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0 pointsmlyle4y ago0 comments

> The vast majority of the studies about Ivermectin have been observational, run by front-line clinicians.

OK, so weak evidence.

> Prior to 2020, basically everyone on earth agreed (including the WHO, who STILL agrees) that front-line clinicians and observational studies are excellent signals that can lead to scientific investigations that can lead to medical breakthroughs.

Sure-- weak/crappy evidence and practitioner intuition can definitely point at worthwhile things to study rigorously, even if most of what they generate is trash.

> The evidence for IVM as a treatment for covid (and many other viruses) is quite strong.

??? Quite a leap you made there.

0 comments

dionian4y ago

Given the recent fall from grace of prestigious journals like the Lancet on the Coronavirus evidence, I think it is useful for all of us to remain skeptical and purely science-based.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

sjwalter4y 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.

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!"

koboll4y 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_masala4y ago

So what were those other things, then?

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mlyleOP4y 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.

nradov4y 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.

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PaulDavisThe1st4y 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.

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jacquesm4y ago

> is something that only somebody carrying water for large pharmaceutical companies would say

This is directly against the HN guidelines.

8note4y 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.

dionian4y 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...

ashtonkem4y 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.

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0 comments

dionian4y ago

Given the recent fall from grace of prestigious journals like the Lancet on the Coronavirus evidence, I think it is useful for all of us to remain skeptical and purely science-based.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

sjwalter4y ago

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!"

koboll4y 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.

chana_masala4y ago

So what were those other things, then?

1 more reply

mlyleOP4y ago

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.

nradov4y ago

1 more reply

PaulDavisThe1st4y 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.

1 more reply

jacquesm4y ago

> is something that only somebody carrying water for large pharmaceutical companies would say

This is directly against the HN guidelines.

8note4y 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.

dionian4y ago

ashtonkem4y 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.

1 more reply

j / k navigate · click thread line to collapse