[HN Gopher] Lesson of ivermectin: meta-analyses based on summary...
___________________________________________________________________
Lesson of ivermectin: meta-analyses based on summary data alone are
unreliable
Author : 4512124672456
Score : 137 points
Date : 2021-09-22 13:39 UTC (9 hours ago)
(HTM) web link (www.nature.com)
(TXT) w3m dump (www.nature.com)
| twofornone wrote:
| The premature smear of potentially effective medications like HCQ
| and Ivermectin by scientifically illiterate media is
| unforgivable. Especially in the case of Ivermectin, given that it
| has one of the most benign safety profiles of any known drug.
|
| There is no excuse. There should have been federally funded
| widespread trials a year ago, there is no downside. Instead you
| now have hospitals forbidding off label prescription with threats
| of termination. None of it makes any sense; people are treating
| science as though it were a religion, and the safety and efficacy
| of the vaccines as some sort of core, unquestionable tenet,
| complete with shaming and excommunication for nonbelievers.
|
| All over a virus which has a complication rate on par with a
| moderate flu year.
| anoonmoose wrote:
| I'm glad that you mentioned HCQ. What happened with HCQ? Was it
| smart that the US bought stockpiles of it, and was it smart for
| doctors to be prescribing it for treatment of COVID, with a
| years hindsight?
| twofornone wrote:
| I think one glaring problem is that two years into the
| pandemic we still don't know...and given the rigid taboo
| which has sprung up around HCQ and other treatments, frankly
| I don't really trust the data. Yes, the initial studies in
| support of HCQ were low quality, but the primary initial
| study which the media jumped on to "discredit" HCQ was
| laughably biased, completely disregarding the early
| stage/prophylactic dosing recommendations and essentially
| overdosed terminally ill patients.
|
| The whole thing has been a huge joke.
| burkaman wrote:
| There is a federally funded widespread trial, but they take a
| while to do correctly: https://www.nih.gov/research-
| training/medical-research-initi...
|
| There was also a federally funded trial of hydroxychloroquine
| last year which has since concluded: https://www.nih.gov/news-
| events/news-releases/nih-halts-clin...
| sjwalter wrote:
| And in the meantime, if you buy into the crazed insanity of
| "pandemic! pandemic! omg we'll all die", then it makes tonnes
| of sense to treat people with a highly-available, incredibly
| safe medication that frontline clinicians all over earth are
| reporting success with, especially a drug that has been dosed
| ~4 billion times over two generations, that has been most
| often dosed by illiterate people and delivered by non-doctor
| NGO workers.
| burkaman wrote:
| I guess the reason doctors aren't prescribing Ivermectin is
| that they don't buy into "crazed insanity" and don't feel
| the need to try anything that might work.
|
| And I can only speak for myself, but the attitude I'm
| seeing is "a lot of people are dying and we should try to
| work together as a society to stop that from happening",
| not "omg we're all gonna die".
| tigershark wrote:
| Chillies have been used for thousands of years as a
| medication and they are perfectly safe. You may want to
| follow the advice of someone else in this thread and shove
| them up your ass.
|
| For sure they will have less side effects than ivermectin
| and they have exactly the same chance of curing covid.
|
| And for your information the covid vaccines have been
| administered 6 billion times, so roughly 50% more than the
| number that you cited about ivermectin.
| danaris wrote:
| Penicillin is also a highly-available, incredibly safe
| medication that's been given billions of times.
|
| It still doesn't make any sense to try giving it to COVID
| patients, because _there 's no reasonable way it would
| actually help them_.
|
| Just because a particular medication is unlikely to kill
| you doesn't mean it's a good idea to promote its use
| against a particular threat, when that threat is completely
| unrelated to what the medication actually does. Penicillin
| is an antibacterial. Ivermectin is an antiparasitic.
| Neither of these are likely to be helpful against a virus.
| twofornone wrote:
| There is a known mechanism by which ivermectin is
| expected to work against covid - it inhibits the protease
| family of enzymes. Incedentally, Pfizer is developing a
| new (read: expensive and on patent) covid drug which also
| happens to work via the same mechanism. So the fact that
| ivermectin is an antiparasitic is irrelevant, as is the
| comparison to penicillin.
| flavius29663 wrote:
| Sorry, but you are wrong. Antibiotics are used in the
| treatment of severe viral infections, because your body
| is not able to fight secondary infections with bacteria
| very well. Antibiotics are given to help your body in
| cases of bad viral infections. Covid-19 is no exception.
| https://www.thelancet.com/journals/langlo/article/PIIS221
| 4-1...
|
| The point is: there are more mechanisms by which our body
| can be helped fight covid, and the Ivermectin proponents
| say that it works only in the early days of the
| infection, not like a full cure.
|
| There are more ways to fight this disease, you are aware
| that the virus itself is not what's killing most people,
| right? Most people die because their body overreacts to
| the virus and damages the lungs (that is why standard
| treatment includes steroids to calm down the antibodies).
| A drug doesn't have to kill off the virus to win.
|
| I have no idea if Ivermectin is helpful or not, but the
| trashing in the media (even calling it horse dewormer -
| while it's a human drug as well) before there is any
| proof against it is just bad, it makes me think there are
| ulterior motives for this.
| anshorei wrote:
| Ivermectin has research going back to the mid-2000's
| showing it has anti-viral properties.
|
| EDIT: Thought I'd come across a study indicating that
| from 2006, but I can't seem to find it. Let's settle on
| mid 2010's instead because the point is mostly that there
| was research showing anti-viral properties before the
| pandemic started, and therefore it was a very logical
| thing for frontline doctors to try on their patients.
| tehjoker wrote:
| "How the coronavirus infects cells -- and why Delta is so
| dangerous"
|
| https://www.nature.com/articles/d41586-021-02039-y
|
| "The virus then ejects its genome directly into the cell. By
| invading in this spring-loaded manner, SARS-CoV-2 infects
| faster than SARS-CoV and avoids being trapped in endosomes,
| according to work published in April by Barclay and her
| colleagues at Imperial College London9.
|
| The virus's speedy entry using TMPRSS2 explains why the malaria
| drug chloroquine didn't work in clinical trials as a COVID-19
| treatment, despite early promising studies in the lab10. Those
| turned out to have used cells that rely exclusively on
| cathepsins for endosomal entry. "When the virus transmits and
| replicates in the human airway, it doesn't use endosomes, so
| chloroquine, which is an endosomal disrupting drug, is not
| effective in real life," says Barclay."
| lez wrote:
| Looking at the greyed out comments it seems HN is not pro, but
| against scientific debate. Questioning science IS part of the
| scientific method.
|
| https://c19ivermectin.com/ is a very adequate counter-argument to
| the article, and it's unfair to the whole scientific community
| that comments are greyed out that mention it.
| cyounkins wrote:
| There is a lot of confusion on whether there actually was a
| significant increase in calls to poison control centers due to
| ingestion of ivermectin.
|
| This [1] official Mississippi government document says, "At least
| 70% of the recent calls have been related to ingestion of
| livestock or animal formulations of ivermectin purchased at
| livestock supply centers."
|
| But then the AP [2] seemed to say that was incorrect: "The
| Associated Press erroneously reported based on information
| provided by the Mississippi Department of Health that 70% of
| recent calls to the Mississippi Poison Control Center were from
| people who had ingested ivermectin to try to treat COVID-19.
| State Epidemiologist Dr. Paul Byers said Wednesday the number of
| calls to poison control about ivermectin was about 2%. He said of
| the calls that were about ivermectin, 70% were by people who had
| ingested the veterinary version of the medicine."
|
| Does anyone have additional clarification?
|
| [1] https://msdh.ms.gov/msdhsite/_static/resources/15400.pdf
|
| [2] https://www.sfgate.com/news/amp/Health-Dept-Stop-taking-
| live...
| tedunangst wrote:
| There was an absurd rush to report that ivermectin is bad that
| resulted in a pretty bad breakdown of the fact checking
| process. A lot of semi-adjacent facts and statements got
| merged. A hospital is full and a hospital treated someone for
| overdose became all the hospitals are filled with overdose
| victims.
|
| (I think eating horse paste is dumb, but that doesn't excuse
| rolling stone lying about the consequences of doing so.)
| burkaman wrote:
| The sources agree, look at the bullet point above the one you
| quoted.
|
| * The Mississippi Poison Control Center has received an
| increasing number of calls from individuals with potential
| ivermectin exposure taken to treat or prevent COVID-19
| infection.
|
| * At least 70% of the recent calls have been related to
| ingestion of livestock or animal formulations of ivermectin
| purchased at livestock supply centers.
|
| So, 70% of "calls from individuals with potential ivermectin
| exposure" were "related to ingestion of livestock or animal
| formulations of ivermectin", which is what the AP's correction
| says.
| cyounkins wrote:
| Ah, I see now. "the recent calls" refers only to calls about
| ivermectin, not ALL recent calls.
|
| Still, the AP misunderstood as well, misreported it, and
| later issued a correction. Before the correction, it was
| syndicated by many news outlets like New York Times. I think
| most people are unaware of the important correction.
| eigengrau5150 wrote:
| I've suspected that for years. I remember my undergrad biology
| prof coming down on students depending on meta-analysis and
| insisting they were no substitute for attempting to replicate the
| experiments themselves.
| simonh wrote:
| Ok you replicate the original study. Presumably you want to use
| this new result to increase your statistical power compared to
| the original result, combining the results of the two
| studies.... which... is.. er... meta analysis.
|
| The whole point of meta analysis is that you have multiple
| studies of the same experiment.
| dekhn wrote:
| that doesn't make scientific sense. Replicating the original
| experiment and doing a meta-analysis have two completely
| different goals. I would have argued that back to the professor
| (and been right).
| gorwell wrote:
| How useful is meta analysis if half or more of the
| experiments don't replicate? As we increasingly discover with
| the replication crisis.
| dekhn wrote:
| I said they had different goals, not that they don't
| overlap.
|
| If you're in a class teaching medical studies, and you tell
| people "go replicate the original experiment instead of
| doing meta analysis", you're doing your students a
| disservice.
|
| Instead say: "It's always important to be able to replicate
| experiments and I encourage everybody in the class who is
| going on to do science or medicine spend at least some time
| in the lab replicating a basic experiment. But medical
| studies are so large and complicated that we can't
| typically repeat them in a reproducible way. Instead, we
| use statistics and probability to make reasonable decisions
| based on the data we have. Sometimes that means removing a
| suspect paper from a meta-analysis because we lack
| confidence in its reproducibility."
|
| For some of the most sophisticated medical science
| experiments we have today, the only way to replicate an
| experiment is to be a postdoc and join the lab that does
| the research, master the technique there, then take your
| reagents and other material to your professor job, and then
| get your local set up to replicate what you did in the
| original lab. This is how it normally works, for example in
| labs like Mina Bissell's where few people in the work even
| have the skills to replicate her experiments.
| dekhn wrote:
| Medical studies can't be replicated in experiments. They
| are almost always one-shot. That's not how medical studies
| (that we do meta analysis) work. It's too expensive and too
| complicated.
| buescher wrote:
| Bingo. Also the problem with meta-analysis of certain kinds
| of studies (say, observational ones) is the file-drawer
| effect: people don't report negative results. So you can go
| from a bunch of studies that show an effect (usually small)
| at marginal statistical significance to a meta-analysis
| that shows very high statistical significance when there is
| really no effect there.
|
| I don't think we have to worry about the file-drawer effect
| much with controversial COVID treatments, though. Do you?
| marcodiego wrote:
| Hmmm... How about meta-analysis considering only results that
| were successfully replicated?
|
| Why not consider an index that is higher with the number of
| successful replications and lower of number of replication
| tries?
| ndr wrote:
| Mind that this is correspondence, not a peer reviewed paper.
|
| For what is worth most meta-study will check if they reach the
| same results leaving-n out (typically one), but I agree that they
| could do much better accessing the underlying data itself.
| rory wrote:
| Ivermectin probably doesn't do anything to fight Covid-19, but
| the American media has really shown their corruption in the way
| they've treated it.
|
| It's clearly a safe drug to take in human-designed doses, and
| it's cheap to produce. Laughing at people for poisoning
| themselves with "horse dewormer" instead of pointing out that
| they are turning to the vet store because their access to
| medicine has been marginalized is sick.
|
| And maybe it does help, I don't know. Unproven != disproven.
| soperj wrote:
| Their access to the vaccine hasn't been marginalized.
| tootie wrote:
| On The Media did a really good segment with a journalist from
| Mother Jones of all places. She broke down the rise of
| Ivermectin and the whiplash response to demonize it even when,
| as you say, it is safe for human consumption and had at least
| some positive in vitro test results. As much as it is not
| worthy of being recommended as a treatment, it's unlikely to be
| harmful and has/had at least a slim chance of working.
|
| https://www.wnycstudios.org/podcasts/otm/segments/how-iverme...
| rualca wrote:
| > As much as it is not worthy of being recommended as a
| treatment, it's unlikely to be harmful and has/had at least a
| slim chance of working.
|
| Keep in mind that Ivermectin is being pushed within
| antivaxers circles as a prophylactic and the true COVID-19
| cure, in contrast with all COVID-19 vaccines and even mask
| mandates.
|
| Thus it's false to claim that this push towards Ivermectin is
| harmless as, at best, it's pushed as a placebo that empowers
| vulnerable people to catch and spread the disease, which
| ultimately means they are harming themselves and everyone
| around them.
| tootie wrote:
| That's not the argument though. Listen to the segment.
| Giving people false hope and baseless medical advice is one
| thing, but the anti-ivermectin crowd was going overboard
| including amplifying specious stories about rampant
| ivermectin poisoning. Ivermectin is absolutely prescribed
| to humans for some conditions and is being actively studied
| as an anti-viral agent against other illnesses (notably
| dengue and yellow fever). Doctors can prescribe it to
| patients unable to be vaccinated within their discretion.
| The debate here is that you can't counter one form of
| misinformation with your own or else nobody is credible.
| rualca wrote:
| > That's not the argument though.
|
| It's not the argument? It is a statement of fact. There
| is no way around it. Consuming a placebo to subsequently
| validate and provide incentives to put yourself and
| others at risk is the whole reason why Ivermectin poses a
| major problem. No one complains that people take
| paracetamol even though it is not effective at reducing
| Covid19 spread. Why is that?
| tptacek wrote:
| It matters a _lot_ if ivermectin doesn 't do anything to stop
| C19, even if it is otherwise safe (it surely is, dosed
| professionally). People take ivermectin instead of vaccinating
| or complying with NPIs. If ivermectin doesn't work, that is a
| very, very big deal.
| rory wrote:
| > _People take ivermectin instead of vaccinating or complying
| with NPIs_
|
| Doing one thing but not another doesn't imply you're doing
| one thing _instead of_ another.
|
| Do you truly believe the people ODing on ivermectin would be
| lining up for vaccinations if it didn't exist?
| threecheese wrote:
| One doesn't imply the other, but it is certainly happening.
| People are using (being led to use) ivermectin as a
| prophylactic against covid, an alternative to the vaccine.
| myrmidon wrote:
| Lining up? Not necessarily.
|
| But it seems almost certain to me that at least some people
| feel safe thanks to taking ivermectin (while distrusting
| mainstream vaccines), and those people _would_ turn
| eventually to the vaccines if those were the only perceived
| path towards C19 safety.
| rory wrote:
| Perhaps on the margin some would, but I suspect most
| would fall into the "natural immunity" camp.
|
| So in my mind, we need to weigh the damage done by
| blocking safe ivermectin use for some number of people to
| the damage done by a much-smaller number of people
| remaining unvaccinated when they otherwise would get the
| jab.
|
| Seems like it could go either way depending on your
| specific assumptions.
| tptacek wrote:
| I don't know what this is supposed to mean, but a close
| family member took ivermectin instead of being vaccinated,
| and caught a serious case.
| rory wrote:
| It's pretty simple: had ivermectin not existed, would
| that person have gotten vaccinated?
| ashtonkem wrote:
| People are literally taking horse formulations of ivermectin
| because doctors are rightfully refusing to prescribe ivermectin
| for an off label and ineffective use.
|
| Oh, and the access to this medicine is "marginalized" BECAUSE
| IT DOESNT WORK TO TREAT COVID. We generally do not expect
| doctors to prescribe medicine that will not work or is not
| appropriate for the patients condition. Complaining about their
| access being marginalized is like complaining that my doctor is
| marginalizing my access to Ketamine because I don't need it.
|
| It's not "corruption" to point that out.
| brandonmenc wrote:
| > People are literally taking horse formulations of
| ivermectin
|
| People are taking the horse formulation because most
| pharmacists won't even _fill_ an off-label prescription for
| the drug, which - even if it has no effect on COVID - is safe
| and taken by a quarter billion people every year.
|
| Let people take it. It's not harmful.
|
| Or, make a big huge deal about people taking it and, well,
| then it becomes a big huge deal.
| vernie wrote:
| Is that really the reason or is it that they can't get a
| doctor to write them an off-label prescription?
| brandonmenc wrote:
| It's probably both, but why would a doctor risk losing
| their license over this? Yet another unintended
| consequence. Doctors are supposed to be able to write
| prescriptions for off-label use.
| sgt101 wrote:
| If they have reason to believe that it's beneficial. If
| they don't then they are being reckless.
| cableshaft wrote:
| A friend of mine found a doctor to prescribe it but his
| pharmacy won't fill it. He is so pissed.
|
| He was only planning to take small doses here or there as
| he's a teacher and around sick kids all the time, as if
| it were like Zinc to hopefully help reduce the severity
| of Covid-19 if he does get it, but despite going through
| the effort and succeeding in finding a doctor willing to
| prescribe it (and my friend even signed a document saying
| he understands it's an experimental treatment and will
| assume any risks), his local CVS is refusing to fill it.
|
| My opinion is if you can get a proper doctor to prescribe
| it (by proper doctor I mean none of this "I got a medical
| exemption for wearing a mask from my Chiropractor"
| bullshit like is going on in Florida), a pharmacy
| shouldn't be allowed to decide not to fill it, as if they
| know better than your doctor.
| mint2 wrote:
| Is your friend vaccinated?
| ashtonkem wrote:
| > pharmacy shouldn't be allowed to decide not to fill it,
| as if they know better than your doctor.
|
| It sounds like you have a pretty misguided idea of how
| pharmacies and pharmacists worked before Covid. You're
| describing a situation where pharmacists act at the
| behest of doctors who know best, when in reality
| pharmacists have always had some level of independent
| authority over what drugs get dispensed to whom thanks to
| their expertise. It's part of the pharmacists job to
| watch out for bad prescriptions, both in terms of abuse
| (e.g. opioids) improper dosages, and unintended side
| effects and interactions between drugs. In some states
| pharmacists have their own ability to prescribe medicine
| on their own.
|
| I'm not sure exactly how much control a pharmacist should
| have over whether a valid prescription is filled, but the
| idea that they're only expected to blindly fulfill the
| order of your doctor is not correct, and never was. In
| fact, they probably know more about the drugs you're
| prescribed than your doctor does, as that's their entire
| speciality. (Especially given the long and sordid history
| of doctors pushing drugs on the basis of pharmaceutical
| sales reps, doctors often actually know very little about
| what they prescribe).
| nobody9999 wrote:
| >t sounds like you have a pretty misguided idea of how
| pharmacies and pharmacists worked before Covid. You're
| describing a situation where pharmacists act at the
| behest of doctors who know best, when in reality
| pharmacists have always had some level of independent
| authority over what drugs get dispensed to whom thanks to
| their expertise. It's part of the pharmacists job to
| watch out for bad prescriptions, both in terms of abuse
| (e.g. opioids) improper dosages, and unintended side
| effects and interactions between drugs. In some states
| pharmacists have their own ability to prescribe medicine
| on their own.
|
| Absolutely. I had to fire my doctor after he prescribed a
| sulfa drug to me, even though I'd made it clear that I
| have an allergy to sulfa drugs.
|
| In fact, I would never have known (well, until I became
| sick/dead) that the drug prescribed was a sulfa drug if
| the pharmacist hadn't known the drug involved and checked
| it against known allergies. He contacted both me and my
| doctor and a different drug was prescribed.
|
| In fact, it's entirely possible that I'm alive today
| thanks to the expertise and knowledge of the pharmacist.
| julianz wrote:
| This "friend of yours" should probably get vaccinated
| then, because we know that works pretty well.
| snovv_crash wrote:
| The pharmacy probably doesn't want any liability so it's
| easier to just blanket-ban 'fad' medicine.
|
| And we make fun of the Chinese using rhino horn for
| erectile disfunction...
| threeseed wrote:
| > pharmacy shouldn't be allowed to decide not to fill it,
| as if they know better than your doctor
|
| They are legally required to make decisions about whether
| or not to fill it.
|
| They are not just some supermarket cashier.
| sgt101 wrote:
| I get where you are coming from, but I think that there is
| a nuance that you have missed. Like many, many drugs - and
| vaccines - ivemectin has some unpleasant and dangerous side
| effects in some people rarely. You can see these if you
| look the drug up
| :https://www.medicalnewstoday.com/articles/ivermectin-oral-
| ta... for example.
|
| The point is that if this drug did help people make it
| through covid (like the vaccines do) then it would be worth
| the risk of these horrible things happening - if they were
| rare (they are). But unfortunately it looks like this is
| not true, so people are taking a risk of having a horrid
| side effect with no chance of the pill working.
|
| On the other hand if you take the pill to avoid river
| blindness then the risk of the side effect seems well worth
| taking to me. But not for covid - 0 benefit for 0.001 risk
| is not good trade.
| brandonmenc wrote:
| All of this is for the patient and their doctor to
| decide.
|
| Not the pharmacist. Not the FDA.
| PaulDavisThe1st wrote:
| They're [often] using the horse formulation _because
| their doctor said no_.
| angelzen wrote:
| This is such a hypothetical. How many people got
| ivermectin against their doctor prescription, and how
| many got adverse effects from that? 1 in 100M?
| ABeeSea wrote:
| Farm supply stores are out of stock from idiots buying
| livestock formation. Some are now requiring proof of
| horse ownership to buy it.
|
| https://www.google.com/amp/s/news.yahoo.com/amphtml/vegas
| -st...
| PaulDavisThe1st wrote:
| Who said anything about adverse effects?
| angelzen wrote:
| GGP: ivemectin has some unpleasant and dangerous side
| effects in some people rarely. [...] people are taking a
| risk of having a horrid side effect with no chance of the
| pill working.
|
| GP: All of this is for the patient and their doctor to
| decide.
|
| P: They're [often] using the horse formulation because
| their doctor said no.
|
| X: How many got the horse formulation and how many got
| adverse effects from [horse formulation]?
|
| C: Who said anything about adverse effects?
|
| It this human brain on Twitter? We can't possibly read 4
| short stanzas in a row and keep the context?
| sgt101 wrote:
| I agree about the pharmacist - but the drug regulator
| really does have to have a role. There is a serious
| information imbalance between patients and doctors and
| both big pharma and lunatic talkshow host millionaries.
| Regulation is important to help prevent junk getting
| pushed into kids arms to make bastards money. It's not
| perfect and they get a lot wrong, but without it you and
| I are at the mercy of some very mercy short people.
| threeseed wrote:
| Pharmacists are not there to blindly dispense drugs.
|
| They have a legal and moral obligation to understand how
| those drugs are going to be used and whether the patient
| is at risk for taking them.
| rualca wrote:
| > All of this is for the patient and their doctor to
| decide.
|
| > Not the pharmacist. Not the FDA.
|
| In case you don't know,the FDA is the US regulatory body
| whose mission is to " [protect] the public health by
| ensuring the safety, efficacy, and security of human and
| veterinary drugs, biological products, and medical
| devices;"
|
| In the US, doctors only prescribe drugs that have been
| verified by the FDA, and pharmacists only distribute
| drugs approved by the FDA.
|
| If not the FDA, who do you think is responsible in the US
| to ensure a drug works and is safe?
|
| The FDA is pretty much the US instition devoted to anti-
| quackery and anti-fraud. Why is this a problem?
| cma wrote:
| > is safe and taken by a quarter billion people every year.
|
| Usually yearly or bi-yearly. Not bi-weekly. There is much
| less safety data on doses that frequent.
| brandonmenc wrote:
| > There is much less safety data on doses that frequent.
|
| You can say the same thing about COVID boosters.
| snovv_crash wrote:
| And yet there is a wealth of data on both the safety and
| the efficacy of covid vaccines, and there is also a
| wealth of data on the effects of getting covid.
|
| So why are people going for something without any data?
| 8note wrote:
| There is some data though, such as it causeing your
| intestinal lining to strip off and look like worms in
| your poo
| threeseed wrote:
| > is safe and taken by a quarter billion people every year
|
| When taken in dosages that have been determined based on
| extensive studies and research.
|
| This doesn't apply to COVID so it is completely responsible
| for them not to supply it.
| heavyset_go wrote:
| It's not a placebo pill, it's an active medication that has
| effects on the body and undergoes metabolism. Ivermectin
| inhibits cytochrome P450, which the majority of
| prescription and OTC drugs are metabolized by.
|
| Administration of a P450 inhibitor will cause the levels of
| other medications in a person's blood to rise, and will
| cause some prodrugs to be ineffective due to reduced
| metabolism.
|
| I can't even walk into a doctors' office and get prescribed
| Singulair, an allergy medication, without giving them a
| reason to believe that I need it. And if I was a doctor,
| I'd err on the side of caution, as well, when it comes to
| prescribing things I don't think my hypothetical patients
| need. Not only is it a question of ethics, it's also a
| question of legal liability and keeping a license to
| practice.
| swader999 wrote:
| Ivermectin from horse paste cleared up all of my long covid
| symptoms except for lung inflammation which prednisone
| fixed after the ivm. Pretty incredible. Felt better after a
| few hours and after each subsequent daily dose of five
| total.
|
| A lot of the studies don't seem to be using enough doses or
| they use too low of a dose. I was at .06g/kg body weight
| per dose. Also you need to take it with zinq!
| dhimes wrote:
| Did you self-medicate, or were you under the direction of
| a medical doctor?
| swader999 wrote:
| My doctor told me to wait it out, anywhere up to twelve
| more months. Yes, I self medicated. Suicide would have
| been my other choice had I not had Ivermectin - felt like
| I was slowly dying to begin with. It was very
| debilitating and impossible to work.
| shapefrog wrote:
| You should take at lest 1g/kg daily for a month to clear
| up the lung inflamation.
| threeseed wrote:
| HN should delete this post and probably your account.
|
| You are actively encouraging people to get on a path that
| ends up in overdose and death.
| swader999 wrote:
| It has a safer profile than Tylenol, Advil and Asprin.
| symlinkk wrote:
| "Apple is evil for adding CSAM checks, imagine if a
| totalitarian government used that to silence people"
|
| "You should be permanently silenced for suggesting a
| medical drug"
|
| Are you feeling any cognitive dissonance?
| [deleted]
| aantix wrote:
| What am I missing?
|
| https://ivmmeta.com/#rct
|
| Evaluation of Ivermectin as a Potential Treatment for Mild to
| Moderate COVID-19: A Double-BlindRandomized Placebo
| Controlled Trial in Eastern India
|
| https://journals.library.ualberta.ca/jpps/index.php/JPPS/art.
| ..
|
| Ivermectin in combination with doxycycline for treating
| COVID-19 symptoms: a randomized trial
|
| https://journals.sagepub.com/doi/pdf/10.1177/030006052110135.
| ..
|
| Ivermectin shows clinical benefits in mild to moderate
| COVID19: a randomized controlled double-blind, dose-response
| study in Lagos
|
| https://academic.oup.com/qjmed/advance-
| article/doi/10.1093/q...
| buu700 wrote:
| In fairness, I see no reason why anyone should be blocked
| from buying any drug they want, whether it be ivermectin or
| heroin. The consequence of this restriction is that a subset
| of the prospective customers will settle for a potentially
| (more) dangerous alternative source, whether that be horse
| formulations or black market heroin cut with fentanyl.
|
| It's also a valid point that unproven and disproven aren't
| equivalent. While I don't think anyone should take medical
| advice from political sources or for political reasons
| (therefore, as far as I'm aware, the well studied vaccines
| should be preferred to ivermectin by the vast majority of
| people at this time), I do think that it should be anyone's
| right to have full bodily autonomy and make whatever choices
| they want. Mainstream consensus is wrong often enough, e.g.
| the disastrous food pyramid that contributed to today's
| obesity epidemic.
|
| I agree with the thrust of your point that the idea that
| there's some kind of widespread anti-Republican medical
| discrimination or corruption going on is silly. Just pointing
| out that how things currently are is not how they ought to
| be, and that this situation is arguably just a subset of the
| widely reviled War on Drugs.
| rory wrote:
| (As the GP) I really appreciate and generally agree with
| your perspective, but:
|
| > _the idea that there 's some kind of widespread anti-
| Republican medical discrimination or corruption going on_
|
| is a total mischaracterization of what I was saying. In
| fact, it's essentially pulled from thin air.
|
| The corruption of the news media is in their choice to mock
| and literally laugh at people sick from veterinary iver
| because kicking the out-group is popular with their
| audience (read $$). They do this instead of explaining (in
| a meaningful way) how we got here, and what steps we can
| take to make the situation better.
| ashtonkem wrote:
| > The corruption of the news media is in their choice to
| mock and literally laugh at people sick from veterinary
| iver because kicking the out-group is popular with their
| audience (read $$). They do this instead of explaining
| (in a meaningful way) how we got here, and what steps we
| can take to make the situation better.
|
| The idea that this is somehow the media's fault for not
| being sufficiently patient and understanding with the
| ivermectin crowd is actually quite pathetic. Stop
| infantilizing these people; they are adults with their
| own agency. Their bad decisions are not the fault of the
| media[0].
|
| 0 - Especially since this crowd was shouting "fake news"
| for years. How exactly is the media going to convince a
| bunch of people who are convinced that they're liars?
| titzer wrote:
| It's just more blame game. Who you blame is who you hate.
| Racists blame black people for being poor, anti-abortion
| activists blame women for being "promiscuous", coastals
| blame red staters for being stupid backwoods yokels, red
| staters blame ivy tower socialists or immigrants,
| liberals blame rich people, socialists blame
| corporations, conservatives blame government, Islamic
| terrorists blame the great Satan, on and on.
|
| Hate = blame
|
| Love = forgiveness
|
| Listen and see whom people blame and that's who they
| hate. See who they apologize for and that's who they
| love.
|
| Been that way since forever.
| dhimes wrote:
| ...And: What you hate tends to be what you don't
| understand. Also since forever.
| buu700 wrote:
| _is a total mischaracterization of what I was saying. In
| fact, it 's essentially pulled from thin air._
|
| You did refer to "marginalization" of (Republicans')
| access to medicine. It was unclear whether you were only
| referring to the effect of well established federal drug
| policy and standards of the medical industry or a more
| specific/deliberate marginalization effort.
|
| _The corruption of the news media is in their choice to
| mock and literally laugh [...]_
|
| Ah, well I'm not aware of that, but that may be because I
| typically rely more on text-based media than video.
| abxnlk wrote:
| First of all, trying out random substances or applying
| existing medicines to different illnesses is _exactly_ how
| doctors and the pharma industry operate.
|
| It's not like doctors actually always understand what is
| going on; for example, I think even the _precise mechanism of
| anesthetics_ isn 't well understood yet.
|
| So people volunteer to test a human approved drug for a
| different application. I don't believe in Ivermectin
| specifically, but there's nothing fundamentally wrong with
| that. It's what medicine does, and most researchers at
| universities don't have a clue either (as we now see in the
| entire Covid19 comedy).
| PaulDavisThe1st wrote:
| > First of all, trying out random substances or applying
| existing medicines to different illnesses is exactly how
| doctors and the pharma industry operate.
|
| Sure, but with methodology and metrics to allow the
| separation of actual effects from placebo, and in some
| cases even just enough methodology to be able to measure
| anything at all.
| rory wrote:
| Although it has more dangers than ivermectin, why shouldn't
| you have access to ketamine if you feel it helps you? A lot
| of people believe it has off-label benefits for their mental
| health, and maybe it does.
|
| Perhaps we just have different general perspectives on the
| individual and society.
| dionian wrote:
| I suspect most people would disagree, and I think I might
| too, but it's curious to examine the arguments and
| justifications for disagreeing
| shapefrog wrote:
| Why not all drugs of all types. Why call it an opiod crisis
| and not just here is what happens when you give everyone
| whatever drugs they hear on the internet make you feel
| good?
|
| First you deny someone ivermectin, next minute you are
| saying only 1 oxycotin with your beer.
| rory wrote:
| The important difference between these drugs is that
| opiates are incredibly addictive, while ketamine is less
| addictive than tobacco or alcohol. Ivermectin isn't
| addictive at all.
|
| Ironically, the opioid crisis is caused far more by
| people's trust in mainstream medicine than by any
| internet fad.
| shapefrog wrote:
| > people's trust in mainstream medicine
|
| Mainstream medicine says it is incredibly addictive with
| an incredibly low lethal dose.
|
| People like to get high, a lot. Probably second only to
| triggering the libs / whatever the lib version is.
| rory wrote:
| > _In the late 1990s, pharmaceutical companies reassured
| the medical community that patients would not become
| addicted to opioid pain relievers and healthcare
| providers began to prescribe them at greater rates._
|
| > _Increased prescription of opioid medications led to
| widespread misuse of both prescription and non-
| prescription opioids before it became clear that these
| medications could indeed be highly addictive._
|
| I assumed this was well-known.
|
| https://www.hhs.gov/opioids/about-the-epidemic/index.html
| shapefrog wrote:
| > _The Opium Wars were two wars waged between the Qing
| dynasty and Western powers in the mid-19th century._
|
| I assumed this was well-known.
| xdennis wrote:
| In some countries they give free needles to heroin addicts.
| Why do they care about harm there but for ivermectin they
| "force" the misinformed people to take the horse paste form?
| JohnWhigham wrote:
| Because half the country and the mainstream media would
| rather revel in laughter at those people than help them.
| They rationalize it as them being too dumb to take the
| vaccine instead of probing why exactly people are so
| distrustful of massive conglomerates that can't be held
| responsible in any way for any side effects their products
| may cause.
|
| The culture wars have fucked this country hard.
| davidw wrote:
| The actual vaccine is free, though.
|
| Edit: we can talk plenty about how bad the US health care
| system is, but in this case, the actual vaccine, that does a
| fantastic job of protecting people from COVID, is free in that
| you don't have to spend a dime out of pocket.
| swader999 wrote:
| If you pay my taxes it is.
| p1necone wrote:
| There's thousands of safe medications that probably do nothing
| to stop covid. Just because one of them has been latched on to
| by right wing nutjobs doesn't mean it makes any sense for
| people to take that over the stuff that's actually been shown
| to help.
| VikingCoder wrote:
| > Unproven != disproven.
|
| How many people have been convinced by the supposed
| effectiveness of Ivermectin and Hydroxychloroquine that they
| then decided to not get vaccinated?
|
| It's really not as simple as "unproven != disproven".
| rajin444 wrote:
| How many people were convinced of the "95+%" effectiveness of
| the vaccine only to learn that it fades? Why weren't they
| told it would fade up front?
| robbiep wrote:
| Firstly, it wasn't at all clear how quickly antibody levels
| would fall, because the data wasn't available. But it was
| clear to _everybody with scientific literacy_ that antibody
| levels would fall over time, because that's how immune
| responses work.
|
| What's been fascinating about the data arising from Pfizer,
| moderne and astra Zeneca dosing intervals is that it seems
| quite likely that the spacing is quite to highly
| responsible for this rather than something inherent to the
| formulation which is adding to our body of evidence and
| understanding
| SnowProblem wrote:
| In my estimation, probably fewer than authorities think.
|
| US Census collect data on reasons for vaccine hesitancy [1].
| #1 and #3 are distrust - of vaccines and of government -
| which anecdotally matches my network. If that's the case,
| then we should expect that mischaracterizing treatments to
| promote vaccines [2] would not be very effective, and most
| Western countries now are leveling off fairly low in their
| vaccination rates [3]. But rather than more honesty, we're
| getting more mandates.
|
| I think Dr. John's Cambell's position, of honest assessment,
| would have been better as the official position [4]. It's
| hard to imagine how trust could be regained now though
| without some sort of reckoning.
|
| 1. https://www.census.gov/library/visualizations/interactive/
| ho...
|
| 2. https://www.youtube.com/watch?v=_gndsUjgPYo
|
| 3. https://youtu.be/hVtX7tY1B0U?t=210
|
| 4. https://www.youtube.com/watch?v=eO9cjy3Rydc&t=600
| x86_64Ubuntu wrote:
| The vaccine is free, so I'm confused about where you get that
| this is an access issue.
| shrubble wrote:
| Incidentally, approximately 11 to 14% of the USA population has
| pinworms, which can be easily stopped by ivermectin. Given the
| very high level of safety of ivermectin, it might make sense to
| make it easier to get on this basis alone.
| buescher wrote:
| I can't sell you ivermectin, but I CAN sell you pinworms, and
| then you can go to your doctor...
| shadowgovt wrote:
| How many users have been taking it in human-designed doses,
| given that it's not generally prescribed for COVID-19 (and
| therefore those who are taking it for that purpose are mostly
| self-medicating)?
| buescher wrote:
| Fortunately for me, I know next to nothing about ivermectin,
| except that the American left is very, very concerned people
| might be taking it, and I don't know of anyone actually
| taking it that doesn't have a radio show or podcast. So in my
| ignorance I would guess very few people are actually taking
| it and a lot of people are talking about it.
| davidw wrote:
| People are turning up in hospitals because they've OD'd on
| it.
| swader999 wrote:
| No they aren't. All of those reports have been retracted.
| davidw wrote:
| https://news.ohsu.edu/2021/09/17/five-oregonians-
| hospitalize... doesn't look retracted to me.
|
| Only stands to reason that if people are taking it kind
| of randomly, a few are going to screw up and take too
| much.
| swader999 wrote:
| Probably ingested the pour on treatment or one of the
| brands that mix other active ingredients that you don't
| want.
| jdsfighter wrote:
| Alternate data point, I live in one of the major cities in
| Oklahoma. I work for a mostly blue collar shop. The
| overwhelming majority of our workers are unvaccinated, and
| I'd say a large fraction of them are very vocal about their
| use of ivermectin.
| input_sh wrote:
| There's a right-wing group prescribing it: https://en.m.wikip
| edia.org/wiki/America%27s_Frontline_Doctor...
|
| They're also the ones that pushed Hydroxychloroquine, have
| connections to the Tea Party, that "demon semen" lady Trump
| endorsed is associated with them, and they had their leader
| and their chief of communication arrested due to their
| participation in Jan 6th.
|
| They're also the reason you'll see Joe Rogan now spreading
| ivermectin bullshit.
| tzs wrote:
| They've also been selling telemedicine consultations to
| prescribe ivermectin, taking the money, and then not
| delivering the consultation [1]. They are a straight up
| scam posing as a charity.
|
| [1] https://time.com/6092368/americas-frontline-doctors-
| covid-19...
| xtracto wrote:
| Outside of the US is prescribed quite often. It is in the
| Mexican Health System Protocol ([1] page 6) and has been
| widely researched [2] in there. Also, in Mexico Ivermectin
| was widely available (without prescription) before Covid19.
| It is commonly used _in children_ against lice, and also in
| the general population as a dewormer once a year (in Mexico,
| people are used to take these type of medications once a
| year).
|
| I understand the hesitation Americans have against it, given
| its lack of availability (I would never consume a medicine
| made for animals) but from my outside perspective, the issue
| has been politicized so much that both "left" and "right"
| Americans get blinded by their views and are not open to even
| _talk_ about it (it 's either, you eat dewormer antivaxxer!
| or muh freedom!).
|
| I got my two vaccines as soon as I could (I had covid in
| march 2020 and had a terrible time, and I am totally pro
| vaccines, shit in Mexico we get a heck of a lot of vaccines
| haha) but given the safety profile of Ivermectin, I am 100%
| in favour of people taking it if they get COVID19.
|
| [1] http://educacionensalud.imss.gob.mx/es/system/files/Algor
| itm...
|
| [2] https://covid19.cdmx.gob.mx/storage/app/media/Articulos/r
| evi...
| shadowgovt wrote:
| My mistake; my comment was extremely US-centric.
|
| In the US, there isn't a taboo against taking it because
| it's generally animal-prescribed; it's used as a human
| anti-parasitic here too. The issue is that people are self-
| medicating with veterinary-supply doses because it isn't
| prescribed for COVID-19 (as it's not indicated for treating
| it).
| h2odragon wrote:
| > (I would never consume a medicine made for animals)
|
| Why not?
|
| I either pay $150+ all up for a doctor visit, prescription,
| etc for antibiotics, or $20 for a bottle of "fish
| antibiotics" at the feed store. Either way I get
| amoxicillin; but from the feed store I get 3x the amount
| and in smaller capsules which makes adjusting dose easier.
|
| We stock the "horse paste" ivermectin for our half dozen
| hounds, I've been known to have a lick of it myself when
| ive been out barefoot in the mud, just in case. we have
| whipworm out here and they're not likely to take in humans
| but when they do its nasty.
| shapefrog wrote:
| I take it you have no problem eating dog food for your 3
| square meals a day plus a few of those chew biscuits for
| a snack?
| shadowgovt wrote:
| Fish antibiotics might be fine, but since they aren't
| regulated for human consumption it's more of a gamble.
| Plenty of chemicals that don't hurt fish that the
| manufacturer therefore won't be testing for that can be
| harmful to a human. But more importantly in the case of
| antibiotics: how do you know amoxicillin is the right one
| for what ails you? There are multiple antibiotics for
| multiple bacteria, and applying the wrong one can throw
| your microbiome out of whack with no treatment to the
| disease itself.
|
| Health care in the US is broken for several reasons, but
| "Doctors see a patient before prescribing the right
| medicine" isn't one of them. DIY medicine has dangers,
| and the FDA regulations are paid for in blood.
|
| https://www.smithsonianmag.com/science-nature/here-are-
| reaso...
| h2odragon wrote:
| > how do you know amoxicillin is the right one for what
| ails you?
|
| In our case, that's what the doctor prescribes for my
| wife's chronic sinus infections whenever she asks one
| about them, and I've been stocking it as a goto first
| antibiotic for veterinary use since i started caring for
| my animals 30yr ago.
|
| In anyone else's case, there's no great barrier to
| educating yourself about what you put in your body and
| why, and taking responsibility for your own health.
| Doctors are _consultants_ , not priests.
| shadowgovt wrote:
| Your circumstance is one of the flaws in the US system.
| Having been given a solid diagnosis once for that initial
| $150 charge, instead of relatively-inexpensive
| maintenance of health that could be done without doctor
| intervention, we require doctors to re-see and re-
| prescribe when a patient has a chronic condition.
|
| There _is_ some wisdom in that (while "when you hear
| hoofbeats, think horses, not zebra" is a good maxim,
| sometimes it's horses _and_ zebra), but IMHO once you 're
| diagnosed with something chronic and treatable, minimize
| the red-tape to keep it treated.
| Clubber wrote:
| >Having been given a solid diagnosis once for that
| initial $150 charge, instead of relatively-inexpensive
| maintenance of health that could be done without doctor
| intervention, we require doctors to re-see and re-
| prescribe when a patient has a chronic condition.
|
| >There is some wisdom in that
|
| It's pretty convenient for the doctors as well. $150 to
| write some shit on a pad and sign it. Good work if you
| can get it.
| shadowgovt wrote:
| Humans are very complicated, and writing the wrong stuff
| on a pad can get someone killed.
|
| Amoxicillin isn't available without a prescription
| because using the wrong antibiotic on a disease can make
| the patient worse.
| Clubber wrote:
| The example I was replying to was when the patient was
| already diagnosed with a chronic illness and still had to
| go back to the doctor every month or so to renew the
| script, because reasons.
| xtracto wrote:
| > Doctors are consultants, not priests.
|
| Oh man you couldn't be more spot on. There's no magic in
| what doctors do and how doctors prescribe a medication.
| There are two advantages that a doctor can have over an
| educated layman: 1) Experience: the number of cases they
| have seen and thus can make an educated inference to what
| is going on. 2) Their knowledge of anatomy (all they
| studied during their 4-6 years education).
|
| Having been living with a chronic condition for more than
| 20 years, having gone to more than 10 _specialists_ in 3
| different countries and countless of studies I 've seen
| the limitation of Medical Doctors (they are human beens
| at the end). There comes a time when you get to see that
| you understand your body better than any doctor could.
| gdulli wrote:
| The "horse dewormer" aspect is definitely a red herring, while
| the underlying problem is the choice to self-medicate based on
| culture war status of vaccines vs. talk-show-host-endorsed
| drugs. And the inevitable overdoses resulting from that. The
| media is not wrong to discourage this type of self-medication.
|
| But access to the vaccines here is free and widespread now, so
| while we could talk all day about problems with access to
| health care in this country, it doesn't apply here. People may
| be choosing to distrust the vaccines and thus triggering a
| shortage of beds and treatment that they themselves will later
| need.
| mgamache wrote:
| And yet the Authors of this letter fail to address the most cited
| meta-analyses (by Dr Lawrie). She's publicly stated the removing
| the Elgazzar data did effect her numbers, but not the conclusion.
| Also, if you read the paper she downgrades the Niaee data for
| several potential biases.
|
| https://pubmed.ncbi.nlm.nih.gov/34145166/
| ashtonkem wrote:
| The other takeaway is that preprint publication is a pathway ripe
| for abuse. The major paper that drove most of this situation, and
| the meta analysis, appears to have been a straight up fraud. But
| it got circulated a lot as a preprint to people who didn't
| understand the difference between a preprint and a peer reviewed
| paper. If the preprint had been more private, this might have
| been averted.
| saalweachter wrote:
| > ... to people who didn't understand the difference between a
| preprint and a peer reviewed paper.
|
| It's worse than that; if you're reading individual papers
| without the context of the larger body of research in a domain,
| you're setting yourself up to get a distorted view of the
| world.
|
| Peer review isn't magic; peer reviewed papers can still have
| errors, oversights, mistakes, outright fraud, or just get
| unlucky in how random chance played out. Peer review just
| filters out the _obviously_ fraudulent or flawed papers so that
| only three reviewers have to spend an afternoon reading and
| understanding why they are useless, and not a thousand journal
| subscribers.
|
| There's nothing wrong with following scientific developments as
| a layperson, but you shouldn't make the mistake of thinking
| because you read something in a published, peer-reviewed paper
| -- even one in a prestigious, well-respected journal like
| Science or Nature -- that it must be true.
| jacquesm wrote:
| That wasn't an accident.
| scoopertrooper wrote:
| What's the motivation for this sort of thing? It seems the very
| thing they crave (attention) will invariably bring them undone
| as attention invites scrutiny.
| avhon1 wrote:
| For one, money. There is an organized group that charges $90
| online for hocus-pocus covid medication prescriptions [1].
| The more people that can be convinced that this is a
| worthwhile purchase, the more money they get.
|
| https://americasfrontlinedoctors.org/treatments/how-do-i-
| get...
| sjwalter wrote:
| > The major paper that drove most of this situation, and the
| meta analysis, appears to have been a straight up fraud.
|
| Umm, wat?!
|
| The vast majority of the studies about Ivermectin have been
| observational, run by front-line clinicians.
|
| Prior to 2020, basically everyone on earth agreed (including
| the WHO, who STILL agrees) that front-line clinicians and
| observational studies are excellent signals that can lead to
| scientific investigations that can lead to medical
| breakthroughs.
|
| The evidence for IVM as a treatment for covid (and many other
| viruses) is quite strong.
|
| There is, no, no large-scale RCT for IVM. However, it is
| inherently obvious that none will happen, none that give it a
| fair shake.
|
| The entire public health apparatus in the West has a huge
| desire to treat all illness with only on-patent, new
| medications.
|
| Do you not thin that this incentive influences what gets into
| the news?
|
| Do you think the public health authorities in Uttar Pradesh
| (https://indianexpress.com/article/cities/lucknow/uttar-
| prade...) are lying?
| pacerwpg wrote:
| > Do you think the public health authorities in Uttar Pradesh
| (https://indianexpress.com/article/cities/lucknow/uttar-
| prade...) are lying?
|
| It's possible, the number of excess deaths in the region over
| a period (1 July 2020 and 31 March 2021) was measured at 197k
| compared to other years, but they only reported 4500 covid
| deaths.
| majormajor wrote:
| > The entire public health apparatus in the West has a huge
| desire to treat all illness with only on-patent, new
| medications.
|
| This and
|
| > The vast majority of the studies about Ivermectin have been
| observational, run by front-line clinicians.
|
| > Prior to 2020, basically everyone on earth agreed
| (including the WHO, who STILL agrees) that front-line
| clinicians and observational studies are excellent signals
| that can lead to scientific investigations that can lead to
| medical breakthroughs.
|
| and
|
| > Doctors in my area are prescribing IVM to treat covid
| because in their experience and that of their peers IT WORKS.
| They have fewer deaths, fewer complications.
|
| Don't really add up. Best case interpretation of your
| argument is that you think doctors are split in half - not
| wholly aligned behind novel treatments - the "throw shit at
| the wall and see what sticks" group and the "only throw new
| custom expensive stuff at it" group, but even that doesn't
| really match what I'm seeing.
|
| A large number of doctors are out there throwing all sorts of
| things at a new disease because nobody knows what works yet.
| The data is going to be incredibly messy. One thing that has
| looked effective in many cases is steroids, very much not
| new. Other things that looked potentially effective haven't
| continued to look effective as more studies have been done.
|
| Where's the massive pushback against steroid treatment if
| this is an institutional greed thing?
|
| It looks to me much more like some people get married to
| their early hunches and dig in hard when the evidence doesn't
| pan out.
|
| Throw enough shit at the wall in enough places and all sorts
| of false leads are going to appear. Some of them getting shot
| down isn't a conspiracy. It's how we learn.
| tehjoker wrote:
| "Antiviral Effects of Ivermectin in COVID-19- Clinically
| Plausible?"
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225296/
|
| "In a study demonstrating the in vitro antiviral activity of
| ivermectin, upon incubation of infected Vero/hSLAM cells with
| 5 mM ivermectin, there was an approximately 5000-fold
| reduction of viral RNA by 48 hours in ivermectin treated
| samples as compared with control. The IC50 of ivermectin was
| found to be approximately 2.5 mM. Ivermectin seems to act on
| IMPa/b1 and inhibits the nuclear translocation of SARS-CoV-2
| (Caly L et al., 2020). Further in-silico studies are required
| to confirm this target of ivermectin in SARS-CoV-2. The
| concentrations of 2.5 and 5 mM correspond to plasma
| concentrations of 2190 and 4370 ng/mL, respectively. These
| concentrations are 50-100 times the peak plasma concentration
| achieved with the 200 mg/kg of ivermectin (the US Food and
| Drug Administration recommended dose for treatment of
| onchocerciasis) (Chaccour C et al., 2017). Even with a dose
| 10 times greater than this dose (i.e., 2000 mg/kg), a peak
| plasma concentration of only ~250 ng/mL has been achieved
| (Guzzo CA et al., 2017)."
|
| "On the basis of the rationale above, any significant
| antiviral activity could not have been achieved with the dose
| used in the study and the resultant plasma concentration of
| the administered ivermectin. Thus, although ivermectin, in
| vitro, is a potent inhibitor of SARS-CoV-2 replication, in
| vivo, the plasma concentration required to achieve the
| antiviral effect far exceeds the therapeutically applicable
| dose."
|
| This thread discusses why the example of Uttar Pradesh's
| program isn't good evidence.
|
| https://twitter.com/GidMK/status/1440131176665006088
| ashtonkem wrote:
| Later studies have also shown that Vero cells are probably
| not a good choice for in vitro Covid tests, due to
| differences in how the virus infects those cells vs. human
| lung cells.
|
| This appears to be an innocent mistake; vero cells are very
| popular with virologists because they're easy to work with
| and familiar. But unfortunately they are a very poor proxy
| for testing Covid cures on, given that they're actually
| monkey kidney cells. But it's a shame we're still headed
| down this wrong path publicly.
|
| https://www.qps.com/2020/08/17/vero-cell-studies-
| misleading-...
| ashtonkem wrote:
| Feel free to actually read the article, it covers this.
| eynsham wrote:
| Consider dexamethasone.
|
| > There is, no, no large-scale RCT for IVM. However, it is
| inherently obvious that none will happen, none that give it a
| fair shake.
|
| Well, the gold standard RCT Recovery
| (https://www.recoverytrial.net/) had a look.
|
| > The entire public health apparatus in the West has a huge
| desire to treat all illness with only on-patent, new
| medications.
|
| Dexamethasone is a cheap steroid. (For that matter, vaccines
| are incredibly cheap and yet nobody seems to have stopped
| them in favour of, say, monoclonal antibodies.)
|
| > Do you not thin that this incentive influences what gets
| into the news?
|
| Evidently not terribly much, given that dexamethasone was at
| least in all the British newspapers.
|
| > Do you think the public health authorities in Uttar Pradesh
| are lying?
|
| Quite plausibly. UP is perhaps the worst governed state in
| India and has been under all political parties. The case of
| Kafeel Khan is rather illustrative.
|
| More to the point, I don't care whether they're lying. The
| whole article is full of vague statements that are hardly a
| good basis to believe anything about ivermectin.
| mlyle wrote:
| > The vast majority of the studies about Ivermectin have been
| observational, run by front-line clinicians.
|
| OK, so weak evidence.
|
| > Prior to 2020, basically everyone on earth agreed
| (including the WHO, who STILL agrees) that front-line
| clinicians and observational studies are excellent signals
| that can lead to scientific investigations that can lead to
| medical breakthroughs.
|
| Sure-- weak/crappy evidence and practitioner intuition can
| definitely point at worthwhile things to study rigorously,
| even if most of what they generate is trash.
|
| > The evidence for IVM as a treatment for covid (and many
| other viruses) is quite strong.
|
| ??? Quite a leap you made there.
| sjwalter wrote:
| Calling the investigatory and experiential evidence of
| thousands of highly-trained doctors (some of whom pioneered
| the standard of care for covid) as "weak evidence" is
| something that only somebody carrying water for large
| pharmaceutical companies would say.
|
| Doctors in my area are prescribing IVM to treat covid
| because in their experience and that of their peers IT
| WORKS. They have fewer deaths, fewer complications.
|
| But it's "weak" evidence just because Pfizer didn't sponsor
| a gigantic RCT to "prove" it.
|
| "The only science is real is expensive science done by
| large corporations!"
| jacquesm wrote:
| > is something that only somebody carrying water for
| large pharmaceutical companies would say
|
| This is directly against the HN guidelines.
| dionian wrote:
| Agreed, retract all the meta-analyses you want, but never
| dismiss actual front line results by physicians. If you
| have a regimen with zero deaths for a disease, I don't
| think we should be suppressing their clinical data. What
| a world...
| ashtonkem wrote:
| "Zero deaths" should have set off your alarm bells.
| That's way too neat of a number for the real world; you
| only get that kind of result with small sample sizes or
| fraud.
|
| Even the vaccines, which are very effective, do not have
| a 0% death rate from infection.
| chana_masala wrote:
| Officially the FDA and CDC say there have been 0 deaths
| from adverse events. I agree, that's way too neat of a
| number for the real world.
| mlyle wrote:
| You're saying re: vaccines? There's been several deaths
| believed to be caused by the vaccines and attributed as
| such by the FDA/CDC.
|
| And, you know, a few hundred thousand lives saved.
| pigeonhole123 wrote:
| Not a troll: how do you know that number? Pfizer's own
| RCT showed no difference in all cause mortality after six
| months
| lamontcg wrote:
| https://www.cdc.gov/vaccines/acip/meetings/downloads/slid
| es-...
|
| 3 deaths from TTS following J&J as of May 7th where there
| were 8.73 million doses of J&J administered.
| oezi wrote:
| Nitpick: there were plenty of deaths reported as adverse
| events. It was just found that they were mostly expected
| in a normal population.
|
| I know in Germany we did have over 20 dead from AZ
| thrombosis.
| 8note wrote:
| I'd consider it weak because covid mostly has non-severe
| symptoms.
|
| A sugar pill could also get the same observational
| results because the number of severe cases is very low.
| koboll wrote:
| It's weak evidence because COVID-19 observational studies
| are riddled with confounders due to COVID patients
| generally throwing everything at it they can to try and
| stay alive.
|
| The exact same pattern occurred with hydroxychloroquine.
| Lots of small observational studies showed promise. Then
| it repeatedly failed large RCTs. It turns out that the
| people with the resources to use HCQ also had the
| resources to use other things, things that were actually
| effective.
| chana_masala wrote:
| So what were those other things, then?
| ashtonkem wrote:
| Dexamethasone, Remdesivir, and monoclonal antibodies are
| part of the go to treatments for severe Covid cases.
| They're the major exotic bits of what they gave trump
| when he got sick, along with a bunch of over the counter
| stuff (zinc, vitamin D, melatonin, etc.) My understanding
| is that the monoclonal antibodies are the really
| expensive treatments.
|
| The Dexamethasone one is an interesting story. It started
| out as a more controversial "throw everything at the wall
| and see what sticks" solution by a specialist who knew
| steroids well. Later studies have shown a strong effect
| on survival, so it's become a fairly uncontroversial part
| of the tool kit for severe Covid.
| makomk wrote:
| Of course, what made Dexamethasone such a breakthrough
| wasn't really the drug itself; I think there's some
| evidence now that other steroids might actually work
| better. The big breakthrough was that some UK researchers
| managed to use the fact that the country got hit hard
| early on in the pandemic to immediately run a bunch of
| large randomized controlled trials on all the most
| promising throw-things-at-the-wall treatments to get
| evidence on which actually worked as soon as possible.
| mlyle wrote:
| > Calling the investigatory and experiential evidence of
| thousands of highly-trained doctors (some of whom
| pioneered the standard of care for covid) as "weak
| evidence" is something that only somebody carrying water
| for large pharmaceutical companies would say.
|
| Keep in mind that bleeding with leeches was once the
| standard of care-- based on clinical intuition and
| observational evidence.
|
| People-- even very smart, well-educated people-- are
| easily fooled. There is a reason why the RCT is the gold
| standard.
| nradov wrote:
| The RCT is the gold standard, but observational studies
| can be sufficient to establish causality when the effect
| size is large enough with a clear dose response curve. No
| one has ever conducted an RCT to prove that cigarette
| smoking causes lung cancer, but we're pretty sure that it
| does.
| mlyle wrote:
| > to establish causality when the effect size is large
| enough with a clear dose response curve.
|
| And when there's some plausible underlying mechanism that
| can be studied by more rigorous means. Otherwise,
| observational studies can find correlation, not
| causation-- and they're not even very robust at that.
| nradov wrote:
| No the dose response curve alone can be sufficient.
| Remember that the FDA has approved multiple SSRI drugs
| for treating clinical depression despite a lack of
| understanding on the actual mechanism of action. There
| are several plausible hypotheses but we really don't know
| why they work.
| mlyle wrote:
| A dose response curve in an observational study is
| irrelevant for establishing causation.
|
| There is a dose-response relationship between umbrellas
| outside and rainfall., but umbrellas do not cause
| rainfall.
|
| And the SSRI point is tangential: they were approved
| based on RCT evidence. Observing umbrella use and
| concluding it causes rainfall, even though we don't know
| of a reason why umbrella use would cause rainfall, is
| quite different.
| PaulDavisThe1st wrote:
| > "The only science is real is expensive science done by
| large corporations!"
|
| The only science that's real when it comes to public
| health is the science done across large enough
| populations and with enough methodology to rule out many
| confounding issues.
|
| That tends to cost money, indeed.
| sjwalter wrote:
| This is a neutered philosophy.
|
| You surrender you're ability to actually know things
| outside the purview of large pharma corps.
|
| Hey, I guess my view is never gonna get approved: Eat
| healthy meat, exercise, and get plenty of sunlight.
|
| Since that's never gonna get a big Pfizer RCT, you should
| wait. Don't exercise. Don't get sunlight.
|
| Just wait until a big pharmacorp tells you what is
| healthy.
| PaulDavisThe1st wrote:
| I considered adding on a coda noting that "costing money"
| doesn't imply big pharma. But I didn't because I
| considered it sort of self-evident. Neverthless, you went
| there anyway.
| shapefrog wrote:
| > I guess my view is never gonna get approved: Eat
| healthy meat, exercise, and get plenty of sunlight.
|
| Study has been approved 1,000s of times and been done
| 1,000s of times.
|
| Eating shit, sitting inside on your sofa all day is less
| healthy. The jury is out on your so called controversial
| view, has been for a long time.
| [deleted]
| ashtonkem wrote:
| Come on, that's clearly a bad faith interpretation of
| what GP said. You've been here long enough to know that
| that's a no no.
| dionian wrote:
| Given the recent fall from grace of prestigious journals
| like the Lancet on the Coronavirus evidence, I think it is
| useful for all of us to remain skeptical and purely
| science-based.
|
| https://www.thelancet.com/journals/lancet/article/PIIS0140-
| 6...
| nradov wrote:
| Yes the quality of scientific research in this area has been
| rather bad with rushes to publish and ineffective peer review.
| Drs. Paul Marik and Pierre Kory recently updated their meta
| analysis to remove the retracted Elgazzar paper, and still found
| a significant effect. I'm not endorsing their letter, just
| pointing out that it exists and isn't mentioned in this Nature
| article.
|
| https://journals.lww.com/americantherapeutics/fulltext/2021/...
|
| Ultimately we need a real large scale controlled trial to settle
| the issue so I'm looking forward to seeing results from NIH
| ACTIV-6.
|
| https://www.nih.gov/research-training/medical-research-initi...
| saalweachter wrote:
| That meta-analysis still includes the Carvallo studies, which
| some people have doubts about:
| https://www.buzzfeednews.com/article/stephaniemlee/ivermecti...
| cageface wrote:
| This article also says that another trial that were included in
| previous meta-analyses should probably also be excluded and
| once all that's it's unlikely the meta-analysis will show an
| effect:
|
| _As these two papers1,6 were the only studies included in that
| meta-analysis to demonstrate an independently significant
| reduction in mortality, the revision will probably show no
| mortality benefit for ivermectin._
| tptacek wrote:
| This letter opens with a defense of the ElGazzar paper, but the
| analyses published by these researchers strongly suggests that
| the paper is indefensible and likely a simple fraud. I'm
| skeptical.
| Spellman wrote:
| Looking at the two papers (original, and updated) they only
| removed the Elgazzer paper but not the contested Shakhsi Niaee
| also mentioned in the Nature article.
|
| This is noteworthy because it's also the only other RCT to show
| strong effect on mortality (see Fig3 in the two papers).
|
| Original Marik, Kory paper Fig3 is here:
| https://pubmed.ncbi.nlm.nih.gov/34375047/#&gid=article-figur...
|
| Also, the Nature article is concerned that the underlying data
| isn't sound due to bad randomization and thus naive meta-
| analysis is inherently flawed in these cases.
| nradov wrote:
| Sure that's a good point. But is mortality the appropriate
| clinical trial endpoint? Mortality rates are already low when
| following the NIH treatment guidelines, so it would take a
| large study population to discern any statistically
| significant effects.
|
| https://www.covid19treatmentguidelines.nih.gov/
|
| In addition to mortality it probably makes sense to look at
| other endpoints such as patient reported symptoms, RT PCR
| test cycle count, and time to hospital discharge. Those
| should allow us to tell if there is a real effect (or not)
| with smaller subject groups.
| scoopertrooper wrote:
| Case fatality has been declining for sure, but it's still
| at about 3%. So it shouldn't be that hard to find a signal.
|
| https://www.abs.gov.au/articles/covid-19-mortality-0
|
| https://www.ajtmh.org/view/journals/tpmd/104/6/article-p217
| 6...
| marcodiego wrote:
| Can we infer that since "we need a real large scale controlled
| trial to settle the issue", the positive effect (if any) is
| necessarily small?
| mnw21cam wrote:
| That's a good inference to make, yes.
| ajross wrote:
| > Yes the quality of scientific research in this area has been
| rather bad with rushes to publish and ineffective peer review
|
| Well, sure, but what else is new? The Ivermectin paper was
| surely bad, but it wasn't outrageously bad nor unexpectedly so.
| The mania that resulted isn't, at it's core, about bad science.
| This won't fix the problem.
| simpleguitar wrote:
| > The Ivermectin paper was surely bad, but it wasn't
| outrageously bad nor unexpectedly so.
|
| Oh, yes it was bad. Very very bad. Outrageously bad. The data
| was mostly fabricated:
|
| https://gidmk.medium.com/is-ivermectin-for-covid-19-based-
| on...
| wombatpm wrote:
| But the larger problem has been the the non-scientific
| audience running with with things to support their
| political narrative. If someone from the right infosphere
| were to promote skinned habanero inserted rectally as a
| potential prophylactic therapy there would be lawsuits
| demanding that treatment for people's family members and a
| furious debate on twitter as to whether habanero or ghost
| peppers should be used.
|
| Bad science has always been around, you learn how to spot
| them in grad school. It just now the larger population is
| learning that bad papers exist.
| gonational wrote:
| Because there are so many studies of ivermectin and because it is
| so widely used, of course there are going to be bunk studies and
| scientifically invalid studies. Do you know how I know this? I
| know this because it was recently shown (within the past ten
| years) that something like 70% of scientific studies can't be
| reproduced (read: they're BS). So if were going to use scientific
| studies at all, to inform our decisions, as a society, then we
| have to accept that there's going to be flaws in some of them.
| And if we know that there are flaws in some of them, we can also
| conclude that a large quantity of corroborating studies is as
| important as the scale of each individual study. The same applies
| to meta-analyses. For example, it's going to be pretty difficult
| to publish over 100 studies[1] that all corroborate the almost-
| same set of basic facts, and then have all +100 of them be
| completely invalid. However, having over 100 different studies of
| a 50-year old medicine, from different scientists in different
| parts of the world based on different data sets over different
| spans of time and under different circumstances, and having the
| data corroborate the same key facts and numbers, I would trust
| this any day over a government funded study of a brand new
| medicine that is in a brand new category of medicines which has
| never been used in history.
|
| There are literally hundreds of studies at this point proving
| that ivermectin is safe and effective for treating many things,
| including influenza and coronavirus, including COVID-19.
|
| There are literally no studies proving that the Pfizer or Moderna
| gene therapies are safe and effective, or even that they are safe
| or effective, at both treating and preventing the spread of
| COVID-19. The latter of the two is the most important in the
| debate over whether people should be forced to take said
| medicines. And it is the inverse of that which has been proven
| through many studies now.
|
| 1. https://c19ivermectin.com/
| creddit wrote:
| > There are literally no studies proving that the Pfizer or
| Moderna gene therapies are safe and effective, or even that
| they are safe or effective, at both treating and preventing the
| spread of COVID-19.
|
| This is... wildly incorrect.
| godzulu wrote:
| https://www.sec.gov/Archives/edgar/data/1682852/000168285220.
| .. Currently, mRNA is considered a gene therapy product by
| the FDA. Unlike certain gene therapies that irreversibly
| alter cell DNA and could act as a source of side effects,
| mRNA-based medicines are designed to not irreversibly change
| cell DNA; however, side effects observed in gene therapy
| could negatively impact the perception of mRNA medicines
| despite the differences in mechanism. In addition, because no
| product in which mRNA is the primary active ingredient has
| been approved, the regulatory pathway for approval is
| uncertain. The number and design of the clinical trials and
| preclinical studies required for the approval of these types
| of medicines have not been established, may be different from
| those required for gene therapy products, or may require
| safety testing like gene therapy products. Moreover, the
| length of time necessary to complete clinical trials and to
| submit an application for marketing approval for a final
| decision by a regulatory authority varies significantly from
| one pharmaceutical product to the next, and may be difficult
| to predict.
| dionian wrote:
| Well, there are certainly no long-term studies.
| mikeyouse wrote:
| Calling them gene therapies too.. wow.
|
| I hope the more science-literate proponents of IVM can
| appreciate how much it harms their case for the vast majority
| of IVM advocates to be this loud and wrong..
| gonational wrote:
| The United States CDC literally changed the definition of
| "vaccine" this year, so that these products could still be
| identified as vaccines. You're going to tell me that it's
| "science illiterate" to consider mRNA therapy as gene
| therapy, because the genes are not actually changed, but
| instead only expressed to create the therapeutic effect.
| But it _is_ "scientifically literate" to call such a
| therapy a "vaccine"?
|
| I hope more _common sense literate_ proponents of science
| can appreciate how much it harms their case for a vast
| majority of science advocates to be loud and wrong.
| jrmg wrote:
| > The United States CDC literally changed the definition
| of "vaccine" this year, so that these products could
| still be identified as vaccines.
|
| For anyone else curious:
|
| _Before the change, the definition for "vaccination"
| read, "the act of introducing a vaccine into the body to
| produce immunity to a specific disease." Now, the word
| "immunity" has been switched to "protection."_ [1]
|
| It seems obvious to me that this was changed because the
| layperson's interpretation of the old wording would make
| it seem like 100% immunity was the result of vaccination.
| That's never been the case. The new wording is just
| clearer in regular English.
|
| > You're going to tell me that it's "science illiterate"
| to consider mRNA therapy as gene therapy, because the
| genes are not actually changed, but instead only
| expressed to create the therapeutic effect.
|
| It's not only science illiterate, it's misleading to a
| layperson too. It sounds as if it's changing the
| patient's DNA.
|
| > I hope more common sense literate proponents of science
| can appreciate how much it harms their case for a vast
| majority of science advocates to be loud and wrong
|
| I do t understand how you think your interpretations lie
| closer to "common sense". They seem to me to be more
| like;y to mislead.
|
| [1]https://www.miamiherald.com/news/coronavirus/article25
| 411126...
| gonational wrote:
| For anybody else who stumbles across the above uninformed
| comment, here is some information for context (wrt "gene
| therapy", etc.):
|
| https://www.nature.com/gt/journal-information
|
| https://www.nature.com/scitable/topicpage/gene-based-
| therape...
|
| A certain degree of ignorance can be forgiven in this day
| and age, because everything is being constantly re-
| defined by the television, and most folks get their
| information from the television.
|
| So don't attack people for not knowing things, but just
| be aware how many low information people are
| unintentionally misleading others. You can even see in
| the parent comment, the primary source of information for
| most of these people is some form of media company (Miami
| Herald, in this case). This is, unfortunately, the new
| normal.
|
| Logging in with different accounts and downvoting this
| won't change the facts.
| mikeyouse wrote:
| > _You 're going to tell me that it's "science
| illiterate" to consider mRNA therapy as gene therapy,
| because the genes are not actually changed .._
|
| Yes. That's exactly what I'm saying. Read your sentence
| back to yourself.
|
| > _But it is "scientifically literate" to call such a
| therapy a "vaccine"?_
|
| Yes. Of course it is. Regardless of what the copy on some
| obscure CDC website says, mRNA vaccines have been in
| development for decades.
| gonational wrote:
| > Regardless of what the copy on some obscure CDC website
| says
|
| Read that, out loud...
|
| All you need to do is set your search parameters to
| filter out items from the past 24 months.
|
| https://www.nature.com/gt/journal-information
|
| https://www.nature.com/scitable/topicpage/gene-based-
| therape...
|
| There are thousands more.
|
| SMH... short memory span is the worst part of the human
| condition.
| acdha wrote:
| > I hope the more science-literate proponents of IVM
|
| If they valued and were capable of reasoning about the
| science, they would not be "proponents" -- they'd recognize
| the current scientific understanding (no known mechanism or
| benefits, significant side-effects) and wait for a solid
| study before recommending anything.
|
| The people you do see advocating it are almost always doing
| so for political or financial purposes and are thus
| unlikely to say anything critical since that'd be bad for
| business.
| JoshuaDavid wrote:
| > If they valued and were capable of reasoning about the
| science, they would not be "proponents" -- they'd
| recognize the current scientific understanding (no known
| mechanism or benefits, significant side-effects) and wait
| for a solid study before recommending anything.
|
| The the standard of "we should not perform treatments
| with known side effects if there is no solid study
| proving the mechanism and benefits of that intervention"
| is unreasonably strict.
|
| Proning (laying the patient on their stomach appears to
| improve oxygenation and improve outcomes) was suspected
| to be helpful by May of 2020. However, even by December
| of 2020 there were not any large randomized controlled
| trials proving this. Proning has risks (like "unplanned
| extubation" i.e. the breathing tube coming out when it
| shouldn't). Should we have foregone that treatment
| because there was no proof of either efficacy or
| mechanism, and there were significant risks associated
| with the treatment?
|
| I personally don't think ivermectin is terribly likely to
| be effective, but the more general statement of "nobody
| who is capable of reasoning about science would be a
| proponent of an unproven treatment that has risks" is
| wrong.
| acdha wrote:
| That's exactly the kind of reason why I included "no
| known method": proning was not a previously unknown
| concept, it clearly changes a known problem, and the
| risks are manageable.
|
| Remdesivir and other antivirals were similarly reasonable
| to try since they had a plausible method of being
| effective, as did the steroid treatments which have been
| so useful for controlling inflammation.
|
| Now, nobody is saying that we can't _try_ new things but
| note also that I was referring to "proponents" -- not
| just people who are willing to try something but who are
| actively advocating it as an effective treatment. The
| vast, vast majority of those people are not running
| experiments or even medical professionals who might
| possibly have some relevant prior experience suggesting
| it was worth trying.
|
| I'm not opposed to research but I think there's a
| substantial ethical line to cross when you switch from
| being open to the possibility of something working to
| running around telling everyone that it works so well
| they should avoid a safe, cheap, and highly effective
| vaccine.
| gonational wrote:
| Yeah, because nothing says "recognize the current
| scientific understanding" like dismissing hundreds of
| studies because of a couple bunk meta-analysis. Also,
| nothing says "recognize the current scientific
| understanding" like injecting an untested medicine into
| your veins to avoid what amounts to the common cold for
| younger people; while ignoring the fact that it does not
| help prevent the spread, and according to the latest
| study on this from Israel (the highest vaccine rate in
| the world), actually enhances the spread, so if the
| argument is "what about the old people that you're going
| to infect", then I guess you've answered that question
| already.
|
| It pays nothing to pretend that you are smarter than
| other people if you're not willing to follow your own
| advice.
| acdha wrote:
| You're packing enough untrue things into that comment
| that it's hard to believe you're acting in good faith
| but:
|
| * It's dismissing the studies which show effects due to
| errors, which leaves the studies not showing beneficial
| effects. Science is built on evidence and thus far it
| hasn't been shown that Ivermectin has a benefit for
| COVID.
|
| * Similarly, it's untrue to the point of being a flagrant
| lie to claim that the vaccines are untested when they
| went through full clinical trials and the high positive
| effects and safety rates shown in those trials have been
| backed up by data from many millions of people
|
| * Similarly, it's flat out wrong to claim that COVID is
| similar to the common cold -- even if you compare it to
| influenza, which is far more serious, that's not true --
| we've seen more children die in the last couple months
| than we typically see in an entire flu season.
|
| * Vaccination does help reduce the spread, and that's
| even shown in the Israeli data -- it's not 100% but if
| you look at the data it's very clear that vaccinated
| people at a significantly lower rate. Israeli comparisons
| are tricky because they have substantially different
| vaccination rates across age categories and a vaccinated
| 80 year old is still more at risk than someone younger,
| especially when those younger people are not taking
| precautions, which brings me to:
|
| * Israel is nowhere near having the highest vaccine rate
| -- that's a tie between Portugal, Malta, and the U.A.E.
| currently -- and at a paltry 62% they're not even in the
| top 25. That's only slightly better than the United
| States at 55%.
|
| * The Iraeli data does not show that vaccination
| increases spread: this is a lie spread by people who are
| comparing unlike things in the knowledge that many people
| will reshare those claims without checking them.
| gonational wrote:
| For anybody else that comes across the above comment,
| ignore the fake news, do some reading of scientific
| studies (e.g., nih.gov, etc.), and you will come to the
| same conclusion: that everything stated in the comment
| above is untrue (except for the countries with the
| vaccination rates - I don't actually know the latest
| stats on that).
|
| I've been trying to do my part to help prevent the spread
| of misinformation that's been spread by corporations and
| Big Pharma, but I don't have time to dissect every fake
| point in a diatribe written by a random person; however,
| all of the claims are very easily debunked.
| seattle_spring wrote:
| "Neoliberal", "big pharma", "Weinstein",
| "c19ivermectin.com", "fake news", "Israel".
|
| I can't tell if this is a real account, or gpt-3 posting
| comments seeded from a couple Breitbart articles.
| creddit wrote:
| Ivermectin doesn't really have significant side effects
| at appropriate doses. It's quite safe. Don't be fooled by
| overblown "horse dewormer stories".
|
| I don't say this to advocate Ivermectin, the only RCT I
| know of/trust found absolutely no effect. I say this to
| gently point out the mismatch between your claims and the
| premise in the first sentence.
| fullstop wrote:
| I agree that it is safe at appropriate doses. The issue
| is that people are self medicating and incorrectly
| calculating doses, since the product was intended for
| livestock.
| gonational wrote:
| The nationwide report that everybody talked about,
| pertaining to poison control centers receiving endless
| calls about this was completely fake. It turned out that
| rather than 70% of calls it was actually 2% of calls and
| over half of them were simply people asking questions
| about dosage.
|
| The other nationwide report about the hospitals in
| Oklahoma being crowded with ivermectin victims to the
| point where they could not even get gunshot victims in to
| see a doctor... well, at least one of the hospital
| systems responded with an open letter stating that this
| was completely fake and that they had not seen even a
| single patient. I find it hard to believe that one
| hospital system would not see a single patient while all
| the other hospitals in the state would be completely
| flooded with them.
|
| If the TV tells you something, you do not have to believe
| it.
|
| Use your brain.
| fullstop wrote:
| I never said a word about any of that. I said that people
| are self medicating and incorrectly calculating an
| appropriate dosage, and I am not wrong. [1]
|
| 1. https://www.fda.gov/consumers/consumer-updates/why-
| you-shoul...
| gonational wrote:
| What evidence did you have that people were doing this,
| which presumably affected your opinion on this topic?
| fullstop wrote:
| 1. Facebook groups where people have admitted to taking
| more than they should have, causing incontinence. Not
| public groups, but one local to my area.
|
| 2. The FDA themselves
|
| I have to ask, are you actually advocating for self-
| medicating with products from Tractor Supply? I've not
| once said anything about my opinion of Ivermectin, only
| that of self medication.
| mikeyouse wrote:
| As one more piece of evidence - two of my family members
| are internal medicine physicians who are running covid
| units -- just a shocking number of people are showing up
| to hospitals with severe Covid after having self-
| medicated with IVM.
| hackingforfun wrote:
| > If the TV tells you something, you do not have to
| believe it.
|
| Where do you think most of the people taking ivermectin
| heard about it? They probably have no idea how ivermectin
| would actually work, but heard it from some conservative
| talk show host that they trust more than scientists
| backing the actual COVID vaccine. I'm astonished by how
| totally backwards all of this is.
| gonational wrote:
| I learned about Ivermectin from MedCram circa May 2020.
|
| Everybody I know personally who did not learn about it
| from me learned about it from Eric Weinstein on the Joe
| Rogan podcast.
|
| A good friend of mine watches Fox News no less than three
| hours a day and took both Pfizer doses months ago.
|
| I suspect you might be projecting, and perhaps you
| learned about Ivermectin from a neoliberal TV show. Most
| of the people who believe in the safety and efficacy of
| Ivermectin believe so precisely because they are _not_
| consuming television propaganda, and so they are still
| able to form their own opinions from real information.
| hackingforfun wrote:
| I consider Joe Rogan a right wing host, and I had heard
| he was telling people about ivermectin. I didn't know
| that originally people heard it from Eric Weinstein on
| his show, although I'm not sure how much of a difference
| that makes. Aren't all right wing / conservative hosts or
| media pretty much saying the same things in terms of
| COVID, anyway?
|
| I do think people also form their opinions of the COVID
| vaccine on real information. I personally consulted
| someone I know who has a PhD in Molecular Biology to
| gather more information on the mRNA vaccines.
| marcosdumay wrote:
| Still, I don't think anybody talking about using
| ivermectin for treating COVID-19 ever recommended what is
| widely tested appropriate doses.
| walterbell wrote:
| Non-sterilizing mRNA vaccines are biologics, which have
| separate regulations and distinct intellectual property
| protections in national laws and international trade
| treaties.
| gonational wrote:
| Would you mind linking me to the evidence that this is
| incorrect?
|
| Posts like mine are being censored across-the-board on the
| Internet because of "interests". I mean, how much more
| evidence could you possibly linked to then 119 studies, yet
| my comment was flagged out of existence. We are literally
| living in a George Orwell novel and the people with jackboots
| are just ordinary citizens, putting the boots on their own
| necks. We are under the spell of like a self-prescribed
| global brainwashing campaign. Nobody cares about science
| anymore, nobody cares about the scientific method, nobody
| cares about actual data anymore, only propaganda. 119 studies
| show evidence of one thing. That's not enough though. But
| then the media says another thing and everybody believes it,
| despite the fact that there are dozens of studies with
| conflicting data showing various counter arguments (such as
| the Israeli pre-print from three weeks ago showing that The
| gene therapy is less effective than natural immunity by a
| factor of 13 to 27 times). This was practically completely
| ignored by the media and everybody on this site. In the past
| everybody here would've been on that shit immediately, trying
| to figure out if it was correct, I mean don't we want out of
| this mess? Does anybody want out of this or does everybody
| feel good about having a boot on their neck for the rest of
| their lives? Let go of your ego for a minute and ask yourself
| that question for real. If you're one of the people who will
| down vote this comment, there is no help for you in the long
| run. But if you want to be honest with yourself, and you want
| this bullshit situation to end, then you need to look at the
| real science in the real data and ask real questions and be
| open to the answers. Even if it means you made a terrible
| mistake somewhere along the way.
| creddit wrote:
| I vouched for your comment. You're allowed to believe
| whatever irrational things you'd like and comment about
| them as much as you'd like as far as I'm concerned. Seems
| it got flagged to death even after the vouch, though.
|
| Let's, however, consider your inane views on the RNA
| vaccines (note that not only is this what everyone refers
| to them as, it's also the case that they are very
| specifically NOT therapies as they are meant to be
| prophylactic to disease rather than treat disease).
|
| > such as the Israeli pre-print from three weeks ago
| showing that The gene therapy is less effective than
| natural immunity by a factor of 13 to 27 times)
|
| Do you really have no idea why that's a stupid attack on
| the vaccines? The idea that natural immunity is superior to
| vaccine acquired immunity says NOTHING about whether or not
| a vaccine provides immunity. If A > B, that doesn't mean
| that B = 0.
|
| Not only that, but the same study showed that natural
| immunity + vaccine > natural immunity. So by your inane
| logic, natural immunity alone does nothing!
|
| But even with this study by all accounts being valid, what
| policy decisions would you change based on it? It's not
| like we would stop vaccinations!
|
| What's more you're concerned that people are ignoring these
| 119 studies but you yourself claimed there was literally no
| evidence of effect for the vaccines when there are hundreds
| of studies (including your cited Israeli study for God's
| sake!) showing their effectiveness!
|
| Beyond all of that, I know of 1 good RCT for Ivermectin in
| the Together Trial (1500 patients unlike the comedy of many
| of the studies you quote) and uh, no effect. Weirdly, they
| do find really great effect from Fluvoxamine and yet you
| quacks never decided to pursue that for some reason...
| swader999 wrote:
| The Together trial only did 3 doses and only 400 mcg/kg -
| nobody else is finding results at that dosage rate
| either. Needs to be 5 days or longer, 600mcg/kg the
| earlier the better.
| creddit wrote:
| Some shocking non-linearities in dose-response you're
| expecting. Point me to the most credible study you have.
| Tired of being shown poorly randomized trials with like
| 50 subjects.
| swader999 wrote:
| Why don't you pay for them lol. It's off patent there's
| no money for large trials. See the links supplied above,
| there's data from entire countries now at least.
| ch4s3 wrote:
| I think the first thing people here are negatively reacting
| to is the phrase "gene therapy", which has a specific
| meaning and the mRNA vaccines are most definitely not gene
| therapy.
|
| I also don't think any scientifically minded person is
| opposed to the idea that natural immunity from previous
| infection provides stronger or longer lasting protection
| for infection. This would be in line with what we see with
| flu. The problem people have is the use of this information
| to encourage people to not get vaccinated. COVID outcomes
| are clearly better for vaccinated individuals than those
| who have not been vaccinated and have no natural immunity.
|
| I don't like the mandates, lockdowns, or passports but I
| think vaccination is still useful in reducing illness,
| spread, and mortality. The data backs that up. No one in my
| opinion should be coerced, but the choice seems so obvious
| to me.
| dreyfan wrote:
| I think you're late for your chiropractor appointment.
| motoboi wrote:
| Someone said it and I totally agree:
|
| Society is not ready to watch science in realtime.
| Gimpei wrote:
| Society isn't ready to watch science any other way either.
| Media outlets routinely take individual studies and vastly
| inflate their results. I suppose it's better if the study is
| peer reviewed, but not much.
| greenonions wrote:
| I agree, though there are two obvious courses of action that
| result from this:
|
| 1. Prevent the viewing 2. Increase the readiness
|
| Of which I think #2 is most preferable.
| toss1 wrote:
| #2 is for sure bviously preferable, but Good Luck With That.
|
| Once you get below the top N% in intelligence levels (5%-20%
| in my experience), the ability to 1) understand any kind of
| complex systems, 2) read, understand, contextualize and
| retain data, and maintain any rigorous logical thinking
| structure (e.g., keeping previously eliminated options
| eliminated) declines rapidly.
|
| The result is that, despite having absolute record numbers
| and percentages of people educated with college degrees, we
| have massive anti-science movements that are literally
| killing thousands of people daily, by ape-ing scientific-
| sounding terms & distorting concepts & data in order to more
| effectively broadcast disinformation - and hordes lap it up.
|
| We even have nurses and healthcare workers, who supposedly
| have been taught and passed tests on basic germ theory,
| actively resisting and campaigning against safe and effective
| public health measures.
|
| A related phenomenon is that college degrees are
| systematically being degraded. I personally know someone who
| was a visiting professor at a US State University, teaching
| introductory economics. He found that many of the students
| didn't even have the math skills (or motivation) to
| understand and wield the basic concepts on assignments,
| classroom discussion, and tests, and of course he was
| recommending them to remedial options and failing them. He
| was explicitly ordered by the administration to pass them or
| quit. He quit.
|
| Sadly, it is looking more and more like this great experiment
| in college for all is not working out as hoped. Instead of a
| culture of wisdom, we have a culture of sophomores -
| literally wise fools, who know very little, but think they
| know it all, and therefore don't have to listen to any expert
| who actually has real knowledge.
|
| It is considered obvious that at 5'6"/168cm, I was not born
| with the attributes necessary to engage in a professional
| basketball career. Yet the same kind of sorting based on
| intelligence is considered something to not discuss, perhaps
| getting too close to eugenics.
|
| I strongly believe that the _opportunity_ should exist for
| any person to get whatever level education they want, without
| financial or other obstacles. But, with the caveat that it
| cannot be dumbed-down - either you can understand and do the
| work and pass, or you do not. The practices seen above, and
| grade inflation in general need to be reset. The problem is
| that failing your students is bad for business, so unlikely
| that most colleges will reform.
| andrewflnr wrote:
| People at my state university would occasionally toss out
| the catchphrase "Ds get degrees!". It made me sad. I agree
| at minimum more people need to fail classes. If you want to
| be nice, counter by allowing more attempts.
| toss1 wrote:
| >>counter by allowing more attempts
|
| Excellent idea - retake any class once for nominal cost
| (and you've already got the textbooks).
| dataduck wrote:
| Perhaps, but unfortunately #1 is more realistic.
| EnlightenedBro wrote:
| For those interested to learn more about Ivermectin, watch
| JRE#1671 podcast episode. Lots of interesting information covered
| about the drug by 2 biologists. It may change your views on this
| for the better, or the worse.
| vernie wrote:
| You're better off if you only associate "JRE" with Java.
| xdennis wrote:
| People shouldn't be taking medical advice from JRE (or
| celebrities (or politicians)), but what's wrong with his
| podcast?
| atty wrote:
| What I find almost more interesting than the article itself is
| the comments that show a non-zero portion of the HN community
| (which I think is generally more intellectually curious and
| educated than average) are actually strongly arguing that
| ivermectin has strong effect, and even crazier, that it may be
| safer or more effective than the mRNA vaccines.
|
| Is this from being incapable of following science and drawing
| rational conclusions? Or is it more of a tribal thing, where they
| are exposed to a biased subset of information/misinformation, and
| are now emotionally invested in the success of ivermectin because
| their tribe is?
|
| Either way, like someone else in the comments said, these past 2
| years have shown us that laypeople are incapable of following
| active science in real time and drawing reasoned conclusions.
| Frankly, this is probably true of everyone who is not an expert
| in the field in question. We need organizations like the CDC and
| FDA to be much better about their messaging (remember the no-mask
| debacle? Great way to lose credibility, guys and gals), and we
| need much better tools to shut down the spread and weaponization
| of misinformation from the anti-vax crowd et al. I honestly don't
| have any idea of how either of those get fixed, however.
| doliveira wrote:
| Seems like you guys should take a look at Brazil as a
| cautionary tale for what happens when these miracle treatments
| are adopted by politically inclined doctors and sold to the
| masses as the magical solution.
| listless wrote:
| Source?
| pigeonhole123 wrote:
| I could change every assumption in this comment to the opposite
| and it would make just as much or little sense.
|
| You can't pretend to be searching for truth if your solution to
| the problem of people making mistakes is to shut down any
| possible way to discuss the disagreement. I just find the
| cognitive dissonance on display here staggering. How do you you
| know you're right? Have you ever been wrong? I suppose you knew
| at the time that you were wrong? Or maybe you just know that
| this time you're right?
| obelos wrote:
| Is there a name for a cognitive bias that predisposes one
| toward favoring iconoclastic positions solely for their
| novelty? Because that seems fairly endemic in the tech
| industry.
| ysleepy wrote:
| Being a contrarian fits that description somewhat.
| rajin444 wrote:
| Your post is assuming a lot of this science is "settled". I
| don't think science is settled - especially in this field.
| Acknowledging that your own statements may be incorrect might
| help you down the path to figuring out a fix.
|
| Hint: as soon as you know you're right, and you make statements
| based on that, when you're inevitably wrong (not saying this in
| a disparaging way - making sense and being right through all
| this is nearly impossible), you will lose all trust.
| tigershark wrote:
| It's because on this website there is a huge number of people
| that just drink whatever is the kool-aid du jour that goes
| around in the right side disinformation circles and social
| networks.
|
| Imagine to oppose a perfectly safe vaccine that has been
| administered 6 BILLION times all around the world and that has
| a proven efficacy of at least one order of magnitude against
| delta variant and to push for a horse dewormer (that bear in
| mind it's perfectly effective for what is used for.. killing
| parasites, not viruses)
|
| I think it's because a lot of the HN demographic has quite a
| big overlap with the people that use social networks where all
| this bullshit originates and it is amplified and it spreads.
| [deleted]
| eloff wrote:
| For me I see the controversy here and I figure it could fall
| either way. Maybe it works, maybe it's just another
| hydroxychloroquine. I'm keeping an open mind. In no way should
| anyone be thinking it's safer or more effective than the mRNA
| vaccines given how many people have had them and the vast
| amount of data we have on that now. Any argument you can make
| on that is just very weak because there isn't that kind of
| rigorous supporting data on the Ivermectin side.
|
| To the downvoters: put up or shut up. Your opinion doesn't
| change the facts.
| buescher wrote:
| The lesson of ivermectin: a lot of medical studies that go
| uncriticized because they're less controversial probably have
| problems similar to the problems of the retracted Elgazzar study
| and the other studies mentioned. Why else would these people
| think they would get away with it?
| defaultprimate wrote:
| Studies are irrelevant at this point, when we have population
| level data of over a billion people across India and Africa, and
| the massive disparities between states/countries that utilized
| Ivermectin, and those that did not. The drug is safe enough to be
| used based on this data alone.
|
| https://www.thedesertreview.com/opinion/columnists/indias-iv...
|
| https://www.thedesertreview.com/news/national/indias-ivermec...
|
| https://www.thedesertreview.com/opinion/columnists/indias-iv...
|
| https://www.thedesertreview.com/opinion/columnists/indias-iv...
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968425/
|
| https://journals.lww.com/americantherapeutics/fulltext/2021/...
| walterbell wrote:
| At this point, news articles should include a bar chart for
| health interventions, including a three year projection of
| vendor revenue, tax costs, quality-adjusted life years,
| societal collateral damage, and risks based on prior usage.
|
| When one option has billions of revenue at stake, investors
| will pay for more/focused studies vs an option to reuse low-
| cost generics. Unfortunately, or fortunately, desperate humans
| have skipped trials of both vaccines and early treatments, so
| there is data on both.
| NotSammyHagar wrote:
| If you are fixated on conspiracy claims against your amazing
| scientific discovery - pretty much you are always wrong, that's
| true for perpetual motion machines, faster than light drives
| (that's the one I hope could be right), extra-ordinary life
| extensions for microbes applies to humans (wish that one could
| be right), and covid. If you use opinion columns from obscure
| news sources to prove you are right, almost always wrong too.
|
| Ivermectin is safe enough to take, the important question is
| does it do any good against covid. At best it doesn't hurt you
| and it's unclear, but probably does nothing. It's certain there
| is no international pharmaceutical conspiracy trying to block
| discussion of it. That's different than trying to avoid showing
| incorrect medical information to people during a worldwide
| medical emergency. The hospitals in my state are full of
| idiotic non-vaxed covid victims. The latest thing is a
| conspiracy that the hospital won't treat them with ivermectin
| because they want them to die.
|
| People are just killing themselves because of their bizarre and
| irrational resistance to safe, life-saving vaccinations and
| preference for random spoutings on the internet to research
| proven treatments. Do people challenge their math professors in
| college because they don't consult fox news for the truth? No.
| I don't have much hope for our future when we can't get these
| simple things right. It's like a new dark ages has come upon
| us. But the truth is we humans were always this foolish.
| gambler wrote:
| So, they demand to change an established scientific practice
| because they don't like the results it produced in a particular
| case. And then everyone wonders why people no longer "trust the
| science".
| simonh wrote:
| The asked for the papers to be revised because they found and
| presented specific clear evidence the data was invalid.
|
| If by "don't like results" you mean "don't like clearly invalid
| and possibly fraudulent results", then yes. Correct.
| nostoc wrote:
| Is meta analysis of unpublished result really such an
| established scientific practice?
| gambler wrote:
| From the article you're commenting on:
|
| _" We recognize that this is a change to long-accepted
| practice and is substantially more rigorous than the
| standards that are typically currently applied"_
|
| Meta-analyses generally follow certain pre-established
| standards. That's the whole point of such studies.
|
| It's one thing to claim that authors of a particular meta-
| study broke the standards. _This is not being claimed here._
| It 's an entirely different thing to claim that the standards
| themselves are broken and need to be changed generally. This
| is a huge claim that casts doubt on tons of prior research.
|
| Maybe we do need more rigorous rules for meta-analysis.
| However, if that's the case, it should be true for all
| research of this type, not just papers examining
| "interventions for COVID-19" (as the article suggests).
|
| Hence, my take on this. It's reasonable to question
| scientific standards if you are willing to demonstrate that
| they are really broken. (This was done with p-hacking, for
| example.) It's not reasonable to say that a _specific subject
| in research_ should have different evidentiary standards
| because of controversy around one drug.
| tptacek wrote:
| I think you're dignifying this comment, which objects to the
| authors request that meta-studies not include fraudulent
| analyses in their inputs as an unwarranted "change to
| established practice".
| programmarchy wrote:
| How does the current field of studies compare to Remdesivir?
| Remdesivir is a repurposed antiviral (originally designed for
| Ebola) with fairly low efficacy, and very severe side effects,
| and it breezed through FDA emergency authorization. I don't
| understand why it seems that the bar is set so low for
| Remdesivir, but so high for Ivermectin.
| lez wrote:
| And even lower for the vaccines.
|
| Ivermectin has been used with marginal side effects, since
| decades.
| sjg007 wrote:
| Are you sure about that?
| https://www.nejm.org/doi/full/10.1056/nejmoa2007764
| programmarchy wrote:
| No, I don't think anyone is, because there are also studies
| that show no benefit: https://www.thelancet.com/journals/lani
| nf/article/PIIS1473-3...
|
| However, I've also heard there's a new study coming out from
| Gilead that demonstrates Remdesivir is highly effective when
| administered in early treatment.
|
| So perhaps the efficacy depends when treatment is given. And
| if that's the case, then meta-studies actually become very
| important, because they can reveal hidden factors like
| dosage, demographic, when to administer treatment, etc.
| simonh wrote:
| >How does the current field of studies compare to Remdesivir?
|
| Remdesivir has three randomised controlled trials all of which
| indicate statistically significant effects, and there don't
| seem to be any credible challenges to these trials results.
| Currently given the concerns about the irregularities in the
| data in it's existing trials, Ivermectin has none.
| swader999 wrote:
| Say goodbye to your kidneys.
| droptablemain wrote:
| I think you answered your own question -- Remdesivir is an
| antiviral and Ivermectin is an antiparasite.
| programmarchy wrote:
| It's not that simple. For example, a protease inhibitor could
| have effects on biological functions that exist in viral and
| parasitic infections. And both Remdesivir and Ivermectin [1]
| have been observed to have antiviral properties in vitro.
|
| [1] https://www.sciencedirect.com/science/article/pii/S016635
| 422...
| veemjeem wrote:
| Many things are effective against covid-19 in-vitro. When
| it was administered in hamsters, there was no effect on
| viral load.
|
| https://www.biorxiv.org/content/10.1101/2020.11.21.392639v1
| gwerbret wrote:
| I'm going to make what is probably a controversial statement,
| which is that, in my experience, most meta-analyses are trash.
|
| A meta-analysis is usually grounded on the assumption that an
| aggregation of multiple, well-conducted studies can provide
| significant information that may not be evident by taking each
| study individually. Essential to this assumption is the premise
| that those studies included in the meta-analysis be
| scientifically rigorous in themselves. Unfortunately, this is
| almost never the case. The great utility of the meta-analysis in
| the clinical literature is such that there have emerged a series
| of standards for how to conduct such analyses, such as
| controlling for bias, controlling for variability, etc. These
| seldom include actual assessment of the scientific quality of the
| studies, as this is harder to standardize. Consequently, there is
| a preponderance of meta-analyzes that come to conclusions that
| are simply not justified, because the studies themselves were not
| scientifically rigorous.
|
| I believe this applies to the situation of ivermectin, and it
| just so happens that this is the thrust of the point raised in
| the Nature article cited here.
| aabaker99 wrote:
| I am also skeptical of meta-analyses.
|
| I will re-post some thoughts I have previously shared from John
| P.A. Ioannidis who is a professor of medicine and thoughtful
| critic of medical research. He often raises good points about
| trends in research and research ethics. His view is that meta-
| analyses are mass produced, redundant, misleading, and
| conflicted [1]!
|
| One criticism of meta-analyses in [1], using anti-depressants
| as a case study: "the results of several meta-analytic
| evaluations that addressed the effectiveness of and/or
| tolerability for diverse antidepressants showed that their
| ranking of antidepressants was markedly different. These
| studies had been conducted by some of the best meta-analysts in
| the world, all of them researchers with major contributions in
| the methods of meta-analysis and extremely experienced in its
| conduct. However, among 12 considered drugs, paroxetine ranked
| anywhere from first to tenth best and sertraline ranked
| anywhere from second to tenth best."
|
| I like this quote because it highlights the conflict of
| interest and misleading-ness(or at least reproducibility
| problems) with meta-analyses. Antidepressants have a huge
| amount of primary research dedicated to them. They also have
| the attention of researchers experienced in meta-analysis. Yet,
| meta-analyses do not agree with each other (and in fact they
| strongly disagree with each other).
|
| [1] https://pubmed.ncbi.nlm.nih.gov/27620683/
| tantalor wrote:
| FiveThirtyEight weights its averages by pollster
| accuracy/methodology.
|
| _Next, we determine how much weight to give each poll in our
| average. First, polls conducted by pollsters with higher
| FiveThirtyEight pollster ratings -- a letter grade measuring
| how accurate and methodologically sound pollsters are -- are
| given more weight_
|
| https://fivethirtyeight.com/features/how-were-tracking-joe-b...
| nradov wrote:
| There is no equivalent feedback mechanism in medical
| research. Other than looking for retracted papers, we don't
| have a reliable way to quantify whether a particular author
| is "correct" more often than another.
| antman wrote:
| The author's Hindex could be an initial weighting factor
| calibas wrote:
| It's so easy to abuse meta-analysis, you simply modify the
| inclusion criteria until you get the results you're looking
| for.
| Spellman wrote:
| Meta-analysis have a good place. But they also have known
| flaws/assumptions.
|
| Often it is impractical to perform large studies. Partially by
| logistics and often by funding. But if there are lots of
| smaller studies you can aggregate the data to check for overall
| significant results. But mainly they are helpful to give a
| "survey" of the current research instead of having to link to
| 10 different studies and hope someone else sorts out what the
| data says.
|
| But as you point out, there are two major flaws in the
| assumptions. First, that the scientific procedure is sound.
| Secondly, that the data is handled properly, and thus you can
| take the summary and back out the underlying data.
|
| Unfortunately trying to fix the first is really, really hard.
|
| The second is somewhat mitigatable. As the Nature article
| suggests, you could publish the underlying data (anonymized of
| course). This would help in two ways. First, the meta-analysis
| could check for confounding variables to control across _all_
| of the data. The second major one is it would help people spot
| fraudulent data.
|
| However, as anyone who handles datasets knows, publishing and
| wrangling data into a useable state from multiple sources is a
| serious pain in the neck. Plus a lot of concerns about how de-
| anonymized the data would be. As we've known, with enough
| metadata it can be used to identify individuals. And publicly
| publishing dais data would definitely allow for some serious
| sleuthing work to be done.
| rscho wrote:
| I've published (and still am publishing) multiple meta
| analyses. IMO,meta analysis on aggregate data is an h-index
| gaming machine that can never increase the value of its
| constituents. The amount of missing info in aggregate data is
| such that it's _always_ impossible to know if the constituent
| studies really draw from the same population, which is the
| cornerstone of meta analysis. And that's very practical,
| because most authors (myself included) mainly use meta
| analysis as a means to build a career, and not at all for
| doing science. IMO, current clinical research has very little
| science left in it. That's a huge shame, and it's a real
| priority to make that change!
| aeternum wrote:
| What do you think about the ability for researches to pick &
| choose which papers to include in a meta-analysis?
|
| Double-blind is important for a reason, researchers are
| exceedingly good at proving what they want to prove even if
| subconscious, can meta-analysis studies ever overcome this?
| trts wrote:
| The problem I saw with the Ivermectin metastudies (which I
| did a fair amount of research on given that people close to
| me had decided to employ it as a prophylactic against Covid)
| was that the people who did the metanalyses were trained to
| read the results rather than grapple with the methodology and
| statistics.
|
| None of the study results were robust, but many of the study
| outcomes were positive. So they were counting up positive
| outcomes and saying that more often than not, it was evidence
| that Ivermectin was effective.
|
| This is a good means of generating a hypothesis, but a bad
| means of generating a conclusion.
|
| Most of these studies were not in any way controlled or
| comparable in their conditions, and some had a very low
| number of observations. It didn't seem plausible that the
| data could be aggregated together.
|
| It will be very interesting to see the results of the larger
| RCTs underway. Regardless of the outcome there _has_ to be a
| lesson for at least some people who arrived at fervent
| conclusions about what a miracle/scam this particular drug
| is. Unfortunately it seems unlikely that it will be a lesson
| that endures.
| nradov wrote:
| The federal government has specific guidance on how to meet
| the legal criteria for de-identifying clinical data. Once
| researchers meet that standard they're generally free to
| publish raw data, unless there's a stricter standard imposed
| by state law or some sort of institutional review board.
|
| https://www.hhs.gov/hipaa/for-
| professionals/privacy/special-...
| gnicholas wrote:
| Do researchers ever pre-register their studies when they do
| meta analyses? Pre-registration makes sense for the timing of
| doing actual studies, but not as much in the case of meta
| analyses (which presumably happen on a much faster timeline).
|
| But given what we've seen with p-hacking, it seems like it
| could be good if people pre-registered their meta analyses
| before crunching the numbers.
| nradov wrote:
| Sure some researchers do pre-register their meta analysis
| studies on clinicaltrials.gov. It's generally optional. Of
| course there's nothing stopping a dishonest researcher from
| doing a little secret p-hacking before pre-registering.
| mohammad_ali85 wrote:
| For systematic reviews there are one of two ways that I'm
| aware of: PROSPERO [1] and Cochrane[2]. Cochrane is slightly
| more rigorous for conducting a review of this type. Although
| you do declare what meta-analyses you intend to do, you can't
| be overly explicit as it is largely dependent on the number
| of studies that are returned in your search strategy. For
| example two studies is too small for a meta-analysis so you
| would do a narrative review (discuss what you found).
|
| [1]https://www.crd.york.ac.uk/prospero/
|
| [2]https://www.cochranelibrary.com
| rscho wrote:
| Good practices dictate that preregistration should always be
| done nowadays, including for meta-analysis. In practice
| though, this has very little impact. There is absolutely no
| guarantee that what's written in the paper is a faithful
| report of what really happened. There's nothing holding back
| dishonest (or, at that point I guess I should write
| 'standard') researcher from doing absolutely whatever they
| want.
| derbOac wrote:
| So I'm someone who has published several meta-analyses of
| different forms, and written about meta-analysis as a topic.
|
| I won't disagree with you that there are many poorly conducted
| meta-analyses. However, I think there's many well-done meta-
| analyses as well, and most importantly maybe meta-analyses
| aren't really different from anything else in life: some are
| good, some are bad, and many are in between.
|
| One thing I've always argued is that meta-analyses have as a
| benefit a way of honing discussion around concrete specifics.
| The linked paper, for example, exists in part because there was
| a meta-analysis drawing attention to the literature at large.
| There's a decent chance that these studies would never be
| discussed if there wasn't a spotlight being pointed at the
| area.
|
| With reviews, what happens is people pick and choose studies
| anyway, or don't, and then come to some subjective conclusion
| that's based on some unclear process. Meta-analysis makes all
| of this clear, and forces everyone to be absolutely explicit
| (or as explicit as can be) about how they're coming to their
| conclusions. If there's something wrong with it, then you can
| point to the specifics of that instead of going back and forth.
|
| The problem with relying on definitive studies alone is that
| sometimes there will be more than one of them, or there won't
| be any definitive study, but many decently-done studies. Or the
| "definitive" study will have some controversial feature that
| doesn't clearly rule it out, but clouds the waters in a way
| that several smaller studies might draw attention to.
| Alternatively, there might be important heterogeneity across
| designs that illuminates moderating variables (like dose, or
| environmental context, or gender, or age, or whatever).
|
| This paper is about meta-analysis of summary statistics, which
| to me is kind of bringing up a red herring. Statistically
| speaking if you can calculate the right summary statistics, the
| results should be the same as having the raw data. Issues about
| irregularities in results apply to raw as well as summary
| statistics; it also seems unrealistic to expect raw data in
| every case, and journals don't apply that standard either (that
| is, journals don't expect reviewers to reanalyze the data from
| scratch).
|
| What's really needed is open data sharing, and scrutiny about
| studies that increases as the stakes of the results increase. I
| can speak to cases where I've been surprised at the state of
| the raw data, even in situations where the whole point of the
| study was to skeptically replicate a finding. Maybe for
| something like invermectin raw data analyses are appropriate.
| But it seems absurd to expect to throw out studies in the
| literature just because you don't have access to the raw data
| in every case.
| rscho wrote:
| Even meta-analysis conducted strictly according to PRISMA can
| be fraught with many issues. IMO, meta analysis is very
| vulnerable to bias in the base data and the honesty of
| multiple researchers, all while p-hacking and various other
| tricks to make papers sexier are already the norm. Forcing
| open data would certainly improve things but would not solve
| the problem of dishonesty in research, since authors would
| simply begin to withhold parts of their data that do not go
| their way.
| dekhn wrote:
| It's best to understand that the vast majority of literature is
| just faulty. Either it's technically wrong (experimental
| mistakes), or missing information (left out a step in the
| methods), or the conclusions are not supported the (valid)
| experiment.
|
| Learning how to filter literature is non-trivial and I don't
| think very many people do it successfully. I've found the best
| thing is to take a group of aggressive smart grad students and
| have them tear every paper apart until I'm convinced there are
| no basic technical errors, and the conclusion is supported by
| the evidence. Then and only then, would I care that the methods
| were incomplete because I'd be ready to run a replication
| experiment, and many of my replications failed because the
| methods section was not sufficient (missing steps, misleading
| instructions, challenging step).
| whiddershins wrote:
| I agree with your general point but in all fairness part of
| doing a meta-analysis is weighting the studies included in it
| based on many of the factors you mention.
| mechE321 wrote:
| The Bayesian gambler in me wants to think this:
|
| The studies on ivermectin seem to be split between "good effect"
| and "no effect," and there don't seem to be any (by my extremely
| informal review! going off of memory here) in the camp of "bad
| effect."
|
| Seems reasonable to take ivermectin as a decent gamble to me
| while we wait on the dang science to get its head out of its
| butt.
| pjc50 wrote:
| Be very careful _how much_ you take:
| https://www.npr.org/sections/coronavirus-live-updates/2021/0...
|
| Remember that the _in vitro_ study that gets cited a lot used a
| concentration that would be lethal in humans.
| rubatuga wrote:
| Poison control center calls are not poisonings. There were no
| significant increases in hospitalizations due to ivermectin.
| It's a fear-mongering article.
| simpleguitar wrote:
| googling for "ivermectin hospitalizations" shows actual
| hospitalizations from ivermectin.
|
| Maybe they are not "significant" enough for you.
|
| Anyways, I've seen enough "iver" posts on [1] to keep me
| away from it.
|
| [1] https://old.reddit.com/r/HermanCainAward/
| NotSammyHagar wrote:
| The reasonable thing is get vaccinated immediately. You could
| also stick chili peppers in your butt, that probably won't hurt
| either. It has as much ability to help as horse dewormer.
| mpalczewski wrote:
| Calling it horse dewormer is either propaganda, or just a
| plain bad faith argument. The inventors of this drug won a
| Nobel prize for the discovery and it's use in humans. It's
| recognized as an essential drug.
| wombatpm wrote:
| But people are purchasing the horse version. What is the
| conversion between a 50 mg tables and a tube of paste for a
| 1200 lb animal? By using the wrong formulation you run the
| risk of liver damage due to an overdose of ivermectin.
| hackerNoose wrote:
| That's a straw man. These people are of course doing
| something dangerous but mainstream newspapers are
| routinely calling doctor prescribed Ivermectin 'horse
| dewormer'. Both 'camps' treatment of this subject has
| been a real low water mark and it looks like the science
| might be as well.
| trompetenaccoun wrote:
| "Reasonable" based on what risk/effect-analysis? For what age
| group? I don't know how many 60 year olds browse HN but I'm
| not going to take either experimental treatment for a disease
| I don't even have any reason being scared of, based on the
| actual data we have. The more hysterical part of society can
| argue about this and inject themselves with whatever they
| like for all I care, just leave the rest of us out of it. Not
| everyone wants to live in fear and under dystopian rights
| restrictions.
| sgt101 wrote:
| I would like to meet you in a casino. Type "Invermectin side
| effects" into any search engine, read the links. These are "bad
| effects".
|
| The fraudulent studies (y'know, including dead patients,
| patients that never existed, drugs that weren't administered
| and so on) have shown a good effect.
|
| The real studies unfortunately showed no effect.
|
| My advice to you; don't gamble. Ever.
| rubatuga wrote:
| You need a better argument than that to convince somebody to
| never gamble lol. Remember, it was also a gamble to trust the
| WHO not to use masks early in the pandemic. We are making
| gambles everyday.
| sgt101 wrote:
| >trust the WHO not to use masks early in the pandemic
|
| That one was a very interesting story. The best informed
| people made rational decisions to mask up, semi informed
| believed the bad advice to do without, the least informed
| acted randomly.
| anoonmoose wrote:
| We did this last year with hydroxychloroquine...all that
| happened was that some Lupus patients had a hard time getting
| their normal prescriptions filled.
|
| The "bad effect" doesn't have to be strictly medical, and may
| not show up in studies. It could be that other people who need
| the medicine can't get it, it could be that it discourages
| people from getting the vaccine, it could just be that we are
| lighting a pile of money on fire for no reasons (that's bad,
| right?).
| josephcsible wrote:
| > all that happened was that some Lupus patients had a hard
| time getting their normal prescriptions filled.
|
| Could we actually not manufacture enough of it, or were
| activist pharmacists just refusing to fill prescriptions of
| it?
| simpleguitar wrote:
| If iver is a good gamble, then wouldn't the vaccine be a better
| gamble?
|
| After all, unlike iver, there is very good hospitalization data
| about vaccinated vs unvaccinated now.
| rory wrote:
| This is true, but just because the two are on opposite sides
| of the culture war doesn't mean they're medically mutually
| exclusive.
| mint2 wrote:
| I didn't realize the lottery gave out different odds based
| on political affiliation.
|
| Do republicans or liberals get better probabilities? Or is
| it only for Covid related odds?
| rory wrote:
| I think you may have replied to the wrong comment, or at
| least, I can't figure out how yours relates.
| simpleguitar wrote:
| Actually, it does.
|
| The only reason one would be taking iver prophylactically,
| is because one wasn't vaccinated. And the only reason to
| take iver after covid symptoms develop is because you
| didn't take the vaccine.
|
| If one was vaccinated and are feeling sick enough to take
| iver, she would be better off with oxygen and hospital SOC.
| rory wrote:
| It seems like you're just saying you don't believe
| ivermectin works? That's fine and likely correct, but
| logically it's completely unrelated to its mutual
| exclusivity to the vaccine.
|
| For instance, if you get tetanus after having the
| vaccine, you'll still be given antibiotics. If someday
| ivermectin _is_ proven to have a positive effect against
| Covid, we won 't withhold it from vaccinated patients.
| marcosdumay wrote:
| Ethical researchers will prematurely stop and publish a "no
| effect" result for any medicine that has bad effects. That is,
| unless the effects are so bad that they can't stop fast enough,
| and they get to measure a statistically relevant harm.
|
| Thus seeing "no effect" places an upper bound on how good an
| effect you will see as "none", and a lower bound as "won't kill
| most people quickly". That's not a good space to gamble into.
|
| It took almost an year until the scientific community settled
| down that HQC for treating COVID-19 is harmful. The actual
| formal result is still "no effect and doing more studies is
| anti-ethical" because nobody can tell exactly how harmful it
| is. Probably nobody will ever be able to tell (and that's a
| good thing).
| The_rationalist wrote:
| https://ivmmeta.com/
| input_sh wrote:
| https://archive.is/9EVIv
| [deleted]
| [deleted]
| corona-research wrote:
| You shall have no other medicine besides me.
| hackingforfun wrote:
| With all the criticism of the mRNA and other COVID vaccines,
| which actually do have science backing them up, what is the
| science that would make ivermectin actually work? It's an
| antiparasitic drug. I see a lot of criticism of the COVID
| vaccines, especially from the right, but then they are fine
| taking hydroxychloroquine or ivermectin if there is any glimmer
| of hope that they will work. I just don't get it. Maybe, just
| _maybe_ , it's not all some big conspiracy, and the vaccines were
| actually designed to help people? Is that so far fetched? Doesn't
| taking something random like hydroxychloroquine or ivermectin
| seem more far fetched? It does to me.
| anshorei wrote:
| Something being designed to help people doesn't make it good.
| There's reason to believe vaccinating using a non-sterilizing
| vaccine during a pandemic exerts an evolutionary pressure on
| the virus that will lead to the vaccine becoming ineffective
| and the the virus endemic. Considering the current
| effectiveness of the vaccines a fully vaccinated population
| will be worse off than a fully recovered population (though the
| population that did not recover may find this rather morbid).
| See natural immunity vs vaccine-induced immunity research in
| Israel.
|
| It's a lot harder to say how a fully vaccinated population will
| fare compared to a fully unvaccinated population. In the short
| term the unvaccinated population will certainly fare worse
| (more sick, more dead), but at a population level they will
| develop a stronger, longer lasting immunity and exert no mono-
| directional pressure. While in the fully vaccinated population,
| as long as the R0 is over 1 (which looks to be the case) the
| virus will be driven towards escape variants, it might not
| matter how many more people remain asymptomatic or how many
| fewer people die when new variants keep driving the pandemic
| forward and render the vaccines ineffective. It's population-
| level immunity that ends pandemics, immunity works very
| different on a population level than on an individual level.
|
| Rather ironically if it turns out that this is indeed the case,
| then the people getting the vaccine are the "selfish" ones
| (protecting themselves short term from serious disease/death at
| the long term cost of the wider population) rather than the
| ones refusing the vaccine. Of course that's not entirely fair
| because people are doing it with the best of intentions and not
| out of "selfishness". I'm pointing this out more to demonstrate
| that things just aren't as simple as the media likes to portray
| it, i.e. with the non-vaccinated as the "selfish" ones.
|
| If it turns out that vaccination campaigns do indeed do more
| harm to the population long-term than good (something we'll
| likely only know for certain after the pandemic is over or,
| more likely at this point, has become endemic), then medicine
| such as Ivermectin, even if only marginally effective at
| combating COVID starts to look a lot more interesting because
| it does not exert those same pressures on the virus.
|
| There's several other ways the vaccines could end up hurting us
| in the long term, such OAS (Original Antigenic Sin) or ADE
| (Anti-body Dependent Enhancement), although it's looking really
| good on those fronts right now so I'm not worried about those.
|
| The discourse going on at the moment on in general is really
| cancerous (even on HN sadly). As much as I find people who
| believe that there is no virus, or that vaccines are made to
| kill people, or following health advice from random internet
| sensations to be ridiculous, I find myself far more worried by
| the lack of intelligent discussion and the instant demonization
| and name-calling of anyone who asks questions that are critical
| of the vaccination campaigns. A large part of that I think is
| that the anti-vaxxers have been given so much media-attention
| (negative) that people assume anyone putting forward critical
| opinions "must be one those" and can be dismissed without
| notice.
|
| No one knows what time will tell. Maybe this only has a one-in-
| a-thousand chance of ending up being the case. But I think it
| would be wise for people pushing for mandates to think about
| how society will look back at the COVID19 pandemic in say 50
| years, if it turns out that the vaccination campaigns had a
| net-negative long-term effect. Is that really a risk we are
| willing to take? My take is that it would be wise to keep safe
| in any way we can: mask up, disinfect, get sun, keep fit,
| socialize responsibly, etc. And to avoid radical action before
| the science is settled, and vaccine mandates _are_ radical.
| Science has a long history of settling on wrong for a while
| before getting it right, let 's give it some time.
| hackingforfun wrote:
| I appreciate your answer and agree that in general it's good
| to keep safe in any we can, including the things you
| mentioned. I also agree that the discussion is quite
| polarized, however, at this point I tend to think the vaccine
| benefits outweigh the cons.
|
| I'm wondering, at what point, if ever, would you decide that
| the COVID vaccines are safe / worth it? Honest question.
|
| Also, as someone else mentioned here [1], isn't natural
| immunity plus vaccine-induced immunity considered even better
| than natural immunity alone? I haven't fact checked this but
| they said that was also found from one of the Israel studies.
| Based on this, wouldn't it still make sense to get the
| vaccine?
|
| You also mentioned the media. Isn't it possible that
| conservative media is also manipulating the truth for their
| narrative? 90% of Fox News staff is vaccinated and yet they
| still cast doubt on the vaccine [2]. Also, Tucker Carlson
| won't say if he's been vaccinated or not [3], yet he's one of
| the big proponents telling people not to get vaccinated. I
| hear this criticism that the media is spreading
| misinformation, but it seems like if that's the case, we
| should consider that it could be happening on both sides.
|
| [1] https://news.ycombinator.com/item?id=28617742
|
| [2] https://www.theguardian.com/media/2021/sep/15/fox-news-
| vacci...
|
| [3] https://www.thedailybeast.com/cnn-host-alisyn-camerota-
| calls...
| swader999 wrote:
| The vaccines are suitable for the vulnerable - older with
| comorbidities. Vaccinating the entire population with a
| leaky vaccine and a virus that can shift and live in animal
| reservoirs is a recipe to breed more dangerous variants.
| winocm wrote:
| Antibiotic selection does not have the same dynamics as
| viral evolution does.
|
| This graphic demonstrates a good example as to the epitope
| coverage across S by both B-cells and T-cells: https://www.
| medrxiv.org/content/medrxiv/early/2021/07/05/202...
|
| You would need to have a variant that selects past all of
| the epitope coverage of both B/T-cell and bypasses affinity
| maturation too. NTD and RBD already has great coverage, but
| the rest of the pre-fusion spike confirmation used in
| vaccines these days has even more coverage than just with
| RBD alone. I think that's why BNT162b1 failed, as it was a
| mRNA encoded receptor binding domain only.
|
| Given how large the breadth (as in epitope coverage)
| already is in RBD alone, you would most likely disrupt ACE2
| receptor binding too at the same time if there was a such a
| massive change all at once to render a vaccine useless.
|
| If you managed to achieve an evolution rate of 250+ AA
| substitutions extremely quickly, all in one fell swoop, I'd
| have much much bigger concerns.
|
| A lot of the variants these days select for escape for RBD
| class 1 and 2 nAbs, even Mu as of now (R346K is in this
| weird overlap between the different classes as per the
| Barnes classification).
|
| You may want to see the following:
|
| https://www.nature.com/articles/s41579-021-00573-0
|
| https://www.nature.com/articles/s41586-020-2852-1
|
| https://www.science.org/doi/full/10.1126/science.abf9302
|
| I think I read some others, but I'll have to dig through my
| browser history more.
| tzs wrote:
| Here is an article from May 2020 about 15 drugs [1], including
| hydroxychloroquine and ivermectin, that were being looked into
| to see if they might help COVID. It goes into the mechanisms
| that led researchers to believe they were worth looking at.
|
| [1] https://www.nature.com/articles/d41591-020-00019-9
|
| Edit: Oops...forgot to link the article. Added.
| [deleted]
| hackingforfun wrote:
| Interesting, thanks.
| winocm wrote:
| I really don't want to go back rehashing the point as to
| why it doesn't work, mainly because finding all of the
| references again and double checking the wording to make
| sure it matches the literature is rather time consuming...
|
| https://news.ycombinator.com/item?id=28544765
| hackingforfun wrote:
| I'm not saying they do work. I just appreciated the
| reference and thought it was interesting to read through.
| I am pro-vaccine and think that is the most effective
| course of action. Anyway, thanks for the link to your
| other post.
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