As a physician with MPH and MS degrees in evidence-based medicine, medical informatics, and biostatistics, I totally agree with you critique of other "expert" analyses in substack. As you suggested, I downloaded and read the study. This RCT was a poor quality study, IMHO, with 12 different treatment centers for the 679 patients who received IVM and with no analysis of secondary outcomes like adverse events or death. I am happy to see the breadth of your analytic critique. Your critique is very much on-point.
The value of RCTs are over-rated since they generally are restricted to early outcomes and do not evaluate late events like adverse events, long-COVID type of events, and events associated with vaccination, which was not even addressed in this RCT analysis. It is truly sad that so many people do not read these studies or have the expertise to critique them. Medicine is a very complex science that is often over-simplified in critiques I have read from others.
I also read a substack today where the author has previously expressed bias against IVM and clearly regurgitated something today that he read regarding this particular study. I’m not very good at data and statistics and I know people easily can use these to mislead people. In this particular study, the method seemed quite flawed for the reasons you stated. Also, as a provider, I don’t prescribe IVM without also making sure the patient is in zinc, and vitamin c and d3. Also, if they have Comorbid conditions, their prescribed dose is higher and generally IVM Is prescribed for 5 - 7 days, not three. IVM is also supposed to be taken with food. ( perhaps you mentioned this). It’s good to read and try to discern truth. I’m so skeptical about everything!
Your rant is completely judtified. I know this because I thought the exact same thing when I saw Berenson's bizarre post. He clearly hadn't read the thing in his rush to troll his own readers. He has a strange anti-ivm and anti-Robert Malone bent that undermines his credibility. His last anti-ivm post was actually embarrassing because the intro or abstract contradicted the actual contents of the paper, probably so it could get published. Even the lovely Jessica Rose was kind enough to try emailing to explain, but Alex is pervious to introspection. I cancelled by subscription. (I do understand these topics, being both an economist and a homemaker. 🙃)
We are fortunate in this day and age to have fairly easy access to studies and the ability to spend as much time as we need to review and think about them. Since COVID came to call, my time has been spent reading and researching as much as possible about the REAL science. Needless to say, I have few friends left and even though they know I was a scientist they ignore and cancel me. Now, some of my friends are victims of the jab. It is all so very sad. At least I know I'm in good and educated company here. Thank you for all your wonderful postings and for you caring rants. From an old broad, NEVER EVER apologize for giving a damn!!!!
Apropos of your excellent rant, a life-simplification strategy of mine is to forever ignore anyone I discover lying to me. I also only consume news from unfamiliar sources by reading. I never watch or listen because it goes by too quickly for me to dependably catch initial lies upon which false conclusions would be based.
I've observed that most people who write lies will include many of them in the first paragraph or two, and this strategy means I can stop reading immediately thereafter. It's irrelevant to me if they write for a self-declared newspaper of record, work for a major university, or if they've won a Pulitzer or Nobel. If I catch them lying, I have carte blanche to ignore their entire life's work. It's better to be uninformed than misinformed, because it's far easier to be fooled than to accept that you had been fooled previously.
No lies is an exceptionally high bar, and the resulting rejection of most people allows me to focus my highest-quality energy, attention and loyalty only on truly good people. It also makes me a better person, since I strive--in interactions with good people--always to satisfy my own standard.
Maybe the best part is you are not reliant on "expert" advice from anyone else, not even to bootstrap your list of good people. You can build your own list one by one, as your growing experience soon makes the process easy and quick. You need only discover one lie from any given person to reject them, and every time you do that, it improves the efficiency, effectiveness, and enjoyment of your life.
This study is yet another study designed to fail. The dosage is less than recommended, for a shorter period of time than recommended starting later than recommended. A large number of participants being eliminated or not following up. Gee, what's not to like here?
Appreciate the comments on statistical significance vs clinical significance
I'm mulling over intellectual laziness and contributing factors of perhaps gatekeeping and credentialism and an educational structure (indoctrination?) for many people that always had an authority figure who purportedly knew the answers, and applying that to other areas of life. I also wonder if for example right now you're 60ish, didn't get your degree in anywhere near the kinds of fields that have you reading research, having flagging energy levels, how driven and competent you feel to tackle digging into studies versus outsourcing conclusions to "trustworthy sources" (my SO's and my struggle to talk in any depth about these kinds of topics to our parents).
On the topic of double blind RCTs and statistical versus clinical significance, I'm glad to have gotten into nutrition as an interest. It became clear there have to be other ways to glean what might be impactful because you can't double blind and randomize people's medium and long term eating habits, and small sample sizes of people with certain chronic illnesses having vastly different results against what is well understood to be the baseline outcomes of that disease (QoL/functional disability, life expectancy, etc) shows the clinical versus statistical significance difference clearly.
“It is also wrong that the government, through main stream media is picking winners and losers, in terms of what science is deemed worthy or even allowed to be presented. The media now presents data and public health policies, which our government approves of as fait accompli. No scientific discussion or dissent allowed. This is not how good science works. Let me restate that. This is not how the scientific process works. This is how “totalitarism” works.”
While there may be problems in the pro-Ivermectin studies, in my opinion any mistakes made were not intentional and parts of many of those studies can still be used in a meta-analysis. By contrast, the anti-ivermectin studies were purposely designed to fail. It seems to me that there has been a concerted effort from the earliest days of the pandemic to deny that any early treatment options using re-purposed medications are effective. Look, for example, at the early hydroxychloroquine trials using near-lethal doses to convince the public that a 65 year-old drug with a proven track record wasn’t safe.
At this point, the American public has been told so many lies by the 3 letter govt agencies, the media and the medical establishment, I don’t think there is any trust at all in the COVID information published.
Consider this (these are CDC statistics): there are 258 Million people in this country over the age of 18. 88% of those people got an initial vaccination shot, but only 75% ended up becoming fully vaccinated. So there was a high level of trust when the govt first said the shots were “safe and effective” but a significant number of people (13%) already lost faith before they got their second shot.
Now, despite being urged to get boosters, only 94 Million of 18+ year-olds (36%) have gotten boosters. That tells me that 64% of the population no longer trusts their government or their doctors on this issue. I’m open to other interpretations of this data, but I don’t see any other logical explanation.
Answer: generally, no, they don't, they only read headlines and, even if they do read studies, apparently the art of critical review is virtually lost, even, it sears me to say, among those *I trained in it!*
Appreciated the rant. Also just found this stack. I subscribe to Robert Malone who had some instructions in one of his stacks on how to read a study. The problem with education vs intelligence is language. Scientific language...words, sentence formation, acronyms ect. Someone with a significant science education can, if he chooses, read a study with a critical eye. Intelligent people have to acquire that ability and that takes time and significant self discipline, especially if someone's innate intelligence is more right brained. In any case that is why I subscribe to substack authors that can do some interpreting for me. I get a variety of different interpretations that I feel keep me honest. For example, you. I find you to be easy to understand and honest. I found Alex to have a great communication style but canceled because of his attacks on Robert Malone. The first time I wrote off as professional jealousy. Then he seemed to 'interpret' the ivermectin study with glee as it undermined the 'competition' and that was a bridge to far. I love reading Brian Mowry but am constantly asking for a translation and/or needing to read several times. I tend to side with Igor and bad cattude on oas but am open. 'Emperor' finds and publishes studies both pro and con the issue in spite of his personal bias and I respect that. Then there are the philosophers and the politicians. All over the world intelligent dialogue about the real world consequences of the abuse of science to undermine our liberties. I love substack. Bottom line...people have seen "the" science as objective and concrete. We were taught to trust that. But science is a journey more than a fact. Scientists are human beings with agendas, egos and bias. When people understand that, they will begin to use proper analysis. For huge numbers of people the door is now opened. The light is on and thanks to people like you the journey has begun.
Thank you for this thoughtful analysis, this study is already making its way through casual conversations and is a helpful reference to share! This medication is a hot topic (everyone gets to have an opinion with limited information) and unfortunately bypasses the nuance of clinical care applied in nearly every appointment which weighs risk vs benefit for treatment (this medication reflects low risk, possible benefit) and cost of treatment (low cost ranks high!). I wish i could underline cost to emphasize this aspect but substack comment doesn't permit me to, sign...
This is not the first South American ivermectin trial that invited placebo deviation in advance (using the Table 3 value to infer deviation, not the Table 2 value), and then achieved apparent equal results on the other end, and also had to change the endpoint due to the first endpoint not panning out (the other being Lopez-Medina et al.). A "shame" since TOGETHER is designed to make innovative treatment research more robust, but the design still breaks apart as soon as they drive it off the lot. But also predictable. Sports and video games don't require trials to figure out how to optimize approach. Medicine shouldn't either. A scoring system and some crowdsourcing, done.
Still, it's interesting that there were such high rates of ER / hospitalization, assuming lots of the placebo group snuck in their own ivm as well. But maybe it should be compared to the more tightly-controlled Malaysia study, which had even higher rates, implying the real improvement was ~10%. What a mess, either way.
As a physician with MPH and MS degrees in evidence-based medicine, medical informatics, and biostatistics, I totally agree with you critique of other "expert" analyses in substack. As you suggested, I downloaded and read the study. This RCT was a poor quality study, IMHO, with 12 different treatment centers for the 679 patients who received IVM and with no analysis of secondary outcomes like adverse events or death. I am happy to see the breadth of your analytic critique. Your critique is very much on-point.
The value of RCTs are over-rated since they generally are restricted to early outcomes and do not evaluate late events like adverse events, long-COVID type of events, and events associated with vaccination, which was not even addressed in this RCT analysis. It is truly sad that so many people do not read these studies or have the expertise to critique them. Medicine is a very complex science that is often over-simplified in critiques I have read from others.
Thank your for your thoughtful input.
I also read a substack today where the author has previously expressed bias against IVM and clearly regurgitated something today that he read regarding this particular study. I’m not very good at data and statistics and I know people easily can use these to mislead people. In this particular study, the method seemed quite flawed for the reasons you stated. Also, as a provider, I don’t prescribe IVM without also making sure the patient is in zinc, and vitamin c and d3. Also, if they have Comorbid conditions, their prescribed dose is higher and generally IVM Is prescribed for 5 - 7 days, not three. IVM is also supposed to be taken with food. ( perhaps you mentioned this). It’s good to read and try to discern truth. I’m so skeptical about everything!
Your rant is completely judtified. I know this because I thought the exact same thing when I saw Berenson's bizarre post. He clearly hadn't read the thing in his rush to troll his own readers. He has a strange anti-ivm and anti-Robert Malone bent that undermines his credibility. His last anti-ivm post was actually embarrassing because the intro or abstract contradicted the actual contents of the paper, probably so it could get published. Even the lovely Jessica Rose was kind enough to try emailing to explain, but Alex is pervious to introspection. I cancelled by subscription. (I do understand these topics, being both an economist and a homemaker. 🙃)
We are fortunate in this day and age to have fairly easy access to studies and the ability to spend as much time as we need to review and think about them. Since COVID came to call, my time has been spent reading and researching as much as possible about the REAL science. Needless to say, I have few friends left and even though they know I was a scientist they ignore and cancel me. Now, some of my friends are victims of the jab. It is all so very sad. At least I know I'm in good and educated company here. Thank you for all your wonderful postings and for you caring rants. From an old broad, NEVER EVER apologize for giving a damn!!!!
Apropos of your excellent rant, a life-simplification strategy of mine is to forever ignore anyone I discover lying to me. I also only consume news from unfamiliar sources by reading. I never watch or listen because it goes by too quickly for me to dependably catch initial lies upon which false conclusions would be based.
I've observed that most people who write lies will include many of them in the first paragraph or two, and this strategy means I can stop reading immediately thereafter. It's irrelevant to me if they write for a self-declared newspaper of record, work for a major university, or if they've won a Pulitzer or Nobel. If I catch them lying, I have carte blanche to ignore their entire life's work. It's better to be uninformed than misinformed, because it's far easier to be fooled than to accept that you had been fooled previously.
No lies is an exceptionally high bar, and the resulting rejection of most people allows me to focus my highest-quality energy, attention and loyalty only on truly good people. It also makes me a better person, since I strive--in interactions with good people--always to satisfy my own standard.
Maybe the best part is you are not reliant on "expert" advice from anyone else, not even to bootstrap your list of good people. You can build your own list one by one, as your growing experience soon makes the process easy and quick. You need only discover one lie from any given person to reject them, and every time you do that, it improves the efficiency, effectiveness, and enjoyment of your life.
Thanks, I love your work.
This study is yet another study designed to fail. The dosage is less than recommended, for a shorter period of time than recommended starting later than recommended. A large number of participants being eliminated or not following up. Gee, what's not to like here?
Appreciate the comments on statistical significance vs clinical significance
I'm mulling over intellectual laziness and contributing factors of perhaps gatekeeping and credentialism and an educational structure (indoctrination?) for many people that always had an authority figure who purportedly knew the answers, and applying that to other areas of life. I also wonder if for example right now you're 60ish, didn't get your degree in anywhere near the kinds of fields that have you reading research, having flagging energy levels, how driven and competent you feel to tackle digging into studies versus outsourcing conclusions to "trustworthy sources" (my SO's and my struggle to talk in any depth about these kinds of topics to our parents).
On the topic of double blind RCTs and statistical versus clinical significance, I'm glad to have gotten into nutrition as an interest. It became clear there have to be other ways to glean what might be impactful because you can't double blind and randomize people's medium and long term eating habits, and small sample sizes of people with certain chronic illnesses having vastly different results against what is well understood to be the baseline outcomes of that disease (QoL/functional disability, life expectancy, etc) shows the clinical versus statistical significance difference clearly.
This is from Dr. Malone’s Substack column today:
“It is also wrong that the government, through main stream media is picking winners and losers, in terms of what science is deemed worthy or even allowed to be presented. The media now presents data and public health policies, which our government approves of as fait accompli. No scientific discussion or dissent allowed. This is not how good science works. Let me restate that. This is not how the scientific process works. This is how “totalitarism” works.”
While there may be problems in the pro-Ivermectin studies, in my opinion any mistakes made were not intentional and parts of many of those studies can still be used in a meta-analysis. By contrast, the anti-ivermectin studies were purposely designed to fail. It seems to me that there has been a concerted effort from the earliest days of the pandemic to deny that any early treatment options using re-purposed medications are effective. Look, for example, at the early hydroxychloroquine trials using near-lethal doses to convince the public that a 65 year-old drug with a proven track record wasn’t safe.
At this point, the American public has been told so many lies by the 3 letter govt agencies, the media and the medical establishment, I don’t think there is any trust at all in the COVID information published.
Consider this (these are CDC statistics): there are 258 Million people in this country over the age of 18. 88% of those people got an initial vaccination shot, but only 75% ended up becoming fully vaccinated. So there was a high level of trust when the govt first said the shots were “safe and effective” but a significant number of people (13%) already lost faith before they got their second shot.
Now, despite being urged to get boosters, only 94 Million of 18+ year-olds (36%) have gotten boosters. That tells me that 64% of the population no longer trusts their government or their doctors on this issue. I’m open to other interpretations of this data, but I don’t see any other logical explanation.
Excellent writeup and opinion. Agree 100%.
Posted on Gab to my timeline:
https://gab.com/rebellium/posts/108057984620217956
Answer: generally, no, they don't, they only read headlines and, even if they do read studies, apparently the art of critical review is virtually lost, even, it sears me to say, among those *I trained in it!*
Appreciated the rant. Also just found this stack. I subscribe to Robert Malone who had some instructions in one of his stacks on how to read a study. The problem with education vs intelligence is language. Scientific language...words, sentence formation, acronyms ect. Someone with a significant science education can, if he chooses, read a study with a critical eye. Intelligent people have to acquire that ability and that takes time and significant self discipline, especially if someone's innate intelligence is more right brained. In any case that is why I subscribe to substack authors that can do some interpreting for me. I get a variety of different interpretations that I feel keep me honest. For example, you. I find you to be easy to understand and honest. I found Alex to have a great communication style but canceled because of his attacks on Robert Malone. The first time I wrote off as professional jealousy. Then he seemed to 'interpret' the ivermectin study with glee as it undermined the 'competition' and that was a bridge to far. I love reading Brian Mowry but am constantly asking for a translation and/or needing to read several times. I tend to side with Igor and bad cattude on oas but am open. 'Emperor' finds and publishes studies both pro and con the issue in spite of his personal bias and I respect that. Then there are the philosophers and the politicians. All over the world intelligent dialogue about the real world consequences of the abuse of science to undermine our liberties. I love substack. Bottom line...people have seen "the" science as objective and concrete. We were taught to trust that. But science is a journey more than a fact. Scientists are human beings with agendas, egos and bias. When people understand that, they will begin to use proper analysis. For huge numbers of people the door is now opened. The light is on and thanks to people like you the journey has begun.
Thank you for this thoughtful analysis, this study is already making its way through casual conversations and is a helpful reference to share! This medication is a hot topic (everyone gets to have an opinion with limited information) and unfortunately bypasses the nuance of clinical care applied in nearly every appointment which weighs risk vs benefit for treatment (this medication reflects low risk, possible benefit) and cost of treatment (low cost ranks high!). I wish i could underline cost to emphasize this aspect but substack comment doesn't permit me to, sign...
I KNOW!!!!!
I note that in the figure (figure 2), every single confidence interval crosses 1! Nuff said?
This is not the first South American ivermectin trial that invited placebo deviation in advance (using the Table 3 value to infer deviation, not the Table 2 value), and then achieved apparent equal results on the other end, and also had to change the endpoint due to the first endpoint not panning out (the other being Lopez-Medina et al.). A "shame" since TOGETHER is designed to make innovative treatment research more robust, but the design still breaks apart as soon as they drive it off the lot. But also predictable. Sports and video games don't require trials to figure out how to optimize approach. Medicine shouldn't either. A scoring system and some crowdsourcing, done.
Still, it's interesting that there were such high rates of ER / hospitalization, assuming lots of the placebo group snuck in their own ivm as well. But maybe it should be compared to the more tightly-controlled Malaysia study, which had even higher rates, implying the real improvement was ~10%. What a mess, either way.