4 ms·

> There seemed to be an overwhelming amount of evidence.... > ....there hadn't been a randomized trial the drug You don't see the contradiction here? Edit: b

> There seemed to be an overwhelming amount of evidence.... > ....there hadn't been a randomized trial the drug You don't see the contradiction here? Edit: because it must be made 100% obvious, clinical trial results are the definition of evidence in medical science.

nicoburns 5y ago
That's not really contradictory. Lots of covid treatments have been discovered in hospital settings by doctors trying desperately to find something to help their patients.
- actually_a_dog 5y ago
  And those were later validated by evidence from clinical trials. Until clinical trials involving significant numbers of patients are available, there is not evidence according to the standards of medical science. That's the contradiction.
  - effie 5y ago
    > there is not evidence according to the standards of medical science. What the hell are you trying to say? That doctors treating patients observations can be dismissed because they don't talk the academic language or their results don't follow academic guidelines? There is more to medicine than just clinical trials. Many different things can count as evidence, even if they are not up to your academic standard. Doctors observations, population-level improvements, and studies of different cohorts. There are levels of evidence, there is strong evidence based on reports of observable ivermectin benefit to profylaxis and some benefit in treatmeant of early infections.
    - dang 5y ago
      Please don't cross into flamewar, especially on divisive topics. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
      - effie 5y ago
        OK I could have worded that better, but I certainly did not want to get into a flamewar. I think there is a well visible point there still.
  - wumpus 5y ago
    It would be nice to make a list of things that appeared to work in hospitals and then failed randomized trials.
    - javagram 5y ago
      Hydroxychloroquine is a good example. Lots of doctors were trying it and thought it seemed to help. Due to the interest in the drug several RCTs of it were performed and it was shown to have no effect on patient recovery or prophylaxis of covid.
      - codeflow2202 5y ago
        This is just partially true. The studies you mention are on late treatment (and often on very high dosages). The data points to good efficacy for early treatment though. It seems clear that the only use for HCQ is during the viral multiplication phase which is not what the large studies have been looking into (they never look into early treatment for some reason).
      - forgingahead 5y ago
        This isn't true. A recent study showed significant results in using HCQ: https://www.straitstimes.com/singapore/health/throat-spray-and-hydroxychloroquine-found-to-reduce-risk-of-covid-19-infection https://www.straitstimes.com/singapore/health/throat-spray-a...
- xattt 5y ago
  Are there any specific “trench innovations” that come to mind?
  - raphlinus 5y ago
    The thing that most immediately comes to mind is Cameron Kyle-Sidell, who recognized that the standard treatment protocols were over-intubating people for hypoxemia, and that overly high pressures of ventilators were causing damage. He faced a great deal of resistance within his institution at the time, and was quite controversial in taking his case to Twitter and Youtube. Since then, he's been vindicated, and protocols have been changed. I post this because I think it's the exception that proves the rule. Dr. Kyle-Sidell is a physician of great perception and insight. For every one of him, there are no doubt hundreds of "hydroxychloroquine doctors" who peddle bullshit without scientific basis to the harm of their patients. But the existence of doctors like him does boost the "maverick doctor bucking the institution" narrative. [1]: https://www.medscape.com/viewarticle/928156 https://www.medscape.com/viewarticle/928156 [2]: https://elemental.medium.com/how-one-covid-19-doctor-became-a-ventilator-whistleblower-a1c2dbdd1b06 https://elemental.medium.com/how-one-covid-19-doctor-became-...
    - ipaddr 5y ago
      These days youtube would ban him.
      - rossjudson 5y ago
        How do you know that?
        pbak 5y ago
        Have you read the headline ? They banned an interview with the inventor of mRNA vaccine tech for saying it might be dangerous and needs more caution and study.
    - foolinaround 5y ago
      > "hydroxychloroquine doctors" who peddle bullshit without scientific basis as of today, the mechanism that made HCQ work has been explained scientifically, right? What is your bias regarding this? Now, that the mechanism is better understood, the doctor who recommended HCQ has now moved on to a better suggestion utilizating the same mechanism.
0-_-0 5y ago
There are degrees of evidence, it's not binary
dolni 5y ago
Is that sort of like how the normal process for vaccine approval is the _definition_ of "safe", and yet government officials and media keep insisting that vaccines approved on an emergency use basis are "safe"? The scientific method is a process. Evidence is just one part of the bigger picture.
darwingr 5y ago
It's an approved drug. Fully licensed and considered to have a wide safety profile. Doctors don't need permission for off-label use. It's just not a thing. We're in strange territory where doctors (professionals) have been demoted to nurses and they can't profess.
- gls2ro 5y ago
  In my country, ivermectin it is an approve drug but not for COVID. Like a lot of other drugs which are approved as being safe but that does not mean they are good for COVID. So I don't see how your argument contradicts the one you are replying which says there is no an overwhelming amount of evidence for ivermectin as a good treatment for COVID. I am also not against being used by doctors who have the time for trying it and seeing if works. As we don't have a wide available treatment which we know for sure (with a high probability) that will cure COVID then maybe trying various scenarios could be a way to cure more people. But we have to take into consideration that giving one treatment means not giving other treatments so it is not an easy choice.
- raarts 5y ago
  In the Netherlands doctors can be fined up to €150.000 if they prescribe Ivermectine or HCQ. Even though they can normally prescribe things off-label.
sjwalter 5y ago
Large RCTs are considered the "gold standard" but you are outright misleading if you are saying that large RCTs are the SOLE definition of evidence in medical science. Or you know nothing about medical science. Observational trials, natural experiments, etc. all constitute evidence. As well, there have been over 25 RCTs performed globally on Ivermectin to date.

nicoburns 5y ago

That's not really contradictory. Lots of covid treatments have been discovered in hospital settings by doctors trying desperately to find something to help their patients.

actually_a_dog 5y ago
And those were later validated by evidence from clinical trials. Until clinical trials involving significant numbers of patients are available, there is not evidence according to the standards of medical science. That's the contradiction.
- effie 5y ago
  > there is not evidence according to the standards of medical science. What the hell are you trying to say? That doctors treating patients observations can be dismissed because they don't talk the academic language or their results don't follow academic guidelines? There is more to medicine than just clinical trials. Many different things can count as evidence, even if they are not up to your academic standard. Doctors observations, population-level improvements, and studies of different cohorts. There are levels of evidence, there is strong evidence based on reports of observable ivermectin benefit to profylaxis and some benefit in treatmeant of early infections.
  - dang 5y ago
    Please don't cross into flamewar, especially on divisive topics. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
    - effie 5y ago
      OK I could have worded that better, but I certainly did not want to get into a flamewar. I think there is a well visible point there still.
- wumpus 5y ago
  It would be nice to make a list of things that appeared to work in hospitals and then failed randomized trials.
  - javagram 5y ago
    Hydroxychloroquine is a good example. Lots of doctors were trying it and thought it seemed to help. Due to the interest in the drug several RCTs of it were performed and it was shown to have no effect on patient recovery or prophylaxis of covid.
    - codeflow2202 5y ago
      This is just partially true. The studies you mention are on late treatment (and often on very high dosages). The data points to good efficacy for early treatment though. It seems clear that the only use for HCQ is during the viral multiplication phase which is not what the large studies have been looking into (they never look into early treatment for some reason).
    - forgingahead 5y ago
      This isn't true. A recent study showed significant results in using HCQ: https://www.straitstimes.com/singapore/health/throat-spray-and-hydroxychloroquine-found-to-reduce-risk-of-covid-19-infection https://www.straitstimes.com/singapore/health/throat-spray-a...
xattt 5y ago
Are there any specific “trench innovations” that come to mind?
- raphlinus 5y ago
  The thing that most immediately comes to mind is Cameron Kyle-Sidell, who recognized that the standard treatment protocols were over-intubating people for hypoxemia, and that overly high pressures of ventilators were causing damage. He faced a great deal of resistance within his institution at the time, and was quite controversial in taking his case to Twitter and Youtube. Since then, he's been vindicated, and protocols have been changed. I post this because I think it's the exception that proves the rule. Dr. Kyle-Sidell is a physician of great perception and insight. For every one of him, there are no doubt hundreds of "hydroxychloroquine doctors" who peddle bullshit without scientific basis to the harm of their patients. But the existence of doctors like him does boost the "maverick doctor bucking the institution" narrative. [1]: https://www.medscape.com/viewarticle/928156 https://www.medscape.com/viewarticle/928156 [2]: https://elemental.medium.com/how-one-covid-19-doctor-became-a-ventilator-whistleblower-a1c2dbdd1b06 https://elemental.medium.com/how-one-covid-19-doctor-became-...
  - ipaddr 5y ago
    These days youtube would ban him.
    - rossjudson 5y ago
      How do you know that?
      - pbak 5y ago
        Have you read the headline ? They banned an interview with the inventor of mRNA vaccine tech for saying it might be dangerous and needs more caution and study.
  - foolinaround 5y ago
    > "hydroxychloroquine doctors" who peddle bullshit without scientific basis as of today, the mechanism that made HCQ work has been explained scientifically, right? What is your bias regarding this? Now, that the mechanism is better understood, the doctor who recommended HCQ has now moved on to a better suggestion utilizating the same mechanism.

0-_-0 5y ago

There are degrees of evidence, it's not binary

dolni 5y ago

Is that sort of like how the normal process for vaccine approval is the _definition_ of "safe", and yet government officials and media keep insisting that vaccines approved on an emergency use basis are "safe"? The scientific method is a process. Evidence is just one part of the bigger picture.

darwingr 5y ago

It's an approved drug. Fully licensed and considered to have a wide safety profile. Doctors don't need permission for off-label use. It's just not a thing. We're in strange territory where doctors (professionals) have been demoted to nurses and they can't profess.

gls2ro 5y ago
In my country, ivermectin it is an approve drug but not for COVID. Like a lot of other drugs which are approved as being safe but that does not mean they are good for COVID. So I don't see how your argument contradicts the one you are replying which says there is no an overwhelming amount of evidence for ivermectin as a good treatment for COVID. I am also not against being used by doctors who have the time for trying it and seeing if works. As we don't have a wide available treatment which we know for sure (with a high probability) that will cure COVID then maybe trying various scenarios could be a way to cure more people. But we have to take into consideration that giving one treatment means not giving other treatments so it is not an easy choice.
raarts 5y ago
In the Netherlands doctors can be fined up to €150.000 if they prescribe Ivermectine or HCQ. Even though they can normally prescribe things off-label.

sjwalter 5y ago

Large RCTs are considered the "gold standard" but you are outright misleading if you are saying that large RCTs are the SOLE definition of evidence in medical science. Or you know nothing about medical science. Observational trials, natural experiments, etc. all constitute evidence. As well, there have been over 25 RCTs performed globally on Ivermectin to date.