I'm going to make what is probably a controversial statement, which is that, in my experience, most meta-analyses are trash.
A meta-analysis is usually grounded on the assumption that an aggregation of multiple, well-conducted studies can provide significant information that may not be evident by taking each study individually. Essential to this assumption is the premise that those studies included in the meta-analysis be scientifically rigorous in themselves. Unfortunately, this is almost never the case. The great utility of the meta-analysis in the clinical literature is such that there have emerged a series of standards for how to conduct such analyses, such as controlling for bias, controlling for variability, etc. These seldom include actual assessment of the scientific quality of the studies, as this is harder to standardize. Consequently, there is a preponderance of meta-analyzes that come to conclusions that are simply not justified, because the studies themselves were not scientifically rigorous.
I believe this applies to the situation of ivermectin, and it just so happens that this is the thrust of the point raised in the Nature article cited here.
It's best to understand that the vast majority of literature is just faulty. Either it's technically wrong (experimental mistakes), or missing information (left out a step in the methods), or the conclusions are not supported the (valid) experiment.
Learning how to filter literature is non-trivial and I don't think very many people do it successfully. I've found the best thing is to take a group of aggressive smart grad students and have them tear every paper apart until I'm convinced there are no basic technical errors, and the conclusion is supported by the evidence. Then and only then, would I care that the methods were incomplete because I'd be ready to run a replication experiment, and many of my replications failed because the methods section was not sufficient (missing steps, misleading instructions, challenging step).
Meta-analysis have a good place. But they also have known flaws/assumptions.
Often it is impractical to perform large studies. Partially by logistics and often by funding. But if there are lots of smaller studies you can aggregate the data to check for overall significant results. But mainly they are helpful to give a "survey" of the current research instead of having to link to 10 different studies and hope someone else sorts out what the data says.
But as you point out, there are two major flaws in the assumptions. First, that the scientific procedure is sound. Secondly, that the data is handled properly, and thus you can take the summary and back out the underlying data.
Unfortunately trying to fix the first is really, really hard.
The second is somewhat mitigatable. As the Nature article suggests, you could publish the underlying data (anonymized of course). This would help in two ways. First, the meta-analysis could check for confounding variables to control across all of the data. The second major one is it would help people spot fraudulent data.
However, as anyone who handles datasets knows, publishing and wrangling data into a useable state from multiple sources is a serious pain in the neck. Plus a lot of concerns about how de-anonymized the data would be. As we've known, with enough metadata it can be used to identify individuals. And publicly publishing dais data would definitely allow for some serious sleuthing work to be done.
The problem I saw with the Ivermectin metastudies (which I did a fair amount of research on given that people close to me had decided to employ it as a prophylactic against Covid) was that the people who did the metanalyses were trained to read the results rather than grapple with the methodology and statistics.
None of the study results were robust, but many of the study outcomes were positive. So they were counting up positive outcomes and saying that more often than not, it was evidence that Ivermectin was effective.
This is a good means of generating a hypothesis, but a bad means of generating a conclusion.
Most of these studies were not in any way controlled or comparable in their conditions, and some had a very low number of observations. It didn't seem plausible that the data could be aggregated together.
It will be very interesting to see the results of the larger RCTs underway. Regardless of the outcome there _has_ to be a lesson for at least some people who arrived at fervent conclusions about what a miracle/scam this particular drug is. Unfortunately it seems unlikely that it will be a lesson that endures.
In my mind, there is also underlying all this the idea that if a drug actually works, then there will be many doctors going on CNN to say that it totally works; that they're super excited by their patients recovering. In other words, the effect should be profound. If the effect is marginal, why bother, even if it is a real measurable effect in well conducted trials? I mean : that doctors observe that some therapy or drug works well is step 1, then step 2 is to conduct trials to prove conclusively that step 1 wasn't a statistical fluke. In this case we seem to have it backwards : we first observed that there is an effect in vitro, then ran trials which proved nothing much, then extracted noise from that data to prove whatever we wanted.
> ...then there will be many doctors going on CNN to say that it totally works...
I don't think we can trust "doctors" anymore.
There were a bunch of doctors (aka America's Frontline Doctors) that were trying to go around and say Ivermectin works. Same with HCQ. The "needle rape" doctor in Idaho said the vaccine is dangerous, but Ivermectin saves lives.
In Idaho, I assure you, doctor's are prescribing patients Ivermectin in the ICU. If it really did work Boise would be the groundswell of Ivermectin miracles, where people are walking out of the ICU, ending the crisis.
Unfortunately, that's not happening. ICU's are primarily being freed up from death now it seems like. ICU's are in the high 90's capacity.
I've published (and still am publishing) multiple meta analyses. IMO,meta analysis on aggregate data is an h-index gaming machine that can never increase the value of its constituents. The amount of missing info in aggregate data is such that it's _always_ impossible to know if the constituent studies really draw from the same population, which is the cornerstone of meta analysis. And that's very practical, because most authors (myself included) mainly use meta analysis as a means to build a career, and not at all for doing science. IMO, current clinical research has very little science left in it. That's a huge shame, and it's a real priority to make that change!
The federal government has specific guidance on how to meet the legal criteria for de-identifying clinical data. Once researchers meet that standard they're generally free to publish raw data, unless there's a stricter standard imposed by state law or some sort of institutional review board.
What do you think about the ability for researches to pick & choose which papers to include in a meta-analysis?
Double-blind is important for a reason, researchers are exceedingly good at proving what they want to prove even if subconscious, can meta-analysis studies ever overcome this?
Do researchers ever pre-register their studies when they do meta analyses? Pre-registration makes sense for the timing of doing actual studies, but not as much in the case of meta analyses (which presumably happen on a much faster timeline).
But given what we've seen with p-hacking, it seems like it could be good if people pre-registered their meta analyses before crunching the numbers.
Sure some researchers do pre-register their meta analysis studies on clinicaltrials.gov. It's generally optional. Of course there's nothing stopping a dishonest researcher from doing a little secret p-hacking before pre-registering.
For systematic reviews there are one of two ways that I'm aware of: PROSPERO [1] and Cochrane[2]. Cochrane is slightly more rigorous for conducting a review of this type. Although you do declare what meta-analyses you intend to do, you can't be overly explicit as it is largely dependent on the number of studies that are returned in your search strategy. For example two studies is too small for a meta-analysis so you would do a narrative review (discuss what you found).
Good practices dictate that preregistration should always be done nowadays, including for meta-analysis. In practice though, this has very little impact. There is absolutely no guarantee that what's written in the paper is a faithful report of what really happened. There's nothing holding back dishonest (or, at that point I guess I should write 'standard') researcher from doing absolutely whatever they want.
FiveThirtyEight weights its averages by pollster accuracy/methodology.
Next, we determine how much weight to give each poll in our average. First, polls conducted by pollsters with higher FiveThirtyEight pollster ratings — a letter grade measuring how accurate and methodologically sound pollsters are — are given more weight
There is no equivalent feedback mechanism in medical research. Other than looking for retracted papers, we don't have a reliable way to quantify whether a particular author is "correct" more often than another.
"Initial"? You haven't proposed any way to improve the weighting, so it would just be H index forever. We'd be baking in a cultural presumption that researchers who are more cited are more likely to be correct. A really dystopian prospect.
Sure, but generally because the aggregated polls were systematically off. You may be thinking of other examples, but the 2016 US presidential election really wasn't that bad of a look for 538, they had Trump at reasonable odds going into election night. It's not like he was at 5%, 538 pegged him at 1/3 odds as polls opened if I remember correctly.
It's on the aggregate of predictions that you can see the accuracy. If my weather app tells me hundred times there is 10% change of rain but it rains 50% of the time after 100 days, it's completely useless.
Same for FiveThirtyEight. They have been massively wrong on multiple counts.
So I'm someone who has published several meta-analyses of different forms, and written about meta-analysis as a topic.
I won't disagree with you that there are many poorly conducted meta-analyses. However, I think there's many well-done meta-analyses as well, and most importantly maybe meta-analyses aren't really different from anything else in life: some are good, some are bad, and many are in between.
One thing I've always argued is that meta-analyses have as a benefit a way of honing discussion around concrete specifics. The linked paper, for example, exists in part because there was a meta-analysis drawing attention to the literature at large. There's a decent chance that these studies would never be discussed if there wasn't a spotlight being pointed at the area.
With reviews, what happens is people pick and choose studies anyway, or don't, and then come to some subjective conclusion that's based on some unclear process. Meta-analysis makes all of this clear, and forces everyone to be absolutely explicit (or as explicit as can be) about how they're coming to their conclusions. If there's something wrong with it, then you can point to the specifics of that instead of going back and forth.
The problem with relying on definitive studies alone is that sometimes there will be more than one of them, or there won't be any definitive study, but many decently-done studies. Or the "definitive" study will have some controversial feature that doesn't clearly rule it out, but clouds the waters in a way that several smaller studies might draw attention to. Alternatively, there might be important heterogeneity across designs that illuminates moderating variables (like dose, or environmental context, or gender, or age, or whatever).
This paper is about meta-analysis of summary statistics, which to me is kind of bringing up a red herring. Statistically speaking if you can calculate the right summary statistics, the results should be the same as having the raw data. Issues about irregularities in results apply to raw as well as summary statistics; it also seems unrealistic to expect raw data in every case, and journals don't apply that standard either (that is, journals don't expect reviewers to reanalyze the data from scratch).
What's really needed is open data sharing, and scrutiny about studies that increases as the stakes of the results increase. I can speak to cases where I've been surprised at the state of the raw data, even in situations where the whole point of the study was to skeptically replicate a finding. Maybe for something like invermectin raw data analyses are appropriate. But it seems absurd to expect to throw out studies in the literature just because you don't have access to the raw data in every case.
Even meta-analysis conducted strictly according to PRISMA can be fraught with many issues. IMO, meta analysis is very vulnerable to bias in the base data and the honesty of multiple researchers, all while p-hacking and various other tricks to make papers sexier are already the norm. Forcing open data would certainly improve things but would not solve the problem of dishonesty in research, since authors would simply begin to withhold parts of their data that do not go their way.
Meta-analysis is a mirror of empirical estimates, really, in my opinion. It doesn't solve the underlying problems of research integrity or lack thereof, but doesn't create them either. It does allow you to model what is being reported though, to be explicit about your assumptions of estimates being reported in the field and how to go about aggregating them.
I agree about open data, for what it's worth, and even things like preregistration to some extent. There's a lot about dishonest research that has nothing to do with the statistics you use, or maybe even your design. It's sort of a never-ending arms race in that regard, and just as important to address the incentive structures that drive it in the first place.
I agree with your general point but in all fairness part of doing a meta-analysis is weighting the studies included in it based on many of the factors you mention.
There more studies you include, the greater the chance you'll get a bad one. If you look at where these meta-analyses often fail, you'll often see just a few "Bad" studies that end up corrupting their results.
You'd think the statistical tools they bring to bear in these would be resistant to this, but it appears to not be the case in several recent cases.
I will re-post some thoughts I have previously shared from John P.A. Ioannidis who is a professor of medicine and thoughtful critic of medical research. He often raises good points about trends in research and research ethics. His view is that meta-analyses are mass produced, redundant, misleading, and conflicted [1]!
One criticism of meta-analyses in [1], using anti-depressants as a case study: "the results of several meta‐analytic evaluations that addressed the effectiveness of and/or tolerability for diverse antidepressants showed that their ranking of antidepressants was markedly different. These studies had been conducted by some of the best meta‐analysts in the world, all of them researchers with major contributions in the methods of meta‐analysis and extremely experienced in its conduct. However, among 12 considered drugs, paroxetine ranked anywhere from first to tenth best and sertraline ranked anywhere from second to tenth best."
I like this quote because it highlights the conflict of interest and misleading-ness(or at least reproducibility problems) with meta-analyses. Antidepressants have a huge amount of primary research dedicated to them. They also have the attention of researchers experienced in meta-analysis. Yet, meta-analyses do not agree with each other (and in fact they strongly disagree with each other).
> I will re-post some thoughts I have previously shared from John P.A. Ioannidis who is a professor of medicine and thoughtful critic of medical research
> In an editorial on STAT published March 17, 2020, Ioannidis called the global response to the COVID-19 pandemic a "once-in-a-century evidence fiasco" and wrote that lockdowns were likely an overreaction to unreliable data.[14] He estimated that the coronavirus could cause 10,000 U.S. deaths if it infected 1% of the U.S. population, and argued that more data was needed to determine if the virus would spread more.[28][5][14] The virus in fact eventually infected far more people, and would cause more than 600,000 deaths in the U.S.[29][28][5] Marc Lipsitch, Director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health, objected to Ioannidis's characterization of the global response in a reply that was published on STAT the next day after Ioannidis's.[30]
> Ioannidis widely promoted a study of which he had been co-author, "COVID-19 Antibody Seroprevalence in Santa Clara County, California", released as a preprint on April 17, 2020. It asserted that Santa Clara County's number of infections was between 50 and 85 times higher than the official count, putting the virus's fatality rate as low as 0.1% to 0.2%.[n 1][32][29] Ioannidis concluded from the study that the coronavirus is "not the apocalyptic problem we thought".[33] The message found favor with right-wing media outlets, but the paper drew criticism from a number of epidemiologists who said its testing was inaccurate and its methods were sloppy.
Okay then.
Nothing like spending a career picking apart people's research and then generating absolutely garbage research outside your field of expertise, that is widely criticized by people who are actually the experts in that field...as being inaccurate and sloppy.
COVID hit, dude went all Don Quixote seeing conspiracies everywhere, and then generated a paper that suited his personal biases...
Your comment is the worst kind of ad hominem. You're simply dismissing one of the most-cited scientists in the world because he wrote something you disagree with.
He was right about the IFR for Covid-19, by the way. Subsequent research has upheld the finding. The primary factor that influences average IFR is the age of the population you're looking at:
> All systematic evaluations of seroprevalence data converge that SARS-CoV-2 infection is widely spread globally. Acknowledging residual uncertainties, the available evidence suggests average global IFR of ~0.15% and ~1.5-2.0 billion infections by February 2021 with substantial differences in IFR and in infection spread across continents, countries and locations.
> The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus.
If you are worried about ad hominems then you should also be worried about Ioannidis, who has taken to Twitter to criticize grad students with orthodox conclusions about COVID for their physical appearance and lack of publications relative to full professors.
I was a fan of Ioannidis when he put out the estimates, but he has lost me since then. I'd rather go with the massive amount of researchers that have built their career studying these things, than the guy from a different field that feels he is better than everyone.
I mean, if your networks ops people are telling you the cause of a problem in your web application, and a manager comes in from another team and says he ran tcpdump and he thinks they are all wrong, and then the networks ops people show what he did wrong with tcpdump, but the manager sticks to his guns, who are you going to believe?
The man ran around screaming about how COVID wasn't a big deal and thus we needed to stop with the lockdowns and whatnot.
As our ERs, ICUs, and morgues were overwhelmed.
Which is still repeatedly happening, in regions with low vaccination and poor pandemic health regulations/orders. Except now it's lots of kids too young to get the vaccine or below age of being able to get the vaccine on their own without parental approval.
It would be exceedingly kind to say his "this isn't a big deal, not that many people percentage-wise are dying"...was at best incredibly heartless.
Ad hominem would be "he's a covid-denier, his research is worthless."
What I actually said was that he was an expert in research quality, and then promptly helped generate very shoddy research that was outside his area of expertise and ended up widely criticized by people actually in that field. Pointing that out is not ad hominem.
Extremely early-on in the pandemic he ran around shouting with no evidence that COVID was not very infectious and not deadly at all, and really, we needed to stop with these silly lockdowns and social distancing and masks and so on.
He then changed his tune to claim that actually covid was very infectious but this meant that the death rate was very low (and thus we needed to stop with these silly lockdowns and social distancing and masks and so on.)
Even his claim of very high infection / low mortality rate were true, it doesn't change the fact that ERs and ICUs have been repeatedly swamped, predominantly in countries, states and counties where political leaders are not employing standard pandemic control measures.
The man was literally shouting "THIS IS NO BIG DEAL STOP LIMITING OUR FREEDOM" while ERs and ICUs filled to the gills with dying people and in many places they literally could not burn the bodies fast enough.
His early claims were junk in part because COVID often was not mentioned or listed as cause of death, especially early in the pandemic.
PS:
> You're simply dismissing one of the most-cited scientists in the world
Appeal to authority. See? I can play that too. Maybe you can fool the average HNer into thinking citations imply credibility, but absolute junk research can end up highly cited because it was junk and many researchers sought to validate said research or pointed out its obvious flaws.
Next time, try arguing this stuff with someone who didn't work in a lab that was doing linguistic analysis of research, a project that existed because citation counts are completely worthless for identify novel research or evaluating its validity. And to head it off at the pass: yeeeeeees, even if you include journal impact factor.
Thanks for posting this. I did not know about about this darker side to Ioannidis.
I think lockdowns are/were a good thing. I won't necessarily fault Ioannidis for comments on lock downs on March 17, 2020 because that's pretty early on in. However, the April 17, 2020 pre-print story is pretty damning.
The other takeaway is that preprint publication is a pathway ripe for abuse. The major paper that drove most of this situation, and the meta analysis, appears to have been a straight up fraud. But it got circulated a lot as a preprint to people who didn’t understand the difference between a preprint and a peer reviewed paper. If the preprint had been more private, this might have been averted.
> ... to people who didn’t understand the difference between a preprint and a peer reviewed paper.
It's worse than that; if you're reading individual papers without the context of the larger body of research in a domain, you're setting yourself up to get a distorted view of the world.
Peer review isn't magic; peer reviewed papers can still have errors, oversights, mistakes, outright fraud, or just get unlucky in how random chance played out. Peer review just filters out the obviously fraudulent or flawed papers so that only three reviewers have to spend an afternoon reading and understanding why they are useless, and not a thousand journal subscribers.
There's nothing wrong with following scientific developments as a layperson, but you shouldn't make the mistake of thinking because you read something in a published, peer-reviewed paper -- even one in a prestigious, well-respected journal like Science or Nature -- that it must be true.
This is a very important point. It is incredibly easy to accidentally cherry pick and/or misread results that confirm one's preexisting bias. As a layperson, the default stance is 'I don't know'. Scanning the abstract of a handful of papers for 5 minutes cannot possibly change that stance.
The troubling thought is that in a field as complex and poorly understood as the intersection of virology with immunology at scale in the middle of a pandemic, the Experts are not much more informed than the layperson. I have yet to hear a single Expert showing even a tiny sliver of epistemic humility.
What's the motivation for this sort of thing? It seems the very thing they crave (attention) will invariably bring them undone as attention invites scrutiny.
For one, money. There is an organized group that charges $90 online for hocus-pocus covid medication prescriptions [1]. The more people that can be convinced that this is a worthwhile purchase, the more money they get.
That and politics. The frontline group was also involved in the Hydroxychloroquine debacle, and they were selected specifically by political actors as a pro-trump solution to the pandemic.
With any of these politically connected things, there’s always a mix of grift, political opportunism, and true believers.
>But it got circulated a lot as a preprint to people who didn’t understand the difference between a preprint and a peer reviewed paper.
peer review doesn't really mean as much as most people think and the paper was circulated by people who very well knew the difference and might have been circulating it precisely because of it.
> The major paper that drove most of this situation, and the meta analysis, appears to have been a straight up fraud.
Umm, wat?!
The vast majority of the studies about Ivermectin have been observational, run by front-line clinicians.
Prior to 2020, basically everyone on earth agreed (including the WHO, who STILL agrees) that front-line clinicians and observational studies are excellent signals that can lead to scientific investigations that can lead to medical breakthroughs.
The evidence for IVM as a treatment for covid (and many other viruses) is quite strong.
There is, no, no large-scale RCT for IVM. However, it is inherently obvious that none will happen, none that give it a fair shake.
The entire public health apparatus in the West has a huge desire to treat all illness with only on-patent, new medications.
Do you not thin that this incentive influences what gets into the news?
"In a study demonstrating the in vitro antiviral activity of ivermectin, upon incubation of infected Vero/hSLAM cells with 5 μM ivermectin, there was an approximately 5000-fold reduction of viral RNA by 48 hours in ivermectin treated samples as compared with control. The IC50 of ivermectin was found to be approximately 2.5 μM. Ivermectin seems to act on IMPα/β1 and inhibits the nuclear translocation of SARS-CoV-2 (Caly L et al., 2020). Further in-silico studies are required to confirm this target of ivermectin in SARS-CoV-2. The concentrations of 2.5 and 5 μM correspond to plasma concentrations of 2190 and 4370 ng/mL, respectively. These concentrations are 50–100 times the peak plasma concentration achieved with the 200 μg/kg of ivermectin (the US Food and Drug Administration recommended dose for treatment of onchocerciasis) (Chaccour C et al., 2017). Even with a dose 10 times greater than this dose (i.e., 2000 μg/kg), a peak plasma concentration of only ~250 ng/mL has been achieved (Guzzo CA et al., 2017)."
"On the basis of the rationale above, any significant antiviral activity could not have been achieved with the dose used in the study and the resultant plasma concentration of the administered ivermectin. Thus, although ivermectin, in vitro, is a potent inhibitor of SARS-CoV-2 replication, in vivo, the plasma concentration required to achieve the antiviral effect far exceeds the therapeutically applicable dose."
This thread discusses why the example of Uttar Pradesh's program isn't good evidence.
Later studies have also shown that Vero cells are probably not a good choice for in vitro Covid tests, due to differences in how the virus infects those cells vs. human lung cells.
This appears to be an innocent mistake; vero cells are very popular with virologists because they’re easy to work with and familiar. But unfortunately they are a very poor proxy for testing Covid cures on, given that they’re actually monkey kidney cells. But it’s a shame we’re still headed down this wrong path publicly.
> The entire public health apparatus in the West has a huge desire to treat all illness with only on-patent, new medications.
Dexamethasone is a cheap steroid. (For that matter, vaccines are incredibly cheap and yet nobody seems to have stopped them in favour of, say, monoclonal antibodies.)
> Do you not thin that this incentive influences what gets into the news?
Evidently not terribly much, given that dexamethasone was at least in all the British newspapers.
> Do you think the public health authorities in Uttar Pradesh are lying?
Quite plausibly. UP is perhaps the worst governed state in India and has been under all political parties. The case of Kafeel Khan is rather illustrative.
More to the point, I don’t care whether they’re lying. The whole article is full of vague statements that are hardly a good basis to believe anything about ivermectin.
> The vast majority of the studies about Ivermectin have been observational, run by front-line clinicians.
OK, so weak evidence.
> Prior to 2020, basically everyone on earth agreed (including the WHO, who STILL agrees) that front-line clinicians and observational studies are excellent signals that can lead to scientific investigations that can lead to medical breakthroughs.
Sure-- weak/crappy evidence and practitioner intuition can definitely point at worthwhile things to study rigorously, even if most of what they generate is trash.
> The evidence for IVM as a treatment for covid (and many other viruses) is quite strong.
Given the recent fall from grace of prestigious journals like the Lancet on the Coronavirus evidence, I think it is useful for all of us to remain skeptical and purely science-based.
Calling the investigatory and experiential evidence of thousands of highly-trained doctors (some of whom pioneered the standard of care for covid) as "weak evidence" is something that only somebody carrying water for large pharmaceutical companies would say.
Doctors in my area are prescribing IVM to treat covid because in their experience and that of their peers IT WORKS. They have fewer deaths, fewer complications.
But it's "weak" evidence just because Pfizer didn't sponsor a gigantic RCT to "prove" it.
"The only science is real is expensive science done by large corporations!"
It's weak evidence because COVID-19 observational studies are riddled with confounders due to COVID patients generally throwing everything at it they can to try and stay alive.
The exact same pattern occurred with hydroxychloroquine. Lots of small observational studies showed promise. Then it repeatedly failed large RCTs. It turns out that the people with the resources to use HCQ also had the resources to use other things, things that were actually effective.
Dexamethasone, Remdesivir, and monoclonal antibodies are part of the go to treatments for severe Covid cases. They’re the major exotic bits of what they gave trump when he got sick, along with a bunch of over the counter stuff (zinc, vitamin D, melatonin, etc.) My understanding is that the monoclonal antibodies are the really expensive treatments.
The Dexamethasone one is an interesting story. It started out as a more controversial “throw everything at the wall and see what sticks” solution by a specialist who knew steroids well. Later studies have shown a strong effect on survival, so it’s become a fairly uncontroversial part of the tool kit for severe Covid.
Of course, what made Dexamethasone such a breakthrough wasn't really the drug itself; I think there's some evidence now that other steroids might actually work better. The big breakthrough was that some UK researchers managed to use the fact that the country got hit hard early on in the pandemic to immediately run a bunch of large randomized controlled trials on all the most promising throw-things-at-the-wall treatments to get evidence on which actually worked as soon as possible.
> Calling the investigatory and experiential evidence of thousands of highly-trained doctors (some of whom pioneered the standard of care for covid) as "weak evidence" is something that only somebody carrying water for large pharmaceutical companies would say.
Keep in mind that bleeding with leeches was once the standard of care-- based on clinical intuition and observational evidence.
People-- even very smart, well-educated people-- are easily fooled. There is a reason why the RCT is the gold standard.
The RCT is the gold standard, but observational studies can be sufficient to establish causality when the effect size is large enough with a clear dose response curve. No one has ever conducted an RCT to prove that cigarette smoking causes lung cancer, but we're pretty sure that it does.
> to establish causality when the effect size is large enough with a clear dose response curve.
And when there's some plausible underlying mechanism that can be studied by more rigorous means. Otherwise, observational studies can find correlation, not causation-- and they're not even very robust at that.
No the dose response curve alone can be sufficient. Remember that the FDA has approved multiple SSRI drugs for treating clinical depression despite a lack of understanding on the actual mechanism of action. There are several plausible hypotheses but we really don't know why they work.
A dose response curve in an observational study is irrelevant for establishing causation.
There is a dose-response relationship between umbrellas outside and rainfall., but umbrellas do not cause rainfall.
And the SSRI point is tangential: they were approved based on RCT evidence. Observing umbrella use and concluding it causes rainfall, even though we don't know of a reason why umbrella use would cause rainfall, is quite different.
> "The only science is real is expensive science done by large corporations!"
The only science that's real when it comes to public health is the science done across large enough populations and with enough methodology to rule out many confounding issues.
I considered adding on a coda noting that "costing money" doesn't imply big pharma. But I didn't because I considered it sort of self-evident. Neverthless, you went there anyway.
Agreed, retract all the meta-analyses you want, but never dismiss actual front line results by physicians. If you have a regimen with zero deaths for a disease, I don't think we should be suppressing their clinical data. What a world...
“Zero deaths” should have set off your alarm bells. That’s way too neat of a number for the real world; you only get that kind of result with small sample sizes or fraud.
Even the vaccines, which are very effective, do not have a 0% death rate from infection.
There's possible confounds, but none can explain vaccinated people being fewer than 6% of deaths (my MLE: about 2% of deaths) and more than 50% of the population. Especially since the vaccinated are, overall, a sicker and older population than the country at large.
The vaccine RCTs were not powered sufficiently to show a reduction in COVID death, given that they had no or basically no COVID death in either group. They did show a huge reduction in illness and severe illness, and now we're observing a commensurate reduction in death in the population.
population normalized death incidence is down by 10x in vaccinated over unvaccinated (which includes recovered individuals in with the unvaccinated, so the number compared to susceptible is probably 20x). with a bit over half the population vaccinated that suggests that at least the 100,000 deaths since june would have been twice as bad without vaccinations. not including any effects of vaccination on reducing infection/transmission (and for all the hype about "waning" the protection against infection is still substantial).
That was the trial that only had 40k participants. Adverse effects are so rare, it had to be administered to tens of millions of people to the public at large before just a few showed up.
Was that 20 more dead from thrombosis than would normally be seen in a similar population of that size? Or 20 total? Because my understanding is that it was only a few more than usual.
Your assertion of the financial incentives of on patent vs off patent doesn't make sense for ivermectin.
For one, the company that sells ivermectin in the US (Bayer) does not currently have an alternative covid treatment. They have publicly stayed that they do not believe ivermectin helps against covid. Secondly, an RX of ivermectin (for humans) appears to cost more ($35) than the vaccine ($20). Additionally, the vaccine is already paid for, whether or not people use it, many countries (especially the US) pre-purchased hundreds of millions of vaccine doses.
Given that vaccines are already sold and adding ivermectin is pretty safe and is being added to the cocktail of treatments, already being used, I see no financial incentives for drug companies to discourage it.
If the FDA approves a therapeutics for covid19, then the emergency approval for experimental vaccines is gone. Not only do they lose vaccine mandates with that, but they also lose liability shield. There is a financial incentive to suppress covid19 therapeutics from pharma (and their stockholders).
This is a myth that keeps getting passed around. The FDA actually had more than one therapeutic with eua for covid19 when they created the eua for the vaccine. There is no rule forbidding an EUA for a vaccine if a therapeutic exists.
> I see no financial incentives for drug companies to discourage it.
Then you’re not looking hard enough. You don’t think endless booster shots are an incentive to dismiss Ivermectin? Discouraging Ivermectin means, not billions, but trillions in revenue.
And that’s not even considering the fact that the vaccines could never be legally approved for emergency use if Ivermectin works.
False. The existence of a therapeutic does not block approval of other treatments or vaccines. In fact, there were multiple emergency authorized therapeutics for c19 when the made the eua for the vaccine.
And no one is talking about endless vaccines. We now have a 3rd booster for at-risk populations. It's possibly/likely that if they extend that recommendation to the rest of the population that 3 doses may be all that is needed for long term, strong immunity. Just like there are 3 doses for hep B and several other vaccines.
It's possible, the number of excess deaths in the region over a period (1 July 2020 and 31 March 2021) was measured at 197k compared to other years, but they only reported 4500 covid deaths.
> The entire public health apparatus in the West has a huge desire to treat all illness with only on-patent, new medications.
This and
> The vast majority of the studies about Ivermectin have been observational, run by front-line clinicians.
> Prior to 2020, basically everyone on earth agreed (including the WHO, who STILL agrees) that front-line clinicians and observational studies are excellent signals that can lead to scientific investigations that can lead to medical breakthroughs.
and
> Doctors in my area are prescribing IVM to treat covid because in their experience and that of their peers IT WORKS. They have fewer deaths, fewer complications.
Don't really add up. Best case interpretation of your argument is that you think doctors are split in half - not wholly aligned behind novel treatments - the "throw shit at the wall and see what sticks" group and the "only throw new custom expensive stuff at it" group, but even that doesn't really match what I'm seeing.
A large number of doctors are out there throwing all sorts of things at a new disease because nobody knows what works yet. The data is going to be incredibly messy. One thing that has looked effective in many cases is steroids, very much not new. Other things that looked potentially effective haven't continued to look effective as more studies have been done.
Where's the massive pushback against steroid treatment if this is an institutional greed thing?
It looks to me much more like some people get married to their early hunches and dig in hard when the evidence doesn't pan out.
Throw enough shit at the wall in enough places and all sorts of false leads are going to appear. Some of them getting shot down isn't a conspiracy. It's how we learn.
Yes the quality of scientific research in this area has been rather bad with rushes to publish and ineffective peer review. Drs. Paul Marik and Pierre Kory recently updated their meta analysis to remove the retracted Elgazzar paper, and still found a significant effect. I'm not endorsing their letter, just pointing out that it exists and isn't mentioned in this Nature article.
Looking at the two papers (original, and updated) they only removed the Elgazzer paper but not the contested Shakhsi Niaee also mentioned in the Nature article.
This is noteworthy because it's also the only other RCT to show strong effect on mortality (see Fig3 in the two papers).
Also, the Nature article is concerned that the underlying data isn't sound due to bad randomization and thus naive meta-analysis is inherently flawed in these cases.
Sure that's a good point. But is mortality the appropriate clinical trial endpoint? Mortality rates are already low when following the NIH treatment guidelines, so it would take a large study population to discern any statistically significant effects.
In addition to mortality it probably makes sense to look at other endpoints such as patient reported symptoms, RT PCR test cycle count, and time to hospital discharge. Those should allow us to tell if there is a real effect (or not) with smaller subject groups.
The reported CFR may be in that region, but most credible sources estimate a much lower real CFR, due both to many undetected / asymptomatic infections, and confusion between deaths with & deaths caused by Covid-19. For a statistical reporting agency such as the ABS to claim to know the actual CFR with any level of certainty seems careless at the very least.
The ABS clearly sets out their method for calculating CFR, which is covid deaths divided by confirmed infections.
Yes, that is only a proxy for the overall all infection fatality rate. However, given the contact tracing, testing, and medical systems have been quite robust in Australia, it shouldn't be too far off the mark.
Furthermore, the 3% figure only applies to the population as a whole. According to the ABS, CFR climbs to over 30% for people 80 and over. Similarly, a recent American study found it to be about 21% [1].
So, back to the original point, it should be very easy to find a mortality signal in a RCT, which included that cohort.
> Yes the quality of scientific research in this area has been rather bad with rushes to publish and ineffective peer review
Well, sure, but what else is new? The Ivermectin paper was surely bad, but it wasn't outrageously bad nor unexpectedly so. The mania that resulted isn't, at it's core, about bad science. This won't fix the problem.
> Ivermectin is an antiparasitic medication used to treat various types of worms and similar diseases. It’s pretty safe, widely in use across the world, and in most ways a useful medication to have on hand if you think you’ve been exposed to contaminated human feces, or if you just need to disinfect your sheep.
Ivermectin is an antiparasitic, but it also has well-known antiviral properties too [1] [2] against Dengue Fever & Yellow Fever, to name two.
The fact that Ivermectin is in Standard of Care for several viral diseases, and he is describing it as an anti-parasitic purely, is indicative of something sordid. Either he is ignorant of the literature (unlikely, it is common knowledge and he claims to be an Epidemiologist), he is pushing a narrative (high potential), he doesn't believe the copious amounts of literature on the use of ivermectin as an anti-viral (again, unlikely), he is minimizing mentioning it for editorial reasons (not a chance, he writes long.....), he misread several viral diseases as actually being worm parasite based (not probable), or he is intentionally misinforming his readers.
This is all regardless of a position about whether or not it is an effective antiviral in the case of this specific virus, or should we say, series of variants.
But the larger problem has been the the non-scientific audience running with with things to support their political narrative. If someone from the right infosphere were to promote skinned habanero inserted rectally as a potential prophylactic therapy there would be lawsuits demanding that treatment for people's family members and a furious debate on twitter as to whether habanero or ghost peppers should be used.
Bad science has always been around, you learn how to spot them in grad school. It just now the larger population is learning that bad papers exist.
I take exception with your analogy because Ivermectin is an incredibly safe and well tolerated drug and has been used in humans for decades. If you used Tic Tacs or something it would be a lot more accurate.
While I understand and appreciate skepticism around someone using IvM for COVID as much as anyone, what is shocking is the the outright lies that have been spread by media, including a recent viral story from Rolling Stone that went on to be retweeted by many prominent journalists including Rachel Maddow, all creating millions of impressions based on a complete fabrication.
The whole thing was made up, the Doctor they got the quote from didn't even work there anymore, nor were any of the claims true. What's creating incurable division right now in society are stories like these, many people are getting scared because the media is forcing a single narrative with outright outrageous lies that they clearly want to push.
This letter opens with a defense of the ElGazzar paper, but the analyses published by these researchers strongly suggests that the paper is indefensible and likely a simple fraud. I'm skeptical.
This article also says that another trial that were included in previous meta-analyses should probably also be excluded and once all that's it's unlikely the meta-analysis will show an effect:
As these two papers1,6 were the only studies included in that meta-analysis to demonstrate an independently significant reduction in mortality, the revision will probably show no mortality benefit for ivermectin.
There is a lot of confusion on whether there actually was a significant increase in calls to poison control centers due to ingestion of ivermectin.
This [1] official Mississippi government document says, "At least 70% of the recent calls have been related to ingestion of livestock or animal formulations of ivermectin purchased at livestock supply centers."
But then the AP [2] seemed to say that was incorrect: "The Associated Press erroneously reported based on information provided by the Mississippi Department of Health that 70% of recent calls to the Mississippi Poison Control Center were from people who had ingested ivermectin to try to treat COVID-19. State Epidemiologist Dr. Paul Byers said Wednesday the number of calls to poison control about ivermectin was about 2%. He said of the calls that were about ivermectin, 70% were by people who had ingested the veterinary version of the medicine."
There was an absurd rush to report that ivermectin is bad that resulted in a pretty bad breakdown of the fact checking process. A lot of semi-adjacent facts and statements got merged. A hospital is full and a hospital treated someone for overdose became all the hospitals are filled with overdose victims.
(I think eating horse paste is dumb, but that doesn't excuse rolling stone lying about the consequences of doing so.)
Eating horse paste is a desperate measure taken by people struggling to maintain dominion over their healthcare decisions. Most patients who've taken matters into their own hands and gone yay for the neigh would have much rather taken Ivermectin packaged for humans prescribed by their doctors. That choice has been stolen from patient and doctor alike via bureaucratic action.
The loss of individual bodily autonomy, doctor-patient relationships, and dominion over one's own healthcare is at stake and those won't be easy human rights usurpations to correct.
The truth is that virtually no human has ever had dominion over their healthcare decisions at any time in history. Having that dominion involves both freedom to choose and the understanding and information you need to choose well. Lewis and Clark taking mercury supplements to help with constipation is not them "having dominion over their healthcare decisions", it's them being woefully uninformed. Humanity never had "dominion over nature" until we could build shelters, control fire, cultivate crops, and tame animals -- advancing medicine and seeking the advice of experts is how we might start to attain such a dominion over personal healthcare. The people who demand Ivermectin, or who go for crystal healing or homeopathy, they don't have "dominion" over their own healthcare, they're just ignorant and have been infected with viral disinformation.
I appreciate your comment though I disagree with what seems to be your interpretation of dominion. Good lord I love this board, people actually converse. I upvoted you too, though I take issue with a couple of your points.
I don't believe anyone ever has or ever will have dominion over the outcome of their actions within any domain - regardless of power they may otherwise wield. The only certainty in life is uncertainty after all. So, I don't find the presence of uncertainty an acceptable lower bound. Additionally, believing our contemporary body of medical knowledge is complete to the point where we aren't currently making mistakes tantamount to mercury laxatives seems to me, dangerously hubristic.
Being able to make choices unconstrained by experts and authorities who believe your decisions are wrong, is the essence of freedom and the impetus propelling all forward progress. Free Inquiry demands we embrace others' self-determination and latitude in their decisions, respecting the near certain presence of unknown unknowns.
More average people now are reading scientific literature than ever before, which should be cause for rejoicing. Sadly, we seem to be ignoring that opportunity and abandoning all semblance of rational, data-driven science.
Rather, we're corrupting Science with Religion, skepticism with faith, breaking into factions mutually recognized as heresies. The data are twisted to fit expectations, not dispassionately observed. We're twisting men of science into priests, models into dogma, literature into liturgy, and inquiry into inquisition. We're not going to notice the unknown unknowns until they've already sunk in their fangs and got a mouth full of buttcheek.
> A lot of semi-adjacent facts and statements got merged. A hospital is full and a hospital treated someone for overdose became all the hospitals are filled with overdose victims.
I thought they said gunshot victims weren't getting treated in some podunk tiny town of less than 10k residents, then they plagiarized a photo to add a racial element, using African Americans, then spread the story everywhere?
The sources agree, look at the bullet point above the one you quoted.
• The Mississippi Poison Control Center has received an increasing number of calls from individuals with potential ivermectin exposure taken to treat or prevent COVID-19
infection.
• At least 70% of the recent calls have been related to ingestion of livestock or animal formulations of ivermectin purchased at livestock supply centers.
So, 70% of "calls from individuals with potential ivermectin exposure" were "related to ingestion of livestock or animal formulations of ivermectin", which is what the AP's correction says.
Ah, I see now. "the recent calls" refers only to calls about ivermectin, not ALL recent calls.
Still, the AP misunderstood as well, misreported it, and later issued a correction. Before the correction, it was syndicated by many news outlets like New York Times. I think most people are unaware of the important correction.
#2 is for sure bviously preferable, but Good Luck With That.
Once you get below the top N% in intelligence levels (5%-20% in my experience), the ability to 1) understand any kind of complex systems, 2) read, understand, contextualize and retain data, and maintain any rigorous logical thinking structure (e.g., keeping previously eliminated options eliminated) declines rapidly.
The result is that, despite having absolute record numbers and percentages of people educated with college degrees, we have massive anti-science movements that are literally killing thousands of people daily, by ape-ing scientific-sounding terms & distorting concepts & data in order to more effectively broadcast disinformation - and hordes lap it up.
We even have nurses and healthcare workers, who supposedly have been taught and passed tests on basic germ theory, actively resisting and campaigning against safe and effective public health measures.
A related phenomenon is that college degrees are systematically being degraded. I personally know someone who was a visiting professor at a US State University, teaching introductory economics. He found that many of the students didn't even have the math skills (or motivation) to understand and wield the basic concepts on assignments, classroom discussion, and tests, and of course he was recommending them to remedial options and failing them. He was explicitly ordered by the administration to pass them or quit. He quit.
Sadly, it is looking more and more like this great experiment in college for all is not working out as hoped. Instead of a culture of wisdom, we have a culture of sophomores - literally wise fools, who know very little, but think they know it all, and therefore don't have to listen to any expert who actually has real knowledge.
It is considered obvious that at 5'6"/168cm, I was not born with the attributes necessary to engage in a professional basketball career. Yet the same kind of sorting based on intelligence is considered something to not discuss, perhaps getting too close to eugenics.
I strongly believe that the opportunity should exist for any person to get whatever level education they want, without financial or other obstacles. But, with the caveat that it cannot be dumbed-down - either you can understand and do the work and pass, or you do not. The practices seen above, and grade inflation in general need to be reset. The problem is that failing your students is bad for business, so unlikely that most colleges will reform.
People at my state university would occasionally toss out the catchphrase "Ds get degrees!". It made me sad. I agree at minimum more people need to fail classes. If you want to be nice, counter by allowing more attempts.
I like it but the proposal either needs to be more persuasive toward universities' limitations or those institutions need to be allowed to fail and be replaced with something more aligned with a university's mission.
Generally, universities are insolvent, being propped up by infinite government-backed loans leveraged against students' future earnings. In turn faced with an endless supply of funding, they've become wastrels and signed up for too many bills which they must cover by incessantly demanding more funding from debtor students. The model created a feedback loop that most universities will find terminal once policy changes out of necessity.
I'm afraid they will likely only hear "retake classes infinitely" as booting students severs revenue. Failing students however, makes that revenue renewable. Corruption is cancer both financially and morally.
Is there any evidence that intelligence is genetic? I dont think your height was stopping you from getting to the NBA, nor is that even remotely obvious. You may find your height to be discouraging, but you could have very well possessed the potential to play professional basketball. You'd be 3 inches taller than Muggsy Bouges who played for 14 seasons, 1 inch taller than 13 year vet Earl Boykins, and the same height as slam dunk contest champion Spud Webb.
Colleges might be letting more people through, but I dont think people are any dumber. Some people just aren't concerned with understanding everything they come across. Some kids go to college for no other reason than that's what they're supposed to do. If they cared they would be able to learn just as much as you or anyone else.
Society isn't ready to watch science any other way either. Media outlets routinely take individual studies and vastly inflate their results. I suppose it's better if the study is peer reviewed, but not much.
And "science" wasn't prepared to display "science" to the public in real time. Instead of we have paywalls, twitter arguments, and media trying to report on scientific studies they don't understand.
And yet the Authors of this letter fail to address the most cited meta-analyses (by Dr Lawrie). She's publicly stated the removing the Elgazzar data did effect her numbers, but not the conclusion. Also, if you read the paper she downgrades the Niaee data for several potential biases.
The lesson of ivermectin: a lot of medical studies that go uncriticized because they're less controversial probably have problems similar to the problems of the retracted Elgazzar study and the other studies mentioned. Why else would these people think they would get away with it?
The studies on ivermectin seem to be split between "good effect" and "no effect," and there don't seem to be any (by my extremely informal review! going off of memory here) in the camp of "bad effect."
Seems reasonable to take ivermectin as a decent gamble to me while we wait on the dang science to get its head out of its butt.
Ethical researchers will prematurely stop and publish a "no effect" result for any medicine that has bad effects. That is, unless the effects are so bad that they can't stop fast enough, and they get to measure a statistically relevant harm.
Thus seeing "no effect" places an upper bound on how good an effect you will see as "none", and a lower bound as "won't kill most people quickly". That's not a good space to gamble into.
It took almost an year until the scientific community settled down that HQC for treating COVID-19 is harmful. The actual formal result is still "no effect and doing more studies is anti-ethical" because nobody can tell exactly how harmful it is. Probably nobody will ever be able to tell (and that's a good thing).
We did this last year with hydroxychloroquine...all that happened was that some Lupus patients had a hard time getting their normal prescriptions filled.
The "bad effect" doesn't have to be strictly medical, and may not show up in studies. It could be that other people who need the medicine can't get it, it could be that it discourages people from getting the vaccine, it could just be that we are lighting a pile of money on fire for no reasons (that's bad, right?).
There is not really a limited supply of this old, cheap, generic medication that we routinely feed to livestock.
If you are concerned about wasting money, consider that for one dose of (also unproven!) medication like convalescent plasma you could buy about a thousand doses of generic, cheap drugs like ivermectin. And that has been tried about 500000 times, still is unproven but is not considered controversial.
Sorry, it was your argument that the small pile of money was a large pile of money. Which it isn’t. And ‘lighting on fire’? Do you also step on the barricades when people waste their own money on homeopathic ‘medicine’?
I mean, yes, I do think homeopathic medicine is a net negative on society, and I complain about it as/when necessary. And I don't see the word "large" in front of "pile of money" in my above comment...
If you really do go around complaining about people taking expensive water because they think it helps them with their health problems perhaps you should try minding your own business a bit more. I’m sure there’s plenty of things to improve in yourself before you start pointing out other peoples problems.
The only reason one would be taking iver prophylactically, is because one wasn't vaccinated. And the only reason to take iver after covid symptoms develop is because you didn't take the vaccine.
If one was vaccinated and are feeling sick enough to take iver, she would be better off with oxygen and hospital SOC.
It seems like you're just saying you don't believe ivermectin works? That's fine and likely correct, but logically it's completely unrelated to its mutual exclusivity to the vaccine.
For instance, if you get tetanus after having the vaccine, you'll still be given antibiotics. If someday ivermectin is proven to have a positive effect against Covid, we won't withhold it from vaccinated patients.
The vaccines are not sterilizing, which means they do not stop you from catching or spreading the virus. It seems to me that any drug that is actually a prophylactic for covid would be a massive improvement.
Poison control center calls are not poisonings. There were no significant increases in hospitalizations due to ivermectin. It's a fear-mongering article.
The reasonable thing is get vaccinated immediately. You could also stick chili peppers in your butt, that probably won't hurt either. It has as much ability to help as horse dewormer.
Calling it horse dewormer is either propaganda, or just a plain bad faith argument. The inventors of this drug won a Nobel prize for the discovery and it’s use in humans. It’s recognized as an essential drug.
But people are purchasing the horse version. What is the conversion between a 50 mg tables and a tube of paste for a 1200 lb animal? By using the wrong formulation you run the risk of liver damage due to an overdose of ivermectin.
That's a straw man. These people are of course doing something dangerous but mainstream newspapers are routinely calling doctor prescribed Ivermectin 'horse dewormer'. Both 'camps' treatment of this subject has been a real low water mark and it looks like the science might be as well.
"Reasonable" based on what risk/effect-analysis? For what age group? I don't know how many 60 year olds browse HN but I'm not going to take either experimental treatment for a disease I don't even have any reason being scared of, based on the actual data we have. The more hysterical part of society can argue about this and inject themselves with whatever they like for all I care, just leave the rest of us out of it. Not everyone wants to live in fear and under dystopian rights restrictions.
I would like to meet you in a casino. Type "Invermectin side effects" into any search engine, read the links. These are "bad effects".
The fraudulent studies (y'know, including dead patients, patients that never existed, drugs that weren't administered and so on) have shown a good effect.
You need a better argument than that to convince somebody to never gamble lol. Remember, it was also a gamble to trust the WHO not to use masks early in the pandemic. We are making gambles everyday.
>trust the WHO not to use masks early in the pandemic
That one was a very interesting story. The best informed people made rational decisions to mask up, semi informed believed the bad advice to do without, the least informed acted randomly.
Studies are irrelevant at this point, when we have population level data of over a billion people across India and Africa, and the massive disparities between states/countries that utilized Ivermectin, and those that did not. The drug is safe enough to be used based on this data alone.
If you are fixated on conspiracy claims against your amazing scientific discovery - pretty much you are always wrong, that's true for perpetual motion machines, faster than light drives (that's the one I hope could be right), extra-ordinary life extensions for microbes applies to humans (wish that one could be right), and covid. If you use opinion columns from obscure news sources to prove you are right, almost always wrong too.
Ivermectin is safe enough to take, the important question is does it do any good against covid. At best it doesn't hurt you and it's unclear, but probably does nothing. It's certain there is no international pharmaceutical conspiracy trying to block discussion of it. That's different than trying to avoid showing incorrect medical information to people during a worldwide medical emergency. The hospitals in my state are full of idiotic non-vaxed covid victims. The latest thing is a conspiracy that the hospital won't treat them with ivermectin because they want them to die.
People are just killing themselves because of their bizarre and irrational resistance to safe, life-saving vaccinations and preference for random spoutings on the internet to research proven treatments. Do people challenge their math professors in college because they don't consult fox news for the truth? No. I don't have much hope for our future when we can't get these simple things right. It's like a new dark ages has come upon us. But the truth is we humans were always this foolish.
If you don't know how citations and data work and are incapable of following them, even in an "opinion" piece, that's your problem.
>Safe and effective...
Every day that becomes more untrue in highly vaccinated populations like the UK and Israel, whose hospitals and morgues are full of vaccinated people.
There is substantial risk when it comes to mass vaccination in the middle of a pandemic as well, especially with highly infectious and rapidly mutating viruses, coupled with vaccines that are extremely ineffective at preventing spread.
So will you refuse to go to the hospital if you get covid - because they aren't following the same sources of what is effective treatment that you do? If you break your leg or have a heart attack will you study up or go to alternative places for treatment? I suspect you would go to the hospital in those cases, because people are only convinced that in this one instance there's a giant lie or something.
I won't need to go to the hospital because I have natural immunity from an infection that was so mild I'm not even sure when I had it.
False equivalence. The treatment methods for heart attack and broken legs have a long history and wealth of data. I gladly take every other vaccine for the same reasons.
They are not reliant on brand new techniques for which no long term testing or data exist against a threat that has repeatedly resisted vaccination with disastrous results historically. They are also not treatments propped up by singular hundred billion dollar companies who have a massive interest in their product being pushed as the only effective prophylactic. Companies that are set to make $30-50 billion, and also happen to be some of the largest lobbyists in the world.
Would you accept Ivermectin as a treatment prescribed by your doctor in India or Japan?
It is possible that anti-parasitic action is what causes those disparities -- if parasites are widespread and cause complications with covid, then treating whole population with an anti-parasitic drug would improve outcomes.
So India and Africa should absolutely keep using IVM.
In high latitudes similar effect could possibly be had with treating everybody with vitamin D.
Unfortunately the current zeitgeist is to send you home with nothing to wait till your lips turn blue.
is that right, if I see my Dr and test positive for covid I get sent home to rest up much like if I had came in with a cold? I think even with the cold they have some sort of medications like cough medicine etc, do they lend no home treatment instructions for those ill with covid?
At this point, news articles should include a bar chart for health interventions, including a three year projection of vendor revenue, tax costs, quality-adjusted life years, societal collateral damage, and risks based on prior usage.
When one option has billions of revenue at stake, investors will pay for more/focused studies vs an option to reuse low-cost generics. Unfortunately, or fortunately, desperate humans have skipped trials of both vaccines and early treatments, so there is data on both.
>Overall, we rate The Desert Review Right-Center Biased and Questionable based on the frequent promotion of pseudoscience, conspiracy theories, and misinformation regarding covid-19.
>Regarding Ivermectin, The Desert Review covers it extensively to the point where you would think this is an Ivermectin promotion source. Perhaps it is as nearly every article talks about the positive virtues of Ivermectin such as this Gaslighting Ivermectin, vaccines and the pandemic for profit and this The great Ivermectin deworming hoax. Many pro-Ivermectin opinion articles are written by Justus R. Hope, MD., who admits this name is a pseudonym underneath the articles he writes.
How does the current field of studies compare to Remdesivir? Remdesivir is a repurposed antiviral (originally designed for Ebola) with fairly low efficacy, and very severe side effects, and it breezed through FDA emergency authorization. I don't understand why it seems that the bar is set so low for Remdesivir, but so high for Ivermectin.
>How does the current field of studies compare to Remdesivir?
Remdesivir has three randomised controlled trials all of which indicate statistically significant effects, and there don't seem to be any credible challenges to these trials results. Currently given the concerns about the irregularities in the data in it's existing trials, Ivermectin has none.
It's not that simple. For example, a protease inhibitor could have effects on biological functions that exist in viral and parasitic infections. And both Remdesivir and Ivermectin [1] have been observed to have antiviral properties in vitro.
I hadn’t seen that paper, but isn’t your statement missing the forest for the trees? If pathology was attenuated, that would help patient recovery, even if viral load wasn’t directly reduced.
> Even though ivermectin had no effect on viral load, SARS-Cov-2-associated pathology was greatly attenuated. IVM had a sex-dependent and compartmentalized immunomodulatory effect, preventing clinical deterioration and reducing olfactory deficit in infected animals. Importantly, ivermectin dramatically reduced the Il-6/Il-10 ratio in lung tissue, which likely accounts for the more favorable clinical presentation in treated animals. Our data support IVM as a promising anti-COVID-19 drug candidate.
Yes, it seemed like it worked in hamsters, but as we well know, most drugs that work in mice don't work in humans. Besides, we already have many anti-inflammatory drugs that can reduce the cytokines, so it's a stretch to use ivermectin strictly as a steroid.
However, I've also heard there's a new study coming out from Gilead that demonstrates Remdesivir is highly effective when administered in early treatment.
So perhaps the efficacy depends when treatment is given. And if that's the case, then meta-studies actually become very important, because they can reveal hidden factors like dosage, demographic, when to administer treatment, etc.
The problem with Remdesivir is that it's often administered way, way too late. If someone's oxygen is at <90% and they're about to need a ventilator, there's already so much viruses in their system, so much inflammation, and so much cell death that stopping new viral reproduction is too little, too late.
Mind that this is correspondence, not a peer reviewed paper.
For what is worth most meta-study will check if they reach the same results leaving-n out (typically one), but I agree that they could do much better accessing the underlying data itself.
With all the criticism of the mRNA and other COVID vaccines, which actually do have science backing them up, what is the science that would make ivermectin actually work? It's an antiparasitic drug. I see a lot of criticism of the COVID vaccines, especially from the right, but then they are fine taking hydroxychloroquine or ivermectin if there is any glimmer of hope that they will work. I just don't get it. Maybe, just maybe, it's not all some big conspiracy, and the vaccines were actually designed to help people? Is that so far fetched? Doesn't taking something random like hydroxychloroquine or ivermectin seem more far fetched? It does to me.
Here is an article from May 2020 about 15 drugs [1], including hydroxychloroquine and ivermectin, that were being looked into to see if they might help COVID. It goes into the mechanisms that led researchers to believe they were worth looking at.
I really don't want to go back rehashing the point as to why it doesn't work, mainly because finding all of the references again and double checking the wording to make sure it matches the literature is rather time consuming...
I'm not saying they do work. I just appreciated the reference and thought it was interesting to read through. I am pro-vaccine and think that is the most effective course of action. Anyway, thanks for the link to your other post.
Something being designed to help people doesn't make it good. There's reason to believe vaccinating using a non-sterilizing vaccine during a pandemic exerts an evolutionary pressure on the virus that will lead to the vaccine becoming ineffective and the the virus endemic. Considering the current effectiveness of the vaccines a fully vaccinated population will be worse off than a fully recovered population (though the population that did not recover may find this rather morbid). See natural immunity vs vaccine-induced immunity research in Israel.
It's a lot harder to say how a fully vaccinated population will fare compared to a fully unvaccinated population. In the short term the unvaccinated population will certainly fare worse (more sick, more dead), but at a population level they will develop a stronger, longer lasting immunity and exert no mono-directional pressure. While in the fully vaccinated population, as long as the R0 is over 1 (which looks to be the case) the virus will be driven towards escape variants, it might not matter how many more people remain asymptomatic or how many fewer people die when new variants keep driving the pandemic forward and render the vaccines ineffective. It's population-level immunity that ends pandemics, immunity works very different on a population level than on an individual level.
Rather ironically if it turns out that this is indeed the case, then the people getting the vaccine are the "selfish" ones (protecting themselves short term from serious disease/death at the long term cost of the wider population) rather than the ones refusing the vaccine. Of course that's not entirely fair because people are doing it with the best of intentions and not out of "selfishness". I'm pointing this out more to demonstrate that things just aren't as simple as the media likes to portray it, i.e. with the non-vaccinated as the "selfish" ones.
If it turns out that vaccination campaigns do indeed do more harm to the population long-term than good (something we'll likely only know for certain after the pandemic is over or, more likely at this point, has become endemic), then medicine such as Ivermectin, even if only marginally effective at combating COVID starts to look a lot more interesting because it does not exert those same pressures on the virus.
There's several other ways the vaccines could end up hurting us in the long term, such OAS (Original Antigenic Sin) or ADE (Anti-body Dependent Enhancement), although it's looking really good on those fronts right now so I'm not worried about those.
The discourse going on at the moment on in general is really cancerous (even on HN sadly). As much as I find people who believe that there is no virus, or that vaccines are made to kill people, or following health advice from random internet sensations to be ridiculous, I find myself far more worried by the lack of intelligent discussion and the instant demonization and name-calling of anyone who asks questions that are critical of the vaccination campaigns. A large part of that I think is that the anti-vaxxers have been given so much media-attention (negative) that people assume anyone putting forward critical opinions "must be one those" and can be dismissed without notice.
No one knows what time will tell. Maybe this only has a one-in-a-thousand chance of ending up being the case. But I think it would be wise for people pushing for mandates to think about how society will look back at the COVID19 pandemic in say 50 years, if it turns out that the vaccination campaigns had a net-negative long-term effect. Is that really a risk we are willing to take? My take is that it would be wise to keep safe in any way we can: mask up, disinfect, get sun, keep fit, socialize responsibly, etc. And to avoid radical action before the science is settled, and vaccine mandates are radical. Science has a long history of settling on wrong for a while before getting it right, let's give it some time.
It's 2021, some 40 years since the eradication of smallpox and nearing the eradication of measles, the latter absurdly contagious on a level much higher than COVID ever was.
But what's that? "anshorei" on HN wants us to stop vaccines, cause clearly that will just cause a super mutation to evolve?
If you believe that, you might just jump off a bridge right now. Because if it's not a COVID mutation, it will just be another virus evolving. They evolve every day! Evolutions big random number generator never stops! Theres a cell multiplying in your body right now, chances are it might just turn into cancer! Is that a risk you are willing to take?
I appreciate your answer and agree that in general it's good to keep safe in any we can, including the things you mentioned. I also agree that the discussion is quite polarized, however, at this point I tend to think the vaccine benefits outweigh the cons.
I'm wondering, at what point, if ever, would you decide that the COVID vaccines are safe / worth it? Honest question.
Also, as someone else mentioned here [1], isn't natural immunity plus vaccine-induced immunity considered even better than natural immunity alone? I haven't fact checked this but they said that was also found from one of the Israel studies. Based on this, wouldn't it still make sense to get the vaccine?
You also mentioned the media. Isn't it possible that conservative media is also manipulating the truth for their narrative? 90% of Fox News staff is vaccinated and yet they still cast doubt on the vaccine [2]. Also, Tucker Carlson won't say if he's been vaccinated or not [3], yet he's one of the big proponents telling people not to get vaccinated. I hear this criticism that the media is spreading misinformation, but it seems like if that's the case, we should consider that it could be happening on both sides.
You would need to have a variant that selects past all of the epitope coverage of both B/T-cell and bypasses affinity maturation too. NTD and RBD already has great coverage, but the rest of the pre-fusion spike confirmation used in vaccines these days has even more coverage than just with RBD alone. I think that's why BNT162b1 failed, as it was a mRNA encoded receptor binding domain only.
Given how large the breadth (as in epitope coverage) already is in RBD alone, you would most likely disrupt ACE2 receptor binding too at the same time if there was a such a massive change all at once to render a vaccine useless.
If you managed to achieve an evolution rate of 250+ AA substitutions extremely quickly, all in one fell swoop, I’d have much much bigger concerns.
A lot of the variants these days select for escape for RBD class 1 and 2 nAbs, even Mu as of now (R346K is in this weird overlap between the different classes as per the Barnes classification).
Viral evolution may have different _mechanisms_ then antibiotic evolution (which is what you go on to post about) but this does not mean it does not have similar _dynamics_, i.e patterns of growth.
The vaccines are suitable for the vulnerable - older with comorbidities. Vaccinating the entire population with a leaky vaccine and a virus that can shift and live in animal reservoirs is a recipe to breed more dangerous variants.
The question of whether ivermectin treats Covid19 in humans is utterly independent of vaccines, HCQ, the state of modern science, whether ivermectin treats other diseases, ivermectin's use in animals, politics, any corrupt ivermectin studies (if you ignore them), and the price of cheese on the moon.
I have learned there are many idiots among us. Many, many idiots.
What I find almost more interesting than the article itself is the comments that show a non-zero portion of the HN community (which I think is generally more intellectually curious and educated than average) are actually strongly arguing that ivermectin has strong effect, and even crazier, that it may be safer or more effective than the mRNA vaccines.
Is this from being incapable of following science and drawing rational conclusions? Or is it more of a tribal thing, where they are exposed to a biased subset of information/misinformation, and are now emotionally invested in the success of ivermectin because their tribe is?
Either way, like someone else in the comments said, these past 2 years have shown us that laypeople are incapable of following active science in real time and drawing reasoned conclusions. Frankly, this is probably true of everyone who is not an expert in the field in question. We need organizations like the CDC and FDA to be much better about their messaging (remember the no-mask debacle? Great way to lose credibility, guys and gals), and we need much better tools to shut down the spread and weaponization of misinformation from the anti-vax crowd et al. I honestly don’t have any idea of how either of those get fixed, however.
I really think covid has broken hacker news. Maybe it’s instructive. It’s the most interesting tech story of the decade. I want to know everything about how the virus works, how we can fight back, what new ideas are out there, etc. for a community that loves articles that require thinking, it should be great.
Instead, covid threads are awful. Comments which are pure drivel and talking points are the norm. Politics has infested and rotted our brains.
So with ivermectin, it’s as I was with HCQ or Vitamin D: I’m open minded and intrigued. I want to read the studies, especially the theoretical ones. Let me watch things develop and let medicine take it to patients if the science gets there. But you can’t do that when every other comment is weaponized to the point where people are scarred to read articles because they might contradict their dogma.
I am sleep-deprived and just caught myself reading this comment thread.
I've been avoiding HN threads about the COVID like I avoid any scaremongering ones on Reddit: it's just a massive pile of people that think they know better than most spreading constant misinformation.
The worst thing about the pandemic is it has made the vast majority of the populace an expert in epidemiology, biological containment, sociology, politics, economy, virology. Everyone has an opinion to share about it. Everyone has something to say about it.
In a forum where most people are technically-minded, this creates the negative and odious version of nerd sniping. Nerds talking out of their arse about stuff way over their head.
I don't like calling for censorship, but I wish dang would demote and let any COVID-related post slide off the front page 10x as fast as any normal thread. They did it for Bitcoin, and frankly it was not such a shitshow.
I could change every assumption in this comment to the opposite and it would make just as much or little sense.
You can’t pretend to be searching for truth if your solution to the problem of people making mistakes is to shut down any possible way to discuss the disagreement. I just find the cognitive dissonance on display here staggering. How do you you know you’re right? Have you ever been wrong? I suppose you knew at the time that you were wrong? Or maybe you just know that this time you’re right?
I am not arguing that I know anything to be right or wrong - I am not an epidemiologist or an infectious disease expert, or a doctor. I explicitly said that us non-experts are not able to verify these things on our own. I am saying that those communities of experts have decided that the question of ivermectin’s effectiveness is effectively settled. There are of course experts that disagree - there always are (I work in physics and we can’t even get 100% agreement on the standard model, for instance). But the group consensus of experts, supported by the scientific evidence, is that it either does not work, or the effect is small enough that it is not worth the risk - this is coming from acquaintances who work in infectious disease and medical research who have been working on Covid, who are part of that community.
I also never said shut down disagreement. That’s a straw man you created. Anti-vax is not a good-intentioned disagreement with sound scientific merit, it is a pseudo-science movement that actively and knowingly disregards the truth. Scientific freedom and discussion is important. Allowing pseudoscience to flourish under some strange argument that their positions are as scientifically valid as actual science, is, frankly, nonsense.
> I am saying that those communities of experts have decided that the question of ivermectin’s effectiveness is effectively settled.
Trials[1] don't tend to be run on settled science, so it really does seem that you've taken a position based on political arguments.
> I also never said shut down disagreement. That’s a straw man you created. Anti-vax is not a good-intentioned disagreement
You've said to shut down disagreement based on a standard that requires mind reading. How is that effectively any different from shutting down disagreement? That old Chomsky quote about Stalin being for free speech he agreed with come to mind.
> Allowing pseudoscience to flourish under some strange argument that their positions are as scientifically valid as actual science, is, frankly, nonsense.
This is an actual straw man, by the way, the comment you're replying to made no such faulty conflation.
Since mind reading is back in fashion I will do some clairvoyancy and predict that I will be labelled anti-vaxx for defending the mere possibility of disagreement and dissent. Now there's a problem with a non-zero number of the HN community you should be concerned about.
You've confused science with politics. There is no scientific consensus on whether ivermectin is an effective treatment for covid. The people claiming this are engaging in politics. There is a consensus that people should not use ivermectin (or any medicine) except as directed by a doctor and not until there is extremely good clinical evidence for its efficacy. But that doesn't imply that ivermectin isn't effective, just that we don't know.
Comparing ivermectin's supposed anti-viral properties to the the standard model or vaccines is absurd.
Ivermectin was suspicious from the beginning, not just because it was promoted by the same people with the same the-FDA-doesn’t-want-you-to-know-drivel. By this point, it’s ridiculous. And, yes, you can switch it around in the comment and it’d make just as much sense. If, that is, you also switch reality.
> and even crazier, that it may be safer or more effective than the mRNA vaccines
It is definitely safer according to the literature
VAERS, even with its data quality issues, is tracking ~7600 deaths from COVID vaccines in the US. VAERS is widely alleged to have large factors of undercounting [1] around vaccine deaths & injuries
> Adverse events from drugs and vaccines are common, but underreported. Although 25% of
ambulatory patients experience an adverse drug event, less than 0.3% of all adverse drug events
and 1-13% of serious events are reported to the Food and Drug Administration (FDA).
Likewise, fewer than 1% of vaccine adverse events are reported. [2]
If VAERS only has 1%, 5%, or 10% of actuals, things are going to get much worse.
However, despite the skyrocketing counts of pericarditis and myocarditis among young men in particular, they are still pushing vaxxes for the youngest that have the lowest death rates from covid.
Really, this is becoming a medical ethics issue of coercion and a violation of Due No Harm.
Your post is assuming a lot of this science is "settled". I don't think science is settled - especially in this field. Acknowledging that your own statements may be incorrect might help you down the path to figuring out a fix.
Hint: as soon as you know you're right, and you make statements based on that, when you're inevitably wrong (not saying this in a disparaging way - making sense and being right through all this is nearly impossible), you will lose all trust.
Settled is a strong claim, but as far as I’m aware (I have many connections amongst the medical and epidemiological communities), the general consensus is that ivermectin does not work. For instance, the FDA, WHO, the AMA, the American Pharmacists Association, and the American Society of Health-System Pharmacists all say it should not be used outside of clinical trials because there is no good evidence for it, and even Merck, the manufacturer, specifically states it should not be used for COVID at all.
I’m not saying no discourse or testing should happen. I’m a scientist, I believe scientific freedom, and of course, that includes a lot of disagreements. But those disagreements happen in the scientific community, not in the general public. What’s happening in the general public is not at all connected to what’s happening in the research.
Instead, I’m interested in how these “treatments” with no strong evidence are getting weaponized by motivated agents (like the anti-vax crowd) to sow distrust both in scientific organizations (the CDC, and the FDA, Pfizer, Moderna, et al), and in the use of tools with proven effectiveness, like the vaccines themselves.
>Instead, I’m interested in how these “treatments” with no strong evidence are getting weaponized by motivated agents (like the anti-vax crowd) to sow distrust both in scientific organizations (the CDC, and the FDA, Pfizer, Moderna, et al), and in the use of tools with proven effectiveness, like the vaccines themselves.
In this polarized environment CDC/FDA/WHO/AMA are political organizations first and authoritative ones second. The conflict of interest here is legitimate and the loss of their authority with the public is in great part their own doing.
Sorry what is the conflict of interest in offering the most accurate information they can?
Even discarding whether we drill into the issues with the relatively small body of ivermectin studies, for or against. There isn’t anything approaching a consensus there.
On the other hand what does have a consensus is that the vaccines work.
Recommending the best possible action is pretty clear and obvious. Using ivermectin as a prophylactic isn’t close to settled and even if it did have a positive result that doesn’t necessarily make it as effective as the vaccines. Nor is it as reasonable a treatment regimen.
As far as actually treating active/severe COVID cases we do have verifiable and working treatment mechanisms. Let’s just actually use what we know works. Makes more sense for everyone.
I’m all for having more, and better studies don on ivermectin. But this is absurd.
The loss of authority with the public is certainly about politics. But it is very obviously a political action being taken upon them, rather than one they’ve put out themselves. They have been politicized, as have many things in recent history for outside political gain.
I have some pretty serious issues with the FDA around many aspects of policy but unless you actually believe (and maybe you do I don’t know) that the vaccines are harmful ( in which case nobody can dissuade you no matter what), then the current advice is pretty obvious and clear cut.
Ideally ivermectin would show a clinical benefit because the best ways we have to treat an active/severe case are very expensive (Remdesivir/monoclonal antibodies) are unlikely to trickle out to most of the world.
>Sorry what is the conflict of interest in offering the most accurate information they can?
* When Fauci was telling people masks aren't needed was he speaking as a scientific authority giving "most accurate information" or was he speaking as a bureaucrat concerned about ppp availability for hospitals?
* When WHO goes against the booster shot narrative is it because of the science or is it because they want vaccines distributed to other parts of the world?
* When these organizations were casting doubt and even CENSORING the Wuhan lab origin theory is it because of the science or because of potential gain of function research and their association?
These "authorities" have chosen to act as political bureaucrats first and they have done it poorly. This is the result.
Decisions have to be made and in the early days surrounding the pandemic PPE for hospitals is an important thing to have. If that is the motivation that is quite literally a medical and health authority decision and also valid. Information in hindsight change things. Triage isn’t politics. You can disagree but I think calling it playing politics is pretty absurd.
Re: Booster shots
So which health authority here then is acting as a political agent? Kind of muddies your perspective. Regardless all authorities don’t explicitly have to agree to be offering good advice. Do we expect everyone to have the right answer all the time? There are also competing interest here. Makes sense for WHO to prefer vaccination go wide. Also makes sense for the US to work to protect its citizens as much as possible, potentially at the expense of the rest of the globe. Does one do more good than the other? How do you quantify that result objectively?
Nothing about the wuhan lab origin is particularly relevant or important as far as the issues of treatment go. I agree this is an entirely political issue, but it is also divorced from what has become politicized as far as COVID treatment and vaccines.
I think it’s a bad faith argument to say the majority of the `political` aspects of the pandemic response are a result of health authorities losing trust because they are acting as political agents.
The counter narrative (if you want to call it that, I don’t know what would be the best thing to call it really) of anti-vax, anti-mask, and alternative (unproven) treatments is decades in the making of a general trend that I do agree is (From an American perspective) a general lack of faith in government. But I also think that a lot of that is political in its inception. And surrounding COVID especially, these are the ideas being amplified by mainstream political figures in an unprecedented way.
There have always been people skeptical of the government. There have always been antivax people. But the flames that are fanning these, especially now are explicitly being done so by political elements for their own personal political gain.
There is barely any defensible basis for the majority of the backlash here. It’s would be kind of funny if it wasn’t so depressing.
You’ve got military personnel making grandiose statements against their vaccine requirements. All of them got several when they enlisted, and there was no issue then for some reason. The anthrax vaccine really did have some major issues (identified pretty much immediately when it was rolled out) but we didn’t have this kind of narrative about it then.
Ultimately this really just reinforces the `politics` aspect to me.
Are there valid areas of debate to have on pandemic response? Absolutely.
Do some of them have political implications? (Boosters)? Sure
Does rejecting (especially) vaccines and masks in spite of the quantifiable data about their efficacy make sense? No.
Does advocating the use of debatably useful substances as an alternative because you’ve chosen to ignore what we do know (for political reasons, in this case your personal politics) make sense? No.
People are allowing their personal politics to override something that isn’t political. The politics are largely coming from outside, especially about pandemic response.
>Triage isn’t politics. You can disagree but I think calling it playing politics is pretty absurd.
You would call it "giving most accurate information" which is technically true but in a legalese sense. Not in a building trust with society sense.
>Nothing about the wuhan lab origin is particularly relevant or important as far as the issues of treatment go. I agree this is an entirely political issue, but it is also divorced from what has become politicized as far as COVID treatment and vaccines.
It's relevant to the issue of being a trustworthy authority figure. The response of the government/media was to censor this narrative while Fauci was internally exchanging emails about it. Not only did it set a new precedent but it was for questionable reasons because like you say they are orthogonal issues from perspective of finding scientific solutions. In other words they squandered the trust of the people for completely political reasons.
>There have always been people skeptical of the government. There have always been antivax people. But the flames that are fanning these, especially now are explicitly being done so by political elements for their own personal political gain.
We are passed that point. We are at a point where many bureaucrats feel justified operating in "post-truth" worldviews. They have gone from reacting to bad faith actors to themselves being part of the systemic problem.
>Does rejecting (especially) vaccines and masks in spite of the quantifiable data about their efficacy make sense? No.
In the context of both parties using the pandemic as a wedge issue for their own causes. In the context of all the doubt medical institutions have generated for themselves. It's not a surprising outcome on the social level.
> but as far as I’m aware (I have many connections amongst the medical and epidemiological communities), the general consensus is that ivermectin does not work.
> For instance, the FDA, WHO, the AMA, the American Pharmacists Association, and the American Society of Health-System Pharmacists all say it should not be used outside of clinical trials because there is no good evidence for it
These two statements don't mean the same thing. The stance for the FDA in particular is not "does not work" but is "we don't know (trials are ongoing), so we don't recommend it".
Are these the same organizations that told us we don't need a mask?
Are these the same organizations that said that controls on international and local travel were not needed?
Are these the same organizations now pushing N95 masks for health workers?
Are these the same organizations that were funding gain-of-function chimeric coronavirus research in Wuhan China?
Are these the same organizations that distanced themselves from a vaccine mandate, now in favor of them?
Are these the same organizations that failed to put out treatment guides for outpatient & inpatient care for COVID, but when they did, eventually, liberally plagiarized from the very doctors they attacked?
It’s because on this website there is a huge number of people that just drink whatever is the kool-aid du jour that goes around in the right side disinformation circles and social networks.
Imagine to oppose a perfectly safe vaccine that has been administered 6 BILLION times all around the world and that has a proven efficacy of at least one order of magnitude against delta variant and to push for a horse dewormer (that bear in mind it’s perfectly effective for what is used for.. killing parasites, not viruses)
I think it’s because a lot of the HN demographic has quite a big overlap with the people that use social networks where all this bullshit originates and it is amplified and it spreads.
I hate to weigh in here, but nothing is "perfectly safe"! This kind of absolute language seems to create distrust when people discover it's not quite true.
At this stage, the safety is fairly quantifiable, too: https://www.publichealthontario.ca/en/health-topics/immuniza... has a weekly adverse effects report which breaks down myocarditis/pericarditis by sex and age, per million population (the most common dangerous side effect for mRNA vaccines).
I see this a lot and it's very strange to see super smart people such as yourself conflate <number of people> with <time>. We cannot observe long-term effects through number of people.
>Imagine to oppose a perfectly safe vaccine that has been administered 6 BILLION times all around the world and that has a proven efficacy of at least one order of magnitude against delta variant and to push for a horse dewormer (that bear in mind it’s perfectly effective for what is used for.. killing parasites, not viruses)
Who here is opposing vaccines? You've created quite the strawman in your head.
>I think it’s because a lot of the HN demographic has quite a big overlap with the people that use social networks where all this bullshit originates and it is amplified and it spreads.
In other words Ivermectin is a proxy issue in the culture war. Hence why it's so polarizing and people are quick to regress from critical thinking to group think narratives.
Seems like you guys should take a look at Brazil as a cautionary tale for what happens when these miracle treatments are adopted by politically inclined doctors and sold to the masses as the magical solution.
Early into the pandemic, a health insurance company ran a fraudulent study to show that HCQ was effective at treating COVID. The patients were enrolled without their consent, the data was manipulated to remove people who died from the statistics, and doctors were pressured to prescribe HCQ and other medications that did not have proof that they are effective.
This fraud was intended to promote a political agenda of mass contamination. The people running the fraudulent study were in contact with high-ranking officials in the Bolsonaro government, by means of a so-called "shadow cabinet" of pro-HCQ doctors and businessmen. This shadow-cabinet bypassed the experts inside the health ministry, in order to promote the idea that the best way to get through the pandemic was to allow it to spread as fast as possible, and try to use HCQ to treat people when they inevitably got infected.
Is there a name for a cognitive bias that predisposes one toward favoring iconoclastic positions solely for their novelty? Because that seems fairly endemic in the tech industry.
Recognized immunologists have argued that their favorite unproven treatment is the best.
I know plenty of anti-vax, some of them remarkably smart, some of them are health professionals.
We are all biased, and overcoming bias is hard. It is a field of expertise by itself, and it is usually not required for tech jobs. Just being smart will only allow you to find more complex but just as fallacious arguments that will confirm your bias. For example, it took me a while to "believe" in climate change, I took a while to realize that solar panels are not just for pocket calculators, and things like that, for a variety of reasons, and found a lot of advanced material to fuel my bias, which still has not completely disappeared. I am not particularly attached to Ivermectin so there is no bias for me to overcome, but I understand that some people can be. Try to think about it yourself, you probably believe in stupid things too.
And getting attached to a cheap treatment for a disease that has been messing with our lives since early 2020 is not what I would consider an unhealthy reaction. It is hope. Getting too attached to it can be a problem, but no matter what we want to think, we are just humans.
"intellectually curious and educated" is a nice way to describe "at the peak of Dunning-Kruger". It's ivermectin now, the same people were writing last year that whoever were suppressing Vitamin D, the obvious COVID prevention protocol. You don't hear much of the latter anymore (it hasn't solved cancer, either).
> Either way, like someone else in the comments said, these past 2 years have shown us that laypeople are incapable of following active science in real time and drawing reasoned conclusions. Frankly, this is probably true of everyone who is not an expert in the field in question. We need organizations like the CDC and FDA to be much better about their messaging (remember the no-mask debacle? Great way to lose credibility, guys and gals), and we need much better tools to shut down the spread and weaponization of misinformation from the anti-vax crowd et al. I honestly don’t have any idea of how either of those get fixed, however.
These two things are at odds with each other. When the authorities are wrong, contradicting them is classified as "misinformation". If they cannot be contradicted, they are the only people capable of correcting themselves. The results of that will be pretty predictable.
For me I see the controversy here and I figure it could fall either way. Maybe it works, maybe it's just another hydroxychloroquine. I'm keeping an open mind. In no way should anyone be thinking it's safer or more effective than the mRNA vaccines given how many people have had them and the vast amount of data we have on that now. Any argument you can make on that is just very weak because there isn't that kind of rigorous supporting data on the Ivermectin side.
To the downvoters: put up or shut up. Your opinion doesn't change the facts.
I'm just happy that HackerNews hasn't generated into a groupthink platform like what Ars Technica devolved into. Check the comment sections over there on articles regarding COVID and perhaps it's more to your liking and perhaps in your opinion the standard of discussion is higher over there.
I am one of those people that would trust Ivermectin more for treating (or prevention) of COVID compared to a mRNA-based vaccine and I have plenty of reasons for thinking so.
Some reasons I would avoid mRNA based vaccines:
- There's plenty of strokes into my family and I worry that I could easily get a stroke as well, perhaps due to genetically smaller arteries in my head (just a hunch). Seems many deaths of mRNA based vaccines were caused by blood clots.
- Looking at the numbers, I really don't believe COVID is very dangerous for most people. COVID is mostly dangerous for obese people, old people, people with co-morbidities and for those people it might make sense to use a vaccine (same we used to do with the flu every year).
- I feel the number of reported deaths are not correct, since in many countries, if people die with COVID, it's reported as a COVID death, while people might have died from e.g. cancer. As such, actual deaths are probably much lower.
- The media's unfair and sensationalist reporting of "horse dewormer" is one of the reasons I don't trust big media anymore (and there's many others in the past as well).
- Overall, Ivermectin is really very safe when using dosages based on body weight. It's cheap and easy to get. It's easy to mass produce. So even if Ivermectin would not work, there's very little risk when using the medicine responsibly.
- I've read many articles and looked at graphs of countries using Ivermectin and to me it seems there's a clear relation with the use of Ivermectin and the reduction in deaths and COVID cases.
- Even if the whole world would take the vaccine, it's very unlikely we'd stop COVID due to immune escape. Several sources already believe COVID is here to stay, like the flu. And I don't wanna bother to take every year a booster for some COVID mutation.
- In my view we can't be sure if the mRNA vaccines are totally safe in the long run. I will wait a couple of years (5 or more) and see if people receive any adverse long term effects. If not, I will be ok to accept mRNA-based vaccines in the future, but not going to take one right now.
- I was actually open to get the (traditional, e.g. weakened or killed off virus) Sinovac vaccine for COVID if it would make movement around easier in Thailand, but since Thailand now wants to combine the Sinovac vaccine with AstraZeneca, I won't bother.
I guess you haven't heard of brazilian healthcare provider Prevent Senior. That's just the tip of the iceberg, more healthcare providers will sure follow the same path.
Looking at the greyed out comments it seems HN is not pro, but against scientific debate. Questioning science IS part of the scientific method.
https://c19ivermectin.com/ is a very adequate counter-argument to the article, and it's unfair to the whole scientific community that comments are greyed out that mention it.
I think a certain segment of the population refuses to believe that there would be purposeful suppression of information that could potentially save millions. They will not believe any information that leads to that conclusion no matter what the evidence. Period. Full stop.
> First: the opinion which it is attempted to suppress by authority may possibly be true. Those who desire to suppress it, of course deny its truth; but they are not infallible. They have no authority to decide the question for all mankind, and exclude every other person from the means of judging. To refuse a hearing to an opinion, because they are sure that it is false, is to assume that their certainty is the same thing as absolute certainty. All silencing of discussion is an assumption of infallibility. Its condemnation may be allowed to rest on this common argument, not the worse for being common.
J. S. Mill wrote the rebuttal to your argument 160+ years ago. He wasn't using it as an anti-vaxx argument either, so it might be time to stop the moralising and simply try to make a persuasive case. I'd wager it's easier without the moralising anyway.
>There is no good faith argument against the vaccine.
Factually false.
1. It isn't a vaccine. It's a chemical signal to make your body make things.
2. It doesn't have the efficacy against the plethora of variants that all coronaviruses like the cold continuously create. You can still get COVID-19 after being "fully vaccinated". Human beings lack the technology to vaccinate against coronaviruses, including COVID and the cold.
3. It has caused blood clots. And the proteins created cluster in reproductive organs.
4. There are no long term studies of its effects.
5. If it kills your spouse, you can't sue the manufacturer.
Stop spreading misinformation about this pseudo-vaccine.
The WHO would prefer you not to take the vaccine if you are at low risk. While not a personal medical argument it's still in good faith. I am being cheeky by extending their booster logic to the whole vaccine - the WHO are probably thinking it but too ashamed to say it out loud.
There are multiple vaccines too! The Australian regulator recommends against some vaccines for the young and up until recently they were the only ones available.
Ivermectin probably doesn't do anything to fight Covid-19, but the American media has really shown their corruption in the way they've treated it.
It's clearly a safe drug to take in human-designed doses, and it's cheap to produce. Laughing at people for poisoning themselves with "horse dewormer" instead of pointing out that they are turning to the vet store because their access to medicine has been marginalized is sick.
And maybe it does help, I don't know. Unproven != disproven.
It matters a lot if ivermectin doesn't do anything to stop C19, even if it is otherwise safe (it surely is, dosed professionally). People take ivermectin instead of vaccinating or complying with NPIs. If ivermectin doesn't work, that is a very, very big deal.
But it seems almost certain to me that at least some people feel safe thanks to taking ivermectin (while distrusting mainstream vaccines), and those people would turn eventually to the vaccines if those were the only perceived path towards C19 safety.
Perhaps on the margin some would, but I suspect most would fall into the "natural immunity" camp.
So in my mind, we need to weigh the damage done by blocking safe ivermectin use for some number of people to the damage done by a much-smaller number of people remaining unvaccinated when they otherwise would get the jab.
Seems like it could go either way depending on your specific assumptions.
One doesn't imply the other, but it is certainly happening. People are using (being led to use) ivermectin as a prophylactic against covid, an alternative to the vaccine.
On The Media did a really good segment with a journalist from Mother Jones of all places. She broke down the rise of Ivermectin and the whiplash response to demonize it even when, as you say, it is safe for human consumption and had at least some positive in vitro test results. As much as it is not worthy of being recommended as a treatment, it's unlikely to be harmful and has/had at least a slim chance of working.
> As much as it is not worthy of being recommended as a treatment, it's unlikely to be harmful and has/had at least a slim chance of working.
Keep in mind that Ivermectin is being pushed within antivaxers circles as a prophylactic and the true COVID-19 cure, in contrast with all COVID-19 vaccines and even mask mandates.
Thus it's false to claim that this push towards Ivermectin is harmless as, at best, it's pushed as a placebo that empowers vulnerable people to catch and spread the disease, which ultimately means they are harming themselves and everyone around them.
That's not the argument though. Listen to the segment. Giving people false hope and baseless medical advice is one thing, but the anti-ivermectin crowd was going overboard including amplifying specious stories about rampant ivermectin poisoning. Ivermectin is absolutely prescribed to humans for some conditions and is being actively studied as an anti-viral agent against other illnesses (notably dengue and yellow fever). Doctors can prescribe it to patients unable to be vaccinated within their discretion. The debate here is that you can't counter one form of misinformation with your own or else nobody is credible.
It's not the argument? It is a statement of fact. There is no way around it. Consuming a placebo to subsequently validate and provide incentives to put yourself and others at risk is the whole reason why Ivermectin poses a major problem. No one complains that people take paracetamol even though it is not effective at reducing Covid19 spread. Why is that?
Just listen to it. It is absolutely not about advocating in favor of ivermectin. It is about very wrong information spread against ivermectin as a response to the misinformation spread in favor of it.
One problem is that people are self-treating with it. Eyeballing measurements of medicine bought at a farm supply store and sticking it in your child's mouth isn't good.
Furthermore, enabling random unproven treatments is on the same level as saying we should stand by and support homeopathic treatments as a valid alternative to vaccines during a pandemic. We don't let people choose between a tetanus shot or a cup of green tea and olive oil when they step on a rusty nail. It doesn't make sense to let them choose between worm meds and a vaccine when it comes to covid.
In my estimation, probably fewer than authorities think.
US Census collect data on reasons for vaccine hesitancy [1]. #1 and #3 are distrust - of vaccines and of government - which anecdotally matches my network. If that's the case, then we should expect that mischaracterizing treatments to promote vaccines [2] would not be very effective, and most Western countries now are leveling off fairly low in their vaccination rates [3]. But rather than more honesty, we're getting more mandates.
I think Dr. John's Cambell's position, of honest assessment, would have been better as the official position [4]. It's hard to imagine how trust could be regained now though without some sort of reckoning.
Firstly, it wasn’t at all clear how quickly antibody levels would fall, because the data wasn’t available. But it was clear to everybody with scientific literacy that antibody levels would fall over time, because that’s how immune responses work.
What’s been fascinating about the data arising from Pfizer, moderne and astra Zeneca dosing intervals is that it seems quite likely that the spacing is quite to highly responsible for this rather than something inherent to the formulation which is adding to our body of evidence and understanding
I certainly knew last year, as we were watching the stage-1 stage-2 trial results come out, that "how long it lasts" was not known. The news was even saying, it may need to be renewed every few years.
And I'm not really a big follower of science. I just assumed it was like "the flu shot" which you need to get every year.
Edit: we can talk plenty about how bad the US health care system is, but in this case, the actual vaccine, that does a fantastic job of protecting people from COVID, is free in that you don't have to spend a dime out of pocket.
If vaccines weren’t so political across the same divide as free/socialized healthcare people might actually realize that it isn’t the end of the world or the American way of life to have access to healthcare. Oh well.
The human-designated dose of ivermectin is usually a one-time dose. One of the problems is that not only have some people use non-human doses, but there are also many who are on a continuous regimen of ivermectin. That can also be dangerous, because it is not how the drug was designed to be used!
How many users have been taking it in human-designed doses, given that it's not generally prescribed for COVID-19 (and therefore those who are taking it for that purpose are mostly self-medicating)?
Outside of the US is prescribed quite often. It is in the Mexican Health System Protocol ([1] page 6) and has been widely researched [2] in there. Also, in Mexico Ivermectin was widely available (without prescription) before Covid19. It is commonly used in children against lice, and also in the general population as a dewormer once a year (in Mexico, people are used to take these type of medications once a year).
I understand the hesitation Americans have against it, given its lack of availability (I would never consume a medicine made for animals) but from my outside perspective, the issue has been politicized so much that both "left" and "right" Americans get blinded by their views and are not open to even talk about it (it's either, you eat dewormer antivaxxer! or muh freedom!).
I got my two vaccines as soon as I could (I had covid in march 2020 and had a terrible time, and I am totally pro vaccines, shit in Mexico we get a heck of a lot of vaccines haha) but given the safety profile of Ivermectin, I am 100% in favour of people taking it if they get COVID19.
> (I would never consume a medicine made for animals)
Why not?
I either pay $150+ all up for a doctor visit, prescription, etc for antibiotics, or $20 for a bottle of "fish antibiotics" at the feed store. Either way I get amoxicillin; but from the feed store I get 3x the amount and in smaller capsules which makes adjusting dose easier.
We stock the "horse paste" ivermectin for our half dozen hounds, I've been known to have a lick of it myself when ive been out barefoot in the mud, just in case. we have whipworm out here and they're not likely to take in humans but when they do its nasty.
Imagine the wet type would go rather well on Carr's Table Water crackers. Could jazz it up with a name like Pate di Cane, perhaps add a dollop of creme fraiche for appearance
I am thinking a more authentic experience than that.
Up end the can into a metal bowl, chuck it on the floor and whistle that dinner is ready. Then if you have been a really good boy, hang around under the dinner table and hope some people food scraps will find their way into your lap.
Fish antibiotics might be fine, but since they aren't regulated for human consumption it's more of a gamble. Plenty of chemicals that don't hurt fish that the manufacturer therefore won't be testing for that can be harmful to a human. But more importantly in the case of antibiotics: how do you know amoxicillin is the right one for what ails you? There are multiple antibiotics for multiple bacteria, and applying the wrong one can throw your microbiome out of whack with no treatment to the disease itself.
Health care in the US is broken for several reasons, but "Doctors see a patient before prescribing the right medicine" isn't one of them. DIY medicine has dangers, and the FDA regulations are paid for in blood.
> how do you know amoxicillin is the right one for what ails you?
In our case, that's what the doctor prescribes for my wife's chronic sinus infections whenever she asks one about them, and I've been stocking it as a goto first antibiotic for veterinary use since i started caring for my animals 30yr ago.
In anyone else's case, there's no great barrier to educating yourself about what you put in your body and why, and taking responsibility for your own health. Doctors are consultants, not priests.
Oh man you couldn't be more spot on. There's no magic in what doctors do and how doctors prescribe a medication. There are two advantages that a doctor can have over an educated layman: 1) Experience: the number of cases they have seen and thus can make an educated inference to what is going on. 2) Their knowledge of anatomy (all they studied during their 4-6 years education).
Having been living with a chronic condition for more than 20 years, having gone to more than 10 specialists in 3 different countries and countless of studies I've seen the limitation of Medical Doctors (they are human beens at the end). There comes a time when you get to see that you understand your body better than any doctor could.
Your circumstance is one of the flaws in the US system. Having been given a solid diagnosis once for that initial $150 charge, instead of relatively-inexpensive maintenance of health that could be done without doctor intervention, we require doctors to re-see and re-prescribe when a patient has a chronic condition.
There is some wisdom in that (while "when you hear hoofbeats, think horses, not zebra" is a good maxim, sometimes it's horses and zebra), but IMHO once you're diagnosed with something chronic and treatable, minimize the red-tape to keep it treated.
>Having been given a solid diagnosis once for that initial $150 charge, instead of relatively-inexpensive maintenance of health that could be done without doctor intervention, we require doctors to re-see and re-prescribe when a patient has a chronic condition.
>There is some wisdom in that
It's pretty convenient for the doctors as well. $150 to write some shit on a pad and sign it. Good work if you can get it.
The example I was replying to was when the patient was already diagnosed with a chronic illness and still had to go back to the doctor every month or so to renew the script, because reasons.
When the disease is something that requires frequent reapplication of antibiotics, it's important to confirm periodically that they're working (and that the problem isn't a different bacteria that's amoxicillin-resistant).
That's a convenient method when the patient can also make a phone call / appointment to inform the doctor they don't seem to be working rather than extorting (and I'm not using that word lightly) $150+ a month. Also consider the multitudes of other medications where there is no real argument to require a monthly extortion fee.
It seems to be this is more for the benefit of the healthcare system financially rather than the patient or the health of the population as a whole.
> Also consider the multitudes of other medications where there is no real argument to require a monthly extortion fee.
I think that's really where one needs to look to square the circle. The drugs available prescription-free have lower risk of injury or disruption when abused. Antibiotics are not in that category, which is why they require doctor oversight and a prescription. Take too much, and you can damage your digestive tract. Take too little, or the wrong kind, and you can worsen the infection by killing the bacteria that the immune system can control, leaving their food supply for the ones the immune system is struggling against.
They could require less doctor oversight perhaps, but probably not zero.
In the US, there isn't a taboo against taking it because it's generally animal-prescribed; it's used as a human anti-parasitic here too. The issue is that people are self-medicating with veterinary-supply doses because it isn't prescribed for COVID-19 (as it's not indicated for treating it).
Fortunately for me, I know next to nothing about ivermectin, except that the American left is very, very concerned people might be taking it, and I don't know of anyone actually taking it that doesn't have a radio show or podcast. So in my ignorance I would guess very few people are actually taking it and a lot of people are talking about it.
Alternate data point, I live in one of the major cities in Oklahoma. I work for a mostly blue collar shop. The overwhelming majority of our workers are unvaccinated, and I'd say a large fraction of them are very vocal about their use of ivermectin.
The article linked simply says there have been people who misused ivermectin who presented at the hospital. For what reason they went we have no idea because it does not say.
For all we know the two individuals who landed in the ICU were admitted because they were attempting to unsuccessfully self-treat COVID and ended up there, not because of the ivermectin misuse but because of COVID itself.
They're also the ones that pushed Hydroxychloroquine, have connections to the Tea Party, that "demon semen" lady Trump endorsed is associated with them, and they had their leader and their chief of communication arrested due to their participation in Jan 6th.
They're also the reason you'll see Joe Rogan now spreading ivermectin bullshit.
They've also been selling telemedicine consultations to prescribe ivermectin, taking the money, and then not delivering the consultation [1]. They are a straight up scam posing as a charity.
> given that it's not generally prescribed for COVID-19
This is disinformation, it turns out. Plenty of doctors are prescribing it. Anyone in the US can go online to one of a dozen telemedicine services and get a prescription for an appropriate dose of ivermectin within hours. This can then be filled at any pharmacy in most states which prohibit pharmacists from refusing to fill prescriptions because they heard on CNN it was for horses. But the media will never report this.
People are literally taking horse formulations of ivermectin because doctors are rightfully refusing to prescribe ivermectin for an off label and ineffective use.
Oh, and the access to this medicine is “marginalized” BECAUSE IT DOESNT WORK TO TREAT COVID. We generally do not expect doctors to prescribe medicine that will not work or is not appropriate for the patients condition. Complaining about their access being marginalized is like complaining that my doctor is marginalizing my access to Ketamine because I don’t need it.
In fairness, I see no reason why anyone should be blocked from buying any drug they want, whether it be ivermectin or heroin. The consequence of this restriction is that a subset of the prospective customers will settle for a potentially (more) dangerous alternative source, whether that be horse formulations or black market heroin cut with fentanyl.
It's also a valid point that unproven and disproven aren't equivalent. While I don't think anyone should take medical advice from political sources or for political reasons (therefore, as far as I'm aware, the well studied vaccines should be preferred to ivermectin by the vast majority of people at this time), I do think that it should be anyone's right to have full bodily autonomy and make whatever choices they want. Mainstream consensus is wrong often enough, e.g. the disastrous food pyramid that contributed to today's obesity epidemic.
I agree with the thrust of your point that the idea that there's some kind of widespread anti-Republican medical discrimination or corruption going on is silly. Just pointing out that how things currently are is not how they ought to be, and that this situation is arguably just a subset of the widely reviled War on Drugs.
(As the GP) I really appreciate and generally agree with your perspective, but:
> the idea that there's some kind of widespread anti-Republican medical discrimination or corruption going on
is a total mischaracterization of what I was saying. In fact, it's essentially pulled from thin air.
The corruption of the news media is in their choice to mock and literally laugh at people sick from veterinary iver because kicking the out-group is popular with their audience (read $$). They do this instead of explaining (in a meaningful way) how we got here, and what steps we can take to make the situation better.
is a total mischaracterization of what I was saying. In fact, it's essentially pulled from thin air.
You did refer to "marginalization" of (Republicans') access to medicine. It was unclear whether you were only referring to the effect of well established federal drug policy and standards of the medical industry or a more specific/deliberate marginalization effort.
The corruption of the news media is in their choice to mock and literally laugh [...]
Ah, well I'm not aware of that, but that may be because I typically rely more on text-based media than video.
> The corruption of the news media is in their choice to mock and literally laugh at people sick from veterinary iver because kicking the out-group is popular with their audience (read $$). They do this instead of explaining (in a meaningful way) how we got here, and what steps we can take to make the situation better.
The idea that this is somehow the media’s fault for not being sufficiently patient and understanding with the ivermectin crowd is actually quite pathetic. Stop infantilizing these people; they are adults with their own agency. Their bad decisions are not the fault of the media[0].
0 - Especially since this crowd was shouting “fake news” for years. How exactly is the media going to convince a bunch of people who are convinced that they’re liars?
It's just more blame game. Who you blame is who you hate. Racists blame black people for being poor, anti-abortion activists blame women for being "promiscuous", coastals blame red staters for being stupid backwoods yokels, red staters blame ivy tower socialists or immigrants, liberals blame rich people, socialists blame corporations, conservatives blame government, Islamic terrorists blame the great Satan, on and on.
Hate = blame
Love = forgiveness
Listen and see whom people blame and that's who they hate. See who they apologize for and that's who they love.
First of all, trying out random substances or applying existing medicines to different illnesses is exactly how doctors and the pharma industry operate.
It's not like doctors actually always understand what is going on; for example, I think even the precise mechanism of anesthetics isn't well understood yet.
So people volunteer to test a human approved drug for a different application. I don't believe in Ivermectin specifically, but there's nothing fundamentally wrong with that. It's what medicine does, and most researchers at universities don't have a clue either (as we now see in the entire Covid19 comedy).
> First of all, trying out random substances or applying existing medicines to different illnesses is exactly how doctors and the pharma industry operate.
Sure, but with methodology and metrics to allow the separation of actual effects from placebo, and in some cases even just enough methodology to be able to measure anything at all.
> People are literally taking horse formulations of ivermectin
People are taking the horse formulation because most pharmacists won't even fill an off-label prescription for the drug, which - even if it has no effect on COVID - is safe and taken by a quarter billion people every year.
Let people take it. It's not harmful.
Or, make a big huge deal about people taking it and, well, then it becomes a big huge deal.
It's not a placebo pill, it's an active medication that has effects on the body and undergoes metabolism. Ivermectin inhibits cytochrome P450, which the majority of prescription and OTC drugs are metabolized by.
Administration of a P450 inhibitor will cause the levels of other medications in a person's blood to rise, and will cause some prodrugs to be ineffective due to reduced metabolism.
I can't even walk into a doctors' office and get prescribed Singulair, an allergy medication, without giving them a reason to believe that I need it. And if I was a doctor, I'd err on the side of caution, as well, when it comes to prescribing things I don't think my hypothetical patients need. Not only is it a question of ethics, it's also a question of legal liability and keeping a license to practice.
I agree that a doctor should not prescribe a drug that is going to interact dangerously with a patient's other medication. I also agree that a pharmacist should not fill a prescription if they know it will interact dangerously with the patient's other medication.
But I also don't know the dosage schedule doctors who are prescribing Ivermectin are using. They're probably using one from a research paper that they believe justifies its use to treat or prevent COVID. Those dosage schedules are afaict similar to how it's used to treat on-label conditions - take one dose every three months, or whatever.
It's pure speculation that doctors are out there writing prescriptions for dangerous dosages of Ivermectin.
However one thing for sure is that in lieu of a prescription, people are more likely to self-medicate with a dangerous formulation and dosage, ex: horse paste.
Yes, but we also have efficacy data on vaccine boosters from small trials that seems reproducible. We don’t have that for ivermectin (the original article here). And the FDA is still arguing about who benefits sufficiently from a booster, but has not yet made it widely available either.
And yet there is a wealth of data on both the safety and the efficacy of covid vaccines, and there is also a wealth of data on the effects of getting covid.
So why are people going for something without any data?
However, there is no data on the long-term effects of the COVID vaccines, mRNA or otherwise. That's an indisputable scientific fact. They just haven't existed long enough for that data to be available. Hopefully a decade from now we'll discover that they were safe.
We do have data on the long-term effects of Ivermectin.
Someone who is not concerned about COVID will take neither a vaccine nor Ivermectin. Someone who is concerned about COVID but who is also concerned about the long-term effects of the vaccine may opt to take Ivermectin. It's their choice. It could also end up being the wrong choice.
> Can you show any other vaccine which has long term, but not short term negative side effects, which this concern might be based on?
I don't know. But we still may be in the "short-term side effect" phase for the COVID vaccines. It hasn't even been a year.
> Because this seems like whataboutism, and of course it's impossible to prove a negative, and people are dying while waiting.
Not sure how it's whataboutism to point out that some people have lower risks of contracting serious COVID, and that their decision to take a very new vaccine may be different than someone who is more at risk for contracting serious COVID.
If they miscalculate and die, well, that's their decision.
> At bi-annual dosage rates, yes. Not daily or even weekly.
Are the COVID/Ivermectin studies doctors are referencing for prescription dosages recommending daily Ivermectin use?
It's been over a year for the initial trials, no long term issues yet. How long seems reasonable to you? What are you basing this timeframe on?
If covid is a low risk, then the vaccine, which is essentially just the immune response to covid without any of the actual viral damage, should be much more benign, yes? I'm failing to see the risk here.
The treatment regimens in current Ivermectin studies are usually daily dosage, for which there are no long term studies for humans. Prophylactic usage of Ivermectin is all over the place, but seems to mostly be within 72h of exposure, so several doses per week, which also doesn't have long term studies. Staying on antibiotics for long periods is generally a bad idea due to disturbing the gut microbiota.
The long term effect of ivermectin seems to be long-COVID (according to the article), which is rare, but just as bad as being unvaccinated, if not worse.
I get where you are coming from, but I think that there is a nuance that you have missed. Like many, many drugs - and vaccines - ivemectin has some unpleasant and dangerous side effects in some people rarely. You can see these if you look the drug up :https://www.medicalnewstoday.com/articles/ivermectin-oral-ta... for example.
The point is that if this drug did help people make it through covid (like the vaccines do) then it would be worth the risk of these horrible things happening - if they were rare (they are). But unfortunately it looks like this is not true, so people are taking a risk of having a horrid side effect with no chance of the pill working.
On the other hand if you take the pill to avoid river blindness then the risk of the side effect seems well worth taking to me. But not for covid - 0 benefit for 0.001 risk is not good trade.
GGP: ivemectin has some unpleasant and dangerous side effects in some people rarely. [...] people are taking a risk of having a horrid side effect with no chance of the pill working.
GP: All of this is for the patient and their doctor to decide.
P: They're [often] using the horse formulation because their doctor said no.
X: How many got the horse formulation and how many got adverse effects from [horse formulation]?
C: Who said anything about adverse effects?
It this human brain on Twitter? We can't possibly read 4 short stanzas in a row and keep the context?
I agree about the pharmacist - but the drug regulator really does have to have a role. There is a serious information imbalance between patients and doctors and both big pharma and lunatic talkshow host millionaries. Regulation is important to help prevent junk getting pushed into kids arms to make bastards money. It's not perfect and they get a lot wrong, but without it you and I are at the mercy of some very mercy short people.
My understanding is that - depending on the jurisdiction - a pharmacist is allowed to refuse filling a prescription if:
- They are morally opposed to the medication, ex: "abortion pills"
- They know that the patient is taking another drug that would result in a deadly interaction
- The patient is drug-seeking a scheduled drug, ex: they've brought multiple valid prescriptions for opiates, but from different doctors
The pharmacist doesn't know why you've been prescribed Ivermectin. They can ask, but you're under no obligation to tell them. Maybe you need it for river blindness. Unlikely, but it's none of their business.
I guess a pharmacist could claim moral opposition to filling an Ivermectin prescription if they believe that sans Ivermectin the patient would instead get a COVID vaccine. That makes sense to me. But it's a slippery slope I'm uncomfortable with.
> All of this is for the patient and their doctor to decide.
> Not the pharmacist. Not the FDA.
In case you don't know,the FDA is the US regulatory body whose mission is to " [protect] the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices;"
In the US, doctors only prescribe drugs that have been verified by the FDA, and pharmacists only distribute drugs approved by the FDA.
If not the FDA, who do you think is responsible in the US to ensure a drug works and is safe?
The FDA is pretty much the US instition devoted to anti-quackery and anti-fraud. Why is this a problem?
I know what the FDA is, what they do, and I agree it is necessary.
The FDA has approved the use of Ivermectin in humans. We're not talking about like, heroin, or some toxic chemical that isn't even a drug.
1 in 5 prescriptions are off-label.
Meaning, to treat conditions that the FDA has not approved the drugs for. This idea that doctors are only allowed to prescribe drugs for FDA-approved use is just like, incorrect.
A friend of mine found a doctor to prescribe it but his pharmacy won't fill it. He is so pissed.
He was only planning to take small doses here or there as he's a teacher and around sick kids all the time, as if it were like Zinc to hopefully help reduce the severity of Covid-19 if he does get it, but despite going through the effort and succeeding in finding a doctor willing to prescribe it (and my friend even signed a document saying he understands it's an experimental treatment and will assume any risks), his local CVS is refusing to fill it.
My opinion is if you can get a proper doctor to prescribe it (by proper doctor I mean none of this "I got a medical exemption for wearing a mask from my Chiropractor" bullshit like is going on in Florida), a pharmacy shouldn't be allowed to decide not to fill it, as if they know better than your doctor.
> pharmacy shouldn't be allowed to decide not to fill it, as if they know better than your doctor.
It sounds like you have a pretty misguided idea of how pharmacies and pharmacists worked before Covid. You’re describing a situation where pharmacists act at the behest of doctors who know best, when in reality pharmacists have always had some level of independent authority over what drugs get dispensed to whom thanks to their expertise. It’s part of the pharmacists job to watch out for bad prescriptions, both in terms of abuse (e.g. opioids) improper dosages, and unintended side effects and interactions between drugs. In some states pharmacists have their own ability to prescribe medicine on their own.
I’m not sure exactly how much control a pharmacist should have over whether a valid prescription is filled, but the idea that they’re only expected to blindly fulfill the order of your doctor is not correct, and never was. In fact, they probably know more about the drugs you’re prescribed than your doctor does, as that’s their entire speciality. (Especially given the long and sordid history of doctors pushing drugs on the basis of pharmaceutical sales reps, doctors often actually know very little about what they prescribe).
>t sounds like you have a pretty misguided idea of how pharmacies and pharmacists worked before Covid. You’re describing a situation where pharmacists act at the behest of doctors who know best, when in reality pharmacists have always had some level of independent authority over what drugs get dispensed to whom thanks to their expertise. It’s part of the pharmacists job to watch out for bad prescriptions, both in terms of abuse (e.g. opioids) improper dosages, and unintended side effects and interactions between drugs. In some states pharmacists have their own ability to prescribe medicine on their own.
Absolutely. I had to fire my doctor after he prescribed a sulfa drug to me, even though I'd made it clear that I have an allergy to sulfa drugs.
In fact, I would never have known (well, until I became sick/dead) that the drug prescribed was a sulfa drug if the pharmacist hadn't known the drug involved and checked it against known allergies. He contacted both me and my doctor and a different drug was prescribed.
In fact, it's entirely possible that I'm alive today thanks to the expertise and knowledge of the pharmacist.
Not really disagreeing that a pharmacist might know more about the drugs than a doctor. I wasn't warned about the potential side effects of Ciprofloxacin once, just told it was an "antibiotic" by the specialist I saw, and the pharmacist did clue me in about some side effects, which I promptly had some of the worst ones after a single pill. I might not have made the connection it was a bad reaction to the pills without their warning, at least not so quickly. I continued to have side effects off and on for years afterwards.
I learned my lesson and now do my own research before just taking any medicine a doctor wants to prescribe now.
But I still don't think pharmacists should be able to just override the decision of a doctor. Make sure the person is fully informed of potential dangers, side effects and correct usage, sure, but not override the doctor. The doctor has had an opportunity to examine and talk to the patient at length, multiple times over multiple visits, and know their history and specific needs, the pharmacist doesn't know any of that background and are most likely just making assumptions.
I mean if it's literal rat poison or a dose guaranteed to kill the person is being prescribed, maybe they can hold off on fulfilling it and alert authorities, but otherwise?
Opioids are a major problem, as there are addicts that cycle doctors to get multiple prescriptions so some doctors might not realize it's being overprescribed, but that's a matter of addiction and abuse and I don't know how a pharmacist is expected to know when it's being abused or not, unless they're getting them all filled at the same pharmacy. Again, they're not spending enough time with these people to know what their situation is. The most interaction I have with my pharmacist is "Picking up a prescription." "Verify your address please?" "My address." "Okay this has these side effects and you should only have it after a meal." "Okay thanks." Yeah that's totally enough for them to make a medical decision on my behalf. /s
If anything, I think them deciding when to withhold medicine could make them MORE liable, not less, because they're inserting themself into the decision process. What if their withholding fulfillment of a prescription results in that person dying? If the doctor said yes and they said no, that seems to open up room for litigation to me.
> But I still don't think pharmacists should be able to just override the decision of a doctor.
You’re free to believe that, but understand that this is well in the “wishes and hopes” territory more than a factual understanding of how doctors, patients, and pharmacists actually interact. Personally I believe the idea that we’d spend a huge amount of time and effort as a society training a whole class of specialists and then declare that they must abide by the decisions made by a generalist to be quite odd. Your personal doctor isn’t able to override your oncologist, so why should they be able to override the experts on prescribed medicine?
> If anything, I think them deciding when to withhold medicine could make them MORE liable, not less, because they're inserting themself into the decision process.
I’m sorry, but that’s clearly motivated reasoning and completely unrelated to the actual law. Pharmacists are subject to medical malpractice laws just like every other type of doctor, there’s no magical “I didn’t insert myself into the process therefore I’m not liable” clause.
> “My experience is enough to determine for everyone else” is a really bad look.
Let's put it this way, I haven't seen any evidence based on what I've seen that this isn't the normal interaction with a pharmacist after decades of seeing pharmacists myself, or sitting waiting for my parents to get medicine filled,
or watching other users interact with pharmacists while I've been waiting in line, etc., across multiple pharmacies in multiple cities.
If there's a more personal and intimate pharmacist reaction that you see as common (or even uncommon), please share those details for me. I would love to have an example otherwise.
> You’re free to believe that, but understand that this is well in the “wishes and hopes” territory more than a factual understanding of how doctors, patients, and pharmacists actually interact.
I made a good faith effort in researching this, and here are some examples of interaction you might be alluding to:
1. The doctor made an obvious mistake in dosage or a might not be aware of safer alternatives and the pharmacist contacts the doctor to verify that there wasn't a mistake on the prescription or mention those alternatives and see if they can persuade the doctor to change the prescription. Great, no issues with me. Everyone makes human mistakes. I do it in software also.
2. Something obvious they can see about the patient gives them some information that contradicts the prescription (i.e. an obviously pregnant women being given a drug that's dangerous to pregnant people). Again, they contact the doctor to inform and verify. Again, no issues from me.
3. Patients sometimes see other specialists and get prescriptions from them without informing their PCP (sometimes on accident), whereas a pharmacy probably sees all of these prescriptions, and can catch when two prescriptions could have dangerous interactions that a PCP or specialist might not realize they were causing because they weren't aware of the other prescription. Again they contact the physician and verify. Again, no issues from me.
4. The pharmacist has a religious reason not to want to fulfill a prescription. Some states that's allowed, some they aren't. In those where it's allowed, most pharmacies have a policy that they must allow another pharmacist at the facility to fulfill the prescription or help transfer the prescription to another doctor. Fine with me.
Note that for the first three, they generally contact the doctor and verify/try to persuade, not outright override and refuse. They help catch problems, not generally cause them. It looks like there are several states where pharmacists are actually required to provide medication[1], although that link mentions specifically personal beliefs, so I don't know if it applies for the other three issues as well.
If that's all you mean, then I don't think we disagree actually. But it doesn't look like it's as clear-cut legally as you were suggesting before, and I'm far from alone in thinking that pharmacists can't just decide never to fulfill a prescription without a damn good reason (i.e. it's definitely going to kill the patient).
Pharmacists can refuse to fill prescriptions they believe will harm the patient. The law does not restrict it to the narrow circumstances you have listed. “You are giving a deworming medicine for Covid as an off label use. No, I believe that this will harm the patient” is 100% within their legal right. My state explicitly states that every pharmacist should consider whether an act is “consistent with the licensee or registrant’s education, training or practice experience” even if it is not expressly forbidden by the bylaws. This is much more expansive than you’re implying.
Legally in my state they must refuse to fill prescriptions they believe were not created by a proper doctor patient relationship, which includes a lot of these Ivermectin phone doctors. But that’s a slightly different issue.
I'm not going to go down the Ivermectin research hole as I've mostly been avoiding it myself.
But Ivermectin is not just a "dewormer" as the media has been running with to sensationalize things and try to throw shade at Joe Rogan for taking, and is known to have antiviral and anti-inflammatory properties, and is known to be safe in proper doses because it's been prescribed to humans for quite some time.
Dr. John Campbell is a highly respected doctor that, since the beginning of this pandemic, has been going over medical studies and data and making them understandable to the general public (I do watch a good handful of his videos, but I've been skipping the Ivermectin ones up until tonight).
The very first video[1] of him going over Ivermectin has a peer-reviewed meta-study that gives moderate-certainty level evidence that when clinicians have given Ivermectin to patients it's resulted in a 62% reduced risk of death compared to not taking it. And honestly that surprised me, up until I watched that tonight I was certain he was going to say it may have had a very mild positive effect and that's all.
I also know my friend highly respects this guy and watches his videos a lot as well. Probably why he was seeking the prescription in the first place, was after seeing the information from these studies, instead of just "well the FDA hasn't approved it therefore it's poison".
Again I'm not going to dig deeper than that right now, I've already spent most of my limited free time this evening doing this instead of other productive things. But yeah, sure looks like a pharmacist could potentially be doing harm by preventing these prescriptions from fulfilling.
I don't even care about this drug specifically (I've been actively avoiding reading up on it and just threw it in with Hydroxychloroquine as a non-drug up until now). It just bothered me to learn that pharmacists were refusing to fill a prescribed drug.
And after listening to my friend provide his reasoning for wanting to take it in small doses, I figured he had researched this a lot more than I had up to this point and was willing to give him the benefit of the doubt.
There are severe issues with the Ivermectin studies that have shown a positive effect. One of them is believed to be an outright piece of fraud. This was literally discussed in the article this thread is about.
If you're just going to ignore the article posted and "do your own research", then stop wasting our time here.
I mentioned the previous comment I am not well researched in this. I didn't even make the connection that the video is referring to the same study that this thread was talking about.
It doesn't matter, I don't care about Ivermectin or what you or anyone think about it, good or bad. I'm not planning to take it and never was.
My point was if something (ANYTHING) gets prescribed by a doctor, pharmacists should generally fill it barring those other reasons I mentioned above. I made my point, you made yours. Have a good day.
Pharmacists go to school 4-6 years to learn about drugs. But hey - they don't get to use any of that knowledge in their job... "Just give me the little white box in cabinet #2 please."
Why do Pharmacists even study and train for up to 6 years if you don't want their opinion on how this drug will affect you?
He is vaccinated. He's been vaccinated since April. Breakthrough infections are a thing. He's also concerned about recent data from Israel about waning efficacy. He'd get a booster shot today if he could get it.
Also thank you for what I presume is you insuinuating by putting "friend of yours" in quotes that you think I'm talking about myself. I've been vaccinated since April and I have been a lot more careful about this virus than at least probably 90% of the people out there, at least in the US. I still wear masks outside the house and avoid going indoors very often (I didn't do it at all until I was vaccinated).
Hell, I wore masks on hiking trails outdoors while holding my breath when walking past others on the trail back in 2020, which was probably overkill in retrospect. I also only had food delivered, never even going through the drive thru, and didn't order anything that couldn't be heated in the microwave for 3 minutes to try to kill the virus since it was unclear whether it transmitted via surfaces back then (so no sushi, sandwiches, salads, ice cream, iced coffee, etc).
Personally I wouldn't try to hunt down some of these alternative drugs, which I'm pretty skeptical of, but there seems to have been some mixed data on this one and I can at least understand why someone might want to give it a shot in reasonable and proven to be safe doses, especially if they have no choice but to be surrounded by it all day long (I work from home, my risk at work is nonexistent).
It's probably both, but why would a doctor risk losing their license over this? Yet another unintended consequence. Doctors are supposed to be able to write prescriptions for off-label use.
My doctor told me to wait it out, anywhere up to twelve more months. Yes, I self medicated. Suicide would have been my other choice had I not had Ivermectin - felt like I was slowly dying to begin with. It was very debilitating and impossible to work.
Although it has more dangers than ivermectin, why shouldn't you have access to ketamine if you feel it helps you? A lot of people believe it has off-label benefits for their mental health, and maybe it does.
Perhaps we just have different general perspectives on the individual and society.
Why not all drugs of all types. Why call it an opiod crisis and not just here is what happens when you give everyone whatever drugs they hear on the internet make you feel good?
First you deny someone ivermectin, next minute you are saying only 1 oxycotin with your beer.
The important difference between these drugs is that opiates are incredibly addictive, while ketamine is less addictive than tobacco or alcohol. Ivermectin isn't addictive at all.
Ironically, the opioid crisis is caused far more by people's trust in mainstream medicine than by any internet fad.
Repeated recreational use of ketamine over years can lead to permanent urinary tract damage, potentially leading to incontinence, etc. "Ketamine bladder syndrome"
> In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers and healthcare providers began to prescribe them at greater rates.
> Increased prescription of opioid medications led to widespread misuse of both prescription and non-prescription opioids before it became clear that these medications could indeed be highly addictive.
In some countries they give free needles to heroin addicts. Why do they care about harm there but for ivermectin they "force" the misinformed people to take the horse paste form?
Because half the country and the mainstream media would rather revel in laughter at those people than help them. They rationalize it as them being too dumb to take the vaccine instead of probing why exactly people are so distrustful of massive conglomerates that can't be held responsible in any way for any side effects their products may cause.
Incidentally, approximately 11 to 14% of the USA population has pinworms, which can be easily stopped by ivermectin. Given the very high level of safety of ivermectin, it might make sense to make it easier to get on this basis alone.
There's thousands of safe medications that probably do nothing to stop covid. Just because one of them has been latched on to by right wing nutjobs doesn't mean it makes any sense for people to take that over the stuff that's actually been shown to help.
The "horse dewormer" aspect is definitely a red herring, while the underlying problem is the choice to self-medicate based on culture war status of vaccines vs. talk-show-host-endorsed drugs. And the inevitable overdoses resulting from that. The media is not wrong to discourage this type of self-medication.
But access to the vaccines here is free and widespread now, so while we could talk all day about problems with access to health care in this country, it doesn't apply here. People may be choosing to distrust the vaccines and thus triggering a shortage of beds and treatment that they themselves will later need.
I've suspected that for years. I remember my undergrad biology prof coming down on students depending on meta-analysis and insisting they were no substitute for attempting to replicate the experiments themselves.
Ok you replicate the original study. Presumably you want to use this new result to increase your statistical power compared to the original result, combining the results of the two studies.... which... is.. er... meta analysis.
The whole point of meta analysis is that you have multiple studies of the same experiment.
that doesn't make scientific sense. Replicating the original experiment and doing a meta-analysis have two completely different goals. I would have argued that back to the professor (and been right).
I said they had different goals, not that they don't overlap.
If you're in a class teaching medical studies, and you tell people "go replicate the original experiment instead of doing meta analysis", you're doing your students a disservice.
Instead say: "It's always important to be able to replicate experiments and I encourage everybody in the class who is going on to do science or medicine spend at least some time in the lab replicating a basic experiment. But medical studies are so large and complicated that we can't typically repeat them in a reproducible way. Instead, we use statistics and probability to make reasonable decisions based on the data we have. Sometimes that means removing a suspect paper from a meta-analysis because we lack confidence in its reproducibility."
For some of the most sophisticated medical science experiments we have today, the only way to replicate an experiment is to be a postdoc and join the lab that does the research, master the technique there, then take your reagents and other material to your professor job, and then get your local set up to replicate what you did in the original lab. This is how it normally works, for example in labs like Mina Bissell's where few people in the work even have the skills to replicate her experiments.
Bingo. Also the problem with meta-analysis of certain kinds of studies (say, observational ones) is the file-drawer effect: people don't report negative results. So you can go from a bunch of studies that show an effect (usually small) at marginal statistical significance to a meta-analysis that shows very high statistical significance when there is really no effect there.
I don't think we have to worry about the file-drawer effect much with controversial COVID treatments, though. Do you?
Medical studies can't be replicated in experiments. They are almost always one-shot. That's not how medical studies (that we do meta analysis) work. It's too expensive and too complicated.
"We recognize that this is a change to long-accepted practice and is substantially more rigorous than the standards that are typically currently applied"
Meta-analyses generally follow certain pre-established standards. That's the whole point of such studies.
It's one thing to claim that authors of a particular meta-study broke the standards. This is not being claimed here. It's an entirely different thing to claim that the standards themselves are broken and need to be changed generally. This is a huge claim that casts doubt on tons of prior research.
Maybe we do need more rigorous rules for meta-analysis. However, if that's the case, it should be true for all research of this type, not just papers examining "interventions for COVID-19" (as the article suggests).
Hence, my take on this. It's reasonable to question scientific standards if you are willing to demonstrate that they are really broken. (This was done with p-hacking, for example.) It's not reasonable to say that a specific subject in research should have different evidentiary standards because of controversy around one drug.
I think you're dignifying this comment, which objects to the authors request that meta-studies not include fraudulent analyses in their inputs as an unwarranted "change to established practice".
And in the meantime, if you buy into the crazed insanity of "pandemic! pandemic! omg we'll all die", then it makes tonnes of sense to treat people with a highly-available, incredibly safe medication that frontline clinicians all over earth are reporting success with, especially a drug that has been dosed ~4 billion times over two generations, that has been most often dosed by illiterate people and delivered by non-doctor NGO workers.
I guess the reason doctors aren't prescribing Ivermectin is that they don't buy into "crazed insanity" and don't feel the need to try anything that might work.
And I can only speak for myself, but the attitude I'm seeing is "a lot of people are dying and we should try to work together as a society to stop that from happening", not "omg we're all gonna die".
Chillies have been used for thousands of years as a medication and they are perfectly safe.
You may want to follow the advice of someone else in this thread and shove them up your ass.
For sure they will have less side effects than ivermectin and they have exactly the same chance of curing covid.
And for your information the covid vaccines have been administered 6 billion times, so roughly 50% more than the number that you cited about ivermectin.
Penicillin is also a highly-available, incredibly safe medication that's been given billions of times.
It still doesn't make any sense to try giving it to COVID patients, because there's no reasonable way it would actually help them.
Just because a particular medication is unlikely to kill you doesn't mean it's a good idea to promote its use against a particular threat, when that threat is completely unrelated to what the medication actually does. Penicillin is an antibacterial. Ivermectin is an antiparasitic. Neither of these are likely to be helpful against a virus.
Ivermectin has research going back to the mid-2000's showing it has anti-viral properties.
EDIT: Thought I'd come across a study indicating that from 2006, but I can't seem to find it. Let's settle on mid 2010's instead because the point is mostly that there was research showing anti-viral properties before the pandemic started, and therefore it was a very logical thing for frontline doctors to try on their patients.
There is a known mechanism by which ivermectin is expected to work against covid - it inhibits the protease family of enzymes. Incedentally, Pfizer is developing a new (read: expensive and on patent) covid drug which also happens to work via the same mechanism. So the fact that ivermectin is an antiparasitic is irrelevant, as is the comparison to penicillin.
Sorry, but you are wrong. Antibiotics are used in the treatment of severe viral infections, because your body is not able to fight secondary infections with bacteria very well. Antibiotics are given to help your body in cases of bad viral infections. Covid-19 is no exception. https://www.thelancet.com/journals/langlo/article/PIIS2214-1...
The point is: there are more mechanisms by which our body can be helped fight covid, and the Ivermectin proponents say that it works only in the early days of the infection, not like a full cure.
There are more ways to fight this disease, you are aware that the virus itself is not what's killing most people, right? Most people die because their body overreacts to the virus and damages the lungs (that is why standard treatment includes steroids to calm down the antibodies). A drug doesn't have to kill off the virus to win.
I have no idea if Ivermectin is helpful or not, but the trashing in the media (even calling it horse dewormer - while it's a human drug as well) before there is any proof against it is just bad, it makes me think there are ulterior motives for this.
"The virus then ejects its genome directly into the cell. By invading in this spring-loaded manner, SARS-CoV-2 infects faster than SARS-CoV and avoids being trapped in endosomes, according to work published in April by Barclay and her colleagues at Imperial College London9.
The virus’s speedy entry using TMPRSS2 explains why the malaria drug chloroquine didn’t work in clinical trials as a COVID-19 treatment, despite early promising studies in the lab10. Those turned out to have used cells that rely exclusively on cathepsins for endosomal entry. “When the virus transmits and replicates in the human airway, it doesn’t use endosomes, so chloroquine, which is an endosomal disrupting drug, is not effective in real life,” says Barclay."
I'm glad that you mentioned HCQ. What happened with HCQ? Was it smart that the US bought stockpiles of it, and was it smart for doctors to be prescribing it for treatment of COVID, with a years hindsight?
I think one glaring problem is that two years into the pandemic we still don't know...and given the rigid taboo which has sprung up around HCQ and other treatments, frankly I don't really trust the data. Yes, the initial studies in support of HCQ were low quality, but the primary initial study which the media jumped on to "discredit" HCQ was laughably biased, completely disregarding the early stage/prophylactic dosing recommendations and essentially overdosed terminally ill patients.
I think your point is the one that surprisingly is going largely unstated here. This entire thread reads exactly the same as the HCQ threads a year+ ago, except now with a new drug. The same complaining about the media, the medical establishment, the same clinging on to weak initial trials which in the case of HCQ that turned out to be nonsense. Will ivermectin turn out the same way?
Also it's interesting that the same political and pundit class now pushing ivermectin first pushed hydroxychloroquine. The same people on the same TV and radio shows. I've got to wonder, if HCQ was the miracle drug they claimed it to be, why aren't they still pushing it? It seems to me they just sort of... stopped talking about it one day. Did it not pan out as they said it would? If not, why are we to trust them this time with this new drug? How long until ivermectin joins HCQ as yesterdays drug-du-jour to fight Covid?
> There are literally no studies proving that the Pfizer or Moderna gene therapies are safe and effective, or even that they are safe or effective, at both treating and preventing the spread of COVID-19.
I hope the more science-literate proponents of IVM can appreciate how much it harms their case for the vast majority of IVM advocates to be this loud and wrong..
> I hope the more science-literate proponents of IVM
If they valued and were capable of reasoning about the science, they would not be “proponents” — they'd recognize the current scientific understanding (no known mechanism or benefits, significant side-effects) and wait for a solid study before recommending anything.
The people you do see advocating it are almost always doing so for political or financial purposes and are thus unlikely to say anything critical since that'd be bad for business.
> If they valued and were capable of reasoning about the science, they would not be “proponents” — they'd recognize the current scientific understanding (no known mechanism or benefits, significant side-effects) and wait for a solid study before recommending anything.
The the standard of "we should not perform treatments with known side effects if there is no solid study proving the mechanism and benefits of that intervention" is unreasonably strict.
Proning (laying the patient on their stomach appears to improve oxygenation and improve outcomes) was suspected to be helpful by May of 2020. However, even by December of 2020 there were not any large randomized controlled trials proving this. Proning has risks (like "unplanned extubation" i.e. the breathing tube coming out when it shouldn't). Should we have foregone that treatment because there was no proof of either efficacy or mechanism, and there were significant risks associated with the treatment?
I personally don't think ivermectin is terribly likely to be effective, but the more general statement of "nobody who is capable of reasoning about science would be a proponent of an unproven treatment that has risks" is wrong.
That's exactly the kind of reason why I included “no known method”: proning was not a previously unknown concept, it clearly changes a known problem, and the risks are manageable.
Remdesivir and other antivirals were similarly reasonable to try since they had a plausible method of being effective, as did the steroid treatments which have been so useful for controlling inflammation.
Now, nobody is saying that we can't _try_ new things but note also that I was referring to “proponents” — not just people who are willing to try something but who are actively advocating it as an effective treatment. The vast, vast majority of those people are not running experiments or even medical professionals who might possibly have some relevant prior experience suggesting it was worth trying.
I'm not opposed to research but I think there's a substantial ethical line to cross when you switch from being open to the possibility of something working to running around telling everyone that it works so well they should avoid a safe, cheap, and highly effective vaccine.
Ivermectin doesn’t really have significant side effects at appropriate doses. It’s quite safe. Don’t be fooled by overblown “horse dewormer stories”.
I don’t say this to advocate Ivermectin, the only RCT I know of/trust found absolutely no effect. I say this to gently point out the mismatch between your claims and the premise in the first sentence.
I agree that it is safe at appropriate doses. The issue is that people are self medicating and incorrectly calculating doses, since the product was intended for livestock.
The nationwide report that everybody talked about, pertaining to poison control centers receiving endless calls about this was completely fake. It turned out that rather than 70% of calls it was actually 2% of calls and over half of them were simply people asking questions about dosage.
The other nationwide report about the hospitals in Oklahoma being crowded with ivermectin victims to the point where they could not even get gunshot victims in to see a doctor... well, at least one of the hospital systems responded with an open letter stating that this was completely fake and that they had not seen even a single patient. I find it hard to believe that one hospital system would not see a single patient while all the other hospitals in the state would be completely flooded with them.
If the TV tells you something, you do not have to believe it.
I never said a word about any of that. I said that people are self medicating and incorrectly calculating an appropriate dosage, and I am not wrong. [1]
1. Facebook groups where people have admitted to taking more than they should have, causing incontinence. Not public groups, but one local to my area.
2. The FDA themselves
I have to ask, are you actually advocating for self-medicating with products from Tractor Supply? I've not once said anything about my opinion of Ivermectin, only that of self medication.
As one more piece of evidence - two of my family members are internal medicine physicians who are running covid units -- just a shocking number of people are showing up to hospitals with severe Covid after having self-medicated with IVM.
> If the TV tells you something, you do not have to believe it.
Where do you think most of the people taking ivermectin heard about it? They probably have no idea how ivermectin would actually work, but heard it from some conservative talk show host that they trust more than scientists backing the actual COVID vaccine. I'm astonished by how totally backwards all of this is.
I learned about Ivermectin from MedCram circa May 2020.
Everybody I know personally who did not learn about it from me learned about it from Eric Weinstein on the Joe Rogan podcast.
A good friend of mine watches Fox News no less than three hours a day and took both Pfizer doses months ago.
I suspect you might be projecting, and perhaps you learned about Ivermectin from a neoliberal TV show. Most of the people who believe in the safety and efficacy of Ivermectin believe so precisely because they are not consuming television propaganda, and so they are still able to form their own opinions from real information.
I consider Joe Rogan a right wing host, and I had heard he was telling people about ivermectin. I didn't know that originally people heard it from Eric Weinstein on his show, although I'm not sure how much of a difference that makes. Aren't all right wing / conservative hosts or media pretty much saying the same things in terms of COVID, anyway?
I do think people also form their opinions of the COVID vaccine on real information. I personally consulted someone I know who has a PhD in Molecular Biology to gather more information on the mRNA vaccines.
Yeah, because nothing says "recognize the current scientific understanding" like dismissing hundreds of studies because of a couple bunk meta-analysis. Also, nothing says "recognize the current scientific understanding" like injecting an untested medicine into your veins to avoid what amounts to the common cold for younger people; while ignoring the fact that it does not help prevent the spread, and according to the latest study on this from Israel (the highest vaccine rate in the world), actually enhances the spread, so if the argument is "what about the old people that you're going to infect", then I guess you've answered that question already.
It pays nothing to pretend that you are smarter than other people if you're not willing to follow your own advice.
You're packing enough untrue things into that comment that it's hard to believe you're acting in good faith but:
* It's dismissing the studies which show effects due to errors, which leaves the studies not showing beneficial effects. Science is built on evidence and thus far it hasn't been shown that Ivermectin has a benefit for COVID.
* Similarly, it's untrue to the point of being a flagrant lie to claim that the vaccines are untested when they went through full clinical trials and the high positive effects and safety rates shown in those trials have been backed up by data from many millions of people
* Similarly, it's flat out wrong to claim that COVID is similar to the common cold — even if you compare it to influenza, which is far more serious, that's not true — we've seen more children die in the last couple months than we typically see in an entire flu season.
* Vaccination does help reduce the spread, and that's even shown in the Israeli data — it's not 100% but if you look at the data it's very clear that vaccinated people at a significantly lower rate. Israeli comparisons are tricky because they have substantially different vaccination rates across age categories and a vaccinated 80 year old is still more at risk than someone younger, especially when those younger people are not taking precautions, which brings me to:
* Israel is nowhere near having the highest vaccine rate — that's a tie between Portugal, Malta, and the U.A.E. currently — and at a paltry 62% they're not even in the top 25. That's only slightly better than the United States at 55%.
* The Iraeli data does not show that vaccination increases spread: this is a lie spread by people who are comparing unlike things in the knowledge that many people will reshare those claims without checking them.
Non-sterilizing mRNA vaccines are biologics, which have separate regulations and distinct intellectual property protections in national laws and international trade treaties.
The United States CDC literally changed the definition of "vaccine" this year, so that these products could still be identified as vaccines. You're going to tell me that it's "science illiterate" to consider mRNA therapy as gene therapy, because the genes are not actually changed, but instead only expressed to create the therapeutic effect. But it is "scientifically literate" to call such a therapy a "vaccine"?
I hope more common sense literate proponents of science can appreciate how much it harms their case for a vast majority of science advocates to be loud and wrong.
> The United States CDC literally changed the definition of "vaccine" this year, so that these products could still be identified as vaccines.
For anyone else curious:
Before the change, the definition for “vaccination” read, “the act of introducing a vaccine into the body to produce immunity to a specific disease.” Now, the word “immunity” has been switched to “protection.” [1]
It seems obvious to me that this was changed because the layperson’s interpretation of the old wording would make it seem like 100% immunity was the result of vaccination. That’s never been the case. The new wording is just clearer in regular English.
> You're going to tell me that it's "science illiterate" to consider mRNA therapy as gene therapy, because the genes are not actually changed, but instead only expressed to create the therapeutic effect.
It’s not only science illiterate, it’s misleading to a layperson too. It sounds as if it’s changing the patient’s DNA.
> I hope more common sense literate proponents of science can appreciate how much it harms their case for a vast majority of science advocates to be loud and wrong
I do t understand how you think your interpretations lie closer to “common sense”. They seem to me to be more like;y to mislead.
A certain degree of ignorance can be forgiven in this day and age, because everything is being constantly re-defined by the television, and most folks get their information from the television.
So don't attack people for not knowing things, but just be aware how many low information people are unintentionally misleading others. You can even see in the parent comment, the primary source of information for most of these people is some form of media company (Miami Herald, in this case). This is, unfortunately, the new normal.
Logging in with different accounts and downvoting this won't change the facts.
I was prepared to believe I was wrong about the technical definition of ‘gene therapy’, but your links are to a description of the journal called “Gene Therapy”, and an article about “Gene-Based Therapeutic Approaches” that mentions the term once.
A google search for “gene therapy” brings up many links to respectable organizations and publications, most of which state that ‘gene therapy’ involves altering the patient’s DNA. No vaccines do this. To call them ‘gene therapy’ to the public (or to ‘low information people’, if you insist) is misleading at best and scaremongering at worst.
As for the link to a Miami Herald article about the CDC’s wording change, how do you suggest I search for the likely source of the parent comment’s information?
It said (with no sourcing) “The United States CDC literally changed the definition of "vaccine" this year, so that these products could still be identified as vaccines” and I wanted to get a sense for the truth of that - and if true, if the legitimacy of the change. What I found did not concern me.
…and thinking about this a bit more, it seems unlikely to me that any sort of approval for medication that makes it less likely that a person would become infected with Covid (colloquially, a ‘vaccine’) would rely on the definition of the word “vaccine” on an informational CDC web site - which seems to be what you’re (perhaps unintentionally) _implying_ with your comments.
If this is what you believe, do you have a source for this?
Would you mind linking me to the evidence that this is incorrect?
Posts like mine are being censored across-the-board on the Internet because of "interests". I mean, how much more evidence could you possibly linked to then 119 studies, yet my comment was flagged out of existence. We are literally living in a George Orwell novel and the people with jackboots are just ordinary citizens, putting the boots on their own necks. We are under the spell of like a self-prescribed global brainwashing campaign. Nobody cares about science anymore, nobody cares about the scientific method, nobody cares about actual data anymore, only propaganda. 119 studies show evidence of one thing. That's not enough though. But then the media says another thing and everybody believes it, despite the fact that there are dozens of studies with conflicting data showing various counter arguments (such as the Israeli pre-print from three weeks ago showing that The gene therapy is less effective than natural immunity by a factor of 13 to 27 times). This was practically completely ignored by the media and everybody on this site. In the past everybody here would've been on that shit immediately, trying to figure out if it was correct, I mean don't we want out of this mess? Does anybody want out of this or does everybody feel good about having a boot on their neck for the rest of their lives? Let go of your ego for a minute and ask yourself that question for real. If you're one of the people who will down vote this comment, there is no help for you in the long run. But if you want to be honest with yourself, and you want this bullshit situation to end, then you need to look at the real science in the real data and ask real questions and be open to the answers. Even if it means you made a terrible mistake somewhere along the way.
I think the first thing people here are negatively reacting to is the phrase "gene therapy", which has a specific meaning and the mRNA vaccines are most definitely not gene therapy.
I also don't think any scientifically minded person is opposed to the idea that natural immunity from previous infection provides stronger or longer lasting protection for infection. This would be in line with what we see with flu. The problem people have is the use of this information to encourage people to not get vaccinated. COVID outcomes are clearly better for vaccinated individuals than those who have not been vaccinated and have no natural immunity.
I don't like the mandates, lockdowns, or passports but I think vaccination is still useful in reducing illness, spread, and mortality. The data backs that up. No one in my opinion should be coerced, but the choice seems so obvious to me.
I vouched for your comment. You're allowed to believe whatever irrational things you'd like and comment about them as much as you'd like as far as I'm concerned. Seems it got flagged to death even after the vouch, though.
Let's, however, consider your inane views on the RNA vaccines (note that not only is this what everyone refers to them as, it's also the case that they are very specifically NOT therapies as they are meant to be prophylactic to disease rather than treat disease).
> such as the Israeli pre-print from three weeks ago showing that The gene therapy is less effective than natural immunity by a factor of 13 to 27 times)
Do you really have no idea why that's a stupid attack on the vaccines? The idea that natural immunity is superior to vaccine acquired immunity says NOTHING about whether or not a vaccine provides immunity. If A > B, that doesn't mean that B = 0.
Not only that, but the same study showed that natural immunity + vaccine > natural immunity. So by your inane logic, natural immunity alone does nothing!
But even with this study by all accounts being valid, what policy decisions would you change based on it? It's not like we would stop vaccinations!
What's more you're concerned that people are ignoring these 119 studies but you yourself claimed there was literally no evidence of effect for the vaccines when there are hundreds of studies (including your cited Israeli study for God's sake!) showing their effectiveness!
Beyond all of that, I know of 1 good RCT for Ivermectin in the Together Trial (1500 patients unlike the comedy of many of the studies you quote) and uh, no effect. Weirdly, they do find really great effect from Fluvoxamine and yet you quacks never decided to pursue that for some reason...
The Together trial only did 3 doses and only 400 mcg/kg - nobody else is finding results at that dosage rate either. Needs to be 5 days or longer, 600mcg/kg the earlier the better.
Some shocking non-linearities in dose-response you’re expecting. Point me to the most credible study you have. Tired of being shown poorly randomized trials with like 50 subjects.
Why don't you pay for them lol. It's off patent there's no money for large trials. See the links supplied above, there's data from entire countries now at least.
LOL pay for what? You can't even point me to the study you trust most and you're sitting here recommending a dosing schedule!! It's a comedy. I've looked at what's posted and the studies are mostly trash! This has 24 patients, not randomized and the treatment contains far more than Ivermectin! https://www.medrxiv.org/content/10.1101/2021.07.06.21259924v...
You people are clowns.
> there's data from entire countries now at least.
Entire countries have been given Ivermectin? News to me!
For those interested to learn more about Ivermectin, watch JRE#1671 podcast episode. Lots of interesting information covered about the drug by 2 biologists. It may change your views on this for the better, or the worse.
Dr. Pierre Kory was one of the main dudes promoting ivermectin -- he references the meta-analysis study on ivermectin that was later redacted. Of course when this interview was released (june 22), the study was not yet redacted (july 14) so it looked like the drug worked far better all the drugs including steroids & antibody treatment.
A meta-analysis is usually grounded on the assumption that an aggregation of multiple, well-conducted studies can provide significant information that may not be evident by taking each study individually. Essential to this assumption is the premise that those studies included in the meta-analysis be scientifically rigorous in themselves. Unfortunately, this is almost never the case. The great utility of the meta-analysis in the clinical literature is such that there have emerged a series of standards for how to conduct such analyses, such as controlling for bias, controlling for variability, etc. These seldom include actual assessment of the scientific quality of the studies, as this is harder to standardize. Consequently, there is a preponderance of meta-analyzes that come to conclusions that are simply not justified, because the studies themselves were not scientifically rigorous.
I believe this applies to the situation of ivermectin, and it just so happens that this is the thrust of the point raised in the Nature article cited here.