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Comment by jacquesm | Hacker News Reader

I've been following with some amazement the number of conspiracy peddlers on HN for the last 18 months or so and one case of conversion isn't going to make me overly happy. It is a bit like the story about the lie getting halfway around the world before the truth puts their shoes on, in the extreme long term the truth will come out, meanwhile, the damage is done. This guy until yesterday wanted his mother to take some ivermectin, 'just in case'. I want my mother to take her doctors advice, not mine.

edit: just one exhibit: https://news.ycombinator.com/threads?id=mewpmewp2

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As an engineer, sometimes I say "ship it!" to code that doesn't make me happy but works and solves a real problem.

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.

I hope that that only goes for things that you can oversee the risks of and that you would refrain from giving medical advice to your relatives assuming that you are not a doctor.

"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.

"Sold out" is a real problem. More people than we want to admit see corruption coupled with big media as a enemy, not a thing to be trusted. Many ordinary people flat out do not know when to trust, so they don't.

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.

I have slowly come to the conclusion that maybe we grew up a bit too fast with respect to media and social media in particular. In the past change to society came slow and we could internalize and stabilize it before the next round of changes appeared.

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.

That danger has been present for a while now.

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.

I will end with this:

"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."

You could try spreading the truth instead of bullying people? I do care about my mothers health you know. And if a doctor isn't convinced by a large number of studies I want them to explain why not rather than call me a conspiracy peddler.

The way someone gets ivermectin is to walk a doctor through the evidence they've seen and then ask them to prescribe it.

I am a doc. I am also a medical researcher, but you (and most other people here) _have_ to realize that the vast majority of practicing MDs are _not_ scientists, and understand almost nothing when reading medical studies. And that's fine, because it's not their job. The profession is bound by guidelines and expert opinion. Experts do research, formulate guidelines, and guidelines get applied by practitioners. And no, that absolutely does not mean you know better than the average doc because you've read 10 studies. That's telling a highly specialized labourer that you know the job better because you've read 0.0001% of the theory.

The dissonance here is intense. On the one hand, "practicing MDs ... understand almost nothing when reading medical studies", but also I don't "know better than the average doc [just] because [I've] read 10 studies."

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?

Great point. Perhaps the idea is that neither you nor the avg doc can conclude much from reading 10 studies. Therefore, defer to the experts?

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.

I wasn't clear. Most of the time, as with prostrate screenings, one of the following is true:

- 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 is a fourth option:

- there a consensus, it is broad and it has good experimental support and high confidence

Your GP may try to lay out the state of research before you, but that does not change the fact that he/she will do one of those things:

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.

More likely: your GP will pass you on to the resident expert at the nearest hospital of your choice.

As someone who is actually an expert in a subfield of medicine, not only do doctors not understand it at all, but the experts making guidelines often recommend the exact opposite of what is the best treatment for the patient, usually for liability reasons, but occasionally for true lack of understanding. The quality of research is so poor that often times there are more flawed studies showing X than proper studies which would show ~X. Other times there is no research on the matter at all, and the conventional wisdom (even among experts!) is incorrect. For fields where practice and theory diverge, like an experimental surgery with sparse research, the surgeons know that the guidelines are useless.

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.

I'm not saying that experts are doing a stellar job or that they're special in any way, far from it. I have slaved enough under 'true experts' to know the extent of the catastrophe. We even had a truly spectacular example of failure at the start of the pandemic with the 'intubate early and withhold steroids' expert opinion. This particular one, I won't ever forget.

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.

>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.

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.

Your Joe is the average HN reader. My Joe is my average patient. I completely agree that the word of experts is meaningless on matters where dust had no time to settle. I however maintain that practitioners have to follow guidelines and experts regardless because I believe in the principle (if not the current application) of evidence-based medicine, and that Joe should not be allowed free access to any drug he wants to prevent frequent self harm.

I agree, but that is quite separate from the posture of epistemological submission to experts that's being used to censor "misinformation".

I don't know about that. I'd rather see all of this stuff disappear from youtube and to deny the conspiracy sphere its oxygen than to let this run its course. The damage is very real. Experts tend to communicate via scientific papers and symposia, not via youtube, that's aimed squarely at the masses only a very small fraction of which has the capacity to interpret what they are hearing, but almost all of them have the capacity to filter that to select the bits that they like or that they feel support their pet desired outcomes.

The damage caused by mis- and dis-information is real, but suppressing dissenting voices (even comically mistaken ones and bad actors) destroys institutional credibility, which is far worse in the long run.

I'd rather allow free speech.

The medical profession gets it wrong with some regularity, but this Ivermectin thing fell out of the sky without any support, and was touted as the miracle cure that big pharma was withholding in order to protect their profits.

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).

I like how you declare yourself an subfield expert & then call an experts in your subfield to be worthless.

Yes, the 'experts' disagree, imagine that! Which ones should we ban from all public discourse?

But why do you even assume that it works? The doctor might not be able to disprove it because disproving is fundamentally hard and may not even be possible. But the direction that makes sense is that we prove if something does work/has an effect.

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.

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