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.