social media. I still cannot believe how much the discussion has been silenced in the same way people discuss "covid vaxx causes magnetism". The fact the interview between Bret Weinstein and Pierre Kory was banned from youtube for non-WHO/CDC/NIH approved covid treatments is a tragedy. I truly hope in the coming years the censorship of this topic will be the catalyst for allowing free speech to prevail on social media.
> The fact the interview between Bret Weinstein and Pierre Kory was banned from youtube for non-WHO/CDC/NIH approved covid treatments is a tragedy.
Banning academics from talking on a platform is a high-risk strategy. It was always possible YouTube would do more harm than good implementing their stupid policy.
Note that their ban might be taking out anyone who wants to talk about Ivermectin neutrally or negatively because of the risk of being censored. It is possible (probable, even) that YouTube is now presenting a biased sample of videos sampled only from people who believe strongly enough in the drug to try and circumvent the ban.
My guess is that if Ivermectin turns out to be useless despite the evidence, a lot of the buzz I've heard will have been generated by YouTube squelching debate meaning that only the pro- side even attempts to get the message out on social media. Because I've only heard of wall-to-wall positive coverage on YouTube and I don't trust the consistency.
" But since there hadn't been a randomized trial "
This is not true. A quick search shows 71 trials covering ivermectin, of which 6 of which are complete, interventional[1], and have results
Yes, it has been explored, trialed, and experimented with quite significantly.
The results show that there might be something there, but it’s not a miracle cure.
The conspiracy angles are coming from those who have been misled into thinking it has been more successful than it really has been, which leads to confusion about why it’s not being used everywhere.
> The conspiracy angles are coming from those who have been misled into thinking it has been more successful than it really has been, which leads to confusion about why it’s not being used everywhere.
No, the "conspiracy angles" are coming from people who have seen youtube videos and HN posts disappearing just for discussing it.
I would like this translated into normal English. This is the basis of the argument of why posts disappear from the article, and I don't understand what the author is trying to say at all:
> One of the challenges of the pandemic period is the degree to which science has become intertwined with politics. Arguments about the efficacy of mask use or ventilators, or the viability of repurposed drugs like hydroxychloroquine or ivermectin, or even the pandemic’s origins, were quashed from the jump in the American commercial press, which committed itself to a regime of simplified insta-takes made opposite to Donald Trump’s comments. With a few exceptions, Internet censors generally tracked with this conventional wisdom, which had the effect of moving conspiracy theories and real scientific debates alike far underground.
Matt Taibbi supposes (in that paragraph) that their motivation in censoring scientific discussion of Ivermectin's effectiveness was to be "opposite to Donald Trump's comments" and thus to conform to one's own ideological tribe ... because if you don't conform, you risk being cancelled, don't you? And he bemoans that politics has corrupted real science and driven actual scientific debate underground.
Refer also to the Solomon Asch conformity experiment which occurred during a previous episode of cancel culture called "McCarthyism".
There are other theories. Some people have supposed that the motivations have to do with the money that big pharma would lose if they couldn't sell their vaccines because a safe and effective alternative was already available and proven, and therefore the conditions of the emergency use authorizations for the vaccines would become void. But nobody has any smoking gun evidence here that I'm aware of, it's just a plausible motivation.
Some people might believe so strongly that vaccines are the only possible savior of humanity that anything which detracts from the success of the vaccine campaign will be devastating, and so they do what they can to shut it down. Bret argues this is illogical if Ivermectin works because all forms of immunity work together to build herd immunity. But logic is unfortunately lost on far too many people.
More far fetched ideas include influence campaigns from foreign powers who aim to see America defeated. If they can influence the right people in the right way at the right time, they might be able to prolong the pandemic in America.
I'm sure there are even more hypotheses as to why such censorship is being attempted.
I can see how that might prove difficult for a non-native speaker. Here's a version written in less fancy English.
During COVID times, scientists have become political. Many scientific arguments were not written about in the American media, because journalists assumed that the truth was the opposite of whatever Donald Trump was saying. Tech firms mostly did the same thing. This means discussion of conspiracy theories and real scientific debates have both been suppressed, and now take place "underground" i.e. in non-mainstream forums.
Well a lot of people with biochem background also have a lot of skepticism about it too.
Ivermectin works by interrupting nerve function of helminths(parasites). covid is a virus, not a multicellular organism with nerves.
I'm not saying ivermectin is useless, but why it would work for covid doesn't make sense (yet at least). Maybe it has some other mechanism to slow down covid that isn't fully understood.
"but why it would work for covid doesn't make sense"
This is the way many treatments work. For example, hydroxychloroquine was a treatment for malaria, but doctors found that some patients with autoimmune disease had their symptoms lessened or eliminated as they were treated for malaria.
So, it has become a milder treatment for autoimmune disease in some cases. The scientific community doesn't 100% understand why it's effective for autoimmune disease, but there you go. It seems to work in many cases.
I say this not as an expert, but as someone who has taken it and it has worked for me. I don't care that the mechanism is unexplained.
there were some studies that seemed to show that it shrank melanomas. my guess is it is triggering the immune system response. but i just write software, so dont go chugging horse dewormer instead of seeing a doctor because this smart guy on hn said it would get rid of your melanoma.
This. A lot of things generate a broad immune response that would probably improve mild to moderate cases of just about anything. My gf secretly switched my usual horse dewormer for Sanka. On the third day I ate the postman, but I haven't had covid since.
With 0.38 risk ratio, it may well be that it should be used everywhere (except for patients already advanced enough to need mechanical ventilation, as mentioned).
I don't have a reference for this but I recently read it was basically used on every tested-positive case with symptoms in Mexico City, with significantly improved results.
Dexamethasone is an approved drug recommended by the FDA for treatment of Covid and it didn’t stop the vaccine EUA. The vaccines are 95-100% effective in trials, no other drug comes close.
* The quoted 95% etc. numbers are in terms of Relative Risk (ie, the ratio of attack rates with and without a vaccine—which is expressed as 1–RR)
* These numbers are essentially a reported efficacy and useless to compare between studies held under different conditions.
With this in mind, from the lancet article linked above:
> However, RRR should be seen against the background risk of being infected and becoming ill with COVID-19, which varies between populations and over time. Although the RRR considers only participants who could benefit from the vaccine, the absolute risk reduction (ARR), which is the difference between attack rates with and without a vaccine, considers the whole population.
>__ARRs tend to be ignored because they give a much less impressive effect size than RRRs: 1.3% for the AstraZeneca–Oxford, 1.2% for the Moderna–NIH, 1.2% for the J&J, 0.93% for the Gamaleya, and 0.84% for the Pfizer–BioNTech vaccines.__
“ ARRs tend to be ignored because they give a much less impressive effect size than RRR”
This is an odd statement. Why would that be the reason to ignore it? ARR is extremely specific to a time frame and location.
Without wide deployment of vaccines, almost everyone would eventually naturally catch the coronavirus at some point in the next several years. As vaccines are deployed, the risk reduces since vaccines reduce the R0 of the virus in that population. Any calculation of ARR would be highly speculative and have to include models about how widely the vaccine would be deployed, the transmissibility and mutation of the virus, and the RRR of the vaccine itself, as well as being stated only for a specific timeframe and location.
Given all this it’s obvious why RRR is the typically reported number and the one that makes sense to use in discussions.
That would depend on the efficacy of the existing possible treatment. Ivermectin is 70%, so it's not as effective as a vaccine. But it's a hell of lot better than nothing.
You can't know how efficient a vaccine is without a trial. You need an authorization first to do that. But you wouldn't get an authorization if something exists, even "only" 70% better, because that 70% would make Covid less lethal than the yearly flu.
Hence 70% is enough to block emergency vaccines trial authorization.
"I heard about Ivermectin for the first time this week"
This is what is extremely disturbing. This result of the control of information occurring in our society.
What's more, it is not just the literal control, but the social conditioning. Within the group of those who have known for a long time, there is a reluctance to share that with anyone else as society will apply any number of taboo labels to such individuals to make them outcasts.
I heard the earth was flat only a few months ago too—it does not make either claim any more likely to be true.
And FWIW, I have seen many ivermectin articles on HN (check my past comments), and all seem to say roughly the same thing, so they get rather annoying in my feed at this point.
I would make the claim to be constantly evaluating the validity of statements I have not heard, and may never hear. This may sound like nonsense, but the flip-side of censorship is not excess of information but curation. If my news sources are trustworthy, then they are filtering useless information for me, while hopefully not belying my trust by censoring important information.
To the other poster, my argument was supposed to be obvious: it was intended to be a simplified example to elucidate concerns by comparison.
It's an approved drug. Fully licensed and considered to have a wide safety profile.
Doctors don't need permission for off-label use. It's just not a thing. We're in strange territory where doctors (professionals) have been demoted to nurses and they can't profess.
In my country, ivermectin it is an approve drug but not for COVID. Like a lot of other drugs which are approved as being safe but that does not mean they are good for COVID.
So I don't see how your argument contradicts the one you are replying which says there is no an overwhelming amount of evidence for ivermectin as a good treatment for COVID.
I am also not against being used by doctors who have the time for trying it and seeing if works. As we don't have a wide available treatment which we know for sure (with a high probability) that will cure COVID then maybe trying various scenarios could be a way to cure more people. But we have to take into consideration that giving one treatment means not giving other treatments so it is not an easy choice.
That's not really contradictory. Lots of covid treatments have been discovered in hospital settings by doctors trying desperately to find something to help their patients.
And those were later validated by evidence from clinical trials. Until clinical trials involving significant numbers of patients are available, there is not evidence according to the standards of medical science. That's the contradiction.
Hydroxychloroquine is a good example. Lots of doctors were trying it and thought it seemed to help. Due to the interest in the drug several RCTs of it were performed and it was shown to have no effect on patient recovery or prophylaxis of covid.
This is just partially true. The studies you mention are on late treatment (and often on very high dosages). The data points to good efficacy for early treatment though. It seems clear that the only use for HCQ is during the viral multiplication phase which is not what the large studies have been looking into (they never look into early treatment for some reason).
> there is not evidence according to the standards of medical science.
What the hell are you trying to say? That doctors treating patients observations can be dismissed because they don't talk the academic language or their results don't follow academic guidelines?
There is more to medicine than just clinical trials.
Many different things can count as evidence, even if they are not up to your academic standard. Doctors observations, population-level improvements, and studies of different cohorts.
There are levels of evidence, there is strong evidence based on reports of observable ivermectin benefit to profylaxis and some benefit in treatmeant of early infections.
The thing that most immediately comes to mind is Cameron Kyle-Sidell, who recognized that the standard treatment protocols were over-intubating people for hypoxemia, and that overly high pressures of ventilators were causing damage. He faced a great deal of resistance within his institution at the time, and was quite controversial in taking his case to Twitter and Youtube. Since then, he's been vindicated, and protocols have been changed.
I post this because I think it's the exception that proves the rule. Dr. Kyle-Sidell is a physician of great perception and insight. For every one of him, there are no doubt hundreds of "hydroxychloroquine doctors" who peddle bullshit without scientific basis to the harm of their patients. But the existence of doctors like him does boost the "maverick doctor bucking the institution" narrative.
Large RCTs are considered the "gold standard" but you are outright misleading if you are saying that large RCTs are the SOLE definition of evidence in medical science.
Or you know nothing about medical science.
Observational trials, natural experiments, etc. all constitute evidence.
As well, there have been over 25 RCTs performed globally on Ivermectin to date.
Is that sort of like how the normal process for vaccine approval is the _definition_ of "safe", and yet government officials and media keep insisting that vaccines approved on an emergency use basis are "safe"?
The scientific method is a process. Evidence is just one part of the bigger picture.
That a widely-disputed "leader" is "promoting" a treatment in a country as diverse and with as many systemic issues as Brazil, has no necessary bearing nor indication of that treatments actual use or resultant efficacy.
That you have a friend that took it and went to the ICU is similarly meaningless. What dosage did he take? What other predispositions did he have? How badly was he exposed? What other treatments were used? Did he keep taking it throughout, or not? You say he's recovering now, would he have died without it, then?
Eg, one of the most recent peer-reviewed meta-studies, whose authors include advisors to the WHO, just published in the Journal of American Therapeutics:
> I doesn't help at all. I have a coworker who as using ivermectin as prophylactic and went to ICU (he is recovering now).
This is an anecdote, and it is dangerous to generalize from it. I have several family members who seemed to respond well to Ivermectin, and recovered better than their initial condition would have indicated.
I am not saying it is definitely a great medicine for Covid and everyone should use it, but we must be careful to not mandate the opposite as well. Let individual patients make the decision to use it with help from their respective doctors. If there is a genuine beneficial effect, it will emerge naturally and more doctors will urge their patients to go for it. If there isn't, the opposite will happen.
Banning it from the top is not going to help most people.
Because a prophylactic means taking it regularly in order to avoid catching it, with the implication of the poster’s statement being that ivermectin, which carries significant risks when taken by a human at various doses, was the cause of the person going to ICU
Your absurdist attempts aside, the important thing to consider with a prophylactic medication is the therapeutic index.
Let’s take vaccines.
Covid itself has a risk of harm of around 1:100 for older age groups of requiring hospitalisation.
Risk of harm for vaccines is established at around 1:200,000.
Ivermectin? There is no good data on the therapeutic index however it is a toxic substance with a low therapeutic index and a narrow therapeutic window.
The sensible thing given the available data is to encourage vaccination. Barring that, masks and social distancing. And of course there are places where both there is no vaccine supply, and social distancing is economically in feasible. Is this a use case for ivermectin? Most data says no because establishing TI and TW and ensuring adequate safety of dosing is logistically about as difficult as maintaining social distancing.
Huh? Ivermectin has been in use for decades and administered in the billions of doses and had only a handful of associated deaths in that time. How to safely dose it is extremely well-known and established.
If you look at any vaccine adverse events reporting system, you do indeed find the 1:200,000 number - as that's indeed where it came from - for all ~70 previous vaccines on the schedule (and adjusted for under-reporting - the raw numbers in the systems are in the 1 in millions in most cases).
The COVID-19 vaccines however, unadjusted, are in the low 1 in 10,000's.
Check any reporting system independent of country/region, you'll find the same massive safety disparity between COVID-19 vaccines and all other vaccines being tracked.
Risk of serious harm from vaccines from a country where I trust the people a lot more than Americans is 1:3571 (based on 446,380 doses). Where are you getting the 1:200,000 from?
Let me add that these reports don't show cause, just correlation. Attempting to determine cause is very speculative and tenuous, and so all adverse events should be reported. So long as everyone understands the vaccines don't actually cause this many adverse events. To be fair, the same goes for COVID-19: deaths associated with COVID-19 are not necessarily caused by COVID-19.
That point being addressed, I would expect the elderly to have a lot more background adverse events, such as death. If we live 28835 days on average, 15 people in this vaccinated group are expected to die every day from non-vaccine causes, and heavily weighted towards the elderly. But I'm not even seeing death as a side-effect, and the number of adverse events among the elderly (who got the vaccine first and have had the lions share of vaccine administration) is actually less than among younger groups. This perplexes me and if anyone thinks they know the answer to this riddle, please share.
[Oh wait... there aren't as many elderly people. hits head]
Maybe, it depends on your opinion of the established safety profile of Ivermectin prior to its attempted maligning. It's a fair comparison to this commenter.
There isn't really. There's as much evidence as we had for hydroxy chloroquine. So, some but unconvincing. And since it's been widely deployed by several desperate governments you'd think we'd know more by now.
In the hundreds of HCQ studies out there, eyeballing it about 2/3 of them show some sort of positive result [0]. Early treatment with the dosage on the lower end of the tested spectrum has 100% positive results [1].
It was odd a week ago to see some of the media suddenly decide to report on one of these [2], like the "HCQ Bad!" blinders had finally been removed.
Both the articles you cite mainly complain about lack of data, but they both predate the study posted here. The NY Times is 3 months old. This study may or may not be good, but neither article address that question.
The social media bans were over people making completely unjustified pronouncements about it's value. Same as the guys claiming HCQ was extremely effective when the data was completely inconclusive. Anyone saying we should widely deploy Ivermectin is spreading dangerous disinformation. Actually relevant and accurate information is being shared and published freely.
As per the latest meta study of June 6, for over on whole year, 549 authors in 60 conclusive studies published on medRxiv, Nature, Wiley (basically the usual medical research forums) during the last year => free and shared, as you asked.
Malone, Weinstein, Kory and al. were banned for two videos made one and two weeks ago talking among other this of this meta study.
That's hardly spreading disinformation, or am I wrong somehow ?
Several point of comparison :
Improvements with Ivermetcin were 76% for early treatment, 46% for late treatments, 85% for Prophylaxis for a 70% average over almost 19K patients. Ivermetcin was forbiden for Covid use in several western countries, and it's distribution forbidden to retail pharmacists (Switzerland is one).
Budesonide and Remdesivir were authorized with respectively averages of 17% and 31% improvement only over 3.5K patients, and it's use promoted everywhere as the miracle drug.
Dr. Raoult's initial HCQ announcement in early February was for 22 cases - very anecdotal and ridiculously insufficient. Later on, by the end of 2020 the hospital he's directing covering the southern third of France had treated 40K+ cases, with broadly similar results. We still hear the same "HCQ was debunked", somehow, and HCQ is still forbiden for Covid use in several countries.
Without randomized trials you cannot recommend a drug because you cannot exclude confounders. It seems wrong to me to even speak of "overwhelming evidence" without a randomized trial or other sound ways to control or identify for confounders (e.g. causal models).
I’ve included every double-blind randomized placebo-controlled trial I could find of ivermectin as a treatment for covid. Using only double-blind placebo-controlled trials means that only the highest quality studies are included in this meta-analysis, which minimizes the risk of biases messing up the results as far as possible. In order to be included, a study also had to provide mortality data, since the goal of the meta-analysis is to see if there is any difference in mortality
....
What we see is a 62% reduction in the relative risk of dying among covid patients treated with ivermectin. That would mean that ivermectin prevents roughly three out of five covid deaths. The reduction is statistically significant (p-value 0,004). In other words, the weight of evidence supporting ivermectin continues to pile up. It is now far stronger than the evidence that led to widespred use of remdesivir earlier in the pandemic, and the effect is much larger and more important (remdesivir was only ever shown to marginally decrease length of hospital stay, it was never shown to have any effect on risk of dying).
I understand why pharmaceutical companies don’t like ivermectin. It’s a cheap generic drug. Even Merck, the company that invented ivermectin, is doing it’s best to destroy the drug’s reputation at the moment. This can only be explained by the fact that Merck is currently developing two expensive new covid drugs, and doesn’t want an off-patent drug, which it can no longer make any profit from, competing with them.
While randomized trials are certainly the gold-standard for determining if you should give a new drug to treat an arbitrary disease, that process is far too conservative during a pandemic where a huge majority of the world cannot access proper medical care. Ivermectin is already massively produced, used throughout the world, and cheap to manufacture (compared to new anti-Covid drugs). Even months ago before the benefits were known, the risks of taking the drug were very small, especially when the treatment guidelines were to do practically nothing.
Still, the many pieces of non-randomized evidence can still clearly point towards this drugs efficacy. The sudden drop in Covid cases in India as the clearest indicator to me.
Ivermectin has been trialed also and has been available on experimental basis even in Europe - and it was found ineffective and is not recommended anymore.
Also similar non-randomized evidence was strongly suggesting that hydroxychloroquine was very effective (e.g. Raoult in France) - until proper randomized trials found it was not effective at all.
So you really can't rely on such evidence. That someone gets better after they got some drug doesn't automatically mean they got better because of the drug. In the absence of controls for other factors (other drugs, spontaneous recovery on their own, etc.) it only means that the drug didn't make their affliction worse.
Not everything has to be immediately a conspiracy of big pharma (or worse).
I read the french research at the time, and it was immediately obvious that it was deeply flawed. Asking around in more expert circles, that did seem to be the uniformly echoed initial reaction even then, from day 1 (not that that means it couldn't have worked, just that the paper that sparked it all was not convincing, at all - but absence of evidence isn't strong evidence of absence in such cases). In retrospect it seems obvious people were looking for some kind of light at the end of the tunnel, and too willing to ignore the warning signs.
The case for ivermectin is not a slam dunk. But it's definitely surpassed the low bar that HCQ set. There is at least quite a lot of suggestive correlation without trivially obvious other explanations, and the data set isn't just "a few people non-randomly selected".
To my non expert opinion the ivermectin case seems at least plausible, whereas HCQ was clearly and obviously nonsense. Still, I'm skeptical, partly precisely because there still hasn't been a slam dunk study and because quite a few proponents seem to have a worryingly conspiratorial view of the world. Stuff like assuming it's not being pushed because it's off patent screams conspiratorial thinking to me, and you hear that quite a lot. And that's a warning sign, because there are quite a lot of interested parties here that really don't care about some pharmaceutical companies profit, and in any case - just because they don't fund it doesn't mean they'll go all Machiavellian and intentionally prolong the pandemic just to sell a future drug, and actually get away with it to boot. At best, the lack of exclusivity might explain why there isn't a specific corporate backer for this research, but it doesn't explain why all of the governments and universities and hospitals etc aren't finding convincing data. So when people see a conspiracy here, I wonder how rationally they're looking at the evidence for Ivermectin, too - and at the end of the day, I'm just a random worried person without the capacity to deeply understand every single relevant bit of data, so I need to be able to find trustworthy sources and research. People that see conspiracies everywhere (without data and without real reason) don't inspire great trust in their analyses.
Still, it's hard to resist the lure of the cheap and affordable silver bullet...
The López-Medina trial was one of the biggest RCTs for Ivermectin. Out of the 60 trials for Ivermectin, it was one of the few that didn't show statistical significance.
It was also seriously flawed - a large percentage of the placebo group was self-medicating using Ivermectin, they mixed up the treatment and placebo group, and they switched the primary outcome in the middle of the trial. That trial still showed improvement, but it didn't reach statistical significance.
"[López-Medina] has many issues. The primary outcome was changed mid-trial from clinical deterioration to complete resolution of symptoms including "not hospitalized and no limitation of activities" as a negative outcome. Critically, temporary side effects of a successful treatment may be considered as a negative outcome, which could result in falsely concluding that the treatment is not effective. Such an outcome is also not very meaningful in terms of assessing how treatment affects the incidence of serious outcomes. With the low risk patient population in this study, there is also little room for improvement - 58% recovered within the first 2 days to "not hospitalized and no limitation of activities" or better. There was only one death (in the control arm). This study also gave ivermectin to the control arm for 38 patients and it is unknown if the full extent of the error was identified, or if there were additional undiscovered errors. The side effect data reported in this trial raises major concerns, with more side effects reported in the placebo arm, suggesting that more placebo patients may have received treatment. Ivermectin was widely used in the population and available OTC at the time of the study. The study protocol allows other treatments but does not report on usage. The name of the study drug was concealed by refering to it as "D11AX22". The presentation of this study also appears to be significantly biased. While all outcomes show a benefit for ivermectin, the abstract fails to mention that much larger benefits are seen for serious outcomes, including the original primary outcome, and that the reason for not reaching statistical signficance is the low number of events in a low risk population where most recover quickly without treatment."
I had the same opinion until my friend convinced me otherwise. The scientific community is taking a long-term approach here. If they were to recommend a drug based without a scientific trial, they risk losing the trust of the world (either from people who want them to only follow the science, and the risk that it is incorrect).
The anti-science block is growing, and they are loud. If they continue to grow it could be an even greater threat to humanity than COVID-19. Science is attempting to fight against it by retreating to a science-only corner, for better or for worse.
It would be nice if we somehow found a way as society to get the message out that scientists often just don't know. Because too often stories like this are interpreted by quite a few people as "science says ivermectin doesn't work". And perhaps that conclusion will turn out to be right, but the point is the jury is still out - and often enough it turns out wrong, and when such a false statement turns out to be wrong, people lose faith in science regardless, even though a reasonable interpretation of the science actually said "don't know" not "doesn't work".
This is kind of a corollary to the issues with rejecting conspiracies - when we reject a supposed conspiracy, due to lack of evidence, that can easily come across as claiming the conspiratorial claim is outright false - but in a sea of such claims, some then turn out to have at least a kernel of truth, which then turns into a big gotcha moment: "see, they're repressing us, we were right all along!"
So while I understand the idea of maintaining trust by not backing anything uncertain, I'm not sure it's the right call. Maybe communicating that uncertainty is better, and even communicating hints and possibilities - instead of trying to control the narrative but thereby ceding the ground to nutjobs until certainty arrives, often granting them considerable prestige if they guess sort of correctly ahead of time.
> The sudden drop in Covid cases in India as the clearest indicator to me.
What's the alleged connection here? Are you claiming that some non-trivial number of patients in India were treated with this? How many, and at what point after being infected? And just how did the treatment affect the case numbers? Generally you'd expect the vast majority of secondary infections to happen before the diagnosis, not after, so a treatment seems totally irrelevant to the case numbers.
Not a primary source, so FWIW. The article compares states in India using ivermectin against those which are not. Some digging in the sources listed might get what you are looking for.
I see no numbers on how many people were treated on either of the first two links, and certainly don't intend to comb through the dross on the third link. So do you actually have a number? It doesn't need to be exact, just a credible source on the order of magnitude will be enough. Are we talking a thousand, a million, or a billion here?
To reduce R by a factor of 2 by the use of a prophylactic drug, you'd need to have half of the population on a regime of the drug. It seems pretty obvious that did not happen if this kind of reporting is the most impactful there is. Just think of the logistics of trying to do that! India has a population of 1.4 billion.
On the other hand, if they only gave the snakeoil to e.g. a single digit number of millions of people the reduction in the number of infections would be imperceptible.
This is a great comment, and an example of why discussion of ivermectin should not be CENSORED but instead debated. These would be good questions to ask the creators of any videos on the topic and from what I can see, the most popular creators would probably be open to the discussion.
Its the governments of the two states that are making the claims in the news articles.
I think it is safe to suppose they or the associated medical authorities have observed a big enough benefit before making that claim.
But no, no concrete numbers, as I think there was not much of tracking the number of patients who were given the drug. May be it is because such numbers are not much of a value in terms of research data due to lack of controls.
>India wouldn't have taken it off the recommended drugs list.
Normally authorities are afraid to go against W.H.O recommendations, because if it didn't work out, it would be hard to justify it on the basis of local observations alone, at least on paper.
But the important thing is that some states still did it, which might indicate there was very observable benefit.
Wait a minute... This post is a debate between two opposing viewpoints. So it also makes the exact opposite point:
The primary difference between a randomized controlled trial and meta-analysis is that the former “provide the highest level of evidence because they contain the least amount of bias. Randomized controlled trials reduce bias, while meta-analyses increase bias."
This Hacker News story is about a recent meta-analysis. But an actual randomized control trial of Ivermectin in March (on 476 patients) found the duration of symptoms on treated and untreated patients "was not significantly different."
Important thing to know about that study is they are testing time to recovery for people with mild covid.
I'm not anywhere near an expert, but two things stood out to me reading this study. First, time to recover in the ivermectin group was 10 days versus 12 in the placebo. The paper calls this "not significant" but it's not clear to me whether that's statistically not significant, and if so, why wouldn't it be, or if knocking two days off recovery isn't that meaningful. The other thing I noticed reading it was that only one person out of 400 died and that person was in the placebo group.
I think the Brett Weinstein response would be something like -
A. Ivermectin's best benefit is as a prophylactic not a treatment.
B. Ivermectin should be administered as early after onset as possible to treat, whereas here there was some delay to get people organized, enrolled in trial, etc.
C. It's hard to measure effect when the disease is mild.
I didn't see the standard deviation reported in the paper. Is it?
I did see the innerquartile range and it was the same for both the ivermectin group and the placebo. To me that suggests that variation in outcomes is probably similar between the two groups.
"hazard ratio for resolution of symptoms, 1.07 [95% CI, 0.87 to 1.32]"
So statistically, those on ivermectin recovered 1.07 times as quickly as those on placebo, but the uncertainty bounds are from 0.87 times as fact to 1.32 times as fast.
Does that mean that the covid vaccines shouldn't be recommended as there's no randomized trials on their long-term effects? Just curious as I'm not well versed on this topic.
Covid vaccines have been tested with randomized trials (Phase 3 of the testing phase). Regarding "long-term", that obviously depends on how you define "long-term but there is no need to move the goalpost.
Generally speaking, in evidence-based medicine drugs and vaccines are not recommended based on incomplete statistics or hunches.
Related post from Matt Taibbi on his Substack, about Bret Weinstein with a short interview of him. With recent takedowns of his videos, many viewers are anticipating his channel will be banned outright by Google/YouTube:
https://taibbi.substack.com/p/meet-the-censored-bret-weinste...
Whether it works or not, there's no money to be made from Ivermectin. It's a very cheap generic drug. Why else would they stamp out all possible investigations of it just to ascertain truth?
Is the same not true for dexamethasone[1], which was the first successful finding from the RECOVERY trial[2]? That's how I've repeatedly seen it described[3] (FWIW, I was treated with dexamethasone for Covid-19 in October 2020).
The same is NOT true for dexamethasone, well not exactly,
since there was no directly competing drug. Dexamethasone, which you can probably confirm, is useful in the later stages of COVID where there's an inflammatory response. Since no other proposed medications were seeking an EUA as a "late stage" therapeutic, there's no chance the already approved Dexamethasone would have blocked the issuance of an EUA.
That's at least my understanding based on the proposed systemic problem in FDAs.
Conversely, in this proposed problem, it's said that ivermectin (and others) are only effective when used in the early stage or even prophylactic. Being already fully licensed medications, that could put the issuance of an EUA for vaccines or Remdesivir in jeopardy.
Yes and the UK discovered its benefit. The US has done nothing to investigate whether generic drugs will treat COVID19. The research is being conducted in the UK and EU where the financial incentives are different.
Basically it's been that there had been no studies to prove it works for covid. It's been used mostly in poorer countries that have had it on hand because it's relatively inexpensive. Doctors in those countries have been sharing info with each other and that's how it started being used a lot.
During that time gather data for this use was begun and it's taken this long to gather enough, over enough time, to prove its efficacy according to the standards required.
People down vote this - they gasp saying "no way could this be true" - yet they complain about big pharma right up until the "right" virus/disease/whatever science thing comes along and their tribe picks it up and runs with it - they're now the savior. The left/right don't realize they both have faith/religion of government. These politicians do not speak for you or me. Voting only leads to consequence without recourse.
You're commenting on a metaanalysis that summarizes 15 published trials, aren't you? Maybe you should spend less time on YouTube inspired guessing. Social media isn't relevant here. YouTube is not the center of the Galaxy. Medical doctors don't make their decisions based on YouTube videos -- at least I hope so.
Edit: sorry for the wrong position in the thread. Should have gone to the parent post.
> You're commenting on a metaanalysis that summarizes 15 published trials, aren't you?
The worrying split here is on HN I get to read 15-study meta-analysis posted by Steph C, int13 Labs CEO.
On YouTube, a PHD holder in a medical field discussing the same 15 study meta-anlysis might expect to have their video pulled.
It is quite worrying that the powers-that-be at YouTube are taking this radically anti-speech approach. It isn't like studies posted on HN are automatically good and on YouTube automatically bad. The YouTubers are probably more qualified to bring attention to studies.
In a sea of bullshit videos, the minions who screen this stuff probably have difficulties to distinguish some phd (in what field?) choosing the wrong channel and bullshit.
Anyway, the original statement was that there are no trials - this in a comment on a meta-analysis.
That's quite an elitist statement. My belief is that a majority of the people that view videos of technical discussions have the capability to understand the context. The ones that do not grasp the subject are far more unlikely to watch the video.
no, it's not elitist. I assume a human does the last decision. this human doesn't care about the content of the video (like you do) but has to make a defendable decision in limited time based on limited information.
> It is quite worrying that the powers-that-be at YouTube are taking this radically anti-speech approach.
Where you see "radical anti-sperch approach" I see a vestigial amount of false positives within a constant stream of crackpot and outright insane, anti-infellectual fearmongering-fueled conspiracy theories.
And let's face it: since when do appeals to authority pass off as a reliable indicator that the author is not a crackpot conspiracy theorist? I mean, during the past year the world had to endure a good share of people abusing their medical licenses to peddle bullshit conspiracy theories.
> Many people pushing Ivermectin have a vested interest in proving the vaccines are unnecessary.
What is their vested interest in a generic, cheap, decades old, off patent drug? Vested interests tend to be in new, patented treatments. That's where big pharma profit is. So let's try a rephrase: Many people pushing patented treatments have a vested interest in proving off patent alternatives are unnecessary.
For example, here's Merck warning against using Ivermectin for Covid-19:
Then a few months later, "Merck Announces Supply Agreement with U.S. Government for Molnupiravir, an Investigational Oral Antiviral Candidate for Treatment of Mild to Moderate COVID-19"
Ok, but let's not get confused. This is different than being an anti-vaxxer. You can speak up for something like Ivermectin AND be a pro-vaxxer. The most prominent voice on this is Bret Weinstein (biology PhD), who is more vaccinated than average. He and his wife and kids are vaccinated for the typical things plus typhoid, rabies, yellow fever... They are pro-vaccine and so am I. Vaccines are one of the best inventions ever.
And so far we do not have any. So until then this story is pushed way further than it has any right to. Weinstein thrives on the censorship, but the fact of the matter is that there simply is no proven efficacy and until then this has no business being promoted to a mainstream audience who might get themselves into a lot of trouble, or who might forego getting vaccinated.
In my case that is far from the case. The implications of an effective treatment such as ivermectin are huge in that
a) Covid passports go away
b) Deaths and illnesses due to covid get reduced greatly
c) It puts a spotlight on why these treatments have not had government sponsored clinical trials considering the ramifications. Incompetence in our governments in regards to these kinds of situations should not be tolerated. For example in Canada the province of BC allowed a trial to commence in may of this year and yet has not started. almost 2 years after the start of this thing? ivermectin has proven safe over the 40 years its been in use and if we try similar doses (which is the recommended for covid) there is all gain and no loss to test even as small trials. I would have certainly taken it since I had severe effects from covid.
d) We don't have to have a phase 3 vaccine trial be a public trial where normally that is phase 4
That's the wrong side to look at this from. These are just people on the fringe with little influence and funding.
If ivermectin was authorized as a viable treatment the vaccines receiving emergency use authorisation wouldn't have been possible. There were and still are billions on the line.
I'm having difficulty understanding this line of reasoning. What does the authorization of ivermectin have to do with the vaccines? Xofluza, Relenza, and Tamiflu have been approved for treating influenza, and that has had no effect on the recommendation that people get their flu shots.
Someone else answered correctly saying an EUA can't be issued if an already licensed drug can help. I would further that point by saying to actually go dig up the true source of that policy on the FDA's website in your country (not someone's summary or interpretation). It's a great exercise that will leave you with some sort of ground truth in this mess.
Same as in coding, you eventually reach a point where you learn that when in doubt, you must read the source.
It's the way that emergency authorisation use works with FDA. They won't issue that if there are other safe viable treatments. These vaccines got that approval because these other options were suppressed.
Nope, that is not the only way. You have side effects. And you have the fact that the vaccine is still in test phase. What are the long term side effects, we don't know. And unless they are obvious we will never know, because vaccine are like a religion too many. You don't question a religion.
You're indirectly admitting that I'm right. The anti vaccine crowd is desperate for a non vaccine cure, because the vaccine is so incredibly effective their beliefs fall apart otherwise
The vaccine is empirically way more dangerous than every other vaccine commonly given. I did the vaccines but I don't understand why we can't be honest about it.
We can believe the vaccine works but that the risk is too great to take it because it's so new. And for the record, I think the alternatives are also too risky.
Well the covid vaccine comes with some caveats to me most crippling to freedoms being the vaccine passports that seemingly all nations are already implementing. Having various viable treatments would obviously put an end to that. Since ivermectin has a long history of safety and already largely available its reasonable that interest is strong.
But not for this particular application, and not in the doses where apparently it has some effect on COVID. And that is the problem with promoting this, as long as you weren't aware of that you probably should not be part of the army of 'useful idiots' of the anti-vax crowd.
I don't think this comment really addresses my point. From what I've seen the dosages (at least for prophylaxis) are similar to what you would normally take. No I don't think it should be rammed down peoples throats without solid evidence but neither should the vaccine. The fact is vaccines take around 7 years to exit trials and so yes I'm hopeful for a proven alternative that's not on trial but the likelihood as far as I'm convinced is nil.
for all the talk of "vaccine passports", not a single state has done it. Biden said he wasnt going to do it months ago. Not a single country has done it in all of the earth.
if I was so worried about such a thing i might start to think maybe I was being manipulated to fear something that didnt exist.
Nobody has implemented vaccine passports. And nobody will.
But the idea of a treatment even close to effective as a vaccine is attractive to those that believe that in such magical thinking
Ivermectin might be cheap but the vaccine is literally free if you're in the US. There's zero reason to not get it, and zero reason to hang onto hope that alternatives will work. We already have an extremely effective treatment, so effective it can wipe of the virus entirely, and its totally free.
Our government under Trump bought the vaccine en masse for a few dollars a dose. Those that refuse such a miracle treatment when the rest of the world dies of COVID are a stain on America's sheen
These are extreme arguments with little legroom for nuance. If you are so sure then so be it. There's more than enough news on this countering most of your re-assurances.
Ok, I was confused by this line of reasoning, so did some digging. I believe it's one of the popular antivax disinfo conspiracy theories. Here's my reading.
The line of reasoning hinges on the vaccines being "experimental" and only being distributed under an Emergency Use Authorization, as opposed to a full approval. The FDA policies for EUA indicate they're only to be used when there is no adequate, approved, and available alternative. This makes a lot of sense - if (let's say) someone comes up with a new flu vaccine (an mRNA one, to continue this example, as that would be kinda exciting), you really want it to go through the full approval process instead of EUA, even if it is better. That's because we have plenty of good, approved flu vaccines.
So, the theory goes, if we had an approved treatment for Covid, then the EUA for the vaccines would be illegal. And so that creates incentives for the pharmaceutical companies to suppress a miracle cure like (they claim) ivermectin.
To anybody with the capacity for rational thought, this is obviously bullshit. We have fully approved treatments already, including remdesivir. The idea that a treatment for Covid, even a pretty good one, would make vaccines unnecessary makes no sense.
I am fairly confident in making the following prediction. Full FDA approval for the Pfizer/BioNTech and Moderna vaccines is likely by the end of the year[1], at which point the above line of reasoning will no longer be applicable. Antivaxxers will smoothly transition to another line of argument.
I do think this "theory" is one reason you see a significant overlap between pro-ivermectin and antivax, for example in the comments of Bret Weinstein videos.
I think what has separated the policy around Covid, vs. say the flu, is the death rate. If the death rate were closer to the flu, or below some threshold that takes spread into account, the response would have been much different.
If a better treatment was available that would lower the death rate that much, it would change the equation.
Yes. Anybody trying to rationalize not getting one of the extremely effective vaccines will be grasping at straws for any other effective treatment. It's a natural outcome.
The vaccines are as effective as the one that eliminated smallpox. To be against it, you need some serious FUD
FUD like the fact that the vaccines have had no completed studies on their long-term effects? Or being part of a demographic that has a low risk from COVID?
Right, so how is it FUD if you simply want to avoid being part of a clinical trial? Vaccines take at least 7 years (usually 10ish) to complete long-term trials.
For young people, the cost-benefit analysis isn't clear at all--much less risk of anything bad at all from covid itself, plus far more years of life to lose or suffer from vaccine injury, which is a totally unknown risk.
To boot, the vaccines contain at least three entirely new technologies never before adopted in vaccine treatment.
Under the PREP act, pharma companies have total immunity from liability. Why would that be. Maybe because the vaccines are still only in stage 3 of clinical trials? Because the long term effects are unknown because it hasn't been long? With worrying reports about side-effects including at least 5000 deaths in the U.S. VAERS database, do you think those quotes are appropriate?
> The idea that a treatment for Covid, even a pretty good one, would make vaccines unnecessary makes no sense.
Actually, it makes perfect sense to many people.
You are shooting down the weak version of this argument. I think you are confounding necessity from the point of view of the state and institutions with necessity from the point of view of many people.
You are correct that the state and health institutions do want to get people vaccinated regardless of other cures, the evidence for that is overwhelming and existence and availability of some alternative strategy/cure isn't going to stop immediately that intent.
However, if there was, hypothetically, an accessible and efficient medication/treatment with profylactic or curing effects for COVID-19, this would make substantial portion of population skeptical about getting the vaccine, especially now that the number of serious cases is low and manageable.
IMO vaccine are pushed as miracle drug. There is probably fanatic peoples in both though. You might also want to check remdisivir, drug that is not efficient, but they pushed it far enough to get a contract of 1 billion, and effectively 0.2 billion have been spent on it.
Yes. Basically none. The vaccines have been given to almost a billion people. And side effects have been tracked. How can we find this number? We already have it.
If there was anything dangerous within even 3 orders of magnitude of those that have died because they didn't get the vaccine it would be front page news.
I don't mean this as a personal attack on that user, but It is really concerning how blind and apologetic some people are to the various things that can go wrong with a Vaccine.
I think the most useful lens to understand the sociology of these kinds of questions is religious belief. And there is no shortage of people out there who want to convince others of their belief.
The narrative for "the Ivermectin story" is particularly compelling, as it involves brave maverick doctors working selflessly to get the word out, suppression and censorship by shadowy organizations (big pharma fearing competition, the big Internet companies just lusting after the power of thought-control), and the empowerment of people to take medical decisions into their own hands.
Incidentally, this was the exact same narrative as HCQ, and is being pushed by a lot of the same people. The end of the story may turn out differently, as the evidence on HCQ is overwhelming that it doesn't work, so you only see dead-enders pushing it, but there is a good chance that Ivermectin will turn out to be at least moderately effective, though the jury is still out.
> If someone died because of a "Take Ivermectin and you'll survive COVID" video on YouTube, who's to blame?
Ivermectin is a prescription drug in the United States. A doctor would most likely reject the request if a patient asked for it solely on a YouTube recommendation. So to answer your question, a prescribing doctor.
IMO YouTube isn't medically qualified to censor ongoing research or debate, just stick a disclaimer and be done with it.
Bret implied he got it from a potentially dodgy source. He was also pointing out "risks" with the vaccine. Even in comments you had people saying they were going to avoid the vaccine and take this drug instead.
> He was also pointing out "risks" with the vaccine.
Whoa whoa whoa. 1 year old mRNA vaccine's risks don't come with scare quotes. He often talks about the lack of long term data. mRNA covid vaccines might have been exceptionally safe so far, yet intellectual honesty demands we admit that indeed we don't have the long term data yet. Implying there would absolutely be no such risk is a fundamentalistic position itself.
There is a "risk" that bill Gates is actually an alien and has been putting microchips into the vaccine.
Pretty much all risks are identified within a short period, it's very rare for there to be long term risks.So yes there may be some theoretical long term risk, but it's soo small that it is misleading to talk about it as a serious risk. Expecially compared to the real and known dangers of Ivermectin and covid.
You can (or could until recently?) get topical ivermectin from pet stores, no prescription. Humans use it to self-diagnose and self-treat rosacea. So there is the risk that people will buy and ingest it.
Must be a bunch of idiots working over there on YouTube, huh? Sounds like you have some inside knowledge about Google's resourcing of and attention paid to the COVID epidemic worldwide.
It doesn't have to be so black and white on youtube's response. They could, for example, but a disclaimer pre-roll ad saying "Don't take medical advice from youtube." There's a difference between Brett's interview, where they discussed the scientific merits of a drug, and someone saying "Here's how much drug you need to buy at your farm store, and how to dilute it." In any case, the analysis for banning topics doesn't consider the risk of how many lives could have been saved if Ivermectin actually is pandemic ending. Some professionals speculate hundreds of thousands of deaths could have been prevented if Ivermectin was given back in November. I don't know either way, but surely the discussion is worth not being banned.
* If X died because of a "Take Ivermectin and you'll survive COVID" video on YouTube, who's to blame?
Assumption: Ivermectin has a net negative effect. Assumption: X relied on Ivermectin exclusively, rejecting the current standard of care procedures.
* If X died because Youtube censored "Take Ivermectin and you'll survive COVID" videos, who's to blame?
Assumption: Ivermectin is effective in certain cases, and X's life could have been saved if Ivermectin were used, possibly in conjunction with other standard procedures, up to and including vaccination.
The point of public conversation is to asses the cost/benefit tradeoffs of different courses of action, especially in presence of incomplete information. Additionally, reliable cost/benefit tradeoffs heavily inform the design of future information gathering campaigns. Given the public's heightened interest in Covid, it is unclear how to have necessary cost/benefit conversations other than in public. Censoring such conversations is potentially costing lives and is eroding the public's trust in the authorities.
This post entirely misunderstands YouTube's position in the whole situation though. YouTube removes content advertising the use of drugs outside of their (at least, at the time of posting the video) prescribed usage. YouTube is not meant to be a message board for "Does ___ work for ____ illness? Let's see!".
You're spot on. But beyond that, the idea that there's any kind of general public enlightenment to be had by spreading the most impactful (not necessarily accurate) videos by algorithmic selection in the face of considerable uncertainty and risk is absurd.
The youtube algorithm and social platform is not some kind of careful dialog for mutual enlightenment. People aren't trying to rationally assess conflicting and limited evidence, and youtubes algorithm certainly doesn't reward any such painstaking work.
As such on youtube which is what this is about, any such discussion is not at all likely to inform; yet because convincing tales sell better, whatever claims are made, are likely to sound convincing to at least some people - truth and honesty are entirely orthogonal issues here, or worse actively selected against (because they're usually messy, unclear, and thus boring).
And thus on youtube the appropriate strategy is at a bare minimum draconian censorship. I mean, ideally they'd dump the sensationalism-boosting algorithm, but that ideal is obviously not a viable request to a platform that depends on user engagement (of any kind) for its survival.
Just because we don't want to live in an Orwellian nightmare doesn't mean all speech is necessarily a value-add, nor that there aren't any social dynamics that can reliably induce harmful speech. The world isn't that simple.
So while it's reasonable for people to seek certainty in uncertain times, that doesn't mean youtube is the place for everybody to debate ideal drug regimens.
Not sure if I got this correctly. The argument is that no rational conversation of public interest can be hosted by youtube, in order to protect the public from the sensationalistic garbage youtube cynically promotes? And the solution is to let the machine rampage freely, but drastically censor certain points of view?
Worse, youtube outcompetes traditional mass-media for ad dollars by exploiting precisely the sensationalism engine. The net result is an uninformed population fed sensationalism on all cylinders, with rampant censorship decided by a tiny clique. I have some doubts whether this is a recipe for a stable prosperous society.
Edit. Of course the bulk of the conversation should happen on technical grounds in the medical media in relative obscurity. But given the high profile of the covid pandemic, should a therapeutic drug with a stack of studies backing claims of positive impact, be discussed in mass-media?
No-one. Since doctors don't go to YouTube to find out what to do. Until there is solid evidence for a drug noone should be going to YouTube to decide what to do, expecially when we have many proven low risks vaccines.
I have read them, and my comment was substantive. A person’s bias is important to call out, as was pointing out the obvious lie that was implying the vaccines aren’t low risk.
> obvious lie that was implying the vaccines aren’t low risk.
If the brand new vaccines using a brand new technology are low risk, is really a matter of opinion. Basically it comes down to how much you trust the authorities and the how much you consider any given research or studies to be unbiased. (Particularly when the full data for the said studies remain unpublished)
You can plainly see that both of these are variable between different people, even within similar schools of thoughts.
So because someone does not share your opinion does not make them a liar.
If that is the case any one saying the new vaccines are "safe and effective", should also be an obvious lie, because the long term safety studies are not done, which objectively makes it a lie.
> If the brand new vaccines using a brand new technology are low risk, is really a matter of opinion. Basically it comes down to how much you trust the authorities and the how much you consider any given research or studies to be unbiased. (Particularly when the full data for the said studies remain unpublished)
That's the nice thing about science though. It's based on (readily available, well recorded) evidence. Deciding that an individual is smarter and/or doesn't believe in science (aka the entire anti vax movement) may be a matter of opinion, but the actual data and risks are not.
> So because someone does not share your opinion does not make them a liar.
Not true. A bunch of doctors went on YouTube about usefulness of hydroxychloroquine in their patients and got taken down by YouTube.
Every person is unique and medications/supplements/food will work for some and not others. Best example is coffee. If you have gene that metabolizes caffeine fast then coffee is good for you and helps you because your body clears caffeine and reaps benefits of antioxidants in coffee. On the other hand if you don’t have that gene then caffeine lingers in your body and causes all sorts of damage and therefore drinking coffee is bad for you.
> If someone died because of a "Take Ivermectin and you'll survive COVID" video on YouTube, who's to blame?
How about the person who took it? We are presumably talking about adults, who we supposedly simultaneously trust with choosing a government that decides over life and death for millions in their own country and abroad.
I agree, people are responsible of themselves. The idea of blaming youtube for acting on information shared on its platform. Is the same level as blaming your microwawe fabricant for killing your cat you put inside.
Cars are marketed by car manufacturers as a safe and reliable way of getting from A to B; Youtube is (to my best knowledge) not marketed by Google as a source of safe and reliable life advice. The better car analogy would be someone who procures metal plates, household cleaner and a school textbook with an illustration of how internal combustion engines work and winds up blowing themselves up with the creation, and even there the textbook author still puts more of a society-backed stamp of approval on the content that was employed than Google does.
Which would seem to speak directly against the idea that Google aren't allowed to police the medical advice being given on their platform. After all, they're not marketing themselves as a safe source of medical advice, so there should naturally be no standards preventing them from controlling what's being displayed.
What do you mean by "aren't allowed"? I'm not disputing that they are allowed to: otherwise I would bring a lawsuit, rather than arguing against it on the internet (as I am, and I believe I am allowed to). Perhaps, though, they should not be allowed to, being the de facto monopolist on user-uploaded video in the anglophone world they are.
And who will judge it misinformation. You want to give someone the right to censor if they think something is false ? You probably think people are to dumb to do that for themselves. You will end up victim of that censorship soon or later. You can be sure someone with more power than you, somewhere, is thinking the same of you (too dumb to think by themselves).
You've posted something like 9 unsubstantive and/or flamebait comments in this thread. That has a seriously damaging effect on discussion, especially when the topic is divisive as this one is. I'm sure you don't intend that, but the effects work that way regardless of intent: https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor....
If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful. Note this one: "Comments should get more thoughtful and substantive, not less, as a topic gets more divisive."
Well this is another very tricky one, I’ll give you that. So many N-order effects.
I still disagree strongly with your characterization of “substance” in this context though. E.g. when another user sent this (ad-hominem) challenge:
> Why is it that everyone who pushes Ivermectin as a miracle cure for COVID is also a conspiracy aficionado?
I responded with a simple and dispassionate explanation, rather than taking offense. Is there no “substance” in my entirely coherent, well-argued, and non-emotional reply?
> Simple. You have defined the latter as some variation on the former.
Perhaps you could call out my "what a pair of years" top-level comment as that was not responding to any of the nasty attacks in this thread, or even dogpiling on the excellent arguments that other people are making. But those kinds of comments function to put me on the record here with a timestamp, so I can link to them later. There is a tiny bit of substance even in those.
It sounds like you might prefer that I disengage and flag all of the nasty posts (e.g. another person in this thread implied that I am a murderer) so "the bureaucracy" can fix this conversation? Sorry, you are a great moderation team, but I am not going to do that, because I don't believe it is a real solution to anything. You cannot fix this kind of conversation from the top down - Quis custodiet ipsos custodes?
Trying will just disenfranchise the out-group further and make the echo-chamber effect worse. If that means this topic cannot be on HN, so be it.
On the other hand, many of my hot takes over the years have been celebrated, but it seems to happen when they are long and dense (and not personal attacks). Perhaps it is because fewer people read/flag them. Perhaps it is because this community values eloquence (or effort) over substance.
Add to that the built-in handicap because this community (like every other) values in-group opinions much more than out-group opinions, and it doesn’t make sense to even try better/longer arguments. I’m going to stop participating in controversy on this site, and move the infowar project over to audio chatrooms, where a conversation like this actually has a chance.
To everyone else: Arguing controversial topics with strangers, in Reddit-style text threads, is primitive and ineffective. The technology is insufficient for the task, and it will never get better.
> The technology is insufficient for the task, and it will never get better.
This is very true. But I don't think it is a problem with technology.
It is just that you cannot really have a valuable insight by putting a 10000 idiots in a room and have them argue it out. In other words, you cannot replace one intelligent man with a 10000 idiots, hence the failure of HN and similar forums.
These things are only good for sharing interesting things, so the best way to use is to just use posted links, and never to engage in discussion.
Commenters going on about how other people are idiots is actually a strong marker of mediocre comments. If you guys would please indulge in that kind of thing somewhere else, we'd appreciate it. It's tedious, and it's against the site guidelines. Note this one:
"Please don't sneer, including at the rest of the community."
I'm with you on this. I've put a nontrivial amount of effort into commenting (including reading a lot of source material and watching video clips), and there has been some interesting discussion, but I'm not convinced it's been worth it.
My suggestion is to be more selective about sources, and perhaps to have an explicit policy. Individual papers tend not to be good sources, as people just use them as weapons to prop up their opinion. Mainstream media pieces aren't either, as they lack intellectual depth. I suggest blog posts by experts (David Gorski, Derek Lowe), pieces by top science journalists (Helen Branswell, Kai Kupferschmidt, Jon Cohen). Note I am not saying only mainstream views should be represented, quite the contrary. If and when Alina Chan posts something long form on lab leak (likely, as she's working on a book), that's a great candidate for spurring intellectually curious discussion.
Here's an observation. I've seen at least three "pro-Ivermectin" posts on the front page in the last six days. Does it seem like that's been balanced with any posts discussing its inefficacy (which is apparently the medical community's dominant view)?
I also remember today's Ivermectin post being flagged. Does that mean the moderators then chose to unflag it (despite the fact there'd already been at least two earlier "pro-Ivermectin" posts throughout the week)? According to the Hacker News FAQ, moderators "sometimes turn flags off when they are unfair."
https://news.ycombinator.com/newsfaq.html
Maybe the question we should be asking is: what made the moderators consider the flagging of this post unfair?
It doesn't seem to me that the dominant view here is that Ivermectin is ineffective, just that it has not yet been proven to be effective, for a certain definition of "proven". With time and stronger studies, that may well be proven, or not.
The whole Ivermectin saga does not deserve the attention that it is getting, those that are relentlessly pushing it are causing people not to get vaccinated and that in turn will prolong the epidemic and lead to people getting ill and some fraction of those will die.
I've read up on this thing as much as I could and it's quite simple: there is at this point in time zero hard evidence that it works in humans short of using it in dosage that is well outside the range that we have data on. It's just the HCQ story warmed over.
> are causing people not to get vaccinated and that in turn will prolong the epidemic
Can you make an argument that people going for natural immunity and relying on currently used COVID treatment protocols in case they decide it is needed will prolong the epidemic more than if they took the vaccine?
Maybe it will do the opposite, as 1) natural immunity may be stronger, last longer 2) some number of non-vaccinated people getting sick, getting isolated and taking effective treatment may on the whole infect less people than if that same number of people gets vaccinated and then interacts with other people and potentially spread the infection more because they don't get strong symptoms.
I'm not saying that you are incorrect, just that the argument that getting vaccinated solves the epidemic quicker isn't clear.
Modulo a few hundred thousand deaths those mechanisms have the same outcome. If you're ok with that by all means, go push herd immunity through infection.
Seeing HN used to promote garbage is going to cause good people to leave, and that in turn is going to accelerate the degree to which garbage will end up on the homepage and so on. This is a downward spiral.
As well as adding a flag to one of the comments in that discussion that attacked you. I don't leave a lot of flags on HN. For various reasons, I'm pretty conservative in my use of flags.
I'm surprised to see this particular piece where I am currently commenting got so many upvotes and so many comments. I asked about the mechanism of how this drug works and got some meaningful engagement and also some really worthless engagement, in my opinion.* And then I lost interest. I couldn't readily see a meaningful connection.
But you are basically talking about censorship. Censorship grows interest in the forbidden topic. I wholly disagree with your position here.
If this is the garbage you claim it is -- and it may well be, I just don't know the topic well enough to affirmatively agree with you -- then there are vastly better ways to kill it without harming freedom of speech.
>If someone died because of a "Take Ivermectin and you'll survive COVID" video on YouTube, who's to blame?
But who is to blame for the deaths of thousands of people, who could have been saved by Ivermectin, which in all probability is happening right now, and has been going on for many months, if not for the censorship of W.H.O, Youtube and media?
> YouTube is not a legitimate source for medical/drug information.
It is not a source, and never was a legitimate source of anything, but a media of communication. I am not sure why people mix the two up. If doctors in one part of their world can share their observations with doctors all over the world, it has tremendous value.
Now it seems that doctors can only share their observations with W.H.O and any inference should come from the top, which they could delay citing sorry "no research" for an arbitrarly long time..
But drug commercials on TV are? I mean, why can't a doctor talk about the benefits of a certain drug with a "but talk to your own doctor first"? How is that any different?
Drug commercials are bad, and banned in pretty much every developed country.
Anyway those drugs have been proven to work, this drug hasn't been proven to work.
My mom is on dialysis, has diabetes and hypertension. Recently for a surgery we had to do a covid test. Dad also took the test. Both were positive.
The nephrologist prescribed ivermectin for mom. She had mild fever for 3 days and recovered. Dad had no obvious symptoms and recovered(he was not prescribed ivermectin, hence did not take it). The govt doctors don't prescribe it just vitamin c, zinc and dolo. This is india btw.
If you don't have a proven, understood mechanism (which ivermectin doesn't for a virus like Covid) then you have to rely on trials, and those just don't stand up.
> If you haven’t had to mess with drug discovery for a living, it’s understandable that you hear that Some Person Somewhere was very sick, took New Therapy X, and suddenly got better, and then assume that there it is, the cure has been found. But that’s not how it works. Real results stand up when you run larger, better-controlled trials, but most early results don’t turn out to be all that real.
> If you don't have a proven, understood mechanism (which ivermectin doesn't for a virus like Covid) then you have to rely on trials, and those just don't stand up.
Please, there are a ton of antiviral drugs without an understood mechanism. We don't even know how Acetaminophen (Tylenol) works!
> > If you don't have a proven, understood mechanism (which ivermectin doesn't for a virus like Covid) then you have to rely on trials, and those just don't stand up.
> Please, there are a ton of antiviral drugs without an understood mechanism
Right, but trials are all that matter - there's a huuuuuuge list of drugs where we "know the mechanism" and it turns out that they still don't actually work despite that.
> What happens to confidence in public health and USG if ivermectin turns out to be safe and effective for COVID, and the genetic vaccines turn out to have signficant safety issues? This looks like a very plausible scenario from where I sit.
Mr. Malone is a very eminent scientist who has one serious problem in this particular case: he really doesn't like big pharma earning billions over what he considers to be his invention.
uhm he doesn't have problems with the system or the concrete tech used by Moderna and AZ, only with the dubious testing of these vaccines
his research becomes more important if these sort of vaccines become a silver bullet for medicine and basically end the modern flu and entire families of coronavirus; he could be looking at a Nobel prize
Next we'll find that the cheap and well-understood hydroxychloroquine is actually relatively effective Covid-19 treatment!
It's disturbing how much the suppression of Covid "wrong-think" over the last year has resulted in useful results and information only very slowly coming out (and generally, in the process, giving a feeling of vindication to the conspiracy theorists).
I have always been, and continue to be, against the idea that "this is such a novel emergency we just need to ignore all the processes that we know and trust". If anything, in those times, when we don't know what is going on, those principles are exactly the type of things we should stick to. I strongly believe it would have done us better over the past year.
> against the idea that this is such a novel emergency we just need to ignore all the processes that we know and trust
There is a pretty well trodden path for new medicine to prove their effectiveness, which all Covid measures have gone through. If ivermectin, hydroxichloroquine or any other alternative drug goes through due course they would have no difficult being accepted.
The reason discussions have been censored is precisely because people have been rallying around a drug like a football club before they’ve had their effectiveness scientifically proven, and demanding to skip the traditional due diligence.
And for some context: this paper was submitted to a mainstream journal in March and rejected for lack of evidence. This publisher who picked it up is not exactly a reputable one (and will benefit immensely from citations of this study).
That’s what gets to me too, and this is the major issue I had with Trump saying anything about anything. He was floundering to look like he had a plan and the moment he mentioned HCQ he turned the whole thing political. It was massively irresponsible.
It should be left to medical science, which is doing pretty damn well with vaccinations and treatments like dexamethasone.
If Ivermectin can be helpful that’s great, and if it’s not then never mind, let’s evaluate other things. But it seems like people need to latch onto something, and then their ego and tribal allegiances won’t let it go.
> mentioned HCQ he turned the whole thing political.
Trump first mentioned it as a possibility and investigation and that he was taking it after consulting with his doctor. That's it. The media made you think otherwise.
Telling the public what drugs he's on is fine.. shouldn't we know what drugs POTUS is taking?
And the people who politicized it were medical journals who published fake studies with no data or vetting. Otherwise the comments would have passed on like every other trivial statement made by politicians. I mean Trump's statements may have been unwise or not backed by a double blind studies that doesn't make them untrue, not does it make them inherently political.
The immediate condemnation that HCQ was not only ineffective but harmful was based on data that does not exist. It was fake.
The only ones politicizing are the ones telling lies.
If you have genuine disagreements with trump, one ought to make them by issuing truths not made up fake studies.
Trump ongoingly and repeatedly pushed hydroxychloroquine, criticized published research showing it was ineffective, and most likely lied about taking hydroxychloroquine seeing as how no evidence or independent confirmation that he was on the drug ever surfaced.
It was not a one off thing, and it was not "mentioned as a possibility".
The only evidence we have that Trump took it is Trump saying he was taking it, and the press secretary while not giving a white house briefing directly saying it was prescribed[1], and the White House physician saying that he didn't see any harm in Trump taking it...[3] but I cannot find a single authoritative report [2] where someone claims to have actually prescribed the drug to Trump - from either the physician, or from Trump himself (remembering it is a prescription drug). The White House press office also never used those words that I can see, instead deflecting that whatever Trump said should be believed (while on the podium at a briefing, where there would be an accountability issue).
So, short version: it was implied by the people who would've had to prescribe it to him that they saw no problem giving it to him if he wanted it...but it seems like everyone carefully avoided saying they actually did prescribe it.
Now, on some level this is irrelevant whether he took it. Because he used the presidential podium to contradict medical professionals and push an ineffective treatment, created a shortage for a drug which a lot of people actually depended on (I knew a colleague who suddenly ran into trouble with this), which as it turned out provided no useful effect in preventing the president from actually catching COVID-19 and has since then continuously proven to be completely ineffective.
Telling the world that you’re taking an unapproved drug, and recommending it for everyone, while being a public figure is not a “trivial statement”. It becomes political the moment that statement is made, since now it’s his word vs the medical establishment. And that’s not gonna be a technical discussion.
> medical journals who published fake studies
There is someone else who thrives on calling things “fake” when they disagree with his opinions…
It was massively irresponsible for a political leader to bring up anything that wasn’t actually shown to work at that point, and the ensuing shitstorm was entirely predictable.
The responsible, statesmanlike thing to do would have been to tell the public all the stuff that he was doing behind the scenes to find solutions, not throw out something specific but unproven.
You’re just proving my point that it became more about sticking to your side and cheering for your team rather than relying on the medical evidence. This sort of stuff should not have been brought into the political sphere in the first place.
There is massive amounts of evidence for that. Even the standard flu nearly disappeared due to these hygiene measures. But what’s the point if you’re going to say those studies are fake?
Try me. I've already read all of the ones I can find - they all say the same thing - masks have a barely positive impact (non-zero, but barely positive) on the transmission of Covid. This is not surprising, as the holes in a mask are significantly bigger than the aerosols that they are supposed to slow.
Many different measures have been implemented, you can't possibly pick one of them and say that particular one has had a definite impact on a certain thing.
At least where I live, the way that Covid deaths were recorded over the winter left plenty of leeway for those dying "with Covid" to have just died of the flu (to be specific, if a patient had symptoms or evidence of a viral respiratory disease being the cause of death, then all that was needed was a "clinical picture of Covid" to make it a Covid death).
> other alternative drug goes through due course they would have no difficult being accepted.
That is quite naive, the "due course" here would mean very costly trials that usually big pharma pays for. I'm not holding my breath for them to pay for that.
Ivermectin is a cheap drug, Mercer (who produces ivermectin) is trying to produce their own covid19 drug.
Further, if there are viable alternative treatments we shouldn’t be using a vaccine still in phase 2/3 trials that haven’t even been tested on animals... the entire emergency use authorization is only allowed if there aren’t safe alternatives.
Ivermectin is generally safe to take, and a known drug with known risks. If it was shown to be effective the vaccine rollouts should be stopped. So, there’s a lot of political and financial reasons to not publicize it.
A treatment isn't an alternative to vaccination. Millions of people have been vaccinated so we know it's safe, while tons of people have died from covid so we know it's not safe.
This study appears to show that there is a treatment that’s ~90% effective at reducing deaths.
The vaccines are not shown to be (may be) safe outside of a brief few month window (for specific classes of people). These are a new class of vaccine and there appears to be significant risk based on the cdc data (VAERS).
To be clear none of the vaccines really completed a standard phase 2 or 3 trial. It had an abridged or expedited version that skipped things like pregnant women, etc. the vaccine is also not 100% effective, which is important as it’s a “leaky” vaccine. Meaning, we’re going to see lots of variants that get around our protection from the vaccine. That’s why treatments are important.
It’s also possible we see genetic defects 2-3 years from now or an increase in cancer. We really have no idea.
> Millions of people have been vaccinated so we know it's safe
In those millions we are missing the number of people that get seriously harmed, and killed due to getting the vaccine. So we do not know it is 100% safe, we only know that it is mostly safe, which is not good enough to be cheery and happy about it.
You can't get EUA for the vaccines if there's a working treatment. The doctor who promoted Hydroxychloroquine and zinc treatment, Dr. Zelenko, is still banned from Twitter for spreading COVID disinformation.
There's both actual conspiracies in this world, and well poisoning to damage the conversations. When you look at the amount of money these companies stand to make from producing billions of vaccinations, you should not be surprised.
> You can't get EUA for the vaccines if there's a working treatment.
Veklury (remdesivir) was approved by the FDA for the treatment of Covid-19 in hospitalized individuals on October 22, 2020. This was a full approval, not an emergency use application: https://www.fda.gov/media/137574/download
We've continued using the vaccines under the existing EUAs even after a treatment was approved.
In fact, the FDA has even granted an EUA for a vaccine after approving Veklury: the Janssen/J&J vaccine received its first EUA on February 27, 2021. https://www.fda.gov/media/146303/download
Even if ivermectin was a perfect treatment for Covid, and even if an approved treatment would pull all the vaccines off the market -- despite that not happening after the FDA approved Veklury -- by the time ivermectin made its way through the approval pipeline to be labelled for this indication, the Pfizer and Moderna vaccines would very likely have received approval as well. So there's no "billions of vaccinations" at risk should another treatment be found to be effective and approved.
Not to mention it’s good to have treatment options in addition to a vaccine. Vaccines aren’t full-proof (treatment options are then good), some people legitimately can’t get vaccinated, and should there be a mutation the vaccines can’t handle then you still want treatment.
This is exactly why instead of censoring podcasts like Bret Weinstein when he brings on guests to discuss ivermectin, other experts should engage in debate with him.
When people who are credible scientists (like many of his guests) get censored it can reasonably look suspicious.
I'm not saying he's correct, I'm just saying the right answer is debate.
A person who is willing to have a calm, 3 hour discussion on a topic is not the kind of person who needs to be censored.
No, the other experts are at work, and don't have time to debate every person out there who has a following. This pandemic is not yet over and guys like Weinstein are all noise and no signal. Keep enough Weinsteins engaged and progress on this front (real progress, not imaginary progress) will grind to a halt.
That’s a valid perspective, but aren’t there thousands of professors and scientists, maybe tens of thousands who could potentially respond?
And isn’t it valuable to have someone respond? Isn’t there value in educating the public so conspiracy theories don’t spread? (And preventing the theories from being discussed just makes them more firmly held, whereas debate doesn’t have that effect.)
Other experts are at work... so let the youtube with no science credentials or credibility judge and censor vocal scientists instead? How is that a desirable process?
It's hilarious how parent comment's opening sentence is a (easily debunked, as you've shown) conspiracy theory, and in the next breath they're trying to sound reasonable and Definitely Not a conspiracy theorist
Please don't post in the flamewar style to HN. It's hugely destructive of the threads, especially when the topic is divisive, and your comment adds no information, just poison. Please don't do that; instead, respond to bad information with accurate information, and weak arguments with stronger ones, without crossing into snark or personal attack. If you can't or don't want to do that, that's fine, but then please don't post.
> You can't get EUA for the vaccines if there's a working treatment.
Per the FDA: ""Under section 564 of the Federal Food, Drug, and Cosmetic Act (FD&C Act), when the Secretary of HHS declares that an emergency use authorization is appropriate, FDA may authorize unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by CBRN threat agents when certain criteria are met, including there are no adequate, approved, and available alternatives.""
And that falls apart under some scrutiny... it says "adequate, approved, and available alternatives." "adequate" being efficacious which is debatable without testing. "approved" which that drug is absolutely not approved for covid use. "available" being enough supply which is debatable if it turns out to be effective and widely used. I see no reason why the EUA for the vaccines would be threatened by this drug also being used in an EUA fashion. if they are going for actual approval for that drug it would take as long as the vaccine to get.
> When you look at the amount of money these companies stand to make from producing billions of vaccinations, you should not be surprised.
I think that when you look at everything through the conspiratorial lens... all you see are conspiracies.
yeah agreed. literally the only people I've seen push this kind of nonsense are antivaxxers and conspiracy theorists. I don't understand why they need it to be true so badly; doesn't pass any of the sniff tests under even a little scrutiny.
Even if it fit all those criteria for being an alternative it's not like it's some kind of thing that couldn't be amended if they really needed/wanted to. saddens me how reactionary everyone is.
Edit: also I forgot to make the point in my replay above... it's not like having three vaccines under is preventing another vaccine from getting EUA so even under this logic framework it is nonsense. are they hinging it on the fact that it's an approved drug for some other disease?
yes in fact literally everyone that pushes the "they are stopping the <insert treatment option> because big pharma wants to make all the money on vaccines" is an antivaxxer or a conspiracy theorist that I have seen in the wild... including my brother so this is a topic I am not taking lightly.
nowhere did I say that this treatment couldn't be effective and no where did I say that they shouldn't look into it as an alternative because I think all tools should be on the table. I am simply saying the part about the EUA thing being pushed by antivaxxers and other conspiracy theorists.
Lots of others have debunked this here. Yet with all this conspiracy stuff there’s a big elephant in the room that no one seems to ever talk about: Covid is a global virus. The FDA can block and approve whatever treatments in the US, but it has no authority in Brazil or Thailand. If all these conspiracy drugs worked well yet the FDA blocked it for some malicious intent, the rest of the world would approve and use it. Particularly since these conspiracy drugs have all been around forever, are generics, and exist globally. Yet we aren’t seeing this emerging despite massive world wide deaths.
In Brazil many people have used Ivermectin and our country is getting a record of 500.000 deaths of covid today.
Also, here in Brazil we had many reports of people needing a liver transplant because they caught drug-induced hepatitis.
So, in summary, 1. Ivermectin doesn't work and 2. it can cause severe health issues if used wrongly.
Wrong - there are countries it’s being widely used in. For example, India and many Easter European countries (and some S. American???).
We need effective vaccines and therapeutics. I don’t understand this push to discredit any therapeutic before reasonable research has even been conducted.
> I don’t understand this push to discredit any therapeutic before reasonable research has even been conducted.
No such thing exists. There are literally dozens of therapeutics in trials , and a few actually approved and in non-trial general use (dexamethasone, remdesevir, and favilavir, in various jurisdictions) — for both, see [0] — the ones that tend to get strongly negative treatment are hydroxychloroquine (not actually in trials) and ivermectin (in Phase 2/3 trials), both on the basis of unsupported scams around both earlier in the pandemic, not any general aversion to therapeutics.
Well, all the data we have is from outside the U.S. so I guess U.S. doctors in-the-know are trying to discuss it but getting shut down on U.S.-based social media.
That chart shows that state being the lowest death toll both before and after ivermectin treatment, which would seem to point to some serious confounding factors in this analysis.
Not to mention dramatic changes else where as well, and that’s assuming this data is accurate. It’s also from very early in the pandemic, when we didn’t know as much generally. Plus correlation =! causation. Could be far better making behaviors there, or all kinds of other factors. That’s why you need randomized double blind clinical trials, done by experts. This arm chair “analysis” is just bad science.
To me, this kind of regional comparison, contrasting before and after Ivermectin was deployed as a treatment, has been the most convincing evidence that Ivermectin is an effective treatment.
This paper by Pierre Kory has graphs that clearly show the evolution of Covid cases and deaths across different states in Peru.
Pfizer, a company that has contributed probably trillions of dollars to global GDP over the past 6 months, is massively underperforming the stock market when you compare pre-pandemic to now [1]. The stock price in theory should price in all the future cash flows from the vaccine. What is your basis that the pharma companies are making tons of money on these vaccines?
It isn't like the vaccines are pure profit. The pharma companies have to develop them, they have to produce them, they have to distribute them, and if they charge too much they get into massive political trouble. It seems like it is basically a giant marketing effort for pharma companies where everybody in the world is benefiting.
1: For example, from Feb 1st, 20 to today, Pfizer is up 10% and the Vanguard total stock index VTI is up 35%
The parent commenter might have wanted to say with that that the vaccines help end the pandemic. The world benefits from that because we are losing massive amounts of money per day while still being stuck in the pandemic.
Dr. Zelenko held studies that 'showed' that HCQ had 100% cure rate by excluding people that moved to an ICU from the treatment group. The studies turned out to be complete bunk. He's a fraud.
Two observational studies, both carried out in New York (Carlucci et al. and Derwan et al.), appear to show promising results in patients treated with a combination of hydroxychloroquine, zinc, and azithromycin. The first, involving 932 paitents, showed a 55% reduction in relative risk of death among those getting zinc in addition to hydroxychloroquine and azithromycin, as compared with those just getting hydroxychloroquine and azithromycin. The second, involving 518 patients, showed an 80% reduction in relative risk of death among those getting the full triple therapy, when compared with a reference sample that didn’t get any of the drugs.
That seems impressive. However, these are low quality observational studies that are seriously limited by the methodology used. The scope for confounding effects is huge. Therefore, these studies should be considered exploratory and hypothesis generating. They certainly should not be considered evidence of any cause and effect relationship.
Source for the EUA stuff? Source that HCQ and zinc are viable treatments? The problem isn't that some of these things might be viable, the problem is we don't know which of the literally hundreds of treatments are actually going to be viable when going through the proper testing and approval process. You can't just scream conspiracy when there much better explanations
"Under section 564 of the Federal Food, Drug, and Cosmetic Act (FD&C Act), when the Secretary of HHS declares that an emergency use authorization is appropriate, FDA may authorize unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by CBRN threat agents when certain criteria are met, including there are no adequate, approved, and available alternatives."
You should probably drill into this if you are interested, but the phrasing most often referenced by people talking about effective therapeutics and the lack of approval by the FDA is, "there are adequate, approved, and available alternatives."
The idea that ivermectin (even if it works, and gets approved for this usage, which'd likely take as long as the vaccines are taking to get to that point) is an adequate alternative to a vaccine, which provides ongoing, lasting protection, is silly.
It'd be like claiming the existence of the iron lung is sufficient to yank the polio vaccine out of production.
> FDA has approved one drug, remdesivir (Veklury), for the treatment of COVID-19 in hospitalized patients aged 12 years and older who weigh at least 40 kg.
Can you point to anything that says the FDA would consider HCQ or any of these other drugs as alternatives to vaccines? They are not the same, and though they could both treat COVID, my reading is not that this would limit vaccine emergency authorization if there was a non vaccine treatment. This is especially true considering there are multiple vaccines approved under emergency use which would be direct competitors. So, nope, I don't buy it from just this wording. I need something saying specifically that alternative treatments would stop a vaccine being approved.
I understand that's what op is trying to say, but op isn't providing sufficient evidence for that. Non vaccines are not alternatives for vaccines. And we have EUAs for things that would be alternatives to each other, multiple vaccines. So there's not reason to think a viable treatment for COVID would prevent a vaccine from getting a EUA.
(PDF warning)(section III, the first list, point #4)
>Source that HCQ and zinc are viable treatments?
Dozens? Hundreds? of doctors speaking out, including videos posted to youtube, that they saw great effectiveness in the trial. The people promoting it weren't a bunch of nobodys, despite what the nightly news told you. There were plenty of frontline workers with actual experience. But that likely won't satisfy your request for a source - which is fine. We all appeal to authority as we see fit. I saw many actual doctors saying "this is effective", and I saw many large corporations working together to shut that conversation down.
And there are papers which show that it does. Rather than descend into a 'my list of papers denoting effectiveness is bigger than your's suggesting the opposite' contest, I suggest you go to http://www.freefullpdf.com/#gsc.tab=0 and do some objective searching yourself preferably without a prior agenda.
A number with a question mark behind it is not evidence, and even if hundreds of doctors did speak up about it, hundreds of doctors thought Cholera was caused by miasma instead of bad drinking water. Hundreds of doctors thought bleeding was the universal cure all. Hundreds of doctors thought washing their hands was useless. Some random number of random doctors saying it may be effective is not evidence of it's effectiveness.
Your document also doesn't say what you think it does. If it did, we wouldn't be able to have multiple vaccines approved. Is there any evidence that the FDA would interpret a non vaccine as an alternative to a vaccine, when there's no issue with granting EUA to multiple vaccines? I doubt it, but would love to see what you have.
We have to do this again? Hydroxychloroquine was debunked months ago.
"Among patients hospitalized with mild-to-moderate Covid-19, the use of hydroxychloroquine, alone or with azithromycin, did not improve clinical status at 15 days as compared with standard care. (Funded by the Coalition Covid-19 Brazil and EMS Pharma; ClinicalTrials.gov number, NCT04322123. opens in new tab.)"
"After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure. (Funded by David Baszucki and Jan Ellison Baszucki and others; ClinicalTrials.gov number, NCT04308668. opens in new tab.)"
"Neither HCQ nor HCQ/AZ shortened the clinical course of outpatients with COVID-19, and HCQ, but not HCQ/AZ, had only a modest effect on SARS-CoV-2 viral shedding. HCQ and HCQ/AZ are not effective therapies for outpatient treatment of SARV-CoV-2 infection."
"Among patients hospitalized with Covid-19, those who received hydroxychloroquine did not have a lower incidence of death at 28 days than those who received usual care. (Funded by UK Research and Innovation and National Institute for Health Research and others; RECOVERY ISRCTN number, ISRCTN50189673. opens in new tab; ClinicalTrials.gov number, NCT04381936. opens in new tab.)"
Hey mate for what it's worth and you might say not much and may be right, the argument I ear goes as follow: the trials showing the ineffectiveness of HCQ use protocols that are inconsistent with the protocols the advocate of HCQ propose.
To my understanding, the proponents tend to say that HCQ is effective when administered as soon as first symptoms (day 0 to 3 I believe). There are also dosage issues and combinations with other drugs, and they say that HCQ is ineffective administered late.
In the first paper you propose, patients treated are already hospitalized (day 14 or fewer still probably not day 0 to 3). The fourth paper states (when following the link the to protocol) that hospitalisation is a condition for eligibility. That's not first symptoms.
The third papers talks about "initiated medication a median of 5.9 days after symptom onset". So not 0 to 3 days?
The second paper you propose talks about administering HCQ as post-exposure prophylaxis. It seems outside of the scope to me.
There are other issues on this debate, dosage, drug combinations, I can't talk about that, this website does:
You are seriously proposing that if an effective treatment had been found in 2020, that the US government would have denied EUA for vaccines while the rest of the world got to work vaccinating their citizens?
I've been monitoring this for a long time now. I have ivermectin on hand for deworming my two mini burros.
Of course, you're not supposed to use it on humans but they say that about fish mox too. But as time went on it was pretty clear to me that it was working to prevent covid from becoming severe in the countries that were using it for that because they had nothing much else to use. I saw many reports of it working.
I also read about vitamin D, melatonin, famotidine, and aspirin helping to reduce severity of infections. So, when my wife and I got our 1st and 2nd jab of the Pfizer vaccine we took all of those and had no reaction to it at all. Our daughter took it before her first jab and had no reaction but didn't for her 2nd and she did get sick. As soon as she told us she wasn't feeling good we dosed her with those and just an hour or so later she was feeling good again.
I haven't been infected and now I've reached full immunity so none of that proves anything at all but it's still been worth knowing.
If Ivermectin worked on COVID-19, the manufacturer of Ivermectin that has made no money on vaccines for COVID-19 would probably be pushing it wouldn't they?
There have been some studies that found it effective in vitro, but as noted in other comments, at several times the safe dosage in vivo.
Actually the EMA link says that current evidence for ivermectin is insufficient and it cannot currently be recommended outside of trials. This not the same as claiming that it does not work or that it is hazardous, although many journalists can seemingly not tell the difference. The FDA’s advisory is mostly about people overdosing on veterinary ivermectin. They emphasize that overdose and medication interactions are possible, veterinary ivermectin is not a good substitute for human ivermectin, and that ivermectin is not an approved treatment for COVID-19. Again, even within the paradigm of blindly listening to authoritative sources, this is not an assertion that normal doses of ivermectin for off-label use are dangerous and should be prohibited for prescription, let alone an order for tech companies to censor the mere mention of it.
When the FDA’s advisory came out, there were articles (eg [1]) referring to ivermectin-the-molecule as a “horse de-wormer” and drawing no distinction between animal and human use (and it has been proven safe and effective in humans, just not for COVID). The level of discourse around this feels like I am reading 90s drug war content.
It seems it is you who is misrepresenting the ema link.
Key quote: "Although ivermectin is generally well tolerated at doses authorised for other indications, side effects could increase with the much higher doses that would be needed to obtain concentrations of ivermectin in the lungs that are effective against the virus. Toxicity when ivermectin is used at higher than approved doses therefore cannot be excluded."
IE, the dose needed for covid could quite possibly be harmful.
Agreed on missing this facet of their advisory. However, the concentration of ivermectin in the early in vitro study was 35x higher than the plasma concentration reached for the approved ivermectin dose [1] whereas the doses used in ivermectin trials (https://ivmmeta.com) range from 1x to 10x the approved dose daily, with successful results as low as 4x approved dose (1x approved dose daily for 4 days)[2]. So whatever ivermectin is doing, it doesn’t seem to require the concentration that the initial in vitro study required.
You've gone from "no, the EMA didn't really to object" to "here's why their objection is wrong". See how that works?
The thing about Covid is that it isn't "super deadly". It has about a 1% fatality rate. That's terrible for society as a whole when the disease is also extremely infectious. But it means that "I took X and recovered from Covid" isn't the most amazing thing.
"So whatever ivermectin is doing, it doesn’t seem to require the concentration that the initial in vitro study required." Maybe the trial dose does nothing at all and people are recovering like they normally do.
This part of their objection was based on an assumption that doesn’t seem to be as bad as they thought. The trials are controlled to varying degrees of quality.
1) Beware of overdosing, because extrapolating from in-vitro studies will yield dosages that are unsafe.
2) We know the dosage required for Ivermectin for be effective, and it is too high.
The first is fact-based and uncontroversial. The second would be completely unfounded and would contradict earlier parts of the statement, so the reasonable assumption is the first interpretation.
Appeals to authority are problematic to begin with. Appeals to authority that misconstrue the authorities (FDA, EMA, and Merck in this case) are counter-productive.
Yes, this is the key item. In vitro there has been some success but at dosage far higher (double digits) than what the safe dose is, and no in vivo trial has been done at those dosages (and likely never will due to the risks involved).
Database of all ivermectin COVID-19 studies. 93 studies, 55 peer reviewed, 56 with results comparing treatment and control groups: https://c19ivermectin.com
Kory et al 2021. Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19. American Journal of Therapeutics, 28(3): e299: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088823/
Nardelli et al 2021. Crying wolf in time of Corona: the strange case of ivermectin and hydroxychloroquine. Is the fear of failure withholding potential life-saving treatment from clinical use?. Signa Vitae, 1: 2. https://oss.signavitae.com/mre-signavitae/article/20210508-3...
Nearly all of your links are broken. I think you copy-pasted the text of links that had been truncated with a "...", where the part prior to "..." is not sufficient to constitute a valid web address.
For instance, the link for Carvallo et al 2010 should be this, which resolves:
https://medicalpressopenaccess.com/upload/1605709669_1007.pd...
Meta-analyses based on 18 randomized controlled treatment trials of ivermectin in COVID-19 have found large, statistically significant reductions in mortality, time to clinical recovery, and time to viral clearance. Furthermore, results from numerous controlled prophylaxis trials report significantly reduced risks of contracting COVID-19 with the regular use of ivermectin. Finally, the many examples of ivermectin distribution campaigns leading to rapid population-wide decreases in morbidity and mortality indicate that an oral agent effective in all phases of COVID-19 has been identified.
•While many treatments have some level of efficacy, they do not replace vaccines and other measures to avoid infection. Only 27% of ivermectin studies show zero events in the treatment arm.
•Elimination of COVID-19 is a race against viral evolution. No treatment, vaccine, or intervention is 100% available and effective for all current and future variants. All practical, effective, and safe means should be used. Not doing so increases the risk of COVID-19 becoming endemic; and increases mortality, morbidity, and collateral damage.
If Ivermectin worked on COVID-19, the manufacturer of Ivermectin that has made no money on vaccines for COVID-19 would probably be pushing it wouldn't they?
Surprise, Merck is now working on anti-viral drug whose profits would be eaten into by an off-patent drug (ivermectin)
> If Ivermectin worked on COVID-19, the manufacturer of Ivermectin that has made no money on vaccines for COVID-19 would probably be pushing it wouldn't they?
No, because it's out of patent. There's little profit to be made. Merck is instead pushing a new drug that they will have a monopoly on.
"Merck Announces Supply Agreement with U.S. Government for Molnupiravir, an Investigational Oral Antiviral Candidate for Treatment of Mild to Moderate COVID-19"
As for Ivermectin effectiveness, it looks promising. There was an evidence based clinical review posted on Nature earlier this week:
"As per data available on 16 May 2021, 100% of 36 early treatment and prophylaxis studies report positive effects (96% of all 55 studies). Of these, 26 studies show statistically significant improvements in isolation. Random effects meta-analysis with pooled effects using the most serious outcome reported 79% and 85% improvement for early treatment and prophylaxis respectively (RR 0.21 [0.11–0.37] and 0.15 [0.09–0.25]). The results were similar after exclusion based sensitivity analysis: 81% and 87% (RR 0.19 [0.14–0.26] and 0.13 [0.07–0.25]), and after restriction to 29 peer-reviewed studies: 82% and 88% (RR 0.18 [0.11–0.31] and 0.12 [0.05–0.30]). Statistically significant improvements were seen for mortality, ventilation, hospitalization, cases, and viral clearance. 100% of the 17 Randomized Controlled Trials (RCTs) for early treatment and prophylaxis report positive effects, with an estimated improvement of 73% and 83% respectively (RR 0.27 [0.18–0.41] and 0.17 [0.05–0.61]), and 93% of all 28 RCTs."
I'll answer, assuming you asked with some good faith. Not every statement of doubt or disfunction is an allegation of conspiracy.
Dexamethasone effectively treats the late, inflammatory stage of COVID19 where most virus is dead but still physically present.
The promise of other licensed medications is partially from their antiviral properties which means they're only expected to be effective as early stage medications.
So that's the difference. Different application. In the same way you wouldn't use Dexamethasone as an interchangeable treatment with monoclonal antibodies or remdesivir, which are also early stage treatments.
The point is that Ivermectin worked, Merck would be pushing it hard because it's a heck of a lot cheaper to make an existing drug you already make then get through R&D and clinical trials for a brand new drug which doesn't yet exist.
For treating what? This study looked at trying to reduce mild COVID-19 symptoms. In fact, the current strongest evidence is for prophylaxis, as well as treating more severe cases. Also the study didn’t show that it was ineffective, it showed that it couldn’t disprove the null hypothesis. Please get your facts straight, before throwing a link to a overly specific RCT to prove your point.
If Ivermectin worked on COVID-19, the manufacturer of Ivermectin that has made no money on vaccines for COVID-19 would probably be pushing it wouldn't they?
You are misinformed. Merck has a particular formulation of Ivermectin that they sell but the vast majority of it is made off patent by other manufacturers for very little profit. If they had an exclusive patent on a drug that they could make any flimsy case for effectiveness against Covid I'm sure they would be pushing it, the way Gilead has with remdesivir.
I don't know what you're referring to, but I'm going to infer that either your information sources are poor and/or you are incredibly susceptible to the power of suggestion.
I have no idea how this is relevant to guidance on an anthelminthic drug, but it seems you believe you have axes to grind, so I'll let you grind them alone.
For the curious, reasonably recent discussions from several TWiV episodes on Ivermectin. [3] is quite recent (Jun 9). [4] reviews a study which is mildly encouraging. I think it's fair to say that the jury is still out, and it does deserve more investigation.
Fun fact: Vincent Racaniello's wife worked on Ivermectin at Merck, and on a recent livestream (the 6/16 one) he suggested it would be reasonable to take it, especially because it's known to be safe.
The best way to prevent this from happening would be to allow doctors to prescribe it, so people don't screw up the dose by buying it from veterinary supply stores.
You may get myocarditis from the vaccines, but that doesn't stop anyone from calling them "safe."
The issue isn't the drug. It's the claim. The drug could be legal for use in the US, and there would still be an issue (unless there were studies good enough to pass FDA scrutiny that demonstrated the drugs effectiveness). In the US, you don't get to make medical claims that you can't prove are valid.
Now, the other questions are whether Youtube should be considered "in the US", and whether Youtube should be an enforcement arm of the FDA. That's the worrying part.
Well... it's the law, and yet the lines aren't quite where we expect them to be.
Have you ever seen an informercial or something talking about a drug to fix something, and then it says something like "this drug has not been proven effective for this use"? That's pushing the line but not crossing it. Those people don't get arrested.
But if you said "Ivermectin is safe and effective for treating Covid", then you've probably crossed it. If you're making money from it, then you may have worse problems than Youtube banning your videos.
I don't know what Bret Weinstein says. If he says "this looks like it may work", he's probably OK. If he says "it's been shown to work", I would be surprised that the FDA hasn't done something.
[Edit: If he says "it's been shown to work" and he's selling it, that's where the FDA will almost certainly step in. If he says it but isn't himself selling it... I don't know how they respond to that.]
Unproven medical treatments are a kind of speech that the US government has aggressively suppressed with the approval of the courts for many years. That situation was abused to suppress the works of Wilhelm Reich (~70 years ago) but I don't see that kind of abuse here. Youtube isn't subject to the first amendment 'cause it's not the government BUT also the first amendment hasn't protected this kind of expression for a long time. Just sayin'.
Edit: and as other said, that the drug is legal is irrelevant and disingenuous. We're talking a new treatment system.
Besides the scads of dubious (or outright dangerous) health-related videos on other topics, YouTube has videos of people flying "wing suits" and engaging in many other risky activities.
Why are they getting the dose wrong? Are doctors refusing or being prevented from prescribing the drug, leaving them to seek out unsafe alternatives like veterinary formulations?
Doctors are refusing to treat covid with it because it's not proven to work and not recommended internationally, so people are self medicating by getting it illegally.
I know that is the “theory” behind the censorship, but I’d suspect the true number of people choosing to do that is a lot smaller than people think. And frankly…if not censoring kills a few idiots and saves many more by allowing the medical professionals to fine tune a treatment, that’s a lot better than killing many to save a few idiots by making potential lifesaving treatment experimentation off limits.
How are censoring YouTube videos from scientists who do this for a living going to help medical professionals fine tune a treatment?
It’s not just the laymen getting censored. It’s everyone.
Also, no offense, but how little faith do you put in our medical professionals and scientists that you think they can’t discern the difference between wheat and chaff?
I am a scientist, I'm a pharmacologist who's time is now mostly spent on covid research. I'm glad youtube is removing most of the dangerous nonsense, because people like you tend to believe it.
Are ya now? Actually “people like me” don’t believe that random people like you are what you claim to be when posting under an anonymous name on the internet.
So no, we don’t just believe the BS we are being told on the internet.
I'm not going to dox myself, but check my comment history if you want. Unless you think I've spent the last several years posting about pharmacology, pharmaceutical companies and PhDs in some elaborate ruse.
Frankly, I’m not that interested enough to make the effort, and don’t care. Especially considering your go to is to insult people you don’t know just because they slightly disagree with you.
So you'd rather not listen to other scientists, doctors, and pharmacologists with real world experience with these drugs for your own research purposes? I mean, if you had YouTube videos explaining your research results, I would watch it.
I think it's important to distinguish two things, which look similar on the surface but are quite different. One is the ability to listen to the scientific discussion taking place on whether Ivermectin is effective. That is reasonable and is a good thing.
The other things is pushing narratives that directly contradict our scientific understanding to an audience of nonscientists. And to be clear, "Ivermectin might work and there are good studies in favor of it" is not in that category, but "Ivermectin is the cure" is.
I think the Pierre Kory and Bret Weinstein podcast[1] is on the border between these two (with a bit of motte and bailey). But to get more insight into how it's landing, check the comments to that video. Lots of people finding ways to procure it, conspiracies, and a strong overlap with antivax.
> pushing narratives that directly contradict our scientific understanding to an audience of nonscientists.
How do you know the audience are nonscientists? Why would that be so bad,are nonscientists to be kept dark until 100% agreement among scientists is reached?
Science advances on many fronts, not just in peer reviewed papers.
I do listen to my colleagues, typically in pre-prints, journals and conferences. Youtube is pretty far down the list of places you would go for credible scientific information.
Ok, but the "wake up sheeple" approach is guaranteed to (a) not persuade, and (b) take the thread into a predictable rut. So please find a different approach to make your substantive points with.
True enough, which is why I tend to steer away from that conversation here, for the most part, but some of the more recent things are so blatant and have deep impact on the tech community that I thinks its time to start talking about the subject, even if from a tech perspective.
Point taken dang, Ill try to make less meta and more substantive points in the future on this divisive topic.
> the history of the world is a history of conspiracy
^ 100% This
I'll join you on this sinking ship. : )
Thanks for saying it arminiusreturns. I think more people need to argue this. Maybe it'll someday flip the script and people will finally become suspicious of authority.
Most people just look at what the majority claims. Maybe if they see enough people arguing for this, they'd flip sides.
It's silly, but logic doesn't even seem to matter since logic and evidence is so quickly brushed aside via the ad-hominem of `conspiracy theorist`.
This is an interesting link. I wasn’t aware they specifically discouraged talking about specific medications. I’m not sure why you’re being downvoted heavily as if you said something offensive..
There were two people, a husband and wife. It was also reported after that police were investigating her for homicide because she was actually very much anti-Trump and had a history of brutalizing her husband publicly. Appears that she gave him a large dose that killed him and took a tiny one herself likely to create some sort of weird alibi.
>But people certainly listened to his words as officials from the Maryland Emergency Management Agency sent out an alert one day after receiving more than 100 calls about ingesting disinfectants as a possible treatment for COVID-19, according to the Governor’s office, and reported by ABC News.
According to the Maryland tweet it was “several”. The others referenced “exposure”. I suspect the media worried and reported the outrage about this far more than people took it seriously enough to do it.
Gonna sound harsh, but if you are dumb enough to ingest a poison on the say so of an obnoxious real estate developer, the world is better off without you. I’m ok with those folks removing themselves from the gene pool.
I am an MD, Data Scientist and epidemiologist. There are three pieces of information which makes me feel something fishy about the study:
1. Sample sizes for all selected studies are very small, and even though they used mixed effects models to treat confounding, there is no way to check what the authors did, since they didn’t shared the code or the data, which is inadmissible since this is a meta analysis and there is no private data involved
2. Any tree chart of Risk Ratios or Odds Ratios that show drastic positive effects must raise one’s eyebrow about partiality in the authors
3. Real world data from Brazil, where they have great death data surveillance AND mass-distribution of ivermectin didn’t show any excitement. Brazil just crossed more than half million deaths as of Jun 19th 2021, and there is a high likelihood of surpass U.S. in deaths.
Based on what we already know about vaccine and PFF2/N95 mask efficacy and safety, it becomes hard to defend approaches such as ivermectin, instead of promoting practices and technologies that showed undeniable success in the real world, instead of doubtful medicines supported by obscure statistics and ideological discourse.
Thanks for the relevant comment - it must be intriguing for anyone who is not used with hearing about the “real world evidence” term in medical sciences.
Usually the highest level of evidence is attributed to randomized controlled trial studies. As the name says, they are performed in a high level of control, to evaluate in a more “insulated” way, the effects of a drug/intervention in a given outcome (reduce death, cure a disease, etc). Unfortunately, we can’t always relate these academic studies with the “real world”, due to an almost infinite number of confounding variables, or in the worst case scenario, if a scientist is manipulating the experiment environment (e.g. selecting a patient population with more likelihood for the desired effect).
This is one of the reasons why you will see with increasing frequency the terms “Real World Evidence (RWE) study” in reputable journals, such as the New England Journal of Medicine, or The Lancet.
These studies occur taking data from epidemiological surveillance, or patient medical records, and usually do a “reality check” on data found in these trials.
It concluded Ivermectin "did not reduce all-cause mortality, length of stay or viral clearance in RCTs in COVID-19 patients with mostly mild disease. IVM did not have effect on AEs or SAEs. IVM is not a viable option to treat COVID-19 patients."
But wait... Before you upvote or downvote me, I want to say this proves something entirely different than what we may think. It proves that there's lots of studies -- some say one thing, some say another. I can produce a study which seems to convincingly prove one side of an issue -- and somebody else can produce a different study which seems to show the opposite.
This article is a pre-print with severe mistakes (in particular they inverted the results for the treatment and control groups in one of the studies, you can't make this up). Read the comments. It's highly unlikely the piece will be published.
Read this peer-reviewed and accepted meta-analysis instead [0]. Conclusion: low- to moderate-certainty evidence of a positive effect depending on the endpoint. Higher certainty would come from higher-powered studies.
The issue I've seen with various studies who claim statistically insignificance when using Ivermectin is because they use too low of a dose and/or don't use it long enough (3 to 5 days instead of 14 days) and/or they don't start using it at first symptoms (in part I've read this can be because can take days for COVID positive tested person to enrol in a study hence giving the virus more time to replicate/take strong hold).
"Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers
progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally."
We don't have extensive studies that injecting bleach helps as well.
There is a huge liability to those companies if it would end with deaths or health issues ("Facebook only looked for profits and didn't care that people were killed by misinformation")
You should not get medical advice from social media, and Facebook is also not the right place to discuss medical research.
Ironically few days ago people here commented that HN was linking to a rant on Facebook about performance in Python affected by shared libraries.
FB was considered not suitable for that kind of discussion and link was changed to bug database, yet some people don't have problem about discussing medical treatment there.
Just to be clear, if we changed a URL from one source to another, that would be rooted in 10+ years of HN moderation practice and would have been about the specific articles, for example we would tend to replace a "rant" with a more substantive/original source. It would imply nothing about FB being "considered not suitable". Plenty of FB articles have been discussed here over the years; though there tend to be issues with login walls and whatnot and I think the community tends to prefer the open web for content.
The antiparasitic ivermectin, with antiviral and anti-inflammatory properties
That makes me wonder at the mechanism and biological pathways involved in how this works at all on anything and how that intersects with Covid-19.
I'm alive in part because for some years my best friend was a former registered nurse who had let her nursing license lapse while she raised her special-needs sons and pursued training in various alternative medicines to try to keep them alive. I remember asking her once in exasperation after several rounds of back and forth still hadn't really answered my question "Yes, but exactly what does this drug do in the body at the cellular level?" And she told me "You are asking questions for which they don't have answers. That's not how drug studies work."
Everything I have read and experienced suggests to me that covid-19 is so deadly largely because of what it does to your blood, not your respiratory system. One of the things that kills people with covid-19 is blood clots.
And parasitic infections sometimes infect your blood cells. This is how malaria works and it's why Sickle Cell trait is protective against it.
So I'm really wondering at that connection. If this is an antiparasitic, does it work by impacting your blood in a particular way? Could that be the connection here for why it seems effective against covid-19?
And I'm wondering if we even have that type of information about this drug nearly twenty years after my friend told me "They don't know that. Drug studies don't answer that."
Some drugs are developed with a particular mechanism in mind: a known protein target, a known binding site, and a molecule designed to match. For these, scientists have a good shot at knowing what's going on. Even then, a doctor might not know - they don't need to.
Other drugs are developed by a more random method - for example, take every druglike chemical you have on the shelf and put it in a vial with COVID-19. In that case, scientists will try to find the mechanism afterwards, but they might never know for sure.
> You are asking questions for which they don't have answers. That's not how drug studies work
A doctor or nurse might not now the answer many times, which is fine, you can’t be an expert on all at once. But the latter is bullshit - any reputable drug study will elaborate (or worst case, speculate) on the action mechanism of the drug in detail. In the case of ivermectin, it’s supposed to inhibit viral replication, here is an example of a study diving into it: https://www.sciencedirect.com/science/article/pii/S016635422...
TL;DW - there is evidence to suggest the spike protein of SARS-CoV-2 is itself cytotoxic and potentially responsible for blood-clotting in both COVID-19 patients/vaccinated.
(Eg, there was at least one major study published in late 2020 that demonstrated the SC2 spike protein specifically eliciting hyperactivity in blood platelets.)
From what I understand, it's the anti-inflammatory piece of Ivermectin that can help with covid because, apparently, the respiratory issue with covid is not caused by covid directly but rather an overexcited autoimmune response.
I'm not a doctor but that's what some doctors on YouTube have said ;)
ivermectin effects chloride channels in neurons of parasites.
in mammals ivermectin effects nuclear transport protiens responsible for mediating signal peptide transport to the nucleus.
the in vivo concentration corresponding to EC50 was reported in the range of 2. to 5. micromolar this is a very problematic dose, for humans; this drug targets host, and pathogen, albeit by different mechanisms.
the nucleus of a eukaryotic; mammalian cell [a.k.a. humans]
is surrounded by a membrane, this membrane has a number of protiens studded into it, some are channels, others "do backflips" to transport things across the nuclear membrane.
why do this ?.... protiens are made outside of the nucleus and must be inserted into the nucleus.
some of these are structural protiens, others are enzymes, and others are signals to the nucleus to switch operations for the time being, constantly chasing after homeostasis.
Ivermectin disrupts signal transport protien, and becomes cytotoxic, in higher doses due to its effect on the genetic expression signaling system.
[ADNDM]
the claim is that CoV2019 infects a cell then produces a protien that enters the host nucleus and ultimately modulates interferon production, by the infected cell, and that Ivermectin can disrupt this.
when covid imports a specific protien this lowers the signal the infected cell attempts to give surrounding cells that there is an invader, and to harden up molecular defenses.
the problem is that the cell relies on this nuclear transport of signals for proper functioning, so you cant just block it, and expect the host to be spared cytotoxic effect.
Sorry, that clip doesn't talk about what I thought it did. I watched the whole 2.5 video before it was censored/taken down from YouTube and somewhere in there they talk about why they think Ivermectin is effective (assuming it is).
"Ivermectin has been shown to inhibit the replication of SARS-CoV-2 in cell cultures.13 However, pharmacokinetic and pharmacodynamic studies suggest that achieving the plasma concentrations necessary for the antiviral efficacy detected in vitro would require administration of doses up to 100-fold higher than those approved for use in humans."
"Since the last revision of this section of the Guidelines, the results of several randomized trials and retrospective cohort studies of ivermectin use in patients with COVID-19 have been published in peer-reviewed journals or have been made available as manuscripts ahead of peer review. Some clinical studies showed no benefits or worsening of disease after ivermectin use,21-24 whereas others reported shorter time to resolution of disease manifestations that were attributed to COVID-19,25-28 greater reduction in inflammatory marker levels,26,27 shorter time to viral clearance,21,26 or lower mortality rates in patients who received ivermectin than in patients who received comparator drugs or placebo.21,26,28
However, most of these studies had incomplete information and significant methodological limitations, which make it difficult to exclude common causes of bias."
> doses up to 100-fold higher than those approved for use in humans.
Drugs are approved according to their use. If they have multiple uses, they will have multiple approved dosages. Someone with sudden sensorineural hearing loss might be prescribed 60mg of prednisone per day, while someone who takes it for rheumatoid arthritis will take only 10 mg per day. One dose is six times the other dose. Both are safe, and both are approved.
It's also necessary to consider the drug's therapeutic index. Therapeutic index is a ratio that measures the difference between the effective dose of a drug and its lethal dose. [1] NIH data indicates that administering ivermectin (at these "100-fold higher" dosages) to treat COVID-19 is no more dangerous than placebo. [2]
If Ivermectin saved anyone, Brazil wouldn't be hotbed for COVID that it is right now. Doctors are prescribing Ivermectin to pretty much anyone who arrives with any signs that appear to be COVID-related. Some people are even taking it by themselves as a form of "prevention". It has not worked as the numbers clearly show.
This is just one more facile such comparison in the thread, alongside "injecting bleach," "snake oil," etc. Whether ivermectin is effective or not, to describe the state of the evidence as though it were equivalent to pure quackery is very dishonest.
This looks less ridiculous than the last metaanalysis on Ivermectin that was posted here.
Still if you look at it there's some reason for caution. Not all of the included studies were RCTs, some were not blinded. If you look at the "Risk of Bias"-Table there are really only three studies that could qualify as high quality.
Unfortunately medical experts are not allowed to discuss this in public, so we’re left with back door meetings where Pharma execs will inevitably push outcomes that will be favorable for their bottom line.
Who wants to invest billions of dollars into a new vaccine/anti-viral drug only to lose out on all that investment by Ivermectin which will not contribute a single cent to the Pharma execs year-end bonus?
Merck sells Ivrmectin and recently had their vaccine candidate fail, they might be behind this push for IVR, with all the behind the scenes PR for it and the questionable speciality anonymous websites in this thread.
The biggest issues for treatment of covid has been:
1. Ignoring frontline doctors
2. Social media becoming the arbiter of truth.
The above have been devastating to countries. For example, India had figured out that Ivermectin was effective last year in august itself and recommending it to everyone as it was easily available. All my friends who took ivermectin had very mild covid. I had prolonged covid and I suspect it was because I was not given Ivermectin.
During the 2nd wave in May, WHO Chief Scientist Soumya Swaminathan tweeted out against Ivermectin. Some states followed her advise (based on a tweet!) and discontinued it resulting in 10x more deaths.
WHO, sadly, has been wrong about everything in this pandemic. I don’t trust them anymore.
Peru is the country with the most deaths per capita in the world. It also had a government-sponsored program to give away free Ivermectin most of last year. The region/state with the highest death count in Peru you ask? Ica. The city with the highest death count? Chincha (in Ica). It is also the city and state with the highest use of Ivermectin - mainly because the lab that sold it and the veterinarian that owns that company and promoted its use (millions spent here), lives there.
It did not matter that Merck (the lab that discovered Ivermectin), said to not use it for COVID. Tons of money made and people died. I have never cussed in HNs, but with all due respect F** tha* shi*!
I think censoring people responsibly discussing Ivermectin is deplorable. It might be a good idea to censor people advocating for using horse-Ivermectin, or selling fake Ivermectin, but there is no excuse for censoring a reasoned discussion of the facts.
I am ambivalent about whether or not it does work. I have read articles that make it seem promising and I have read articles that suggest it does very little or nothing. Not sure how to come to a conclusion there. However, everything I have read does seem to agree that it is safe to take and cheap so it certainly seems reasonable to try.
N=1.
Me and my 2 year old had covid. My wife started ivermectin and never got sick. Shared bed and sick 2 year old wants mommy.
Ivermectin didn't work for me (diarrhea) but my fever went from 102.7 down to 99 12 hours after HQC after 6 days of a slow downward spiral (fever kept going up and up every day). So for me, my take is the drugs absolutely worked.
Please don't take HN threads further into flamewar, especially not on divisive topics.
We all know that anecdotes aren't statistical evidence. That doesn't make them offtopic. They're interesting, and they're the lifeblood of conversation. Generally on HN the approach is to trust readers to be able to make their own minds.
If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful. Note these ones: "Don't be snarky.", "Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.", and "Comments should get more thoughtful and substantive, not less, as a topic gets more divisive."
I don't see any reason to think that mikeytown2's comment is being weaponized by politicians or that mikeytown2 is a weaponizing politician.
My purview is limited to HN and I try never to extrapolate beyond that, but as far as HN goes, we've always favored the principle that readers are smart enough to make up their own minds. I've been saying that for 7 years (https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...) and I don't think that the crises and tectonic shifts of the past few years have given any reason to change that. (It has been a lot of work trying to shore up a culture of thoughtful commenting, with mixed results, but that's a separate issue.) IMO you guys should worry less about restricting what other people might see or think and worry more about finding the best information and the best arguments to persuade each other with.
To repeat, lest anyone misunderstand: my remarks are limited to HN, which is the space I've observed enough to speak about. I'm not saying HN is an exception, and I'm not saying it isn't an exception; I don't know.
Edit: two more points. First, I think there's a perspective bias here. We all assume that we're the smart one capable of making judgments about what the dumber ones might think, but literally everyone sees themselves that way. That shows not only that we can't all be right about that, but—more interestingly—that this entire line of thinking is invalid. It's a hard-wired unreliable narrator.
Second and last, if HN readers aren't smart enough to make up their own minds, then this place is fucked, so we might as well make a Pascal's wager.
> Second and last, if HN readers aren't smart enough to make up their own minds, then this place is fucked, so we might as well make a Pascal's wager.
That's not how this works. If you allow enough bullshit through the filter that's another example of the 'broken windows' theory: it will accelerate evaporative cooling, leading to more bullshit being posted and ending up on the homepage and so on. As moderator you are one of the very few people that can stop that spiral from getting out of control and the balance is quite precarious.
"On-Topic: Anything that good hackers would find interesting. That includes more than hacking and startups. If you had to reduce it to a sentence, the answer might be: anything that gratifies one's intellectual curiosity."
There is nothing in there about censoring things because they have been weaponized by politicians or because they are a threat.
If we all used generics to treat disease, how would pharma companies make tens of billions on vaccines and boosters and re-boosters, market less-effective drugs with five-figure price tags, and who would repay YouTube and Twitter for the fortune they make on pharma advertising?
Pharma profits, big tech profits, and nurse tik-toks must take priority over disease prevention.
Not even the new, just haven't been picked on up on HN earlier. The sciency Covid-19 subreddit was all over it last summer when HCQ had been proven ineffective.
I was living in São Paulo when the pandemic started, so when I went into lock down mode, it made no sense for me to stay in SP, since the cases over there was high (compared to the small city my parents live), so I went to stay with my parents. Fast forward 6 months the company I was working for went full remote, new contracts and everything. So I decided to terminate my rent contract for the condo I was pay (but not living in) in SP. So, in the middle of the pandemic I had to go to SP to get my stuff and return the apartment. As prevention I took a lot of Vitamin C (with zinc) and Ivermectin. My rationale was: every one needs to take vermin medicine once a year, so why not Ivermectin, who some people are saying that is showing some results in the prevention and treatment of the COVID? So I took the recommend dose for my weight and went on my way. I did take care of my self with the default stuff as well, mask, alcohol for the hands, staying away from people... Glad to say that I did not contract the disease. At least I did not have any symptoms and wasn't sick.
Users flagged it. That's basically always the reason when you see [flagged] on a submission. (With comments it's a little more ambiguous - moderators will also sometimes put [flagged] on a comment, though still in a tiny minority of cases.)
We sometimes turn off flags, especially when an article seems to contain enough significant new information to support a substantive discussion. I've done that in this case.
Let’s not forget the censorship of the lab leak hypothesis. A few months ago it was a racist theory that constituted thoughtcrime and couldn’t be mentioned, and now the mainstream thinking is that it’s the most likely explanation.
I remember it differently as not a "lab leak hypothesis" but a claim that the virus was not from nature but was a man-made virus, to wit:
"I can present solid scientific evidence to our audience that this virus, COVID-19 SARS-CoV-2 virus, actually is not from nature. It is a man-made virus created in the lab."
Exactly - the problem isn't the consideration of a lab leak as a possible source, it's the presentation of that theory embellished well beyond what's plausible without any evidence - and then suggesting it's not just a far out there possibility, but actually the most likely source. And all that when it was a convenient diversionary tactic - looking for a scapegoat.
Let's not forget that not only is the lab leak theory to this day just one possibility, it's still not backed by much evidence, whereas many other viruses have jumped species before without needing a lab.
Finally, even in the unlikely event it turns out to have leaked from the lab and we manage to get convincing evidence of that now, that doesn't actually make those claims last year any more defensible. It's not OK to spout wild claims without evidence - even though if you do so often enough, you'll get lucky sometimes. Even a broken clock is right twice a day, but that does not mean breaking clocks is a valid strategy for telling the time.
And unless I'm missing something, it's just not plausible that fox news or mike pompeo or whoever had some secret evidence - if they had it, they would have shared it, somebody would have leaked it, or at the very least other corroborating sources would have appeared. None of that happened: ergo they were lying at least by exaggeration - and that's assuming they even believed the story to be at least plausible.
Exactly. Let's also not forget that for this virus to have escaped, there would have had to have been incredibly lax safety procedures. That doesn't mean that wasn't the case, just that we would have had trained researchers and technicians working with viruses similar to other viruses that have jumped species and caused serious disease under the equivalent of BSL-1 (i.e. no precautions). BSL-2 is required for procedures where a potentially human-infectious virus may be aerosolized.
For the zoonotic leap hypothesis, all you need is for some people to be near some sick bats. Which one is simpler?
Coronaviruses were being studied in a BSL-4 lab in Wuhan. That is ~100 metres from the meat market which was supposedly the epicentre of the original outbreak. Theoretically the safety standards would be very high. But all it takes is one slip-up. And it wouldn't be the first time that has happened. Seems pretty simple to me.
The zoonotic leap is definitely plausible too. But there you have to explain how the virus mutated to be infectious to humans. Whereas the lab is known to have intentionally modified the coronaviruses it was studying to be infectious to humans.
Sure, I'm not denying the plausibility of either scenario. But, which one is more likely: a virus jumped from animal to human, just as has happened many times before in history (and, without our help, for that matter), or safety procedures were not being followed in a lab that studies viruses with the very highest level of safety controls? How many times has the latter happened compared to the former?
Bat coronaviruses were studied at BSL-2 as they were not believed to be dangerous to humans. Reference: the head of the WIV covid lab. https://news.yahoo.com/chinas-bat-woman-center-pandemic-1814... “ Shi said that bat viruses in China could be studied in BSL-2 labs because there was no evidence that they directly infected humans, a view supported by some other scientists.”
A few incidents with excessively dangerous stuff like smallpox aside, most laboratory security incidents are essentially no worse than what millions of people experience on any given day. Scratched by sick animals, tick bites, mosquitos, bites larger animals, eating sick animals, getting blood from a different animal in an open (perhaps tiny) wound, breathing the air of densely held animals, leeches, etc etc etc.
I mean, not saying labs shouldn't be extremely careful, especially if the pathogen isn't unusually dangerous - but the outside world generally contains quite a few dangerous pathogens too, any more more (and more intense) interactions between host and human in which bad things can happen.
To be clear, these issues are serious and need addressing, but nevertheless the sheer numbers involved would suggest that the security incidents by themselves are unlikely to cause this kind of pandemic. We'd need some additional ingredient, like intention infection with multiple human subjects over a prolonged period, or extremely successful gain-of-function... something that can shift those otherwise billion-to-one odds very, very far.
Out of a kind of morbid fascination if indeed it turns out this long shot actually happened it would be really interesting to read the post-mortem as to which factors contributed, because it kind of has to be a list of bad luck and poor decisions.
(But to reiterate: it's not OK to ignore risks even if they aren't the most likely source of pandemic outbreaks, that's a way too low bar!)
> all you need is for some people to be near some sick bats.
Seems that there are multiple problems with that..
1. High level of optimisation for Human transmission, without many mutations indicating the possibility that it was pre-optimised somewhere before making the jump.
2. Presense of double `CGG` which is left as a common market to denote lab insertions.
>The insertion sequence of choice is the double CGG. That’s because it is readily available and convenient, and scientists have a great deal of experience inserting it. An additional advantage of the double CGG sequence compared with the other 35 possible choices: It creates a useful beacon that permits the scientists to track the insertion in the laboratory.
So on the other hand, for lab leak, only these needs to be satisfied.
1. They were doing GoF research on viruses trying optimise for human transmission.
2. Someone had a bad day and didn't follow the strict procedures, and ended up getting infected with a super charged virus.
What makes the above far fetched is only if you take the chinese researcher's word for granted, and accpet that there was no such research being conducted there, and no virus that was close enough was stored in the lab to start the research with. But without that, I think the lab leak is much more probably, and I think most experts will agree as well (They don't because they have a hard time doubting fellow reserchers without evidence).
There are really two separate lab leak hypotheses:
1. That it was made in the lab and accidentally released
2. That it was made in the lab and released intentionally as some kind of biowarfare or population control.
(1) has been discussed as a definite possibility by credible scientists since day 1 (and although it's true that the mainstream media didn't really pick up on it, I don't see much evidence that they intentionally buried it)
(2) is straying very heavily into conspiracy theory territory.
Nobody ever seriously discussed (1). The best (and so obvious) rebuttal to (2) is "If COVID is a weapon, it sucks." The only time (2) comes up is when people want to censor (1) so they twist it into something similar to (2).
That could be what you call a „limited hangout“. You only admit what you can’t hide any longer.
Firstly it was a no-go to claim it came from the lab. „It came from a wet market“ was the only truth you were allowed to claim without getting censored. Now that Fauci‘s emails are visible, it becomes more evident that the origin is a lab.
Now you are only allowed to claim that it accidentally escaped from a lab.
What’s next? Maybe we will see new evidence coming out that it was created and released on purpose. Let’s wait and see what we will be allowed to say then on social media.
I have downvoted you, because I believe that it is a complete fabrication to claim that the mainstream thinking is "that it's the most likely explanation". As far as I can tell, most experts have settled on "unlikely but possible".
I would be happy to "undown" you if you can provide evidence.
It veered off topic. I agree that there's a point of connection between the media/tech/institutional treatment of that question and this one, but arguing about who said "man made" vs. whatever a year ago is way into a different field of weeds.
Ivermectin has to be one, presumptuously, of the most ridiculous foreign PSYOP interventions in recent memory. I believe that somewhere there's a bet going on for how many Westerners they can get taking dog medication thinking it makes them immune to COVID19.
We already have a cure! In most countries, it's even _free_! And yet I read paranoid blogs online from conspiracy theorists who refuse a vaccine but guzzle down veterinary medication user to treat heartworm and digestive parasites.
Pound me with downvotes, I'll hold my breath until I see a large scale randomized double-blind trial.
Please don't post flamebait to HN, and especially not on divisive topics. That amounts to trolling, in effect if not in intention, and it leads to exactly the opposite of what we're trying for here.
> Conclusions: In comparison to SOC or placebo, IVM did not reduce all-cause mortality, length of stay or viral clearance in RCTs in COVID-19 patients with mostly mild disease. IVM did not have effect on AEs or SAEs. IVM is not a viable option to treat COVID-19 patients. [1]
I would prefer to see a single RCT with at least a few thousand patients, but the early results aren't looking positive. It's a repeat of HCQ-AZ and that people are lending credence to RCTs with double digit cohorts is what causes people to rush out and eat medications intended for dogs. It _actively promotes harm to individuals who take medications for no reason, which have side effects_. I would prefer that HN not allow discussion of what appears to be medicine advice without a basis in clinical results.
This is one of those cases where it's helpful, in fact indispensable, to remember that there is exactly one thing we're optimizing for on HN, namely intellectual curiosity: https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor.... The fact that we have a clear guiding principle is my favorite thing about moderating HN because how the hell would one decide these things otherwise.
It seems clear that the community has genuine intellectual curiosity in discussing this topic. It's also a flamewar topic so we need to take the usual care not to end up in a flamewar; that sometimes works and sometimes doesn't. This thread doesn't seem to be doing too badly. The OP seems like a substantive enough article to at least provide a basis for a good discussion.
Not sure if this is too far down in your inbox, but I will write nonetheless...
> This is one of those cases where it's helpful, in fact indispensable, to remember that there is exactly one thing we're optimizing for on HN, namely intellectual curiosity...
Dang, respectfully, is it not true that "we are optimizing for" is a function of not only moderation, but the inherent (lack of) capabilities of rather feature sparse threaded internet discussions with upvotes/downvotes/flagging?
There's no doubt, "it is what it is", but perspectives upon reality that are limited to only how reality currently is overlooks how reality could be, such as if moderation here was not so good (a portion you seem to see clearly, as ample evidence exists elsewhere) or if the features of a forum were strategically expanded (a portion you may not see so clearly, since afaik there's not really anything much more sophisticated out there).
As you say in another comments:
> To repeat, lest anyone misunderstand: my remarks are limited to HN, which is the space I've observed enough to speak about. I'm not saying HN is an exception, and I'm not saying it isn't an exception; I don't know.
> Edit: two more points. First, I think there's a perspective bias here. We all assume that we're the smart one capable of making judgments about what the dumber ones might think, but literally everyone sees themselves that way. That shows not only that we can't all be right about that, but—more interestingly—that this entire line of thinking is invalid. It's a hard-wired unreliable narrator.
As you clearly know, human judgment (even that of intelligent people) is highly unreliable, and this unreliability is typically invisible to the individual. I believe that features could be added to forum software that could improve upon this situation, over and above the manual moderator moderation and downvote mechanisms that are currently our only defences.
> Second and last, if HN readers aren't smart enough to make up their own minds, then this place is fucked, so we might as well make a Pascal's wager.
Or, we could transform the fabric of reality, which is to some arguably significant degree composed of the forum software that facilitates communication between nodes (human minds) within this system.
Of course, I am not insisting that you do this, I am only offering it as an idea for your consideration.
At one point in the past there were no internet discussion forums, and then someone invented one and the world was changed.
At one point in the past there were no internet discussion forums with voting, and then someone invented one and the world was changed.
At one point in the past there were no internet discussion forums with threaded conversations, and then someone invented one and the world was changed.
Has mankind reached the pinnacle of what can be achieved with respect to the optimization of intellectual discussion on internet forums, or might there be a few different things that have not yet been tried, or even thought of (if large quantities of intelligent people set their minds to the task)?
EDIT: An additional wrinkle of complexity: what if someone builds one, and it takes off and becomes a powerful juggernaut in the domain of thought-shaping-at-scale, but the founders are evil, or can be converted, or displaced? We arguably see some examples of this already.
Ah ok. I feel pretty sure that there are other improvements to be made! But most likely any significant ones would come from somebody starting a new forum with a different set of initial conditions.
If those who currently run forums consciously choose to not consider expanding functionality to truly maximize the optimization of their goal (in this case, intellectual curiosity), this seems true by definition.
The problem with your argument is that what you call "expanding functionality" can easily have negative effects. If you have a specific idea that you're confident would help HN to optimize better for intellectual curiosity, I'd like to hear it.
I have many ideas, ranging from simple to extremely complex (some of which would require an entirely new platform).
A few examples (if ever implementing such things, I would do it in an "experimental mode" that can be enabled for specific threads):
- offer more options than simply upvoting & downvoting, perhaps something like a list of tags (epistemically unsound, speculative, smart, insightful, outside-the-box thinking, etc)
- When downvoting a user, offer/force the downvoter to provide a reason from a list (which could be voted on by others who agree/disagree), perhaps with the additional ability to provide specific reasoning. Some benefits of this might be for the downvoted user to actually have some insight into why they are being downvoted, it may make the downvoter put a little more effort into considering why they are downvoting, and it would provide additional metadata on conversations which could be used for a variety of things.
- Some sort "cultural mode" for threads of certain kinds, which might include things like "epistemic strictness". So for example, for culture war (politics) threads, it might be interesting to set Epistemic Strictness = High, meaning certain common behaviors would be forbidden, such as asserting imaginary beliefs as facts (mind reading, future reading, etc). Or, the same idea could be run under two threads, with opposite ends of the spectrum of a specific dimension...so if we were discussing the viability of nuclear power, one might have one thread for "extreme optimism" (the goal being to collect as large as possible set of why it is plausibly a good idea), and its counterpart could be "extreme pessimism" (why it is plausibly not a good idea).
Of course, some of these are better/easier than others, all of them are debateable from a cost/benefit/risk perspective, opinions would vary (a HN meta-thread seems like a fine approach for that...or as a general idea), etc.
My basic thinking is this: HN is an influential site, populated by intelligent and influential people, and the world has a lot of complex problems going on simultaneously (some people even think some of these problems are in the existential threat to humanity category). Considering this, is it possible that the HN Hivemind (a massive cluster of knowledge and skilled biological compute) produce some valuable new for humanity (new ideas, new ways of thinking, etc) if this cluster was orchestrated in a more optimal manner?
And of course: this is not your job. It is no one's job. And if hard jobs with no plausible economic return are not assigned to someone, they often do not get done, and humanity eventually suffers the consequences (with or without realizing why).
We've considered things like that over the years, but I think these and similar ideas suffer from a common flaw: people who disagree about X would disagree about reasons for upvoting/downvoting X or the level of "epistemic strictness" re X. So you'd just get the same arguments repeated at a meta level, which would not be a win.
I'm sorry to sound so dismissive; it's at least partly because I'm writing hastily. I don't mean to reflexively put down new ideas and I know it's all too easy to come across that way. At the same time, we're not going to add more metaness to HN because it actually goes against the core value of curiosity. Metaness has a peculiar attraction but it's not intellectual curiosity; I've sometimes called it the crack of internet forums.
You don't think HN users are capable of realizing when they are engaged in mind/future reading, even if it was an explicit rule? You surely know the userbase better than me, but this seems unlikely.
If you want nothing to change, so be it, but the idea that functionality changes cannot have an effect is very frustrating.
Correct. Not only HN users but humans in general—I just don't think we work that way. The way we work is that we have our preference on X and then we propagate that preference through every edge in our mental graph of associations from X.
One can imagine a user saying something like "Although I personally am against nuclear power, since this is the 'optimism' thread it isn't the best place for my counterarguments so I'll post them in the 'pessimism' thread instead". However, such people are somewhere between vanishingly rare and unicorns. Statistically they may as well not exist.
> Correct. Not only HN users but humans in general—I just don't think we work that way.
I am curious if this is actually true (that humans are unable, with concentration, to realize they cannot read minds), but maybe I have an excess of curiosity! :)
I have seen people pointing out the low price of the horse formulations on Twitter without the obvious caveat that dosage will definitely make the poison in this case.
The fact that you call it a dog medication shows that you lack a basic knowledge about the history of this drug.
Problem with vaccines is that they take time to be effective (for AZ vaccine up to 14 weeks). In addition vaccines are not 100% effective. Therefor it is definitely beneficial to have some form of cure.
I think the future is going to look back on this pandemic and be simply amazed that the public allowed social media companies to dictate to the world what scientists and the people could and could not discuss. Much in the same way we look at the 16th century with Galileo and the Catholic Church.
This thread is literally under a scientific publication investigating the effectiveness of Ivermecitin, but yeah, basically like Galileo Galilei. Except not at all.
Any discussion of ivermectin on platforms like YouTube, Facebook, and twitter is met with ceremonial bans or deletion. Even when the discussion is between doctors or is part of a senate hearing (see: dark horse podcast with Bret and Cory, and Cory’s testimony to the senate which have both been taken off YouTube)
YouTube and Facebook are public platforms. Nobody benefits from the general public being sold unsubstantiated theories of miracle medicine X before there is scientific consensus. My beetroot-cures-cancer video has no right to be there either.
We are talking about scientists presenting important evidence about existing and useful treatments, and about the public discussing it, and about large companies censoring that debate. That is not anywhere near "selling miracle cures". Discussing good news, even if they may be incomplete or inaccurate is beneficial to many people.
Most of these videos are not “evidence” being presented, but merely opinions or advocacy. The general public has no need to “discuss” unproven treatments. Evidence is presented through studies and medical journals.
Witness testimony is evidence, these are respectable and accomplished people. You are wrong about the needs of the public. Public does need to be able to communicate about this. There are levels of evidence, not everything is presented through medical journals. However, there are papers in those journals too, see the article that this discussion is associated with.
Discussions about ivermectin must be banned from youtube.
It smells of Trump too much.
Any scientific dissent, even justified, should not be tolerated.
I am genuinely curious to know what made you come to that conclusion?
Assuming you mean darkhorse, what episode and what in that episode makes him alt right? Please be specific. If there are multiple examples then just provide a few.
Just browse the latest videos - these are clearly political and they are classical alt-right subjects: anti-vax, lab leak theory, how we are not racists, how we are being censored, something about trans-sexual people, portland riots ...
Can you please not post unsubstantive and/or flamebait comments to HN? If you have substantive information to share, please share it thoughtfully. If you post like you're doing in this thread, it's just pouring fuel on the flames, and no one learns anything from that.
Moreover, you discredit your own view by posting like this, which isn't in your interest—and if your view happens to be correct, then you're actually discrediting the truth as well, and that's a harmful thing to do. https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor...
A world-famous scientific authority (and co-author of the paper in question) being banned from Twitter because her professional opinion doesn't match the allowed narrative? With 3.8 million dead (and counting) How is this not substantive and relevant to the discussion?
It doesn’t even matter whether either hcq/zinc and ivermectin 100% effective or even work at all. We still have no options for early treatment, and therefore both/either should have been used heavily
> It doesn’t even matter whether either hcq/zinc and ivermectin 100% effective or even work at all. There were no alternatives for early treatment, and therefore both/either should have been used heavily
The possible outcomes are not only in the range between "100% effective" and "not work at all"; beyond that point on the line there's also "it's harmful", and it's known that these drugs do have negative side effects (in fact, IIRC one of the reasons for the early hope that HCQ would work was that its harmful side effects were already known, and less harmful than the then observed effects of the disease it was supposed to treat). Worse, "using heavily" a drug increases the chance and severity of its side effects.
And even for "not work at all", there's still a harmful effect, in that people can delay or avoid seeking more effective treatments, believing that whatever they're taking would work.
This is wrong on both points
1 - both drugs are safer than Tylenol,
2 - you can’t seek a more effective treatment as they do not exist. Well, there is remdisvir which is only available in the US and actually is dangerous and unproven
"For one thing, animal drugs are often highly concentrated because they are used for large animals like horses and cows, which can weigh a lot more than we do—a ton or more. Such high doses can be highly toxic in humans.
Moreover, FDA reviews drugs not just for safety and effectiveness of the active ingredients, but also for the inactive ingredients. Many inactive ingredients found in animal products aren’t evaluated for use in people. Or they are included in much greater quantity than those used in people. In some cases, we don’t know how those inactive ingredients will affect how ivermectin is absorbed in the human body."
The use of ivermectin in humans to treat parasites won a Nobel Prize.
Quoting from the Wikipedia page:
"Half of the 2015 Nobel Prize in Physiology or Medicine was awarded jointly to Campbell and Ōmura for discovering avermectin, "the derivatives of which have radically lowered the incidence of river blindness and lymphatic filariasis, as well as showing efficacy against an expanding number of other parasitic diseases"
"There seems to be a growing interest in a drug called ivermectin to treat humans with COVID-19. Ivermectin is often used in the U.S. to treat or prevent parasites in animals.
The FDA has received multiple reports of patients who have required medical support and been hospitalized after self-medicating with ivermectin intended for horses."
Hydroperoxyl (the common name for hydrogen dioxide) should just break down into water and oxygen gas as soon as it encounters H+ ions (e.g. when it touches liquid water), no? Is there some particular reason you think the dangers are being repressed? If your answer is something to do with "free radicals" my understanding is that most of those come from metabolic processes rather than things you eat.
Thanks for correcting me, meant to say dihydrogen monoxide, aka water ;)
My point being that you can over-dose on almost any compound at high enough doses. So instead of driving the conversation underground and letting patients self-medicate, we should empower doctors with proper information rather than painting Ivermectin as a conspiracy theory drug
"If you have a prescription for ivermectin for an FDA-approved use, get it from a legitimate source and take it exactly as prescribed. Never use medications intended for animals on yourself. Ivermectin preparations for animals are very different from those approved for humans."
Remember if Ivermectin was considered a safe treatment, there would have been no Emergency Use Authorization for vaccines. There was huge incentives to suppress the Ivermectin story until the vaccines were approved. Merck claimed it's own drug (off patent) did not have enough safety data. This is a drug taken by millions of people every month for decades.
All I said was there was a disincentive and claimed it's being wrongly characterized as 'unsafe' by the company that brought it to market. Are either of those statements incorrect?
Yes. I believe it is factually incorrect that a treatment with the claimed efficacy numbers would have prevented an EUA, given the vaccines we got were both safe and more effective.
The vaccine is experimental and the full safety profile is still being discovered. The EUA specially requires that there is "no adequate, approved, and available alternatives". The conclusion: "large reductions in COVID-19 deaths are possible using ivermectin" suggests it may be a viable alternative to widescale deployment of a vaccine that did not go through the full approval process.
No, sorry. The linked study suggests a 60% reduction in deaths from this drug. Even if it were true, it is nowhere enough to be an adequeate alternative to the vaccines, that were both vastly more effective at reducing deaths and could also significantly reduce transmission.
If you got the first dose of vaccine and then presented with COVID (that does happen), a short course of ivermectin immediately could likely do you some real good.
That is totally irrelevant to the subject at hand: whether use of this drug would have prevented EUAs for vaccines. It clearly would not have, this is just a pure conspiracy theory.
I am double vaccinated. I'm not proposing ivermectin as a substitute for vaccination. It's a palliative which may reduce serious consequences if an unvaccinated (or partially vaccinated) person presents with COVID. In that case, a vaccination would not act quickly enough to develop immunity. Even early use of Ivermectin would not have prevented the EUAs, because around 30% of those taking Ivermectin develop serious COVID, some progressing to death.
The problem is the EUA argument preventing the use of Ivermectin, not the other way around.
You are missing the point. We now have some idea of the effectiveness. No one wanted to hear anything about Ivermectin for most of the past year. The world economies have lost trillions and some large portion of the 3.8 million dead were needless. Pharma companies knew there was a potential for Ivermectin and worked to discredit it because it was a threat.
No, "there is a worldwide conspiracy to suppress Ivermectin so that Big Pharma can make vaccines" is clearly a conspiracy theory, it's not a tautology.
Why the tinfoil? When the WHO and the CDC/NIH and public officials lie repeatedly and demonstrably you can not trust them. Sort of invites wondering what the game is, because it's not public health.
Giving the benefit of the doubt (that new evidence is compelling), that still doesn't retroactively justify anything. The information available in the past is not affected by the informative available in the future. If we discover that Bush irrefutably orchestrated 9/11, that doesn't make the conspiracy theorists' rationales more rational. It feels natural to make that connection, but that's only in service of our side-taking tendencies.
The problem is that the quality/quantity of evidence has not changed.
Plenty of folks have been drawing attention to the lab leak hypothesis way before it reached mainstream, and they were using the exact same arguments and facts that the mainstream is co-opting now.
The only difference is that Trump is out of office, so people are less afraid to associate with the idea that the Lab Leak Hypothesis is worth investigating
Authority is the problem. We need to use our own minds. The very idea that an ad tech co is backing an amorphous group of authoritative governmental bodies is repugnant.
> And here is Merck, that sells Ivermectin
Ivermectin has been out of patent for years--so it is not particularly profitable anyway. The initial claim insinuates that Merck went against its own interest, but there was never much profit to be made from an old and proven safe drug that can be sold by generic manufactures.
It's impossible to be an expert in every field, particularly those as complicated as medicine. Furthermore, you don't have to rely on authority, I linked to an RCT showing it was ineffective.
"Not particularly profitable", which is speculative, is still profitable. I highly doubt any one at Merck is actively working against selling a drug they already manufacture at a profit, but feel free to provide evidence otherwise.
> Authority is the problem. We need to use our own minds.
No offense, but that depends on the quality of minds. What you've just said is exactly what Q-Anon proponents say, just before they go on to repeat absolutely baseless conspiracy theories they heard about on YouTube.
