It's worse than that; if you're reading individual papers without the context of the larger body of research in a domain, you're setting yourself up to get a distorted view of the world.
Peer review isn't magic; peer reviewed papers can still have errors, oversights, mistakes, outright fraud, or just get unlucky in how random chance played out. Peer review just filters out the obviously fraudulent or flawed papers so that only three reviewers have to spend an afternoon reading and understanding why they are useless, and not a thousand journal subscribers.
There's nothing wrong with following scientific developments as a layperson, but you shouldn't make the mistake of thinking because you read something in a published, peer-reviewed paper -- even one in a prestigious, well-respected journal like Science or Nature -- that it must be true.
The troubling thought is that in a field as complex and poorly understood as the intersection of virology with immunology at scale in the middle of a pandemic, the Experts are not much more informed than the layperson. I have yet to hear a single Expert showing even a tiny sliver of epistemic humility.
https://americasfrontlinedoctors.org/treatments/how-do-i-get...
With any of these politically connected things, there’s always a mix of grift, political opportunism, and true believers.
peer review doesn't really mean as much as most people think and the paper was circulated by people who very well knew the difference and might have been circulating it precisely because of it.
Umm, wat?!
The vast majority of the studies about Ivermectin have been observational, run by front-line clinicians.
Prior to 2020, basically everyone on earth agreed (including the WHO, who STILL agrees) that front-line clinicians and observational studies are excellent signals that can lead to scientific investigations that can lead to medical breakthroughs.
The evidence for IVM as a treatment for covid (and many other viruses) is quite strong.
There is, no, no large-scale RCT for IVM. However, it is inherently obvious that none will happen, none that give it a fair shake.
The entire public health apparatus in the West has a huge desire to treat all illness with only on-patent, new medications.
Do you not thin that this incentive influences what gets into the news?
Do you think the public health authorities in Uttar Pradesh (https://indianexpress.com/article/cities/lucknow/uttar-prade...) are lying?
OK, so weak evidence.
> Prior to 2020, basically everyone on earth agreed (including the WHO, who STILL agrees) that front-line clinicians and observational studies are excellent signals that can lead to scientific investigations that can lead to medical breakthroughs.
Sure-- weak/crappy evidence and practitioner intuition can definitely point at worthwhile things to study rigorously, even if most of what they generate is trash.
> The evidence for IVM as a treatment for covid (and many other viruses) is quite strong.
??? Quite a leap you made there.
Doctors in my area are prescribing IVM to treat covid because in their experience and that of their peers IT WORKS. They have fewer deaths, fewer complications.
But it's "weak" evidence just because Pfizer didn't sponsor a gigantic RCT to "prove" it.
"The only science is real is expensive science done by large corporations!"
Even the vaccines, which are very effective, do not have a 0% death rate from infection.
3 deaths from TTS following J&J as of May 7th where there were 8.73 million doses of J&J administered.
And, you know, a few hundred thousand lives saved.
There's possible confounds, but none can explain vaccinated people being fewer than 6% of deaths (my MLE: about 2% of deaths) and more than 50% of the population. Especially since the vaccinated are, overall, a sicker and older population than the country at large.
The vaccine RCTs were not powered sufficiently to show a reduction in COVID death, given that they had no or basically no COVID death in either group. They did show a huge reduction in illness and severe illness, and now we're observing a commensurate reduction in death in the population.
population normalized death incidence is down by 10x in vaccinated over unvaccinated (which includes recovered individuals in with the unvaccinated, so the number compared to susceptible is probably 20x). with a bit over half the population vaccinated that suggests that at least the 100,000 deaths since june would have been twice as bad without vaccinations. not including any effects of vaccination on reducing infection/transmission (and for all the hype about "waning" the protection against infection is still substantial).
I know in Germany we did have over 20 dead from AZ thrombosis.
https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vacc...
The exact same pattern occurred with hydroxychloroquine. Lots of small observational studies showed promise. Then it repeatedly failed large RCTs. It turns out that the people with the resources to use HCQ also had the resources to use other things, things that were actually effective.
The Dexamethasone one is an interesting story. It started out as a more controversial “throw everything at the wall and see what sticks” solution by a specialist who knew steroids well. Later studies have shown a strong effect on survival, so it’s become a fairly uncontroversial part of the tool kit for severe Covid.
The only science that's real when it comes to public health is the science done across large enough populations and with enough methodology to rule out many confounding issues.
That tends to cost money, indeed.
Keep in mind that bleeding with leeches was once the standard of care-- based on clinical intuition and observational evidence.
People-- even very smart, well-educated people-- are easily fooled. There is a reason why the RCT is the gold standard.
And when there's some plausible underlying mechanism that can be studied by more rigorous means. Otherwise, observational studies can find correlation, not causation-- and they're not even very robust at that.
There is a dose-response relationship between umbrellas outside and rainfall., but umbrellas do not cause rainfall.
And the SSRI point is tangential: they were approved based on RCT evidence. Observing umbrella use and concluding it causes rainfall, even though we don't know of a reason why umbrella use would cause rainfall, is quite different.
This is directly against the HN guidelines.
A sugar pill could also get the same observational results because the number of severe cases is very low.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225296/
"In a study demonstrating the in vitro antiviral activity of ivermectin, upon incubation of infected Vero/hSLAM cells with 5 μM ivermectin, there was an approximately 5000-fold reduction of viral RNA by 48 hours in ivermectin treated samples as compared with control. The IC50 of ivermectin was found to be approximately 2.5 μM. Ivermectin seems to act on IMPα/β1 and inhibits the nuclear translocation of SARS-CoV-2 (Caly L et al., 2020). Further in-silico studies are required to confirm this target of ivermectin in SARS-CoV-2. The concentrations of 2.5 and 5 μM correspond to plasma concentrations of 2190 and 4370 ng/mL, respectively. These concentrations are 50–100 times the peak plasma concentration achieved with the 200 μg/kg of ivermectin (the US Food and Drug Administration recommended dose for treatment of onchocerciasis) (Chaccour C et al., 2017). Even with a dose 10 times greater than this dose (i.e., 2000 μg/kg), a peak plasma concentration of only ~250 ng/mL has been achieved (Guzzo CA et al., 2017)."
"On the basis of the rationale above, any significant antiviral activity could not have been achieved with the dose used in the study and the resultant plasma concentration of the administered ivermectin. Thus, although ivermectin, in vitro, is a potent inhibitor of SARS-CoV-2 replication, in vivo, the plasma concentration required to achieve the antiviral effect far exceeds the therapeutically applicable dose."
This thread discusses why the example of Uttar Pradesh's program isn't good evidence.
This appears to be an innocent mistake; vero cells are very popular with virologists because they’re easy to work with and familiar. But unfortunately they are a very poor proxy for testing Covid cures on, given that they’re actually monkey kidney cells. But it’s a shame we’re still headed down this wrong path publicly.
https://www.qps.com/2020/08/17/vero-cell-studies-misleading-...
It's possible, the number of excess deaths in the region over a period (1 July 2020 and 31 March 2021) was measured at 197k compared to other years, but they only reported 4500 covid deaths.
> There is, no, no large-scale RCT for IVM. However, it is inherently obvious that none will happen, none that give it a fair shake.
Well, the gold standard RCT Recovery (https://www.recoverytrial.net/) had a look.
> The entire public health apparatus in the West has a huge desire to treat all illness with only on-patent, new medications.
Dexamethasone is a cheap steroid. (For that matter, vaccines are incredibly cheap and yet nobody seems to have stopped them in favour of, say, monoclonal antibodies.)
> Do you not thin that this incentive influences what gets into the news?
Evidently not terribly much, given that dexamethasone was at least in all the British newspapers.
> Do you think the public health authorities in Uttar Pradesh are lying?
Quite plausibly. UP is perhaps the worst governed state in India and has been under all political parties. The case of Kafeel Khan is rather illustrative.
More to the point, I don’t care whether they’re lying. The whole article is full of vague statements that are hardly a good basis to believe anything about ivermectin.
This and
> The vast majority of the studies about Ivermectin have been observational, run by front-line clinicians.
> Prior to 2020, basically everyone on earth agreed (including the WHO, who STILL agrees) that front-line clinicians and observational studies are excellent signals that can lead to scientific investigations that can lead to medical breakthroughs.
and
> Doctors in my area are prescribing IVM to treat covid because in their experience and that of their peers IT WORKS. They have fewer deaths, fewer complications.
Don't really add up. Best case interpretation of your argument is that you think doctors are split in half - not wholly aligned behind novel treatments - the "throw shit at the wall and see what sticks" group and the "only throw new custom expensive stuff at it" group, but even that doesn't really match what I'm seeing.
A large number of doctors are out there throwing all sorts of things at a new disease because nobody knows what works yet. The data is going to be incredibly messy. One thing that has looked effective in many cases is steroids, very much not new. Other things that looked potentially effective haven't continued to look effective as more studies have been done.
Where's the massive pushback against steroid treatment if this is an institutional greed thing?
It looks to me much more like some people get married to their early hunches and dig in hard when the evidence doesn't pan out.
Throw enough shit at the wall in enough places and all sorts of false leads are going to appear. Some of them getting shot down isn't a conspiracy. It's how we learn.
For one, the company that sells ivermectin in the US (Bayer) does not currently have an alternative covid treatment. They have publicly stayed that they do not believe ivermectin helps against covid. Secondly, an RX of ivermectin (for humans) appears to cost more ($35) than the vaccine ($20). Additionally, the vaccine is already paid for, whether or not people use it, many countries (especially the US) pre-purchased hundreds of millions of vaccine doses.
Given that vaccines are already sold and adding ivermectin is pretty safe and is being added to the cocktail of treatments, already being used, I see no financial incentives for drug companies to discourage it.
Then you’re not looking hard enough. You don’t think endless booster shots are an incentive to dismiss Ivermectin? Discouraging Ivermectin means, not billions, but trillions in revenue.
And that’s not even considering the fact that the vaccines could never be legally approved for emergency use if Ivermectin works.
And no one is talking about endless vaccines. We now have a 3rd booster for at-risk populations. It's possibly/likely that if they extend that recommendation to the rest of the population that 3 doses may be all that is needed for long term, strong immunity. Just like there are 3 doses for hep B and several other vaccines.
Yes.