This is worth reading purely for the writing alone. Scott Alexander is a treasure:
> As best I can tell, this is some kind of Egyptian trial. It might or might not be an RCT; it says stuff like “Patients were self-allocated to the treatment groups; the first 3 days of the week for the intervention arm while the other 3 days for symptomatic treatment”. Were they self-allocated in the sense that they got to choose? Doesn’t that mean it’s not random? Aren’t there seven days in a week? These are among the many questions that Elalfy et al do not answer for us.
> This is worth reading purely for the writing alone. Scott Alexander is a treasure
This post is a breath of fresh air for the blog and feels refreshingly well-researched. Between that and the unquestionable popularity of COVID-related discussion, it’s no wonder this article is popular.
Scott is undeniably a good blog writer with an entertaining writing style that resonates with his reader base. However, I’ve become disillusioned with a lot of his other recent writings like the “Great Families” post in which he presented a lot of conjecture that pandered to his core readership without any research or evidence to support it. Specifically, his position that genetics are the primary explanation for “Great Families” while ignoring obvious heritability of things like wealth and social status. Even the old Slate Star Codex and new Astral Codex Ten communities started calling him out on it after that article.
Scott’s writings are undeniably entertaining and usually quite fun to read, but I’ve long since learned to read them more critically because his writings have a way of projecting a sort of humble confidence while either hedging any statements so much that little is actually communicated, or sometimes inserting conjecture or feelings with a lot of linguistic window dressing such that it’s easy to mistake it for fact.
I hope this article is a sign that the writings are shifting more toward the old-school, heavily-researched style that made the blog so popular.
Oh, no wonder this was so entertaining to read, didn't even catch that this was astral codex. I laughed out loud at Cadegiani et al:
> A crazy person decided to put his patients on every weird medication he could think of, and 585 subjects ended up on a combination of ivermectin, hydroxychloroquine, azithromycin, and nitazoxanide, with dutasteride and spironolactone "optionally offered" and vitamin D, vitamin C, zinc, apixaban, rivaraxoban, enoxaparin, and glucocorticoids "added according to clinical judgment". There was no control group, but the author helpfully designated some random patients in his area as a sort-of-control, and then synthetically generated a second control group based on “a precise estimative based on a thorough and structured review of articles indexed in PubMed and MEDLINE and statements by official government agencies and specific medical societies”.
> The fraud-hunters have examined this paper closely and are unable to find any signs of fraud. I think this paper is legitimate and that its findings need to be seriously considered. ... And there’s always the chance it was a fluke, right? Can something have a p-value less than 0.001 and still be a fluke?
...
> And it was! It was a fluke! A literal, physical, fluke!
Edit: If you like puns and this writing, you'll likely enjoy some of Scott's other works, like "The Study of Anglophysics" [1] and (especially if you're at least passingly familiar with Judaism and Kabbalah) Unsong [2].
While reading this piece I got a little depressed that most journalism is just such utter trash compared to it. I've read so many articles on ivermectin and none of them gave me even ten percent of the clarity that this article gave me. Can you imagine if writing and journalism of this calibre was commonplace among practising "journalists"? And look at how this piece compares to the CDC's and WHO's science communication. It's a shame that clear thinking and communication is so scarce.
NIH seems to have pretty good analysis into Ivermectin. For some reason or another, people don't know it exists. Its pretty straightforward frankly. Turns out that people on the internet are terrible at meta-analysis.
While Scott has a pretty decent natural talent for writing, he also has a MD, he's a board licensed practicing psychiatrist who has been working for a decade in the field, and he has spent at least the last twenty years gaining a pretty decent broad exposure to statistical and research methods. I don't believe he disclosed what Substack paid him, but he is in the "paid tier" and has said it was a mistake to even agree to that because the subscriptions he has gotten exceed what Substack paid him.
In short, if you want most journalism to hire licensed medical doctors with decades of experience in science and statistics, and natural writing talent on top of that, expect journalism to get a lot more expensive. A market certainly exists for Scott, but I'm not sure the market exists for all journalists to be as highly qualified as Scott. Or, for that matter, even for CDC and WHO PR arms. They definitely aren't paying their communications officers whatever Substack is paying Scott, or probably even what his psychiatry practice is paying him.
He has an earlier piece whose point is that the WHO can never be accurate, because they always have to prioritize "sounding trustworthy" over accuracy, and random blogs don't.
This is a huge factor. Dumbing things down creates a dumber audience. If you look at newscasts and newspapers from the 70's and compare them to today the difference is amazing.
Whilst journalist/PR summaries are so notoriously bad they're a punchline when you talk to actual researchers, I think we have to be charitable here and acknowledge that most communication about COVID doesn't have the luxury of writing about every single trial registered (or making puns on the word "fluke"!) So it tends to summarise it as "initially promising results for Invermectin were fraudulent, whilst large trials found no effect at all. Also it has side effects, like most other drugs, so the people ordering it in doses for horses aren't being as clever as they think" which isn't nearly as entertaining or as thorough as Scott's writing, but is a broadly accurate summary of the state of scientific evidence.
(Of course you can also summarise it as "there's weak evidence for Invermectin having some therapeutic benefit which is probably related to preexisting conditions"... but we know how quickly that snowballs into "Invermectin stops COVID, scientists ADMIT IT" by the same people that deny the much stronger evidence for vaccine efficacy. Science journalism is bad, but not as bad as the selective reading of it.)
No no... You can't expect a journalist to carefully make a very detailed and informed article like this carefully evaluating 30 scientific articles of meta-anilisys sites wich favored a specific view. They are not spcialists in most things and this was published long after the peak of of the pandemic.
What they should do is to query specialists to obtain better information, instead of opinions. Consult different views, argue why on view is right or wrong and then inform the public.
for free online news, perhaps. pay for stat, nytimes, economist, scientific american etc you will find journalists who cover science with good understanding.
by the way few good science journalists would cover the story this way. instead they would mostly be quoting experts interpreting the significance of the various studies.
And Scott Alexander would never be one of them. Can you imagine a nytimes science writer quoting a psychiatrist on ivermectin's effectiveness? Never happen.
(also all of these sources' coverage of ivermectin has been much more limited because of the fact that the drug is a scam)
This is exactly the sort of thing that YouTube, Twitter, et al are suppressing. Someone thoughtfully listening seriously to what the proponents of Ivermectin are saying, weighing it up and saying "looks good but you forgot...".
You can't get this sort of excellent rebuttal without allowing a site like https://ivmmeta.com/ into the debate.
There is little evidence of such analysis being suppressed. I think it is just relatively rare, because it is a lot of work and takes particular skill.
Most people who care about this research are indeed crackpots, unfortunately. Those who aren't have mostly moved on from Ivermectin because they have better things to do. Ivermectin is being tested in large RCTs, as it should. If it works, it will be used. If it doesn't, it won't. Until we know, doctors will do what works.
Meanwhile, ivmmeta.com will get passed on from person to person that wants to sustain their delusion and the website here will be preaching to the choir.
I wonder if YouTube would have been better to implement a no medical advice policy. Not a no advice which runs contrary to the official guidelines policy.
The real story (in my opinion) behind Ivermectin are the studies not being conducted. Here you have a ton of studies claiming to have found benefit with a worldwide, massively available drug that has practically zero risks for most people (and it's an extremely well understood drug) and we don't have first world countries conducting RCTs to understand it better.
So you have to ask yourself - when do we get high quality RCTs, who funds them and why? This to me is a clear cut indicator that we have very maligned incentives for health science. How can we be this far into a global pandemic, with all of this funding and not have multiple high quality RCTs on this drug? It's sad to say the least. Even if Ivermectin ends up being fairly weak or completely ineffective - surely there's something to learn here...
> The real story (in my opinion) behind Ivermectin are the studies not being conducted. Here you have a ton of studies claiming to have found benefit with a worldwide, massively available drug that has practically zero risks for most people (and it's an extremely well understood drug) and we don't have first world countries conducting RCTs to understand it better.
First world countries are in the process of conducting RCTs testing Ivermectin, for example the activ-6 and covid-out studies in the US.
> So you have to ask yourself - when do we get high quality RCTs, who funds them and why? This to me is a clear cut indicator that we have very maligned incentives for health science. How can we be this far into a global pandemic, with all of this funding and not have multiple high quality RCTs on this drug? It's sad to say the least. Even if Ivermectin ends up being fairly weak or completely ineffective - surely there's something to learn here...
The thing to learn here is that there's no conspiracy, trials are underway, and science is already working properly.
> Here you have a ton of studies claiming to have found benefit
Maybe the real reason we aren't seeing more trials being funded is that scientists are looking at these early studies and what we already know of the drug and concluding that it's not an avenue worth pursuing? (Especially when we already have several proven vaccines in place).
By way of analogy are you going to invest your time to build a web framework for Cobol running on mainframes? I'm sure it's been done, but it's probably not worth your time to build one as we already have many high quality web frameworks available.
With a meta-analysis, if you detect a high number of fraudulent studies, shouldn’t that negatively affect your trust of the studies which you didn’t detect any problem with?
Let us imagine you looked at 100 papers, and you could tell 99 of them had severe problems, and one looked OK. That information would make you suspicious that the one paper also had severe problems, but that you just didn’t detect the problems.
From article: “We’ve gone from 29 studies to 11, getting rid of 18 along the way. For the record, we eliminated 2/19 for fraud, 1/19 for severe preregistration violations, 10 for methodological problems, and 6 because Dr. Meyerowitz-Katz was suspicious of them.”
This article is a nice counterpoint to what's felt like a trend of Scott's writing (outside of psychology) increasingly becoming contrarianism in search of evidence. Many pieces he's written in the last 1-2 yrs feel like he'll use some back-of-the-envelope calculation to get some ballpark (associative) estimate of some relationship and then base a worldview around it (or work backwards from the latter to the former), decades of causal inference and economics literature be damned. I guess maybe the delineation is social science vs medical science topics. When he's in his wheelhouse he's great to read.
His alien thought experiment in the “Political Takeaway” section at the bottom is a masterpiece. If you’ve struggled to explain where science lost democracy, this must be as crisp as it’ll ever be described.
> People are going to fight hard against this, partly because it’s annoying and partly because of (imho exaggerated) patient privacy related concerns. Somebody’s going to try make some kind of gated thing where you have to prove you have a PhD and a “legitimate cause” before you can access the data, and that person should be fought tooth and nail...
I have a huge amount of respect for Scott, and the rational thinking that he shares with us. However, I'd like to make two arguments against the above.
1. Personally-identifiable information is protected by law over on this side of the pond. This is one of those cases where the thinking is quite different between the US and Europe. In Europe, you need to get the permission of everyone involved in the study before you can publish your data about them, if there is any chance that they can be identified from that data. In a lot of ways this is good, but one way in particular is that it encourages pre-planned proper studies, where you set it all up properly and get every participant to sign the permission sheet, which is good for science.
2. Sometimes absolutely full data release is overkill and inappropriate. For example, if I'm planning to publish a paper saying that mutations in a particular small region of the human genome cause a particular disease, then it is sufficient to publish the list of causative mutations. Full data release would mean publishing the entire sequencing run for the patient - that's inappropriate because you can identify someone from it, and you also then know a huge amount of information about them - their traits and congenital conditions. A lot of journals are pushing for this, and the compromise that we seem to have reached is to store the full sequencing data in a secure repository and provide access given a really good reason. Likewise, a census will report statistics about areas of a country, but the raw data is kept back because it is deeply personal in nature.
So my points are that data shouldn't go into a study unless it can be openly published, and that there are types of raw data that are too personal or voluminous to openly release, and the data derived from it should be released instead.
> This is one of those cases where the thinking is quite different between the US and Europe. In Europe, you need to get the permission of everyone involved in the study before you can publish your data about them, if there is any chance that they can be identified from that data.
In the US there are all sorts of protections for research subjects both in terms of potential harm and privacy. In fact, there are mechanisms to be exempt on keeping consent documentation if that is the primary mechanism in which the subject could be harmed (for instance, in a data leak). His thinking is contentious at best and would generally be regarded as unethical. People seeking medical treatment should not have to agree to have their raw data disclosed and this falls under the undue influence principle of ethical research.
Love the final explanation for how ivermectin can be incidentally good for COVID-19 patients, even if it does nothing to COVID-19 directly.
In fact, as the author cites from another researcher, the trials are a strong piece of evidence for "add[ing] ivermectin to mass drug administration programs." In other words, global medical welfare, where we just give everyone a bunch of a cheap and effective medications to counteract the most prolific diseases. In addition to reducing mortality from diseases targeted by the medication, it will probably reduce incidental mortality when people contract multiple conditions at once. I.e. getting ivermectin for a detected COVID-19 infection has a 10% chance of helping you, because you have a 10% chance of having an undetected worm infection that will kill you if your immune system is suppressed by drugs that are used to prevent COVID-19 from killing you.
I do think the ending political metaphor doesn't quite fit, however. I see more parallels with workplace politics than an alien invasion, for why our societies have become so divided on relatively meaningless issues. Uniting disparate factions to work towards a common goal is an uphill battle that sees more failure than success, most often in our workplaces. To me, the ivermectin drama was just another example of an emergent situation that wasn't optimally handled by a collection of random individuals, who despite the best intentions, were unable to unite a group. Doesn't make them bad people, or mean they have the wrong approach. Just means they weren't ready to tackle such a difficult challenge. Positive outcomes take dedicated effort, they don't come automatically because we assume the status quo is good enough to us immune to random chance.
This is from ivmmeta.com, part of a sprawling empire of big professional-looking sites promoting unorthodox coronavirus treatments. I have no idea who runs it - they’ve very reasonably kept their identity secret - but my hat is off to them...Putting aside the question of accuracy and grading only on presentation and scale, this is the most impressive act of science communication I have ever seen.
I asked a few questions previously on HN about Ivermectin and got answers that killed my interest in the topic (because I don't think it is relevant). But this piece is a delight.
In my opinion, the main crux is this: there are moneyed interests who are motivated to generate mistrust and otherization based on political parties. In the USA, Fox News has a strong incentive to inspire hatred and fear of Democratic policy, and MSNBC has a strong incentive to inspire hatred of the GOP. The same is true for Twitter, FB, NYT, WSJ, WaPo, literally any media outlet. Hatred, fear, outrage, worry, anxiety: they all drive viewers to advertisements.
One major example, these media groups facilitated making a huge rift on climate change belief. The fossil fuel industry saw in the GOP, and some moderate Dems like Manchin, an opportunity to create doubt and slow the transition off their fossil fuel products. Now, the GOP has leaned into anti-scientist, anti-elitist sentiment, fed by Fox News and others. They're not totally anti-science, they still use abortion science, ivermectin science, and all the wonders of modern life...but they ARE anti-scientist, anti-elitist, anti-university.
And Why? We're hating each other so media companies can make a few measly cents.
Funny how all this article ends up saying it's all a matter of trust.
Which is exactly what medecine has always been about, and why ultimately you end up getting prescriptions by you own doctor, that you have a bound with and that you trust.
The most insane thing that happened with this pandemic ( at least in europe) is how we decided to throw all this through the window and let states impose medical decisions on people and their children, not realizing people were still considering them highly incompetent in general.
It was a fun read, but implying that a drug dealer from Kern county is related to a published researcher from Mexico just because they have the same surname is not really cool.
One time I didn't believe Scott when he wrote a "More than you wanted to know" article. This time, I took his word for it and scrolled (and scrolled and scrolled) to the bottom to read the summary.
"It feels right to me because it’s the most troll-ish possible solution. Everybody was wrong!" - I know this is said tongue-in-cheek, but this mischaracterizes the medical scientists who have been working themselves to the bone trying to understand this virus and disease.
Actual medical science, and science in general, doesn't make claims beyond what we know for certain (or at least, we're very explicit about the claim's certainty). And what we know for certain in medical science is actually quite small. People, both for clout and for profit, make up bullshit when there are gaps in knowledge.
"Believing science", as stated a few times in this article, should actually be framed as: reserving judgement until we have evidence. We should have a bit more respect and patience for the process of acquiring actual knowledge. And people who make claims beyond what we actually know should be held accountable culturally (and financially) for being liars.
> This is from ivmmeta.com, part of a sprawling empire of big professional-looking sites promoting unorthodox coronavirus treatments. I have no idea who runs it - they’ve very reasonably kept their identity secret
Why are they hiding their identity? That means that it can be anyone who does this.
-----------------
But even more important. The website also claims that each of the following individual medicines works:
Fluvoxamine
Proxalutamide
Iota-carrageenan
Molnupiravir
Quercetin
Povidone-Iodine
Curcumim
Casirivimab
Sotrovimab
Bamlanivimab
Nitazoxanide
Budesonide
Zinc
Bromhexine
Colchicine
Vitamin D
Aspirin
Favipiravir
Hydroxychloroquine
Remdesivir
Vitamin C
I find it unlikely that all those claims are true which in turn makes me question their scientific approach.
I don't understand the point of the image of the meth seizure when discussing this study [1]. The last name is the same, but if you understand Mexican surnames, it is strongly unlikely that the two different people are in any way closely related. I like reading Scott's writing, but this really detracts from the overall quality of the article, because it seems like a vaguely racist dig without any relevance.
It can be poor writing, intentional obfuscation, misdirection, or a lot of other things, but to jump to racism just because the subject is from a different country than the author is pretty unfair.
I also think it's humor. Scott probably just came across it while searching the name. When you search something on twitter, it is bolded in the results just like in the image.
The caption is an example of irony I think: incongruity between what is expected and what is presented, mixed with saying the opposite of what you mean. Quite clear from context. I laughed when I saw it.
"...everyone still PCR positive by day 7 so it was impossible to compare groups"
Eh, isn't this what a PCR-test does: detect RNA?
A medicine doesn't magically remove virus RNA. It might break down the virus or block it's ability to reproduce but the RNA will still be detected.
With all bashing on Ivermectin, I just wonder what people think about it! First, there's no money to be made from it - no patents, it costs cents per dose, and everybody can manufacture it! Second, it has proven anti-viral properties against HIV, HPV, etc. In general, it's not like some crazy guy decided to use try it against SARS-CoV-2 - scientists were looking to repurpose antivirals. Plus, it has a pretty decent and long-established safety record. Compare it to Remdesivir, let's say, which comes with terrible side effects! Also, the dosage has been pretty low and recommendations have changed - from 0.2mg/kg now it's 0.4-0.6mg/kg with Delta. Pretty much all my friends who followed the I-MASK+ protocol [0], didn't get severe course of COVID-19. Yeah, it's anecdotal data, but there are no exceptions!
[+] [-] Shank|4 years ago|reply
> As best I can tell, this is some kind of Egyptian trial. It might or might not be an RCT; it says stuff like “Patients were self-allocated to the treatment groups; the first 3 days of the week for the intervention arm while the other 3 days for symptomatic treatment”. Were they self-allocated in the sense that they got to choose? Doesn’t that mean it’s not random? Aren’t there seven days in a week? These are among the many questions that Elalfy et al do not answer for us.
[+] [-] PragmaticPulp|4 years ago|reply
This post is a breath of fresh air for the blog and feels refreshingly well-researched. Between that and the unquestionable popularity of COVID-related discussion, it’s no wonder this article is popular.
Scott is undeniably a good blog writer with an entertaining writing style that resonates with his reader base. However, I’ve become disillusioned with a lot of his other recent writings like the “Great Families” post in which he presented a lot of conjecture that pandered to his core readership without any research or evidence to support it. Specifically, his position that genetics are the primary explanation for “Great Families” while ignoring obvious heritability of things like wealth and social status. Even the old Slate Star Codex and new Astral Codex Ten communities started calling him out on it after that article.
Scott’s writings are undeniably entertaining and usually quite fun to read, but I’ve long since learned to read them more critically because his writings have a way of projecting a sort of humble confidence while either hedging any statements so much that little is actually communicated, or sometimes inserting conjecture or feelings with a lot of linguistic window dressing such that it’s easy to mistake it for fact.
I hope this article is a sign that the writings are shifting more toward the old-school, heavily-researched style that made the blog so popular.
[+] [-] jmcgough|4 years ago|reply
> A crazy person decided to put his patients on every weird medication he could think of, and 585 subjects ended up on a combination of ivermectin, hydroxychloroquine, azithromycin, and nitazoxanide, with dutasteride and spironolactone "optionally offered" and vitamin D, vitamin C, zinc, apixaban, rivaraxoban, enoxaparin, and glucocorticoids "added according to clinical judgment". There was no control group, but the author helpfully designated some random patients in his area as a sort-of-control, and then synthetically generated a second control group based on “a precise estimative based on a thorough and structured review of articles indexed in PubMed and MEDLINE and statements by official government agencies and specific medical societies”.
[+] [-] LeifCarrotson|4 years ago|reply
> The fraud-hunters have examined this paper closely and are unable to find any signs of fraud. I think this paper is legitimate and that its findings need to be seriously considered. ... And there’s always the chance it was a fluke, right? Can something have a p-value less than 0.001 and still be a fluke?
...
> And it was! It was a fluke! A literal, physical, fluke!
Edit: If you like puns and this writing, you'll likely enjoy some of Scott's other works, like "The Study of Anglophysics" [1] and (especially if you're at least passingly familiar with Judaism and Kabbalah) Unsong [2].
[1]: https://slatestarcodex.com/2014/04/03/the-study-of-anglophys...
[2]: https://unsongbook.com/
[+] [-] WithinReason|4 years ago|reply
[+] [-] csee|4 years ago|reply
[+] [-] dragontamer|4 years ago|reply
https://www.covid19treatmentguidelines.nih.gov/tables/table-...
NIH seems to have pretty good analysis into Ivermectin. For some reason or another, people don't know it exists. Its pretty straightforward frankly. Turns out that people on the internet are terrible at meta-analysis.
[+] [-] nonameiguess|4 years ago|reply
In short, if you want most journalism to hire licensed medical doctors with decades of experience in science and statistics, and natural writing talent on top of that, expect journalism to get a lot more expensive. A market certainly exists for Scott, but I'm not sure the market exists for all journalists to be as highly qualified as Scott. Or, for that matter, even for CDC and WHO PR arms. They definitely aren't paying their communications officers whatever Substack is paying Scott, or probably even what his psychiatry practice is paying him.
[+] [-] astrange|4 years ago|reply
[+] [-] BurningFrog|4 years ago|reply
This was true before the profession entered the death spiral of the last 1-2 decades, and is extremely true now.
[+] [-] jacquesm|4 years ago|reply
[+] [-] notahacker|4 years ago|reply
(Of course you can also summarise it as "there's weak evidence for Invermectin having some therapeutic benefit which is probably related to preexisting conditions"... but we know how quickly that snowballs into "Invermectin stops COVID, scientists ADMIT IT" by the same people that deny the much stronger evidence for vaccine efficacy. Science journalism is bad, but not as bad as the selective reading of it.)
[+] [-] marcodiego|4 years ago|reply
What they should do is to query specialists to obtain better information, instead of opinions. Consult different views, argue why on view is right or wrong and then inform the public.
[+] [-] marstall|4 years ago|reply
by the way few good science journalists would cover the story this way. instead they would mostly be quoting experts interpreting the significance of the various studies.
And Scott Alexander would never be one of them. Can you imagine a nytimes science writer quoting a psychiatrist on ivermectin's effectiveness? Never happen.
(also all of these sources' coverage of ivermectin has been much more limited because of the fact that the drug is a scam)
[+] [-] roenxi|4 years ago|reply
You can't get this sort of excellent rebuttal without allowing a site like https://ivmmeta.com/ into the debate.
[+] [-] bayesian_horse|4 years ago|reply
Most people who care about this research are indeed crackpots, unfortunately. Those who aren't have mostly moved on from Ivermectin because they have better things to do. Ivermectin is being tested in large RCTs, as it should. If it works, it will be used. If it doesn't, it won't. Until we know, doctors will do what works.
[+] [-] commandlinefan|4 years ago|reply
I fear that if it had any name except Scott Alexander's attached to it, it would have been flagged/dead on here within a few minutes as well.
[+] [-] jacquesm|4 years ago|reply
[+] [-] Imnimo|4 years ago|reply
[+] [-] VBprogrammer|4 years ago|reply
[+] [-] toolz|4 years ago|reply
So you have to ask yourself - when do we get high quality RCTs, who funds them and why? This to me is a clear cut indicator that we have very maligned incentives for health science. How can we be this far into a global pandemic, with all of this funding and not have multiple high quality RCTs on this drug? It's sad to say the least. Even if Ivermectin ends up being fairly weak or completely ineffective - surely there's something to learn here...
[+] [-] resoluteteeth|4 years ago|reply
First world countries are in the process of conducting RCTs testing Ivermectin, for example the activ-6 and covid-out studies in the US.
> So you have to ask yourself - when do we get high quality RCTs, who funds them and why? This to me is a clear cut indicator that we have very maligned incentives for health science. How can we be this far into a global pandemic, with all of this funding and not have multiple high quality RCTs on this drug? It's sad to say the least. Even if Ivermectin ends up being fairly weak or completely ineffective - surely there's something to learn here...
The thing to learn here is that there's no conspiracy, trials are underway, and science is already working properly.
[+] [-] MissionInfl|4 years ago|reply
ACTIV-6's tagline is "Outpatient Repurposed Drugs" which matches up with your description. There are other ACTIV trials with other focuses: https://www.nih.gov/research-training/medical-research-initi...
[+] [-] josho|4 years ago|reply
Maybe the real reason we aren't seeing more trials being funded is that scientists are looking at these early studies and what we already know of the drug and concluding that it's not an avenue worth pursuing? (Especially when we already have several proven vaccines in place).
By way of analogy are you going to invest your time to build a web framework for Cobol running on mainframes? I'm sure it's been done, but it's probably not worth your time to build one as we already have many high quality web frameworks available.
[+] [-] czzr|4 years ago|reply
[+] [-] unknown|4 years ago|reply
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[+] [-] peakaboo|4 years ago|reply
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[+] [-] robocat|4 years ago|reply
Let us imagine you looked at 100 papers, and you could tell 99 of them had severe problems, and one looked OK. That information would make you suspicious that the one paper also had severe problems, but that you just didn’t detect the problems.
From article: “We’ve gone from 29 studies to 11, getting rid of 18 along the way. For the record, we eliminated 2/19 for fraud, 1/19 for severe preregistration violations, 10 for methodological problems, and 6 because Dr. Meyerowitz-Katz was suspicious of them.”
[+] [-] yxwvut|4 years ago|reply
[+] [-] mike_h|4 years ago|reply
[+] [-] mnw21cam|4 years ago|reply
I have a huge amount of respect for Scott, and the rational thinking that he shares with us. However, I'd like to make two arguments against the above.
1. Personally-identifiable information is protected by law over on this side of the pond. This is one of those cases where the thinking is quite different between the US and Europe. In Europe, you need to get the permission of everyone involved in the study before you can publish your data about them, if there is any chance that they can be identified from that data. In a lot of ways this is good, but one way in particular is that it encourages pre-planned proper studies, where you set it all up properly and get every participant to sign the permission sheet, which is good for science.
2. Sometimes absolutely full data release is overkill and inappropriate. For example, if I'm planning to publish a paper saying that mutations in a particular small region of the human genome cause a particular disease, then it is sufficient to publish the list of causative mutations. Full data release would mean publishing the entire sequencing run for the patient - that's inappropriate because you can identify someone from it, and you also then know a huge amount of information about them - their traits and congenital conditions. A lot of journals are pushing for this, and the compromise that we seem to have reached is to store the full sequencing data in a secure repository and provide access given a really good reason. Likewise, a census will report statistics about areas of a country, but the raw data is kept back because it is deeply personal in nature.
So my points are that data shouldn't go into a study unless it can be openly published, and that there are types of raw data that are too personal or voluminous to openly release, and the data derived from it should be released instead.
[+] [-] hervature|4 years ago|reply
In the US there are all sorts of protections for research subjects both in terms of potential harm and privacy. In fact, there are mechanisms to be exempt on keeping consent documentation if that is the primary mechanism in which the subject could be harmed (for instance, in a data leak). His thinking is contentious at best and would generally be regarded as unethical. People seeking medical treatment should not have to agree to have their raw data disclosed and this falls under the undue influence principle of ethical research.
[+] [-] Joking_Phantom|4 years ago|reply
In fact, as the author cites from another researcher, the trials are a strong piece of evidence for "add[ing] ivermectin to mass drug administration programs." In other words, global medical welfare, where we just give everyone a bunch of a cheap and effective medications to counteract the most prolific diseases. In addition to reducing mortality from diseases targeted by the medication, it will probably reduce incidental mortality when people contract multiple conditions at once. I.e. getting ivermectin for a detected COVID-19 infection has a 10% chance of helping you, because you have a 10% chance of having an undetected worm infection that will kill you if your immune system is suppressed by drugs that are used to prevent COVID-19 from killing you.
I do think the ending political metaphor doesn't quite fit, however. I see more parallels with workplace politics than an alien invasion, for why our societies have become so divided on relatively meaningless issues. Uniting disparate factions to work towards a common goal is an uphill battle that sees more failure than success, most often in our workplaces. To me, the ivermectin drama was just another example of an emergent situation that wasn't optimally handled by a collection of random individuals, who despite the best intentions, were unable to unite a group. Doesn't make them bad people, or mean they have the wrong approach. Just means they weren't ready to tackle such a difficult challenge. Positive outcomes take dedicated effort, they don't come automatically because we assume the status quo is good enough to us immune to random chance.
[+] [-] DoreenMichele|4 years ago|reply
This is from ivmmeta.com, part of a sprawling empire of big professional-looking sites promoting unorthodox coronavirus treatments. I have no idea who runs it - they’ve very reasonably kept their identity secret - but my hat is off to them...Putting aside the question of accuracy and grading only on presentation and scale, this is the most impressive act of science communication I have ever seen.
I asked a few questions previously on HN about Ivermectin and got answers that killed my interest in the topic (because I don't think it is relevant). But this piece is a delight.
[+] [-] WhompingWindows|4 years ago|reply
One major example, these media groups facilitated making a huge rift on climate change belief. The fossil fuel industry saw in the GOP, and some moderate Dems like Manchin, an opportunity to create doubt and slow the transition off their fossil fuel products. Now, the GOP has leaned into anti-scientist, anti-elitist sentiment, fed by Fox News and others. They're not totally anti-science, they still use abortion science, ivermectin science, and all the wonders of modern life...but they ARE anti-scientist, anti-elitist, anti-university.
And Why? We're hating each other so media companies can make a few measly cents.
[+] [-] bsaul|4 years ago|reply
Which is exactly what medecine has always been about, and why ultimately you end up getting prescriptions by you own doctor, that you have a bound with and that you trust.
The most insane thing that happened with this pandemic ( at least in europe) is how we decided to throw all this through the window and let states impose medical decisions on people and their children, not realizing people were still considering them highly incompetent in general.
[+] [-] low_tech_love|4 years ago|reply
[+] [-] junon|4 years ago|reply
This is well put. It's pretty remarkable indeed.
[+] [-] pchristensen|4 years ago|reply
[+] [-] beebmam|4 years ago|reply
Actual medical science, and science in general, doesn't make claims beyond what we know for certain (or at least, we're very explicit about the claim's certainty). And what we know for certain in medical science is actually quite small. People, both for clout and for profit, make up bullshit when there are gaps in knowledge.
"Believing science", as stated a few times in this article, should actually be framed as: reserving judgement until we have evidence. We should have a bit more respect and patience for the process of acquiring actual knowledge. And people who make claims beyond what we actually know should be held accountable culturally (and financially) for being liars.
[+] [-] lolspace|4 years ago|reply
Why are they hiding their identity? That means that it can be anyone who does this.
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But even more important. The website also claims that each of the following individual medicines works:
Fluvoxamine
Proxalutamide
Iota-carrageenan
Molnupiravir
Quercetin
Povidone-Iodine
Curcumim
Casirivimab
Sotrovimab
Bamlanivimab
Nitazoxanide
Budesonide
Zinc
Bromhexine
Colchicine
Vitamin D
Aspirin
Favipiravir
Hydroxychloroquine
Remdesivir
Vitamin C
I find it unlikely that all those claims are true which in turn makes me question their scientific approach.
[+] [-] tristor|4 years ago|reply
[1]: https://www.biomedres.info/biomedical-research/effects-of-iv...
[+] [-] djrogers|4 years ago|reply
[+] [-] phdelightful|4 years ago|reply
The caption is an example of irony I think: incongruity between what is expected and what is presented, mixed with saying the opposite of what you mean. Quite clear from context. I laughed when I saw it.
[+] [-] joenot443|4 years ago|reply
[+] [-] BurningFrog|4 years ago|reply
[+] [-] 0des|4 years ago|reply
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[+] [-] Wolf_Larsen|4 years ago|reply
https://www.census.gov/quickfacts/fact/table/bakersfieldcity...
[+] [-] tdrdt|4 years ago|reply
Eh, isn't this what a PCR-test does: detect RNA? A medicine doesn't magically remove virus RNA. It might break down the virus or block it's ability to reproduce but the RNA will still be detected.
[+] [-] nikolay|4 years ago|reply
[0]: https://covid19criticalcare.com/covid-19-protocols/i-mask-pl...