4 ms·

I don't know whether ivermectin is an effective, let alone transformative, treatment for covid. I certainly hope it is! We could all do with some good news. I

I don't know whether ivermectin is an effective, let alone transformative, treatment for covid. I certainly hope it is! We could all do with some good news. I don't have time or expertise to evaluate, let alone conduct, clinical trial methodologies or meta-analyses, so I have to rely on secondary sources. The institutional consensus (from WHO, etc) is that the treatment is unproven, and further research is required. https://www.who.int/news-room/feature-stories/detail/who-advises-that-ivermectin-only-be-used-to-treat-covid-19-within-clinical-trials https://www.who.int/news-room/feature-stories/detail/who-adv... It is apparent that there is a community (ivmmeta, BIRD, FLCCC) who strongly disagree and believe that ivermectin efficacy is already proven. So the question becomes: who to believe? We definitely have historical examples of astroturfing, regulatory capture, etc occurring - such as oil companies going to enormous lengths to muddy the science around climate change. And we also have recent examples (HCQ is the obvious one) where a large number of people became very excited about a treatment which has, I think, been fairly conclusively shown to be ineffective. I have no magic method to determine which of these is the case this time, but my money is on IVM being a washout after further research. I am skeptical of the BIRD folks, because they are acting and talking like a pressure group, not an open-minded body. I frankly doubt their impartiality when evaluating the evidence - I'm not alleging a nefarious purpose, just the omnipresent danger of becoming too attached to your pet hypothesis. To paraphrase your statement, I hope the truth on ivermectin comes out. And I hope it is an effective treatment. But these are two separate hopes. BTW: You're providing an example here of how, once you start looking at a particular issue with a conspiracy mindset, you can easily construct an impervious epistemic bubble. The large trials cannot be trusted because they have been designed to fail; shadowy forces lie behind the doubts cast on the Elgazzar trial; and so on. This is not to say that conspiracies never exist. But it is worth asking yourself: what could I learn at this point which would change my mind?

jamesblonde 5y ago
You're implying I have selective bias in the evidence I put forward. However, you have only put forward a hunch - "my money is on". Your method of critique is post-modern - you have your evidence, they have their evidence. But that is not true. There are no studies (apart from one) that show Ivermectin is not effective - it's just the effect level that differs between them. There are now 30 RCTs! When you know that Ivermectin works best when given early and at higher (but safe!) doses, you can design studies that show a lower effect level. Just give it late at low doses on a healthy cohort. Then you conclude "Ivermectin has no effect". But meta analyses account for variances between RCTs - and they show it works. If you look at the MacMaster and Oxford trials - it allows participants who have had first sympthoms of Covid up to 14 days ago, from age 30. And they only dose for the first 2/3 days at 200/300 mcg/kg, respectively. We know from the meta analyses there is a dose response, and ivermectin has safety data with over 1200 mcg/kg. So, yes, you can design a RCT to give the answer you want - if you are incentivized to do so. Show me the incentive and i will show you the outcome.
- jamesblonde 5y ago
  I submit this article by the independent Swiss Policy Research institute as supporting evidence in my claims. Great read. https://swprs.org/the-ivermectin-debate/ https://swprs.org/the-ivermectin-debate/
  - me_again 5y ago
    Thanks. You might find this interesting. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

jamesblonde 5y ago

You're implying I have selective bias in the evidence I put forward. However, you have only put forward a hunch - "my money is on". Your method of critique is post-modern - you have your evidence, they have their evidence. But that is not true. There are no studies (apart from one) that show Ivermectin is not effective - it's just the effect level that differs between them. There are now 30 RCTs! When you know that Ivermectin works best when given early and at higher (but safe!) doses, you can design studies that show a lower effect level. Just give it late at low doses on a healthy cohort. Then you conclude "Ivermectin has no effect". But meta analyses account for variances between RCTs - and they show it works. If you look at the MacMaster and Oxford trials - it allows participants who have had first sympthoms of Covid up to 14 days ago, from age 30. And they only dose for the first 2/3 days at 200/300 mcg/kg, respectively. We know from the meta analyses there is a dose response, and ivermectin has safety data with over 1200 mcg/kg. So, yes, you can design a RCT to give the answer you want - if you are incentivized to do so. Show me the incentive and i will show you the outcome.

jamesblonde 5y ago
I submit this article by the independent Swiss Policy Research institute as supporting evidence in my claims. Great read. https://swprs.org/the-ivermectin-debate/ https://swprs.org/the-ivermectin-debate/
- me_again 5y ago
  Thanks. You might find this interesting. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...