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.
This is the first serious anti-Ivermectin argument I've seen.
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?
I discounted a highly biased echo chamber in social media and more traditional media and went with 30-odd studies that appear to have been assembled in good faith even now. I changed my mind immediately on seeing "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".
You are describing how you want me to be thinking, not how I am thinking.
That this single article would change your mind is fortunate, but I do not suspect that to hold true for the bulk of the conspiracy peddlers that remain.
Article publishes sound arguments, doesn't talk down to the audience, admits problems with appeals to authority... and converts a conspiracy believer!
...No way, there is no way that can possibly work, the others are way too dumb, and the convert is a bad person... basically anything to just go back to pretending appeals to authority work. Despite clear evidence to the contrary. Or lamenting that they don't. I'm drawing some parallels with miracle cures here ;)
edit: just one exhibit: https://news.ycombinator.com/threads?id=mewpmewp2
Edit: I meant this to go with debating techniques, not cures. There are people for whom no amount of saying "why can't you just listen to Dr. Fauci" is going to work. We can say they are bad people, but that doesn't work very well for getting them to agree either.
You are right to call out above that there were other anti-Ivermectin arguments before and roenxi might not have had the background to understand them. That's exactly the point: here we have an argument that he can understand, and it's effective. This is good science journalism. The kind that doesn't work (too much moralizing or too confusing for the general audience) is bad journalism.
"move fast and break stuff" is the wrong attitude for medicine and aerospace.
But a solution is better than no solution, and of all the countermeasures that we had available in March 2020 we only used a fraction.
See:
https://www.youtube.com/watch?v=AqRHH6e-y6I
note the date on that video.
As to your edit: no, here we have an argument that he thinks he understands, that's not the same thing. The argument as presented is at best a hypothesis, it isn't proof of anything, just one more theory that may or may not end up being the right one explaining the sometimes observed effect, assuming it really was observed in the first place.
This is precisely what makes this discussion so tiring: people will be swayed one way or the other based on arguments that they have no way of understanding unless they were trained in that particular field.
Unfortunately, there are plenty of politicians that fall into the same trap, leading to terrible examples of wishful thinking, outright quackery and conspiracy amplification. The harm that this is causing is substantial.
So even if this article swayed one person I'm pretty sure you'll be able to find people who get the opposite out of it, because hey 'x' has now joined the establishment, must have sold out.
They then seek others and continue to have conversations, and they find others lacking trust resonates and that opens the door for a lot of BS normally and easily seen.
Just an example of the difficulty we now face:
Hiding YouTube dislikes will, among other effects, serve to help big corporate media compete against new media.
Hiding the dislikes also breeds more mistrust. This is unavoidable no matter how reasoned the move is.
Public trust in corporate media is really low, and the younger a potential user of that media is the worse those metrics are.
Had that same media held more closely to journalism, rather than access journalism, which is essentially a sales job, the trust problems we struggle with today would not have grown into the chronic problem it all is today.
You identified politicians committing similar abuse of the public trust.
Look at Russiagate. Basically, it flat out did not happen the way many believed it did. Back when that started, many and myself included went to the original documents, saw speculation and in some cases saw it helpfully color coded, and turned on the news only to see all that elevated to fact.
That scared me frankly.
What can one conclude?
I do not see how judging others helps right now. Not saying anyone did here, but I am saying that is happening a lot and when it happens the door for good info to find it's way home gets closed. Advocates render their efforts far less potent.
Secondly, the lack of trust really can't be assigned to people. We have a lot of "they are stupid" type discussion, judgement and rationalization going on and very little of that is helpful.
ie: 70 million people voted for...
The people who had a far better position of authority and trust denigrated that themselves, and for dollars and ratings.
All that is a real mess!
How can authorities, who have abused public trust be counted on to fact check and improve on misinformation without amplifying the already chronic trust problems they created?
In a more basic sense, how can we improve on public trust at all?
I am not sure how that is done quickly.
Longer term, we need media that makes informing people a priority. And doing that likely means a move away from the current AD and access based media we have now.
Given how things are right now, the more important thing is to avoid judgement of others and encourage more and better information exchange. We will not know what reaches people, until it does.
Once it does, we need those people to continue seeking better information so we see more people making better choices more of the time.
Now the changes are coming so fast and are so drastic that we as society - including our legal system - have no way of keeping up with it. Technology routinely moves from one phase to the next before the legal framework has caught up with it. This translates into effectively operating without a legal framework for a very important chunk of society.
That's dangerous territory. I don't have any solutions and I'm sure that there are plenty of people that disagree with me but I've gone from a technophile to being very skeptical about the degree to which I allow tech into my life. Familiarity breeds contempt, or something to that effect.
"Thinks they understand"
That will be true for very large numbers of people. Not their fault at all. It simply does not happen that a population all ends up able to sort these kinds of things out.
Implying they should is fine in the sense of self improvement, but as policy? Nope.
Perhaps it is time we, as concerned people, begin to take much harder look at our national priorities and demand the public interest be far better served than it is today.
Having done that, and sadly we are no where close to the basic consensus needed, we will find painful discussions like this one are a lot less frequent.
Know what I did not see in this exchange?
"Yes! You got there. How can we reach more people and help get past this?"
Feels a lot more like, "better late than never, and you need to do much better."
However, and as a thought exercise, say we did not go down the Citizens United path after Reagan repealed the Fairness Doctrine, and Clinton Telecommunications Act of 1996.
Social media viewed through that lens, one where both the public interest is a thing we recognize must at least compete with profit, and the public trust is recognized and maintained as the high value part of our Democracy it is.
I do not disagree with you about tech and the law being behind. And right now we remain in a particularly difficult time due to so many legislators not understanding tech well enough to perform their role as well as it needs to be performed.
That said, our difficulty right now is greatly exacerbated by basic policy priority shifts that happened well in advance of tech.
Owning that is particularly difficult too. Money and markets are a higher priority than the public interest is, and that is true for government as well as big media.
The vacuum was there and significant, leaving tech, social media to rapidly expand into it.
Had that time been one of more robust public trust, social media would have to compete much harder, and regulation may well have both been more effective as well as earlier, more robust in its positive impact.
The way someone gets ivermectin is to walk a doctor through the evidence they've seen and then ask them to prescribe it.
What you yourself _have_ to realize is that the expert researchers who are in a position to create and inform guidelines are themselves not some kind of 'super-experts' who know everything better than normal experts. They're just researchers in a political position in a bureaucracy.
I don't exaggerate when I say that an average HN reader could write better guidelines for patient outcomes in my subfield, with no prior training, simply by reading a few studies and observing a practice.
Now, does any of this apply to internal medicine, specifically covid? Probably not. But when the data is anything other than crystal clear, you should not assume the expert guidelines are anything more than some guesses by guys in a room. The consequence of knowing this is that all guidelines and consensus is suspect until you see the data yourself, like TFA outlines. In this case it seems true that Ivermectin doesn't cure covid. But with my experience, the exact opposite result could have been shown and I would not be surprised whatsoever; experts saying it doesn't work does not constitute in my eyes anything other than noise until the data is clear.
What I'm saying is only that:
- on average, experts do spectacularly better than Joe Schmoe. Including science degree holders thinking they understand medical studies while missing the whole political and social context of the field.
- it's not the job of field practitioners to prescribe experimental therapies, and those people cannot do better than follow expert opinion and guidelines.
But I actually agree with you on all points, especially regarding flawed research and understanding. Which makes people basing opinions solely on papers without any practical knowledge of the field wrong all the more often. Does it make it a good idea for people to go and try on their own the thing they read about in the last issue of 'covid today'? I don't think so.
I'm saying that, when the data is unclear and Joe is thorough, I don't even think that's true. Or at least it's not spectacularly better. My point is that for something like Ivermectin where the data was initially null and even now isn't super clear, the word of experts was basically meaningless. Trust them if you don't care enough to look into it, but if you're Joe I'd say just go ahead and believe whatever you understand to be correct until there's a better consensus.
So even if the data is unclear we can safely conclude that it isn't a miracle cure and never was. And Joe Schmoe here isn't talking about some condition that he's been walking around with for a while and has studied extensively, Joe Schmoe here is a guy who believes doing your own research is watching youtube videos by people who have done their own research reading a bunch of papers without understanding any of it.
The problem is that that gets in the way of achieving the goal: beating this pandemic, and that isn't going to happen with ivermectin. (Or HCQ for that matter).
Is the idea that doctors deserve deference because they are conditioned to submit to guidelines formulated by experts?
There is a lack of consensus on many long-standing, common medical questions, much less novel diseases. When I ask my GP about prostate screening, for example, he lays out the current state of research as best he can, but delegates the decision to me. Why is the COVID situation different, given that experts are still fighting through a figurative fog of war?
As to why the COVID situation is different, presumably because prostate cancer screening affects only you (and perhaps your family in the case of a true/false positive/negative diagnosis), and COVID represents a threat to everyone around you, and everyone around them, etc.
- There is no expert consensus (on treatments, etiology, etc.).
- Consensus exists, but the level of consensus is overstated.
- There is broad consensus, but with relatively low confidence.
A generalized public health threat like a pandemic doesn't change the epistemological calculus, nor the sociology of knowledge.
- there a consensus, it is broad and it has good experimental support and high confidence
1. Treat you according to guidelines/expert opinion, should you choose to.
2. Give you the opportunity to participate in a relevant study.
But _never ever_ will your GP formulate an experimental treatment plan based on his own research. Not GP's job, and big risk of liability. Your GP has at best a cursory view of the research happening in a certain field. COVID is different due to several good and bad reasons: hugely politicized, confusing messages from experts, and most of all novelty. 'Lack of medical consensus' usually means 'several treatments backed by experts are available', not 'do what you like'. COVID is too new for the dust around expert debates to have settled. That's what makes it different.
The zero hypothesis is the long standing default, that a random thing will not cure this illness. The alternative hypothesis is that it does cure it and then we can analyze the results based on the results of a fair trial.
It's not bullying or "talking down to" to simply ignore bullshit, it's effective use of your time.
I was never an ivermectin proponent — although I thought the "horse dewormer" rhetoric was self-defeating, because it's obviously and well-known to be also a human dewormer (amongst other parasites), and the "horse" part just seemed to be played up to make ivermectin supporters look stupid — but this article is indeed the first one I've seen to make the parasite-COVID-comorbidity argument. It's not, in fact, the first time that argument has been made... But it seems like the first time that link was made was within the last month, as the blog post links to the following Twitter thread from a medical researcher: https://twitter.com/AviBittMD/status/1456376484180922368
It's not ridiculous to me that this blog post would be someone's first encounter with that argument, considering how recent the link is.
I have a little bit of experience with reading lots of research papers about COVID safety measures, and coming to the opposite conclusion of medical experts: in early 2020 I read lots of papers on masks, and tried to convince most of my family to mask up even when the CDC said that masks didn't work. I happened to be right, and to my parents, I now look like a smart and forward-thinking, science-driven person. But that's only because I was right! I could see someone doing the same with the ivermectin studies, and while it appears that they were wrong, I don't think it deserves dismissal or derision — especially when it comes from someone willing to change their mind and admit they were wrong when presented with compelling evidence to the contrary.
It's not a lot in absolute numbers, but it probably hides a sizable amount of cases not serious enough to get to poison control.
By way of comparison, every year, two out of every million people in the US die by falling out of bed.
Because the introduced question was regarding characterization of proponents, not the rate injury.
It’s very unfortunate that Covid started under trump because being anti-science was part of his marketing message to his base, many because of the risk to certain jobs with caring about climate change (aka the great “hoax”) and the association of science/medicine and abortion.
Unfortunately explaining the rationale in a way that people can comprehend and not tune out is very very difficult, and far more time consuming than whatever 2 syllables Trump could come up with as a retort.
These two perspectives are not equivalent opposites though.
"Believe in science" is not a religious statement.
It is a shorthand for "trust in the scientific institutions that have proven their track record via decades of public health progress, and not in anti-scientific rhetoric with a culture war agenda".
That concept wasn't even controversial on most of the political right until their recent nationalist turn.
The facts are out there, whether you believe it or not, and eventually the scientific method will catch up.
Of course if you're not a trained scientist, then it's hard to appreciate how the scientific method works, and that even when we're very sure of something, true scientists will always hedge their statements. This will be misinterpreted by those who are outside this world as there being more gray than actually exists, and those with an agenda will drive a truck right through it.
Pretty sad, but that's what we've ended up with. It was incentivized for.
Suggesting that there's no way someone could have the mental stamina to read 30 papers, over the course of two years, is completely ridiculous, insulting, and invalidates your viewpoint, in my opinion.
There's a chasm between the epistemic question of "does this drug really work?" and the pragmatic question of "does a risk-reward analysis under uncertainty say that I should take this mostly safe drug that might slightly reduce my covid severity?"
FWIW, I wouldn't take ivermectin either as a prophylactic or therapeutic, the evidence just isn't strong enough, but I don't really fault anyone that would add it into the stack of treatments upon a diagnosis in the hopes of a small net benefit.
- Silicon valley rationalist types taking stacks of vitamins despite having no evidence on bioavailability because they are generally without side effects and who knows, you might live forever. I think the consensus on this now is that more or less this is not a useful practice, though I am unaware of any evidence for it being unsafe.
- Prophylactic hormone replacement therapy in middle aged women, which was eventually generally recognized as unsafe because of unexpected cancer risks not initially understood.
- Prophylactic breast self-examination, mammograms, and prostate exams based solely on age, the former of which have been significantly dialed back over the last decade because the risk of false positives or catching slow-growing low risk cancers causes a net negative from the treatment. I don't know what the state of prostate exam research is.
- Prophylactic aspirin for heart stuff: we seem to go back and forth on this, but the last I read was that actually there's mounting concern about chronic low-dose aspiring. At the very least, it's not obvious this is doing anything.
- Statin treatment in response to mild elevated blood pressure with no symptom of disease; not exactly prophylactic, but close in the sense that it's about advance management of expected disease. And last I read, researchers were increasingly recommending dialing back statin treatment for minorly elevated blood pressure because of, again, unforseen side effects.
So I just mention this to say that what I take from your post is "the precautionary principle suggests giving more weight to prophylaxis with no known side effects" and what I take from major medical stories in my lifetime is "no known side effects almost always turns out to involve side effects in the end, and that has to be part of the precautionary principle as well".
And I should note all of the above prophylaxis is based on clearly defined treatment regimens and physician supervision, not the kind of wild west ordering various formulations of ivermectin at unknown doses with or without medical supervision on an ad hoc basis.
I had alarming symptoms after the chloroquine treatments, and regret having done it. But nobody would ever put chloroquine in the "no known side effects" bucket.
I didn't say that I don't fault people for taking it as a prophylactic. I do fault people for doing that because the side effects of long term use are less known, as you say.
If you're familiar with software development, this is akin to "there's a bug in my codebase and I'm just going to add a bunch of code that probably won't affect anything in the hope that it will fix the bug".
Meds shouldn't be administered in this way. It just ads noise to the system and will complicate things down the road.
If they were miracle drugs as described the effect would be so large that those studies would be unnecessary. But here we are, and study it we will.
There is tentative evidence of a small to medium effect, but the quality of that evidence is low and that quality is insufficient to recommend use. This then deserves more attention and resources to figure out if it's real and why there's an effect. That's how science works.
Contrary to your claims here, scientists aren't studying it because some cranks on the internet propped it up. They're studying it because some field doctors had positive anecdotal experiences and some early studies showed promise.
As you've said, the medical establishment really wants to end the pandemic. Which is why they're looking into this drug, among many others.
That's not a given, that depends on the patient, the dose and a host of other factors. You may well end up harming someone significantly. You are in no position to proscribe any kind of medication to someone else unless you happen to be a licensed practitioner.
"That's not a given"
"You are in no position"
It is true, but unfortunate, that in many societies only licensed practitioners are in a position to prescribe (or proscribe) most drugs. That's a policy that does some good but also an enormous amount of harm.
Also, I don't like your first sentence, it's a rhetorical gotcha that is actually not in line with the medical establishment's thinking on ivermectin's hypothesized mechanism of action:
https://www.covid19treatmentguidelines.nih.gov/therapies/ant...
If you're not familiar with the field the studies are in, it might be a good idea to rely on the opinion of someone who is; unfortunately, this means you have to judge whose opinion to rely on, which puts you in the position of trying to guess who's really familiar with the field. It's going to be hard for you to do better at this than just believing whatever is most popular.
Scott Alexander wrote a post about this actually: https://slatestarcodex.com/2019/06/03/repost-epistemic-learn...
There were loud, even unreasonable, voices in the debate but nobody was raising an actual problem with the results. Ivermectin has a respectable safety profile. "Maybe it works, no obvious downside" was a reasonable position.
It was always a long shot, the evidence was weak. But loudest voices in the anti-ivermectin crowd are people like, eg, jacquesm in this thread. A lot of bluster, a smidge of bullying and a weak-sauce appeal to authority for why statistical evidence should be ignored. And YouTube et al. believe it to be convincing evidence or they wouldn't bother to censor discussion of it. If that is the opposition then they don't seem to have uncovered a methodological problem yet or they'd raise it.
But Scott raises an interesting theory that would be enough to explain ivmmeta.com. Since it was only ever weak evidence that is enough for me to change my mind.
I haven't seen any of these. I just run into irrational and offensive people like you that accuse me of wanting to drink bleach when I bring up the topic of Ivermectin.
This article removed all doubt for me. I needed to see the thought process while pouring over the studies.
You shouldn't make so many assumptions about people based on your political bias. Some people want to understand. That doesn't make them foolish or antivaxers.
So go study medicine, assuming you have 10 years to burn and are willing to take a massive pay cut.
The average HN'er probably knows how to program a computer and some of them may even know how to program one well.
If a guy that runs a fishing boat with not even the most basic idea about programming, hardware, software, satellite systems, general relativity and integrating all of the above into a working solution came to them with a request to really understand how his GPS works before he would put it to use we'd likely tell them to just trust the experts.
> So “believe experts”? That would have been better advice in this case. But the experts have beclowned themselves again and again throughout this pandemic, from the first stirrings of “anyone who worries about coronavirus reaching the US is dog-whistling anti-Chinese racism”, to the Surgeon-General tweeting “Don’t wear a face mask”, to government campaigns focusing entirely on hand-washing (HEPA filters? What are those?) Not only would a recommendation to trust experts be misleading, I don’t even think you could make it work. People would notice how often the experts were wrong, and your public awareness campaign would come to naught.
> But also: one of the data detectives who exposed some fraudulent ivermectin papers was a medical student, which puts him somewhere between pond scum and hookworms on the Medical Establishment Totem Pole. Some of the people whose studies he helped sink were distinguished Professors of Medicine and heads of Health Institutes. If anyone interprets “trust experts” as “mere medical students must not publicly challenge heads of Health Institutes”, then we’ve accidentally thrown the fundamental principle of science out with the bathwater. But Pierre Kory, spiritual leader of the Ivermectin Jihad, is a distinguished critical care doctor. What heuristic tells us “Medical students should be allowed to publicly challenge heads of Health Institutes” but not “Distinguished critical care doctors should be allowed to publicly challenge the CDC”?
I think it is horribly demeaning to respond to someone asking how GPS work by saying "you can't try to understand without years of training, just trust us." That is exactly the kind of response that alienates people and fosters mistrust.
https://en.wikipedia.org/wiki/Pierre_Kory
Really, in a just world that guy would lose his license to practice medicine. I find it interesting that 'the lone voice' has such a power over 'the establishment', as though the lone voice is always right because they're the underdog.
There is an excellent movie about the theme of an infectious disease where some blogger/journalist goes all out on promoting 'Forsythia', a medication that does absolutely nothing against the disease, but that - using the exact same mechanisms as Ivermectin, HCQ and others - gets promoted to the hilt. I'm not sure if this is life imitating art or some kind of coincidence but it is uncanny to which degree the stories overlap:
https://www.imdb.com/title/tt1598778/
We so want to believe in that miracle cure that big pharma is denying us.
It's not quite the same. The people who build / maintain GPS have a lot more reason to trust them, and as a result, people do.
Until a while ago, if I recall correctly. GPS was <<lying>>. Its accuracy was deliberately hobbled to within tens of meters in order to prevent it being used for destructive purposes, I believe.
Did the GPS system know your position with a much greater accuracy ?
Yes.
Did the GPS system by design not provide this accurate information and instead sent something less accurate?
Yes.
How do you call that thing where you tell a partial truth? At best, a half truth.
For example the US government remarks about masks in February 2020 (I think it was February), were partly true.
It's trusted because it's been far more trustworthy than public health guidance and policy. And the same goes for airplanes, brake pads, and other tired comparisons. Trusting one does not imply one should trust all other proclaimed experts in all other fields in all other contexts.
That's a tautology. It's more trustworthy because it hasn't been politicized.
I mean, that's half the job of a professional programmer right there.
It's great you changed your mind but I bet there's plenty of people who haven't. Like I wonder what Bret Weinstein now thinks.
When you see someone you disagree with convinced by an argument, I think that should be an occasion for celebration and joy! People changing their minds to what you believe to be true is the only way to get change. It needs to be encouraged and people who manage to do this need recognition.
Changing your mind in polarized situations is hard! People who manage it did something impressive. Heck, even people who are willing to listen to the other side deserve recognition.
You saw someone who changed their mind, and you chastised them for not having changed their mind earlier, and for having been wrong before. That is rather counter-productive. Instead, be happy with the conversion. If you want more interaction, ask them why they believed the other thing before. Less importantly, ask them what changed their mind.
> Less importantly, ask them what changed their mind.
They wrote about that in this thread, and it proves that they do not understand the basic argument made, at all. As converts go, it's a pretty sad case.
The author of this article did a fantastic job, but all it has done for me is to show how hard it is for people to digest information and to draw meaningful conclusions from it.
On another note: this is why I'm not particularly hopeful about humanity getting their act together with respect to climate change.
The establishment very clearly does do this, and it's why the whole playbook you listed works in the first place.
Nothing this article says is new. This is all old hat.
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.
No, there is data that might point to a positive effect, that's something completely different than data that proves a positive effect.
Note that this is exactly how these things happen, someone writes something with a particular audience in mind and then others will come along, cherry pick it, distort it and then pass it on as fact. You are step #1 of the Chinese Whispers game and it has already meaningfully changed.
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.
It is a strange phenomenon that people are so ready to disagree with people who spent decades achieving exactly that kind of knowledge.
And if anyone who said "many scientists/doctors believe it to work against Covid-19" is getting banned, then that statement has 0 signal.
As Scott points out in this article, without knowing about the parasitic worm situation https://ivmmeta.com/ is both reasonable and moderately convincing.
No it isn't, it's full of obvious fraud! That's what the entire rest of the article points out. And they put an unwarranted warning against one of the few non-fraudulent studies because it doesn't go their way:
[re: Lopez-Medina et al]
> "I’m making a big deal of this because ivmmeta.com - the really impressive meta-analysis site I’ve been going off of - puts a special warning letter underneath their discussion of this study, urging us not to trust it. They don’t do this for any of the other ones we’ve addressed so far - not the one by the guy whose other studies were all frauds, not the one where 50% of 21 people had headaches, not the unrandomized one where the groups were completely different before the experiment started, not even the one by the guy accused of crimes against humanity. Only this one. This makes me a lot less charitable to ivmmeta than I would otherwise be; I think it’s hard to choose this particular warning letter strategy out of well-intentioned commitment to truth. They just really don’t like this big study that shows ivermectin doesn’t work."
That's the nearest Scott gets to directly accusing ivmmeta of fraud.
It might be that the list is riddled with fraud, but it isn't obviously so. I'm comfortable with many of the studies having methodological errors - that is why it is called "low quality evidence" instead of "high quality evidence" - and I assume the base rate for badly done studies is quite high.
[0] https://en.wikipedia.org/wiki/Replication_crisis#In_medicine
That's a pretty sensational claim.
Who benefits from this fraud?
The ivermectin manufacturers, researchers receiving funding from pharmaceutical company or the government, or the ivmmeta.com website itself (I see no third party ads or assets at all -- not even GA)?
Meanwhile, back at the Pfizer ranch, they just bought a few small countries for cash.
What you should do instead is to listen to your medical authorities who even if they do make mistakes have your best interests at heart, contrary to those that are pushing the quackery in an attempt to further destabilize our societies. You made yourself a willing collaborator in that, something to think about.
Over 40 doctors, most of them MD/PhDs, from 4 of the 10 top ranked hospitals in the world for the relevant issue, told me I’m an idiot, because that disease is a 1:10,000,000 thing, it can’t be the cause. It’s probably a virus and I should just go home and wait a few weeks.
And after 3 months (10 days of which were in-patient) and 40 or so specialists, and 5 hospitals), a doctor looked at all the data and said “of course you are right, we start treatment tomorrow” and we did.
All it cost was some irreversible brain and CNS damage, a few years at home - not much, right?
And through the years and some Facebook groups, I’ve met other parents in similar situations. Some had a 5 year delay in diagnosis because it’s a rare disease, stories about the medical system incredibly similar. That’s 5 years of irreversible brain damage and general suffering. Also, it’s more likely severely under diagnosed and actually more like 1:1,000,000
It was just the beginning of a journey. An eye opening one about incompetence and incentives.
The assumption that health authorities in particular (and authorities in general) have your best interest at heart, and are competent, are severely lacking in evidence. You might not have been bitten by that, and I’m happy for you that you weren’t.
Health authorities and professionals optimize for a lot of things, that only sometimes coincide with your interests as an individual. E.g. they might prefer you stay sick than get better, if there’s a 1:10,000 chance you’ll sue them (regardless of merit). I am intimately familiar with such a case.
Of note, the pharmaceutical industry, which is intimately intertwined with regulatory agencies and health authorities, is incentivized to make you a paying regular customer (Office 365) rather than selling you a one time product. Unfortunately, that means managed chronic illness rather than cure.
Which is not to say HCQ or IVM or whatever are the cure. But the idea of “trusting the authorities” is something you only do until it bites you hard.
I lost a sister (at the ripe old age of 23) to such a case so I'm quite familiar with the territory. In spite of that the default for me is to follow what my doctors tell me, and only if it doesn't work would I start to read up more and to try to come up with suggestions, but not with diagnosis.
Health authorities preferring you to stay sick rather than to get better should re-read the oath of the medical profession, that's despicable.
And agreed that there is a lot wrong in mixing business and health care, but those are the kind of setups that we apparently favor. I recall a doctor here in NL remarking to me that money and health are mutually exclusive, because if doctors have to make decisions based on finance they are immediately transgressing their oath. I can see his point, but I also understand basic resource allocation issues and the medical profession does not operate in a vacuum.
These are hard problems.
I reside in Israel these days, which has a system similar to NL ttbomk. The doctors that treat you (in the public system) are not incentivized other than to cure you, except perhaps through the occasional marketing cruise.
But high up ministry of health people have been indicted (including through corona) for pushing and in some cases mandating useless treatments after receiving a bribe.
The doctor at the hospital just got the memo “the recommended treatment in case of x is y”.
These indictments are for what can actually be proved. I’m sure there are more cases that have not been found, and also in other countries.
The only one who really has your best interests in my mind is yourself; if you are capable of doing research, you are likely more qualified for your own situation than specialists.
WHO recommends against remdesivir. FDA and IMOH promote it as a wonderdrug. Who would you trust?
The WHO recommends against using remdesivir in hospitalized patients -- which is very different from your claim! The FDA and others make their cutoff point slightly but not substantially later, e.g. remdisivir isn't indicated when a hospitalized patient is on high-flow oxygen. Their disagreement isn't one of substance, just one of scope, and all doctors treating Covid know the rationale behind each cutoff point.
But instead any of that nuance, people say things like the "WHO disagrees with FDA" and decide that both are useless so they should take medical advice from morons with podcasts?
I actually read the papers on remdesivir, and as a result decided that I will not take it if offered, whether hospitalized or not, because of my risk/reward preferences, which may or may not align with the doctor's or the system's.
In Israel (where I now reside), AFAIK, they are happily administering it to hospitalized covid patients; at least, they were giving it out a lot until they started treating with regeneron. Now, Israel has its own definition for requiring hospitalization than the WHO or the FDA (e.g. SpO2<94% is considered severe and requiring hospitalization -- if you have a positive PCR test).
Do you think the doctors treating covid are actually aware of the minute differences between WHO, FDA, IMOH definitions? I checked with a couple I know. They have no idea.
My GP.
I could read the research papers and the guidelines, but for that I would first need a medical degree in the relevant (sub)fields, figure out who is and who isn't telling the truth/stacking the deck/fudging the data/angling for funding and so on and then finally I'd have to weigh those papers and all of their contradictions and arrive at some conclusion. The chances of me getting that wrong are just as high as the chances of my GP debugging a piece of software by reading papers about debugging.
For rare diseases the job of a GP is not to diagnose but to pass you on to someone who can. You also have the right to a second opinion here in case you don't trust the advice that you are getting and finally, you can ask for arbitrage if you are then still not happy.
That said, plenty of errors are made, but I don't think the software industry has any right to speak about mistakes made in other fields, our own house has been on fire for the last three decades in that respect and the only thing we've done to deal with it is to avow any responsibility.
But very likely (especially in the US, but also in other places), his considerations have to do with not increasing his malpractice insurance premium.
Your and his interests are not aligned. And that chasm is larger than anyone likes to admit.
If you want to outsource your health decisions to someone else, who may be more knowledgeable in general, but may be less knowledgeable on any specific matter you dive into, and whose incentives are only generally aligned with yours - by all means do.
I don't, and this has paid great dividends for me so far. People who are capable of reading and understanding research (not all are), and have the ability to reach far out to well informed people and consult with them (not all can), are also likely to be in this situation -- and those people potentially lose dearly for not doing so.
In your anecdote, you suffered a failure to diagnose, and specifically, a failure to diagnose a rare disease.
This is unfortunate, and bad, and a problem to try to figure out, but it is a completely different sort of failure than what other people are proposing for HCQ or IVM, that there is a highly effective and inexpensive treatment that the medical establishment is failing to recognize despite apparently having such clear evidence in its favor that people on Facebook can understand it.
The diagnostic failure was just the beginning.
(And, unlike the HCQ/IVM case, which I don't support and is in general speculative - the guy responsible for the official recommendation was actually convicted for taking bribes from the company making the treatment. I won't divulge any details, because that will de-anonymize me - the disease is rare enough that people in the field know each other and all the cases).
p.s: That treatment (in combination) is also used for other, similar diseases, each is rare, but overall it was a lucrative market for the drug company.
They, like every other person, have their own best interest at heart, which, if you're lucky, aligns with yours. "Just listen to the authorities" is probably the worst advice ever given.
The problem with this pandemic is that a lot of people in places of power have made mistakes, sometimes really bad ones (for instance, such as pursuing herd immunity) rather than to follow the WHO expert advice. This could easily be construed as authorities acting against your best interests and in fact in quite a few places people have died that need not have died at all.
But there is a difference between 'political authorities' and 'medical authorities', the WHO has been fairly consistent and sensible in their advice to date, what political authorities locally do with that advice is another matter entirely, that runs the gamut of Bolsonaro to Boris Johnson to Jacinda Ardern and everything in between.
Pursuing herd immunity is a viable strategy only if you can actually achieve it.
Sweden has done far worse than their neighbors in this respect. But given the fact that it drags on all you can say is that as long as we don't treat this as a global problem your local measures matter less than you think.
Countries that did fantastically well early on showed it could be done, but because they were the exception eventually they too became overwhelmed through imported cases. If that had not happened, which would have required a more synchronized approach, then the total damage would be a fraction of what it is today.
And this isn't over yet, not by far and it is a much harder problem now than it was in March last year.
https://www.statista.com/statistics/1111779/coronavirus-deat...
Denmark, Finland, Norway and Iceland all did considerably better, and have demographics and local conditions that are closer together than comparing Sweden with the rest of Europe. It's a thinly populated Nordic country, so the comparison material should be countries that match those criteria, not the average of the EU, which runs the gamut of high density extremely interconnected countries with major airline hubs all the way to vast emptiness with the occasional city.
It's an easy mistake to make though.
https://www.worldometers.info/coronavirus/country/netherland...
"Use social distancing and isolation to avoid COVID and get vaccinated as quickly as possible" is good advice from well-meaning people who do know better. Sorry it's unpleasant, but if the USA behaved rationally, there wouldn't be 750K+ dead today.
Sweden readily admits that its approach was a terrible mistake. It's just not as embarrassingly bad as other countries, particularly ones that, with sensible leaders, should have done much better (UK, USA).
It does?!? Funny, how can I have totally missed something as big as that?
I'm a Swedish "expat"; I have now lived abroad for just a little longer than I lived in Sweden (26 vs 26.5 years), but I've always followed Swedish media and I still travel there regularly. All I've seen is some hemming and hawing about "Perhaps not totally optimal"; far from any flat-out admission of "terrible mistake". And when I spent a long weekend there three weeks ago, the populace at large certainly didn't seem aware of any such thing.
Got any handy links to this admission by Sweden?
https://www.wsj.com/articles/scientist-behind-swedens-no-loc...
> The epidemiologist behind Sweden’s controversial decision to forgo a mandatory lockdown conceded for the first time that more restrictions might have helped prevent a surge in coronavirus-related deaths.
Mixed messaging by people in the media undercut a lot of support for the countermeasures, which was then further amplified using social media to pretend that scientists are divided in their opinions when in fact they weren't, except for a few lone holdouts, who - yay controversy - were given a disproportionate amount of airtime.
Throughout the pandemic the experts, including the WHO, have been very frequently wrong. That doesn't necessarily mean you'll be better off following advice from secret messages encoded for you in game show hosts, or, worse, Donald Trump's actual opinions. But blind faith in experts hardly seems to be justified.
Also, even the "moderately convincing" evidence is in my opinion not nearly enough. It might be if Covid-19 were a modestly important disease with only a few labs and clinics running working on it. But it's not. Throw enough shit against the wall, eventually something will stick by chance. This is a globally distributed experiment, and it is impossible to control for publication bias and all quality issues...
The only reason to think why Ivermectin should work against Sars-Cov-2 is because it has shown some action in cell cultures at ridiculously high doses, and maybe there have been other anti-viral interactions in the literature. For widespread use, there needs to be more and better evidence, especially given the currently available vaccines and treatments.
It is a fallacy. https://en.wikipedia.org/wiki/Argument_from_authority . To make an argument, there needs to be an argument.
This seems to be a common and recurring theme: my opinion is worth as much as the opinion of an expert in the field because their argument can be discarded as an argument from authority. But they are an authority and I'll be happy to believe them compared to believing you, who are not active in their field at all.
See:
https://news.ycombinator.com/item?id=28067406
and
https://news.ycombinator.com/item?id=29235584
"I'm no medical anything but I do have extensive academic and statistical training."
But you forgot that that only applies to those fields that you actually know something about, otherwise this is about as transparent an appeal to authority as one can make. Who cares about your extensive academic and statistical training if you start off with nonsense? Garbage in, garbage out, no matter how good the program is.
This is wrong to the point where you really might want to take a deep breath. The point of experts is they have thought about a field more and are better at making sound arguments in that field. "Most scientists/doctors believe..." is literally, exactly and unambiguously a fallacious argument. The only thing that matters is why they would believe that.
And if that why is "statistical significance", I'm friends with enough doctors to know I'm better at interpreting stats than they are. If the answer they go to is parasitic worms then yeah, that is why they are experts and I'm not. It is a compelling argument.
I stand by my comments and disagree that they make the point you want them to. The 1st isn't even about medical opinion if you read it closely, it is scepticism of politics.
This is an excellent point. It is so good that I think it may serve as the definition of an expert: An expert is someone who is better at making sound arguments in that field. Sound arguments being what matters and not the person making the argument, just as the calculations matter more than the mathematician.
Probability dictates that any doctor - let alone most doctors' - opinion trumps yours and everybody else that parrots you, because they will be right far more often than you about medical things.
You may be better at interpreting the statistics than your doctor friends but you are not better at medicine, are not wired into their world as much as they are and in fact are most likely blabbing nonsense.
You can stand by your comments but that just proves my original point: that you consider your own opinion to be a higher one than someone trained in the field that you have an opinion on. See your other comment in this thread regarding how medicine prescription works, it doesn't but that isn't going to stop you from being convinced and it would not surprise me if you felt that that doctor is making an argument from authority.
Suggestion: assume that you are a layperson in medicine, act accordingly. And go get vaccinated if you haven't been already, and ask your doctor if they thinks that's a good idea, rather than to believe me, yet another stranger on the internet.
And I suspect you would have had the same conviction about smoking had you lived in the 1960s and noticed that many doctors recommended smoking.
No, it does matter why a doctor believes what they believe. The vast majority of them just follow the official top down advice. And some actors, notably tobacco and pharmaceutical industries, have been using that to subvert science (to great effect and profit) for decades.
Which, again, I note, is not a statement about IVM or HCQ or Cominraty - it’s about the reasons for your own convictions, which seem to completely ignore decades of evidence.
It does not at all matter that doctors know better than me about 99% of medical things. When I have a specific issue, it is far more likely I can know more about it by spending 100 hours studying, than a trained doctor does without studying. It is likely he would know more than me if he spent 5 hours, but it is very unlikely that he has.
I haven’t disagreed with doctor about many things in my life. But in the 3 or so things which I found vitally important to research, and in which I came to a different conclusion than the specialists, I was proven right.
And real doctors promoting smoking goes back much further than that, all the way to the early 1900's.
It's that kind of activity that undermines the authority the profession, but it's the wrong conclusion to make that if doctors were wrong about smoking they are also wrong about everything else. Usually they are not.
https://www.rgare.com/knowledge-center/media/articles/smokin...
Indeed. And usually, there is no significant objection to the medical consensus, so it is irrelevant the "all medical advice" space.
The interesting (from my perspective, but also from an information theoretic one) things are those about which there is disagreement. And the "usually right" on those subjects goes down significantly - perhaps it's still "usually", but maybe it's just 60% rather than the 99% of the "right" things which inspire people to blindly believe doctors about everything. And perhaps it's just 20%; We'll likely know about today's status only in 30 years.
For example, there is still consensus about statin use to reduce cardiac problems through cholesterol lowering. I looked a little into that; the evidence is severely lacking, especially if you consider all cause mortality rather than just "lowering myocardial infraction risk" (which you can achieve 100% with Cyanide!). I have informally surveyed about 20 doctors, of which one was a cardiologist. Everyone other than the cardiologist was convinced statins are the best thing since sliced bread, have no risks, and excellent efficiency. Not one of them actually knew much about, e.g. statin effect on all cause mortality, or much of anything else related to statins except the official line and up-to-date (the service) summaries. The cardiologist still thought statins were a good thing, but was much more reserved about recommending them to anyone with high blood lipids, because he actually read the research and had actual experience (and discussions with informed colleagues).
"If you are not a logician your opinion on fallacies doesn't matter at all."
>Probability dictates that any doctor - let alone most doctors' - opinion trumps yours and everybody else that parrots you, because they will be right far more often than you about medical things.
You really have not spent much time around doctors, I think. Doctors (GPs) know about as much on a topic as someone who Googles the current country guidelines. For anything novel, I'd trust a statistician over a GP to interpret data every time.
Don't like it? Get a second opinion. Don't like that? Request a review. Don't like that? Self medicate to your hearts content, or go with crystals, aromatherapy or whatever you believe works. But don't go around the interwebs spouting your self derived conclusion from papers that you barely - if at all - understood as fact.
Because that's the rub: the people who were all over Vitamin-D, Bleach, HCQ and lately Ivermectin were just looking for excuses not to vaccinate and that is a problem, none of these miracle cures were miracle cures, they weren't even cures. At best they were no-ops, at worst they harmed the health of those that received them. By amplifying these messages thousands of people have needlessly died.
But Ivermectin seems to have run its course. I predict a new miracle cure with a new champion somewhere in the next couple of months, just like Vitamin-D and HCQ before it.
And to the extent that the article does say that even a legitimate authority needs to present an argument, in this context, they have!
Like the situation here is medical experts have said "hmm these studies that appear to show ivermectin's effectiveness are fraudulent and suspicious".
Like, with the exception of the complete theory that ivermectin studies in some nations are naturally confounded by the presence of worms, the arguments he's made about the unreliability of the ivermectin data is the mainstream argument about the unreliability of ivermectin data. He even cites a number of experts whose analysis he sometimes relies on!
We did adopt his methods, but many years and hundreds of deaths too late, and not before declaring him insane for his beliefs and putting him in an asylum.
What I'm saying is that authority has a dark side. Sometimes the establishment is actually wrong. Regardless of right or wrong, it always chooses to erase its critics. Some of us disagree with the erasure, even in cases where the critics are wrong.
The thing where the case you linked went off the rails for me is that there was no downside to trying his methods earlier, but ego got in the way, and ego is by definition unscientific. But people will be people, that you won't be able to fix, I'm afraid.
Actually, the reason people didn't believe him is interesting because they were using an earlier scientific method - he didn't have a good explanation for the mechanism, so they dismissed it with "correlation is not causation". We're better at using things whose mechanism we don't understand now, like Tylenol.
What is interesting (to me) is that which we now consider to be common sense was at one point controversial.
Between hydroxychloroquine and Ivermectine you are (worldwide) probably looking at a few hundred thousand extra people dead because they (or in some cases their leaders) chose to believe that bullshit rather than to get vaccinated.
Fortunately during the polio years we didn't have the internet, the carnage would have been incredible.
Polio, measles etc. are entirely different.
I'm fully resigned to the fact that we won't know for sure if Ivermectin helps with any of this shit for at least another decade until tensions subside. Could be that millions of people died while they didn't have to. Could be that it's total horseshit. There's no way to know, and "consensus" means next to nothing in these circumstances.
At the same time, we have vaccines, which do work (though the slow roll-out and the many, many hold outs certainly don't help, as well as that it leaves the question of how to deal with children for the moment mostly unanswered).
And propagating this Ivermectine (and Hydroxychloroquine as the predecessor) nonsense has caused a lot of people to forego their vaccinations. And that does have very clear effects.
So even if consensus doesn't mean truth typically it is the experts that go against the grain with hard proof in their pocket that win out over the long term.
It is very rarely going to happen that new scientific truth will come from conspiracy theorists rather than from the establishment, though I guess if you live long enough that too will one day happen.
Citation needed. I think people forego vaccinations due primarily to how hard they are being pushed, and due to almost 2 years of pretty much nonstop incoherence (or even outright lies sometimes) from the health authorities and the press worldwide.
Case in point: we're still being told by talking heads that "vaccines can stop covid" whereas the reality is nothing can stop it - it's endemic. And that was clear to any sane person back in February of 2020.
Who is spreading the misinformation that all ulcers are caused by H. Pillory?