4 ms·

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%

by 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.
- 0-_-0 5y ago
  Then you have to explain why are results about Ivermectin more likely to be thrown out than studies about hydroxychloroquine (https://hcqmeta.com/ https://hcqmeta.com/), which has only 73.8% positive studies and shows much smaller improvement. Why are prophylaxis studies more successful than early treatment studies, which are more successful than late treatment studies? Are they more likely to be thrown out? Why are people throwing out studies exactly in a pattern to create a sort of pattern that would indicate a working drug?
  - gus_massa 5y ago
    Which studies are published and which are dropped is not so easy to calculate. Sometimes the team need to publish to get a grant, sometimes one graduate student needs a paper to get the degree, sometimes some of the team member is too famous or a friend of the editor. It vary a lot, papers get published with not good enough but "promising" results. Also, if the main objective of the study (like reducing the number of death) is not successful, you can pick another criteria of successfulness like number of day in the hospital, viral load after a week, ... there are many to choice. In particular in the fists study about hydroxychloroquine by Raoult, he claims that it's a success, but if you read the paper you can notice that there is no one death in the trial group and no deaths in the control group. (And the control group is not a randomized control group, just an unrelated bunch of patients in another city.) About why early interventions with hydroxychloroquine get apparent better results: That's a good question, but the publication bias is not the only source of problems. It's difficult to be sure, but look at the study here in the OP. My guess is that the treatment with ivermectin includes implicitly phones call "Locatel" and that additional care from doctors improve the result. Other studies have similar additional care for the people under treatment. And if you start the phone calls earlier, it's better that starting late. So you may measure it in the trials. You may disagree with my explanation, and it's fine. The real problem is how to be sure if I'm wrong or you are wrong (or both). So the solution is to do double blind studies, were some people that get the medicine and other people that get a placebo that looks identical. But the important part is that both get all the additional health treatment. Both get phone calls that perhaps are useful. Both get automatic weakly nurse checks that are common in other treatments and perhaps are useful. ... So it's not necessary to guess if any of the other part of the treatment is useful, because the only difference is drug vs placebo.
    - 0-_-0 5y ago
      Isn't your last paragraph describing a randomized controlled trial? The page lists 31 for Ivermectin [0] and (for comparison) 40 for HCQ [1]. I don't find the evidence for HCQ convincing, but Ivermectin seems solid from what I can tell. It's hard to explain 28 out of 31 randomized controlled trials showing a positive result with bias, since you would expect that bias to affect both HCQ and Ivermectin. Why would Ivermectin show much better results than HCQ? What kind of bias would affect Ivermectin much more than HCQ? [0]: https://ivmmeta.com/#fig_fpr https://ivmmeta.com/#fig_fpr [1]: https://hcqmeta.com/#fcite_rct https://hcqmeta.com/#fcite_rct (Figure 7, scroll down)

by 0-_-0 5y ago

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.

0-_-0 5y ago
Then you have to explain why are results about Ivermectin more likely to be thrown out than studies about hydroxychloroquine (https://hcqmeta.com/ https://hcqmeta.com/), which has only 73.8% positive studies and shows much smaller improvement. Why are prophylaxis studies more successful than early treatment studies, which are more successful than late treatment studies? Are they more likely to be thrown out? Why are people throwing out studies exactly in a pattern to create a sort of pattern that would indicate a working drug?
- gus_massa 5y ago
  Which studies are published and which are dropped is not so easy to calculate. Sometimes the team need to publish to get a grant, sometimes one graduate student needs a paper to get the degree, sometimes some of the team member is too famous or a friend of the editor. It vary a lot, papers get published with not good enough but "promising" results. Also, if the main objective of the study (like reducing the number of death) is not successful, you can pick another criteria of successfulness like number of day in the hospital, viral load after a week, ... there are many to choice. In particular in the fists study about hydroxychloroquine by Raoult, he claims that it's a success, but if you read the paper you can notice that there is no one death in the trial group and no deaths in the control group. (And the control group is not a randomized control group, just an unrelated bunch of patients in another city.) About why early interventions with hydroxychloroquine get apparent better results: That's a good question, but the publication bias is not the only source of problems. It's difficult to be sure, but look at the study here in the OP. My guess is that the treatment with ivermectin includes implicitly phones call "Locatel" and that additional care from doctors improve the result. Other studies have similar additional care for the people under treatment. And if you start the phone calls earlier, it's better that starting late. So you may measure it in the trials. You may disagree with my explanation, and it's fine. The real problem is how to be sure if I'm wrong or you are wrong (or both). So the solution is to do double blind studies, were some people that get the medicine and other people that get a placebo that looks identical. But the important part is that both get all the additional health treatment. Both get phone calls that perhaps are useful. Both get automatic weakly nurse checks that are common in other treatments and perhaps are useful. ... So it's not necessary to guess if any of the other part of the treatment is useful, because the only difference is drug vs placebo.
  - 0-_-0 5y ago
    Isn't your last paragraph describing a randomized controlled trial? The page lists 31 for Ivermectin [0] and (for comparison) 40 for HCQ [1]. I don't find the evidence for HCQ convincing, but Ivermectin seems solid from what I can tell. It's hard to explain 28 out of 31 randomized controlled trials showing a positive result with bias, since you would expect that bias to affect both HCQ and Ivermectin. Why would Ivermectin show much better results than HCQ? What kind of bias would affect Ivermectin much more than HCQ? [0]: https://ivmmeta.com/#fig_fpr https://ivmmeta.com/#fig_fpr [1]: https://hcqmeta.com/#fcite_rct https://hcqmeta.com/#fcite_rct (Figure 7, scroll down)