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

#161

Post by [deleted] » Wed, Sep 22, 2021, 5:50 PM UTC

sjwalter wrote: post #160

PaulDavisThe1st wrote: post #144

Earlier quoted context omitted.

> "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.

[deleted]

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

#162

Post by trts » Wed, Sep 22, 2021, 5:51 PM UTC

Spellman wrote: post #90

gwerbret wrote: post #44

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…

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…

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.

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

#163

Post by ashtonkem » Wed, Sep 22, 2021, 5:51 PM UTC

sjwalter wrote: post #160

PaulDavisThe1st wrote: post #144

Earlier quoted context omitted.

> "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.

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.

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

#164

Post by PaulDavisThe1st » Wed, Sep 22, 2021, 6:20 PM UTC

sjwalter wrote: post #160

PaulDavisThe1st wrote: post #144

Earlier quoted context omitted.

> "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.

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.

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

#165

Post by ashtonkem » Wed, Sep 22, 2021, 6:27 PM UTC

dionian wrote: post #59

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.…

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...

“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.

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

#166

Post by simpleguitar » Wed, Sep 22, 2021, 6:50 PM UTC

rory wrote: post #116

simpleguitar wrote: post #94

Earlier quoted context omitted.

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.

This is true, but just because the two are on opposite sides of the culture war doesn't mean they're medically mutually exclusive.

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.

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

#167

Post by ashtonkem » Wed, Sep 22, 2021, 6:51 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…

> 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?

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

#168

Post by simpleguitar » Wed, Sep 22, 2021, 6:54 PM UTC

rubatuga wrote: post #139

pjc50 wrote: post #126

Earlier quoted context omitted.

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.

Poison control center calls are not poisonings. There were no significant increases in hospitalizations due to ivermectin. It's a fear-mongering article.

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/

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

#169

Post by twofornone » Wed, Sep 22, 2021, 7:12 PM UTC

anoonmoose wrote: post #115

twofornone wrote: post #21

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 prescript…

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?

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.

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

#170

Post by ashtonkem » Wed, Sep 22, 2021, 7:13 PM UTC

tehjoker wrote: post #70

sjwalter wrote: post #45

Earlier quoted context omitted.

> 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 scient…

"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 μM 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 fo…

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-...