Live data from Hacker News

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

nature.com

181–190 of 493 posts

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

#181
post #179

Earlier quoted context omitted.

No they aren't. All of those reports have been retracted.

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.

Probably ingested the pour on treatment or one of the brands that mix other active ingredients that you don't want.

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

#182
post #25

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 s…

The vaccine is free, so I'm confused about where you get that this is an access issue.

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

#183

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.

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

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

#184
post #106

Earlier quoted context omitted.

> 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.

> There is much less safety data on doses that frequent. You can say the same thing about COVID boosters.

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?

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

#185
post #142

Earlier quoted context omitted.

(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 understandin…

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.

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

#186

Earlier quoted context omitted.

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…

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.

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

#187
post #84

Earlier quoted context omitted.

Is that really the reason or is it that they can't get a doctor to write them an off-label prescription?

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…

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...

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

#188

Earlier quoted context omitted.

> 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,…

>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.

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

#189
post #49

Earlier quoted context omitted.

> 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 practitione…

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.…

> 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.

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

#190
post #65

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.…

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 t…

So what were those other things, then?
Post reply on HN