Ivermectin: Much More Than You Wanted to Know

based on the rest of study design I'm less confident

If you read a few paragraphs past your quote, Scott comes right out and declares the "genetics" is the explanation that he thinks is correct:

> The other obvious answer is “genetics!” I think this one is right

He then applies some softball counter-arguments to the genetics argument to hedge and give the "both sides" treatment. However, the article is clearly structured to give a tour of possible arguments while subtly giving the most credence and the least hedging to the genetics argument. Combined with the not-so-subtle declaration from Scott that "I think this one is right" in the middle of the article, he expertly walks the reader into the conclusion he wants while making them feel like they came to that conclusion on their own after an objective tour of the research.

Ivermectin is not alternative medicine. Ivermectin used for COVID symptoms is off-label use.

CNN made fun of him because he dared stray from the official narrative and he dared try doing something through his own research rather than doing exactly as the government and media told him to do.

It does mean you might have to downplay some things which might be true but will cause more harm than good if emphasized.

I personally can never do that but I won't judge people who are in a situation where every thing they say has a huge impact on our collective future.

Humans have a very poor track record at actually advancing any "greater good" when they choose option 2. In practice, "the greater good" turns out to be whatever helps those particular humans keep their power and status. That's why option 1 is the only acceptable one.

> We need a narrative and the cost is accuracy.

If this is actually true (I don't think it is), then our civilization is doomed.

> We need to have more empathy for people who are the decision makers and have to make difficult choices.

No, we need to stop thinking that certain people should be given the power to be "decision makers" and tell the rest of us what to do. The only acceptable thing for people in public health positions to do should be your option 1 above.

Pharisees of the modern world. You will be the end of us.

This line of thinking is a feedback loop, averaging down the social expectation closer to the lower bound every year.

Slowing down the BS a bit, increasing free flow of information for a more informed generation following ours, is the only answer.

tl;dr We will become stupider, and less critical-thinking, if we allow it.

This is now milked for more than it is worth by those that would like to discredit him but at the same time have probably never held a position of some responsibility towards a populace that is ill equipped to deal with scientific uncertainty.

I think this condescension does more harm than good. The "common man" is plenty smart enough to make decisions for themselves using reasonable judgement. They will make mistakes, but at a similar rate to the experts.

A message of "we're not sure, but this virus seems to be transmitted mostly by air, and we thinks wearing a mask will probably help. We suggest you wear one when reasonably possible" will likely encourage a lot of people to wear masks, while a message of "OMG PANIC AND WEAR MASKS ALWAYS AND YELL AT PEOPLE WHO DON'T" is not likely to.

Few journalists like covering that sort of stuff, a whole bunch dreamed of being investigative journalists breaking corruption and other public interest stories. But there simply aren't enough people reading those stories to maintain nearly enough staff for them.

Scott Alexander can also do what he does because he's not required to be totally accurate. It's opinion, backed by experience and training, but still opinion. He's also not writing to a deadline, except one he sets himself.

Real journalism is a lot harder than informed commentary.

It is a strange phenomenon that people are so ready to disagree with people who spent decades achieving exactly that kind of knowledge.

Now consider that this is just one example of a class of such issues and that there is an enormous echo chamber for such bullshit which extends right into hackernews.

The way it works:

- posit some bullshit miracle cure

- recruit useful idiots to help promote the issue, sow division

- downplay all of the arguments against, make it seem like it is the establishment that does this

- eventually, give up and move on to the next miracle cure

- go back to step one

It is interesting to see that it is the same people that over-and-over-again allow themselves to be recruited like this. Note that you were making 'pro-Ivermectin comments just yesterday' without knowing what you are talking about.

Why were you making those comments?

What were you trying to achieve by amplifying something that made no sense?

Don't you feel any responsibility for pushing such stories when the end result can be that people end up harming themselves or others on account of this?

That simply armchair science blogging psychiatrist's hypothesis. He even admits as much,

>But this theory feels right to me. It feels right to me because it’s the most troll-ish possible solution. Everybody was wrong!

None of the studies looked at worms. It is correlation == causation logical fallacy to conclude this based only on speculation. If you want to start arguing with that approach there is no bottom as there are just as many correlation == causation counter examples like https://i0.wp.com/noqreport.com/wp-content/uploads/2021/09/I...

You simply cannot dismiss that Ivermectin only works because worms until you have studies proving that. You can only say that it works, but you're not sure about why. Good to see that even after he cherry picked all the studies as hard as he could, he still had to reach this basic conclusion.

Meanwhile over the last 11 months most of the vaccines have been extremely effective at reducing hospitalization and death. My 3yo son caught COVID from one of his classmates at preschool - my wife and I are fully vaccinated - and we were both able to avoid an infection while under quarantine with our son.

No, that's just a hypothesis. To move that to 'probably' would require a very carefully designed study.

But that's a fine point in that case. And most people who talk about these studies will violate the policy by a wide margin, rather than doing a well rounded analysis.

You can't deliberately encourage people to take Ivermectin. But JUST citing a study wouldn't do that. Especially not with all the debunking of the other stuff.

Your eagerness to jump on to this idea (which is a cool theory, and isn't meritless, but it should be stressed is a theory that a psychiatrist and social commentator came up with) makes me think you should be wary of how personally susceptible you are to what I'm going to call "fetishization of contrarianism". It's fun to be right, and fun to be right when other people are wrong. It's cool.

But its easy to move from "I don't implicitly value what experts say" to "I implicitly distrust so-called experts", which you appear to be doing throughout this and other threads. You've further jumped from what could uncharitably be called a conspiracy theory to a counter-conspiracy theory. Scott even presents his idea as, essentially a conspiracy theory:

> It feels right to me because it’s the most troll-ish possible solution. Everybody was wrong!

"everyone was wrong", look at me, I'm right, here's a fantastic narrative that perfectly ties up all the loose ends. He looks smart and cool. And you do too[1] if you agree with him. But, to keep on theme, this is a brain worm. (and since we're on a Scott Alexander post, I'll tie this into the broader theme of rationalism) And it's a brain worm that I think a lot of people who otherwise think they're rational/rationalist fall for. The conventional wisdom is, usually, mostly right. Not always all the way right, and sometimes really wrong. But usually, it's most of the way there.

This makes alternate modes of thinking really boring, because despite all the fancy self-reflection and attempts to be superior, you're going to draw relatively few conclusions that are all that different from the mainstream. So what's the point? Either you do all this work for a marginal gain, or...or...or, well what if the conventional wisdom is actually wrong a lot more often? What if the experts are misleading us? What if the experts fall into thinking traps that make them wrong all the time? We shouldn't just disregard the experts, we should actively distrust them and assume the opposite! This opens up lots of possibilities for cool ideas. Incredibly compelling narratives, narratives where you can say that everyone else was wrong, and you were right. You can be a hero, or at least feel like one. Outsmarting the experts is cool, and knowing things first is cool. It's cool. And the "problem" with this is that sometimes you'll be right. The government is spying on citizens illegally. Snowden was right. And Ivermectin might have a small effect on covid, and even cooler it might be due to worms! But there have been tons of quack covid cures (HCQ, bleach, silver, etc.) and not every conspiracy theory about the government is true, even if the narrative would be cooler, because we distrust the government and the profit motives of these corporations, and that makes us want to distrust everything they do.

But the world is more boring than that, and even though the contrary opinion is true sometimes, usually it isn't.

[1]: Another, potentially equally compelling take here is that Scott's presentation here has allowed you to change your mind without admitting (even to yourself) that you were wrong! Because as he presents it, you weren't "wrong". We really, really dislike doing that, but this way you don't have to. The data did/does show an an effect for Ivermectin. You were right. That the effect was due to a "global" confounding factor allows you to change your conclusion without admitting that you were wrong in how you did the analysis. Like, whether or not you were wrong, the people who disagreed with you were right: it's unlikely that it would be helpful for your mother or whomever to take Ivermectin. The rational thing to do here would be to update your priors to trust the "experts" a bit more, perhaps their expert analysis that you weren't willing to believe before, had some truth to it, even though you don't know precisely how or why they reached that conclusion!

> 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.

Science takes time, the pandemic has been around for less than 2 years. Ivermectin has been a suggested for what, a year at most?

>Is it really such a huge conspiracy theory that researchers simply don't want to bite the hand that feeds them?

If a scientist could definitively prove ivermectin was effective they would be world famous. The reason so many shitty papers got published so quickly on ivermectin is because people were trying (and failing) to grab that fame and fortune. The incentives are obvious.

Consider that maybe your need to see conspiracy in the world comes from within, rather than external forces.

Wouldn't it have been way easier to just sell pills they already manufacture than investing all the time and energy into new stuff?

In this case, if Ivermectin was so effective against Covid, then Merck would be commercially incentivised to prove that.

When you combine that fact with the facts that complex problems rarely have simple solutions, that such high levels of collaboration are rare, & that the same people promoting Ivermectin are also promoting theories of 2020 election fraud, it's pretty easy to doubt that this conspiracy theory is realistic.

This came out of UK research at the start of the pandemic and has easily saved hundreds of thousands of lives.

The ivermectin notes that spurred this on was an Australian in-vitro study that noted that ivermectin had activity against sars-cov-2 in high dose, in-vitro.

It was promptly lost in the noise because basically everything, even high dose H20, can be shown to have in-vitro effectiveness against viral replication, and there were more promising avenues of research.

Then it pops out again after the anti-fact brigade lost the evidence pile-on with both hydroxychloroquine and azithromycin and along comes a study that immediately gets trumpeted as revolutionising the treatment of covid but it turns out has horrific methodological and statistical problems, and the scientific world gets to work trying to establish the facts, and so far things don’t look good for ivermectin as a treatment.

Yet there’s still a global conspiracy of top level research scientists and doctors trying to suppress these easy wins and maximise worldwide misery.

You seem like you like to do your own research, how do you process those facts?

Science makes mistakes, all the time. But it does learn from those mistakes. The harm done during the intervening years is terrible, but likely a price we can not avoid.

A bigger problem in my opinion is the degree to which science allows itself to be 'bought' by commerce, for instance in the case of smoking, climate change denial and other major issues that end up harming lots of people in very concrete ways. The man or woman in the white coat has a lot of authority and squandering that by throwing the scientific method out of the window to be replaced by a stack of green bills is a real problem.

The site might look professional, but it still could just be another true believer. If you frenetically ban the content, more people will believe the message and more importantly disbelieve yours since it "obviously" cannot stand scrutiny.

And there are real problems here, the infrastructure to censor certain message on social media got quite effective and to believe tech companies as government contractors won't use it to spread falsehoods is naive. Not by conspiracy, it is just a dynamic government will certainly show.

There is a degree of nuance that is definitely lost when people say to trust the science, which is to say that the rigorous process is what is generally trusted, but that isn't how it is communicated which is why "trusting the science" is probably a slogan that does more harm than benefit. For example it is sort of tone deaf to say that now, after how science experts have handled the first part of the pandemic, or how science has been used to justify things like the oversubscribing of opioids, or what they have said regarding nutrition (sugars vs fats), or carbon emissions and even smoking in the past. Politicizing science taints science more than it benefits politicians, but since they don't bear the costs of that erosion of trust, they will continue to politicize it.

Places with lots of parasitic infections need better infrastructure and general hygiene to prevent infection. They don't need all the locals actively breeding drug-resistant parasites. Parasites are enough of a nightmare without cavalierly passing out drugs for funsies.

Well, until 2020. Then we had another infectious disease. Which is why we're having this conversation.

This is of course just a gut feeling and not a studied understanding.

Pretending both sides are the same when their differences are plain as day is both foolish and damaging.

I cannot as I'm only learning of this now and reflecting on what I've known from before. Trump directing "the EPA to remove statements about climate change" is largely irrelevant (to me personally) when there are active industries apart from politics that are striving for "greener" technologies.

Take for example the transition from Toyota's hybrid vehicles to Tesla's or, solar array proliferation seen from Google Maps timeline.

Similarly, in science, Occam's razor is used as an abductive heuristic in the development of theoretical models rather than as a rigorous arbiter between candidate models.[5][6] In the scientific method, Occam's razor is not considered an irrefutable principle of logic or a scientific result; the preference for simplicity in the scientific method is based on the falsifiability criterion.

https://en.m.wikipedia.org/wiki/Occam's_razor

Coincidentally:

https://news.ycombinator.com/item?id=29250580

Sure, it's used in humans too. But there are people dosing with equine supplies.

There is a plenty of evidence for that. We can start with censorship of ivermectin on social platforms.

> The cult of "magic miracle cure" that has built up around this one particular drug is fucking terrifying

That's a perfect definition for people believing in phizer and moderna.

As I was reading the article, this is really what leaped out at me. There are lots of people and doctors who think ivermectin works. It's clearly a question worth investigating. Why are all the studies based on 50 people in Bangladesh?

That, in turn, is very strongly connected to the cost of running drug trials that will get past the FDA and patent rights. So it's not surprising that people end up being very cynical about this.

You are trying to make a personal offence and claims without any references. That sounds like a blind repeating of the narrative, even if it wasn't intended to be so.

TFA found that more reliable studies found it was helpful than not. You are the one who is anti-science.

If you don't have that difficulty then you probably haven't thought about it long enough - yet.

> "Sometimes these people even have a specific theory for why elites are covering up ivermectin, like that pharma companies want you to use more expensive patented drugs instead. This theory is extremely plausible. Pharma companies are always trying to convince people to use expensive patented drugs instead of equally good generic alternatives. Ivermectin believers probably heard about this from the many, many good articles by responsible news outlets, discussing the many, many times pharma companies have tried to trick people into using more expensive patented medications. Like this ACSH article about Nexium. Or my article on esketamine. Given that dozens of studies said a drug worked, and elites continued to deny it worked, and there are well-known times where elites lie about drugs in order to make money, it was an incredibly reasonable inference that this was one of those times.

> If you have a lot of experience with pharma, you know who lies and who doesn’t, and you know what lies they’re willing to tell and which ones they shrink back from. As far as I know, no reputable scientist has ever come out and said ‘esketamine definitely works better than regular ketamine’. The regulatory system just heavily implied it.

> I claim that with ivermectin, even the people who don’t usually lie were saying it was ineffective, and they were saying it more directly and decisively than liars usually do. But most people can’t translate Pharma → English fluently enough to know where the space of “things people routinely lie about and nobody worries about it too much” ends. So they incredibly reasonably assume anything could be a lie. And if you don’t know which statements about pharmaceuticals are lies, “the one that has dozens of studies contradicting it” is a pretty good heuristic!"

[0] https://trends.google.de/trends/explore?date=all&q=Luc%20Mon...

Comment section is pretty Western-centric in behaving as if the article proves Ivermectin doesn't work. The fact that we know (or are pretty sure we know) what the mechanism of action is doesn't make it "not work", it just makes it another tool in the box.

You can't sell a drug unless it has at least one approval. Manufacturers can't advertise or say that it treats anything but the approved illness. Doctors can usually prescribe an approved drug for any other illness. Insurance may give people trouble for unapproved prescriptions.

Covid has further completed this, as pharmacies have started to refuse filling some prescriptions despite doctors orders.

So zinc and vitamine D which enhance and modulate the immune system are recommended.

It's not as clearcut as you make it seem. The current vaccines lose their effectiveness over time and are significantly less effective against the delta variant to start with.