I was talking about the FDA tweet. The FDA web page is more reasonable, including the statement that studies are currently ongoing. The FDA generally doesn't want people to self-medicate with drugs they have not yet approved, and their policy is consistent with that, but the tweet goes well beyond that.
Tweets are for public consumption, this will have been sent out by PR bods not scientists, and the cynical assumption is to go the P.T. Barnum route and treat the general public as gulls that are easily fooled, so dumb the message down as much as possible and throw a scare into them to stop them from doing something stupid.
Doesn't help their cause, but then again anything on Twitter is going to be a disaster.
Don't use ivermectin because . . . horses. That's the level of scientific reasoning by our FDA. Also, never take medical research advice from a tweet that refers to "Y'all."
At this moment, the entire topic is a bleeding mess, and it doesn't help that the anti-vaccination movement has been dragged into it. I'd like some kind of statement of what the position is from every side.
I don't know what the pro-ivermectin side think or believe, and I doubt it's monolithic. Do they think it will protect them from Covid so they don't need vaccination? Do they think it will help in addition? Do they imagine it is a miracle cure, such that if all else fails when you are badly sick, ivermectin will cure you?
I think there probably is a selection of views, from the die-hard "vaccines make you sterile, this is all a plot to hide information from the public, They don't want you to know about this one cheap, easy cure" to people who genuinely believe, if they or their family member gets sick, that this is the thing that will cure them when all else fails, as well as the scientifically-literate mavericks who try anything on the basis that "I read two studies and this might make you live forever" (I'm still not forgiving anyone over 'metformin will attenuate the hallmarks of aging').
I see why the FDA is pushing the horse de-wormer angle, I honestly do. I think the folksy tone is annoying, but that's down to whoever puts out these PR pieces and they're not scientists, they're involved in administrative work. It's aiming for the imagined "your audience is dumber than you think" level of explaining: the general public won't or can't follow the science, if we give them an inch on this they'll take a mile, there is no solid evidence yet that ivermectin works, and some hapless types are rushing out buying up veterinary supplies and then overdosing and then clogging up ER rooms. So we have to scare them straight.
All the studies to date are all over the place, as nobody seems to be researching the same thing. So some are done on mild cases, some are done on people in ICU, some are done on older, some on younger, some in Third World, some in First and Second World, some on ivermectin alone, some on ivermectin in an entire cocktail of 'try it and see' -there is no consistent result; for every study that says "it helped", there's another one that says "it did nothing".
So far, what I've been able to glean is that *once* you have developed *mild* Covid, then a course of ivermectin *may* keep you from developing more serious version, and it does seem to reduce viral load *but* it doesn't relieve symptoms (you'll still have cough, fever, etc. for the same length of time as someone on on ivermectin). That's the best results so far.
So going to your doctor and asking for (human version) of ivermectin does nothing *until* you're already sick with Covid. Oh, and what is the effective dosage? Nobody quite knows, and bioavailability and serum concentrations are dependent on whether or not you ate a full meal and/or had a glass of alcohol with it (one study recommends exactly that, to get the highest blood serum concentration). Dosage depends on bodyweight, as well, so that's another calculation - it's not as simple as "take two tablets every day for five days".
Ordinarily, yes, it seems "it doesn't do any harm so even if it does no good, why not prescribe it?", but this isn't a question of "let them take zinc and vitamin C if they think it'll stave off a cold", this is a vexed and polarised question, and there *are* people who think it will magically shield them from Covid so no need for vaccination (still the best preventative) or any of the infection control protocols.
Yelling at the FDA not to be influenced by public demand fuelled by ill-informed stories going around on social media is contradictory to the criticism of the FDA for being influenced by public demand for the Alzheimer's drug. That too was "well if it does no good, it'll do no harm" - is the only difference there that Aduhelm is eye-wateringly expensive? https://www.policymed.com/2021/09/woodcock-calls-for-hhs-oig-investigation-into-aduhelm-approval.html
I see a lot of left wing people on my FB feed repeating the "it's horse medicine, don't take it" memes. It's lowered my respect for them, since it's also a medicine for humans.
I think the problem there is (1) yes, it is a medicine for humans but only for very restricted uses (2) if you go to your doctor looking for this for Covid, you will get "no" as an answer (3) determined/desperate people make the connection "well, it's the same thing in veterinary medicines" and go buy them and take them (4) this is not a good idea (5) unless you're familiar with the use of ivermectin for treating parasites in humans and other diseases like scabies or acne rosacea, you'll have heard of ivermectin, if you've ever heard of it, as a product to dose sheep, horses and cattle.
Hence the "it's horse medicine" trope which has possibly blossomed out of the "don't take the horse medicine version!"
I agree the FDA shot itself in the foot over this, but to give them as much benefit of the doubt as possible, they are trying to keep people from going out and eating horse de-wormer paste. I think they fear if they go the proper explanation about "yes, this is a medicine used for humans; yes, the active ingredient is the same as the cattle drench etc.", then people will ignore the bit about "however, we have no conclusive evidence as yet for its efficacy and if you don't have Covid, taking it will do no good anyway" and skip straight to "if my doctor won't prescribe it, let's go to the vet and claim Fluffy has worms!" so they're using a simplistic and bombastic IT'S FOR HORSES, DUMMIES! message.
"Veterinary teams must communicate with pet owners that may be seeking ivermectin for themselves or suddenly (without a prior prescription or purchase of an ivermectin containing product from the veterinarian) for their pets, that people should never take medications indicated for animals. The FDA has evaluated the safety and efficacy of an individual veterinary medication in the specific animal species for which they are labeled. Taking drugs intended for animals can cause serious harm in people. Veterinary teams will need to educate owners of these facts and that ivermectin prescribed for animals cannot be used to treat COVID-19.
Q: Can I take my pet’s heartworm medication to prevent COVID-19?
A: Ivermectin is not approved for the prevention or treatment of COVID-19. No one should take any medicine to treat or prevent COVID-19 unless it has been prescribed to you by your health care provider.
Q: Are there any risks to humans if they take ivermectin?
A: Veterinary team members need to remind pet owners that currently there are no FDA-approved drug products, human or veterinary, to treat COVID-19. Taking any medication that is not prescribed by their doctor or health care provider, may result in grave circumstances. Advise the pet owner to never take an unprescribed medication, and to call their health care provider.
It is prudent for veterinary team members to be familiar with some of the side-effects that are associated with ivermectin to better educate owners on the dangers of taking a medication that was prescribed for their pet. According to the FDA, these include “skin rash, nausea, vomiting, diarrhea, stomach pain, facial or limb swelling, neurologic adverse events (dizziness, seizures, confusion), sudden drop in blood pressure, severe skin rash potentially requiring hospitalization and liver injury (hepatitis).” Additionally, the FDA states “laboratory abnormalities include decrease in white cell count and elevated liver tests.”
The coronavirus pandemic is producing anxiety and fear in people around the world. Fear leads some individuals to wish for and believe in solutions that are not proven. Therefore, veterinary teams must remain calm and professional when faced with questions from pet owners stating that ivermectin is a cure for COVID-19. We must continue to be rational and educate owners regarding up to date information on COVID-19 and veterinary medicine; including the fact that use of ivermectin for the prevention or treatment of COVID-19 should be avoided as its benefits and safety for these purposes have not been established."
Keep in mind that one of the issues here is that I don't really trust the FDA anymore to put my health over political expediency. I don't know how good ivermectin is at treating covid, but I also wouldn't be that shocked if studies on ivermectin weren't being prioritized for a combination of economic and political reasons.
2 years ago I trusted the US government when they said not to buy masks, and you're silly if you do. 3 months later there were no masks available and my local municipality send my a cheap porous cloth and mandated I wear it out.
1.5 years ago I trusted the US government when they said lockdowns were so important people couldn't go to work. 3 months after that I watched as people took to the streets shouting about social justice. I was told that social justice is more important than covid.
1 year ago I was told the vaccines are available and needed to go into every arm in the country. the FDA only recently approved a single vaccine of the three.
Its very frustrating to me. I want to trust the FDA and the government for health information. I know not qualified to make these types of decisions for myself. But I can't help but notice that the government continuously chooses political expediency over my health needs and I think it would be foolish to trust them too much at this point.
The Lincoln Project is a bunch of grifters who used to claim to be Republican, because that's who paid them, and now claim to support Democrats, because that's who's paying them. I'd say that anyone who doesn't believe the Lincoln Project people is doing the right thing
When my kids were younger and still ate dirt on purpose at one point we needed treatment for worms. IIRC we were prescribed ivermectin, which I think we filled - it was some kind of banana-flavored chalky liquid. There was also an over-the-counter one in Walgreens which might have been ivermectin - there's one now which is a different chemical, Reese's pinworm tablets, but this was about 5 years ago (California). My sense of it then was that it was commonly prescribed and commonly used.
We took it and we were fine.
I find it surprising that so many people seem to believe it really isn't for humans. Either they never had to take it, forgot the chemical name, or just repeat things they hear.
Why did you have any respect at all? I know how long you've been reading idiot leftist randos on the internet, and making a heroic effort to assume goodwill on their part. I've been there for most of it.
Also, my sympathies are more left than right on some issues. I think being trans is a good choice for some of the people who make it, and I think a lot of US justice system atrocities are partly driven by racism. I favor reproductive rights and I think homosexuality is normal variation.
yeah jokes tend to be downright false and misleading. that’s the funny part. it’s Twitter. I personally enjoyed Trump’s tweets, but he said a lot of downright false and misleading tweets too
there have probably been thousands of reasonable and measured announcements about ivermectin that you didn’t notice since they weren’t jokes and didn’t get 100k likes
the article itself is literally a reasonable and measured announcement. if the Twitter account posted some simple and boringly stated sentence, it’s get maybe fifty likes.
I wonder if part of this whole... farrago... has to do with that other medical person doing the tearful Twitter post about holding the hands of young, healthy, unvaccinated people dying of Covid in Alabama? That one too went all round the houses, so I imagine that this story - another doctor with another Covid morality tale! - just reinforced both sides about their beliefs as to what is going on.
I honestly can't remember. I think it was one of those "sort of true" stories, in that at least one person did die, but there may have been complicating factors. A bit like the story Scott mentions - yeah, there are some people dosing themselves on the animal version of ivermectin and ending up in hospital with overdoses, but it's only a few and it's not preventing people who got shot from being treated (as distinct from 'ER rooms are full of Covid patients which is what is taking up the beds').
Thank you for this, Trebuchet. I've appreciated many replies in this discussion for clearly articulating the issues I had with the article, primarily relating to its implausibility in practical terms. You've given me here an entirely new line of thought on this that I hadn't considered. I'll be paying more attention to this angle going forward.
A binary worldview leaves little room for "The ones that mother gives you don't do anything at all". And per Robin Hanson, a whole lot of healthcare is that way!
Ivermectin is an approved medication for treating parasites, including human beings. But there's no reason for an antiparasite medication to also function as an antiviral, seeing as how most of them aren't (though the antidepressant fluvoxamine, by chance, appears to be). And the likely result of taking a standard dose of IVM will likely to be nothing.
Hanson is well known for his claim that something like half of all medical spending in the US is a waste, which explains why beyond the level of a country like Spain spending more money on healthcare has no effect on actual health outcomes.
Ivermectin also has anti-viral properties, it is used to treat Dengue Fever etc. Ivermectin is one of the safest medicines on the planet, having been giving to millions of human children all over the world, it is on WHO's list of essential medicines and won the Nobel prize in 2015.
The veterinary and human versions of Ivermectin are the same, one is not more dangerous than the other. People are getting sick from being too stupid to figure out how to dose themselves correctly, not from it being a veterinary product. People aren't going to give their $30,000 thoroughbred a medicine that could make them sick.
As far as evidence that Ivermectin works, physicians in India, Japan, Indonesia, Peru and elsewhere would not be using the drug to treat COVID if it was not helping. They are not stupid, they are seeing results.
It is also possible to be both pro-vaccine AND pro-ivermectin. Mind boggling, I know...
> As far as evidence that Ivermectin works, physicians in India, Japan, Indonesia, Peru and elsewhere would not be using the drug to treat COVID if it was not helping. They are not stupid, they are seeing results.
Using something that doesn't work is common in medicine. That's what most medicine was like prior to the earlier 20th century:
Uh, OK, but we are in the 21st century now, and I very much doubt that physicians in other parts of the world who are using Ivermectin are that ignorant. Even if that were the case, IVM is one of the safest drugs out there so where is the harm? I suggest looking at the National Institute of Health site (maybe you've heard of them) and doing a search for Ivermectin, which produces results like this:
"The findings indicate with moderate certainty that ivermectin treatment in COVID-19 provides a significant survival benefit. Our certainty of evidence judgment was consolidated by the results of trial sequential analyses, which show that the required IS has probably already been met. Low-certainty evidence on improvement and deterioration also support a likely clinical benefit of ivermectin. Low-certainty evidence suggests a significant effect in prophylaxis. Overall, the evidence also suggests that early use of ivermectin may reduce morbidity and mortality from COVID-19. This is based on (1) reductions in COVID-19 infections when ivermectin was used as prophylaxis, (2) the more favorable effect estimates for mild to moderate disease compared with severe disease for death due to any cause, and (3) on the evidence demonstrating reductions in deterioration."
Where do you find that ivermectin is used to treate dengue fever? Wikipedia, the CDC, and the Mayo Clinic all disagree with you -- they all say there is no specific known treatment for dengue fever.
The NIH COVID-19 guidelines[1] do mention that ivermectin has been shown to have activity against dengue virus in cell cultures (as it has against SARS-CoV-2 also in cell culture) -- but the required concentration of the drug is about 100 times the maximum approved dose used for the treatment of parasites. That is, to get the same effect against dengue (or SARS-CoV-2) you see in cell culture, you would need to take 100x the normal dose. I don't think anyone knows whether that would still be safe.
I typed "ivermectin dengue fever" into google and got a bunch of recent studies supporting the use with various dosages. But they are recent, so it's possible the CDC and Mayo (and Wikipedia) have just not updated their guidelines/recommendations/articles.
There are plenty of well researched drugs used by millions of people that are both “dangerous” and “not FDA approved for indications they are not approved for”. Most any chemotherapy drug or strong immunosuppressant, for instance, and many many others.
Yeah, it’s not chemo. But your original statement was poorly stated. And off label medication use absolutely can be dangerous, both in terms of drug interactions and low rate side effects. Especially, say, dosing it yourself using prepared animal medicine or using it to the exclusion of vaccines, is reasonable to call dangerous.
Which points to the hypocrisy. Anti-IVM people use excuses about size or lack of RCTs to try to block it, or say the efficacy signal isn't high enough. Meanwhile all manner of other drugs are freely prescribed off-label with not real testing. The latest alzheimer's drug approved by the FDA showed no significant efficacy against alz in the trials. Puberty blockers are handed out to GNC kids like candy without any RCTs. It's like the wild west for most drugs, but IVM is held to a higher standard, even while it's safer than all these other interventions. Why?
I agree. So the why question remains. When you look at the whole data landscape minor critiques about the IVM data don't hold up relative to business-as-usual in pharma. That points to a specific agenda being brought to bear in this case. And if IVM threatens an agenda, it's reasonable to look with some scrutiny at the data and messaging saying it's no good. After all, cigarette companies suppressed the truth for years with help from our institutions.
They kinda do? Methodological critiques are extremely common in medicine and the FDA very frequently nixes trials and drugs over various concerns. Which is arguably good, although the blog thinks they are too aggressive. Aduhelm was an outlier (I mean look at the dozen not approved Alzheimer’s antibodies), and puberty blockers are also an outlier.
That scrutiny doesn't typically apply to repurposed drugs though. Once something is FDA approved like IVM is, off label usage is free and clear. In this case the pressure to not employ that norm is wild. I'm in Canada and our doctors can't even use it discretionally. IN the US it's allowed but the pressure not to is severe enough to dissuade many docs who want to. That is not normal.
There’s familiar deception, and unfamiliar deception.
I think the “everything is a conspiracy” heuristic is widespread. Some people’s next step is “but I know how to read between the lines of the mainstream media” so they just use their decoder ring on the same sources and call it true. For other people the next step is “and therefore I should disregard information and rely on friends and family.” That creates a bubble of followers around whoever has the decoder ring.
Of course the lying media is three or four steps past the decoder ring and can now reliably convince readers of certain things, without even directly saying it.
The lying media problem is corrosive in so many ways.
I mean, taking a drug for completely the wrong purpose at doses you have to figure out yourself is a recipe for disaster. The dose makes the poison, after all.
Hate to break to to you, dude, but the Trump campaign did collude with Russia, they did destroy evidence and Trump did successfully obstruct justice. There is a mountain of evidence for all these things, and none of it relies on the Steele dossier.
The fact that you buy into calling it a "tale" is an indictment of your media diet and/or refusal to read either the Mueller report or the Senate Intel committee report.
I thought the conclusion of the Mueller report was that they didn't have enough to charge anyone with that... although "collusion" isn't actually a legal term.
Collusion isn't a legal term, but in its colloquial use the Trump campaign colluded over and over.
They did not have enough evidence to charge the Trump campaign, but part of the reason they did not have enough evidence is because much of it was destroyed or out of reach. Bannon, Manafort, Stone, Prince and several others deleted their text and Whatsapp messages. Manafort and Stone both lied (and continue to avoid telling the truth to this day), and Joseph Mifsud disappeared.
And the obstruction absolutely happened. Trump rewarded Manafort and Stone for their silence with pardons.
From my perspective, anyone who has bought and sold commercial real estate in the New York metropolitan area has dealt with mafias. In the 70s/80s it was still the Italian and Irish mafia. After the Soviet Union fell and people started leaving Russia, soon there was a Russian presence in NYC and from what little I could see the mafia found it to be a supportive ecosystem. I did not get any data on the Russian mafia in commercial real estate but the prior mafias were (as per person there working in real estate at that time). I did encounter a Russian person from a business family whose family was paying the Russian mob regularly, I never knew for what, didn't need or want to know. Casino gambing? of course no mafia there, right. As far as I can tell, it is very unlikely that Trump never dealt with anyone with Russian mob connections. Given his money and types of business, it's almost impossible. Given his personality and social role, it's improbable that he didn't pursue it, especially when he needed additional financing. Would he have looked away, kept his head down, not involved himself in their deals? Hmm. Probably not. Keeping in mind that he was a Democrat for years and did not seek a political role. But at that point, in that world, he had friends who knew people. It's not that here's this wealthy person, with no organized crime dealings ever, who suddenly needs political intelligence and randomly seeks out the Russian mob. There's an ecosystem there and I don't think he even went that far outside that, ah, tentacular ecosystem.
And yes, when it looked like they might get in trouble, they did all the things they do to make it go away, and it mostly went away, unless the tax return thing in New York is still cooking.
One of the very large, less often told stories in the US is organized crime. Street gangs are only part of it. It's less visible in the West and to some extent different organizations, but still happening. Silicon Valley may be the only concentration of wealth in the US that is not largely mafia-run or strongly mafia-influenced, primarily due to the engineering/intellectual aspects aren't immediately amenable to mafia infiltration. Of course utilizing social media for propaganda and political influence is more their skill set.
I think people from other parts of the country just don't realize; it seems like a bad spy movie until, looking at the ecosystem there, that was expected behavior.
>Any media reporting that ivermectine, a well-researched drug routinely used by millions if not billions of people, is "dangerous" and "non FDA approved" is lying and has an agenda.
Yglesias is (wittingly or not) guilty of the classic issue of overinterpreting change-in-rate stats - yes, ivermectin overdoses increased BY PERCENTAGE, but from next to nothing to... also next to nothing. It's like when shark attack deaths increase from 2 to 8 in a given year and the newspapers say "SHARK KILLINGS INCREASE 400%!"
"It's like when shark attack deaths increase from 2 to 8 in a given year and the newspapers say 'SHARK KILLINGS INCREASE 400%!'"
When, of course, the accurate headline would be: SHARK KILLINGS INCREASE 300%!
:-)
But, yeah.
Something I've tried to hammer into my son is: What is the baseline????
This plays at least two ways:
1) A small baseline allows for large percentage increases with tiny absolute increases (also, the small baseline is more susceptible to random fluctuations ...)
2) A large baseline allows for large absolute increases that are tiny percentage increases (and, again, possibly just random noise).
The baseline to be established should also come with a spread.
Sigh.
I don't expect any of these in normal reporting, though.
Hmmm... Now by the law of rationalist irony I just learned, next time I'm going to share a statistic on this site, it's going to make me look like a fool... :)
"Hmmm... Now by the law of rationalist irony I just learned, next time I'm going to share a statistic on this site, it's going to make me look like a fool... :)"
This trick is to attribute the statistic to someone (possibly fictional). If it doesn't get challenged, you look good. If it does get challenged you can blame the (possibly fictional) source.
I read in an article by Johns Bobkins that this was, 100% of the time, the correct stance to take, the other 20% of the time you should definitely attribute a real person, because law of someone elses averages are that you'll need to find them on twitter when you need to quote them.
And yet, it absolutely will be reported as "400%" because it sounds more grandiose and people that would notice the difference are not even 0.4% of the audience.
If we know there are two shark attacks, and we read a headline saying "shark attacks increase 300%", it's a little ambiguous as to whether this means "number of shark attacks now increased *to* 3x (of what it was)", i.e. 6; or "number of shark attacks now increased *by* (an additional) 3x (of what it was)", i.e. 8.
Perhaps the standard is to read it the latter way, I don't know... but I bet you tons of sensationalist articles use it the other way, too, so you can just claim you were adding verisimilitude by this example.
If you see a headline saying "X has increased 20%," you expect X to now be 120% of its previous value, not 20% of its previous value. This also holds for values greater than 100%, although it can seem confusing.
I mean, the percentage increase in this case does tell us that *something* real is happening. If shark attack deaths are 1 or 2 most years, with an occasional 3, and this year we have 8, then maybe that tells us that someone decided to plan a floating steak tartare party in a great white breeding area or something.
It's not significant as a fraction of the death rate or injury rate, but it's significant in the statistical sense of telling us that some new causal factor is involved.
Sometimes we should ignore causes of death that are much smaller than the background rate of death and injure. But if there's a really easy thing to stop, then even if it's quite a bit smaller than other causes, it's good to know about it so we can do something about it.
(Not that most of us in the smug audience are in a position to do anything about ivermectin fans.)
Actually, the percent increase *doesn't* tell us anything real is happening if we don't know the baseline average and, say, standard deviation.
The year with the "2" could have been an unusually good (bad?) year for shark attacks. Maybe you'll see "8" in a year every five years or so and this is that year.
Eh, the law of small numbers means things can jump around a lot from year to year. A small town could have 0 homicides in one year, then in the next year if it has any there would be an infinite percentage increase from the previous year.
Another fun fact with percentages: Suppose I need something now that costs a dollar. I borrow a dollar from you on the understanding that I will pay you back two dollars tomorrow. You are being a bit usurious in truth, but this is still good value for me. But the APR on this loan is more than a Googol (10^100)!
The value is 7.515*10^111%, to be precise. Of course this is assuming that your friend would be unreasonable and demand double again if you were a day late on the payment.
If your friend is slightly more reasonable and demands only a dollar per day late in extra payment, this could be interpreted as a 590% APR distributed linearly over the year.
In the Ivermectin case, we know the thing that's happening--we're trying to figure out whether it's had a meaningful effect on the world or not. Showing that Ivermectin poisoning is up is a decent piece of evidence to suggest that, indeed, more people are taking Ivermectin and more people are getting sick from it. The question is whether the size of that increase is more consistent with the view that this is a very fringe thing that's been exaggerated by the media, or that this is a serious problem.
From this perspective, the baseline of "number of Ivermectin poisonings in a normal year where people aren't self-medicating with it" seems like a somewhat misleading baseline. It would be more meaningful to know something like how much this has pushed up the rate of poisonings overall.
Not necessarily. What are the percentage fluctuations away from 1/2 for the probability of getting heads if you throw a coin 3 times? How about 300 or 3 million?
"It's not significant as a fraction of the death rate or injury rate, but it's significant in the statistical sense of telling us that some new causal factor is involved."
With such a small base rate, it could be just natural randomness. I would call it statistically insignificant. Now, if the increase was sustained year after year…
How is this different from what he says in the tweet: "In percentage-wise terms there has been a huge increase in ivermectin-related poison control calls but it's from a low base" ?
Then what is his contrarian contention against the conventional wisdom that Rolling Stone fucked up at all? I don't understand the argumentative content that's being proffered - "all of these people think Rolling Stone fucked, but there HAS been a big percentage increase in ivermectin poisoning!, but also it's from a tiny baseline and has essentially no social or epidemiological consequence at all"? What is the nut of that set of claims that I'm not grasping?
Yglesias wasn't trying to be contrarian. Nowadays his whole deal is that he writes things that are popular and probably true, in a way that makes him look contrarian to people who are too online.
The second part of the clipped tweet praises scorn and mockery, but that scorn and mockery is irrelevant given that we're talking about dozens of cases in a country of ~330 million.
I don't feel like he's praising scorn and mockery. He's just saying it's good news that the cases have went down and off-handedly gives credit to the scorn and mockery.
The number of people suffering from Ivermectin poisoning because they're taking Ivermectin to protect them from coronavirus is very small.
The number of people suffering from coronavirus because they're taking
Ivermectin to protect them from coronavirus is very large.
In theory, "take all the Ivermectin you want provided you also get vaccinated and wear a mask" is a perfectly reasonable position; in practice human nature makes it much closer to either/or.
"scorn and mockery are not good ways to persuade people not to take Ivermectin and get vaccinated instead"
and
"scorn and mockery may be good ways to persuade people not to take Ivermectin and get vaccinated instead, but the cost in damage to the social fabric is too high"
are both defensible positions (i.e. they may be /wrong/, but they're not /obviously/ wrong to me on the brief thought I've given them), but I don't think either is self-evident (i.e. they're not /obviously/ right, either); I'd have to think more about the first, and if it's not true I'd be surprised but not amazed if the second were.
I'm dubious about this, but I can't think of an easy way to test it. So I'm just gonna spell out my objection, and you can decide how plausible you find it.
I find it really plausible that there are lots of people taking Ivermectin who aren't vaccinated/masking.
I find it implausible that there are lots of people who *would* be vaccinated/masking if Ivermectin didn't exist who aren't currently doing that.
Let's grant arguendo that we know enough to be pretty confident Ivermectin doesn't do anything vs COVID. I'm not 100% on this irl, or even 95%, but it's a decent possibility.
When I imagine the Ivermectin free world, it isn't a world where there aren't fake COVID cures. Ivermectin isn't the only fake COVID cure in our world, and without Ivermectin filling that niche there's more room for the next best candidate.
My model of people who aren't vaccinated is that a lot of them- probably more than half- wouldn't be vaccinated in a world with no fake cures. But that's not the counterfactual- a world without Ivermectin is one where the fake cures are slightly more obviously fake, slightly less convincing, and I'd expect that to have an extremely marginal impact.
As I said, I don't see any way to test this, but do people actually disagree? Is Ivermectin special somehow- an outlier in convincingness as a Covid cure?
I think his motivation is his argument that when it comes to vaccines/ivermectin/etc, lots of right-of-center types spend more time tut-tutting liberals like him for going about convincing people the wrong way (i.e. with scorn and mockery rather than sympathy), than they do going after the conservatives acting 100% in bad faith.
In other words, some center-right person says "liberals why are you being so mean to anti-vaxxers?" but ignore, e.g., Tucker Carlson saying that vaccines don't work, and how is Yglesias worse than Carlson on this?
The "see, scorn does work!" bit is a part of that whole argument.
Does say that Carlson is acting in bad faith, but just kinda accepts that as a fact of nature and then 11 more tweets about how scorn and ridicule is so bad.
Is that what he's saying? Yglesias seems to be trying to get at the actual truth: There has indeed been an uptick, but the absolute number of cases is small, so Rolling Stone was wrong, but there is a grain of truth here.
But maybe that's just how I interpret it because that's how Scott presents it. Is there context I'm missing here?
I read it that way as well, but I did notice that I had to insert the bit in the parenthesis myself. Yglesias' point strikes me as being literally true, but missing an important bit of scorn for people who speak of large percentage increases from tiny bases. I don't think he needs to say "And that's terrible" at the end of that first paragraph, but given his audience (Twitter) he really probably should have clarified and added the parenthetical you did, Edward. One could easily read his Tweet and think "Yes, so it is true!" given how most people don't know stats at all.
DeBoer, Alexander is too much of a coward (no, he isn't--I'm just trying to motivate him). I'm a subscriber of yours, too. Do the work for all of us that I'm trying to get Scot to do: if all the practitioners around the world who report positive (not foolproof)effect are wrong, what are the most credible reasons why they're wrong: grift, glory, methodological flaws, placebo, hallucination, confirmation bias, whatever. Do it. Do it for the few religious people who deeply respect yours and Alexander's work, who don't think IVM is a miracle, but neither do we think it's all a mirage.
I don't think he's guilty of saying something untrue. I do think he's guilty, as he often is, of wanting to carve out a contrarian niche on a subject when there really isn't one in the offing. See my response to Scott.
He is..? He says "Fortunately it's from a very low base". It seems like he's actually got things exactly right. The point of his tweet is exactly your point: The relative rate is large, but the absolute number is small, so it's not really a big deal.
Everyone who has replied to this comment so far is guilty of "too good to check" bias. Ivermectin doses went from a low point of 26 in the month of January 2020 to a high of 459 in the month of August 2021. This is three orders of magnitude larger than less than 1 shark attack per month. And it's not yet clear if the slight decrease at the end of August is variability or a trend. Ivermectin cases this year have been way above typical variation. The sample size is large enough that this is not overinterpreting.
It would be interesting to see what it is in OK alone; unfortunately, the website requires that you send it a form to get data, which is ridiculous, but anyway. . .One of the complaints I've heard about this story is that rural people are much more likely to have actually given ivermectin to horses and therefore to be aware that the dose is much larger than it would be for a person (and even among horses, the dose you give a new-born colt is much smaller than it would be for a full-grown stallion; the product information emphasizes this, and the dispensers are specifically designed to make creating the proper dose easy.)
Percentages are a great way for manipulators to manipulate a particular message they want to convey. A huge array of %-based statements can be devised with the same data, and it’s no wonder the general public can’t keep up. Given the bear traps involved, I fully expect a stupid error in the next para!
Taking the shark attack scenario, the simplest ratio for the public to understand is “shark attacks went up by a factor of 4” (last year they were 2, this year they’re 8, 2x4 is 8). Understandably, those who are somewhat numerate but not math trained would then think: “wow, up 400%!” (factor of 4, up 400%, easy logic). Coming up with 300% is more tricky for the average reader, because subtraction of the original number is required (was 2, went up by 6 to 8, 6 is 300% of 2). But wait, if we look backwards, we could also say “shark attacks were 75% less last year” (2 is 25% of 8). So there’s another % we can imagine. (This last manipulation is rife in economic reporting, and very misleading. If house prices go up 100% in one year, then crash by 50%....thank goodness, I’ve only lost half my gains!!! Nope, you’re back at the same number, it’s just the use of percentages misleading your perception.)
What if we have the following breakup? The first six months there were 4 attacks, the next six months also 4 attacks. So headlines would read at the end of each 6 month period: “shark attacks up 100%!” (2 to 4 is 100% increase, 4 to 8 is 100% increase). Wow, that’s 200% in a year, a brand new % number!
Of course, if you really want to hide stuff, convert to log data!
The CDC bulletin said calls to poison centers about ivermectin are at 5x over baseline, but they don’t tell us the base rate ether. They do have a graph showing how much prescriptions increased: https://emergency.cdc.gov/han/2021/han00449.asp
He literally said this, in his tweet. He said that it's large by percentage but from a low base. He's not guilty of anything ...
The classic reason that change-in-rate is misleading is because noise can be confused for an actual change. Even if it's low odds, a fourfold increase in shark attacks could be notable if real ... but probably it's not real and rather just a happenstance.
Here we have enough data points to form a clear trend, plus a reasonable causal hypothesis. So it's not really a problem to say that indeed cases are up.
Thus the mirage of relative risk. Pharma frequently uses this to make their interventions appear miraculous, when in actuality they're almost insignificant.
I like this section: "This story doesn’t make me feel smug and superior to everyone else. It makes me feel confused and annoyed. This is how true things usually make me feel, so I think I’ve dodged the Law of Rationalist Irony and might have some chance of being right this time". obviously this can lead to its own bias (choosing not to believe anything that would make you feel good, on purpose, is definitely a real problem common with depression) but i think a bias towards truth being confusing and annoying is better than the alternative, and i try to lean on it (another potential failure case?: stories emphasizing how bizarre and baffling and mysterious some fact is, when actually its pretty normal and explicable. this kind of thing is annoyingly common among fuck yeah science types)
Really appreciated the careful dive into what actual facts exist about this situation. But.
I submit that those with a decent brain and a B-S detector (like me, of course) didn't need a follow-up to know that the original story as presented was almost certainly B-S. Hospitals overwhelmed with a steady stream of ivermectin overdoses such that they were turning away GUNSHOT victims? Both parts of that story are prima facia ridiculous.
Yea, that got me too. I sometimes wonder if people who live in cities just assume that rural areas are just like cities in all respects, just spread out more, as though the density doesn't change anything. (For good or ill, although for my part I much prefer the country side to cities.)
I assumed that the hospital was full of ivermectin victims and that there was some kind of policy forbidding them from kicking out already-hospitalized patients to make room for new patients (ie, new gunshot victims), but in hindsight surely they would have used standard triage procedures to prioritize gunshot victims *somehow*.
You're right, and both parts are so ridiculous that nothing short of extreme, brain-eating bias could account for why the BBC, The Guardian et al went with it.
But if I had read the original story (I hadn't), I would have experienced that same little jolt of joy I always feel when the idiocies of the Trump World are examined and for a few moments at least, perhaps long enough for me to have forwarded the article, I would have reveled in it.
Eh, the weakest interpretation of the claim is that a single doctor turned away victim from a single incident at the same time the hospital ha at least 1 horse dewormer case taking up a bed at some hospital somewhere in the country. Even if there's only a few hundred dewormer cases nationally I could imagine that coincidence happening somewhere, as coincidences are prone to do.
I mean, not 'worthy' from our perspective, but certainly the type of thing I'd expect to see reported.
Even for relatively good reporting, the formula is often 'find an unrepresentative anecdote that's attention-grabbing to put in the headline and first paragraph, then do any real reporting in the rest of the article.'
This is the greatest shame in these types of episodes. If people stop trying to figure out what is happening then we will be worse off and the insiders who do know what is happening will be empowered.
Maybe sort of? But the insiders won't be empowered to spread the truth if they want to, because the public will be too epistemically helpless to recognize the facts of the case. They'll only be empowered in cases where they benefit from public ignorance.
Strongly disagree. The point of epistemic learned helplessness is not that you shouldn't try to figure out what is happening, it's that
a) when doing so, you should attach more weight to secondary knowledge ("most people who have looked at this think X" and "most of the experts who have looked at this think X") and less to primary knowledge ("my attempt to look at this shows X") than most people do.
b) If you /do/ think you've figured out what is happening, you should attach a higher probability than most people do to the possibility that you're wrong.
I mean, that switches it from a descriptive claim (people will develop epistemic learned helplessness) to a normative one (people SHOULD do epistemic learned helplessness this way.)
But regardless of how people ought to be epistemicly helpless and how nobly they should strive to understand something anyhow... practically, admitting that you can't determine truth from fiction removes most of the interest in continuing to study it.
Consider the example from Scott in the coining essay. I suspect that he spent far less time reading pseudohistories and thinking about whether they were likely to be correct once he gave up on being able to tell if they were true. What's the point? If you're mostly unable to tell if they're true and going to rely on expert opinion anyhow, you're wasting your time and exposing yourself to infohazards by continuing to epistemically engage with pseudohistories.
Also, the idea that there are "insiders who do know what is happening" strikes me as textbook conspiracy theory.
It's not a matter of universal insiders vs universal outsiders. Many people understand something; almost no-one understands more than a few things in any depth.
This is so true. I spent my career working a specific set of issues that are hot in the media occasionally. They are always oversimplified and sometimes egregiously wrong for obviously self-serving reasons (from the people providing the simplifications). But the people providing them probably believe them.
I have no idea how you could ever figure out the actual situation without working in the field.
And the truth about the subject is frustrating, complicated, and morally ambivalent.
Well... if you want a good but sort of depressing read, try "What Americans Know about Politics and why it Matters" by Carpini and Keeter. Short version: no one knows anything about politics or how the political system works. When I say that, I don't mean things like "no one knows the history of the filibuster rule" but more like "a tiny fraction of people know who their congressman is, and only a few more know how many senators their state has." The survey data is sad.
A related point, which I think is from that book but might be somewhere else (sorry, did a lot of studying the topic a number of years back) is that the more television news people watch the less they know about the political system. They know more of the personalities, who is in what office etc., but less about how things actually work. I take this to mean that most media coverage of politics is on net misleading, presenting a view of what the writers want you to believe is true, with very little and very hard to separate actual truth value.
I don't know that that situation will ever change, just as the nature of the beast, so I tend to favor government forms where people don't need to know what is going on, because very little is actually going on. I don't know how stable such forms of government can be, however.
At least one polio vaccine has traditionally been given on a sugar cube you eat, but I think that one has (weakened) live virus, so they only use it in villages where there has already been an outbreak.
There also have been stories about companies working on skin patch vaccines. They say there are 400 microscopic needles, but I bet it doesn’t feel like a needle, and would overcome quite a bit of hesitation.
The Sabin vaccine was oral, compared to the Salk which was injected. The purpose was partly safety -- if you eat it the virus can still be a bit more vigorous and not give you polio -- but it turned out to have fortunate side effects, in that people developed enteric immunity to polio, which was a bit more useful than bloodstream immunity *and* they shed the weakened virus and willy-nilly inoculated a few other people for free.
It's a shame we can't do the same with COVID, i.e. give people some kind of compromised (but still replication-competent) virus which (1) gave them immunity and (2) which they could unknowingly share with other people, e.g. family members who were passionately anti-vaxx. "Achoo!" "Well, now I feel funny for a few days, but afterward by gum I have not got COVID even after going to 4 raves, clearly a triumph for my regime of clean-living, vitamin D and zinc, and prayers to Viritrilibia."
I just checked and there are now 4 attenuated covid vaccines in development. I believe two were abandoned in preclinical testing. Meissa is in phase 1, and Codagenix is also phase 1 but it is doing something very strange involving re-designing the whole virus from scratch.
There are several replicating viral vector vaccine candidates that work by doing things like taking a weakened virus other than sars-cov-2 and engineering it to express the sars-cov-2 spike proteins. This is not wholy unlike the AZ vaccine and has some of the same potential downsides, namely, developing immunity to the vector.
The attenuated flu vaccine is not infectious, so I don't know if we can expect these to be communicable or not for the purposes of causing community immunity.
Seems to be tricky, but maybe genetic engineering could do it. It's a neat concept: engineer a virus which is *way more* infectious than SARS-CoV-2, but which causes no harm. People would "vaccinate" each other unknowingly and we could *encourage* meeting face to face, shaking hands, coughing on each other...
Well, at least we won't have to speculate as to whether COVID-22 was an accidental lab release; we'll know full well it was deliberate. Now, about the error bars on your IFR calculation. I mean, how are you even going to test this? I don't think you're going to convince a full clinical trial's worth of test subjects to be locked into a sealed biodome for the duration, but if part of your plan is to make the virus way more contagious than the one that just infected a significant fraction of humanity, that's kind of what it would take.
The Sabin vaccine did cause some cases of Polio. Quote from Wikipedia. "Oral polio vaccine results in vaccine-associated paralytic poliomyelitis in about three per million doses." In some rare cases, the Sabin Polio virus mutated into a more dangerous form.
The Salk vaccine was/is better (the virus is dead). However, at least one bad batch of the Salk vaccine was made (by Cutter laboratories) which scared the public (for good reason).
Yes, I know. I was referring to the early manufacturing difficulties, to which you allude, and the fact that in principle you can slip up a little with the oral vaccine and it's less likely to give you the disease because it's still got to get into the bloodstream. Mind you, although the Sabin vaccine was heralded at its inception in part because of its improved safety, I do not know if safety was actually a key part of Sabin's motivation, so I probably phrased that too strongly.
I have read through several accounts of the introduction of the Polio vaccine in the US. Too me, there were many surprises. First, Polio vaccines were used outside of the US for several years before any vaccine was approved in the US. Second, it took quite a few years before the US was heavily / highly vaccinated. Apparently, quite a few Americans were scared of the early Salk vaccine (because of a few very bad batches) and waited for the Sabine vaccine (roughly 5 years later).
I think I got both in public school as a child. Given that I was born in 1955, that would have been in the 1960s. Note that vaccine hesitancy played no role in when I received the vaccine. Parents/schools made all of the decisions and kids had zero say in the matter. Was there vaccine hesitancy on the part of the parents/schools? I really don't know. Certainly, the Cutter incident scared lots of people.
My sense of it, is that because Polio had been around forever, people didn't feel any great urgency about getting vaccinated.
KE, Your statement is partially wrong. The Sabin Polio vaccine did use sugar cubes with an attenuated form of the virus. However, it was widely used in the US and the USSR and not limited to "villages where there has already been an outbreak." See Carl Pham partially accurate comments below.
Like most folks, I dislike needles. The good news is that the COVID-19 needle is very, very, thin. Some of the needles of my youth were much thicker (and more painful).
“ivermectin is an antiparasitic drug that looked promising against COVID in an early study. Later it started looking less promising, and investigators found that the early study was fraudulent.”
NO NO NO NO NO NO NO
There were MANY studies that showed some benefit from Ivermectin all over the world, and many meta-analyses and reviews concluding it had benefits. There were also studies that showed no benefit, but problems with many of them too.
YOU FELL INTO THE TRAP!!!!!
Your word “the” is the lie. It is the MAIN technique of sophists to confuse “or” and “and” and to attack an “or” by focusing on a single term and defend an “and” by defending a single term.
Yes. I disagree with the framing of the post as well. With tons of conflicting evidence, to claim that we "know ivermectin is ineffective" is... overconfident.
Is it worth betting on whether the consensus on this will change? That seems like the easiest way to turn it into a bet, but I would be extremely sympathetic if your position was that the consensus was wrong but will stay wrong forever.
I have not researched this in depth personally. I'm basing this off of a belief that I have good intuitions about when the medical consensus is vs. isn't wrong, plus the fact that people said very similar things about HCQ and I did research that one in (non-zero) depth personally and am still pretty sure it's wrong.
In my red-tribe circles, the hopes around IVM seem much higher than they ever were around HCQ. I've been having trouble making sense myself of the evidence and the discourse around it: I'd dearly love to see the result of you giving it a post's worth of attention.
I remember @__ice9 on twitter being a big source of IVM boosting, even while he said HCQ was useless (unless combined with another treatment to block the other channel by which COVID spread). But apparently he died some months ago.
Yea, it seems the optimism around HCQ was mostly fueled by the fact that Trump was optimistic about it and his supporters felt the need to stick up for him (similar to the "injecting bleach" situation). But IVM wasn't endorsed by Trump but rather made it to the forefront on its own momentum, and by virtue of actual scientists including it in their strategies.
Trump was optimistic about HCQ because he had taken it, and he had taken it because there was already momentum behind it back before vaccines were available.
I had a similar intuition but after listening to Joe Rogan's podcast #1671 - Bret Weinstein & Dr. Pierre Kory I changed my mind. Thanks for trying to improve the opening of the post, I appreciate it, it's much better now.
I don't understand Weinstein's problems with BOTH mRNA & adenovirus vaccines. They latter are novel relatively to inactivated virus vaccines, but they had been used for other diseases and as far as I know didn't cause problems. And if he thinks the spike protein itself is so harmful... doesn't that make COVID sufficiently harmful you'd want to immunize yourself before the long wait for Novavax vaccines to be available?
Isnt Novavax just an injection of basically pure spike protein? I guess it doesn’t make your cells manufacture it, the way the virus or the adenovirus or the mRNA do. But I thought novavax was for people worried about genetics, not the spike protein. (Also, even though they are manufacturing Novavax in my town, I’m pretty disappointed in all the setbacks they keep having.)
Mostly. The spike protein itself has probably been engineered a little, so it's stable on its own, but more importantly the vaccine also contains an adjuvant, as these particle vaccines usually do, which kicks up the immune system strongly at the site of the injection, so that it starts reacting to the particle strongly, which otherwise (in the absence of the adjuvant) it wouldn't do.
Personally, I'd rather have weird mRNA than an adjuvant, because I'm very sure my cells have multiple robust mechanisms for dealing with alien mRNA, whereas they may or may not have good mechanisms to deal with some random bunch of compounds that provokes a strong general immune response. (Although I should emphasize that adjuvants are very well tested for general harmlessness and are usually made of some biological molecules anyway, so I don't really feel much qualms about them in an absolute sense.)
I'm pretty confused about those things too. When I said "I changed my mind" I meant it more as in "it made me think that without deeper research I can't conclude that it probably doesn't work", but then I never did the research :p . I'm not a strong follower of Weinstein but I do believe in his intellectual honesty. I have no idea what he thinks about adenovirus vaccines. When I listened to him interviewing Robert W. Malone (if you want to look him up I recommend looking at his google scholar rather than reading what random people write about him) I got the impression that the main issue with the mRNA vaccines is that they were supposed to be designed so that the spike protein would stay locally where injected, and insufficient testing led doctors to mistakenly conclude that they had successfully achieved this (which is something that apparently other more traditional vaccines do achieve). Then it turned out that they had not succeeded at all, and basically they have no idea of what the implications are. This is just my flawed recollection, I'm sorry I can't give you a better answer.
My take on Weinstein from having watched a bunch of his podcasts is that he tries to be honest, but he's also strongly driven by a desire to be right when other people are wrong.
I wish he'd just been dubious about vaccines and pushed for more research into whether existing drugs might help against COVID instead of putting such a large bet on Ivermectin.
Indeed, he is an interesting case study in pure, unadulterated contrarian bias can look like. Sometimes right,sometimes wrong, but never adding much information because repeating !establishment_consensus isn't hard to do for yourself.
Yes, I agree he has a strong distrust the consensus view and institutions.
I find it frustrating, that so many of his claims are actually easy to disconfirm. Like his claim that the mRNA vaccine is dangerous -- we have data on hundreds of millions of Americans who are vaccinated -- if it's dangerous, that danger has not showed up in the data.
Or his claim that widespread adoption of vaccines will drive selection pressure to make vaccines less effective. Could be true, but isn't this a Generalized Argument against Vaccines? And also if true natural immunity cause the same selection pressure, as unexposed hosts reduce in quantity?
If he were more doxastically open to the question, he would explore why that selection pressure is not a problem for other vaccines that allowed us to, for example, eliminate smallpox, nearly eliminate polio, as well as keep countless others at bay (Measles, Mumps, Rubella, even Hepatitis B).
I find Weinstein's assertion that the vaccines are benefiting from regulatory capture to be not thought through
Regulatory capture results from an imbalance of incentives and lack of public attention enabling a small number of insiders to influence the regulatory system to their advantage to the cost of competitors and customers
With covid the incentives of the customers are essentially as large as possible and the level of public attention the same
If pharma routinely benefits from capture trying to get away with it with covid vaccines would be monumentally dumb and risk giving up the whole game. And the J&J pull would have to be a wild outlier or an intentional camouflage so complicated the idea that the whole scheme doesn't have any smoking gun other than "ivermectin is a miracle drug and the only explanation for it not being recognized is a conspiracy" is highly unlikely and should certainly be presumed against to the nth degree
I think the incentives against ivermectin are clear: it's off patent, it's probably not as effective as the vaccines, assuming it has some effect. From a public health perspective, vaccines are the clear recommended solution to the pandemic.
The media has also doubled down on submitting to health authorities who are pursuing public health goals. Ergo, vaccines all the way.
So financial, professional and media incentives are all pro-vaccine and anti-alternatives to vaccines. I don't see why capture isn't feasible in this context.
I guess in terms of general 'institution capture' there's a case that the vaccines have it. The J&J pull may be killer evidence against specific/direct regulatory capture but there is definitely a type of momentum with the vaccines that isn't about to turn on a dime. And a miracle cure suffers from two heuristics that tend to shut it out of consideration: too good to be true, as well as too bad to be true if it actually is a miracle being shut down
But I think there are enough theoretical incentives for a 'miracle cure' that it would not be able to be suppressed. Saving billions, saving people who won't take the vaccines, saving the social controversy over vaccine mandates. If ivm for instance has anything like a vaccine equivalent effect even a badly designed study should pick up a big signal, yet Bret claimed one study was purposely designed to find no effect due to presumably planning to test ivm as a treatment too late for it to have a chance to. In the end it's too big a conspiracy under too bright of a light to be reasonable to advance without any hard evidence
> But I think there are enough theoretical incentives for a 'miracle cure' that it would not be able to be suppressed.
Agreed, but what would that look like? Would it look anything like what we're seeing?
Time will tell. I've heard about a few randomized controlled trials using IVM as a prophylactic, which is allegedly it's most effective application. Hopefully we'll get definitive results either way withing 3-6 months, and let's hope they find n little to no benefit because the contrary would be quite damning.
"Currently available data do not show ivermectin is effective against COVID-19. Clinical trials assessing ivermectin tablets for the prevention or treatment of COVID-19 in people are ongoing."
Despite the title, the page is mostly warning people against taking animal ivermectin. I read the quote not as "we know it is ineffective" but "we do not know if it is effective."
Right, and the FDA is all about denying people access to drugs that haven't been proven effective. But if a drug is cheap and safe and *might* help, the FDA should get out of the way. Particularly when you have people on ventilators, which have an 80% death rate.
It absolutely is worth betting on since the ICU doctors who administer ivermectin are claiming it is saving lives, and they have provided links to studies and meta analyses that are very encouraging. I would like you see you deep dive this (similar to your Vitamin D post). Here is a starting point, provided by the ICU physicians who comprise the Front Line Covid Critical Care Alliance (FLCCC): https://covid19criticalcare.com/ivermectin-in-covid-19/ As one of the commenters mentions elsewhere, Dr. Pierre Kory, one of the physicians in this group, was interviewed with Bret Weinstein on Joe Rogan’s podcast.
Note that it has been repeatedly demonstrated that average physicians are awful at statistical epistemology (see, the classic Bayes mammogram test.) It's not part of their job, and it's BARELY part of their training at all. We have organizations dedicated to telling doctors what the correct treatment plan is based on the science so they don't have to be good at it.
So a group of front-line physicians doesn't really start with any special credibility on this. And the FLCCC's previous uncritical advocacy work on other failed intervention lowers my interest in their opinion further.
The FLCCC updates its recommended protocols as new data comes in.
They used to recommend HCQ - when I got a preventative/exposure protocol months ago, it was part of it - but now they no longer do.
And now they're including mouthwash as part of the recommended protocols, because there's been encouraging early data on it and using mouthwash is effectively harmless, so why not?
The whole point of the FLCC is to move faster than the WHO, FDA, et al because they have actual patients who are sick *right now*. Doctors are the ones who should be deciding the cost benefit analysis of promising interventions for individual patients, not huge institutions.
But doctors are (on average) awful at estimating risk, and so are awful at cost-benefit. I don't see why we would trust them en masse above 'huge institutions' that have people who are actually good at interpreting data.
Fundamentally I'm libertarian on this, and it's not ultimately doctors OR institutions that should decide cost-benefit of interventions; it's patients. They pay the costs, absorb the risks and reap the benefits, so they have to be given the responsibility of making the decision too (barring cases with notable societal costs like highly addictive meds.)
But I think your trust in front-line doctors is misplaced in general, and in the FLCC in particular. As you note, they got HCQ wrong. And while they eventually recognized that, they did so well after it was clear to people used to doing medical lit reviews that it was almost certainly not a useful therapy. (In spite of the fact that numerous front-line doctors were SURE it was helping their patients.)
"But doctors are (on average) awful at estimating risk, and so are awful at cost-benefit."
The risk of using ivermectin is a given -- it's essentially zero. So even dumb old doctors can figure out that the abundant evidence of benefits is greater than zero.
By the way, if the same rigor in requiring double-blind, peer reviewed, cost-benefit proof were applied to masks, lockdowns, and social distancing we'd still be studying those and saying the "jury is still out -- not enough evidence."
The shifting burdens of proof and definitions of "evidence" is all so tiresome.
coward. Do the work. (No, I don't think you're a coward. I hold you in the highest esteem. I'm just trying to motivate you--as I did in another comment somewhere in this long thread)
FWIW, there are enough smart people saying ivermectin works, combined with suspiciously overwhelming media consensus that it's bullshit horse paste, that I am both confused and suspicious. I would love if you tried to puzzle it out, and predict that if you do you'll end up confused and annoyed about the truth :)
It almost certainly does nothing, but I've also dosed a zillion animals with it and also myself and various other random barefoot running around the jungle types and it has basically no side effects at the deworming dose, so why not?
Here I answer why not: Because it isn't (at least in the US) being proposed as a miraculous cheap drug to save lives; it's being offered up as an alternative to the vaccine. It is inherently political, and massively sus.
This on top of a bunch of placebo controlled double blind trials that show nothing.
There are also a bunch of placebo controlled double blind trials that show improvement https://c19ivermectin.com/
I think vaccines vs. ivermectin is a false dichotomy, I'm not sure why it's commonly framed as either/or when one is preventative and the other is for treatment. Vaccinated individuals can still get COVID, why not include it as a treatment option given there's a chance it might help, and at worst it does no harm?
If your reasoning is that even the perception of having an alternative removes the incentive for people to get vaccinated, therefore we should push the narrative that it doesn't work and that vaccination is the only solution in order to nudge people towards that direction, now *that* would be massively sus political manipulation.
It shows no significant benefit as an early treatment, after symptoms have already appeared. That was never it's proposed benefit though, it was always recommended as a prophylactic. Controlled trials on this use are conspicuously absent, although I've heard of a few in progress.
Clearly there is some large cohort that is never going to get the vaccine, and there is some large subset of that cohort that would or is taking ivermectin. Seems like a no-brainer to follow these people and do a retrospective analysis of its effectiveness at preventing COVID infection. That doesn't undermine the pro-vaccine messaging.
No evidence is no evidence. I'll change my stance when it is proven to actually do somthing, unlike the last 10 miracale cures people have put their faith in so they don't have to get the vaccine that has no* side effects and provably works
>That was never it's proposed benefit though, it was always recommended as a prophylactic.
But how is one supposed to know when to take it? It needs to be dosed very frequently. It's not practical for the entire population to be on IVM as a prophylactic basis.
Dosage schedule isn't clear at all. Countries are using it right now and targeting regions that are experiencing spikes in cases. Everything you mentioned seem like solvable issues, particularly if IVM is effective and supplements the vaccine.
The folks at [twiv](https://www.microbe.tv/twiv/) still seem to hold out a reasonable chance of it providing some benefit and are waiting for further studies before ruling it out completely. Of course, that's in a clinical setting, and not, you know, vet sourced and self-administered. At this point, I'd assume anyone trying to manage its use on their own will just fuck themselves over.
Someone who has covid now doesn't have the luxury of waiting until 2023 or 2024 for the data from another study. There is enough data on the oral use of ivermectin to say conclusively that there is a minuscule risk of serious side effects when taken at specific doses, so if someone wants to try it as an adjunct treatment to the disease, the only risk involved is that it may possibly be ineffective.
These trials normally only take a few months so you won't be waiting until 2023 for the results. But you are right that it is no skin off my nose if people want to take a sensible dose of ivermectin (or anything else) if they have Covid. I just don't see the point of holding strong opinions on its effectiveness either way until a proper clinical trial concludes.
The problem is that the "medical consensus" is fundamentally unscientific because they fail to rigorously define Marginal Benefits and Marginal Costs and then fail to quantify whether MB>MC. Instead they just look at the data and then apparently get some gestalt "gut feeling" that the treatment at issue is either a good idea or not.
For example, is the Net Present Value of using Ivermectin higher or lower than wearing a facemask? The medical researchers and bureaucrats can't or won't say -- they just say one is prohibited and the other is mandated, and please trust their "judgment" that this is right.
Perhaps we need to recognize that medical professionals aren't able to do cost-benefit analysis. Instead, we should turn over their medical data to economists who will then use it to make the final cost-benefit decision.
Yes, the evidence that ivm is helpful against COVID goes far beyond the one discredited trial. It’s amazing how many doctors using it on the front line talk favourably about it but the medical authorities and academics like Balloux pour scorn on it, and invoke cheap shots like “horse medicine” rather than debate the evidence.
The horse medicine thing is kind of funny to me. My dad's side of the family is horse people, and we had horses for a while when he was young and trying to make a living raising them. Given my experience there, I am pretty sure people spend about as much money on their horses' health as their own families. More if you count out of pocket expenses. Horses are bloody expensive, and people who keep them are... well, it's a life style that is pretty all consuming for all but the very wealthy. A good horse costs more than a very good car, and has much more yearly maintenance.
If by some strange alchemy the tools used to keep a Porsche 911 running perfectly also worked on humans, I'd be comfortable scheduling an appointment for a mechanic. Likewise, I expect the standard of care for most horses is rather higher than for the average human, especially considering that horses are very fragile animals compared to people. You can get away with all kinds of crazy stuff with humans that would kill a very expensive animal.
And the crazy distortions caused by insurance coverage aren't an issue in veterinary medicine. People pay for what works with their own money, and thus have no incentive to seek treatments that aren't cost effective.
You do know that ivermectin is an FDA-approved drug for human use, and on the WHO list of essential medicines, right? It's used to treat diseases that aren't particularly common in the United States, so until recently it's been fairly obscure, but it wasn't brought up as a potential COVID cure because "hey, let's try horse dewormer!"; it was tested because it was a commonly-used and widely-available drug that had some theoretical and early experimental basis for maybe being useful.
The horse-medicine part only comes in to play because the human version isn't available over the counter, and American doctors are now mostly telling their peculiar new drug-seeking patients to go away and stop bothering them. And for that matter, the pharmacists have started calling the doctors and saying "are you *sure*?"
The veterinary version being available over the counter, that's what the desperate (and/or desperately ignorant) are going for.
Yes, I do know that... I was building on Roger's point about calling it horse medicine was a cheap shot, specifically that horse medicine is taken more seriously than human medicine is in many cases.
Please read a little more closely and carefully, John.
Please be a whole lot less obnoxious, "Hammer". I just reread your entire post, closely and carefully, and it was entirely consistent with someone who believed that ivermectin was used only in veterinary practice arguing (correctly, as it turns out) that veterinary drugs are of high quality and may sometimes be the right tool for treating sick humans. Hence my question/clarification.
I was in a call where a handful of people with IVM prescriptions had them denied by the pharmacy, cuz…pharmacists know more than doctors here in the upside-down.
> There were also studies that showed no benefit, but problems with many of them too.
I've seen a metaanalysis that declared there was no conclusive data on the issue, but I haven't seen any primary studies that showed no benefit. Can you provide a source?
Complete tangent, but I've been curious about the classical sources on rhetoric - I don't know what to look for. Suppose I want to read some distilled wisdom from Greece or Rome on making effective oral arguments. Who wrote it? Where do I find it?
Also he said Ivermectin is completely useless, or something like that. Even with the dimmest possible view of Ivermectin that isn’t true. You can make a good argument it isn’t as effective as a vaccination (maybe), but it’s been used and prescribed by doctors the world over and tops the list of early treatments during an infection.
I’m not saying you have to be a cheerleader, but why drop the ball of cautious, rational thinking at the one yard line? It’s weird in/out group stuff I thought was beneath this forum.
I meant maybe someone would want to make that case. I did not mean to imply that IVM is better than the vaccines. I don’t care enough to make the case.
I will add that I am especially disappointed in you because you’re a PHYSICIAN and in addition you have written extensively about issues related to drug trials. I don’t know what weird bias overcame you here, but the financial incentives for expensive patentable therapeutics and vaccines and the regulatory roadblocks around EUAs for vaccines created very strong pressures to disparage the use of cheap known-to-be-safe drugs like Ivermectin and HCQ for treatment of COVID (which in the case of HCQ led to many “designed to fail” studies and some fake studies and in the case of Ivermectin which seems even more promising than HCQ for early treatment led to many many many lies in the media).
I've edited the beginning of the post slightly. My goal is to make it clear that I have no personal extra information that ivermectin doesn't work, while also leaning strongly in that direction on priors. I don't want to add to information cascades, but I also don't want to have to personally research every widely-agreed claim super in-depth before citing it as background information. I hope the new phrasing better balances these considerations.
Thank you for the rephrasing! It is much appreaciated (At least by me, who is still confused by the issue and at the same time views most of not-strictly-scientific information about it as signalling)
Fluvoxamine is a cheap drug already approved as an anti-depressant which received high marks from the same recent trials that failed to find benefits for IVM/HCQ.
A request: Can we chill on the "disappointed in you" language until we have significant evidence of negligence as opposed to casual error? The Principle of Charity applies.
I thought carefully about it and don’t use it lightly. It’s not so much a “causal error” as ignorance unpardonable in someone in Scotts’s position not to know that there was much much more than one study favoring Ivermectin. It represents a major failure in whatever his information-gathering procedures are.
None of them do in isolation, no. When dozens cluster around a signal, and that signal is reinforced by natural experiments worldwide, and when they are both reinforced by the impressions of frontline doctors, it's worth a look. Multiple meta-analyses are showing promise. And the risk/benefit tradeoff makes it worthwhile even if the results are inconclusive. It's one of the safest drugs in history. Before the taps got turned off and people started resorting to vet IVM, there were 16 deaths recorded in 30 years of use with about 4 billion doses. In other words, it's almost certainly more beneficial than dangerous, and normalizing it would do a lot to restore a certain cohort's trust in the intitutions.
Very few deaths is not the same as a drug being safe; it's quite possible for a drug to have extremely nasty side effects that don't risk causing death.
I don't know much about IVM in humans, but I have heard that it can cause serious neurological damage in animals, and death stats aren't going to tell you if that's also a risk for humans
It is extremely safe, and tolerated well in humans even at much higher than recommended doses. There are a few animals (like the collie dog breed) for which it is highly toxic. Worldwide it is routinely administered by non-professionals, and is regarded as being safer than aspirin.
If it saves a single life, and the cost of that success is not denominated in any significant fraction of a life, then nobody should stand in the way of anybody trying to save a life. I will die on that hill.
To make matters worse, at this stage 99% of the people facing the “choice” of opting for an unproven treatment have consciously chosen to avoid needing it in the first place by getting vaccinated.
No, seriously, tone it down. I'm a touch disappointed in Scott myself, and that first slug at IVM is really bad, but he's a sensitive soul. Please don't go around saying things that will hurt him / make him less likely to write in future.
Fluvoxamine also promising, known side effects long term related to its psychiatric effectiveness but perfectly safe for a short course of early treatment; not as much of a threat to Big Pharma as IVM and HCQ were but I predict we will start seeing sophistry and bad studies about it too if it continues to look good.
More expensive, part of a drug class (SSRI) people are more wary of, not available without prescription anywhere, not as suitable for long term prophylactic use so less competitive with what they want to develop.
The prices are the same, goedrx.com/ivermectingoodrx.com/fluvoxamine . Long term prophylactic use would be a massive coup for pharma companies as tens to hundreds of millions of people would take a new frequent drug, as opposed to a still somewhat cheap vaccine once. And current drugs for hospital treatment are also very cheap and off patent. Other SSRIs work in places where it’s unavailable.
Sorry I wrote that quickly, the prices are very comparable (within 50%) and the entire rationale collapses when we look at dexamethasone, the currently used drug, https://m.goodrx.com/dexamethasone much cheaper than both
No, conspiratorial thinking would not make testable predictions. The whole danger of conspiracy theories is that their implications can never be tested so there is no negative feedback. Stating that some groups have incentives one way or the other regarding something and predicting that they will act in their own best interest is merely paying attention to human nature.
The evidence for ivermectin is not that strong. It may still prove to have a modest effect but seems unlikely to be the pandemic killer that Bret Weinstein or Pierre Kory think it is.
The financial motive by pharmaceuticals does exist but it’s not the only one. Countries that don’t have vaccines have a huge motivation to find cheaper alternatives. IVM has also increased in price due to all this advocacy.
It might! But these steroids were already part of protocols to treat symptoms in similar diseases and were used extensively in hospitals all along. Just because big pharmaceutical companies were able to corruptly slander some potential competitors to the drugs they wanted to develop doesn’t mean that they were able to do that to every single one.
Please be careful not to impute to me views I have not stated. I think HCQ has some benefit, IVM probably has more benefit, neither is a reliable cure, but I am ABSOLUTELY CERTAIN that those two drugs have been lied about and slandered because I have identified the bad math and bad study design and bad reporting and actual fraud in many cases. When the story about the Oklahoma hospitals came out I instantly posted on my Twitter feed that it looked like 100% bullshit. When the Surgisphere study about HCQ came out in the Lancet, I posted within 24 hours that it looked fraudulent, for exactly the reasons that it later turned out to be fraudulent. I have been following very closely all along and reviewing the statistics and the data myself because I am a professional statistician and the news media are completely untrustworthy.
I am open to other explanations than “financial incentive” for the behavior we have seen to push vaccines and disparage some drugs, of course, but I am quite sure that explanations are needed!
What are the lies and slander? There was a fake pro IVM study and a fake anti HCQ study, so maybe just when you have the entire globe participating you’ll get some fakes, I don’t see bias there.
It’s a numbers game. There are fakes and lies on all sides, but I have been paying close attention, and measuring by media attention, the lies and fakes have been overwhelmingly against IVM and HCQ and remain so, it is bleeding obvious to anyone whose information diet is not dominated by the USA mainstream media and social media which have been extremely suppressive of one side but not of the other.
And again, a drug one has to take preventatively once a day or week is much better for big pharma than a one or two dose vaccine or a steroid for severe cases...
Why? If a drug is generic any drug company can make it, including those not under the "Big Pharma" heading. Small Pharma, if you will. Big Pharma doesn't get any benefit from Small Pharma getting money, and in fact there is the danger that some Small Pharma firm might rise to be a real challenger to Big Pharma. Industry leaders tend to work very hard to keep out entrants and potential competition.
I mean in practice nobody other than the social media fringe people is suggesting prophylactic use of any drug, so it’s a moot point anyway.
It looks like the “price” of a vaccine is around $20 at the top, much less than the current price of a month of ivermectin. If you could get everyone to take ivermectin for a year (which you can’t, but that’s sort of what the fringe folks are suggesting) I think pharma companies would be happy about even a piece of that. I don’t know that much about the structure of pharmaceutical industry, but I can’t really imagine that Big Pharma as a whole would be against that, especially since some Big Pharmas don’t have their own successful vaccines. https://www.ft.com/content/657b123a-78ba-4fba-b18e-23c07e313331 Modern a and BNT were “upstarts”! The case for that intervention is, in general, absurdly weak. Yes, the New York Rhymes sucks and yes, pharma companies do bad stuff, but that doesn’t mean they suppressed some random drug.
Where are you getting your prices for vaccines and ivermectin? Just curious.
There are a lot of historic examples of pharma companies doing... strange things to keep their drugs from going generic, and having very little interest in producing generic drugs themselves. Scott has some posts from back in the day about the topic of drug companies adding a minor coating to a pill or some other thing to extend patent protection as I recall, and psychotherapeutics that are the same but slightly different and cost large amounts more, but overall there is a long, really tedious literature in the intellectual property sphere citing the bad habits of "Big Pharma" when it comes to doing anything and everything to extend patents and totally losing all interest in generic drugs.
The take home message of it all is that there are billions to be made off a patent drug, and very little to be made off generics, so companies that are invested in the patent drugs are willing to drop a few million here and there to make sure those off patent are not serious competitors. This is one of those "known things" in the research. So, does a company that has a patent vaccine under temporary FDA allowance want to sell X units of vaccine at Y$, the whole market being split between the 3-4 firms that are allowed to make and sell the vaccine, or do they want to sell X+A units of generic drug at Y$-B$ split between the literally hundreds of firms manufacturing the generic drug all over the world? When is (X*Y)/4 < (X+A)*(Y-B)/(100) ? A would have to be very big and B very small in percentage terms for that to be a good bet.
If I were a pharma company with a vaccine patent, I would push really hard on the vaccine, and use the other generic as a back up plan I would use only if necessary. Especially if I sunk a ton of cash in getting the vaccine developed and passed through the FDA; caring about sunk costs is not fallacious when you are an executive and have to justify your decisions re: spending a ton of cash and getting negative returns.
One of the biggest non-vaccine game-changers was dexamethasone which has been shown to reduce mortality by about 30%. It's cheap, off-patent, and has been widely used for decades. It's actively being used because it's been shown to be effective.
Why doesn't the medical establishment get credit for this?
The issues with trials should cause you to update in favor of more uncertainty generally. Not give evidence for "whatever the counter establishment position is its true"
Tremendous article, thanks very much. I just read The Scout Mindset. A twinge of smugness or satisfaction I might feel when reading news stories (I've left twitter, thank God) is definitely a warning sign that I need to ask myself, wait, what's my bias. Twinges of anxiety and resentment reading a news story are signs I need to pause, back off, get willing to move outside my comfort zone, reread. All the news and opinion pieces on Afghanistan has me thinking about bias a lot. I haven't ended up annoyed - it's too large a tragedy for that. I have definitely ended up confused and uncertain. Maybe that's the right place to be, but it leaves my feeling like I've failed my duty as a citizen or something. Just thinking I don't know the truth, or can't reach a conclusion, just not taking a position - that's not enough.
The claim of area correlations between ivermectin and death rates are totally ridiculous. That doesn’t work at all as a form of a analysis, especially when there’s other massive variation between geographic areas.
Is it though? Peru was an interesting case where they started and then stopped administration of Ivermectin on a very large scale. Combine this with over 20 RCTs, 2 animal models, multiple meta-analysis, dose-correlated reduction in multiple jurisdictions in India, and a logical mechanism of action. As someone who tries to be rational it is hard for me to reject all of this.
Yes, it is pretty much unreasonable in any context to do a plain correlation between two things like that and expect it to mean anything. If you have strong reason to believe there is some difference between the two treatment groupsthat is totally independent from any other cause, like an idiosyncratic policy variation or intended randomization, and there’s enough samples within those two groups, you can analyze based on that, but even that isn’t reliable and absent that it is totally absurd. The temporal correlation they claim is equally absurd, and given Covid lines go up and down in every country and multiple have prescribe ivermectin the line up and down will overlap it in at least a quarter. It is meaningless and makes me question the rest of the analysis somewhat. The others have been debated incessantly elsewhere but that’s my only point here.
Not to mention Covid today is a different strain than covid last year.
What strain is Peru dealing with before mass Ivermectin treatment, and what strain after? I don't know when any of these changes occurred. But I know that a whole bunch of anecdotes need to be statistically investigated. Even though it would make sense to be good data, someone has to check, because it is never too good to check.
You have to do randomised controlled trials simultaneously. It sounds like some of those are in progress.
I looked at the Peru numbers to try an entry for the Better Skeptics challenge to crowdsource quality arguments against the Weinstein ivermectin point of view
It seemed reasonable to get excited about as there were only certain provinces who tried it and the given numbers appeared to show 80% effectiveness. But there was no trend I could see in the case numbers. By the end of the summer ivm was so popular in Peru as a preventative that a researcher reported 8/10 people they tried to recruit for a study were already on it
If you trust the Peru numbers on treatment it seems you have to give up on any preventative effect as well as find a way to explain why they stopped using it
Ponder the truth that there exists a graduate student or post-doc researcher in Anthropology who will refuse the standard treatment for River Blindness because it's a deadly poison, part of a Trumpist conspiracy theory.
Does there? I doubt it, you're talking about a small educated group following the traditions of their specific field there, not general population dealing with a topic thy have no knowledge of or traditions about.
I think the main point about the story is that it is effectively a stand-in for vaccine refusal/hesitancy among people who are medically and financially able to get a vaccine.
As for your post, it's a great reminder to be skeptical of any story that's poorly sourced/hastily thrown out to the world.
It's interesting that I think you could say both sides are actually correct in certain substantial ways
It is accurate to say major media outlets excersiced no care in checking a story that is clearly wrong in the literal metric of whether ivermectin side effects are causing any strain on the health system
It is also accurate to say that ivermectin has become a set piece in the general anti-vaxx arguement and by giving people the impression there is a fully effective alternative it is pretty directly causing a strain on the health system through greater numbers of unvaccinated people
There is an anti-ivermectin case that could have been the story but through careless knee jerking the blue team media discredited themselves and probably bolstered pro-ivermectin sentiment. Maybe we could refer to incidents of the blue team media shooting themselves in the foot like this as a Horse Paste Fiasco
Alright so yeah, information is now food. If it's palatable and pleasing it's probably unhealthy. A good information diet involves lots of whole, bland informations that aren't particularly motivating to consume and maybe involves periods of fasting. Got it.
Intuitive news reading, like intuitive eating, probably only works when you’ve adequately trained yourself to recognize the phenomenology appropriately.
Some things are delicious and healthy in the right amounts. Like fruit, or meat. If they don't trigger an immediate craving for more it's a good sign.
I've always thought of books in terms of junk food, healthy food, unchewable hardtack, etc, and my aim is to write books that are juicy yet nourishing...
There are really only two possible culprits for this whole debacle. If you watch the Channel 4 interview (as you stated, this appears to be the source from which most outlets copy/pasted without additional investigation) they very clearly link the 'ivermectin is dangerous' and the 'this is the reason why hospitals are full' bullet points.
"Dr. McElyea said patients are packing his eastern and southeastern Oklahoma hospitals after taking ivermectin doses meant for a full-sized horse, because they believed false claims the horse de-wormer could fight COVID-19."
That CLEARLY implies the cause/effect. Without the unedited interview, it's hard to go any deeper. Back to the two possible culprits, either the reporter is purposefully misinterpreting the doctor or the doctor was being dishonest. The doctor has refused to comment any further and Channel 4 hasn't updated the story with any information that helps sort this out.
Thank you for looking into this! I’m not even sure the doctor was necessarily being dishonest, maybe merely making a locally true but exaggerated statement based on secondhand information about a small number of hospitals or patients. So it could be mass carelessness and a total lack of desire to understand scale and implications.
My priors on statements by doctors/nurses about hospital capacity being true started sky high but sadly keep falling and are now firmly below 0.5. This isn't the first time the press has picked up on bizarre and implausible statements by medical staff and blasted them around the world without doing even the most basic checks. Mostly when I searched for evidence for these claims I found they were only investigated by PatriotFreedomEagles type sites, and they had often found many reasons to be highly skeptical of the stories.
In this case there was a Twitter blowup and it seems Rolling Stone felt they couldn't ignore it, but mostly such investigations do get ignored.
One theme that kept cropping up a few months ago was news reports of young people in ICUs saying things like, "I came down with really severe COVID, I wish I had listened to authority and got vaccinated". Investigative YouTubers discovered that a remarkably large fraction of these people appeared to have prior acting or related TV experience (e.g. having appeared in reality TV shows). It's not proof of anything, but the P value on that correlation would have to be very low given how rare such reports are, how often they featured obscure actors and the low proportion of the population that has appeared on television. It really makes it very difficult to trust anything you see in TV news.
I mean generally there are a million doc+nurses and the few that are gonna say interesting stuff even if it’s wrong will get more airtime lol. Same for many other things. Actual reports from nurses and doctors people personally know tend to be slightly better
I think I'd still place a high prior on an assertion re hospital capacity by a random doctor or nurse, but an even higher prior on any media source having cherrypicked the most extreme assertion they could find in support of their preferred narrative.
> Investigative YouTubers discovered that a remarkably large fraction of these people appeared to have prior acting or related TV experience (e.g. having appeared in reality TV shows). It's not proof of anything, but the P value on that correlation would have to be very low given how rare such reports are, how often they featured obscure actors and the low proportion of the population that has appeared on television. It really makes it very difficult to trust anything you see in TV news.
I know the suggested conclusion is 'actors are on tv about this, so they must be acting', but contrarian instinct wonders how much of the effect would come from 'this is happening to many people including actors, but actors are more likely to be interested in/connected enough to get on TV to talk about things'. (Would you seek out a reporter if you got sick?)
Could P(seeks being on TV|actor) be higher enough than P(seeks being on TV|¬actor) to make P(actor|seeks being on TV) seem disproportionately large compared to P(actor)?
(This is also another instance where the base rate would be helpful for comparison: how often are media-connected people the ones who appear in news stories *in general?*)
Yes, that could happen. I am skeptical because I don't see any immediately obvious way to convert acting experience to access to journalists, given they're very different parts of any TV operation. And these people are supposedly fighting for their lives in intensive care. They are too sick to be phoning around TV stations pitching their story. Unless journalists are seeking out people with acting experience specifically, but that's the whole conspiracy theory to begin with.
I honestly am not sure what to make of this. It's a pile of anecdotes rather than statistics, the logical induction is incredible even for people cynical about the media, and frankly I just don't want to believe it. On the other hand, I can't really justify my instinctive rejection of these findings. It feels emotional rather than logical. Logically, I know young people virtually never end up in ICU due to COVID. And I know that getting COVID that badly is a basically random event. And I know people are virtually never TV actors. Thus logically the union of these sets should be incredibly small, not large enough for people to notice and document a pattern. One of them even got work sheet her appearance and told a local newspaper she didn't know what had caused her sudden streak of career luck! But .... what can you do? There's no proof anywhere. Just suspicious coincidences.
This has been my soap box since the mid 90’s: there’s nothing there that’s worthwhile; it’s all manipulation. Yes, that’s an overly-bombastic thing to say but decades of watching the TV-news media ecology deteriorate, and seeing the same patterns emerge on YouTube should be a huge alarm for people who care about information. The medium is manipulative to its core from camera placement, mise en scene and scripts to the editorial staff, length of segments and pedigree of guests. At every point it is a crafted product meant to drive viewers to advertisers. Kill your television!
I only watch tv news when I'm in a restaurant and the television is on. To my mind, the hell of it is that they tease with something that might be interesting. Then they futz around for half an hour. Then the thing which might be interesting turns out to be a nothing burger.
I suppose that's better than flat-out lying, but it isn't good.
If you liked this article, I bet you'll enjoy some of Matt Orchard's documentary videos, especially this one (to avoid spoilers I won't explain further):
>>>Only you, reading this ACX article, are getting the full story and learning more about the world instead of just confirming your biases.
>>>Did you believe that?
Nope, because you failed to note that the original headline picture showed people in coats and hoodies in SEPTEMBER in Oklahoma. Picture was from later winter this year (possibly January). This was...God, such bad news presentation, and I missed that clothing issue the first time I saw the picture.
Great article. Baselines and context are important, but they are anathema to "good stories," which the media desperately needs. I've been in financial markets and a stock analyst for decades. For a while, I was on the floor of SG Warburg (now UBS), which was a big international broker. Reporters would always need a story about why certain stocks were up or down. Since we were a little unique at the time thanks to our global desk we could feed them great lines that they would run with like "we've seen some major short-selling out of the Far East this morning" or "sovereign wealth funds are in buying US equities heavily since they are selling off some of their European bank holdings." Mind you these were all made up but it got the reporter off the phone right away with a "story" that would make their editor happy. This happened all the time when I was covering individual stocks as well so I had to make up something like "well the quarter was in line but A/R increased more than revenue and inventories went up sequentially which could alarm investors." Taleb writes about this in "Fooled by Randomness" which is excellent.
He distinguishes clearly between the cattle ivermectin, horse ivermectin, and human ivermectin. He says things like there are a bunch of under-powered studies of human-ivermectin-helping-cure-covid that are inconclusive, one meta-analysis of human ivermectin concluding that it's inconclusive, and two meta-analyses concluding that there's good evidence that ivermectin works on covid. Malone also points out conflict-of-interest problems and how they feed into conspiracy theories -- he talks about how Merck came out and said ivermectin is toxic when in fact it's classified by the WHO as an essential medicine, and how Merck might have had self-interested reasons to make that statement because it's making money precisely off of covid interventions that are not ivermectin.
On the other side, Tom Bartlett, who is a writer in Austin, Texas, who has lots of journalistic publications and has won an award of some kind in investigative reporting, has a hit piece on Malone in the Atlantic (https://www.theatlantic.com/science/archive/2021/08/robert-malone-vaccine-inventor-vaccine-skeptic/619734/). Bartlett starts by casting doubt on Malone's claim to have invented mRNA technology (though later in the article he confirms that he's found the early articles where Malone did just that -- Bartlett winds up emphasizing that the mRNA tech as it exists now is the product of hundreds of scientific contributions since then). Bartlett also accuses Malone of being a vaccine skeptic (though it turns out, later in the same article, Bartlett admits Malone is not skeptical about most vaccines, just the new ones that use mRNA tech in a previously untested way). So given Bartlett's reporting on Malone, we are supposed to think that Malone is a crazy unhinged far-right vaccine skeptic who is casting doubt on mRNA tech (and by extension supporting things like ivermectin) because he is... what? Because he's greedy for money? Hardly; there's not much money in the anti-vaxx business these days. Because he likes the attention from far-right wing-nuts, or at least the people whom Bartlett regards as far-right wing-nuts? That... looks like Bartlett's main explanation.
Except that Malone doesn't sound crazy and unhinged. I mean, he's got an interview where he talks like a normal human being reasoning through data. He's got the academic articles. Even Bartlett admits he actually invented the early mRNA tech. And nobody's disputing that Malone has decades of working in vaccine manufacture/consulting/whatever at pharma companies, where he was apparently not crazy enough to get fired. So he's actually got the credentials, right? And when he talks about financial conflicts of interest -- well, those are real things in the messy world of human relationships, right?
Granted, I haven't checked the data that Malone says exists. I *did* check the WHO classification list, and ivermectin is indeed there: https://list.essentialmeds.org/medicines/58.
I honestly don't have time to go digging up all those inconclusive studies and meta-analyses of ivermectin. That's, frankly, what the specialists are for. Is anyone here actually up on all this research? And if the specialists don't agree with each other -- then do we have any basis at all for thinking that people are trying ivermectin because they are "far-right wing-nuts" as opposed to people just like us who are trying to make sense of things?
Here's an amateur-psychologist way to Bulverize Malone: as one of the early pioneers of mRNA he feels a sense of ownership of the technology, even as it has moved beyond him. He's casting FUD on such later work he wasn't involved in and emphasizing his own position as an authority above everyone who came later.
That's more-or-less the approach the article takes, except it's more "he feels this tech was stolen from him, so he's railing against it in bitterness."
Your argument is that Malone "sounds" like he isn't crazy, that you're too lazy to dig through meta-analyses yourself (nor to trust Scott on them), and thus Malone must be right?
My take is that Malone is a quack. He did some foundational research in the area over 30 years ago and has spent most of the past decade complaining about imagined slights. I don't think Malone even has a job to be fired from any more.
Has Scott actually done a deep dive on ivermectin? If so, that's amazing, I totally missed it, and I need to go read it.
Actually, right now I'm the opposite of lazy -- just too busy to read much! Which is why I miss honest journalists. Their role used to be "go gather all the specialist opinions and make them accessible to the layman," so we don't all have to go read specialist articles on our own and thus multiply reading time/effort per person.
I came to make this exact comment. I shouldn't have to go to Scott to find an accurate conclusion to this story. A decent journalist should be able to put this together, and thus the "too good to check" criticism remains in force. If a random psych blogger put this story together, why did it become a nationally mistaken story from multiple platforms? I can't rely on Scott to check every story, and I clearly can't rely on the media (Left or Right) to ask more than surface-level questions.
So why should I read the news? Is it better to read journalism that I know to be poor/heavily biased/consistently wrong, or to skip the news altogether? I don't have time to dive into every story. That's literally what journalism is supposed to be for. But it's not something that the market provides at the moment. Unless I'm missing where the decent journalists are. Is there a national paper that is engaged in legitimate journalism anymore?
The large and well conducted trials seem to be showing little and no effect. That has been my amateur vague sense, as well as the direct conclusion of a number of “actual scientists” who I’ve seen look into this. The antis seem to have consistently had principled and sensible objections, comparisons, and arguments, while the pros have tended to have more careless and less scientific points.
Most of the inconclusive studies have issues. Doses too low, or not given early enough, or given on an empty stomach, or flawed control groups. These issues are well-documented.
It’s weird how the conclusive studies with those same issues are fine despite having no control group! That sort of thing absolutely can be an issue, but flawed small observational or effective n=10 RCTs just aren’t useful so I’ll still go with the studies with some meaning
Whoops, the comment I made below was in reference to a reply to someone else, so here you go: "None of them do in isolation, no. When dozens cluster around a signal, and that signal is reinforced by natural experiments worldwide, and when they are both reinforced by the impressions of frontline doctors, it's worth a look. Multiple meta-analyses are showing promise. And the risk/benefit tradeoff makes it worthwhile even if the results are inconclusive. It's one of the safest drugs in history. Before the taps got turned off and people started resorting to vet IVM, there were 16 deaths recorded in 30 years of use with about 4 billion doses. In other words, it's almost certainly more beneficial than dangerous, and normalizing it would do a lot to restore a certain cohort's trust in the intitutions."
That Atlantic article is crazy. You've heard of "damning with faint praise;" this is "praising with weak damnation." His fellow scientists say he was uncompromising! Oh, no! Uncompromising people are obviously much less trustworthy, because they…don't go along with the herd? I called people he says agree with him, and they…don't say anything about that one way or another, but I'll frame what they did say in a way that implies that he's a liar! Oh no! He got suspended from LinkedIn for posting "misinformation" (as if that isn't practically an *endorsement* at this point)!
I had been exposed to huge amounts of positive spin on Ivermectin through my social media network so I found the articles and videos above very useful in getting a more balanced perspective. Still seems like to me it may turn out to have a small or moderate effect in the end. But it does not look like to me the evidence is clear enough yet that it is.
If that's how it was being used I wouldn't care. A guy does all he should to avoid COVID and, when he gets it, to prevent its further spread and treat it - while also taking this other thing he found on the Internet? Fine.
Then it's like a likely useless vitamin supplement - who knows if it helps, and if he takes it who cares?
Sadly that's not how it's being used. It is the latest fad in a number of them that a large group of peoplr have flocked to. These people at various times have denied COVID's existence, then that it is especially infectious, crippling, or deadly. They don't want to be told what to do by smug people they don't like, and they wish none of this were happening in the first place.
They rebel then by refusing to take measures agaibst catching or spreading COVID. not wearing masks, not vaccinated, often not both. Their kid is obviously coming down with it but they still send them to school. They start feeling something in their throat but insist it's just a sinus infection; they go to work and then a birthday party anyway.
This medicine is another straw they cling to to justify their BS - we shouldn't be mad at them, as we'd not be afraid of it if we'd educated ourselves about this miracle cure as they did. It's plentiful and cheap and absolutely works; why should they keep their lives on hold because the rest of us are pussies about it?!?
I just lived through a fourth wave these a-holes either caused or greatly contributed to. We (Acadiana, Louisiana) had the highest COVID fatality rate in the world for weeks - overflowing hospitals, masses sick and dying, the works.
Maybe it's different for all of ya'll in more civilized (or at least genteel) places. Here, the response of masses of my fellow Cajuns was to point to this supposed miracle drug (the horse version - lots of horse racing here) to justify their bull, needlessly endanger me and my family (unvaccinated kids - thanks FDA!, jerks), and cripple our society and economy.
I'm sick of them, and I'm sick of their shit. I also have no patience for sophistic arguments divorced from the real world that those who should know better should indulge this bull.
Just because it's not harming you and your social circle, and there is a theoretical scenario in which a not irrational person could choose to try it, does not mean it is not causing a lot of harm., nor absolve us of our responsibility to advocate for the shit that actually helps instead.
So you think Paul's word salad was worth reading? I understand wanting to rant because people disagree with you, but I don't see anything logical or evidentiary in his post that warranted anything more than abrupt dismissal.
I appreciate the sociological background on the responses to COVID where you live. Psychosocial phenomena surround everything and I think we have not gotten as far into it as we need to in terms of medical decision making.
The rest of this post will be non-evidentiary but exploratory. I would very much like to come up with a way to bring the COVID denialists on board and so these are questions/thoughts to that effect.
"Culture of poverty" is a maligned phrase but it describes a few things that matter here. I spent some time working/living in somewhat rural areas with limited access to good medical care and where people often had lower incomes. There were strategies of function that were multigenerational, ways of dealing with a) lack of doctors and b) lack of money to pay them and c) lack of sick leave from work. People worked sick, no matter what. A sign of being a responsible adult was the ability to work sick. If you collapsed on the job, at least you had gotten paid up until that point. Adult dentistry was either, get them drunk until the pain goes away or get them very drunk and pull out the tooth with pliers. People took their kids to school sick for the same reasons; they could not afford to stay home from work, plus the kid needed to get used to doing things while ill. It was a jam-the-throttle-open way of living and sometimes the philosophy was applied in increasingly dangerous ways. If they have to disregard safety precautions for financial reasons in some areas, for some people disregarding safety precautions became a way of life. Being generally on the receiving end of bureaucratic problems, and medical malpractice, people generally did not believe the government was there to help them.
Drop a pandemic into this, and what do people do? They approach this new health situation the same way they approach other health situations; prioritize work for financial survival, and ignore and mock those who can afford medicine and those who access it. It's been the approach to everything from broken ribs to depression to cancer for decades. In a way it's been the approach to rural survival for generations; try to have enough kids that some of them survive, and work until you drop.
Having a new approach would benefit them now, and benefit everyone else due to the dynamics of pandemic. But their priors on how to deal with medical problems are very strong, perhaps cultural at this point even. Unfortunately the messengers of a better approach are usually coming from the groups that would have mocked their survival strategies before now.
I am sure you are aware of all this and I don't write it to criticize your feelings or your perspective on your neighbors. I just realized who your description was reminding me of, though, and I wanted to write some of it out. I vaguely recall people taking veterinary antibiotics sometimes and being ok; people who are sick with no insurance get creative. So:
a) veterinary antibiotics among the poor are not a new thing
b) ignoring illness and injury is not a new thing for poor people either
In a way it all makes a lot of sense. Fear of medical malpractice is also real; there's always a relative or friend who died in the hospital due to medical error, or something similar, and rather than analyze it, people reject the medical establishment.
Also groupthink, of course. It wasn't fun to be the one who disagreed with whatever the family had decided, even if they were wrong. That social pressure (I think) has roots in the relationship of the working and poor classes to obedience; when you're allowed to cause problems and when you have to get in line and do your duty. "Thinking" seems obvious to people with a certain relationship to education and to earning money; it is far from obvious as a survival behavior for those who are usually punished for asking questions of the boss.
Their priors are very strong against this type of thing.
The denialists of various stripes take advantage of this insularity among the poor. Somebody needs to meet the refusers where they are and bring advertising dollars: Fox News ads, famous Republicans saying "take the vaccine." If Dubya, Sarah Palin and the cake shop people would make a pro-vaccine ad and air it on Fox, the country music TV stations, and the evangelical channels, they might get somewhere. People need to get past what they think ought to work and go for what probably will work. Unfortunately the lives of the poor have not always been a priority for the middle, wealthy or intellectual classes; "they only care because now we're making THEM sick" is a reasonable observation here.
Those heuristics you describe still match and thread through the working pathway product of reality and survival in those places better than anything practically implementable that has yet ever been proposed by the "usually coming from the groups that would have mocked their survival strategies before now". Especially those groups are pluralty and probably majority full of people who fully agreed with the "deplorable" comment, or at least didnt push back on their "friends" when it got said.
What did that cohort need? They needed paying fullfilling non-makework not-bullshit jobs in a job market that got so tight of their cohort that employers started offering sick days, education credits, and insurance. The previous President gave that to them, with better results and better metrics since income-by-cohort metrics first started being gathering in the US. Ever. Which, of course, is why he was literally the worst and had to go.
I think you're right, those heuristics are still good - as far as they go. I'm afraid this is going to sound like a rant, hopefully I can keep it on the coherent side. The comment "we will all hang together or we will all hang separately" (Ben Franklin? Revolutionary War?) is true here. It's hard to do when the public face of leadership is contradictory, dishonest; it's extra hard to do when the public face of leadership is filtered through the legacy media and then amplified through social media, all in contradictory and dishonest ways.
"We are living in a volatile political environment. You know, to just be grossly generalistic, you could put half of Trump’s supporters into what I call the basket of deplorables. Right?
[Laughter/applause]
The racist, sexist, homophobic, xenophobic, Islamaphobic — you name it. And unfortunately there are people like that. And he has lifted them up. He has given voice to their websites that used to only have 11,000 people — now how 11 million. He tweets and retweets their offensive hateful mean-spirited rhetoric. Now, some of those folks — they are irredeemable, but thankfully they are not America. But the other basket — and I know this because I see friends from all over America here — I see friends from Florida and Georgia and South Carolina and Texas — as well as, you know, New York and California — but that other basket of people are people who feel that the government has let them down, the economy has let them down, nobody cares about them, nobody worries about what happens to their lives and their futures, and they’re just desperate for change. It doesn’t really even matter where it comes from. They don’t buy everything he says, but he seems to hold out some hope that their lives will be different. They won’t wake up and see their jobs disappear, lose a kid to heroine (sp), feel like they’re in a dead-end. Those are people we have to understand and empathize with as well."
The last half of that paragraph isn't quoted when people talk about the "deplorable" comment. I had never read the whole thing but realized I should. The other point to make about that speech, which I didn't know - the article was published 9/10/2016, quoting remarks given recently at an "LGBT for Hillary" fundraising event. The trope of "I had to leave my small town where everyone hates gay people and move to the city in order to come out and be safe" is pretty well-worn. Reading the speech, I'm thinking she was not only playing to the crowd as urbanites or Democrats but as people with negative opinions of the hypothetical homophobic hometowns they left behind. The earlier part of the speech sketches that out as well.
There's a billboard not too far from where I live that said "Turn off all media" for a while. This is a great example of it, because I know the media twist words - they did that to Trump a few times and they did it to Hillary too. It's not a monolithic media, it's multiple media factions competing to fool us as often as possible.
The "narrative" is made to look like it benefits one side or another, and sometimes it does, but enough of the time it just makes people fight. It's the middle school "friend" who tells Jimmy what Sam said, then tells Sam what Jimmy said, and soon they're beating each other up after school, and then it turns out the friend was making 9/10 of it up. There are real disagreements but it doesn't have to go down like this all the time.
NAFTA did need to be re-negotiated and he did that. We did need to leave Afghanistan and he and his successor have now pulled that off. I don't know if it will come to fruition but we need a national service program that sends coastal kids to the flyover states to work for a year and sends kids from flyover states to the coast. I didn't have a reference point for "ravaged by meth" until I was in a town where half the people were going about their day making the chewing face and so many of the kids were being raised by grandparents and disabled from uterine drug exposure. I didn't have a reference point for rural concern about gangs and drugs until I saw how there were no opportunities there, just like in some cities, saw kids (and their reluctant parents, by extension) joining that life.
That's one place the opportunity heuristic breaks down. "I'm not doing well in school, I have no money, therefore I should drop out and sell drugs" is a crisis of confidence, of social support, but also of heuristic. Since when should that even be a choice? It illustrates how cut off people feel. When the gang is a better employment alternative, there's a bad problem. This is why I support apprenticeships, charter schools, alternative high schools, any pathway that can get kids over the bump and into a career. That happens partly by broadening the heuristic. "This is actually an option for me," "I should take this scholarship and train as a mechanic," etc. The heuristic focuses on surviving demeaning agricultural and industrial jobs. It doesn't empower people to find something else when those jobs dry up. Part of the problem with making jobs reappear is we don't have the industrial base; factories are owned overseas anyway; automation. "You sold us out, now fix it" versus "You have the wrong politics, you don't deserve help" goes nowhere. I agree jobs is what people need and I think one of the only paths to that is UBI, so that people have the resources to get at whatever opportunities are available, or pool resources and start companies.
Similarly the heuristic doesn't compensate for the lies coming through the TV. People have every right to be confused, it's confusing, just like Scott's essay shows. "They're lying so we should ignore them" doesn't work anymore. I also think people systematically underestimate how much of social media - and possibly regular media at this point - is active propaganda or is unintentionally repeating propaganda. This is everybody, not just anti-vaxxers. Everybody underestimates it.
Many of the small bookstores went out of business; local newspapers are owned out of the area, publish less and less, and feel little to no responsibility to the people they serve to provide accurate content. It's not "If I write lies I'll hear about it when I see Bill next door," it's "if I write lies no one will notice and it's published far from here." So the pipeline of accurate information is missing there even more than it's missing in the suburbs and urbs.
Another data point from my time on the other side of the mirror was hearing the young rural children of color who were sure Obama was not a US citizen. No group of people is always correct, with or without the media distortions and lies.
Conversely, not long ago I had someone (who I have known for years) spend an evening ranting about how Hillary supporters had manipulated Bernie Sanders' numbers in the caucus there. The very next night this person ranted about how there had been no election fraud. I finally said "but isn't that election fraud?" and they looked confused and changed the subject. Nondeplorable media heuristics aren't terribly effective either.
When I got Covid (after 2 doses of Moderna) I had breathing problems. One evening I was talking on the phone with someone from the other side of the mirror, me huffing and puffing, saying "dammit, I didn't think it would be like this." The next time I spoke with them, a month later, they had gotten the vaccine. Did facing the symptoms of someone they knew make a difference? Maybe. People do over-emphasize things that happen to people they know.
And the media totally built it up like "if you get the vaccine you won't get sick." That impression was 100% being broadcast for months, during the whole "business can reopen when we get the vaccines because then no one will get sick" routine. Where exactly that inaccuracy originated I'll never know, but it was certainly spin; now they say "we always said people would still get sick" which, well, that's not the impression I got. I hadn't even thought of having to ask "but is it a vaccine against death by Covid or against illness from Covid?"
Can disparate factions agree in the face of this much mis/disinformation? Some of the stories put "the left" fully congruent with "the media." I don't think that's fully true, neither is "the right" fully congruent with "the media."
It just reminds me of suicide; someone gets to the edge of their heuristic, doesn't have information about what to do next, and concludes that there is nothing available and they should commit suicide. That type of thought precedes attempts, however quickly. This is why I think Scott's whole codex thing is important; getting people to think about how they think is vital and necessary. Expanding the heuristic of the suicidal person takes several forms. Expanding the heuristic of other marginalized people is also very important. Yes, there are legitimate questions about the vaccine.
If there wasn't so much manufactured distrust, the people who are the inheritors of the infantry heuristic, who breathe the diesel fumes and drink the tap water, would take the vaccine. They would be lining up for it.
Anyway. Too much rant but I think it's onto something so I'm not deleting it this time.
Are you worried at all about this being a universal argument for all forms of pharmaceutical and nonpharmaceutical intervention against any illness? Certainly it is the same one people will use to try to convince me to wear a mask indoors for the rest of my life. It would also work for chloroquine, and fluvoxamine (which I would take!), and every other medication that has been used in tiny pilot studies for COVID, and obviously the vaccines, too.
I would want my loved one to take one of the vaccines—ideally Moderna because I was in the trial, but hey I'm not picky—and possibly fluvoxamine if they tested positive anyway, but I'm not going to suggest they wear a mask for the rest of their life or wear a helmet in the car or avoid contact with my children, and absent better evidence I probably wouldn't beg them to take ivermectin either.
It is absolutely not a ridiculous hypothetical. There are many drugs that are safe for a healthy person to take but might hasten their death if they were in critical condition.
This is a perfectly good reason for the FDA to avoid rubber stamping it's use in 100,000's of people. We do not have any evidence that this is the case. On the other hand we also don't really have any evidence that it helps with Covid (Yes, I know you believe otherwise).
>And if the specialists don't agree with each other -- then do we have any basis at all for thinking that people are trying ivermectin because they are "far-right wing-nuts" as opposed to people just like us who are trying to make sense of things?
Even if there's evidence
supporting the use of ivermectin, hell, even if the studies are gold-standard RCTs performed by God himself, the people saying "I don't need the vaccine, I can just take ivermectin" are wingnuts. They're cherry-picking the studies that support ivermectin while ignoring the much larger evidence base in favor of the vaccine.
Every conspiracy theory has a tiny kernel of truth, that's how it's able to catch on and spread. Vitamin C really is healthy for you, chemicals really can make frogs change sex, there really are (small) studies supporting ivermectin. Then people think "if this part of the theory that I can check is true, maybe the crazy part is true too." Or "I don't know what to believe, so I might as well go with the drug I feel comfortable with instead of the vaccine I don't." But rejecting the vaccine is still wingnuttery, and I think it's good to call it out as such.
When you have one treatment that's widely accepted as safe and effective, and one that might be a little cheaper but it's uncertain if it'll be effective, the answer is "go with the known-good treatment while you run a bigger trial on the uncertain one," not "shrug and pick whichever one sounds good." Get vaccinated, and then you don't have to worry about the specifics of what drug you'll get if you land in the ICU.
Add to the above that the folks ridiculing your preference are caught in many, many lies and are caught suppressing the truth for political gain because they hate you politically and culturally. They call you a "COVID denier" when when you don't deny the existence of COVID, all you are is skeptical about X Y or Z (where Z might be "developed in a lab in Wuhan").
You can SEE the lies they are saying and they never apologize for so how can you trust them about things you can't see?
The bias from the "Mandarin Class" is causing significant social trouble.
The manufacturer of ivermectin urged people not to use it to treat Covid. They could be making billions off this noise, and _still_ urged people not to take it. The evidence of anti-viral properties are weak (it's for parasites, so even if it does have anti-viral properties, you can't expect it to be the best medicine to take).
I think this is a coincidence - it had me look up an old article where he DID talk about how he writes though! Might be interestinng: https://slatestarcodex.com/2016/02/20/writing-advice/ (spoiler: more than 5 parts)
I think the original conclusion of this story: that newspapers and the MSM are simply not doing their due diligence on reporting and fact checking, is still accurate, even if the truth is that it was complicated in general. The fact remains that the original story that KFOR insinuated, and that others outright state, is simply wrong and pretty much a complete fabrication. There is an interesting meta-conclusion about partisanship, but the primary result shouldn't be detracted from.
The question then to ask is what about the media's incentive structure leads to this. Journalists still like to believe in their old value set, but the collapse of traditional print media and progressively lower advertising income means most news outlets are focused on just mass producing as much content as possible to get the millions of clicks needed to survive
Due diligence, please. You can get this article and most of Scott's writing for free here, and his name isn't exactly a secret.
But you're right that you should be able to get this sort of information from the mainstream media. Or more exactly, if the mainstream media were doing its job, this article wouldn't even exist.
Its almost like their main source of funding is drying up so they're getting desperate and don't have time to do due diligence. News is a public good and needs public funding mechanisms, not just advertisement.
Government funding would be one way to solve the collective action problem for funding news, and is common in other countries. It's a domain where quadratic voting using dollars and a government seed fund would actually make some sense, but that requires a government with some level of technical competence and trust, so unlikely to happen at a national level. In the meantime we're dependent on organizations like ProPublica and random bloggers for quality control and vague coordination of donation based news.
Government funding makes it even less likely that we'll get accurate reporting about the government.
Newspapers were largely supported by paid classified ads. And then Craigslist came along, and it was free and searchable. This was very hard on newspapers.
Yeah. I was having a conversation about that with my father immediately before seeing this, which is why I went straight to "and yet no one is actually calling the hospitals to see what they say".
Local newspapers had a great combination of local news, local reporting, local advertising, and local classified ads, plus this like local obituaries. There used to be three big ones in my home town, but now the combination has about 11 staff members and mostly reprints the AP. There were multiple reporters following city government as a full time job, but now... If there were corruption, how would we even know?
IIRC, there's a great quote by Marshall McLuhan about the classifieds being the lifeblood of the newspapers...
"The classified ads (and stock-market quotations) are the bedrock of the press. Should an alternative source of easy access to such diverse daily information be found, the press will fold."
At the very least it would be better than this junk, where people don't have time to actually report. Something like voting on which newspapers get specifically government funding would help to alleviate the conflict of interest. And in the states, having local/state/federal reporting would naturally result in fact-checkers with different agendas.
Ah, I was thinking about the national/state level papers and television, where the funding comes from general ads, which have been eaten by facebook/google instead. I hadn't heard about the craigslist-local paper connection before.
There was a point when BBC news started using clickbait headlines - despite having no reason to do so. They've eased off that a little now I feel, but I think it demonstrates that they're part of the same bubble as all the other journalists and subject to all the same biases as that culture.
I know that after the last election they were considering restricting their correspondents' use of twitter after some controversies involving journalists posting partisan and false information. I'm not sure if anything came of that.
How is news a public good? Which type of news is a public good? Why would third party funding help reporters do due diligence when they can't be bothered to call or email people now? Why would third party funding make consumers of news stories demand more due diligence?
Sorry for all the questions, but no part of your post makes much sense individually or in part, other than media's funding drying up. Especially your claim of news being a public good; as an economist, that makes my hair stand on end.
I'm not trying to disrespect Scott, but really, he just does 30 minutes more googling than the average person is willing to do, and then packages it up neatly in a nice-sounding essay. You can get the facts yourself if you wanted to, nothing here requires a medical degree or pulitzer prize.
Most people just don't care about "truth" that much, especially if it contradicts their tribe's beliefs in any way. It's amusing how this fact still manages to confuse rationalists when they rediscover it for the thousandth time.
I will acknowledge you got me on Act 2 (but not on Act 3, though I still hadn’t (and have not) clicked through anything), but my defense is that I heard about this first through Eliezer and not from some random bluecheck.
However, that does not absolve me completely, and I am appropriately chastised.
Thank you for being the only commenter so far who took this in the spirit in which it was intended.
Both I and II "got me" at various points in me learning about this story. I think I was unusually cautious this week because I was reading Scout Mindset, and that there's about a 50% chance that without that I would have gotten stuck at I, and a 25% chance that I would have gotten stuck at II.
I think the reason I won't join the ranks of Calion is the framing seems to imply that there's not a clear right stance here, that I'm definitely being fooled one way or another by these media stories and there was no way I could have been wise to what was going on with each of them.
As these stories went through twitter, I went something like this:
Stage I: "Nope, bullshit, there's no possible way this is true anywhere; there's just not enough people who A. have heard of ivermectrin B. are the kind of conspiracy theorist right-wingers who would take it in as an alternative to going to the hospital C. know where to get it D. have covid E. have covid bad enough to want to take it and F. then go get it and take it for this to be even kind of plausible".
Stage II: "Nope, bullshit, there's no way one local hospital has 0 cases and other local hospitals are completely dedicated to treating this."
Stage III: "Yup, OK, exactly like you'd expect: some extremely minimal amount of people have taken this medicine, and an even smaller amount have had complications; it's a near non-issue".
The problem with what you are doing is that you are framing it in a way that makes it appear there wasn't a heuristic that would predict all three of these stages, and that everyone was just led around by the nose. But the heuristic of "The media will lie to make the right look bad, and make minimal problems related to the fringe right look absolutely massive in pursuit of that" predicts everything you mentioned, and something like >50% of your readership was using this heuristic the entire time.
It's not bad to question media stories or twitter bluechecks, but part of the point of being skeptical of them in the first place is to build up predictive heuristics - eventually you know the way they lie or are frequently wrong, and you get better/faster/more efficient and parsing things like this.
As a writer, one of your patterns is to be extremely reluctant to acknowledge instances where conflict theory perfectly predicts what happens - you are a mistake-theory purist, so this is to be expected. But the result here is that you are treating the side that got everything here right as if they did so by accident, instead of giving them credit where it's due. I am proposing that this is wrong, and that you should stop doing it.
I disagree. I think he's saying that most people, *including him,* have the wrong heuristics on this kind of thing. You're saying you have the correct heuristic. If that's actually true, good for you! For me, what I got wrong is assuming that the claim was that he worked at that hospital (group) so that the whole story was more-or-less fabricated. That is *not* the case, so I got fooled. You didn't.
Your last three paragraphs need to be read and reread by everyone. Jumping up 1 more level, the reason Scott had a blind spot here is that despite his recent bad experiences with the media, he still retains enough political affinity with them to WANT them to be reliable which makes him reluctant both to plumb the full depths of their perfidy, and to update WAY further back than he wants to about what that implies about the opinions he has formed about “the right”.
Maybe he’s disgusted with them but overcorrecting, engaging with them a little more than logic would dictate in order to not feel bad for loathing them? Hmm. Not sure.
Media are part of the psychosocial landscape which makes it interesting for the epidemiology of ideas. If you can drop a red ball in the pipe in Oklahoma and have a hundred blue ones pop out all over the world, that’s an interesting machine.
If you think the story is about the media lying to make right wingers look bad then you missed part II. The triumphant right wingers lie to make the media look bad too.
That’s a relatively minor second order effect and the topic is about media lies. Making right wingers look bad is far from their only motivation or bias, but it’s still pervasive and if you don’t take it into account you’ll err in a systematic way.
I'm not sure that's a "relatively minor second order effect". If we're talking about media lies, then understanding that making the newspapers and tv news look bad is an extremely central motivation for many of these right wingers is important.
I’ve been working in and criticizing media for over 30 years. It is absolutely a second order effect. They look bad because they lie. They lie because of biases in many different categories, but for the particular polarity “left-right”, the lies are overwhelmingly against the right and for the left, until you get further to the left than the edge of the American mainstream represented by Bernie Sanders, when they start lying against the left and in favor of mainstream liberals and Democrats.
Those lies are pointed out by those on the right because those on the left prefer not to point out lies that favor the left (again, only as far as the left edge of the American mainstream, further left than that also complains about the American media).
I'm glad you brought this up, because it pretty well illustrates my problem here. To recap:
Stage 1. Media outlet makes a nearly completely unsubstantiated but extremely extraordinary claim; based on the word of a single doctor, they publish an article claiming that so many people are overdosing on Ivermectrin in a particular area that gunshot victims are being left to die. This claim also conveniently makes their outgroup look bad and stupid.
Stage 1.B:
Every conservative goes "well, that sounds like bullshit, and it's from a publication that hates us very, very much."
Stage 1.C:
Noticing that Rolling Stone hasn't done any of the due diligence you'd want and expect for an extraordinary claim, the hospital getting caught in the crossfire indicates that all the evidence they have points to the claim being bullshit and they haven't interacted with Ivermectin at all, much less so many overdoses that they are allowing gunshot victims to bleed out in the streets.
At the end of stage one, we are left with a extraordinary claim that is implausible, unsubstantiated, and negative to the claimant's hated outgroup. It is contradicted by at least some evidence. At this point, Rolling Stone has already been shown to be pretty bad - we know to a pretty high level of certainty they didn't do their jobs, regardless of the truth of the claim.
Regarding the truth of the claim, we'd have to believe in a local situation where people negatively affected by the medication are selectively visiting hospitals in such a way that some of them have had literally no interactions with ivermectin complications of any kind, while others are bursting to the gills with OD's so serious they out-triage fatal firearm injuries.
Stage 2:
A bunch of people say "Yes, this is an unsubstantiated extreme claim that is very unlikely to be true. But to outweigh Rolling Stone's completely unsubstantiated and unlikely claim aimed at making their outgroup look bad, just providing strong counter-evidence isn't enough - we need an official statement from every hospital in the state.
Stage 3:
It is shown that Rolling Stone's claim is more or less mathematically impossible; even if every documented Ivermectin case in the country was isolated to one state, there probably aren't enough of them to overload their medical system.
I can't emphasize enough: Conflict theory perfectly predicts that the claims in 1. are bullshit, that you and others would come up and immediately believe a completely inadequate and non-sensical counter in 2, and that 3. would show the claim was never plausible enough to take seriously in the first place.
Scott is pretending that this heuristic (people who hate us and have made that clear will lie about us, so if it seems unlikely it's very probably false unless they show strong evidence) doesn't exist, and that everyone got led around by the nose equally here. But that isn't the case - only one side believed an unsubstantiated lie. One side was completely correct on all points, and believed only reasonable relatively clear things at any point.
Is he pretending it doesn’t exist, or merely hasn’t adopted it and doesn’t think most people have either? Again, you’re claiming that he’s claiming that it was *impossible* to have come to the right answer here not by chance, but I don’t see where he says that or anything equivalent.
Imagine I walk up to a gate that doesn't have a keyhole, and I'm unaware of a secret keyhole for the gate concealed in puzzle-box style behind several sliding stones in the mason-work to which the gate is anchored and have never heard tell of a key for the gate. Later on when I tell you I had to jump the gate, you can't accuse me of ignoring the key-and-lock solution.
Now imagine for years people have been telling me I don't have to jump the gate; they've explained to me dozens of times where the keyhole is, and have shoved duplicate key after duplicate key into my hands, but secretly I think locks are an out-group thing and I don't want to be associated with the outgroup, so I refuse to use the key or even acknowledge that things like keys and keyholes exist. If I show up and start talking about how weird it is that I had to jump the gate again, you'd be justified saying I should stop ignoring keys.
For Scott to ignore the concept of unlocking here, he had to follow the following steps:
1. Acknowledge that one side had done something mind-bendingly dishonest to discredit their outgroup
2. Acknowledge that the outgroup had provided evidence undercutting the unfair accusations of their accusers
3. Acknowledge that the claims of the accusers are basically mathematically impossible in addition to defying common sense
4. Pretend that both sides are on equal trickery-footing here by asking in every case "did the tricksters trick you?" for all actions by each group, as if they were equivalent and one group wasn't under unfair fire from another.
Or, shorter version:
1. Tell a story in which one side lied and the other side provided evidence they weren't telling the truth, and accuse the side playing defense of lying for not providing *enough* evidence that the mathematically impossible thing wasn't true.
He's trying to apply an implied heuristic here of "both sides are liars - watch out!" where in this case we look and it's not consistent; one side didn't lie. There's a better heuristic of "one side has sufficient cultural cover to lie and not get called on it, and does so" that actually tracks this situation beautifully, but he won't acknowledge it. He's not dumb, and he's not unaware of us telling him where the keys are on this kind of situation; he just for whatever reason thinks saying "yup, in this case these guys lied and these guys told the truth" is gauche, and keeps jumping the fence anyhow.
Also relevant to your stage I, ivermectin is an approved drug for use in humans, and it is one of the drugs lots of people looked at and said "let's see if this one is any good against COVID". That strongly argues for it to have a high theraputic index, and thus unlikely to put people in an ICU even if they take a horse-sized dose.
one thing that isn’t emphasized enough is that this is just one terrible news story in a sea of tens of thousands of terrible news stories out of a galaxy of millions of merely unimportant and uninteresting news articles. It wasn’t worth anyone getting mad about - “Rolling Stone”, not even the NYT.
I mean I actively don’t pay attention to this sort of thing at all, and am usually able to prove them wrong when necessary. It’s more like not giving homeless money when they beg, if they’re professional beggars. The stuff is bad so stop reading it!
*I* can stop reading it. Making *everyone I associate with* stop reading it is another level of difficulty. I certainly didn’t hear about this by reading Rolling Stone!
There’s permissiveness versus justice. If there are certain standards, and under them many people are being punished in a way that seems unfair, you can either revise the standards or just expand the region of “ok.” Revising the standards means maintaining some criteria for judging good and bad. Permissiveness means you can dodge ever having to do the hard work of revising.
Permissiveness seems to work for a while. Eventually, it’s either a spiritual practice, or one hits a wall and concludes no, x is bad. Y,z and pdq may still not be crimes or bad, but I’m done dealing with x. So yes I agree with you but it took quite a bit for me to accept I would have to judge some situations negatively and not conceal that. If I want to take some responsibility for maintaining or creating a better world, I have to eschew the ineffective altruism of protecting the profits and egos of the journalism status quo. Because at least some of them very well do know better, and it has large consequences to other human beings. I don’t know what to do about it but paying the better ones seems to be a start.
The two leading headlines on Fox News dot com are:
“ President's approval takes a nosedive, only 2 others have had lower ratings at this point of term”
This ... may or may not be true? The quote says that Biden has lower approval comes from ABC. He does have lower disapproval than only two presidents in the unstated time period (which is from 538’s thing here https://projects.fivethirtyeight.com/biden-approval-rating I think) but - using that side as a source - disapproval isn’t 1-approval and 3 presidents had lower approval than him (specifically Clinton) from my reading. Factually this is good faith. However, this obsession about poll numbers as a way to criticize your opposition is generally terrible, so on the balance this still sucks as a pattern.
and
“ Newsom rally speaker calls Larry Elder 'blackface' and it gets worse from there”
Where the real quote (from an alternate title!) is “a Black face on White supremacy“ which isn’t “blackface”. That’s a big difference IMO! “Blackface”, as one word, means something that “a black face” doesn’t.
So you’re probably right that this is more egregious than most! Nevertheless I still think it’s not worth caring about, and the only reason I’m even commenting is that I’ve seen the story fifty times by now and have had most of my friends get upset at it from various sides.
(1) This isn't just Rolling Stone, as Scott pointed out, it includes very serious publications such as the BBC.
(2) Scott's point here, as I read it, is not whether or not *this* article is so important, it is a critique on media and our consumption of it in general using this article as an example.
I think this is an extremely poignant piece and am sharing it with others.
When Hunter S. Thompson was still alive, Rolling Stone was edgy? Had a reputation for accuracy? Confrontation? Elevating cultural touchstones (on the cover of the the Rolling Stone etc)? That has been going downhill. This is sort of waving goodbye while the magazine sinks beneath the surface of the slime.
I've read some of the stuff Hunter S. Thompson published in Rolling Stone. (Fear and Loathing on the Campaign Trail 1972.) He definitely lied in its pages, in ways that the editors knew were lies. Like, when he reported that Edmund Muskie was addicted to some drug called "ibogaine". He just made that up.
The reason Hunter S. Thompson is famous is that he blatantly disregarded objectivity, as a kind of protest against mainstream journalism's supposedly-objective, but actually sneakily biased, practices. It's called "gonzo journalism".
Anyway, Hunter S. Thompson shouldn't be a reason for Rolling Stone to have a reputation for accuracy. Literary value, maybe, political impact, maybe, but not accuracy.
Thank you for correcting me on that. That's depressing. I had somehow thought the gonzo part was both gonzo and accurate. In retrospect that should have been obviously not true.
The problem is that, to alter the famous line from the Congressman, a little bias here and a little bias there and soon you've got real distortion. This article is particularly problematic for two reasons:
1.) There is a serious debate going on right now as to the efficacy of ivermectin as a treatment for COVID. Regardless of which side you come down on, this article is bad: if you think it IS effective, a story casting aspersions on the intelligence of people who use it will mean that fewer people will take advantage of its benefits. If you think that it ISN'T effective, a story casting aspersions on the intelligence of people who use it which turns out to be, to put it politely, questionably sourced simply fuels the "conspiracy theory" that the "Establishment" is trying to suppress ivermectin, and therefore will drive more people towards an ineffective course of treatment.
2.) This is simply another example of one side portraying the other as being less human somehow. If we hope to avoid a shooting war in this country, both sides need to cut it out.
I am a child of the waning days of the slide rule, which taught me that "If it doesn't make sense, it's probably wrong." It doesn't make sense that Ivermectin, shown to be safe for so many years, could be causing so many overdoses, nor is it sensible that you could have such a failure of the triage system that gunshot victims are not being treated over unlikely Ivermectin overdoses. What are the symptoms of an overdose of vet ivermectin, anyway? Uncontrollable whinnying?
I almost got busted on Act 2 - but I randomly saw a tweet by Jesse Singal asking about the doc not mentioning a hospital. This prompted me to read the RS article which already had the 'correction' up, noticed all of the leaps in causality (the doc is part of a medical group that hasn't specifically worked _here_ for some time, etc, etc) and decided everyone is crazy and I didn't really care that much anymore.
It's like progressing through a video game, where the writing contains both blue and red rings, and a reader will see some of them as powerups and some of them as danger. If the character gains strength from eating blue rings and loses it from eating red rings, then when the character has gotten enough of their preferred rings they stop read/eating. Maybe clicking on the links would be too much effort and the resulting media might not have the right powerups.
I'd say this is confirmation-seeking for sure, reading for confirmation of one's biases. Is the polarization increased by the presence of both red and blue rings? I think it might be. Does a red ring have more red points if it's adjacent to a blue ring? Sometimes I've read articles while sortof tallying the number of red or blue rings. The sequence ring-ring-totally unsupported allegation is not uncommon. I can't think of written material I've encountered that will build in both directions. Some have both red and blue rings, but they usually pick a side and only have either all red or all blue unsupported allegations.
There is a temptation to make a media source sound more reliable if they are throwing in both red and blue rings. I guess that's the bothsidesism. This is a good reminder that it may be full of a whole range of partisan powerups and still be airborne fiction.
I did buy into acts 1 and 2 enough, and then I think I did buy 3 for a while, but went back to it several times. I think I get it now and this is a very valuable example and well structured. Yep, there's the frustration and annoyance.
So, since the NPDS data is national, I think ~0.25 patients per day for Oklahoma is pretty good systematic evidence that this is not happening.
On the other hand, I get to have a semi-informed anecdote for this one. As I type, I'm on the premises of the biggest hospital complex in the state of Oklahoma, where I work every day. I can see with my own eyes -- literally 20 minutes ago as I came in from the parking lot, and every weekday before today -- that the ERs are not overflowing, that there are not patients sitting in ambulances and helicopters, etc. I have never heard any of the physicians and others I work with mention ivermectin poisoning as a major problem. Of course that isn't proof, but media being what it is now, I put a high premium on my own eyes and ears.
Then there is the suspicious framing of the story -- since we are a backwards red state, we must have droves of gun violence victims from our random shooting sprees competing for ER and ICU space with people guzzling snake oil cures. I guess we also must put our many overflow patients into teepees outside the Great Medicine Man Tent. But back in reality, best I can tell, Oklahoma hospitals are in the same situation as presumably any other state: strained, but not "overwhelmed", by COVID-19 patients in addition to the normal distribution of patients.
Of course my bias is that national media will get many things about red states wrong, so perhaps if I were to walk across the street and ask the hospital staff for statistics, then (assuming they would give them to me), I would be proven wrong. It's also possible that things are different in rural areas, although the complex where I'm at is the trauma center where severe gunshot victims, etc, are transferred for the whole surrounding region, so I would expect them to be piling up here if this were actually happening.
It's a global problem, it's not specific to Oklahoma. Switzerland is going through the same thing right now - a bunch of news stories asking why the country has decommissioned hundreds of ICU beds over the past year and ICU capacity is now being used as a justification/excuse for vaccine passports.
And given the numbers for OK shown at the website that James C. links to two posts up, it works out to a decrease of a bit more than 1.5 beds per hospital, which does not strike me as traumatic.
So, your claim is that staff are quitting because of vaccine mandates, and not because of, say, burnout caused by an endless stream of covid patients?
Seriously, hop on /r/nursing on any day of the week and I guarantee you'll see a post about burnout on the front page, often coupled with a comment on how difficult it is to provide care for people who think that the virus that's killing them is a hoax. And this was happening well before hospitals started to mandate vaccinations.
The comment I was replying to didn't mention burnout anywhere. And I suspect that this is a *much* larger reason for people quitting than mandates, because, as I said, complaints of burnout were appearing before mandates did. It's not false indignation, I genuinely think you are being misleading by headlining "vaccine mandates" and backgrounding "burnout."
This is the same error as the post is warning about - headlining "people in the ICU with an overdose" when the
main reason for overwhelming ICUs is "people with COVID."
I think you are probably right, intuitively it makes sense that burn out is the main reason, as it was mentionned in the news during first wave without any vaccine in sight.
This, however, does not change the main point here: risk of exceeding ICU capacity is the #1 justification for all covid policies, and people rightly wondered (during the first wave) why #ICU was not increased. The narrative then was that it was impossible to train new ICU staff fast enough. I don't know if it's true, but at least the idea of ICU capacity was a variable was floating around...Now ICU capacity is barely discussed. It's still mentioned as a justification for worrying about Covid, but like ICU capacity was some sort of physical constant unaffected by trivialities like staff salaries and compensations. And #ICU staff decrease is a second-order news discussed only as an abstract risk of mandating vaccination for hospital workers.
I wouldn't be surprised if there were instances of patients being transferred, and I can speak with a lot less confidence about ICU beds than I can about the ER, because I can actually see the ER just in passing, whereas I have to hear about the ICU by talking to people and asking specific questions.
My overall impression is that: 1) Hospitals are reserving excess ICU capacity for themselves in case they might need it, hence it must be a pain to get a hospital to accept an ICU transfer and harder than if a patient came from that hospital's own ER. Meaning that overall this could put rural hospitals who need to transfer into a tough spot. 2) Perhaps ICU slots are not being triaged effectively.
But providers nationwide have been saying for the last year that ICU capacity is extremely tight. What I don't know is whether "some instances of patients being transferred out of state" is evidence for the implied claim "Oklahoma is worse off in terms of ICU capacity than other states".
Judging from the website James C. posts below, most states are not doing significantly better than Oklahoma--and one of the few that is is the left's favorite punching bag, South Dakota, hence why one patient was allegedly being transferred there. Could it be. . .natural immunity?
What frustrates me with all of the hospital overflowing stories is a lack of any numbers or context. What avg of beds are typically occupied? How many patients are typically moved around in urban hospitals in normal situations? I've seen articles that conflate non-urban hospitals (I'm assuming can't handle more than a couple ICU if any at all) and urban hospitals. I rarely feel like I'm reading anything that is attempting to explain what is happening as opposed to manipulating me into being alarmed.
This is my biggest complaint with the news. Every time I see a story saying Thailand is having a huge covid outbreak or whatever, I have to dig and dig and dig to get any context on whether Thailand is doing worse than Vietnam or South Korea, let alone Vermont or another US state that is supposedly doing fine right now.
This is exactly what I would like to know. I've tried to calm down some people I work with regarding their COVID fears, but then they fall back on "well, what if I have to take my child to the hospital and am asked to drive four hours to another one instead?" to which I have no retort.
I've seen it occasionally noted that ICU beds are often mostly in use, so I don't know if 95% should alarm me or not. I just looked at this website: https://protect-public.hhs.gov/pages/hospital-utilization and see that for five hospitals near me, available in-patient beds range from -19% to 23% and ICU beds range from 0% to 35%. So all over the place.
My limited understanding is that hospitals work to keep ICU beds about 70% full. If that's exceeded on a long-term basis, they'll look at increasing capacity. If it's routinely below that, they won't build new capacity and might stop staffing some of the beds/units.
This means that 95% occupancy means about 25% percentage points higher occupancy than "desired", and about a 30% relative increase.
So here's the thing. I totally did believe you the first time, but I believed it because **you** wrote it. This genuinely doesn't seem like bad practice on reflection. After all, what is the point of carefully selecting a few sources to read among a sea of information if not that you can believe what they say without fact checking them?
Perhaps this stems from some kind of bias, but I am pretty confident that, if I had read something like this on twitter, my reaction would be 'no idea what's true here'. In fact, that's a reaction I have quite often.
I mean this is just a joke, and the entire point of (these sorts) jokes is to both expose and make you more aware and willing to critique such immediate trust, by using it and then exposing that false use. Scott has been wrong a lot before - less than most! - but you should evaluate what he says yourself even if you aren’t able to do it properly.
I too tend to trust Scott, and that is why I am here, but elsewhere in the comments he writes that he had about a 50% chance of getting stuck in Part I and a 25% chance of getting stuck in Part II, and may only have made it to Part II because he happened to be reading a book about bias.
So one take-away from this is to attach wide error bars to your beliefs, even when they come from reading Scott!
(I do like to think that if he was going to use this specific case as an important part of some blog post, he would have done the research then. As in fact he ended up doing for this post.)
"Only you, reading this ACX article, are getting the full story and learning more about the world instead of just confirming your biases."
Well, I definitely don't believe _that_. Partly because you practically admitted that you do not know the "full story", if such a thing even exists. Also, I'm not necessarily here to learn more about the world. I was promised a play in three acts. It was a nice play.
But perhaps I have learned a bit about (or confirmed my biases of) how other people learn about (or confirm their biases of) the world. It is interesting how easy it is to go meta once the object level becomes vague, uncertain and perhaps not that important. In fact, I'm doing it right now! But I think the question is relevant: for how many people is the object level claim in the original article (i.e. whether gunshot victims were unable to be treated "due to" an ER being filled with ivermectine overdose patients. ), what matters? I'd guess the answer is of rather limited value if you do not expect to be visiting an ER in Oklahoma. In other words, local news. Which it basically was, for a while. For many, this seems to be mainly a soldier in the culture war, although this case is interesting, because both sides appear to believe the soldier is fighting for them. What to make of all this, then? That's up to you, although I'm reinforcing my bias of initial smug skepticism about minor events across the pond.
I mean there have literally been ten thousand RCTs showing that Chinese traditional medicine is effective. (One meta analysis covered 4000 at the same time and another did 3000...). Nevertheless, it doesn’t. You can do bad RCTs, and many do.
Here's the thing though: even if ivermectin has anti-viral properties, it's still not the best medicine to take for covid. It has even worse side-effects than the vaccines, while also being less effective. In that sense it's absolutely correct to say ivermectin is ineffective against covid.
Also the manufacturer of ivermectin said that it is ineffective against covid, so there's that.
What's your source on ivermectin having worse side effects than the vaccines? I'm interested in what claims they're making about the side effects of ivermectin. It's pretty well accepted that the vaccines can put you out of commission for a day or two, whereas for ivermectin the worst common side effects seem to be mild fever, joint pain, and itching.
So i can tell you the following. I am not a Republican. I have actually read most of the articles and links. I have been following on Ivermectin for a long time. The media has been biased, you are still being biased.
1- the hospital came out with a public letter because that doctor is affiliated with them. And the same as with dr McCullough who's medical group he worked for just for having their name mentioned in an introduction to an interview. This group felt the need to dissociate/protect themselves from anything related to this mr.
2- Japanese health associations endorsed Ivermectin recently (and i am not talking about the public speech from Fabruary).
3- india just recently made Ivermectin part of the list of essential deugs to fight covid
I am bringing out those 2 recent developments to let you know, that not just early signs were positive, but even later experiences were. Which can explain the latest developments mentioned above.
4- Satoshi (the proud Nobel prize winner for Ivermectin discovery) and other collaborators, published a new study on the risks of IVM in the context of potential covid therapeutics.. You might want to check it: very very very low risk. The study is over 50 pages and quite conclusive and extensive.
5- point 4 doesn't answer for people using animal forms. But it does answer the false media claims (for multiple months now) that IVM has high risk.
6- YouTube has removed any testimony from anypne who took IVM and then spoke positively about the results .. You can still find thoae on other platforms, if you are interested in what those people had to say(maybe you will learn something).
7- Correlation is not causality, i know. But that correlation seems to have saved some interesting lives.
8- you might want to check the number of non republican doctors (they seem to be educated enough to have an MD degree), that have used and prescribed IVM and what are the results they saw. Live ICU doctors, family practitioners, etc.
Maybe then you can have an investigative answer about all this. Maybe you will have a different opinion, or maybe your opinion will be more strengthened. But if you want to start saying that you want to use logic and fight bias, well start looking at what those advocates of IVM are clinging to. You already know the other side anyway.
Ivermectin is a drug that, under certain circumstances can be useful with certain covid cases. Ivermectin is also a pretty low risk drug, when taken in appropriate dosage and formulation. Individual anecdotal reports are still dangerous, because the individual anecdotal reports don't necessarily contain any information about appropriate dosage and formulation, and they lead many people to go around their doctor, and get animal formulations at dosages that are too high for humans, which can have some unfortunate side effects.
Or do you think there is some level of home use that is actually supported by current evidence? If so, it would be good to publicize the information about what that level and formulation is, so that people don't just go around buying random things that say "ivermectin" on the side!
@Jane: Can you provide links for your statements 2 and 3? I can't find online support, beyond the statement that two Indian states were using Ivermectin.
I have found support for the statement about India. For Japan, it looks as though the head of the Tokyo medical association came out for Ivermectin, but not any official government body.
I think you should add more hedging at the beginning around ivermectin. I don't know that there's *good evidence*, but based on the studies I've seen I don't think it's crazy to believe that it *might* work. (I can even think of some reasons it might work, such as killing worms that suppress immune response. That might even account for some heterogeneity in findings. But this isn't my field.)
Probably some number of people are taking appropriate doses of ivermectin on the merits of some study they've read. Hey, that's their prerogative. And then some number are eating the horse paste wholesale and going to the hospital and taking up ER slots.
Anyway, I'd be a little more cautious in saying that it's been fully discounted already, or that there's *no* remaining evidence.
My wife's a dog breeder, so I already knew that the initial story was implausible. Ivermectin has a huge gap between 'clinical dose' and 'toxic overdose.' There's no way people are being hospitalized en masse from overdosing on it.
A bit disanalogous. The issue is with people taking the horse formulation, so I'd imagine the clinical dose for that is much higher than for humans, given body mass etc, so closer to human toxic level
Ivermectin for horse doesn't come in horse-doses, any more than e.g. toothpaste comes in human-mouth-doses. It's entirely possible that people self-medicating with Ivermectin may sometimes squeeze out more than they ought to for their daily dose, but not because they are simplistically taking "one horse-dose" and that's way too much.
Also, as near as I can tell the theraputic index for ivermectin is high enough that if you took a horse-sized dose you'd still probably be OK. Well, OK-ish, but not get-thee-to-an-ICU bad.
This seems like a feedback loop. Being polarized makes people not think clearly about issues. Looking at issues unclearly, as you mentioned, ratchets up polarization by reinforcing one's preconceptions...
Did you hear? Paul Krugman filed for personal bankruptcy.
I try to be on high alert when I run to into a story that absolutely confirms my personal biases - the ones I’m aware of anyway. The ones I’m not aware of remain a work in progress.
That story wasn't even internally consistent. E.g. it said that (1) his total loans add up to $7.35M, (2) he has a $8.7 loan for a condo & (3) his total assets are $33k.
I wrote a Substack post about Ivermectin 6 weeks ago: https://yevaud.substack.com/p/thoughts-on-ivermectin/comments . TLDR - the studies that claim it is "90% effective" are all fraudulent, the studies that claim it is "useless" have data that suggests it is 20% effective, and US research hospitals haven't looked into it because they have incompetent management.
That hasn't changed, but now there's a fourth point: "don't take an overdose of horse paste".
One thing I’ve noticed is the 20% effectiveness claims in studies are in some outcomes. But other outcomes have null or harm results. Given that and the noise inherent their null conclusions are the right choice IMO
My understanding is that the skepticism against ivermectin is a combination of:
1) the prior probability for "X cures Y" is quite small;
2) the evidence in favor of ivermectin seems to be the same as you would expect in the universe where ivermectin is neither helpful nor harmful: because of noise, studies find either small positive or small negative results; and because of selection bias, the ones with small positive bias are more likely to be published.
"That hasn't changed, but now there's a fourth point: "don't take an overdose of horse paste"."
It's cattle drench over here rather than horse wormer, but the point still stands: dosages calibrated for animals that have a much higher bodyweight than humans are not going to do a human good.
And the important point: even if it's 20% effective in treating some of the symptoms, the question has never been 'should you take ivermectin if you have symptoms.'
The debate is 'should you take ivermectin INSTEAD OF a vaccine.' That's the battle line people are arguing over here.
Unless those studies show it's *more* effective than getting vaccinated, both for individual an community health outcomes - and they definitely don't - none of them actually provide enough weight to support the 'don't get vaccinated' side.
I feel like people give too little thought to how different pieces of misinformation have different impact. If you mistakenly believe vaccines are dangerous and ivermectin works, and are middle-aged or older, you'll incur a sizeable risk of dying and a sizeable risk of causing someone else to die. If you mistakenly believe hospitals are full of people with ivermectin poisoining, you'll be more likely to rely on vaccination instead, which happens to be the correct thing to do, even if your reasons for it would be somewhat incorrect. Maybe it would cause a few people would reject ivermectin in some scenario where it would be actually helpful for them, or refuse to go to a hospital because you overestimate how overcrowded it is - but on the net, the average receiver of such misinformation would probably be better off.
That's not to say it's a good idea to spread information that you know is false or unverified but think is useful (although I do think this is sometimes a better explanation of why spreading happens than people actually wishful-thinking it true). For one thing, judging whether a claim about something happening at some hospital is true is easy enough that the average journalist can reliably do it, while judging claims about drugs and vaccines isn't, and judging the exact effect of a story on its audience is also hard, so you'd regularly misjudge those things and cause harm. And it would poison the well - if the facts you build your calculations on might have been falsified by someone in the name of some past cost-benefit calculus of their own, it becomes impossible to make good judgments about anything. We should be working on building a web of reliable knowledge fragments, not fighting fire with fire.
Still, I think if you spend most of your misinformation-related attention on false stories with low impact that happen to be convenient for your biases, and ignore false stories with high impact that line up less nicely with your prejudices, you are still committing some meta version of the confirmation bias, even if the way you verify and judge the specific stories you pay attention to is correct and unbiased 100% of the time.
There's a second-order effect you're missing (well, you do hint at it), which I (and I assume Scott) would say overwhelms the issues you mention, and that's that this sort of thing undermines the trust in the media in general, which leaves people much more susceptible to misinformation and conspiracy theory. Your reasoning is like the journalists': Every time, they don't bother to check in a sort of Pascal's Wager: Even if it's false, it would be better if people believed it was true, so why bother to check? But every time that happens, it makes the larger problem worse. I'd have to see other examples of him ignoring more-important stories to focus on less-important ones (though he's not a journalist or news outlet, so this would not really be a bad thing), but in this case, I think the decrease-in-institutional-trust effect is pretty large.
I suspect the situation is similar wrt erosion of trust in the media: false news stories have some impact, but most of it is driven by propaganda by opposing interests and by changes to the technology landscape, and would happen irrespective of how well they are doing. (Compare with erosion of trust in scientific institutions, which I think for all their faults perform considerably better than they did a few decades ago.) If you focus on clean-cut stories about media bias, you are liable of misleading yourself about the larger picture even if those stories are all truthful.
(Admittedly, I don't have any evidence for this, and finding out people's real reasons for mistrusting media seems like a difficult thing to do with lots of response bias. But it lines up with what we know about human behavior in general.)
My feeling—and I try to keep in touch with where both conservatives and Progressives are coming from, at least until they block me—is that while the propaganda certainly would exist regardless, the many many blatantly false news stories—all, in the “mainstream journalism” (i.e. not conservative-specific) realm, erring on the side of making conservatives look bad—have dramatically increased the plausibility of that propaganda, which in a sane journalistic environment would be treated as propaganda usually is: Taken seriously by a hardcore base, and viewed with skepticism by most other people. But conservatives have gained the impression that the media establishment is firmly against them, and willing to use any means, honest or dishonest, to discredit and humiliate them, and what’s more, that impression seems to be *correct.* To my view, this is having a profound impact on the political and social landscape, to include the election of Trump.
There's a noble lie argument basically. If the harms of invermectin are exaggerated people are less likely to take it, and more likely to take the vaccine, which is the outcome we want from a public health perspective. But as with all such things that has to be weighed against loss of credibility.
I fell completely for Act II... despite just having been exposed to the morale of Act I and, well, that there were 3 Acts. [insert large facepalm]
Of the ones I checked, The Guardian actually has an "amendment disclaimer" at the end. But it pretty much looks like the left the article/title as is, and then just slapped at the end this:
"[NHS] said [...] that Dr McElyea was not an employee but was affiliated with a medical staffing group that provided coverage for its emergency room. NHS Sequoyah had not treated any patients due to complications related to taking ivermectin [...]"
I kind of think that this is even worse than no amendment? Because one can hope that e.g. the BBC one didn't know of the controversy and left it as is. The Guardian's has a "fact-checking done, good job, let's pat ourselves in the back" feeling. Despite the title literally saying the doctor made the ivermectin->hospital collapse implication. But well, maybe, at least they tried? I don't know anymore.
This is a marvelous post! Instapundit has a recent post (by Ed Driscoll) about the story, and the comments illustrate every scene in your play . . . I added a comment with a link to the post, since you said it was okay to share.
In some sense, the true story does not matter here. The style of reporting here is what matters. We need to find a way to incentivize this, or at least disincentivize that *other* stuff.
This kind of fake news is encouraged by the capitalist economic system. When there's a major financial incentive to lie for sensationalist clicks the media will of course do so as their primary concern is one thing - profit. Once again we see the profit incentive perverting the proper functioning of society.
The antidote to the problems of capitalism is always more capitalism. The problem here (as always) is insufficient competition. Sure, news outlets lie for profit. But the problem is that there's really nowhere else to turn. As the understanding of the problem becomes more widespread, I expect the market to come up with better solutions. (And note that some of the problem is due to the FCC limiting the number of broadcast news outlets, creating an oligopoly. I'm not sure how much of an impact this has had, but given how influential broadcast news was for decades, I wouldn't rule it out. Also note, as Radley Balko has pointed out, that journalists are, by and large, cheerleaders for the State, which would seem a difficult problem to blame on capitalism.)
Capitalism gives people what they want. And lots of people want to have their prejudices confirmed regardless of the truth. The real problem is the customers/consumers:
Agency isn't relevant. Bad outcomes are relevant. If all you want to do is have a scapegoat to blame, then sure, you can blame the bad agents here.
But if you want to actually improve the situation for people in the world, you need to figure out what change will actually result in an improvement for them, rather than just figuring out who to blame, and then also blaming the next person that does exactly the same thing.
When the system provides a huge incentive and no penalty for someone to do this, it seems not very productive to complain about people taking the action when you could be complaining about the system that rewards it.
I actually don't think capitalism is significantly to blame here - as TGGP says its acting as a proxy for the preference of people to read clickbait stories instead of valuing true information. Any other system that replaces capitalism should still try to reward people for giving other people what they want, so the answer is probably perpendicular to the economic system.
To second order, capitalism does tend to put a very large number of people under a lot of pressure and eat up available time and attention and this might put them in a threat state where it feels more important to protect their tribe/worldview than to seek knowledge (survive rather than thrive).
I wouldn't blame capitalism for putting people under pressure etc. but rather the ever increasing trend towards making everything political. Personally, the fact that people seem to want to dictate what is mandatory and what is forbidden in every aspect of life, and punish me for not wanting to make the same choices they do is what makes me feel threatened.
I think it's the other way around. I think people are afraid of an environment where saying things publicly can cause you to lose your job - but that's scary because the cost of living is huge and jobs that pay well enough to meet them are scarce. It's the material conditions that make that situation threatening, not the mere fact of people booing you. How scary would that environment be if we lived in a world where people had more financial security and any old job could be expected to provide you with the necessities of life?
Saying "the real problem is the customers" is all fine and good if you're just looking for someone to blame. But if you want to end up with a better outcome, you want to figure out what change to the system can result in a better outcome *even with* problematic customers like this.
The BBC is a capitalist entity now? They had as much of an obligation to confirm this story as anyone else. One that might plausibly have been satisfied by a close reading that indicated Rolling Stone had properly confirmed the story, but that turns out not to be the case. So what's the explanation for non-capitalist BBC being just as eager to jump on the "stupid idiots with their horse dewormer" bandwagon as everyone else?
The harsher the competition the more measures one will utilize to get ahead. Why would a company whose primary concern is profit put things like journalistic principles ahead of profit simply because competition is fiercer when doing such a thing would jeopardize the financial success and future employment of the outlet? There are plenty of good news sites out there if you look hard enough, they just are not well known for the aforementioned reasons, among others.
This is the way things have always been in journalism and there's no reason to think that "more competition" would make things better as opposed to worsen them. More competition has never led to improvements in anything, its only ever led to a bigger cannibalistic frenzy.
>"journalists are, by and large, cheerleaders for the State, which would seem a difficult problem to blame on capitalism.)"
Generally those in power are aligned to the interest of big business (who own the media) by virtue of this aforementioned fact.
You mean Science and Nature the scientific journals? I really don't think they do, at all. Nature is terrible. I read a paper in it the other week where literally the very first statement was wrong, and unambiguously so - it claimed Sweden had amongst the worst per-capita COVID mortality in Europe, in fact Sweden has significantly better than average per-capita COVID mortality. The statement was wrong on the date of publication and wrong on the date of submission. The paper was claiming that because despite being published in August 2021 the data it used only ran up to July 2020. More than a year out of date!
Sure, local news is terrible and untrustworthy, but at least it's actually about things that happened recently. Nature can't even manage that.
Are you sure it was in Nature proper and not one of the many Nature BioMolCom whatevers? Nature proper has higher standards. And a few bad papers doesn’t make the general journal not a top journal and a place where a lot of innovative and important research is published.
I think that's Nature proper. At least I see no evidence it's a sub-journal.
People keep insisting that Nature has high standards, but this paper is not an isolated incident. They keep publishing BS papers by this team at Imperial College London, they keep getting called on it, and they just don't seem to learn or even care. Often the papers have problems so basic you are forced to conclude nobody without major conflicts of interest can have actually read the paper at any point before publication. For example one of the previous papers from that team, also published in Nature, was an exercise in fiction and circular logic - and actually admitted that in the paper itself! Didn't matter, nobody cared, and because it flattered the egos of academics it now has 1300+ citations. It's this sort of thing that makes people think science is garbage.
>The harsher the competition the more measures one will utilize to get ahead.
True. If competition gets harsh enough, perhaps one will even try *good journalistic practices* to get ahead, rather than using their platform to push their own political agenda!
>Why would a company whose primary concern is profit put things like journalistic principles ahead of profit simply because competition is fiercer when doing such a thing would jeopardize the financial success and future employment of the outlet?
This begs the question. You’re assuming that there’s zero market for good journalism. If that’s true, don’t we, as a society, deserve what we get? But if it’s *not* true, then in a sufficiently competitive environment, good journalistic practices would result in profits, as those people who want that flock to that outlet. In the long run, I suspect that this would put pressure on the rest, too: Yes, people want to be told what they want to hear, but they also don’t like finding out they’ve been wrong, and they would like to believe that they’re not ignorant rubes consuming obvious propaganda. And I think that people also would like the truth, though that’s fairly low on the priority scale.
>There are plenty of good news sites out there if you look hard enough, they just are not well known for the aforementioned reasons, among others.
Certainly not well-known to me! Could you direct me to some of them?
Competition seems pretty harsh now, and the FCC isn’t doing all that much harm to the internet news services. Making a better service is great but there are lots and uh readers aren’t so much
If there is zero market for good journalism, why do you think it would ever be produced by anyone under any economic system? If you take the assumption that there is zero market for good journalism as true, the only answer is that no one wants good journalism and it will never be produced, every by anyone for any reason, because no one wants it.
Empirically, at least a few people want good journalism because people complain about the bad stuff, so... there is a market, although perhaps a small one compared to the market for bad stuff.
once upon a time, in a land far away in a time before time, some people knew how to vaccinate people (well, variolate) and very few had it happen. A thousand years layer, trade and information sharing and states and scientific investigation developed to share it. It was not a good thing that nobody wanted variolation. Neither is it a good thing that the market for cheap and whole healthy food is smaller than that for food that causes massive healthcare costs. Even if we restrict ourselves to the unfeeling and abstract knowledge of that dismal science Economics, market failures and stabilizing interventions? As well as innovation and changes in information causing unmet niches to be filled, are more a rule than an exception. Given that, to say that nobody wanting something meaning it doesn’t matter is comical and harmful. Who wanted biomedical science in 1650? “If I had asked them why to make, they’d have told me faster horses”.
>More competition has never led to improvements in anything
Except better and cheaper computers, food, appliances, air travel, clothing, and most of the things that make up our modern world. Perhaps the most striking example is TV, which sucked (TV was rightly called the “boob tube”) until streaming services broke long-standing broadcast and cable oligopolies and started producing genuinely good programming.
>Generally those in power are aligned to the interest of big business (who own the media) by virtue of this aforementioned fact.
That’s true, which explains our regulatory state, but it doesn’t hold water here, as generally the owners of media outlets are conservatives.
I should have said "CEOs" rather than "owners," though the latter is probably true too; I would guess that the average stockholder leans conservative. CEOs in general are much more likely to be conservative (https://www.cnn.com/2019/05/14/business/republican-democrat-ceos/index.html), and I see no reason to think that that doesn't apply to media companies (in fact I've seen it claimed that media company CEOs are largely conservative, though I can't find that claim at the moment).
Moreover, I think this misses the point. Journalists do tend to align with the interests of politicians, but that *hardly* means that they're advocates for big business. I strongly suggest you read this article: https://reason.com/2010/11/01/the-media-arent-liberal/
News for a long time hued pretty closely to "just the facts, mam" and went out of its way to attempt to be objective. But that was when TV news was a loss leader and when print news had ads that paid for the news gathering. More capitalism obliterated that.
Now we get "narrative" news that doesn't really hide its "lesson" agenda and clickbait headlines not just from fringe outlets but from the NY Times and WashPo. So the problem isn't so much "insufficient competition" as it is the optimizing for every last cent in every possible way which is capitalism taken to its logical extreme.
The problem with the market here is that people in general aren't willing to pay extra for well researched stuff, when they can get so much for free. But good quality journalism is a public good. So. There's a collective action issue
The Soviet’s had plenty of fake news and science. They were seen as a beacon of anti capitalism by many in the US at the time.
Let’s say we just nuked money and corporations. They’re gone. Wouldn’t news article writers still want to write interesting and well viewed articles? People still share internet pages that debt agreed with but were not correct? Even pre capitalism, or merely among groups of children or social groups, false rumors and malicious slander were and are common. Profit isn’t the only driver.
And those entirely different reasons were what, exactly? (For the moment, we'll skip over the fact that every socialist news service was just as full of crap as the Soviets' was.)
And as far as profit being a driver: one does not succeed in a capitalist system for very long unless one gives the market what it wants, in a way which is at least perceived to be better than what others are providing. If the people want news which is informative and accurate, sooner or later the outlets which produce informative, accurate news will succeed and drive the others out of business. On the other hand, if what people want is to have their prejudices confirmed, then that is what the market will provide--and even a theoretically perfect socialist system completely driven by the desires of the masses (which has never existed, and never will) isn't going to solve that problem.
Do you have an example of a non-capitalist economic system that produces news that is high quality and objective with regards to truth? My sense is that all state run news systems without free competition tend to be uniformly bad, as in the news is very uniform because it cleaves to the state's story and very bad in that is lies like it is its job. Which of course is its job. Pravda isn't exactly held up as an example of journalistic integrity.
Good article. A well done article. I have no place to complain about it.
My main takeaway from it is yet more despair and hopelessness. It takes hours or days just to maybe understand an infinitesimal fraction of a fraction of a single issue. I mostly understood that by now, but I guess a reminder is helpful. I just need to remember to keep myself resigned to the fact that I will only ever understand a couple pieces of this world's billion-piece puzzle.
OK. I actually live in Oklahoma City and happen to know a couple of ICU nurses, and they've been saying our hospitals are overwhelmed for a while, long before ivermectin became a talking point. Neither has mentioned anything to do with poisoning cases, although I just asked specifically and haven't heard back.
As for gunshot victims, that doesn't ring true either. Checking the crime statistics, there have been 52 aggravated assaults in the last month here in OKC. Obviously that's not a perfect match for gunshot victims (many aggravated assaults are not with guns, some people get shot by accident) but I don't think the rate for the metro is higher than 2/day. The ICUs are full to the point that it might be hard to deal with, but it's COVID, not ivermectin.
Wait. Looks like I screwed up my numbers on gun injuries because the data field I was looking at was based on the map's zoom level. I now have 146 aggravated assaults in the last month. OK, 5/day rather than 2/day.
Heard back from one of my friends. She'd only heard of one person in her hospital when I first asked, although she did a bit of checking and there were a few more. But I really doubt she wouldn't have heard more initially if there were a lot.
Do I believe you could, rather than reflexively default to other experts, deploy your perfectly suited analytical skills to the patient, humble evaluation of the purported antiviral, anti-inflammatory, immunomodulatory capacities of a repurposed drug which, when employed with other therapeutics in concert, have shown enough promise not to dismiss them out of hand (and which people might reasonably, vaccinated or not, employ when, not if, they get it)? Hell, yes.
or, if I might modify my humble request (dude, I'm the one of maybe three people in your whole listserv with any metaphysical commitments, so for the love of God, answer questions just this once outside your bubble): what's your analysis of all the reasons people are seeing positive potential? If all those practitioners who see therapeutic effect are wrong, what are all the reasons, and the most likely reasons, they're wrong: grift, glory, methodological flaws, placebo, confirmation bias, hallucination, fraud?
I think people are seeing positive results (and that Cochrane meta-study has links to a lot of studies that are "no result/slight result" rather than "wowzers, this is a miracle cure!") is because (a) many of the studies, as listed above, are done in countries where I'd expect a lot of poor/rural communities with bad/poor health outcomes, including worm and other parasite infestations and (b) everyone is looking for the new silver bullet.
So you're a peasant farmer in Bangladesh and you picked up a worm infestation. You also picked up a dose of Covid. Treating you with an anti-parasitic drug in combination with other therapies is going to show a better result than leaving your system to fight off both at once.
Your prior on the effectiveness of any given drug for covid should be pretty low given the vast number of drug candidates in trials that fail. There has also been a massive global effort over the past two years to find safe and effective treatments for covid, so seems unlikely there's be any low hanging fruit
Cochrane reports are often viewed as the "gold standard" for meta-analyses. This one concludes "Currently, evidence on efficacy and safety of ivermectin for prevention of SARS‐CoV‐2 infection and COVID‐19 treatment is conflicting."
This is the same trial platform that found the beneficial effects of (cheap, out of patent) dexamethasone, which I read somewhere (sorry, can't find link quickly) is said to have saved tens of thousands of lives. So it's hardly like "mega-corp" is suppressing this, it's just being careful.
Science is slowly winding its windy path to the likely truth, whatever that turns out to be.
I've pulled out what I could from that Cochrane report on where the studies were carried out, and my uneducated opinion remains the same: that the efficacy, if any, is best where it reduces the parasite load and frees up the immune system to fight off the virus and respond to treatment. If you're a patient in developing or third world countries, it's probably no harm to get dosed on an anti-parasitic drug. If you're a first world patient in otherwise good health, I think the benefits, even prophylactic, are dubious to useless.
1. Bangladesh
2. Spain
3. Pakistan
4. Mexico
5. India
6. India
7. Argentina
8. Colombia
9. India
10. Turkey
11. Brazil
12. Pakistan
13. Egypt
14. Lagos, Africa
15. India
16. Brazil
17. Spain
18. Argentina
19. Pakistan
20. Bangladesh
21. Egypt (this was a favourable study, later withdrawn due to concerns raised)
This is a very clever way of reading the data and in the spirit of Scott's post I am going to preemptively cop to being on this level of "Did you believe that"
Well, I could be totally wrong and ivermectin turns out to be an amazing anti-viral on top of everything else. But I'm going to stick to "it does what it says on the tin and if you're suffering from sarcoptic mange mites, go right ahead, but otherwise cool it unless a doctor prescribes the human version to you".
People are so anxious for "definite sure-cures!" that they'll swallow (ha!) any story about "this showed up in clinical trials as IT REALLY WORKS". I'm just surprised to see otherwise reasonable people jumping at "Doctors hate this ONE WEIRD TRICK" kind of story, but hey, we're all only human!
They note that 90 drugs have been approved in the 53 years covered by the review, despite thousands of candidates, and of those 41 were specific to HIV and another 18 to hep C, leaving ~30 drugs over half a century for all other viral diseases. To be sure, prospects are looking up, but it's in general a very, very hard problem to solve, for the simple reason that viruses until they infect a cell *have* no biochemistry with which you can hope to interfere, and once they infect a cell their biochemistry is tightly twined up with yours. The protease inhibitors for HIV were arguably the first clear win, and *those* began with the tremendous advantage of having an atomic-level resolution of the exact (and highly conserved, and unique to the virus) enzyme with which they needed to interfere. Pretty much no other virus in history was as intensely studied as HIV in the 80s and 90s, and even then it took $billions and decades to painstakingly craft an effective drug.
It's certainly *possible* that some random existing drug so perfectly matches up with the SARS-CoV-2 lifecycle that it turns out to be the equivalent of a protease inhibitor for HIV (as opposed to the near uselessness of Tamiflu for flu) -- but if so that would be a spectacularly lucky thing, the equivalent of a cross-Atlantic hole-in-one. That doesn't mean it couldn't have happened, but it's quite reasonable to be skeptical a priori. Drawing all the correct numbers on Powerball on your first try would be more likely.
If true, that means that basically everyone on every side of the ivermectin debate was simultaneously right and wrong, and that we were all too mindkilled to figure it out early enough to be useful. Any outcome that infuriating seems likely to happen, of course.
The problem with this sort of thing is that it takes a smart person like Scott a decent amount of effort to sort out what is going on. People normally can't do this and it is not a good use of their time. The most unfortunate form of this sort of debacle is when it deals with someone's reputation and their life accidentally gets somewhat ruined. If you're unwilling to do this much research to fact check, should you not watch news at all?
> If you're unwilling to do this much research to fact check, should you not watch news at all?
Well, if the only reason you watch the news is for truth-seeking, yeah, it's probably not a good idea to rely on it without fact-checking. On the other hand, there are lots of reasons (some good and some bad) to watch the news anyway: be entertained, get topics for conversation, get insights into public opinion, etc.
I only watch/read/listen to news to find out who's dead and what politicians have been caught with their fingers in the till (our mini-scandal over Katherine Zappone continues to rumble on, but nobody is going to be punished for it or bear any responsibility, and I've already read a couple of newspaper articles about 'is it really so bad, really?' where the political stance of the newspaper proprietors is being pushed by the opinion columnists faithfully).
Watch news for the sort of purely factual reporting that is almost certain to be correct. Today's weather forecast is probably accurate. Yesterday's sports scores are almost never wrong. If a press release is out saying a new restaurant is opening down the street next week, probably true. News can have the exact release date of a movie you're hoping to see when it comes out.
Don't rely on news to form your opinion on large-scale social trends informing your beliefs about how public policy should work based on spectacular single-event accounts.
As someone who lives in Oklahoma, I have also been confused and annoyed by this whole thing. I'm not saying that absolutely no one here is doing stupid things with ivermectin... but if enough people were doing this that it overcrowded the local hospitals, I think I would have heard of that. My local doctors don't seem any busier than normal. Not sure about the local hospitals, but considering we're currently in a Covid spike, "the surge of Covid cases is overcrowding hospitals" sounds plausible... especially since the OKC hospitals serve not just the metro area, but also the rural towns, where vaccination rates are lower.
As a side note: I believe I have ivermectin somewhere in the house. I was prescribed the cream version for my acne several years ago. Does this mean I can claim to be "one of those idiot Oklahomans talking ivermectin"?
As per references to NHS Sequoyah, the hospital seems at least somewhat related to Dr. McElyea himself as it is one of the two hospitals U.S. News lists he is affiliated with:
As soon as you divide people/newspapers etc. into "the good guys" doing good reporting and "the bad guys" spreading misinformation you set yourself up for the fall. As soon as you look for easy categorical answers in something as messy as daily news you set yourself up for the fall.
A more truthful view might sometimes feel confusing and annoying, but it is also possible to appreciate the complexity of the world with a sense of wonder. Then epistemic doubt comes naturally. As someone said: If you wish to see the truth, then hold no opinions for or against anything (https://www.age-of-the-sage.org/buddhism/third_patriarch_zen.html).
Scott, I think you are trying too hard to find equipoise. It all starts with RS running headline behind the click-baity "Doctor says...X is true" as opposed to "X is true". Further, a real news organization would have heard the quote and demanded hard data: which hospital, on what day, with how many numbers etc. The reporting technique RS used sets my Bayesian priors at 'highly improbable'.
And indeed the lack of follow up data in the article implies either 'too good to check so we didn't' or the far worse 'we did inquire, it was not confirmed, and we ran with it anyway.'
I am also burdened with some insider information as physician. First, Ivermectin overdose is likely to cause the type of symptoms (mild GI mostly) that would have all triage-abiding staff drop the Ivermectin patient like the proverbial hot potato if a hot trauma came in. Any delay would be measured in seconds. Further, not all gunshot wounds need urgent attention. Indeed, my first surgical case as an intern was removing a bullet that was present for two weeks...a case so ho hum the residents did not want any part of it. Thus, the gestalt of the article, "Ivermectin overdoses are causing gunshot victims to get worse care", is highly unlikely even if these OD cases were far more common than they are
I have to say, the headline as written made me wonder "Good gosh, how many shootings are there in Oklahoma that the hospitals are being filled with them, except now the ivermectin poisonings are pushing those out?"
Are there a lot of gunshot victims? If there are three cases of ivermectin poisoning, are they displacing three gunshot victims or only one, on the basis that "you're okay, you only shot yourself in the foot, it's not lethal, but these three will die if not treated immediately, so you have to wait longer to be seen"?
I'm just pleased I followed this through the same three acts and reached the same satisfyingly muddy conclusions before reading this. [Act I was egregious, Act II satisfying, Act II interesting].
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It's the same with ivermectin itself, it's not gonna be no panacea, but it ain't no hemlock neither. I actually think a lot of confusion [political stream info-hysteria issues aside] is around interpretation of academic rigour and phrasing, so I'm waiting on the Oxford study.
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At the moment I have as much time for people that shout 'horse de-wormer duh, it doesn't work' at people taking a human, safe dose to hedge an albeit small bet [sympathetic prescription if you will] as those that take a veterinary dose thinking it'll cure them and vaccines won't.
You repeatedly refer to the hospital with phrases like “some random unrelated hospital” but that hospital was not “unrelated”. Our first clue Is that the hospital’s statement says: “Dr. McElyea has not worked at our Sallisaw location in over 2 months”, a line which suggests he HAD recently worked at that exact hospital, making that specific hospital a good candidate to perhaps be the one he was talking about. Which might naturally lead people in the area and/or press to be concerned/wondering about THAT hospital, which explains them making a statement about it.
Which lists two affiliated hospitals, one of which is the one that made the statement.
Quote: “Dr. Jason A. Mcelyea is a family medicine doctor in Sallisaw, Oklahoma and is affiliated with multiple hospitals in the area, including Integris Grove Hospital and *Northeastern Health System Sequoyah*.”
NHS weighed in first. Integris Grove Hospital hasn’t yet responded to requests for comment but a third hospital in the area that he is thought to sometimes work with (McAlester Regional) has; the statement they made was: “At this time we are not aware of any Ivermectin overdoses at our facility. Dr. McElyea is not employed with McAlester Regional Health Center.”
TL;DR: the hospitals making statements are related by (a) physical proximity to his practice, (b) having worked with him at some point (and being identified as such in well-indexed online sources).
There's a nice irony that a news story piling on to the general perception that red states are briming with anti-vaxxers led with a photo of people in a red state lining up for vaccinations.
I don't think there's anything specific about Rolling Stones there; thorough fact-checking was once considered a requirement for any serious newspaper, and then fell victim to to changing business models - social media siphoning advertisers away with its promise of much better targeting resulted in most media organizations' budget decreasing by a magnitude or so, consumers turned out to not care about accuracy all that much, but - in a world of instant notifications and social-media-mediated news - they do care a lot about speed which goes counter to accuracy. It's a big problem; I'm not sure it is useful to treat it as a moral problem (other than maybe, as Scott implies, a problem with our own epistemic mores as news consumers).
I'm not sure that's really true. Is anyone actually offering accurate, properly checked, trustworthy news that has a systematic, engineered approach to accuracy? I can't think of any. I'd be interested if there was.
I think the root cause is journalism culture: the average journalist thinks the way to make news more trustworthy is to hire superior journalists (at best), or to attack people who claim news isn't trustworthy (at worst). They don't think, "maybe we should create and constantly refine a system for ensuring everything we print is true".
At the big tech firms, when there's a failure (like an outage) there's a whole post-mortem process you follow, action items are defined, tickets are filed and assigned, there's followup, and often new automated checks are put in place to stop the problem repeating. That's why the big internet sites are these days more reliable than your internet connection. Also, famous software failures like the Therac-25 are taught and studied, people do research into ways to avoid repeats, they hold entire conferences on the question of improving reliability.
Journalism has absolutely no notion of this. If a journalist publishes an outrageously deceptive or false article, at best you get an apology or the journalist might be fired. There is never any kind of more in depth followup where an explanation of process failure and improvement is posted. They just don't think that way.
2 got me, but I'm not convinced you actually refuted it. Relying on the word of a single doctor without bothering to check does seem to be what actually happened.
For what it's worth, I have no specific distrust of Rolling Stone compared to any other publication short of purely public databases like FRED or the US Census tables. But the idea that hospitals anywhere are seeing large amounts of poisoning cases and turning away gunshot victims doesn't pass a basic smell test. I can easily believe a doctor somewhere saw one gunshot victim in triage having to wait a bit longer at a hospital that was also currently treating one poisoning victim, said something in a moment of frustration, and the news ran with it because it makes for a good headline likely to attract this kind of attention, that is, no one was specifically lying exactly, but the framing was intentionally sensational and misleading and nobody bothered to check how bad this problem really was.
That still seems to be true. Hospitals in Oklahoma are almost certainly not seeing many poisoning or gunshot victims compared to everything else people show up for, and Rolling Stone and the BBC and whoever picked this up from the original local source do not appear to have made any effort to figure out how prevalent either poisonings or gunshots are right now in any specific region of Oklahoma at all, nor did they call the original doctor that was quoted by the local news.
> I’m still not really sure about a lot of this, and I still haven’t done anything extreme like call any of the hospitals or doctors involved. It’s just what I think is the most likely picture.
The much less extreme yet equally effective strategy is "hire someone to call hospitals for you." Research assistants are pretty useful!
That's what newspapers used to do. But they basically can't afford it now due to the collapse in revenue from subscriptions, classifieds, etc. And the only reliable revenue stream now is advertising which depends on getting as many views as possible, incentivising mass production of clickbait
I never know the line between confirmation bias and making sensible judgments.
Like, I believed the initial statement because I have a high trust in Scott A. He has earned that trust by being reliable over years. I'd also be inclined to believe it because I do not trust the media as far as I can throw them. This distrust has been earned by being highly unreliable over the years. So I see that tweet on this website it seems like a slam dunk. And later turns out to be a slam dunk (Scott makes it seem like a gray area, I don't see it that way).
Like, these broad generalizations might be wrong 20% of the time. But I don't need to be more right than that.
I don't know about Scott, but I'm willing to bite the bullet and admit to feeling smugly superior to Rolling Stone, and The Guardian and BBC and anyone else who bought in to really any version of this story.
One's prior for "maybe the latest crazy medical fad is causing people to poison themselves in such vast numbers that they are overwhelming hospitals on a regional level" ought to be very low. Has that *ever* happened? It's certainly quite rare. There are some deeply stupid people out there, but there seem to be barriers against stupidity manifesting in this particular fashion.
A member of a high-trust society might be forgiven for taking a single report from a reputable newspaper as cause to update from "very very unlikely, not worth considering" to "oh crap, this is really happening". But reporters and editors for a reputable newspaper should *not* be forgiven for running a story like this without e.g. calling hospitals to check, asking their in-house medical experts whether it's even plausible, or, yes, checking out the National Poison Data Center. If you're a reporter, randos with an axe to grind will call you with stories about how the outgroup is stupid and evil, and it's your job to sort out a little wheat from a lot of chaff in a way that requires tedious effort. Shame on all of them.
Also, we don't live in a really high-trust society, particularly where the mass media is concerned, and Rolling Stone is not a reputable newspaper. They're the ones who broke the UVA fraternity rape "scandal", remember? One should have at least a moderately high prior for any mainstream news outlet, and Rolling Stone in particular, inadequately fact-checking claims that the right-wing outgroup is stupid and running exaggerated "right-wing outgroup is stupid" stories; if it's Fox News s/right-wing/left-wing. *Particularly* if you are e.g. an editor at BBC deciding whether to just blindly run a Rolling Stone (or Fox News) story under your own masthead.
And you should have an even higher prior that anyone "debunking" anyone else on Twitter, of all places, is taking an inadequately-researched cheap shot that doesn't debunk much of anything.
There were only ever two rational responses to any of this. First, seeing a fantastic story aligned with the known biases of the medium, quickly look to see if they are making a strong effort to call out their confirming sources and saying "nope, so it's probably grossly exaggerated at the very least and irrelevant to me, so I'm ignoring it". Or second, deciding that it might be relevant and looking for reliable sources yourself. That applies to the original story and the "debunking" tweet, though if you've appropriately dismissed the original story then why would you bother with the tweet.
Is there anyone here who saw the original story and thought it was likely to be at all close to the truth?
Well as a dyed in the wool empiricist my priors were:
(1) People are generally self-centered tribal idiots (if mostly well-meaning self centered tribal idiots), and therefore...
(2) In a pandemic some modest fraction will do dumbass things, and
(3) A larger fraction will seek confirmation of their hopes and fears about the pandemic in the anecdata of the dumbasses, and
(4) Those responsible for reporting, whose Christmas bonuses depend on page clicks, will exaggerate the dumbassery in ways that assist the confirmation bias of whatever their readership demographic is, and finally
(5) What is *actually going on* is exceedingly hard to know, unless it's happening to you personally right now, and is probably only determinable to any reasonable degree long after the dust settles, and perhaps not even then (cf. Rashomon), and therefore
(6) You should base your personal actions on what you have personally experienced, and what has been long established by painful repetition of empirical confirmation, and generally ignore emergent stories that suggest upending either. And also:
(7) Being a reporter or pundit is a miserable career that would give me ulcers.
Every one of the versions of the story you told supported all 6 priors, so I didn't experience any displacement shock at any point. Nor do I worry much about what it means if yet another version of the story emerges, because I rather suspect it will be in line with all 6 priors.
I'll latch onto this comment because it perfectly expresses a part of my point that I would have otherwise expressed pretty poorly.
What I want to add is how completely uninteresting the stories are. That is, the problem is not an object-level bias, it's priorities, I am not clicking any links or researching the story further not because at any point I believe what I'm reading, or even believe I correctly interpret what I'm reading, but because I don't expect it will lead to any meaningful new information. As someone mentioned above, a minimally functional bullshit detector can catch the sheer implausibility of Act I, so I'd disregard it as journalistic malpractice on first sight. For this reason, I'm also not going to bother researching Act II, not because I'm inclined to believe it unquestionably, but because unless one is having a particular narrow interest in the culture wars and the ways media stories are conceived, there's nothing to gain from checking whether a particular instance of tribal bickering is properly founded and researched. Act III manages to salvage some actual information from the debacle, but the information is expected, mundane and of no practical use, unless you're a doctor on the frontlines of covid treatment, in which case your education and first-hand knowledge probably makes news reports redundant.
Becoming a scout is the easy part, the hard part is deciding which areas of the vast unknown terrain one should be scouting. Now, that - that requires metic experience and necessarily implies using imprecise heuristics, since no human being, not even humanity as a whole, so far, has time and resources to research and put together a perfect 1:1 map of all that ever was. Surely, those heuristics lead to biased perception, blind spots, epistemic closure and all those other things we want to avoid. Thing is, they're unavoidable. I have adopted and I advocate extreme agnosticism and never believing yourself to be right, but that's a philosophical, not praxeological position. Praxis requires making choices and acting on them, and that's functionally indistinguishable from believing one is getting a fuller story than people making other choices. I don't see a way around this.
When I saw the original tweet, my first thought was: “Hmm, this isn't the first time Rolling Stone published a false story that was ‘too good to check’, is it?” And I looked it up and remembered that in 2015 they published a campus rape story that turned out to be extremely shoddily sourced and was retracted: https://en.wikipedia.org/wiki/A_Rape_on_Campus
The most important thing is that there were no serious consequences for the reporter, Sabrina Erdely. She wasn't fired. She gave a grudging apology and that was it.
So, no matter what else we can say about this whole thing, Rolling Stone can't be trusted and should basically be ignored.
These things tend to get forgotten, which means there are no real consequences for Ederly or Rolling Stone. I'm commenting here to do a tiny bit to counter that.
This seems like it is falling prey to the same phenomenon above of being too good to check, because when I do check, it seem Sabrina Erdely was found liable for $2 million in damages for defamation, currently works for a local Jewish podcast in Philadelphia, and her personal website doesn't show a story published by any national publication since 2013.
Oh, well, that's good. But I was specifically talking about Rolling Stone's explicit response, which was not to fire her. That's what I distinctly remember at the time, and it's what Wikipedia says:
“Spokesmen for both publisher Wenner[67] and Will Dana, managing editor, said that Erdely would continue to write articles for Rolling Stone.[68]”
So I guess “no real consequences for Ederly” was wrong, thanks for checking more thoroughly and correcting that. The accurate statement would be “Rolling Stone decided not to enforce any consequences.”
Or possibly she suffered no consequences whatsoever for writing the UVA article, and was relegated to podcast ignominy for something completely different like e.g. sleeping with the wife of Rolling Stone's publisher. There's lots of possibilities that need to be checked before we can consider this one properly debunked :-)
The Sequoia Hospital System isn’t unrelated to Dr. McElyea or to this story. The doctor is a member of a physicians group that is contracted with Sequoia and the public statement by Sequoia explicitly says that McElyea has worked at Sequoia but not in two months. So, yes, the statement by Sequoia does refute the Rolling Stone story directly. Scott is inferring, without any evidence, that McElyea is contracted with other hospitals where these overdoses may be occurring. Further, McElyea is a family practitioner so it is doubtful he spends much time in a hospital although he apparently does appear in hospitals sometimes.
Despite Scott’s weak argument that “ both sides are culpable”, the fact still remains that the Rolling Stone story and the original KFOR story lack any facts whatsoever. They don’t name a specific hospital, a source who actually has personal knowledge of the alleged Ivermectin overdoses or any facts showing how McElyea supposedly has knowledge of any cases, let alone cases where people have gone blind. The Rolling Stone article is fiction. The fact that the Sequoia system is in fact contracted with McElyea’s physician group and the fact that McElyea has apparently worked in at least one of Sequoia’s hospitals directly contradicts the Rolling Stone article. Scott also mistakenly believes that Sequoia is one hospital. In fact, Sequoia operates multiple hospitals in the eastern part of Oklahoma where McElyea practices. Therefore, its statement that there have been no Ivermectin overdose cases at it’s facilities is probative evidence contradicting the claims in Rolling Stone. So no, the evidence isn’t equally lacking. The side that made the claim has precisely no facts to back up its claim. The side that debunked the story has multiple pieces of directly, probative evidence to back it up. The pedantic left may claim that the evidence isn’t dispositive but its mire than they have. Maybe elitists, icluding Scott, should STFU.
The true story is that news media don't do very much original reporting anymore, it's a lot easier and cheaper to pick up a wire story and rewrite it and run it as your 'own' piece.
Also, headlines grab eyeballs and eyeballs turn into money (via selling advertising), so the most startling rather than the most factual headline on the story is the one that is run.
I'm beginning to wonder if this is also a story that is like the chloroquine story, again with an alleged poisoning over "this was touted as a wonder drug" (then it was supposed to be alleged attempted murder, I haven't seen a definite conclusion either way):
Exactly how many people are taking ivermectin (I'm not surprised they're using the animal version since that's probably easier to get than trying to persuade a doctor to prescribe it when you don't have worms)? And again, if you're taking a dose calibrated for a horse or cow, yes you are going to overdose and poison yourself. But are there really that many cases of ivermectin-taking?
prescriptions for ivermectin (for humans) increased about 20 fold to 88,000 per week in the USA in August. Data does not include people taking over the counter veterinary dispensed ivermectin
It’s funny how this is just BTFOing fake news but gets more attention than the systematic investigations of complex problems or conceptual posts or book reviews. Oh well.
I think the tone of this post underplays the difference between a major media outlet making these mistakes and a random ACX reader making these mistakes. Like, you could come away from this post thinking "huh, wow, I do exactly the same thing I was criticizing Rolling Stone for doing", without also thinking "wow, it's horrifying that Rolling Stone -- an organization with power -- doesn't take its responsibility seriously enough to overcome this tempting error & check its stories"
"Later it started looking less promising, and investigators found that a major supporting study was fraudulent." There is still overwhelming positive data for Ivermectin's effectiveness. You are referencing one study (Elgazzar) which when completely removed from the meta analyses, does not change the conclusion that Ivermectin is still clearly favored vs the control. 62% decrease in death lowers to 49% decrease in death. While the confidence drops by removing the Elgazzar study it DOES NOT indicate that Ivermectin is not effective. This is unbelievably irresponsible of you.
What I am observing here in this very entertaining post is constant subtle switching between "to establish that something happened, there should be reliable evidence of it" and "to establish that something happened, there's enough that somebody said it happened and there's no reliable evidence that it could not, under any circumstances, have happened".
It is pretty clear that neither RS nor anybody else had any reliable evidence of hospitals being "overwhelmed" by ivermectin overdosing right-wing rubes. In fact, I don't think there's even a reliable evidence of "gunshot victims" "waiting" for anything, either ivermectin-related or not, beyond usual time a person would wait in other circumstances. All we have is the words about one case from one doctor, which doesn't give any verifyable details. And even that was not about turning the gunshot victim away but about transferring them to a different care facility (which may have a thousand reasons to not accept anybody who is already being treated by other facility just because some random doctor wants them to).
That should be the end of it, but somehow the fact that the hospital hasn't been named becomes important - did you notice the switch between "it happened" and "you can't prove it didn't happen if I don't tell you enough details to catch me"? The problem is not whether the story has been "debunked" or not - the problem is it shouldn't ever be "bunked" in the first place, and breathlessly reprinted verbatim by everbody knowing how to operate the copy-paste facility. It shouldn't be the story of "everybody is a little wrong in various ways", it should be "a MSM outlet has published fake news again, a lot of people got fooled again, and learned nothing again, and won't until they learn not to trust any reporting at all they get from those quarters, at least not without extremely heavy evidentiary proof".
This. One would certainly hope that the standard for publishing within a news organization, at least concerning serious news stories, is not "Someone said something." At the very least, a couple of calls should have been made.
Scott's being too charitable to the left in his attempt to squeeze a post about generic human flaws out of a situation which isn't really about that.
The left was incorrect about its basic claims and the right was correct about them. The original article was in fact misleading and got that way because of political bias in the media.
It's true that the debunking of the original article wasn't completely on point, but that doesn't make the situation symmetrical. There's a big difference between a basically true claim with bad evidence and a basically false claim.
Disagree. Making a correct basically true claim with bad evidence is not better than making a basically false claim with bad evidence. It's just luckier.
If you walk into a casino and put a $1000 on red at the roulette table, then you made a bad investment decision, regardless of whether you end up winning or not.
If someone tells me "I took a Delta plane to Colorado", I'm going to come to the belief that he took Delta to Colorado without looking at any evidence at all. If it turned out that he actually misremembered the airplane and it was really United, and I would have discovered that had I checked for evidence, it would still be right for me not to have checked, and even though I had believed something incorrect because I had failed to check for evidence, I would still have been basically correct.
The media constantly lies about Republicans doing stupid things, and that original post is pretty much unbelievable anyway. The post was never likely to be true even without additional evidence.
> Disagree. Making a correct basically true claim with bad evidence is not better than making a basically false claim with bad evidence.
I don't think it was bad evidence at all though. If the claim is that "Rural Oklahoma hospitals are overrun with X" then one rural Oklahoma hospital saying "Actually we haven't seen any cases of X" is reasonably good (not the best possible, but reasonably good) evidence against the claim.
I don't understand why, considering the low risk of ivermectin, it's not used more. Like so if it's useful you save a bunch of lives if it's useless no harm or very little harm is done.
What am I missing?
I see distguibished ppl on both sides of the debate but more distinguished people being anti ivy, certainly more doctors.
The medical profession, having only quite recently put away the leeches and the pointy hat with stars on it, prides itself on having pretty strict evidentiary standards which amount to "If a trial of sufficient level of rigour says this is a good treatment then we give it, and if it doesn't then we don't". This is usually a pretty good decision.
Medical professionals have a hard enough job already without being expected to make their own decisions (based on a careful reading of whatever new preprints have hit the servers in the last 48 hours) about exactly which not-officially-approved treatments have a sufficiently favourable risk-reward ratio.
When someone is already sick you don't just toss in extra medicine, as that strains the immune system further and can result in drugs interactions, side effects, and other complications. So there is a real downside
FWIW I didn't really feel 'gotcha' at the various test points in this article, because I didn't at any point during the reading of it feel like I had confidence in what was going on - that I had something capable of being tested. This is not because of the particular story or the post, I just ... don't interact with writing like that? I had read it as a claim but hadn't stopped to consider the validity of it yet. I would usually not get around to that part until I reached the end of the article and reflected on it. Is this an unusual way to consume media?
I'm not saying that I would have got it right when I got to the end, but I don't tend to stop and assess in the middle of things like that.
Act III, paragraph 3, "complications of treating ivermectin." There are definitely complications of treating ivermectin but the sentence might need a "Covid with."
I can't blame you for not seeing everything, but the clip I saw of the doctor he didn't say "do not take Ivermectin", he actually said something like "consult your doctor before taking Ivermectin, so you don't end up in the ER" (not the exact quote). I think that's a pretty important difference.
And while, yes IVM's effectiveness for Covid is still not certain, enough doctors still believe it's a good risk/reward, or is mildly effective to warrant not discarding it yet.
> A Democrat reads some fraction of this story, and sees a bunch of idiot conspiracy theorists taking deadly horse medication to cure COVID. A doctor warns people that his hospital is overcrowded with poisoning cases, and the media dutifully reports on this. Then an unrelated hospital puts out a press release saying they’re not involved and - even though this changes nothing - Republicans seize on this to declare the entire media is “fake news” and nobody should trust anything they read and the horse dewormer conspiracists were right all along.
>
> A Republican reads some fraction of this story, and sees the media falsely reporting that ivermectin is overcrowding local hospitals, even though the hospitals themselves are denying this. Also, using a fake photo of something else to imply that lines at local hospitals are stretching out the door. Also, declaring that 70% of poison incidents are due to ivermectin when it’s really 2%.
The message from your blog post is, if I've read it correctly: "Every news report at every step along the way, on both the left and the right, was either maliciously misleading or sufficiently incompetent to look maliciously misleading". And so, wouldn't the Republicans screaming "fake news" actually be correct? (ignoring for the moment that they would likely not call their own side just as fake)
Way back in the day, I read a post on an old LiveJournal, the dude was yva-something, called "Epistemic Learned Helplessness". This post has been formative for my thinking on issues like this. The argument in the original post went, roughly: "If you are aware that people smarter than you are capable of generating convincing-sounding arguments for a position, and you are not equipped to be able to tell truth from falsehood (because you are not an expert in the relevant field, but they are), then it is a reasonable position to take to say something like 'yes, that appears to be a rational argument for position X, but I'm just going to ignore it'"
For years now I've felt the same way about the news, and this ACX post reinforces that I made the correct decision. Per your sleuthing to write this article, it is overwhelmingly clear that if I go and read the news on this issue, whatever I walk away thinking, it will be factually wrong. I could spend hours of my day doing a deep dive, phoning hospitals, and doing journalists' jobs for them, and maybe hit on the truth. But it will be a massive investment in time and effort, and at the end of it I will have nothing of value to show for it (since this story affects my life zero). I assert that, in the face of an environment so hostile to establishing truth, the correct response is to write it all off as noise and ignore it. It may be correct, it may not be, but I will not be able to tell the difference between correct reporting, and correct-appearing-but-actually-manipulative reporting. So I choose epistemic learned helplessness
Funny thing here is that we're pretty well equipped to know - or at least very very very strongly suspect - it's a falsehood: it cites no specific facts beyond the words of one person, it contradicts the available data and expert testimony, it is accompanied by a picture that is clearly not matching the story (a long line of "gunshot victims" standing in wait? Are they all superheroes or what? Look how they are dressed - it's 90+F now in Oklahoma!) and fitting perfectly a fashionable narrative... Anybody whose BS detector did not alarm should turn it in for servicing. It's not one of those complex cases.
I mean I'm not claiming it's easy to know what happens in Oklahoma healthcare right now in detail. I am saying it's pretty easy to see RS is full of bovine manure and should be ignored from now on forever.
It’s true the original story didn’t mention the hospital but the hospital DID mention the doctor and was NOT (as Scott had claimed) “unrelated”. It wasn’t a random hospital in Oklahoma, it was a *chain* of hospitals that specific doctor had worked with in the area where his practice was.
The hospital press release didn’t by itself ABSOLUTELY PROVE the story was a hoax/exaggeration but certainly should have shifted the burden of proof enough that we could reasonably *assume* it was a hoax/exaggeration…and triply so now that *even more* hospitals he worked with have weighed in on the matter - there’s no wiggle room left!
The meta-story was that there was strong evidence to suggest Rolling Stone messed up…and there was such evidence, and they had (which even they admit), full stop. The first round of skeptics were *correct* to be skeptical, no meta^2 need apply!
“Keep an open mind, but not so open your brain falls out”
I don't think a newspaper reporting on the facts can count as a "dox". In fact, getting people's names right seems like exactly the kind of fact-checking that we should be applauding.
Re: Scout Mindset. Also use the replacement experiment Galef recommends.
Instead of "Hospital in Oklahoma Turns Away Gunshot Victims Due To Ivermectin Patients Overcrowding ERs", try "Hospital in California Turns Away Gunshot Victims Due to Severe Covid-Vaccine Side-Effect Sufferers Overcrowding ERs".
I'd assume most people here and ones that bought the Oklahoma Ivermectin story would immediately look for the URL of the latter California Vaccine story and guess it came from a conspiracy site--rightfully so. Yet, so many people instantly were sold on the OK Ivermectin story because it fit the narrative neatly.
It's like the levels of Inception in blog form! Beautiful!
But I did believe the third time. Repetition bias on my part?
"Law Of Rationalist Irony" just sounds like a special case of Murphy's Law, which in turn is just a popular instance of confirmation bias enshrined in "law". So I checked: you made it up just now!
Dr. McElyea does explicitly link overcrowding with ivermectin abuse.
There were 11 cases of "ivermectin exposure" reported to the Oklahoma Center for Poison and Drug Information since the beginning of May.
Three hospitals that Dr. McElyea has worked at, NHS-Sequoyah, Integris Grove Hospital, and McAlester Regional Health Center, have issued statements that do not support his statements.
This started with a ZOOM meeting of the Healthier Oklahoma Coalition (affiliated with the Oklahoma State Medical Association). They published a video of it on their Facebook page on 8/31. Dr. McElyea appears in the video beginning at 12:38. He explicitly links ivermectin abuse to the overcrowding beginning at 15:01.
He repeats that ivermectin abuse is one of the causes of overcrowding in his interview with KFOR. Here is the most complete version of Dr. McElyea's interview with KFOR that I could find:
Scott Schaeffer, managing director of the Oklahoma Center for Poison and Drug Information, says there were 11 cases of ivermectin "exposure" reported to them since the beginning of May (as of 8/25).
"Contributes to overcrowding" seems like a pretty meaningless claim.
If overcrowding is occurring, then every single health condition suffered by anyone is contributing to it.
So it's probably fair to say that it's strictly true, but designed to mislead. I guess the big difference is that Dr McElyea is attempting to mislead with good intentions (to dissuade people from taking overdoses of ivermectin by overplaying the dangers) while Rolling Stone is attempting to mislead with bad intentions (to make those darn rural red tribers look like a bunch of dumb yokels).
Here are the conclusions I draw from the available info:
1. The origin of the idea that ivermectin toxicity cases were overwhelming hospitals
to the point that serious trauma cases were not treated in a timely manner
originated with Dr. McElyea.
2. KFOR, Rolling Stone did not misrepresent what Dr. McElyea said.
3. There is no evidence KFOR or Rolling Stone made even a feeble attempt at fact
checking Dr. McElyea's claims.
4. Ivermectin abuse has had very little, if any, effect on the hospitals in eastern
Oklahoma.
I think Dr. McElyea puposefully misled, KFOR and Rolling Stone reported his claims unchallenged because it fit their schema. As to Dr. McElyea's motive, I don't have enough information.
I rewatched the the videos I linked in my op. In the Healthier Oklahoma Coalition video, he first mentions the gunshot victim and explains the delays due to there being no beds in the big-city hospitals that they can transfer patients to, leading to congestion in the rural ERs he works at. He then says that there are "other things that back us up", specifically "I've really seen a spike in" "more than a handful of" ivermectin poisonings.
In the KFOR "More of Dr. McElyea's Interview With KFOR" video however, he draws a direct line between the delay in the gunshot victim's treatment and ivermectin poisoning cases.
I love the fact that just the starting seed for this essay still needs explaining (for anyone who hasn't been following along obsessively). There's a word that's become popular in China recently to describe companies that spend all their time grinding their gears on administrative processes without actually producing any more stuff: convolution. Information these days is convoluted, i.e. it's all information about information.
The thing is, I think that it's always been this way. The job of digging through the information to real stuff, unmediated by human concepts, is exactly what science is, and it's really really hard. Information is by its nature convoluted.
(I'm a translator, and this occasionally bites me in the ass. If I'm translating a sentence from Chinese, standard procedure is to think about what the sentence means in the real world, and then write that in English. But surprisingly often, the Chinese sentence doesn't refer directly to the real world, but to some other linguistic artifacts (in Chinese); and you then just have to do your best to recreate the many-layered, or even infinite regress.)
I'm not sure what to do with this knowledge. But it certainly supports the whole echo-chamber idea, that we're mostly trapped reading ideas about ideas that we already have.
I know this might be a difficult ask, but can you try to give an English translation of an example of "...the Chinese sentence doesn't refer directly to the real world, but to some other linguistic artifacts..."? It sounds very interesting.
Like say something makes a twist or reference to a common English saying or a cultural reference that wouldn’t make sense for Americans. There’s no corresponding thing in American sayings or ideas. We have lots of them too in English
I'm strangely reminded of a dusty linguistics joke:
"A professor lecturing his class says 'We're all familiar with the fact that in English a double negative can mean 'yes' -- as in, 'They're ain't no way I'm not going!' -- but fortunately there are no double positives that mean 'no.'
"From the back of the class a voice mutters sarcasticaly 'yeah, right.'"
I'm not sure it always has been. One thing that is novel today is that the cost of acquiring information is historically low, almost zero for most people. That's quite different from even in my lifetime: if I wanted information on, say, ivermectin, I'd have to trundle on down to the library, probably enlist the help of a reference librarian, acquire some books, read a bunch, probably go back for the correct books, read some more... Either that, or persue learned journals (also in the library) for the opinion of scholars and analysts. In short, it would be quite expensive for me to acquire information -- enormously so, compared to googling "ivermectin" or doing a FB/Twitter search.
How might this change things? Well, consider that acquisition of information used to be expensive for *everybody*. The reference librarian can only stock a finite number of reference books, so she's going to want to be sure they're *good* books. The guy writing a monograph can only spend so much time looking up papers in the massive tomes of an abstracts service, and then finding the journals in the stacks, or waiting impatiently for interlibrary loan to deliver them. Both these people are highly motivated to look for the best and highest-quality information they can find, because it's expensive for them to get, and it's expensive for them to pass along bad information to *their* customers since, unlike these electronic days, to correct it is not just a few keystrokes but rather a laborious and embarassing process.
In an era when the cost of merely acquiring information is high, perhaps everyone involved in its trafficking becomes quite careful of its quality, simply because the cost of fixing mistakes (which involves more information exchange) is high. Willy nilly, the result may be that the average information that filters down to the end consumer is fairly high quality, since it cost quite a lot to gather and disseminate even *before* we consider its cost of initial acquisition.
Conversely, perhaps when the cost of dissemination falls to near zero...well, we get the difference between e-mail and regular first-class snail mail: the former is totally dominated by spam. Thus the Internet giveth and the Internet taketh away.
I suspect the root error is that writers are using "people taking ivermectin" as a metonym for antivaxxers in general. Like, it's not true that ivermectin poisoning is directly putting people in the hospital to the extent that they're crowding out other patients, but it *is* probably true that people taking ivermectin are disproportionately likely to wind up in the hospital... with COVID, because they're taking ivermectin instead of getting vaccinated.
One of the most frustrating outcomes of this whole ivermectin controversy is how difficult it is for patients who actually NEED it to get it prescribed. For the past year, I've been dealing with a serious case of treatment-resistant scabies, and it took 8 months until I was finally given a proper dose of ivermectin from a dermatologist - and only then after all other possible causes for my skin condition had been ruled out (I'd tried all other treatments more often than I can count and none of them were effective). During this time I was so itchy that I got less than 4 hours sleep on most nights and scratched so deeply that I now have permanent scars on my skin. I also had to defer my doctoral studies and neglected important relationships in my life, being too physically and mentally exhausted. I think this is quite a serious consequence of doctors being reluctant to prescribe ivermectin that has been ignored. Hell, I even had to split my prescribed dose with a friend of mine who had caught scabies off me, who was also not responding to standard treatments, and who could not get an ivermectin prescription of her own no matter how hard she tried. Thankfully we're both past this horrible infection, but I'm still recovering from the impact that it has had on my life.
(I'm located in a country where you can't get ivermectin OTC, even for 'veterinary' purposes, so getting a prescription was my only option)
It is a recognised treatment for scabies, so that's a legitimate use. This is the worst part of people jumping at 'miracle cures', that means that real need is ignored or actively discouraged because it gets lumped in with "are you only looking for this because you read some stupid online article about it being a miracle cure?"
1. In New Zealand, ivermectin was first approved for treating roundworm in sheep. When I hear of it being used in humans, an overused portmanteau of "sheep" and "people" inevitably invades my mind.
2. The post confirmed my bias that Twitter should be taken round the back of the barn and shot.
3. The post is also rather click-baity. This makes me sad.
Alright, I'll bite: what is the relevance of Achilles and Chiron to this article? Is it just free association between medicine, people and horses, or is there some clever joke I'm missing?
(For those who are confused by the question, the front page of the substack illustrates this article with a painting of a centaur and a man, it doesn't seem to be visible on this page.)
I assumed it was "Chiron is centaur, that is horse + man; people are taking medicine meant for horses; that is also horse + man; conclusion - only Chiron can safely take ivermectin" 😁
Time for a Dante quote! From the Inferno, canto 12, where the centaurs are guards in this circle of Hell, and Chiron retains his intelligence, as distinct from the more animalistic nature of his comrades:
Between the edge of moat and precipice
ran centaurs in a file and armed with arrows,
as when they went off hunting in our world.
They saw us coming, stopped, and three
departed from the troop with bows
and shafts they had selected with great care.
One cried from afar: 'To what torment
do you come, you two approaching down the slope?
Tell us from there. If not, I draw my bow.'
My master said: 'We will give our answer
to Chiron once we have come closer.
Your will was always hasty, to your hurt.'
Then he nudged me, saying: 'That is Nessus,
who died for lovely Deianira
and fashioned of himself his own revenge.
'The middle one, his gaze fixed on his chest,
is the great Chiron, he who raised Achilles.
The other one is Pholus, who was so filled with wrath.
Good summary. Though the whole thing is dwarfed by unvaxxed Covid patients filling up hospitals and ER's. I saw 2 ivermectin overdoses, for the first time ever in my 20 year ER career. Gunshots are rare, so two rare things occurring is unusual, but absolutely does happen in the ER. Also there are never lines in an ER. The chair space just fills up, and people starting sitting outside. Though right now, with such a young Covid cohort, people check in, wait 10 minutes, then decide to leave. The sickest just sit in chairs because to walk around takes too much air.
I do wonder how much of this issue can be avoided by just avoiding polarizing topics ala politics.
Most things I <try> to read about outside of SSC and the subreddit, which I use as my dose of US politics, are kinda boring factual-o-theoretical claims about things.
And while I agree observation is theory-laden and theory is made by the gullible trusting bad observation and so on, reading papers and /r/molecularbiology or lobste.rs requires a much lower level of scepticism than dealing with politics.
Most conclusions are tentative and non-committal and at most incentive for further readings or self-experiments. And the ROI is pretty good in terms of happiness due to changed behaviour, money, better conversation.
Armadillos penises, when erect, are around half the size of their torso, but they are not as intimidating as those of e.g. Rhinos, because they are thin and conical. More interestingly, their erect penis will likely be spotted when sleeping, because they sometimes sleep on their side or back. But here's the kicker: Unlike most animals, this erection happens during non-REM sleep
This is 100% more relevant to my life than whether or not X hospital in county so-and-so couldn't admit what-and-what because who-and-who bad and won't follow doctors advice. This is a fact that has ramifications in my ontology of sleep. I learnt this fact 5 days ago and I already used it once as an intro into a dirty conversation, and those are super hard to come by, for me at least. It's funny, cute, interesting.
And I'm pretty sure nobody's lying to me about it. Am I ~100% confident? No. But I'd bet you 80/20 that if you set up a camera to look at sleeping armadillos at the zoo we'll notice them sleeping with their belly exposed and we'll see their arms twitching when their penis is inert, and their members being steady when their member is erect. And I can ultimately increase that confidence in a really straightforward way. There's no partizanship to this, how could there be?
That's the beauty of science and engineering and of ""intellectual"" pursuits in general. And if the past is to generalize, 100,000 sleeping armadillo style facts at some point cumulate into nuclear energy, and it all pays off. And if it doesn't ? What's the harm, look at how cute the Armadillo is
You left out the angle that the only reason people are getting poisoned taking the horse de-wormer is because their paternalistic, New York Times reading doctors refuse to give them a prescription for the (harmless) human version of the medicine...
The reason they are getting poisoned is because they are dumb enough to take medical advice from Facebook posts. In general, there are legitimate complaints about "my doctor isn't taking my problem seriously and thinks I'm only drug-seeking", but when it comes to "I want this medication because I read somewhere it's a miracle cure", and there is no evidence at all that it is a miracle cure, and while it won't poison Jim or Susan, it's likely they'll come back in a panic once they take it and come out in a rash or have swelling of the extremities, so it's not worth prescribing unless they really need it - then I'm on board the "You don't need this, it won't do you any good, if you're really worried get vaccinated and observe social distancing rules" train.
I'm in favor of treating grownups like grownups. The doctor can give good advice, along the lines you suggest, but if one of his patients still wants the ivermectin, I'd say the doctor should prescribe it for them. Ditto if the patient wants opioids, or anything else-- give the patient good advice, but if they still want the drug, advise them that you think it is medically useless, and write the prescription. Doctors are not their patient's mom; their patients aren't 10 years old. Even if a patient wants something that is really dangerous, or dangerous in combination with something else they are already taking, I'd say, a doctor SHOULD take the same approach-- find out if they are looking to commit suicide, and if they are, help them out, otherwise, tell them vigorously that death or whatever the outcome they should expect-- as they write the prescription. That isn't possible for the doctor to do, practically and legally, for opioids, because of meddling bureaucrats, but for something like ivermectin there is no reason for them to deny a patient the prescription if that is what they really want-- it will be a good learning experience for them-- or perhaps, a good placebo-- but it's not, and shouldn't be, the doctor's call.
In practice, I think the current system is better, as most people dont know anything about medicine, and this would lead to severe perverse incentives where pharma companies could convince people to take useless drugs and make bank. If you’re smart and know your stuff, you can often just find a doctor who will believe your idea.
That's not a doctor, that's a sweetshop owner. "Oh you want a lollipop? Here you go!"
The point of a doctor, after all, is to diagnose and treat an ailment, not to hand out drugs like selling tins of beans. In your scenario, why even bother with a prescription? Just go to a chemist and buy it all over the counter. Some countries do that, I understand.
And any doctor foolish enough to follow your advice will be sued into oblivion by the families afterwards, you see that with the example in one news story: the guy plainly wasn't vaccinated, got covid, wanted ivermectin as a miracle cure, and now the family are suing the hospital for not giving it to him. If a doctor does tell the patient "this is useless to dangerous", prescribes it anyway, and the patient has an adverse reaction or dies, there are two ways this goes afterwards:
(1) "He/she didn't know how dangerous it was, you should have warned them! You are at fault and this is malpractice!"
(2) "I did warn him/her" "Then you knew it was dangerous and you shouldn't have prescribed it! You are at fault and this is malpractice!"
I'm not in favor of treating doctors like robots programmed to do the bidding of whomever calls on them professionally, whatever their own judgment.
I believe physicians, no less than patients, should be treated like grownups and allowed to act on their own judgment. If I call an electrician and ask him to rewire my house in a way that he considers insanely dangerous (and is moreover against code), he is entirely free to reject my business. We don't have a meeting of minds, there is no obligation on either side.
I don't see why a physician should not feel equally free to exhibit the same agency: if he thinks I'm nuts and my proposed course of treatment stupid, he should be free to similarly reject my business and tell me to look elsewhere for professional assistance.
We've already had one spambot advertising Dr. Herbal Cure cured my AIDs and epilepsy and dose of the clap, do you really advocate that we all rush off and order the miracle herbal cure because somebody sent an email swearing it worked for them? And herbs are all natural anyway, they are harmless, so why not take this product?
There are probably a million different pointless herbal remedies. One worries that there’s be a million different pointless pharmaceutical remedies if deregulated, and those might have bad side effects
Here’s one way to think about it: if you cared about what was really going on in hospitals in Oklahoma (like maybe you live there or have relatives there) you would investigate. If you notice that you’re not actually investigating, that’s pretty good evidence that you’re not actively curious about it. Better to admit there are questions you don’t have good answers for, and that you’re just going to let them remain unanswered.
(Of course if you *are* actively curious, please do investigate and get back to us.)
It might seem somehow wrong to admit that you’re not curious about something. Social media often convinces us that we care about all sorts of things, but reading articles that show up in your newsfeed is only a weak, passive, opportunistic curiosity.
In some sense that’s okay. It would be impractical to investigate everything that goes by. Knowing what you’re actively curious about is useful self-knowledge.
But I wonder about the things we passively absorb without investigating, so we think we know things that we haven’t checked out. How does this affect your priors?
I believed part 1 hook, line, and sinker, without so much as three seconds of research. Having this pointed out was very valuable, I am updating by adding "don't believe stuff automatically, you dimwit" to my wishlist of mental reflexes. Thank you!
(At least I didn't believe the second part automatically.)
I’d make two points. Firstly the more right wing perspective that the media are sloppy click hungry entertainment outlets masquerading as news outlets which can be relied upon to report even basic factual information is by and large true. It is hard to clock at this or many other stories as anything other than fake news. It is fake in that it is not true and is presented as though it were true. The silliness comes from thinking any body exists on the right or anywhere that has any interest in reporting the truth.
Their own fake news criticism is itself wrong in that it implies some source of truth exists. But if any story matters to any powerful player, then it will almost certainly have extreme bias in its reporting with a filthy myopic lens used. Marketing, propaganda, ownership models, manufacturing consent, etc it has all been there all along like Cesar’s reports of his glorious conquests of the barbarian armies of he north which mostly consisted of slaughtering and enslaving small villages.
Secondly I’d point to the quite pessimistic and seemingly uninformed views on ivermectin presented. The FLCCC cited by others is simply putting information together and they have dozens of peer reviewed and double blind etc studies along with large National or large region implementations.
One even needs zero studies when looking at the raw figures which came out of India where a ‘natural’ experiment happened with their big covid wave a few months ago. These are extremely positive results and we should be trying whatever we can in a pandemic as long as it is safe. There is even passive evidence from lower covid rates in some parts of Africa, quite possibly matching up well with existing use of ivermectin for its well known and longstanding use against parasites which can cause blindness.
In states which used ivermectin Emma’s bs those thst didn’t, dramatically different outcomes in terms of the spread of the disease and deaths in hose states. A similar large scale rollout and use of ivermectin in, I think, Columbia o had dramatic effects. Unless covid waves just randomly fell apart in places using ivermectin in ways dissimilar to other places.
Looking at the evidence and arguments put forward to use a drug in a pandemic where we cannot wait or rely on stupid ideas of waiting around for 5 years or 20 years for large bodies of evidence to accumulate thorough the regular channels. This is a safe drug, which has saved millions of people from blindness and is a WHO essential medication used over 4 billion times in humans and if it helped even 10% of what people claim we should use it and let the studies and whatever play out over time.
Instead we have an insane and bizarre and inexplicable wave of health policy bodies and media censorship and smear campaigns. Here is no charitable argument left for the wide scale and systematic attempts to suppress this safe drug which has been widely used for decades. And like with the idiotic and horribly evidence free war on drugs, it is the illegal or non offical nature of it which has caused nearly all the problems. No one would be using the veterinary drug supply or confused on dosages if every GP in the land were allowed to freely proscribe it to anyone who wants it.
What criteria and standards should we use when combating a pandemic? Should we go with anything that is safe to use and see what sticks or should we wait around for clinical trials? His isn’t the standard of a big pharma company trying to get more profits from their drugs by getting long slow approvals that come with patent and profit protection…this is more like with cancer where people try all sorts of things and a certain amount of non standard ethics comes into pay with open human experimentation fuelled by personal choice.
In the context of a pandemic, if people want to volunteer to take and try various already approved drugs…what possible argument could exist to stop the, or not to study them? If here is one, I’d disagree with it. We must find rapid fire ways to try things out. Overall it shows massive wholes in the current system of drug development and usage approval. We cant use a 5 year process for something we need to know immediately and could easily be found out in 3 months or 6 months with willing participants. We certainly did this exact thing with the extremely high profit vaccine development, so why the complete hypocrisy? Could billions and billions of dollars and existing systems which are almost entirely reliant on big pharma possibly lead to double standards? Is a person an insane conspiritard for thinking any of this?
According to news media whose board members sit on none big pharma and big media companies…we should forget everything and accept government mandated multi vaccines of covid boosters and flu shots forever and ever under penalty of not being allowed to work or go to public places as enforced by a National monitoring system.
Even 3 years ago THAT would be the crazy person narrative. If I said 3 years ago that our freedom of movement be limited for years at a time or huge monitoring systems would be put in place, then that’d be Alex Jones level stupid person ideas. But now 2 years into covid, you are now considered insane NOT to openly embrace using a fast tracked vaccine made by companies who obtained total legal immunity and which doesn’t stop the spread of the virus and a total media ban and open assault on ‘misinformation’ about drugs which may or may not work on a brand new disease…when no one can know before hand what will work or not.
So…we have to get the vax to stop the spread, but also it doesn’t actually stop the spread of the virus, perhaps slowing it down a little. Endless insane sounding double speak and you’re crazy for saying it sounds crazy. Meanwhile covid spreads like wildfire in 90% vaccinated Israel and across the UK…but we have to get it for public health reasons to protect others? Yet getting it does not protect other people…..round and round it goes and it is no deemed insane to question this?
"One even needs zero studies when looking at the raw figures which came out of India where a ‘natural’ experiment happened with their big covid wave a few months ago. These are extremely positive results and we should be trying whatever we can in a pandemic as long as it is safe. There is even passive evidence from lower covid rates in some parts of Africa, quite possibly matching up well with existing use of ivermectin for its well known and longstanding use against parasites which can cause blindness."
Ivermectin is well-known and longstanding use *against parasites*, which you mention in your comment, but seem not to have understood. You are saying "this is a safe and effective drug!" and yes it is - *when used as intended*.
What you are extrapolating from "it's used to treat parasitic infections in humans" is "therefore it should be used for covid", with a side of "what can it hurt, it won't kill you" and unexamined anecdotes about "and they used it in India and they're getting fabulous results!"
I'm not so convinced about those fabulous results, I imagine that any benefits may come from the anti-parasitic treatment. If you have two patients, A and B, both in hospital undergoing treatment for Covid, and both have roundworm infestations as well, and A gets treated with Ivermectin which kills off the roundworms but B does not - I am going to guess that A will do better than B. But I don't think you can conclude from that "Ivermectin cures Covid!"
And the problem with this sunny assumption of "what harm can it do?" is that some people are refusing to get vaccinated, which is our best preventative at present, and along with others are all rushing off to buy veterinary products containing ivermectin, which are graduated for animals much larger than humans; believing this will save them; overdosing then because they're taking dosages calibrated for horses and cows; then ending up in the hospital with the side-effects of same.
So I'm going to go through that Cochrane meta-study and pull out the ones from India and Colombia, if I can find them, and other ones from Third World countries as well, and let's see what the authors of those studies say, shall we?
(1) Mexico:
Methods: This a controlled, clinical, randomized, double-blind trial that included patients with COVID-19-induced pneumonia and hospitalization criteria, but no severe respiratory failure. Patients were randomized to one of three groups: Group1-hydroxychloroquine, 400 mg every 12 hours on the first day and subsequently, 200 mg every 12 hours for 4 days, Group 2-ivermectin, 12 mg or 18 mg, according to patient weight and, Group 3-placebo. At inclusion, blood samples for arterial blood gases and biochemical markers associated with a poor prognosis were obtained. The primary outcome was established as the duration of hospitalization until discharge due to patient improvement, the total duration of hospitalization, and the safety outcomes were either respiratory deterioration or death.
Conclusions: In non-critical hospitalized patients with COVID-19 pneumonia, neither ivermectin nor hydroxychloroquine decreases the number of in-hospital days, respiratory deterioration, or deaths.
(Well, no wonder cure there! But maybe it was because they didn't do it in India?)
(2) Bangladesh: (this one is more favourable)
The aim of this study was to investigate the role of ivermectin alone or in combination with doxycycline in the treatment of adult COVID-19 patients presenting with mild symptoms. It was hoped that treatment early in the course of infection would decrease the viral load, shorten the duration of illness, and halt transmission.
A 5-day course of ivermectin resulted in an earlier clearance of the virus compared to placebo (p = 0.005), thus indicating that early intervention with this agent may limit viral replication within the host. In the 5-day ivermectin group, there was a significant drop in CRP and LDH by day 7, which are indicators of disease severity. It is noteworthy that the viral nucleic acid Ct value (indicator of viral load) dropped significantly compared to the placebo group on day 7 and day 14. In the absence of co-morbidity, a 5-day course of ivermectin treatment showed faster SARS-CoV-2 virus clearance compared to the placebo arm (9 vs 13 days; p = 0.02).
Although the study sample was too small (n = 72) to draw any solid conclusions, the results provide evidence of the potential benefit of early intervention with the drug ivermectin for the treatment of adult patients diagnosed with mild COVID-19. First, early intervention promoted faster viral clearance during disease onset, which might have prevented significant immune system involvement and hastened the recovery. Secondly, early intervention reduced the viral load faster, thus may help block disease transmission in the general population. A larger randomized controlled clinical trial of ivermectin treatment appears to be warranted to validate these important findings.
(So this one looks like faster viral clearance compared to the other two groups, with a smattering of "it MIGHT do this and that").
(3) Spain: a single-dose of ivermectin trial
This pilot study was designed to assess the question of whether further investments in the potential repurposing of ivermectin were warranted. As such, we aimed at generating evidence on viral kinetics, antibody response and clinical efficacy in a cohort of patients at low risk of severe disease. Without a clearly defined mechanism of action, a sole signal in any of said parameters would not suffice to justify further efforts. This pilot shows a trend to lower viral loads in the ivermectin group, a trend to lower IgG titers that may reflect lesser systemic exposure to the virus and clinical benefit in cardinal symptoms of COVID-19 associated with tissue damage: anosmia/hyposmia and cough. These results are in line with emerging evidence from trials in Bangladesh and Argentina, as well as with recent data from a SARS-CoV-2 hamster model from Institute Pasteur which also showed a marked sex dichotomy in the effect of ivermectin on anosmia/hyposmia.
Pending confirmation of these results, this pilot sheds some light on the potential mechanism of action of ivermectin against COVID-19. Note the trial was not powered to detect modest differences in viral load, yet a small effect is suggested when viral load was ascertained directly by PCR and indirectly using IgG titers as markers of systemic exposure. Also, in this pilot ivermectin has not shortened the duration of symptoms associated with systemic inflammation such as fever or malaise, nor has it had a measurable impact on inflammatory markers. Given these findings, consideration should be given to mechanisms of action different from a direct antiviral or anti-inflammatory effect. One alternative explanation might be a positive allosteric modulation of the nicotinic acetylcholine receptor caused by ivermectin and leading to a downregulation of the ACE-2 receptor and viral entry into the cells of the respiratory epithelium and olfactory bulb.
(So it sorta works but not the way we expected?)
(4) Pakistan:
Our study didn’t show statistically any significant difference between case and control group. In Ivermectin’s (case group) recovery was almost equal to control group who received only conventional symptomatic treatment, so this is the need of the day that we need to conduct more randomized controlled trials across our country involving major tertiary care health care facilities with larger sample size to assess its efficacy for validating the use of Ivermectin against SARS-CoV-2. Nearly 40 clinical trials are
ongoing world over for measuring the outcome of COVID-19 treatment with Ivermectin.
(Neutral on this; it does point out that the different studies are all testing different groups e.g. some patients are mild, some are severe, some are getting mixed treatments, etc.)
(5) India:
Results A total of 115 patients were enrolled for the study of which 112 were included in the final analysis. Of them, 55 were randomised to the intervention arm while 57 were randomised to the placebo arm. There was no significant difference in the baseline characteristics of the two arms. There was no significant difference in the primary outcome, i.e. negative RT-PCR status on day 6 between the two groups. Similarly, there was no significant difference between the two groups in most of the secondary outcome measures, viz. symptom status on day 6, discharge status on day 10, admission to ICU, and need for invasive mechanical ventilation. However, while there was no in-hospital mortality in the intervention arm, there were 4 deaths in the placebo arm. As a result, all patients in the intervention arm (n=56) were successfully discharged as compared to 93.1% (n=54/58) in the placebo arm (RR 1.1, 95% CI 1.0 to 1.2, p=0.019).
Conclusion There was no difference in the primary outcome i.e. negative RT-PCR status on day 6 of admission with the use of ivermectin. However, a significantly higher proportion of patients were discharged alive from the hospital when they received ivermectin
(They're taking this as ivermectin prevented mortality, but that's not so obvious, given that the two groups had little to no difference otherwise. So what was the magic going on here?)
DISCUSSION: In this study we did not observe any benefit of adding ivermectin to the hydroxychloroquine in the management of patients of SARS-CoV-2 resistant to standard care treatment. Our finding are based on small cohort of asymptomatic or patients with mild symptoms of COVID-19.Such patients were recruited when they did not responded to the standard treatment. Ivermectin was tested as an adjuvant drug to the standard treatment with hydroxychloroquine. On comparisons of patients receiving hydroxychloroquine plus ivermectin with the patients receiving hydroxychloroquine alone, no significant difference was observed in the cure rates. There were no significant adverse effects were observed in patients receiving ivermectin. The use of ivermectin 12 mg single dose as an adjuvant to standard treatment was based on the widespread uncontrolled studies that suggested that the ivermectin has antiviral activity against a broad range of viruses. .Based on these studies it was concluded that ivermectin's nuclear transport inhibitory activity may be effective against SARS-CoV-2.
(This is one of those "throw it against the wall and see what sticks" studies; ivermectin didn't do much but that's not what they were studying. Result here neutral again, I think).
(7) Argentina:
Findings: The trial run between May 18 and September 29, 2020 with 45 randomized patients (30 in the IVM group and 15 controls). There was no difference in viral load reduction between groups but a significant difference in reduction was found in patients with higher median plasma IVM levels (72% IQR 59 – 77) versus untreated controls (42% IQR 31 – 73) (p=0·004). The mean ivermectin plasma concentration levels also showed a positive correlation with viral decay rate (r:0·47, p=0·02). Adverse events were reported in 5 (33%) patients in the controls and 13 (43%) in the IVM treated group, without a relationship between IVM plasma levels and adverse events.
Interpretation: A concentration dependent antiviral activity of oral high dose IVM was identified in this pilot trial at a dosing regimen that was well tolerated. Large trials with clinical endpoints are necessary to determine the clinical utility of IVM in COVID-19.
(This one contradicts the Bangladesh and Spain studies about reductions in viral load, but it does show 'something something need high doses').
(8) Colombia:
Findings: In this randomized clinical trial that included 476 patients, the duration of symptoms was not significantly different for patients who received a 5-day course of ivermectin compared with placebo (median time to resolution of symptoms, 10 vs 12 days; hazard ratio for resolution of symptoms, 1.07).
Meaning: The findings do not support the use of ivermectin for treatment of mild COVID-19, although larger trials may be needed to understand effects on other clinically relevant outcomes.
(And this one contradicts the Indian 5-day trial. They don't seem to have seen a positive effect re: mortality, and they did manage to screw up the 'which group gets what' dosing. Read the whole thing: https://jamanetwork.com/journals/jama/fullarticle/2777389)
(9) India (different study):
In our study subjects, Ivermectin did not improve the time to symptom recovery, clinical status at day 14, or hospital-free days at day 28 after drug administration. Similar results were observed in the only other randomized-trial of Ivermectin (12 µg/kg) in predominantly mild COVID-19 patients (n=62) in Bangladesh, wherein Podder et al(19) found that Ivermectin failed to hasten the resolution of symptoms compared to usual care. The same investigators repeated RT-PCR only once on day 10 and found that most patients had attained a negative result(19). In contrast, we performed RT-PCR at days 3, 5 and 7 to serially evaluate decline in viral load with Ivermectin. Our rationale was that faster viral load decline may enable the non-severe COVID-19 patient to become non-infectious sooner, thereby limiting the contagion. Indeed, it has been shown that at a lower viral load (CT > 24), infectivity declines with lower viral culture positivity(20). Hence the trend towards increased viral negativity at day 5 with ivermectin 24 mg in our trial, particularly among mildly ill patients, encourages further exploration in this regard.
In a retrospective study of hospitalized patients in Florida(21), patients who received Ivermectin were found to have a significantly lower mortality that those who did not (15% versus 25%). The mortality benefit remained significant after propensity-matched analysis and adjusting for confounders. However, they included patients with greater illness severity than our study population, illustrated by lack of mortality in our trial. Furthermore, the greater use of concurrent therapies and retrospective design preclude drawing definitive conclusions from their data. Nonetheless, we did find a 56.2-61.5% RT-PCR negativity among moderately ill patients who received Ivermectin at day 5 of enrolment. The immunomodulatory rather than antiviral effect of Ivermectin may be hypothetically more important in moderate and severe COVID-19
(Interesting results that you get more bang for your buck, as it were, if you take your ivermectin after a meal and with booze. Again, some contradictory findings).
I'm not going to go through the whole list, but going by this, if you want ivermectin to work, then you should be in India (parts thereof), Bangladesh, or Florida.
Here's that Florida study, read the whole thing because this was another "throw it at the wall and see what sticks" measure, the patients were getting hydroxychloroquine with or without azithromycin as well:
Charts of consecutive patients hospitalized at four Broward Health hospitals in Florida with confirmed COVID-19 between March 15 and May 11, 2020, treated with or without ivermectin were reviewed. Hospital ivermectin dosing guidelines were provided, but treatment decisions were at the treating physician’s discretion. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included mortality in patients with severe pulmonary involvement, extubation rates for mechanically ventilated patients, and length of stay. Severe pulmonary involvement was defined as need for Fio2 ≥ 50%, noninvasive ventilation, or invasive ventilation at study entry. Logistic regression and propensity score matching were used to adjust for confounders.
Results
Two hundred eighty patients, 173 treated with ivermectin and 107 without ivermectin, were reviewed. Most patients in both groups also received hydroxychloroquine, azithromycin, or both. Univariate analysis showed lower mortality in the ivermectin group (15.0% vs 25.2%; OR, 0.52; 95% CI, 0.29-0.96; P = .03). Mortality also was lower among ivermectin-treated patients with severe pulmonary involvement (38.8% vs 80.7%; OR, 0.15; 95% CI, 0.05-0.47; P = .001). No significant differences were found in extubation rates (36.1% vs 15.4%; OR, 3.11; 95% CI, 0.88-11.00; P = .07) or length of stay. After multivariate adjustment for confounders and mortality risks, the mortality difference remained significant (OR, 0.27; 95% CI, 0.09-0.80; P = .03). One hundred ninety-six patients were included in the propensity-matched cohort. Mortality was significantly lower in the ivermectin group (13.3% vs 24.5%; OR, 0.47; 95% CI, 0.22-0.99; P < .05), an 11.2% (95% CI, 0.38%-22.1%) absolute risk reduction, with a number needed to treat of 8.9 (95% CI, 4.5-263).
Interpretation
Ivermectin treatment was associated with lower mortality during treatment of COVID-19, especially in patients with severe pulmonary involvement. Randomized controlled trials are needed to confirm these findings.
My notion is that if there is less COVID in regions where ivermectin is routinely used against parasites, then RCTs on patients with COVID might not be relevant. It's plausible that having a background level of ivermectin in the body does some good. Deiseach might be right that the advantage is from lowering the parasite load rather than ivermectin being good for people in general.
"But I really am reading Scout Mindset, and it really does have me thinking about the ways our irrationality is polarizing us."
You're making the assumption that polarization is irrational. When we're talking about contending classes, polarization seems to flow naturally.
Also, you have already read a book that talks about media inaccuracies at great length and explains them well - "Manufacturing Consent" by Chomsky and Herman. From memory you didn't really give it a good review? Perhaps in light of all this fretting about inaccuracy and polarization you should give it a re-read.
Manufacturing Consent came out in 1988. It's at least possible that the media was more biased against the left then and more biased against the right now.
I wonder if someone mixed up stories/details whether intentionally or not. There was an oddly similar story in the news in Texas, though it didn't seem to garner the same spotlight or attention.
" A Houston man continues to wait for surgery at Ben Taub Hospital roughly a week after getting shot six times.
"Everybody is really surprised I’m still in this bed a week later," said Joel Valdez (J.D.)"
I'm more surprised that he got shot six times, survived, and a week later is not only still alive and well but is able to give interviews to the media. It would be preferable if they got the bullets out, sure, but he doesn't sound as if he's at death's door.
I see another link to a story where people are chasing the miracle cure; it's a pity the man died, but I'm betting that the reluctance of the family to comment on whether or not he was vaccinated (while plenty happy to claim ivermectin could have cured him) means "no, he wasn't".
This is the entire problem: if people are refusing to do that much prevention as getting vaccinated, then pinning their hopes on 'I read a Facebook post that says this really is a cure but the government doesn't want us to know', then what do you expect to happen?
Human beings are notoriously poor at probabilities. The probability that grandpa would snuff it after being fully vaccinated is some number D such that 0% < D < 100%, alas. The exact value is unimportant, what's important is that there is one group of people who will observe D < 100% so we might as well take it as D ~ 0%, which means if the old fool had only been vaccinated he would've been just fine, so he basically just committed suicide. Another group of people will observe D > 0% so we might as well take it as D ~ 100% which means the vaccine wouldn't have changed a damned thing.
There *have* been unconfirmed sightings of people to whom X can happen, and they do not immediately conclude P(X) ~ 100%, and also to whom Y can *not* happen and they do not immediately conclude P(Y) ~ 0%. Field expeditions have been unable to confirm their numbers and habits, however.
As you hinted at with this poison control database, it seems to be really important to have a reliable source that you don't have to perennially recursively check ad infinitum.
For example, if I already knew the poison database was reliable, I could go there and stop.
The FDA (if we trust them anymore) have a page up about it, it's rather long on folksy heartiness and short on WHAT IS THE EXACT CHEMICAL FORMULATION, GUYS? but then again if it's for the general public, they're treating us as illiterate idiots (fair enough):
"Ivermectin Products for Animals Are Different from Ivermectin Products for People
For one thing, animal drugs are often highly concentrated because they are used for large animals like horses and cows, which weigh a lot more than we do—a ton or more. Such high doses can be highly toxic in humans. Moreover, the FDA reviews drugs not just for safety and effectiveness of the active ingredients, but also for the inactive ingredients. Many inactive ingredients found in products for animals aren’t evaluated for use in people. Or they are included in much greater quantity than those used in people. In some cases, we don’t know how those inactive ingredients will affect how ivermectin is absorbed in the human body."
I'm trying to look up dosages for humans versus animals; so far I've got an initial dosage (in the human tablet for parasites treatment) of 200 micrograms/0.2 milligrams ivermectin/kg of body weight
Now, the American news reports are talking about people taking horse paste formulation, and one such gives a dosage of 0.2 mg ivermectin/kg of body weight (same as in humans, above).
However, the dosing syringe delivers a dose of "Each syringe delivers 120mg ivermectin, sufficient to treat 600kg of bodyweight. Each weight marking on the syringe plunger will deliver sufficient paste to treat 100kg bodyweight", so one dose of the weight marking would be 20 milligrams of ivormectin.
100 kg = 220 lbs. So unless your weight is 100 kg/220 lbs, taking one dose from the syringe would give you an overdose of ivormectin.
And going back to our human formulation, overdose can result in:
"In accidental intoxication with, or significant exposure to, unknown quantities of veterinary formulations of ivermectin in humans, either by ingestion, inhalation, injection, or exposure to body surfaces, the following adverse effects have been reported most frequently: rash, edema, headache, dizziness, asthenia, nausea, vomiting, and diarrhea. Other adverse effects that have been reported include: seizure, ataxia, dyspnea, abdominal pain, paresthesia, urticaria, and contact dermatitis."
And this is a study on high dosages in humans - safe or not? (Ivermectin appears not to be toxic even in relatively high doses, so unless you eat an entire box full or the likes, you'll get sick with an overdose but not likely to die):
They freely admit they can't test it on humans at such dosages, so they poison poor little fishies.
"The oral drug administration is well known for the high compliance and ease of administration, and it is so far the only approved for ivermectin in humans. In the treatment of onchocerciasis, the approved dose of ivermectin is 0.15 mg/kg, but the frequency of administration is still controversial and the duration of treatment has not been established. With the aim to provide more information on means for its safe administration, besides preventing future drug resistance, evidently the evaluation of adequate dosages is equally an actual demand. In terms of gastrointestinal side effects of the currently approved doses of ivermectin, cases of anorexia, constipation, diarrhea, nausea, vomiting and abdominal distention were reported. Hematologic side effects have included decreased leukocyte count, eosinophilia, increased hemoglobin, hematomatous swellings associated with prolonged prothrombin times, leukopenia and anemia.
Considering that some gastrointestinal and hematological side effects have been described in humans after administration of the conventional doses of ivermectin, the usage of larger amounts of the drug for possible repurposing requires further information on tolerability and safety. Since the intestinal tract is a region of absorption of the drug after oral administration, the safety of the intestinal tissues needs to be assessed after high dosage administration. Likewise, the hematologic conditions are required and the same can provide important information on the high dosage toxicity. However, little is known in terms of ivermectin interaction and alterations in intestinal tissues and blood cells after oral administration of higher doses, mainly because such studies in humans are difficult to perform or rather impossible. Thereby, the studies using different animal models are crucial. In our recent studies we described the physicochemical and in vivo mucoadhesive characteristics of a drug formulation produced with chitosan-N-arginine and alginate polyelectrolytes incorporating ivermectin. In the present contribution, we aimed to evaluate the histological effects in intestinal tissues and hematological variations after the oral administration of relative high doses of ivermectin by means of the drug carrier in ornamental fish Corydoras schwartzi as in vivo animal model. The aim of this study was to contribute to the exploration of dosage possibilities for expanded applications of this drug."
So the conclusion seems to be that you'd need to take a ton of the stuff to kill yourself, but since high dosages haven't been tested on humans, and if you're taking veterinary products those are calibrated for much bigger animals like cows and horses, so you are likely to take a dose *much* higher than meant for humans. And we just don't know (yet) how bad that could be for you.
>100 kg = 220 lbs. So unless your weight is 100 kg/220 lbs, taking one dose from the syringe would give you an overdose of ivermectin.
Ivermectin has a high therapeutic index and has been shown to be safe up to 2mg/kg (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133431/#:~:text=Ivermectin%20has%20a%20wide%20therapeutic,dose%20of%20800%20mcg%2Fkg.), so even if you only weigh 50kg, that dose would be very unlikely to be toxic. I'm not sure I agree with calling it an "overdose" (I guess technically anything above the effective dose would be considered an overdose, but the effective dosage for treating COVID has not been established), but it would be unlikely to be a dangerous dose.
>if you're taking veterinary products those are calibrated for much bigger animals like cows and horses, so you are likely to take a dose *much* higher than meant for humans.
The size of the package is calibrated for much bigger animals, but it clearly tells you the appropriate dosage by body weight (which happens to be about the same in humans and animals apparently), and comes with gradations to measure out an appropriate dose.
Unless you're suggesting that people are likely to just blindly consume the whole package rather than reading the instructions or do any research on the appropriate human dosage, I don't see why it would follow that just because the package contains a much higher quantity than anyone needs, people would be likely to take a much higher dosage.
Incidentally, the package you linked above (https://www.bimeda.ie/media/k2/attachments/1BIM098_Data_Sheet.pdf) contains about 120mg of the active ingredient, which is just under the 2mg/kg threshold for someone who weighs 60kg (which I think is on the very low end of body weight for adults). I'm not sure if they designed the package with that in mind or if this just happens to be the optimal amount for a horse, but even if someone *does* blindly consume the entire tube, it likely wouldn't result in severe toxicity.
Quality and rigor of testing may be relevant. If you accidentally let slip a few micrograms of some potent carcinogen into your cattle meds during manufacture because you need to tighten up the bottom line by trimming some corners, who cares? Not the buyer or seller or government. Those cows are going to the slaughterhouse this fall anyway.
How relevant this is I do not know, since the formulation of meds is a murky pool of cross-national supply chains and repeated relabeling into which only the hardiest would willingly dive. It is certainly possible that the stuff destined for pigs and beefs is distinctly less pure 'n' wholesome than that warranted for babes in arms, or on the other hand maybe it all comes out of the same pot.
Considering how often there are changes between the "newsletter" post and the actual final post, please consider prefacing your posts (either all of them, or at least the more probably edited ones like this one) with a boilerplate text like you do with the "Links for X" posts. Something along the lines of "I sometimes/often edit my posts after receiving feedback on them on the comments, so to read the latest version go to..."
I usually come to the web/blog version, but sometimes I read them on the mail when I'm in a hurry or on mobile. And when I do that, I often mentally check "Read" if not reminded of the fact that the blog is still out there. Come to think of it, maybe both a preface and a postface for each post, reminding of the possibility of the post being edited)
I feel justifiably smug that I got more of this story here than I have anywhere else on the internet. My confidence I've gotten the whole story is low, but my attitude that Ivermectin is mostly a nothing burger has been confirmed. Similarly, my attitude that trusting the media is fraught with errors has been confirmed. If this story updated one thing, it's to further down rate information about covid, because it appears to have changed from credible threat to tool of fear.
in what way? it's still true that it's not very effective against covid (if at all), has worse side-effects than the vaccines, is more expensive than the vaccines, and is still causing hospitalisations (because people are catching covid by taking a poor treatment, not because they are being poisoned).
I just don't see how this is a 'nothing burger'. it's still very much misinformation and one side is clearly still wrong, even if the other side's news articles are exaggerating the insanity of ivermectin use.
> An important controversial point to consider in any rationale is the 5 µM required concentration to reach the anti-SARS-CoV-2 action of ivermectin observed in vitro,17 which is much higher than 0.28 µM, the maximum reported plasma concentration achieved in vivo with a dose of approximately 1700 µg/kg (about nine times the FDA-approved dosification).24 25
Shouldn't this basic fact put an end to any debate? If a massive overdose puts you at 5% of the required plasma concentration needed for it to even work _in theory_, how could it possibly work in practice?
Unless another plausible mechanism of action has been found, why is this even still being studied? It's utterly bizarre.
I volunteer in EMS. When I first heard about this story, my thought was "... that's not how ERs work". ERs are pretty much the masters of triage. My quick look through Wikipedia suggests that even severe cases of Ivermectin overdose are only going to require supportive care. The ER will need to rule out a bunch of stuff, but most of that work will be offloaded onto techs of one stripe or another. Then they get placed in an ICU for a bit. Situations which are truly able to "overwhelm" an ER involve mass-casualty incidents like airplane crashes or mass shooting incidents.
My assumption about the initial headline was a misunderstanding by the public. That some kid got a superficial wound from improper use of a pellet gun and got taken to the ER by their mother. The kid had to wait in the waiting room for like an hour or something and the mother got mad. At some point, she found out that (among the usual scrapes, falls, aches, pains, dizzy spells, med refills and prolapses) one of the ER beds was occupied by an Ivermectin patient. And then threw a hissy fit which eventually turned into "gunshot victim unable to be seen due to people taking horse dewormer".
My response to the initial denial was that the reporting was sloppy because they didn't phone and check. Because I hadn't read either the article or the denial. But more to the point, this wouldn't have been an issue if the initial reporting had gotten confirmation from a hospital, anywhere. And any hospital system is going to have PR/crisis communications people available, at least 5x8 if not 24x7.
If people are taking the horse dosage of Ivermectin, the issue really is with the availability of veterinary medicine OTC, but not human medication. Having human-rated medication available OTC would at least ensure correct dosage of the medication taken inappropriately.
The only "gunshot" quote in that mountain of bad reporting was describing a single statement from a doctor who had one case where he wanted to transfer a gunshot wound patient - already in his care, not being turned away - to another facility for "higher level" care (no idea what that means) but has been refused. He linked it to COVID load (no mention of IVM in that quote) but there's no proof it's actually the case. That's as much as the "gunshot" angle goes.
Yes, it says they handled 459 incidents for August, but the pie chart makes it more interesting. There are four categories on the pie chart that sound very much like they imply "nobody would be going to a hospital for this". Those categories make up 78% of the cases. If my interpretation of that is correct, and you would need to fall into the "minor effect" category to wind up at a hospital, that means for all of 2021, you are looking at ~252 cases that might include hospitalization. Assuming it remains proportional to the total cases, that would be about 101 cases hitting hospitals in August. So the claim is hospitals are being crippled by between 101 and 252 cases of ivermectin OD.
While some counties are getting their asses kicked, most of them are not at max er capacity. ICU is worse, but more than half of them have space for a gunshot victim. Additionally, you can see that the ICU capacity is almost 100% COVID use because it literally tells you the number of ICU beds being occupied by COVID patients.
You write that the hospital press release changes nothing, but you point out earlier in your article that one hospital in the same region having zero overdose cases makes it unlikely that nearby hospitals are overwhelmed with overdoses.
It sounds like you're stretching really hard to make a lame both sides are wrong argument.
Say what you want, the MSM, and public health institutions, are clearly smearing IVM every chance they get. India's "FDA" just approved the drug as essential for treating covid19. Taken in proper doses, it is one of the safest drugs in the world. Safer than aspirin. It's founders were given a Nobel prize in 2015 and the WHO lists IVM as an essential drug.
If you are ignorant to the truth about IVM, and read USA legacy media, chances are high you think it's a horse dewormer only, and crazy cooks are eating horse paste because of a "conspiracy theory".
The truth is closer to this. USA health regulators are suppressing info on IVM, and instructing doctors not to use it. Some pharmacies refuse to fill scripts, from doctors, for IVM. Therefore, some people are taking the livestock version. This of course can be dangerous, because doses for 2000lb+ animals are obviously much higher than for humans.
Japan has recommended it's use for COVID-19, and India has lowered it's price and listed it as an essential treatment for COVID-19.
Skeptical or not, to completely ignore the use of the drug around the world to treat COVID-19 shows bias and adds to the lack of trust many Americans have in major news outlets.
FOR WHAT IT IS SUPPOSED TO TREAT, WHICH IS PARASITIC INFECTIONS.
This is the same type of misleading advertising which leads to shilling for laetrile clinics and Magic Mineral for Autism cures. Your "the truth is that USA health regulators are suppressing info on IVM" is closer to the same sort of "the big combines don't want you to know about the car engine that runs on water" stories that get passed around. Ivermectin has side-effects, if you are allergic to any of the components you'll have a reaction, and it can react badly when taken in combination with other drugs. Prescribing it willy-nilly to every single person will mean, at best, a rush of people with "I took this and then my legs swelled up! Am I having a heart attack?" symptoms clogging up ER departments.
If you have a dose of worms, scabies, or acne rosacea, you can go and get prescribed ivermectin with my blessings. If you think it will cure a virus because a study in India (which is contradicted by other studies done in other regions of India) says it reduces viral load (but not other symptoms) and so might reduce length of stay in hospital/mortality rates, so you are pinning your hopes on it and not getting a vaccine because, you know, all those stories about the vaccines will make you sterile... why do you believe the studies about ivermectin but not the studies about the vaccines?
I find it quite interesting that you pick out one part of what I wrote, in which I never stated WHY the WHO lists it as an essential drug, yet completely ignore the part about India and Japan using the drug for covid-19. Completely ignore...
"I find it quite interesting that you pick out one part of what I wrote, in which I never stated WHY the WHO lists it as an essential drug"
Well now my deario, come let me take you by the hand as we gambol through the flowery meads of trying to pull a fast one.
(1) You laud ivermectin as a wonder drug (true, in limited cases)
(2) You then slide neatly into "India's 'FDA' just approved the drug as essential for treating covid19." (Yes, and in India you can buy antibiotics over the counter whereas over here you need a doctor's prescription. Want to fight over that? https://www.nature.com/articles/s41415-020-1210-x )
(3) And then we get the smooth operator - the appeal to authority combined with "this sentence is here. and this sentence follows it. by implication, one leads on from the other, whereas in fact they are two separate sentences" (I've recently used this tactic myself in a fanfic in order to inveigle the hero into believing something that is not true and will, in fact, lead to A Very Sticky Situation. It's lying without lying! You say one true thing, and then you say another true thing, and let the listener/reader fill in the gaps that A causes B where it is no such thing):
"the WHO lists IVM as an essential drug".
And by not saying *why* or *for what purposes* the WHO list it as essential, you let the casual reader dupe themselves into "India approved it for Covid... WHO lists it as essential... WHO backs it as Covid treatment".
I'm not smart. I'm not particularly aware. But even I recognise when someone is trying the hard sell on me, and my sugarlump, I am very, *very* resistant to the hard sell.
You are a great illustration of exactly what is wrong with the world right now, and exactly what this article attempts to identify. You are talking out of your rear based on your own biases. I'm a commenter. I'm not a writer. I'm not trying to convince anyone of anything. I'm simply observing and commenting. The drug in question is widely used around the world for treatment against covid-19. USA MSM treats it is as horse-wormer that is poisonous to humans. That is a blatantly false narrative. You're reading into the words and injecting your pre-conceived perception of the type of person I must be to dare point out the drug is being used against covid-19. You've gone from claiming it's only use is against parasites, to claiming I'm an anti-vaxxer, to announcing me as an IVM promoter using sneaky tactics to dupe people. You should enter a mental gymnastics competition. Enjoy.
"You are a great illustration of exactly what is wrong with the world right now"
I am but humbly following in the footsteps of the departed great ones:
Allegedly The Times (of London, do I really need to distinguish this from the others of New York and Los Angeles? Perhaps I do) once sent out an inquiry to famous authors, asking the question, “What’s wrong with the world today?” and Chesterton responded simply,
“Dear Sir,
I am.
Yours, G.K. Chesterton.”
Now peeps, if I say that I've heard shoving a stick of barley sugar up your arse is a great prophylactic against Covid-19, I'm not trying to convince anyone of anything. I'm simply observing and commenting. Any boiled-sugar related traumatic incidents ending in a trip to your local A&E are not on me.
Also, you're showing your bias here too, very clearly. I write that ivermectin is being used in other parts of the world, and you assume I'm an anti-vaxxer and banking my life on ivermectin. All I said is the media and US medical institutions are smearing the drug. You added all the other stuff out of assumption, not fact. Maybe you should apply for a job at The Rolling Stone. Seems you fit their M.O.
How can we claim suppression of information? Let's see. How about: https://taibbi.substack.com/p/meet-the-censored-ivermectin-critic YouTube banning any mention of IVM, even criticism about it, because it's just to dangerous to mention Drug-That-Must-Not-Be-Named. Looks a bit like, you know, suppression to me.
That's from the FDA. It clearly implies that Ivermectin is only for horses, which is false. It clearly implies that Ivermectin is known to be useless for treating Covid and dangerous, both of which are false. The actual FDA webbed statement on Ivermectin for Covid is that they don't know if it is effective and tests are currently being done.
As best I can tell, the danger is from the use of doses intended for animals, not doses for humans — a practice encouraged by the attempt to demonize the drug and thus prevent doctors from prescribing it.
I have not found any reference to Japan officially approving it. What seems to have happened is that the chairman of the Tokyo medical association came out in favor of Ivermectin, but that wasn't any sort of official government policy statement.
Am I the only one who remembers Rolling Stone's breathless front page article on rape at the University of Virginia, the one that RS had to retract in its entirety?
Yes, and that's why fake news flourish - no consequences. They do a fake story, they get caught, and everybody still is treating them as if they're so reliable that one can reprint stories from them verbatim without even bothering with minimal checks. Zero incentive to ever do better.
You: This…turns out to be completely true. The story never mentions Sequoyah Hospital! Dr. McElyea has worked at Sequoyah in the past, but he’s a traveling doctor and works lots of places
Me: Dr. McElyea listed Sequoyah Hospital on his LinkIn. To the best of my knowledge, he did not name any other hospitals that he worked at in his LinkIn profile.
Regardless of where he worked, a reasonable story would have said "we contacted Hospital X for comment, and they said ..."
But none of the stories said that.
None of the places that ran with this called up so much as a single hospital anywhere in OK to get a check on the story.
None of the "news organizations" that claim to have talked to Dr. McElyea asked him what hospital that was at, and then called up the hospital to get a comment on the matter.
Every single "news" organization that ran with the story utterly failed to display even a shred of journalistic ethics, or even competence.
You: None of these sources mentioned that the original article had never claimed Sequoyah Hospital was involved.
Their story was - I guess - too good to check.
Me: No, their story was true. The claims were garbage. The only hospital he was publicly linked to denied the story, and the none of the people pushing the story had any hospitals quoted defending the story.
Could they have said "we contacted Sequoyah Hospital, which is the only hospital in his LinkedIn profile, and they said the story is garbage"? Yes, they could have.
But, did they essentially get every detail correct, unlike the people they were attacking?
**A Democrat reads some fraction of this story, and sees a bunch of idiot conspiracy theorists taking deadly horse medication to cure COVID.**
So, the Democrat story so far is completely contrary to the facts.
**A doctor warns people that his hospital is overcrowded with poisoning cases, and the media dutifully reports on this. **
Still completely false to fact
**Then an unrelated hospital puts out a press release saying they’re not involved and - even though this changes nothing - Republicans seize on this to declare the entire media is “fake news” and nobody should trust anything they read and the horse dewormer conspiracists were right all along.**
The hospital IS related to the case, because it's the only hospital listed on the Dr's LinkedIn profile.
As the articles don't name the hospital where this is supposedly happening, and NO hospital has come forward to say it is happening (because it isn't), this is, at best, a complaint that the Republicans did not dot all their i's and cross all their t's while taking about the Democrats' narrative
**A Republican reads some fraction of this story, and sees the media falsely reporting that ivermectin is overcrowding local hospitals, even though the hospitals themselves are denying this.**
True assessment of the situation (do you have a hospital claiming that "ivermectin poisoning is overcrowding local hospitals"?)
**Also, using a fake photo of something else to imply that lines at local hospitals are stretching out the door.**
Again, a true assessment of the situation.
**Also, declaring that 70% of poison incidents are due to ivermectin when it’s really 2%.**
Finally, a true assent of the situation.
So, the final score is:
Democrats: two flat out falsehoods, one complaint about a technical detail that doesn't actually help them
Republicans: Three true understandings of the situation.
We're all scoring this as "the GOP is the reality based community", right?
I would've loved to take a look at what studies and why they were fraudulent if you cared to link the information. Also, is this really the right time to criticize Fox? Remember when Trump was criticizing the left at Charlottesville and that really wasn't the right time to do it? This is like that. This article struck me as lazy and biased.
Here's a drug that all those awful anti-vax people (or you know, people who maybe don't like the government using their basic human rights to blackmail them into taking experimental drugs) would actually take. If it works, even to some degree, that would benefit both sides and save lives. Wouldn't that be great? Why not have a sane review of ivermectin instead of beating the 'media sucks' drum? Like how come countries authorize the use of ivermectin to treat covid at least in Europe, Asia, and South America? Why were the studies fraudulent? What about other studies? Why not just let people take the drug if it's safe (so they know how to take it safely and don't have to overdose on the horse version or whatever)?
The crazy people sure put a lot of effort into their craziness: https://c19ivermectin.com/ I would genuinely like to see the other side of this story, but "horse-drugged conspiracy theorists" won't cut it.
Naturally, this will be cleared up by the expert "fact checkers" whose mission is to tirelessly debunk exactly such inaccurate facts on the internet! Here goes.
The first result is the Guardian's misinformation article itself. Second, is the Rolling Stone's weaselly "clarification" to its original misinformation article that says "**One Hospital** Denies Oklahoma Doctor’s Story of Ivermectin Overdoses Causing ER Delays for Gunshot Victims." Third result is a Reason magazine article (not an official "fact check"), arguing that "The Media Fell for a Viral Hoax About Ivermectin Overdoses Straining Rural Hospitals."
Finally, (for the first page), the Tenth Result is a site that links to the Reason article (#3, above) but with a caveat that it is "From the Right," and that Reason "Leans Right."
I also ran the identical search on Duck Duck Go, which unlike Google, returns the most relevant results without the Orwellian gaslight filter. The first result is a "fact check" that unequivocally reports the claim as "false" and actually provides the relevant facts to prove it:
"It turns out the story is fake. Northeastern Health System, which Dr. McElyea used to work with as a staffing agency said his report is completely false. * * * * According to the National Poison Data System, there have been 1,143 cases of ivermectin exposure. While cases of ivermectin exposure are up, 102 of the 1,143 cases recorded by the NPDS showed patients who experienced moderate or major effects from misusing the drug. 13% of patients reported with ivermectin exposure had minor effects. 66% had no effects. Each year, the NPDS says ivermectin cases range between 400 and 500. This year’s total is more than a 100% increase, but the numbers are so few. In reality, the ivermectin story appears to be more media hype than an actual medical emergency and most Americans probably won’t be going to their local feed store to buy a ‘horse dewormer’ to prevent COVID-19. But that’s what they want you to think because it makes a great headline."
Scott, fantastic article thank you. Very clear demonstration of an *incredible* problem that exists in today's media and public discourse. I will be recommending this piece widely.
The fact that there are so many comments below about whether or not ivermectin is effective is surprising. The efficacy of ivermectin is not the primary purpose of this piece yet that is all 50% of the commentators below want to discuss.
I've never seen anything like this. There are literally thousands (tens of thousands?) of fringe treatments for various medical ailments. Psychiatry in particular is a mine field of conflicting studies, insufficient evidence, and experimental treatments.
I'm interested in what is going on here. The obvious answers:
1. Covid-19 is affecting more lives than any of those other items, so its medical treatment is receiving more widespread discussion.
2. Politicization of the handling of COVID has spiraled out of control. People who once cheered for project warp speed now think it was secretly a government effort to poison them / Big Pharma attempt to graft the public. Somehow Trump's participation in funding this graft is not part of the conversation.
3. Aggressive misinformation for political (international or domestic) reasons is being latched onto by the media. This is leading them to act like the sky is falling and huge swaths of the population believe it. If you believe this, then the only difference between Flat Earthers and horse dewormer users is MSM attention, not actual threats.
I think all 3 are true. I hover not far from "nothing to see here". I don't actually believe faith in ivermectin is preventing meaningful #s of people from being vaccinated (correlation != causation). The data makes it clear poisoning/ODs from this are insignificant (likely about equal to the spike in Tide Pod poisonings when that fad was around).
So what are we left with? In my opinion a coordinated, intentional campaign to drive further division in our country.
That the current medical consensus is that ivermectin is not the right solution to the COVID pandemic.
That self treating yourself with off label uses is not advisable?
That buying animal-grade products for human consumption is not advisable?
None of that is misinformation. Yes, their tone is obnoxious. Yes, they are unreasonable close minded to the potential of the treatments. Yes, they should do better.
"People who once cheered for project warp speed now think it was secretly a government effort to poison them"
And people who told us they wouldn't take any vaccine recommended by Trump (see, for example, Biden, Harris), are now telling us everyone must take it, and if you don't you're the one destroying America.
"Aggressive misinformation for political (international or domestic) reasons is being latched onto by the media." you mean, like the "scientific studies" that "proved" that HCG didn't;t work, while completely ignoring the actually successful HCG protocol (Step 1: you have to take it with zinc)?
"In my opinion a coordinated, intentional campaign to drive further division in our country"
An interesting claim, coming from someone whose every example is about how those bad Other people are behaving. Are you on the side of the dividers?
I actually don't think its the "others" as you call them trying to divide the country. I think everyone is being manipulated.
An obscure treatment is being promoted by very few people.
Its message is amplified by manipulators
The pro-establishment side responds overly aggressively to this
The anti-establishment side sees their enemy attacking something with unreasonable energy and jumps to a defense that they otherwise wouldn't care much for
This increases the apparent size of the "believers", leading to a ramping of the pressure by the pro-establishment
Leads more anti-establishment to engage
Etc.
It's all quite obnoxious and I do believe we are vulnerable to this sort of manipulation right now.
1: Find out how the supporters of a treatment say it should be used, and what its effects "will be".
2: Decide whether or not the treatment as described would be valuable if it worked
3: If yes, then look at the studies that "disprove" the treatment, and ask
"Are these studies applying the treatment the way the treatment's supporters say it should be used?"
For example:
Suggested protocol for HCQ: "take it with Zinc and Azithromycin when symptoms show up"
Test "proving HCQ doesn't work":
Protocol: Give HCQ by itself to people who've already been hospitalized. See that no improvement happens
When the establishment repeatedly does that, it leaves me no longer believing anything they say. But that's because of their actions, not anyone else's response
I understand your point. As a partial mitigating factor, some of the studies on HCQ were biased towards hospital / ICU usage because (1) that's where the researchers worked or had access to, (2) they were seeking something useful for that context and investigation HCQ, (3) it's easier to experiment on human subjects who are in desperate need for SOMETHING to help, than on still relatively healthy people in early stages of a disease which is usually mild or moderate.
I don't think that all of the "late stage" studies were intentionally trying to obfuscate questions of early stage usage (though some non-researcher HCQ opponents did try to use the results that way).
Nice job with the jiu-jitsu moves in this post. I came to the same conclusion this weekend, that the doctor made two separate statements that were willfully or accidentally conflated. It’s such an unnecessary tempest in a teapot when we should be focused on what’s really important right now - fiddling while Rome burns. Make that California.
The first two sections of this piece are lies, designed to deceive. They do a good job, as intended. But: People *will* stop reading partway through the first section, or the second, and you'll have left them with a false narrative that they'll spread further. This isn't just people who can't be bothered to read a whole article (though they are worth being concerned about) it's also the many people face distractions or obligations that take them away from this article.
Don't be Andy Borowitz. Don't spread fake news under the justification that the dupes should have known better.
(As an aside, even as somebody who read the four linked articles and made sure he had time to read to the end [I could see what you were doing], this was unpleasant. I don't enjoy people lying to me. And if I were duped by either or both of the sections, I imagine I would feel worse and maybe stop reading. It's clever, Scott, but is it worth it?)
Anyone who doesn't bother to read all the way through an article - well, that is part of what this post is about. "I read the headline, I know all I need to know".
Headlines are written not by the reporter but by someone else, they're maximised to grab attention so they'll be as lurid as possible (within the traditions of the media in question; a tabloid headline is always going to be more SHOCK, HORROR! than the mainstream media), and they often misrepresent the story.
Not having the patience or curiosity to read *all* the way through means we are not looking for the facts of a story, we're trying to confirm our biases ("I knew that lot were like that!"). Blaming Scott for demonstrating how we fool ourselves is asking for spoon-feeding not challenging pieces that show how easily something can be made to seem what it is not.
I'm glad I had the forethought to respond to these objections before you made them:
"This isn't just people who can't be bothered to read a whole article (though they are worth being concerned about) it's also the many people [who] face distractions or obligations that take them away from this article."
That's pretty much everyone. It's an unfortunate fact of the world we live in that few of us can completely block off time and guarantee that we will not be disturbed.
Note that there was nothing about people just reading the headline.
That said, it doesn't really matter. Even if people have terrible epistemic hygiene, that's no excuse for poisoning the drinking water. This article is, for two sections, intentionally deceiving its readers. Not allowing them to fool themselves, _deceiving them_ (see "Did you believe that?"). And that's bad, it shouldn't be normalized and, yes, Scott should feel bad.
Yeah the objection of 'what if someone doesn't read all of Scott's post' and gets the wrong message is a duh! You don't know what Scott's message is till you've reached the end of his post. It's not a news item, it's a story... in three acts this time. :^)
Oh good, so nobody who doesn't already know Scott should read ACX, nor should anyone who cannot be sure that they can't read it end-to-end in a single sitting without being interrupted!
Ummm... have you read Scott Alexander? Sometimes it's _long_.
Huh, I thought the point of the post was to try and use the media 'lies' to cause a little cognitive dissonance in his readers, and show how the media is all about the message (narrative) and not about the truth. He was simply trying to highlight our biases.
I will say it's too bad this message got lost in all the ivermectin uncertainty.
Yes, some percentage of people will stop reading this before they get to the 'punchline' and come away with the wrong impression based on a partial read. And yes, a percentage of that percentage will even be people who aren't normally inclined to just skimming the headlines.
... but focusing only on the potential harms of the article's structure ignores its benefits - I think the piece is much more effective as is - I think a goal of this piece is to demonstrate how the vast majority of us are susceptible to believing selective reporting even if we think we aren't, and the current framing of the article is very good at that, in a way that I think a more 'up front' presentation of the facts wouldn't be.
And the more upfront version just wouldn't be as interesting, IMO, which means fewer people would read it, and it'd have less positive impact.
I'm sure it catches people in the act and that was Scott's intention! When Kahneman talks about system 1 and system 2, he would on several occasions force people to use their system 2's by tricking people who aren't. But Kahneman wasn't spreading fake news in doing so.
It's hard for Scott to achieve his intended effect without deceiving people. But a note saying "Be sure to read this in one sitting" would help. I'd include something like "Narrative 1", "Narrative 2", "Narrative 3" to start each section, which would clue people in while only somewhat undermining Scott's goals. And look, the title does something similar, albeit far more weakly.
Lying to people can be useful in teaching rationality. But in general, it's quite bad, and I think Scott should have erred on the side of not lying in this particular case. (And in general.)
Scott says "this story doesn’t make me feel smug and superior to everyone else". However in my case, it totally makes me feel smug and superior to everyone else. Seemingly ALL of the Republicans who populate my social media feeds were tripping over themselves to highlight Sequoyah Hospital's ***perfect*** debunking of the original story, and piled on with the fact that Dr. McElyea hasn't worked lately at that hospital, claiming that it made the debunking even more debunkier - e.g. I saw one Facebook denizen deducing from it that Dr. McElyea was therefore providing information that was out of date (!?!). Such positions could've made some sense if the original story had attached its specific claims to that particular hospital. "Too good to check" indeed. And some of them were indeed musing on that whole thing about not scrutinizing the stories that are all too convenient for one's preferred political faction. But in their case the checking that they skipped was just reading the articles that they're attacking - a whole lot easier than the checking that they expect from their opponents.
Meanwhile I knew all along that the original story was crap anyway. So I've got this situation where the only discernable difference between me and all those smelly people in my political outgroup is this horrendously dumb and hilariously stereotypical mistake that they all made. Yes, their mistake was pretty incidental to the particular real-world referent - but if they're all going to go around acting as if the real message here is about which political faction is more trustworthy, then OK fine, mine is.
1: Dr. McElyea had one hospital listed in his LinkedIn profile: Sequoyah Hospital
2: None of the articles with the "IVM overdoses flooding ERs" name a hospital
3: Noe one has come forward with any rural OK hospital whose ER is being overloaded by IVM overdosers
So, those people who you feel "smug and superior" towards:
1: Were correct: The story was bunk
2: Had support for the story from the most logical hospital to be connected to Dr. McElyea
3: Were not saying anything that was incorrect (which would be the case if, for example, he had meant a different hospital, and that different hospital did have an ER overflowing with IVM overdose cases)
So, what is it that you get to feel "smug and superior" about?
What is it that you know, of any importance, about this subject that they don't?
The thing that I know is that doctors sometimes work in multiple hospitals? (I think they also actually know this, but they've gone and twisted themselves into acting as if they don't know it). You also have here multiple sources (both the original story and the Sequoyah Hospital statement) pointing to this particular doctor working in multiple hospitals.
The Sequoyah Hospital statement gives you 2 facts: #1 that particular hospital doesn't have patients suffering from ivermectin mishaps, and #2 that particular doctor hasn't worked in that particular hospital for a while.
#1 deals a blow to the original story - a fatal one if you are also in a position to add certain other relevant knowledge. In my view the most likely correct response to #2 is to think nothing of it because #1 is dispositive anyway. Some people might reason their way into #2 opening the window at least a crack to restoring the validity of the original story. This is an error in my view, but that reasoning isn't ferkakte like treating #2 as an additional flaw in the original story. That seemingly must be coming from an excess of enthusiasm they have about their wonderful, joyous, blessed debunking.
Hmm. So, I agree with you about what the Sequoyah Hospital statement tells us. But I think you're missing connected implications
1: People read the initial claims, and looked up Dr. McElyea
2: His LinkedIn profile said he worked at Sequoyah Hospital
3: They connected Sequoyah Hospital to ask about all this
4: Sequoyah Hospital said, it's not happening here, and he hasn't worked here in a while, so we can't be the place he's talking about, assuming he isn't making up the story out of whole cloth
We agreed so far?
Add in:
5: None of the stories specify the hospital where this happened
6: As Deiseach pointed out, we have the recent total BS "story" of the medical person's Twitter post about holding the hands of young, healthy, unvaccinated people dying of Covid in Alabama
1: This appears to be another completely made up story
2: We don't even know that the guy has been working in an ER in the last couple of months, since the only hospital known to be connected to him says he hasn't worked there
Now, #2 can be refuted by providing the name of the hospital he was working at when he made those claims.
But until we've gotten a "yes, he worked in our ER last week, and yes, we did have to turn away gunshot victims because the ER was so full" from some hospital, the second part of the Sequoyah Hospital statement is evidence (not proof, but evidence) that every single part of his story (as provided to us by the left wing media) is false
And that's why your Republican Facebook friends were passing it around and gloating about it. Because "you can't beat something with nothing."
And, so far as I know, there is still no evidence (no named hospital willing to agree this happened) that his claim that "the ER was rejecting gunshot victims because it was too full" is even true.
When Obama since the ObamaCare bill into law, his staffers grabbed a bunch of people, and put them in lab coats, so that the press could claim that Obama was surrounded by a bunch of clapping doctors when he signed it into law.
So, when the press claims they have a doctor who is telling you this vitally important left wing talking point, those of us on the right start out with these questions:
1: Is this person in fact a doctor
2: Is this Dr a Dr in the relevant field (is he an ER doc?)
3: Could this Dr have actually had the experience he claimed to have (has he worked in an ER in the last week? month?)
4: If all the above is true, would the Dr be violating HIPPA, and putting himself at serious professional risk, by telling this story?
"How do you know what you think you know?"
When the answer to that is "because X told me so", you must then ask "could X possibly know that?"
The second half of the Sequoyah Hospital statement goes to #3:
I would at least believe this post to a much greater extent (perhaps 10x or so) than I would believe claims from the other publications mentioned in this article, so it's clearly a strong step in the right direction (the fun part is where my initial confidence is like 5%, so 10*5% is still only 50%!)
"This variant was first detected in Peru in December 2020 but was not considered a VoI by WHO until June 14 this year.
By April 2021, Peru reported that 81% of Covid cases sequenced were associated with Lambda.
To date, cases of Lambda have been reported in 40 countries around the world with the majority located in Peru, Chile and the US. It is now considered the dominant variant in Argentina, Chile and Colombia.
...Dr Maria Van Kerkhove, the WHO’s technical lead on Covid-19, said the organisation is tracking the strain as some have warned it could be more transmissible than the Delta variant."
Oh, and we've got Mu as well!
"Mu was designated a VoI by WHO on August 30 and has been reported in 45 countries to date.
Mu was first detected in Colombia in January 2021 and has since seen some sporadic reports of cases and some larger outbreaks reported in South America and Europe.
"Although the global prevalence of the Mu variant among sequenced cases has declined and is currently below 0.1%, the prevalence in Colombia (39%) and Ecuador (13%) has consistently increased," WHO said in its weekly Epidemiological Update."
And they've both turned up in Ireland, so more fun to come for the rest of the year.
I have found that the "Law of Rationalist Irony" tends to generalize. When I catch myself making a social judgement, it almost inevitably reflects how I am feeling about myself in the moment. So when I call someone stupid, I am usually feeling stupid, when I call someone selfish and mean, I am usually feeling selfish and mean, etc.
Curiously, I think this rationalist principle (or at least the principle combined with the injunction not to be like this) may be most succinctly expressed by the Bible verse, Matthew 7:4:
“Do not judge, so that you may not be judged. 2 For with the judgment you make you will be judged, and the measure you give will be the measure you get."
At least for me this advice has been surprisingly useful in avoiding the judgement trap.
IMHO, the right wing framing is much more correct.
The Rolling Stone twitter headline is "Gunshot victims left waiting as horse dewormer overdoses overwhelm Oklahoma hospitals, doctor says."
The addition of "doctor says" saves the statement from being literally false, but the fact is that horse dewormer overdoses are not overwhelming Oklahoma hospitals, and Rolling Stone didn't do the rudimentary fact checking that would have revealed that they weren't.
I first read the phrase "Too Good To Check: A Play In Three Acts" in the context of the Duke rape hoax ("A Rape on Campus'). That hoax also involved Rolling Stone. You would think they would learn. You would think...
That's the University of Virginia rape hoax, not Duke. The UVA rape hoax was Rolling Stone (at least primarily), while the longer ago Duke rape hoax, if I recall correctly, fully ensnared the entire mainstream media. You can look at it optimistically - the more recent one was somewhat more contained
Your are quite correct. I am mixing up my hoaxes. Of course, the real scandal is that real murders (Hannah Graham) have been ignored by media, while fake crimes have been given wall-to-wall publicity.
apropos comments downthread, there are several registered clinical trials or ivermectin use in treating Covid in the USA, and many more internationally. Most are recruiting: https://clinicaltrials.gov/
I think the underlying issue is that news organisations are incentivised for clicks not truth. As long is that is the case we won't get a truthful media.
I find it kind of weird that Scott hasn't yet looked into IVM and made a post about it. It seems like it's exactly his domain: a drug that has showed some promise and that has sparked controversy and confusion. How has he not done a piece on this?
Of course 70% of the hospitalized cases are using the vet formulation. I'm surprised it's not higher. No doubt many of the vaccine deniers are pure and simple(minded) cheapskates who won't pop for a doctor's visit to get a scrip. Especially since he may tell them they're loony. Is the human version more expensive, Damned if I actually know...just presumption on my part. Stuff we get for Sheila the dog is cheaper than similar for me.
Disclaimer: I withdraw the simpleminded term for commenters at my own blog who all are smart and well-educated enough to come up with truly complex excuses for copping out on vaccines. Some are even long-term friends. :-]. Hope none of them die.
I'm still left wondering how many people are trying ivermectin, and how many — in total numbers, not dodgy percentages — are ending up sick enough to report it.
When media outlets report that "Oklahoma hospitals are overwhelmed" by ivermectin poisoning cases and a regional hospital in the quoted physician's practice area issues a release saying it hasn't seen _any_ such cases, how is that in your view an "unrelated" hospital?
Why on earth didn't Rolling Stone or the Guardian (to pick two offenders) pick up the phone and confirm this startling information? Blaming "both sides" is pretty lame.
I had never heard of the Law of Rationalist Irony, but I love that framing as a way of curbing your biases. It certainly makes me wonder how many times I've fallen into that trap.
That looks dishonest.
He's talking about the FDA tweet.
I was talking about the FDA tweet. The FDA web page is more reasonable, including the statement that studies are currently ongoing. The FDA generally doesn't want people to self-medicate with drugs they have not yet approved, and their policy is consistent with that, but the tweet goes well beyond that.
Tweets are for public consumption, this will have been sent out by PR bods not scientists, and the cynical assumption is to go the P.T. Barnum route and treat the general public as gulls that are easily fooled, so dumb the message down as much as possible and throw a scare into them to stop them from doing something stupid.
Doesn't help their cause, but then again anything on Twitter is going to be a disaster.
Don't use ivermectin because . . . horses. That's the level of scientific reasoning by our FDA. Also, never take medical research advice from a tweet that refers to "Y'all."
At this moment, the entire topic is a bleeding mess, and it doesn't help that the anti-vaccination movement has been dragged into it. I'd like some kind of statement of what the position is from every side.
I don't know what the pro-ivermectin side think or believe, and I doubt it's monolithic. Do they think it will protect them from Covid so they don't need vaccination? Do they think it will help in addition? Do they imagine it is a miracle cure, such that if all else fails when you are badly sick, ivermectin will cure you?
I think there probably is a selection of views, from the die-hard "vaccines make you sterile, this is all a plot to hide information from the public, They don't want you to know about this one cheap, easy cure" to people who genuinely believe, if they or their family member gets sick, that this is the thing that will cure them when all else fails, as well as the scientifically-literate mavericks who try anything on the basis that "I read two studies and this might make you live forever" (I'm still not forgiving anyone over 'metformin will attenuate the hallmarks of aging').
I see why the FDA is pushing the horse de-wormer angle, I honestly do. I think the folksy tone is annoying, but that's down to whoever puts out these PR pieces and they're not scientists, they're involved in administrative work. It's aiming for the imagined "your audience is dumber than you think" level of explaining: the general public won't or can't follow the science, if we give them an inch on this they'll take a mile, there is no solid evidence yet that ivermectin works, and some hapless types are rushing out buying up veterinary supplies and then overdosing and then clogging up ER rooms. So we have to scare them straight.
All the studies to date are all over the place, as nobody seems to be researching the same thing. So some are done on mild cases, some are done on people in ICU, some are done on older, some on younger, some in Third World, some in First and Second World, some on ivermectin alone, some on ivermectin in an entire cocktail of 'try it and see' -there is no consistent result; for every study that says "it helped", there's another one that says "it did nothing".
So far, what I've been able to glean is that *once* you have developed *mild* Covid, then a course of ivermectin *may* keep you from developing more serious version, and it does seem to reduce viral load *but* it doesn't relieve symptoms (you'll still have cough, fever, etc. for the same length of time as someone on on ivermectin). That's the best results so far.
So going to your doctor and asking for (human version) of ivermectin does nothing *until* you're already sick with Covid. Oh, and what is the effective dosage? Nobody quite knows, and bioavailability and serum concentrations are dependent on whether or not you ate a full meal and/or had a glass of alcohol with it (one study recommends exactly that, to get the highest blood serum concentration). Dosage depends on bodyweight, as well, so that's another calculation - it's not as simple as "take two tablets every day for five days".
And ivermectin has side-effects, whereby somebody might take this, develop any symptom from this list https://www.medicalnewstoday.com/articles/ivermectin-oral-tablet#side-effects and then panic their way to the ER.
Ordinarily, yes, it seems "it doesn't do any harm so even if it does no good, why not prescribe it?", but this isn't a question of "let them take zinc and vitamin C if they think it'll stave off a cold", this is a vexed and polarised question, and there *are* people who think it will magically shield them from Covid so no need for vaccination (still the best preventative) or any of the infection control protocols.
Yelling at the FDA not to be influenced by public demand fuelled by ill-informed stories going around on social media is contradictory to the criticism of the FDA for being influenced by public demand for the Alzheimer's drug. That too was "well if it does no good, it'll do no harm" - is the only difference there that Aduhelm is eye-wateringly expensive? https://www.policymed.com/2021/09/woodcock-calls-for-hhs-oig-investigation-into-aduhelm-approval.html
I see a lot of left wing people on my FB feed repeating the "it's horse medicine, don't take it" memes. It's lowered my respect for them, since it's also a medicine for humans.
I think the problem there is (1) yes, it is a medicine for humans but only for very restricted uses (2) if you go to your doctor looking for this for Covid, you will get "no" as an answer (3) determined/desperate people make the connection "well, it's the same thing in veterinary medicines" and go buy them and take them (4) this is not a good idea (5) unless you're familiar with the use of ivermectin for treating parasites in humans and other diseases like scabies or acne rosacea, you'll have heard of ivermectin, if you've ever heard of it, as a product to dose sheep, horses and cattle.
Hence the "it's horse medicine" trope which has possibly blossomed out of the "don't take the horse medicine version!"
I agree the FDA shot itself in the foot over this, but to give them as much benefit of the doubt as possible, they are trying to keep people from going out and eating horse de-wormer paste. I think they fear if they go the proper explanation about "yes, this is a medicine used for humans; yes, the active ingredient is the same as the cattle drench etc.", then people will ignore the bit about "however, we have no conclusive evidence as yet for its efficacy and if you don't have Covid, taking it will do no good anyway" and skip straight to "if my doctor won't prescribe it, let's go to the vet and claim Fluffy has worms!" so they're using a simplistic and bombastic IT'S FOR HORSES, DUMMIES! message.
https://todaysveterinarynurse.com/articles/what-veterinary-teams-need-to-know-about-ivermectin-and-covid-19/
"Veterinary teams must communicate with pet owners that may be seeking ivermectin for themselves or suddenly (without a prior prescription or purchase of an ivermectin containing product from the veterinarian) for their pets, that people should never take medications indicated for animals. The FDA has evaluated the safety and efficacy of an individual veterinary medication in the specific animal species for which they are labeled. Taking drugs intended for animals can cause serious harm in people. Veterinary teams will need to educate owners of these facts and that ivermectin prescribed for animals cannot be used to treat COVID-19.
Q: Can I take my pet’s heartworm medication to prevent COVID-19?
A: Ivermectin is not approved for the prevention or treatment of COVID-19. No one should take any medicine to treat or prevent COVID-19 unless it has been prescribed to you by your health care provider.
Q: Are there any risks to humans if they take ivermectin?
A: Veterinary team members need to remind pet owners that currently there are no FDA-approved drug products, human or veterinary, to treat COVID-19. Taking any medication that is not prescribed by their doctor or health care provider, may result in grave circumstances. Advise the pet owner to never take an unprescribed medication, and to call their health care provider.
It is prudent for veterinary team members to be familiar with some of the side-effects that are associated with ivermectin to better educate owners on the dangers of taking a medication that was prescribed for their pet. According to the FDA, these include “skin rash, nausea, vomiting, diarrhea, stomach pain, facial or limb swelling, neurologic adverse events (dizziness, seizures, confusion), sudden drop in blood pressure, severe skin rash potentially requiring hospitalization and liver injury (hepatitis).” Additionally, the FDA states “laboratory abnormalities include decrease in white cell count and elevated liver tests.”
The coronavirus pandemic is producing anxiety and fear in people around the world. Fear leads some individuals to wish for and believe in solutions that are not proven. Therefore, veterinary teams must remain calm and professional when faced with questions from pet owners stating that ivermectin is a cure for COVID-19. We must continue to be rational and educate owners regarding up to date information on COVID-19 and veterinary medicine; including the fact that use of ivermectin for the prevention or treatment of COVID-19 should be avoided as its benefits and safety for these purposes have not been established."
Keep in mind that one of the issues here is that I don't really trust the FDA anymore to put my health over political expediency. I don't know how good ivermectin is at treating covid, but I also wouldn't be that shocked if studies on ivermectin weren't being prioritized for a combination of economic and political reasons.
2 years ago I trusted the US government when they said not to buy masks, and you're silly if you do. 3 months later there were no masks available and my local municipality send my a cheap porous cloth and mandated I wear it out.
1.5 years ago I trusted the US government when they said lockdowns were so important people couldn't go to work. 3 months after that I watched as people took to the streets shouting about social justice. I was told that social justice is more important than covid.
1 year ago I was told the vaccines are available and needed to go into every arm in the country. the FDA only recently approved a single vaccine of the three.
Its very frustrating to me. I want to trust the FDA and the government for health information. I know not qualified to make these types of decisions for myself. But I can't help but notice that the government continuously chooses political expediency over my health needs and I think it would be foolish to trust them too much at this point.
I guess the Lincoln Project is left wing, though there seem to be a lot of left wing people who don't believe it.
https://www.independent.co.uk/news/world/americas/lincoln-project-ad-horse-worm-covid-b1915930.html
If it matters, "it's horse medicine, don't take it" denigrates a lot of third world people who take it as a useful medicine.
The Lincoln Project is a bunch of grifters who used to claim to be Republican, because that's who paid them, and now claim to support Democrats, because that's who's paying them. I'd say that anyone who doesn't believe the Lincoln Project people is doing the right thing
As I recall, their ads were more nasty than false.
They actually did what they were paid for.
When my kids were younger and still ate dirt on purpose at one point we needed treatment for worms. IIRC we were prescribed ivermectin, which I think we filled - it was some kind of banana-flavored chalky liquid. There was also an over-the-counter one in Walgreens which might have been ivermectin - there's one now which is a different chemical, Reese's pinworm tablets, but this was about 5 years ago (California). My sense of it then was that it was commonly prescribed and commonly used.
We took it and we were fine.
I find it surprising that so many people seem to believe it really isn't for humans. Either they never had to take it, forgot the chemical name, or just repeat things they hear.
Why did you have any respect at all? I know how long you've been reading idiot leftist randos on the internet, and making a heroic effort to assume goodwill on their part. I've been there for most of it.
I'm not sure. Some of it is that they at least seem to mean well, while a lot of people on the right do a cheerful attacks on empathy.
It may not make sense to have more tolerance for people who are sad/angry when they attack empathy, but my emotions are what they are.
Also, my sympathies are more left than right on some issues. I think being trans is a good choice for some of the people who make it, and I think a lot of US justice system atrocities are partly driven by racism. I favor reproductive rights and I think homosexuality is normal variation.
I cringe at the current fashionable use of "y'all" on Twitter to express condescension.
This is the most sciency science anybody scienced on Twitter in the history of science!
it’s a joke and it clearly worked to get the article attention so it’s fine
yeah jokes tend to be downright false and misleading. that’s the funny part. it’s Twitter. I personally enjoyed Trump’s tweets, but he said a lot of downright false and misleading tweets too
there have probably been thousands of reasonable and measured announcements about ivermectin that you didn’t notice since they weren’t jokes and didn’t get 100k likes
well the linked article is entirely reasonable and measured. The Twitter account used less sarcastic phrasing earlier in the year and it got much less attention https://mobile.twitter.com/US_FDA/status/1367929940058988544
the article itself is literally a reasonable and measured announcement. if the Twitter account posted some simple and boringly stated sentence, it’s get maybe fifty likes.
Bravo
Well...I would take issue with "subsequently."
I wonder if part of this whole... farrago... has to do with that other medical person doing the tearful Twitter post about holding the hands of young, healthy, unvaccinated people dying of Covid in Alabama? That one too went all round the houses, so I imagine that this story - another doctor with another Covid morality tale! - just reinforced both sides about their beliefs as to what is going on.
https://www.al.com/news/2021/07/im-sorry-but-its-too-late-alabama-doctor-on-treating-unvaccinated-dying-covid-patients.html
I'm not clear. Was that one true or a hoax?
I honestly can't remember. I think it was one of those "sort of true" stories, in that at least one person did die, but there may have been complicating factors. A bit like the story Scott mentions - yeah, there are some people dosing themselves on the animal version of ivermectin and ending up in hospital with overdoses, but it's only a few and it's not preventing people who got shot from being treated (as distinct from 'ER rooms are full of Covid patients which is what is taking up the beds').
Thank you for this, Trebuchet. I've appreciated many replies in this discussion for clearly articulating the issues I had with the article, primarily relating to its implausibility in practical terms. You've given me here an entirely new line of thought on this that I hadn't considered. I'll be paying more attention to this angle going forward.
A binary worldview leaves little room for "The ones that mother gives you don't do anything at all". And per Robin Hanson, a whole lot of healthcare is that way!
Ivermectin is an approved medication for treating parasites, including human beings. But there's no reason for an antiparasite medication to also function as an antiviral, seeing as how most of them aren't (though the antidepressant fluvoxamine, by chance, appears to be). And the likely result of taking a standard dose of IVM will likely to be nothing.
Hanson is well known for his claim that something like half of all medical spending in the US is a waste, which explains why beyond the level of a country like Spain spending more money on healthcare has no effect on actual health outcomes.
https://www.overcomingbias.com/2007/09/cut-medicine-in.html
https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-care-is-wrong-a-primer/
Ivermectin also has anti-viral properties, it is used to treat Dengue Fever etc. Ivermectin is one of the safest medicines on the planet, having been giving to millions of human children all over the world, it is on WHO's list of essential medicines and won the Nobel prize in 2015.
The veterinary and human versions of Ivermectin are the same, one is not more dangerous than the other. People are getting sick from being too stupid to figure out how to dose themselves correctly, not from it being a veterinary product. People aren't going to give their $30,000 thoroughbred a medicine that could make them sick.
As far as evidence that Ivermectin works, physicians in India, Japan, Indonesia, Peru and elsewhere would not be using the drug to treat COVID if it was not helping. They are not stupid, they are seeing results.
It is also possible to be both pro-vaccine AND pro-ivermectin. Mind boggling, I know...
> As far as evidence that Ivermectin works, physicians in India, Japan, Indonesia, Peru and elsewhere would not be using the drug to treat COVID if it was not helping. They are not stupid, they are seeing results.
Using something that doesn't work is common in medicine. That's what most medicine was like prior to the earlier 20th century:
https://westhunt.wordpress.com/2016/03/31/medicine-as-a-pseudoscience/
And doctors continued to do things that were worse than useless:
https://occludedsun.wordpress.com/tag/frank-t-vertosick-jr/
It was just balanced out by SOME things (like antibiotics) that actually helped.
Uh, OK, but we are in the 21st century now, and I very much doubt that physicians in other parts of the world who are using Ivermectin are that ignorant. Even if that were the case, IVM is one of the safest drugs out there so where is the harm? I suggest looking at the National Institute of Health site (maybe you've heard of them) and doing a search for Ivermectin, which produces results like this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248252/
"The findings indicate with moderate certainty that ivermectin treatment in COVID-19 provides a significant survival benefit. Our certainty of evidence judgment was consolidated by the results of trial sequential analyses, which show that the required IS has probably already been met. Low-certainty evidence on improvement and deterioration also support a likely clinical benefit of ivermectin. Low-certainty evidence suggests a significant effect in prophylaxis. Overall, the evidence also suggests that early use of ivermectin may reduce morbidity and mortality from COVID-19. This is based on (1) reductions in COVID-19 infections when ivermectin was used as prophylaxis, (2) the more favorable effect estimates for mild to moderate disease compared with severe disease for death due to any cause, and (3) on the evidence demonstrating reductions in deterioration."
Where do you find that ivermectin is used to treate dengue fever? Wikipedia, the CDC, and the Mayo Clinic all disagree with you -- they all say there is no specific known treatment for dengue fever.
The NIH COVID-19 guidelines[1] do mention that ivermectin has been shown to have activity against dengue virus in cell cultures (as it has against SARS-CoV-2 also in cell culture) -- but the required concentration of the drug is about 100 times the maximum approved dose used for the treatment of parasites. That is, to get the same effect against dengue (or SARS-CoV-2) you see in cell culture, you would need to take 100x the normal dose. I don't think anyone knows whether that would still be safe.
----------------
[1] https://www.covid19treatmentguidelines.nih.gov/therapies/antiviral-therapy/ivermectin/
I typed "ivermectin dengue fever" into google and got a bunch of recent studies supporting the use with various dosages. But they are recent, so it's possible the CDC and Mayo (and Wikipedia) have just not updated their guidelines/recommendations/articles.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6277121/
https://pubmed.ncbi.nlm.nih.gov/33462580/
http://www.rcpt.org/abstractdb/media/abstract/CON2018/Best%20Resident27/BRA_77_Eakkawit.pdf
This study done in Thailand used a 400 microgram/kg dose.
There are plenty of well researched drugs used by millions of people that are both “dangerous” and “not FDA approved for indications they are not approved for”. Most any chemotherapy drug or strong immunosuppressant, for instance, and many many others.
Yeah, it’s not chemo. But your original statement was poorly stated. And off label medication use absolutely can be dangerous, both in terms of drug interactions and low rate side effects. Especially, say, dosing it yourself using prepared animal medicine or using it to the exclusion of vaccines, is reasonable to call dangerous.
I mean some docs have prescribed ivermectin and most docs don’t prescribe whatever patients want.
Which points to the hypocrisy. Anti-IVM people use excuses about size or lack of RCTs to try to block it, or say the efficacy signal isn't high enough. Meanwhile all manner of other drugs are freely prescribed off-label with not real testing. The latest alzheimer's drug approved by the FDA showed no significant efficacy against alz in the trials. Puberty blockers are handed out to GNC kids like candy without any RCTs. It's like the wild west for most drugs, but IVM is held to a higher standard, even while it's safer than all these other interventions. Why?
yes all of those are bad. IVM, Aduhelm, and puberty blockers all are bad.
I agree. So the why question remains. When you look at the whole data landscape minor critiques about the IVM data don't hold up relative to business-as-usual in pharma. That points to a specific agenda being brought to bear in this case. And if IVM threatens an agenda, it's reasonable to look with some scrutiny at the data and messaging saying it's no good. After all, cigarette companies suppressed the truth for years with help from our institutions.
They kinda do? Methodological critiques are extremely common in medicine and the FDA very frequently nixes trials and drugs over various concerns. Which is arguably good, although the blog thinks they are too aggressive. Aduhelm was an outlier (I mean look at the dozen not approved Alzheimer’s antibodies), and puberty blockers are also an outlier.
That scrutiny doesn't typically apply to repurposed drugs though. Once something is FDA approved like IVM is, off label usage is free and clear. In this case the pressure to not employ that norm is wild. I'm in Canada and our doctors can't even use it discretionally. IN the US it's allowed but the pressure not to is severe enough to dissuade many docs who want to. That is not normal.
However, unlike many others, Ivermectin is a very safe drug when given in the proper dosage.
it isn’t useful, though, afaicf?
There’s familiar deception, and unfamiliar deception.
I think the “everything is a conspiracy” heuristic is widespread. Some people’s next step is “but I know how to read between the lines of the mainstream media” so they just use their decoder ring on the same sources and call it true. For other people the next step is “and therefore I should disregard information and rely on friends and family.” That creates a bubble of followers around whoever has the decoder ring.
Of course the lying media is three or four steps past the decoder ring and can now reliably convince readers of certain things, without even directly saying it.
The lying media problem is corrosive in so many ways.
I mean, taking a drug for completely the wrong purpose at doses you have to figure out yourself is a recipe for disaster. The dose makes the poison, after all.
Hate to break to to you, dude, but the Trump campaign did collude with Russia, they did destroy evidence and Trump did successfully obstruct justice. There is a mountain of evidence for all these things, and none of it relies on the Steele dossier.
The fact that you buy into calling it a "tale" is an indictment of your media diet and/or refusal to read either the Mueller report or the Senate Intel committee report.
I'm not here to convince you with my proof. I'm here to pity your willful blindness. Good day.
I thought the conclusion of the Mueller report was that they didn't have enough to charge anyone with that... although "collusion" isn't actually a legal term.
Collusion isn't a legal term, but in its colloquial use the Trump campaign colluded over and over.
They did not have enough evidence to charge the Trump campaign, but part of the reason they did not have enough evidence is because much of it was destroyed or out of reach. Bannon, Manafort, Stone, Prince and several others deleted their text and Whatsapp messages. Manafort and Stone both lied (and continue to avoid telling the truth to this day), and Joseph Mifsud disappeared.
And the obstruction absolutely happened. Trump rewarded Manafort and Stone for their silence with pardons.
From my perspective, anyone who has bought and sold commercial real estate in the New York metropolitan area has dealt with mafias. In the 70s/80s it was still the Italian and Irish mafia. After the Soviet Union fell and people started leaving Russia, soon there was a Russian presence in NYC and from what little I could see the mafia found it to be a supportive ecosystem. I did not get any data on the Russian mafia in commercial real estate but the prior mafias were (as per person there working in real estate at that time). I did encounter a Russian person from a business family whose family was paying the Russian mob regularly, I never knew for what, didn't need or want to know. Casino gambing? of course no mafia there, right. As far as I can tell, it is very unlikely that Trump never dealt with anyone with Russian mob connections. Given his money and types of business, it's almost impossible. Given his personality and social role, it's improbable that he didn't pursue it, especially when he needed additional financing. Would he have looked away, kept his head down, not involved himself in their deals? Hmm. Probably not. Keeping in mind that he was a Democrat for years and did not seek a political role. But at that point, in that world, he had friends who knew people. It's not that here's this wealthy person, with no organized crime dealings ever, who suddenly needs political intelligence and randomly seeks out the Russian mob. There's an ecosystem there and I don't think he even went that far outside that, ah, tentacular ecosystem.
And yes, when it looked like they might get in trouble, they did all the things they do to make it go away, and it mostly went away, unless the tax return thing in New York is still cooking.
One of the very large, less often told stories in the US is organized crime. Street gangs are only part of it. It's less visible in the West and to some extent different organizations, but still happening. Silicon Valley may be the only concentration of wealth in the US that is not largely mafia-run or strongly mafia-influenced, primarily due to the engineering/intellectual aspects aren't immediately amenable to mafia infiltration. Of course utilizing social media for propaganda and political influence is more their skill set.
I think people from other parts of the country just don't realize; it seems like a bad spy movie until, looking at the ecosystem there, that was expected behavior.
Any media making that claim is reffering to the horse paste version, not the human version.
If they don't mention that explicitly, they're being sloppy or imprecise, but they're reporting a true thing poorly.
I notice your goalposts have moved.
>Any media reporting that ivermectine, a well-researched drug routinely used by millions if not billions of people, is "dangerous" and "non FDA approved" is lying and has an agenda.
Nothing you link makes those claims.
'non fda approved' and 'not approved for treatment of covid' are not the same concept. AS I'm sure you know.
Nor is 'dangerous' and 'can be overdosed.' You can overdose on water.
"puts it more bluntly" link points to the wrong site
Thanks, fixed.
Yglesias is (wittingly or not) guilty of the classic issue of overinterpreting change-in-rate stats - yes, ivermectin overdoses increased BY PERCENTAGE, but from next to nothing to... also next to nothing. It's like when shark attack deaths increase from 2 to 8 in a given year and the newspapers say "SHARK KILLINGS INCREASE 400%!"
"It's like when shark attack deaths increase from 2 to 8 in a given year and the newspapers say 'SHARK KILLINGS INCREASE 400%!'"
When, of course, the accurate headline would be: SHARK KILLINGS INCREASE 300%!
:-)
But, yeah.
Something I've tried to hammer into my son is: What is the baseline????
This plays at least two ways:
1) A small baseline allows for large percentage increases with tiny absolute increases (also, the small baseline is more susceptible to random fluctuations ...)
2) A large baseline allows for large absolute increases that are tiny percentage increases (and, again, possibly just random noise).
The baseline to be established should also come with a spread.
Sigh.
I don't expect any of these in normal reporting, though.
fucking christ
I promise I know the difference between 300% and 400% :(
Your point was quite valid. I just couldn't resist ...
Do I believe that?
Hmmm... Now by the law of rationalist irony I just learned, next time I'm going to share a statistic on this site, it's going to make me look like a fool... :)
"Hmmm... Now by the law of rationalist irony I just learned, next time I'm going to share a statistic on this site, it's going to make me look like a fool... :)"
This trick is to attribute the statistic to someone (possibly fictional). If it doesn't get challenged, you look good. If it does get challenged you can blame the (possibly fictional) source.
I don't know if I'm joking here or not ...
I read in an article by Johns Bobkins that this was, 100% of the time, the correct stance to take, the other 20% of the time you should definitely attribute a real person, because law of someone elses averages are that you'll need to find them on twitter when you need to quote them.
Joke or not, this is going to be my MO from now on... :)
It's OK to show less iron rigor when you're obviously making a rhetorical point using made-up numbers!
"I promise I know the difference between 300% and 400% :("
100%, right??????? :-)
I was fine right up till this one and now I long for death
"I was fine right up till this one and now I long for death"
I will treat this as ... praise?
You've put 110% into this!
And yet, it absolutely will be reported as "400%" because it sounds more grandiose and people that would notice the difference are not even 0.4% of the audience.
Were you even wrong, though?
If we know there are two shark attacks, and we read a headline saying "shark attacks increase 300%", it's a little ambiguous as to whether this means "number of shark attacks now increased *to* 3x (of what it was)", i.e. 6; or "number of shark attacks now increased *by* (an additional) 3x (of what it was)", i.e. 8.
Perhaps the standard is to read it the latter way, I don't know... but I bet you tons of sensationalist articles use it the other way, too, so you can just claim you were adding verisimilitude by this example.
If you see a headline saying "X has increased 20%," you expect X to now be 120% of its previous value, not 20% of its previous value. This also holds for values greater than 100%, although it can seem confusing.
If X is a percentage, it's horribly ambiguous.
"Inflation jumps (by) 20%" - from 5% to 6%, or 5% to 25%?
That’s what the term “percentage point” is for
Did you know, right-handed people commit 89% of all base-rate errors!
I mean, the percentage increase in this case does tell us that *something* real is happening. If shark attack deaths are 1 or 2 most years, with an occasional 3, and this year we have 8, then maybe that tells us that someone decided to plan a floating steak tartare party in a great white breeding area or something.
It's not significant as a fraction of the death rate or injury rate, but it's significant in the statistical sense of telling us that some new causal factor is involved.
Sometimes we should ignore causes of death that are much smaller than the background rate of death and injure. But if there's a really easy thing to stop, then even if it's quite a bit smaller than other causes, it's good to know about it so we can do something about it.
(Not that most of us in the smug audience are in a position to do anything about ivermectin fans.)
Actually, the percent increase *doesn't* tell us anything real is happening if we don't know the baseline average and, say, standard deviation.
The year with the "2" could have been an unusually good (bad?) year for shark attacks. Maybe you'll see "8" in a year every five years or so and this is that year.
Under reasonable hypotheses, the yearly number of shark attacks is Poisson-distributed so the standard deviation is the square root of the average.
I really hope this was a joke about sharks eating fish
Took me a moment... but thank you for that.
The awkward moment when you make French puns by accident
Or sharks *being* fish - in Australia, gummy shark is the most common "fish" of "fish and chips".
Ew. That sounds viler than vegemite, mate.
I was disappointed to search and discover that gummy shark is a species of shark and not referring to shark-shaped gummy candies.
Yep.
Eh, the law of small numbers means things can jump around a lot from year to year. A small town could have 0 homicides in one year, then in the next year if it has any there would be an infinite percentage increase from the previous year.
Another fun fact with percentages: Suppose I need something now that costs a dollar. I borrow a dollar from you on the understanding that I will pay you back two dollars tomorrow. You are being a bit usurious in truth, but this is still good value for me. But the APR on this loan is more than a Googol (10^100)!
The value is 7.515*10^111%, to be precise. Of course this is assuming that your friend would be unreasonable and demand double again if you were a day late on the payment.
If your friend is slightly more reasonable and demands only a dollar per day late in extra payment, this could be interpreted as a 590% APR distributed linearly over the year.
In the Ivermectin case, we know the thing that's happening--we're trying to figure out whether it's had a meaningful effect on the world or not. Showing that Ivermectin poisoning is up is a decent piece of evidence to suggest that, indeed, more people are taking Ivermectin and more people are getting sick from it. The question is whether the size of that increase is more consistent with the view that this is a very fringe thing that's been exaggerated by the media, or that this is a serious problem.
From this perspective, the baseline of "number of Ivermectin poisonings in a normal year where people aren't self-medicating with it" seems like a somewhat misleading baseline. It would be more meaningful to know something like how much this has pushed up the rate of poisonings overall.
Not necessarily. What are the percentage fluctuations away from 1/2 for the probability of getting heads if you throw a coin 3 times? How about 300 or 3 million?
"It's not significant as a fraction of the death rate or injury rate, but it's significant in the statistical sense of telling us that some new causal factor is involved."
With such a small base rate, it could be just natural randomness. I would call it statistically insignificant. Now, if the increase was sustained year after year…
How is this different from what he says in the tweet: "In percentage-wise terms there has been a huge increase in ivermectin-related poison control calls but it's from a low base" ?
Then what is his contrarian contention against the conventional wisdom that Rolling Stone fucked up at all? I don't understand the argumentative content that's being proffered - "all of these people think Rolling Stone fucked, but there HAS been a big percentage increase in ivermectin poisoning!, but also it's from a tiny baseline and has essentially no social or epidemiological consequence at all"? What is the nut of that set of claims that I'm not grasping?
Yglesias wasn't trying to be contrarian. Nowadays his whole deal is that he writes things that are popular and probably true, in a way that makes him look contrarian to people who are too online.
The second part of the clipped tweet praises scorn and mockery, but that scorn and mockery is irrelevant given that we're talking about dozens of cases in a country of ~330 million.
I don't feel like he's praising scorn and mockery. He's just saying it's good news that the cases have went down and off-handedly gives credit to the scorn and mockery.
The number of people suffering from Ivermectin poisoning because they're taking Ivermectin to protect them from coronavirus is very small.
The number of people suffering from coronavirus because they're taking
Ivermectin to protect them from coronavirus is very large.
In theory, "take all the Ivermectin you want provided you also get vaccinated and wear a mask" is a perfectly reasonable position; in practice human nature makes it much closer to either/or.
Of course,
"scorn and mockery are not good ways to persuade people not to take Ivermectin and get vaccinated instead"
and
"scorn and mockery may be good ways to persuade people not to take Ivermectin and get vaccinated instead, but the cost in damage to the social fabric is too high"
are both defensible positions (i.e. they may be /wrong/, but they're not /obviously/ wrong to me on the brief thought I've given them), but I don't think either is self-evident (i.e. they're not /obviously/ right, either); I'd have to think more about the first, and if it's not true I'd be surprised but not amazed if the second were.
I'm dubious about this, but I can't think of an easy way to test it. So I'm just gonna spell out my objection, and you can decide how plausible you find it.
I find it really plausible that there are lots of people taking Ivermectin who aren't vaccinated/masking.
I find it implausible that there are lots of people who *would* be vaccinated/masking if Ivermectin didn't exist who aren't currently doing that.
Let's grant arguendo that we know enough to be pretty confident Ivermectin doesn't do anything vs COVID. I'm not 100% on this irl, or even 95%, but it's a decent possibility.
When I imagine the Ivermectin free world, it isn't a world where there aren't fake COVID cures. Ivermectin isn't the only fake COVID cure in our world, and without Ivermectin filling that niche there's more room for the next best candidate.
My model of people who aren't vaccinated is that a lot of them- probably more than half- wouldn't be vaccinated in a world with no fake cures. But that's not the counterfactual- a world without Ivermectin is one where the fake cures are slightly more obviously fake, slightly less convincing, and I'd expect that to have an extremely marginal impact.
As I said, I don't see any way to test this, but do people actually disagree? Is Ivermectin special somehow- an outlier in convincingness as a Covid cure?
I think his motivation is his argument that when it comes to vaccines/ivermectin/etc, lots of right-of-center types spend more time tut-tutting liberals like him for going about convincing people the wrong way (i.e. with scorn and mockery rather than sympathy), than they do going after the conservatives acting 100% in bad faith.
In other words, some center-right person says "liberals why are you being so mean to anti-vaxxers?" but ignore, e.g., Tucker Carlson saying that vaccines don't work, and how is Yglesias worse than Carlson on this?
The "see, scorn does work!" bit is a part of that whole argument.
As it happens, after writing this I checked Conor Friedersdorf's twitter and he has a thread up that is the sort of thing Yglesias is pissed at: https://twitter.com/conor64/status/1434912898204278787
Does say that Carlson is acting in bad faith, but just kinda accepts that as a fact of nature and then 11 more tweets about how scorn and ridicule is so bad.
Is that what he's saying? Yglesias seems to be trying to get at the actual truth: There has indeed been an uptick, but the absolute number of cases is small, so Rolling Stone was wrong, but there is a grain of truth here.
But maybe that's just how I interpret it because that's how Scott presents it. Is there context I'm missing here?
That's exactly how I read it. "The percent is way up, but from a low base, (therefore there is nothing really interesting here)."
I read it that way as well, but I did notice that I had to insert the bit in the parenthesis myself. Yglesias' point strikes me as being literally true, but missing an important bit of scorn for people who speak of large percentage increases from tiny bases. I don't think he needs to say "And that's terrible" at the end of that first paragraph, but given his audience (Twitter) he really probably should have clarified and added the parenthetical you did, Edward. One could easily read his Tweet and think "Yes, so it is true!" given how most people don't know stats at all.
DeBoer, Alexander is too much of a coward (no, he isn't--I'm just trying to motivate him). I'm a subscriber of yours, too. Do the work for all of us that I'm trying to get Scot to do: if all the practitioners around the world who report positive (not foolproof)effect are wrong, what are the most credible reasons why they're wrong: grift, glory, methodological flaws, placebo, hallucination, confirmation bias, whatever. Do it. Do it for the few religious people who deeply respect yours and Alexander's work, who don't think IVM is a miracle, but neither do we think it's all a mirage.
Didn’t he literally say - “but it’s from a low base?” I don’t think he’s guilty of this…
Agreed. The tweet makes this exact point, but more concisely.
I don't think he's guilty of saying something untrue. I do think he's guilty, as he often is, of wanting to carve out a contrarian niche on a subject when there really isn't one in the offing. See my response to Scott.
Aren't all three of us (me, you, Yglesias) addicted to annoying contrarianism in only very slightly different ways?
Of course! Why do you think I'm such a keen observer of such?
maybe that's the common thread on why I read all three of you!
Does Yglesias have an Substack?
You (and Freddie, it has to be said) couldn't be more wrong...
Three contrarians walk into a bar...
It writes itself - provided only two options they will come to have a majority in favor, whereupon they will spontaneously combust. What a way to go.
Only because someone said they shouldn't.
Do you really consider yourself a contrarian? You don't really seem like one to me.
That is because you literally only care about precisely one thing, and it happens to be something where he holds the mainstream position.
Huh? I care about a lot of things.
Since he said it was from s very low base, I don’t think he’s guilty of anything.
He is..? He says "Fortunately it's from a very low base". It seems like he's actually got things exactly right. The point of his tweet is exactly your point: The relative rate is large, but the absolute number is small, so it's not really a big deal.
Everyone who has replied to this comment so far is guilty of "too good to check" bias. Ivermectin doses went from a low point of 26 in the month of January 2020 to a high of 459 in the month of August 2021. This is three orders of magnitude larger than less than 1 shark attack per month. And it's not yet clear if the slight decrease at the end of August is variability or a trend. Ivermectin cases this year have been way above typical variation. The sample size is large enough that this is not overinterpreting.
Here is the original data: https://piper.filecamp.com/uniq/ZO3aGrYGXdIUhiJ7.pdf
It would be interesting to see what it is in OK alone; unfortunately, the website requires that you send it a form to get data, which is ridiculous, but anyway. . .One of the complaints I've heard about this story is that rural people are much more likely to have actually given ivermectin to horses and therefore to be aware that the dose is much larger than it would be for a person (and even among horses, the dose you give a new-born colt is much smaller than it would be for a full-grown stallion; the product information emphasizes this, and the dispensers are specifically designed to make creating the proper dose easy.)
Percentages are a great way for manipulators to manipulate a particular message they want to convey. A huge array of %-based statements can be devised with the same data, and it’s no wonder the general public can’t keep up. Given the bear traps involved, I fully expect a stupid error in the next para!
Taking the shark attack scenario, the simplest ratio for the public to understand is “shark attacks went up by a factor of 4” (last year they were 2, this year they’re 8, 2x4 is 8). Understandably, those who are somewhat numerate but not math trained would then think: “wow, up 400%!” (factor of 4, up 400%, easy logic). Coming up with 300% is more tricky for the average reader, because subtraction of the original number is required (was 2, went up by 6 to 8, 6 is 300% of 2). But wait, if we look backwards, we could also say “shark attacks were 75% less last year” (2 is 25% of 8). So there’s another % we can imagine. (This last manipulation is rife in economic reporting, and very misleading. If house prices go up 100% in one year, then crash by 50%....thank goodness, I’ve only lost half my gains!!! Nope, you’re back at the same number, it’s just the use of percentages misleading your perception.)
What if we have the following breakup? The first six months there were 4 attacks, the next six months also 4 attacks. So headlines would read at the end of each 6 month period: “shark attacks up 100%!” (2 to 4 is 100% increase, 4 to 8 is 100% increase). Wow, that’s 200% in a year, a brand new % number!
Of course, if you really want to hide stuff, convert to log data!
The CDC bulletin said calls to poison centers about ivermectin are at 5x over baseline, but they don’t tell us the base rate ether. They do have a graph showing how much prescriptions increased: https://emergency.cdc.gov/han/2021/han00449.asp
Did Scott update the graphic since you wrote this or did you not see that Yglesias specifically points out the low base rate in his tweet?
Either way this is a great example of the exact topic of this post.
Isn't that exactly the point of his tweet? That a percentage increase from a small baseline isn't very meaningful
He literally said this, in his tweet. He said that it's large by percentage but from a low base. He's not guilty of anything ...
The classic reason that change-in-rate is misleading is because noise can be confused for an actual change. Even if it's low odds, a fourfold increase in shark attacks could be notable if real ... but probably it's not real and rather just a happenstance.
Here we have enough data points to form a clear trend, plus a reasonable causal hypothesis. So it's not really a problem to say that indeed cases are up.
"from next to nothing to... also next to nothing"
Thus the mirage of relative risk. Pharma frequently uses this to make their interventions appear miraculous, when in actuality they're almost insignificant.
I like this section: "This story doesn’t make me feel smug and superior to everyone else. It makes me feel confused and annoyed. This is how true things usually make me feel, so I think I’ve dodged the Law of Rationalist Irony and might have some chance of being right this time". obviously this can lead to its own bias (choosing not to believe anything that would make you feel good, on purpose, is definitely a real problem common with depression) but i think a bias towards truth being confusing and annoying is better than the alternative, and i try to lean on it (another potential failure case?: stories emphasizing how bizarre and baffling and mysterious some fact is, when actually its pretty normal and explicable. this kind of thing is annoyingly common among fuck yeah science types)
I really enjoyed reading this, tho' it sent an uncanny chill down my spine.
Really appreciated the careful dive into what actual facts exist about this situation. But.
I submit that those with a decent brain and a B-S detector (like me, of course) didn't need a follow-up to know that the original story as presented was almost certainly B-S. Hospitals overwhelmed with a steady stream of ivermectin overdoses such that they were turning away GUNSHOT victims? Both parts of that story are prima facia ridiculous.
"Hordes of gunshot victims" in the first place is unlikely.
I dunno where you live. Where I live, they definitely travel in "Hordes."
Yea, that got me too. I sometimes wonder if people who live in cities just assume that rural areas are just like cities in all respects, just spread out more, as though the density doesn't change anything. (For good or ill, although for my part I much prefer the country side to cities.)
I assumed that the hospital was full of ivermectin victims and that there was some kind of policy forbidding them from kicking out already-hospitalized patients to make room for new patients (ie, new gunshot victims), but in hindsight surely they would have used standard triage procedures to prioritize gunshot victims *somehow*.
You're right, and both parts are so ridiculous that nothing short of extreme, brain-eating bias could account for why the BBC, The Guardian et al went with it.
But if I had read the original story (I hadn't), I would have experienced that same little jolt of joy I always feel when the idiocies of the Trump World are examined and for a few moments at least, perhaps long enough for me to have forwarded the article, I would have reveled in it.
Eh, the weakest interpretation of the claim is that a single doctor turned away victim from a single incident at the same time the hospital ha at least 1 horse dewormer case taking up a bed at some hospital somewhere in the country. Even if there's only a few hundred dewormer cases nationally I could imagine that coincidence happening somewhere, as coincidences are prone to do.
I mean, not 'worthy' from our perspective, but certainly the type of thing I'd expect to see reported.
Even for relatively good reporting, the formula is often 'find an unrepresentative anecdote that's attention-grabbing to put in the headline and first paragraph, then do any real reporting in the rest of the article.'
Now I get how people develop epistemic learned helplessness
This is the greatest shame in these types of episodes. If people stop trying to figure out what is happening then we will be worse off and the insiders who do know what is happening will be empowered.
Maybe sort of? But the insiders won't be empowered to spread the truth if they want to, because the public will be too epistemically helpless to recognize the facts of the case. They'll only be empowered in cases where they benefit from public ignorance.
> They'll only be empowered in cases where they benefit from public ignorance.
Which should be the vast majority of cases
Strongly disagree. The point of epistemic learned helplessness is not that you shouldn't try to figure out what is happening, it's that
a) when doing so, you should attach more weight to secondary knowledge ("most people who have looked at this think X" and "most of the experts who have looked at this think X") and less to primary knowledge ("my attempt to look at this shows X") than most people do.
b) If you /do/ think you've figured out what is happening, you should attach a higher probability than most people do to the possibility that you're wrong.
I mean, that switches it from a descriptive claim (people will develop epistemic learned helplessness) to a normative one (people SHOULD do epistemic learned helplessness this way.)
But regardless of how people ought to be epistemicly helpless and how nobly they should strive to understand something anyhow... practically, admitting that you can't determine truth from fiction removes most of the interest in continuing to study it.
Consider the example from Scott in the coining essay. I suspect that he spent far less time reading pseudohistories and thinking about whether they were likely to be correct once he gave up on being able to tell if they were true. What's the point? If you're mostly unable to tell if they're true and going to rely on expert opinion anyhow, you're wasting your time and exposing yourself to infohazards by continuing to epistemically engage with pseudohistories.
Also, the idea that there are "insiders who do know what is happening" strikes me as textbook conspiracy theory.
It's not a matter of universal insiders vs universal outsiders. Many people understand something; almost no-one understands more than a few things in any depth.
This is so true. I spent my career working a specific set of issues that are hot in the media occasionally. They are always oversimplified and sometimes egregiously wrong for obviously self-serving reasons (from the people providing the simplifications). But the people providing them probably believe them.
I have no idea how you could ever figure out the actual situation without working in the field.
And the truth about the subject is frustrating, complicated, and morally ambivalent.
Well... if you want a good but sort of depressing read, try "What Americans Know about Politics and why it Matters" by Carpini and Keeter. Short version: no one knows anything about politics or how the political system works. When I say that, I don't mean things like "no one knows the history of the filibuster rule" but more like "a tiny fraction of people know who their congressman is, and only a few more know how many senators their state has." The survey data is sad.
A related point, which I think is from that book but might be somewhere else (sorry, did a lot of studying the topic a number of years back) is that the more television news people watch the less they know about the political system. They know more of the personalities, who is in what office etc., but less about how things actually work. I take this to mean that most media coverage of politics is on net misleading, presenting a view of what the writers want you to believe is true, with very little and very hard to separate actual truth value.
I don't know that that situation will ever change, just as the nature of the beast, so I tend to favor government forms where people don't need to know what is going on, because very little is actually going on. I don't know how stable such forms of government can be, however.
The Ivermectin story supports the theory that a lot of anti-vax sentiment is the result of a fear of needles.
I know people have been working on vaccines taken nasally, but I haven't heard much recently. I dislike needles but still got my COVID shots that way.
At least one polio vaccine has traditionally been given on a sugar cube you eat, but I think that one has (weakened) live virus, so they only use it in villages where there has already been an outbreak.
There also have been stories about companies working on skin patch vaccines. They say there are 400 microscopic needles, but I bet it doesn’t feel like a needle, and would overcome quite a bit of hesitation.
https://www.fiercebiotech.com/research/covid-19-vaccine-packed-into-skin-patch-shows-promise-mice
1975 German ad for oral polio vaccination (I remember getting that sugar cubes, too): https://zeithistorische-forschungen.de/sites/default/files/medien/static/2013-3/Thiessen-Abb-5.jpg
A friend of mine is no anti-vaxxer but waits at home for a covid-vaccine without the sting.
The Sabin vaccine was oral, compared to the Salk which was injected. The purpose was partly safety -- if you eat it the virus can still be a bit more vigorous and not give you polio -- but it turned out to have fortunate side effects, in that people developed enteric immunity to polio, which was a bit more useful than bloodstream immunity *and* they shed the weakened virus and willy-nilly inoculated a few other people for free.
It's a shame we can't do the same with COVID, i.e. give people some kind of compromised (but still replication-competent) virus which (1) gave them immunity and (2) which they could unknowingly share with other people, e.g. family members who were passionately anti-vaxx. "Achoo!" "Well, now I feel funny for a few days, but afterward by gum I have not got COVID even after going to 4 raves, clearly a triumph for my regime of clean-living, vitamin D and zinc, and prayers to Viritrilibia."
I just checked and there are now 4 attenuated covid vaccines in development. I believe two were abandoned in preclinical testing. Meissa is in phase 1, and Codagenix is also phase 1 but it is doing something very strange involving re-designing the whole virus from scratch.
There are several replicating viral vector vaccine candidates that work by doing things like taking a weakened virus other than sars-cov-2 and engineering it to express the sars-cov-2 spike proteins. This is not wholy unlike the AZ vaccine and has some of the same potential downsides, namely, developing immunity to the vector.
The attenuated flu vaccine is not infectious, so I don't know if we can expect these to be communicable or not for the purposes of causing community immunity.
Seems to be tricky, but maybe genetic engineering could do it. It's a neat concept: engineer a virus which is *way more* infectious than SARS-CoV-2, but which causes no harm. People would "vaccinate" each other unknowingly and we could *encourage* meeting face to face, shaking hands, coughing on each other...
Well, at least we won't have to speculate as to whether COVID-22 was an accidental lab release; we'll know full well it was deliberate. Now, about the error bars on your IFR calculation. I mean, how are you even going to test this? I don't think you're going to convince a full clinical trial's worth of test subjects to be locked into a sealed biodome for the duration, but if part of your plan is to make the virus way more contagious than the one that just infected a significant fraction of humanity, that's kind of what it would take.
The Sabin vaccine did cause some cases of Polio. Quote from Wikipedia. "Oral polio vaccine results in vaccine-associated paralytic poliomyelitis in about three per million doses." In some rare cases, the Sabin Polio virus mutated into a more dangerous form.
The Salk vaccine was/is better (the virus is dead). However, at least one bad batch of the Salk vaccine was made (by Cutter laboratories) which scared the public (for good reason).
Yes, I know. I was referring to the early manufacturing difficulties, to which you allude, and the fact that in principle you can slip up a little with the oral vaccine and it's less likely to give you the disease because it's still got to get into the bloodstream. Mind you, although the Sabin vaccine was heralded at its inception in part because of its improved safety, I do not know if safety was actually a key part of Sabin's motivation, so I probably phrased that too strongly.
I have read through several accounts of the introduction of the Polio vaccine in the US. Too me, there were many surprises. First, Polio vaccines were used outside of the US for several years before any vaccine was approved in the US. Second, it took quite a few years before the US was heavily / highly vaccinated. Apparently, quite a few Americans were scared of the early Salk vaccine (because of a few very bad batches) and waited for the Sabine vaccine (roughly 5 years later).
I think I got both in public school as a child. Given that I was born in 1955, that would have been in the 1960s. Note that vaccine hesitancy played no role in when I received the vaccine. Parents/schools made all of the decisions and kids had zero say in the matter. Was there vaccine hesitancy on the part of the parents/schools? I really don't know. Certainly, the Cutter incident scared lots of people.
My sense of it, is that because Polio had been around forever, people didn't feel any great urgency about getting vaccinated.
KE, Your statement is partially wrong. The Sabin Polio vaccine did use sugar cubes with an attenuated form of the virus. However, it was widely used in the US and the USSR and not limited to "villages where there has already been an outbreak." See Carl Pham partially accurate comments below.
Like most folks, I dislike needles. The good news is that the COVID-19 needle is very, very, thin. Some of the needles of my youth were much thicker (and more painful).
Motivated reasoning is powerful. I've seen 10% of anti-vaxxers are driven by fear of needles.
Interesting.Absolutely brilliant book by Julia Galef
You start all wrong.
“ivermectin is an antiparasitic drug that looked promising against COVID in an early study. Later it started looking less promising, and investigators found that the early study was fraudulent.”
NO NO NO NO NO NO NO
There were MANY studies that showed some benefit from Ivermectin all over the world, and many meta-analyses and reviews concluding it had benefits. There were also studies that showed no benefit, but problems with many of them too.
YOU FELL INTO THE TRAP!!!!!
Your word “the” is the lie. It is the MAIN technique of sophists to confuse “or” and “and” and to attack an “or” by focusing on a single term and defend an “and” by defending a single term.
Shame on you.
Yes. I disagree with the framing of the post as well. With tons of conflicting evidence, to claim that we "know ivermectin is ineffective" is... overconfident.
Is it worth betting on whether the consensus on this will change? That seems like the easiest way to turn it into a bet, but I would be extremely sympathetic if your position was that the consensus was wrong but will stay wrong forever.
I have not researched this in depth personally. I'm basing this off of a belief that I have good intuitions about when the medical consensus is vs. isn't wrong, plus the fact that people said very similar things about HCQ and I did research that one in (non-zero) depth personally and am still pretty sure it's wrong.
In my red-tribe circles, the hopes around IVM seem much higher than they ever were around HCQ. I've been having trouble making sense myself of the evidence and the discourse around it: I'd dearly love to see the result of you giving it a post's worth of attention.
I remember @__ice9 on twitter being a big source of IVM boosting, even while he said HCQ was useless (unless combined with another treatment to block the other channel by which COVID spread). But apparently he died some months ago.
I also remember that, and continue to be confused.
Yea, it seems the optimism around HCQ was mostly fueled by the fact that Trump was optimistic about it and his supporters felt the need to stick up for him (similar to the "injecting bleach" situation). But IVM wasn't endorsed by Trump but rather made it to the forefront on its own momentum, and by virtue of actual scientists including it in their strategies.
Trump was optimistic about HCQ because he had taken it, and he had taken it because there was already momentum behind it back before vaccines were available.
I had a similar intuition but after listening to Joe Rogan's podcast #1671 - Bret Weinstein & Dr. Pierre Kory I changed my mind. Thanks for trying to improve the opening of the post, I appreciate it, it's much better now.
I don't understand Weinstein's problems with BOTH mRNA & adenovirus vaccines. They latter are novel relatively to inactivated virus vaccines, but they had been used for other diseases and as far as I know didn't cause problems. And if he thinks the spike protein itself is so harmful... doesn't that make COVID sufficiently harmful you'd want to immunize yourself before the long wait for Novavax vaccines to be available?
Isnt Novavax just an injection of basically pure spike protein? I guess it doesn’t make your cells manufacture it, the way the virus or the adenovirus or the mRNA do. But I thought novavax was for people worried about genetics, not the spike protein. (Also, even though they are manufacturing Novavax in my town, I’m pretty disappointed in all the setbacks they keep having.)
Mostly. The spike protein itself has probably been engineered a little, so it's stable on its own, but more importantly the vaccine also contains an adjuvant, as these particle vaccines usually do, which kicks up the immune system strongly at the site of the injection, so that it starts reacting to the particle strongly, which otherwise (in the absence of the adjuvant) it wouldn't do.
Personally, I'd rather have weird mRNA than an adjuvant, because I'm very sure my cells have multiple robust mechanisms for dealing with alien mRNA, whereas they may or may not have good mechanisms to deal with some random bunch of compounds that provokes a strong general immune response. (Although I should emphasize that adjuvants are very well tested for general harmlessness and are usually made of some biological molecules anyway, so I don't really feel much qualms about them in an absolute sense.)
I'm pretty confused about those things too. When I said "I changed my mind" I meant it more as in "it made me think that without deeper research I can't conclude that it probably doesn't work", but then I never did the research :p . I'm not a strong follower of Weinstein but I do believe in his intellectual honesty. I have no idea what he thinks about adenovirus vaccines. When I listened to him interviewing Robert W. Malone (if you want to look him up I recommend looking at his google scholar rather than reading what random people write about him) I got the impression that the main issue with the mRNA vaccines is that they were supposed to be designed so that the spike protein would stay locally where injected, and insufficient testing led doctors to mistakenly conclude that they had successfully achieved this (which is something that apparently other more traditional vaccines do achieve). Then it turned out that they had not succeeded at all, and basically they have no idea of what the implications are. This is just my flawed recollection, I'm sorry I can't give you a better answer.
My take on Weinstein from having watched a bunch of his podcasts is that he tries to be honest, but he's also strongly driven by a desire to be right when other people are wrong.
I wish he'd just been dubious about vaccines and pushed for more research into whether existing drugs might help against COVID instead of putting such a large bet on Ivermectin.
Indeed, he is an interesting case study in pure, unadulterated contrarian bias can look like. Sometimes right,sometimes wrong, but never adding much information because repeating !establishment_consensus isn't hard to do for yourself.
Yes, I agree he has a strong distrust the consensus view and institutions.
I find it frustrating, that so many of his claims are actually easy to disconfirm. Like his claim that the mRNA vaccine is dangerous -- we have data on hundreds of millions of Americans who are vaccinated -- if it's dangerous, that danger has not showed up in the data.
Or his claim that widespread adoption of vaccines will drive selection pressure to make vaccines less effective. Could be true, but isn't this a Generalized Argument against Vaccines? And also if true natural immunity cause the same selection pressure, as unexposed hosts reduce in quantity?
If he were more doxastically open to the question, he would explore why that selection pressure is not a problem for other vaccines that allowed us to, for example, eliminate smallpox, nearly eliminate polio, as well as keep countless others at bay (Measles, Mumps, Rubella, even Hepatitis B).
I find Weinstein's assertion that the vaccines are benefiting from regulatory capture to be not thought through
Regulatory capture results from an imbalance of incentives and lack of public attention enabling a small number of insiders to influence the regulatory system to their advantage to the cost of competitors and customers
With covid the incentives of the customers are essentially as large as possible and the level of public attention the same
If pharma routinely benefits from capture trying to get away with it with covid vaccines would be monumentally dumb and risk giving up the whole game. And the J&J pull would have to be a wild outlier or an intentional camouflage so complicated the idea that the whole scheme doesn't have any smoking gun other than "ivermectin is a miracle drug and the only explanation for it not being recognized is a conspiracy" is highly unlikely and should certainly be presumed against to the nth degree
I think the incentives against ivermectin are clear: it's off patent, it's probably not as effective as the vaccines, assuming it has some effect. From a public health perspective, vaccines are the clear recommended solution to the pandemic.
The media has also doubled down on submitting to health authorities who are pursuing public health goals. Ergo, vaccines all the way.
So financial, professional and media incentives are all pro-vaccine and anti-alternatives to vaccines. I don't see why capture isn't feasible in this context.
I guess in terms of general 'institution capture' there's a case that the vaccines have it. The J&J pull may be killer evidence against specific/direct regulatory capture but there is definitely a type of momentum with the vaccines that isn't about to turn on a dime. And a miracle cure suffers from two heuristics that tend to shut it out of consideration: too good to be true, as well as too bad to be true if it actually is a miracle being shut down
But I think there are enough theoretical incentives for a 'miracle cure' that it would not be able to be suppressed. Saving billions, saving people who won't take the vaccines, saving the social controversy over vaccine mandates. If ivm for instance has anything like a vaccine equivalent effect even a badly designed study should pick up a big signal, yet Bret claimed one study was purposely designed to find no effect due to presumably planning to test ivm as a treatment too late for it to have a chance to. In the end it's too big a conspiracy under too bright of a light to be reasonable to advance without any hard evidence
> But I think there are enough theoretical incentives for a 'miracle cure' that it would not be able to be suppressed.
Agreed, but what would that look like? Would it look anything like what we're seeing?
Time will tell. I've heard about a few randomized controlled trials using IVM as a prophylactic, which is allegedly it's most effective application. Hopefully we'll get definitive results either way withing 3-6 months, and let's hope they find n little to no benefit because the contrary would be quite damning.
If you're at all curious about Ivermectin, it seems to me that the best cases for and against are:
https://ivmmeta.com/
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full
What the FDA currently says is:
"Currently available data do not show ivermectin is effective against COVID-19. Clinical trials assessing ivermectin tablets for the prevention or treatment of COVID-19 in people are ongoing."
https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19
Despite the title, the page is mostly warning people against taking animal ivermectin. I read the quote not as "we know it is ineffective" but "we do not know if it is effective."
Right, and the FDA is all about denying people access to drugs that haven't been proven effective. But if a drug is cheap and safe and *might* help, the FDA should get out of the way. Particularly when you have people on ventilators, which have an 80% death rate.
Recommended: https://www.mountainhomemag.com/2021/05/01/356268/mountain-home-may-2021
FDA is the most conservative institution we have, so I'd expect them to be the last ones to actually endorse Ivermectin as treatment for covid.
It absolutely is worth betting on since the ICU doctors who administer ivermectin are claiming it is saving lives, and they have provided links to studies and meta analyses that are very encouraging. I would like you see you deep dive this (similar to your Vitamin D post). Here is a starting point, provided by the ICU physicians who comprise the Front Line Covid Critical Care Alliance (FLCCC): https://covid19criticalcare.com/ivermectin-in-covid-19/ As one of the commenters mentions elsewhere, Dr. Pierre Kory, one of the physicians in this group, was interviewed with Bret Weinstein on Joe Rogan’s podcast.
Note that it has been repeatedly demonstrated that average physicians are awful at statistical epistemology (see, the classic Bayes mammogram test.) It's not part of their job, and it's BARELY part of their training at all. We have organizations dedicated to telling doctors what the correct treatment plan is based on the science so they don't have to be good at it.
So a group of front-line physicians doesn't really start with any special credibility on this. And the FLCCC's previous uncritical advocacy work on other failed intervention lowers my interest in their opinion further.
The FLCCC updates its recommended protocols as new data comes in.
They used to recommend HCQ - when I got a preventative/exposure protocol months ago, it was part of it - but now they no longer do.
And now they're including mouthwash as part of the recommended protocols, because there's been encouraging early data on it and using mouthwash is effectively harmless, so why not?
https://covid19criticalcare.com/wp-content/uploads/2020/11/FLCCC-Alliance-I-MASKplus-Protocol-ENGLISH.pdf
The whole point of the FLCC is to move faster than the WHO, FDA, et al because they have actual patients who are sick *right now*. Doctors are the ones who should be deciding the cost benefit analysis of promising interventions for individual patients, not huge institutions.
But doctors are (on average) awful at estimating risk, and so are awful at cost-benefit. I don't see why we would trust them en masse above 'huge institutions' that have people who are actually good at interpreting data.
Fundamentally I'm libertarian on this, and it's not ultimately doctors OR institutions that should decide cost-benefit of interventions; it's patients. They pay the costs, absorb the risks and reap the benefits, so they have to be given the responsibility of making the decision too (barring cases with notable societal costs like highly addictive meds.)
But I think your trust in front-line doctors is misplaced in general, and in the FLCC in particular. As you note, they got HCQ wrong. And while they eventually recognized that, they did so well after it was clear to people used to doing medical lit reviews that it was almost certainly not a useful therapy. (In spite of the fact that numerous front-line doctors were SURE it was helping their patients.)
"But doctors are (on average) awful at estimating risk, and so are awful at cost-benefit."
The risk of using ivermectin is a given -- it's essentially zero. So even dumb old doctors can figure out that the abundant evidence of benefits is greater than zero.
By the way, if the same rigor in requiring double-blind, peer reviewed, cost-benefit proof were applied to masks, lockdowns, and social distancing we'd still be studying those and saying the "jury is still out -- not enough evidence."
The shifting burdens of proof and definitions of "evidence" is all so tiresome.
coward. Do the work. (No, I don't think you're a coward. I hold you in the highest esteem. I'm just trying to motivate you--as I did in another comment somewhere in this long thread)
Do insults help motivate you?
Do buttons help you?
Ma’am, I hang on his every word. I also figure he can see between the lines of a playful challenge.
FWIW, there are enough smart people saying ivermectin works, combined with suspiciously overwhelming media consensus that it's bullshit horse paste, that I am both confused and suspicious. I would love if you tried to puzzle it out, and predict that if you do you'll end up confused and annoyed about the truth :)
It almost certainly does nothing, but I've also dosed a zillion animals with it and also myself and various other random barefoot running around the jungle types and it has basically no side effects at the deworming dose, so why not?
Here I answer why not: Because it isn't (at least in the US) being proposed as a miraculous cheap drug to save lives; it's being offered up as an alternative to the vaccine. It is inherently political, and massively sus.
This on top of a bunch of placebo controlled double blind trials that show nothing.
There are also a bunch of placebo controlled double blind trials that show improvement https://c19ivermectin.com/
I think vaccines vs. ivermectin is a false dichotomy, I'm not sure why it's commonly framed as either/or when one is preventative and the other is for treatment. Vaccinated individuals can still get COVID, why not include it as a treatment option given there's a chance it might help, and at worst it does no harm?
If your reasoning is that even the perception of having an alternative removes the incentive for people to get vaccinated, therefore we should push the narrative that it doesn't work and that vaccination is the only solution in order to nudge people towards that direction, now *that* would be massively sus political manipulation.
It shows no significant benefit as an early treatment, after symptoms have already appeared. That was never it's proposed benefit though, it was always recommended as a prophylactic. Controlled trials on this use are conspicuously absent, although I've heard of a few in progress.
Clearly there is some large cohort that is never going to get the vaccine, and there is some large subset of that cohort that would or is taking ivermectin. Seems like a no-brainer to follow these people and do a retrospective analysis of its effectiveness at preventing COVID infection. That doesn't undermine the pro-vaccine messaging.
No evidence is no evidence. I'll change my stance when it is proven to actually do somthing, unlike the last 10 miracale cures people have put their faith in so they don't have to get the vaccine that has no* side effects and provably works
A vaccine with no side-effects is a fantasy.
I replied to your other comment with a link to a ton of evidence, I'll link it again here for ease of reference: https://c19ivermectin.com/
Is your stance still "no evidence"?
>That was never it's proposed benefit though, it was always recommended as a prophylactic.
But how is one supposed to know when to take it? It needs to be dosed very frequently. It's not practical for the entire population to be on IVM as a prophylactic basis.
Dosage schedule isn't clear at all. Countries are using it right now and targeting regions that are experiencing spikes in cases. Everything you mentioned seem like solvable issues, particularly if IVM is effective and supplements the vaccine.
The folks at [twiv](https://www.microbe.tv/twiv/) still seem to hold out a reasonable chance of it providing some benefit and are waiting for further studies before ruling it out completely. Of course, that's in a clinical setting, and not, you know, vet sourced and self-administered. At this point, I'd assume anyone trying to manage its use on their own will just fuck themselves over.
I'll just wait for the outcome of this trial: https://www.ox.ac.uk/news/2021-06-23-ivermectin-be-investigated-possible-treatment-covid-19-oxford-s-principle-trial
Someone who has covid now doesn't have the luxury of waiting until 2023 or 2024 for the data from another study. There is enough data on the oral use of ivermectin to say conclusively that there is a minuscule risk of serious side effects when taken at specific doses, so if someone wants to try it as an adjunct treatment to the disease, the only risk involved is that it may possibly be ineffective.
These trials normally only take a few months so you won't be waiting until 2023 for the results. But you are right that it is no skin off my nose if people want to take a sensible dose of ivermectin (or anything else) if they have Covid. I just don't see the point of holding strong opinions on its effectiveness either way until a proper clinical trial concludes.
The problem is that the "medical consensus" is fundamentally unscientific because they fail to rigorously define Marginal Benefits and Marginal Costs and then fail to quantify whether MB>MC. Instead they just look at the data and then apparently get some gestalt "gut feeling" that the treatment at issue is either a good idea or not.
For example, is the Net Present Value of using Ivermectin higher or lower than wearing a facemask? The medical researchers and bureaucrats can't or won't say -- they just say one is prohibited and the other is mandated, and please trust their "judgment" that this is right.
Perhaps we need to recognize that medical professionals aren't able to do cost-benefit analysis. Instead, we should turn over their medical data to economists who will then use it to make the final cost-benefit decision.
Yes, the evidence that ivm is helpful against COVID goes far beyond the one discredited trial. It’s amazing how many doctors using it on the front line talk favourably about it but the medical authorities and academics like Balloux pour scorn on it, and invoke cheap shots like “horse medicine” rather than debate the evidence.
The horse medicine thing is kind of funny to me. My dad's side of the family is horse people, and we had horses for a while when he was young and trying to make a living raising them. Given my experience there, I am pretty sure people spend about as much money on their horses' health as their own families. More if you count out of pocket expenses. Horses are bloody expensive, and people who keep them are... well, it's a life style that is pretty all consuming for all but the very wealthy. A good horse costs more than a very good car, and has much more yearly maintenance.
If by some strange alchemy the tools used to keep a Porsche 911 running perfectly also worked on humans, I'd be comfortable scheduling an appointment for a mechanic. Likewise, I expect the standard of care for most horses is rather higher than for the average human, especially considering that horses are very fragile animals compared to people. You can get away with all kinds of crazy stuff with humans that would kill a very expensive animal.
And the crazy distortions caused by insurance coverage aren't an issue in veterinary medicine. People pay for what works with their own money, and thus have no incentive to seek treatments that aren't cost effective.
You do know that ivermectin is an FDA-approved drug for human use, and on the WHO list of essential medicines, right? It's used to treat diseases that aren't particularly common in the United States, so until recently it's been fairly obscure, but it wasn't brought up as a potential COVID cure because "hey, let's try horse dewormer!"; it was tested because it was a commonly-used and widely-available drug that had some theoretical and early experimental basis for maybe being useful.
The horse-medicine part only comes in to play because the human version isn't available over the counter, and American doctors are now mostly telling their peculiar new drug-seeking patients to go away and stop bothering them. And for that matter, the pharmacists have started calling the doctors and saying "are you *sure*?"
The veterinary version being available over the counter, that's what the desperate (and/or desperately ignorant) are going for.
Yes, I do know that... I was building on Roger's point about calling it horse medicine was a cheap shot, specifically that horse medicine is taken more seriously than human medicine is in many cases.
Please read a little more closely and carefully, John.
Please be a whole lot less obnoxious, "Hammer". I just reread your entire post, closely and carefully, and it was entirely consistent with someone who believed that ivermectin was used only in veterinary practice arguing (correctly, as it turns out) that veterinary drugs are of high quality and may sometimes be the right tool for treating sick humans. Hence my question/clarification.
I was in a call where a handful of people with IVM prescriptions had them denied by the pharmacy, cuz…pharmacists know more than doctors here in the upside-down.
"It’s amazing how many doctors using it on the front line talk favourably about it" can you give any examples?
> There were also studies that showed no benefit, but problems with many of them too.
I've seen a metaanalysis that declared there was no conclusive data on the issue, but I haven't seen any primary studies that showed no benefit. Can you provide a source?
Nevermind, I'm an idiot.
Nonsense. Idiots don't know they're idiots. That's why they're so harmful.
> It is the MAIN technique of sophists
Complete tangent, but I've been curious about the classical sources on rhetoric - I don't know what to look for. Suppose I want to read some distilled wisdom from Greece or Rome on making effective oral arguments. Who wrote it? Where do I find it?
https://en.m.wikipedia.org/wiki/Rhetoric_(Aristotle)
(Sorry iPhone screwing up threading so I replied to you in the wrong place before)
readers are advised to consider the value of P(B|A) - P(B|~A) carefully before using this strongly-worded comment to update their priors on P(A). C.f. "The Control Group is Out of Control", etc. https://www.lesswrong.com/posts/bXuAXCbzw9hsJSuEN/the-control-group-is-out-of-control
The the is a trap!
This comment is phenomenal
>There were MANY studies that showed some benefit from Ivermectin all over the world
Most of which were low-powered and non-randomized.
Also he said Ivermectin is completely useless, or something like that. Even with the dimmest possible view of Ivermectin that isn’t true. You can make a good argument it isn’t as effective as a vaccination (maybe), but it’s been used and prescribed by doctors the world over and tops the list of early treatments during an infection.
I’m not saying you have to be a cheerleader, but why drop the ball of cautious, rational thinking at the one yard line? It’s weird in/out group stuff I thought was beneath this forum.
I meant maybe someone would want to make that case. I did not mean to imply that IVM is better than the vaccines. I don’t care enough to make the case.
Best. Post. In. Quite. Some. Time. Nice work.
I will add that I am especially disappointed in you because you’re a PHYSICIAN and in addition you have written extensively about issues related to drug trials. I don’t know what weird bias overcame you here, but the financial incentives for expensive patentable therapeutics and vaccines and the regulatory roadblocks around EUAs for vaccines created very strong pressures to disparage the use of cheap known-to-be-safe drugs like Ivermectin and HCQ for treatment of COVID (which in the case of HCQ led to many “designed to fail” studies and some fake studies and in the case of Ivermectin which seems even more promising than HCQ for early treatment led to many many many lies in the media).
I've edited the beginning of the post slightly. My goal is to make it clear that I have no personal extra information that ivermectin doesn't work, while also leaning strongly in that direction on priors. I don't want to add to information cascades, but I also don't want to have to personally research every widely-agreed claim super in-depth before citing it as background information. I hope the new phrasing better balances these considerations.
Thank you for the rephrasing! It is much appreaciated (At least by me, who is still confused by the issue and at the same time views most of not-strictly-scientific information about it as signalling)
Fluvoxamine is a cheap drug already approved as an anti-depressant which received high marks from the same recent trials that failed to find benefits for IVM/HCQ.
A request: Can we chill on the "disappointed in you" language until we have significant evidence of negligence as opposed to casual error? The Principle of Charity applies.
I thought carefully about it and don’t use it lightly. It’s not so much a “causal error” as ignorance unpardonable in someone in Scotts’s position not to know that there was much much more than one study favoring Ivermectin. It represents a major failure in whatever his information-gathering procedures are.
none of those studies are large enough nor consistent enough to draw strong conclusions that IVM works against COVID
None of them do in isolation, no. When dozens cluster around a signal, and that signal is reinforced by natural experiments worldwide, and when they are both reinforced by the impressions of frontline doctors, it's worth a look. Multiple meta-analyses are showing promise. And the risk/benefit tradeoff makes it worthwhile even if the results are inconclusive. It's one of the safest drugs in history. Before the taps got turned off and people started resorting to vet IVM, there were 16 deaths recorded in 30 years of use with about 4 billion doses. In other words, it's almost certainly more beneficial than dangerous, and normalizing it would do a lot to restore a certain cohort's trust in the intitutions.
Very few deaths is not the same as a drug being safe; it's quite possible for a drug to have extremely nasty side effects that don't risk causing death.
I don't know much about IVM in humans, but I have heard that it can cause serious neurological damage in animals, and death stats aren't going to tell you if that's also a risk for humans
It is extremely safe, and tolerated well in humans even at much higher than recommended doses. There are a few animals (like the collie dog breed) for which it is highly toxic. Worldwide it is routinely administered by non-professionals, and is regarded as being safer than aspirin.
If it saves a single life, and the cost of that success is not denominated in any significant fraction of a life, then nobody should stand in the way of anybody trying to save a life. I will die on that hill.
You don’t know that it is saving lives and not cost lives by trying an ineffective treatment over a demonstrated effective treatment.
To make matters worse, at this stage 99% of the people facing the “choice” of opting for an unproven treatment have consciously chosen to avoid needing it in the first place by getting vaccinated.
You don't know what other demonstrated effective treatment is not being attempted as well.
If you die on that hill then it better save at least two lives.
Seriously.. promoting IVM as “preventive” and so *instead* of the vaccine is costing lives rather than saving lives.
No, seriously, tone it down. I'm a touch disappointed in Scott myself, and that first slug at IVM is really bad, but he's a sensitive soul. Please don't go around saying things that will hurt him / make him less likely to write in future.
How does this explain Fluvoxamine?
Fluvoxamine also promising, known side effects long term related to its psychiatric effectiveness but perfectly safe for a short course of early treatment; not as much of a threat to Big Pharma as IVM and HCQ were but I predict we will start seeing sophistry and bad studies about it too if it continues to look good.
Why is it less of a threat?
More expensive, part of a drug class (SSRI) people are more wary of, not available without prescription anywhere, not as suitable for long term prophylactic use so less competitive with what they want to develop.
The prices are the same, goedrx.com/ivermectin goodrx.com/fluvoxamine . Long term prophylactic use would be a massive coup for pharma companies as tens to hundreds of millions of people would take a new frequent drug, as opposed to a still somewhat cheap vaccine once. And current drugs for hospital treatment are also very cheap and off patent. Other SSRIs work in places where it’s unavailable.
Sorry I wrote that quickly, the prices are very comparable (within 50%) and the entire rationale collapses when we look at dexamethasone, the currently used drug, https://m.goodrx.com/dexamethasone much cheaper than both
This is conspiratorial thinking at its best.
No, conspiratorial thinking would not make testable predictions. The whole danger of conspiracy theories is that their implications can never be tested so there is no negative feedback. Stating that some groups have incentives one way or the other regarding something and predicting that they will act in their own best interest is merely paying attention to human nature.
The evidence for ivermectin is not that strong. It may still prove to have a modest effect but seems unlikely to be the pandemic killer that Bret Weinstein or Pierre Kory think it is.
The financial motive by pharmaceuticals does exist but it’s not the only one. Countries that don’t have vaccines have a huge motivation to find cheaper alternatives. IVM has also increased in price due to all this advocacy.
A good primer:
https://link.medium.com/xiu8iG9gljb
They've been using generic steroids since the start of the pandemic. Why wouldn't the financial motive you imply affect that?
It might! But these steroids were already part of protocols to treat symptoms in similar diseases and were used extensively in hospitals all along. Just because big pharmaceutical companies were able to corruptly slander some potential competitors to the drugs they wanted to develop doesn’t mean that they were able to do that to every single one.
Please be careful not to impute to me views I have not stated. I think HCQ has some benefit, IVM probably has more benefit, neither is a reliable cure, but I am ABSOLUTELY CERTAIN that those two drugs have been lied about and slandered because I have identified the bad math and bad study design and bad reporting and actual fraud in many cases. When the story about the Oklahoma hospitals came out I instantly posted on my Twitter feed that it looked like 100% bullshit. When the Surgisphere study about HCQ came out in the Lancet, I posted within 24 hours that it looked fraudulent, for exactly the reasons that it later turned out to be fraudulent. I have been following very closely all along and reviewing the statistics and the data myself because I am a professional statistician and the news media are completely untrustworthy.
I am open to other explanations than “financial incentive” for the behavior we have seen to push vaccines and disparage some drugs, of course, but I am quite sure that explanations are needed!
What are the lies and slander? There was a fake pro IVM study and a fake anti HCQ study, so maybe just when you have the entire globe participating you’ll get some fakes, I don’t see bias there.
It’s a numbers game. There are fakes and lies on all sides, but I have been paying close attention, and measuring by media attention, the lies and fakes have been overwhelmingly against IVM and HCQ and remain so, it is bleeding obvious to anyone whose information diet is not dominated by the USA mainstream media and social media which have been extremely suppressive of one side but not of the other.
And again, a drug one has to take preventatively once a day or week is much better for big pharma than a one or two dose vaccine or a steroid for severe cases...
Why? If a drug is generic any drug company can make it, including those not under the "Big Pharma" heading. Small Pharma, if you will. Big Pharma doesn't get any benefit from Small Pharma getting money, and in fact there is the danger that some Small Pharma firm might rise to be a real challenger to Big Pharma. Industry leaders tend to work very hard to keep out entrants and potential competition.
[I don’t know what I’m talking anout]
I mean in practice nobody other than the social media fringe people is suggesting prophylactic use of any drug, so it’s a moot point anyway.
It looks like the “price” of a vaccine is around $20 at the top, much less than the current price of a month of ivermectin. If you could get everyone to take ivermectin for a year (which you can’t, but that’s sort of what the fringe folks are suggesting) I think pharma companies would be happy about even a piece of that. I don’t know that much about the structure of pharmaceutical industry, but I can’t really imagine that Big Pharma as a whole would be against that, especially since some Big Pharmas don’t have their own successful vaccines. https://www.ft.com/content/657b123a-78ba-4fba-b18e-23c07e313331 Modern a and BNT were “upstarts”! The case for that intervention is, in general, absurdly weak. Yes, the New York Rhymes sucks and yes, pharma companies do bad stuff, but that doesn’t mean they suppressed some random drug.
Where are you getting your prices for vaccines and ivermectin? Just curious.
There are a lot of historic examples of pharma companies doing... strange things to keep their drugs from going generic, and having very little interest in producing generic drugs themselves. Scott has some posts from back in the day about the topic of drug companies adding a minor coating to a pill or some other thing to extend patent protection as I recall, and psychotherapeutics that are the same but slightly different and cost large amounts more, but overall there is a long, really tedious literature in the intellectual property sphere citing the bad habits of "Big Pharma" when it comes to doing anything and everything to extend patents and totally losing all interest in generic drugs.
The take home message of it all is that there are billions to be made off a patent drug, and very little to be made off generics, so companies that are invested in the patent drugs are willing to drop a few million here and there to make sure those off patent are not serious competitors. This is one of those "known things" in the research. So, does a company that has a patent vaccine under temporary FDA allowance want to sell X units of vaccine at Y$, the whole market being split between the 3-4 firms that are allowed to make and sell the vaccine, or do they want to sell X+A units of generic drug at Y$-B$ split between the literally hundreds of firms manufacturing the generic drug all over the world? When is (X*Y)/4 < (X+A)*(Y-B)/(100) ? A would have to be very big and B very small in percentage terms for that to be a good bet.
If I were a pharma company with a vaccine patent, I would push really hard on the vaccine, and use the other generic as a back up plan I would use only if necessary. Especially if I sunk a ton of cash in getting the vaccine developed and passed through the FDA; caring about sunk costs is not fallacious when you are an executive and have to justify your decisions re: spending a ton of cash and getting negative returns.
One of the biggest non-vaccine game-changers was dexamethasone which has been shown to reduce mortality by about 30%. It's cheap, off-patent, and has been widely used for decades. It's actively being used because it's been shown to be effective.
Why doesn't the medical establishment get credit for this?
The issues with trials should cause you to update in favor of more uncertainty generally. Not give evidence for "whatever the counter establishment position is its true"
Tremendous article, thanks very much. I just read The Scout Mindset. A twinge of smugness or satisfaction I might feel when reading news stories (I've left twitter, thank God) is definitely a warning sign that I need to ask myself, wait, what's my bias. Twinges of anxiety and resentment reading a news story are signs I need to pause, back off, get willing to move outside my comfort zone, reread. All the news and opinion pieces on Afghanistan has me thinking about bias a lot. I haven't ended up annoyed - it's too large a tragedy for that. I have definitely ended up confused and uncertain. Maybe that's the right place to be, but it leaves my feeling like I've failed my duty as a citizen or something. Just thinking I don't know the truth, or can't reach a conclusion, just not taking a position - that's not enough.
Has this very recent review been discredited? https://www.sciencedirect.com/science/article/pii/S2052297521000883?via%3Dihub
The claim of area correlations between ivermectin and death rates are totally ridiculous. That doesn’t work at all as a form of a analysis, especially when there’s other massive variation between geographic areas.
Is it though? Peru was an interesting case where they started and then stopped administration of Ivermectin on a very large scale. Combine this with over 20 RCTs, 2 animal models, multiple meta-analysis, dose-correlated reduction in multiple jurisdictions in India, and a logical mechanism of action. As someone who tries to be rational it is hard for me to reject all of this.
Yes, it is pretty much unreasonable in any context to do a plain correlation between two things like that and expect it to mean anything. If you have strong reason to believe there is some difference between the two treatment groupsthat is totally independent from any other cause, like an idiosyncratic policy variation or intended randomization, and there’s enough samples within those two groups, you can analyze based on that, but even that isn’t reliable and absent that it is totally absurd. The temporal correlation they claim is equally absurd, and given Covid lines go up and down in every country and multiple have prescribe ivermectin the line up and down will overlap it in at least a quarter. It is meaningless and makes me question the rest of the analysis somewhat. The others have been debated incessantly elsewhere but that’s my only point here.
Not to mention Covid today is a different strain than covid last year.
What strain is Peru dealing with before mass Ivermectin treatment, and what strain after? I don't know when any of these changes occurred. But I know that a whole bunch of anecdotes need to be statistically investigated. Even though it would make sense to be good data, someone has to check, because it is never too good to check.
You have to do randomised controlled trials simultaneously. It sounds like some of those are in progress.
I looked at the Peru numbers to try an entry for the Better Skeptics challenge to crowdsource quality arguments against the Weinstein ivermectin point of view
It seemed reasonable to get excited about as there were only certain provinces who tried it and the given numbers appeared to show 80% effectiveness. But there was no trend I could see in the case numbers. By the end of the summer ivm was so popular in Peru as a preventative that a researcher reported 8/10 people they tried to recruit for a study were already on it
If you trust the Peru numbers on treatment it seems you have to give up on any preventative effect as well as find a way to explain why they stopped using it
Ponder the truth that there exists a graduate student or post-doc researcher in Anthropology who will refuse the standard treatment for River Blindness because it's a deadly poison, part of a Trumpist conspiracy theory.
I expect it's more likely that a hypothetical grad student who comes down with river blindness would take the medication without realizing what it is.
Hopefully they'll also be taking prophylactic HQ against Malaria too, yes. But I'd bet a dollar That Guy's out there.
Does there? I doubt it, you're talking about a small educated group following the traditions of their specific field there, not general population dealing with a topic thy have no knowledge of or traditions about.
Seems unlikely. People understand different drugs do different things
I think the main point about the story is that it is effectively a stand-in for vaccine refusal/hesitancy among people who are medically and financially able to get a vaccine.
As for your post, it's a great reminder to be skeptical of any story that's poorly sourced/hastily thrown out to the world.
It's interesting that I think you could say both sides are actually correct in certain substantial ways
It is accurate to say major media outlets excersiced no care in checking a story that is clearly wrong in the literal metric of whether ivermectin side effects are causing any strain on the health system
It is also accurate to say that ivermectin has become a set piece in the general anti-vaxx arguement and by giving people the impression there is a fully effective alternative it is pretty directly causing a strain on the health system through greater numbers of unvaccinated people
There is an anti-ivermectin case that could have been the story but through careless knee jerking the blue team media discredited themselves and probably bolstered pro-ivermectin sentiment. Maybe we could refer to incidents of the blue team media shooting themselves in the foot like this as a Horse Paste Fiasco
Alright so yeah, information is now food. If it's palatable and pleasing it's probably unhealthy. A good information diet involves lots of whole, bland informations that aren't particularly motivating to consume and maybe involves periods of fasting. Got it.
Great way to frame this.
Like food, the really good stuff tastes great, and we all enjoyed this post way more than the articles above :)
Intuitive news reading, like intuitive eating, probably only works when you’ve adequately trained yourself to recognize the phenomenology appropriately.
I find both Scott's post and your comment palatable and pleasing?!?!
Some things are delicious and healthy in the right amounts. Like fruit, or meat. If they don't trigger an immediate craving for more it's a good sign.
I've always thought of books in terms of junk food, healthy food, unchewable hardtack, etc, and my aim is to write books that are juicy yet nourishing...
+1 for the metaphor.
There are really only two possible culprits for this whole debacle. If you watch the Channel 4 interview (as you stated, this appears to be the source from which most outlets copy/pasted without additional investigation) they very clearly link the 'ivermectin is dangerous' and the 'this is the reason why hospitals are full' bullet points.
"Dr. McElyea said patients are packing his eastern and southeastern Oklahoma hospitals after taking ivermectin doses meant for a full-sized horse, because they believed false claims the horse de-wormer could fight COVID-19."
Source: https://kfor.com/news/local/patients-overdosing-on-ivermectin-backing-up-rural-oklahoma-hospitals-ambulances/
That CLEARLY implies the cause/effect. Without the unedited interview, it's hard to go any deeper. Back to the two possible culprits, either the reporter is purposefully misinterpreting the doctor or the doctor was being dishonest. The doctor has refused to comment any further and Channel 4 hasn't updated the story with any information that helps sort this out.
I agree with this and have edited the post to make this clearer.
Thank you for looking into this! I’m not even sure the doctor was necessarily being dishonest, maybe merely making a locally true but exaggerated statement based on secondhand information about a small number of hospitals or patients. So it could be mass carelessness and a total lack of desire to understand scale and implications.
My priors on statements by doctors/nurses about hospital capacity being true started sky high but sadly keep falling and are now firmly below 0.5. This isn't the first time the press has picked up on bizarre and implausible statements by medical staff and blasted them around the world without doing even the most basic checks. Mostly when I searched for evidence for these claims I found they were only investigated by PatriotFreedomEagles type sites, and they had often found many reasons to be highly skeptical of the stories.
In this case there was a Twitter blowup and it seems Rolling Stone felt they couldn't ignore it, but mostly such investigations do get ignored.
One theme that kept cropping up a few months ago was news reports of young people in ICUs saying things like, "I came down with really severe COVID, I wish I had listened to authority and got vaccinated". Investigative YouTubers discovered that a remarkably large fraction of these people appeared to have prior acting or related TV experience (e.g. having appeared in reality TV shows). It's not proof of anything, but the P value on that correlation would have to be very low given how rare such reports are, how often they featured obscure actors and the low proportion of the population that has appeared on television. It really makes it very difficult to trust anything you see in TV news.
I mean generally there are a million doc+nurses and the few that are gonna say interesting stuff even if it’s wrong will get more airtime lol. Same for many other things. Actual reports from nurses and doctors people personally know tend to be slightly better
I think I'd still place a high prior on an assertion re hospital capacity by a random doctor or nurse, but an even higher prior on any media source having cherrypicked the most extreme assertion they could find in support of their preferred narrative.
> Investigative YouTubers discovered that a remarkably large fraction of these people appeared to have prior acting or related TV experience (e.g. having appeared in reality TV shows). It's not proof of anything, but the P value on that correlation would have to be very low given how rare such reports are, how often they featured obscure actors and the low proportion of the population that has appeared on television. It really makes it very difficult to trust anything you see in TV news.
I know the suggested conclusion is 'actors are on tv about this, so they must be acting', but contrarian instinct wonders how much of the effect would come from 'this is happening to many people including actors, but actors are more likely to be interested in/connected enough to get on TV to talk about things'. (Would you seek out a reporter if you got sick?)
Could P(seeks being on TV|actor) be higher enough than P(seeks being on TV|¬actor) to make P(actor|seeks being on TV) seem disproportionately large compared to P(actor)?
(This is also another instance where the base rate would be helpful for comparison: how often are media-connected people the ones who appear in news stories *in general?*)
Yes, that could happen. I am skeptical because I don't see any immediately obvious way to convert acting experience to access to journalists, given they're very different parts of any TV operation. And these people are supposedly fighting for their lives in intensive care. They are too sick to be phoning around TV stations pitching their story. Unless journalists are seeking out people with acting experience specifically, but that's the whole conspiracy theory to begin with.
I honestly am not sure what to make of this. It's a pile of anecdotes rather than statistics, the logical induction is incredible even for people cynical about the media, and frankly I just don't want to believe it. On the other hand, I can't really justify my instinctive rejection of these findings. It feels emotional rather than logical. Logically, I know young people virtually never end up in ICU due to COVID. And I know that getting COVID that badly is a basically random event. And I know people are virtually never TV actors. Thus logically the union of these sets should be incredibly small, not large enough for people to notice and document a pattern. One of them even got work sheet her appearance and told a local newspaper she didn't know what had caused her sudden streak of career luck! But .... what can you do? There's no proof anywhere. Just suspicious coincidences.
“TV news”
This has been my soap box since the mid 90’s: there’s nothing there that’s worthwhile; it’s all manipulation. Yes, that’s an overly-bombastic thing to say but decades of watching the TV-news media ecology deteriorate, and seeing the same patterns emerge on YouTube should be a huge alarm for people who care about information. The medium is manipulative to its core from camera placement, mise en scene and scripts to the editorial staff, length of segments and pedigree of guests. At every point it is a crafted product meant to drive viewers to advertisers. Kill your television!
I only watch tv news when I'm in a restaurant and the television is on. To my mind, the hell of it is that they tease with something that might be interesting. Then they futz around for half an hour. Then the thing which might be interesting turns out to be a nothing burger.
I suppose that's better than flat-out lying, but it isn't good.
If you liked this article, I bet you'll enjoy some of Matt Orchard's documentary videos, especially this one (to avoid spoilers I won't explain further):
The Coldest Case Ever Solved: https://www.youtube.com/watch?v=wiZmXnFC8_k
Thanks. It's quite something. Do watch it to the end.
>>>Only you, reading this ACX article, are getting the full story and learning more about the world instead of just confirming your biases.
>>>Did you believe that?
Nope, because you failed to note that the original headline picture showed people in coats and hoodies in SEPTEMBER in Oklahoma. Picture was from later winter this year (possibly January). This was...God, such bad news presentation, and I missed that clothing issue the first time I saw the picture.
Now I'm waiting to see how long it takes before someone actually does start making phone calls... :-)
Next week's headline: Oklahoma hospitals turning away gunshot victims because they're too busy taking calls from inquisitive blog readers
This just proves my already held belief that I’m smarter and my life is better by not being on Twitter.
It really is a digital Bedlam, complete with people visiting to watch the crazy people.
Totally. 100%.
This is way too good, and the big reason I follow your blog. Thanks!
Great article. Baselines and context are important, but they are anathema to "good stories," which the media desperately needs. I've been in financial markets and a stock analyst for decades. For a while, I was on the floor of SG Warburg (now UBS), which was a big international broker. Reporters would always need a story about why certain stocks were up or down. Since we were a little unique at the time thanks to our global desk we could feed them great lines that they would run with like "we've seen some major short-selling out of the Far East this morning" or "sovereign wealth funds are in buying US equities heavily since they are selling off some of their European bank holdings." Mind you these were all made up but it got the reporter off the phone right away with a "story" that would make their editor happy. This happened all the time when I was covering individual stocks as well so I had to make up something like "well the quarter was in line but A/R increased more than revenue and inventories went up sequentially which could alarm investors." Taleb writes about this in "Fooled by Randomness" which is excellent.
As a non-scientist, can I ask more about the evidence against ivermectin?
So here's the sort of complicated politi -- I mean, 4D play-writing -- that I'm seeing. There are scientists like Robert Malone (early inventor of mRNA technology, long-term pharma consultant and employee) who specifically discuss the viability of ivermectin as a therapeutic for covid. Malone has a long interview on it here: https://www.theepochtimes.com/part-2-dr-robert-malone-on-ivermectin-escape-mutants-and-the-faulty-logic-of-vaccine-mandates_3981859.html.
He distinguishes clearly between the cattle ivermectin, horse ivermectin, and human ivermectin. He says things like there are a bunch of under-powered studies of human-ivermectin-helping-cure-covid that are inconclusive, one meta-analysis of human ivermectin concluding that it's inconclusive, and two meta-analyses concluding that there's good evidence that ivermectin works on covid. Malone also points out conflict-of-interest problems and how they feed into conspiracy theories -- he talks about how Merck came out and said ivermectin is toxic when in fact it's classified by the WHO as an essential medicine, and how Merck might have had self-interested reasons to make that statement because it's making money precisely off of covid interventions that are not ivermectin.
On the other side, Tom Bartlett, who is a writer in Austin, Texas, who has lots of journalistic publications and has won an award of some kind in investigative reporting, has a hit piece on Malone in the Atlantic (https://www.theatlantic.com/science/archive/2021/08/robert-malone-vaccine-inventor-vaccine-skeptic/619734/). Bartlett starts by casting doubt on Malone's claim to have invented mRNA technology (though later in the article he confirms that he's found the early articles where Malone did just that -- Bartlett winds up emphasizing that the mRNA tech as it exists now is the product of hundreds of scientific contributions since then). Bartlett also accuses Malone of being a vaccine skeptic (though it turns out, later in the same article, Bartlett admits Malone is not skeptical about most vaccines, just the new ones that use mRNA tech in a previously untested way). So given Bartlett's reporting on Malone, we are supposed to think that Malone is a crazy unhinged far-right vaccine skeptic who is casting doubt on mRNA tech (and by extension supporting things like ivermectin) because he is... what? Because he's greedy for money? Hardly; there's not much money in the anti-vaxx business these days. Because he likes the attention from far-right wing-nuts, or at least the people whom Bartlett regards as far-right wing-nuts? That... looks like Bartlett's main explanation.
Except that Malone doesn't sound crazy and unhinged. I mean, he's got an interview where he talks like a normal human being reasoning through data. He's got the academic articles. Even Bartlett admits he actually invented the early mRNA tech. And nobody's disputing that Malone has decades of working in vaccine manufacture/consulting/whatever at pharma companies, where he was apparently not crazy enough to get fired. So he's actually got the credentials, right? And when he talks about financial conflicts of interest -- well, those are real things in the messy world of human relationships, right?
Granted, I haven't checked the data that Malone says exists. I *did* check the WHO classification list, and ivermectin is indeed there: https://list.essentialmeds.org/medicines/58.
In fact, back in March the WHO even admitted that it could be used in clinical trials for treating covid (https://www.who.int/news-room/feature-stories/detail/who-advises-that-ivermectin-only-be-used-to-treat-covid-19-within-clinical-trials). That's presumably an acknowledgement that there might be something to those studies indicating that ivermectin is inconclusive but in such a way that further studies are a good idea?
I honestly don't have time to go digging up all those inconclusive studies and meta-analyses of ivermectin. That's, frankly, what the specialists are for. Is anyone here actually up on all this research? And if the specialists don't agree with each other -- then do we have any basis at all for thinking that people are trying ivermectin because they are "far-right wing-nuts" as opposed to people just like us who are trying to make sense of things?
Here's an amateur-psychologist way to Bulverize Malone: as one of the early pioneers of mRNA he feels a sense of ownership of the technology, even as it has moved beyond him. He's casting FUD on such later work he wasn't involved in and emphasizing his own position as an authority above everyone who came later.
So I just had to look up "Bulverize," and it is the word I didn't know existed that describes 90% of American journalism.
That's more-or-less the approach the article takes, except it's more "he feels this tech was stolen from him, so he's railing against it in bitterness."
Your argument is that Malone "sounds" like he isn't crazy, that you're too lazy to dig through meta-analyses yourself (nor to trust Scott on them), and thus Malone must be right?
My take is that Malone is a quack. He did some foundational research in the area over 30 years ago and has spent most of the past decade complaining about imagined slights. I don't think Malone even has a job to be fired from any more.
Has Scott actually done a deep dive on ivermectin? If so, that's amazing, I totally missed it, and I need to go read it.
Actually, right now I'm the opposite of lazy -- just too busy to read much! Which is why I miss honest journalists. Their role used to be "go gather all the specialist opinions and make them accessible to the layman," so we don't all have to go read specialist articles on our own and thus multiply reading time/effort per person.
I feel like I need a deep dive on Ivermectin by Scott lol.
And one on vaccine effectiveness. And one on deaths caused by vaccines.
I came to make this exact comment. I shouldn't have to go to Scott to find an accurate conclusion to this story. A decent journalist should be able to put this together, and thus the "too good to check" criticism remains in force. If a random psych blogger put this story together, why did it become a nationally mistaken story from multiple platforms? I can't rely on Scott to check every story, and I clearly can't rely on the media (Left or Right) to ask more than surface-level questions.
So why should I read the news? Is it better to read journalism that I know to be poor/heavily biased/consistently wrong, or to skip the news altogether? I don't have time to dive into every story. That's literally what journalism is supposed to be for. But it's not something that the market provides at the moment. Unless I'm missing where the decent journalists are. Is there a national paper that is engaged in legitimate journalism anymore?
The large and well conducted trials seem to be showing little and no effect. That has been my amateur vague sense, as well as the direct conclusion of a number of “actual scientists” who I’ve seen look into this. The antis seem to have consistently had principled and sensible objections, comparisons, and arguments, while the pros have tended to have more careless and less scientific points.
Thanks, I appreciate this! (Anti here means "anti-ivermectin"? Or "anti-vaxx"? Sorry, so many antis these days...)
I mean anti-ivermectin
Thanks! And sympathies - web arguments are exhausting.
Sorry for not going into detail but I’ve already spent two hours arguing about this on various websites just today...
Most of the inconclusive studies have issues. Doses too low, or not given early enough, or given on an empty stomach, or flawed control groups. These issues are well-documented.
It’s weird how the conclusive studies with those same issues are fine despite having no control group! That sort of thing absolutely can be an issue, but flawed small observational or effective n=10 RCTs just aren’t useful so I’ll still go with the studies with some meaning
See my other comment to you about the stacked data and meta-analyses.
Whoops, the comment I made below was in reference to a reply to someone else, so here you go: "None of them do in isolation, no. When dozens cluster around a signal, and that signal is reinforced by natural experiments worldwide, and when they are both reinforced by the impressions of frontline doctors, it's worth a look. Multiple meta-analyses are showing promise. And the risk/benefit tradeoff makes it worthwhile even if the results are inconclusive. It's one of the safest drugs in history. Before the taps got turned off and people started resorting to vet IVM, there were 16 deaths recorded in 30 years of use with about 4 billion doses. In other words, it's almost certainly more beneficial than dangerous, and normalizing it would do a lot to restore a certain cohort's trust in the intitutions."
That Atlantic article is crazy. You've heard of "damning with faint praise;" this is "praising with weak damnation." His fellow scientists say he was uncompromising! Oh, no! Uncompromising people are obviously much less trustworthy, because they…don't go along with the herd? I called people he says agree with him, and they…don't say anything about that one way or another, but I'll frame what they did say in a way that implies that he's a liar! Oh no! He got suspended from LinkedIn for posting "misinformation" (as if that isn't practically an *endorsement* at this point)!
Great phrase, "praising with weak damnation." I'll remember that!
Some of the studies that found Ivermectin works has turned out to be fraudulent or probably fraudulent:
https://gidmk.medium.com/is-ivermectin-for-covid-19-based-on-fraudulent-research-part-3-5066aa6819b3
I have also found good arguments against there being sufficient evidence yet for Ivermectin being effective in this blogpost and these videos:
https://medium.com/rebel-wisdom/on-vaccine-safety-ivermectin-and-the-dark-horse-podcast-an-investigation-f32491d4c970
https://www.youtube.com/watch?v=XClxXWWuyG4
https://www.youtube.com/watch?v=plLmTWHeKrI&t=1844s
https://www.youtube.com/watch?v=GwzfnZfo-rU&t=6359s
https://www.youtube.com/watch?v=t_42LVirfNI
I had been exposed to huge amounts of positive spin on Ivermectin through my social media network so I found the articles and videos above very useful in getting a more balanced perspective. Still seems like to me it may turn out to have a small or moderate effect in the end. But it does not look like to me the evidence is clear enough yet that it is.
What if taking Ivermectin saved somebody's life? At a low cost and low risk of harm?
Would you, knowing that, want a loved one to be prescribed Ivermectin even if its effectiveness had not been proven?
If that's how it was being used I wouldn't care. A guy does all he should to avoid COVID and, when he gets it, to prevent its further spread and treat it - while also taking this other thing he found on the Internet? Fine.
Then it's like a likely useless vitamin supplement - who knows if it helps, and if he takes it who cares?
Sadly that's not how it's being used. It is the latest fad in a number of them that a large group of peoplr have flocked to. These people at various times have denied COVID's existence, then that it is especially infectious, crippling, or deadly. They don't want to be told what to do by smug people they don't like, and they wish none of this were happening in the first place.
They rebel then by refusing to take measures agaibst catching or spreading COVID. not wearing masks, not vaccinated, often not both. Their kid is obviously coming down with it but they still send them to school. They start feeling something in their throat but insist it's just a sinus infection; they go to work and then a birthday party anyway.
This medicine is another straw they cling to to justify their BS - we shouldn't be mad at them, as we'd not be afraid of it if we'd educated ourselves about this miracle cure as they did. It's plentiful and cheap and absolutely works; why should they keep their lives on hold because the rest of us are pussies about it?!?
I just lived through a fourth wave these a-holes either caused or greatly contributed to. We (Acadiana, Louisiana) had the highest COVID fatality rate in the world for weeks - overflowing hospitals, masses sick and dying, the works.
Maybe it's different for all of ya'll in more civilized (or at least genteel) places. Here, the response of masses of my fellow Cajuns was to point to this supposed miracle drug (the horse version - lots of horse racing here) to justify their bull, needlessly endanger me and my family (unvaccinated kids - thanks FDA!, jerks), and cripple our society and economy.
I'm sick of them, and I'm sick of their shit. I also have no patience for sophistic arguments divorced from the real world that those who should know better should indulge this bull.
Just because it's not harming you and your social circle, and there is a theoretical scenario in which a not irrational person could choose to try it, does not mean it is not causing a lot of harm., nor absolve us of our responsibility to advocate for the shit that actually helps instead.
Many words, little information.
How does this site not have a block function.
Eff off
Wow. Such engagement, munificent good faith!
I am reconsidering your earlier posts in light of this one.
So you think Paul's word salad was worth reading? I understand wanting to rant because people disagree with you, but I don't see anything logical or evidentiary in his post that warranted anything more than abrupt dismissal.
I appreciate the sociological background on the responses to COVID where you live. Psychosocial phenomena surround everything and I think we have not gotten as far into it as we need to in terms of medical decision making.
The rest of this post will be non-evidentiary but exploratory. I would very much like to come up with a way to bring the COVID denialists on board and so these are questions/thoughts to that effect.
"Culture of poverty" is a maligned phrase but it describes a few things that matter here. I spent some time working/living in somewhat rural areas with limited access to good medical care and where people often had lower incomes. There were strategies of function that were multigenerational, ways of dealing with a) lack of doctors and b) lack of money to pay them and c) lack of sick leave from work. People worked sick, no matter what. A sign of being a responsible adult was the ability to work sick. If you collapsed on the job, at least you had gotten paid up until that point. Adult dentistry was either, get them drunk until the pain goes away or get them very drunk and pull out the tooth with pliers. People took their kids to school sick for the same reasons; they could not afford to stay home from work, plus the kid needed to get used to doing things while ill. It was a jam-the-throttle-open way of living and sometimes the philosophy was applied in increasingly dangerous ways. If they have to disregard safety precautions for financial reasons in some areas, for some people disregarding safety precautions became a way of life. Being generally on the receiving end of bureaucratic problems, and medical malpractice, people generally did not believe the government was there to help them.
Drop a pandemic into this, and what do people do? They approach this new health situation the same way they approach other health situations; prioritize work for financial survival, and ignore and mock those who can afford medicine and those who access it. It's been the approach to everything from broken ribs to depression to cancer for decades. In a way it's been the approach to rural survival for generations; try to have enough kids that some of them survive, and work until you drop.
Having a new approach would benefit them now, and benefit everyone else due to the dynamics of pandemic. But their priors on how to deal with medical problems are very strong, perhaps cultural at this point even. Unfortunately the messengers of a better approach are usually coming from the groups that would have mocked their survival strategies before now.
I am sure you are aware of all this and I don't write it to criticize your feelings or your perspective on your neighbors. I just realized who your description was reminding me of, though, and I wanted to write some of it out. I vaguely recall people taking veterinary antibiotics sometimes and being ok; people who are sick with no insurance get creative. So:
a) veterinary antibiotics among the poor are not a new thing
b) ignoring illness and injury is not a new thing for poor people either
In a way it all makes a lot of sense. Fear of medical malpractice is also real; there's always a relative or friend who died in the hospital due to medical error, or something similar, and rather than analyze it, people reject the medical establishment.
Also groupthink, of course. It wasn't fun to be the one who disagreed with whatever the family had decided, even if they were wrong. That social pressure (I think) has roots in the relationship of the working and poor classes to obedience; when you're allowed to cause problems and when you have to get in line and do your duty. "Thinking" seems obvious to people with a certain relationship to education and to earning money; it is far from obvious as a survival behavior for those who are usually punished for asking questions of the boss.
Their priors are very strong against this type of thing.
The denialists of various stripes take advantage of this insularity among the poor. Somebody needs to meet the refusers where they are and bring advertising dollars: Fox News ads, famous Republicans saying "take the vaccine." If Dubya, Sarah Palin and the cake shop people would make a pro-vaccine ad and air it on Fox, the country music TV stations, and the evangelical channels, they might get somewhere. People need to get past what they think ought to work and go for what probably will work. Unfortunately the lives of the poor have not always been a priority for the middle, wealthy or intellectual classes; "they only care because now we're making THEM sick" is a reasonable observation here.
But yes I agree it needs to end.
"But yes I agree it needs to end."
Why?
Those heuristics you describe still match and thread through the working pathway product of reality and survival in those places better than anything practically implementable that has yet ever been proposed by the "usually coming from the groups that would have mocked their survival strategies before now". Especially those groups are pluralty and probably majority full of people who fully agreed with the "deplorable" comment, or at least didnt push back on their "friends" when it got said.
What did that cohort need? They needed paying fullfilling non-makework not-bullshit jobs in a job market that got so tight of their cohort that employers started offering sick days, education credits, and insurance. The previous President gave that to them, with better results and better metrics since income-by-cohort metrics first started being gathering in the US. Ever. Which, of course, is why he was literally the worst and had to go.
I think you're right, those heuristics are still good - as far as they go. I'm afraid this is going to sound like a rant, hopefully I can keep it on the coherent side. The comment "we will all hang together or we will all hang separately" (Ben Franklin? Revolutionary War?) is true here. It's hard to do when the public face of leadership is contradictory, dishonest; it's extra hard to do when the public face of leadership is filtered through the legacy media and then amplified through social media, all in contradictory and dishonest ways.
I looked up that deplorable "deplorables" speech. https://time.com/4486502/hillary-clinton-basket-of-deplorables-transcript/
I'll quote a little bit here:
"We are living in a volatile political environment. You know, to just be grossly generalistic, you could put half of Trump’s supporters into what I call the basket of deplorables. Right?
[Laughter/applause]
The racist, sexist, homophobic, xenophobic, Islamaphobic — you name it. And unfortunately there are people like that. And he has lifted them up. He has given voice to their websites that used to only have 11,000 people — now how 11 million. He tweets and retweets their offensive hateful mean-spirited rhetoric. Now, some of those folks — they are irredeemable, but thankfully they are not America. But the other basket — and I know this because I see friends from all over America here — I see friends from Florida and Georgia and South Carolina and Texas — as well as, you know, New York and California — but that other basket of people are people who feel that the government has let them down, the economy has let them down, nobody cares about them, nobody worries about what happens to their lives and their futures, and they’re just desperate for change. It doesn’t really even matter where it comes from. They don’t buy everything he says, but he seems to hold out some hope that their lives will be different. They won’t wake up and see their jobs disappear, lose a kid to heroine (sp), feel like they’re in a dead-end. Those are people we have to understand and empathize with as well."
The last half of that paragraph isn't quoted when people talk about the "deplorable" comment. I had never read the whole thing but realized I should. The other point to make about that speech, which I didn't know - the article was published 9/10/2016, quoting remarks given recently at an "LGBT for Hillary" fundraising event. The trope of "I had to leave my small town where everyone hates gay people and move to the city in order to come out and be safe" is pretty well-worn. Reading the speech, I'm thinking she was not only playing to the crowd as urbanites or Democrats but as people with negative opinions of the hypothetical homophobic hometowns they left behind. The earlier part of the speech sketches that out as well.
There's a billboard not too far from where I live that said "Turn off all media" for a while. This is a great example of it, because I know the media twist words - they did that to Trump a few times and they did it to Hillary too. It's not a monolithic media, it's multiple media factions competing to fool us as often as possible.
The "narrative" is made to look like it benefits one side or another, and sometimes it does, but enough of the time it just makes people fight. It's the middle school "friend" who tells Jimmy what Sam said, then tells Sam what Jimmy said, and soon they're beating each other up after school, and then it turns out the friend was making 9/10 of it up. There are real disagreements but it doesn't have to go down like this all the time.
NAFTA did need to be re-negotiated and he did that. We did need to leave Afghanistan and he and his successor have now pulled that off. I don't know if it will come to fruition but we need a national service program that sends coastal kids to the flyover states to work for a year and sends kids from flyover states to the coast. I didn't have a reference point for "ravaged by meth" until I was in a town where half the people were going about their day making the chewing face and so many of the kids were being raised by grandparents and disabled from uterine drug exposure. I didn't have a reference point for rural concern about gangs and drugs until I saw how there were no opportunities there, just like in some cities, saw kids (and their reluctant parents, by extension) joining that life.
That's one place the opportunity heuristic breaks down. "I'm not doing well in school, I have no money, therefore I should drop out and sell drugs" is a crisis of confidence, of social support, but also of heuristic. Since when should that even be a choice? It illustrates how cut off people feel. When the gang is a better employment alternative, there's a bad problem. This is why I support apprenticeships, charter schools, alternative high schools, any pathway that can get kids over the bump and into a career. That happens partly by broadening the heuristic. "This is actually an option for me," "I should take this scholarship and train as a mechanic," etc. The heuristic focuses on surviving demeaning agricultural and industrial jobs. It doesn't empower people to find something else when those jobs dry up. Part of the problem with making jobs reappear is we don't have the industrial base; factories are owned overseas anyway; automation. "You sold us out, now fix it" versus "You have the wrong politics, you don't deserve help" goes nowhere. I agree jobs is what people need and I think one of the only paths to that is UBI, so that people have the resources to get at whatever opportunities are available, or pool resources and start companies.
Similarly the heuristic doesn't compensate for the lies coming through the TV. People have every right to be confused, it's confusing, just like Scott's essay shows. "They're lying so we should ignore them" doesn't work anymore. I also think people systematically underestimate how much of social media - and possibly regular media at this point - is active propaganda or is unintentionally repeating propaganda. This is everybody, not just anti-vaxxers. Everybody underestimates it.
Many of the small bookstores went out of business; local newspapers are owned out of the area, publish less and less, and feel little to no responsibility to the people they serve to provide accurate content. It's not "If I write lies I'll hear about it when I see Bill next door," it's "if I write lies no one will notice and it's published far from here." So the pipeline of accurate information is missing there even more than it's missing in the suburbs and urbs.
Another data point from my time on the other side of the mirror was hearing the young rural children of color who were sure Obama was not a US citizen. No group of people is always correct, with or without the media distortions and lies.
Conversely, not long ago I had someone (who I have known for years) spend an evening ranting about how Hillary supporters had manipulated Bernie Sanders' numbers in the caucus there. The very next night this person ranted about how there had been no election fraud. I finally said "but isn't that election fraud?" and they looked confused and changed the subject. Nondeplorable media heuristics aren't terribly effective either.
When I got Covid (after 2 doses of Moderna) I had breathing problems. One evening I was talking on the phone with someone from the other side of the mirror, me huffing and puffing, saying "dammit, I didn't think it would be like this." The next time I spoke with them, a month later, they had gotten the vaccine. Did facing the symptoms of someone they knew make a difference? Maybe. People do over-emphasize things that happen to people they know.
And the media totally built it up like "if you get the vaccine you won't get sick." That impression was 100% being broadcast for months, during the whole "business can reopen when we get the vaccines because then no one will get sick" routine. Where exactly that inaccuracy originated I'll never know, but it was certainly spin; now they say "we always said people would still get sick" which, well, that's not the impression I got. I hadn't even thought of having to ask "but is it a vaccine against death by Covid or against illness from Covid?"
Can disparate factions agree in the face of this much mis/disinformation? Some of the stories put "the left" fully congruent with "the media." I don't think that's fully true, neither is "the right" fully congruent with "the media."
It just reminds me of suicide; someone gets to the edge of their heuristic, doesn't have information about what to do next, and concludes that there is nothing available and they should commit suicide. That type of thought precedes attempts, however quickly. This is why I think Scott's whole codex thing is important; getting people to think about how they think is vital and necessary. Expanding the heuristic of the suicidal person takes several forms. Expanding the heuristic of other marginalized people is also very important. Yes, there are legitimate questions about the vaccine.
If there wasn't so much manufactured distrust, the people who are the inheritors of the infantry heuristic, who breathe the diesel fumes and drink the tap water, would take the vaccine. They would be lining up for it.
Anyway. Too much rant but I think it's onto something so I'm not deleting it this time.
Are you worried at all about this being a universal argument for all forms of pharmaceutical and nonpharmaceutical intervention against any illness? Certainly it is the same one people will use to try to convince me to wear a mask indoors for the rest of my life. It would also work for chloroquine, and fluvoxamine (which I would take!), and every other medication that has been used in tiny pilot studies for COVID, and obviously the vaccines, too.
I would want my loved one to take one of the vaccines—ideally Moderna because I was in the trial, but hey I'm not picky—and possibly fluvoxamine if they tested positive anyway, but I'm not going to suggest they wear a mask for the rest of their life or wear a helmet in the car or avoid contact with my children, and absent better evidence I probably wouldn't beg them to take ivermectin either.
It's a universal argument *against* prohibiting people from trying. Even Trump defended the right to try. EVEN TRUMP.
Right? EVEN TRUMP is not an argument. It's a symptom of conspiratorial thinking.
No. https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/right-try
And what if taking Ivermectin kills someone that might have otherwise lived?
What if they get struck by lightning while playing mumblety-peg in a hot tub set to 110 degrees F?
Let's not make up ridiculous hypotheticals. I won't if you won't.
It is absolutely not a ridiculous hypothetical. There are many drugs that are safe for a healthy person to take but might hasten their death if they were in critical condition.
This is a perfectly good reason for the FDA to avoid rubber stamping it's use in 100,000's of people. We do not have any evidence that this is the case. On the other hand we also don't really have any evidence that it helps with Covid (Yes, I know you believe otherwise).
Can't your hypothesis be used to advocate against taking the vaccine?
What if "taking the vaccine kills someone that might have otherwise lived"?
That's not a ridiculous hypothetical. There are cases where a vaccine hastens death.
If it weren't for double standards some people wouldn't have any standards at all.
>And if the specialists don't agree with each other -- then do we have any basis at all for thinking that people are trying ivermectin because they are "far-right wing-nuts" as opposed to people just like us who are trying to make sense of things?
Even if there's evidence
supporting the use of ivermectin, hell, even if the studies are gold-standard RCTs performed by God himself, the people saying "I don't need the vaccine, I can just take ivermectin" are wingnuts. They're cherry-picking the studies that support ivermectin while ignoring the much larger evidence base in favor of the vaccine.
Every conspiracy theory has a tiny kernel of truth, that's how it's able to catch on and spread. Vitamin C really is healthy for you, chemicals really can make frogs change sex, there really are (small) studies supporting ivermectin. Then people think "if this part of the theory that I can check is true, maybe the crazy part is true too." Or "I don't know what to believe, so I might as well go with the drug I feel comfortable with instead of the vaccine I don't." But rejecting the vaccine is still wingnuttery, and I think it's good to call it out as such.
When you have one treatment that's widely accepted as safe and effective, and one that might be a little cheaper but it's uncertain if it'll be effective, the answer is "go with the known-good treatment while you run a bigger trial on the uncertain one," not "shrug and pick whichever one sounds good." Get vaccinated, and then you don't have to worry about the specifics of what drug you'll get if you land in the ICU.
Add to the above that the folks ridiculing your preference are caught in many, many lies and are caught suppressing the truth for political gain because they hate you politically and culturally. They call you a "COVID denier" when when you don't deny the existence of COVID, all you are is skeptical about X Y or Z (where Z might be "developed in a lab in Wuhan").
You can SEE the lies they are saying and they never apologize for so how can you trust them about things you can't see?
The bias from the "Mandarin Class" is causing significant social trouble.
The manufacturer of ivermectin urged people not to use it to treat Covid. They could be making billions off this noise, and _still_ urged people not to take it. The evidence of anti-viral properties are weak (it's for parasites, so even if it does have anti-viral properties, you can't expect it to be the best medicine to take).
Really, what more do you want??
Is there a reason why Scott almost always formats his entry in 5 distinct parts ? (except in this case...)
I'm sure he thought about this a lot and would be very interested in his reasonnings behind this.
Thanks!
I think this is a coincidence - it had me look up an old article where he DID talk about how he writes though! Might be interestinng: https://slatestarcodex.com/2016/02/20/writing-advice/ (spoiler: more than 5 parts)
I think the original conclusion of this story: that newspapers and the MSM are simply not doing their due diligence on reporting and fact checking, is still accurate, even if the truth is that it was complicated in general. The fact remains that the original story that KFOR insinuated, and that others outright state, is simply wrong and pretty much a complete fabrication. There is an interesting meta-conclusion about partisanship, but the primary result shouldn't be detracted from.
The question then to ask is what about the media's incentive structure leads to this. Journalists still like to believe in their old value set, but the collapse of traditional print media and progressively lower advertising income means most news outlets are focused on just mass producing as much content as possible to get the millions of clicks needed to survive
Why the HELL do I have to get the actual facts from a $100/year Substack by a guy writing under a pseudonym?
Due diligence, please. You can get this article and most of Scott's writing for free here, and his name isn't exactly a secret.
But you're right that you should be able to get this sort of information from the mainstream media. Or more exactly, if the mainstream media were doing its job, this article wouldn't even exist.
Its almost like their main source of funding is drying up so they're getting desperate and don't have time to do due diligence. News is a public good and needs public funding mechanisms, not just advertisement.
Funding from the government?
Meanwhile, I'm just bemused at Craigslist knocking over so many dominos.
Government funding would be one way to solve the collective action problem for funding news, and is common in other countries. It's a domain where quadratic voting using dollars and a government seed fund would actually make some sense, but that requires a government with some level of technical competence and trust, so unlikely to happen at a national level. In the meantime we're dependent on organizations like ProPublica and random bloggers for quality control and vague coordination of donation based news.
Not sure what you're getting at with Craigslist
Government funding makes it even less likely that we'll get accurate reporting about the government.
Newspapers were largely supported by paid classified ads. And then Craigslist came along, and it was free and searchable. This was very hard on newspapers.
Yeah. I was having a conversation about that with my father immediately before seeing this, which is why I went straight to "and yet no one is actually calling the hospitals to see what they say".
Local newspapers had a great combination of local news, local reporting, local advertising, and local classified ads, plus this like local obituaries. There used to be three big ones in my home town, but now the combination has about 11 staff members and mostly reprints the AP. There were multiple reporters following city government as a full time job, but now... If there were corruption, how would we even know?
IIRC, there's a great quote by Marshall McLuhan about the classifieds being the lifeblood of the newspapers...
Here it is:
"The classified ads (and stock-market quotations) are the bedrock of the press. Should an alternative source of easy access to such diverse daily information be found, the press will fold."
Yes, we should have government funding for the arts, too, and then we'll never have artists going what artists do best: critique the status quo.
At the very least it would be better than this junk, where people don't have time to actually report. Something like voting on which newspapers get specifically government funding would help to alleviate the conflict of interest. And in the states, having local/state/federal reporting would naturally result in fact-checkers with different agendas.
Ah, I was thinking about the national/state level papers and television, where the funding comes from general ads, which have been eaten by facebook/google instead. I hadn't heard about the craigslist-local paper connection before.
And yet the BBC is among the list of outlets who repeated the Rolling Stone article. Funding seems like one of a few different factors.
Maybe we should find out more about the BBC. Is their fact-checking usually this bad? Are they underfunded for what they're trying to do?
The bias I notice from the BBC is going for the emotion. They keep asking people how they feel.
There was a point when BBC news started using clickbait headlines - despite having no reason to do so. They've eased off that a little now I feel, but I think it demonstrates that they're part of the same bubble as all the other journalists and subject to all the same biases as that culture.
I know that after the last election they were considering restricting their correspondents' use of twitter after some controversies involving journalists posting partisan and false information. I'm not sure if anything came of that.
How is news a public good? Which type of news is a public good? Why would third party funding help reporters do due diligence when they can't be bothered to call or email people now? Why would third party funding make consumers of news stories demand more due diligence?
Sorry for all the questions, but no part of your post makes much sense individually or in part, other than media's funding drying up. Especially your claim of news being a public good; as an economist, that makes my hair stand on end.
I'm not trying to disrespect Scott, but really, he just does 30 minutes more googling than the average person is willing to do, and then packages it up neatly in a nice-sounding essay. You can get the facts yourself if you wanted to, nothing here requires a medical degree or pulitzer prize.
Scott realized there was something there to research, which a lot of people didn't.
Word seems to be getting out: a right wing take on the story.
https://www.youtube.com/watch?v=2gKq9Y1f-r4
Most people just don't care about "truth" that much, especially if it contradicts their tribe's beliefs in any way. It's amusing how this fact still manages to confuse rationalists when they rediscover it for the thousandth time.
A subscription model means that he's less dependent on maximising number of clicks then the standard newspaper model which needs lots of novel content
I will acknowledge you got me on Act 2 (but not on Act 3, though I still hadn’t (and have not) clicked through anything), but my defense is that I heard about this first through Eliezer and not from some random bluecheck.
However, that does not absolve me completely, and I am appropriately chastised.
Thank you for being the only commenter so far who took this in the spirit in which it was intended.
Both I and II "got me" at various points in me learning about this story. I think I was unusually cautious this week because I was reading Scout Mindset, and that there's about a 50% chance that without that I would have gotten stuck at I, and a 25% chance that I would have gotten stuck at II.
I think the reason I won't join the ranks of Calion is the framing seems to imply that there's not a clear right stance here, that I'm definitely being fooled one way or another by these media stories and there was no way I could have been wise to what was going on with each of them.
As these stories went through twitter, I went something like this:
Stage I: "Nope, bullshit, there's no possible way this is true anywhere; there's just not enough people who A. have heard of ivermectrin B. are the kind of conspiracy theorist right-wingers who would take it in as an alternative to going to the hospital C. know where to get it D. have covid E. have covid bad enough to want to take it and F. then go get it and take it for this to be even kind of plausible".
Stage II: "Nope, bullshit, there's no way one local hospital has 0 cases and other local hospitals are completely dedicated to treating this."
Stage III: "Yup, OK, exactly like you'd expect: some extremely minimal amount of people have taken this medicine, and an even smaller amount have had complications; it's a near non-issue".
The problem with what you are doing is that you are framing it in a way that makes it appear there wasn't a heuristic that would predict all three of these stages, and that everyone was just led around by the nose. But the heuristic of "The media will lie to make the right look bad, and make minimal problems related to the fringe right look absolutely massive in pursuit of that" predicts everything you mentioned, and something like >50% of your readership was using this heuristic the entire time.
It's not bad to question media stories or twitter bluechecks, but part of the point of being skeptical of them in the first place is to build up predictive heuristics - eventually you know the way they lie or are frequently wrong, and you get better/faster/more efficient and parsing things like this.
As a writer, one of your patterns is to be extremely reluctant to acknowledge instances where conflict theory perfectly predicts what happens - you are a mistake-theory purist, so this is to be expected. But the result here is that you are treating the side that got everything here right as if they did so by accident, instead of giving them credit where it's due. I am proposing that this is wrong, and that you should stop doing it.
I disagree. I think he's saying that most people, *including him,* have the wrong heuristics on this kind of thing. You're saying you have the correct heuristic. If that's actually true, good for you! For me, what I got wrong is assuming that the claim was that he worked at that hospital (group) so that the whole story was more-or-less fabricated. That is *not* the case, so I got fooled. You didn't.
Your last three paragraphs need to be read and reread by everyone. Jumping up 1 more level, the reason Scott had a blind spot here is that despite his recent bad experiences with the media, he still retains enough political affinity with them to WANT them to be reliable which makes him reluctant both to plumb the full depths of their perfidy, and to update WAY further back than he wants to about what that implies about the opinions he has formed about “the right”.
Maybe he’s disgusted with them but overcorrecting, engaging with them a little more than logic would dictate in order to not feel bad for loathing them? Hmm. Not sure.
Media are part of the psychosocial landscape which makes it interesting for the epidemiology of ideas. If you can drop a red ball in the pipe in Oklahoma and have a hundred blue ones pop out all over the world, that’s an interesting machine.
If you think the story is about the media lying to make right wingers look bad then you missed part II. The triumphant right wingers lie to make the media look bad too.
That’s a relatively minor second order effect and the topic is about media lies. Making right wingers look bad is far from their only motivation or bias, but it’s still pervasive and if you don’t take it into account you’ll err in a systematic way.
I'm not sure that's a "relatively minor second order effect". If we're talking about media lies, then understanding that making the newspapers and tv news look bad is an extremely central motivation for many of these right wingers is important.
I’ve been working in and criticizing media for over 30 years. It is absolutely a second order effect. They look bad because they lie. They lie because of biases in many different categories, but for the particular polarity “left-right”, the lies are overwhelmingly against the right and for the left, until you get further to the left than the edge of the American mainstream represented by Bernie Sanders, when they start lying against the left and in favor of mainstream liberals and Democrats.
Those lies are pointed out by those on the right because those on the left prefer not to point out lies that favor the left (again, only as far as the left edge of the American mainstream, further left than that also complains about the American media).
I'm glad you brought this up, because it pretty well illustrates my problem here. To recap:
Stage 1. Media outlet makes a nearly completely unsubstantiated but extremely extraordinary claim; based on the word of a single doctor, they publish an article claiming that so many people are overdosing on Ivermectrin in a particular area that gunshot victims are being left to die. This claim also conveniently makes their outgroup look bad and stupid.
Stage 1.B:
Every conservative goes "well, that sounds like bullshit, and it's from a publication that hates us very, very much."
Stage 1.C:
Noticing that Rolling Stone hasn't done any of the due diligence you'd want and expect for an extraordinary claim, the hospital getting caught in the crossfire indicates that all the evidence they have points to the claim being bullshit and they haven't interacted with Ivermectin at all, much less so many overdoses that they are allowing gunshot victims to bleed out in the streets.
At the end of stage one, we are left with a extraordinary claim that is implausible, unsubstantiated, and negative to the claimant's hated outgroup. It is contradicted by at least some evidence. At this point, Rolling Stone has already been shown to be pretty bad - we know to a pretty high level of certainty they didn't do their jobs, regardless of the truth of the claim.
Regarding the truth of the claim, we'd have to believe in a local situation where people negatively affected by the medication are selectively visiting hospitals in such a way that some of them have had literally no interactions with ivermectin complications of any kind, while others are bursting to the gills with OD's so serious they out-triage fatal firearm injuries.
Stage 2:
A bunch of people say "Yes, this is an unsubstantiated extreme claim that is very unlikely to be true. But to outweigh Rolling Stone's completely unsubstantiated and unlikely claim aimed at making their outgroup look bad, just providing strong counter-evidence isn't enough - we need an official statement from every hospital in the state.
Stage 3:
It is shown that Rolling Stone's claim is more or less mathematically impossible; even if every documented Ivermectin case in the country was isolated to one state, there probably aren't enough of them to overload their medical system.
I can't emphasize enough: Conflict theory perfectly predicts that the claims in 1. are bullshit, that you and others would come up and immediately believe a completely inadequate and non-sensical counter in 2, and that 3. would show the claim was never plausible enough to take seriously in the first place.
Scott is pretending that this heuristic (people who hate us and have made that clear will lie about us, so if it seems unlikely it's very probably false unless they show strong evidence) doesn't exist, and that everyone got led around by the nose equally here. But that isn't the case - only one side believed an unsubstantiated lie. One side was completely correct on all points, and believed only reasonable relatively clear things at any point.
Is he pretending it doesn’t exist, or merely hasn’t adopted it and doesn’t think most people have either? Again, you’re claiming that he’s claiming that it was *impossible* to have come to the right answer here not by chance, but I don’t see where he says that or anything equivalent.
Imagine I walk up to a gate that doesn't have a keyhole, and I'm unaware of a secret keyhole for the gate concealed in puzzle-box style behind several sliding stones in the mason-work to which the gate is anchored and have never heard tell of a key for the gate. Later on when I tell you I had to jump the gate, you can't accuse me of ignoring the key-and-lock solution.
Now imagine for years people have been telling me I don't have to jump the gate; they've explained to me dozens of times where the keyhole is, and have shoved duplicate key after duplicate key into my hands, but secretly I think locks are an out-group thing and I don't want to be associated with the outgroup, so I refuse to use the key or even acknowledge that things like keys and keyholes exist. If I show up and start talking about how weird it is that I had to jump the gate again, you'd be justified saying I should stop ignoring keys.
For Scott to ignore the concept of unlocking here, he had to follow the following steps:
1. Acknowledge that one side had done something mind-bendingly dishonest to discredit their outgroup
2. Acknowledge that the outgroup had provided evidence undercutting the unfair accusations of their accusers
3. Acknowledge that the claims of the accusers are basically mathematically impossible in addition to defying common sense
4. Pretend that both sides are on equal trickery-footing here by asking in every case "did the tricksters trick you?" for all actions by each group, as if they were equivalent and one group wasn't under unfair fire from another.
Or, shorter version:
1. Tell a story in which one side lied and the other side provided evidence they weren't telling the truth, and accuse the side playing defense of lying for not providing *enough* evidence that the mathematically impossible thing wasn't true.
He's trying to apply an implied heuristic here of "both sides are liars - watch out!" where in this case we look and it's not consistent; one side didn't lie. There's a better heuristic of "one side has sufficient cultural cover to lie and not get called on it, and does so" that actually tracks this situation beautifully, but he won't acknowledge it. He's not dumb, and he's not unaware of us telling him where the keys are on this kind of situation; he just for whatever reason thinks saying "yup, in this case these guys lied and these guys told the truth" is gauche, and keeps jumping the fence anyhow.
Also relevant to your stage I, ivermectin is an approved drug for use in humans, and it is one of the drugs lots of people looked at and said "let's see if this one is any good against COVID". That strongly argues for it to have a high theraputic index, and thus unlikely to put people in an ICU even if they take a horse-sized dose.
Now available in full Contra! https://residentcontrarian.substack.com/p/contra-scott-alexander-on-literally
one thing that isn’t emphasized enough is that this is just one terrible news story in a sea of tens of thousands of terrible news stories out of a galaxy of millions of merely unimportant and uninteresting news articles. It wasn’t worth anyone getting mad about - “Rolling Stone”, not even the NYT.
I mean I actively don’t pay attention to this sort of thing at all, and am usually able to prove them wrong when necessary. It’s more like not giving homeless money when they beg, if they’re professional beggars. The stuff is bad so stop reading it!
*I* can stop reading it. Making *everyone I associate with* stop reading it is another level of difficulty. I certainly didn’t hear about this by reading Rolling Stone!
yep
There’s permissiveness versus justice. If there are certain standards, and under them many people are being punished in a way that seems unfair, you can either revise the standards or just expand the region of “ok.” Revising the standards means maintaining some criteria for judging good and bad. Permissiveness means you can dodge ever having to do the hard work of revising.
Permissiveness seems to work for a while. Eventually, it’s either a spiritual practice, or one hits a wall and concludes no, x is bad. Y,z and pdq may still not be crimes or bad, but I’m done dealing with x. So yes I agree with you but it took quite a bit for me to accept I would have to judge some situations negatively and not conceal that. If I want to take some responsibility for maintaining or creating a better world, I have to eschew the ineffective altruism of protecting the profits and egos of the journalism status quo. Because at least some of them very well do know better, and it has large consequences to other human beings. I don’t know what to do about it but paying the better ones seems to be a start.
This one is more egregious than most.
The two leading headlines on Fox News dot com are:
“ President's approval takes a nosedive, only 2 others have had lower ratings at this point of term”
This ... may or may not be true? The quote says that Biden has lower approval comes from ABC. He does have lower disapproval than only two presidents in the unstated time period (which is from 538’s thing here https://projects.fivethirtyeight.com/biden-approval-rating I think) but - using that side as a source - disapproval isn’t 1-approval and 3 presidents had lower approval than him (specifically Clinton) from my reading. Factually this is good faith. However, this obsession about poll numbers as a way to criticize your opposition is generally terrible, so on the balance this still sucks as a pattern.
and
“ Newsom rally speaker calls Larry Elder 'blackface' and it gets worse from there”
Where the real quote (from an alternate title!) is “a Black face on White supremacy“ which isn’t “blackface”. That’s a big difference IMO! “Blackface”, as one word, means something that “a black face” doesn’t.
So you’re probably right that this is more egregious than most! Nevertheless I still think it’s not worth caring about, and the only reason I’m even commenting is that I’ve seen the story fifty times by now and have had most of my friends get upset at it from various sides.
(1) This isn't just Rolling Stone, as Scott pointed out, it includes very serious publications such as the BBC.
(2) Scott's point here, as I read it, is not whether or not *this* article is so important, it is a critique on media and our consumption of it in general using this article as an example.
I think this is an extremely poignant piece and am sharing it with others.
When Hunter S. Thompson was still alive, Rolling Stone was edgy? Had a reputation for accuracy? Confrontation? Elevating cultural touchstones (on the cover of the the Rolling Stone etc)? That has been going downhill. This is sort of waving goodbye while the magazine sinks beneath the surface of the slime.
I've read some of the stuff Hunter S. Thompson published in Rolling Stone. (Fear and Loathing on the Campaign Trail 1972.) He definitely lied in its pages, in ways that the editors knew were lies. Like, when he reported that Edmund Muskie was addicted to some drug called "ibogaine". He just made that up.
The reason Hunter S. Thompson is famous is that he blatantly disregarded objectivity, as a kind of protest against mainstream journalism's supposedly-objective, but actually sneakily biased, practices. It's called "gonzo journalism".
Anyway, Hunter S. Thompson shouldn't be a reason for Rolling Stone to have a reputation for accuracy. Literary value, maybe, political impact, maybe, but not accuracy.
Thank you for correcting me on that. That's depressing. I had somehow thought the gonzo part was both gonzo and accurate. In retrospect that should have been obviously not true.
The problem is that, to alter the famous line from the Congressman, a little bias here and a little bias there and soon you've got real distortion. This article is particularly problematic for two reasons:
1.) There is a serious debate going on right now as to the efficacy of ivermectin as a treatment for COVID. Regardless of which side you come down on, this article is bad: if you think it IS effective, a story casting aspersions on the intelligence of people who use it will mean that fewer people will take advantage of its benefits. If you think that it ISN'T effective, a story casting aspersions on the intelligence of people who use it which turns out to be, to put it politely, questionably sourced simply fuels the "conspiracy theory" that the "Establishment" is trying to suppress ivermectin, and therefore will drive more people towards an ineffective course of treatment.
2.) This is simply another example of one side portraying the other as being less human somehow. If we hope to avoid a shooting war in this country, both sides need to cut it out.
After 'This essay is bad and I should feel bad' (and at that moment I was enlightened) I've generally expected this sort of thing from you.
I am a child of the waning days of the slide rule, which taught me that "If it doesn't make sense, it's probably wrong." It doesn't make sense that Ivermectin, shown to be safe for so many years, could be causing so many overdoses, nor is it sensible that you could have such a failure of the triage system that gunshot victims are not being treated over unlikely Ivermectin overdoses. What are the symptoms of an overdose of vet ivermectin, anyway? Uncontrollable whinnying?
I almost got busted on Act 2 - but I randomly saw a tweet by Jesse Singal asking about the doc not mentioning a hospital. This prompted me to read the RS article which already had the 'correction' up, noticed all of the leaps in causality (the doc is part of a medical group that hasn't specifically worked _here_ for some time, etc, etc) and decided everyone is crazy and I didn't really care that much anymore.
It's like progressing through a video game, where the writing contains both blue and red rings, and a reader will see some of them as powerups and some of them as danger. If the character gains strength from eating blue rings and loses it from eating red rings, then when the character has gotten enough of their preferred rings they stop read/eating. Maybe clicking on the links would be too much effort and the resulting media might not have the right powerups.
I'd say this is confirmation-seeking for sure, reading for confirmation of one's biases. Is the polarization increased by the presence of both red and blue rings? I think it might be. Does a red ring have more red points if it's adjacent to a blue ring? Sometimes I've read articles while sortof tallying the number of red or blue rings. The sequence ring-ring-totally unsupported allegation is not uncommon. I can't think of written material I've encountered that will build in both directions. Some have both red and blue rings, but they usually pick a side and only have either all red or all blue unsupported allegations.
There is a temptation to make a media source sound more reliable if they are throwing in both red and blue rings. I guess that's the bothsidesism. This is a good reminder that it may be full of a whole range of partisan powerups and still be airborne fiction.
I did buy into acts 1 and 2 enough, and then I think I did buy 3 for a while, but went back to it several times. I think I get it now and this is a very valuable example and well structured. Yep, there's the frustration and annoyance.
So, since the NPDS data is national, I think ~0.25 patients per day for Oklahoma is pretty good systematic evidence that this is not happening.
On the other hand, I get to have a semi-informed anecdote for this one. As I type, I'm on the premises of the biggest hospital complex in the state of Oklahoma, where I work every day. I can see with my own eyes -- literally 20 minutes ago as I came in from the parking lot, and every weekday before today -- that the ERs are not overflowing, that there are not patients sitting in ambulances and helicopters, etc. I have never heard any of the physicians and others I work with mention ivermectin poisoning as a major problem. Of course that isn't proof, but media being what it is now, I put a high premium on my own eyes and ears.
Then there is the suspicious framing of the story -- since we are a backwards red state, we must have droves of gun violence victims from our random shooting sprees competing for ER and ICU space with people guzzling snake oil cures. I guess we also must put our many overflow patients into teepees outside the Great Medicine Man Tent. But back in reality, best I can tell, Oklahoma hospitals are in the same situation as presumably any other state: strained, but not "overwhelmed", by COVID-19 patients in addition to the normal distribution of patients.
Of course my bias is that national media will get many things about red states wrong, so perhaps if I were to walk across the street and ask the hospital staff for statistics, then (assuming they would give them to me), I would be proven wrong. It's also possible that things are different in rural areas, although the complex where I'm at is the trauma center where severe gunshot victims, etc, are transferred for the whole surrounding region, so I would expect them to be piling up here if this were actually happening.
Do you think https://tulsaworld.com/news/state-and-regional/watch-now-this-is-not-just-covid-domino-effect-backs-up-oklahoma-hospitals-with-no/article_20c0d850-0a62-11ec-a376-e7df03dd09bf.html is also not true?
It's a global problem, it's not specific to Oklahoma. Switzerland is going through the same thing right now - a bunch of news stories asking why the country has decommissioned hundreds of ICU beds over the past year and ICU capacity is now being used as a justification/excuse for vaccine passports.
And given the numbers for OK shown at the website that James C. links to two posts up, it works out to a decrease of a bit more than 1.5 beds per hospital, which does not strike me as traumatic.
So, your claim is that staff are quitting because of vaccine mandates, and not because of, say, burnout caused by an endless stream of covid patients?
Seriously, hop on /r/nursing on any day of the week and I guarantee you'll see a post about burnout on the front page, often coupled with a comment on how difficult it is to provide care for people who think that the virus that's killing them is a hoax. And this was happening well before hospitals started to mandate vaccinations.
The comment I was replying to didn't mention burnout anywhere. And I suspect that this is a *much* larger reason for people quitting than mandates, because, as I said, complaints of burnout were appearing before mandates did. It's not false indignation, I genuinely think you are being misleading by headlining "vaccine mandates" and backgrounding "burnout."
This is the same error as the post is warning about - headlining "people in the ICU with an overdose" when the
main reason for overwhelming ICUs is "people with COVID."
I think you are probably right, intuitively it makes sense that burn out is the main reason, as it was mentionned in the news during first wave without any vaccine in sight.
This, however, does not change the main point here: risk of exceeding ICU capacity is the #1 justification for all covid policies, and people rightly wondered (during the first wave) why #ICU was not increased. The narrative then was that it was impossible to train new ICU staff fast enough. I don't know if it's true, but at least the idea of ICU capacity was a variable was floating around...Now ICU capacity is barely discussed. It's still mentioned as a justification for worrying about Covid, but like ICU capacity was some sort of physical constant unaffected by trivialities like staff salaries and compensations. And #ICU staff decrease is a second-order news discussed only as an abstract risk of mandating vaccination for hospital workers.
I wouldn't be surprised if there were instances of patients being transferred, and I can speak with a lot less confidence about ICU beds than I can about the ER, because I can actually see the ER just in passing, whereas I have to hear about the ICU by talking to people and asking specific questions.
My overall impression is that: 1) Hospitals are reserving excess ICU capacity for themselves in case they might need it, hence it must be a pain to get a hospital to accept an ICU transfer and harder than if a patient came from that hospital's own ER. Meaning that overall this could put rural hospitals who need to transfer into a tough spot. 2) Perhaps ICU slots are not being triaged effectively.
But providers nationwide have been saying for the last year that ICU capacity is extremely tight. What I don't know is whether "some instances of patients being transferred out of state" is evidence for the implied claim "Oklahoma is worse off in terms of ICU capacity than other states".
Judging from the website James C. posts below, most states are not doing significantly better than Oklahoma--and one of the few that is is the left's favorite punching bag, South Dakota, hence why one patient was allegedly being transferred there. Could it be. . .natural immunity?
What frustrates me with all of the hospital overflowing stories is a lack of any numbers or context. What avg of beds are typically occupied? How many patients are typically moved around in urban hospitals in normal situations? I've seen articles that conflate non-urban hospitals (I'm assuming can't handle more than a couple ICU if any at all) and urban hospitals. I rarely feel like I'm reading anything that is attempting to explain what is happening as opposed to manipulating me into being alarmed.
This is the biggest problem, nobody wants to actually have any clue what’s going on (and even if they did know, what would they do with that info?)
This is my biggest complaint with the news. Every time I see a story saying Thailand is having a huge covid outbreak or whatever, I have to dig and dig and dig to get any context on whether Thailand is doing worse than Vietnam or South Korea, let alone Vermont or another US state that is supposedly doing fine right now.
This is exactly what I would like to know. I've tried to calm down some people I work with regarding their COVID fears, but then they fall back on "well, what if I have to take my child to the hospital and am asked to drive four hours to another one instead?" to which I have no retort.
I've seen it occasionally noted that ICU beds are often mostly in use, so I don't know if 95% should alarm me or not. I just looked at this website: https://protect-public.hhs.gov/pages/hospital-utilization and see that for five hospitals near me, available in-patient beds range from -19% to 23% and ICU beds range from 0% to 35%. So all over the place.
My limited understanding is that hospitals work to keep ICU beds about 70% full. If that's exceeded on a long-term basis, they'll look at increasing capacity. If it's routinely below that, they won't build new capacity and might stop staffing some of the beds/units.
This means that 95% occupancy means about 25% percentage points higher occupancy than "desired", and about a 30% relative increase.
Did you believe that?
Yes. Yes, I do. That's why I'm willing to be a paid subscriber. Because this site makes me a better person (inasmuch as that's possible).
Because you are already marvellous or because you are so sunk in sin as to be beyond redemption?
Ah! I was thinking of the latter but, if asked, I'll insist it's the former.... :)
So here's the thing. I totally did believe you the first time, but I believed it because **you** wrote it. This genuinely doesn't seem like bad practice on reflection. After all, what is the point of carefully selecting a few sources to read among a sea of information if not that you can believe what they say without fact checking them?
Perhaps this stems from some kind of bias, but I am pretty confident that, if I had read something like this on twitter, my reaction would be 'no idea what's true here'. In fact, that's a reaction I have quite often.
I mean this is just a joke, and the entire point of (these sorts) jokes is to both expose and make you more aware and willing to critique such immediate trust, by using it and then exposing that false use. Scott has been wrong a lot before - less than most! - but you should evaluate what he says yourself even if you aren’t able to do it properly.
I too tend to trust Scott, and that is why I am here, but elsewhere in the comments he writes that he had about a 50% chance of getting stuck in Part I and a 25% chance of getting stuck in Part II, and may only have made it to Part II because he happened to be reading a book about bias.
So one take-away from this is to attach wide error bars to your beliefs, even when they come from reading Scott!
(I do like to think that if he was going to use this specific case as an important part of some blog post, he would have done the research then. As in fact he ended up doing for this post.)
"Only you, reading this ACX article, are getting the full story and learning more about the world instead of just confirming your biases."
Well, I definitely don't believe _that_. Partly because you practically admitted that you do not know the "full story", if such a thing even exists. Also, I'm not necessarily here to learn more about the world. I was promised a play in three acts. It was a nice play.
But perhaps I have learned a bit about (or confirmed my biases of) how other people learn about (or confirm their biases of) the world. It is interesting how easy it is to go meta once the object level becomes vague, uncertain and perhaps not that important. In fact, I'm doing it right now! But I think the question is relevant: for how many people is the object level claim in the original article (i.e. whether gunshot victims were unable to be treated "due to" an ER being filled with ivermectine overdose patients. ), what matters? I'd guess the answer is of rather limited value if you do not expect to be visiting an ER in Oklahoma. In other words, local news. Which it basically was, for a while. For many, this seems to be mainly a soldier in the culture war, although this case is interesting, because both sides appear to believe the soldier is fighting for them. What to make of all this, then? That's up to you, although I'm reinforcing my bias of initial smug skepticism about minor events across the pond.
The fact you don't even know Ivermectin has been shown to be effective in dozen of RCTs makes me rethink your intelligence.
At a minimum, you should just admit that "you don't know if it works or not".
Yet you state that it's clearly ineffective.
Please go back to the drawing board.
I mean there have literally been ten thousand RCTs showing that Chinese traditional medicine is effective. (One meta analysis covered 4000 at the same time and another did 3000...). Nevertheless, it doesn’t. You can do bad RCTs, and many do.
Here's the thing though: even if ivermectin has anti-viral properties, it's still not the best medicine to take for covid. It has even worse side-effects than the vaccines, while also being less effective. In that sense it's absolutely correct to say ivermectin is ineffective against covid.
Also the manufacturer of ivermectin said that it is ineffective against covid, so there's that.
What's your source on ivermectin having worse side effects than the vaccines? I'm interested in what claims they're making about the side effects of ivermectin. It's pretty well accepted that the vaccines can put you out of commission for a day or two, whereas for ivermectin the worst common side effects seem to be mild fever, joint pain, and itching.
Are there medicines you think work well for COVID?
You're missing the entire point of the article here.
Cool. So would you be able to share this very good and reliable data showing it works well against covid?
This is updated regularly:
https://ivmmeta.com/
Great page! Thanks for the link
Budy i am glad i read this article.
So i can tell you the following. I am not a Republican. I have actually read most of the articles and links. I have been following on Ivermectin for a long time. The media has been biased, you are still being biased.
1- the hospital came out with a public letter because that doctor is affiliated with them. And the same as with dr McCullough who's medical group he worked for just for having their name mentioned in an introduction to an interview. This group felt the need to dissociate/protect themselves from anything related to this mr.
2- Japanese health associations endorsed Ivermectin recently (and i am not talking about the public speech from Fabruary).
3- india just recently made Ivermectin part of the list of essential deugs to fight covid
I am bringing out those 2 recent developments to let you know, that not just early signs were positive, but even later experiences were. Which can explain the latest developments mentioned above.
4- Satoshi (the proud Nobel prize winner for Ivermectin discovery) and other collaborators, published a new study on the risks of IVM in the context of potential covid therapeutics.. You might want to check it: very very very low risk. The study is over 50 pages and quite conclusive and extensive.
5- point 4 doesn't answer for people using animal forms. But it does answer the false media claims (for multiple months now) that IVM has high risk.
6- YouTube has removed any testimony from anypne who took IVM and then spoke positively about the results .. You can still find thoae on other platforms, if you are interested in what those people had to say(maybe you will learn something).
7- Correlation is not causality, i know. But that correlation seems to have saved some interesting lives.
8- you might want to check the number of non republican doctors (they seem to be educated enough to have an MD degree), that have used and prescribed IVM and what are the results they saw. Live ICU doctors, family practitioners, etc.
Maybe then you can have an investigative answer about all this. Maybe you will have a different opinion, or maybe your opinion will be more strengthened. But if you want to start saying that you want to use logic and fight bias, well start looking at what those advocates of IVM are clinging to. You already know the other side anyway.
This all sounds like it adds up to the following:
Ivermectin is a drug that, under certain circumstances can be useful with certain covid cases. Ivermectin is also a pretty low risk drug, when taken in appropriate dosage and formulation. Individual anecdotal reports are still dangerous, because the individual anecdotal reports don't necessarily contain any information about appropriate dosage and formulation, and they lead many people to go around their doctor, and get animal formulations at dosages that are too high for humans, which can have some unfortunate side effects.
Or do you think there is some level of home use that is actually supported by current evidence? If so, it would be good to publicize the information about what that level and formulation is, so that people don't just go around buying random things that say "ivermectin" on the side!
Yeah there's a motte and bailey thing here with "invermectin has some clinical uses" and "you should buy it and self medicate"
@Jane: Can you provide links for your statements 2 and 3? I can't find online support, beyond the statement that two Indian states were using Ivermectin.
I have found support for the statement about India. For Japan, it looks as though the head of the Tokyo medical association came out for Ivermectin, but not any official government body.
I think you should add more hedging at the beginning around ivermectin. I don't know that there's *good evidence*, but based on the studies I've seen I don't think it's crazy to believe that it *might* work. (I can even think of some reasons it might work, such as killing worms that suppress immune response. That might even account for some heterogeneity in findings. But this isn't my field.)
Probably some number of people are taking appropriate doses of ivermectin on the merits of some study they've read. Hey, that's their prerogative. And then some number are eating the horse paste wholesale and going to the hospital and taking up ER slots.
Anyway, I'd be a little more cautious in saying that it's been fully discounted already, or that there's *no* remaining evidence.
Fantastic post, one of your best.
My wife's a dog breeder, so I already knew that the initial story was implausible. Ivermectin has a huge gap between 'clinical dose' and 'toxic overdose.' There's no way people are being hospitalized en masse from overdosing on it.
...unless they're from herding breeds (some collies and sheepdogs), which can get serious side effects from it due to an MDR1 mutation. :-)
Right, good point! I remember hearing about that from a collie breeder. :)
Er, that is, a breeder of collies. Not a breeder who IS a collie. Have to be clear on these things. :P
A bit disanalogous. The issue is with people taking the horse formulation, so I'd imagine the clinical dose for that is much higher than for humans, given body mass etc, so closer to human toxic level
Ivermectin for horse doesn't come in horse-doses, any more than e.g. toothpaste comes in human-mouth-doses. It's entirely possible that people self-medicating with Ivermectin may sometimes squeeze out more than they ought to for their daily dose, but not because they are simplistically taking "one horse-dose" and that's way too much.
Also, as near as I can tell the theraputic index for ivermectin is high enough that if you took a horse-sized dose you'd still probably be OK. Well, OK-ish, but not get-thee-to-an-ICU bad.
"the ways our irrationality is polarizing us."
This seems like a feedback loop. Being polarized makes people not think clearly about issues. Looking at issues unclearly, as you mentioned, ratchets up polarization by reinforcing one's preconceptions...
Did you hear? Paul Krugman filed for personal bankruptcy.
I try to be on high alert when I run to into a story that absolutely confirms my personal biases - the ones I’m aware of anyway. The ones I’m not aware of remain a work in progress.
That story wasn't even internally consistent. E.g. it said that (1) his total loans add up to $7.35M, (2) he has a $8.7 loan for a condo & (3) his total assets are $33k.
Google finds this was a false story going around in 2013!
https://www.businessinsider.com/paul-krugman-bankruptcy-story-false-spreads-2013-3
As background about the USA's Poison Control service, I found this episode of RadioLab interesting: https://www.wnycstudios.org/podcasts/radiolab/articles/poison-control
Yea those people are doing gods work
I wrote a Substack post about Ivermectin 6 weeks ago: https://yevaud.substack.com/p/thoughts-on-ivermectin/comments . TLDR - the studies that claim it is "90% effective" are all fraudulent, the studies that claim it is "useless" have data that suggests it is 20% effective, and US research hospitals haven't looked into it because they have incompetent management.
That hasn't changed, but now there's a fourth point: "don't take an overdose of horse paste".
The Wikipedia saying https://en.wikipedia.org/wiki/Wikipedia:Don%27t_stuff_beans_up_your_nose comes to mind on that advice.
One thing I’ve noticed is the 20% effectiveness claims in studies are in some outcomes. But other outcomes have null or harm results. Given that and the noise inherent their null conclusions are the right choice IMO
My understanding is that the skepticism against ivermectin is a combination of:
1) the prior probability for "X cures Y" is quite small;
2) the evidence in favor of ivermectin seems to be the same as you would expect in the universe where ivermectin is neither helpful nor harmful: because of noise, studies find either small positive or small negative results; and because of selection bias, the ones with small positive bias are more likely to be published.
"That hasn't changed, but now there's a fourth point: "don't take an overdose of horse paste"."
It's cattle drench over here rather than horse wormer, but the point still stands: dosages calibrated for animals that have a much higher bodyweight than humans are not going to do a human good.
https://www.youtube.com/watch?v=llDoaK9To3Y
And the important point: even if it's 20% effective in treating some of the symptoms, the question has never been 'should you take ivermectin if you have symptoms.'
The debate is 'should you take ivermectin INSTEAD OF a vaccine.' That's the battle line people are arguing over here.
Unless those studies show it's *more* effective than getting vaccinated, both for individual an community health outcomes - and they definitely don't - none of them actually provide enough weight to support the 'don't get vaccinated' side.
No, the current debate is whether people should take ivermectin at all.
It's really, really not, at least in the US.
I feel like people give too little thought to how different pieces of misinformation have different impact. If you mistakenly believe vaccines are dangerous and ivermectin works, and are middle-aged or older, you'll incur a sizeable risk of dying and a sizeable risk of causing someone else to die. If you mistakenly believe hospitals are full of people with ivermectin poisoining, you'll be more likely to rely on vaccination instead, which happens to be the correct thing to do, even if your reasons for it would be somewhat incorrect. Maybe it would cause a few people would reject ivermectin in some scenario where it would be actually helpful for them, or refuse to go to a hospital because you overestimate how overcrowded it is - but on the net, the average receiver of such misinformation would probably be better off.
That's not to say it's a good idea to spread information that you know is false or unverified but think is useful (although I do think this is sometimes a better explanation of why spreading happens than people actually wishful-thinking it true). For one thing, judging whether a claim about something happening at some hospital is true is easy enough that the average journalist can reliably do it, while judging claims about drugs and vaccines isn't, and judging the exact effect of a story on its audience is also hard, so you'd regularly misjudge those things and cause harm. And it would poison the well - if the facts you build your calculations on might have been falsified by someone in the name of some past cost-benefit calculus of their own, it becomes impossible to make good judgments about anything. We should be working on building a web of reliable knowledge fragments, not fighting fire with fire.
Still, I think if you spend most of your misinformation-related attention on false stories with low impact that happen to be convenient for your biases, and ignore false stories with high impact that line up less nicely with your prejudices, you are still committing some meta version of the confirmation bias, even if the way you verify and judge the specific stories you pay attention to is correct and unbiased 100% of the time.
There's a second-order effect you're missing (well, you do hint at it), which I (and I assume Scott) would say overwhelms the issues you mention, and that's that this sort of thing undermines the trust in the media in general, which leaves people much more susceptible to misinformation and conspiracy theory. Your reasoning is like the journalists': Every time, they don't bother to check in a sort of Pascal's Wager: Even if it's false, it would be better if people believed it was true, so why bother to check? But every time that happens, it makes the larger problem worse. I'd have to see other examples of him ignoring more-important stories to focus on less-important ones (though he's not a journalist or news outlet, so this would not really be a bad thing), but in this case, I think the decrease-in-institutional-trust effect is pretty large.
I suspect the situation is similar wrt erosion of trust in the media: false news stories have some impact, but most of it is driven by propaganda by opposing interests and by changes to the technology landscape, and would happen irrespective of how well they are doing. (Compare with erosion of trust in scientific institutions, which I think for all their faults perform considerably better than they did a few decades ago.) If you focus on clean-cut stories about media bias, you are liable of misleading yourself about the larger picture even if those stories are all truthful.
(Admittedly, I don't have any evidence for this, and finding out people's real reasons for mistrusting media seems like a difficult thing to do with lots of response bias. But it lines up with what we know about human behavior in general.)
My feeling—and I try to keep in touch with where both conservatives and Progressives are coming from, at least until they block me—is that while the propaganda certainly would exist regardless, the many many blatantly false news stories—all, in the “mainstream journalism” (i.e. not conservative-specific) realm, erring on the side of making conservatives look bad—have dramatically increased the plausibility of that propaganda, which in a sane journalistic environment would be treated as propaganda usually is: Taken seriously by a hardcore base, and viewed with skepticism by most other people. But conservatives have gained the impression that the media establishment is firmly against them, and willing to use any means, honest or dishonest, to discredit and humiliate them, and what’s more, that impression seems to be *correct.* To my view, this is having a profound impact on the political and social landscape, to include the election of Trump.
There's a noble lie argument basically. If the harms of invermectin are exaggerated people are less likely to take it, and more likely to take the vaccine, which is the outcome we want from a public health perspective. But as with all such things that has to be weighed against loss of credibility.
I fell completely for Act II... despite just having been exposed to the morale of Act I and, well, that there were 3 Acts. [insert large facepalm]
Of the ones I checked, The Guardian actually has an "amendment disclaimer" at the end. But it pretty much looks like the left the article/title as is, and then just slapped at the end this:
"[NHS] said [...] that Dr McElyea was not an employee but was affiliated with a medical staffing group that provided coverage for its emergency room. NHS Sequoyah had not treated any patients due to complications related to taking ivermectin [...]"
I kind of think that this is even worse than no amendment? Because one can hope that e.g. the BBC one didn't know of the controversy and left it as is. The Guardian's has a "fact-checking done, good job, let's pat ourselves in the back" feeling. Despite the title literally saying the doctor made the ivermectin->hospital collapse implication. But well, maybe, at least they tried? I don't know anymore.
This is a marvelous post! Instapundit has a recent post (by Ed Driscoll) about the story, and the comments illustrate every scene in your play . . . I added a comment with a link to the post, since you said it was okay to share.
In some sense, the true story does not matter here. The style of reporting here is what matters. We need to find a way to incentivize this, or at least disincentivize that *other* stuff.
https://en.m.wikipedia.org/wiki/Rhetoric_(Aristotle)
This kind of fake news is encouraged by the capitalist economic system. When there's a major financial incentive to lie for sensationalist clicks the media will of course do so as their primary concern is one thing - profit. Once again we see the profit incentive perverting the proper functioning of society.
The antidote to the problems of capitalism is always more capitalism. The problem here (as always) is insufficient competition. Sure, news outlets lie for profit. But the problem is that there's really nowhere else to turn. As the understanding of the problem becomes more widespread, I expect the market to come up with better solutions. (And note that some of the problem is due to the FCC limiting the number of broadcast news outlets, creating an oligopoly. I'm not sure how much of an impact this has had, but given how influential broadcast news was for decades, I wouldn't rule it out. Also note, as Radley Balko has pointed out, that journalists are, by and large, cheerleaders for the State, which would seem a difficult problem to blame on capitalism.)
Capitalism gives people what they want. And lots of people want to have their prejudices confirmed regardless of the truth. The real problem is the customers/consumers:
https://www.overcomingbias.com/2020/11/the-real-problem.html
The people who exploit this tendency is not a part of the problem?
Remove an exploiter and someone else will fill the niche.
The next exploiter who fills the niche would also be a problem.
I mean you can just as well blame the rotting food that you ate for making you sick, but what the hell will that do
Fruit does not have agency.
Agency isn't relevant. Bad outcomes are relevant. If all you want to do is have a scapegoat to blame, then sure, you can blame the bad agents here.
But if you want to actually improve the situation for people in the world, you need to figure out what change will actually result in an improvement for them, rather than just figuring out who to blame, and then also blaming the next person that does exactly the same thing.
When the system provides a huge incentive and no penalty for someone to do this, it seems not very productive to complain about people taking the action when you could be complaining about the system that rewards it.
I actually don't think capitalism is significantly to blame here - as TGGP says its acting as a proxy for the preference of people to read clickbait stories instead of valuing true information. Any other system that replaces capitalism should still try to reward people for giving other people what they want, so the answer is probably perpendicular to the economic system.
To second order, capitalism does tend to put a very large number of people under a lot of pressure and eat up available time and attention and this might put them in a threat state where it feels more important to protect their tribe/worldview than to seek knowledge (survive rather than thrive).
I wouldn't blame capitalism for putting people under pressure etc. but rather the ever increasing trend towards making everything political. Personally, the fact that people seem to want to dictate what is mandatory and what is forbidden in every aspect of life, and punish me for not wanting to make the same choices they do is what makes me feel threatened.
I think it's the other way around. I think people are afraid of an environment where saying things publicly can cause you to lose your job - but that's scary because the cost of living is huge and jobs that pay well enough to meet them are scarce. It's the material conditions that make that situation threatening, not the mere fact of people booing you. How scary would that environment be if we lived in a world where people had more financial security and any old job could be expected to provide you with the necessities of life?
Saying "the real problem is the customers" is all fine and good if you're just looking for someone to blame. But if you want to end up with a better outcome, you want to figure out what change to the system can result in a better outcome *even with* problematic customers like this.
The BBC is a capitalist entity now? They had as much of an obligation to confirm this story as anyone else. One that might plausibly have been satisfied by a close reading that indicated Rolling Stone had properly confirmed the story, but that turns out not to be the case. So what's the explanation for non-capitalist BBC being just as eager to jump on the "stupid idiots with their horse dewormer" bandwagon as everyone else?
The BBC makes money just like anybody else.
The BBC makes money in a manner that is rather different than that experienced by most of us, and isn't really what we would call "capitalism".
The harsher the competition the more measures one will utilize to get ahead. Why would a company whose primary concern is profit put things like journalistic principles ahead of profit simply because competition is fiercer when doing such a thing would jeopardize the financial success and future employment of the outlet? There are plenty of good news sites out there if you look hard enough, they just are not well known for the aforementioned reasons, among others.
This is the way things have always been in journalism and there's no reason to think that "more competition" would make things better as opposed to worsen them. More competition has never led to improvements in anything, its only ever led to a bigger cannibalistic frenzy.
>"journalists are, by and large, cheerleaders for the State, which would seem a difficult problem to blame on capitalism.)"
Generally those in power are aligned to the interest of big business (who own the media) by virtue of this aforementioned fact.
Plenty of “for profit companies” (science, nature) have more journalistic integrity! There is more in heaven and earth than capitalism, free markets,
Communism, and good intention. Other reasons exist! And matter!
If we're talking about academic stuff then sure but that's the exception not the rule
There are also plenty of industry news and research services, and internal research departments that are very straight with facts.
still exceptions to the rule
You mean Science and Nature the scientific journals? I really don't think they do, at all. Nature is terrible. I read a paper in it the other week where literally the very first statement was wrong, and unambiguously so - it claimed Sweden had amongst the worst per-capita COVID mortality in Europe, in fact Sweden has significantly better than average per-capita COVID mortality. The statement was wrong on the date of publication and wrong on the date of submission. The paper was claiming that because despite being published in August 2021 the data it used only ran up to July 2020. More than a year out of date!
Sure, local news is terrible and untrustworthy, but at least it's actually about things that happened recently. Nature can't even manage that.
Are you sure it was in Nature proper and not one of the many Nature BioMolCom whatevers? Nature proper has higher standards. And a few bad papers doesn’t make the general journal not a top journal and a place where a lot of innovative and important research is published.
The paper is here:
https://www.nature.com/articles/s41598-021-95699-9#Sec7
I think that's Nature proper. At least I see no evidence it's a sub-journal.
People keep insisting that Nature has high standards, but this paper is not an isolated incident. They keep publishing BS papers by this team at Imperial College London, they keep getting called on it, and they just don't seem to learn or even care. Often the papers have problems so basic you are forced to conclude nobody without major conflicts of interest can have actually read the paper at any point before publication. For example one of the previous papers from that team, also published in Nature, was an exercise in fiction and circular logic - and actually admitted that in the paper itself! Didn't matter, nobody cared, and because it flattered the egos of academics it now has 1300+ citations. It's this sort of thing that makes people think science is garbage.
>The harsher the competition the more measures one will utilize to get ahead.
True. If competition gets harsh enough, perhaps one will even try *good journalistic practices* to get ahead, rather than using their platform to push their own political agenda!
>Why would a company whose primary concern is profit put things like journalistic principles ahead of profit simply because competition is fiercer when doing such a thing would jeopardize the financial success and future employment of the outlet?
This begs the question. You’re assuming that there’s zero market for good journalism. If that’s true, don’t we, as a society, deserve what we get? But if it’s *not* true, then in a sufficiently competitive environment, good journalistic practices would result in profits, as those people who want that flock to that outlet. In the long run, I suspect that this would put pressure on the rest, too: Yes, people want to be told what they want to hear, but they also don’t like finding out they’ve been wrong, and they would like to believe that they’re not ignorant rubes consuming obvious propaganda. And I think that people also would like the truth, though that’s fairly low on the priority scale.
>There are plenty of good news sites out there if you look hard enough, they just are not well known for the aforementioned reasons, among others.
Certainly not well-known to me! Could you direct me to some of them?
Competition seems pretty harsh now, and the FCC isn’t doing all that much harm to the internet news services. Making a better service is great but there are lots and uh readers aren’t so much
>This begs the question. You’re assuming that there’s zero market for good journalism.
All you have to do is look around to see that is the case, or at the very least people are bad at recognizing it. Law of supply and demand.
If there is zero market for good journalism, why do you think it would ever be produced by anyone under any economic system? If you take the assumption that there is zero market for good journalism as true, the only answer is that no one wants good journalism and it will never be produced, every by anyone for any reason, because no one wants it.
Empirically, at least a few people want good journalism because people complain about the bad stuff, so... there is a market, although perhaps a small one compared to the market for bad stuff.
If that's the case, who cares? If nobody wants something, and the market doesn't provide it, then that's a *good* thing, not a bad one.
once upon a time, in a land far away in a time before time, some people knew how to vaccinate people (well, variolate) and very few had it happen. A thousand years layer, trade and information sharing and states and scientific investigation developed to share it. It was not a good thing that nobody wanted variolation. Neither is it a good thing that the market for cheap and whole healthy food is smaller than that for food that causes massive healthcare costs. Even if we restrict ourselves to the unfeeling and abstract knowledge of that dismal science Economics, market failures and stabilizing interventions? As well as innovation and changes in information causing unmet niches to be filled, are more a rule than an exception. Given that, to say that nobody wanting something meaning it doesn’t matter is comical and harmful. Who wanted biomedical science in 1650? “If I had asked them why to make, they’d have told me faster horses”.
>More competition has never led to improvements in anything
Except better and cheaper computers, food, appliances, air travel, clothing, and most of the things that make up our modern world. Perhaps the most striking example is TV, which sucked (TV was rightly called the “boob tube”) until streaming services broke long-standing broadcast and cable oligopolies and started producing genuinely good programming.
>Generally those in power are aligned to the interest of big business (who own the media) by virtue of this aforementioned fact.
That’s true, which explains our regulatory state, but it doesn’t hold water here, as generally the owners of media outlets are conservatives.
Online streaming is better than TV but I wouldn’t call much of it genuinely good!
Game of Thrones. House of Cards. Breaking Bad. I could go on. There's some absolutely amazing TV out there.
those are all exceptions, and still are meh on a civilization scale
>That’s true, which explains our regulatory state, but it doesn’t hold water here, as generally the owners of media outlets are conservatives.
I don't see any evidence for that.
I should have said "CEOs" rather than "owners," though the latter is probably true too; I would guess that the average stockholder leans conservative. CEOs in general are much more likely to be conservative (https://www.cnn.com/2019/05/14/business/republican-democrat-ceos/index.html), and I see no reason to think that that doesn't apply to media companies (in fact I've seen it claimed that media company CEOs are largely conservative, though I can't find that claim at the moment).
Moreover, I think this misses the point. Journalists do tend to align with the interests of politicians, but that *hardly* means that they're advocates for big business. I strongly suggest you read this article: https://reason.com/2010/11/01/the-media-arent-liberal/
There are plenty of other places to turn, like, here, or just sciencemag.org or pubpeer.com or whatever, and people don’t
News for a long time hued pretty closely to "just the facts, mam" and went out of its way to attempt to be objective. But that was when TV news was a loss leader and when print news had ads that paid for the news gathering. More capitalism obliterated that.
Now we get "narrative" news that doesn't really hide its "lesson" agenda and clickbait headlines not just from fringe outlets but from the NY Times and WashPo. So the problem isn't so much "insufficient competition" as it is the optimizing for every last cent in every possible way which is capitalism taken to its logical extreme.
>News for a long time hued pretty closely to "just the facts, mam" and went out of its way to attempt to be objective.
Pre-TV news was rife with misinformation though (USS Maine, Zinoviev Letter etc)
Humans are human. Nothing’s perfect. The question is, was pre-FCC news better than post-FCC news?
The problem with the market here is that people in general aren't willing to pay extra for well researched stuff, when they can get so much for free. But good quality journalism is a public good. So. There's a collective action issue
I would say there's more demand for biased media flattering the prejudices of the audience vs accurate media.
The Soviet’s had plenty of fake news and science. They were seen as a beacon of anti capitalism by many in the US at the time.
Let’s say we just nuked money and corporations. They’re gone. Wouldn’t news article writers still want to write interesting and well viewed articles? People still share internet pages that debt agreed with but were not correct? Even pre capitalism, or merely among groups of children or social groups, false rumors and malicious slander were and are common. Profit isn’t the only driver.
>The Soviet’s had plenty of fake news and science.
Yes but for entirely different reasons that had nothing to do with economics or socialism necessarily.
>Profit isn’t the only driver.
Sure, but it significantly worsens it.
The reasons were because of Socialism though. The lies were to cover up the failures of the socialist economic model.
That's government PR policy, not economics though.
And those entirely different reasons were what, exactly? (For the moment, we'll skip over the fact that every socialist news service was just as full of crap as the Soviets' was.)
And as far as profit being a driver: one does not succeed in a capitalist system for very long unless one gives the market what it wants, in a way which is at least perceived to be better than what others are providing. If the people want news which is informative and accurate, sooner or later the outlets which produce informative, accurate news will succeed and drive the others out of business. On the other hand, if what people want is to have their prejudices confirmed, then that is what the market will provide--and even a theoretically perfect socialist system completely driven by the desires of the masses (which has never existed, and never will) isn't going to solve that problem.
>And those entirely different reasons were what, exactly?
PR management/totalitarianism
>On the other hand, if what people want is to have their prejudices confirmed, then that is what the market will provide-
A system that preys on maladaptive human tendencies is not a problem to you?
The BBC (government funded) was one which fell for it as well.
It's still a for-profit organization
Do you have an example of a non-capitalist economic system that produces news that is high quality and objective with regards to truth? My sense is that all state run news systems without free competition tend to be uniformly bad, as in the news is very uniform because it cleaves to the state's story and very bad in that is lies like it is its job. Which of course is its job. Pravda isn't exactly held up as an example of journalistic integrity.
Good article. A well done article. I have no place to complain about it.
My main takeaway from it is yet more despair and hopelessness. It takes hours or days just to maybe understand an infinitesimal fraction of a fraction of a single issue. I mostly understood that by now, but I guess a reminder is helpful. I just need to remember to keep myself resigned to the fact that I will only ever understand a couple pieces of this world's billion-piece puzzle.
OK. I actually live in Oklahoma City and happen to know a couple of ICU nurses, and they've been saying our hospitals are overwhelmed for a while, long before ivermectin became a talking point. Neither has mentioned anything to do with poisoning cases, although I just asked specifically and haven't heard back.
As for gunshot victims, that doesn't ring true either. Checking the crime statistics, there have been 52 aggravated assaults in the last month here in OKC. Obviously that's not a perfect match for gunshot victims (many aggravated assaults are not with guns, some people get shot by accident) but I don't think the rate for the metro is higher than 2/day. The ICUs are full to the point that it might be hard to deal with, but it's COVID, not ivermectin.
Wait. Looks like I screwed up my numbers on gun injuries because the data field I was looking at was based on the map's zoom level. I now have 146 aggravated assaults in the last month. OK, 5/day rather than 2/day.
Heard back from one of my friends. She'd only heard of one person in her hospital when I first asked, although she did a bit of checking and there were a few more. But I really doubt she wouldn't have heard more initially if there were a lot.
Do I believe you could, rather than reflexively default to other experts, deploy your perfectly suited analytical skills to the patient, humble evaluation of the purported antiviral, anti-inflammatory, immunomodulatory capacities of a repurposed drug which, when employed with other therapeutics in concert, have shown enough promise not to dismiss them out of hand (and which people might reasonably, vaccinated or not, employ when, not if, they get it)? Hell, yes.
You mean dexamethasone?
i'd be cool with that, too.
we're all going to get this at some point.
or, if I might modify my humble request (dude, I'm the one of maybe three people in your whole listserv with any metaphysical commitments, so for the love of God, answer questions just this once outside your bubble): what's your analysis of all the reasons people are seeing positive potential? If all those practitioners who see therapeutic effect are wrong, what are all the reasons, and the most likely reasons, they're wrong: grift, glory, methodological flaws, placebo, confirmation bias, hallucination, fraud?
I think people are seeing positive results (and that Cochrane meta-study has links to a lot of studies that are "no result/slight result" rather than "wowzers, this is a miracle cure!") is because (a) many of the studies, as listed above, are done in countries where I'd expect a lot of poor/rural communities with bad/poor health outcomes, including worm and other parasite infestations and (b) everyone is looking for the new silver bullet.
So you're a peasant farmer in Bangladesh and you picked up a worm infestation. You also picked up a dose of Covid. Treating you with an anti-parasitic drug in combination with other therapies is going to show a better result than leaving your system to fight off both at once.
Your prior on the effectiveness of any given drug for covid should be pretty low given the vast number of drug candidates in trials that fail. There has also been a massive global effort over the past two years to find safe and effective treatments for covid, so seems unlikely there's be any low hanging fruit
There's a Cochrane report on the efficacy of Ivermectin for COVID-19 treatment, which looks at the reputable studies (ignoring the notable fake one - see https://steamtraen.blogspot.com/2021/07/Some-problems-with-the-data-from-a-Covid-study.html).
Cochrane reports are often viewed as the "gold standard" for meta-analyses. This one concludes "Currently, evidence on efficacy and safety of ivermectin for prevention of SARS‐CoV‐2 infection and COVID‐19 treatment is conflicting."
See https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full
All the trials had few participants (total of 14 studies with total of 1678 participants).
Soon, we'll get reports from some actual large scale studies, e.g.
https://www.ox.ac.uk/news/2021-06-23-ivermectin-be-investigated-possible-treatment-covid-19-oxford-s-principle-trial
This is the same trial platform that found the beneficial effects of (cheap, out of patent) dexamethasone, which I read somewhere (sorry, can't find link quickly) is said to have saved tens of thousands of lives. So it's hardly like "mega-corp" is suppressing this, it's just being careful.
Science is slowly winding its windy path to the likely truth, whatever that turns out to be.
I've pulled out what I could from that Cochrane report on where the studies were carried out, and my uneducated opinion remains the same: that the efficacy, if any, is best where it reduces the parasite load and frees up the immune system to fight off the virus and respond to treatment. If you're a patient in developing or third world countries, it's probably no harm to get dosed on an anti-parasitic drug. If you're a first world patient in otherwise good health, I think the benefits, even prophylactic, are dubious to useless.
1. Bangladesh
2. Spain
3. Pakistan
4. Mexico
5. India
6. India
7. Argentina
8. Colombia
9. India
10. Turkey
11. Brazil
12. Pakistan
13. Egypt
14. Lagos, Africa
15. India
16. Brazil
17. Spain
18. Argentina
19. Pakistan
20. Bangladesh
21. Egypt (this was a favourable study, later withdrawn due to concerns raised)
22. Brazil
23. Palestine
24. Iraq
25. Iran
26. Mexico
27. Bangladesh
28. Dominican Republic
29. Iran
30. Iran
31. Florida, USA
32. Singapore
33. Iran
34. India
35. Pakistan
36. Iran
37. Iran
38. Brazil
39. Zambia
40. Lebanon
41. Peru
42. Colombia
43. Lagos
44. Argentina
45. Egypt
46. Australia
That would be pretty funny if it turned out to be true. Great case story for later training.
This is a very clever way of reading the data and in the spirit of Scott's post I am going to preemptively cop to being on this level of "Did you believe that"
Well, I could be totally wrong and ivermectin turns out to be an amazing anti-viral on top of everything else. But I'm going to stick to "it does what it says on the tin and if you're suffering from sarcoptic mange mites, go right ahead, but otherwise cool it unless a doctor prescribes the human version to you".
People are so anxious for "definite sure-cures!" that they'll swallow (ha!) any story about "this showed up in clinical trials as IT REALLY WORKS". I'm just surprised to see otherwise reasonable people jumping at "Doctors hate this ONE WEIRD TRICK" kind of story, but hey, we're all only human!
It's worth noting, I think, that truly effective antiviral drugs are exceedingly rare. Here's a little review:
https://journals.asm.org/doi/10.1128/CMR.00102-15
They note that 90 drugs have been approved in the 53 years covered by the review, despite thousands of candidates, and of those 41 were specific to HIV and another 18 to hep C, leaving ~30 drugs over half a century for all other viral diseases. To be sure, prospects are looking up, but it's in general a very, very hard problem to solve, for the simple reason that viruses until they infect a cell *have* no biochemistry with which you can hope to interfere, and once they infect a cell their biochemistry is tightly twined up with yours. The protease inhibitors for HIV were arguably the first clear win, and *those* began with the tremendous advantage of having an atomic-level resolution of the exact (and highly conserved, and unique to the virus) enzyme with which they needed to interfere. Pretty much no other virus in history was as intensely studied as HIV in the 80s and 90s, and even then it took $billions and decades to painstakingly craft an effective drug.
It's certainly *possible* that some random existing drug so perfectly matches up with the SARS-CoV-2 lifecycle that it turns out to be the equivalent of a protease inhibitor for HIV (as opposed to the near uselessness of Tamiflu for flu) -- but if so that would be a spectacularly lucky thing, the equivalent of a cross-Atlantic hole-in-one. That doesn't mean it couldn't have happened, but it's quite reasonable to be skeptical a priori. Drawing all the correct numbers on Powerball on your first try would be more likely.
If true, that means that basically everyone on every side of the ivermectin debate was simultaneously right and wrong, and that we were all too mindkilled to figure it out early enough to be useful. Any outcome that infuriating seems likely to happen, of course.
The problem with this sort of thing is that it takes a smart person like Scott a decent amount of effort to sort out what is going on. People normally can't do this and it is not a good use of their time. The most unfortunate form of this sort of debacle is when it deals with someone's reputation and their life accidentally gets somewhat ruined. If you're unwilling to do this much research to fact check, should you not watch news at all?
> If you're unwilling to do this much research to fact check, should you not watch news at all?
Well, if the only reason you watch the news is for truth-seeking, yeah, it's probably not a good idea to rely on it without fact-checking. On the other hand, there are lots of reasons (some good and some bad) to watch the news anyway: be entertained, get topics for conversation, get insights into public opinion, etc.
I only watch/read/listen to news to find out who's dead and what politicians have been caught with their fingers in the till (our mini-scandal over Katherine Zappone continues to rumble on, but nobody is going to be punished for it or bear any responsibility, and I've already read a couple of newspaper articles about 'is it really so bad, really?' where the political stance of the newspaper proprietors is being pushed by the opinion columnists faithfully).
Watch news for the sort of purely factual reporting that is almost certain to be correct. Today's weather forecast is probably accurate. Yesterday's sports scores are almost never wrong. If a press release is out saying a new restaurant is opening down the street next week, probably true. News can have the exact release date of a movie you're hoping to see when it comes out.
Don't rely on news to form your opinion on large-scale social trends informing your beliefs about how public policy should work based on spectacular single-event accounts.
> If you're unwilling to do this much research to fact check, should you not watch news at all?
Correct.
Most people would be better off watching/reading/hearing 95% less "news".
> Have you clicked through to any of the links yet? No? Not even after I admitted I’m probably biased here?
I know this isn't your point, but this makes me wonder...do people click links *while* they're reading an article?
If I were to check your sources, I would have gone back and done it after reading everything you'd written.
I do, it’s often faster. Often wait til the end as well
I open links in a new tab. In other news, I have several dozen tabs and nly a GB or so of ram free.
As someone who lives in Oklahoma, I have also been confused and annoyed by this whole thing. I'm not saying that absolutely no one here is doing stupid things with ivermectin... but if enough people were doing this that it overcrowded the local hospitals, I think I would have heard of that. My local doctors don't seem any busier than normal. Not sure about the local hospitals, but considering we're currently in a Covid spike, "the surge of Covid cases is overcrowding hospitals" sounds plausible... especially since the OKC hospitals serve not just the metro area, but also the rural towns, where vaccination rates are lower.
As a side note: I believe I have ivermectin somewhere in the house. I was prescribed the cream version for my acne several years ago. Does this mean I can claim to be "one of those idiot Oklahomans talking ivermectin"?
“ Okay, this time I promise I’m not trying to psych you out.”
I dunno Scott, I’m waiting for the follow on “gotcha” post. Like that final jump scare at the end of the Sissie Spacek version of “Carrie”. :)
As per references to NHS Sequoyah, the hospital seems at least somewhat related to Dr. McElyea himself as it is one of the two hospitals U.S. News lists he is affiliated with:
https://health.usnews.com/doctors/jason-mcelyea-815102#hospitals
However by the hospital's own admission, Dr. McElyea hasn't worked at their location in over two months:
https://www.facebook.com/NHSSequoyah/posts/4192195714168045
As soon as you divide people/newspapers etc. into "the good guys" doing good reporting and "the bad guys" spreading misinformation you set yourself up for the fall. As soon as you look for easy categorical answers in something as messy as daily news you set yourself up for the fall.
A more truthful view might sometimes feel confusing and annoying, but it is also possible to appreciate the complexity of the world with a sense of wonder. Then epistemic doubt comes naturally. As someone said: If you wish to see the truth, then hold no opinions for or against anything (https://www.age-of-the-sage.org/buddhism/third_patriarch_zen.html).
Scott, I think you are trying too hard to find equipoise. It all starts with RS running headline behind the click-baity "Doctor says...X is true" as opposed to "X is true". Further, a real news organization would have heard the quote and demanded hard data: which hospital, on what day, with how many numbers etc. The reporting technique RS used sets my Bayesian priors at 'highly improbable'.
And indeed the lack of follow up data in the article implies either 'too good to check so we didn't' or the far worse 'we did inquire, it was not confirmed, and we ran with it anyway.'
I am also burdened with some insider information as physician. First, Ivermectin overdose is likely to cause the type of symptoms (mild GI mostly) that would have all triage-abiding staff drop the Ivermectin patient like the proverbial hot potato if a hot trauma came in. Any delay would be measured in seconds. Further, not all gunshot wounds need urgent attention. Indeed, my first surgical case as an intern was removing a bullet that was present for two weeks...a case so ho hum the residents did not want any part of it. Thus, the gestalt of the article, "Ivermectin overdoses are causing gunshot victims to get worse care", is highly unlikely even if these OD cases were far more common than they are
I have to say, the headline as written made me wonder "Good gosh, how many shootings are there in Oklahoma that the hospitals are being filled with them, except now the ivermectin poisonings are pushing those out?"
Are there a lot of gunshot victims? If there are three cases of ivermectin poisoning, are they displacing three gunshot victims or only one, on the basis that "you're okay, you only shot yourself in the foot, it's not lethal, but these three will die if not treated immediately, so you have to wait longer to be seen"?
I'm just pleased I followed this through the same three acts and reached the same satisfyingly muddy conclusions before reading this. [Act I was egregious, Act II satisfying, Act II interesting].
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It's the same with ivermectin itself, it's not gonna be no panacea, but it ain't no hemlock neither. I actually think a lot of confusion [political stream info-hysteria issues aside] is around interpretation of academic rigour and phrasing, so I'm waiting on the Oxford study.
-
At the moment I have as much time for people that shout 'horse de-wormer duh, it doesn't work' at people taking a human, safe dose to hedge an albeit small bet [sympathetic prescription if you will] as those that take a veterinary dose thinking it'll cure them and vaccines won't.
You repeatedly refer to the hospital with phrases like “some random unrelated hospital” but that hospital was not “unrelated”. Our first clue Is that the hospital’s statement says: “Dr. McElyea has not worked at our Sallisaw location in over 2 months”, a line which suggests he HAD recently worked at that exact hospital, making that specific hospital a good candidate to perhaps be the one he was talking about. Which might naturally lead people in the area and/or press to be concerned/wondering about THAT hospital, which explains them making a statement about it.
To confirm, there’s this page on the doctor’s practice: https://health.usnews.com/doctors/jason-mcelyea-815102
Which lists two affiliated hospitals, one of which is the one that made the statement.
Quote: “Dr. Jason A. Mcelyea is a family medicine doctor in Sallisaw, Oklahoma and is affiliated with multiple hospitals in the area, including Integris Grove Hospital and *Northeastern Health System Sequoyah*.”
NHS weighed in first. Integris Grove Hospital hasn’t yet responded to requests for comment but a third hospital in the area that he is thought to sometimes work with (McAlester Regional) has; the statement they made was: “At this time we are not aware of any Ivermectin overdoses at our facility. Dr. McElyea is not employed with McAlester Regional Health Center.”
(Source: https://www.nwahomepage.com/news/around-the-region/oklahoma-hospitals-respond-after-doctor-says-ivermectin-overdoses-backing-up-emergency-rooms/ )
TL;DR: the hospitals making statements are related by (a) physical proximity to his practice, (b) having worked with him at some point (and being identified as such in well-indexed online sources).
There's a nice irony that a news story piling on to the general perception that red states are briming with anti-vaxxers led with a photo of people in a red state lining up for vaccinations.
Another meta- to all this is that Rolling Stone was once infamous for its almost pedantic fact-checking. Matt Taibbi wrote about it here: https://taibbi.substack.com/p/fact-checking-takes-another-beating
I don't think there's anything specific about Rolling Stones there; thorough fact-checking was once considered a requirement for any serious newspaper, and then fell victim to to changing business models - social media siphoning advertisers away with its promise of much better targeting resulted in most media organizations' budget decreasing by a magnitude or so, consumers turned out to not care about accuracy all that much, but - in a world of instant notifications and social-media-mediated news - they do care a lot about speed which goes counter to accuracy. It's a big problem; I'm not sure it is useful to treat it as a moral problem (other than maybe, as Scott implies, a problem with our own epistemic mores as news consumers).
I'm not sure that's really true. Is anyone actually offering accurate, properly checked, trustworthy news that has a systematic, engineered approach to accuracy? I can't think of any. I'd be interested if there was.
I think the root cause is journalism culture: the average journalist thinks the way to make news more trustworthy is to hire superior journalists (at best), or to attack people who claim news isn't trustworthy (at worst). They don't think, "maybe we should create and constantly refine a system for ensuring everything we print is true".
At the big tech firms, when there's a failure (like an outage) there's a whole post-mortem process you follow, action items are defined, tickets are filed and assigned, there's followup, and often new automated checks are put in place to stop the problem repeating. That's why the big internet sites are these days more reliable than your internet connection. Also, famous software failures like the Therac-25 are taught and studied, people do research into ways to avoid repeats, they hold entire conferences on the question of improving reliability.
Journalism has absolutely no notion of this. If a journalist publishes an outrageously deceptive or false article, at best you get an apology or the journalist might be fired. There is never any kind of more in depth followup where an explanation of process failure and improvement is posted. They just don't think that way.
Rolling Stone actually did go through an external audit to do a post-mortem on where their processes failed after the debunking of their article on the UVA rape case. https://en.wikipedia.org/wiki/A_Rape_on_Campus#Columbia_University_School_of_Journalism's_investigation
It sounds like they learned nothing from that debacle and didn't change a thing.
FYI Yahoo News is just a news aggregator. That article you linked to there was actually from Insider.
Oh my god you got me twice even though the title says three acts
2 got me, but I'm not convinced you actually refuted it. Relying on the word of a single doctor without bothering to check does seem to be what actually happened.
For what it's worth, I have no specific distrust of Rolling Stone compared to any other publication short of purely public databases like FRED or the US Census tables. But the idea that hospitals anywhere are seeing large amounts of poisoning cases and turning away gunshot victims doesn't pass a basic smell test. I can easily believe a doctor somewhere saw one gunshot victim in triage having to wait a bit longer at a hospital that was also currently treating one poisoning victim, said something in a moment of frustration, and the news ran with it because it makes for a good headline likely to attract this kind of attention, that is, no one was specifically lying exactly, but the framing was intentionally sensational and misleading and nobody bothered to check how bad this problem really was.
That still seems to be true. Hospitals in Oklahoma are almost certainly not seeing many poisoning or gunshot victims compared to everything else people show up for, and Rolling Stone and the BBC and whoever picked this up from the original local source do not appear to have made any effort to figure out how prevalent either poisonings or gunshots are right now in any specific region of Oklahoma at all, nor did they call the original doctor that was quoted by the local news.
> I’m still not really sure about a lot of this, and I still haven’t done anything extreme like call any of the hospitals or doctors involved. It’s just what I think is the most likely picture.
The much less extreme yet equally effective strategy is "hire someone to call hospitals for you." Research assistants are pretty useful!
That's what newspapers used to do. But they basically can't afford it now due to the collapse in revenue from subscriptions, classifieds, etc. And the only reliable revenue stream now is advertising which depends on getting as many views as possible, incentivising mass production of clickbait
I never know the line between confirmation bias and making sensible judgments.
Like, I believed the initial statement because I have a high trust in Scott A. He has earned that trust by being reliable over years. I'd also be inclined to believe it because I do not trust the media as far as I can throw them. This distrust has been earned by being highly unreliable over the years. So I see that tweet on this website it seems like a slam dunk. And later turns out to be a slam dunk (Scott makes it seem like a gray area, I don't see it that way).
Like, these broad generalizations might be wrong 20% of the time. But I don't need to be more right than that.
I don't know about Scott, but I'm willing to bite the bullet and admit to feeling smugly superior to Rolling Stone, and The Guardian and BBC and anyone else who bought in to really any version of this story.
One's prior for "maybe the latest crazy medical fad is causing people to poison themselves in such vast numbers that they are overwhelming hospitals on a regional level" ought to be very low. Has that *ever* happened? It's certainly quite rare. There are some deeply stupid people out there, but there seem to be barriers against stupidity manifesting in this particular fashion.
A member of a high-trust society might be forgiven for taking a single report from a reputable newspaper as cause to update from "very very unlikely, not worth considering" to "oh crap, this is really happening". But reporters and editors for a reputable newspaper should *not* be forgiven for running a story like this without e.g. calling hospitals to check, asking their in-house medical experts whether it's even plausible, or, yes, checking out the National Poison Data Center. If you're a reporter, randos with an axe to grind will call you with stories about how the outgroup is stupid and evil, and it's your job to sort out a little wheat from a lot of chaff in a way that requires tedious effort. Shame on all of them.
Also, we don't live in a really high-trust society, particularly where the mass media is concerned, and Rolling Stone is not a reputable newspaper. They're the ones who broke the UVA fraternity rape "scandal", remember? One should have at least a moderately high prior for any mainstream news outlet, and Rolling Stone in particular, inadequately fact-checking claims that the right-wing outgroup is stupid and running exaggerated "right-wing outgroup is stupid" stories; if it's Fox News s/right-wing/left-wing. *Particularly* if you are e.g. an editor at BBC deciding whether to just blindly run a Rolling Stone (or Fox News) story under your own masthead.
And you should have an even higher prior that anyone "debunking" anyone else on Twitter, of all places, is taking an inadequately-researched cheap shot that doesn't debunk much of anything.
There were only ever two rational responses to any of this. First, seeing a fantastic story aligned with the known biases of the medium, quickly look to see if they are making a strong effort to call out their confirming sources and saying "nope, so it's probably grossly exaggerated at the very least and irrelevant to me, so I'm ignoring it". Or second, deciding that it might be relevant and looking for reliable sources yourself. That applies to the original story and the "debunking" tweet, though if you've appropriately dismissed the original story then why would you bother with the tweet.
Is there anyone here who saw the original story and thought it was likely to be at all close to the truth?
Well as a dyed in the wool empiricist my priors were:
(1) People are generally self-centered tribal idiots (if mostly well-meaning self centered tribal idiots), and therefore...
(2) In a pandemic some modest fraction will do dumbass things, and
(3) A larger fraction will seek confirmation of their hopes and fears about the pandemic in the anecdata of the dumbasses, and
(4) Those responsible for reporting, whose Christmas bonuses depend on page clicks, will exaggerate the dumbassery in ways that assist the confirmation bias of whatever their readership demographic is, and finally
(5) What is *actually going on* is exceedingly hard to know, unless it's happening to you personally right now, and is probably only determinable to any reasonable degree long after the dust settles, and perhaps not even then (cf. Rashomon), and therefore
(6) You should base your personal actions on what you have personally experienced, and what has been long established by painful repetition of empirical confirmation, and generally ignore emergent stories that suggest upending either. And also:
(7) Being a reporter or pundit is a miserable career that would give me ulcers.
Every one of the versions of the story you told supported all 6 priors, so I didn't experience any displacement shock at any point. Nor do I worry much about what it means if yet another version of the story emerges, because I rather suspect it will be in line with all 6 priors.
I'll latch onto this comment because it perfectly expresses a part of my point that I would have otherwise expressed pretty poorly.
What I want to add is how completely uninteresting the stories are. That is, the problem is not an object-level bias, it's priorities, I am not clicking any links or researching the story further not because at any point I believe what I'm reading, or even believe I correctly interpret what I'm reading, but because I don't expect it will lead to any meaningful new information. As someone mentioned above, a minimally functional bullshit detector can catch the sheer implausibility of Act I, so I'd disregard it as journalistic malpractice on first sight. For this reason, I'm also not going to bother researching Act II, not because I'm inclined to believe it unquestionably, but because unless one is having a particular narrow interest in the culture wars and the ways media stories are conceived, there's nothing to gain from checking whether a particular instance of tribal bickering is properly founded and researched. Act III manages to salvage some actual information from the debacle, but the information is expected, mundane and of no practical use, unless you're a doctor on the frontlines of covid treatment, in which case your education and first-hand knowledge probably makes news reports redundant.
Becoming a scout is the easy part, the hard part is deciding which areas of the vast unknown terrain one should be scouting. Now, that - that requires metic experience and necessarily implies using imprecise heuristics, since no human being, not even humanity as a whole, so far, has time and resources to research and put together a perfect 1:1 map of all that ever was. Surely, those heuristics lead to biased perception, blind spots, epistemic closure and all those other things we want to avoid. Thing is, they're unavoidable. I have adopted and I advocate extreme agnosticism and never believing yourself to be right, but that's a philosophical, not praxeological position. Praxis requires making choices and acting on them, and that's functionally indistinguishable from believing one is getting a fuller story than people making other choices. I don't see a way around this.
When I saw the original tweet, my first thought was: “Hmm, this isn't the first time Rolling Stone published a false story that was ‘too good to check’, is it?” And I looked it up and remembered that in 2015 they published a campus rape story that turned out to be extremely shoddily sourced and was retracted: https://en.wikipedia.org/wiki/A_Rape_on_Campus
The most important thing is that there were no serious consequences for the reporter, Sabrina Erdely. She wasn't fired. She gave a grudging apology and that was it.
So, no matter what else we can say about this whole thing, Rolling Stone can't be trusted and should basically be ignored.
These things tend to get forgotten, which means there are no real consequences for Ederly or Rolling Stone. I'm commenting here to do a tiny bit to counter that.
This seems like it is falling prey to the same phenomenon above of being too good to check, because when I do check, it seem Sabrina Erdely was found liable for $2 million in damages for defamation, currently works for a local Jewish podcast in Philadelphia, and her personal website doesn't show a story published by any national publication since 2013.
Oh, well, that's good. But I was specifically talking about Rolling Stone's explicit response, which was not to fire her. That's what I distinctly remember at the time, and it's what Wikipedia says:
“Spokesmen for both publisher Wenner[67] and Will Dana, managing editor, said that Erdely would continue to write articles for Rolling Stone.[68]”
And those two references seem to check out.
So I guess “no real consequences for Ederly” was wrong, thanks for checking more thoroughly and correcting that. The accurate statement would be “Rolling Stone decided not to enforce any consequences.”
Or possibly she suffered no consequences whatsoever for writing the UVA article, and was relegated to podcast ignominy for something completely different like e.g. sleeping with the wife of Rolling Stone's publisher. There's lots of possibilities that need to be checked before we can consider this one properly debunked :-)
The Sequoia Hospital System isn’t unrelated to Dr. McElyea or to this story. The doctor is a member of a physicians group that is contracted with Sequoia and the public statement by Sequoia explicitly says that McElyea has worked at Sequoia but not in two months. So, yes, the statement by Sequoia does refute the Rolling Stone story directly. Scott is inferring, without any evidence, that McElyea is contracted with other hospitals where these overdoses may be occurring. Further, McElyea is a family practitioner so it is doubtful he spends much time in a hospital although he apparently does appear in hospitals sometimes.
Despite Scott’s weak argument that “ both sides are culpable”, the fact still remains that the Rolling Stone story and the original KFOR story lack any facts whatsoever. They don’t name a specific hospital, a source who actually has personal knowledge of the alleged Ivermectin overdoses or any facts showing how McElyea supposedly has knowledge of any cases, let alone cases where people have gone blind. The Rolling Stone article is fiction. The fact that the Sequoia system is in fact contracted with McElyea’s physician group and the fact that McElyea has apparently worked in at least one of Sequoia’s hospitals directly contradicts the Rolling Stone article. Scott also mistakenly believes that Sequoia is one hospital. In fact, Sequoia operates multiple hospitals in the eastern part of Oklahoma where McElyea practices. Therefore, its statement that there have been no Ivermectin overdose cases at it’s facilities is probative evidence contradicting the claims in Rolling Stone. So no, the evidence isn’t equally lacking. The side that made the claim has precisely no facts to back up its claim. The side that debunked the story has multiple pieces of directly, probative evidence to back it up. The pedantic left may claim that the evidence isn’t dispositive but its mire than they have. Maybe elitists, icluding Scott, should STFU.
So the 'true story' is still that major media outlets including Rolling Stone made the whole thing up based on misrepresenting a radio interview
The true story is that news media don't do very much original reporting anymore, it's a lot easier and cheaper to pick up a wire story and rewrite it and run it as your 'own' piece.
Also, headlines grab eyeballs and eyeballs turn into money (via selling advertising), so the most startling rather than the most factual headline on the story is the one that is run.
This article was an absolute delight—it reminded me of this excellent piece on your writing style: https://sashachapin.substack.com/p/some-of-scott-alexanders-writing
I'm beginning to wonder if this is also a story that is like the chloroquine story, again with an alleged poisoning over "this was touted as a wonder drug" (then it was supposed to be alleged attempted murder, I haven't seen a definite conclusion either way):
https://www.nytimes.com/2020/03/24/us/chloroquine-poisoning-coronavirus.html
Exactly how many people are taking ivermectin (I'm not surprised they're using the animal version since that's probably easier to get than trying to persuade a doctor to prescribe it when you don't have worms)? And again, if you're taking a dose calibrated for a horse or cow, yes you are going to overdose and poison yourself. But are there really that many cases of ivermectin-taking?
prescriptions for ivermectin (for humans) increased about 20 fold to 88,000 per week in the USA in August. Data does not include people taking over the counter veterinary dispensed ivermectin
https://emergency.cdc.gov/han/2021/han00449.asp
It’s funny how this is just BTFOing fake news but gets more attention than the systematic investigations of complex problems or conceptual posts or book reviews. Oh well.
Amusingly there is decent evidence that TriCor actually works well against Covid and is pretty safe:
https://www.israelnationalnews.com/News/News.aspx/312235
Why doesn't that go viral on social media?
I think the tone of this post underplays the difference between a major media outlet making these mistakes and a random ACX reader making these mistakes. Like, you could come away from this post thinking "huh, wow, I do exactly the same thing I was criticizing Rolling Stone for doing", without also thinking "wow, it's horrifying that Rolling Stone -- an organization with power -- doesn't take its responsibility seriously enough to overcome this tempting error & check its stories"
"Later it started looking less promising, and investigators found that a major supporting study was fraudulent." There is still overwhelming positive data for Ivermectin's effectiveness. You are referencing one study (Elgazzar) which when completely removed from the meta analyses, does not change the conclusion that Ivermectin is still clearly favored vs the control. 62% decrease in death lowers to 49% decrease in death. While the confidence drops by removing the Elgazzar study it DOES NOT indicate that Ivermectin is not effective. This is unbelievably irresponsible of you.
Also, Elgazzar has not (yet) been proven fraudulent.
What I am observing here in this very entertaining post is constant subtle switching between "to establish that something happened, there should be reliable evidence of it" and "to establish that something happened, there's enough that somebody said it happened and there's no reliable evidence that it could not, under any circumstances, have happened".
It is pretty clear that neither RS nor anybody else had any reliable evidence of hospitals being "overwhelmed" by ivermectin overdosing right-wing rubes. In fact, I don't think there's even a reliable evidence of "gunshot victims" "waiting" for anything, either ivermectin-related or not, beyond usual time a person would wait in other circumstances. All we have is the words about one case from one doctor, which doesn't give any verifyable details. And even that was not about turning the gunshot victim away but about transferring them to a different care facility (which may have a thousand reasons to not accept anybody who is already being treated by other facility just because some random doctor wants them to).
That should be the end of it, but somehow the fact that the hospital hasn't been named becomes important - did you notice the switch between "it happened" and "you can't prove it didn't happen if I don't tell you enough details to catch me"? The problem is not whether the story has been "debunked" or not - the problem is it shouldn't ever be "bunked" in the first place, and breathlessly reprinted verbatim by everbody knowing how to operate the copy-paste facility. It shouldn't be the story of "everybody is a little wrong in various ways", it should be "a MSM outlet has published fake news again, a lot of people got fooled again, and learned nothing again, and won't until they learn not to trust any reporting at all they get from those quarters, at least not without extremely heavy evidentiary proof".
This. One would certainly hope that the standard for publishing within a news organization, at least concerning serious news stories, is not "Someone said something." At the very least, a couple of calls should have been made.
Scott's being too charitable to the left in his attempt to squeeze a post about generic human flaws out of a situation which isn't really about that.
The left was incorrect about its basic claims and the right was correct about them. The original article was in fact misleading and got that way because of political bias in the media.
It's true that the debunking of the original article wasn't completely on point, but that doesn't make the situation symmetrical. There's a big difference between a basically true claim with bad evidence and a basically false claim.
Disagree. Making a correct basically true claim with bad evidence is not better than making a basically false claim with bad evidence. It's just luckier.
If you walk into a casino and put a $1000 on red at the roulette table, then you made a bad investment decision, regardless of whether you end up winning or not.
If someone tells me "I took a Delta plane to Colorado", I'm going to come to the belief that he took Delta to Colorado without looking at any evidence at all. If it turned out that he actually misremembered the airplane and it was really United, and I would have discovered that had I checked for evidence, it would still be right for me not to have checked, and even though I had believed something incorrect because I had failed to check for evidence, I would still have been basically correct.
The media constantly lies about Republicans doing stupid things, and that original post is pretty much unbelievable anyway. The post was never likely to be true even without additional evidence.
> Disagree. Making a correct basically true claim with bad evidence is not better than making a basically false claim with bad evidence.
I don't think it was bad evidence at all though. If the claim is that "Rural Oklahoma hospitals are overrun with X" then one rural Oklahoma hospital saying "Actually we haven't seen any cases of X" is reasonably good (not the best possible, but reasonably good) evidence against the claim.
So you're saying that the real moral is that *your* outgroup are bad... 🤔
Say both are equally bad, but one controls a bigger part of the narrative. Which will do more harm?
" Only you, reading this ACX article, are getting the full story and learning more about the world instead of just confirming your biases."
at what point do we get to post the replying 'YES' meme?
how long is our checklist ?
I don't understand why, considering the low risk of ivermectin, it's not used more. Like so if it's useful you save a bunch of lives if it's useless no harm or very little harm is done.
What am I missing?
I see distguibished ppl on both sides of the debate but more distinguished people being anti ivy, certainly more doctors.
The medical profession, having only quite recently put away the leeches and the pointy hat with stars on it, prides itself on having pretty strict evidentiary standards which amount to "If a trial of sufficient level of rigour says this is a good treatment then we give it, and if it doesn't then we don't". This is usually a pretty good decision.
Medical professionals have a hard enough job already without being expected to make their own decisions (based on a careful reading of whatever new preprints have hit the servers in the last 48 hours) about exactly which not-officially-approved treatments have a sufficiently favourable risk-reward ratio.
When someone is already sick you don't just toss in extra medicine, as that strains the immune system further and can result in drugs interactions, side effects, and other complications. So there is a real downside
"Only you, reading this ACX article, are getting the full story and learning more about the world instead of just confirming your biases.
Did you believe that?"
Ofc not but I think it's fair to say we are relatively less biased on average, whatever that is worth.
> Ofc not but I think it's fair to say we are relatively less biased on average, whatever that is worth.
Sure, until you're asked to consider that privilege may in some form exist and matter.
"This story doesn’t make me feel smug and superior to everyone else. It makes me feel confused and annoyed." Boy can I relate to that statement : (
FWIW I didn't really feel 'gotcha' at the various test points in this article, because I didn't at any point during the reading of it feel like I had confidence in what was going on - that I had something capable of being tested. This is not because of the particular story or the post, I just ... don't interact with writing like that? I had read it as a claim but hadn't stopped to consider the validity of it yet. I would usually not get around to that part until I reached the end of the article and reflected on it. Is this an unusual way to consume media?
I'm not saying that I would have got it right when I got to the end, but I don't tend to stop and assess in the middle of things like that.
Act III, paragraph 3, "complications of treating ivermectin." There are definitely complications of treating ivermectin but the sentence might need a "Covid with."
Scott: The media wasn't entirely fair to the people taking horse drugs, so people who claim the media is evil and biased have a point.
Also Scott: I'm going to trust long-time outright racists when they link me studies about HBD.
I can't blame you for not seeing everything, but the clip I saw of the doctor he didn't say "do not take Ivermectin", he actually said something like "consult your doctor before taking Ivermectin, so you don't end up in the ER" (not the exact quote). I think that's a pretty important difference.
And while, yes IVM's effectiveness for Covid is still not certain, enough doctors still believe it's a good risk/reward, or is mildly effective to warrant not discarding it yet.
jesus, this is demoralizing. is that the point?
O mg.
> Only you, reading this ACX article, are getting the full story and learning more about the world instead of just confirming your biases.
This but unironically.
above average post
> A Democrat reads some fraction of this story, and sees a bunch of idiot conspiracy theorists taking deadly horse medication to cure COVID. A doctor warns people that his hospital is overcrowded with poisoning cases, and the media dutifully reports on this. Then an unrelated hospital puts out a press release saying they’re not involved and - even though this changes nothing - Republicans seize on this to declare the entire media is “fake news” and nobody should trust anything they read and the horse dewormer conspiracists were right all along.
>
> A Republican reads some fraction of this story, and sees the media falsely reporting that ivermectin is overcrowding local hospitals, even though the hospitals themselves are denying this. Also, using a fake photo of something else to imply that lines at local hospitals are stretching out the door. Also, declaring that 70% of poison incidents are due to ivermectin when it’s really 2%.
The message from your blog post is, if I've read it correctly: "Every news report at every step along the way, on both the left and the right, was either maliciously misleading or sufficiently incompetent to look maliciously misleading". And so, wouldn't the Republicans screaming "fake news" actually be correct? (ignoring for the moment that they would likely not call their own side just as fake)
Way back in the day, I read a post on an old LiveJournal, the dude was yva-something, called "Epistemic Learned Helplessness". This post has been formative for my thinking on issues like this. The argument in the original post went, roughly: "If you are aware that people smarter than you are capable of generating convincing-sounding arguments for a position, and you are not equipped to be able to tell truth from falsehood (because you are not an expert in the relevant field, but they are), then it is a reasonable position to take to say something like 'yes, that appears to be a rational argument for position X, but I'm just going to ignore it'"
For years now I've felt the same way about the news, and this ACX post reinforces that I made the correct decision. Per your sleuthing to write this article, it is overwhelmingly clear that if I go and read the news on this issue, whatever I walk away thinking, it will be factually wrong. I could spend hours of my day doing a deep dive, phoning hospitals, and doing journalists' jobs for them, and maybe hit on the truth. But it will be a massive investment in time and effort, and at the end of it I will have nothing of value to show for it (since this story affects my life zero). I assert that, in the face of an environment so hostile to establishing truth, the correct response is to write it all off as noise and ignore it. It may be correct, it may not be, but I will not be able to tell the difference between correct reporting, and correct-appearing-but-actually-manipulative reporting. So I choose epistemic learned helplessness
Funny thing here is that we're pretty well equipped to know - or at least very very very strongly suspect - it's a falsehood: it cites no specific facts beyond the words of one person, it contradicts the available data and expert testimony, it is accompanied by a picture that is clearly not matching the story (a long line of "gunshot victims" standing in wait? Are they all superheroes or what? Look how they are dressed - it's 90+F now in Oklahoma!) and fitting perfectly a fashionable narrative... Anybody whose BS detector did not alarm should turn it in for servicing. It's not one of those complex cases.
I mean I'm not claiming it's easy to know what happens in Oklahoma healthcare right now in detail. I am saying it's pretty easy to see RS is full of bovine manure and should be ignored from now on forever.
Scott's point is bigger than that
The original story was false. But the meta-story was also false. And maybe even the meta^2-story!
So what is the correct story? I assert the answer is unknowable in a reasonable amount of time, and bypass the entire thing
The meta-story wasn’t false!
It’s true the original story didn’t mention the hospital but the hospital DID mention the doctor and was NOT (as Scott had claimed) “unrelated”. It wasn’t a random hospital in Oklahoma, it was a *chain* of hospitals that specific doctor had worked with in the area where his practice was.
The hospital press release didn’t by itself ABSOLUTELY PROVE the story was a hoax/exaggeration but certainly should have shifted the burden of proof enough that we could reasonably *assume* it was a hoax/exaggeration…and triply so now that *even more* hospitals he worked with have weighed in on the matter - there’s no wiggle room left!
The meta-story was that there was strong evidence to suggest Rolling Stone messed up…and there was such evidence, and they had (which even they admit), full stop. The first round of skeptics were *correct* to be skeptical, no meta^2 need apply!
“Keep an open mind, but not so open your brain falls out”
I'm guessing you don't realize that the "Epistemic Learned Helplessness" post was by Scott, possibly under his pre-SSC pseudonym of Yvain.
Or maybe you do and are pretending not to as a joke.
> Or maybe you do and are pretending not to as a joke.
I was trying not to retro-dox him since I vaguely recalled that being a thing we weren't supposed to do
I don't think a newspaper reporting on the facts can count as a "dox". In fact, getting people's names right seems like exactly the kind of fact-checking that we should be applauding.
Re: Scout Mindset. Also use the replacement experiment Galef recommends.
Instead of "Hospital in Oklahoma Turns Away Gunshot Victims Due To Ivermectin Patients Overcrowding ERs", try "Hospital in California Turns Away Gunshot Victims Due to Severe Covid-Vaccine Side-Effect Sufferers Overcrowding ERs".
I'd assume most people here and ones that bought the Oklahoma Ivermectin story would immediately look for the URL of the latter California Vaccine story and guess it came from a conspiracy site--rightfully so. Yet, so many people instantly were sold on the OK Ivermectin story because it fit the narrative neatly.
This is a brilliant post. After reading it I immediately bought "The Scout Mindset".
> Did you believe that?
> Did you believe that?
> Did you believe that?
It's like the levels of Inception in blog form! Beautiful!
But I did believe the third time. Repetition bias on my part?
"Law Of Rationalist Irony" just sounds like a special case of Murphy's Law, which in turn is just a popular instance of confirmation bias enshrined in "law". So I checked: you made it up just now!
Dr. McElyea does explicitly link overcrowding with ivermectin abuse.
There were 11 cases of "ivermectin exposure" reported to the Oklahoma Center for Poison and Drug Information since the beginning of May.
Three hospitals that Dr. McElyea has worked at, NHS-Sequoyah, Integris Grove Hospital, and McAlester Regional Health Center, have issued statements that do not support his statements.
This started with a ZOOM meeting of the Healthier Oklahoma Coalition (affiliated with the Oklahoma State Medical Association). They published a video of it on their Facebook page on 8/31. Dr. McElyea appears in the video beginning at 12:38. He explicitly links ivermectin abuse to the overcrowding beginning at 15:01.
https://fb.watch/7Sqed6j5ZO/
He repeats that ivermectin abuse is one of the causes of overcrowding in his interview with KFOR. Here is the most complete version of Dr. McElyea's interview with KFOR that I could find:
https://kfor.com/on-air/seen-on-tv/more-of-dr-mcelyeas-interview-with-kfor/
Scott Schaeffer, managing director of the Oklahoma Center for Poison and Drug Information, says there were 11 cases of ivermectin "exposure" reported to them since the beginning of May (as of 8/25).
https://kfor.com/news/coronavirus/oklahoma-center-for-poison-and-drug-information-receiving-more-calls-from-people-becoming-ill-after-taking-ivermectin-to-treat-covid-19/
Here are links to stories about the hospital statements that contradict Dr. McElyea's account:
https://okcfox.com/news/local/two-oklahoma-hospitals-differ-on-doctors-claims-over-ivermectin-overdoses
https://www.nwahomepage.com/news/around-the-region/oklahoma-hospitals-respond-after-doctor-says-ivermectin-overdoses-backing-up-emergency-rooms/
"Contributes to overcrowding" seems like a pretty meaningless claim.
If overcrowding is occurring, then every single health condition suffered by anyone is contributing to it.
So it's probably fair to say that it's strictly true, but designed to mislead. I guess the big difference is that Dr McElyea is attempting to mislead with good intentions (to dissuade people from taking overdoses of ivermectin by overplaying the dangers) while Rolling Stone is attempting to mislead with bad intentions (to make those darn rural red tribers look like a bunch of dumb yokels).
Here are the conclusions I draw from the available info:
1. The origin of the idea that ivermectin toxicity cases were overwhelming hospitals
to the point that serious trauma cases were not treated in a timely manner
originated with Dr. McElyea.
2. KFOR, Rolling Stone did not misrepresent what Dr. McElyea said.
3. There is no evidence KFOR or Rolling Stone made even a feeble attempt at fact
checking Dr. McElyea's claims.
4. Ivermectin abuse has had very little, if any, effect on the hospitals in eastern
Oklahoma.
I think Dr. McElyea puposefully misled, KFOR and Rolling Stone reported his claims unchallenged because it fit their schema. As to Dr. McElyea's motive, I don't have enough information.
Dr. McElyea is now saying he was misquoted by KFOR.
https://www.news9.com/story/6136ad349daa7c0c0b36d064/oklahoma-doctor-at-center-of-viral-ivermectin-story-says-report-is-wrong
I rewatched the the videos I linked in my op. In the Healthier Oklahoma Coalition video, he first mentions the gunshot victim and explains the delays due to there being no beds in the big-city hospitals that they can transfer patients to, leading to congestion in the rural ERs he works at. He then says that there are "other things that back us up", specifically "I've really seen a spike in" "more than a handful of" ivermectin poisonings.
In the KFOR "More of Dr. McElyea's Interview With KFOR" video however, he draws a direct line between the delay in the gunshot victim's treatment and ivermectin poisoning cases.
Nice work thanks
You're welcome, and thank you
I love the fact that just the starting seed for this essay still needs explaining (for anyone who hasn't been following along obsessively). There's a word that's become popular in China recently to describe companies that spend all their time grinding their gears on administrative processes without actually producing any more stuff: convolution. Information these days is convoluted, i.e. it's all information about information.
The thing is, I think that it's always been this way. The job of digging through the information to real stuff, unmediated by human concepts, is exactly what science is, and it's really really hard. Information is by its nature convoluted.
(I'm a translator, and this occasionally bites me in the ass. If I'm translating a sentence from Chinese, standard procedure is to think about what the sentence means in the real world, and then write that in English. But surprisingly often, the Chinese sentence doesn't refer directly to the real world, but to some other linguistic artifacts (in Chinese); and you then just have to do your best to recreate the many-layered, or even infinite regress.)
I'm not sure what to do with this knowledge. But it certainly supports the whole echo-chamber idea, that we're mostly trapped reading ideas about ideas that we already have.
I know this might be a difficult ask, but can you try to give an English translation of an example of "...the Chinese sentence doesn't refer directly to the real world, but to some other linguistic artifacts..."? It sounds very interesting.
Like say something makes a twist or reference to a common English saying or a cultural reference that wouldn’t make sense for Americans. There’s no corresponding thing in American sayings or ideas. We have lots of them too in English
I'm strangely reminded of a dusty linguistics joke:
"A professor lecturing his class says 'We're all familiar with the fact that in English a double negative can mean 'yes' -- as in, 'They're ain't no way I'm not going!' -- but fortunately there are no double positives that mean 'no.'
"From the back of the class a voice mutters sarcasticaly 'yeah, right.'"
Isn't that a triple negative? I'm not American so maybe I don't parse 'Ain't, no, not' in the same way.
Could be! I originally mean to write "I ain't not going" but decided at the last moment to add a little extra fizz.
I should have added that it was also a dusty linguistics joke I'd never heard, and I found it really funny
I'm not sure it always has been. One thing that is novel today is that the cost of acquiring information is historically low, almost zero for most people. That's quite different from even in my lifetime: if I wanted information on, say, ivermectin, I'd have to trundle on down to the library, probably enlist the help of a reference librarian, acquire some books, read a bunch, probably go back for the correct books, read some more... Either that, or persue learned journals (also in the library) for the opinion of scholars and analysts. In short, it would be quite expensive for me to acquire information -- enormously so, compared to googling "ivermectin" or doing a FB/Twitter search.
How might this change things? Well, consider that acquisition of information used to be expensive for *everybody*. The reference librarian can only stock a finite number of reference books, so she's going to want to be sure they're *good* books. The guy writing a monograph can only spend so much time looking up papers in the massive tomes of an abstracts service, and then finding the journals in the stacks, or waiting impatiently for interlibrary loan to deliver them. Both these people are highly motivated to look for the best and highest-quality information they can find, because it's expensive for them to get, and it's expensive for them to pass along bad information to *their* customers since, unlike these electronic days, to correct it is not just a few keystrokes but rather a laborious and embarassing process.
In an era when the cost of merely acquiring information is high, perhaps everyone involved in its trafficking becomes quite careful of its quality, simply because the cost of fixing mistakes (which involves more information exchange) is high. Willy nilly, the result may be that the average information that filters down to the end consumer is fairly high quality, since it cost quite a lot to gather and disseminate even *before* we consider its cost of initial acquisition.
Conversely, perhaps when the cost of dissemination falls to near zero...well, we get the difference between e-mail and regular first-class snail mail: the former is totally dominated by spam. Thus the Internet giveth and the Internet taketh away.
I suspect the root error is that writers are using "people taking ivermectin" as a metonym for antivaxxers in general. Like, it's not true that ivermectin poisoning is directly putting people in the hospital to the extent that they're crowding out other patients, but it *is* probably true that people taking ivermectin are disproportionately likely to wind up in the hospital... with COVID, because they're taking ivermectin instead of getting vaccinated.
One of the most frustrating outcomes of this whole ivermectin controversy is how difficult it is for patients who actually NEED it to get it prescribed. For the past year, I've been dealing with a serious case of treatment-resistant scabies, and it took 8 months until I was finally given a proper dose of ivermectin from a dermatologist - and only then after all other possible causes for my skin condition had been ruled out (I'd tried all other treatments more often than I can count and none of them were effective). During this time I was so itchy that I got less than 4 hours sleep on most nights and scratched so deeply that I now have permanent scars on my skin. I also had to defer my doctoral studies and neglected important relationships in my life, being too physically and mentally exhausted. I think this is quite a serious consequence of doctors being reluctant to prescribe ivermectin that has been ignored. Hell, I even had to split my prescribed dose with a friend of mine who had caught scabies off me, who was also not responding to standard treatments, and who could not get an ivermectin prescription of her own no matter how hard she tried. Thankfully we're both past this horrible infection, but I'm still recovering from the impact that it has had on my life.
(I'm located in a country where you can't get ivermectin OTC, even for 'veterinary' purposes, so getting a prescription was my only option)
The Ivermectin worked, or is working?
It is a recognised treatment for scabies, so that's a legitimate use. This is the worst part of people jumping at 'miracle cures', that means that real need is ignored or actively discouraged because it gets lumped in with "are you only looking for this because you read some stupid online article about it being a miracle cure?"
1. In New Zealand, ivermectin was first approved for treating roundworm in sheep. When I hear of it being used in humans, an overused portmanteau of "sheep" and "people" inevitably invades my mind.
2. The post confirmed my bias that Twitter should be taken round the back of the barn and shot.
3. The post is also rather click-baity. This makes me sad.
Strong disagree about 3. It's partially about click-baity influences but surely more about the painful pervasivesness of self-delusion.
So, it's a drug for sheeple?
Click-baity, or concept-handle? https://slatestarcodex.com/2016/02/20/writing-advice/
Alright, I'll bite: what is the relevance of Achilles and Chiron to this article? Is it just free association between medicine, people and horses, or is there some clever joke I'm missing?
(For those who are confused by the question, the front page of the substack illustrates this article with a painting of a centaur and a man, it doesn't seem to be visible on this page.)
I assumed it was "Chiron is centaur, that is horse + man; people are taking medicine meant for horses; that is also horse + man; conclusion - only Chiron can safely take ivermectin" 😁
Mostly I just admired the painting.
Yeah, a half-horse, half-man doctor seemed like the appropriate symbol for the ivermectin controversy.
Time for a Dante quote! From the Inferno, canto 12, where the centaurs are guards in this circle of Hell, and Chiron retains his intelligence, as distinct from the more animalistic nature of his comrades:
Between the edge of moat and precipice
ran centaurs in a file and armed with arrows,
as when they went off hunting in our world.
They saw us coming, stopped, and three
departed from the troop with bows
and shafts they had selected with great care.
One cried from afar: 'To what torment
do you come, you two approaching down the slope?
Tell us from there. If not, I draw my bow.'
My master said: 'We will give our answer
to Chiron once we have come closer.
Your will was always hasty, to your hurt.'
Then he nudged me, saying: 'That is Nessus,
who died for lovely Deianira
and fashioned of himself his own revenge.
'The middle one, his gaze fixed on his chest,
is the great Chiron, he who raised Achilles.
The other one is Pholus, who was so filled with wrath.
'Around the moat they go in thousands,
shooting arrows at any soul that rises
higher from the blood than guilt allows.'
As we drew near those swift wild beasts,
Chiron took an arrow and with its nock
pulled back his beard along his jaw.
When he had uncovered his enormous mouth
he said to his companions: 'Have you observed
the one behind dislodges what he touches?
'That is not what the feet of dead men do.'
And my good leader, now at Chiron's breast,
where his two natures join, replied:
'He is indeed alive, and so alone,
it is my task to show him this dark valley.
Necessity compels us, not delight.
Good summary. Though the whole thing is dwarfed by unvaxxed Covid patients filling up hospitals and ER's. I saw 2 ivermectin overdoses, for the first time ever in my 20 year ER career. Gunshots are rare, so two rare things occurring is unusual, but absolutely does happen in the ER. Also there are never lines in an ER. The chair space just fills up, and people starting sitting outside. Though right now, with such a young Covid cohort, people check in, wait 10 minutes, then decide to leave. The sickest just sit in chairs because to walk around takes too much air.
I do wonder how much of this issue can be avoided by just avoiding polarizing topics ala politics.
Most things I <try> to read about outside of SSC and the subreddit, which I use as my dose of US politics, are kinda boring factual-o-theoretical claims about things.
And while I agree observation is theory-laden and theory is made by the gullible trusting bad observation and so on, reading papers and /r/molecularbiology or lobste.rs requires a much lower level of scepticism than dealing with politics.
Most conclusions are tentative and non-committal and at most incentive for further readings or self-experiments. And the ROI is pretty good in terms of happiness due to changed behaviour, money, better conversation.
Armadillos penises, when erect, are around half the size of their torso, but they are not as intimidating as those of e.g. Rhinos, because they are thin and conical. More interestingly, their erect penis will likely be spotted when sleeping, because they sometimes sleep on their side or back. But here's the kicker: Unlike most animals, this erection happens during non-REM sleep
https://ars.els-cdn.com/content/image/1-s2.0-S0960982219315155-gr2.jpg
This is 100% more relevant to my life than whether or not X hospital in county so-and-so couldn't admit what-and-what because who-and-who bad and won't follow doctors advice. This is a fact that has ramifications in my ontology of sleep. I learnt this fact 5 days ago and I already used it once as an intro into a dirty conversation, and those are super hard to come by, for me at least. It's funny, cute, interesting.
And I'm pretty sure nobody's lying to me about it. Am I ~100% confident? No. But I'd bet you 80/20 that if you set up a camera to look at sleeping armadillos at the zoo we'll notice them sleeping with their belly exposed and we'll see their arms twitching when their penis is inert, and their members being steady when their member is erect. And I can ultimately increase that confidence in a really straightforward way. There's no partizanship to this, how could there be?
That's the beauty of science and engineering and of ""intellectual"" pursuits in general. And if the past is to generalize, 100,000 sleeping armadillo style facts at some point cumulate into nuclear energy, and it all pays off. And if it doesn't ? What's the harm, look at how cute the Armadillo is
You left out the angle that the only reason people are getting poisoned taking the horse de-wormer is because their paternalistic, New York Times reading doctors refuse to give them a prescription for the (harmless) human version of the medicine...
The reason they are getting poisoned is because they are dumb enough to take medical advice from Facebook posts. In general, there are legitimate complaints about "my doctor isn't taking my problem seriously and thinks I'm only drug-seeking", but when it comes to "I want this medication because I read somewhere it's a miracle cure", and there is no evidence at all that it is a miracle cure, and while it won't poison Jim or Susan, it's likely they'll come back in a panic once they take it and come out in a rash or have swelling of the extremities, so it's not worth prescribing unless they really need it - then I'm on board the "You don't need this, it won't do you any good, if you're really worried get vaccinated and observe social distancing rules" train.
I'm in favor of treating grownups like grownups. The doctor can give good advice, along the lines you suggest, but if one of his patients still wants the ivermectin, I'd say the doctor should prescribe it for them. Ditto if the patient wants opioids, or anything else-- give the patient good advice, but if they still want the drug, advise them that you think it is medically useless, and write the prescription. Doctors are not their patient's mom; their patients aren't 10 years old. Even if a patient wants something that is really dangerous, or dangerous in combination with something else they are already taking, I'd say, a doctor SHOULD take the same approach-- find out if they are looking to commit suicide, and if they are, help them out, otherwise, tell them vigorously that death or whatever the outcome they should expect-- as they write the prescription. That isn't possible for the doctor to do, practically and legally, for opioids, because of meddling bureaucrats, but for something like ivermectin there is no reason for them to deny a patient the prescription if that is what they really want-- it will be a good learning experience for them-- or perhaps, a good placebo-- but it's not, and shouldn't be, the doctor's call.
In practice, I think the current system is better, as most people dont know anything about medicine, and this would lead to severe perverse incentives where pharma companies could convince people to take useless drugs and make bank. If you’re smart and know your stuff, you can often just find a doctor who will believe your idea.
That's not a doctor, that's a sweetshop owner. "Oh you want a lollipop? Here you go!"
The point of a doctor, after all, is to diagnose and treat an ailment, not to hand out drugs like selling tins of beans. In your scenario, why even bother with a prescription? Just go to a chemist and buy it all over the counter. Some countries do that, I understand.
And any doctor foolish enough to follow your advice will be sued into oblivion by the families afterwards, you see that with the example in one news story: the guy plainly wasn't vaccinated, got covid, wanted ivermectin as a miracle cure, and now the family are suing the hospital for not giving it to him. If a doctor does tell the patient "this is useless to dangerous", prescribes it anyway, and the patient has an adverse reaction or dies, there are two ways this goes afterwards:
(1) "He/she didn't know how dangerous it was, you should have warned them! You are at fault and this is malpractice!"
(2) "I did warn him/her" "Then you knew it was dangerous and you shouldn't have prescribed it! You are at fault and this is malpractice!"
I'm not in favor of treating doctors like robots programmed to do the bidding of whomever calls on them professionally, whatever their own judgment.
I believe physicians, no less than patients, should be treated like grownups and allowed to act on their own judgment. If I call an electrician and ask him to rewire my house in a way that he considers insanely dangerous (and is moreover against code), he is entirely free to reject my business. We don't have a meeting of minds, there is no obligation on either side.
I don't see why a physician should not feel equally free to exhibit the same agency: if he thinks I'm nuts and my proposed course of treatment stupid, he should be free to similarly reject my business and tell me to look elsewhere for professional assistance.
We've already had one spambot advertising Dr. Herbal Cure cured my AIDs and epilepsy and dose of the clap, do you really advocate that we all rush off and order the miracle herbal cure because somebody sent an email swearing it worked for them? And herbs are all natural anyway, they are harmless, so why not take this product?
There are probably a million different pointless herbal remedies. One worries that there’s be a million different pointless pharmaceutical remedies if deregulated, and those might have bad side effects
Here’s one way to think about it: if you cared about what was really going on in hospitals in Oklahoma (like maybe you live there or have relatives there) you would investigate. If you notice that you’re not actually investigating, that’s pretty good evidence that you’re not actively curious about it. Better to admit there are questions you don’t have good answers for, and that you’re just going to let them remain unanswered.
(Of course if you *are* actively curious, please do investigate and get back to us.)
It might seem somehow wrong to admit that you’re not curious about something. Social media often convinces us that we care about all sorts of things, but reading articles that show up in your newsfeed is only a weak, passive, opportunistic curiosity.
In some sense that’s okay. It would be impractical to investigate everything that goes by. Knowing what you’re actively curious about is useful self-knowledge.
But I wonder about the things we passively absorb without investigating, so we think we know things that we haven’t checked out. How does this affect your priors?
I believed part 1 hook, line, and sinker, without so much as three seconds of research. Having this pointed out was very valuable, I am updating by adding "don't believe stuff automatically, you dimwit" to my wishlist of mental reflexes. Thank you!
(At least I didn't believe the second part automatically.)
I’d make two points. Firstly the more right wing perspective that the media are sloppy click hungry entertainment outlets masquerading as news outlets which can be relied upon to report even basic factual information is by and large true. It is hard to clock at this or many other stories as anything other than fake news. It is fake in that it is not true and is presented as though it were true. The silliness comes from thinking any body exists on the right or anywhere that has any interest in reporting the truth.
Their own fake news criticism is itself wrong in that it implies some source of truth exists. But if any story matters to any powerful player, then it will almost certainly have extreme bias in its reporting with a filthy myopic lens used. Marketing, propaganda, ownership models, manufacturing consent, etc it has all been there all along like Cesar’s reports of his glorious conquests of the barbarian armies of he north which mostly consisted of slaughtering and enslaving small villages.
Secondly I’d point to the quite pessimistic and seemingly uninformed views on ivermectin presented. The FLCCC cited by others is simply putting information together and they have dozens of peer reviewed and double blind etc studies along with large National or large region implementations.
One even needs zero studies when looking at the raw figures which came out of India where a ‘natural’ experiment happened with their big covid wave a few months ago. These are extremely positive results and we should be trying whatever we can in a pandemic as long as it is safe. There is even passive evidence from lower covid rates in some parts of Africa, quite possibly matching up well with existing use of ivermectin for its well known and longstanding use against parasites which can cause blindness.
In states which used ivermectin Emma’s bs those thst didn’t, dramatically different outcomes in terms of the spread of the disease and deaths in hose states. A similar large scale rollout and use of ivermectin in, I think, Columbia o had dramatic effects. Unless covid waves just randomly fell apart in places using ivermectin in ways dissimilar to other places.
Looking at the evidence and arguments put forward to use a drug in a pandemic where we cannot wait or rely on stupid ideas of waiting around for 5 years or 20 years for large bodies of evidence to accumulate thorough the regular channels. This is a safe drug, which has saved millions of people from blindness and is a WHO essential medication used over 4 billion times in humans and if it helped even 10% of what people claim we should use it and let the studies and whatever play out over time.
Instead we have an insane and bizarre and inexplicable wave of health policy bodies and media censorship and smear campaigns. Here is no charitable argument left for the wide scale and systematic attempts to suppress this safe drug which has been widely used for decades. And like with the idiotic and horribly evidence free war on drugs, it is the illegal or non offical nature of it which has caused nearly all the problems. No one would be using the veterinary drug supply or confused on dosages if every GP in the land were allowed to freely proscribe it to anyone who wants it.
What criteria and standards should we use when combating a pandemic? Should we go with anything that is safe to use and see what sticks or should we wait around for clinical trials? His isn’t the standard of a big pharma company trying to get more profits from their drugs by getting long slow approvals that come with patent and profit protection…this is more like with cancer where people try all sorts of things and a certain amount of non standard ethics comes into pay with open human experimentation fuelled by personal choice.
In the context of a pandemic, if people want to volunteer to take and try various already approved drugs…what possible argument could exist to stop the, or not to study them? If here is one, I’d disagree with it. We must find rapid fire ways to try things out. Overall it shows massive wholes in the current system of drug development and usage approval. We cant use a 5 year process for something we need to know immediately and could easily be found out in 3 months or 6 months with willing participants. We certainly did this exact thing with the extremely high profit vaccine development, so why the complete hypocrisy? Could billions and billions of dollars and existing systems which are almost entirely reliant on big pharma possibly lead to double standards? Is a person an insane conspiritard for thinking any of this?
According to news media whose board members sit on none big pharma and big media companies…we should forget everything and accept government mandated multi vaccines of covid boosters and flu shots forever and ever under penalty of not being allowed to work or go to public places as enforced by a National monitoring system.
Even 3 years ago THAT would be the crazy person narrative. If I said 3 years ago that our freedom of movement be limited for years at a time or huge monitoring systems would be put in place, then that’d be Alex Jones level stupid person ideas. But now 2 years into covid, you are now considered insane NOT to openly embrace using a fast tracked vaccine made by companies who obtained total legal immunity and which doesn’t stop the spread of the virus and a total media ban and open assault on ‘misinformation’ about drugs which may or may not work on a brand new disease…when no one can know before hand what will work or not.
So…we have to get the vax to stop the spread, but also it doesn’t actually stop the spread of the virus, perhaps slowing it down a little. Endless insane sounding double speak and you’re crazy for saying it sounds crazy. Meanwhile covid spreads like wildfire in 90% vaccinated Israel and across the UK…but we have to get it for public health reasons to protect others? Yet getting it does not protect other people…..round and round it goes and it is no deemed insane to question this?
"One even needs zero studies when looking at the raw figures which came out of India where a ‘natural’ experiment happened with their big covid wave a few months ago. These are extremely positive results and we should be trying whatever we can in a pandemic as long as it is safe. There is even passive evidence from lower covid rates in some parts of Africa, quite possibly matching up well with existing use of ivermectin for its well known and longstanding use against parasites which can cause blindness."
Ivermectin is well-known and longstanding use *against parasites*, which you mention in your comment, but seem not to have understood. You are saying "this is a safe and effective drug!" and yes it is - *when used as intended*.
What you are extrapolating from "it's used to treat parasitic infections in humans" is "therefore it should be used for covid", with a side of "what can it hurt, it won't kill you" and unexamined anecdotes about "and they used it in India and they're getting fabulous results!"
I'm not so convinced about those fabulous results, I imagine that any benefits may come from the anti-parasitic treatment. If you have two patients, A and B, both in hospital undergoing treatment for Covid, and both have roundworm infestations as well, and A gets treated with Ivermectin which kills off the roundworms but B does not - I am going to guess that A will do better than B. But I don't think you can conclude from that "Ivermectin cures Covid!"
And the problem with this sunny assumption of "what harm can it do?" is that some people are refusing to get vaccinated, which is our best preventative at present, and along with others are all rushing off to buy veterinary products containing ivermectin, which are graduated for animals much larger than humans; believing this will save them; overdosing then because they're taking dosages calibrated for horses and cows; then ending up in the hospital with the side-effects of same.
So I'm going to go through that Cochrane meta-study and pull out the ones from India and Colombia, if I can find them, and other ones from Third World countries as well, and let's see what the authors of those studies say, shall we?
(1) Mexico:
Methods: This a controlled, clinical, randomized, double-blind trial that included patients with COVID-19-induced pneumonia and hospitalization criteria, but no severe respiratory failure. Patients were randomized to one of three groups: Group1-hydroxychloroquine, 400 mg every 12 hours on the first day and subsequently, 200 mg every 12 hours for 4 days, Group 2-ivermectin, 12 mg or 18 mg, according to patient weight and, Group 3-placebo. At inclusion, blood samples for arterial blood gases and biochemical markers associated with a poor prognosis were obtained. The primary outcome was established as the duration of hospitalization until discharge due to patient improvement, the total duration of hospitalization, and the safety outcomes were either respiratory deterioration or death.
Conclusions: In non-critical hospitalized patients with COVID-19 pneumonia, neither ivermectin nor hydroxychloroquine decreases the number of in-hospital days, respiratory deterioration, or deaths.
(Well, no wonder cure there! But maybe it was because they didn't do it in India?)
(2) Bangladesh: (this one is more favourable)
The aim of this study was to investigate the role of ivermectin alone or in combination with doxycycline in the treatment of adult COVID-19 patients presenting with mild symptoms. It was hoped that treatment early in the course of infection would decrease the viral load, shorten the duration of illness, and halt transmission.
A 5-day course of ivermectin resulted in an earlier clearance of the virus compared to placebo (p = 0.005), thus indicating that early intervention with this agent may limit viral replication within the host. In the 5-day ivermectin group, there was a significant drop in CRP and LDH by day 7, which are indicators of disease severity. It is noteworthy that the viral nucleic acid Ct value (indicator of viral load) dropped significantly compared to the placebo group on day 7 and day 14. In the absence of co-morbidity, a 5-day course of ivermectin treatment showed faster SARS-CoV-2 virus clearance compared to the placebo arm (9 vs 13 days; p = 0.02).
Although the study sample was too small (n = 72) to draw any solid conclusions, the results provide evidence of the potential benefit of early intervention with the drug ivermectin for the treatment of adult patients diagnosed with mild COVID-19. First, early intervention promoted faster viral clearance during disease onset, which might have prevented significant immune system involvement and hastened the recovery. Secondly, early intervention reduced the viral load faster, thus may help block disease transmission in the general population. A larger randomized controlled clinical trial of ivermectin treatment appears to be warranted to validate these important findings.
(So this one looks like faster viral clearance compared to the other two groups, with a smattering of "it MIGHT do this and that").
(3) Spain: a single-dose of ivermectin trial
This pilot study was designed to assess the question of whether further investments in the potential repurposing of ivermectin were warranted. As such, we aimed at generating evidence on viral kinetics, antibody response and clinical efficacy in a cohort of patients at low risk of severe disease. Without a clearly defined mechanism of action, a sole signal in any of said parameters would not suffice to justify further efforts. This pilot shows a trend to lower viral loads in the ivermectin group, a trend to lower IgG titers that may reflect lesser systemic exposure to the virus and clinical benefit in cardinal symptoms of COVID-19 associated with tissue damage: anosmia/hyposmia and cough. These results are in line with emerging evidence from trials in Bangladesh and Argentina, as well as with recent data from a SARS-CoV-2 hamster model from Institute Pasteur which also showed a marked sex dichotomy in the effect of ivermectin on anosmia/hyposmia.
Pending confirmation of these results, this pilot sheds some light on the potential mechanism of action of ivermectin against COVID-19. Note the trial was not powered to detect modest differences in viral load, yet a small effect is suggested when viral load was ascertained directly by PCR and indirectly using IgG titers as markers of systemic exposure. Also, in this pilot ivermectin has not shortened the duration of symptoms associated with systemic inflammation such as fever or malaise, nor has it had a measurable impact on inflammatory markers. Given these findings, consideration should be given to mechanisms of action different from a direct antiviral or anti-inflammatory effect. One alternative explanation might be a positive allosteric modulation of the nicotinic acetylcholine receptor caused by ivermectin and leading to a downregulation of the ACE-2 receptor and viral entry into the cells of the respiratory epithelium and olfactory bulb.
(So it sorta works but not the way we expected?)
(4) Pakistan:
Our study didn’t show statistically any significant difference between case and control group. In Ivermectin’s (case group) recovery was almost equal to control group who received only conventional symptomatic treatment, so this is the need of the day that we need to conduct more randomized controlled trials across our country involving major tertiary care health care facilities with larger sample size to assess its efficacy for validating the use of Ivermectin against SARS-CoV-2. Nearly 40 clinical trials are
ongoing world over for measuring the outcome of COVID-19 treatment with Ivermectin.
(Neutral on this; it does point out that the different studies are all testing different groups e.g. some patients are mild, some are severe, some are getting mixed treatments, etc.)
(5) India:
Results A total of 115 patients were enrolled for the study of which 112 were included in the final analysis. Of them, 55 were randomised to the intervention arm while 57 were randomised to the placebo arm. There was no significant difference in the baseline characteristics of the two arms. There was no significant difference in the primary outcome, i.e. negative RT-PCR status on day 6 between the two groups. Similarly, there was no significant difference between the two groups in most of the secondary outcome measures, viz. symptom status on day 6, discharge status on day 10, admission to ICU, and need for invasive mechanical ventilation. However, while there was no in-hospital mortality in the intervention arm, there were 4 deaths in the placebo arm. As a result, all patients in the intervention arm (n=56) were successfully discharged as compared to 93.1% (n=54/58) in the placebo arm (RR 1.1, 95% CI 1.0 to 1.2, p=0.019).
Conclusion There was no difference in the primary outcome i.e. negative RT-PCR status on day 6 of admission with the use of ivermectin. However, a significantly higher proportion of patients were discharged alive from the hospital when they received ivermectin
(They're taking this as ivermectin prevented mortality, but that's not so obvious, given that the two groups had little to no difference otherwise. So what was the magic going on here?)
(6) India (different study):
DISCUSSION: In this study we did not observe any benefit of adding ivermectin to the hydroxychloroquine in the management of patients of SARS-CoV-2 resistant to standard care treatment. Our finding are based on small cohort of asymptomatic or patients with mild symptoms of COVID-19.Such patients were recruited when they did not responded to the standard treatment. Ivermectin was tested as an adjuvant drug to the standard treatment with hydroxychloroquine. On comparisons of patients receiving hydroxychloroquine plus ivermectin with the patients receiving hydroxychloroquine alone, no significant difference was observed in the cure rates. There were no significant adverse effects were observed in patients receiving ivermectin. The use of ivermectin 12 mg single dose as an adjuvant to standard treatment was based on the widespread uncontrolled studies that suggested that the ivermectin has antiviral activity against a broad range of viruses. .Based on these studies it was concluded that ivermectin's nuclear transport inhibitory activity may be effective against SARS-CoV-2.
(This is one of those "throw it against the wall and see what sticks" studies; ivermectin didn't do much but that's not what they were studying. Result here neutral again, I think).
(7) Argentina:
Findings: The trial run between May 18 and September 29, 2020 with 45 randomized patients (30 in the IVM group and 15 controls). There was no difference in viral load reduction between groups but a significant difference in reduction was found in patients with higher median plasma IVM levels (72% IQR 59 – 77) versus untreated controls (42% IQR 31 – 73) (p=0·004). The mean ivermectin plasma concentration levels also showed a positive correlation with viral decay rate (r:0·47, p=0·02). Adverse events were reported in 5 (33%) patients in the controls and 13 (43%) in the IVM treated group, without a relationship between IVM plasma levels and adverse events.
Interpretation: A concentration dependent antiviral activity of oral high dose IVM was identified in this pilot trial at a dosing regimen that was well tolerated. Large trials with clinical endpoints are necessary to determine the clinical utility of IVM in COVID-19.
(This one contradicts the Bangladesh and Spain studies about reductions in viral load, but it does show 'something something need high doses').
(8) Colombia:
Findings: In this randomized clinical trial that included 476 patients, the duration of symptoms was not significantly different for patients who received a 5-day course of ivermectin compared with placebo (median time to resolution of symptoms, 10 vs 12 days; hazard ratio for resolution of symptoms, 1.07).
Meaning: The findings do not support the use of ivermectin for treatment of mild COVID-19, although larger trials may be needed to understand effects on other clinically relevant outcomes.
(And this one contradicts the Indian 5-day trial. They don't seem to have seen a positive effect re: mortality, and they did manage to screw up the 'which group gets what' dosing. Read the whole thing: https://jamanetwork.com/journals/jama/fullarticle/2777389)
(9) India (different study):
In our study subjects, Ivermectin did not improve the time to symptom recovery, clinical status at day 14, or hospital-free days at day 28 after drug administration. Similar results were observed in the only other randomized-trial of Ivermectin (12 µg/kg) in predominantly mild COVID-19 patients (n=62) in Bangladesh, wherein Podder et al(19) found that Ivermectin failed to hasten the resolution of symptoms compared to usual care. The same investigators repeated RT-PCR only once on day 10 and found that most patients had attained a negative result(19). In contrast, we performed RT-PCR at days 3, 5 and 7 to serially evaluate decline in viral load with Ivermectin. Our rationale was that faster viral load decline may enable the non-severe COVID-19 patient to become non-infectious sooner, thereby limiting the contagion. Indeed, it has been shown that at a lower viral load (CT > 24), infectivity declines with lower viral culture positivity(20). Hence the trend towards increased viral negativity at day 5 with ivermectin 24 mg in our trial, particularly among mildly ill patients, encourages further exploration in this regard.
In a retrospective study of hospitalized patients in Florida(21), patients who received Ivermectin were found to have a significantly lower mortality that those who did not (15% versus 25%). The mortality benefit remained significant after propensity-matched analysis and adjusting for confounders. However, they included patients with greater illness severity than our study population, illustrated by lack of mortality in our trial. Furthermore, the greater use of concurrent therapies and retrospective design preclude drawing definitive conclusions from their data. Nonetheless, we did find a 56.2-61.5% RT-PCR negativity among moderately ill patients who received Ivermectin at day 5 of enrolment. The immunomodulatory rather than antiviral effect of Ivermectin may be hypothetically more important in moderate and severe COVID-19
(Interesting results that you get more bang for your buck, as it were, if you take your ivermectin after a meal and with booze. Again, some contradictory findings).
I'm not going to go through the whole list, but going by this, if you want ivermectin to work, then you should be in India (parts thereof), Bangladesh, or Florida.
Here's that Florida study, read the whole thing because this was another "throw it at the wall and see what sticks" measure, the patients were getting hydroxychloroquine with or without azithromycin as well:
https://journal.chestnet.org/article/S0012-3692(20)34898-4/fulltext#secsectitle0085
Study Design and Methods
Charts of consecutive patients hospitalized at four Broward Health hospitals in Florida with confirmed COVID-19 between March 15 and May 11, 2020, treated with or without ivermectin were reviewed. Hospital ivermectin dosing guidelines were provided, but treatment decisions were at the treating physician’s discretion. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included mortality in patients with severe pulmonary involvement, extubation rates for mechanically ventilated patients, and length of stay. Severe pulmonary involvement was defined as need for Fio2 ≥ 50%, noninvasive ventilation, or invasive ventilation at study entry. Logistic regression and propensity score matching were used to adjust for confounders.
Results
Two hundred eighty patients, 173 treated with ivermectin and 107 without ivermectin, were reviewed. Most patients in both groups also received hydroxychloroquine, azithromycin, or both. Univariate analysis showed lower mortality in the ivermectin group (15.0% vs 25.2%; OR, 0.52; 95% CI, 0.29-0.96; P = .03). Mortality also was lower among ivermectin-treated patients with severe pulmonary involvement (38.8% vs 80.7%; OR, 0.15; 95% CI, 0.05-0.47; P = .001). No significant differences were found in extubation rates (36.1% vs 15.4%; OR, 3.11; 95% CI, 0.88-11.00; P = .07) or length of stay. After multivariate adjustment for confounders and mortality risks, the mortality difference remained significant (OR, 0.27; 95% CI, 0.09-0.80; P = .03). One hundred ninety-six patients were included in the propensity-matched cohort. Mortality was significantly lower in the ivermectin group (13.3% vs 24.5%; OR, 0.47; 95% CI, 0.22-0.99; P < .05), an 11.2% (95% CI, 0.38%-22.1%) absolute risk reduction, with a number needed to treat of 8.9 (95% CI, 4.5-263).
Interpretation
Ivermectin treatment was associated with lower mortality during treatment of COVID-19, especially in patients with severe pulmonary involvement. Randomized controlled trials are needed to confirm these findings.
My notion is that if there is less COVID in regions where ivermectin is routinely used against parasites, then RCTs on patients with COVID might not be relevant. It's plausible that having a background level of ivermectin in the body does some good. Deiseach might be right that the advantage is from lowering the parasite load rather than ivermectin being good for people in general.
"But I really am reading Scout Mindset, and it really does have me thinking about the ways our irrationality is polarizing us."
You're making the assumption that polarization is irrational. When we're talking about contending classes, polarization seems to flow naturally.
Also, you have already read a book that talks about media inaccuracies at great length and explains them well - "Manufacturing Consent" by Chomsky and Herman. From memory you didn't really give it a good review? Perhaps in light of all this fretting about inaccuracy and polarization you should give it a re-read.
His review: https://slatestarcodex.com/2015/09/11/book-review-manufacturing-consent/
Yeah, he wasn't all that impressed.
Manufacturing Consent came out in 1988. It's at least possible that the media was more biased against the left then and more biased against the right now.
Manufacturing Consent goes over the structural reasons as to why the media is biased a certain way. That same structure is still in place.
Here's a good takedown of Scott's review:
https://rhizzone.net/articles/article-review-book-review-manufacturing-consent/
The summary is that Scott wasn't impressed because he didn't really understand it.
I am so very glad that someone is writing articles like this one.
I wonder if someone mixed up stories/details whether intentionally or not. There was an oddly similar story in the news in Texas, though it didn't seem to garner the same spotlight or attention.
https://www.fox26houston.com/news/houston-man-shot-6-times-a-week-later-still-waiting-for-surgery-at-hospital-overwhelmed-by-covid-19
There's the link to the story including an interview with the shooting victim.
" A Houston man continues to wait for surgery at Ben Taub Hospital roughly a week after getting shot six times.
"Everybody is really surprised I’m still in this bed a week later," said Joel Valdez (J.D.)"
I'm more surprised that he got shot six times, survived, and a week later is not only still alive and well but is able to give interviews to the media. It would be preferable if they got the bullets out, sure, but he doesn't sound as if he's at death's door.
I see another link to a story where people are chasing the miracle cure; it's a pity the man died, but I'm betting that the reluctance of the family to comment on whether or not he was vaccinated (while plenty happy to claim ivermectin could have cured him) means "no, he wasn't".
https://www.fox26houston.com/news/74-year-old-veteran-prescribed-ivermectin-dies-after-houston-hospital-refused-to-administer-family
This is the entire problem: if people are refusing to do that much prevention as getting vaccinated, then pinning their hopes on 'I read a Facebook post that says this really is a cure but the government doesn't want us to know', then what do you expect to happen?
Human beings are notoriously poor at probabilities. The probability that grandpa would snuff it after being fully vaccinated is some number D such that 0% < D < 100%, alas. The exact value is unimportant, what's important is that there is one group of people who will observe D < 100% so we might as well take it as D ~ 0%, which means if the old fool had only been vaccinated he would've been just fine, so he basically just committed suicide. Another group of people will observe D > 0% so we might as well take it as D ~ 100% which means the vaccine wouldn't have changed a damned thing.
There *have* been unconfirmed sightings of people to whom X can happen, and they do not immediately conclude P(X) ~ 100%, and also to whom Y can *not* happen and they do not immediately conclude P(Y) ~ 0%. Field expeditions have been unable to confirm their numbers and habits, however.
Obviously, P(100>>P(X)>>0 | not me) = 0 and P(100>P(X)>0|me) = 100
As you hinted at with this poison control database, it seems to be really important to have a reliable source that you don't have to perennially recursively check ad infinitum.
For example, if I already knew the poison database was reliable, I could go there and stop.
What is the difference between ivermectin for humans and ivermectin for animals? Is it just the size of the dose, or are there other factors?
I don't know if you meant these, but price and legality?
No, people are talking as though there's a medical difference.
The FDA (if we trust them anymore) have a page up about it, it's rather long on folksy heartiness and short on WHAT IS THE EXACT CHEMICAL FORMULATION, GUYS? but then again if it's for the general public, they're treating us as illiterate idiots (fair enough):
https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19
"Ivermectin Products for Animals Are Different from Ivermectin Products for People
For one thing, animal drugs are often highly concentrated because they are used for large animals like horses and cows, which weigh a lot more than we do—a ton or more. Such high doses can be highly toxic in humans. Moreover, the FDA reviews drugs not just for safety and effectiveness of the active ingredients, but also for the inactive ingredients. Many inactive ingredients found in products for animals aren’t evaluated for use in people. Or they are included in much greater quantity than those used in people. In some cases, we don’t know how those inactive ingredients will affect how ivermectin is absorbed in the human body."
Thank you.
Is there some reason why people can't use part of the large animal dose? Or is it just that they don't?
I'm trying to look up dosages for humans versus animals; so far I've got an initial dosage (in the human tablet for parasites treatment) of 200 micrograms/0.2 milligrams ivermectin/kg of body weight
https://www.rxlist.com/stromectol-drug.htm#dosage
Now, the American news reports are talking about people taking horse paste formulation, and one such gives a dosage of 0.2 mg ivermectin/kg of body weight (same as in humans, above).
https://www.bimeda.ie/media/k2/attachments/1BIM098_Data_Sheet.pdf
However, the dosing syringe delivers a dose of "Each syringe delivers 120mg ivermectin, sufficient to treat 600kg of bodyweight. Each weight marking on the syringe plunger will deliver sufficient paste to treat 100kg bodyweight", so one dose of the weight marking would be 20 milligrams of ivormectin.
100 kg = 220 lbs. So unless your weight is 100 kg/220 lbs, taking one dose from the syringe would give you an overdose of ivormectin.
And going back to our human formulation, overdose can result in:
"In accidental intoxication with, or significant exposure to, unknown quantities of veterinary formulations of ivermectin in humans, either by ingestion, inhalation, injection, or exposure to body surfaces, the following adverse effects have been reported most frequently: rash, edema, headache, dizziness, asthenia, nausea, vomiting, and diarrhea. Other adverse effects that have been reported include: seizure, ataxia, dyspnea, abdominal pain, paresthesia, urticaria, and contact dermatitis."
And this is a study on high dosages in humans - safe or not? (Ivermectin appears not to be toxic even in relatively high doses, so unless you eat an entire box full or the likes, you'll get sick with an overdose but not likely to die):
https://www.sciencedirect.com/science/article/pii/S2405844020326633
They freely admit they can't test it on humans at such dosages, so they poison poor little fishies.
"The oral drug administration is well known for the high compliance and ease of administration, and it is so far the only approved for ivermectin in humans. In the treatment of onchocerciasis, the approved dose of ivermectin is 0.15 mg/kg, but the frequency of administration is still controversial and the duration of treatment has not been established. With the aim to provide more information on means for its safe administration, besides preventing future drug resistance, evidently the evaluation of adequate dosages is equally an actual demand. In terms of gastrointestinal side effects of the currently approved doses of ivermectin, cases of anorexia, constipation, diarrhea, nausea, vomiting and abdominal distention were reported. Hematologic side effects have included decreased leukocyte count, eosinophilia, increased hemoglobin, hematomatous swellings associated with prolonged prothrombin times, leukopenia and anemia.
Considering that some gastrointestinal and hematological side effects have been described in humans after administration of the conventional doses of ivermectin, the usage of larger amounts of the drug for possible repurposing requires further information on tolerability and safety. Since the intestinal tract is a region of absorption of the drug after oral administration, the safety of the intestinal tissues needs to be assessed after high dosage administration. Likewise, the hematologic conditions are required and the same can provide important information on the high dosage toxicity. However, little is known in terms of ivermectin interaction and alterations in intestinal tissues and blood cells after oral administration of higher doses, mainly because such studies in humans are difficult to perform or rather impossible. Thereby, the studies using different animal models are crucial. In our recent studies we described the physicochemical and in vivo mucoadhesive characteristics of a drug formulation produced with chitosan-N-arginine and alginate polyelectrolytes incorporating ivermectin. In the present contribution, we aimed to evaluate the histological effects in intestinal tissues and hematological variations after the oral administration of relative high doses of ivermectin by means of the drug carrier in ornamental fish Corydoras schwartzi as in vivo animal model. The aim of this study was to contribute to the exploration of dosage possibilities for expanded applications of this drug."
So the conclusion seems to be that you'd need to take a ton of the stuff to kill yourself, but since high dosages haven't been tested on humans, and if you're taking veterinary products those are calibrated for much bigger animals like cows and horses, so you are likely to take a dose *much* higher than meant for humans. And we just don't know (yet) how bad that could be for you.
In sum: don't take animal medicines.
>100 kg = 220 lbs. So unless your weight is 100 kg/220 lbs, taking one dose from the syringe would give you an overdose of ivermectin.
Ivermectin has a high therapeutic index and has been shown to be safe up to 2mg/kg (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133431/#:~:text=Ivermectin%20has%20a%20wide%20therapeutic,dose%20of%20800%20mcg%2Fkg.), so even if you only weigh 50kg, that dose would be very unlikely to be toxic. I'm not sure I agree with calling it an "overdose" (I guess technically anything above the effective dose would be considered an overdose, but the effective dosage for treating COVID has not been established), but it would be unlikely to be a dangerous dose.
>if you're taking veterinary products those are calibrated for much bigger animals like cows and horses, so you are likely to take a dose *much* higher than meant for humans.
The size of the package is calibrated for much bigger animals, but it clearly tells you the appropriate dosage by body weight (which happens to be about the same in humans and animals apparently), and comes with gradations to measure out an appropriate dose.
Unless you're suggesting that people are likely to just blindly consume the whole package rather than reading the instructions or do any research on the appropriate human dosage, I don't see why it would follow that just because the package contains a much higher quantity than anyone needs, people would be likely to take a much higher dosage.
Incidentally, the package you linked above (https://www.bimeda.ie/media/k2/attachments/1BIM098_Data_Sheet.pdf) contains about 120mg of the active ingredient, which is just under the 2mg/kg threshold for someone who weighs 60kg (which I think is on the very low end of body weight for adults). I'm not sure if they designed the package with that in mind or if this just happens to be the optimal amount for a horse, but even if someone *does* blindly consume the entire tube, it likely wouldn't result in severe toxicity.
Quality and rigor of testing may be relevant. If you accidentally let slip a few micrograms of some potent carcinogen into your cattle meds during manufacture because you need to tighten up the bottom line by trimming some corners, who cares? Not the buyer or seller or government. Those cows are going to the slaughterhouse this fall anyway.
How relevant this is I do not know, since the formulation of meds is a murky pool of cross-national supply chains and repeated relabeling into which only the hardiest would willingly dive. It is certainly possible that the stuff destined for pigs and beefs is distinctly less pure 'n' wholesome than that warranted for babes in arms, or on the other hand maybe it all comes out of the same pot.
Request to Scott:
Considering how often there are changes between the "newsletter" post and the actual final post, please consider prefacing your posts (either all of them, or at least the more probably edited ones like this one) with a boilerplate text like you do with the "Links for X" posts. Something along the lines of "I sometimes/often edit my posts after receiving feedback on them on the comments, so to read the latest version go to..."
I usually come to the web/blog version, but sometimes I read them on the mail when I'm in a hurry or on mobile. And when I do that, I often mentally check "Read" if not reminded of the fact that the blog is still out there. Come to think of it, maybe both a preface and a postface for each post, reminding of the possibility of the post being edited)
I feel justifiably smug that I got more of this story here than I have anywhere else on the internet. My confidence I've gotten the whole story is low, but my attitude that Ivermectin is mostly a nothing burger has been confirmed. Similarly, my attitude that trusting the media is fraught with errors has been confirmed. If this story updated one thing, it's to further down rate information about covid, because it appears to have changed from credible threat to tool of fear.
" Ivermectin is mostly a nothing burger "
in what way? it's still true that it's not very effective against covid (if at all), has worse side-effects than the vaccines, is more expensive than the vaccines, and is still causing hospitalisations (because people are catching covid by taking a poor treatment, not because they are being poisoned).
I just don't see how this is a 'nothing burger'. it's still very much misinformation and one side is clearly still wrong, even if the other side's news articles are exaggerating the insanity of ivermectin use.
> An important controversial point to consider in any rationale is the 5 µM required concentration to reach the anti-SARS-CoV-2 action of ivermectin observed in vitro,17 which is much higher than 0.28 µM, the maximum reported plasma concentration achieved in vivo with a dose of approximately 1700 µg/kg (about nine times the FDA-approved dosification).24 25
https://ebm.bmj.com/content/early/2021/05/26/bmjebm-2021-111678
Shouldn't this basic fact put an end to any debate? If a massive overdose puts you at 5% of the required plasma concentration needed for it to even work _in theory_, how could it possibly work in practice?
Unless another plausible mechanism of action has been found, why is this even still being studied? It's utterly bizarre.
I volunteer in EMS. When I first heard about this story, my thought was "... that's not how ERs work". ERs are pretty much the masters of triage. My quick look through Wikipedia suggests that even severe cases of Ivermectin overdose are only going to require supportive care. The ER will need to rule out a bunch of stuff, but most of that work will be offloaded onto techs of one stripe or another. Then they get placed in an ICU for a bit. Situations which are truly able to "overwhelm" an ER involve mass-casualty incidents like airplane crashes or mass shooting incidents.
My assumption about the initial headline was a misunderstanding by the public. That some kid got a superficial wound from improper use of a pellet gun and got taken to the ER by their mother. The kid had to wait in the waiting room for like an hour or something and the mother got mad. At some point, she found out that (among the usual scrapes, falls, aches, pains, dizzy spells, med refills and prolapses) one of the ER beds was occupied by an Ivermectin patient. And then threw a hissy fit which eventually turned into "gunshot victim unable to be seen due to people taking horse dewormer".
My response to the initial denial was that the reporting was sloppy because they didn't phone and check. Because I hadn't read either the article or the denial. But more to the point, this wouldn't have been an issue if the initial reporting had gotten confirmation from a hospital, anywhere. And any hospital system is going to have PR/crisis communications people available, at least 5x8 if not 24x7.
If people are taking the horse dosage of Ivermectin, the issue really is with the availability of veterinary medicine OTC, but not human medication. Having human-rated medication available OTC would at least ensure correct dosage of the medication taken inappropriately.
The only "gunshot" quote in that mountain of bad reporting was describing a single statement from a doctor who had one case where he wanted to transfer a gunshot wound patient - already in his care, not being turned away - to another facility for "higher level" care (no idea what that means) but has been refused. He linked it to COVID load (no mention of IVM in that quote) but there's no proof it's actually the case. That's as much as the "gunshot" angle goes.
OK, I dug up the actual poison data center pdf https://piper.filecamp.com/uniq/ZO3aGrYGXdIUhiJ7.pdf
Yes, it says they handled 459 incidents for August, but the pie chart makes it more interesting. There are four categories on the pie chart that sound very much like they imply "nobody would be going to a hospital for this". Those categories make up 78% of the cases. If my interpretation of that is correct, and you would need to fall into the "minor effect" category to wind up at a hospital, that means for all of 2021, you are looking at ~252 cases that might include hospitalization. Assuming it remains proportional to the total cases, that would be about 101 cases hitting hospitals in August. So the claim is hospitals are being crippled by between 101 and 252 cases of ivermectin OD.
Then you can go look at actual Oklahoma ER capacity here https://data.oklahoman.com/covid-19-hospital-capacity/oklahoma/40/
While some counties are getting their asses kicked, most of them are not at max er capacity. ICU is worse, but more than half of them have space for a gunshot victim. Additionally, you can see that the ICU capacity is almost 100% COVID use because it literally tells you the number of ICU beds being occupied by COVID patients.
This isn't an oops, this was straight up lying.
You write that the hospital press release changes nothing, but you point out earlier in your article that one hospital in the same region having zero overdose cases makes it unlikely that nearby hospitals are overwhelmed with overdoses.
It sounds like you're stretching really hard to make a lame both sides are wrong argument.
Thank you for this piece. I find it very helpful.
Thank you for writing this piece. It’s very helpful.
Say what you want, the MSM, and public health institutions, are clearly smearing IVM every chance they get. India's "FDA" just approved the drug as essential for treating covid19. Taken in proper doses, it is one of the safest drugs in the world. Safer than aspirin. It's founders were given a Nobel prize in 2015 and the WHO lists IVM as an essential drug.
If you are ignorant to the truth about IVM, and read USA legacy media, chances are high you think it's a horse dewormer only, and crazy cooks are eating horse paste because of a "conspiracy theory".
The truth is closer to this. USA health regulators are suppressing info on IVM, and instructing doctors not to use it. Some pharmacies refuse to fill scripts, from doctors, for IVM. Therefore, some people are taking the livestock version. This of course can be dangerous, because doses for 2000lb+ animals are obviously much higher than for humans.
Japan has recommended it's use for COVID-19, and India has lowered it's price and listed it as an essential treatment for COVID-19.
Skeptical or not, to completely ignore the use of the drug around the world to treat COVID-19 shows bias and adds to the lack of trust many Americans have in major news outlets.
"the WHO lists IVM as an essential drug"
FOR WHAT IT IS SUPPOSED TO TREAT, WHICH IS PARASITIC INFECTIONS.
This is the same type of misleading advertising which leads to shilling for laetrile clinics and Magic Mineral for Autism cures. Your "the truth is that USA health regulators are suppressing info on IVM" is closer to the same sort of "the big combines don't want you to know about the car engine that runs on water" stories that get passed around. Ivermectin has side-effects, if you are allergic to any of the components you'll have a reaction, and it can react badly when taken in combination with other drugs. Prescribing it willy-nilly to every single person will mean, at best, a rush of people with "I took this and then my legs swelled up! Am I having a heart attack?" symptoms clogging up ER departments.
I don't see how you can claim Sinister Suppression of Information when any fool (such as myself) can simply Google the damn thing: https://www.webmd.com/drugs/2/drug-1122/ivermectin-oral/details
If you have a dose of worms, scabies, or acne rosacea, you can go and get prescribed ivermectin with my blessings. If you think it will cure a virus because a study in India (which is contradicted by other studies done in other regions of India) says it reduces viral load (but not other symptoms) and so might reduce length of stay in hospital/mortality rates, so you are pinning your hopes on it and not getting a vaccine because, you know, all those stories about the vaccines will make you sterile... why do you believe the studies about ivermectin but not the studies about the vaccines?
I find it quite interesting that you pick out one part of what I wrote, in which I never stated WHY the WHO lists it as an essential drug, yet completely ignore the part about India and Japan using the drug for covid-19. Completely ignore...
"I find it quite interesting that you pick out one part of what I wrote, in which I never stated WHY the WHO lists it as an essential drug"
Well now my deario, come let me take you by the hand as we gambol through the flowery meads of trying to pull a fast one.
(1) You laud ivermectin as a wonder drug (true, in limited cases)
(2) You then slide neatly into "India's 'FDA' just approved the drug as essential for treating covid19." (Yes, and in India you can buy antibiotics over the counter whereas over here you need a doctor's prescription. Want to fight over that? https://www.nature.com/articles/s41415-020-1210-x )
(3) And then we get the smooth operator - the appeal to authority combined with "this sentence is here. and this sentence follows it. by implication, one leads on from the other, whereas in fact they are two separate sentences" (I've recently used this tactic myself in a fanfic in order to inveigle the hero into believing something that is not true and will, in fact, lead to A Very Sticky Situation. It's lying without lying! You say one true thing, and then you say another true thing, and let the listener/reader fill in the gaps that A causes B where it is no such thing):
"the WHO lists IVM as an essential drug".
And by not saying *why* or *for what purposes* the WHO list it as essential, you let the casual reader dupe themselves into "India approved it for Covid... WHO lists it as essential... WHO backs it as Covid treatment".
I'm not smart. I'm not particularly aware. But even I recognise when someone is trying the hard sell on me, and my sugarlump, I am very, *very* resistant to the hard sell.
You are a great illustration of exactly what is wrong with the world right now, and exactly what this article attempts to identify. You are talking out of your rear based on your own biases. I'm a commenter. I'm not a writer. I'm not trying to convince anyone of anything. I'm simply observing and commenting. The drug in question is widely used around the world for treatment against covid-19. USA MSM treats it is as horse-wormer that is poisonous to humans. That is a blatantly false narrative. You're reading into the words and injecting your pre-conceived perception of the type of person I must be to dare point out the drug is being used against covid-19. You've gone from claiming it's only use is against parasites, to claiming I'm an anti-vaxxer, to announcing me as an IVM promoter using sneaky tactics to dupe people. You should enter a mental gymnastics competition. Enjoy.
"You are a great illustration of exactly what is wrong with the world right now"
I am but humbly following in the footsteps of the departed great ones:
Allegedly The Times (of London, do I really need to distinguish this from the others of New York and Los Angeles? Perhaps I do) once sent out an inquiry to famous authors, asking the question, “What’s wrong with the world today?” and Chesterton responded simply,
“Dear Sir,
I am.
Yours, G.K. Chesterton.”
Now peeps, if I say that I've heard shoving a stick of barley sugar up your arse is a great prophylactic against Covid-19, I'm not trying to convince anyone of anything. I'm simply observing and commenting. Any boiled-sugar related traumatic incidents ending in a trip to your local A&E are not on me.
Also, you're showing your bias here too, very clearly. I write that ivermectin is being used in other parts of the world, and you assume I'm an anti-vaxxer and banking my life on ivermectin. All I said is the media and US medical institutions are smearing the drug. You added all the other stuff out of assumption, not fact. Maybe you should apply for a job at The Rolling Stone. Seems you fit their M.O.
"Maybe you should apply for a job at The Rolling Stone. Seems you fit their M.O."
In the immortal words of Dr. Hook and The Medicine Show:
"But the thrill we've never known
Is the thrill that'll getcha when you get your picture
On the cover of the Rollin' Stone"
https://www.youtube.com/watch?v=KuvfIePDbgY
(Ah, the music of my tween years! "Sylvia's Mother" the tear-jerked played to distraction on the radio!)
How can we claim suppression of information? Let's see. How about: https://taibbi.substack.com/p/meet-the-censored-ivermectin-critic YouTube banning any mention of IVM, even criticism about it, because it's just to dangerous to mention Drug-That-Must-Not-Be-Named. Looks a bit like, you know, suppression to me.
"I don't see how you can claim Sinister Suppression of Information"
How about sinister propagation of false information, by the people who are supposed to be in the job of doing the opposite?
https://twitter.com/US_FDA/status/1429050070243192839
That's from the FDA. It clearly implies that Ivermectin is only for horses, which is false. It clearly implies that Ivermectin is known to be useless for treating Covid and dangerous, both of which are false. The actual FDA webbed statement on Ivermectin for Covid is that they don't know if it is effective and tests are currently being done.
https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19
As best I can tell, the danger is from the use of doses intended for animals, not doses for humans — a practice encouraged by the attempt to demonize the drug and thus prevent doctors from prescribing it.
"Japan has recommended it's use for COVID-19, and India has lowered it's price and listed it as an essential treatment for COVID-19."
Can you provide links for both of those? All I could find was that two Indian states were using it.
Interestingly enough, when I switched from Google to Duck Duck Go, I found references to India including Ivermectin as recommended for some patients.
https://www.forbesindia.com/article/take-one-big-story-of-the-day/hcq-to-ivermectin-why-india-has-got-it-wrong-in-covid19-treatment/68219/1
I have not found any reference to Japan officially approving it. What seems to have happened is that the chairman of the Tokyo medical association came out in favor of Ivermectin, but that wasn't any sort of official government policy statement.
Am I the only one who remembers Rolling Stone's breathless front page article on rape at the University of Virginia, the one that RS had to retract in its entirety?
https://en.wikipedia.org/wiki/A_Rape_on_Campus
Yes, and that's why fake news flourish - no consequences. They do a fake story, they get caught, and everybody still is treating them as if they're so reliable that one can reprint stories from them verbatim without even bothering with minimal checks. Zero incentive to ever do better.
Nope, scott's written about that in one of his more notable pieces: https://slatestarcodex.com/2014/12/17/the-toxoplasma-of-rage/
You: This…turns out to be completely true. The story never mentions Sequoyah Hospital! Dr. McElyea has worked at Sequoyah in the past, but he’s a traveling doctor and works lots of places
Me: Dr. McElyea listed Sequoyah Hospital on his LinkIn. To the best of my knowledge, he did not name any other hospitals that he worked at in his LinkIn profile.
Regardless of where he worked, a reasonable story would have said "we contacted Hospital X for comment, and they said ..."
But none of the stories said that.
None of the places that ran with this called up so much as a single hospital anywhere in OK to get a check on the story.
None of the "news organizations" that claim to have talked to Dr. McElyea asked him what hospital that was at, and then called up the hospital to get a comment on the matter.
Every single "news" organization that ran with the story utterly failed to display even a shred of journalistic ethics, or even competence.
You: None of these sources mentioned that the original article had never claimed Sequoyah Hospital was involved.
Their story was - I guess - too good to check.
Me: No, their story was true. The claims were garbage. The only hospital he was publicly linked to denied the story, and the none of the people pushing the story had any hospitals quoted defending the story.
Could they have said "we contacted Sequoyah Hospital, which is the only hospital in his LinkedIn profile, and they said the story is garbage"? Yes, they could have.
But, did they essentially get every detail correct, unlike the people they were attacking?
Yes, they did
Sorry, that should be "LinkedIn", not "LinkIn"
Recent study: https://news.mit.edu/2021/crowd-source-fact-checking-0901
TLDR: random people in small groups are as good at quickly recognizing fake news as "fact checkers".
**A Democrat reads some fraction of this story, and sees a bunch of idiot conspiracy theorists taking deadly horse medication to cure COVID.**
So, the Democrat story so far is completely contrary to the facts.
**A doctor warns people that his hospital is overcrowded with poisoning cases, and the media dutifully reports on this. **
Still completely false to fact
**Then an unrelated hospital puts out a press release saying they’re not involved and - even though this changes nothing - Republicans seize on this to declare the entire media is “fake news” and nobody should trust anything they read and the horse dewormer conspiracists were right all along.**
The hospital IS related to the case, because it's the only hospital listed on the Dr's LinkedIn profile.
As the articles don't name the hospital where this is supposedly happening, and NO hospital has come forward to say it is happening (because it isn't), this is, at best, a complaint that the Republicans did not dot all their i's and cross all their t's while taking about the Democrats' narrative
**A Republican reads some fraction of this story, and sees the media falsely reporting that ivermectin is overcrowding local hospitals, even though the hospitals themselves are denying this.**
True assessment of the situation (do you have a hospital claiming that "ivermectin poisoning is overcrowding local hospitals"?)
**Also, using a fake photo of something else to imply that lines at local hospitals are stretching out the door.**
Again, a true assessment of the situation.
**Also, declaring that 70% of poison incidents are due to ivermectin when it’s really 2%.**
Finally, a true assent of the situation.
So, the final score is:
Democrats: two flat out falsehoods, one complaint about a technical detail that doesn't actually help them
Republicans: Three true understandings of the situation.
We're all scoring this as "the GOP is the reality based community", right?
I would've loved to take a look at what studies and why they were fraudulent if you cared to link the information. Also, is this really the right time to criticize Fox? Remember when Trump was criticizing the left at Charlottesville and that really wasn't the right time to do it? This is like that. This article struck me as lazy and biased.
Here's a drug that all those awful anti-vax people (or you know, people who maybe don't like the government using their basic human rights to blackmail them into taking experimental drugs) would actually take. If it works, even to some degree, that would benefit both sides and save lives. Wouldn't that be great? Why not have a sane review of ivermectin instead of beating the 'media sucks' drum? Like how come countries authorize the use of ivermectin to treat covid at least in Europe, Asia, and South America? Why were the studies fraudulent? What about other studies? Why not just let people take the drug if it's safe (so they know how to take it safely and don't have to overdose on the horse version or whatever)?
The crazy people sure put a lot of effort into their craziness: https://c19ivermectin.com/ I would genuinely like to see the other side of this story, but "horse-drugged conspiracy theorists" won't cut it.
Because that wasn't what Scott thought was interesting about the series of events.
With all this talk about drugs for livestock, I feel like we're living in a Seinfeld episode right now:
KRAMER: Ehh.. No expiration date on this.. (Opens it, then starts coughing directly onto the food)
JERRY: There is now. Kramer, you should really get that cough checked out by a doctor.
KRAMER: Nah, no, no, no. No doctors for me. A bunch of lackeys and yes-men all towing the company line.. Plus, they botched my vasectomy.
JERRY: They botched it?
KRAMER: I'm even more potent now!
.....
KRAMER: Hey.
GEORGE: What's with the dog?
KRAMER: (Petting Smuckers) Yeah, this is Smuckers. I borrowed him. (Starts coughing)
GEORGE: Oh..
(Smuckers coughs)
KRAMER: (Pointing at the dog) Yeah, we share the same affliction, so I'm gonna have a vet check us out.
GEORGE: A vet?
KRAMER: Oh, I'll take a vet over an M.D. any day. They gotta be able to cure a lizard, a chicken, a pig, a frog - all on the same day.
GEORGE: So, if I may jump ahead - you're gonna take dog medicine?
KRAMER: (Smiling) You bet we are! Huh, Smuckers? (Smuckers coughs. They turn to leave) I'll see ya.
Naturally, this will be cleared up by the expert "fact checkers" whose mission is to tirelessly debunk exactly such inaccurate facts on the internet! Here goes.
I just ran a Google search for "Fact Check - Oklahoma hospitals deluged by ivermectin overdoses," which is the exact title of the Guardian piece that is still up. https://www.theguardian.com/world/2021/sep/04/oklahoma-doctor-ivermectin-covid-coronavirus
The first result is the Guardian's misinformation article itself. Second, is the Rolling Stone's weaselly "clarification" to its original misinformation article that says "**One Hospital** Denies Oklahoma Doctor’s Story of Ivermectin Overdoses Causing ER Delays for Gunshot Victims." Third result is a Reason magazine article (not an official "fact check"), arguing that "The Media Fell for a Viral Hoax About Ivermectin Overdoses Straining Rural Hospitals."
Fourth through Seventh are news reports that uncritically parrot the original disinformation and conduct no fact checking whatever: https://www.bbc.com/news/world-us-canada-58449876 ; https://www.wionews.com/world/oklahoma-hospitals-deluged-by-ivermectin-overdoses-410858 ; https://www.msn.com/en-in/news/world/oklahoma-hospitals-deluged-by-ivermectin-overdoses/ar-AAO7rqv ;
Eighth result is a really good article on Merck suppressing Ivermectin generally, but not addressed to the Oklahoma story specifically. https://trialsitenews.com/mercks-deadly-vioxx-playbook-redux-a-debunked-smear-campaign-against-its-competing-drug-the-fda-approved-nobel-prize-honored-ivermectin/
Ninth result is an article criticizing the "left's science denial" generally, but only mentioning the Oklahoma story in passing. https://unherd.com/2021/09/the-lefts-science-denial/
Finally, (for the first page), the Tenth Result is a site that links to the Reason article (#3, above) but with a caveat that it is "From the Right," and that Reason "Leans Right."
I also ran the identical search on Duck Duck Go, which unlike Google, returns the most relevant results without the Orwellian gaslight filter. The first result is a "fact check" that unequivocally reports the claim as "false" and actually provides the relevant facts to prove it:
"It turns out the story is fake. Northeastern Health System, which Dr. McElyea used to work with as a staffing agency said his report is completely false. * * * * According to the National Poison Data System, there have been 1,143 cases of ivermectin exposure. While cases of ivermectin exposure are up, 102 of the 1,143 cases recorded by the NPDS showed patients who experienced moderate or major effects from misusing the drug. 13% of patients reported with ivermectin exposure had minor effects. 66% had no effects. Each year, the NPDS says ivermectin cases range between 400 and 500. This year’s total is more than a 100% increase, but the numbers are so few. In reality, the ivermectin story appears to be more media hype than an actual medical emergency and most Americans probably won’t be going to their local feed store to buy a ‘horse dewormer’ to prevent COVID-19. But that’s what they want you to think because it makes a great headline."
https://www.shorenewsnetwork.com/2021/09/05/fact-check-are-u-s-hospitals-being-overrun-by-ivermectin-patients-as-reported-by-the-left/
Snopes hasn't gotten to it yet, but this might have some entertainment value.
https://www.snopes.com/fact-check/oklahoma-hydroxychloroquine-return/
Scott, fantastic article thank you. Very clear demonstration of an *incredible* problem that exists in today's media and public discourse. I will be recommending this piece widely.
The fact that there are so many comments below about whether or not ivermectin is effective is surprising. The efficacy of ivermectin is not the primary purpose of this piece yet that is all 50% of the commentators below want to discuss.
I've never seen anything like this. There are literally thousands (tens of thousands?) of fringe treatments for various medical ailments. Psychiatry in particular is a mine field of conflicting studies, insufficient evidence, and experimental treatments.
I'm interested in what is going on here. The obvious answers:
1. Covid-19 is affecting more lives than any of those other items, so its medical treatment is receiving more widespread discussion.
2. Politicization of the handling of COVID has spiraled out of control. People who once cheered for project warp speed now think it was secretly a government effort to poison them / Big Pharma attempt to graft the public. Somehow Trump's participation in funding this graft is not part of the conversation.
3. Aggressive misinformation for political (international or domestic) reasons is being latched onto by the media. This is leading them to act like the sky is falling and huge swaths of the population believe it. If you believe this, then the only difference between Flat Earthers and horse dewormer users is MSM attention, not actual threats.
I think all 3 are true. I hover not far from "nothing to see here". I don't actually believe faith in ivermectin is preventing meaningful #s of people from being vaccinated (correlation != causation). The data makes it clear poisoning/ODs from this are insignificant (likely about equal to the spike in Tide Pod poisonings when that fad was around).
So what are we left with? In my opinion a coordinated, intentional campaign to drive further division in our country.
What is exactly is the misinformation?
That the current medical consensus is that ivermectin is not the right solution to the COVID pandemic.
That self treating yourself with off label uses is not advisable?
That buying animal-grade products for human consumption is not advisable?
None of that is misinformation. Yes, their tone is obnoxious. Yes, they are unreasonable close minded to the potential of the treatments. Yes, they should do better.
"People who once cheered for project warp speed now think it was secretly a government effort to poison them"
And people who told us they wouldn't take any vaccine recommended by Trump (see, for example, Biden, Harris), are now telling us everyone must take it, and if you don't you're the one destroying America.
"Aggressive misinformation for political (international or domestic) reasons is being latched onto by the media." you mean, like the "scientific studies" that "proved" that HCG didn't;t work, while completely ignoring the actually successful HCG protocol (Step 1: you have to take it with zinc)?
"In my opinion a coordinated, intentional campaign to drive further division in our country"
An interesting claim, coming from someone whose every example is about how those bad Other people are behaving. Are you on the side of the dividers?
I actually don't think its the "others" as you call them trying to divide the country. I think everyone is being manipulated.
An obscure treatment is being promoted by very few people.
Its message is amplified by manipulators
The pro-establishment side responds overly aggressively to this
The anti-establishment side sees their enemy attacking something with unreasonable energy and jumps to a defense that they otherwise wouldn't care much for
This increases the apparent size of the "believers", leading to a ramping of the pressure by the pro-establishment
Leads more anti-establishment to engage
Etc.
It's all quite obnoxious and I do believe we are vulnerable to this sort of manipulation right now.
My algorithm:
1: Find out how the supporters of a treatment say it should be used, and what its effects "will be".
2: Decide whether or not the treatment as described would be valuable if it worked
3: If yes, then look at the studies that "disprove" the treatment, and ask
"Are these studies applying the treatment the way the treatment's supporters say it should be used?"
For example:
Suggested protocol for HCQ: "take it with Zinc and Azithromycin when symptoms show up"
Test "proving HCQ doesn't work":
Protocol: Give HCQ by itself to people who've already been hospitalized. See that no improvement happens
When the establishment repeatedly does that, it leaves me no longer believing anything they say. But that's because of their actions, not anyone else's response
I understand your point. As a partial mitigating factor, some of the studies on HCQ were biased towards hospital / ICU usage because (1) that's where the researchers worked or had access to, (2) they were seeking something useful for that context and investigation HCQ, (3) it's easier to experiment on human subjects who are in desperate need for SOMETHING to help, than on still relatively healthy people in early stages of a disease which is usually mild or moderate.
I don't think that all of the "late stage" studies were intentionally trying to obfuscate questions of early stage usage (though some non-researcher HCQ opponents did try to use the results that way).
https://trialsitenews.com/medical-associations-citing-merck-et-al-declare-war-on-ivermectin-use-targeting-covid-19-in-america/
https://trialsitenews.com/u-s-poison-control-ivermectin-data-analyzed-by-trialsite-some-surprises/?fbclid=IwAR0bBxPxd8O3CFrFHkw_TC7dmqmv_IP6-nsnEsmE9MFfSMW5DkMcQc0tilI
Nice job with the jiu-jitsu moves in this post. I came to the same conclusion this weekend, that the doctor made two separate statements that were willfully or accidentally conflated. It’s such an unnecessary tempest in a teapot when we should be focused on what’s really important right now - fiddling while Rome burns. Make that California.
In case anyone wants a little time off from Ivermectin, was that story about a hacker taking control of a chastity cage actually a hoax?
https://www.youtube.com/watch?v=vEM6SHbjY7Y
I don't know, all I've got is a comedian claiming he invented the story, Vice picked it up, and so did a lot of other news sources.
Please stop doing this Scott.
The first two sections of this piece are lies, designed to deceive. They do a good job, as intended. But: People *will* stop reading partway through the first section, or the second, and you'll have left them with a false narrative that they'll spread further. This isn't just people who can't be bothered to read a whole article (though they are worth being concerned about) it's also the many people face distractions or obligations that take them away from this article.
Don't be Andy Borowitz. Don't spread fake news under the justification that the dupes should have known better.
(As an aside, even as somebody who read the four linked articles and made sure he had time to read to the end [I could see what you were doing], this was unpleasant. I don't enjoy people lying to me. And if I were duped by either or both of the sections, I imagine I would feel worse and maybe stop reading. It's clever, Scott, but is it worth it?)
Anyone who doesn't bother to read all the way through an article - well, that is part of what this post is about. "I read the headline, I know all I need to know".
Headlines are written not by the reporter but by someone else, they're maximised to grab attention so they'll be as lurid as possible (within the traditions of the media in question; a tabloid headline is always going to be more SHOCK, HORROR! than the mainstream media), and they often misrepresent the story.
Not having the patience or curiosity to read *all* the way through means we are not looking for the facts of a story, we're trying to confirm our biases ("I knew that lot were like that!"). Blaming Scott for demonstrating how we fool ourselves is asking for spoon-feeding not challenging pieces that show how easily something can be made to seem what it is not.
I'm glad I had the forethought to respond to these objections before you made them:
"This isn't just people who can't be bothered to read a whole article (though they are worth being concerned about) it's also the many people [who] face distractions or obligations that take them away from this article."
That's pretty much everyone. It's an unfortunate fact of the world we live in that few of us can completely block off time and guarantee that we will not be disturbed.
Note that there was nothing about people just reading the headline.
That said, it doesn't really matter. Even if people have terrible epistemic hygiene, that's no excuse for poisoning the drinking water. This article is, for two sections, intentionally deceiving its readers. Not allowing them to fool themselves, _deceiving them_ (see "Did you believe that?"). And that's bad, it shouldn't be normalized and, yes, Scott should feel bad.
Yeah the objection of 'what if someone doesn't read all of Scott's post' and gets the wrong message is a duh! You don't know what Scott's message is till you've reached the end of his post. It's not a news item, it's a story... in three acts this time. :^)
Oh good, so nobody who doesn't already know Scott should read ACX, nor should anyone who cannot be sure that they can't read it end-to-end in a single sitting without being interrupted!
Ummm... have you read Scott Alexander? Sometimes it's _long_.
No one said you had to read it in a single sitting, but yeah you need to read the whole thing. And new readers will quickly learn that. I did.
Huh, I thought the point of the post was to try and use the media 'lies' to cause a little cognitive dissonance in his readers, and show how the media is all about the message (narrative) and not about the truth. He was simply trying to highlight our biases.
I will say it's too bad this message got lost in all the ivermectin uncertainty.
Yes, some percentage of people will stop reading this before they get to the 'punchline' and come away with the wrong impression based on a partial read. And yes, a percentage of that percentage will even be people who aren't normally inclined to just skimming the headlines.
... but focusing only on the potential harms of the article's structure ignores its benefits - I think the piece is much more effective as is - I think a goal of this piece is to demonstrate how the vast majority of us are susceptible to believing selective reporting even if we think we aren't, and the current framing of the article is very good at that, in a way that I think a more 'up front' presentation of the facts wouldn't be.
And the more upfront version just wouldn't be as interesting, IMO, which means fewer people would read it, and it'd have less positive impact.
I'm sure it catches people in the act and that was Scott's intention! When Kahneman talks about system 1 and system 2, he would on several occasions force people to use their system 2's by tricking people who aren't. But Kahneman wasn't spreading fake news in doing so.
It's hard for Scott to achieve his intended effect without deceiving people. But a note saying "Be sure to read this in one sitting" would help. I'd include something like "Narrative 1", "Narrative 2", "Narrative 3" to start each section, which would clue people in while only somewhat undermining Scott's goals. And look, the title does something similar, albeit far more weakly.
Lying to people can be useful in teaching rationality. But in general, it's quite bad, and I think Scott should have erred on the side of not lying in this particular case. (And in general.)
Scott says "this story doesn’t make me feel smug and superior to everyone else". However in my case, it totally makes me feel smug and superior to everyone else. Seemingly ALL of the Republicans who populate my social media feeds were tripping over themselves to highlight Sequoyah Hospital's ***perfect*** debunking of the original story, and piled on with the fact that Dr. McElyea hasn't worked lately at that hospital, claiming that it made the debunking even more debunkier - e.g. I saw one Facebook denizen deducing from it that Dr. McElyea was therefore providing information that was out of date (!?!). Such positions could've made some sense if the original story had attached its specific claims to that particular hospital. "Too good to check" indeed. And some of them were indeed musing on that whole thing about not scrutinizing the stories that are all too convenient for one's preferred political faction. But in their case the checking that they skipped was just reading the articles that they're attacking - a whole lot easier than the checking that they expect from their opponents.
Meanwhile I knew all along that the original story was crap anyway. So I've got this situation where the only discernable difference between me and all those smelly people in my political outgroup is this horrendously dumb and hilariously stereotypical mistake that they all made. Yes, their mistake was pretty incidental to the particular real-world referent - but if they're all going to go around acting as if the real message here is about which political faction is more trustworthy, then OK fine, mine is.
Please correct me where I'm wrong:
1: Dr. McElyea had one hospital listed in his LinkedIn profile: Sequoyah Hospital
2: None of the articles with the "IVM overdoses flooding ERs" name a hospital
3: Noe one has come forward with any rural OK hospital whose ER is being overloaded by IVM overdosers
So, those people who you feel "smug and superior" towards:
1: Were correct: The story was bunk
2: Had support for the story from the most logical hospital to be connected to Dr. McElyea
3: Were not saying anything that was incorrect (which would be the case if, for example, he had meant a different hospital, and that different hospital did have an ER overflowing with IVM overdose cases)
So, what is it that you get to feel "smug and superior" about?
What is it that you know, of any importance, about this subject that they don't?
The thing that I know is that doctors sometimes work in multiple hospitals? (I think they also actually know this, but they've gone and twisted themselves into acting as if they don't know it). You also have here multiple sources (both the original story and the Sequoyah Hospital statement) pointing to this particular doctor working in multiple hospitals.
The Sequoyah Hospital statement gives you 2 facts: #1 that particular hospital doesn't have patients suffering from ivermectin mishaps, and #2 that particular doctor hasn't worked in that particular hospital for a while.
#1 deals a blow to the original story - a fatal one if you are also in a position to add certain other relevant knowledge. In my view the most likely correct response to #2 is to think nothing of it because #1 is dispositive anyway. Some people might reason their way into #2 opening the window at least a crack to restoring the validity of the original story. This is an error in my view, but that reasoning isn't ferkakte like treating #2 as an additional flaw in the original story. That seemingly must be coming from an excess of enthusiasm they have about their wonderful, joyous, blessed debunking.
Hmm. So, I agree with you about what the Sequoyah Hospital statement tells us. But I think you're missing connected implications
1: People read the initial claims, and looked up Dr. McElyea
2: His LinkedIn profile said he worked at Sequoyah Hospital
3: They connected Sequoyah Hospital to ask about all this
4: Sequoyah Hospital said, it's not happening here, and he hasn't worked here in a while, so we can't be the place he's talking about, assuming he isn't making up the story out of whole cloth
We agreed so far?
Add in:
5: None of the stories specify the hospital where this happened
6: As Deiseach pointed out, we have the recent total BS "story" of the medical person's Twitter post about holding the hands of young, healthy, unvaccinated people dying of Covid in Alabama
https://www.al.com/news/2021/07/im-sorry-but-its-too-late-alabama-doctor-on-treating-unvaccinated-dying-covid-patients.html
Combine these, and what do you get?
1: This appears to be another completely made up story
2: We don't even know that the guy has been working in an ER in the last couple of months, since the only hospital known to be connected to him says he hasn't worked there
Now, #2 can be refuted by providing the name of the hospital he was working at when he made those claims.
But until we've gotten a "yes, he worked in our ER last week, and yes, we did have to turn away gunshot victims because the ER was so full" from some hospital, the second part of the Sequoyah Hospital statement is evidence (not proof, but evidence) that every single part of his story (as provided to us by the left wing media) is false
And that's why your Republican Facebook friends were passing it around and gloating about it. Because "you can't beat something with nothing."
And, so far as I know, there is still no evidence (no named hospital willing to agree this happened) that his claim that "the ER was rejecting gunshot victims because it was too full" is even true.
Do you know of any such evidence?
When Obama since the ObamaCare bill into law, his staffers grabbed a bunch of people, and put them in lab coats, so that the press could claim that Obama was surrounded by a bunch of clapping doctors when he signed it into law.
So, when the press claims they have a doctor who is telling you this vitally important left wing talking point, those of us on the right start out with these questions:
1: Is this person in fact a doctor
2: Is this Dr a Dr in the relevant field (is he an ER doc?)
3: Could this Dr have actually had the experience he claimed to have (has he worked in an ER in the last week? month?)
4: If all the above is true, would the Dr be violating HIPPA, and putting himself at serious professional risk, by telling this story?
"How do you know what you think you know?"
When the answer to that is "because X told me so", you must then ask "could X possibly know that?"
The second half of the Sequoyah Hospital statement goes to #3:
When Obama SIGNED the ObamaCare bill
I would at least believe this post to a much greater extent (perhaps 10x or so) than I would believe claims from the other publications mentioned in this article, so it's clearly a strong step in the right direction (the fun part is where my initial confidence is like 5%, so 10*5% is still only 50%!)
"Did you believe that?"
My stomach dropped, my face got hot, and I started looking around my physical environment for some kind of excuse.
...Thank you for the experience points.
Way down the thread when discussing the various studies, someone asked what variant were they studying in Peru?
https://www.irishexaminer.com/news/arid-40389986.html
Turns out it's a new one - Lambda:
"This variant was first detected in Peru in December 2020 but was not considered a VoI by WHO until June 14 this year.
By April 2021, Peru reported that 81% of Covid cases sequenced were associated with Lambda.
To date, cases of Lambda have been reported in 40 countries around the world with the majority located in Peru, Chile and the US. It is now considered the dominant variant in Argentina, Chile and Colombia.
...Dr Maria Van Kerkhove, the WHO’s technical lead on Covid-19, said the organisation is tracking the strain as some have warned it could be more transmissible than the Delta variant."
Oh, and we've got Mu as well!
"Mu was designated a VoI by WHO on August 30 and has been reported in 45 countries to date.
Mu was first detected in Colombia in January 2021 and has since seen some sporadic reports of cases and some larger outbreaks reported in South America and Europe.
"Although the global prevalence of the Mu variant among sequenced cases has declined and is currently below 0.1%, the prevalence in Colombia (39%) and Ecuador (13%) has consistently increased," WHO said in its weekly Epidemiological Update."
And they've both turned up in Ireland, so more fun to come for the rest of the year.
I have found that the "Law of Rationalist Irony" tends to generalize. When I catch myself making a social judgement, it almost inevitably reflects how I am feeling about myself in the moment. So when I call someone stupid, I am usually feeling stupid, when I call someone selfish and mean, I am usually feeling selfish and mean, etc.
Curiously, I think this rationalist principle (or at least the principle combined with the injunction not to be like this) may be most succinctly expressed by the Bible verse, Matthew 7:4:
“Do not judge, so that you may not be judged. 2 For with the judgment you make you will be judged, and the measure you give will be the measure you get."
At least for me this advice has been surprisingly useful in avoiding the judgement trap.
IMHO, the right wing framing is much more correct.
The Rolling Stone twitter headline is "Gunshot victims left waiting as horse dewormer overdoses overwhelm Oklahoma hospitals, doctor says."
The addition of "doctor says" saves the statement from being literally false, but the fact is that horse dewormer overdoses are not overwhelming Oklahoma hospitals, and Rolling Stone didn't do the rudimentary fact checking that would have revealed that they weren't.
I first read the phrase "Too Good To Check: A Play In Three Acts" in the context of the Duke rape hoax ("A Rape on Campus'). That hoax also involved Rolling Stone. You would think they would learn. You would think...
That's the University of Virginia rape hoax, not Duke. The UVA rape hoax was Rolling Stone (at least primarily), while the longer ago Duke rape hoax, if I recall correctly, fully ensnared the entire mainstream media. You can look at it optimistically - the more recent one was somewhat more contained
Your are quite correct. I am mixing up my hoaxes. Of course, the real scandal is that real murders (Hannah Graham) have been ignored by media, while fake crimes have been given wall-to-wall publicity.
> That hoax also involved Rolling Stone. You would think they would learn. You would think...
I think they learned they can get away with it. That technically is a kind of learning...
This piece articulates why I feel stupid all the time
"Did you believe that?"
I DON'T KNOW ANYMORE
apropos comments downthread, there are several registered clinical trials or ivermectin use in treating Covid in the USA, and many more internationally. Most are recruiting: https://clinicaltrials.gov/
I think the underlying issue is that news organisations are incentivised for clicks not truth. As long is that is the case we won't get a truthful media.
I find it kind of weird that Scott hasn't yet looked into IVM and made a post about it. It seems like it's exactly his domain: a drug that has showed some promise and that has sparked controversy and confusion. How has he not done a piece on this?
Of course 70% of the hospitalized cases are using the vet formulation. I'm surprised it's not higher. No doubt many of the vaccine deniers are pure and simple(minded) cheapskates who won't pop for a doctor's visit to get a scrip. Especially since he may tell them they're loony. Is the human version more expensive, Damned if I actually know...just presumption on my part. Stuff we get for Sheila the dog is cheaper than similar for me.
Disclaimer: I withdraw the simpleminded term for commenters at my own blog who all are smart and well-educated enough to come up with truly complex excuses for copping out on vaccines. Some are even long-term friends. :-]. Hope none of them die.
I'm still left wondering how many people are trying ivermectin, and how many — in total numbers, not dodgy percentages — are ending up sick enough to report it.
When media outlets report that "Oklahoma hospitals are overwhelmed" by ivermectin poisoning cases and a regional hospital in the quoted physician's practice area issues a release saying it hasn't seen _any_ such cases, how is that in your view an "unrelated" hospital?
Why on earth didn't Rolling Stone or the Guardian (to pick two offenders) pick up the phone and confirm this startling information? Blaming "both sides" is pretty lame.
I had never heard of the Law of Rationalist Irony, but I love that framing as a way of curbing your biases. It certainly makes me wonder how many times I've fallen into that trap.
Oh, the punch line of this one hit me right in the face.