Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

nature.com

Post reply on HN
Print view View original

391–400 of 493 posts

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

#391

Post by rapind »

ekianjo wrote: post #329
tantalor wrote: post #82

Earlier quoted context omitted.

FiveThirtyEight weights its averages by pollster accuracy/methodology. Next, we determine how much weight to give each poll in our average. First, polls conducted by pollsters with higher FiveThirtyEight pollster ratings — a letter grade measuring how accurate and methodologically sound pollsters are — are given more weight https://fivethirtyeight.com/features/how-were-tracking-joe-b...

FiveThirtyEight forecasts are very questionable themselves. Been completely wrong on multiple counts.

So is the weather forecast though. 10% chance of rain tomorrow means, yeah it could rain. Doesn't mean it isn't useful.

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

#392

Post by [deleted] »

mcguire wrote: post #319
mpalczewski wrote: post #285

Earlier quoted context omitted.

Calling it horse dewormer is either propaganda, or just a plain bad faith argument. The inventors of this drug won a Nobel prize for the discovery and it’s use in humans. It’s recognized as an essential drug.

...as a dewormer.

[deleted]

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

#393

Post by evv555 »

hellotomyrars wrote: post #376
evv555 wrote: post #363

Earlier quoted context omitted.

>Sorry what is the conflict of interest in offering the most accurate information they can? * When Fauci was telling people masks aren't needed was he speaking as a scientific authority giving "most accurate information" or was he speaking as a bureaucrat concerned about ppp availability for hospitals? * When WHO goes against the booster shot narrative is it because of the science or is it because they want vaccines…

With respect, Decisions have to be made and in the early days surrounding the pandemic PPE for hospitals is an important thing to have. If that is the motivation that is quite literally a medical and health authority decision and also valid. Information in hindsight change things. Triage isn’t politics. You can disagree but I think calling it playing politics is pretty absurd. Re: Booster shots So which health author…

>Triage isn’t politics. You can disagree but I think calling it playing politics is pretty absurd.

You would call it "giving most accurate information" which is technically true but in a legalese sense. Not in a building trust with society sense.

>Nothing about the wuhan lab origin is particularly relevant or important as far as the issues of treatment go. I agree this is an entirely political issue, but it is also divorced from what has become politicized as far as COVID treatment and vaccines.

It's relevant to the issue of being a trustworthy authority figure. The response of the government/media was to censor this narrative while Fauci was internally exchanging emails about it. Not only did it set a new precedent but it was for questionable reasons because like you say they are orthogonal issues from perspective of finding scientific solutions. In other words they squandered the trust of the people for completely political reasons.

>There have always been people skeptical of the government. There have always been antivax people. But the flames that are fanning these, especially now are explicitly being done so by political elements for their own personal political gain.

We are passed that point. We are at a point where many bureaucrats feel justified operating in "post-truth" worldviews. They have gone from reacting to bad faith actors to themselves being part of the systemic problem.

>Does rejecting (especially) vaccines and masks in spite of the quantifiable data about their efficacy make sense? No.

In the context of both parties using the pandemic as a wedge issue for their own causes. In the context of all the doubt medical institutions have generated for themselves. It's not a surprising outcome on the social level.

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

#394

Post by cmrdporcupine »

rory wrote: post #254
shapefrog wrote: post #247

Earlier quoted context omitted.

Why not all drugs of all types. Why call it an opiod crisis and not just here is what happens when you give everyone whatever drugs they hear on the internet make you feel good? First you deny someone ivermectin, next minute you are saying only 1 oxycotin with your beer.

The important difference between these drugs is that opiates are incredibly addictive, while ketamine is less addictive than tobacco or alcohol. Ivermectin isn't addictive at all. Ironically, the opioid crisis is caused far more by people's trust in mainstream medicine than by any internet fad.

Repeated recreational use of ketamine over years can lead to permanent urinary tract damage, potentially leading to incontinence, etc. "Ketamine bladder syndrome"

https://www.nursingtimes.net/clinical-archive/medicine-manag...

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

#395

Post by cableshaft »

ashtonkem wrote: post #385
cableshaft wrote: post #384

Earlier quoted context omitted.

> 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…

I'm not going to go down the Ivermectin research hole as I've mostly been avoiding it myself.

But Ivermectin is not just a "dewormer" as the media has been running with to sensationalize things and try to throw shade at Joe Rogan for taking, and is known to have antiviral and anti-inflammatory properties, and is known to be safe in proper doses because it's been prescribed to humans for quite some time.

Dr. John Campbell is a highly respected doctor that, since the beginning of this pandemic, has been going over medical studies and data and making them understandable to the general public (I do watch a good handful of his videos, but I've been skipping the Ivermectin ones up until tonight).

The very first video[1] of him going over Ivermectin has a peer-reviewed meta-study that gives moderate-certainty level evidence that when clinicians have given Ivermectin to patients it's resulted in a 62% reduced risk of death compared to not taking it. And honestly that surprised me, up until I watched that tonight I was certain he was going to say it may have had a very mild positive effect and that's all.

[1]: https://www.youtube.com/watch?v=3j7am9kjMrk

I also know my friend highly respects this guy and watches his videos a lot as well. Probably why he was seeking the prescription in the first place, was after seeing the information from these studies, instead of just "well the FDA hasn't approved it therefore it's poison".

Again I'm not going to dig deeper than that right now, I've already spent most of my limited free time this evening doing this instead of other productive things. But yeah, sure looks like a pharmacist could potentially be doing harm by preventing these prescriptions from fulfilling.

I don't even care about this drug specifically (I've been actively avoiding reading up on it and just threw it in with Hydroxychloroquine as a non-drug up until now). It just bothered me to learn that pharmacists were refusing to fill a prescribed drug.

And after listening to my friend provide his reasoning for wanting to take it in small doses, I figured he had researched this a lot more than I had up to this point and was willing to give him the benefit of the doubt.

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

#396

Post by gjsman-1000 »

tantalor wrote: post #82
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…

FiveThirtyEight weights its averages by pollster accuracy/methodology. Next, we determine how much weight to give each poll in our average. First, polls conducted by pollsters with higher FiveThirtyEight pollster ratings — a letter grade measuring how accurate and methodologically sound pollsters are — are given more weight https://fivethirtyeight.com/features/how-were-tracking-joe-b...

FiveThirtyEight is literally owned by Disney - and should be treated as such. How is FTE determining their "pollster rating"?

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

#397

Post by pid-1 »

rapind wrote: post #391
ekianjo wrote: post #329

Earlier quoted context omitted.

FiveThirtyEight forecasts are very questionable themselves. Been completely wrong on multiple counts.

So is the weather forecast though. 10% chance of rain tomorrow means, yeah it could rain. Doesn't mean it isn't useful.

You can check rain forecast results thousands of times and estimate how often they are correct.

Assigning probabilities to events that happen infrequently (US pres. Elections, wars, end of the world...) is bullshit IMO.

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

#398

Post by Izkata »

atty wrote: post #311
rajin444 wrote: post #252

Earlier quoted context omitted.

Your post is assuming a lot of this science is "settled". I don't think science is settled - especially in this field. Acknowledging that your own statements may be incorrect might help you down the path to figuring out a fix. Hint: as soon as you know you're right, and you make statements based on that, when you're inevitably wrong (not saying this in a disparaging way - making sense and being right through all this…

Settled is a strong claim, but as far as I’m aware (I have many connections amongst the medical and epidemiological communities), the general consensus is that ivermectin does not work. For instance, the FDA, WHO, the AMA, the American Pharmacists Association, and the American Society of Health-System Pharmacists all say it should not be used outside of clinical trials because there is no good evidence for it, and ev…

> but as far as I’m aware (I have many connections amongst the medical and epidemiological communities), the general consensus is that ivermectin does not work.

> For instance, the FDA, WHO, the AMA, the American Pharmacists Association, and the American Society of Health-System Pharmacists all say it should not be used outside of clinical trials because there is no good evidence for it

These two statements don't mean the same thing. The stance for the FDA in particular is not "does not work" but is "we don't know (trials are ongoing), so we don't recommend it".

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

#399

Post by unmole »

sjwalter wrote: post #45
ashtonkem wrote: post #26

The other takeaway is that preprint publication is a pathway ripe for abuse. The major paper that drove most of this situation, and the meta analysis, appears to have been a straight up fraud. But it got circulated a lot as a preprint to people who didn’t understand the difference between a preprint and a peer reviewed paper. If the preprint had been more private, this might have been averted.

> 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…

> Do you think the public health authorities in Uttar Pradesh are lying?

Yes.

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

#400

Post by mythrwy »

winocm wrote: post #186
hackingforfun wrote: post #159

Earlier quoted context omitted.

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…

Viral evolution may have different _mechanisms_ then antibiotic evolution (which is what you go on to post about) but this does not mean it does not have similar _dynamics_, i.e patterns of growth.
Post reply on HN