166 Comments

As a Twitter follower of just about everyone mentioned in this post and someone who is just trying to make sense of the data on promising early treatment options for Covid, I applaud you for this write-up. The combination of intellectual rigor, unemotional review of the data, and most of all the tone of respect in communication is admirable. We need more of this everywhere. Thank you for your efforts.

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I'm almost certain being able to have conversations like this will matters more than the issue at hand in the long run, and it's not like the issue is unimportant.

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Then why don't you answer questions people have about your article?

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Dec 16, 2021
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One response - "ROFL" - fits all comments?

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If the side effects are non-existent and/or manageable, and the only effect is placebo, it would be worth it for that effect alone, IMO.

But yes, the lack of large-scale IVM or HCQ trial by the many governments willing to spend $Bs on unproven vaccines flies in the face of ... well, sanity, to be honest.

There would be more than enough volunteers, that much is obvious.

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A few trials from the manufacturer: effective!!

30+ from independent sources: we need more studies.

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The double standards are indeed mind-boggling.

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Especially because Ivermectin is not contraindicated for any sub-group while the manufacture in the "blinded" trials mentions in a secret hard to read page breaked table in a supplementary index on safety and efficacy that their product will individually harm people who are infected and also help in spreading the virus at the population level as a result. Ivermectin has no such concerns.

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Update - Source for the claim that Pfizer trial showed people vulnerable to Infection will get infected even faster when injected. See Surveillance time and incidence rate for baseline Sars-cov-2 positive without and without antibodies on Page 12 of supplementary appendix of the six month Safety and efficacy followup published in NEJM.

Or read the hard the to read part here on my post. https://almostwrong.substack.com/p/what-if-the-negative-105-vaccine

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You are brilliant! Thanks for putting in the time. The biggest red flag in all of this— why is there such a concerted effort by so many people and organizations to demolish any virtue in ivermectin. It’s obvious that people won’t give ivermectin a chance, which is a signal that it can’t work for some conspiratorial purpose that I can’t name. One day we will understand why the Fauci cult of Covid 19 became such blind zealots.

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Side point, but you omitted from the litany of past self-owns GidMK's enthused gleeful promulgation of the transparently ridiculous Rolling Stone horse dewormer ICU hoax. We're dealing with bad faith gatekeepers for Project Vax, one who has published a couple of biased articles on Medium, one who's a demented Tim Pool stalker, and one who apparently aspires to debunk Vitamin D.

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This "war of the Alex's" is a lesson in debate, scientific and constructive thinking. And English. Thank you for the hard work you have put into this.

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Damn, this is such a good article! Perfect dissections of some of the same issues that I had with SlateStarCodex's article. A++

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I know nothing of Mr. Marinos or his background, but this essay suggests he's a natural philosopher, uncorrupted by ideology, who will deliver a reliable verdict once all the evidence is in. The contrast between his approach and that of some of the people whose positions he's doing his best to steel-man couldn't be starker. Unfortunately, their less scrupulous approach is more representative of the era, but the fact that Mr. Marinos has apparently found an audience is heartening.

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what exactly "uncorrupted by ideology" means?

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It's the philosophical enterprise that gets corrupted when ideology enters philosophy departments. Genuine truth pursuit requires a readiness to follow evidence wherever it leads. Ideological commitment requires subordinating evidence to the needs of a cause. Ideologues will sometimes debate with you in ways that seem 'philosophical;' but no matter how airtight your logic or persuasive your evidence, they aren't really open to being deflected away from the conclusions they know they have to reach. As with religious believers, it isn't ideologues' reason you're dealing with but their will: they will not understand you, or join any disinterested investigation that could threaten what's truly important to them.

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Ooorrrr.... maybe you're just plain wrong. Have you ever considered it? I mean, philosophically?

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Interrogating the foundations of my beliefs has been standard practice for me since the 1960s, cute little rodent. You should try it yourself sometime:

"The genuine inquirer wants to get to the truth of the matter that concerns him, whether or not that truth comports with what he believed at the outset of his investigation, and whether or not his acknowledgement of that truth is likely to get him tenure, or to make him rich, famous, or popular. So he is motivated to seek out and assess the worth of evidence and arguments thoroughly and impartially. This doesn't just mean that he will be hard-working; it is a matter, rather, of willingness to re-think, to re-appraise, to spend as long as it takes on the detail that might be fatal, to give as much thought to the last one percent as to the rest. The genuine inquirer will be ready to acknowledge, to himself as well as others, where his evidence and arguments seem shakiest, and his articulation of problem or solution vaguest. He will be willing to go with the evidence even to unpopular conclusions, and to welcome someone else’s having found the truth he was seeking. And, far from having a motive to obfuscate, he will try to see and explain things as clearly as he can."

--Susan Haack

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"Nan-in, a Japanese master during the Meiji era (1868-1912), recieved a university professor who came to inqure about Zen.

Nan-in served tea. He poured his visitor's cup full, and then kept on pouring.

The professor watched the overflow until he could no longer restrain himself. "It is overfull. No more will go in!"

"Like this cup," Nan-in said, "you are full of your own opinions and speculations. How can I show you Zen unless you first empty your up?”

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Great work Alex.

Like Alex, I don't consider myself on "Team Ivermectin". I obviously hope that Pfizer and Merck's new covid drugs are highly effective against covid.

I also agree with Alex that fundamental sensemaking is the most important issue here, and that Ivermectin is merely one of the more useful examples we have that illustrates the profound derangement of our current sensemaking, largely due to the information pollution committed by corpogov (the modern fusion of corporations and governments).

Here is my epistemic baseline with regard to Ivermectin. It is an old drug that has a well established strong safety record. If it even shows minor efficacy in treating covid, it's use is a no brainer. Full stop.

Further, it is a generic drug, and therefore there is *more* reason to trust data that shows its efficacy. This is an obvious heuristic, or at least it should be. When billions of dollars are at stake, we should expect grotesque derangement of public sensemaking. We should expect troll farms, sock puppets, and ghost written articles by "scientists" supporting billion dollar product X. That is where the incentives lie, unfortunately.

The coordinated campaign against Ivermectin was, and continues to be, amazing. We witnessed the FDA tweet propaganda that equated IVM with horse dewormer. We saw Rolling Stone publish a curious article that claimed that gunshot victims were being left to die because Emergency Departments were being overwhelmed by ivermectin overdoses. The article read as if it was penned by the current iteration of Operation Mockingbird, and was widely disseminated throughout the media landscape. We saw a Regime "comedian" "joke" that people taking "horse goo" should be refused medical care.

As for Ivermectin, we have a January 2021 study that examined 47 different drugs to assess their efficacy for inhibiting 3CLpro enzyme--a key protease used by SARS CoV-2 for viral replication.

https://www.nature.com/articles/s42003-020-01577-x

What did this study find? Ivermectin had the highest efficacy out of all the drugs tested for inhibition of 3CLpro.

What is the mechanism of action for Pfizer's new covid drug? Inhibition of 3CLpro.

Did Pfizer sensibly design their soon to be patented and released drug based on publicly and/or privately known data derived from research on Ivermectin?

I don't know, but it would have been a very logical thing to do.

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I am so heartened when I read the clarity of your thinking - and Alex's. The tide is turning. Rolling Stone, Colbert and much of the MSM were, years ago, beacons of intelligence and honesty. Good riddance to them. They are being supplanted by Substack and Rumble.

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I took the Rolling Stone article and FDA tweet as absolute proof that it had to have significant efficacy. Subtlety is not their strong suit.

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A mechanism! This explains a lot, and indicates why it's something to use in *early* treatment...

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Nice post!

I get the sense that the overall disagreement boils down to: Scott has the intuition that buying into IVM given the evidence he's seen would be proving too much, whereas Alexandros has the intuition that rejecting it would be an isolated demand for rigor.

And that might very well be fixed with backs and forths like this article; where Scott may learn that some of the evidence he didn't look at is important (the studies by GidMK or the other parallel lines of evidence other than formal studies that Scott probably didn't look into much); or where Scott gives Alexandros some better examples of similar levels of evidence in favour of obviously false things.

Also, wecome to here! And yes, this is a nicer place for rounded-up thoughts than a network of twitter threads (that I cannot even read properly on tweetdeck because of your shadowbanning or sth)

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great analysis. it is hard for me to understand why we throw everything at this virus, except safe alternative treatments. whatever we are seeing here coming out of the mic.. it is not competence and health nerd is a symptom of that.

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You're a breath of fresh air in the ether of madness we inquisitive lay people are feeling today. Please keep engaging so honestly. Your thoughts and conclusions are supporting so many of our desparate personal wars within the fog we are all trying so hard to navigate through.

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Re: trust in experts or doctors - I want to mention here Peter Attia (PA) and his podcast. I don't know if you listened to his podcasts or not, but they are very interesting in general. He's pushing the idea that we need to learn from the medical advances to live a life free of disease for as long as possible. His idea is that the goal is not to live longer (though it might be a side effect of life style changes), but to live a high quality life as long as possible. Now, fast forward, he invited Paul Offit (PO) this year in one of his podcasts to talk about vaccines in general, and the CV19 vaccines in particular. You probably know already that PO is an adept of CV19 vaccines, for kids as well (I do not want to go there). In the podcast PA mentioned his wife got the vaccine, then she went for an X-Ray, and they observed she had swollen lymph nodes. The radiologist mentioned that it is common for vaccinated women to have this issue. What struck me is that for an intelligent guy so preoccupied to be healthy in old age he and his wife chose to get vaccinated, and he kind of brushed off his wife's side effects. At that point I did not know whether I can trust him anymore. Well, I don't trust him... The damage is done. Does he genuinely believe the CV19 vaccines are good for one's health, or for his health or his wife's health? Is it possible that he lied in the podcast, and he and his wife didn't get the CV19 vaccine? Was he paid to promote the CV19 vaccines to his listeners base, and organize the interview with PO, who's a proponent of CV19 vaccines?

I have another example - Sam Harris. I recall vividly, when Wikileaks was about to dump HRC's & DNC's emails, Sam Harris tweeted something in the line "what can be interesting in these emails". Sorry, I cannot find his tweet (I tried to search for it but I could not find it), but it was an unusual comment coming from him. I always have seen him as a promoter of atheistic topics. Did he genuinely believe there was not going to be anything interesting in those emails? Can he be that dumb? Was he paid to follow an agenda? Either way, it cemented my idea that the guy cannot be trusted. I haven't listened to him recently. I know he got into meditation.

Same with these guys mentioned in the article (minus Scott, but the jury is still out), are they sincere? I doubt it. The fact that GidMK and his buddies didn't provide the data to support their point of views indicate to me that they are propagandists.

Ultimately, like you said in the article, a sane health authority would have explored all the other treatments, and it would have used them by now if there were indications that they work. Instead they took a different path, and here we are.

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I would like to add one point that may have relevance to the apparent mystery behind the coordinated campaign against ivermectin. The point is unoriginal, but it doesn’t seem to be raised much nowadays.

Pfizer is pushing for an Emergency Use Authorization for their new Covid drug, which has the same mechanism of action as has been demonstrated in studies by Ivermectin (3CL Protease inhibition).

From my reading of the EUA guidelines, it appears that an EUA would not be granted if there is a drug in the same class which shows efficacy.

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Nah it doesn't. But keep fooling you, bet it feels nice.

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"Nah it doesn't" could refer to:

- the existence of a "coordinated campaing against ivermectin"

- the implied equivalence between IVM and paxlovid

- the implication that IVM shows any efficacy as a treatment.

You chose the one it wasn't considered.

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there's obviously a coordinated campaign against ivermectin - the Rolling Stone article proves that.

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@steersman

Did you unironically link to the propaganda website “factcheck.org”?

This is from your website:

“Pfizer’s 3CL protease inhibitor is nothing like ivermectin,” Dr. David Boulware, an infectious disease specialist at the University of Minnesota, told us in an email.”

Well David, if it’s 3CL protease inhibition was achieved just like Ivermectin’s, then Pfizer couldn’t get a patent on the drug. Is this really the level of argumentation here?

Again, here’s a January 2021 study that examined 47 different drugs to assess their efficacy for inhibiting 3CLpro enzyme--the key protease used by SARS CoV-2 for viral replication.

https://www.nature.com/articles/s42003-020-01577-x

Ivermectin had the highest efficacy out of all the drugs tested for inhibition of 3CLpro.

Regardless of lab studies, real world data indicates its efficacy along with a long and significant safety record. But I guess if one just knows ahead of time that its just like “homeopathy” (whatever that means), then all the data in the world is meaningless, except the data that comes from pharmaceutical companies with billion dollar sized conflicts of interest.

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Aurelius,

“propaganda website” – you might be a bit less quick to judge a book by its cover.

However, in any case, thanks for the Nature link, although you might note a salient quote from it, to wit:

“Although the anti-viral activity of ivermectin mediated through the blocking of α/β1 importin is established [since 2011], herein we report the inhibitory effects of ivermectin on 3CLpro enzyme of SARS-CoV-2, suggesting additional anti-viral mechanism of ivermectin towards SARS-CoV-2.”

There are apparently two quite different anti-viral mechanisms in play – screwing with the “α/β1 importin” or with the “3-chymotrypsin like protease (3CLpro)”. However, different drugs require very different blood concentrations for their “enzymatic activity [IC50)”.

In particular, that Nature article specifies that ivermectin requires a level of 21.5 µM (which seems to correlate to a certain number of nanograms per millilitre [ng/ml], although I’m not sure of the exact numerical relationship) to have a significant effect on that 3CLpro. However, ivermectin has the same reduction on enzymatic activity [IC50] on the “α/β1 importin” at much lower levels – according to these NCBI articles (first one apparently referenced in the Nature article), somewhere in the vicinity of 2 µM:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3327999/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172803/

But as the latter emphasizes, that 2 µM level is itself some 10 to 20 times the “highest regulatory approved dose of ivermectin” in cases of river blindness which corresponds to a blood concentration level of 0.12–0.14 μM [about 110 ng/ml according to the 2nd article].

So that Nature study was using a level that was about 200 times that of the “highest regulatory approved dose” – likely to be rather toxic. Although the levels used in the Ivmmeta studies – possibly in the vicinity of a 1 µM level from what I can see – may have been sufficient to have at least some impact on the α/β1 importin mechanism and thereby on the survival of some patients studied.

Fairly decent article at the somewhat misnamed Science-Based Medicine – they seem to “think” that sexes are spectra – on the topic:

https://sciencebasedmedicine.org/pfizer-new-covid-19-protease-inhibitor-drug-is-not-just-repackaged-ivermectin/

A particular note that emphasizes my argument above:

“Spoiler alert: Ivermectin does inhibit the same protease that [Pfizer’s] PF-07321332 does, but, as is the case for viral replication, it requires a concentration that is not achievable by oral dosing.”

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As for Facebooks “fact-check.org” being an obvious propaganda website (and as far as I can tell, that goes for the whole lot of the Soviet-style genre)

About 15% of their assets are in Johnson and Johnson stock ($1.7 million).

https://greatgameindia.com/facebook-factcheck-funded-vaccine-lobby/

I notice that in your earlier comment you rolled your eyes at the mention that we are seeing a obviously coordinated campaign against Ivermectin.

Let’s check in on Dr Andrew Hill, who authored one of the meta-analyses on Ivermectin:

“Dr Lawrie asked Hill to explain his U-turn on ivermectin, which his own analysis found overwhelmingly effective. “How can you do this?” she inquired politely. “You are causing irreparable harm.” Hill explained that he was in a “tricky situation” because his sponsors had put pressure on him. Hill is a University of Liverpool virologist who serves as an adviser to Bill Gates and the Clinton Foundation. He told me his sponsor was Unitaid.

Unitaid is a quasi-governmental advocacy organisation funded by the Bill & Melinda Gates Foundation…

Hill: ‘Unitaid has a say in the conclusions of the paper. Yeah.’

Lawrie: ‘Okay. So, who is it in Unitaid, then? Who is giving you opinions on your evidence?’

Hill: ‘Well, it’s just the people there. I don’t . . .’

Lawrie: ‘So they have a say in your conclusions.’

Hill: ‘Yeah.’

https://roundingtheearth.substack.com/p/who-manages-unitaid-context-behind

Back to your comment.

Your argument against IVM with regard to covid relies upon arbitrary claims that *in the lab* supposedly efficacious blood levels of Ivermectin in the petri dish can’t be reached at maximum safe doses.

You didn’t address my point that

“Regardless of lab studies, real world data indicates its efficacy along with a long and significant safety record.”

Out of curiosity, what was the maximum safe dose for Pfizer’s mRNA vaccine?

Judging by the orders of magnitude greater adverse effects than all other prior vaccines combined—in the real world, *outside the lab*—it may be reasonable to suggest that they exceeded the maximum safe dose. Of course, when your vaccine relies upon the production of a (now) known-to-be endothelial toxin in spike protein, perhaps there is no “safe dose” at all- certainly not when weighed against the minuscule risk that covid and especially Omicron infection presents to healthy children, for example.

What is the maximum safe effective dose for Pfizer’s new covid drug?

Whatever Pfizer says it is.

I’m old enough to remember Merck's drug Vioxx, which has been estimated to have killed 40-50,000 people, for which Merck manipulated and hid data which indicated a 200-400% increased mortality rate in the drug group.

I wonder what the maximum safe dose of Vioxx was.

In closing:

“Not only did Merck produce a series of fake medical journals to promote Vioxx in Australia, but the articles were ghostwritten by doctors who deny they worked on them…”

https://www.cbsnews.com/news/docs-say-merck-placed-their-names-on-ghostwritten-vioxx-articles/

Obviously nothing like this is going on today, no way.

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Aurelius:

"obvious propaganda website": and, pray tell, what exactly have they said that is false?

Did you bother to read anything of what I'd posted? I more or less conceded that the Ivermectin levels in the Ivmmeta studies *could have been* high enough to account for the differences in outcomes. Even if the improvements don't seem to have been major or all that significant. You might try digging through the Ivmmeta studies and find out what levels of ivermectin were used and how they compare to doses used for things like river-blindness.

"real world data indicates its efficacy": the question, as I expended some effort trying to illustrate and summarize, is "efficacy" for which effects on which anti-viral mechanisms, and at what levels. There are some significant differences. And some evidence of significant toxic effects at higher than recommended doses:

https://www.medpagetoday.com/infectiousdisease/covid19/95162

"remember Merck's drug Vioxx": good point, something that Wikipedia confirms:

https://en.wikipedia.org/wiki/Merck_%26_Co.#Vioxx

You might note the closing paragraphs from that SBM article I linked:

"No one, least of all I, denies that large pharmaceutical companies have done some pretty shady things, but 'suppressing' ivermectin in favor of the Pfizer and Merck drugs does not appear to be one of them."

Someone once said:

"It is difficult to get a man to understand something when his salary depends upon his not understanding it.”

No doubt that is part of what is happening with Unitaid and maybe other drugs and organizations. But that hardly constitutes proof of covid vaccines being useless or worse than useless.

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There are many sources that indicate that the covid vaccines are useless or worse than useless with regard to Omicron.

Common sense would be the first source, as the inarguable toxic spike protein which is produced in utterly variable quantities by different individuals in response to the same dose of mRNA is the spike of the two year old extinct Wuhan strain.

Here is an excellent primer on the statistical manipulation which is simply and cleanly laid out by El Gato Malo:

https://boriquagato.substack.com/p/bayesian-datacrime-defining-vaccine

And a nice little recent vignette on how that manipulation plays out in real time:

https://metatron.substack.com/p/alberta-just-inadvertently-confessed

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Thanks for the links. But I think both of them have their thumbs on the scales or are rather careless, although one of them had a link to a website by Toby Young - he's written several essays for Quillette - that looks useful:

https://dailysceptic.org/about/

No doubt there's a lot of misinformation, and people misunderstanding or misinterpreting data. Not surprising given the complexity of the issue.

But it seems clear that it does take some time - anywhere from 10 to 14 days - for Covid vaccines - as with those for other diseases - to fully develop. See the Conversation article and the Science Direct article, including the graph of how long it takes for full immunity:

https://theconversation.com/how-long-do-covid-vaccines-take-to-start-working-161876

https://www.sciencedirect.com/science/article/pii/S2666634021001525

https://ars.els-cdn.com/content/image/1-s2.0-S2666634021001525-fx1_lrg.jpg

Why I think it probable that that Metatron article is out to lunch about the Alberta statistics, notably in arguing that "many events in the first 14 days were shifted from the vaccinated to the unvaccinated cohort." An argument and claim which I don't think the actual statistics justifies.

In particular, try looking at Table 6 and the rates per 100,000 for the 3 and 2 doses versus the unvaccinated:

https://www.alberta.ca/stats/covid-19-alberta-statistics.htm#vaccine-outcomes

Note the rates for the 30-59 age groups for the 2 dose versus the unvaccinated: anywhere from 10 to 20 times more likely for the unvaccinated to be hospitalized. Even worse in comparison to the triple-vaccinated.

And, as there are anywhere from 4 to 6 months intervals between 1 dose - which apparently aren't even included - the 2 dose, & the 3 dose groups, it seems unlikely that the unvaccinated numbers are greatly inflated. People in the 2 dose cohort, for example, who contract Covid within the first 14 days are likely to remain in the 1 dose cohort, and not be lumped in with the unvaccinated.

Though I'll concede that that may be somewhat moot - that information doesn't seem readily available on a quick skim.

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Last thing I will say, the shills can have the final say, and of course they will, again and again....

It is incredible how little attention has been paid to the fact that we have no fucking clue how much toxic spike protein each individual is producing in response to the same dose of mRNA.

No fucking clue.

It's as if we were dosing a new heart attack medication, and we just rolled the roulette wheel to determine how much of the drug each person was going to receive.

Beyond bonkers.

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Did you unironically refer to factcheck.org as a "propaganda website"?

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Indeed i did, shill.

And that's why comment sections of this nature end up being filled with propaganda from shills, while real people, the kind who don't get paid by Pharma's subsidiaries or the NGO/foundation umbrella army that includes propaganda websites like "factcheck.org", drop out.

It's also why these types of comment sections need to be heavily regulated, and imo only paid subscribers should be allowed to post. If the shill army wants to comment, at least they are then kicking in some cash to the author.

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And your evidence for that "propaganda websites" accusation is what? Something you've pulled out of your nether regions?

Looks pretty credible to me - even Wikipedia gives some evidence of that; for example:

"FactCheck.org also won a 2010 Sigma Delta Chi Award from the Society of Professional Journalists for reporting on deceptive claims made about the federal health care legislation."

https://en.wikipedia.org/wiki/FactCheck.org

And the Annenberg Foundation which funds FactCheck is likewise, funding, as it does, many PBS stations and programs:

https://en.wikipedia.org/wiki/Annenberg_Foundation

Think you're going to have to do better than what looks like little more than conspiracy theory and butthurt.

Though I'll concede that "Big Pharma" is not without a wart or two.

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These people will just say that Wikipedia is a propaganda website, and the website saying Wikipedia is reliable is also a propaganda website, and so on. It's Illuminati turtles all the way down.

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🙂 Certainly a lot of conspiracy theories floating about these days - moot whether they're more common on the left than the right.

And certainly far too many on both sides are far too quick to throw stones at Wikipedia - The People's Encyclopedia (tm). I often link to Natalie Wolchover's quite credible rebuttal on the topic at Live Science:

https://www.livescience.com/32950-how-accurate-is-wikipedia.html

Generally a great site that I periodically contribute to - not least for the ready accessibility to any number of topics, science and math in particular.

However, some evidence to think that their vaunted "neutral point of view" is pretty much dead in the water, particularly when it comes to the topic of sex and gender. ICYMI, my run-in with the "Star Chamber" there on that topic:

https://medium.com/@steersmann/wikipedias-lysenkoism-410901a22da2

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> Indeed i did, shill.

Clearly some high caliber critical thinking going on here.

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🙂 Guess it's a case of nobody complaining until it's their own ox that's getting gored ... 😉

Nice that there are sites like the Babylon Bee which are "equal-opportunity" mockers and knockers ...

https://babylonbee.com/news/joel-osteen-tests-positive-for-heresy

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"coordinated campaign" 🙄

As for the similarly untenable "same mechanism of action", see:

https://www.factcheck.org/2021/10/scicheck-merck-pfizer-covid-19-antivirals-different-from-ivermectin/

Ivermectin does, in fact, have some anti-viral effects. But those come from the fact that its target is "not a viral component, but a host protein important in intracellular transport". Entirely different chemistry from the Pfizer & Merck anti-virals under development.

But that kinda makes ivermectin somewhat toxic at the "half maximal inhibitory concentration" (IC50) level, and not particularly effective at the "highest regulatory approved dose of ivermectin" which is at least a thirtieth to a fiftieth less than that IC50:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172803/

Sure there may be, as the NCBI article suggests, some benefit in enhancing a person's immune system at those much lower levels. As it says, it may be "key to enabling the body's immune system to begin to mount the full antiviral response before the infection takes control." And that benefit may well contribute to *some* of the differences in the ivmmeta studies - even apart from the effects of possible worm infections.

But those benefits look to be marginal at best - entirely consistent with the concentration levels of recommended doses - and likely only to manifest themselves when the patient is more or less on death's doorstep.

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Under section 564 of the Federal Food, Drug, and Cosmetic Act (FD&C Act), when the Secretary of HHS declares that an emergency use authorization is appropriate, FDA may authorize unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by CBRN threat agents when certain criteria are met, **including there are no adequate, approved, and available alternatives.**”

https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization

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You can obviously go into huge complexity analysing all the studies, but if you stand back and look at the population data where ivm has been widely used (Japan, India, Mexico etc) those with an open mind should at least say “that looks interesting”. Add to that the number of front line doctors, the ones who are inclined to move away from fda etc dogma, who swear by early treatment using repurposed drugs in various combinations and claim they have virtually no deaths — do we think they are all liars? Give the problem with replication issues in the science world these real world anecdotes seem as powerful as anything.

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Jesus, that's the first time I saw Nick Brown's tweet equating vitamin d with crimes against humanity.

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"In fact, in a sane world, we’d have done the same for many of the substances on this list and probably a few more. This is real evidence that the public health establishment is indeed not acting sanely, and it does weigh on my ability to take them at their word on everything else they say on early treatment and beyond." No truer words than these !

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"I think of it as like the Large Hadron Collider. If the people who run the LHC ever become biased, we’re doomed, because there’s no way ordinary citizens can pool all of our small hadron colliders and get equally robust results."

I have in my background some Physics training and I know Scott doesn't because he wouldn't have assumed that Physicist just collude to announce results. In real empirical science, the hallmark is perpetual self-doubt. This is the reason why when the Higgs Boson signal was trying to be observed in 2012, the LHC had two teams looking the experiments independently without knowing the results of the other (CMS and ATLAS collaborations). They could still be wrong about their conclusions but they at least tried to not trick themselves. They might still have but the public is not required to believe anything about the Standard Model of Physics because findings made no impact on what we knew and didn't know. We still don't have a calculation that explains why the masses of whatever masses particles have, have that mass. It's just an empirical observation.

Most importantly, the whole world is not being asked to unquestionably obey orders based on experiments conducted by two adversarial teams!

Now, what if people in Infectious diseases and Medicine had the kind of skepticism and demand for empiricism that Physicists demand from each other?

Can any medical researcher confidently say that if we had teams in a blinded study where you do not know the status of the person you are collaborating with (vaccination status, support for specific infection prevention measures) and do no know what group is the treated group or untreated, that all teams will come-up with the exact same computational result as LHC scientists with Higgs Boson?

I really doubt that if experimentalists and data analysts were not suffering from grave conflicts of interest with respect to their own health/immunization status, and the policy positions of the funding agencies they write grants to, we would see such synonymous conclusions every single time.

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It is possible to achieve consensus on bounded matters like the data from the LHC. It is not possible with questions about ivermectin's efficacy. We crave simple ways of understanding like the equations of the standard model, for instance ivermectin cuts death rates from COVID by xx%. But every human being is unique and each of our circumstances is different and changing. The parameters are infinite and non linear.

That is the reason I trust a deep thinking doctor to treat my particular disease symptoms, NOT the policies developed by governmental agencies that are captured by big pharma $$$.

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I agree. Especially when aggregate level results are forced on the individual, it's crazy!

Imagine people being penalized in Death Valley, California for carry a water bottle or people in Alaska wearing a coat based on the aggregate observation that the west coast of North America is 75 degree Fahrenheit, therefore nobody should be wasting precious resource like water, or mink fur. It could be worse though, they could use the example of a person freezing to death in Alaska to encourage the people in and around Death Valley to wear a fur coat and then use the example of people dying from dehydration to tell people in Alaska that they must turn off the heat, and continuously rehydrate, even if the only form of h20 is ice. 4 gallons every hour.

I think ivermectin's or any treatment's efficacy can still be compared at the population level if we had done the same amount of fundamental work that Physics has had to over the past millennia to more stringently measure outcomes. But having looked at the literature in epidemiology, it's really not a hard science at all and frankly, if say solid state physicists were asked to redo everything, they'd come up with a far more clear and precise fundamental formulations improve the population level measurements at least. I mean, is it hard to derive a formula that incorporates stringent bounds on what the outcome of a population level mass intervention should be in order to measure effectiveness? I don't think so, it needs at the very minimum a simple conditions like the deployment may not increase the overall prevalence of the condition, it may not increase the morbidity without a corresponding decline in mortality, and it should not rely on adjustable criteria.

I wrote another reply on the topic: https://doyourownresearch.substack.com/p/a-conflict-of-blurred-visions/comment/3774916

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Put another way:

Ruling out benefit is hard at the individual level, this should be enough to justify the use of anything for any single individual.

Ruling in harm at the population level is not hard, detecting this should be enough to justify the prevention of mass deployment of something at the population level.

However, if we never build robust theories to measure this kind of population level harm, then we will never have ways to detect it, even if it's clearly present in the data. This is what I am worried about because we are fixated on ruling out harm at the individual level which is just impossible given how complicated you rightly mentioned the body and the interaction with the environment is. We will never be able to rule out harm for a person quickly enough, but we can easily rule in benefit at the population level and that should be sufficient to allow individuals to do what they want to help their situations.

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The beauty of this approach is that it never prevents an individual person from accessing that which they feel helps them - be it a specific vaccine, a specific drug, or a specific activity, and it also prevents the harmful effects of any individual choice to the population from being self-corrected by other individual choices in the population that compensate for that harm. Example: let's assume someone thinks a live attenuated virus is a good idea for them. And someone thinks Merck's pill is for them.

Their individual choices will not doom the entire population to a sub-optimal outcome as long as no restrictions are applied to people's ability to communicate, access, learn from the actions of others to revise their decisions in light of feedback. The moment we try to homogenize and restrict the population's individual choices, we leave everything down to luck, and then luck might run out.

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The most important difference being: whether we know all the questions and answers about particles, they still remain as are/ as would be, physics of the world will not be changed by what we know or do not know.

You cannot say this for Medicine: knowledge of what is or would be directly influences decisions of humans and on humans.

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Definitely. I'd add that sometimes misunderstandings about fundamental physics and fundamental limits in observation and measurement can obscure harms of engineering efforts if they are manifesting as second or third order effects in the future.

We really only catch the mistakes when it works so poorly that it's impossible to ignore causality. The most well known example that I can think of is the deployment of the Tsar Bomba by USSR, it "was more than 3,300 times as powerful as the atomic bomb that killed at least 70,000 people in Hiroshima". The untold part is that the calculations were off. The bomb exploded with a higher yield than the 100 petajoules or whatever was expected. How could that be? We don't know for sure, but it could be for many reasons including but not limited to (1) Einsteins mass energy equivalence is only approximately correct and that pushing the limits ends up exposing the errors non-linearly. (2) something was wrong with the engineering assumptions (3) and measurements and how enriched the radioactive material was or (4) thermonuclear reaction is an incorrect (or approximately correct) theory and nuclear fusion never happens, something else happens that we don't know that's more complicated and our models are currently incapable of grasping that.

I'll quote a passage from the BBC:

Tsar Bomba detonated at 11:32, Moscow time. In a flash, the bomb created a fireball five miles wide. The fireball pulsed upwards from the force of its own shockwave. The flash could be seen from 1,000km (630 miles) away.

The bomb’s mushroom cloud soared to 64km (40 miles) high, with its cap spreading outwards until it stretched nearly 100km (63 miles) from end to end. It must have been, from a very far distance perhaps, an awe-inspiring sight.

On Novaya Zemlya, the effects were catastrophic. In the village of Severny, some 55km (34 miles) from Ground Zero, all houses were completely destroyed (this is the equivalent to Gatwick airport being destroyed by a bomb that had fallen on Central London). In Soviet districts hundreds of miles from the blast zone, damage of all kinds – houses collapsing, roofs falling in, damage to doors, windows shattering – were reported. Radio communications were disrupted for more than an hour.

This mock-up of Tsar Bomba show's the weapon's enormous size (Credit: Science Photo Library)

This mock-up of Tsar Bomba show's the weapon's enormous size (Credit: Science Photo Library)

Durovtsev’s Tupolev was lucky to survive; the blast wave from Tsar Bomba caused the giant bomber to plummet more than 1,000m (3,300ft) before the pilot could regain control.

One Soviet cameraman who witnessed the detonation said:

“The clouds beneath the aircraft and in the distance were lit up by the powerful flash. The sea of light spread under the hatch and even clouds began to glow and became transparent. At that moment, our aircraft emerged from between two cloud layers and down below in the gap a huge bright orange ball was emerging. The ball was powerful and arrogant like Jupiter. Slowly and silently it crept upwards... Having broken through the thick layer of clouds it kept growing. It seemed to suck the whole Earth into it. The spectacle was fantastic, unreal, supernatural.”

Tsar Bomba unleashed almost unbelievable energy – now widely agreed to be in the order of 57 megatons, or 57 million tons of TNT. That is more than 1,500 times that of the Hiroshima and Nagasaki bombs combined, and 10 times more powerful than all the munitions expended during World War Two. Sensors registered the bomb’s blast wave orbiting the Earth not once, not twice, but three times."

Already, people cannot agree about the yield from the bomb but the fact that it blew away many villages and that's after the adjustment to the total weight of the payload was cut to half to allow the bombers a 50% chance of escape from the shockwave itself!

Notice, you'd think that this does effect the modern world but it absolutely does because in 2015 they found that the regions around where the bomb was dropped had a background radioactive radiation of as much as 130x greater than average.

We use nuclear fission for nuclear power, but every single attempt since the 1960's to create nuclear fusion power has failed. As my Physics professor at university would joke: "We are always five more years away from cold fusion". A dig at how poorly some of our best attempts at engineering something useful from our theories about mass energy equivalences have worked out.

Not being able to calculate mass from a theoretical standpoint is absolutely fundamental because we rely on equations to inform us about what we will get experimentally from utilizing something. These equations could be wrong and we wouldn't be able to detect it unless we really messed up. Imagine if a drone existed that could autonomously drop miniaturized thermonuclear bombs, then we would have eliminated the harm self-limiting "our pilots needs to be away from the fallout of our experiments" clause. Elon Musk understands these risks when he talks about us slowly incorporating in-situ algorithmic artificial intelligence to assist and self-correct our predictive failures in real-time. But he's also jokingly proposed nuking Mars. The only reason why can't harm ourselves with our bad calculations from Fundamental Physics is simply because we haven't yet engineered a way to do so yet, so every mistake is costly and clear and immediate. (Example: Facebooks satellite launch failure).

This may not be so in the future, and I used to think when I was involved in experiments that Physics is far more filled with unexplained, voodoo stuff that just seems to work for no good reason, than we want to acknowledge...so we start inventing mythologies and stories and models to explain it. I used to naively think medicine is probably a "realer" science because every mistake is far more costly and easy to observe.

I was so wrong. Medicine is actually far worse than physics and the only reason why it couldn't be as harmful as mistakes from Physics is because we could scalably deploy those mistakes before we'd detect them. This is the case right now. The only reason this pandemic hasn't reached its crescendo is because we've not found the means yet to mass deploy a bad calculation before we can detect it. If the process is sufficiently slow, there is never a strong enough signal to prove causality. But will this be the case forever?

No. I've learned through this pandemic that the basic work that any field needs to do for it to be real empirical science leading to engineering and then measuring outcome is totally lacking in Medicine and health. In physics, the wrong mass calculation has lead to admitting many mistakes like "the worst calculation in the history of science" when the zero point energy calculated from a specific quantum field theory was off by 120 orders of magnitude when we tried to detect it in space in the early part of the century. That's a mistake that's so big, that if we had tried to incorporate such a theory into our daily lives through engineering before checking if it's true, we wouldn't have single laser beam work. You can forget about any light based communication.

But I've found that in medicine, we don't have to check anything. The equivalent of this kind of mistake in Physics would be: LHC scientists announcing that we have to change the SI units to fix a negative mass problem (due to dark matter in the universe being 25x more than our calculation). And then we use this new formula and suddenly we have UV light being released from lights that were supposed to be microwave length and the resulting cancer is being treated by radiation therapy where the computer calculates 25x smaller photon emission and burns every patient that comes under the treatment table.

The medical community wouldn't tell you that something is wrong, they will say, the cancer rates are going up because people are not showing up for x-ray and mir screening sooner. They will be burned again. All because these instruments depend upon empirical observations, statistically fit into equations that are approximate enough that they just work well enough to not cause greater harm than we can reasonably ignore.

This is the scary truth. The pandemic is just exposing something that's always been difficult about human understanding informing our efforts to engineer solutions and then be able to check if our solutions worked or not. This is easy in programming and computing in general because we just know when the program fails and it's not because of a "variant" that can't be addressed. It's much harder outside of IT because we simply haven't developed means to trace our errors. This asymmetry favors the bold and the reckless more than the doubtful and skeptical because our instinct is to trust boldness as we implicitly assume that confidence must come from knowledge and experience.

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