4 ms·

Different websites (such as https://ivmmeta.com/ https://ivmmeta.com/, https://c19ivermectin.com/ https://c19ivermectin.com/, https://tratamientotemprano.org/es

by m-p-3 5y ago

Different websites (such as https://ivmmeta.com/ https://ivmmeta.com/, https://c19ivermectin.com/ https://c19ivermectin.com/, https://tratamientotemprano.org/estudios-ivermectina/ https://tratamientotemprano.org/estudios-ivermectina/, among others) have conducted meta-analyses with ivermectin studies, showing unpublished colourful forest plots which rapidly gained public acknowledgement and were disseminated via social media, without following any methodological or report guidelines. These websites do not include protocol registration with methods, search strategies, inclusion criteria, quality assessment of the included studies nor the certainty of the evidence of the pooled estimates. Prospective registration of systematic reviews with or without meta-analysis protocols is a key feature for providing transparency in the review process and ensuring protection against reporting biases, by revealing differences between the methods or outcomes reported in the published review and those planned in the registered protocol. These websites show pooled estimates suggesting significant benefits with ivermectin, which has resulted in confusion for clinicians, patients and even decision-makers. This is usually a problem when performing meta-analyses which are not based in rigorous systematic reviews, often leading to spread spurious or fallacious findings. Concluding, research related to ivermectin in COVID-19 has serious methodological limitations resulting in very low certainty of the evidence, and continues to grow. The use of ivermectin, among others repurposed drugs for prophylaxis or treatment for COVID-19, should be done based on trustable evidence, without conflicts of interest, with proven safety and efficacy in patient-consented, ethically approved, randomised clinical trials. Source: Misleading clinical evidence and systematic reviews on ivermectin for COVID-19; https://ebm.bmj.com/content/early/2021/05/26/bmjebm-2021-111678 https://ebm.bmj.com/content/early/2021/05/26/bmjebm-2021-111...

0-_-0 5y ago
The only specific ctiticism is the following sentence, the rest is designed to create fear, uncertainty and doubt: These websites do not include protocol registration with methods, search strategies, inclusion criteria, quality assessment of the included studies nor the certainty of the evidence of the pooled estimates. This is false. The ivmmeta.com page says: Typical meta analyses involve subjective selection criteria, effect extraction rules, and study bias evaluation, which can be used to bias results towards a specific outcome. In order to avoid bias we include all studies and use a pre-specified method to extract results from all studies (we also present results after exclusions). They also compare prospective and retrospective studies and see no significant difference. You could have at least scrolled through the page before blindly copy-pasting something from Google.
- gus_massa 5y ago
  One of the problem with meta analysis is the lack of pre-registration of most of the studies about ivermectin. There are many studies in many places. Imagine just for a moment that some new drug has no effect. Anyway, 1/20 of them will get a fake statistical significant result. The problem is that this study with a fake good result has a high chance of been published. The other 19 have a high chance of not been published, because the doctors lost interest, because the journal don't like null results, or other similar reasons. So if you make a review of the published studies, you will only find only/mostly the ones that get a good result due to a fluke. This is not an imaginary problem, this is a known problem. Imagine Big Pharma has a new drug, and they want to it approved. They can hire 100 universities/hospitals to run a clinical study, suggest that only the ones with a good fluke result get published and then they get about 5 good papers about the drug. Perhaps they don't even have to make a suggestion, because it's boring to write a paper about a drug that does not work so the medic just don't write it, and it's boring to read a paper about a drug that does not work so the journal just publish it. It's the same effect, and nobody is lying ;) . The solution for this is pre-registration. Before starting the trial, you must register it, explain what drugs you are going to use, what are you going to measure. With pre-registration, now the 100 studies are public. If you later find 5 good and 95 inconclusive or bad or disappeared, you know in the meta analysis the 5 good studies are only flukes.
  - 0-_-0 5y ago
    I understand the P-hacking problem, but if that was the source of the positive result in the meta analysis that would mean that scientists are throwing away 95% of their studies on one of the most promising COVID treatments during a pandemic. In this case there's not really a reason to throw away a negative result. Considering the controversy around Ivermectin a study showing a negative result would get a huge amount of citations and attention. In any case, thank you for trying to use reason in your argument, we need more around this subject.
    - gus_massa 5y ago
      > scientists are throwing away 95% of their studies My guess is that most of these are not studies on purpose. A MD or a Hospital tries a new drug that seam promising for a week/month. If the result is good they get very happy, and try to make as many fuss as possible, that means that they publish their work in some journal. If the result is bad they lose interest in the subject, or try to hide the wrong results under the carpet, or don't want to spend time in a paper that is very difficult to publish. So the good results of the informal tries are published, and the bad result get lost. No conspiracy. Just people doing people things. > one of the most promising COVID treatments during a pandemic I don't think it's promising, but I think it's important to discuss about it and try to understand why it is necessary to get better evidence.

by m-p-3 5y ago

0-_-0 5y ago

The only specific ctiticism is the following sentence, the rest is designed to create fear, uncertainty and doubt: These websites do not include protocol registration with methods, search strategies, inclusion criteria, quality assessment of the included studies nor the certainty of the evidence of the pooled estimates. This is false. The ivmmeta.com page says: Typical meta analyses involve subjective selection criteria, effect extraction rules, and study bias evaluation, which can be used to bias results towards a specific outcome. In order to avoid bias we include all studies and use a pre-specified method to extract results from all studies (we also present results after exclusions). They also compare prospective and retrospective studies and see no significant difference. You could have at least scrolled through the page before blindly copy-pasting something from Google.

gus_massa 5y ago
One of the problem with meta analysis is the lack of pre-registration of most of the studies about ivermectin. There are many studies in many places. Imagine just for a moment that some new drug has no effect. Anyway, 1/20 of them will get a fake statistical significant result. The problem is that this study with a fake good result has a high chance of been published. The other 19 have a high chance of not been published, because the doctors lost interest, because the journal don't like null results, or other similar reasons. So if you make a review of the published studies, you will only find only/mostly the ones that get a good result due to a fluke. This is not an imaginary problem, this is a known problem. Imagine Big Pharma has a new drug, and they want to it approved. They can hire 100 universities/hospitals to run a clinical study, suggest that only the ones with a good fluke result get published and then they get about 5 good papers about the drug. Perhaps they don't even have to make a suggestion, because it's boring to write a paper about a drug that does not work so the medic just don't write it, and it's boring to read a paper about a drug that does not work so the journal just publish it. It's the same effect, and nobody is lying ;) . The solution for this is pre-registration. Before starting the trial, you must register it, explain what drugs you are going to use, what are you going to measure. With pre-registration, now the 100 studies are public. If you later find 5 good and 95 inconclusive or bad or disappeared, you know in the meta analysis the 5 good studies are only flukes.
- 0-_-0 5y ago
  I understand the P-hacking problem, but if that was the source of the positive result in the meta analysis that would mean that scientists are throwing away 95% of their studies on one of the most promising COVID treatments during a pandemic. In this case there's not really a reason to throw away a negative result. Considering the controversy around Ivermectin a study showing a negative result would get a huge amount of citations and attention. In any case, thank you for trying to use reason in your argument, we need more around this subject.
  - gus_massa 5y ago
    > scientists are throwing away 95% of their studies My guess is that most of these are not studies on purpose. A MD or a Hospital tries a new drug that seam promising for a week/month. If the result is good they get very happy, and try to make as many fuss as possible, that means that they publish their work in some journal. If the result is bad they lose interest in the subject, or try to hide the wrong results under the carpet, or don't want to spend time in a paper that is very difficult to publish. So the good results of the informal tries are published, and the bad result get lost. No conspiracy. Just people doing people things. > one of the most promising COVID treatments during a pandemic I don't think it's promising, but I think it's important to discuss about it and try to understand why it is necessary to get better evidence.