This is a public peer review of Scott Alexander’s essay on ivermectin, of which this is the ninth part. You can find an index containing all the articles in this series here. In today’s episode, we look into a theme that runs throughout Scott’s essay: his deference to randomized controlled trials (RCTs) above all other forms of evidence—in particular, how this bias affects his treatment of three non-RCT studies: Merino et al., Mayer et al., and Chahla et al.
Aug 6, 2022·edited Aug 6, 2022Liked by Alexandros Marinos
In addition:
I'm surprised how much Scott Alexander distorts Merino's study when he describes it. As if he hadn't read it.
SA's claim 1: "if you called a hotline and said you had COVID, they sent you an emergency kit".
That is not what the study says. Patients who received a positive test for a test were *given* a kit (under certain conditions.) SA seems to be making a confusion with the phone *monitoring* a subset of the patients were offered: they were called a few days after they had received a positive test, to check how they felt and to advise them to go to hospital according to the description they gave of their own health state.
SA's claim 2: "18,074 people got the kit"
Inaccurate : 83,000 patients got hte kit, out of whom 77,381 were included in the study. Among whom 18,074 received a monitoring phone call.
SA's claim 3: "Their control group is people from before they started giving out the kits, people from after they stopped giving out the kits, and people who didn’t want the kits."
Where does that come from? Mexico didn't stop giving out the kits (not right after the study, at least). Here's what the study mentions: "The control group are positive symptomatic patients, from 23 November to 28 December, and the treated group are positive symptomatic patients from 28 December to 28 January."
(The City of Mexico started delivering the kits to any person who tested positive — under certain conditions — as from Dec 28th 2020)
SA's claim 4: "There are differences in who got COVID early in the epidemic vs. later, and in people who did opt for medical kits vs. didn’t. To correct these, the researchers tried to adjust for confounders"
The reasons the authors adjusted for confounders are not exactly the ones SA mentions. Unlike SA is suggesting, there is no "early in the pandemic" involved in the study : the time difference between control group and treated group is exactly 1 month: Nov 23-Dec 28 2020 for the control group, and Dec 28 2020-Jan 28 2021 for the treated group.
Aug 6, 2022·edited Aug 6, 2022Liked by Alexandros Marinos
In 2018, Adrian Currie published the book, "Rock, Bone, and Ruin," as part of the MIT Press series, "Life and Mind: Philosophical Issues in Biology and Psychology." Currie treats three of the historical sciences: geology, paleontology, and archaeology. He could have included cosmology, evolutionary ecology, and biogeography as well. And Peter Turchin's cliodynamics finally brought historical science to history itself.
The point of Currie's book is to explore what kinds of evidence allow scientific conclusions to be drawn when manipulative experiments are impossible because of the expanses of time and space that would be involved. Reviewing the many tactics used by scientists who are thus constrained, Currie concludes that these investigators are "methodological omnivores" who must be far more creative than laboratory scientists.
In the politically manipulated SARS-2 environment, RCT's are most easily mounted by well-funded agencies, and such agencies are precisely those which are most likely to have been bribed in some fashion to disfavor early treatment of Covid. So, in terms of feasibility of doing valid manipulative experiments like RTC's, politization of early treatment is analogous to the space-time constraints of the historical sciences. If the experimental manipulations are manipulated dishonestly, and we know that they have been, then that is a constraint on acquiring knowledge.
Being methodologically omnivorous and accepting the epistemic utility of observational studies is a rational response to corrupted RCT's.
Just found out that Scott Alexander has always been that way (or at least since 2016) :
Kary Mullis is kind of cheating since he was not technically a psychedelicist. He was a biochemist in the completely unrelated field of bacterial iron transport molecules. But he did try LSD in 1966 back when it was still a legal research chemical. In fact he tried 1000 micrograms of it, one of the biggest doses I’ve ever heard of someone taking. Like the others, Mullis was a brilliant scientist – he won the Nobel Prize in Chemistry for inventing the polymerase chain reaction. Like the others, Mullis got really weird fast. He is a global warming denialist, HIV/AIDS denialist, and ozone hole denialist; on the other hand, he does believe in the efficacy of astrology. He also believes he has contacted extraterrestrials in the form of a fluorescent green raccoon, and “founded a business with the intent to sell pieces of jewelry containing the amplified DNA of deceased famous people like Elvis Presley”.
I’m simply a housewife with a passion for the welfare of mankind. The fact that ivermectin has very little side effects and is a proven and essential medicine, makes this entire fiasco so ridiculous! Obviously so much deep and malicious activity going on behind the scenes.
In addition:
I'm surprised how much Scott Alexander distorts Merino's study when he describes it. As if he hadn't read it.
SA's claim 1: "if you called a hotline and said you had COVID, they sent you an emergency kit".
That is not what the study says. Patients who received a positive test for a test were *given* a kit (under certain conditions.) SA seems to be making a confusion with the phone *monitoring* a subset of the patients were offered: they were called a few days after they had received a positive test, to check how they felt and to advise them to go to hospital according to the description they gave of their own health state.
SA's claim 2: "18,074 people got the kit"
Inaccurate : 83,000 patients got hte kit, out of whom 77,381 were included in the study. Among whom 18,074 received a monitoring phone call.
SA's claim 3: "Their control group is people from before they started giving out the kits, people from after they stopped giving out the kits, and people who didn’t want the kits."
Where does that come from? Mexico didn't stop giving out the kits (not right after the study, at least). Here's what the study mentions: "The control group are positive symptomatic patients, from 23 November to 28 December, and the treated group are positive symptomatic patients from 28 December to 28 January."
(The City of Mexico started delivering the kits to any person who tested positive — under certain conditions — as from Dec 28th 2020)
SA's claim 4: "There are differences in who got COVID early in the epidemic vs. later, and in people who did opt for medical kits vs. didn’t. To correct these, the researchers tried to adjust for confounders"
The reasons the authors adjusted for confounders are not exactly the ones SA mentions. Unlike SA is suggesting, there is no "early in the pandemic" involved in the study : the time difference between control group and treated group is exactly 1 month: Nov 23-Dec 28 2020 for the control group, and Dec 28 2020-Jan 28 2021 for the treated group.
Besides — and this has nothing to do with Scott Alexander — thanks to your paper, I've just found out that Merino's paper has been withdrawn by the preprint server where it had been published. And the reasons are incredible: https://socopen.org/2022/02/04/on-withdrawing-ivermectin-and-the-odds-of-hospitalization-due-to-covid-19-by-merino-et-al/
> But, we now know that when tested in the real world, well, it’s not true. RCTs don't seem to yield more information than observational studies.
There are famous counter-examples like hormone replacement therapy: https://archive.ph/lCCwf
Cochrane does try to integrate non-RCTs but with care: https://training.cochrane.org/handbook/current/chapter-14#section-14-2
In 2018, Adrian Currie published the book, "Rock, Bone, and Ruin," as part of the MIT Press series, "Life and Mind: Philosophical Issues in Biology and Psychology." Currie treats three of the historical sciences: geology, paleontology, and archaeology. He could have included cosmology, evolutionary ecology, and biogeography as well. And Peter Turchin's cliodynamics finally brought historical science to history itself.
The point of Currie's book is to explore what kinds of evidence allow scientific conclusions to be drawn when manipulative experiments are impossible because of the expanses of time and space that would be involved. Reviewing the many tactics used by scientists who are thus constrained, Currie concludes that these investigators are "methodological omnivores" who must be far more creative than laboratory scientists.
In the politically manipulated SARS-2 environment, RCT's are most easily mounted by well-funded agencies, and such agencies are precisely those which are most likely to have been bribed in some fashion to disfavor early treatment of Covid. So, in terms of feasibility of doing valid manipulative experiments like RTC's, politization of early treatment is analogous to the space-time constraints of the historical sciences. If the experimental manipulations are manipulated dishonestly, and we know that they have been, then that is a constraint on acquiring knowledge.
Being methodologically omnivorous and accepting the epistemic utility of observational studies is a rational response to corrupted RCT's.
Just found out that Scott Alexander has always been that way (or at least since 2016) :
Kary Mullis is kind of cheating since he was not technically a psychedelicist. He was a biochemist in the completely unrelated field of bacterial iron transport molecules. But he did try LSD in 1966 back when it was still a legal research chemical. In fact he tried 1000 micrograms of it, one of the biggest doses I’ve ever heard of someone taking. Like the others, Mullis was a brilliant scientist – he won the Nobel Prize in Chemistry for inventing the polymerase chain reaction. Like the others, Mullis got really weird fast. He is a global warming denialist, HIV/AIDS denialist, and ozone hole denialist; on the other hand, he does believe in the efficacy of astrology. He also believes he has contacted extraterrestrials in the form of a fluorescent green raccoon, and “founded a business with the intent to sell pieces of jewelry containing the amplified DNA of deceased famous people like Elvis Presley”.
https://slatestarcodex.com/2016/04/28/why-were-early-psychedelicists-so-weird/?
And then read this : https://joomi.substack.com/p/remembering-kary-mullis?
I’m simply a housewife with a passion for the welfare of mankind. The fact that ivermectin has very little side effects and is a proven and essential medicine, makes this entire fiasco so ridiculous! Obviously so much deep and malicious activity going on behind the scenes.