This is a public peer review of Scott Alexander’s essay on ivermectin, of which this is the third part (though it was written before the rest of the series).
Flavio Cadegiani is a brave and competent doctor. His researches on anti androgens have saved thousands of lives. He has brought the paper’s raw data to light since day one. Anyone can check on this. Sadly his case is one more on the high pile of infamous aggressions doctors that dared to treat covid patients have suffered. The truth will prevail.
Scott's comments are an example of how discourse has gone on for the last two years. A rumour, whisper in someone's ear, and you go get the Brand Name Pfizer vaccine because it is safe. Except that if the same gimlet eye was trained on what they did, these other people would look like angels.
Welcome to the real world. In a situation requiring fast response in the face of uncertainty, it is the lack of correction from feedback that is the killer, literally.
The whole of the establishment from top to bottom desperately wanted a tidy solution, and damned if they weren't going to control whatever needing control to get it. Whether it really worked or not.
This is normal, this is how everything works, in every domain. Most of the time it really doesn't matter. My objection to the vaccines or whatever was the ridiculous notion that everyone should do the same thing. 9 out of 10 things won't work, so you don't give one thing to everyone.
1. Media has largely failed, perhaps due to a combination of the internet, social media incentives, growing government size politicizing media, etc.
2. Rationalists come along and say, "Well, we don't know how to fix media, but we do have an alternative of rationalism."
3. Most humans -- even self-proclaimed rationalists -- struggle to interpret a fire-hose of straight data, science, and theory (what rationalism offers), so they want a journalist to simplify things for them and write in an emotional, humorous, and clever way.
4. Scott finds his niche. He's smarter than journalists so he can use the tools of rationalists, and he has the natural word artistry of a journalist.
5. Except that Scott isn't doing real journalism, but instead doing some sort of concoction of half-rationalism and half-sensationalist journalism (the picture caption of Cadegiani alone proves that). Scott didn't seem to do the most basic journalistic acts of contacting Cadegiani for comment.
If that's right, then I think there is a huge market for someone to combine rationalism and good journalism, and outcompete grifters like Scott.
I'm not pressing "like" only because of the word grifter, though I certainly understand the exasperation and I agree with most of the rest of what you wrote.
Totally understand and I don't want to drag you into something, so I'm not at all offended if you don't like any of my comments.
I used that word because when he's being paid so much money and instead of diving deeper into the legitimate concerns on his ivermectin article -- dramatically important stuff -- he's posting articles about "AI scaling", I find his heuristics in choosing topics for the money his readers are giving him to be manipulative.
At least I comend you for being even handed. You were upset at me for the cognitive dissonance comment, but given that your reaction does not seem to be biased in one direction or another, I now understand that you were speaking your mind honestly.
yes, my only question is "What's in it for him?" Maybe someone knows the answer to that. Or is just simply he thinks he'll get a good resume (temporarily) doing stuff like this?
I doubt this happens at any conscious level. It would be predictable that someone like Scott would be the first entry to fill this market demand. It takes significant effort to accomplish both good rationalism and good journalism. Scott approximates both to some degree and has no significant competition.
TheZvi fits better that description of trying to fill a niche of journalist/rationalist. Scott writes about what he's been writing about all his blogging life, which was whatever was on his mind those days. Sometimes it's important stuff, sometimes it isn't; sometimes its current events, sometimes not; often it's non-fiction, sometimes fiction.
Several of his relatives are well established in the medical industry. What's good for the family business is good for Scott Siskind, no matter if it's bad for the public.
I generally don't find conflict of interest arguments to be slam dunk, nevermind ones about one's extended family. There might be some internalized perspective there, but he should be allowed to have an opinion, bad as this one is, no matter what his relatives do.
Certainly Dr. Siskind has every right to his opinion. Nevertheless there has been an alignment of mainstream medical personalities, and the rank-and-file, against what I see as a rational multi-pronged SARS-2 response: indoor air purification, immune-boosting prophylaxis, early treatment, protection of the vulnerable whether in LTC or at home, maintenance of the small business economy. When the U.S. federal and most of the state governments failed to approach the problem with these rational steps, I became radicalized.
Having worked and lived in several institutional settings where a local "deep state" was in actual control pursuing ends that were not good for the majority, by mid-2020 I became crimson-pilled, redder than red. I am beyond the psychological point where I wish to give the benefit of the doubt. Having watched some of your interviews, I think you go to extremes of fair-mindedness. Perhaps that is innate with you, or you haven't experienced much duplicity in face-to-face aspects of life, or giving an opponent the benefit of the doubt is tactically wise in your opinion.
After the several prolonged experiences of my not being suspicious enough of those with power, I came to see the world as populated mostly by knaves and fools. Perhaps your readers would profit from understanding how and why you remain so phenomenally tolerant. A post on that some day?
Having grown up in Greece at least I had the benefit of living in a country where to assert the deep state is onto something is at least understood as an obvious expectation, not a conspiracy.
The reason I try to be as careful as I can is not for them, it is for me. I do not trust my brain in situations as messy as these and I use every guardrail I can. It's not like the constraints I observe are preventing me from making strong claims and pointing out bad logic. It's just that the most common error I detect in others is when they let go of this discipline. For instance in the case of Scott here, he has betrayed his rationalist training. Maybe he thinks he's too smart, maybe he's not exposed himself to counterarguments, I can't say for sure. What I can say is that this article is many levels below his capabilities, and had he observed his own lessons closely, he would have avoided such disastrous errors. So I try not to make the same mistakes. Reasoning is very very difficult if you want to feel confident in your conclusions, as I do.
This seems... decidedly uncharitable to Scott. Of all of his articles about medicine, I'd say that most of them make it clear he *hates* the medical establishment and wants it to go die in a fire. See his IRB Nightmare, or his continual railing against the FDA, the medical insurance establishment, etc
It feels weird to me that you know enough about Scott to know his last name, and the careers of his relatives... but not recognize how anti-mainstream-medical-industry he is.
the whole reason he quit working at a hospital and started his own clinic was to try to get away from the insanity and horrible irrationality of the medical establishment. He's practically a crank at this point!
Given that this is the case... i mean... how many times does someone have to rocket across the line, write essays about how the line is horrible, tweet about how all the different ways the line is murdering people for the sake of bureaucracy, etc, before you'll stop looking for uncharitable just-so stories about why they're motivated to toe the line?
...sorry if this seems hostile, I am genuinely interested in dialogue
I found the non-pseudonym of Scott Alexander simply by Googling and learned about his family from his clinic website's personal sketch.
I never read anything of his other than the hit piece on Flavio. I am perfectly content being uncharitable to anyone who does anything that will, even at several removes, result in innocent persons dying because of denied medical treatment. If he is as pure as you claim, how do you explain his attack on someone very active in finding existing drugs to treat Covid? By his article on Flavio he allied himself with the scum of the earth.
did you see his correction? He didn't back off 100% but he did about a thousand percent more than your average stooge would have. I suspect that... hmm. How to word it?
If we took all of the people in the world about whom you would have a negative reaction to for reasons associated with the medical establishment (along the lines of "they lied about x on y occasion, killing z people" or "they continue to push medical narrative abc even in the face of counterevidence") and for whom that reaction was as strong as your negative reaction to Scott...
and showed them a single counterargument to something that they believed about medicine, a counterargument which was *as good as* the counterargument which DYOR gave to Scott regarding Flavio...
...I suspect that, of all of those people, Scott's response to learning evidence that he was wrong would be *leagues* ahead of every other person. I suspect he would be one of a single digit number of people who didn't dismiss the counterargument out of hand. I suspect he would be one of two or three who actually perceived the argument as saying what it actually said in reality, instead of mentally warping it to the point where it was a strawman. And I suspect he would be the *only* one to issue a public retraction where he literally used the words "I was wrong" in that order, and then wrote multiple paragraphs explaining that the evidence he saw pushed him away from his earlier position and towards the counterargument's position to a certain degree, and explaining exactly what degree that was.
And he deserves a great deal of credit for that. It makes him practically unique.
...doesn't it? Maybe I need help finding better people. Can you point me to any other person doing anything like that anywhere, about anything, across the whole planet?
my impression is that "going back and updating your actual beliefs based on counterevidence presented by political opposition, then posting a public retraction where you explain that you were wrong, and why you changed your mind" is something human beings, for the most part, just don't do. I've always been incredibly impressed by Scott's "Mistakes" page, and I check up on it all the time. That's how I found this article and ended up responding to your comment.
I have a high opinion of Scott, and that's why I have spent all this time critiquing his work.
Sadly, it seems Scott is happy to fix peripheral points, but not to recognize that the essay's core has been compromised by the mathematical issues.
I don't know who else would go further, but I do know Scott refuses to converse with the person who has provided him with not just one but two major corrections to his article.
Curious about his blog after your comment reached my email, I read his review of "Albion's Seed," a book I know well. The conspicuous thing about the review was the portrayal of the Borderers, aka Scots-Irish, as barbarians. Another low-brow hit piece. Seems to be Dr. Siskind's specialty. You will never convince me that he does not have political motives for everything he writes.
I remember getting frustrated with that article but Scott was attempting to shoot through every Ivermectin study in play and so some of the tone he dropped in there seemed to me just a way to break up the tedium of the work at hand. This isn't to see its OK, but I do think it wasn't quite as mean as it seems in this response.
Would you feel that way if you were the person in question, humiliated to an audience of hundreds of thousands or millions? Mind you, Scott dressed me down for hypothesizing he was feeling cognitive dissonance. The double standards is the part I quite simply cannot stomach, more than anything else in this whole mess.
You are right. I was trying to say given the larger article he was rifling through studies trying to filter it down to the ones that deserve the most attention it isn't as mean as when you see it on its own. What I don't get is why so many commentators had no issue punching down when it came to Ivermectin
That's kind of the nature of sophistry. Rhetoric and sleight of hand are use to trick the reader. I strongly disagree with "it isn't as mean as when you see it on its own". It's just as mean.
When I resided in Brasil, I knew extremely competent dentists, physicians, and biologists. Scott Alexander doesn't know enough about the country to assess the political climate nor the level of science that exists there. His mindset is imperialistic. From here forward, I will doubt anything that someone so silly writes.
My wife and I have listened to the flccc.net weekly Wednesday zoom meeting for over a year, and Flavio has been a guest a number of times. He's always been impressive, I only wish his English was more perfect. He has been a target for the same reason anyone else is who says Covid is easily treatable and who treats patients and keeps them out of the hospital, much less from dying.
crimes against humanity - can be directed at those insisting we need more trials to test ivermectin. In a pandemic , at least offer acheap , repurposed safe drug . I trust doctors who treat patients , attempt to find solutions rather than following big pharma
Strangely but perhaps also not so strangely these days, today on 10th June 2022 the paper by F Cadegiani et al, "Proxalutamide Reduces the Rate of Hospitalization for COVID-19 Male Outpatients: A Randomized Double-Blinded Placebo-Controlled Trial" was retracted by the Chief Editors of Frontiers In Medicine after advice from an undisclosed "external expert". It notes that "The authors disagree with this retraction."
Yeah, this is a whole other ridiculous story. And you can guess who the most likely candidate is to be the "external expert". That's why I wrote that I don't want to go into all the claims about Cadegiani in general. Maybe I'll write about that at some point.
“The investigation found that the claims made in the conclusions were not adequately supported by the methodology of the study. In particular, as confirmed by an external expert, the process of allocation to treatment and control was not sufficiently random.”
None of that is a crime against humanity. And now that we know they lied, maybe we don't take the other things they said too seriously. This is obvious and explained in the post.
As for your "transgender drug" and other bad faith comments, I'll give you one more chance to make a constructive comment that shows you understand what is in the post. If you fail to do so you will have the same conclusion here as you had in the subreddit that banned you for being obnoxious and ruining the discussion.
I'm ENT doctor with more than 2000 treated patientsI used proxatuamide-like antiandrogen drugs such as bicalutamide and dutasteride in 50 patients, as directed by Dr. Cadegiani. I used it at home with 88% saturation, my father, who is a doctor and is 84 years old and a pregnant woman about to be intubated. ALL recovered, without sequelae. I didn't find the photo you posted mocking him funny. It was unfortunate. Perhaps you are still immature in certain considerations
Flavio Cadegiani is a brave and competent doctor. His researches on anti androgens have saved thousands of lives. He has brought the paper’s raw data to light since day one. Anyone can check on this. Sadly his case is one more on the high pile of infamous aggressions doctors that dared to treat covid patients have suffered. The truth will prevail.
Scott's comments are an example of how discourse has gone on for the last two years. A rumour, whisper in someone's ear, and you go get the Brand Name Pfizer vaccine because it is safe. Except that if the same gimlet eye was trained on what they did, these other people would look like angels.
Welcome to the real world. In a situation requiring fast response in the face of uncertainty, it is the lack of correction from feedback that is the killer, literally.
The whole of the establishment from top to bottom desperately wanted a tidy solution, and damned if they weren't going to control whatever needing control to get it. Whether it really worked or not.
This is normal, this is how everything works, in every domain. Most of the time it really doesn't matter. My objection to the vaccines or whatever was the ridiculous notion that everyone should do the same thing. 9 out of 10 things won't work, so you don't give one thing to everyone.
Shocking behavior by Scott. Here's a hypothesis:
1. Media has largely failed, perhaps due to a combination of the internet, social media incentives, growing government size politicizing media, etc.
2. Rationalists come along and say, "Well, we don't know how to fix media, but we do have an alternative of rationalism."
3. Most humans -- even self-proclaimed rationalists -- struggle to interpret a fire-hose of straight data, science, and theory (what rationalism offers), so they want a journalist to simplify things for them and write in an emotional, humorous, and clever way.
4. Scott finds his niche. He's smarter than journalists so he can use the tools of rationalists, and he has the natural word artistry of a journalist.
5. Except that Scott isn't doing real journalism, but instead doing some sort of concoction of half-rationalism and half-sensationalist journalism (the picture caption of Cadegiani alone proves that). Scott didn't seem to do the most basic journalistic acts of contacting Cadegiani for comment.
If that's right, then I think there is a huge market for someone to combine rationalism and good journalism, and outcompete grifters like Scott.
I'm not pressing "like" only because of the word grifter, though I certainly understand the exasperation and I agree with most of the rest of what you wrote.
Totally understand and I don't want to drag you into something, so I'm not at all offended if you don't like any of my comments.
I used that word because when he's being paid so much money and instead of diving deeper into the legitimate concerns on his ivermectin article -- dramatically important stuff -- he's posting articles about "AI scaling", I find his heuristics in choosing topics for the money his readers are giving him to be manipulative.
At least I comend you for being even handed. You were upset at me for the cognitive dissonance comment, but given that your reaction does not seem to be biased in one direction or another, I now understand that you were speaking your mind honestly.
yes, my only question is "What's in it for him?" Maybe someone knows the answer to that. Or is just simply he thinks he'll get a good resume (temporarily) doing stuff like this?
I doubt this happens at any conscious level. It would be predictable that someone like Scott would be the first entry to fill this market demand. It takes significant effort to accomplish both good rationalism and good journalism. Scott approximates both to some degree and has no significant competition.
TheZvi fits better that description of trying to fill a niche of journalist/rationalist. Scott writes about what he's been writing about all his blogging life, which was whatever was on his mind those days. Sometimes it's important stuff, sometimes it isn't; sometimes its current events, sometimes not; often it's non-fiction, sometimes fiction.
Several of his relatives are well established in the medical industry. What's good for the family business is good for Scott Siskind, no matter if it's bad for the public.
I generally don't find conflict of interest arguments to be slam dunk, nevermind ones about one's extended family. There might be some internalized perspective there, but he should be allowed to have an opinion, bad as this one is, no matter what his relatives do.
Certainly Dr. Siskind has every right to his opinion. Nevertheless there has been an alignment of mainstream medical personalities, and the rank-and-file, against what I see as a rational multi-pronged SARS-2 response: indoor air purification, immune-boosting prophylaxis, early treatment, protection of the vulnerable whether in LTC or at home, maintenance of the small business economy. When the U.S. federal and most of the state governments failed to approach the problem with these rational steps, I became radicalized.
Having worked and lived in several institutional settings where a local "deep state" was in actual control pursuing ends that were not good for the majority, by mid-2020 I became crimson-pilled, redder than red. I am beyond the psychological point where I wish to give the benefit of the doubt. Having watched some of your interviews, I think you go to extremes of fair-mindedness. Perhaps that is innate with you, or you haven't experienced much duplicity in face-to-face aspects of life, or giving an opponent the benefit of the doubt is tactically wise in your opinion.
After the several prolonged experiences of my not being suspicious enough of those with power, I came to see the world as populated mostly by knaves and fools. Perhaps your readers would profit from understanding how and why you remain so phenomenally tolerant. A post on that some day?
Having grown up in Greece at least I had the benefit of living in a country where to assert the deep state is onto something is at least understood as an obvious expectation, not a conspiracy.
The reason I try to be as careful as I can is not for them, it is for me. I do not trust my brain in situations as messy as these and I use every guardrail I can. It's not like the constraints I observe are preventing me from making strong claims and pointing out bad logic. It's just that the most common error I detect in others is when they let go of this discipline. For instance in the case of Scott here, he has betrayed his rationalist training. Maybe he thinks he's too smart, maybe he's not exposed himself to counterarguments, I can't say for sure. What I can say is that this article is many levels below his capabilities, and had he observed his own lessons closely, he would have avoided such disastrous errors. So I try not to make the same mistakes. Reasoning is very very difficult if you want to feel confident in your conclusions, as I do.
This seems... decidedly uncharitable to Scott. Of all of his articles about medicine, I'd say that most of them make it clear he *hates* the medical establishment and wants it to go die in a fire. See his IRB Nightmare, or his continual railing against the FDA, the medical insurance establishment, etc
It feels weird to me that you know enough about Scott to know his last name, and the careers of his relatives... but not recognize how anti-mainstream-medical-industry he is.
the whole reason he quit working at a hospital and started his own clinic was to try to get away from the insanity and horrible irrationality of the medical establishment. He's practically a crank at this point!
Given that this is the case... i mean... how many times does someone have to rocket across the line, write essays about how the line is horrible, tweet about how all the different ways the line is murdering people for the sake of bureaucracy, etc, before you'll stop looking for uncharitable just-so stories about why they're motivated to toe the line?
...sorry if this seems hostile, I am genuinely interested in dialogue
I found the non-pseudonym of Scott Alexander simply by Googling and learned about his family from his clinic website's personal sketch.
I never read anything of his other than the hit piece on Flavio. I am perfectly content being uncharitable to anyone who does anything that will, even at several removes, result in innocent persons dying because of denied medical treatment. If he is as pure as you claim, how do you explain his attack on someone very active in finding existing drugs to treat Covid? By his article on Flavio he allied himself with the scum of the earth.
did you see his correction? He didn't back off 100% but he did about a thousand percent more than your average stooge would have. I suspect that... hmm. How to word it?
If we took all of the people in the world about whom you would have a negative reaction to for reasons associated with the medical establishment (along the lines of "they lied about x on y occasion, killing z people" or "they continue to push medical narrative abc even in the face of counterevidence") and for whom that reaction was as strong as your negative reaction to Scott...
and showed them a single counterargument to something that they believed about medicine, a counterargument which was *as good as* the counterargument which DYOR gave to Scott regarding Flavio...
...I suspect that, of all of those people, Scott's response to learning evidence that he was wrong would be *leagues* ahead of every other person. I suspect he would be one of a single digit number of people who didn't dismiss the counterargument out of hand. I suspect he would be one of two or three who actually perceived the argument as saying what it actually said in reality, instead of mentally warping it to the point where it was a strawman. And I suspect he would be the *only* one to issue a public retraction where he literally used the words "I was wrong" in that order, and then wrote multiple paragraphs explaining that the evidence he saw pushed him away from his earlier position and towards the counterargument's position to a certain degree, and explaining exactly what degree that was.
And he deserves a great deal of credit for that. It makes him practically unique.
...doesn't it? Maybe I need help finding better people. Can you point me to any other person doing anything like that anywhere, about anything, across the whole planet?
my impression is that "going back and updating your actual beliefs based on counterevidence presented by political opposition, then posting a public retraction where you explain that you were wrong, and why you changed your mind" is something human beings, for the most part, just don't do. I've always been incredibly impressed by Scott's "Mistakes" page, and I check up on it all the time. That's how I found this article and ended up responding to your comment.
I have a high opinion of Scott, and that's why I have spent all this time critiquing his work.
Sadly, it seems Scott is happy to fix peripheral points, but not to recognize that the essay's core has been compromised by the mathematical issues.
I don't know who else would go further, but I do know Scott refuses to converse with the person who has provided him with not just one but two major corrections to his article.
Curious about his blog after your comment reached my email, I read his review of "Albion's Seed," a book I know well. The conspicuous thing about the review was the portrayal of the Borderers, aka Scots-Irish, as barbarians. Another low-brow hit piece. Seems to be Dr. Siskind's specialty. You will never convince me that he does not have political motives for everything he writes.
I remember getting frustrated with that article but Scott was attempting to shoot through every Ivermectin study in play and so some of the tone he dropped in there seemed to me just a way to break up the tedium of the work at hand. This isn't to see its OK, but I do think it wasn't quite as mean as it seems in this response.
Would you feel that way if you were the person in question, humiliated to an audience of hundreds of thousands or millions? Mind you, Scott dressed me down for hypothesizing he was feeling cognitive dissonance. The double standards is the part I quite simply cannot stomach, more than anything else in this whole mess.
I concede.
Take the picture caption of Cadegiani on its own. You don't think that's mean?
You are right. I was trying to say given the larger article he was rifling through studies trying to filter it down to the ones that deserve the most attention it isn't as mean as when you see it on its own. What I don't get is why so many commentators had no issue punching down when it came to Ivermectin
That's kind of the nature of sophistry. Rhetoric and sleight of hand are use to trick the reader. I strongly disagree with "it isn't as mean as when you see it on its own". It's just as mean.
When I resided in Brasil, I knew extremely competent dentists, physicians, and biologists. Scott Alexander doesn't know enough about the country to assess the political climate nor the level of science that exists there. His mindset is imperialistic. From here forward, I will doubt anything that someone so silly writes.
this article really suits your substack title "do your own research."
love it.
Another great essay.
My wife and I have listened to the flccc.net weekly Wednesday zoom meeting for over a year, and Flavio has been a guest a number of times. He's always been impressive, I only wish his English was more perfect. He has been a target for the same reason anyone else is who says Covid is easily treatable and who treats patients and keeps them out of the hospital, much less from dying.
crimes against humanity - can be directed at those insisting we need more trials to test ivermectin. In a pandemic , at least offer acheap , repurposed safe drug . I trust doctors who treat patients , attempt to find solutions rather than following big pharma
Strangely but perhaps also not so strangely these days, today on 10th June 2022 the paper by F Cadegiani et al, "Proxalutamide Reduces the Rate of Hospitalization for COVID-19 Male Outpatients: A Randomized Double-Blinded Placebo-Controlled Trial" was retracted by the Chief Editors of Frontiers In Medicine after advice from an undisclosed "external expert". It notes that "The authors disagree with this retraction."
https://www.frontiersin.org/articles/10.3389/fmed.2022.964099/full
Yeah, this is a whole other ridiculous story. And you can guess who the most likely candidate is to be the "external expert". That's why I wrote that I don't want to go into all the claims about Cadegiani in general. Maybe I'll write about that at some point.
“The investigation found that the claims made in the conclusions were not adequately supported by the methodology of the study. In particular, as confirmed by an external expert, the process of allocation to treatment and control was not sufficiently random.”
If only those guys were running the NEJM...
...and were using the same standards for all papers...
Nice to see someone standing up to the bad guys.
None of that is a crime against humanity. And now that we know they lied, maybe we don't take the other things they said too seriously. This is obvious and explained in the post.
As for your "transgender drug" and other bad faith comments, I'll give you one more chance to make a constructive comment that shows you understand what is in the post. If you fail to do so you will have the same conclusion here as you had in the subreddit that banned you for being obnoxious and ruining the discussion.
Bye bye.
I'm ENT doctor with more than 2000 treated patientsI used proxatuamide-like antiandrogen drugs such as bicalutamide and dutasteride in 50 patients, as directed by Dr. Cadegiani. I used it at home with 88% saturation, my father, who is a doctor and is 84 years old and a pregnant woman about to be intubated. ALL recovered, without sequelae. I didn't find the photo you posted mocking him funny. It was unfortunate. Perhaps you are still immature in certain considerations
Perhaps you misunderstood. My article is not mocking Dr Cadegiani.
True Alexandros, I read it again. I apologize for my mistake. You have done an honest and spectacular job. Thank you very much.