9 ms·

Calling the investigatory and experiential evidence of thousands of highly-trained doctors (some of whom pioneered the standard of care for covid) as "weak evid

Calling the investigatory and experiential evidence of thousands of highly-trained doctors (some of whom pioneered the standard of care for covid) as "weak evidence" is something that only somebody carrying water for large pharmaceutical companies would say. Doctors in my area are prescribing IVM to treat covid because in their experience and that of their peers IT WORKS. They have fewer deaths, fewer complications. But it's "weak" evidence just because Pfizer didn't sponsor a gigantic RCT to "prove" it. "The only science is real is expensive science done by large corporations!"

dionian 5y ago
Agreed, retract all the meta-analyses you want, but never dismiss actual front line results by physicians. If you have a regimen with zero deaths for a disease, I don't think we should be suppressing their clinical data. What a world...
- ashtonkem 5y ago
  “Zero deaths” should have set off your alarm bells. That’s way too neat of a number for the real world; you only get that kind of result with small sample sizes or fraud. Even the vaccines, which are very effective, do not have a 0% death rate from infection.
  - chana_masala 5y ago
    Officially the FDA and CDC say there have been 0 deaths from adverse events. I agree, that's way too neat of a number for the real world.
    - lamontcg 5y ago
      https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-05-12/07-COVID-Shimabukuro-508.pdf https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-... 3 deaths from TTS following J&J as of May 7th where there were 8.73 million doses of J&J administered.
    - mlyle 5y ago
      You're saying re: vaccines? There's been several deaths believed to be caused by the vaccines and attributed as such by the FDA/CDC. And, you know, a few hundred thousand lives saved.
      - pigeonhole123 5y ago
        Not a troll: how do you know that number? Pfizer’s own RCT showed no difference in all cause mortality after six months
        jjeaff 5y ago
        That was the trial that only had 40k participants. Adverse effects are so rare, it had to be administered to tens of millions of people to the public at large before just a few showed up.
        mlyle 5y ago
        Which number? The few hundred thousand saved? There's possible confounds, but none can explain vaccinated people being fewer than 6% of deaths (my MLE: about 2% of deaths) and more than 50% of the population. Especially since the vaccinated are, overall, a sicker and older population than the country at large. The vaccine RCTs were not powered sufficiently to show a reduction in COVID death, given that they had no or basically no COVID death in either group. They did show a huge reduction in illness and severe illness, and now we're observing a commensurate reduction in death in the population.
        lamontcg 5y ago
        https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm?s_cid=mm7037e1_w https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm?s_cid=mm... population normalized death incidence is down by 10x in vaccinated over unvaccinated (which includes recovered individuals in with the unvaccinated, so the number compared to susceptible is probably 20x). with a bit over half the population vaccinated that suggests that at least the 100,000 deaths since june would have been twice as bad without vaccinations. not including any effects of vaccination on reducing infection/transmission (and for all the hype about "waning" the protection against infection is still substantial).
    - oezi 5y ago
      Nitpick: there were plenty of deaths reported as adverse events. It was just found that they were mostly expected in a normal population. I know in Germany we did have over 20 dead from AZ thrombosis.
      - jjeaff 5y ago
        Was that 20 more dead from thrombosis than would normally be seen in a similar population of that size? Or 20 total? Because my understanding is that it was only a few more than usual.
        oezi 5y ago
        I can't seem to find the information and think I probably confused this with the UK reporting: https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vaccine-ema-finds-possible-link-very-rare-cases-unusual-blood-clots-low-blood https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vacc...
koboll 5y ago
It's weak evidence because COVID-19 observational studies are riddled with confounders due to COVID patients generally throwing everything at it they can to try and stay alive. The exact same pattern occurred with hydroxychloroquine. Lots of small observational studies showed promise. Then it repeatedly failed large RCTs. It turns out that the people with the resources to use HCQ also had the resources to use other things, things that were actually effective.
- chana_masala 5y ago
  So what were those other things, then?
  - ashtonkem 5y ago
    Dexamethasone, Remdesivir, and monoclonal antibodies are part of the go to treatments for severe Covid cases. They’re the major exotic bits of what they gave trump when he got sick, along with a bunch of over the counter stuff (zinc, vitamin D, melatonin, etc.) My understanding is that the monoclonal antibodies are the really expensive treatments. The Dexamethasone one is an interesting story. It started out as a more controversial “throw everything at the wall and see what sticks” solution by a specialist who knew steroids well. Later studies have shown a strong effect on survival, so it’s become a fairly uncontroversial part of the tool kit for severe Covid.
    - makomk 5y ago
      Of course, what made Dexamethasone such a breakthrough wasn't really the drug itself; I think there's some evidence now that other steroids might actually work better. The big breakthrough was that some UK researchers managed to use the fact that the country got hit hard early on in the pandemic to immediately run a bunch of large randomized controlled trials on all the most promising throw-things-at-the-wall treatments to get evidence on which actually worked as soon as possible.
PaulDavisThe1st 5y ago
> "The only science is real is expensive science done by large corporations!" The only science that's real when it comes to public health is the science done across large enough populations and with enough methodology to rule out many confounding issues. That tends to cost money, indeed.
- sjwalter 5y ago
  This is a neutered philosophy. You surrender you're ability to actually know things outside the purview of large pharma corps. Hey, I guess my view is never gonna get approved: Eat healthy meat, exercise, and get plenty of sunlight. Since that's never gonna get a big Pfizer RCT, you should wait. Don't exercise. Don't get sunlight. Just wait until a big pharmacorp tells you what is healthy.
  - deleted 5y ago
    [deleted]
  - ashtonkem 5y ago
    Come on, that’s clearly a bad faith interpretation of what GP said. You’ve been here long enough to know that that’s a no no.
  - PaulDavisThe1st 5y ago
    I considered adding on a coda noting that "costing money" doesn't imply big pharma. But I didn't because I considered it sort of self-evident. Neverthless, you went there anyway.
  - shapefrog 5y ago
    > I guess my view is never gonna get approved: Eat healthy meat, exercise, and get plenty of sunlight. Study has been approved 1,000s of times and been done 1,000s of times. Eating shit, sitting inside on your sofa all day is less healthy. The jury is out on your so called controversial view, has been for a long time.
mlyle 5y ago
> Calling the investigatory and experiential evidence of thousands of highly-trained doctors (some of whom pioneered the standard of care for covid) as "weak evidence" is something that only somebody carrying water for large pharmaceutical companies would say. Keep in mind that bleeding with leeches was once the standard of care-- based on clinical intuition and observational evidence. People-- even very smart, well-educated people-- are easily fooled. There is a reason why the RCT is the gold standard.
- nradov 5y ago
  The RCT is the gold standard, but observational studies can be sufficient to establish causality when the effect size is large enough with a clear dose response curve. No one has ever conducted an RCT to prove that cigarette smoking causes lung cancer, but we're pretty sure that it does.
  - mlyle 5y ago
    > to establish causality when the effect size is large enough with a clear dose response curve. And when there's some plausible underlying mechanism that can be studied by more rigorous means. Otherwise, observational studies can find correlation, not causation-- and they're not even very robust at that.
    - nradov 5y ago
      No the dose response curve alone can be sufficient. Remember that the FDA has approved multiple SSRI drugs for treating clinical depression despite a lack of understanding on the actual mechanism of action. There are several plausible hypotheses but we really don't know why they work.
      - mlyle 5y ago
        A dose response curve in an observational study is irrelevant for establishing causation. There is a dose-response relationship between umbrellas outside and rainfall., but umbrellas do not cause rainfall. And the SSRI point is tangential: they were approved based on RCT evidence. Observing umbrella use and concluding it causes rainfall, even though we don't know of a reason why umbrella use would cause rainfall, is quite different.
jacquesm 5y ago
> is something that only somebody carrying water for large pharmaceutical companies would say This is directly against the HN guidelines.
8note 5y ago
I'd consider it weak because covid mostly has non-severe symptoms. A sugar pill could also get the same observational results because the number of severe cases is very low.

dionian 5y ago

Agreed, retract all the meta-analyses you want, but never dismiss actual front line results by physicians. If you have a regimen with zero deaths for a disease, I don't think we should be suppressing their clinical data. What a world...

ashtonkem 5y ago
“Zero deaths” should have set off your alarm bells. That’s way too neat of a number for the real world; you only get that kind of result with small sample sizes or fraud. Even the vaccines, which are very effective, do not have a 0% death rate from infection.
- chana_masala 5y ago
  Officially the FDA and CDC say there have been 0 deaths from adverse events. I agree, that's way too neat of a number for the real world.
  - lamontcg 5y ago
    https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-05-12/07-COVID-Shimabukuro-508.pdf https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-... 3 deaths from TTS following J&J as of May 7th where there were 8.73 million doses of J&J administered.
  - mlyle 5y ago
    You're saying re: vaccines? There's been several deaths believed to be caused by the vaccines and attributed as such by the FDA/CDC. And, you know, a few hundred thousand lives saved.
    - pigeonhole123 5y ago
      Not a troll: how do you know that number? Pfizer’s own RCT showed no difference in all cause mortality after six months
      - jjeaff 5y ago
        That was the trial that only had 40k participants. Adverse effects are so rare, it had to be administered to tens of millions of people to the public at large before just a few showed up.
      - mlyle 5y ago
        Which number? The few hundred thousand saved? There's possible confounds, but none can explain vaccinated people being fewer than 6% of deaths (my MLE: about 2% of deaths) and more than 50% of the population. Especially since the vaccinated are, overall, a sicker and older population than the country at large. The vaccine RCTs were not powered sufficiently to show a reduction in COVID death, given that they had no or basically no COVID death in either group. They did show a huge reduction in illness and severe illness, and now we're observing a commensurate reduction in death in the population.
      - lamontcg 5y ago
        https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm?s_cid=mm7037e1_w https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm?s_cid=mm... population normalized death incidence is down by 10x in vaccinated over unvaccinated (which includes recovered individuals in with the unvaccinated, so the number compared to susceptible is probably 20x). with a bit over half the population vaccinated that suggests that at least the 100,000 deaths since june would have been twice as bad without vaccinations. not including any effects of vaccination on reducing infection/transmission (and for all the hype about "waning" the protection against infection is still substantial).
  - oezi 5y ago
    Nitpick: there were plenty of deaths reported as adverse events. It was just found that they were mostly expected in a normal population. I know in Germany we did have over 20 dead from AZ thrombosis.
    - jjeaff 5y ago
      Was that 20 more dead from thrombosis than would normally be seen in a similar population of that size? Or 20 total? Because my understanding is that it was only a few more than usual.
      - oezi 5y ago
        I can't seem to find the information and think I probably confused this with the UK reporting: https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vaccine-ema-finds-possible-link-very-rare-cases-unusual-blood-clots-low-blood https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vacc...

koboll 5y ago

It's weak evidence because COVID-19 observational studies are riddled with confounders due to COVID patients generally throwing everything at it they can to try and stay alive. The exact same pattern occurred with hydroxychloroquine. Lots of small observational studies showed promise. Then it repeatedly failed large RCTs. It turns out that the people with the resources to use HCQ also had the resources to use other things, things that were actually effective.

chana_masala 5y ago
So what were those other things, then?
- ashtonkem 5y ago
  Dexamethasone, Remdesivir, and monoclonal antibodies are part of the go to treatments for severe Covid cases. They’re the major exotic bits of what they gave trump when he got sick, along with a bunch of over the counter stuff (zinc, vitamin D, melatonin, etc.) My understanding is that the monoclonal antibodies are the really expensive treatments. The Dexamethasone one is an interesting story. It started out as a more controversial “throw everything at the wall and see what sticks” solution by a specialist who knew steroids well. Later studies have shown a strong effect on survival, so it’s become a fairly uncontroversial part of the tool kit for severe Covid.
  - makomk 5y ago
    Of course, what made Dexamethasone such a breakthrough wasn't really the drug itself; I think there's some evidence now that other steroids might actually work better. The big breakthrough was that some UK researchers managed to use the fact that the country got hit hard early on in the pandemic to immediately run a bunch of large randomized controlled trials on all the most promising throw-things-at-the-wall treatments to get evidence on which actually worked as soon as possible.

PaulDavisThe1st 5y ago

> "The only science is real is expensive science done by large corporations!" The only science that's real when it comes to public health is the science done across large enough populations and with enough methodology to rule out many confounding issues. That tends to cost money, indeed.

sjwalter 5y ago
This is a neutered philosophy. You surrender you're ability to actually know things outside the purview of large pharma corps. Hey, I guess my view is never gonna get approved: Eat healthy meat, exercise, and get plenty of sunlight. Since that's never gonna get a big Pfizer RCT, you should wait. Don't exercise. Don't get sunlight. Just wait until a big pharmacorp tells you what is healthy.
- deleted 5y ago
  [deleted]
- ashtonkem 5y ago
  Come on, that’s clearly a bad faith interpretation of what GP said. You’ve been here long enough to know that that’s a no no.
- PaulDavisThe1st 5y ago
  I considered adding on a coda noting that "costing money" doesn't imply big pharma. But I didn't because I considered it sort of self-evident. Neverthless, you went there anyway.
- shapefrog 5y ago
  > I guess my view is never gonna get approved: Eat healthy meat, exercise, and get plenty of sunlight. Study has been approved 1,000s of times and been done 1,000s of times. Eating shit, sitting inside on your sofa all day is less healthy. The jury is out on your so called controversial view, has been for a long time.

mlyle 5y ago

> Calling the investigatory and experiential evidence of thousands of highly-trained doctors (some of whom pioneered the standard of care for covid) as "weak evidence" is something that only somebody carrying water for large pharmaceutical companies would say. Keep in mind that bleeding with leeches was once the standard of care-- based on clinical intuition and observational evidence. People-- even very smart, well-educated people-- are easily fooled. There is a reason why the RCT is the gold standard.

nradov 5y ago
The RCT is the gold standard, but observational studies can be sufficient to establish causality when the effect size is large enough with a clear dose response curve. No one has ever conducted an RCT to prove that cigarette smoking causes lung cancer, but we're pretty sure that it does.
- mlyle 5y ago
  > to establish causality when the effect size is large enough with a clear dose response curve. And when there's some plausible underlying mechanism that can be studied by more rigorous means. Otherwise, observational studies can find correlation, not causation-- and they're not even very robust at that.
  - nradov 5y ago
    No the dose response curve alone can be sufficient. Remember that the FDA has approved multiple SSRI drugs for treating clinical depression despite a lack of understanding on the actual mechanism of action. There are several plausible hypotheses but we really don't know why they work.
    - mlyle 5y ago
      A dose response curve in an observational study is irrelevant for establishing causation. There is a dose-response relationship between umbrellas outside and rainfall., but umbrellas do not cause rainfall. And the SSRI point is tangential: they were approved based on RCT evidence. Observing umbrella use and concluding it causes rainfall, even though we don't know of a reason why umbrella use would cause rainfall, is quite different.

jacquesm 5y ago

> is something that only somebody carrying water for large pharmaceutical companies would say This is directly against the HN guidelines.

8note 5y ago

I'd consider it weak because covid mostly has non-severe symptoms. A sugar pill could also get the same observational results because the number of severe cases is very low.