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

nature.com

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

#41

Post by scoopertrooper »

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.

What's the motivation for this sort of thing? It seems the very thing they crave (attention) will invariably bring them undone as attention invites scrutiny.

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

#42

Post by mikeyouse »

_2d30 wrote: post #27
gonational wrote: post #9

Because there are so many studies of ivermectin and because it is so widely used, of course there are going to be bunk studies and scientifically invalid studies. Do you know how I know this? I know this because it was recently shown (within the past ten years) that something like 70% of scientific studies can't be reproduced (read: they're BS). So if were going to use scientific studies at all, to inform our decisio…

> There are literally no studies proving that the Pfizer or Moderna gene therapies are safe and effective, or even that they are safe or effective, at both treating and preventing the spread of COVID-19. This is... wildly incorrect.

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..

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

#43

Post by burkaman »

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…

There is a federally funded widespread trial, but they take a while to do correctly: https://www.nih.gov/research-training/medical-research-initi...

There was also a federally funded trial of hydroxychloroquine last year which has since concluded: https://www.nih.gov/news-events/news-releases/nih-halts-clin...

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

#44

Post by gwerbret »

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-analysis be scientifically rigorous in themselves. Unfortunately, this is almost never the case. The great utility of the meta-analysis in the clinical literature is such that there have emerged a series of standards for how to conduct such analyses, such as controlling for bias, controlling for variability, etc. These seldom include actual assessment of the scientific quality of the studies, as this is harder to standardize. Consequently, there is a preponderance of meta-analyzes that come to conclusions that are simply not justified, because the studies themselves were not scientifically rigorous.

I believe this applies to the situation of ivermectin, and it just so happens that this is the thrust of the point raised in the Nature article cited here.

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

#45

Post by sjwalter »

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 scientific investigations that can lead to medical breakthroughs.

The evidence for IVM as a treatment for covid (and many other viruses) is quite strong.

There is, no, no large-scale RCT for IVM. However, it is inherently obvious that none will happen, none that give it a fair shake.

The entire public health apparatus in the West has a huge desire to treat all illness with only on-patent, new medications.

Do you not thin that this incentive influences what gets into the news?

Do you think the public health authorities in Uttar Pradesh (https://indianexpress.com/article/cities/lucknow/uttar-prade...) are lying?

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

#46

Post by gdulli »

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…

The "horse dewormer" aspect is definitely a red herring, while the underlying problem is the choice to self-medicate based on culture war status of vaccines vs. talk-show-host-endorsed drugs. And the inevitable overdoses resulting from that. The media is not wrong to discourage this type of self-medication.

But access to the vaccines here is free and widespread now, so while we could talk all day about problems with access to health care in this country, it doesn't apply here. People may be choosing to distrust the vaccines and thus triggering a shortage of beds and treatment that they themselves will later need.

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

#47

Post by rory »

ashtonkem wrote: post #30
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…

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…

Although it has more dangers than ivermectin, why shouldn't you have access to ketamine if you feel it helps you? A lot of people believe it has off-label benefits for their mental health, and maybe it does.

Perhaps we just have different general perspectives on the individual and society.

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

#48

Post by ashtonkem »

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…

Feel free to actually read the article, it covers this.

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

#49

Post by mlyle »

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…

> 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 practitioner intuition can definitely point at worthwhile things to study rigorously, even if most of what they generate is trash.

> The evidence for IVM as a treatment for covid (and many other viruses) is quite strong.

??? Quite a leap you made there.

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

#50

Post by sjwalter »

burkaman wrote: post #43
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…

There is a federally funded widespread trial, but they take a while to do correctly: https://www.nih.gov/research-training/medical-research-initi... There was also a federally funded trial of hydroxychloroquine last year which has since concluded: https://www.nih.gov/news-events/news-releases/nih-halts-clin...

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-doctor NGO workers.
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