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Lesson of ivermectin: meta-analyses based on summary data alone are unreliable

nature.com

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Re: Lesson of ivermectin: meta-analyses based on summary data alone are unreliable

#121
post #66

Earlier quoted context omitted.

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-do…

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 wh…

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.

Re: Lesson of ivermectin: meta-analyses based on summary data alone are unreliable

#122

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-analys…

It's so easy to abuse meta-analysis, you simply modify the inclusion criteria until you get the results you're looking for.

Re: Lesson of ivermectin: meta-analyses based on summary data alone are unreliable

#123
post #95

Earlier quoted context omitted.

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 u…

> (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 t…

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...

Re: Lesson of ivermectin: meta-analyses based on summary data alone are unreliable

#124
post #88

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.

You're better off if you only associate "JRE" with Java.

People shouldn't be taking medical advice from JRE (or celebrities (or politicians)), but what's wrong with his podcast?

Re: Lesson of ivermectin: meta-analyses based on summary data alone are unreliable

#125
post #27

Earlier quoted context omitted.

> 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.

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 n…

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.

Re: Lesson of ivermectin: meta-analyses based on summary data alone are unreliable

#126

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.

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.

Re: Lesson of ivermectin: meta-analyses based on summary data alone are unreliable

#127
post #109

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.

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.

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.

Re: Lesson of ivermectin: meta-analyses based on summary data alone are unreliable

#128

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-analys…

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.

Re: Lesson of ivermectin: meta-analyses based on summary data alone are unreliable

#129

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-analys…

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.

Re: Lesson of ivermectin: meta-analyses based on summary data alone are unreliable

#130

Earlier quoted context omitted.

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)?

There's a right-wing group prescribing it: https://en.m.wikipedia.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 spre…

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...

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