5 ms·

Isn't the correct answer to wait for more reliable studies? Which is what most "anti-ivermectin" folks were saying to begin with? If your primary goal is to ha

Isn't the correct answer to wait for more reliable studies? Which is what most "anti-ivermectin" folks were saying to begin with? If your primary goal is to have a miracle cure in hand that would allow you to push back against vaccine mandates, then this approach probably won't sit well. But if you are interesting in actually finding truth, than waiting for larger, more robust studies was the answer.

csee 5y ago
Why wait? Why not take ivermectin as a precautionary therapeutic given it is well tolerated with low risk of side effects? There's a chasm between the epistemic question of "does this drug really work?" and the pragmatic question of "does a risk-reward analysis under uncertainty say that I should take this mostly safe drug that might slightly reduce my covid severity?" FWIW, I wouldn't take ivermectin either as a prophylactic or therapeutic, the evidence just isn't strong enough, but I don't really fault anyone that would add it into the stack of treatments upon a diagnosis in the hopes of a small net benefit.
- jacquesm 5y ago
  > given it is well tolerated with low risk of side effects That's not a given, that depends on the patient, the dose and a host of other factors. You may well end up harming someone significantly. You are in no position to proscribe any kind of medication to someone else unless you happen to be a licensed practitioner.
  - csee 5y ago
    "That's not a given" I never said it was a given. You're using another definition of the word "given" in order to argue. "You are in no position" Who said I was in a position to be making that decision? That's completely irrelevant.
  - kragen 5y ago
    While it's true that virtually any substance has a toxic dose, avoiding that dose is straightforward for drugs as well-known and widely-used as ivermectin. There is no risk of harming someone significantly. (There's also, I think, no chance of being effective against covid at safe doses.) It is true, but unfortunate, that in many societies only licensed practitioners are in a position to prescribe (or proscribe) most drugs. That's a policy that does some good but also an enormous amount of harm.
    - jacquesm 5y ago
      You mean this straightforward? https://news.ycombinator.com/item?id=29262479 https://news.ycombinator.com/item?id=29262479
      - kragen 5y ago
        What do you mean?
- notafraudster 5y ago
  What other prophylactic treatments do you take in your life before or after COVID? Because in my lifetime I can think of only a small number of classes of general prophylactic treatments I've ever seen a small number of groups of people take. - Silicon valley rationalist types taking stacks of vitamins despite having no evidence on bioavailability because they are generally without side effects and who knows, you might live forever. I think the consensus on this now is that more or less this is not a useful practice, though I am unaware of any evidence for it being unsafe. - Prophylactic hormone replacement therapy in middle aged women, which was eventually generally recognized as unsafe because of unexpected cancer risks not initially understood. - Prophylactic breast self-examination, mammograms, and prostate exams based solely on age, the former of which have been significantly dialed back over the last decade because the risk of false positives or catching slow-growing low risk cancers causes a net negative from the treatment. I don't know what the state of prostate exam research is. - Prophylactic aspirin for heart stuff: we seem to go back and forth on this, but the last I read was that actually there's mounting concern about chronic low-dose aspiring. At the very least, it's not obvious this is doing anything. - Statin treatment in response to mild elevated blood pressure with no symptom of disease; not exactly prophylactic, but close in the sense that it's about advance management of expected disease. And last I read, researchers were increasingly recommending dialing back statin treatment for minorly elevated blood pressure because of, again, unforseen side effects. So I just mention this to say that what I take from your post is "the precautionary principle suggests giving more weight to prophylaxis with no known side effects" and what I take from major medical stories in my lifetime is "no known side effects almost always turns out to involve side effects in the end, and that has to be part of the precautionary principle as well". And I should note all of the above prophylaxis is based on clearly defined treatment regimens and physician supervision, not the kind of wild west ordering various formulations of ivermectin at unknown doses with or without medical supervision on an ad hoc basis.
  - csee 5y ago
    I said I don't fault people for using it as a precautionary therapeutic upon diagnosis. I didn't say that I don't fault people for taking it as a prophylactic. I do fault people for doing that because the side effects of long term use are less known, as you say.
- stef25 5y ago
  > FWIW, I wouldn't take ivermectin either as a prophylactic or therapeutic, the evidence just isn't strong enough, but I don't really fault anyone that would add it into the stack of treatments upon a diagnosis in the hopes of a small net benefit. If you're familiar with software development, this is akin to "there's a bug in my codebase and I'm just going to add a bunch of code that probably won't affect anything in the hope that it will fix the bug". Meds shouldn't be administered in this way. It just ads noise to the system and will complicate things down the road.
  - jonnycoder 5y ago
    You make a good point even though I take supplements such as vitamin d, etc. I would argue that the human body is already so complex that troubleshooting it similar to how we troubleshoot software is not a fair comparison because software is easier in a relative sense!
    - jacquesm 5y ago
      Would you rather trust a software guy or a doctor, even a very good one, to troubleshoot a computer program?
      - kragen 5y ago
        You mean Con Kolivas? I'd trust Con Kolivas over most "software guys".
- hef19898 5y ago
  Why not using a de-wormer against a virus? Well, because that's what vaccines are there for. And we do have rather effective ones by now. All of which have a low risk of side effects as well.
  - csee 5y ago
    Using ivermectin as a therapeutic and getting the vaccine are not mutually exclusive. Also, I don't like your first sentence, it's a rhetorical gotcha that is actually not in line with the medical establishment's thinking on ivermectin's hypothesized mechanism of action: https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ivermectin/ https://www.covid19treatmentguidelines.nih.gov/therapies/ant...
- qqqwerty 5y ago
  The issue is that folks who are taking ivermectin are doing it in lieu of getting vaccinated. If you get vaccinated and want to take ivermectin for the heck of it, no one is going to stop you. But if you claim that ivermectin is a miracle cure for covid and as such vaccines are no longer necessary, then that is a problem.
- kaba0 5y ago
  Why not pray for satan with a goat sacrifice? That also doesn’t harm you and has similar quality of evidence for working. But my point is that there are literally infinite things that could cure covid, but in the end only empirical evidence is meaningful. But we have to choose our “fights” and methods with not even a probably way of effect are more than likely useless.
  - jacquesm 5y ago
    And that touches on another problem: all of this Ivermectin (and HCQ before it) bullshit takes funding away from studies that might turn up something useful. The only reason these drugs are even studied at this point is because they are so well publicized, even if there is approximately zero proof that they actually work. If they were miracle drugs as described the effect would be so large that those studies would be unnecessary. But here we are, and study it we will.
    - csee 5y ago
      Again, stop saying "proof". You're misusing this word. It really seems like you have an ideological axe to grind. There is not "zero proof". Did you read the article? What you are saying and your level of confidence seem detached from the article's contents. There is tentative evidence of a small to medium effect, but the quality of that evidence is low and that quality is insufficient to recommend use. This then deserves more attention and resources to figure out if it's real and why there's an effect. That's how science works. Contrary to your claims here, scientists aren't studying it because some cranks on the internet propped it up. They're studying it because some field doctors had positive anecdotal experiences and some early studies showed promise. As you've said, the medical establishment really wants to end the pandemic. Which is why they're looking into this drug, among many others.

csee 5y ago

Why wait? Why not take ivermectin as a precautionary therapeutic given it is well tolerated with low risk of side effects? There's a chasm between the epistemic question of "does this drug really work?" and the pragmatic question of "does a risk-reward analysis under uncertainty say that I should take this mostly safe drug that might slightly reduce my covid severity?" FWIW, I wouldn't take ivermectin either as a prophylactic or therapeutic, the evidence just isn't strong enough, but I don't really fault anyone that would add it into the stack of treatments upon a diagnosis in the hopes of a small net benefit.

jacquesm 5y ago
> given it is well tolerated with low risk of side effects That's not a given, that depends on the patient, the dose and a host of other factors. You may well end up harming someone significantly. You are in no position to proscribe any kind of medication to someone else unless you happen to be a licensed practitioner.
- csee 5y ago
  "That's not a given" I never said it was a given. You're using another definition of the word "given" in order to argue. "You are in no position" Who said I was in a position to be making that decision? That's completely irrelevant.
- kragen 5y ago
  While it's true that virtually any substance has a toxic dose, avoiding that dose is straightforward for drugs as well-known and widely-used as ivermectin. There is no risk of harming someone significantly. (There's also, I think, no chance of being effective against covid at safe doses.) It is true, but unfortunate, that in many societies only licensed practitioners are in a position to prescribe (or proscribe) most drugs. That's a policy that does some good but also an enormous amount of harm.
  - jacquesm 5y ago
    You mean this straightforward? https://news.ycombinator.com/item?id=29262479 https://news.ycombinator.com/item?id=29262479
    - kragen 5y ago
      What do you mean?
notafraudster 5y ago
What other prophylactic treatments do you take in your life before or after COVID? Because in my lifetime I can think of only a small number of classes of general prophylactic treatments I've ever seen a small number of groups of people take. - Silicon valley rationalist types taking stacks of vitamins despite having no evidence on bioavailability because they are generally without side effects and who knows, you might live forever. I think the consensus on this now is that more or less this is not a useful practice, though I am unaware of any evidence for it being unsafe. - Prophylactic hormone replacement therapy in middle aged women, which was eventually generally recognized as unsafe because of unexpected cancer risks not initially understood. - Prophylactic breast self-examination, mammograms, and prostate exams based solely on age, the former of which have been significantly dialed back over the last decade because the risk of false positives or catching slow-growing low risk cancers causes a net negative from the treatment. I don't know what the state of prostate exam research is. - Prophylactic aspirin for heart stuff: we seem to go back and forth on this, but the last I read was that actually there's mounting concern about chronic low-dose aspiring. At the very least, it's not obvious this is doing anything. - Statin treatment in response to mild elevated blood pressure with no symptom of disease; not exactly prophylactic, but close in the sense that it's about advance management of expected disease. And last I read, researchers were increasingly recommending dialing back statin treatment for minorly elevated blood pressure because of, again, unforseen side effects. So I just mention this to say that what I take from your post is "the precautionary principle suggests giving more weight to prophylaxis with no known side effects" and what I take from major medical stories in my lifetime is "no known side effects almost always turns out to involve side effects in the end, and that has to be part of the precautionary principle as well". And I should note all of the above prophylaxis is based on clearly defined treatment regimens and physician supervision, not the kind of wild west ordering various formulations of ivermectin at unknown doses with or without medical supervision on an ad hoc basis.
- csee 5y ago
  I said I don't fault people for using it as a precautionary therapeutic upon diagnosis. I didn't say that I don't fault people for taking it as a prophylactic. I do fault people for doing that because the side effects of long term use are less known, as you say.
stef25 5y ago
> FWIW, I wouldn't take ivermectin either as a prophylactic or therapeutic, the evidence just isn't strong enough, but I don't really fault anyone that would add it into the stack of treatments upon a diagnosis in the hopes of a small net benefit. If you're familiar with software development, this is akin to "there's a bug in my codebase and I'm just going to add a bunch of code that probably won't affect anything in the hope that it will fix the bug". Meds shouldn't be administered in this way. It just ads noise to the system and will complicate things down the road.
- jonnycoder 5y ago
  You make a good point even though I take supplements such as vitamin d, etc. I would argue that the human body is already so complex that troubleshooting it similar to how we troubleshoot software is not a fair comparison because software is easier in a relative sense!
  - jacquesm 5y ago
    Would you rather trust a software guy or a doctor, even a very good one, to troubleshoot a computer program?
    - kragen 5y ago
      You mean Con Kolivas? I'd trust Con Kolivas over most "software guys".
hef19898 5y ago
Why not using a de-wormer against a virus? Well, because that's what vaccines are there for. And we do have rather effective ones by now. All of which have a low risk of side effects as well.
- csee 5y ago
  Using ivermectin as a therapeutic and getting the vaccine are not mutually exclusive. Also, I don't like your first sentence, it's a rhetorical gotcha that is actually not in line with the medical establishment's thinking on ivermectin's hypothesized mechanism of action: https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ivermectin/ https://www.covid19treatmentguidelines.nih.gov/therapies/ant...
qqqwerty 5y ago
The issue is that folks who are taking ivermectin are doing it in lieu of getting vaccinated. If you get vaccinated and want to take ivermectin for the heck of it, no one is going to stop you. But if you claim that ivermectin is a miracle cure for covid and as such vaccines are no longer necessary, then that is a problem.
kaba0 5y ago
Why not pray for satan with a goat sacrifice? That also doesn’t harm you and has similar quality of evidence for working. But my point is that there are literally infinite things that could cure covid, but in the end only empirical evidence is meaningful. But we have to choose our “fights” and methods with not even a probably way of effect are more than likely useless.
- jacquesm 5y ago
  And that touches on another problem: all of this Ivermectin (and HCQ before it) bullshit takes funding away from studies that might turn up something useful. The only reason these drugs are even studied at this point is because they are so well publicized, even if there is approximately zero proof that they actually work. If they were miracle drugs as described the effect would be so large that those studies would be unnecessary. But here we are, and study it we will.
  - csee 5y ago
    Again, stop saying "proof". You're misusing this word. It really seems like you have an ideological axe to grind. There is not "zero proof". Did you read the article? What you are saying and your level of confidence seem detached from the article's contents. There is tentative evidence of a small to medium effect, but the quality of that evidence is low and that quality is insufficient to recommend use. This then deserves more attention and resources to figure out if it's real and why there's an effect. That's how science works. Contrary to your claims here, scientists aren't studying it because some cranks on the internet propped it up. They're studying it because some field doctors had positive anecdotal experiences and some early studies showed promise. As you've said, the medical establishment really wants to end the pandemic. Which is why they're looking into this drug, among many others.