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Ivermectin: Much More Than You Wanted to Know

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Re: Ivermectin: Much More Than You Wanted to Know

#701

Post by kragen »

thaumaturgy wrote: post #51
roenxi wrote: post #27

Earlier quoted context omitted.

> This is the first anti-Ivermectin argument that you want to believe... I discounted a highly biased echo chamber in social media and more traditional media and went with 30-odd studies that appear to have been assembled in good faith even now. I changed my mind immediately on seeing "Parasitic worms are a significant confounder in some ivermectin studies, such that they made them get a positive result even when hon…

May I ask, completely sincerely, what approach you would settle on for trying to discriminate truth from fiction if you believed you couldn't get reliable information from reading 30-odd studies?

If the 30-odd studies are chosen adversarially to persuade you to believe something that isn't true, probably asking someone more trustworthy for relevant studies would be a good idea.

If you're not familiar with the field the studies are in, it might be a good idea to rely on the opinion of someone who is; unfortunately, this means you have to judge whose opinion to rely on, which puts you in the position of trying to guess who's really familiar with the field. It's going to be hard for you to do better at this than just believing whatever is most popular.

Scott Alexander wrote a post about this actually: https://slatestarcodex.com/2019/06/03/repost-epistemic-learn...

Re: Ivermectin: Much More Than You Wanted to Know

#702

Post by kragen »

notafraudster wrote: post #228
csee wrote: post #192

Earlier quoted context omitted.

Why wait? Why not take ivermectin as a precautionary therapeutic given it is well tolerated with low risk of side effects? There's a chasm between the epistemic question of "does this drug really work?" and the pragmatic question of "does a risk-reward analysis under uncertainty say that I should take this mostly safe drug that might slightly reduce my covid severity?" FWIW, I wouldn't take ivermectin either as a pro…

What other prophylactic treatments do you take in your life before or after COVID? Because in my lifetime I can think of only a small number of classes of general prophylactic treatments I've ever seen a small number of groups of people take. - Silicon valley rationalist types taking stacks of vitamins despite having no evidence on bioavailability because they are generally without side effects and who knows, you mig…

I took chloroquine as a prophylactic treatment. Not against covid, obviously; against malaria. Also, I took prophylactic treatments for measles, mumps, rubella, tetanus, polio, and another dozen or so diseases. I'm currently taking vitamin D; my original justification for this was as a prophylactic against covid, but now it's just a prophylactic against hypovitaminosis D.

I had alarming symptoms after the chloroquine treatments, and regret having done it. But nobody would ever put chloroquine in the "no known side effects" bucket.

Re: Ivermectin: Much More Than You Wanted to Know

#703

Post by beagle3 »

jacquesm wrote: post #198
beagle3 wrote: post #178

Earlier quoted context omitted.

I admire your conviction. And I suspect you would have had the same conviction about smoking had you lived in the 1960s and noticed that many doctors recommended smoking. No, it does matter why a doctor believes what they believe. The vast majority of them just follow the official top down advice. And some actors, notably tobacco and pharmaceutical industries, have been using that to subvert science (to great effect…

In the 1960's smoking was already considered very bad for your health, in fact a large 1951 study amongst the doctors themselves pretty much proved that, but that didn't stop lobbying and advertising by the Tobacco companies, including the use of actors posing as doctors from continuing to push the false narrative and if not for some pretty heavy legal restrictions they would still be doing this today (and they still…

> but it's the wrong conclusion to make that if doctors were wrong about smoking they are also wrong about everything else. Usually they are not.

Indeed. And usually, there is no significant objection to the medical consensus, so it is irrelevant the "all medical advice" space.

The interesting (from my perspective, but also from an information theoretic one) things are those about which there is disagreement. And the "usually right" on those subjects goes down significantly - perhaps it's still "usually", but maybe it's just 60% rather than the 99% of the "right" things which inspire people to blindly believe doctors about everything. And perhaps it's just 20%; We'll likely know about today's status only in 30 years.

For example, there is still consensus about statin use to reduce cardiac problems through cholesterol lowering. I looked a little into that; the evidence is severely lacking, especially if you consider all cause mortality rather than just "lowering myocardial infraction risk" (which you can achieve 100% with Cyanide!). I have informally surveyed about 20 doctors, of which one was a cardiologist. Everyone other than the cardiologist was convinced statins are the best thing since sliced bread, have no risks, and excellent efficiency. Not one of them actually knew much about, e.g. statin effect on all cause mortality, or much of anything else related to statins except the official line and up-to-date (the service) summaries. The cardiologist still thought statins were a good thing, but was much more reserved about recommending them to anyone with high blood lipids, because he actually read the research and had actual experience (and discussions with informed colleagues).

Re: Ivermectin: Much More Than You Wanted to Know

#704

Post by tqi »

jacquesm wrote: post #555
tqi wrote: post #406

Earlier quoted context omitted.

I think that rationale is patronizing nonsense. At best, this behavior is short-sighted and forgets erosion of trust is cumulative.

Agreed it is patronizing. Knowing quite a few people, I'm not sure that isn't the right approach. People just want to get on with their lives, they don't want to know the degree of uncertainty behind decision x or y. And they'll believe anybody that tells them whatever they want to hear that allows them to get on with their lives. A guy like Fauci has very little choice: he can either lie, or he can cause a mass pani…

> he can either lie, or he can cause a mass panic or a run on critical resources

Agree that Fauci was/is in a tough spot, but I think it's a mistake to conceptualize these decisions as a stage game as opposed to a repeated game. "Lying" or selectively emphasizing truths to achieve a specific outcome is borrowing against future trust in an effort to solve the present problem, and is suboptimal long term.

Re: Ivermectin: Much More Than You Wanted to Know

#705

Post by kragen »

jacquesm wrote: post #613
jonnycoder wrote: post #604

Earlier quoted context omitted.

You make a good point even though I take supplements such as vitamin d, etc. I would argue that the human body is already so complex that troubleshooting it similar to how we troubleshoot software is not a fair comparison because software is easier in a relative sense!

Would you rather trust a software guy or a doctor, even a very good one, to troubleshoot a computer program?

You mean Con Kolivas? I'd trust Con Kolivas over most "software guys".

Re: Ivermectin: Much More Than You Wanted to Know

#706

Post by beagle3 »

mikeyouse wrote: post #377
beagle3 wrote: post #184

Earlier quoted context omitted.

Indeed, the oath is a theatre prop and not much more. I reside in Israel these days, which has a system similar to NL ttbomk. The doctors that treat you (in the public system) are not incentivized other than to cure you, except perhaps through the occasional marketing cruise. But high up ministry of health people have been indicted (including through corona) for pushing and in some cases mandating useless treatments…

This is a good example of how ill-equipped most people are to forming their own opinions about things this complex. The WHO recommends against using remdesivir in hospitalized patients -- which is very different from your claim! The FDA and others make their cutoff point slightly but not substantially later, e.g. remdisivir isn't indicated when a hospitalized patient is on high-flow oxygen. Their disagreement isn't o…

You are arguing against a point I didn't make, and supporting the point I was trying to make.

I actually read the papers on remdesivir, and as a result decided that I will not take it if offered, whether hospitalized or not, because of my risk/reward preferences, which may or may not align with the doctor's or the system's.

In Israel (where I now reside), AFAIK, they are happily administering it to hospitalized covid patients; at least, they were giving it out a lot until they started treating with regeneron. Now, Israel has its own definition for requiring hospitalization than the WHO or the FDA (e.g. SpO2Do you think the doctors treating covid are actually aware of the minute differences between WHO, FDA, IMOH definitions? I checked with a couple I know. They have no idea.

Re: Ivermectin: Much More Than You Wanted to Know

#707

Post by kragen »

jacquesm wrote: post #214
csee wrote: post #192

Earlier quoted context omitted.

Why wait? Why not take ivermectin as a precautionary therapeutic given it is well tolerated with low risk of side effects? There's a chasm between the epistemic question of "does this drug really work?" and the pragmatic question of "does a risk-reward analysis under uncertainty say that I should take this mostly safe drug that might slightly reduce my covid severity?" FWIW, I wouldn't take ivermectin either as a pro…

> given it is well tolerated with low risk of side effects That's not a given, that depends on the patient, the dose and a host of other factors. You may well end up harming someone significantly. You are in no position to proscribe any kind of medication to someone else unless you happen to be a licensed practitioner.

While it's true that virtually any substance has a toxic dose, avoiding that dose is straightforward for drugs as well-known and widely-used as ivermectin. There is no risk of harming someone significantly. (There's also, I think, no chance of being effective against covid at safe doses.)

It is true, but unfortunate, that in many societies only licensed practitioners are in a position to prescribe (or proscribe) most drugs. That's a policy that does some good but also an enormous amount of harm.

Re: Ivermectin: Much More Than You Wanted to Know

#708

Post by beagle3 »

jacquesm wrote: post #485
blindmute wrote: post #367

Earlier quoted context omitted.

Why would you trust a local GP? They are almost certainly the least knowledgeable person in the chain of authority from which you could choose to trust. They will either follow the guidelines or their anecdotal experience. You could read the research papers and the guidelines yourself and have a better understanding of the issue than a given GP. For anything rare, you could probably read the subreddit about the diagn…

No, but he is in that chain of authority, and I'm not and if he passes on advice based on what he knows in general and what he knows about me I take it that he's not doing that because he wants to diminish the size of his practice. I could read the research papers and the guidelines, but for that I would first need a medical degree in the relevant (sub)fields, figure out who is and who isn't telling the truth/stackin…

> I take it that he's not doing that because he wants to diminish the size of his practice.

But very likely (especially in the US, but also in other places), his considerations have to do with not increasing his malpractice insurance premium.

Your and his interests are not aligned. And that chasm is larger than anyone likes to admit.

Re: Ivermectin: Much More Than You Wanted to Know

#709

Post by beagle3 »

saalweachter wrote: post #478
beagle3 wrote: post #157

Earlier quoted context omitted.

You may disregard my pseudonymous self’s statement, but one of my children had a weird disease, which I managed to figure out watching YouTube videos of similar symptoms and reading Wikipedia (at first, then pubmed etc) Over 40 doctors, most of them MD/PhDs, from 4 of the 10 top ranked hospitals in the world for the relevant issue, told me I’m an idiot, because that disease is a 1:10,000,000 thing, it can’t be the ca…

I think you need to be careful to distinguish between two different kinds of failures of the medical system here. In your anecdote, you suffered a failure to diagnose , and specifically, a failure to diagnose a rare disease . This is unfortunate, and bad, and a problem to try to figure out, but it is a completely different sort of failure than what other people are proposing for HCQ or IVM, that there is a highly eff…

In that story, which is very long and has all kind of hollywood quality twists (and heros, and villains), there was a highly effective and (relatively, ~$10K overall) cheap treatment, where the official treatment was $30K/month with potential for stopping at some point, but most kids are on it for years before they can stop.

The diagnostic failure was just the beginning.

(And, unlike the HCQ/IVM case, which I don't support and is in general speculative - the guy responsible for the official recommendation was actually convicted for taking bribes from the company making the treatment. I won't divulge any details, because that will de-anonymize me - the disease is rare enough that people in the field know each other and all the cases).

p.s: That treatment (in combination) is also used for other, similar diseases, each is rare, but overall it was a lucrative market for the drug company.

Re: Ivermectin: Much More Than You Wanted to Know

#710

Post by mewpmewp2 »

jesterson wrote: post #662
mewpmewp2 wrote: post #397

Earlier quoted context omitted.

Which government is that? The one who paid. I'm aware of frequent vaccine complications, but haven't heard of government doing any payouts.

Singapore government. There is a special fund for people who got severe health complications due to vaccination and as far as I know, it’s being used quite often. Although, personally i can only speak about the case I have mentioned.

How's the current mentality towards vaccines in Singapore?
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