Lesson of ivermectin: meta-analyses based on summary data alone are unreliable • Hacker News Board

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

#151

Post by anshorei » Wed, Sep 22, 2021, 5:15 PM UTC

danaris wrote: post #66

sjwalter wrote: post #50

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…

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.

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

#152

Post by JohnWhigham » Wed, Sep 22, 2021, 5:16 PM UTC

xdennis wrote: post #118

ashtonkem wrote: post #30

Earlier quoted context omitted.

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 m…

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?

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.

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

#153

Post by jdsfighter » Wed, Sep 22, 2021, 5:16 PM UTC

buescher wrote: post #60

shadowgovt wrote: post #36

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)?

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.

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.

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

#154

Post by JoshuaDavid » Wed, Sep 22, 2021, 5:17 PM UTC

acdha wrote: post #53

mikeyouse wrote: post #42

Earlier quoted context omitted.

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..

> 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 a…

> 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.

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

#155

Post by shadowgovt » Wed, Sep 22, 2021, 5:21 PM UTC

h2odragon wrote: post #131

shadowgovt wrote: post #123

Earlier quoted context omitted.

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 w…

> 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…

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.

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

#156

Post by acdha » Wed, Sep 22, 2021, 5:26 PM UTC

JoshuaDavid wrote: post #154

acdha wrote: post #53

Earlier quoted context omitted.

> 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 a…

> 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 int…

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.

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

#157

Post by defaultprimate » Wed, Sep 22, 2021, 5:29 PM UTC

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.ncbi.nlm.nih.gov/pmc/articles/PMC7968425/

https://journals.lww.com/americantherapeutics/fulltext/2021/...

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

#158

Post by buu700 » Wed, Sep 22, 2021, 5:35 PM UTC

rory wrote: post #142

buu700 wrote: post #92

Earlier quoted context omitted.

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 equivalen…

(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 kicki…

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.

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

#159

Post by hackingforfun » Wed, Sep 22, 2021, 5:42 PM UTC

anshorei wrote: post #150

hackingforfun wrote: post #99

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, ju…

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…

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...

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

#160

Post by sjwalter » Wed, Sep 22, 2021, 5:45 PM UTC

PaulDavisThe1st wrote: post #144

sjwalter wrote: post #56

Earlier quoted context omitted.

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.…

> "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.

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.