Ivermectin: Much More Than You Wanted to Know

https://astralcodexten.substack.com/p/ivermectin-much-more-than-you-wanted

by 4monthsaway • 5 years ago

735 711 5 years ago

astralcodexten.substack.com

junon• 5 years ago

Even an atheist can appreciate a cathedral, and even an ivermectin skeptic should be able to appreciate this website.

This is well put. It's pretty remarkable indeed.

mint2• 5 years ago

Okay it was too long for me and I got side tracked. Is his opinion in the end that ivermectin helps if you have worms?

I got to the point where he talked about the studies showing no benefit were all from areas with low prevalence of worms and the studies showing benefits were all places with high prevalence of worms.

robbedpeter5• 5 years ago

It looks like it definitely helps if worms are a problem, and maybe possibly helps without, to the extent that further research is justified, but not so much that we should dose the world with ivermectin just in case.

bayesian_horse13• 5 years ago

And I would add that there are now two drugs who are known to work better, in addition to monoclonal antibodies and multiple vaccines with more than 7 billion doses administered for over a year...

Ivermectin MIGHT work... but really... let's move on.

OGforces• 5 years ago

This guy is a brain genius according to a subset of the web and he spends this much real estate on invermectin and blesses us with this gem:

“Mainstream medicine has reacted with slogans like ‘believe Science’. I don’t know if those kinds of slogans ever help, but they’re especially unhelpful here. A quick look at ivermectin supporters shows their problem is they believed Science too much.”

Then he quotes. Their. Tweets. to tell us the ACTUAL problem with this contingent.

Talk about unhelpful. My man has less expertise in abnormal psych than the average sex worker and conflates his ability to dissect standard issue science publications with expertise in sociology (Nate Silver suffers from similar delusions of grandeur, and also writes insufferable, unhelpful, overconfident political diagnoses). I’d rather he didn’t amplify what he published, and I think it was not worth his time.

pchristensen• 5 years ago

One time I didn't believe Scott when he wrote a "More than you wanted to know" article. This time, I took his word for it and scrolled (and scrolled and scrolled) to the bottom to read the summary.

roenxi12• 5 years ago

This is exactly the sort of thing that YouTube, Twitter, et al are suppressing. Someone thoughtfully listening seriously to what the proponents of Ivermectin are saying, weighing it up and saying "looks good but you forgot...".

You can't get this sort of excellent rebuttal without allowing a site like https://ivmmeta.com/ into the debate.

jacquesm87• 5 years ago

Meanwhile, ivmmeta.com will get passed on from person to person that wants to sustain their delusion and the website here will be preaching to the choir.

roenxi12• 5 years ago

I changed my mind. I was making pro-Ivermectin comments just yesterday.

This is the first serious anti-Ivermectin argument I've seen.

bayesian_horse13• 5 years ago

There is little evidence of such analysis being suppressed. I think it is just relatively rare, because it is a lot of work and takes particular skill.

Most people who care about this research are indeed crackpots, unfortunately. Those who aren't have mostly moved on from Ivermectin because they have better things to do. Ivermectin is being tested in large RCTs, as it should. If it works, it will be used. If it doesn't, it won't. Until we know, doctors will do what works.

roenxi12• 5 years ago

Going through one of those studies from https://ivmmeta.com/ on YouTube would be a risky proposition for a YouTuber. It goes against YouTube's medical misinformation policy [0]. It is pretty clear that a study with that sort of effect size could encourage someone to take Ivermectin. Particularly the "Categorical claims that Ivermectin is an effective treatment for COVID-19 " would be a worry depending on how the censors feel that day. They'd potentially be arguing a technicality against some Silicon Valley type with an axe to grind.

Despite the fact that it appears those studies were honest, and picking up an actual factual effect. Now it turns out, laughably in hindsight, that the effect is probably whether people had parasites or not and I hadn't thought of that. But it isn't obvious how I'm going to figure that out without someone pointing it out to me. Ideally on YouTube where there are some really good channels covering COVID, often with actual doctors involved.

No-one else seems to have figured it out either, given I've seen lots of people shouting at each other and none suggested it as a possibility.

[0] https://support.google.com/youtube/answer/9891785?hl=en

RubberMullet• 5 years ago

There is little evidence of such analysis being suppressed.

...

Most people who care about this research are indeed crackpots, unfortunately.

Where is the evidence to support this statement?

podgaj4• 5 years ago

Dr. John Campbell posted a video that was "fact checked" by facebook which he calmly dismantles in the video below. Facebook puts up a big warning if you see it or post it. Soft censorship is still censorship.

https://www.youtube.com/watch?v=ObTAOvgd_JE

aantix• 5 years ago

There is little evidence of such analysis being suppressed.

Why did this post get flagged on HN?

https://imgur.com/a/GgDVfNe

mgamache2• 5 years ago

"There is little evidence of such analysis being suppressed"

Please think about that for a while...

abandonliberty• 5 years ago

Doctors are are much more trades/crafts people than scientists. Among the several I know personally and/or professionally, few are current with the latest research, or even know how to interpret it. They follow the treatment manuals they're provided, which do the best they can with the information available at the time. At the beginning of COVID, the manuals had to make many decisions on incomplete data; none of the drugs they recommended early on are still in use.

Most of the world understands this. It's mostly in the USA that we deify doctors. Few have first-year statistics competency, or can critically read a publication. And that's fine - it's not their profession.

VBprogrammer• 5 years ago

I wonder if YouTube would have been better to implement a no medical advice policy. Not a no advice which runs contrary to the official guidelines policy.

jacquesm87• 5 years ago

This is going to the heart of the problem: Youtube has replaced TV, and what people see on TV they tend believe to be real, and even if they don't believe that at the moment they see it they may well remember it as fact later on.

I think youtube is great for showing people DIY stuff, for home videos and so on, but it has clearly allowed itself to be hijacked as a platform for politics and it was/is ill prepared for the attempt at weaponizing the immense audience that it commands.

commandlinefan2• 5 years ago

This is exactly the sort of thing that YouTube, Twitter, et al are suppressing

I fear that if it had any name except Scott Alexander's attached to it, it would have been flagged/dead on here within a few minutes as well.

ImaCake• 5 years ago

This is maybe true. But I have seen more than a few dubious COVID articles gain traction on HN. There are several times I have tried to clarify basic statistical points as well. So it’s not a given that it would have been flagged/dead.

kaba09• 5 years ago

The thing is, 99 out of 100 people repeating conspiracy theories don’t have a single coherent thought behind the whole thing.

It will be a straw man, but it is statistically like that:

They may start by how research grants decide the results of studies and thus your study is one of those payed ones, but then jump ship and go that this sea snake extrude homeopathy will treat covid, just go look it up yourself, and then even if there is a “paper” for that, it is from goddamn Atlantis with no peer-review and was tested on 2 parrots.

Imnimo• 5 years ago

If Twitter is suppressing this analysis, why does the article cite many tweets from people doing the actual legwork?

robbedpeter5• 5 years ago

This is great. It also underscores a methodological opportunity - is there a way to group together a huge amount of studies, regardless of disease or treatment, and create a semantic association graph that takes things like climate, culture, geography, and the like into account?

You could rank researchers and institutions and locations in order to weight contributions to meta-studies, but you would be also able to associate confounders like parasites almost immediately. I have to imagine it would be the ultimate tool in identifying novel uses for existing drugs.

If this could be done with open source software, it could be a killer app for scihub. Medicine, nutrition, chemical processes, energy science, all sorts of things could benefit the world.

Hell, what if there's a correlation with elevation? It looks like there's a lower death rate at higher elevation - how much air pressure is the threshold for viruses getting into lungs? Could a strong coughing fit at sea level be more dangerous than one at the summit of everest? Does less coughing occur in low humidity, low dust places?

astrange6• 5 years ago

If there was such a tool, you wouldn't be able to use it for much because you'd have to preregister all your searches.

beebmam• 5 years ago

"It feels right to me because it’s the most troll-ish possible solution. Everybody was wrong!" - I know this is said tongue-in-cheek, but this mischaracterizes the medical scientists who have been working themselves to the bone trying to understand this virus and disease.

Actual medical science, and science in general, doesn't make claims beyond what we know for certain (or at least, we're very explicit about the claim's certainty). And what we know for certain in medical science is actually quite small. People, both for clout and for profit, make up bullshit when there are gaps in knowledge.

"Believing science", as stated a few times in this article, should actually be framed as: reserving judgement until we have evidence. We should have a bit more respect and patience for the process of acquiring actual knowledge. And people who make claims beyond what we actually know should be held accountable culturally (and financially) for being liars.

robbedpeter5• 5 years ago

"A lot of what you're seeing as attacks on me, quite frankly, are attacks on science, because all of the things that I have spoken about, consistently from the very beginning, have been fundamentally based on science,"

"And that’s the reason why I say people who then criticize me about that are actually criticizing science"

It's a problem with differentiating science from the scientists, and when someone mistakes themselves for an arbiter of truth, they damage public trust in science as a concept. The scientific method, big S Science, is the best tool humans have. People are fallible, flawed, arrogant, tribal idiots, and Science lets us rise above our weakness.

Criticizing Fauci for being a weaselly political hack, repeatedly lying in public "for the greater good", lashing out with the above claims, and other serious ethical defects are fine - he's human. He is also capable and trained in understanding scientific data, and is undeniably an expert.

However, as he has made so abundantly clear, he's lost perspective and recognition of his own flaws and biases, and doubled down on the politicization of science and the pandemic response. We need apolitical dispassionate scientists with the understanding that they as people are separate from their studies and recommendations.

When the scientist starts lying to the public for reasons that amount to "I know better" or "the public is too stupid or incompetent to handle the truth," it undermines Science.

"Believe Science" should be a no-brainer. It shouldn't be a team blue political slogan, or used to defend personal failings - both of which are despicable.

jacquesm87• 5 years ago

The attacks on Fauci are despicable. Note that he's anything but a weaselly political hack, but he did get replaced by one during the Trump reign. The man has more integrity than the bulk of that particular administration.

fallingknife5• 5 years ago

Actual medical science, and science in general, doesn't make claims beyond what we know for certain

Medical science made the claim that multiple sclerosis was "female hysteria," until imaging technology was able to see the damage. A doctor I know today claims that a lot of patients symptoms are really psychological and everyone at work is annoyed when they come in. When I brought up the case of multiple sclerosis, and maybe many patients have disorders which are not known to medical science because they are dismissed in the same way, I was met with a "that's ridiculous" defense. When I pressed further and ask for evidence on that point, I was given the fact that these patients with unexplained symptoms are highly correlated with anxiety. When I asked if having an undiagnosed medical disorder, and being told by doctors who clearly don't want to help you, and are clearly annoyed you are there, that it's all in your head might give someone anxiety, it was not well received. Medical science comes to all kinds of BS conclusions about the unknown without a shred of evidence.

astrange6• 5 years ago

A doctor isn't a medical scientist, he's a kind of very self-confident mechanic.

bobcostas55• 5 years ago

Actual medical science, and science in general, doesn't make claims beyond what we know for certain

What would you say about the FDA's recent approval of aduhelm? Do we know that it works "for certain"? Or is the FDA not part of the medical science establishment?

jcranmer• 5 years ago

The FDA's scientific committee nearly unanimously voted against aduhelm. The political side of the FDA overruled that consensus to give preliminary approval, which has been thoroughly panned by a large portion of the medical and scientific community, prompted three resignations from said committee, and has prompted a Congressional investigation.

Aduhelm's approval basically came about in violation of the FDA's processes, so it's hopefully merely a one-off example of corruption rather than a harbinger of the death of science at the FDA.

native_samples7• 5 years ago

"Actual medical science, and science in general, doesn't make claims beyond what we know for certain"

Unfortunately I read papers that do this, all the time. Science in general not only makes claims well beyond what's known for certain but does it so consistently that vast numbers of people, including many scientists themselves, have lost sight of the scientific method and have normalized bad, unscientific behaviour.

And this is ultimately how you end up with more than half of all drug trials being fraudulent or useless ...

mike_h• 5 years ago

His alien thought experiment in the “Political Takeaway” section at the bottom is a masterpiece. If you’ve struggled to explain where science lost democracy, this must be as crisp as it’ll ever be described.

raxxorrax3• 5 years ago

It got political, but he still doesn't capture the gist and whole of the argument. You cannot argue against an imaginary position which he still espouses. There are just democrats and conservatives for him. That is a deep socialization which depending on age might be a permanent affliction.

But that isn't reflective of every position against a vaccination (or additional measures), it is more the explanation of a naive child. There are millions of reasons that could drive people to not play along:

- Don't trust doctors

- Don't trust politicians

- Don't trust media

- Has environment that shares the same opinions, difficult to go against the grain

- There a doctors critical of methods like lockdown and even the vaccine itself

- There a doctors that warned against vaccinating within a pandemic and their predictions became true to a degree

- Countries that didn't lock down came decently through the pandemic if they had otherwise good healthcare

- We combine vaccination with secondary measures like passes and mandatory health controls

- Covid is endemic and you will get it anyway, we still see different rules for vaccinated/unvaccinated people

- There are people unreasonably afraid of Covid

- People throw away liberties for questionable safety and will still end up getting Covid in the end

- ...

Most of it is indeed a trust issue, but the problem is that there are currently few people in the public sphere that deserve that trust. I am vaccinated, I make this statement because there are fearful people that demand that you justify yourself. I am not really inclined to accommodate them, there is a saying that "the smarter one gives in" and this is clearly a case like that.

Ivermectin wouldn't be the wonder cure, if criticism of it would be more analyzed in a way the author did. It is a good step. This is getting to a principled discussion if you just ban other voices.

jacquesm87• 5 years ago

This isn't an accident or a simple case of being wrong: this is a case of a fairly orchestrated campaign. That it has a lot of footsoldiers that aren't aware that they are being used is a real pity and a problem. The big question to me is how will we deal with the next round of bullshit cures that is undoubtedly waiting in the wings to play on those exact same feelings? Are people going to do this again, or will they wise up after having been played twice already?

ayngg2• 5 years ago

I think like he said, it is all trust. Without trust, people are wary of your motivations. When you are in that position, having the people you don't trust do things like promote the narrative of "trust science" just looks like they are using scientists as mouthpieces to co-opt their trust to push a narrative. Moderating misinformation looks like censorship, mandates look like coercion, etc.

Overall it was just a colossal failure of communication by policy makers, who had already eroded most of their trust before the pandemic, which then got exacerbated by contemporary journalism that felt like it had no qualms about making everything as divisive as possible for engagement.

I don't think people have lost trust in science, but politicians using "science" in this way of communication are doing a pretty good job of trying to erode that trust.

istinetz• 5 years ago

Moderating misinformation looks like censorship

Not to be adversarial, but there have definitely been a few instances which are just censorship and not moderating misinformation. And there are definitely some hot topics on which I will flat out ignore research, because I know only some conclusions are allowed and publishable.

I think it's pointless to discuss specific examples - my point is, it's not only an issue of managing trust, because the science doesn't deserve that trust.

xenadu02• 5 years ago

tl;dr: A lot of ivermectin COVID studies are garbage. When you throw them out it seems like there might be a mild positive correlation but that depends on your methodology.

But when you look at the bigger picture the decent positive studies often come from areas of the world where parasitic worms are prevalent. There is a specific parasitic worm Strongyloides stercoralis that multiplies out of control sometimes causing death when corticosteroids are taken - the exact kind of corticosteroids that improve survivability for those with COVID.

For good quality studies ivermectin seems positive for COVID in areas with high parasitic worm infection rates and negative for areas without such infections, though more data is needed. This seems like a tidy answer because it shows everyone got part of the story wrong and it has a plausible mechanism of action which was previously lacking (ivermectin kills parasitic worms that suppress the immune system and/or multiply out of control when other drugs necessary to recover from CVOID are given).

tzs3• 5 years ago

But when you look at the bigger picture the decent positive studies often come from areas of the world where parasitic worms are prevalent.

I bet someone could make decent money selling parasitic worm eggs or larvae or whatever the heck it is that gets into people that causes a parasitic worm infection so that people can infest themselves when they get COVID symptoms in order to make the ivermectin they then take more effective.

A depressingly large number of the people that end up on /r/HermanCainAward as nominees or winners would believe that is reasonable.

DoreenMichele5• 5 years ago

This is wonderfully fun stuff to read:

This is from ivmmeta.com, part of a sprawling empire of big professional-looking sites promoting unorthodox coronavirus treatments. I have no idea who runs it - they’ve very reasonably kept their identity secret - but my hat is off to them...Putting aside the question of accuracy and grading only on presentation and scale, this is the most impressive act of science communication I have ever seen.

I asked a few questions previously on HN about Ivermectin and got answers that killed my interest in the topic (because I don't think it is relevant). But this piece is a delight.

Cthulhu_2• 5 years ago

I want to know who's behind those sites, the fact that nobody knows who's behind them is shady. Or is having sites pushing meta-studies about anything normal and I just missed it?

jack_pp• 5 years ago

Is it so shady to mask your identity when so many people have been crucified for even hinting ivermectin might be beneficial?

user-the-name3• 5 years ago

The paragraph you quoted is, alone, pretty much enough to dismiss this entire article outright. It shows such a reckless disregard for critical thinking that it is impossible to trust anything that comes after it.

He sees a slick and well-presented site on a topic that is not only politically fraught, but well known to have a massive propaganda effort behind it, and he just completely refuses to even consider questioning it as a source? That is reckless beyond words.

j-bos• 5 years ago

He uses the site as list of studies to review, and throughout the article lays out why the site itself is not a reliable source.

mcphage2• 5 years ago

It shows such a reckless disregard for critical thinking that it is impossible to trust anything that comes after it.

I don't think that paragraph is as complimentary as you do.

shkkmo5• 5 years ago

The paragraph quoted is making a point about how to effectively present and communicate scientific topics, not ascribing dependability.

Indeed, the entire article is a systematic rebuttal of ivmmeta's claims. Rebuttals are more convincing if you treat the topic in good faith rather than assuming fraud from the outset.

I don't understand how you can see this as "reckless beyond words" when it seems like exactly the sort of systematic analysis that we need more of.

BurningFrog7• 5 years ago

You quoted this, but don't seem to have understood it:

Putting aside the question of accuracy and grading only on presentation and scale

tehjoker• 5 years ago

We have multiple vaccines and two (EUA) proven oral treatments now.

cbg03• 5 years ago

Yes, but the sneaky government is offering those freely, so that's very suspicious to some folks that would rather have "the good stuff" off of the black market.

havkd• 5 years ago

Ivermectin is completely safe (even if it doesn’t work). The rest of treatments, well, we will know in a few years or decades.

podgaj4• 5 years ago

The government is using tax dollars to pay for the drugs from these companies.

tzs3• 5 years ago

One of the popular memes posted to social media among the future /r/HermanCainAward nominee set is that if the government was really offering COVID vaccination for our own good then whey aren't they offering free chemotherapy and insulin?

99% of the time when you can tell from their other posts what politicians and parties they vote for, it is the politicians and parties that work tirelessly to block any attempt to have the government provide chemotherapy and insulin.

jmnicolas2• 5 years ago

Interesting read, I appreciate that the author isn't dogmatic and is open to discussion.

However I think he misrepresent some anti-vaxxers: it's not a matter of trusting science, it's a matter of trusting scientists with heavy conflict of interest to tell the truth while most of us don't have the required scientific knowledge to evaluate if they're telling the truth.

Pfizer and Moderna combined are making more than $1000 every second (stop and calculate how much money that makes for a year, that's mind boggling). Do they have an incentive to lie?

The fact that the discussion is immediately shut down and doubt isn't allowed is a big red flag. Let me quote the author:

Here this question is especially tough, because, uh, if you say anything in favor of ivermectin you will be cast out of civilization and thrown into the circle of social hell reserved for Klan members and 1/6 insurrectionists. All the health officials in the world will shout “horse dewormer!” at you and compare you to Josef Mengele. But good doctors aren’t supposed to care about such things. Your only goal is to save your patient. Nothing else matters.

He's funny, but the underlying reality is very sad.

Add to this the power grab by politicians toward totalitarianism, color me very skeptical about the situation.

jesterson9• 5 years ago

However I think he misrepresent some anti-vaxxers: it's not a matter of trusting science, it's a matter of trusting scientists with heavy conflict of interest to tell the truth while most of us don't have the required scientific knowledge to evaluate if they're telling the truth.

That's an excellent point - unfortunately people who are easily labeled as "anti-vaxxers" and perceived as uneducated anti-scince crowd quite often happen to be the people who just don't digest unsubstantiated narratives easily, which actually is a right way to listen to people and companies with potential conflict of interest.

A number of people (myself included) would perhaps pay less attention to ivermectin as in covid drug if crowd would really take it and do studies instead of just publicly mocking people who are trying to look into it. That attitude makes people think there is an agenda behind and big pharma revenues makes all of us think it's not entirely untrue.

Regrettably a lot of people related to science forget that science is not a blind belief in authority but actually quite the opposite - question authority in everything.

mewpmewp218• 5 years ago

I still don't know whether Ivermectin works or not, but mainstream media calling it horse paste is absolutely disingenuous and what increases distrust from me. It's as if they are incapable of understanding that same substance could be used for multiple species for multiple different conditions and in fact it has been used for multiple species.

So anyone calling it horse paste, horse medicine or even focusing on that makes me question their intelligence.

matthewmacleod• 5 years ago

A number of people—probably not including myself, if I'm honest—would take this statement more seriously if it wasn't a complaint that a thing which has already happened, and continues to happen, isn't happening.

Seriously. There are trials for any number of medications underway, including Ivermectin. There is, at the point, no evidence whatsoever to suggest it is being unreasonably withheld in any way. The cult of "magic miracle cure" that has built up around this one particular drug is fucking terrifying

Nursie14• 5 years ago

Studies have been done. It has been found lacking. You're getting mocked because you're blind to this and sticking to something that bad actors are touting as a miracle cure, while science and medicine move on in the search for things that actually help.

Like dexamethasone, remdesivir etc etc

orwin• 5 years ago

A number of people (myself included) would perhaps pay less attention to ivermectin as in covid drug if crowd would really take it and do studies instead of just publicly mocking people who are trying to look into it.

I don't think i've ever mocked any ivermectine taker (at least not for taking a medecine that may help some of his problems), and most "vaxxed" didn't either. And i'm aware than not all unvaccinated people are anti-vax (my brother is waiting for the Valneva himself). But as long as people tell me "look at the data", i will send them the data from the least vaccinated country in europe, Bulgaria (i even have a quick link on my phone), and ask them to explain to me their mortality rates, and grin a little. I'm not really mocking them, i just like seeing people trying to justify themselves, i find it fascinating. Note that i like seeing this in the "i fucking love science" crowd as well (people really have trouble explaining the moon's crescents, it is really funny), but as this is a novelty, it have more potential.

stonogo• 5 years ago

Mind boggling? $1k/s is around $31 billion. First of all, just Pfizer brought in more money than that last year -- around $10 billion more. But let's set that aside for now, because they're slated to bring in twice as much this year.

You think Pfizer and Moderna are somehow coordinating a global censorship campaign to defend that income? Sure, Pfizer's projects $82 billion in revenue is real money. But it's less than half of Amazon's income. Facebook brings that much in every year. Apple and AT&T crush these numbers, but nobody's going around deleting every tweet about how Mac OS has gone downhill or AT&T's cell service sucks.

In other words, it's just not enough money to have this kind of pull. Even if Pfizer and Moderna were lying their asses off to everyone who would listen, they just don't have the cash to buy off every medical expert and microbiologist of any standing -- and even if they did, the relevant government agencies can't accept hush money and aren't particularly interested in advancing some cartoonish corporate ruse.

Biological and medical research is a competitive field; most of these people slogged through six or eight years of underpaid postdoctoral work just to build the qualifications to participate in meaningful research as PI. Are there crooks who will take a check to parrot a party line? Sure. Is that common enough to enable the kind of overwhelming consensus we see today? Absolutely not ... but let's say I'm wrong: there just isn't enough money to pull it off.

This is why the current crop of conspiracy nuts insists the scheme isn't just about profits but also about some kind of vague assault on unspecified civil liberties -- it's necessary to ascribe actual evil to the movitation before it's even remotely believeable.

mewpmewp218• 5 years ago

Supposedly they are not buying everyone off. Look, 2008 happened, why couldn't similar thing that happened in financial industry happen in medicine industry?

The motivations, rushing of everything could be just aligned enough to cause all of this. Safety studies excluding some participants, some important data. All you'd have to pay off is to exclude certain data, for which there are ALREADY reports coming out for. For example Maddie de Garay's injuries excluded, there's report of someone else's vaccine injury being excluded from the original study.

BMJ coming up with the article of falsified data etc.

The way Pfizer reportedly conducted side effect studies. E.g. asking participants to report their side effects on 7th day in the app without any freeform text or custom symptoms - only predetermined symptoms. For any custom symptom you had to contact the doctors, who may have just ignored you or determined your symptoms to be irrelevant since they didn't have motivation or time to deal with you.

Pfizer just pressuring subcontractors just enough for them to provide data that favours vaccine safety, and there's just not enough time to double check everything so all of it just flies by.

Mainstream media has reported absolutely none of it. None of the excluded participants, nothing about the BMJ article. Nothing about how Pfizer conducted the studies. Everyone is clueless about that. There's already so much PR built towards hating "anti-vaxxers" and considering them uneducated and unintellectual, so the word "vaccine" is already associated in everyone's mind as something good, safe and effective. The PR is already there, you just have to work out something that you could call "vaccine", and help out people in the current very desperate situation.

Very few are actually closely looking into the data and there are actually plenty of scientists and doctors talking about it, but they are getting debunked using very superficial arguments and just finding anything slightly wrong or misleading about what they are saying and they are immediately considered "debunked".

Similarly during 2008, very few people were predicting this crash and everyone just wanted to pretend together that everything was going well. All the experts, economists etc. And human anatomy is somehow simpler than financial system?

phreeza5• 5 years ago

However I think he misrepresent some anti-vaxxers: it's not a matter of trusting science, it's a matter of trusting scientists with heavy conflict of interest to tell the truth while most of us don't have the required scientific knowledge to evaluate if they're telling the truth.

But you don't have to trust only scientists directly or indirectly employed by those companies. There are plenty of subject-matter experts who work for competitors or are tenured in academia who would have very little to lose from criticising the rollout.

jmnicolas2• 5 years ago

who would have very little to lose from criticising the rollout

I beg to differ, here is an example: Luc Montagnier, a Nobel prize recipient, has been completely marginalized after emitting doubts about vaccine safety and is now absolutely inaudible in anything mainstream.

It's just an example, there are several more. Anybody that saw how he was treated probably though really hard before emitting any dissenting opinion in public.

It feels like the Inquisition.

native_samples7• 5 years ago

Ah yes, academia, that famous bastion of free thought where success is totally unconnected to whether your colleagues like you and nobody ever gets cancelled. One where, as the fine article points out, 95% of biology professors vote Democrat.

Academia is the last segment of society I trust on these topics.

whiterock• 5 years ago

fun (sad?) fact: Ivermectin is sold out in pharmacies in Upper Austria.

https://www.nachrichten.at/oberoesterreich/entwurmungsmittel...

yxwvut2• 5 years ago

This article is a nice counterpoint to what's felt like a trend of Scott's writing (outside of psychology) increasingly becoming contrarianism in search of evidence. Many pieces he's written in the last 1-2 yrs feel like he'll use some back-of-the-envelope calculation to get some ballpark (associative) estimate of some relationship and then base a worldview around it (or work backwards from the latter to the former), decades of causal inference and economics literature be damned. I guess maybe the delineation is social science vs medical science topics. When he's in his wheelhouse he's great to read.

unanswered6• 5 years ago

contrarianism in search of evidence

But that is literally what this article is, and Scott admits as much! He says that he chose worms as the most "trollish" possible response, despite a lack of any strong evidence at all that worms are the answer.

jacquesm87• 5 years ago

The funny thing is that for all of their supposed smarts the bulk of the commenters in favor of the 'new' worm theory are jumping on it, just like they jumped on Ivermectin in the first place. It is in a way an interesting experience to see this happen in real-time.

yxwvut2• 5 years ago

You’re totally right. I was more referring to his review of the merits of the various studies, which as a statistician I actually agreed with - I mostly read the article to understand the history of these studies, having no prior familiarity beyond the high level understanding that the evidence was weak. I expected this article to largely be pro-ivermectin-as-underdog given that the mainstream opinion is that it isn't, but I suppose this fits even more. His claim that it’s all able to be chalked up to worms is dubious at best - selection bias of one form or another (publication, metric selection, etc) seems substantially more likely. Sure enough, though his readership is credulously adopting this theory just as easily as they adopt his other contrarian points.

EdwardDiego7• 5 years ago

My step-son was recently prescribed a small one off dose of ivermectin by a dermatologist to deal with a rather resistant case of scabies he acquired at a sports tournament.

It took the pharmacy a couple of days to source, because signficant controls had to be put in place around prescribing it due to well, I'm just going to say what I think - the amazing capacity for the Internet to deliver dumbassery to people who are open to it, thanks to the algorithms implemented by Google and Facebook.

The current dominance of algorithmic social media is going to make a fascinating history book one day. Right now it feels somewhat dystopian how easily misinformation is spread online because it yields a high engagement metric.

jacquesm87• 5 years ago

Yes, and what's more: how easy it is to enlist people to push such a bullshit story further than it would ever go on its own. That is the really bad side of this, the weaponizing of social media to do real world harm to entire populations.

radu_floricica3• 5 years ago

Did you read the article? One of the main points was that it's not dumbassery. You have multiple studies saying a drug works, being contradicted by experts that have been wrong multiple time this year and have a vested interest in what they're claiming. This is the opposite of dumb.

It turned out not to be true, but such is life - not all the correct choices are also true in the end.

It's also counterproductive in so many ways to call this dumb. And it's making yourself a huge disfavor by believing that everything you see online but disagree with is automatically misinformation.

EdwardDiego7• 5 years ago

People seeking out medication because they think it's a prophylactic for Covid-19 is not what any of those studies covered.

EdwardDiego7• 5 years ago

Incidentally, you're right about my throwing labels around not exactly helping things - I'd edit my comment to change it if I was still within the edit window.

s1artibartfast12• 5 years ago

The ironic part of this is that Ivermectin is not FDA approved for the treatment of scabies.

Your doctor was prescribing it off label, based on personal judgement that it has therapeutic effect. That is not to say it doesn't work for scabies, I hope it worked for you.

EdwardDiego7• 5 years ago

Good thing I'm not American then eh. ;)

https://www.medsafe.govt.nz/profs/datasheet/s/Stromectoltab....

EdwardDiego7• 5 years ago

On this, the CDC mention it as a last resort[1]. What's the role of FDA approval for usages of a drug in American law? Is my understanding correct that it's perfectly legal for physicians to prescribe off label, but you couldn't market ivermectin for the treatment of scabies to the public?

[1] https://www.cdc.gov/parasites/scabies/health_professionals/m...

viktorcode• 5 years ago

Well, at least the parasite endemic among humans sure is in decline now

DoreenMichele5• 5 years ago

Or, alternately, the incidence of drug-resistant parasitic infections is on the upswing due to misuse of the drug.

radu_floricica3• 5 years ago

It would be polite to come with sources or arguments for this, especially in this conversation. Occam says that taking an anti-parasitic drug will lead to less parasites. You can't just put second order effects on the table and claim it's a coin toss.

h2odragon3• 5 years ago

I've read of growing Ivermectin resistance in some kinds of worms but not they kinds that were well targeted by it in the first place, just the ones that had good survival rates already. No citations, sorry; this was reading i did years ago. Might find references in tapeworm treatment discussion.

Joking_Phantom2• 5 years ago

Love the final explanation for how ivermectin can be incidentally good for COVID-19 patients, even if it does nothing to COVID-19 directly.

In fact, as the author cites from another researcher, the trials are a strong piece of evidence for "add[ing] ivermectin to mass drug administration programs." In other words, global medical welfare, where we just give everyone a bunch of a cheap and effective medications to counteract the most prolific diseases. In addition to reducing mortality from diseases targeted by the medication, it will probably reduce incidental mortality when people contract multiple conditions at once. I.e. getting ivermectin for a detected COVID-19 infection has a 10% chance of helping you, because you have a 10% chance of having an undetected worm infection that will kill you if your immune system is suppressed by drugs that are used to prevent COVID-19 from killing you.

I do think the ending political metaphor doesn't quite fit, however. I see more parallels with workplace politics than an alien invasion, for why our societies have become so divided on relatively meaningless issues. Uniting disparate factions to work towards a common goal is an uphill battle that sees more failure than success, most often in our workplaces. To me, the ivermectin drama was just another example of an emergent situation that wasn't optimally handled by a collection of random individuals, who despite the best intentions, were unable to unite a group. Doesn't make them bad people, or mean they have the wrong approach. Just means they weren't ready to tackle such a difficult challenge. Positive outcomes take dedicated effort, they don't come automatically because we assume the status quo is good enough to us immune to random chance.

jacquesm87• 5 years ago

That depends on the side effects and the dose required+. So no, you can't just draw that conclusion.

+ edit: , etc...

Thanks Cthulhu_.

Cthulhu_2• 5 years ago

And of course whether parasites can adapt to become resistant (?) to the treatments.

DoreenMichele5• 5 years ago

When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections.

Medical stuff doesn't work the way most people would like to imagine it does. This sounds like a terrible thing to conclude. I'm rather unsettled to see it lauded here on HN.

darrenf• 5 years ago

When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections.
Medical stuff doesn't work the way most people would like to imagine it does. This sounds like a terrible thing to conclude. I'm rather unsettled to see it lauded here on HN.

Indeed, this exact thing is headline news in the UK today from our Health Security Agency - don't take antibiotics unless you definitely have something treatable by them: https://www.bbc.co.uk/news/health-59310099

LordDragonfang• 5 years ago

When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections.

I think this is an extremely jaded take, resulting from growing up in a post-antibiotics society. The risk factor for those "scary antibiotic-resistant infections" is still an order of magnitude less than the class of diseases antibiotics almost totally eliminated. In the 30 years following penicillin's discovery, deaths from bacterial infection dropped from accounting for over 22% of all deaths to just 6% [1] (MRSA deaths, by comparison, currently represent less than half a percent). "End of disease" may be hyperbole, but between antibiotics and vaccines, infectious diseases were almost totally knocked off the leading causes of death.

The only reason why we even have antibiotic resistant bacteria is because they keep getting prescribed, because they're so damn useful. "Medical stuff" does, in fact, work like that, to some extent.

[1] https://dash.harvard.edu/bitstream/handle/1/8889467/Gottfrie...

dkga• 5 years ago

Veterinarian here, used to ivermectin as it should be used - as an anti parasitic.

I fully agree with this view above.

mrow84• 5 years ago

I’m certainly no expert but isn’t the evolutionary timescale for parasites considerably longer than for bacteria? That would presumably lead to quite different consequences (though of course the evolutionary pressure, and thus the risk, is still there).

HelloNurse• 5 years ago

Wouldn't we risk force-evolving ivermectine resistant parasites with the same mechanism as antibiotic resistant bacteria?

BurningFrog7• 5 years ago

You have a valid point.

But note that it's a much easier point to make from a region where parasitic worms don't exist.

raverbashing• 5 years ago

For real, prophylaxis of enteral worms should have been more popular in developed countries.

It's amazing how hygiene practices are sometimes poor and tropical diseases are unknown in developed countries

But then you go visit somewhere and/or some animal product is imported in questionable ways and you get a worm. Which for 95% of people will be mildly inconsequential but it might also cause problems.

jacquesm87• 5 years ago

This is the basis for many religious food taboos.

vmception2• 5 years ago

This is interesting, it is similar to how doctors just include gonorrhea treatment for women that expect to bear children. Instead of embarrassing any particular woman who would suddenly have something to explain to the partner, they just give it to many amongst the cocktail of various other obscure sounding drugs.

Veelox• 5 years ago

I do think the ending political metaphor doesn't quite fit, however.

Literally none of my immediate family has gotten the vaccine. I know several more people who haven't gotten it. I have been reading Scott since around 2015. I would say I sit in an interesting intersection of worlds for this issue.

While the facts of the metaphor are slightly off, I think Scott got the emotional feeling exactly correct. There are hostile aliens who actively gone against my interests in the past, they have been wrong before, their is a good chance they could use this for their own gain. That is exactly how my parents feel.

WhompingWindows2• 5 years ago

I think you should clarify that Ivermectin works better in higher-worm-prevalence areas. It's not remotely true that 10% of Americans have undetected worms. The praised study in the post highlights 12.5% as "high" prevalence, so 10% would be nearly high -- not true in the developed world.

naasking8• 5 years ago

According to the CDC, 3.7 million people in the US are infected with Trichomoniasis. That's at least 10%.

https://www.cdc.gov/media/releases/2014/p0508-npi.html

Joking_Phantom2• 5 years ago

10% is a token number for argument's sake, not any rate based on reality

nisegami• 5 years ago

I have unironically been advocating for this approach with Metformin in my country. I think it'd have incredible positive effects.

Shank• 5 years ago

This is worth reading purely for the writing alone. Scott Alexander is a treasure:

As best I can tell, this is some kind of Egyptian trial. It might or might not be an RCT; it says stuff like “Patients were self-allocated to the treatment groups; the first 3 days of the week for the intervention arm while the other 3 days for symptomatic treatment”. Were they self-allocated in the sense that they got to choose? Doesn’t that mean it’s not random? Aren’t there seven days in a week? These are among the many questions that Elalfy et al do not answer for us.

jmcgough• 5 years ago

Oh, no wonder this was so entertaining to read, didn't even catch that this was astral codex. I laughed out loud at Cadegiani et al:

A crazy person decided to put his patients on every weird medication he could think of, and 585 subjects ended up on a combination of ivermectin, hydroxychloroquine, azithromycin, and nitazoxanide, with dutasteride and spironolactone "optionally offered" and vitamin D, vitamin C, zinc, apixaban, rivaraxoban, enoxaparin, and glucocorticoids "added according to clinical judgment". There was no control group, but the author helpfully designated some random patients in his area as a sort-of-control, and then synthetically generated a second control group based on “a precise estimative based on a thorough and structured review of articles indexed in PubMed and MEDLINE and statements by official government agencies and specific medical societies”.

WithinReason6• 5 years ago

The patients got Sunday off of course

thyrsus• 5 years ago

If the study was in Egypt, that would have been Friday.

PragmaticPulp2• 5 years ago

This is worth reading purely for the writing alone. Scott Alexander is a treasure

This post is a breath of fresh air for the blog and feels refreshingly well-researched. Between that and the unquestionable popularity of COVID-related discussion, it’s no wonder this article is popular.

Scott is undeniably a good blog writer with an entertaining writing style that resonates with his reader base. However, I’ve become disillusioned with a lot of his other recent writings like the “Great Families” post in which he presented a lot of conjecture that pandered to his core readership without any research or evidence to support it. Specifically, his position that genetics are the primary explanation for “Great Families” while ignoring obvious heritability of things like wealth and social status. Even the old Slate Star Codex and new Astral Codex Ten communities started calling him out on it after that article.

Scott’s writings are undeniably entertaining and usually quite fun to read, but I’ve long since learned to read them more critically because his writings have a way of projecting a sort of humble confidence while either hedging any statements so much that little is actually communicated, or sometimes inserting conjecture or feelings with a lot of linguistic window dressing such that it’s easy to mistake it for fact.

I hope this article is a sign that the writings are shifting more toward the old-school, heavily-researched style that made the blog so popular.

commandlinefan2• 5 years ago

ignoring obvious heritability of things like wealth and social status

He addresses that in the section section - besides the intro, he leads with it:

"the next generation becomes semi-famous fashion designers and TV personalities and journalists, which seem like typical jobs for people who are well-connected and good at performing class, but don't need to be amazingly bright. Sometimes they become politicians, another job which benefits from lots of name recognition.

But I've tried to avoid mentioning these careers, and focus on actually impressive achievements that are hard to fake. And also, none of these families except the Tagores were fantastically rich; there are thousands or millions of families richer than they are who don’t have any of their accomplishments. For example, Cornelius Vanderbilt's many descendants are famous only for being very rich and doing rich people things very well (one of them won a yachting prize; another was an art collector; a third was Anderson Cooper)."

SkeuomorphicBee2• 5 years ago

Most of the writing is fantastic, but I'm very disappointed by the take that "everyone was wrong", by the implication that doctors didn't know they should treat for worms before giving immunosuppressants. Guess what, doctors in the developing world already knew that, it was always the standard practice on Brazilian hospitals. In fact, ivermectin was in very high demand in hospitals before it was suspected to be a Covid19 treatment. That whole paragraph reads like some really bad exceptionalism (it it doesn't exist here it doesn't exist).

Arete314159• 5 years ago

I actually come from one of those so-called Great Families. Three generations back, there were 3 siblings who all had national or smaller success in creative, financial, and mathematical fields, including one who won a nobel prize. Many of their descendants also had successes, although of a more modest variety.

However, in my generation, there were lots of money problems. And they did what money problems tend to do -- delay, deny, disappoint, cause health problems, and make everything harder.

The "brains," such as they were, were still there. If we take the usual markers* of intelligence there were Ivy League admissions, Fulbright scholarships, and so on. But for me at least, not having affordable healthcare at age 20 impacted my life much more in a negative way than getting a 5 on the Calculus AP impacted it in a positive way.

I'm much less interested in the concept of inherited genius than I am in universal health insurance and free college.

*Which are themselves problematic, and often merely markers of class, but it's the best I can do here for a HN comment

LeifCarrotson• 5 years ago

Spoilers ahead, but I loved this pun:

The fraud-hunters have examined this paper closely and are unable to find any signs of fraud. I think this paper is legitimate and that its findings need to be seriously considered. ... And there’s always the chance it was a fluke, right? Can something have a p-value less than 0.001 and still be a fluke?

...

And it was! It was a fluke! A literal, physical, fluke!

Edit: If you like puns and this writing, you'll likely enjoy some of Scott's other works, like "The Study of Anglophysics" [1] and (especially if you're at least passingly familiar with Judaism and Kabbalah) Unsong [2].

[1] https://slatestarcodex.com/2014/04/03/the-study-of-anglophys...

[2] https://unsongbook.com/

Terretta• 5 years ago

Sort of undermined the entire payoff there. Maybe this is a rare time to use all caps: *** SPOILER ***

Also in the SPOILER reveal, you could just quote ”And it was!” to show you enjoyed the setup and delayed gratification pun w/o tipping the whole game.

‘Twas a gem though.

deell223• 5 years ago

Small correction: you can very much enjoy and love Unsong without understanding of Judaism and Kabbalah.

pieter_mj7• 5 years ago

In the pilot of House, M.D., a patient is treated with Albendazole for a parasitic worm infestation. Not a fluke, but closely related :)

Albendazole is also considered for treating covid.

edit : hm, I think I remember Dr. House making the fluke joke ...

bsaul2• 5 years ago

Funny how all this article ends up saying it's all a matter of trust.

Which is exactly what medecine has always been about, and why ultimately you end up getting prescriptions by you own doctor, that you have a bound with and that you trust.

The most insane thing that happened with this pandemic ( at least in europe) is how we decided to throw all this through the window and let states impose medical decisions on people and their children, not realizing people were still considering them highly incompetent in general.

jpcosta• 5 years ago

There are medical bodies staffed by professionals that study these matters, and the states (should) base their decisions on what their findings are. To me the problems starts when decision makers and then the general population start trusting fringe conclusions and trying to interpret medical data when they have no training to do so.

bsaul2• 5 years ago

Why go through state then ?

When a new cure for cancer is found, we don't expect the minister of health to recommend or advise its use to the general public on TV, do we ? We assume professional MD will learn about it via their regular channel, and recommend the treatments on patients that they judge relevant.

robocat• 5 years ago

With a meta-analysis, if you detect a high number of fraudulent studies, shouldn’t that negatively affect your trust of the studies which you didn’t detect any problem with?

Let us imagine you looked at 100 papers, and you could tell 99 of them had severe problems, and one looked OK. That information would make you suspicious that the one paper also had severe problems, but that you just didn’t detect the problems.

From article: “We’ve gone from 29 studies to 11, getting rid of 18 along the way. For the record, we eliminated 2/19 for fraud, 1/19 for severe preregistration violations, 10 for methodological problems, and 6 because Dr. Meyerowitz-Katz was suspicious of them.”

jacquesm87• 5 years ago

A good rule is to simply wait. Bad science has a way of being negated over the longer term. But if you want results today you could always try to replicate the experiment (which is one of the reasons why asking scientists to show their data in raw from should be mandatory in my opinion).

capableweb• 5 years ago

Bad science has a way of being negated over the longer term.

Humans started to experiment with Lobotomy around 1930s and it wasn't until after 1950s that we started to realize that it probably did more harm than good. António Egas Moniz even won a Nobel Prize for "discovery of the therapeutic value of leucotomy in certain psychoses".

Yes, bad science will probably be negated over long term, but what about the harm it does during those years? Can't we find a way to reduce the harm of experimental science? Maybe things aren't that long as my example today, but I still feel we can do more to prevent bad science in the first place.

red_trumpet• 5 years ago

Depends. If you are a doctor treating COVID, you wouldn't want to miss out on an effective medicine, right?

mewpmewp218• 5 years ago

Depends on what would be the supposed cause of the fraud? What would be the motivations?

elcomet• 5 years ago

and 6 because Dr. Meyerowitz-Katz was suspicious of them.”

That's a bit frightening, of course someone would be suspicious if results were going against his/her opinions

bschne• 5 years ago

I asked him about his decision-making, and he listed a combination of serious statistical errors and small red flags adding up. I was pretty uncomfortable with most of these studies myself, so I will err on the side of severity, and remove all studies that either I or Dr. Meyerowitz-Katz disliked

From further up, though we don't _quite_ know the details, but it's not like he went "Oh well some random person disagrees with them so better throw them out"

rossdavidh• 5 years ago

If "With a meta-analysis, if you detect a high number of fraudulent studies..." applied here, perhaps so. But most of those eliminated were not for fraud, in fact only 2 were for fraud, the rest were flawed in ways which, I'm afraid, is equally common (or nearly so) in studies on any other topic. Also, not all of the studies he threw out showed ivermectin working, I recall at least one showed the opposite but that doesn't mean we throw out all studies showing ivermectin doesn't work.

Also, the whole point of the exercise is what do you find if you apply good statistical and methodological rigor, but don't have any anti-ivermectin bias.

BurningFrog7• 5 years ago

Maybe. But 2/19 fraudulent studies aren't a high number.

gunapologist996• 5 years ago

"6 because Dr. Meyerowitz-Katz was suspicious of them"?

That... seems like cherry-picking for the results you are looking for.

lolspace• 5 years ago

This is from ivmmeta.com, part of a sprawling empire of big professional-looking sites promoting unorthodox coronavirus treatments. I have no idea who runs it - they’ve very reasonably kept their identity secret

Why are they hiding their identity? That means that it can be anyone who does this.

-----------------

But even more important. The website also claims that each of the following individual medicines works:

Fluvoxamine

Proxalutamide

Iota-carrageenan

Molnupiravir

Quercetin

Povidone-Iodine

Curcumim

Casirivimab

Sotrovimab

Bamlanivimab

Nitazoxanide

Budesonide

Zinc

Bromhexine

Colchicine

Vitamin D

Aspirin

Favipiravir

Hydroxychloroquine

Remdesivir

Vitamin C

I find it unlikely that all those claims are true which in turn makes me question their scientific approach.

WithinReason6• 5 years ago

The problem is likely to be with the scientific approach of the studies included (they are not filtered) than the meta-analysis itself.

shkkmo5• 5 years ago

The article points out several ways that ivmmeta's meta-analysis may be flawed:

Meyerowitz-Katz accuses ivmmeta of cherry-picking what statistic to use for their forest plot. That is, if a study measures ten outcomes, they sometimes take the most pro-ivermectin outcome.
(how come I’m finding a bunch of things on the edge of significance, but the original ivmmeta site found a lot of extremely significant things? Because they combined ratios, such that “one death in placebo, zero in ivermectin” looked like a nigh-infinite benefit for ivermectin, whereas I’m combining raw numbers.

Given that there is a lot of complexity and debate on how to integrate studies with disparate primary outcomesbane measures, the fault may indeed lie with the ivmmeta analysis methodology.

shusaku• 5 years ago

Such good writing. I was anxious about trying to read it all, but he kept me hooked to the end.

I think it’s important to address ivermectin support on its own terms - as a potentially plausible scientific theory in a debris field of confusing evidence, which should be debated to the usual standards of scientific debate. I’ve tried to do that above.

This is also how I’ve kind of tried to view things, yet I continue to be disappointed. The studies shown here were way worse than I imagined. Just like when someone in my personal life says to me they’re skeptical of the vaccines. I want to take them seriously, I’m waiting for them to talk to give well reasoned arguments about hard choices and uncertainty, but it ends up being arguments one can dismiss with five minutes of research.

I predict that over the next 100 years bioethics will dominate the discourse. I want people to be ready to challenge the status quo and experts going forward. But covid has really shown that we’re not even remotely prepared. What will it take, four years of mandatory biology and philosophy for high school students?

esun• 5 years ago

Maybe even just an intro to stats course in early high school would help?

native_samples7• 5 years ago

What arguments do they give you?

tdrdt• 5 years ago

"...everyone still PCR positive by day 7 so it was impossible to compare groups"

Eh, isn't this what a PCR-test does: detect RNA? A medicine doesn't magically remove virus RNA. It might break down the virus or block it's ability to reproduce but the RNA will still be detected.

Tycho• 5 years ago

How similar to Ivermectin is the new Pfizer covid drug?

pjc504• 5 years ago

Paxlovid: https://en.wikipedia.org/wiki/PF-07321332 protease inhibitor;

Ivermectin: https://en.wikipedia.org/wiki/Ivermectin binds to chloride channels and is a nerve poison for invertebrates.

The molecular layouts look completely different.

gardnr5• 5 years ago

This study shows Ivermectin functions as a protease inhibitor https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996102/

Here is the fact check evaluation from Reuters: https://www.reuters.com/article/factcheck-coronavirus-pfizer...

low_tech_love4• 5 years ago

It was a fun read, but implying that a drug dealer from Kern county is related to a published researcher from Mexico just because they have the same surname is not really cool.

comicjk3• 5 years ago

I agree. I wonder, though - the author has written a lot about political signaling and trust. I wouldn't put it past him to add a joke that's deliberately anathema to liberals, in order to relax the hackles of the conservatives he's trying to convince to use real medicine.

s1artibartfast12• 5 years ago

Why do you think the joke could be joke could be viewed as anathema to liberals in particular?

I was trying to dissect this comment and couldn't figure out the political angle.

shkkmo5• 5 years ago

It is pretty cringy. I believe the implication is that the study was so poorly performed and produced such outlandish results that the researchers had to be high on drugs or something...

s1artibartfast12• 5 years ago

I think you missed the point of the comparison. It wasn't a real claim that they are literally the same person. It was a joke that that the study was so suspicious and potentially fraudulent that the author could be a criminal drug dealer...

low_tech_love4• 5 years ago

Sure it’s a joke. A very bad, tasteless, and racist joke. I get it!

yholio• 5 years ago

I want a world where “I did a study, but I can’t show you the data” should be taken as seriously as “I determined P = NP, but I can’t show you the proof.”

The fact that this is not standard practice highlights some societal bias in favor of people in white lab coats that can't possibly be suspected of fraud or incompetence - for it will shatter our sense of safety and control over the world.

People are people and power corrupts. When your publication has the power to turn you into a celebrity, skyrocket your career and land you a top paying job and speaking arrangements, the corruption potential is strong. As the author further elaborates:

But even if it’s only 1%, these will make up much more than 1% of published studies, and much more than 1% of important ground-breaking published studies, because correct studies can only prove true things, but false studies can prove arbitrarily interesting hypotheses (did you know there was an increase in the suicide rate on days that Donald Trump tweeted?!?) and those are the ones that will get published and become famous.
So if the lesson of the original replication crisis was “read the methodology” and “read the preregistration document”, this year’s lesson is “read the raw data”. Which is a bit more of an ask. Especially since most studies don’t make it available.

rmbyrro3• 5 years ago

Mainstream medicine has reacted with slogans like “believe Science”. I don’t know if those kinds of slogans ever help, but they’re especially unhelpful here.

To me such slogans are a disservice. Science should not be a matter of belief by definition.

This way of promoting science is what brings belief-centric discussions to an arena that cannot benefit from beliefs.

I remember one presidential debate in the US where the interviewer asked Trump: "Do you believe the science of climate change?"

Making such question is an absurdity and reflects the almost religious way these subjects have been considered lately.

No scientific field, study or conclusion should be a matter of belief.

notahacker4• 5 years ago

Science is a means of approaching beliefs. Science is not the philosophical position that we should be agnostic about the existence of gravity or magnitude of gravitational forces. Unlike other means of reaching beliefs, science supposes there is little reason to hold a belief that cannot be supported by induction from experimental data, and that a correctly set up experiment can falsify previously held beliefs and require the theory to be updated. A corollary of this is that stuff generally isn't to be believed simply because a very old book and much revered book says so (which is bad news for Aristotle's speculation as well as monotheism, but somewhat better news for Newton's laws because there are practical working applications of them). But when it comes to anthropogenic climate change or vaccine efficacy the evidence very much is there - people can either believe it is probably true or demonstrate their superior understanding of why evidence actually doesn't support the hypothesis (ideally by counter example, but pointing out confounding factors that have been missed is a start). Either approach is consistent with science, though only the latter will further scientific knowledge. An approach to formulating beliefs which isn't consistent with science is the prior that if scientists virtually all agree on the evidence base for something, the contrarian theory is probably right.

rmbyrro3• 5 years ago

It seems we think very much the same. Given the historical background, I just think it would be better to use words such as knowledge, understanding, thinking, rationale, instead of belief.

tzs3• 5 years ago

I remember one presidential debate in the US where the interviewer asked Trump: "Do you believe the science of climate change?"
Making such question is an absurdity and reflects the almost religious way these subjects have been considered lately.

What question would you ask to ascertain someone's state of mind on climate change?

rmbyrro3• 5 years ago

I'd ask two questions:

"What do you know about the science of Climate Change?"

"What do you think is your role as a President to apply our knowledge in this area?"

csee6• 5 years ago

While reading this piece I got a little depressed that most journalism is just such utter trash compared to it. I've read so many articles on ivermectin and none of them gave me even ten percent of the clarity that this article gave me. Can you imagine if writing and journalism of this calibre was commonplace among practising "journalists"? And look at how this piece compares to the CDC's and WHO's science communication. It's a shame that clear thinking and communication is so scarce.

jacquesm87• 5 years ago

This is a huge factor. Dumbing things down creates a dumber audience. If you look at newscasts and newspapers from the 70's and compare them to today the difference is amazing.

api• 5 years ago

There are a lot of conspiracy theories about this but I think it’s just a race to the bottom in search of the largest audience.

It seems to still be getting worse. I remember cable news being tolerable 10 years ago. Now when I see it at an airport or something I can almost feel the ice pick ramming up into my brain and swishing around.

astrange6• 5 years ago

He has an earlier piece whose point is that the WHO can never be accurate, because they always have to prioritize "sounding trustworthy" over accuracy, and random blogs don't.

romeros2• 5 years ago

WHO has no other option than being inaccurate.

Society needs a simple answer. Do this. Do that etc. Put on a mask. Wash your hands. Practice social distancing. Use approved vaccines. Take booster shots etc are pretty simple to follow. Likewise don't take non approved stuff. Easy to understand and simple to follow.

Nuances will likely hurt and confuse the common man. That's why the news and celebs and politicians etc try to keep things simple.

Dr. Fauci knew that a lot of the things he was saying might not be 100% accurate and yet he did it. The reason being that on the whole his message was a net positive effect on the public.

Likewise CNN made fun of Joe Rogan for taking Ivermectin because we don't want general public to experiment with alternative medicine. It's better to just stick to the proven stuff.

Basically, there is no choice here. Or basically two choices: 1. Be 100% accurate and risk confusing people 2. Be strategic about it and for the greater good.

We need a narrative and the cost is accuracy. We need to have more empathy for people who are the decision makers and have to make difficult choices.

notahacker4• 5 years ago

Whilst journalist/PR summaries are so notoriously bad they're a punchline when you talk to actual researchers, I think we have to be charitable here and acknowledge that most communication about COVID doesn't have the luxury of writing about every single trial registered (or making puns on the word "fluke"!) So it tends to summarise it as "initially promising results for Invermectin were fraudulent, whilst large trials found no effect at all. Also it has side effects, like most other drugs, so the people ordering it in doses for horses aren't being as clever as they think" which isn't nearly as entertaining or as thorough as Scott's writing, but is a broadly accurate summary of the state of scientific evidence.

(Of course you can also summarise it as "there's weak evidence for Invermectin having some therapeutic benefit which is probably related to preexisting conditions"... but we know how quickly that snowballs into "Invermectin stops COVID, scientists ADMIT IT" by the same people that deny the much stronger evidence for vaccine efficacy. Science journalism is bad, but not as bad as the selective reading of it.)

marcosdumay2• 5 years ago

Well, I have never witnessed some thing in real life that was correctly reported on the news. Not even once.

And I'm talking about basic things like getting the order of the facts correct, or who said what. Some times there is even video of the thing on the news, and the journalist narrates on the sequence, and says something different form what is on the video.

I do really not expect those teams to get the details behind medical research right.

By the way, with the amount of fraud going on those studies, I wouldn't trust "weak evidence that it has some effect" in any real extent. Also, the Brazilian numbers (that are uncontested on the article, just non-randomized) are completely fraudulent, it's a large scandal here, with the police investigating it and many people that may get some prison time for murdering; the people that took ivermectin died about 3 times more often than the ones that didn't.

nonameiguess• 5 years ago

While Scott has a pretty decent natural talent for writing, he also has a MD, he's a board licensed practicing psychiatrist who has been working for a decade in the field, and he has spent at least the last twenty years gaining a pretty decent broad exposure to statistical and research methods. I don't believe he disclosed what Substack paid him, but he is in the "paid tier" and has said it was a mistake to even agree to that because the subscriptions he has gotten exceed what Substack paid him.

In short, if you want most journalism to hire licensed medical doctors with decades of experience in science and statistics, and natural writing talent on top of that, expect journalism to get a lot more expensive. A market certainly exists for Scott, but I'm not sure the market exists for all journalists to be as highly qualified as Scott. Or, for that matter, even for CDC and WHO PR arms. They definitely aren't paying their communications officers whatever Substack is paying Scott, or probably even what his psychiatry practice is paying him.

naasking8• 5 years ago

I'm not sure the market exists for all journalists to be as highly qualified as Scott

I'm not sure we need as many journalists as we currently have. Do we really need another rehashing of the latest culture war nonsense? If you strip out all of these pseudo-journalists and consider only journalists covering real facts and in-depth analysis, that's a considerably smaller group that could plausibly consist of a number of Scotts.

bhelkey• 5 years ago

I am not sure that Scott would fit into a newspaper environment.

Scott has some really interesting articles. He has one huge advantage over journalists. He seemingly doesn't work in the same deadline constrained world that typical journalists do:

> I know I’m two months late here. Everyone’s already made up their mind and moved on to other things.

dragontamer• 5 years ago

NIH is in charge of research. CDC takes the research and makes recommendations.

https://www.covid19treatmentguidelines.nih.gov/tables/table-...

NIH seems to have pretty good analysis into Ivermectin. For some reason or another, people don't know it exists. Its pretty straightforward frankly. Turns out that people on the internet are terrible at meta-analysis.

jacquesm87• 5 years ago

Turns out that people on the internet are terrible at meta-analysis.

Color me surprised.

BurningFrog7• 5 years ago

I think the simple fact is that people with this scientific literacy and ability have much better career option than becoming journalists.

This was true before the profession entered the death spiral of the last 1-2 decades, and is extremely true now.

marcodiego2• 5 years ago

No no... You can't expect a journalist to carefully make a very detailed and informed article like this carefully evaluating 30 scientific articles of meta-anilisys sites wich favored a specific view. They are not spcialists in most things and this was published long after the peak of of the pandemic.

What they should do is to query specialists to obtain better information, instead of opinions. Consult different views, argue why on view is right or wrong and then inform the public.

darkerside4• 5 years ago

And what if you don't understand enough of the topic to pick the right specialist? (Answer: you go with the person who sounds the most confident)

marstall• 5 years ago

for free online news, perhaps. pay for stat, nytimes, economist, scientific american etc you will find journalists who cover science with good understanding.

by the way few good science journalists would cover the story this way. instead they would mostly be quoting experts interpreting the significance of the various studies.

And Scott Alexander would never be one of them. Can you imagine a nytimes science writer quoting a psychiatrist on ivermectin's effectiveness? Never happen.

(also all of these sources' coverage of ivermectin has been much more limited because of the fact that the drug is a scam)

271828182846• 5 years ago

All the health officials in the world will shout “horse dewormer!” at you and compare you to Josef Mengele.

Well, as a German I feel obligated to recommend those officials to read up on Josef Mengele and then reconsider throwing that name around so casually.

JohnWhigham• 5 years ago

Blame the Twitterati for the normalization of calling people "Nazis" over slight political disagreements.

jmull• 5 years ago

It's a Twitter thing now, but it might be useful to understand that it predates Twitter.

E.g., "Goodwin's Law" is supposed to have been coined in 1990, and of course it was a pretty well established phenomenon to earn a coined term.

I know from first-hand experience it was happening on BBS's and newsgroups in the '80s. I would be more surprised than not if it wasn't happening before then too.

(And if you want to generalize slightly, calling someone a Nazi is simply a current way of demonizing your opponent. People have been demonizing their opponents since well before there were Nazis.)

jacquesm87• 5 years ago

Usenet wants a word.

rory• 5 years ago

He means it as a metaphor for "they'll say you're extremely evil," and Mengele is the most evil scientist that's also a household name. Treating any name like it's Voldemort isn't a helpful norm for a society to uphold.

I'm pretty sure Scott is Jewish, so I imagine he's aware of Mengele's work.

podgaj4• 5 years ago

Hold on, science never ends, amiright?

I want to focus on this article:

https://sciencebasedmedicine.org/pfizer-new-covid-19-proteas...

Where they conclude:

"Spoiler alert: Ivermectin does inhibit the same protease that PF-07321332 does, but, as is the case for viral replication, it requires a concentration that is not achievable by oral dosing."

So Ivermection COULD work. That is not me saying that, that is an scientific article debunking Ivermectin. (As an aside, the politics of this, they will not even say that yes, ivermection COULD work but the dose needed would be too high).

But the protease all these drugs try to inhibit is TMPRSS2. Now TMPRSS2 is made by a gene, and genetic changes affect the amount of this enzyme, leading to higher or lower function.

https://academic.oup.com/jid/article/212/8/1214/2193475

These gene changes could make us more or less vulnerable to COVID in some populations:

https://www.biorxiv.org/content/10.1101/2021.10.04.463014v1

So, unless you filter out genetic diversity (which they never do) you will never find out the population Ivermectin MIGHT help. Maybe it would help someone like me who carries that polymorphism. Maybe that is why it seems to work well in other countries?

And what about checking if these patients were zinc deficient or not? Because ADAM17 uses zinc, and ADAM17 snips ACE2 off of the cell making Soluble ACE2. SARS2 will attach to this soluble ACE2 not allowing TMPRSS2 to let SARS2 into the cell.

https://www.frontiersin.org/files/Articles/576745/fimmu-11-5...

https://www.ahajournals.org/cms/asset/36a2c66b-1ca8-43e9-944...

So maybe, if someone has enough zinc then ivermectin, or any protease inhibitor, will be more effective at lower doses?

And you know that people with river blindness, the thing Ivermectin treats, have lower levels of zicn and supplementation is urged in these patients:

http://www.sciencepub.net/nature/0504/03_0312_nmorsi_serum_n... (PDF)

"The depleted mean serum trace elements in the infected volunteers than their control subjects implicated the deficiency of copper, selenuim and zinc in the pathogenesis of onchocerciasis and the need to incorporated dietary trace element supplements in management of onchocerciasis."

So all of those studies, IMHO, need to be thrown out.

This is science, no blogs here, and I have the vaccine so I am not anti-vax. So please, don't come at me from that angle. This is a reasonable hypothesis.

I carry the TMPRSS2 polymorphism they mention in the article above. Yes, my experience is anecdotal, but I was discovered to have a zinc deficiency well before COVID (they had a medical reason for testing it) and supplementing with zinc ended the colds and flus I would get three times a year. It has been 10 years and I have not had only minor symptoms a few times.

mrfusion• 5 years ago

I wish he could find a way to do this analysis blind for these kind of controversial issues.

I felt like he was in the hunt to end up with a certain conclusion from the beginning.

I felt like his article on vitamin D for covid was similar. “Looks promising but I’m going to say it doesn’t work because I take covid seriously or something”

xtracto• 5 years ago

I agree. I read through the whole review of each article and on several of them the author tries hard to discredit them but doesn't find a reason so he just concludes with some witty question seeding FUD. Like the Mexican one: he just says he doubts it because it was made in Mexico? A lot of his cars, software and food is made in Mexico.

darkerside4• 5 years ago

And it was! It was a fluke! A literal, physical, fluke! For my whole life, God has been placing terrible puns in my path to irritate me, and this would be the worst one ever! So it has to be true!

I think I don't get the joke here. Can someone dissect it for me? (Yes, thereby killing it)

I love this man's writing so much. Intelligent, empathetic, visionary, and simple. All at the same time. With no other author do I do as frequently think, "this article is way too long, no way I'm going to read all this," and before I know it, I'm at the end.

snowwrestler2• 5 years ago

Fluke is a type of worm

BurningFrog7• 5 years ago

Oh, wow. I had no idea!

https://www.merriam-webster.com/dictionary/liver%20fluke

snowwrestler2• 5 years ago

The top part of the article is excellent, and literal worms as a confounding factor in trials of a deworming treatment makes a ton of sense.

The end of the article, where he speculates about vaccine denial, is less useful.

It’s kind of funny that the author spends most of the article rigorously applying the empirical and inductive scientific method, but then at the end just takes off on a flight into his own mind like some kind of ancient philosopher, finding their way by the power of thought alone.

It’s really easy to fool oneself into thinking that because you are smart and knowledgeable in one area, you are smart and knowledgeable in general. That’s how ego and the mind works. It turns out, that’s not how knowledge works though. You have to observe and test to build real knowledge.

The author, in exploring vaccine denial, would probably be better served by following the same method he did for ivermectin: exhaustively surveying the current state of scientific studies of the phenomenon, and attempting to rigorously synthesize it.

bsdetector• 5 years ago

The top part of the article is excellent, and literal worms as a confounding factor in trials of a deworming treatment makes a ton of sense.

The blogger's idea is supported by 9 data points, 7 or 8 that kind of match the hypothesis when plotted on an at least somewhat arbitrary axis. Not a statistics expert, but pretty sure you could find many things that correlate that well.

It's a tempting idea that a 'horse dewormer' works by deworming because people believed to be idiots turn out to be idiots, faith in institutions is unshaken, and everything makes sense. But ivermectin has been and is being investigated for efficacy against many single-strand RNA viruses so 'deworming' is only one possible explanation and must be supported by actual evidence.

cryptica• 5 years ago

What I don't understand is what is the incentive to publish fake studies to make a cheap generic (low profit) medicine look good? Even Merck, one of the manufacturers of Ivermectin claimed that the studies are invalid (then soon after announced that they are releasing a more expensive competing medicine which they have full patent rights over...). On the other hand, I know exactly what the incentives are to promote vaccines, lockdowns, bailouts, mandates and mass firings.

Journalists often said "To find the truth, follow the money, look at the incentives." It seems that 99.9% of the money is against Ivermectin. Based on my experience working for big corporations, I wouldn't be surprised at all if some directors organized a campaign to threaten, silence and discredit scientists who pose a threat to corporate profits. That is not far fetched at all. Anyone remember big tobacco funding studies to prove that smoking is harmless? You think corporations are less powerful today? With all that money printing and trillion dollar bailouts? With all the media censorship?

Big corporations managed to corrupt the legal system to get Steven Donziger jailed, why couldn't they corrupt the medical establishment in the same way to slander research papers and researchers. How do we know the password was really just 1234... That whole story sounds made up.

WhompingWindows2• 5 years ago

In my opinion, the main crux is this: there are moneyed interests who are motivated to generate mistrust and otherization based on political parties. In the USA, Fox News has a strong incentive to inspire hatred and fear of Democratic policy, and MSNBC has a strong incentive to inspire hatred of the GOP. The same is true for Twitter, FB, NYT, WSJ, WaPo, literally any media outlet. Hatred, fear, outrage, worry, anxiety: they all drive viewers to advertisements.

One major example, these media groups facilitated making a huge rift on climate change belief. The fossil fuel industry saw in the GOP, and some moderate Dems like Manchin, an opportunity to create doubt and slow the transition off their fossil fuel products. Now, the GOP has leaned into anti-scientist, anti-elitist sentiment, fed by Fox News and others. They're not totally anti-science, they still use abortion science, ivermectin science, and all the wonders of modern life...but they ARE anti-scientist, anti-elitist, anti-university.

And Why? We're hating each other so media companies can make a few measly cents.

iszomer3• 5 years ago

Now, the GOP has leaned into anti-scientist, anti-elitist sentiments, fed by Fox News and others..

I wouldn't fault them for your view of their broad sentiments on this trend but I think if you went back over the last twenty years, these sentiments were more often aligned for the left-wing.

"The real conversation has to be about what solutions we're in favor of." -- Dan Crenshaw, on the Daily Show

https://youtu.be/HWsS7N8KmYY?t=1141

boston_clone2• 5 years ago

The last twenty years gives us a few administrations from which we can asses policy making decisions: Bush; Obama; Trump; and now Biden.

Of those four, I don't think it's possible to make a good-faith argument that Obama and Biden administrations have been more anti-science than either Bush's or Trump's. A single sound bite from Dan Crenshaw talking about shifting the focus of conversation towards solutions doesn't refute the fact that Trump had directed the EPA to remove statements about climate change from their website, withdrew our participation from the Paris Accords, and made public statements drenched in falsehoods about how climate change is a hoax. Similarly, Bush rejecting the Kyoto Protocol and allowing Exxon to have an active role in making climate change policy goes completely against your assertions.

Could you provide some sources to substantiate your viewpoint? I'd love to know if I'm just being overly biased here, or if we've fallen prey to disinformation campaigns.

Clubber• 5 years ago

It's also good for the people in power. It's a pretty straight forward divide and conquer strategy. The US public want probably 80% of the same thing (economic), but we won't get it because we bicker about the 20% (cultural/wedge).

philosopher12344• 5 years ago

We do not live in a society with two equal sides. The GOP has made destroying democracy/hating "the media" core to their platform, as opposed to centering their platform on some sort of policy goal. Do democrats hate the GOP? Sure, but their coalition is not nearly as structurally oriented around this fact.

gunapologist996• 5 years ago

I appreciate that you drew a distinction, because being anti-science and anti-scientist are not the same thing at all.

The current way that science, i.e., research, is being funded has very little to do with the Scientific Method and seems very broken.

That seems to be the GOP stance; that huge funds are flowing from big corporate interests into universities. It seems quite simple to purchase nearly whatever research you like.

kaba09• 5 years ago

The US is not the only country though. And while some small bad research may get bought, these are usually easy to spot by experts in the field, or even by simply looking at the methodology which may be bad even from a statistical point of view.

mark_l_watson• 5 years ago

A friend’s wife has been suffering the effects of long haul COVID-19 for about two months. A few weeks ago her doctor gave her a prescription for Ivermectin and while still very ill, she is feeling better, and the improvement happened quickly. Just one datapoint. I myself am very careful, vaccinations and I wear a quality mask when shopping. My wife and I have reduced our social circle to just about ten people who we sit down with inside for dinner.

shkkmo5• 5 years ago

Any possibility that part of her long covid symptoms were due to an undiagnosed parasitic worm infection that got worse due to the covid treatment's immune suppression?

gfodor• 5 years ago

Lots of apologies are owed, none will be delivered. Glad we have an explanation.

toolz4• 5 years ago

The real story (in my opinion) behind Ivermectin are the studies not being conducted. Here you have a ton of studies claiming to have found benefit with a worldwide, massively available drug that has practically zero risks for most people (and it's an extremely well understood drug) and we don't have first world countries conducting RCTs to understand it better.

So you have to ask yourself - when do we get high quality RCTs, who funds them and why? This to me is a clear cut indicator that we have very maligned incentives for health science. How can we be this far into a global pandemic, with all of this funding and not have multiple high quality RCTs on this drug? It's sad to say the least. Even if Ivermectin ends up being fairly weak or completely ineffective - surely there's something to learn here...

MissionInfl2• 5 years ago

We do have first world countries conducting RCTs to understand it better. For example, see ACTIV-6 coming out of Duke University: https://clinicaltrials.gov/ct2/show/NCT04885530

ACTIV-6's tagline is "Outpatient Repurposed Drugs" which matches up with your description. There are other ACTIV trials with other focuses: https://www.nih.gov/research-training/medical-research-initi...

czzr• 5 years ago

There are two large high quality studies mentioned in the article.

resoluteteeth• 5 years ago

The real story (in my opinion) behind Ivermectin are the studies not being conducted. Here you have a ton of studies claiming to have found benefit with a worldwide, massively available drug that has practically zero risks for most people (and it's an extremely well understood drug) and we don't have first world countries conducting RCTs to understand it better.

First world countries are in the process of conducting RCTs testing Ivermectin, for example the activ-6 and covid-out studies in the US.

So you have to ask yourself - when do we get high quality RCTs, who funds them and why? This to me is a clear cut indicator that we have very maligned incentives for health science. How can we be this far into a global pandemic, with all of this funding and not have multiple high quality RCTs on this drug? It's sad to say the least. Even if Ivermectin ends up being fairly weak or completely ineffective - surely there's something to learn here...

The thing to learn here is that there's no conspiracy, trials are underway, and science is already working properly.

gunapologist996• 5 years ago

First world countries are in the process of conducting RCTs testing Ivermectin, for example the activ-6 and covid-out studies in the US.

... "in the process of"?

How long has ivermectin existed? How long has the pandemic been around for? How long has ivermectin been claimed to have huge benefits for, regardless of the source?

Isn't it possible that there are some other reasons why RCT's haven't been conducted yet by "trustworthy" sources in the view of these meta-analyses?

Is it really such a huge conspiracy theory that researchers simply don't want to bite the hand that feeds them? Is it not a fact that literally billions that have flowed into the coffers of Big Pharma for the vaccines and their $700/pill protease inhibitor drug, and the fact that almost all research studies are performed with funding dollars that originate from them or from HHS/CDC/NIH, which also now see a dramatic, multi-fold increase in power, reach, and funding?

Wolf_Larsen3• 5 years ago

The thing to learn here is that there's no conspiracy, trials are underway, and science is already working properly.

Thank God! I was worried it may be a nuanced situation full of brazen conflicts of interest.

josho• 5 years ago

Here you have a ton of studies claiming to have found benefit

Maybe the real reason we aren't seeing more trials being funded is that scientists are looking at these early studies and what we already know of the drug and concluding that it's not an avenue worth pursuing? (Especially when we already have several proven vaccines in place).

By way of analogy are you going to invest your time to build a web framework for Cobol running on mainframes? I'm sure it's been done, but it's probably not worth your time to build one as we already have many high quality web frameworks available.

tristor3• 5 years ago

I don't understand the point of the image of the meth seizure when discussing this study [1]. The last name is the same, but if you understand Mexican surnames, it is strongly unlikely that the two different people are in any way closely related. I like reading Scott's writing, but this really detracts from the overall quality of the article, because it seems like a vaguely racist dig without any relevance.

[1] https://www.biomedres.info/biomedical-research/effects-of-iv...

djrogers• 5 years ago

It can be poor writing, intentional obfuscation, misdirection, or a lot of other things, but to jump to racism just because the subject is from a different country than the author is pretty unfair.

BurningFrog7• 5 years ago

I took it as just a joke.

joenot443• 5 years ago

It's not racist. If it's a joke that didn't land for you, that's fine, but calling it racist is incorrect and deliberately inflammatory.

Wolf_Larsen3• 5 years ago

You may be a good candidate for Ivermectin, sir. I believe you have worms in your brain.

https://www.census.gov/quickfacts/fact/table/bakersfieldcity...

tristor3• 5 years ago

I'm aware of the demographics in Bakersfield. I live in a city with a larger proportion of the population being Hispanic than Bakersfield, hence why I am aware of how Mexican culture utilizes hyphenated surnames.

Your link to demographic statistics does nothing to change my mind that this was vaguely racist (culturist?). I don't think Scott is racist, I just think this was a non sequitur that had no place within what was an otherwise fantastic piece of writing. It adds nothing and takes something away, and could have been better for doing without.

dang• 5 years ago

Posting like this will get you banned here, regardless of how wrong someone is or you feel they are. Please review the site guidelines and don't post like this again. It's enough to respectfully provide correct information.

https://news.ycombinator.com/newsguidelines.html

phdelightful• 5 years ago

I also think it's humor. Scott probably just came across it while searching the name. When you search something on twitter, it is bolded in the results just like in the image.

The caption is an example of irony I think: incongruity between what is expected and what is presented, mixed with saying the opposite of what you mean. Quite clear from context. I laughed when I saw it.

nmz• 5 years ago

Ah yes, death is an acceptable outcome.

skyde• 5 years ago

so his conclusion is that ivermectin reduce mortality significantly only when patient suffer from both covid and worms?

mmcnl• 5 years ago

There’s a video of a talk about it, but I am not going to watch it, because it is a video

I also never watch videos. I'd much rather read a well-written article that is searchable and actually has references to sources.

ufo2• 5 years ago

Some aditional context about the Szenta Fonseca et al paper: the study was based on the Hapvida insurance provider, which has been accused of forcing their doctors to prescribe the "covid kit" medication including chloroquine and ivermectin.

https://oglobo.globo.com/politica/video-mostra-que-ministeri...

The Hapvida data was also used by the Bolsonaro administration, to propagate a destructive political agenda in favor of "early treatment" and against vaccines.

tlb• 5 years ago

Are meta-analyses that just average all the results from all the studies less reliable than picking a paper at random?

I'd expect that to be the case if the bogus studies report the most dramatic results. A single bogus study out of 10 can skew the whole meta-analysis, but if you picked randomly you'd be 90% likely to get an honest one.

kadoban• 5 years ago

Based on the article, most papers are complete shit. So, at least in this subject area, that seems like a still bad strategy.

paul7986• 5 years ago

Can't stand close minded people who can not fathom that other treatments could work from ivermectin to the upcoming pill Pfizer is putting out to something else. It's ridiculous that their bias drives them 100% vs. being objective in that science and research takes time .. years ... time will tell and provide all of us with many treatments against COvid as there now is for the flu.

Politic bias blinds objectivity and it's ridiculous for people who believe themselves to be intelligent people. Especially those who believe everything and live by their biased manipulated for profit media of choice. Here is one of many examples of the media spinning it's bias agenda and years later getting caught https://www.axios.com/steele-dossier-discredited-media-corre... . Of course it's happens on both sides like all that ridiculous story about Clinton pedo pizza parlor thing. The media is garbage and not to live one's life by ... years of science is!

mnw21cam• 5 years ago

People are going to fight hard against this, partly because it’s annoying and partly because of (imho exaggerated) patient privacy related concerns. Somebody’s going to try make some kind of gated thing where you have to prove you have a PhD and a “legitimate cause” before you can access the data, and that person should be fought tooth and nail...

I have a huge amount of respect for Scott, and the rational thinking that he shares with us. However, I'd like to make two arguments against the above.

1. Personally-identifiable information is protected by law over on this side of the pond. This is one of those cases where the thinking is quite different between the US and Europe. In Europe, you need to get the permission of everyone involved in the study before you can publish your data about them, if there is any chance that they can be identified from that data. In a lot of ways this is good, but one way in particular is that it encourages pre-planned proper studies, where you set it all up properly and get every participant to sign the permission sheet, which is good for science.

2. Sometimes absolutely full data release is overkill and inappropriate. For example, if I'm planning to publish a paper saying that mutations in a particular small region of the human genome cause a particular disease, then it is sufficient to publish the list of causative mutations. Full data release would mean publishing the entire sequencing run for the patient - that's inappropriate because you can identify someone from it, and you also then know a huge amount of information about them - their traits and congenital conditions. A lot of journals are pushing for this, and the compromise that we seem to have reached is to store the full sequencing data in a secure repository and provide access given a really good reason. Likewise, a census will report statistics about areas of a country, but the raw data is kept back because it is deeply personal in nature.

So my points are that data shouldn't go into a study unless it can be openly published, and that there are types of raw data that are too personal or voluminous to openly release, and the data derived from it should be released instead.

hervature• 5 years ago

This is one of those cases where the thinking is quite different between the US and Europe. In Europe, you need to get the permission of everyone involved in the study before you can publish your data about them, if there is any chance that they can be identified from that data.

In the US there are all sorts of protections for research subjects both in terms of potential harm and privacy. In fact, there are mechanisms to be exempt on keeping consent documentation if that is the primary mechanism in which the subject could be harmed (for instance, in a data leak). His thinking is contentious at best and would generally be regarded as unethical. People seeking medical treatment should not have to agree to have their raw data disclosed and this falls under the undue influence principle of ethical research.

heywherelogingo• 5 years ago

Ivermectin - as unnecessary as the vaccines.

Wolf_Larsen3• 5 years ago

"The Scott Alexander article misses the whole point. Of course ivermectin on its own is not particularly helpful (unless you want to treat worms,

The treatment regimen the American group is recommending includes Vitamin D, Vitamin C, Zinc and a Zinc ionophore (drug that facilitates cellular absorption of Zinc). The ionophore can be Ivermectin, Hydroxychloroquine or Quercetin.

I have been baffled up until now why studies are not looking specifically at the combined treatment, just the ionophore, with no regard to whether it was being taken with Zinc or the other drugs. The fact that even Scott seems to have overlooked this is very concerning.

It's the Zinc that inhibits replication in many viruses, and ionophores like ivermectin increase zinc absorption."

https://marginalrevolution.com/marginalrevolution/2021/11/we...

_djo_3• 5 years ago

Studies have looked at the supposed I-MASK and MATH+ protocols, or at least similar combinations of Ivermectin and Zinc, and found no benefit there either.

Anecdotally I also know a half a dozen people who were doing the I-MASK protocol because they believed the FLCCC and got severe enough COVID to be committed to ICU. Two had to be ventilated. They weren't in particularly high risk groups and their outcomes seemed identical to acquaintances who were taking nothing.

This is a dead horse. Stop flogging it.

andrewclunn• 5 years ago

He does a much better job of trying to relate to those "not of his tribe" than most do. Now I WISH he hadn't hand waved the vaccine hesitancy by saying the data there was "overwhelming" without going into it at all.

etchalon• 5 years ago

An absolutely fantastic post. I have nothing else to add.

It takes the proponents arguments seriously, even as its dismantling them, but isn't dismissive or condescending.

It just methodically, and earnestly, points out how they're wrong.

he0001• 5 years ago

So the conclusion is that if you are already sick, your chances to beat COVID-19 are lower? Doesn’t this apply to many other drugs as well?

marcodiego2• 5 years ago

TLDR:

The Summary Ivermectin doesn’t reduce mortality in COVID a significant amount (let’s say d > 0.3) in the absence of comorbid parasites: 85-90% confidence

Parasitic worms are a significant confounder in some ivermectin studies, such that they made them get a positive result even when honest and methodologically sound: 50% confidence

Fraud and data processing errors are of similar magnitude to p-hacking and methodological problems in explaining bad studies (95% confidence interval for fraud: between >1% and 5% as important as methodological problems; 95% confidence interval for data processing errors: between 5% and 100% as important)

Probably “Trust Science” is not the right way to reach proponents of pseudoscientific medicine: ???% confidence

trhway• 5 years ago

The generic broad anti-viral props of ivermectin seems to have been established during the last decade https://www.sciencedirect.com/science/article/pii/S016635422... so it isn't out of the blue that it may work as anti-covid, though whether it rises to a clinical effect that i guess is the question right now. To me it looks like the small positive clinical effect reported in many places matches that generic broad anti-viral props, and it also shows that it isn't a "cure", at least not in the current form. So all this drama is kind of strange - why not prescribe to the patients who want it? Not that doctors have anything better to offer anyway, and the patients will get a deworming as a bonus.

nikolay• 5 years ago

With all bashing on Ivermectin, I just wonder what people think about it! First, there's no money to be made from it - no patents, it costs cents per dose, and everybody can manufacture it! Second, it has proven anti-viral properties against HIV, HPV, etc. In general, it's not like some crazy guy decided to use try it against SARS-CoV-2 - scientists were looking to repurpose antivirals. Plus, it has a pretty decent and long-established safety record. Compare it to Remdesivir, let's say, which comes with terrible side effects! Also, the dosage has been pretty low and recommendations have changed - from 0.2mg/kg now it's 0.4-0.6mg/kg with Delta. Pretty much all my friends who followed the I-MASK+ protocol [0], didn't get severe course of COVID-19. Yeah, it's anecdotal data, but there are no exceptions!

[0] https://covid19criticalcare.com/covid-19-protocols/i-mask-pl...

daxfohl• 5 years ago

So now could a similar analysis be done for HCQ?

Granted, presumably patients coinfected with malaria would be far less numerous and far more obvious than those with parasites. But any other comorbidities that HCQ might affect?

weeblewobble3• 5 years ago

I think if the IVM proponents were operating in good faith, their message would have been something like "There's some evidence that IVM can mitigate severe COVID infections, but it's relatively weak so you shouldn't rely on it to the exclusion of other ways of protecting yourself."

But that's not what happened. IVM (like HCQ before it) is a prop, a cudgel, a red herring in the ongoing and well-funded political project to undermine faith in government and polarize the electorate

Ivermectin: Much More Than You Wanted to Know

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