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Comment by roenxi | Hacker News Reader

It is easier to treat steelmanning as a hazy middle ground and pick examples that clearly are or clearly aren't.

Eg, the strongest pro-ivermectin argument was "There is all this evidence that lots of people who take ivermectin have much better outcomes after COVID. We should let people take ivermectin". Scott Alexander was literally the first person I saw to acknowledge the evidence before arguing against taking ivermectin to treat COVID. Which is quite an impressive first since I'd seen a lot of weirdly authoritarian people trying and failing to argue effectively against the drug up until then. Those people had failed to steelman the pro-ivermectin position.

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Lots of people acknowledge the evidence, almost everyone who is in a position to evaluate that evidence then points out that the existing evidence is, at best, of extremely poor quality, and at worst, outright fraudulent. They also usually acknowledge that there are higher quality studies underway that will answer the question definitively.

It’s honestly one of the most kind blowing instances of alternative thinking that is out there, this constant shifting of the goalposts in the pursuit of freedom from the big pharma conspiracy and the evils of fauci. Like, we have perfectly good evidence that this whole conspiracy is bunk, because we have an example of the exact same thing (a generic, cheap as chips medication that markedly improved survival with severe covid - steroids) but actually backed by good quality studies and not some alternative paper mill

None of that is steelmanning either. You're making a very common mistake of dismissing evidence ("the existing evidence is, at best, of extremely poor quality, and at worst, outright fraudulent") which with benefit of hindsight appears to be both accurate and in good faith [0].

Now that evidence wasn't conclusive (indeed, the argument for ivermectin in 1st world countries has been more or less demolished), but someone has to do what Scott did and come up with a better reason to dismiss the evidence than an appeal to authority. Just claiming you want to ignore it because experts ignore it is hardly a strong argument compared to a pretty reasonable number of studies showing a positive effect. And it is easy to see why some people would turn to conspiracy theories if that is the best other people can come up with in casual conversation.

[0] I mean, you go to a region where 10% of the population has parasites and hand out ivermectin. That'll have a fantastic effect on COVID outcomes. There'll be an obvious positive impact that any study would pick up.

Never been pro-ivermectin as a primary tool for Covid, but can you actually back up, “indeed, the argument for ivermectin in 1st world countries has been more or less demolished.”

I read Scott’s piece the day it was published and was over all impressed but don’t buy the conclusion. Westerners are filled with all sorts of parasites and as far as I’m aware we are not universally cleaner in that regard, for example with worms, than other places. That to me suggests that to the extent a significant fraction of the population would benefit from deworming, ivermectin’s widespread use in some of our hospitals during the pandemic was not entirely illfounded and may have even played a part in more than one life saving treatment regimen.

So I would love evidence that says clearly why it doesn’t work here but works in poorer places because somehow Americans are too good for parasites. My experience tells me this is wrong, and many Americans are carrying all sorts of bugs. Go read the Amazon reviews for proguard!

Is this just your feeling, that western countries have just as many parasites as developing countries?

That makes me think you don't have much experience in developing nations. Sanitation is a serious problem in large parts of the 3rd world. Availability of clean water is a problem. Sewage capture and treatment is a big problem. These are not big problems in most of the western world.

I'm sure there are studies finding that most people regardless of where they live have some parasites. But the question is whether you have large amounts of the kind of parasites that make you sick and more specifically, the kinds of parasites that can be treated with ivermectin.

“the question is whether you have large amounts of the kind of parasites that make you sick and more specifically, the kinds of parasites that can be treated with ivermectin.”

It would be a useful study, to the extent Covid remains a concern for public health agencies. If you are familiar with poverty in America, you wouldn’t think sanitation and parasites aren’t issues here. They just aren’t as common.

They aren't as common by an order of magnitude or more.

I’ve absolutely seen a narrative along the lines of “don’t take the leaky mRNA vax with it’s dangerous spike proteins, make ivermectin and vitamin D”

I’ve also seen pro-vaccine pro-ivermectin narrative, but all the same.

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