7 ms·

> In the group that took the drug, 11% needed hospitalization or an extended ER stay, compared to 16% of those on dummy pills. Is that really promising? Very c

> In the group that took the drug, 11% needed hospitalization or an extended ER stay, compared to 16% of those on dummy pills. Is that really promising? Very close to margin of error if not within.

pertymcpert 5y ago
> The results, published Wednesday in the journal Lancet Global Health, were so strong that independent experts monitoring the study recommended stopping it early because the results were clear.
- nottorp 5y ago
  I'd like some info about those "independent experts".
  - tinus_hn 5y ago
    Yeah, I only trust experts employed by the manufacturers of new, expensive, patented medication with severely limited availability!
    - nottorp 5y ago
      I only trust experts that are specified, not nebulous "independent experts" :)
- darkerside 5y ago
  This sounds suspiciously vague. What experts? How did they become involved? Did they stop it because the study proved an effect, or because it was clearly not designed to be able to prove an effect?
  - _3u10 5y ago
    How does your ad hominem questioning of their expertise / how they became involved invalidate the results? The study reached its statistical significance goal, and thus the study was ended as it would be immoral beyond that point to continue to give people placebos when they knew the drug was working. I'd suggest reading up on the Tuskegee syphilis study for the ethics behind why studies are ended early once treatments have been statistically validated.
- darkerside 5y ago
  > When the DSMC met on Aug 5, 2021, it recommended that the TOGETHER trial stop randomly assigning patients to the fluvoxamine group, as this comparison had met the prespecified superiority criterion for the primary endpoint (prespecified superiority threshold 97·6%). This... is not how it's supposed to work.
  - _3u10 5y ago
    Perhaps they were more interested in saving people's lives than waiting for the trial to conclude... I mean the downside is people are less depressed while on a ventilator.
    - ARandomerDude 5y ago
      No. It's called p-hacking, and it's a sleazy way to get published. https://youtu.be/42QuXLucH3Q https://youtu.be/42QuXLucH3Q
      - bpodgursky 5y ago
        This is not p-hacking. p-hacking is when you don't pre-register your hypothesis and you hunt for ones which hit .05 after the fact. There was a single hypothesis being tested here.
        scotty79 5y ago
        Also this was >0.60 not around 0.05 If I read correctly.
        darkerside 5y ago
        It was an adaptive clinical trial with multiple arms, so it wasn't a single hypothesis. Apparently this is considered legitimate in medical trials, but I have some reservations about the concept.
    - nuerow 5y ago
      > Perhaps they were more interested in saving people's lives than waiting for the trial to conclude... The bit "waiting for the trial to conclude" actually means "determine if the drug actually has any effect or not". No matter how much you are interested in saving people's lives, or any other moralistic fallacy that might pop up, you can only help them if you give them treatments that actually work. Cutting short a study is falling short of the most basic requirement to meet that goal.
ekianjo 5y ago
Margin of error is not fixed. Depends on sample size. if you have a group of millions your error range will be in the hundredth of a percent. Here we are not talking about 20 people in each group. 1500. Thats very significant. I recommend you take some stats courses if this does not make sense.
rtpg 5y ago
Dunno about the sample size, but sounds like "1/3rd of hospitalizations prevented" to me. Though it's like... isn't the vaccine in the initial phases like "80+% of hospitalizations prevented"? I guess it's good to have all these options but would be nice to just get good vaccine coverage.
SkittyDog 5y ago
16% > 11% represents a 31% decrease in the absolute number of hospitalizations. That's nearly a ONE THIRD improvement in the hospitalization rate. In places where hospitals are at or near capacity, that would make a huge difference. Or were you trying to make a statement about the statistical validity of the result, because the outcomes differ by 5%? Because that's not how statistics work. A well constructed study of sufficient size can provide detect arbitrarily small differences in outcomes--you just need a bigger study size, the smaller the difference you want to detect. You would learn about this any 101-level statistics course, and a lot more useful information, too.
- s5300 5y ago
  IMO, one of the largest hurdles that modern society is going to have to overcome is the average person's understanding of large (or small) numbers and basic statistics. I think a large issue within that hurdle is that a lot of people simply won't want to learn, or apply the knowledge after learning.
  - SkittyDog 5y ago
    And the funny thing is that the original commenter was looking at a trivial math problem. It wasn't even a question of statistical validity, it was just "What does it mean to compare percentages to each other?" That's grade-school mathematics. I see this kind of error pretty frequently, and it's usually not a failure of mathematics... Most often, the person has some pre-existing negative emotional reaction to the stated conclusion, and their brain searches for something to criticize, in order to soothe those negative emotions. I could only speculate as to why the original poster doesn't like hearing that an existing drug shows promise in treating COVID. Maybe they're a big Ivermectin booster, and they don't like the idea of another drug threatening their favorite?
    - matjet 5y ago
      I think you might want to reconsider your opinion of others. I believe the OP was referring to this result being on the edge of statistical significance given: The effect size relative to the base population; The fact that many similar trials are performed and discarded with similar drugs; And as we see when looking deeper, there are other issues such as early stopping. It is not unreasonable to suspect the effect could disappear given more data.
z80x86 5y ago
> A cheap antidepressant reduced the need for hospitalization among high-risk adults with COVID-19 in a study hunting for existing drugs that could be repurposed to treat coronavirus. You’re right to be suspicious; data dredging 101.
- shapefrog 5y ago
  Astham went from being a risk factor to a risk reduction factor. Smoking likewise, we are even at the point where One study suggests this could be because nicotine interferes with ACE2 receptors, which may prevent the virus from entering cells. Why isnt everyone having a cigarette each day to interfere with the ACE2 receptors?
bellyfullofbac 5y ago
Hah, backseat statistician are we? The next sentence of the article that said experts recommended to end the trials early should make it clear to you that to them that's really promising. Your last sentence basically says you're sure you know better than the panel of experts. I don't know what the point of my reply is other than to recommend to you to have some humility that you might not know stuff...
ekianjo 5y ago
Effect size.

> In the group that took the drug, 11% needed hospitalization or an extended ER stay, compared to 16% of those on dummy pills. Is that really promising? Very close to margin of error if not within.

pertymcpert 5y ago

> The results, published Wednesday in the journal Lancet Global Health, were so strong that independent experts monitoring the study recommended stopping it early because the results were clear.

nottorp 5y ago
I'd like some info about those "independent experts".
- tinus_hn 5y ago
  Yeah, I only trust experts employed by the manufacturers of new, expensive, patented medication with severely limited availability!
  - nottorp 5y ago
    I only trust experts that are specified, not nebulous "independent experts" :)
darkerside 5y ago
This sounds suspiciously vague. What experts? How did they become involved? Did they stop it because the study proved an effect, or because it was clearly not designed to be able to prove an effect?
- _3u10 5y ago
  How does your ad hominem questioning of their expertise / how they became involved invalidate the results? The study reached its statistical significance goal, and thus the study was ended as it would be immoral beyond that point to continue to give people placebos when they knew the drug was working. I'd suggest reading up on the Tuskegee syphilis study for the ethics behind why studies are ended early once treatments have been statistically validated.
darkerside 5y ago
> When the DSMC met on Aug 5, 2021, it recommended that the TOGETHER trial stop randomly assigning patients to the fluvoxamine group, as this comparison had met the prespecified superiority criterion for the primary endpoint (prespecified superiority threshold 97·6%). This... is not how it's supposed to work.
- _3u10 5y ago
  Perhaps they were more interested in saving people's lives than waiting for the trial to conclude... I mean the downside is people are less depressed while on a ventilator.
  - ARandomerDude 5y ago
    No. It's called p-hacking, and it's a sleazy way to get published. https://youtu.be/42QuXLucH3Q https://youtu.be/42QuXLucH3Q
    - bpodgursky 5y ago
      This is not p-hacking. p-hacking is when you don't pre-register your hypothesis and you hunt for ones which hit .05 after the fact. There was a single hypothesis being tested here.
      - scotty79 5y ago
        Also this was >0.60 not around 0.05 If I read correctly.
      - darkerside 5y ago
        It was an adaptive clinical trial with multiple arms, so it wasn't a single hypothesis. Apparently this is considered legitimate in medical trials, but I have some reservations about the concept.
  - nuerow 5y ago
    > Perhaps they were more interested in saving people's lives than waiting for the trial to conclude... The bit "waiting for the trial to conclude" actually means "determine if the drug actually has any effect or not". No matter how much you are interested in saving people's lives, or any other moralistic fallacy that might pop up, you can only help them if you give them treatments that actually work. Cutting short a study is falling short of the most basic requirement to meet that goal.

ekianjo 5y ago

Margin of error is not fixed. Depends on sample size. if you have a group of millions your error range will be in the hundredth of a percent. Here we are not talking about 20 people in each group. 1500. Thats very significant. I recommend you take some stats courses if this does not make sense.

rtpg 5y ago

Dunno about the sample size, but sounds like "1/3rd of hospitalizations prevented" to me. Though it's like... isn't the vaccine in the initial phases like "80+% of hospitalizations prevented"? I guess it's good to have all these options but would be nice to just get good vaccine coverage.

SkittyDog 5y ago

16% > 11% represents a 31% decrease in the absolute number of hospitalizations. That's nearly a ONE THIRD improvement in the hospitalization rate. In places where hospitals are at or near capacity, that would make a huge difference. Or were you trying to make a statement about the statistical validity of the result, because the outcomes differ by 5%? Because that's not how statistics work. A well constructed study of sufficient size can provide detect arbitrarily small differences in outcomes--you just need a bigger study size, the smaller the difference you want to detect. You would learn about this any 101-level statistics course, and a lot more useful information, too.

s5300 5y ago
IMO, one of the largest hurdles that modern society is going to have to overcome is the average person's understanding of large (or small) numbers and basic statistics. I think a large issue within that hurdle is that a lot of people simply won't want to learn, or apply the knowledge after learning.
- SkittyDog 5y ago
  And the funny thing is that the original commenter was looking at a trivial math problem. It wasn't even a question of statistical validity, it was just "What does it mean to compare percentages to each other?" That's grade-school mathematics. I see this kind of error pretty frequently, and it's usually not a failure of mathematics... Most often, the person has some pre-existing negative emotional reaction to the stated conclusion, and their brain searches for something to criticize, in order to soothe those negative emotions. I could only speculate as to why the original poster doesn't like hearing that an existing drug shows promise in treating COVID. Maybe they're a big Ivermectin booster, and they don't like the idea of another drug threatening their favorite?
  - matjet 5y ago
    I think you might want to reconsider your opinion of others. I believe the OP was referring to this result being on the edge of statistical significance given: The effect size relative to the base population; The fact that many similar trials are performed and discarded with similar drugs; And as we see when looking deeper, there are other issues such as early stopping. It is not unreasonable to suspect the effect could disappear given more data.

z80x86 5y ago

> A cheap antidepressant reduced the need for hospitalization among high-risk adults with COVID-19 in a study hunting for existing drugs that could be repurposed to treat coronavirus. You’re right to be suspicious; data dredging 101.

shapefrog 5y ago
Astham went from being a risk factor to a risk reduction factor. Smoking likewise, we are even at the point where One study suggests this could be because nicotine interferes with ACE2 receptors, which may prevent the virus from entering cells. Why isnt everyone having a cigarette each day to interfere with the ACE2 receptors?

bellyfullofbac 5y ago

Hah, backseat statistician are we? The next sentence of the article that said experts recommended to end the trials early should make it clear to you that to them that's really promising. Your last sentence basically says you're sure you know better than the panel of experts. I don't know what the point of my reply is other than to recommend to you to have some humility that you might not know stuff...

ekianjo 5y ago

Effect size.