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HCQ and IVM, again

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  • HCQ and IVM, again

    I'm putting this here, but it intersects with public health policy, so I have no objection if TPTB move it to Civics.

    The last few minutes of Ben Carson's segment with Hannity guest-host Pete Hegseth rekindled my interest in hydroxychloroquine and ivermectin. Dr. Carson advocated their use as therapeutics. Predictably, Mediaite basically farted at him, and gave a link debunking the drugs -- which gave no evidence, but only said, "Nope, they don't work."

    Here is an hour-long Harvey Risch audio interview from 30 days ago. I'm only a few minutes in, so I'm not presenting it as evidence at this point.

    My questions are these:

    -- On what basis do people claim these drugs are useless?

    -- How do you explain the many practicing physicians who claim to have success with them?
    Geislerminian Antinomian Kenotic Charispneumaticostal Gender Mutualist-Egalitarian.

    Beige Federalist.

    "Everybody is somebody's heretic."

    Social Justice is usually the opposite of actual justice.

    Proud member of the LGBFJB community.

    Would-be Grand Vizier of the Padishah Maxi-Super-Ultra-Hyper-Mega-MAGA King Trumpius Rex.

    Justice for Ashli Babbitt!

    Justice for Matthew Perna!

  • #2
    Boy, I wish a transcript was available.
    Geislerminian Antinomian Kenotic Charispneumaticostal Gender Mutualist-Egalitarian.

    Beige Federalist.

    "Everybody is somebody's heretic."

    Social Justice is usually the opposite of actual justice.

    Proud member of the LGBFJB community.

    Would-be Grand Vizier of the Padishah Maxi-Super-Ultra-Hyper-Mega-MAGA King Trumpius Rex.

    Justice for Ashli Babbitt!

    Justice for Matthew Perna!

    Comment


    • #3
      Originally posted by NorrinRadd View Post

      -- How do you explain the many practicing physicians who claim to have success with them?
      Reserve judgement at this time, and will do some checking, though 'many practicing physicians who claim to have success with them' is not a reliable source. It remains an anecdotal claim similar to TV advertisements.
      Glendower: I can call spirits from the vasty deep.
      Hotspur: Why, so can I, or so can any man;
      But will they come when you do call for them? Shakespeare’s Henry IV, Part 1, Act III:

      go with the flow the river knows . . .

      Frank

      I do not know, therefore everything is in pencil.

      Comment


      • #4
        Originally posted by NorrinRadd View Post
        I'm putting this here, but it intersects with public health policy, so I have no objection if TPTB move it to Civics.

        The last few minutes of Ben Carson's segment with Hannity guest-host Pete Hegseth rekindled my interest in hydroxychloroquine and ivermectin. Dr. Carson advocated their use as therapeutics. Predictably, Mediaite basically farted at him, and gave a link debunking the drugs -- which gave no evidence, but only said, "Nope, they don't work."

        Here is an hour-long Harvey Risch audio interview from 30 days ago. I'm only a few minutes in, so I'm not presenting it as evidence at this point.

        My questions are these:

        -- On what basis do people claim these drugs are useless?

        -- How do you explain the many practicing physicians who claim to have success with them?
        For starters, you shouldn't lump these two drugs together. For hydroxychloroquine, there's been some large, high quality trials now that show it doesn't do anything. For ivermectin, those trials are now in progress. So, the status is quite different.

        At the moment, it's most accurate to say that there is no evidence that ivermectin is effective.There's been a lot of small, poor quality trials done with it, such that an aggregate meta-analysis of these trials wasn't able to conclude anything.

        Personally, I don't expect it will end up being useful for three reasons:
        Nobody's proposed a compelling mechanism by which it should affect SARS-CoV-2 infections. Ultimately, there has to be some chemical interaction somewhere, and none has been identified.
        A significant amount of the research supporting its effectiveness appears to be either sloppy or fraudulent.
        The trials that are in progress should have reached the point where an interim analysis was done to determine if there was such a clear positive effect that it would be unethical to withhold the drug from a placebo group. Since that hasn't happened, it doesn't look like there's a clear positive effect.

        I'm certainly prepared to be wrong if evidence comes in. But so far, I've seen no reason to change my low expectations for the drug.


        So, how do I explain doctors that claim success? It's a known phenomenon, and happens all the time with things like cancer or weight loss drugs that turn out not to work either. A doctor treats a few patients, random chance gives a few of them positive results, then confirmation bias takes over and the doctor finds ways to keep justifying his beliefs even as the numbers get larger and the success goes down. They start focusing on how it might be the drug + some other factor - an additional drug, some dietary factor, whatever.

        We saw this in a big way with hydroxychloroquine, where over time, a whole bunch of additional stuff supposedly had to be added for it to supposedly work: zinc, azithromycin, a couple of vitamins, and treatment had to be started early. People just couldn't accept that it didn't, so they kept finding ways of dismissing the evidence by claiming some other factor was needed.
        "Any sufficiently advanced stupidity is indistinguishable from trolling."

        Comment


        • #5
          Thanks for replying. I've now watched the entire Risch interview, so I'll occasionally reference it by paraphrase. Since there's no transcript, I won't attempt to quote directly, nor will I try to pore through it to find time-stamps.

          Originally posted by TheLurch View Post
          For starters, you shouldn't lump these two drugs together. For hydroxychloroquine, there's been some large, high quality trials now that show it doesn't do anything. For ivermectin, those trials are now in progress. So, the status is quite different.

          At the moment, it's most accurate to say that there is no evidence that ivermectin is effective.There's been a lot of small, poor quality trials done with it, such that an aggregate meta-analysis of these trials wasn't able to conclude anything.

          Personally, I don't expect it will end up being useful for three reasons:
          Nobody's proposed a compelling mechanism by which it should affect SARS-CoV-2 infections. Ultimately, there has to be some chemical interaction somewhere, and none has been identified.
          A significant amount of the research supporting its effectiveness appears to be either sloppy or fraudulent.
          The trials that are in progress should have reached the point where an interim analysis was done to determine if there was such a clear positive effect that it would be unethical to withhold the drug from a placebo group. Since that hasn't happened, it doesn't look like there's a clear positive effect.

          I'm certainly prepared to be wrong if evidence comes in. But so far, I've seen no reason to change my low expectations for the drug.
          The main ivermectin trial that was in the news was the Oxford "Principle" study that was cancelled early fairly recently. This page notes that back in June, shortly before the study even began, concerns were raised that it was designed to fail. I don't know whether the other studies were better. In general, it's been my observation for several years that any study is likely to have critics complaining about problems with how it was carried out.


          So, how do I explain doctors that claim success? It's a known phenomenon, and happens all the time with things like cancer or weight loss drugs that turn out not to work either. A doctor treats a few patients, random chance gives a few of them positive results, then confirmation bias takes over and the doctor finds ways to keep justifying his beliefs even as the numbers get larger and the success goes down. They start focusing on how it might be the drug + some other factor - an additional drug, some dietary factor, whatever.

          We saw this in a big way with hydroxychloroquine, where over time, a whole bunch of additional stuff supposedly had to be added for it to supposedly work: zinc, azithromycin, a couple of vitamins, and treatment had to be started early. People just couldn't accept that it didn't, so they kept finding ways of dismissing the evidence by claiming some other factor was needed.
          Ok, multiple points there, so multiple responses, not in quite the order of your points:

          -- Virtually from the moment HCQ was first recommended, it was said to work better when started as early as possible, so that was not a late addition. In the interview, Dr. Risch avers that Covid essentially behaves as two different diseases in the hospital vs. outpatient settings. When the patient needs to be hospitalized, most of the problems are coming from the extreme immune response, and neither HCQ nor ivermectin have any meaningful benefit.

          -- It appears to me (and to Dr. Risch, if I understand him correctly) that you are prioritizing scientists above practitioners, and in essence saying all practitioners are prone to using snake oil and leeches, while scientists are above such foibles.

          -- It is not just "a" doctor treating "a few" patients. Thousands of doctors treating multiple thousands of patients worldwide have reported positive results. Many have documented their results. Dr. Risch reports that virtually if not literally all those studies have been positive.

          -- The things you're criticizing basically translate to despising the practice of medicine. Physicians should be allowed to consider input from "scientists," but use their own medical judgment in treating individual patients: Try things, observe and record results, tweak the treatment as needed. They should not be in fear of losing their jobs for prescribing "unproven" treatments, especially ones as safe as HCQ.

          -- Dr. Risch noted that, as long as given early enough, HCQ shows benefit on its own, but shows *more* benefit as part of a multi-faceted regimen.
          Geislerminian Antinomian Kenotic Charispneumaticostal Gender Mutualist-Egalitarian.

          Beige Federalist.

          "Everybody is somebody's heretic."

          Social Justice is usually the opposite of actual justice.

          Proud member of the LGBFJB community.

          Would-be Grand Vizier of the Padishah Maxi-Super-Ultra-Hyper-Mega-MAGA King Trumpius Rex.

          Justice for Ashli Babbitt!

          Justice for Matthew Perna!

          Comment


          • #6
            Originally posted by NorrinRadd View Post
            The main ivermectin trial that was in the news was the Oxford "Principle" study that was cancelled early fairly recently. This page notes that back in June, shortly before the study even began, concerns were raised that it was designed to fail. I don't know whether the other studies were better. In general, it's been my observation for several years that any study is likely to have critics complaining about problems with how it was carried out.
            From what I can tell, the trial was only put on hold temporarily while drug supply issues were worked out. If you've seen otherwise, please point me to that information.

            In any case, that criticism is garbage. The complaint is that they're testing it on people in high risk groups - which turns out to be exactly how Merck and Pfizer tested their drugs. This is because a) these groups provide a more sensitive indication of effectiveness and b) that's exactly the population you need the drug to be effective in to make a significant difference on the course of this pandemic.

            Yes, there will often be complaints about the designs of trials. But it's not like that's a reason to throw up your hands and say "who knows?" It's possible to actually evaluate the complaints and see if they're sensible criticisms.

            Originally posted by NorrinRadd View Post
            -- It appears to me (and to Dr. Risch, if I understand him correctly) that you are prioritizing scientists above practitioners, and in essence saying all practitioners are prone to using snake oil and leeches, while scientists are above such foibles.
            That's not what I'm saying. What I'm prioritizing is evidence. In these clinical trials, the evidence is gathered by practicing MDs.

            Let me summarize your complaint by turning the question back to you: at what point are you willing to accept evidence from clinical trials? Because the answer from what you're saying here is looking like "never" - you value anecdotal accounts from individual MDs above evidence. If that's the case, then there's nothing much else for us to discuss.
            "Any sufficiently advanced stupidity is indistinguishable from trolling."

            Comment


            • #7
              More Ivermectin studies with Dr. John Campbell.


              Study 1 -- Ivermectin outperformed Remdesivir in terms of mortality by about 70%.


              Study 2 -- Ivermectin prophylactically effective at significantly reducing infections, hospitalizations, mortality.


              Geislerminian Antinomian Kenotic Charispneumaticostal Gender Mutualist-Egalitarian.

              Beige Federalist.

              "Everybody is somebody's heretic."

              Social Justice is usually the opposite of actual justice.

              Proud member of the LGBFJB community.

              Would-be Grand Vizier of the Padishah Maxi-Super-Ultra-Hyper-Mega-MAGA King Trumpius Rex.

              Justice for Ashli Babbitt!

              Justice for Matthew Perna!

              Comment


              • #8
                Originally posted by NorrinRadd View Post
                My questions are these:

                -- On what basis do people claim these drugs are useless?
                They aren't useless. For example, invermectin is very good for killing parasitic worms.
                -- How do you explain the many practicing physicians who claim to have success with them?
                People make mistakes. People tell lies.

                Jorge: Functional Complex Information is INFORMATION that is complex and functional.

                mikewhitney: What if the speed of light changed when light is passing through water? ... I have 3 semesters of college Physics.

                Mountain Man: First of all, the Bible is a fixed document.
                Mountain Man on covid-19: We're talking about an illness with a better than 99.9% rate of survival.

                Sparko: Even the deists like Jefferson believed in the Christian God, ...

                Comment


                • #9
                  Originally posted by Roy View Post
                  They aren't useless. For example, invermectin is very good for killing parasitic worms.
                  People make mistakes. People tell lies.
                  It's obvious why MM calls you "Ignorant Roy."

                  In context, it should have been clear that by "useless," I meant "for treating or preventing Chicom Flu."

                  Your simplistic dismissal of the observations of thousands of practicing physicians is just retarded.

                  Perhaps you also have some boneheaded responses to offer in regard to Post #7.
                  Geislerminian Antinomian Kenotic Charispneumaticostal Gender Mutualist-Egalitarian.

                  Beige Federalist.

                  "Everybody is somebody's heretic."

                  Social Justice is usually the opposite of actual justice.

                  Proud member of the LGBFJB community.

                  Would-be Grand Vizier of the Padishah Maxi-Super-Ultra-Hyper-Mega-MAGA King Trumpius Rex.

                  Justice for Ashli Babbitt!

                  Justice for Matthew Perna!

                  Comment


                  • #10
                    Originally posted by NorrinRadd View Post

                    It's obvious why MM calls you "Ignorant Roy."

                    In context, it should have been clear that by "useless," I meant "for treating or preventing Chicom Flu."

                    Your simplistic dismissal of the observations of thousands of practicing physicians is just retarded.
                    I'm not dismissing the observations of thousands of practicing physicians. I'm skeptical that observations ever existed.

                    You haven't provided any evidence of them.

                    Perhaps you also have some boneheaded responses to offer in regard to Post #7.
                    I watched it.
                    He began by noting that Ivermectin's discovery led to a Nobel prize award, as if that was in any way related to effectiveness against coronavirus.

                    He then talked about costs - also irrelevant to effectiveness.

                    Then he went on to the actual study. After saying he hadn't found any more details other than the short summary cited, he simply read out the text of the summary (which he'd retyped for some reason), so I basically wasted lots of time watching him say things I'd just read. His analysis was just him reading out the numerical results, without giving any indication of knowing what odds ratios or p-values actually meant (and getting it wrong). His inability to work out what 0.0001 represented as a fraction without counting digits was painful to watch. Finally, he announced that the study showed Invermectin to be better than Remdesivir "unequivocably", yet the study authors disagree: "Further double-blinded placebo-controlled RCTs with large samples are required for definite conclusion." Perhaps he retyped the paper so that he didn't have to show that sentence.

                    He moves onto a second study, which he describes as being written by "scientists and clinicians", and says that the type of work he is interested in is clinician led because "there's no money in it" - but neglects to say that one of the authors is a Canadian dentist and another is an animal scientist. This doesn't mean their work is unreliable, but it does mean his assessment of the authors is complete bollocks. Once again he just reads out sentences retyped from the paper, with no attempt at explaining, and no sign of any underlying knowledge of clinical studies or data analysis.

                    I don't know what conclusions I'm supposed to draw from watching some-one read something that seems to be outside their expertise, but I doubt they're the conclusions you would want.

                    I then looked up who John Campbell is, and quickly discovered that he's a youtube blogger who has been spreading misinformation about the UK death statistics, by effectively claiming that asthmatics who died after catching COVID were killed by asthma, and has been criticised by the Office of National Statistics for misusing their data. That's the same dumb mistake MM keeps making, so you may think correcting it is a "boneheaded response", but it actually invalidates any idea that John Campbell is worth taking seriously.

                    Next time just link to the studies directly and not via some incompetent blogger.
                    Last edited by Roy; 03-09-2022, 06:58 AM.
                    Jorge: Functional Complex Information is INFORMATION that is complex and functional.

                    mikewhitney: What if the speed of light changed when light is passing through water? ... I have 3 semesters of college Physics.

                    Mountain Man: First of all, the Bible is a fixed document.
                    Mountain Man on covid-19: We're talking about an illness with a better than 99.9% rate of survival.

                    Sparko: Even the deists like Jefferson believed in the Christian God, ...

                    Comment


                    • #11
                      Here we have yet another large, high quality clinical trial that shows no utility in ivermectin treatments:
                      https://www.nejm.org/doi/full/10.1056/NEJMoa2115869

                      This came out of a group that, in a separate trial, did find an antidepressant was apparently affective, so it's not like they have some bias against cheap, repurposed drugs. Yet they found nothing here.

                      Ivermectin advocates, who couldn't care less that the collection of small trials that seemingly worked used all sorts of different dosing regimens, are suddenly upset about this study's dosing. Go figure.
                      "Any sufficiently advanced stupidity is indistinguishable from trolling."

                      Comment

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