This is worth reading purely for the writing alone. Scott Alexander is a treasure:
> As best I can tell, this is some kind of Egyptian trial. It might or might not be an RCT; it says stuff like “Patients were self-allocated to the treatment groups; the first 3 days of the week for the intervention arm while the other 3 days for symptomatic treatment”. Were they self-allocated in the sense that they got to choose? Doesn’t that mean it’s not random? Aren’t there seven days in a week? These are among the many questions that Elalfy et al do not answer for us.
> This is worth reading purely for the writing alone. Scott Alexander is a treasure
This post is a breath of fresh air for the blog and feels refreshingly well-researched. Between that and the unquestionable popularity of COVID-related discussion, it’s no wonder this article is popular.
Scott is undeniably a good blog writer with an entertaining writing style that resonates with his reader base. However, I’ve become disillusioned with a lot of his other recent writings like the “Great Families” post in which he presented a lot of conjecture that pandered to his core readership without any research or evidence to support it. Specifically, his position that genetics are the primary explanation for “Great Families” while ignoring obvious heritability of things like wealth and social status. Even the old Slate Star Codex and new Astral Codex Ten communities started calling him out on it after that article.
Scott’s writings are undeniably entertaining and usually quite fun to read, but I’ve long since learned to read them more critically because his writings have a way of projecting a sort of humble confidence while either hedging any statements so much that little is actually communicated, or sometimes inserting conjecture or feelings with a lot of linguistic window dressing such that it’s easy to mistake it for fact.
I hope this article is a sign that the writings are shifting more toward the old-school, heavily-researched style that made the blog so popular.
Most of the writing is fantastic, but I'm very disappointed by the take that "everyone was wrong", by the implication that doctors didn't know they should treat for worms before giving immunosuppressants. Guess what, doctors in the developing world already knew that, it was always the standard practice on Brazilian hospitals. In fact, ivermectin was in very high demand in hospitals before it was suspected to be a Covid19 treatment. That whole paragraph reads like some really bad exceptionalism (it it doesn't exist here it doesn't exist).
The everyone-was-wrong part was about scientists missing the worm connection when looking at the aggregate data, not about practicing doctors and worm treatments.
Because it was not related to Covid. If someone with heart problems is admitted with Covid they will receive their heart medications in the hospital, that doesn't mean that now heart medication is a Covid medication, so doesn't get mentioned in studies. The same goes for dewormer, it was in normal use against worms. Only after people started believing that it could be a treatment for Covid, that it started being studied for that (with different protocols). And then we found out that it is just a dewormer like we thought in the beginning.
Except in this case the dewormer is the central focus of the study. The relationship between worms in the population and its influence on covid outcomes makes that highly relevant to the publications. If it's known to be present in the general public, then not controlling for that in your study is just shoddy science.
Ivermectin being cheap and widely available is really important here. Something like that- instead of a novel vaccine made with novel tech in very specific first world factories- is very attractive to cash strapped governments and public health systems.
> ignoring obvious heritability of things like wealth and social status
He addresses that in the section section - besides the intro, he leads with it:
"the next generation becomes semi-famous fashion designers and TV personalities and journalists, which seem like typical jobs for people who are well-connected and good at performing class, but don't need to be amazingly bright. Sometimes they become politicians, another job which benefits from lots of name recognition.
But I've tried to avoid mentioning these careers, and focus on actually impressive achievements that are hard to fake. And also, none of these families except the Tagores were fantastically rich; there are thousands or millions of families richer than they are who don’t have any of their accomplishments. For example, Cornelius Vanderbilt's many descendants are famous only for being very rich and doing rich people things very well (one of them won a yachting prize; another was an art collector; a third was Anderson Cooper)."
True, but that's an example of the endless hedging I mentioned: His writing style is very good at throwing in little counter examples here and there to give a "both sides" type impression, but then he pokes holes in the counter-arguments in the build-up to the conclusion he actually wants to present.
If you read a few paragraphs past your quote, Scott comes right out and declares the "genetics" is the explanation that he thinks is correct:
> The other obvious answer is “genetics!” I think this one is right
He then applies some softball counter-arguments to the genetics argument to hedge and give the "both sides" treatment. However, the article is clearly structured to give a tour of possible arguments while subtly giving the most credence and the least hedging to the genetics argument. Combined with the not-so-subtle declaration from Scott that "I think this one is right" in the middle of the article, he expertly walks the reader into the conclusion he wants while making them feel like they came to that conclusion on their own after an objective tour of the research.
I think the fact is that he presents himself as speaking from a highly informed, relatively unbiased presentation of a subject he finds interesting. In fact, he is arguing for a position. Reading an article meant to be informative vs reading an article meant to convince you of a position are two very different things.
I mean, it's hard to be informed and also not have a position. I think the best you can do is read an article about the information that convinced the author (and the information that made them less confident).
The ideal is that an author is unbiased before seeing the evidence, then forms an opinion based on the strength of the evidence. An article that chronicles such a journey, presenting an opinion but also the strongest counter-arguments to that opinion, is about the best one can hope for in scientific writing.
I actually come from one of those so-called Great Families. Three generations back, there were 3 siblings who all had national or smaller success in creative, financial, and mathematical fields, including one who won a nobel prize. Many of their descendants also had successes, although of a more modest variety.
However, in my generation, there were lots of money problems. And they did what money problems tend to do -- delay, deny, disappoint, cause health problems, and make everything harder.
The "brains," such as they were, were still there. If we take the usual markers* of intelligence there were Ivy League admissions, Fulbright scholarships, and so on. But for me at least, not having affordable healthcare at age 20 impacted my life much more in a negative way than getting a 5 on the Calculus AP impacted it in a positive way.
I'm much less interested in the concept of inherited genius than I am in universal health insurance and free college.
*Which are themselves problematic, and often merely markers of class, but it's the best I can do here for a HN comment
This is super interesting, because it actually makes the case for 'old money' taking better care of the rest of the world, not for the benefit of the rest of the world but for their downstream.
Oh, no wonder this was so entertaining to read, didn't even catch that this was astral codex. I laughed out loud at Cadegiani et al:
> A crazy person decided to put his patients on every weird medication he could think of, and 585 subjects ended up on a combination of ivermectin, hydroxychloroquine, azithromycin, and nitazoxanide, with dutasteride and spironolactone "optionally offered" and vitamin D, vitamin C, zinc, apixaban, rivaraxoban, enoxaparin, and glucocorticoids "added according to clinical judgment". There was no control group, but the author helpfully designated some random patients in his area as a sort-of-control, and then synthetically generated a second control group based on “a precise estimative based on a thorough and structured review of articles indexed in PubMed and MEDLINE and statements by official government agencies and specific medical societies”.
> The fraud-hunters have examined this paper closely and are unable to find any signs of fraud. I think this paper is legitimate and that its findings need to be seriously considered. ... And there’s always the chance it was a fluke, right? Can something have a p-value less than 0.001 and still be a fluke?
...
> And it was! It was a fluke! A literal, physical, fluke!
Edit: If you like puns and this writing, you'll likely enjoy some of Scott's other works, like "The Study of Anglophysics" [1] and (especially if you're at least passingly familiar with Judaism and Kabbalah) Unsong [2].
While reading this piece I got a little depressed that most journalism is just such utter trash compared to it. I've read so many articles on ivermectin and none of them gave me even ten percent of the clarity that this article gave me. Can you imagine if writing and journalism of this calibre was commonplace among practising "journalists"? And look at how this piece compares to the CDC's and WHO's science communication. It's a shame that clear thinking and communication is so scarce.
NIH seems to have pretty good analysis into Ivermectin. For some reason or another, people don't know it exists. Its pretty straightforward frankly. Turns out that people on the internet are terrible at meta-analysis.
While Scott has a pretty decent natural talent for writing, he also has a MD, he's a board licensed practicing psychiatrist who has been working for a decade in the field, and he has spent at least the last twenty years gaining a pretty decent broad exposure to statistical and research methods. I don't believe he disclosed what Substack paid him, but he is in the "paid tier" and has said it was a mistake to even agree to that because the subscriptions he has gotten exceed what Substack paid him.
In short, if you want most journalism to hire licensed medical doctors with decades of experience in science and statistics, and natural writing talent on top of that, expect journalism to get a lot more expensive. A market certainly exists for Scott, but I'm not sure the market exists for all journalists to be as highly qualified as Scott. Or, for that matter, even for CDC and WHO PR arms. They definitely aren't paying their communications officers whatever Substack is paying Scott, or probably even what his psychiatry practice is paying him.
> I'm not sure the market exists for all journalists to be as highly qualified as Scott
I'm not sure we need as many journalists as we currently have. Do we really need another rehashing of the latest culture war nonsense? If you strip out all of these pseudo-journalists and consider only journalists covering real facts and in-depth analysis, that's a considerably smaller group that could plausibly consist of a number of Scotts.
That's what the public demands, so that's what news companies cater for in order to make a profit and stay in business.
Few journalists like covering that sort of stuff, a whole bunch dreamed of being investigative journalists breaking corruption and other public interest stories. But there simply aren't enough people reading those stories to maintain nearly enough staff for them.
Scott Alexander can also do what he does because he's not required to be totally accurate. It's opinion, backed by experience and training, but still opinion. He's also not writing to a deadline, except one he sets himself.
Real journalism is a lot harder than informed commentary.
Journalists aren't required to be totally accurate either. Most journalism is opinion, especially these days. Sometimes also informed opinion backed by experience, often not even that.
I'm just not seeing this distinction you claim exists.
> Journalists at established media houses are accountable, including to internal and external ombuds or public editors. They also rely on reputation.
Which is ultimately irrelevant, because most mainstream outlets are partisan and look after their own, both on the right and left. You only need to look at the ridiculous coverage of Obama, Trump, Russia, Rittenhouse and dozens more examples over the past few years. The people who peddled misinformation haven't suffered any consequences.
There are a lot of real facts out there, more of them every day. Not all of them worth considering show up in spreadsheets at central sites, some have to be ascertained and reported by someone on the spot. And I would distinguish between reporting and commentary.
I am not sure that Scott would fit into a newspaper environment.
Scott has some really interesting articles. He has one huge advantage over journalists. He seemingly doesn't work in the same deadline constrained world that typical journalists do:
>> I know I’m two months late here. Everyone’s already made up their mind and moved on to other things.
He has an earlier piece whose point is that the WHO can never be accurate, because they always have to prioritize "sounding trustworthy" over accuracy, and random blogs don't.
Society needs a simple answer. Do this. Do that etc. Put on a mask. Wash your hands. Practice social distancing. Use approved vaccines. Take booster shots etc are pretty simple to follow. Likewise don't take non approved stuff. Easy to understand and simple to follow.
Nuances will likely hurt and confuse the common man. That's why the news and celebs and politicians etc try to keep things simple.
Dr. Fauci knew that a lot of the things he was saying might not be 100% accurate and yet he did it. The reason being that on the whole his message was a net positive effect on the public.
Likewise CNN made fun of Joe Rogan for taking Ivermectin because we don't want general public to experiment with alternative medicine. It's better to just stick to the proven stuff.
Basically, there is no choice here. Or basically two choices:
1. Be 100% accurate and risk confusing people
2. Be strategic about it and for the greater good.
We need a narrative and the cost is accuracy. We need to have more empathy for people who are the decision makers and have to make difficult choices.
I need to clarify. I am not implying that WHO / CDC is lying outright. It's just that they have to be very careful and choose the right message to convey to the general public.
It does mean you might have to downplay some things which might be true but will cause more harm than good if emphasized.
I personally can never do that but I won't judge people who are in a situation where every thing they say has a huge impact on our collective future.
I’m not sure why you’re getting smoked with the DVs there, I agree with you, I think it’s true.
Society has been so trained by political theatre and non-stop news channels for single answers that are capable of defying facts due to their non-life threatening nature that if a message isn’t straightforward, succinct, and unchanging then the messenger gets killed the moment it varies. Like politicians with the other side waiting for the slip up.
Except unfortunately science doesn’t work like this because nature can’t be fooled and at the beginning we don’t have as clear facts as we would like to. And the process of zeroing in on clearer and more concise answers is confusing and scares the shit out of the average punter. And the media are excited to be able to have a messenger who continues to vary their message.
It’s all a really sad state of affairs. I think WHO/CDC/Australian governments (really the only relevant one for me) and everyone else could have done a much better job but I feel I know why and how we ended up with such a communications disaster
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 panic or a run on critical resources. The general public isn't going to hold back when they believe toilet paper or masks are going to be in short supply when they feel that they need them, restraint is for other people.
> 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.
He may have been simply told what to say. The man strikes me as having integrity and trying to do the right thing even in impossible situations, such as being part of the Trump administrations' misdirection engine and refusing to buckle. That's the main reason the right wing of the United States hates his guts, he didn't sign the oath of loyalty. And was promptly replaced.
This is also why trust in these institutions is at an all time low. When your decision-makers are telling you lies and half truths for your own good, it becomes harder to know when they're telling the truth. This is the environment that causes fringe groups and theories to thrive.
Or why they don’t trust doctors in general, because medicine is a very inexact science filled with lies and half truths along with real truths? I get that might be unnerving to many (even if medicine is overall beneficial), but these people really sound like a classic case of “perfect is the enemy of good.”
"Doctors are like monkeys with hammers trying to fix computers. We bang against stuff and will try a lot of things if we don't know what you've got. We may even get it right. But if you have a broken leg, an appendix that needs removal, a clear case of something that can be treated with anti-biotics, then we can perform small miracles."
I don't know enough of the profession to estimate how accurate that statement is but it has colored my view.
Anecdotally this rings very true. Actually I'd be even more cynical than it. I know two people that were facing serious chronic health issues that were not readily diagnosed. They were treated like a hot potato between specialists.
In one case it took nearly 2 year to arrive at a correct diagnosis and corrective action, which involved both medication and surgery.
In the other case the person was moving into liver failure, and placed on the transplant list. Luckily a family friend worked for the same healthcare organization as an IT professional, and knew exactly what to do. She marched the patient into the ER, had her sit down in a wheel chair, and made it crystal clear that she was going to be a gigantic PITA until they found out what was killing the patient. Within the day they had a plausible answer, and confirmed it with lab results within the week as I recall.
It shouldn't be this way, but unfortunately in US healthcare it is. Having an uncommon illness is an absolute nightmare, one that destroys entire families finances if not outright killing people.
This is unfortunately fairly accurate. There is a deep and wide ocean of the things we know inexactly, and a growing pool of things we can work miracles on.
However as the complexity of patients grows and the burden of disease shifts from infectious disease to chronic causes with lifestyle origins and aging, and anxiety - particularly in the teenage and young adults (a shift that has been underway at the top end for 30 years for the older part of the population, and since smartphones on the lower side! that the ocean is growing as well.
Thank you. I hold that person in very high regard and it stuck with me through the years as something that I see more and more confirmation of and yet, it seems to be a pretty harsh judgment.
I wouldn't be any less harsh about my own profession though.
> I don't know enough of the profession to estimate how accurate that statement is but it has colored my view.
We see the medicine of 200 years ago as barbaric, and I can guarantee that people 200 years in the future will see today's medicine as barbaric. There is simply lots of room for improvement even if improvement has been made in the past, but why should that give us colored views of the whole field?
> There is simply lots of room for improvement even if improvement has been made in the past, but why should that give us colored views of the whole field?
Especially since most of us -- most readers here do something computer-related, right? -- are ourselves in an (even more rapidly) evolving field of work, where what's "true" is constantly changing.
Add 'hard truths' to that list too. Lifestyle & diet have a huge impact on health, but a portion of the population refuse to acknowledge this or want to hear about it from their doctor.
When the same people (and more) that are in the fringe groups try to create a storm of complaint when scientific/medical advice/understanding changes, it's non-trivial for decision-makers to figure out what to say.
"non-trivial" is definitely the right word. I don't envy the decision makers, but I hope they realize that by being dishonest about masks in the beginning they sent the message that they were willing to lie for the greater good. This gave real credibility to the "they're inflating the numbers to make it seem worse than it is" theory because the scarier the virus seems, the more people will follow guidelines and fewer people will die. That theory, that the reported numbers are false, has led to far more deaths.
I hope the lesson that gets learned is to be more honest to the public, and not the opposite.
Scientific consensus didn't change on masks. It was known very early that they best prevent the spread of Covid.
When Western governments lied to get around supply issues, while distracting people with quasi-religious rituals around hand hygiene, they not only caused preventable deaths among populations at risk, they planted the seed for long term education and trust issues. More than a year later westerners still have terrible understanding of how the virus spreads, terrible mask education, AND mistrust of health authorities.
The antidote to misinformation isn't more misinformation, it's truth.
> When Western governments lied to get around supply issues (...)
I don't know what you interpreted as a lie. What I saw was two updates that sparked advisories to curtail surgical mask runs:
* the initial WHO position from between late 2019 to early 2020 on the risk of COVID spread, back when COVID was still the Wuhan epidemic and little was known about it, where they quoted Chinese health officials on how the risk of airborne transmission was deemed low. Therefore, based on those observations, surgical masks and gloves were deemed unnecessary.
* The updated WHO position around early 2020 after airborne transmissions started to be reported and corroborated by multiple sources which caused a supply crunch of surgical masks and gloves which were putting frontline workers in risk.
* a call to the widespread adoption of masks from around mid 2020, whether surgical masks or cloth, when their availability started to not be put into question.
Updating advisories based on new data on a developing problem might be seen as flipfloping in politics, but it's not lying or a bad thing.
I remember this guy. The specific claim was that he does not believe that masks will prevent new infections due to people not socially distancing and wearing them incorrectly, NOT that masks are ineffective. He concedes that the evidence suggests masks themselves work.
I've seen this guy get cited in anti-vaxx circles, using extremely simplified claims. Of course when I bring up the fact that he advocates for social distancing, anti-vaxxers get angry at me.
Yes, there is some nuance there now, but it wasn't always so. That's his way of very slowly walking back his claims, a bit of a no true Scotsman, but now 'no true mask'. "masks don't work" -> "ordinary masks don't work" -> "ordinary masks don't work because people won't take other precautions when they wear masks" and so on.
The damage was already done by the time he started with the qualifications and to this day 100's of thousands, if not millions of people will quote the head of the RIVM (correctly or not) to support their anti-mask (often coupled with anti-vaxx) stance.
And social distancing + masks = better than social distancing without. Even Fauci called him to task about this, his response was that 'he would study their claims' (their claim: that masks do work).
When people like Jaap van Dissel cross the official line published by the country it immediately erodes the platform that we all depend on to get through this. From someone in his position one would assume a basic familiarity with the difference between official policy and scientific fact and when it is appropriate to take which viewpoint.
That does not seem to be true. Wikipedia's article on Jaap van Dissel[1] links to a Reuters news article from September 2020[2] where van Dissel is referred to have made the following claim:
> The head of infectious diseases at the Netherlands’ National Institute for Public Health (RIVM), Jaap van Dissel, has argued there is no scientific proof of cloth masks’ effectiveness, and that they might do more harm than good by giving users a false sense of security.
Please note that the criticism refers to cloth mask (not surgical), whose effectiveness has been since then reported to be lower than 40%. Also, the thesis is that relying on an ineffective protection measure does more harm than good as this potentiates the spread of the disease.
That's exactly what I meant when I wrote that over time he has moved his position. First it was all masks, then cloth masks, then they didn't work because then other measures wouldn't work etc. But he never came out to say he simply got it wrong.
> That's exactly what I meant when I wrote that over time he has moved his position.
Isn't your source citing the WHO's advisory from early 2020 on how face masks were counterproductive as they convey a false sense of security and thus contribute to violate critical measures such as social distancing and washing hands?
> “Masks can also create a false sense of security, leading people to neglect measures like hand hygiene and physical distancing,” Adhanom said. “I cannot say this enough: Masks will not protect you alone from COVID-19.”
This was a quote from a WHO representative, made two months after your source was published.
Speaking of "the public" as a single entity is about as useful as approximating a curve with a straight line - i.e. unless it's the most trivial case, it's oversimplified to the point of being doomed to failure.
The public is comprised of people with vast differences in cognitive ability, education, and scientific training. Most members of the public, even in highly educated countries, are easily fooled by a wide variety of logical fallacies, emotional manipulation, and statistical misdirection.
So why didn’t you post this reply one comment up when he calls the public morons? Instead you choose to correct the person who says the public is actually smarter than we think?
I’m not implying you meant anything by it. But it should be noted that people here are arguing, and you’re coming down with a sort of correction that could be applied to either side of the argument. You appear to take a side by choosing this comment without any further nuance.
Apologies if it sounds like I’m saying you’re doing something horribly wrong here, I just find this particular dynamic interesting in internet discussions. It happens all the time.
Where, exactly, did the previous comment call the public "morons"? Are you discarding any other interpretation of that comment in order to avoid any nuance?
> Nuances will likely hurt and confuse the common man. That's why the news and celebs and politicians etc try to keep things simple.
You can pretend there is "nuance" to saying that the common man would be hurt and confused by facts. I see this plainly as calling people morons in a polite manner. Sorry if it hurts your sensibilities that someone would lay bare the underlying meaning of a comment.
Also, please by all means ignore the actual point of my comment, which is, why do people go around correcting a specific comment when that applies to at least one more comment up the chain. Any replies re: "morons" will be ignored.
"Nuances will likely hurt and confuse the common man. "
I think this condescension does more harm than good. The "common man" is plenty smart enough to make decisions for themselves using reasonable judgement. They will make mistakes, but at a similar rate to the experts.
A message of "we're not sure, but this virus seems to be transmitted mostly by air, and we thinks wearing a mask will probably help. We suggest you wear one when reasonably possible" will likely encourage a lot of people to wear masks, while a message of "OMG PANIC AND WEAR MASKS ALWAYS AND YELL AT PEOPLE WHO DON'T" is not likely to.
> Dr. Fauci knew that a lot of the things he was saying might not be 100% accurate and yet he did it. The reason being that on the whole his message was a net positive effect on the public.
This is now milked for more than it is worth by those that would like to discredit him but at the same time have probably never held a position of some responsibility towards a populace that is ill equipped to deal with scientific uncertainty.
> Likewise CNN made fun of Joe Rogan for taking Ivermectin because we don't want general public to experiment with alternative medicine. It's better to just stick to the proven stuff.
Ivermectin is not alternative medicine. Ivermectin used for COVID symptoms is off-label use.
CNN made fun of him because he dared stray from the official narrative and he dared try doing something through his own research rather than doing exactly as the government and media told him to do.
If there's one thing I've learned over and over during this pandemic, it is that "do your own research" is immediately followed by a train of bullshit that only demonstrates extreme susceptibility to confirmation bias.
The first Western people protecting themselves with face masks, those were "do your own research" people. Before April 2020, the Western mainstream claimed/lied that masks don't work.
And it’s amazing how his own research throws the vaccine out whilst going headlong for monoclonal antibodies, and the cognitive dissonance that makes processing this so deafening is that one is new and there are no long term trials and… the other doesn’t get the same treatment by his brain?
I also love the blinkered trope he continues to roll out that public health doesn’t tell everyone to exercise and not smoke and eat healthily. Which it does constantly, but he can’t see this because he can’t compute that the magnitude of the response to covid drowns out the baseline public health messages that have been in widespread adoption and classroom teaching for 30 years.
As much as he’d like to be, he’s not an independent thinker - him saying ‘I hate tribes’ doesn’t make it so - he’s part of tribes as well
> 1. Be 100% accurate and risk confusing people 2. Be strategic about it and for the greater good.
Humans have a very poor track record at actually advancing any "greater good" when they choose option 2. In practice, "the greater good" turns out to be whatever helps those particular humans keep their power and status. That's why option 1 is the only acceptable one.
> We need a narrative and the cost is accuracy.
If this is actually true (I don't think it is), then our civilization is doomed.
> We need to have more empathy for people who are the decision makers and have to make difficult choices.
No, we need to stop thinking that certain people should be given the power to be "decision makers" and tell the rest of us what to do. The only acceptable thing for people in public health positions to do should be your option 1 above.
I feel like your underlying assumption here is that the average human has a similar level of intelligence and critical thinking skills as the average HN community member.
At the risk of coming across as extremely snobby, that just isn't true at all.
> At the risk of coming across as extremely snobby, that just isn't true at all.
If you think the people who grow our food, make our clothes, build our houses and cars, fix our plumbing and heating and air conditioning when it breaks, run our electrical wiring safely, run the utility plants that provide our power and water and sewage disposal, and do the thousands of other things that are necessary to keep our technological society working, have less intelligence and common sense than you do, you don't come across to me as snobby, just woefully uninformed.
> Yes, you did. You said "the average human". All of those folks are average humans.
In that case, so are all other humans too. The GP did not mention any specific occupational or educational categories; that was all your own invention.
> I feel like your underlying assumption here is that the average human has a similar level of intelligence and critical thinking skills as the average HN community member.
No. My underlying assumption is that my country (the US) is supposed to be a free country, where people are expected to make their own decisions and manage their own lives. If a significant fraction of people aren't capable of doing that, then, as I said in another post downthread, that's a problem, yes, but it's not a problem that can be fixed by just telling everyone to trust the experts. That makes the problem worse, not better.
That's highly dependent on a bunch of stuff that you can not choose at birth. For some variations of those you are going to find yourself decidedly less free than others.
Agreed that blind trust in experts makes the problem worse - in principle. But with hysteria just around the corner (of which the wishful thinking that a cheap and common cure exists is one exponent) I can see why authorities chose to try to massage the message. Where they wrong? Probably, in the general case, yes. Were they wrong in this case? Possibly, but I would not be too sure of that, taking into account that even the highest levels of politics were actively spreading mis-information against informed scientific consensus. If we actually had trusted the experts things would likely look a lot better. But instead, we outsourced our trust and hence our decision making to committees, politicians and the lens of the media.
The fact that every country acted on its own was yet another confounding factor, if this had been a giant synchronized operation then it likely would have worked out differently as well. Even today we are still seeing giant differences between countries, rather than that the rich countries structurally help the poor.
> That's highly dependent on a bunch of stuff that you can not choose at birth.
Meaning, which country you are born in? Yes, of course; that's why I specified which country I was talking about.
My original comment about the poor track record humans have of actually advancing "the greater good" when they think that's what they are doing was meant to be general, however.
> If we actually had trusted the experts things would likely look a lot better.
Which experts are these? From what I can see, with the benefit of 20-20 hindsight, two actions that the world could have taken to drastically reduce the impact of COVID, much more than anything anyone actually did, are:
(1) Stop all international travel, sometime around late January or early February 2020.
(2) Make the vaccines that were discovered in January 2020 available, at least to high risk people (e.g., the elderly, health care workers) in high risk areas, sometime in February or March 2020.
I'm not aware of any "expert" that ever recommended either of those things. Indeed, experts were vociferously recommending against #1.
I would say I am smart enough to recognize how ignorant I am. I put more weight in what experts say because they have the years of education and experience to help guide them, and I won't get that from a night on wikipedia, facebook, or youtube.
> I put more weight in what experts say because they have the years of education and experience to help guide them
Unless those years of education and experience translate into actually being able to make better predictions about what to do than you can, they're useless as something to rely on.
How much time are you going to spend learning enough virology to make your own decisions in this case? How much time are you going to spend on the tens of thousands of other fields that you need to understand in order to make your own decisions?
Alternatively, what do you do for a living? Do you make decisions that affect others? Or do you provide 100% accurate information in sufficient detail that they can make those decisions individually?
> How much time are you going to spend learning enough virology to make your own decisions in this case?
If experts in various fields could be trusted to just tell the truth about what they've found and not try to spin it or filter it, their information would be much more useful. It's precisely because the average person cannot trust experts to just tell the truth about what they've found that it's so hard for average people to get information they feel they can trust.
Also, being an expert in virology, for example, does not make a person an expert in human psychology; but trying to spin or filter your information about virology (or anything else) based on how you think people are going to receive it is a human psychology problem, not a virology problem. And if spinning and filtering scientific information was viewed, as it properly should be, as a matter of psychology, it would be much more obvious how manipulative it is--do you really want so-called psychology "experts" spinning and filtering the information you get based on their model of how human minds work?
In short: your implicit assumption that I, as a non-expert in a given field, can just trust the experts to tell me what to do is wrong--dangerously so. If the decision really matters to you, you take the time to learn enough about the field to at least be able to apply some intelligent common sense.
> How much time are you going to spend on the tens of thousands of other fields that you need to understand in order to make your own decisions?
You don't need to take time to learn tens of thousands of fields in order to apply intelligent common sense to your everyday life decisions, or even to decisions about something like COVID. Intelligent common sense just about viral illnesses in general, which should be common knowledge to any adult in a first world country in the 21st century, should have been enough to tell people in the US, for example, to wear masks and social distance around the end of February 2020, which is when my wife and I started doing it. If it's really true that a majority of the US population is unable to exercise that much intelligence and common sense, then our society certainly has a problem, but "just trust the experts" is not going to solve it, it will make it worse.
> what do you do for a living? Do you make decisions that affect others?
Not in any way that requires me to communicate information to others, no. What I do does affect others, but only in the sense that my work, which is in a technical field, has to be done right in a technical sense.
That said, I should be clear that my comments about what public officials should do are made from the viewpoint of a citizen, not from the viewpoint of an official.
why not have 2 levels? One for ACX level deep dives complete with assumptions, contingencies, and probability distributions and another for public consumption.
romeros is right. public health people have to do third-order thinking to maximize the overall health impact. I haven't done RCTs but we studied them in detail in my stats class in grad school.
no they don't. They just need to be honest about what they do know and what they don't and don't assert something is true when it's "we're not sure". Just do zero-order thinking. Don't patronize the public.
Guess what. If you don't trust the public. Why should the public trust you?
The public has been taught by people who don't do science that knowledge and truth are supposed to be immutable. When faced with scientists who acknowledge that their understanding and advice is contingent, the public as a statistical entity says "WTF?" and chooses not to trust.
You are bootstrapping your understanding of society on that assumption itself and thus begging the question.
Do you actually get out and talk to people? Most people are ok with nuance. Most things we consume as entertainment, from lowbrow housewives of Atlanta to highbrow pbs space time are full of dizzying nuance and unknowable truths (but not star trek. Star trek no longer has nuance).
We're fine with nuance in entertainment, in romance, in food, in professional team sports, in many things. I would dispute that the same level of comfort extends to "when elected (or not) leaders tell us what we should do."
Precisely. Just observe the discussion about scientific theories and you can see firsthand that the public wants simple and clear black-and-white stuff (and to be told what to do) and not some kind of qualified statement that turns 99.9% certainty into something that can be spun as 50/50.
"In another promising medical development, the biotechnology company Moderna has announced its COVID-19 vaccine could be up to 94.5% effective. The news comes a week after Pfizer announced its vaccine could be up to 90% effective based on a similar, early analysis from its Phase 3 trial." (https://abcnews.go.com/Health/moderna-announces-initial-phas...)
"And then there were three. U.K. pharmaceutical giant AstraZeneca, along with its partners at Oxford University, became on Monday the third team to announce positive late stage trial results for a COVID-19 vaccine. The "AZD1222" vaccine was "highly effective'' in preventing disease, with up to 90% efficacy in patients receiving one of the dose regimens used in trials, AstraZeneca announced." (https://www.cbsnews.com/news/covid-vaccine-oxford-astrazenca...)
The GP's point isn't something that is verified with controlled randomized data...And moreso, it's about what happens after the controlled trial. Communicating science is about taking it from a controlled lab and moving it into the real world where unfortunately politics purposefully muddies all the waters.
The point is that WHO is a political organization with a political mission that needs science to get it done. While it employs and funds countless great scientists doing meticulous work...the people you will see and hear from at WHO are international politicians.
This is clearly satire and good satire at that. I’m sorry this site has not recognized this for the great social commentary that it is. You have my vote.
This is a huge factor. Dumbing things down creates a dumber audience. If you look at newscasts and newspapers from the 70's and compare them to today the difference is amazing.
There are a lot of conspiracy theories about this but I think it’s just a race to the bottom in search of the largest audience.
It seems to still be getting worse. I remember cable news being tolerable 10 years ago. Now when I see it at an airport or something I can almost feel the ice pick ramming up into my brain and swishing around.
Whilst journalist/PR summaries are so notoriously bad they're a punchline when you talk to actual researchers, I think we have to be charitable here and acknowledge that most communication about COVID doesn't have the luxury of writing about every single trial registered (or making puns on the word "fluke"!) So it tends to summarise it as "initially promising results for Invermectin were fraudulent, whilst large trials found no effect at all. Also it has side effects, like most other drugs, so the people ordering it in doses for horses aren't being as clever as they think" which isn't nearly as entertaining or as thorough as Scott's writing, but is a broadly accurate summary of the state of scientific evidence.
(Of course you can also summarise it as "there's weak evidence for Invermectin having some therapeutic benefit which is probably related to preexisting conditions"... but we know how quickly that snowballs into "Invermectin stops COVID, scientists ADMIT IT" by the same people that deny the much stronger evidence for vaccine efficacy. Science journalism is bad, but not as bad as the selective reading of it.)
Well, I have never witnessed some thing in real life that was correctly reported on the news. Not even once.
And I'm talking about basic things like getting the order of the facts correct, or who said what. Some times there is even video of the thing on the news, and the journalist narrates on the sequence, and says something different form what is on the video.
I do really not expect those teams to get the details behind medical research right.
By the way, with the amount of fraud going on those studies, I wouldn't trust "weak evidence that it has some effect" in any real extent. Also, the Brazilian numbers (that are uncontested on the article, just non-randomized) are completely fraudulent, it's a large scandal here, with the police investigating it and many people that may get some prison time for murdering; the people that took ivermectin died about 3 times more often than the ones that didn't.
No no... You can't expect a journalist to carefully make a very detailed and informed article like this carefully evaluating 30 scientific articles of meta-anilisys sites wich favored a specific view. They are not spcialists in most things and this was published long after the peak of of the pandemic.
What they should do is to query specialists to obtain better information, instead of opinions. Consult different views, argue why on view is right or wrong and then inform the public.
for free online news, perhaps. pay for stat, nytimes, economist, scientific american etc you will find journalists who cover science with good understanding.
by the way few good science journalists would cover the story this way. instead they would mostly be quoting experts interpreting the significance of the various studies.
And Scott Alexander would never be one of them. Can you imagine a nytimes science writer quoting a psychiatrist on ivermectin's effectiveness? Never happen.
(also all of these sources' coverage of ivermectin has been much more limited because of the fact that the drug is a scam)
This is exactly the sort of thing that YouTube, Twitter, et al are suppressing. Someone thoughtfully listening seriously to what the proponents of Ivermectin are saying, weighing it up and saying "looks good but you forgot...".
You can't get this sort of excellent rebuttal without allowing a site like https://ivmmeta.com/ into the debate.
There is little evidence of such analysis being suppressed. I think it is just relatively rare, because it is a lot of work and takes particular skill.
Most people who care about this research are indeed crackpots, unfortunately. Those who aren't have mostly moved on from Ivermectin because they have better things to do. Ivermectin is being tested in large RCTs, as it should. If it works, it will be used. If it doesn't, it won't. Until we know, doctors will do what works.
Dr. John Campbell posted a video that was "fact checked" by facebook which he calmly dismantles in the video below. Facebook puts up a big warning if you see it or post it. Soft censorship is still censorship.
> Those who aren't have mostly moved on from Ivermectin because they have better things to do. Ivermectin is being tested in large RCTs, as it should. If it works, it will be used. If it doesn't, it won't. Until we know, doctors will do what works.
Going through one of those studies from https://ivmmeta.com/ on YouTube would be a risky proposition for a YouTuber. It goes against YouTube's medical misinformation policy [0]. It is pretty clear that a study with that sort of effect size could encourage someone to take Ivermectin. Particularly the "Categorical claims that Ivermectin is an effective treatment for COVID-19
" would be a worry depending on how the censors feel that day. They'd potentially be arguing a technicality against some Silicon Valley type with an axe to grind.
Despite the fact that it appears those studies were honest, and picking up an actual factual effect. Now it turns out, laughably in hindsight, that the effect is probably whether people had parasites or not and I hadn't thought of that. But it isn't obvious how I'm going to figure that out without someone pointing it out to me. Ideally on YouTube where there are some really good channels covering COVID, often with actual doctors involved.
No-one else seems to have figured it out either, given I've seen lots of people shouting at each other and none suggested it as a possibility.
Exactly. But all we have a slew of low grade anecdata masquerading as studies and a very large machine magnifying that into 'cheap miracle cure suppressed by MSM and big pharma'.
> Now it turns out, laughably in hindsight, that the effect is probably whether people had parasites or not and I hadn't thought of that.
Your eagerness to jump on to this idea (which is a cool theory, and isn't meritless, but it should be stressed is a theory that a psychiatrist and social commentator came up with) makes me think you should be wary of how personally susceptible you are to what I'm going to call "fetishization of contrarianism". It's fun to be right, and fun to be right when other people are wrong. It's cool.
But its easy to move from "I don't implicitly value what experts say" to "I implicitly distrust so-called experts", which you appear to be doing throughout this and other threads. You've further jumped from what could uncharitably be called a conspiracy theory to a counter-conspiracy theory. Scott even presents his idea as, essentially a conspiracy theory:
> It feels right to me because it’s the most troll-ish possible solution. Everybody was wrong!
"everyone was wrong", look at me, I'm right, here's a fantastic narrative that perfectly ties up all the loose ends. He looks smart and cool. And you do too[1] if you agree with him. But, to keep on theme, this is a brain worm. (and since we're on a Scott Alexander post, I'll tie this into the broader theme of rationalism) And it's a brain worm that I think a lot of people who otherwise think they're rational/rationalist fall for. The conventional wisdom is, usually, mostly right. Not always all the way right, and sometimes really wrong. But usually, it's most of the way there.
This makes alternate modes of thinking really boring, because despite all the fancy self-reflection and attempts to be superior, you're going to draw relatively few conclusions that are all that different from the mainstream. So what's the point? Either you do all this work for a marginal gain, or...or...or, well what if the conventional wisdom is actually wrong a lot more often? What if the experts are misleading us? What if the experts fall into thinking traps that make them wrong all the time? We shouldn't just disregard the experts, we should actively distrust them and assume the opposite! This opens up lots of possibilities for cool ideas. Incredibly compelling narratives, narratives where you can say that everyone else was wrong, and you were right. You can be a hero, or at least feel like one. Outsmarting the experts is cool, and knowing things first is cool. It's cool. And the "problem" with this is that sometimes you'll be right. The government is spying on citizens illegally. Snowden was right. And Ivermectin might have a small effect on covid, and even cooler it might be due to worms! But there have been tons of quack covid cures (HCQ, bleach, silver, etc.) and not every conspiracy theory about the government is true, even if the narrative would be cooler, because we distrust the government and the profit motives of these corporations, and that makes us want to distrust everything they do.
But the world is more boring than that, and even though the contrary opinion is true sometimes, usually it isn't.
[1]: Another, potentially equally compelling take here is that Scott's presentation here has allowed you to change your mind without admitting (even to yourself) that you were wrong! Because as he presents it, you weren't "wrong". We really, really dislike doing that, but this way you don't have to. The data did/does show an an effect for Ivermectin. You were right. That the effect was due to a "global" confounding factor allows you to change your conclusion without admitting that you were wrong in how you did the analysis. Like, whether or not you were wrong, the people who disagreed with you were right: it's unlikely that it would be helpful for your mother or whomever to take Ivermectin. The rational thing to do here would be to update your priors to trust the "experts" a bit more, perhaps their expert analysis that you weren't willing to believe before, had some truth to it, even though you don't know precisely how or why they reached that conclusion!
Nope, it's not against the medical misinformation policy.
But that's a fine point in that case. And most people who talk about these studies will violate the policy by a wide margin, rather than doing a well rounded analysis.
You can't deliberately encourage people to take Ivermectin. But JUST citing a study wouldn't do that. Especially not with all the debunking of the other stuff.
> Nope, it's not against the medical misinformation policy.
"I have reviewed these studies, they seem sound and there are no real downsides to taking Ivermectin. I can't think of any reason not to take it. I don't recommend taking it, maybe I haven't thought of something" is a position a reasonable person could come to after browsing through the available evidence. Are you absolutely sure a video like that would be kosher on YouTube?
It sounds extremely disingenuous to me, just typing it out.
But most of them aren't sound. Those that aren't are still weak evidence and not really block-buster. Also, "there are no real downsides" is misinformation. If you let on that you are an expert when you aren't, and say "I reviewed them" then that's misinformation. Some is in the gray area, but even the gray area actually causes the kind of harm these policies try to prevent.
There really are no real downsides to taking ivermectin at its usual therapeutic doses. I'm not an expert, but ivermectin is well enough understood that I don't need to be an expert to know that. That's why there are regularly ivermectin programs that dose literally every single person in a town with ivermectin for a month or so as a parasite extermination campaign.
(I have somewhat less confidence in my second opinion about ivermectin, which is that precisely because it's so safe, it's vanishingly unlikely to have antiviral effects at those doses. That's something I could easily be wrong about because I'm not an expert.)
Unfortunately at the 'usual therapeutic doses' there is no effect at all, you're looking at a substantial increase. The biggest direct proof for anti-viral effect was an in vitro study at substantially elevated levels.
Doctors are are much more trades/crafts people than scientists. Among the several I know personally and/or professionally, few are current with the latest research, or even know how to interpret it. They follow the treatment manuals they're provided, which do the best they can with the information available at the time. At the beginning of COVID, the manuals had to make many decisions on incomplete data; none of the drugs they recommended early on are still in use.
Most of the world understands this. It's mostly in the USA that we deify doctors. Few have first-year statistics competency, or can critically read a publication. And that's fine - it's not their profession.
Because 'works' in a medical context is a boolean that encompasses everything from 'order of magnitude lower chances of death' (effective vaccines) to '1% relative reduction in death' (off-label use of some random drug not intended to target improvement in COVID recovery), so the focus has naturally been on finding treatments with high effect sizes and distributing them as quickly as possible. Not to mention the herd immunity element to vaccines.
This is maybe true. But I have seen more than a few dubious COVID articles gain traction on HN. There are several times I have tried to clarify basic statistical points as well. So it’s not a given that it would have been flagged/dead.
Ivermectin pushers are such a mysterious group, its a generic drug cheap drug, there is no apparent personal incentives for whoever is pushing it. It seems to be a result of the fractured us vs them conspiratorial types who truly believe they are doing good in the world.
Meanwhile, ivmmeta.com will get passed on from person to person that wants to sustain their delusion and the website here will be preaching to the choir.
This is the first anti-Ivermectin argument that you want to believe, but there have been many serious anti-Ivermectin arguments in the past. It's just that you don't have the background knowledge to digest them, but that doesn't stop you from wanting to believe that there is some kind of miracle cure that 'they' are suppressing.
Now consider that this is just one example of a class of such issues and that there is an enormous echo chamber for such bullshit which extends right into hackernews.
The way it works:
- posit some bullshit miracle cure
- recruit useful idiots to help promote the issue, sow division
- downplay all of the arguments against, make it seem like it is the establishment that does this
- eventually, give up and move on to the next miracle cure
- go back to step one
It is interesting to see that it is the same people that over-and-over-again allow themselves to be recruited like this. Note that you were making 'pro-Ivermectin comments just yesterday' without knowing what you are talking about.
Why were you making those comments?
What were you trying to achieve by amplifying something that made no sense?
Don't you feel any responsibility for pushing such stories when the end result can be that people end up harming themselves or others on account of this?
> 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 honest and methodologically sound: 50% confidence".
You are describing how you want me to be thinking, not how I am thinking.
I have a pretty good memory for comment histories and you've been pushing this for far more than it is worth.
That this single article would change your mind is fortunate, but I do not suspect that to hold true for the bulk of the conspiracy peddlers that remain.
Isn't this an example of some rigid and ineffective thinking patterns?
Article publishes sound arguments, doesn't talk down to the audience, admits problems with appeals to authority... and converts a conspiracy believer!
...No way, there is no way that can possibly work, the others are way too dumb, and the convert is a bad person... basically anything to just go back to pretending appeals to authority work. Despite clear evidence to the contrary. Or lamenting that they don't. I'm drawing some parallels with miracle cures here ;)
I've been following with some amazement the number of conspiracy peddlers on HN for the last 18 months or so and one case of conversion isn't going to make me overly happy. It is a bit like the story about the lie getting halfway around the world before the truth puts their shoes on, in the extreme long term the truth will come out, meanwhile, the damage is done. This guy until yesterday wanted his mother to take some ivermectin, 'just in case'. I want my mother to take her doctors advice, not mine.
As an engineer, sometimes I say "ship it!" to code that doesn't make me happy but works and solves a real problem.
Edit: I meant this to go with debating techniques, not cures. There are people for whom no amount of saying "why can't you just listen to Dr. Fauci" is going to work. We can say they are bad people, but that doesn't work very well for getting them to agree either.
You are right to call out above that there were other anti-Ivermectin arguments before and roenxi might not have had the background to understand them. That's exactly the point: here we have an argument that he can understand, and it's effective. This is good science journalism. The kind that doesn't work (too much moralizing or too confusing for the general audience) is bad journalism.
I hope that that only goes for things that you can oversee the risks of and that you would refrain from giving medical advice to your relatives assuming that you are not a doctor.
"move fast and break stuff" is the wrong attitude for medicine and aerospace.
But a solution is better than no solution, and of all the countermeasures that we had available in March 2020 we only used a fraction.
As to your edit: no, here we have an argument that he thinks he understands, that's not the same thing. The argument as presented is at best a hypothesis, it isn't proof of anything, just one more theory that may or may not end up being the right one explaining the sometimes observed effect, assuming it really was observed in the first place.
This is precisely what makes this discussion so tiring: people will be swayed one way or the other based on arguments that they have no way of understanding unless they were trained in that particular field.
Unfortunately, there are plenty of politicians that fall into the same trap, leading to terrible examples of wishful thinking, outright quackery and conspiracy amplification. The harm that this is causing is substantial.
So even if this article swayed one person I'm pretty sure you'll be able to find people who get the opposite out of it, because hey 'x' has now joined the establishment, must have sold out.
"Sold out" is a real problem. More people than we want to admit see corruption coupled with big media as a enemy, not a thing to be trusted. Many ordinary people flat out do not know when to trust, so they don't.
They then seek others and continue to have conversations, and they find others lacking trust resonates and that opens the door for a lot of BS normally and easily seen.
Just an example of the difficulty we now face:
Hiding YouTube dislikes will, among other effects, serve to help big corporate media compete against new media.
Hiding the dislikes also breeds more mistrust. This is unavoidable no matter how reasoned the move is.
Public trust in corporate media is really low, and the younger a potential user of that media is the worse those metrics are.
Had that same media held more closely to journalism, rather than access journalism, which is essentially a sales job, the trust problems we struggle with today would not have grown into the chronic problem it all is today.
You identified politicians committing similar abuse of the public trust.
Look at Russiagate. Basically, it flat out did not happen the way many believed it did. Back when that started, many and myself included went to the original documents, saw speculation and in some cases saw it helpfully color coded, and turned on the news only to see all that elevated to fact.
That scared me frankly.
What can one conclude?
I do not see how judging others helps right now. Not saying anyone did here, but I am saying that is happening a lot and when it happens the door for good info to find it's way home gets closed. Advocates render their efforts far less potent.
Secondly, the lack of trust really can't be assigned to people. We have a lot of "they are stupid" type discussion, judgement and rationalization going on and very little of that is helpful.
ie: 70 million people voted for...
The people who had a far better position of authority and trust denigrated that themselves, and for dollars and ratings.
All that is a real mess!
How can authorities, who have abused public trust be counted on to fact check and improve on misinformation without amplifying the already chronic trust problems they created?
In a more basic sense, how can we improve on public trust at all?
I am not sure how that is done quickly.
Longer term, we need media that makes informing people a priority. And doing that likely means a move away from the current AD and access based media we have now.
Given how things are right now, the more important thing is to avoid judgement of others and encourage more and better information exchange. We will not know what reaches people, until it does.
Once it does, we need those people to continue seeking better information so we see more people making better choices more of the time.
I have slowly come to the conclusion that maybe we grew up a bit too fast with respect to media and social media in particular. In the past change to society came slow and we could internalize and stabilize it before the next round of changes appeared.
Now the changes are coming so fast and are so drastic that we as society - including our legal system - have no way of keeping up with it. Technology routinely moves from one phase to the next before the legal framework has caught up with it. This translates into effectively operating without a legal framework for a very important chunk of society.
That's dangerous territory. I don't have any solutions and I'm sure that there are plenty of people that disagree with me but I've gone from a technophile to being very skeptical about the degree to which I allow tech into my life. Familiarity breeds contempt, or something to that effect.
That will be true for very large numbers of people. Not their fault at all. It simply does not happen that a population all ends up able to sort these kinds of things out.
Implying they should is fine in the sense of self improvement, but as policy? Nope.
Perhaps it is time we, as concerned people, begin to take much harder look at our national priorities and demand the public interest be far better served than it is today.
Having done that, and sadly we are no where close to the basic consensus needed, we will find painful discussions like this one are a lot less frequent.
Know what I did not see in this exchange?
"Yes! You got there. How can we reach more people and help get past this?"
Feels a lot more like, "better late than never, and you need to do much better."
However, and as a thought exercise, say we did not go down the Citizens United path after Reagan repealed the Fairness Doctrine, and Clinton Telecommunications Act of 1996.
Social media viewed through that lens, one where both the public interest is a thing we recognize must at least compete with profit, and the public trust is recognized and maintained as the high value part of our Democracy it is.
I do not disagree with you about tech and the law being behind. And right now we remain in a particularly difficult time due to so many legislators not understanding tech well enough to perform their role as well as it needs to be performed.
That said, our difficulty right now is greatly exacerbated by basic policy priority shifts that happened well in advance of tech.
Owning that is particularly difficult too. Money and markets are a higher priority than the public interest is, and that is true for government as well as big media.
The vacuum was there and significant, leaving tech, social media to rapidly expand into it.
Had that time been one of more robust public trust, social media would have to compete much harder, and regulation may well have both been more effective as well as earlier, more robust in its positive impact.
You could try spreading the truth instead of bullying people? I do care about my mothers health you know. And if a doctor isn't convinced by a large number of studies I want them to explain why not rather than call me a conspiracy peddler.
The way someone gets ivermectin is to walk a doctor through the evidence they've seen and then ask them to prescribe it.
I am a doc. I am also a medical researcher, but you (and most other people here) _have_ to realize that the vast majority of practicing MDs are _not_ scientists, and understand almost nothing when reading medical studies. And that's fine, because it's not their job. The profession is bound by guidelines and expert opinion. Experts do research, formulate guidelines, and guidelines get applied by practitioners. And no, that absolutely does not mean you know better than the average doc because you've read 10 studies. That's telling a highly specialized labourer that you know the job better because you've read 0.0001% of the theory.
As someone who is actually an expert in a subfield of medicine, not only do doctors not understand it at all, but the experts making guidelines often recommend the exact opposite of what is the best treatment for the patient, usually for liability reasons, but occasionally for true lack of understanding. The quality of research is so poor that often times there are more flawed studies showing X than proper studies which would show ~X. Other times there is no research on the matter at all, and the conventional wisdom (even among experts!) is incorrect. For fields where practice and theory diverge, like an experimental surgery with sparse research, the surgeons know that the guidelines are useless.
What you yourself _have_ to realize is that the expert researchers who are in a position to create and inform guidelines are themselves not some kind of 'super-experts' who know everything better than normal experts. They're just researchers in a political position in a bureaucracy.
I don't exaggerate when I say that an average HN reader could write better guidelines for patient outcomes in my subfield, with no prior training, simply by reading a few studies and observing a practice.
Now, does any of this apply to internal medicine, specifically covid? Probably not. But when the data is anything other than crystal clear, you should not assume the expert guidelines are anything more than some guesses by guys in a room. The consequence of knowing this is that all guidelines and consensus is suspect until you see the data yourself, like TFA outlines. In this case it seems true that Ivermectin doesn't cure covid. But with my experience, the exact opposite result could have been shown and I would not be surprised whatsoever; experts saying it doesn't work does not constitute in my eyes anything other than noise until the data is clear.
I'm not saying that experts are doing a stellar job or that they're special in any way, far from it. I have slaved enough under 'true experts' to know the extent of the catastrophe. We even had a truly spectacular example of failure at the start of the pandemic with the 'intubate early and withhold steroids' expert opinion. This particular one, I won't ever forget.
What I'm saying is only that:
- on average, experts do spectacularly better than Joe Schmoe. Including science degree holders thinking they understand medical studies while missing the whole political and social context of the field.
- it's not the job of field practitioners to prescribe experimental therapies, and those people cannot do better than follow expert opinion and guidelines.
But I actually agree with you on all points, especially regarding flawed research and understanding. Which makes people basing opinions solely on papers without any practical knowledge of the field wrong all the more often. Does it make it a good idea for people to go and try on their own the thing they read about in the last issue of 'covid today'? I don't think so.
>on average, experts do spectacularly better than Joe Schmoe. Including science degree holders thinking they understand medical studies while missing the whole political and social context of the field.
I'm saying that, when the data is unclear and Joe is thorough, I don't even think that's true. Or at least it's not spectacularly better. My point is that for something like Ivermectin where the data was initially null and even now isn't super clear, the word of experts was basically meaningless. Trust them if you don't care enough to look into it, but if you're Joe I'd say just go ahead and believe whatever you understand to be correct until there's a better consensus.
The medical profession gets it wrong with some regularity, but this Ivermectin thing fell out of the sky without any support, and was touted as the miracle cure that big pharma was withholding in order to protect their profits.
So even if the data is unclear we can safely conclude that it isn't a miracle cure and never was. And Joe Schmoe here isn't talking about some condition that he's been walking around with for a while and has studied extensively, Joe Schmoe here is a guy who believes doing your own research is watching youtube videos by people who have done their own research reading a bunch of papers without understanding any of it.
The problem is that that gets in the way of achieving the goal: beating this pandemic, and that isn't going to happen with ivermectin. (Or HCQ for that matter).
Your Joe is the average HN reader. My Joe is my average patient. I completely agree that the word of experts is meaningless on matters where dust had no time to settle. I however maintain that practitioners have to follow guidelines and experts regardless because I believe in the principle (if not the current application) of evidence-based medicine, and that Joe should not be allowed free access to any drug he wants to prevent frequent self harm.
I don't know about that. I'd rather see all of this stuff disappear from youtube and to deny the conspiracy sphere its oxygen than to let this run its course. The damage is very real. Experts tend to communicate via scientific papers and symposia, not via youtube, that's aimed squarely at the masses only a very small fraction of which has the capacity to interpret what they are hearing, but almost all of them have the capacity to filter that to select the bits that they like or that they feel support their pet desired outcomes.
The damage caused by mis- and dis-information is real, but suppressing dissenting voices (even comically mistaken ones and bad actors) destroys institutional credibility, which is far worse in the long run.
The dissonance here is intense. On the one hand, "practicing MDs ... understand almost nothing when reading medical studies", but also I don't "know better than the average doc [just] because [I've] read 10 studies."
Is the idea that doctors deserve deference because they are conditioned to submit to guidelines formulated by experts?
There is a lack of consensus on many long-standing, common medical questions, much less novel diseases. When I ask my GP about prostate screening, for example, he lays out the current state of research as best he can, but delegates the decision to me. Why is the COVID situation different, given that experts are still fighting through a figurative fog of war?
Great point. Perhaps the idea is that neither you nor the avg doc can conclude much from reading 10 studies. Therefore, defer to the experts?
As to why the COVID situation is different, presumably because prostate cancer screening affects only you (and perhaps your family in the case of a true/false positive/negative diagnosis), and COVID represents a threat to everyone around you, and everyone around them, etc.
Your GP may try to lay out the state of research before you, but that does not change the fact that he/she will do one of those things:
1. Treat you according to guidelines/expert opinion, should you choose to.
2. Give you the opportunity to participate in a relevant study.
But _never ever_ will your GP formulate an experimental treatment plan based on his own research. Not GP's job, and big risk of liability. Your GP has at best a cursory view of the research happening in a certain field. COVID is different due to several good and bad reasons: hugely politicized, confusing messages from experts, and most of all novelty. 'Lack of medical consensus' usually means 'several treatments backed by experts are available', not 'do what you like'. COVID is too new for the dust around expert debates to have settled. That's what makes it different.
But why do you even assume that it works? The doctor might not be able to disprove it because disproving is fundamentally hard and may not even be possible. But the direction that makes sense is that we prove if something does work/has an effect.
The zero hypothesis is the long standing default, that a random thing will not cure this illness. The alternative hypothesis is that it does cure it and then we can analyze the results based on the results of a fair trial.
This is a blogger who took time out of their day to do this. Why do you have to be catered to to be convinced? The blogger didn't produce any new data, it was already there, you chose to ignore it, or rather, picked something else to be convinced by.
It's not bullying or "talking down to" to simply ignore bullshit, it's effective use of your time.
I was never an ivermectin proponent — although I thought the "horse dewormer" rhetoric was self-defeating, because it's obviously and well-known to be also a human dewormer (amongst other parasites), and the "horse" part just seemed to be played up to make ivermectin supporters look stupid — but this article is indeed the first one I've seen to make the parasite-COVID-comorbidity argument. It's not, in fact, the first time that argument has been made... But it seems like the first time that link was made was within the last month, as the blog post links to the following Twitter thread from a medical researcher: https://twitter.com/AviBittMD/status/1456376484180922368
It's not ridiculous to me that this blog post would be someone's first encounter with that argument, considering how recent the link is.
I have a little bit of experience with reading lots of research papers about COVID safety measures, and coming to the opposite conclusion of medical experts: in early 2020 I read lots of papers on masks, and tried to convince most of my family to mask up even when the CDC said that masks didn't work. I happened to be right, and to my parents, I now look like a smart and forward-thinking, science-driven person. But that's only because I was right! I could see someone doing the same with the ivermectin studies, and while it appears that they were wrong, I don't think it deserves dismissal or derision — especially when it comes from someone willing to change their mind and admit they were wrong when presented with compelling evidence to the contrary.
Please provide sources that "many people" are using horse doses. I only hear of well known people such as Joe Rogan and Aaron Rodgers using human-prescribed pill form ivermectin.
On the contrary, the majority of people who called poison control were "worried well" who had no symptoms. And I think "not a lot in absolute numbers" is really underselling it: the total number of "reported exposure cases" was 459 in a country of 330 million people, up from 133 cases the previous month (before people started thinking ivermectin was a suppressed miracle cure). That's one out of every million people. Of those, zero died.
By way of comparison, every year, two out of every million people in the US die by falling out of bed.
There were many news articles stating this that were corrected for grossly exaggerating the situation. I would suggest going back and re-reading the source material to see if it has been updated or has disappeared.
What’s a better practice is to explain the rationale per situation, what is known and what is not known. The right turned science into a culture war flashpoint, which meant the left blindly preaches “believe in science” as if it’s about faith. This is all very disingenuous and not at all what science is actually about.
It’s very unfortunate that Covid started under trump because being anti-science was part of his marketing message to his base, many because of the risk to certain jobs with caring about climate change (aka the great “hoax”) and the association of science/medicine and abortion.
Unfortunately explaining the rationale in a way that people can comprehend and not tune out is very very difficult, and far more time consuming than whatever 2 syllables Trump could come up with as a retort.
> The right turned science into a culture war flashpoint, which meant the left blindly preaches “believe in science” as if it’s about faith.
These two perspectives are not equivalent opposites though.
"Believe in science" is not a religious statement.
It is a shorthand for "trust in the scientific institutions that have proven their track record via decades of public health progress, and not in anti-scientific rhetoric with a culture war agenda".
That concept wasn't even controversial on most of the political right until their recent nationalist turn.
Knowledge and understanding of the world is constantly growing. There are endless examples of how scientists and other intellectuals have a current paradigm of how something must work, only to be disproven in the future (usually by someone who gets castigated until held up years later). So to say 'believe in science' is actually dogma. It makes me cringe when I see it as a political banner, or along side signs like 'in this house we believe in....' It would be more accurate to say 'the scientific method works', but it really only works in the long run. At any point in time our understanding is incomplete and erroneous.
The facts are out there, whether you believe it or not, and eventually the scientific method will catch up.
Of course if you're not a trained scientist, then it's hard to appreciate how the scientific method works, and that even when we're very sure of something, true scientists will always hedge their statements. This will be misinterpreted by those who are outside this world as there being more gray than actually exists, and those with an agenda will drive a truck right through it.
No, people who will amplify bullshit because they want to believe in miracles rather than to face the music. As long as it is just about yourself go wild, do whatever you want. But keep your mental viruses to yourself, lest they destroy the lives of others.
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?
In short: papers lie, and grad school teaches you to read around the lies. Papers lie because people are competitive (you lose your job if you aren't publishing), want their narrative to be true (don't we all), and the people reading the papers professionally know how to interpret them.
Pretty sad, but that's what we've ended up with. It was incentivized for.
Reading 30 studies certainly seems to be a bad way to learn anything unless you're conducting a meta-analysis of them. For one thing, you'd get tired. But just shoving 30 pieces of information into your head and forgetting some of them doesn't help you find out which of them were correct.
Especially in a field in which you are not trained, do not have the background knowledge required to understand the various qualifications and established best practices in. That gap can be absolutely enormous, even for fields that are peripherally related. Specialization is there for a reason, the body of knowledge that we now command is way too large for any single individual to absorb to a substantial depth.
Suggesting that there's no way someone could have the mental stamina to read 30 papers, over the course of two years, is completely ridiculous, insulting, and invalidates your viewpoint, in my opinion.
Why are you assuming they tried to read it in one sitting? Nothing remotely suggests that in the comment thread. All we know is that they read 30 papers sometime within the last two years or so. You chose a perspective, and just reinforced it, that they were incapable of extracting anything useful from reading those papers, which is insulting. It could be that they read a paper every couple of days, or perhaps when they became available. For some reason, it seems you've already decided that they're incompetent.
Isn't the correct answer to wait for more reliable studies? Which is what most "anti-ivermectin" folks were saying to begin with? If your primary goal is to have a miracle cure in hand that would allow you to push back against vaccine mandates, then this approach probably won't sit well. But if you are interesting in actually finding truth, than waiting for larger, more robust studies was the answer.
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 prophylactic or therapeutic, the evidence just isn't strong enough, but I don't really fault anyone that would add it into the stack of treatments upon a diagnosis in the hopes of a small net benefit.
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 might live forever. I think the consensus on this now is that more or less this is not a useful practice, though I am unaware of any evidence for it being unsafe.
- Prophylactic hormone replacement therapy in middle aged women, which was eventually generally recognized as unsafe because of unexpected cancer risks not initially understood.
- Prophylactic breast self-examination, mammograms, and prostate exams based solely on age, the former of which have been significantly dialed back over the last decade because the risk of false positives or catching slow-growing low risk cancers causes a net negative from the treatment. I don't know what the state of prostate exam research is.
- Prophylactic aspirin for heart stuff: we seem to go back and forth on this, but the last I read was that actually there's mounting concern about chronic low-dose aspiring. At the very least, it's not obvious this is doing anything.
- Statin treatment in response to mild elevated blood pressure with no symptom of disease; not exactly prophylactic, but close in the sense that it's about advance management of expected disease. And last I read, researchers were increasingly recommending dialing back statin treatment for minorly elevated blood pressure because of, again, unforseen side effects.
So I just mention this to say that what I take from your post is "the precautionary principle suggests giving more weight to prophylaxis with no known side effects" and what I take from major medical stories in my lifetime is "no known side effects almost always turns out to involve side effects in the end, and that has to be part of the precautionary principle as well".
And I should note all of the above prophylaxis is based on clearly defined treatment regimens and physician supervision, not the kind of wild west ordering various formulations of ivermectin at unknown doses with or without medical supervision on an ad hoc basis.
It occurs to me that I didn't mention PReP for HIV, which is obviously effective in what it does. I do tend to think of the direct risk in a PReP context as more severe, and also PReP requires active management of a physician's care, so it is a bit different than the thing being discussed, but it's also a counterexample to my point and so in charity I decided to add it in this reply.
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.
I said I don't fault people for using it as a precautionary therapeutic upon diagnosis.
I didn't say that I don't fault people for taking it as a prophylactic. I do fault people for doing that because the side effects of long term use are less known, as you say.
> FWIW, I wouldn't take ivermectin either as a prophylactic or therapeutic, the evidence just isn't strong enough, but I don't really fault anyone that would add it into the stack of treatments upon a diagnosis in the hopes of a small net benefit.
If you're familiar with software development, this is akin to "there's a bug in my codebase and I'm just going to add a bunch of code that probably won't affect anything in the hope that it will fix the bug".
Meds shouldn't be administered in this way. It just ads noise to the system and will complicate things down the road.
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!
Why not pray for satan with a goat sacrifice? That also doesn’t harm you and has similar quality of evidence for working. But my point is that there are literally infinite things that could cure covid, but in the end only empirical evidence is meaningful. But we have to choose our “fights” and methods with not even a probably way of effect are more than likely useless.
And that touches on another problem: all of this Ivermectin (and HCQ before it) bullshit takes funding away from studies that might turn up something useful. The only reason these drugs are even studied at this point is because they are so well publicized, even if there is approximately zero proof that they actually work.
If they were miracle drugs as described the effect would be so large that those studies would be unnecessary. But here we are, and study it we will.
Again, stop saying "proof". You're misusing this word. It really seems like you have an ideological axe to grind. There is not "zero proof". Did you read the article? What you are saying and your level of confidence seem detached from the article's contents.
There is tentative evidence of a small to medium effect, but the quality of that evidence is low and that quality is insufficient to recommend use. This then deserves more attention and resources to figure out if it's real and why there's an effect. That's how science works.
Contrary to your claims here, scientists aren't studying it because some cranks on the internet propped it up. They're studying it because some field doctors had positive anecdotal experiences and some early studies showed promise.
As you've said, the medical establishment really wants to end the pandemic. Which is why they're looking into this drug, among many others.
> 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.
The issue is that folks who are taking ivermectin are doing it in lieu of getting vaccinated. If you get vaccinated and want to take ivermectin for the heck of it, no one is going to stop you. But if you claim that ivermectin is a miracle cure for covid and as such vaccines are no longer necessary, then that is a problem.
Why not using a de-wormer against a virus? Well, because that's what vaccines are there for. And we do have rather effective ones by now. All of which have a low risk of side effects as well.
Using ivermectin as a therapeutic and getting the vaccine are not mutually exclusive.
Also, I don't like your first sentence, it's a rhetorical gotcha that is actually not in line with the medical establishment's thinking on ivermectin's hypothesized mechanism of action:
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.
It is obvious that ivmmeta.com is picking up something that is a real signal. The only question is a signal of what. Fraud? Bias by the site authors? One of many complex statistical effects? A working drug?
There were loud, even unreasonable, voices in the debate but nobody was raising an actual problem with the results. Ivermectin has a respectable safety profile. "Maybe it works, no obvious downside" was a reasonable position.
It was always a long shot, the evidence was weak. But loudest voices in the anti-ivermectin crowd are people like, eg, jacquesm in this thread. A lot of bluster, a smidge of bullying and a weak-sauce appeal to authority for why statistical evidence should be ignored. And YouTube et al. believe it to be convincing evidence or they wouldn't bother to censor discussion of it. If that is the opposition then they don't seem to have uncovered a methodological problem yet or they'd raise it.
But Scott raises an interesting theory that would be enough to explain ivmmeta.com. Since it was only ever weak evidence that is enough for me to change my mind.
> many serious anti-Ivermectin arguments in the past
I haven't seen any of these. I just run into irrational and offensive people like you that accuse me of wanting to drink bleach when I bring up the topic of Ivermectin.
This article removed all doubt for me. I needed to see the thought process while pouring over the studies.
You shouldn't make so many assumptions about people based on your political bias. Some people want to understand. That doesn't make them foolish or antivaxers.
So go study medicine, assuming you have 10 years to burn and are willing to take a massive pay cut.
The average HN'er probably knows how to program a computer and some of them may even know how to program one well.
If a guy that runs a fishing boat with not even the most basic idea about programming, hardware, software, satellite systems, general relativity and integrating all of the above into a working solution came to them with a request to really understand how his GPS works before he would put it to use we'd likely tell them to just trust the experts.
The argument you are making is directly addressed in the article.
> So “believe experts”? That would have been better advice in this case. But the experts have beclowned themselves again and again throughout this pandemic, from the first stirrings of “anyone who worries about coronavirus reaching the US is dog-whistling anti-Chinese racism”, to the Surgeon-General tweeting “Don’t wear a face mask”, to government campaigns focusing entirely on hand-washing (HEPA filters? What are those?) Not only would a recommendation to trust experts be misleading, I don’t even think you could make it work. People would notice how often the experts were wrong, and your public awareness campaign would come to naught.
> But also: one of the data detectives who exposed some fraudulent ivermectin papers was a medical student, which puts him somewhere between pond scum and hookworms on the Medical Establishment Totem Pole. Some of the people whose studies he helped sink were distinguished Professors of Medicine and heads of Health Institutes. If anyone interprets “trust experts” as “mere medical students must not publicly challenge heads of Health Institutes”, then we’ve accidentally thrown the fundamental principle of science out with the bathwater. But Pierre Kory, spiritual leader of the Ivermectin Jihad, is a distinguished critical care doctor. What heuristic tells us “Medical students should be allowed to publicly challenge heads of Health Institutes” but not “Distinguished critical care doctors should be allowed to publicly challenge the CDC”?
I think it is horribly demeaning to respond to someone asking how GPS work by saying "you can't try to understand without years of training, just trust us." That is exactly the kind of response that alienates people and fosters mistrust.
Really, in a just world that guy would lose his license to practice medicine. I find it interesting that 'the lone voice' has such a power over 'the establishment', as though the lone voice is always right because they're the underdog.
There is an excellent movie about the theme of an infectious disease where some blogger/journalist goes all out on promoting 'Forsythia', a medication that does absolutely nothing against the disease, but that - using the exact same mechanisms as Ivermectin, HCQ and others - gets promoted to the hilt. I'm not sure if this is life imitating art or some kind of coincidence but it is uncanny to which degree the stories overlap:
Dinstinguished critical care doctors who go to Caribbean medical schools who have to pay hospitals to accept their graduates as residents probably should be given short shrift at first when challenging the CDC.
The experts involved in building / maintaining GPS haven't admitted to lying to him about it to preserve the use of GPS for people deemed more important, gone back and forth on whether or not he needs to use two GPS devices (instead of one) for the safety of others, and those experts' recommendations haven't led to policies that have destroyed the livelihoods of his or his friends' families--sometimes with unclear ties to actual societal well-being.
It's not quite the same. The people who build / maintain GPS have a lot more reason to trust them, and as a result, people do.
Until a while ago, if I recall correctly. GPS was <<lying>>. Its accuracy was deliberately hobbled to within tens of meters in order to prevent it being used for destructive purposes, I believe.
Saying "your location is somewhere within X, up to ~5 meters" isn't lying. It's not even a half truth, but it's still pretty far from the point here.
It's trusted because it's been far more trustworthy than public health guidance and policy. And the same goes for airplanes, brake pads, and other tired comparisons. Trusting one does not imply one should trust all other proclaimed experts in all other fields in all other contexts.
Not sure that’s the most comforting analogy to pick. GPS is maintained and controlled by the US military. They can shut it off, used to secretly make it intentionally inaccurate, have dual-band devices to protect against failures of GPS by using competitors, etc
Perhaps, although I didn't pick the analogy, and even accepting at face value what you're saying: clearly there is justifiably a much higher level of trust in GPS than public health advice, and for good reason: its scope is limited and it's had a much better track record.
Sam Harris mentioned this theory of it being pointless to engage people who have their own theories because you'll be faced with a never ending stream of "yeah but did you read this random 90 page paper on X?" and all kinds of other questions even the best professional can't counter without wasting huge amounts of time.
It's great you changed your mind but I bet there's plenty of people who haven't. Like I wonder what Bret Weinstein now thinks.
That is lazy. Indeed, there is no point in refuting a random 90 page paper. However, a good professional should be able to quickly summarize the state of the area touched by the paper and provide a short list of key citations and publications. A good professional should also be able to say "this is outside of my area of expertise" and point to the general direction of where expert feedback can be sought.
Edit: I probably wrote this comment to aggresively, which is ironic given that that is what I am arguing against. My apologies.
When you see someone you disagree with convinced by an argument, I think that should be an occasion for celebration and joy! People changing their minds to what you believe to be true is the only way to get change. It needs to be encouraged and people who manage to do this need recognition.
Changing your mind in polarized situations is hard! People who manage it did something impressive. Heck, even people who are willing to listen to the other side deserve recognition.
You saw someone who changed their mind, and you chastised them for not having changed their mind earlier, and for having been wrong before. That is rather counter-productive. Instead, be happy with the conversion. If you want more interaction, ask them why they believed the other thing before. Less importantly, ask them what changed their mind.
I'm happy with their conversion but realize that the reason why they became converted is actually false: they now claim they are convinced by facts they very obviously still do not understand. Besides, probably the only reason they allowed themselves to be convinced is because of the fig leaf handed by the article in being able to claim to 'have been right all along'.
> Less importantly, ask them what changed their mind.
They wrote about that in this thread, and it proves that they do not understand the basic argument made, at all. As converts go, it's a pretty sad case.
The author of this article did a fantastic job, but all it has done for me is to show how hard it is for people to digest information and to draw meaningful conclusions from it.
On another note: this is why I'm not particularly hopeful about humanity getting their act together with respect to climate change.
Not to mention, the thing the article eventually points out; that ivermectin had the most efficacy in areas that also have large populations suffering from parasites, isn't new.
Nothing this article says is new. This is all old hat.
>Ivermectin doesn’t reduce mortality in COVID a significant amount (let’s say d > 0.3) in the absence of comorbid parasites: 85-90% confidence
That simply armchair science blogging psychiatrist's hypothesis. He even admits as much,
>But this theory feels right to me. It feels right to me because it’s the most troll-ish possible solution. Everybody was wrong!
None of the studies looked at worms. It is correlation == causation logical fallacy to conclude this based only on speculation. If you want to start arguing with that approach there is no bottom as there are just as many correlation == causation counter examples like https://i0.wp.com/noqreport.com/wp-content/uploads/2021/09/I...
You simply cannot dismiss that Ivermectin only works because worms until you have studies proving that. You can only say that it works, but you're not sure about why. Good to see that even after he cherry picked all the studies as hard as he could, he still had to reach this basic conclusion.
As the blog post indicates, there is data proving a positive effect. That's not in question. The author is simply speculating why that is the case at this point, the specific reason for the positive effect.
> As the blog post indicates, there is data proving a positive effect.
No, there is data that might point to a positive effect, that's something completely different than data that proves a positive effect.
Note that this is exactly how these things happen, someone writes something with a particular audience in mind and then others will come along, cherry pick it, distort it and then pass it on as fact. You are step #1 of the Chinese Whispers game and it has already meaningfully changed.
Personally I'm naturally skeptical of any suggested COVID treatments because they tend to be trendy. Before ivermectin, it was hydroxychloroquine. And before hydroxychloroquine, it was vitamin D, melatonin, and diluted bleach. And before that it was that it was only harmful to people who lead unhealthy lifestyles: It was less a disease and more like cosmic justice for living an indulgent, gluttonous sedentary lifestyle.
Meanwhile over the last 11 months most of the vaccines have been extremely effective at reducing hospitalization and death. My 3yo son caught COVID from one of his classmates at preschool - my wife and I are fully vaccinated - and we were both able to avoid an infection while under quarantine with our son.
It would be hilarious if just like this argues fairly convincingly for ivermectin, all of those (well, the first two) actually turned out to be true, but only for malaria infected and vitamin D deficient patients.
That literally isn't an argument. It is a statement.
And if anyone who said "many scientists/doctors believe it to work against Covid-19" is getting banned, then that statement has 0 signal.
As Scott points out in this article, without knowing about the parasitic worm situation https://ivmmeta.com/ is both reasonable and moderately convincing.
No it isn't, it's full of obvious fraud! That's what the entire rest of the article points out. And they put an unwarranted warning against one of the few non-fraudulent studies because it doesn't go their way:
[re: Lopez-Medina et al]
> "I’m making a big deal of this because ivmmeta.com - the really impressive meta-analysis site I’ve been going off of - puts a special warning letter underneath their discussion of this study, urging us not to trust it. They don’t do this for any of the other ones we’ve addressed so far - not the one by the guy whose other studies were all frauds, not the one where 50% of 21 people had headaches, not the unrandomized one where the groups were completely different before the experiment started, not even the one by the guy accused of crimes against humanity. Only this one. This makes me a lot less charitable to ivmmeta than I would otherwise be; I think it’s hard to choose this particular warning letter strategy out of well-intentioned commitment to truth. They just really don’t like this big study that shows ivermectin doesn’t work."
That's the nearest Scott gets to directly accusing ivmmeta of fraud.
The base rate in medicine is around 10% of studies being fraudulent [0]. That is roughly the rate that Scott came to in the article ("We’ve gone from 29 studies to 11, getting rid of 18 along the way. For the record, we eliminated 2/19 for fraud").
It might be that the list is riddled with fraud, but it isn't obviously so. I'm comfortable with many of the studies having methodological errors - that is why it is called "low quality evidence" instead of "high quality evidence" - and I assume the base rate for badly done studies is quite high.
The ivermectin manufacturers, researchers receiving funding from pharmaceutical company or the government, or the ivmmeta.com website itself (I see no third party ads or assets at all -- not even GA)?
Meanwhile, back at the Pfizer ranch, they just bought a few small countries for cash.
This article doesn't move the needle at all for those that have a basic understanding of the mechanisms at work and who don't fall for the first conspiracy theory that gets lobbed their way.
What you should do instead is to listen to your medical authorities who even if they do make mistakes have your best interests at heart, contrary to those that are pushing the quackery in an attempt to further destabilize our societies. You made yourself a willing collaborator in that, something to think about.
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 cause. It’s probably a virus and I should just go home and wait a few weeks.
And after 3 months (10 days of which were in-patient) and 40 or so specialists, and 5 hospitals), a doctor looked at all the data and said “of course you are right, we start treatment tomorrow” and we did.
All it cost was some irreversible brain and CNS damage, a few years at home - not much, right?
And through the years and some Facebook groups, I’ve met other parents in similar situations. Some had a 5 year delay in diagnosis because it’s a rare disease, stories about the medical system incredibly similar. That’s 5 years of irreversible brain damage and general suffering. Also, it’s more likely severely under diagnosed and actually more like 1:1,000,000
It was just the beginning of a journey. An eye opening one about incompetence and incentives.
The assumption that health authorities in particular (and authorities in general) have your best interest at heart, and are competent, are severely lacking in evidence. You might not have been bitten by that, and I’m happy for you that you weren’t.
Health authorities and professionals optimize for a lot of things, that only sometimes coincide with your interests as an individual. E.g. they might prefer you stay sick than get better, if there’s a 1:10,000 chance you’ll sue them (regardless of merit). I am intimately familiar with such a case.
Of note, the pharmaceutical industry, which is intimately intertwined with regulatory agencies and health authorities, is incentivized to make you a paying regular customer (Office 365) rather than selling you a one time product. Unfortunately, that means managed chronic illness rather than cure.
Which is not to say HCQ or IVM or whatever are the cure. But the idea of “trusting the authorities” is something you only do until it bites you hard.
And for every story like yours - and I know of a few of those - there are examples of people who were absolutely convinced that their child had 'x' or 'y' when it in fact wasn't the case. It is great that you had the perseverance to see this through, and unfortunately it isn't rare at all that local medical care is not up to speed with rare diseases or misdiagnosing a rare disease as a more common one.
I lost a sister (at the ripe old age of 23) to such a case so I'm quite familiar with the territory. In spite of that the default for me is to follow what my doctors tell me, and only if it doesn't work would I start to read up more and to try to come up with suggestions, but not with diagnosis.
Health authorities preferring you to stay sick rather than to get better should re-read the oath of the medical profession, that's despicable.
And agreed that there is a lot wrong in mixing business and health care, but those are the kind of setups that we apparently favor. I recall a doctor here in NL remarking to me that money and health are mutually exclusive, because if doctors have to make decisions based on finance they are immediately transgressing their oath. I can see his point, but I also understand basic resource allocation issues and the medical profession does not operate in a vacuum.
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 after receiving a bribe.
The doctor at the hospital just got the memo “the recommended treatment in case of x is y”.
These indictments are for what can actually be proved. I’m sure there are more cases that have not been found, and also in other countries.
The only one who really has your best interests in my mind is yourself; if you are capable of doing research, you are likely more qualified for your own situation than specialists.
WHO recommends against remdesivir. FDA and IMOH promote it as a wonderdrug. Who would you trust?
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 one of substance, just one of scope, and all doctors treating Covid know the rationale behind each cutoff point.
But instead any of that nuance, people say things like the "WHO disagrees with FDA" and decide that both are useless so they should take medical advice from morons with podcasts?
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. SpO2<94% is considered severe and requiring hospitalization -- if you have a positive PCR test).
Do 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.
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 diagnosis and get more trustworthy advice than from a GP.
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/stacking the deck/fudging the data/angling for funding and so on and then finally I'd have to weigh those papers and all of their contradictions and arrive at some conclusion. The chances of me getting that wrong are just as high as the chances of my GP debugging a piece of software by reading papers about debugging.
For rare diseases the job of a GP is not to diagnose but to pass you on to someone who can. You also have the right to a second opinion here in case you don't trust the advice that you are getting and finally, you can ask for arbitrage if you are then still not happy.
That said, plenty of errors are made, but I don't think the software industry has any right to speak about mistakes made in other fields, our own house has been on fire for the last three decades in that respect and the only thing we've done to deal with it is to avow any responsibility.
The divergence is not as big as in the US then, but your incentives are still not perfectly aligned.
If you want to outsource your health decisions to someone else, who may be more knowledgeable in general, but may be less knowledgeable on any specific matter you dive into, and whose incentives are only generally aligned with yours - by all means do.
I don't, and this has paid great dividends for me so far. People who are capable of reading and understanding research (not all are), and have the ability to reach far out to well informed people and consult with them (not all can), are also likely to be in this situation -- and those people potentially lose dearly for not doing so.
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 effective and inexpensive treatment that the medical establishment is failing to recognize despite apparently having such clear evidence in its favor that people on Facebook can understand it.
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.
> who even if they do make mistakes have your best interests at heart
They, like every other person, have their own best interest at heart, which, if you're lucky, aligns with yours. "Just listen to the authorities" is probably the worst advice ever given.
In the case of a pandemic it is probably pretty good advice, unless you are of the opinion that your authorities are acting against your interest.
The problem with this pandemic is that a lot of people in places of power have made mistakes, sometimes really bad ones (for instance, such as pursuing herd immunity) rather than to follow the WHO expert advice. This could easily be construed as authorities acting against your best interests and in fact in quite a few places people have died that need not have died at all.
But there is a difference between 'political authorities' and 'medical authorities', the WHO has been fairly consistent and sensible in their advice to date, what political authorities locally do with that advice is another matter entirely, that runs the gamut of Bolsonaro to Boris Johnson to Jacinda Ardern and everything in between.
Yeah, I agree, that in the case of a pandemic, the health authorities interests are pretty well aligned with a member of the general public. However, there are always issues in this kind of situation when the authorities got it wrong. In a political environment, changing course is seen as an admission of being wrong, and a loss of face. So we continue on with the initial policy. We are currently facing this problem as all experts seem to agree that covid will be endemic, but we are still flailing around with (increasingly half-assed) prevention measures as if we are still going to stop the virus. I disagree that pursuing herd immunity was a bad decision. With every day the pandemic drags on, Sweden's decision is looking better and better.
Agreed that there is a lot of ego involved, and that certainly doesn't help. In NL we have a couple of nice examples of that.
Pursuing herd immunity is a viable strategy only if you can actually achieve it.
Sweden has done far worse than their neighbors in this respect. But given the fact that it drags on all you can say is that as long as we don't treat this as a global problem your local measures matter less than you think.
Countries that did fantastically well early on showed it could be done, but because they were the exception eventually they too became overwhelmed through imported cases. If that had not happened, which would have required a more synchronized approach, then the total damage would be a fraction of what it is today.
And this isn't over yet, not by far and it is a much harder problem now than it was in March last year.
Denmark, Finland, Norway and Iceland all did considerably better, and have demographics and local conditions that are closer together than comparing Sweden with the rest of Europe. It's a thinly populated Nordic country, so the comparison material should be countries that match those criteria, not the average of the EU, which runs the gamut of high density extremely interconnected countries with major airline hubs all the way to vast emptiness with the occasional city.
In addition to that, it's worth pointing out that even the architect of the Swedish policy defending his strategy acknowledges it would have been dramatically worse if Swedes hadn't mostly worked from home and observed social distancing anyway (i.e. the exact opposite of what most anti-lockdown campaigners want). Also, they imposed strict external travel restrictions to ensure they never imported as many cases as the worse-performing European countries did, and deployed all sorts of restrictions short of lockdosn like banning gatherings of 8 people or more. It's really not the poster child for muh freedom
In 10 years, when most of the dust has settled, we'll be able to explain what we saw in Sweden and the surrounding countries as a combination of population density, interactions, medical policy, and randomness. It's hardly fair to consider only a small number of variables in cases like these.
Yeah, but here's my prediction for what we'll find: In one way it was pretty random that it was precisely Sweden that adopted such stupid medical policies versus covid; in another, given what we know of these countries' larger political environment and post-WW2 history, it was perhaps to be expected.
That mirrors my expectation. Which by the way is a pet peeve of mine: the reliance on the 'R0' factor for reporting in the press, R0 is something you can at best establish when an epidemic has run its course, but it is being treated as this magic wheel that we can turn to ensure a desirable level of infections, which is complete madness, it's an output, and a delayed one at that, not an input.
I think many people have learned the limits of science, public health, and mainstream scientific reporting over the past few years. It has repeatedly exposed that the way people think about causality is not consistent with scientific thought. R0 is just one of many examples.
"You don't need to wear masks" was bad advice from well-meaning people who should've known better. The researchers who did know better couldn't push past deeply-entrenched anti-miasma attitudes quickly enough.
"Use social distancing and isolation to avoid COVID and get vaccinated as quickly as possible" is good advice from well-meaning people who do know better. Sorry it's unpleasant, but if the USA behaved rationally, there wouldn't be 750K+ dead today.
Sweden readily admits that its approach was a terrible mistake. It's just not as embarrassingly bad as other countries, particularly ones that, with sensible leaders, should have done much better (UK, USA).
> Sweden readily admits that its approach was a terrible mistake.
It does?!? Funny, how can I have totally missed something as big as that?
I'm a Swedish "expat"; I have now lived abroad for just a little longer than I lived in Sweden (26 vs 26.5 years), but I've always followed Swedish media and I still travel there regularly. All I've seen is some hemming and hawing about "Perhaps not totally optimal"; far from any flat-out admission of "terrible mistake". And when I spent a long weekend there three weeks ago, the populace at large certainly didn't seem aware of any such thing.
> The epidemiologist behind Sweden’s controversial decision to forgo a mandatory lockdown conceded for the first time that more restrictions might have helped prevent a surge in coronavirus-related deaths.
Spot on. The developed world really has no excuses.
Mixed messaging by people in the media undercut a lot of support for the countermeasures, which was then further amplified using social media to pretend that scientists are divided in their opinions when in fact they weren't, except for a few lone holdouts, who - yay controversy - were given a disproportionate amount of airtime.
Nobody in their right mind would have predicted before the pandemic that some of the most developed countries in the world will have some of the highest death counts.
I fear this will be deeply ingrained in the social consciousness and lead to further divisiveness down the line.
This is true, at least, it is for me. I never expected that my country (far down the list in population) would be in the top 30 countries for COVID cases. Disappointment doesn't begin to describe it.
I think that actually the countries that have successfully fought covid (PRC, Taiwan, Vietnam, South Korea, New Zealand as you mention, Thailand, Singapore, Australia, Iceland, etc.) have done so in significant part by violating the WHO expert advice to, for example, permit unrestricted travel. Your country and mine have about 100 times more deaths per capita than any country in that list, perhaps because they followed the WHO's advice.
Throughout the pandemic the experts, including the WHO, have been very frequently wrong. That doesn't necessarily mean you'll be better off following advice from secret messages encoded for you in game show hosts, or, worse, Donald Trump's actual opinions. But blind faith in experts hardly seems to be justified.
Sweden, the country where the authorities apologized for messing up, that Sweden?
People on average gained 10 kg? Really, I have no idea where you get this nonsense but clearly you are not interested in a factual debate but in one that gives you what you want: the ability to ignore this pandemic as though it doesn't exit.
There are no ICU beds for the gerontocracy, there are simply ICU beds, and there is a limited number of them, they will have a COVID patient in them or someone else, and in case of surplus they might be free.
The medical authorities and the politicians should not be confused.
Spain had 14,8% excess mortality than in normal years, Germany had 2,4% less dead, Sweden had 3% more dead. These numbers are adjusted for demographic changes. Sweden now looks pretty solid as well as Spain regarding new cases.
Sure, if you just compare it to Norway and Finland, it is very true that Sweden has worse values, more than 3 times as many dead at minimum. But the answer if it was the correct or wrong choice will be answered after the current seasonal outbreak or in a few years.
edit: Just looked it up again, Spain and Sweden are currently leading with Kosovo for having the lowest case incidence in Europe. Gibraltar has the highest and everyone is vaccinated there. I remember the articles about Gibraltar being the first immune country. They now have cancelled many official events.
The Community of Madrid is the succession tax haven of the country, so loads of people go live there their last years so their families aren't taxed on the inherited wealth.
Combine with the regional government short of condemning to death the elderly in nursing homes by refusing to hospitalize them[0], but I guess it's fine since they forgave themselves [1].
Add to the mix that the healthcare access hasn't kept up to handle what Madrid brought to itself, and then you obtain these numbers [2].
TL;DR: during the first wave, while most regions had peak excess deaths of 10-50%, Madrid had 200%, at the same time as being one of the most populous. In the rest of the periods, Madrid has been usually at the lead as well.
With Madrid removed the numbers are in line with Germany and Sweden.
"APA’s survey of U.S. adults, conducted in late February 2021 by The Harris Poll, shows that a majority of adults (61%) experienced undesired weight changes (weight gain or loss) since the pandemic started, with 42% reporting they gained more weight than they intended. Of those, they gained an average of 29 pounds (the median amount gained was 15 pounds) and 10% said they gained more than 50 pounds, the poll found."
61 percent could have gone either up or down, and 42% said they gained more weight than they intended, of those that gained some gained more than 10 kg, and a smaller fraction gained more than 50 pounds.
So, what does this say:
(1) that people should adapt their eating habits to their needs
(2) that it is possible to lose weight and to gain weight unintended (which is something that isn't really news, see also: weight watchers and the whole weight loss industry)
(3) that the study did not correct for what would have been the result of the poll had COVID not happen
(4) that the word 'lockdown' that you ascribe to the cause does not appear in the article text, but the word 'stress' does
and finally
(5) that you link to this article because you think it supports your statement above when in fact that really isn't the case.
In my opinion it should be an argument, especially for people who don't have that expertise.
Also, even the "moderately convincing" evidence is in my opinion not nearly enough. It might be if Covid-19 were a modestly important disease with only a few labs and clinics running working on it. But it's not. Throw enough shit against the wall, eventually something will stick by chance. This is a globally distributed experiment, and it is impossible to control for publication bias and all quality issues...
The only reason to think why Ivermectin should work against Sars-Cov-2 is because it has shown some action in cell cultures at ridiculously high doses, and maybe there have been other anti-viral interactions in the literature. For widespread use, there needs to be more and better evidence, especially given the currently available vaccines and treatments.
It is only a fallacy when you are an expert as well, but when you are a layperson in a field and you are discarding real expert opinions because you don't like them you don't get to claim that their opinions are arguments from authority and therefore by definition fallacies. Maybe actually read that wikipedia page instead of just linking to it?
This seems to be a common and recurring theme: my opinion is worth as much as the opinion of an expert in the field because their argument can be discarded as an argument from authority. But they are an authority and I'll be happy to believe them compared to believing you, who are not active in their field at all.
"I'm no medical anything but I do have extensive academic and statistical training."
But you forgot that that only applies to those fields that you actually know something about, otherwise this is about as transparent an appeal to authority as one can make. Who cares about your extensive academic and statistical training if you start off with nonsense? Garbage in, garbage out, no matter how good the program is.
> It is only a fallacy when you are an expert as well...
This is wrong to the point where you really might want to take a deep breath. The point of experts is they have thought about a field more and are better at making sound arguments in that field. "Most scientists/doctors believe..." is literally, exactly and unambiguously a fallacious argument. The only thing that matters is why they would believe that.
And if that why is "statistical significance", I'm friends with enough doctors to know I'm better at interpreting stats than they are. If the answer they go to is parasitic worms then yeah, that is why they are experts and I'm not. It is a compelling argument.
I stand by my comments and disagree that they make the point you want them to. The 1st isn't even about medical opinion if you read it closely, it is scepticism of politics.
"The point of experts is they have thought about a field more and are better at making sound arguments in that field."
This is an excellent point. It is so good that I think it may serve as the definition of an expert: An expert is someone who is better at making sound arguments in that field. Sound arguments being what matters and not the person making the argument, just as the calculations matter more than the mathematician.
No, if you are not a doctor your opinion on any of this doesn't matter at all, it's that simple.
Probability dictates that any doctor - let alone most doctors' - opinion trumps yours and everybody else that parrots you, because they will be right far more often than you about medical things.
You may be better at interpreting the statistics than your doctor friends but you are not better at medicine, are not wired into their world as much as they are and in fact are most likely blabbing nonsense.
You can stand by your comments but that just proves my original point: that you consider your own opinion to be a higher one than someone trained in the field that you have an opinion on. See your other comment in this thread regarding how medicine prescription works, it doesn't but that isn't going to stop you from being convinced and it would not surprise me if you felt that that doctor is making an argument from authority.
Suggestion: assume that you are a layperson in medicine, act accordingly. And go get vaccinated if you haven't been already, and ask your doctor if they thinks that's a good idea, rather than to believe me, yet another stranger on the internet.
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 and profit) for decades.
Which, again, I note, is not a statement about IVM or HCQ or Cominraty - it’s about the reasons for your own convictions, which seem to completely ignore decades of evidence.
It does not at all matter that doctors know better than me about 99% of medical things. When I have a specific issue, it is far more likely I can know more about it by spending 100 hours studying, than a trained doctor does without studying. It is likely he would know more than me if he spent 5 hours, but it is very unlikely that he has.
I haven’t disagreed with doctor about many things in my life. But in the 3 or so things which I found vitally important to research, and in which I came to a different conclusion than the specialists, I was proven right.
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 do, in some countries).
And real doctors promoting smoking goes back much further than that, all the way to the early 1900's.
It's that kind of activity that undermines the authority the profession, 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.
> 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).
>No, if you are not a doctor your opinion on any of this doesn't matter at all, it's that simple.
>Probability dictates that any doctor - let alone most doctors' - opinion trumps yours and everybody else that parrots you, because they will be right far more often than you about medical things.
You really have not spent much time around doctors, I think. Doctors (GPs) know about as much on a topic as someone who Googles the current country guidelines. For anything novel, I'd trust a statistician over a GP to interpret data every time.
I've spent enough time around doctors to know that as long as you have something obvious they'll make the right diagnosis, and that if it is something rare they might get it right. But for GPs that doesn't really matter: they don't diagnose unless it is something simple, they just pass you on to the relevant expert after performing their filter function to avoid hypochondriacs from clogging the system.
Don't like it? Get a second opinion. Don't like that? Request a review. Don't like that? Self medicate to your hearts content, or go with crystals, aromatherapy or whatever you believe works. But don't go around the interwebs spouting your self derived conclusion from papers that you barely - if at all - understood as fact.
Because that's the rub: the people who were all over Vitamin-D, Bleach, HCQ and lately Ivermectin were just looking for excuses not to vaccinate and that is a problem, none of these miracle cures were miracle cures, they weren't even cures. At best they were no-ops, at worst they harmed the health of those that received them. By amplifying these messages thousands of people have needlessly died.
But Ivermectin seems to have run its course. I predict a new miracle cure with a new champion somewhere in the next couple of months, just like Vitamin-D and HCQ before it.
Most of that wikipedia article is devoted to pointing out that most of the time "argument from authority" is legitimate.
And to the extent that the article does say that even a legitimate authority needs to present an argument, in this context, they have!
Like the situation here is medical experts have said "hmm these studies that appear to show ivermectin's effectiveness are fraudulent and suspicious".
Like, with the exception of the complete theory that ivermectin studies in some nations are naturally confounded by the presence of worms, the arguments he's made about the unreliability of the ivermectin data is the mainstream argument about the unreliability of ivermectin data. He even cites a number of experts whose analysis he sometimes relies on!
It would be a fallacy to say "this argument is necessarily true because an authority claimed it was so", but it isn't a fallacy to say "this authority in this subject claimed it was so and it far more probable that they know what they are talking about than you, who are not an authority in this subject."
We did adopt his methods, but many years and hundreds of deaths too late, and not before declaring him insane for his beliefs and putting him in an asylum.
What I'm saying is that authority has a dark side. Sometimes the establishment is actually wrong. Regardless of right or wrong, it always chooses to erase its critics. Some of us disagree with the erasure, even in cases where the critics are wrong.
Yes, so you trust in the scientific method in the long term and in the expert consensus in the short term.
The thing where the case you linked went off the rails for me is that there was no downside to trying his methods earlier, but ego got in the way, and ego is by definition unscientific. But people will be people, that you won't be able to fix, I'm afraid.
I don't think we adopted handwashing because of him.
Actually, the reason people didn't believe him is interesting because they were using an earlier scientific method - he didn't have a good explanation for the mechanism, so they dismissed it with "correlation is not causation". We're better at using things whose mechanism we don't understand now, like Tylenol.
There is a whole industry in off-label use of medicine, and there are also quite a few studies that try to move off-label use to on-label use once the link is clear.
What is interesting (to me) is that which we now consider to be common sense was at one point controversial.
Because people will happily discard evidence that contradicts that which they want to believe. There is apparently something attractive about 'miracle cure suppressed by vested interests' that pretty much guarantees its spread. All you need to do is plant the seed with some gullible people and they'll run with it and parrot it to everybody that will listen, doing a boatload of damage in the process.
Between hydroxychloroquine and Ivermectine you are (worldwide) probably looking at a few hundred thousand extra people dead because they (or in some cases their leaders) chose to believe that bullshit rather than to get vaccinated.
Most scientists/doctors believed at one point that ulcers were caused by "stress". My father lost half his stomach to an ulcer surgery. Nowadays ulcers are cured with antibiotics in the span of a week. Don't put much stock in what crowds "believe" to be true, _especially_ when _not_ believing it means they can't work in their field.
That's science working as intended: theories getting replaced by better theories. There is plenty that we are probably going to find out more about in the future that will invalidate some of what we believe today to be true. But that's fine, as long as we stick to the scientific method that will all come out, even if it takes a while. Science has brought us further in 400 years than anything that came before. Right now it has given us vaccines, which are the best way to deal with COVID-19, and the anti-vaxx crowd and the pro-hydrochloroquine and pro-ivermectin crowd show large overlap.
Fortunately during the polio years we didn't have the internet, the carnage would have been incredible.
There would have been no carnage with polio. Vaccines have a demonstrable and long lasting effect and the disease is more severe for all age groups, so people would have taken the vaccine.
Yeah, I knew a guy who got his legs destroyed by it. Given how well the polio vaccine is tolerated, and how grim the prognosis is without it, I don't think there'd be any issues with vaccine adoption. Measles one could argue either way - the disease is far less severe in most people.
Sure, but my point is "consensus" doesn't necessarily mean "truth", even though the vast majority of people use the terms interchangeably. "Everyone but one person is wrong" is a situation we've seen numerous times before in the history of science. And when the matters of social acceptability, prestige, politics, and just plain ability to make a living enter into the consideration, very, very few people would even be willing to challenge the status quo. I wouldn't. I have mouths to feed.
I'm fully resigned to the fact that we won't know for sure if Ivermectin helps with any of this shit for at least another decade until tensions subside. Could be that millions of people died while they didn't have to. Could be that it's total horseshit. There's no way to know, and "consensus" means next to nothing in these circumstances.
The consensus in the medical world is that if there is a link it is extremely weak, far weaker than you'd need to establish that 'millions died while they didn't have to' as you write, and that if it works it probably needs very high doses, higher than considered safe.
At the same time, we have vaccines, which do work (though the slow roll-out and the many, many hold outs certainly don't help, as well as that it leaves the question of how to deal with children for the moment mostly unanswered).
And propagating this Ivermectine (and Hydroxychloroquine as the predecessor) nonsense has caused a lot of people to forego their vaccinations. And that does have very clear effects.
So even if consensus doesn't mean truth typically it is the experts that go against the grain with hard proof in their pocket that win out over the long term.
It is very rarely going to happen that new scientific truth will come from conspiracy theorists rather than from the establishment, though I guess if you live long enough that too will one day happen.
I agree with both of you. We can't 100% argue that the prevailing wisdom is infallible because of real examples of the opposite occurring rarely, like the ulcer case. However, on the balance I prefer to go with prevailing wisdom. It's a judgement call that requires a human to detail with probabilities and humans are very bad at probabilities.
> has caused a lot of people to forego their vaccinations
Citation needed. I think people forego vaccinations due primarily to how hard they are being pushed, and due to almost 2 years of pretty much nonstop incoherence (or even outright lies sometimes) from the health authorities and the press worldwide.
Case in point: we're still being told by talking heads that "vaccines can stop covid" whereas the reality is nothing can stop it - it's endemic. And that was clear to any sane person back in February of 2020.
I wonder if YouTube would have been better to implement a no medical advice policy. Not a no advice which runs contrary to the official guidelines policy.
This is going to the heart of the problem: Youtube has replaced TV, and what people see on TV they tend believe to be real, and even if they don't believe that at the moment they see it they may well remember it as fact later on.
I think youtube is great for showing people DIY stuff, for home videos and so on, but it has clearly allowed itself to be hijacked as a platform for politics and it was/is ill prepared for the attempt at weaponizing the immense audience that it commands.
The thing is, 99 out of 100 people repeating conspiracy theories don’t have a single coherent thought behind the whole thing.
It will be a straw man, but it is statistically like that:
They may start by how research grants decide the results of studies and thus your study is one of those payed ones, but then jump ship and go that this sea snake extrude homeopathy will treat covid, just go look it up yourself, and then even if there is a “paper” for that, it is from goddamn Atlantis with no peer-review and was tested on 2 parrots.
The real story (in my opinion) behind Ivermectin are the studies not being conducted. Here you have a ton of studies claiming to have found benefit with a worldwide, massively available drug that has practically zero risks for most people (and it's an extremely well understood drug) and we don't have first world countries conducting RCTs to understand it better.
So you have to ask yourself - when do we get high quality RCTs, who funds them and why? This to me is a clear cut indicator that we have very maligned incentives for health science. How can we be this far into a global pandemic, with all of this funding and not have multiple high quality RCTs on this drug? It's sad to say the least. Even if Ivermectin ends up being fairly weak or completely ineffective - surely there's something to learn here...
> The real story (in my opinion) behind Ivermectin are the studies not being conducted. Here you have a ton of studies claiming to have found benefit with a worldwide, massively available drug that has practically zero risks for most people (and it's an extremely well understood drug) and we don't have first world countries conducting RCTs to understand it better.
First world countries are in the process of conducting RCTs testing Ivermectin, for example the activ-6 and covid-out studies in the US.
> So you have to ask yourself - when do we get high quality RCTs, who funds them and why? This to me is a clear cut indicator that we have very maligned incentives for health science. How can we be this far into a global pandemic, with all of this funding and not have multiple high quality RCTs on this drug? It's sad to say the least. Even if Ivermectin ends up being fairly weak or completely ineffective - surely there's something to learn here...
The thing to learn here is that there's no conspiracy, trials are underway, and science is already working properly.
> First world countries are in the process of conducting RCTs testing Ivermectin, for example the activ-6 and covid-out studies in the US.
... "in the process of"?
How long has ivermectin existed? How long has the pandemic been around for? How long has ivermectin been claimed to have huge benefits for, regardless of the source?
Isn't it possible that there are some other reasons why RCT's haven't been conducted yet by "trustworthy" sources in the view of these meta-analyses?
Is it really such a huge conspiracy theory that researchers simply don't want to bite the hand that feeds them? Is it not a fact that literally billions that have flowed into the coffers of Big Pharma for the vaccines and their $700/pill protease inhibitor drug, and the fact that almost all research studies are performed with funding dollars that originate from them or from HHS/CDC/NIH, which also now see a dramatic, multi-fold increase in power, reach, and funding?
When everyone goes and beats the ‘we already have ivermectin’ drum, it’s clearly a pharmaceutical conspiracy’ why doesn’t anyone bring up the massive and significant lifesaving properties of adding steroids to the mix.
This came out of UK research at the start of the pandemic and has easily saved hundreds of thousands of lives.
The ivermectin notes that spurred this on was an Australian in-vitro study that noted that ivermectin had activity against sars-cov-2 in high dose, in-vitro.
It was promptly lost in the noise because basically everything, even high dose H20, can be shown to have in-vitro effectiveness against viral replication, and there were more promising avenues of research.
Then it pops out again after the anti-fact brigade lost the evidence pile-on with both hydroxychloroquine and azithromycin and along comes a study that immediately gets trumpeted as revolutionising the treatment of covid but it turns out has horrific methodological and statistical problems, and the scientific world gets to work trying to establish the facts, and so far things don’t look good for ivermectin as a treatment.
Yet there’s still a global conspiracy of top level research scientists and doctors trying to suppress these easy wins and maximise worldwide misery.
You seem like you like to do your own research, how do you process those facts?
In this case, if Ivermectin was so effective against Covid, then Merck would be commercially incentivised to prove that.
When you combine that fact with the facts that complex problems rarely have simple solutions, that such high levels of collaboration are rare, & that the same people promoting Ivermectin are also promoting theories of 2020 election fraud, it's pretty easy to doubt that this conspiracy theory is realistic.
Well this is nonsensical for a myriad of reasons, including that a derivative that was patented and proven to work would just encourage people to take the cheap generic that also works but is more widely available and has better understood risk profile, but it does show potential motive as to why it's taken this long to get real RCTs spun up to study ivermectin.
>How long has the pandemic been around for? How long has ivermectin been claimed to have huge benefits for, regardless of the source?
Science takes time, the pandemic has been around for less than 2 years. Ivermectin has been a suggested for what, a year at most?
>Is it really such a huge conspiracy theory that researchers simply don't want to bite the hand that feeds them?
If a scientist could definitively prove ivermectin was effective they would be world famous. The reason so many shitty papers got published so quickly on ivermectin is because people were trying (and failing) to grab that fame and fortune. The incentives are obvious.
Consider that maybe your need to see conspiracy in the world comes from within, rather than external forces.
> Here you have a ton of studies claiming to have found benefit
Maybe the real reason we aren't seeing more trials being funded is that scientists are looking at these early studies and what we already know of the drug and concluding that it's not an avenue worth pursuing? (Especially when we already have several proven vaccines in place).
By way of analogy are you going to invest your time to build a web framework for Cobol running on mainframes? I'm sure it's been done, but it's probably not worth your time to build one as we already have many high quality web frameworks available.
Not to mention the lunacy of assessing efficacy of drugs by reading internet forums and social media. Why do scientists bother with expensive studies when they can just read Facebook? /s
Happy opposite day. Aside from all the other words, it ends in summary with a first item of 'Ivermectin doesn’t reduce mortality in COVID a significant amount'.
the final study list he compiled shows 80-85% confidence for <30% mortality reduction and the author confirms that in the comments. This is 80-85% confidence that hundreds and hundreds of thousands of lives could've been saved with ivermectin. You didn't read closely enough.
Notably though, at no point does the author even suggest it doesn't work - just that the statistical significance isn't high
I'm not sure where you're reaching 'hundreds and hundreds of thousands', perhaps because there's a big range between zero and thirty percent.
In medical trials, statistical significance is the milestone to reach before broadly claiming something 'works'. Dozens of other treatments were put through trials. Some had promising initial results. Most didn't work.
No one is claiming it works - I'm refuting the point you've made which is that it doesn't work - which is contrary to what the data shows. The data shows that it's not reaching the medical milestone you refer to, but it does show that it's more likely helping.
You've claimed it doesn't work - nothing says that. Nothing even suggests that.
Quite the mental pretzel there. If no one is claiming it works, and you claim that I claim that it doesn't work, maybe that's reason at work? Unfortunately, I never claimed it didn't work.
Edit: I see you might have confused me for a parent post by lalaland1125 who did claim this.
Would you please stop taking HN threads further into ideological flamewar? You've been doing this repeatedly and we've already asked you to stop. It's not what this site is for, it lowers discussion quality dramatically, and we ban accounts that keep doing it.
With a meta-analysis, if you detect a high number of fraudulent studies, shouldn’t that negatively affect your trust of the studies which you didn’t detect any problem with?
Let us imagine you looked at 100 papers, and you could tell 99 of them had severe problems, and one looked OK. That information would make you suspicious that the one paper also had severe problems, but that you just didn’t detect the problems.
From article: “We’ve gone from 29 studies to 11, getting rid of 18 along the way. For the record, we eliminated 2/19 for fraud, 1/19 for severe preregistration violations, 10 for methodological problems, and 6 because Dr. Meyerowitz-Katz was suspicious of them.”
A good rule is to simply wait. Bad science has a way of being negated over the longer term. But if you want results today you could always try to replicate the experiment (which is one of the reasons why asking scientists to show their data in raw from should be mandatory in my opinion).
> Bad science has a way of being negated over the longer term.
Humans started to experiment with Lobotomy around 1930s and it wasn't until after 1950s that we started to realize that it probably did more harm than good. António Egas Moniz even won a Nobel Prize for "discovery of the therapeutic value of leucotomy in certain psychoses".
Yes, bad science will probably be negated over long term, but what about the harm it does during those years? Can't we find a way to reduce the harm of experimental science? Maybe things aren't that long as my example today, but I still feel we can do more to prevent bad science in the first place.
If you can improve on the scientific method I'm sure lots of people would be very happy but for now it is the best we've got, the results speak for themselves.
Science makes mistakes, all the time. But it does learn from those mistakes. The harm done during the intervening years is terrible, but likely a price we can not avoid.
A bigger problem in my opinion is the degree to which science allows itself to be 'bought' by commerce, for instance in the case of smoking, climate change denial and other major issues that end up harming lots of people in very concrete ways. The man or woman in the white coat has a lot of authority and squandering that by throwing the scientific method out of the window to be replaced by a stack of green bills is a real problem.
They're saying, instead of waiting 18 months to figure out the best decision for you and your family instead of jumping to a conclusion based on political affiliation correlated to the part of the country you happen to live in, wait 20 years because science iz kewl.
If "With a meta-analysis, if you detect a high number of fraudulent studies..." applied here, perhaps so. But most of those eliminated were not for fraud, in fact only 2 were for fraud, the rest were flawed in ways which, I'm afraid, is equally common (or nearly so) in studies on any other topic. Also, not all of the studies he threw out showed ivermectin working, I recall at least one showed the opposite but that doesn't mean we throw out all studies showing ivermectin doesn't work.
Also, the whole point of the exercise is what do you find if you apply good statistical and methodological rigor, but don't have any anti-ivermectin bias.
> I asked him about his decision-making, and he listed a combination of serious statistical errors and small red flags adding up. I was pretty uncomfortable with most of these studies myself, so I will err on the side of severity, and remove all studies that either I or Dr. Meyerowitz-Katz disliked
From further up, though we don't _quite_ know the details, but it's not like he went "Oh well some random person disagrees with them so better throw them out"
This article is a nice counterpoint to what's felt like a trend of Scott's writing (outside of psychology) increasingly becoming contrarianism in search of evidence. Many pieces he's written in the last 1-2 yrs feel like he'll use some back-of-the-envelope calculation to get some ballpark (associative) estimate of some relationship and then base a worldview around it (or work backwards from the latter to the former), decades of causal inference and economics literature be damned. I guess maybe the delineation is social science vs medical science topics. When he's in his wheelhouse he's great to read.
But that is literally what this article is, and Scott admits as much! He says that he chose worms as the most "trollish" possible response, despite a lack of any strong evidence at all that worms are the answer.
You’re totally right. I was more referring to his review of the merits of the various studies, which as a statistician I actually agreed with - I mostly read the article to understand the history of these studies, having no prior familiarity beyond the high level understanding that the evidence was weak. I expected this article to largely be pro-ivermectin-as-underdog given that the mainstream opinion is that it isn't, but I suppose this fits even more. His claim that it’s all able to be chalked up to worms is dubious at best - selection bias of one form or another (publication, metric selection, etc) seems substantially more likely. Sure enough, though his readership is credulously adopting this theory just as easily as they adopt his other contrarian points.
The funny thing is that for all of their supposed smarts the bulk of the commenters in favor of the 'new' worm theory are jumping on it, just like they jumped on Ivermectin in the first place. It is in a way an interesting experience to see this happen in real-time.
If they're anything like me, they've always wanted the ivermectin thing to be worms-at-best-crap-at-worst, but have refused to accept "shut up and stop listening to the wrong science" as evidence in favor of that proposition. From that perspective their behavior is not only rational, it's far more rational and pro-science than the mainstream. Not surprising given who the audience is.
His alien thought experiment in the “Political Takeaway” section at the bottom is a masterpiece. If you’ve struggled to explain where science lost democracy, this must be as crisp as it’ll ever be described.
It got political, but he still doesn't capture the gist and whole of the argument. You cannot argue against an imaginary position which he still espouses. There are just democrats and conservatives for him. That is a deep socialization which depending on age might be a permanent affliction.
But that isn't reflective of every position against a vaccination (or additional measures), it is more the explanation of a naive child. There are millions of reasons that could drive people to not play along:
- Don't trust doctors
- Don't trust politicians
- Don't trust media
- Has environment that shares the same opinions, difficult to go against the grain
- There a doctors critical of methods like lockdown and even the vaccine itself
- There a doctors that warned against vaccinating within a pandemic and their predictions became true to a degree
- Countries that didn't lock down came decently through the pandemic if they had otherwise good healthcare
- We combine vaccination with secondary measures like passes and mandatory health controls
- Covid is endemic and you will get it anyway, we still see different rules for vaccinated/unvaccinated people
- There are people unreasonably afraid of Covid
- People throw away liberties for questionable safety and will still end up getting Covid in the end
- ...
Most of it is indeed a trust issue, but the problem is that there are currently few people in the public sphere that deserve that trust. I am vaccinated, I make this statement because there are fearful people that demand that you justify yourself. I am not really inclined to accommodate them, there is a saying that "the smarter one gives in" and this is clearly a case like that.
Ivermectin wouldn't be the wonder cure, if criticism of it would be more analyzed in a way the author did. It is a good step. This is getting to a principled discussion if you just ban other voices.
This isn't an accident or a simple case of being wrong: this is a case of a fairly orchestrated campaign. That it has a lot of footsoldiers that aren't aware that they are being used is a real pity and a problem. The big question to me is how will we deal with the next round of bullshit cures that is undoubtedly waiting in the wings to play on those exact same feelings? Are people going to do this again, or will they wise up after having been played twice already?
Maybe, although without further evidence accusation of conspiracies will fly back into your face.
The site might look professional, but it still could just be another true believer. If you frenetically ban the content, more people will believe the message and more importantly disbelieve yours since it "obviously" cannot stand scrutiny.
And there are real problems here, the infrastructure to censor certain message on social media got quite effective and to believe tech companies as government contractors won't use it to spread falsehoods is naive. Not by conspiracy, it is just a dynamic government will certainly show.
I think like he said, it is all trust. Without trust, people are wary of your motivations. When you are in that position, having the people you don't trust do things like promote the narrative of "trust science" just looks like they are using scientists as mouthpieces to co-opt their trust to push a narrative. Moderating misinformation looks like censorship, mandates look like coercion, etc.
Overall it was just a colossal failure of communication by policy makers, who had already eroded most of their trust before the pandemic, which then got exacerbated by contemporary journalism that felt like it had no qualms about making everything as divisive as possible for engagement.
I don't think people have lost trust in science, but politicians using "science" in this way of communication are doing a pretty good job of trying to erode that trust.
Not to be adversarial, but there have definitely been a few instances which are just censorship and not moderating misinformation. And there are definitely some hot topics on which I will flat out ignore research, because I know only some conclusions are allowed and publishable.
I think it's pointless to discuss specific examples - my point is, it's not only an issue of managing trust, because the science doesn't deserve that trust.
No you are absolutely correct, I was just illustrating the disconnect between what people think they are communicating and what it actually comes across as.
There is a degree of nuance that is definitely lost when people say to trust the science, which is to say that the rigorous process is what is generally trusted, but that isn't how it is communicated which is why "trusting the science" is probably a slogan that does more harm than benefit. For example it is sort of tone deaf to say that now, after how science experts have handled the first part of the pandemic, or how science has been used to justify things like the oversubscribing of opioids, or what they have said regarding nutrition (sugars vs fats), or carbon emissions and even smoking in the past. Politicizing science taints science more than it benefits politicians, but since they don't bear the costs of that erosion of trust, they will continue to politicize it.
> People are going to fight hard against this, partly because it’s annoying and partly because of (imho exaggerated) patient privacy related concerns. Somebody’s going to try make some kind of gated thing where you have to prove you have a PhD and a “legitimate cause” before you can access the data, and that person should be fought tooth and nail...
I have a huge amount of respect for Scott, and the rational thinking that he shares with us. However, I'd like to make two arguments against the above.
1. Personally-identifiable information is protected by law over on this side of the pond. This is one of those cases where the thinking is quite different between the US and Europe. In Europe, you need to get the permission of everyone involved in the study before you can publish your data about them, if there is any chance that they can be identified from that data. In a lot of ways this is good, but one way in particular is that it encourages pre-planned proper studies, where you set it all up properly and get every participant to sign the permission sheet, which is good for science.
2. Sometimes absolutely full data release is overkill and inappropriate. For example, if I'm planning to publish a paper saying that mutations in a particular small region of the human genome cause a particular disease, then it is sufficient to publish the list of causative mutations. Full data release would mean publishing the entire sequencing run for the patient - that's inappropriate because you can identify someone from it, and you also then know a huge amount of information about them - their traits and congenital conditions. A lot of journals are pushing for this, and the compromise that we seem to have reached is to store the full sequencing data in a secure repository and provide access given a really good reason. Likewise, a census will report statistics about areas of a country, but the raw data is kept back because it is deeply personal in nature.
So my points are that data shouldn't go into a study unless it can be openly published, and that there are types of raw data that are too personal or voluminous to openly release, and the data derived from it should be released instead.
> This is one of those cases where the thinking is quite different between the US and Europe. In Europe, you need to get the permission of everyone involved in the study before you can publish your data about them, if there is any chance that they can be identified from that data.
In the US there are all sorts of protections for research subjects both in terms of potential harm and privacy. In fact, there are mechanisms to be exempt on keeping consent documentation if that is the primary mechanism in which the subject could be harmed (for instance, in a data leak). His thinking is contentious at best and would generally be regarded as unethical. People seeking medical treatment should not have to agree to have their raw data disclosed and this falls under the undue influence principle of ethical research.
Love the final explanation for how ivermectin can be incidentally good for COVID-19 patients, even if it does nothing to COVID-19 directly.
In fact, as the author cites from another researcher, the trials are a strong piece of evidence for "add[ing] ivermectin to mass drug administration programs." In other words, global medical welfare, where we just give everyone a bunch of a cheap and effective medications to counteract the most prolific diseases. In addition to reducing mortality from diseases targeted by the medication, it will probably reduce incidental mortality when people contract multiple conditions at once. I.e. getting ivermectin for a detected COVID-19 infection has a 10% chance of helping you, because you have a 10% chance of having an undetected worm infection that will kill you if your immune system is suppressed by drugs that are used to prevent COVID-19 from killing you.
I do think the ending political metaphor doesn't quite fit, however. I see more parallels with workplace politics than an alien invasion, for why our societies have become so divided on relatively meaningless issues. Uniting disparate factions to work towards a common goal is an uphill battle that sees more failure than success, most often in our workplaces. To me, the ivermectin drama was just another example of an emergent situation that wasn't optimally handled by a collection of random individuals, who despite the best intentions, were unable to unite a group. Doesn't make them bad people, or mean they have the wrong approach. Just means they weren't ready to tackle such a difficult challenge. Positive outcomes take dedicated effort, they don't come automatically because we assume the status quo is good enough to us immune to random chance.
In fact, as the author cites from another researcher, the trials are a strong piece of evidence for "add[ing] ivermectin to mass drug administration programs." In other words, global medical welfare, where we just give everyone a bunch of a cheap and effective medications to counteract the most prolific diseases.
When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections.
Medical stuff doesn't work the way most people would like to imagine it does. This sounds like a terrible thing to conclude. I'm rather unsettled to see it lauded here on HN.
> When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections.
> Medical stuff doesn't work the way most people would like to imagine it does. This sounds like a terrible thing to conclude. I'm rather unsettled to see it lauded here on HN.
Indeed, this exact thing is headline news in the UK today from our Health Security Agency - don't take antibiotics unless you definitely have something treatable by them: https://www.bbc.co.uk/news/health-59310099
Parasites are notoriously hard to treat. They are harder to treat than bacterial infection.
Places with lots of parasitic infections need better infrastructure and general hygiene to prevent infection. They don't need all the locals actively breeding drug-resistant parasites. Parasites are enough of a nightmare without cavalierly passing out drugs for funsies.
The WHO's guideline for "preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups" https://apps.who.int/iris/handle/10665/258983 isn't about "passing out drugs for funsies". They recommend mass drug administration for at-risk groups because hundreds of millions of people are suffering from parasitic worm infections that can easily be treated with a single dose of a cheap anthelmintic drug, but diagnosing every single case beforehand would be much more expensive.
Of course improving hygiene to prevent infection is important (that's also stressed in the guideline), but that will take much longer, while mass drug administration has immediate benefits.
Fear of drug resistance isn't a good reason to withhold treatment from people who really need it. The WHO's much more sensible strategy is to encourage research into alternative drugs in case drug resistance becomes a significant concern.
I’m certainly no expert but isn’t the evolutionary timescale for parasites considerably longer than for bacteria? That would presumably lead to quite different consequences (though of course the evolutionary pressure, and thus the risk, is still there).
That’s certainly already the case. Ivermectin has lost effectiveness against particularly insidious parasites such as Haemonchus Contortus (barber pole worm). We’ve resorted to other treatments such as Moxidectin, Levamisole, etc, all of which are more expensive and harder to dose safely and effectively.
I can totally understand how Ivermectin got its following— it’s an amazing general purpose medicine around the farm. I generally use it responsibly by verifying the presence of parasites before administering (which can be literally any animal on the farm with almost any parasite) … but then there are times such as when my daughter had a single pet chicken (among many healthy ones) that wasn’t looking so hot … Whereas previously I’d just dispatch the animal and be done with it, now I give a dose of Ivermectin and isolate for a few days before calling in the grim reaper. So far the success rate is something like 90% where now my 9 year old daughter administers it herself. While I acknowledge this isn’t the most responsible, I can imagine others have had similar experiences which explain some of the popularity of Ivermectin with rural folk.
The drug may end up in the manure, and the parasites may encounter it there at a marginally-lethal dose. When the parasite progresses further in its life cycle, its offspring may be resistant when they infect the next livestock animal.
Most parasites have a life-cycle that includes time spent outside the preferred host animal, including in zoonotic species that may not have symptomatic infections. They may acquire resistance in any stage, in any place they encountered the drug.
It obviously cannot. But the issue isn't giving it to animals without any parasites, it is in giving it to animals with parasites but that do not need the anti-parasitic in order to recover. Once you have determined that the animal is sick enough to need treatment and that the sickness is most likely caused by the parasites, then you can make the decision that the risk of furthering resistance is outweighed by the need to treat the animal. If you have determined that there is no chance the animal has parasites, then there's no risk of furthering resistance but also no need to give the treatment.
I think this largely right, but resistance generally does not just evolve in the animals "that do not need it to recover", as all parasites/bacteria are more likely die in that case, but in more extensive cases where some of the parasites/bacteria survive and there are more reproductive events that can introduce a resistant genetic variation. This is why some consider that people not completing the full course of antibiotics- only taking them until they feel better, may be a greater contributor.
In nature, both the antiparasitic and the parasite will have a tendency to end up in places that you don't necessarily want them to be for the purposes of motivated hypothetical reasoning.
aka the chicken will urinate out some amount of ivermectin, unprocessed by the chicken, and then some amount will make it elsewhere that will allow for natural selection to take place (eggs or wherever). Once is infinitesimal, but give every animal some ivermectin for funsies, and you've now bred ivermectin resistance.
There's an issue with collies and collie-derived dog breeds; used to be warnings (even mentioned in an episode of "House"). But. Most of the lines running around today are the ones that weren't sensitive and didn't die from ivermectin. So it's no longer such an issue.
Widespread administration does lead to the development of resistant parasites. That's not an hypothetical, that's what you see on any farm if you prolong the treatment for too long.
It's always recommended that you cycle through different anti-parasite treatments.
The CDC estimates that _at least_ 30% of all anti-biotic prescriptions are inappropriately prescribed. I'd wager an over-prescription of Ivermectin (that by some unknown characteristic appears it would save massive numbers of lives) isn't likely to evolve parasites (which evolve much more slowly than bacteria to begin with) to be resistant in a dangerously meaningful way given what we see with bacteria resistance.
This is of course just a gut feeling and not a studied understanding.
I'm curious whether a similar mechanism would apply to the COVID vaccines? Can someone with some expertise in the area help clarify if this is the case? Are we accidentally creating vaccine resistant COVID strains with mass vaccination similar to how mass ivermectin creates ivermectin resistant parasites?
>When they invented antibiotics, people began predicting "the end of disease." Fast forward a few decades and we have the rise of scary antibiotic-resistant infections.
I think this is an extremely jaded take, resulting from growing up in a post-antibiotics society. The risk factor for those "scary antibiotic-resistant infections" is still an order of magnitude less than the class of diseases antibiotics almost totally eliminated. In the 30 years following penicillin's discovery, deaths from bacterial infection dropped from accounting for over 22% of all deaths to just 6% [1] (MRSA deaths, by comparison, currently represent less than half a percent). "End of disease" may be hyperbole, but between antibiotics and vaccines, infectious diseases were almost totally knocked off the leading causes of death.
The only reason why we even have antibiotic resistant bacteria is because they keep getting prescribed, because they're so damn useful. "Medical stuff" does, in fact, work like that, to some extent.
The major reason why we have antibiotic resistant bacteria is because we use literal tons of the stuff for meat production and too many countries have too lax controls for antibiotic use in humans, which means they are taken for things were they don't help, or are not necessary, and are taken in the wrong dosage and for the wrong duration.
Exactly, if we only used it when there was a chance of it being effective that would be that, but instead your average cow is a walking antibiotic laboratory.
I simply misparsed "those treatments" in your comment, thinking that they referred to antibiotics, which this threat is about after all. I'm aware that Malaria is not a bacterial infection.
I think you should clarify that Ivermectin works better in higher-worm-prevalence areas. It's not remotely true that 10% of Americans have undetected worms. The praised study in the post highlights 12.5% as "high" prevalence, so 10% would be nearly high -- not true in the developed world.
There are probably many other factors that I should have listed there, my bad, I did not mean to make an exhaustive list, in fact the opposite, that's the first two things that came to mind.
> I do think the ending political metaphor doesn't quite fit, however.
Literally none of my immediate family has gotten the vaccine. I know several more people who haven't gotten it. I have been reading Scott since around 2015. I would say I sit in an interesting intersection of worlds for this issue.
While the facts of the metaphor are slightly off, I think Scott got the emotional feeling exactly correct. There are hostile aliens who actively gone against my interests in the past, they have been wrong before, their is a good chance they could use this for their own gain. That is exactly how my parents feel.
This is interesting, it is similar to how doctors just include gonorrhea treatment for women that expect to bear children. Instead of embarrassing any particular woman who would suddenly have something to explain to the partner, they just give it to many amongst the cocktail of various other obscure sounding drugs.
For real, prophylaxis of enteral worms should have been more popular in developed countries.
It's amazing how hygiene practices are sometimes poor and tropical diseases are unknown in developed countries
But then you go visit somewhere and/or some animal product is imported in questionable ways and you get a worm. Which for 95% of people will be mildly inconsequential but it might also cause problems.
This is from ivmmeta.com, part of a sprawling empire of big professional-looking sites promoting unorthodox coronavirus treatments. I have no idea who runs it - they’ve very reasonably kept their identity secret - but my hat is off to them...Putting aside the question of accuracy and grading only on presentation and scale, this is the most impressive act of science communication I have ever seen.
I asked a few questions previously on HN about Ivermectin and got answers that killed my interest in the topic (because I don't think it is relevant). But this piece is a delight.
I want to know who's behind those sites, the fact that nobody knows who's behind them is shady. Or is having sites pushing meta-studies about anything normal and I just missed it?
The paragraph you quoted is, alone, pretty much enough to dismiss this entire article outright. It shows such a reckless disregard for critical thinking that it is impossible to trust anything that comes after it.
He sees a slick and well-presented site on a topic that is not only politically fraught, but well known to have a massive propaganda effort behind it, and he just completely refuses to even consider questioning it as a source? That is reckless beyond words.
The paragraph quoted is making a point about how to effectively present and communicate scientific topics, not ascribing dependability.
Indeed, the entire article is a systematic rebuttal of ivmmeta's claims. Rebuttals are more convincing if you treat the topic in good faith rather than assuming fraud from the outset.
I don't understand how you can see this as "reckless beyond words" when it seems like exactly the sort of systematic analysis that we need more of.
Right—it's like saying "I don't know who the bank robber was—they've very reasonably kept their identity secret." Sure, it's reasonable for a bank robber to get keep their identity secret, because they're doing something shady.
In my opinion, the main crux is this: there are moneyed interests who are motivated to generate mistrust and otherization based on political parties. In the USA, Fox News has a strong incentive to inspire hatred and fear of Democratic policy, and MSNBC has a strong incentive to inspire hatred of the GOP. The same is true for Twitter, FB, NYT, WSJ, WaPo, literally any media outlet. Hatred, fear, outrage, worry, anxiety: they all drive viewers to advertisements.
One major example, these media groups facilitated making a huge rift on climate change belief. The fossil fuel industry saw in the GOP, and some moderate Dems like Manchin, an opportunity to create doubt and slow the transition off their fossil fuel products. Now, the GOP has leaned into anti-scientist, anti-elitist sentiment, fed by Fox News and others. They're not totally anti-science, they still use abortion science, ivermectin science, and all the wonders of modern life...but they ARE anti-scientist, anti-elitist, anti-university.
And Why? We're hating each other so media companies can make a few measly cents.
We do not live in a society with two equal sides. The GOP has made destroying democracy/hating "the media" core to their platform, as opposed to centering their platform on some sort of policy goal. Do democrats hate the GOP? Sure, but their coalition is not nearly as structurally oriented around this fact.
I appreciate that you drew a distinction, because being anti-science and anti-scientist are not the same thing at all.
The current way that science, i.e., research, is being funded has very little to do with the Scientific Method and seems very broken.
That seems to be the GOP stance; that huge funds are flowing from big corporate interests into universities. It seems quite simple to purchase nearly whatever research you like.
The US is not the only country though. And while some small bad research may get bought, these are usually easy to spot by experts in the field, or even by simply looking at the methodology which may be bad even from a statistical point of view.
> Now, the GOP has leaned into anti-scientist, anti-elitist sentiments, fed by Fox News and others..
I wouldn't fault them for your view of their broad sentiments on this trend but I think if you went back over the last twenty years, these sentiments were more often aligned for the left-wing.
"The real conversation has to be about what solutions we're in favor of." -- Dan Crenshaw, on the Daily Show
The last twenty years gives us a few administrations from which we can asses policy making decisions: Bush; Obama; Trump; and now Biden.
Of those four, I don't think it's possible to make a good-faith argument that Obama and Biden administrations have been more anti-science than either Bush's or Trump's. A single sound bite from Dan Crenshaw talking about shifting the focus of conversation towards solutions doesn't refute the fact that Trump had directed the EPA to remove statements about climate change from their website, withdrew our participation from the Paris Accords, and made public statements drenched in falsehoods about how climate change is a hoax. Similarly, Bush rejecting the Kyoto Protocol and allowing Exxon to have an active role in making climate change policy goes completely against your assertions.
Could you provide some sources to substantiate your viewpoint? I'd love to know if I'm just being overly biased here, or if we've fallen prey to disinformation campaigns.
The viewpoint you're responding to is the GOP strategy, not a viewpoint derived from facts. The strategy being, pretend both sides are equal and that any suggestion of difference in respect to valuing science or democracy is actually a bias.
Pretending both sides are the same when their differences are plain as day is both foolish and damaging.
> The viewpoint you're responding to is the GOP strategy, not a viewpoint derived from facts.
I wondered about this too but wasn't aware this is a "GOP strategy". In contrast, I only responded because I'm still wrapping my head around a Michael Malice quote:
"Conservatism is progressivism with speed limits."
I'm honestly not sure what you're trying to say with your comment.
I don't think I'm creating a false equivalence between the respective parties; their differences are certainly clear - one of those differences being a closed-ears approach to scientific evidence.
> Could you provide some sources to substantiate your viewpoint?
I cannot as I'm only learning of this now and reflecting on what I've known from before. Trump directing "the EPA to remove statements about climate change" is largely irrelevant (to me personally) when there are active industries apart from politics that are striving for "greener" technologies.
Take for example the transition from Toyota's hybrid vehicles to Tesla's or, solar array proliferation seen from Google Maps timeline.
Anecdotally, it seems to have gotten worse, I know STEM grads who I'd never think of being anti-science announcing they are "vaccine hesitant". We speak about it behind their backs but really no one even tries to discuss this with them.
I know this is a false equivalence argument but one might frame vaccine hesitancy as simply people unwilling to be mandated to inject anything into their bodies. Can you imagine if the government sought to mandate heroine injection as the only standard way of pain relief? That's what I think most average people think about when they are "vaccine hesitant".
It's also good for the people in power. It's a pretty straight forward divide and conquer strategy. The US public want probably 80% of the same thing (economic), but we won't get it because we bicker about the 20% (cultural/wedge).
Funny how all this article ends up saying it's all a matter of trust.
Which is exactly what medecine has always been about, and why ultimately you end up getting prescriptions by you own doctor, that you have a bound with and that you trust.
The most insane thing that happened with this pandemic ( at least in europe) is how we decided to throw all this through the window and let states impose medical decisions on people and their children, not realizing people were still considering them highly incompetent in general.
There are medical bodies staffed by professionals that study these matters, and the states (should) base their decisions on what their findings are. To me the problems starts when decision makers and then the general population start trusting fringe conclusions and trying to interpret medical data when they have no training to do so.
When a new cure for cancer is found, we don't expect the minister of health to recommend or advise its use to the general public on TV, do we ? We assume professional MD will learn about it via their regular channel, and recommend the treatments on patients that they judge relevant.
"Sometimes these people even have a specific theory for why elites are covering up ivermectin, like that pharma companies want you to use more expensive patented drugs instead. This theory is extremely plausible. Pharma companies are always trying to convince people to use expensive patented drugs instead of equally good generic alternatives. Ivermectin believers probably heard about this from the many, many good articles by responsible news outlets, discussing the many, many times pharma companies have tried to trick people into using more expensive patented medications. Like this ACSH article about Nexium. Or my article on esketamine. Given that dozens of studies said a drug worked, and elites continued to deny it worked, and there are well-known times where elites lie about drugs in order to make money, it was an incredibly reasonable inference that this was one of those times.
If you have a lot of experience with pharma, you know who lies and who doesn’t, and you know what lies they’re willing to tell and which ones they shrink back from. As far as I know, no reputable scientist has ever come out and said ‘esketamine definitely works better than regular ketamine’. The regulatory system just heavily implied it."
Why? I think he has a point. We live in a society that is geared around profit. That is literally how our society functions. Economic activity is incentivised by the profit motive, important national metrics like GDP focus primarily on profit driven output and growth, even engineering or medical problems are often framed in economic terms like cost/benefit. I think it’s silly in this kind of context to ignore the profit motive.
No it's not. What you are saying is everything is biased by money, therefore I can't trust anyone. What people are telling you is that you don't really understand the bias, not that the bias doesn't exist.
The (western) COVID vaccine manufacturers still make ~1000$/s in profit from them. Gates / BMGF are invested in literally almost all of them, even the obscure Indian ones, not just Moderna and BionTech
Yes. But compared to what this crisis has cost us to date that is a very small drop in the bucket. think trillions, not billions. And it's not over yet. And Gates has so much money he's probably invested in the whole F500. But the whole Gates/Soros/whichever bogeyman you want to add here story is getting a bit long in the tooth.
Yeah it also lead to trillions in wealth increase of the ultra rich. There also is a difference between deliberately investing in vaccine companies and then publicly advocation for patent protections to remain in place and buying a vanguard etf. Just because someone is the target of Crazy conspiracies doesn’t make their behavior less reprehensible.
Have I missed anything? I don’t think the discussion is about vaccines. For what is worth, I think both the vaccines and ivermectin work. I just think multinational profit driven companies are more incentivised to promote vaccines, which generate a huge profit, over ivermectin which doesn’t make that much of a profit.
If you think ivermectin works then you are essentially disqualified because as the article linked here nicely explains there are some hypothesis about how it might work if it works but there is no proof, in which case the medical establishment would be all over it, because they too want this pandemic to end asap.
Whether they could make more profit off this probably factors for some people but on the whole the medical profession is result driven.
Don't use the word "proof". That's a word that's only appropriate in deductive disciplines like mathematics.
Also let's accurately represent what the article is saying:
"Again and again, more people are surviving (or avoiding complications) when they get the drug. It’s a pattern strong enough to common-sensically notice. But there isn’t an undeniable, unbreachable fortress of evidence."
This to me reads consistent with "ivermectin has a reasonably good chance of working a little bit but it isn't conclusive.", which is in contrast to your statement that thinking ivermectin works is equal to quackery.
Personally I think it's either a very small effect or no effect at all, but I don't think the quackery designation fits for people who simply believe that there's some small benefit there (although I do think that label fits for those that think it can replace vaccines)
You can think ivermectin works just fine. But what you shouldn't do is pass that on to others as fact in a game of Chinese whispers that ends with 'MSM and big pharma are in cahoots to deny us this cheap medicine that really works against COVID to protect the profits of big pharma'.
And that's exactly how it goes.
Quackery: "dishonest practices and claims to have special knowledge and skill in some field, typically medicine."
You don't have the knowledge, you don't have the skill, so don't go around giving advice about non-proven cures (or in fact, about any cures).
It was a fun read, but implying that a drug dealer from Kern county is related to a published researcher from Mexico just because they have the same surname is not really cool.
It is pretty cringy. I believe the implication is that the study was so poorly performed and produced such outlandish results that the researchers had to be high on drugs or something...
I think you missed the point of the comparison.
It wasn't a real claim that they are literally the same person. It was a joke that that the study was so suspicious and potentially fraudulent that the author could be a criminal drug dealer...
I’m not in the mood to give a lecture on how the real racism is between the lines, if you can’t see it, good for you. The entire article is condescending against research done outside the main european/north-american axis, using words like “Egyptian” and “Mexican” to set the tone of the comments, as if to say “you know what to expect from these people”. There is absolutely no reason to connect the researcher and the criminal like he did other than prejudice. Surely I can find a criminal in the USA with your surname, but I bet you wouldn’t find it funny if I publicly implied you were related, or even worse, that you were connected to their crimes.
>The entire article is condescending against research done outside the main european/north-american axis, using words like “Egyptian” and “Mexican” to set the tone of the comments, as if to say “you know what to expect from these people”.
I agree that the article is condescending/skeptical of studies outside the european/north-american axis. I don't think the driver is a belief that brown people can't do science, but that medical research coming from these countries is generally lower quality and less likely to be replicable. The latter is a commonly held belief in the medical research community, which has a basis in reality.
>There is absolutely no reason to connect the researcher and the criminal like he did other than prejudice.
The alternate reason is given at length in the three paragraphs above. Of all the studies, this one is the most likely to be deliberate fraud. The comparison of the joke is demeaning and is intended to be disparaging. The insinuation is that Espitia-Hernandez the doctor is as trustworthy as Espitia-Hernandez the drug dealer, not because they are both Mexican or family, but because Espitia-Hernandez the doctor is a liar and a fraudster.
I agree. I wonder, though - the author has written a lot about political signaling and trust. I wouldn't put it past him to add a joke that's deliberately anathema to liberals, in order to relax the hackles of the conservatives he's trying to convince to use real medicine.
It's not liberal vs conservative in a policy sense, but in a cultural sense, much more important for signaling. I think many liberals (I include myself) would say it's racially tinged to joke that a doctor and a drug dealer must be related because they have the same Spanish name.
I see, so it separates the people that assume that it is an example of racial profiling because there is a POC involved? Is the assumption that the person being mocked is singled out because of their Spanish last name.
Something like that, sure. Apart from the question of whether the joke is good or bad, I think it's pretty clear from the reactions here that it has a political valence.
I agree that is strong point that such comments trigger some readers.
I imagine that any politically savvy author like this one evaluates the inclusion of jokes involving POC in their editing process today.
As far as intent, I am more inclined to believe the author decided to leave it intentionally, not to endear the conservative reader, but because they believe that while some readers may be offended, that they didn't want to engage in self censorship when they personally didn't see anything objectionable. After all, I think the conservative reader would gloss over this as unremarkable, and only some liberal readers would hear it as a "dog whistle", so they aren't endearing anyone.
I think this is inline with some of the author's other writings which advocate taking responsibility for one's actions and intentions, but not necessarily catering to everyone else's possible reactions and emotions.
That said, I'm usually assume pretty charitable intentions as a reader when it comes to this sort of thing, so I have my own biases.
The point remains that he singled out a latin-american surname in order to google and look for criminals to relate to. That means he expected to find something, and did. Would he think to do the same with an european surname? And more importantly, would it still sound cool and funny to his audience?
I honestly assumed he found the tweet when looking the researcher, and would have made the same joke if the name were Mike Smith. I didn't think the joke was especially entertaining, and don't see it being any more or less cool or funny with a Spanish name.
I could see how if the exact opposite were true, it could be racist.
One time I didn't believe Scott when he wrote a "More than you wanted to know" article. This time, I took his word for it and scrolled (and scrolled and scrolled) to the bottom to read the summary.
"It feels right to me because it’s the most troll-ish possible solution. Everybody was wrong!" - I know this is said tongue-in-cheek, but this mischaracterizes the medical scientists who have been working themselves to the bone trying to understand this virus and disease.
Actual medical science, and science in general, doesn't make claims beyond what we know for certain (or at least, we're very explicit about the claim's certainty). And what we know for certain in medical science is actually quite small. People, both for clout and for profit, make up bullshit when there are gaps in knowledge.
"Believing science", as stated a few times in this article, should actually be framed as: reserving judgement until we have evidence. We should have a bit more respect and patience for the process of acquiring actual knowledge. And people who make claims beyond what we actually know should be held accountable culturally (and financially) for being liars.
"A lot of what you're seeing as attacks on me, quite frankly, are attacks on science, because all of the things that I have spoken about, consistently from the very beginning, have been fundamentally based on science,"
"And that’s the reason why I say people who then criticize me about that are actually criticizing science"
It's a problem with differentiating science from the scientists, and when someone mistakes themselves for an arbiter of truth, they damage public trust in science as a concept. The scientific method, big S Science, is the best tool humans have. People are fallible, flawed, arrogant, tribal idiots, and Science lets us rise above our weakness.
Criticizing Fauci for being a weaselly political hack, repeatedly lying in public "for the greater good", lashing out with the above claims, and other serious ethical defects are fine - he's human. He is also capable and trained in understanding scientific data, and is undeniably an expert.
However, as he has made so abundantly clear, he's lost perspective and recognition of his own flaws and biases, and doubled down on the politicization of science and the pandemic response. We need apolitical dispassionate scientists with the understanding that they as people are separate from their studies and recommendations.
When the scientist starts lying to the public for reasons that amount to "I know better" or "the public is too stupid or incompetent to handle the truth," it undermines Science.
"Believe Science" should be a no-brainer. It shouldn't be a team blue political slogan, or used to defend personal failings - both of which are despicable.
The attacks on Fauci are despicable. Note that he's anything but a weaselly political hack, but he did get replaced by one during the Trump reign. The man has more integrity than the bulk of that particular administration.
I'm honestly baffled by this. The man literally lied to the public and openly admitted to lying. There are plenty of legitimate criticisms of Fauci, and plenty of reasons to be question whether public health officials should be lying to the public about public health.
Maybe you think Fauci changed his mind based on new evidence on mask effectiveness, but he literally says he advised against masks due to a fear of PPE shortages, and not due to changing evidence. So either way he lied: either he lied about mask effectiveness thus spreading health misinformation, or he lied about why he advised against wearing masks thus undermining public trust in his advice.
Fauci admits to moving the goalposts on vaccination rates and explains it's because of his "gut feeling that the country is finally ready to hear what he really thinks":
I could dissect these even further and point out numerous other instances, but these are egregious enough to undermine public trust IMO. Public health officials should not be deceiving the public, they should be above reproach.
And your parents told you that if you ate spinach you'd be just as strong as Popeye. Were they lying? Yes, absolutely. Were they wrong? No, eating greens is good for you.
You have a peculiar standard for truth, it seems to depend on which side of the debate someone is for the person to be held to the 'lily white' standard or the 'can shoot someone on broadway and get away with it' standard.
Riddle me this: If Fauci had said 'masks work but we need you all to hang back and not buy them because we need them for the medical profession' resulting in a mass run on masks resulting in even larger numbers of death in care workers how would you view him? Is there any way in which according to you he could have discharged his duty without engaging in lies (white or otherwise) to get to a desired effect without further collateral damage?
> And your parents told you that if you ate spinach you'd be just as strong as Popeye. Were they lying? Yes, absolutely. Were they wrong? No, eating greens is good for you.
Yes, they were wrong to lie. Not that your false equivalence is in any way relevant because Fauci is a public servant of the people, and parents are not servants of their children.
> You have a peculiar standard for truth, it seems to depend on which side of the debate someone is for the person to be held to the 'lily white' standard or the 'can shoot someone on broadway and get away with it' standard.
There's nothing peculiar about wanting public health officials to not deceive the public about public health, which is their duty. What bizarro world do you live in where this is ok? In no other country on Earth did public health officials do this, even though they were facing their own PPE shortages.
> If Fauci had said 'masks work but we need you all to hang back and not buy them because we need them for the medical profession' resulting in a mass run on masks resulting in even larger numbers of death in care workers how would you view him?
I would view him as an honest public health official who did his duty, which is how I view the public health officials in my country who didn't lie to us, and where no such disaster happened.
> Is there any way in which according to you he could have discharged his duty without engaging in lies (white or otherwise) to get to a desired effect without further collateral damage?
Yes, and this has been explained ad-nauseum by people with legitimate criticisms of Fauci, although of course, even such legitimate criticisms are simply brushed off as partisan posturing, just like you're trying to do now.
During the PPE shortages, there was plenty of coverage about how to make your own mask. Plenty of commercial outlets voluntarily limited PPE purchases. Non-binding recommendations from public health officials could have encouraged such policies, and also provided official guides on making masks until PPE supplies were replenished.
Now I want you to look in the mirror and ask why you're trying to cover for him? What public purpose does it serve? This public servant lied to the public, and has lost the public trust even according to polls. The only people covering for him are die hard Democrats because he gave Trump the proverbial middle finger. Is that "credential" really more important for a public health official than the public trust?
> Actual medical science, and science in general, doesn't make claims beyond what we know for certain
Medical science made the claim that multiple sclerosis was "female hysteria," until imaging technology was able to see the damage. A doctor I know today claims that a lot of patients symptoms are really psychological and everyone at work is annoyed when they come in. When I brought up the case of multiple sclerosis, and maybe many patients have disorders which are not known to medical science because they are dismissed in the same way, I was met with a "that's ridiculous" defense. When I pressed further and ask for evidence on that point, I was given the fact that these patients with unexplained symptoms are highly correlated with anxiety. When I asked if having an undiagnosed medical disorder, and being told by doctors who clearly don't want to help you, and are clearly annoyed you are there, that it's all in your head might give someone anxiety, it was not well received. Medical science comes to all kinds of BS conclusions about the unknown without a shred of evidence.
"Actual medical science, and science in general, doesn't make claims beyond what we know for certain"
Unfortunately I read papers that do this, all the time. Science in general not only makes claims well beyond what's known for certain but does it so consistently that vast numbers of people, including many scientists themselves, have lost sight of the scientific method and have normalized bad, unscientific behaviour.
And this is ultimately how you end up with more than half of all drug trials being fraudulent or useless ...
>Actual medical science, and science in general, doesn't make claims beyond what we know for certain
What would you say about the FDA's recent approval of aduhelm? Do we know that it works "for certain"? Or is the FDA not part of the medical science establishment?
The FDA's scientific committee nearly unanimously voted against aduhelm. The political side of the FDA overruled that consensus to give preliminary approval, which has been thoroughly panned by a large portion of the medical and scientific community, prompted three resignations from said committee, and has prompted a Congressional investigation.
Aduhelm's approval basically came about in violation of the FDA's processes, so it's hopefully merely a one-off example of corruption rather than a harbinger of the death of science at the FDA.
> This is from ivmmeta.com, part of a sprawling empire of big professional-looking sites promoting unorthodox coronavirus treatments. I have no idea who runs it - they’ve very reasonably kept their identity secret
Why are they hiding their identity? That means that it can be anyone who does this.
-----------------
But even more important. The website also claims that each of the following individual medicines works:
Fluvoxamine
Proxalutamide
Iota-carrageenan
Molnupiravir
Quercetin
Povidone-Iodine
Curcumim
Casirivimab
Sotrovimab
Bamlanivimab
Nitazoxanide
Budesonide
Zinc
Bromhexine
Colchicine
Vitamin D
Aspirin
Favipiravir
Hydroxychloroquine
Remdesivir
Vitamin C
I find it unlikely that all those claims are true which in turn makes me question their scientific approach.
The article points out several ways that ivmmeta's meta-analysis may be flawed:
> Meyerowitz-Katz accuses ivmmeta of cherry-picking what statistic to use for their forest plot. That is, if a study measures ten outcomes, they sometimes take the most pro-ivermectin outcome.
> (how come I’m finding a bunch of things on the edge of significance, but the original ivmmeta site found a lot of extremely significant things? Because they combined ratios, such that “one death in placebo, zero in ivermectin” looked like a nigh-infinite benefit for ivermectin, whereas I’m combining raw numbers.
Given that there is a lot of complexity and debate on how to integrate studies with disparate primary outcomesbane measures, the fault may indeed lie with the ivmmeta analysis methodology.
I don't understand the point of the image of the meth seizure when discussing this study [1]. The last name is the same, but if you understand Mexican surnames, it is strongly unlikely that the two different people are in any way closely related. I like reading Scott's writing, but this really detracts from the overall quality of the article, because it seems like a vaguely racist dig without any relevance.
It can be poor writing, intentional obfuscation, misdirection, or a lot of other things, but to jump to racism just because the subject is from a different country than the author is pretty unfair.
I also think it's humor. Scott probably just came across it while searching the name. When you search something on twitter, it is bolded in the results just like in the image.
The caption is an example of irony I think: incongruity between what is expected and what is presented, mixed with saying the opposite of what you mean. Quite clear from context. I laughed when I saw it.
Posting like this will get you banned here, regardless of how wrong someone is or you feel they are. Please review the site guidelines and don't post like this again. It's enough to respectfully provide correct information.
I'm aware of the demographics in Bakersfield. I live in a city with a larger proportion of the population being Hispanic than Bakersfield, hence why I am aware of how Mexican culture utilizes hyphenated surnames.
Your link to demographic statistics does nothing to change my mind that this was vaguely racist (culturist?). I don't think Scott is racist, I just think this was a non sequitur that had no place within what was an otherwise fantastic piece of writing. It adds nothing and takes something away, and could have been better for doing without.
It was clearly a joke. A questionable study ended up having a result from a google/twitter search of the same name made for a humorous reference. Did you take the same racist conclusion from the photo of the guy who had the 7 month PhD? This is a blog entry, not a professional scholarly work, and so it was written to be enjoyed.
> Did you take the same racist conclusion from the photo of the guy who had the 7 month PhD?
No, because the quip there wasn't based upon the person's name (which originates from their culture) and a stereotype about their place of origin. It's amazing how context is important.
The seizure was in the US, despite being a Hispanic name. I don’t understand why you’re jumping to conclusions about place of origin. It’s easy to imagine the name could have been Smith and the same content could have been written and fit right in.
Please don’t be snarky about context — not only is it against HN guidelines, it’s not giving full faith to me or anyone else who might read this and the blog entry in its entirety.
"...everyone still PCR positive by day 7 so it was impossible to compare groups"
Eh, isn't this what a PCR-test does: detect RNA?
A medicine doesn't magically remove virus RNA. It might break down the virus or block it's ability to reproduce but the RNA will still be detected.
With all bashing on Ivermectin, I just wonder what people think about it! First, there's no money to be made from it - no patents, it costs cents per dose, and everybody can manufacture it! Second, it has proven anti-viral properties against HIV, HPV, etc. In general, it's not like some crazy guy decided to use try it against SARS-CoV-2 - scientists were looking to repurpose antivirals. Plus, it has a pretty decent and long-established safety record. Compare it to Remdesivir, let's say, which comes with terrible side effects! Also, the dosage has been pretty low and recommendations have changed - from 0.2mg/kg now it's 0.4-0.6mg/kg with Delta. Pretty much all my friends who followed the I-MASK+ protocol [0], didn't get severe course of COVID-19. Yeah, it's anecdotal data, but there are no exceptions!
Are meta-analyses that just average all the results from all the studies less reliable than picking a paper at random?
I'd expect that to be the case if the bogus studies report the most dramatic results. A single bogus study out of 10 can skew the whole meta-analysis, but if you picked randomly you'd be 90% likely to get an honest one.
tl;dr: A lot of ivermectin COVID studies are garbage. When you throw them out it seems like there might be a mild positive correlation but that depends on your methodology.
But when you look at the bigger picture the decent positive studies often come from areas of the world where parasitic worms are prevalent. There is a specific parasitic worm Strongyloides stercoralis that multiplies out of control sometimes causing death when corticosteroids are taken - the exact kind of corticosteroids that improve survivability for those with COVID.
For good quality studies ivermectin seems positive for COVID in areas with high parasitic worm infection rates and negative for areas without such infections, though more data is needed. This seems like a tidy answer because it shows everyone got part of the story wrong and it has a plausible mechanism of action which was previously lacking (ivermectin kills parasitic worms that suppress the immune system and/or multiply out of control when other drugs necessary to recover from CVOID are given).
> But when you look at the bigger picture the decent positive studies often come from areas of the world where parasitic worms are prevalent.
I bet someone could make decent money selling parasitic worm eggs or larvae or whatever the heck it is that gets into people that causes a parasitic worm infection so that people can infest themselves when they get COVID symptoms in order to make the ivermectin they then take more effective.
A depressingly large number of the people that end up on /r/HermanCainAward as nominees or winners would believe that is reasonable.
Such good writing. I was anxious about trying to read it all, but he kept me hooked to the end.
> I think it’s important to address ivermectin support on its own terms - as a potentially plausible scientific theory in a debris field of confusing evidence, which should be debated to the usual standards of scientific debate. I’ve tried to do that above.
This is also how I’ve kind of tried to view things, yet I continue to be disappointed. The studies shown here were way worse than I imagined. Just like when someone in my personal life says to me they’re skeptical of the vaccines. I want to take them seriously, I’m waiting for them to talk to give well reasoned arguments about hard choices and uncertainty, but it ends up being arguments one can dismiss with five minutes of research.
I predict that over the next 100 years bioethics will dominate the discourse. I want people to be ready to challenge the status quo and experts going forward. But covid has really shown that we’re not even remotely prepared. What will it take, four years of mandatory biology and philosophy for high school students?
He means it as a metaphor for "they'll say you're extremely evil," and Mengele is the most evil scientist that's also a household name. Treating any name like it's Voldemort isn't a helpful norm for a society to uphold.
I'm pretty sure Scott is Jewish, so I imagine he's aware of Mengele's work.
It's a Twitter thing now, but it might be useful to understand that it predates Twitter.
E.g., "Goodwin's Law" is supposed to have been coined in 1990, and of course it was a pretty well established phenomenon to earn a coined term.
I know from first-hand experience it was happening on BBS's and newsgroups in the '80s. I would be more surprised than not if it wasn't happening before then too.
(And if you want to generalize slightly, calling someone a Nazi is simply a current way of demonizing your opponent. People have been demonizing their opponents since well before there were Nazis.)
I think we ought to re-invigorate "Philistines" as the term for "people who disagree with us even though we haven't listened to what they said". It's got a better flavor, ya'know? and the whole historical angle should appeal to the kiddies.
I think if the IVM proponents were operating in good faith, their message would have been something like "There's some evidence that IVM can mitigate severe COVID infections, but it's relatively weak so you shouldn't rely on it to the exclusion of other ways of protecting yourself."
But that's not what happened. IVM (like HCQ before it) is a prop, a cudgel, a red herring in the ongoing and well-funded political project to undermine faith in government and polarize the electorate
Can't stand close minded people who can not fathom that other treatments could work from ivermectin to the upcoming pill Pfizer is putting out to something else. It's ridiculous that their bias drives them 100% vs. being objective in that science and research takes time .. years ... time will tell and provide all of us with many treatments against COvid as there now is for the flu.
Politic bias blinds objectivity and it's ridiculous for people who believe themselves to be intelligent people. Especially those who believe everything and live by their biased manipulated for profit media of choice. Here is one of many examples of the media spinning it's bias agenda and years later getting caught https://www.axios.com/steele-dossier-discredited-media-corre... . Of course it's happens on both sides like all that ridiculous story about Clinton pedo pizza parlor thing. The media is garbage and not to live one's life by ... years of science is!
This is great. It also underscores a methodological opportunity - is there a way to group together a huge amount of studies, regardless of disease or treatment, and create a semantic association graph that takes things like climate, culture, geography, and the like into account?
You could rank researchers and institutions and locations in order to weight contributions to meta-studies, but you would be also able to associate confounders like parasites almost immediately. I have to imagine it would be the ultimate tool in identifying novel uses for existing drugs.
If this could be done with open source software, it could be a killer app for scihub. Medicine, nutrition, chemical processes, energy science, all sorts of things could benefit the world.
Hell, what if there's a correlation with elevation? It looks like there's a lower death rate at higher elevation - how much air pressure is the threshold for viruses getting into lungs? Could a strong coughing fit at sea level be more dangerous than one at the summit of everest? Does less coughing occur in low humidity, low dust places?
> As best I can tell, this is some kind of Egyptian trial. It might or might not be an RCT; it says stuff like “Patients were self-allocated to the treatment groups; the first 3 days of the week for the intervention arm while the other 3 days for symptomatic treatment”. Were they self-allocated in the sense that they got to choose? Doesn’t that mean it’s not random? Aren’t there seven days in a week? These are among the many questions that Elalfy et al do not answer for us.