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

#381

Post by robbiep » Thu, Sep 23, 2021, 2:14 AM UTC

alvah wrote: post #328

scoopertrooper wrote: post #61

Earlier quoted context omitted.

Case fatality has been declining for sure, but it's still at about 3%. So it shouldn't be that hard to find a signal. https://www.abs.gov.au/articles/covid-19-mortality-0 https://www.ajtmh.org/view/journals/tpmd/104/6/article-p2176...

The reported CFR may be in that region, but most credible sources estimate a much lower real CFR, due both to many undetected / asymptomatic infections, and confusion between deaths with & deaths caused by Covid-19. For a statistical reporting agency such as the ABS to claim to know the actual CFR with any level of certainty seems careless at the very least.

The term you are looking for is IFR

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

#382

Post by shusaku » Thu, Sep 23, 2021, 2:16 AM UTC

atty wrote: post #218

What I find almost more interesting than the article itself is the comments that show a non-zero portion of the HN community (which I think is generally more intellectually curious and educated than average) are actually strongly arguing that ivermectin has strong effect, and even crazier, that it may be safer or more effective than the mRNA vaccines. Is this from being incapable of following science and drawing rati…

I really think covid has broken hacker news. Maybe it’s instructive. It’s the most interesting tech story of the decade. I want to know everything about how the virus works, how we can fight back, what new ideas are out there, etc. for a community that loves articles that require thinking, it should be great.

Instead, covid threads are awful. Comments which are pure drivel and talking points are the norm. Politics has infested and rotted our brains.

So with ivermectin, it’s as I was with HCQ or Vitamin D: I’m open minded and intrigued. I want to read the studies, especially the theoretical ones. Let me watch things develop and let medicine take it to patients if the science gets there. But you can’t do that when every other comment is weaponized to the point where people are scarred to read articles because they might contradict their dogma.

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

#383

Post by [deleted] » Thu, Sep 23, 2021, 2:24 AM UTC

cableshaft wrote: post #369

ashtonkem wrote: post #365

Earlier quoted context omitted.

> But I still don't think pharmacists should be able to just override the decision of a doctor. You’re free to believe that, but understand that this is well in the “wishes and hopes” territory more than a factual understanding of how doctors, patients, and pharmacists actually interact. Personally I believe the idea that we’d spend a huge amount of time and effort as a society training a whole class of specialists a…

> “My experience is enough to determine for everyone else” is a really bad look. Let's put it this way, I haven't seen any evidence based on what I've seen that this isn't the normal interaction with a pharmacist after decades of seeing pharmacists myself, or sitting waiting for my parents to get medicine filled, or watching other users interact with pharmacists while I've been waiting in line, etc., across multiple…

[deleted]

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

#384

Post by cableshaft » Thu, Sep 23, 2021, 2:26 AM UTC

ashtonkem wrote: post #365

cableshaft wrote: post #364

Earlier quoted context omitted.

Not really disagreeing that a pharmacist might know more about the drugs than a doctor. I wasn't warned about the potential side effects of Ciprofloxacin once, just told it was an "antibiotic" by the specialist I saw, and the pharmacist did clue me in about some side effects, which I promptly had some of the worst ones after a single pill. I might not have made the connection it was a bad reaction to the pills withou…

> But I still don't think pharmacists should be able to just override the decision of a doctor. You’re free to believe that, but understand that this is well in the “wishes and hopes” territory more than a factual understanding of how doctors, patients, and pharmacists actually interact. Personally I believe the idea that we’d spend a huge amount of time and effort as a society training a whole class of specialists a…

> You’re free to believe that, but understand that this is well in the “wishes and hopes” territory more than a factual understanding of how doctors, patients, and pharmacists actually interact.

I made a good faith effort in researching this, and here are some examples of interaction you might be alluding to:

1. The doctor made an obvious mistake in dosage or a might not be aware of safer alternatives and the pharmacist contacts the doctor to verify that there wasn't a mistake on the prescription or mention those alternatives and see if they can persuade the doctor to change the prescription. Great, no issues with me. Everyone makes human mistakes. I do it in software also.

2. Something obvious they can see about the patient gives them some information that contradicts the prescription (i.e. an obviously pregnant women being given a drug that's dangerous to pregnant people). Again, they contact the doctor to inform and verify. Again, no issues from me.

3. Patients sometimes see other specialists and get prescriptions from them without informing their PCP (sometimes on accident), whereas a pharmacy probably sees all of these prescriptions, and can catch when two prescriptions could have dangerous interactions that a PCP or specialist might not realize they were causing because they weren't aware of the other prescription. Again they contact the physician and verify. Again, no issues from me.

4. The pharmacist has a religious reason not to want to fulfill a prescription. Some states that's allowed, some they aren't. In those where it's allowed, most pharmacies have a policy that they must allow another pharmacist at the facility to fulfill the prescription or help transfer the prescription to another doctor. Fine with me.

Note that for the first three, they generally contact the doctor and verify/try to persuade, not outright override and refuse. They help catch problems, not generally cause them. It looks like there are several states where pharmacists are actually required to provide medication[1], although that link mentions specifically personal beliefs, so I don't know if it applies for the other three issues as well.

If that's all you mean, then I don't think we disagree actually. But it doesn't look like it's as clear-cut legally as you were suggesting before, and I'm far from alone in thinking that pharmacists can't just decide never to fulfill a prescription without a damn good reason (i.e. it's definitely going to kill the patient).

[1]: https://www.nbcnews.com/news/us-news/can-pharmacist-legally-...

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

#385

Post by ashtonkem » Thu, Sep 23, 2021, 2:34 AM UTC

cableshaft wrote: post #384

ashtonkem wrote: post #365

Earlier quoted context omitted.

> But I still don't think pharmacists should be able to just override the decision of a doctor. You’re free to believe that, but understand that this is well in the “wishes and hopes” territory more than a factual understanding of how doctors, patients, and pharmacists actually interact. Personally I believe the idea that we’d spend a huge amount of time and effort as a society training a whole class of specialists a…

> You’re free to believe that, but understand that this is well in the “wishes and hopes” territory more than a factual understanding of how doctors, patients, and pharmacists actually interact. I made a good faith effort in researching this, and here are some examples of interaction you might be alluding to: 1. The doctor made an obvious mistake in dosage or a might not be aware of safer alternatives and the pharmac…

Pharmacists can refuse to fill prescriptions they believe will harm the patient. The law does not restrict it to the narrow circumstances you have listed. “You are giving a deworming medicine for Covid as an off label use. No, I believe that this will harm the patient” is 100% within their legal right. My state explicitly states that every pharmacist should consider whether an act is “consistent with the licensee or registrant’s education, training or practice experience” even if it is not expressly forbidden by the bylaws. This is much more expansive than you’re implying.

Legally in my state they must refuse to fill prescriptions they believe were not created by a proper doctor patient relationship, which includes a lot of these Ivermectin phone doctors. But that’s a slightly different issue.

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

#386

Post by adamdusty » Thu, Sep 23, 2021, 2:37 AM UTC

toss1 wrote: post #89

greenonions wrote: post #39

Earlier quoted context omitted.

I agree, though there are two obvious courses of action that result from this: 1. Prevent the viewing 2. Increase the readiness Of which I think #2 is most preferable.

#2 is for sure bviously preferable, but Good Luck With That. Once you get below the top N% in intelligence levels (5%-20% in my experience), the ability to 1) understand any kind of complex systems, 2) read, understand, contextualize and retain data, and maintain any rigorous logical thinking structure (e.g., keeping previously eliminated options eliminated) declines rapidly. The result is that, despite having absolu…

Is there any evidence that intelligence is genetic? I dont think your height was stopping you from getting to the NBA, nor is that even remotely obvious. You may find your height to be discouraging, but you could have very well possessed the potential to play professional basketball. You'd be 3 inches taller than Muggsy Bouges who played for 14 seasons, 1 inch taller than 13 year vet Earl Boykins, and the same height as slam dunk contest champion Spud Webb.

Colleges might be letting more people through, but I dont think people are any dumber. Some people just aren't concerned with understanding everything they come across. Some kids go to college for no other reason than that's what they're supposed to do. If they cared they would be able to learn just as much as you or anyone else.

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

#387

Post by colordrops » Thu, Sep 23, 2021, 2:39 AM UTC

dboreham wrote: post #338

trts wrote: post #162

Earlier quoted context omitted.

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…

In my mind, there is also underlying all this the idea that if a drug actually works, then there will be many doctors going on CNN to say that it totally works; that they're super excited by their patients recovering. In other words, the effect should be profound. If the effect is marginal, why bother, even if it is a real measurable effect in well conducted trials? I mean : that doctors observe that some therapy or…

Determining effectiveness through the number or media reach of doctors talking about it is the opposite of science.

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

#388

Post by trainsplanes » Thu, Sep 23, 2021, 2:43 AM UTC

tootie wrote: post #180

rory wrote: 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…

On The Media did a really good segment with a journalist from Mother Jones of all places. She broke down the rise of Ivermectin and the whiplash response to demonize it even when, as you say, it is safe for human consumption and had at least some positive in vitro test results. As much as it is not worthy of being recommended as a treatment, it's unlikely to be harmful and has/had at least a slim chance of working. h…

One problem is that people are self-treating with it. Eyeballing measurements of medicine bought at a farm supply store and sticking it in your child's mouth isn't good.

Furthermore, enabling random unproven treatments is on the same level as saying we should stand by and support homeopathic treatments as a valid alternative to vaccines during a pandemic. We don't let people choose between a tetanus shot or a cup of green tea and olive oil when they step on a rusty nail. It doesn't make sense to let them choose between worm meds and a vaccine when it comes to covid.

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

#389

Post by colordrops » Thu, Sep 23, 2021, 2:44 AM UTC

dataduck wrote: post #69

greenonions wrote: post #39

Earlier quoted context omitted.

I agree, though there are two obvious courses of action that result from this: 1. Prevent the viewing 2. Increase the readiness Of which I think #2 is most preferable.

Perhaps, but unfortunately #1 is more realistic.

Hiding science from the public has got to be one of the worst suggestions I've ever heard on this site.

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

#390

Post by gnicholas » Thu, Sep 23, 2021, 2:46 AM UTC

ekianjo wrote: post #330

gnicholas wrote: post #128

Earlier quoted context omitted.

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.

how would you know when they actually started the analysis?

That's one of the reasons I was asking. Perhaps they could pre-register prior to being given the full data from other studies?