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Alex M has released a new entry in his series criticizing Scott's take on ivermectin. I'm linking it here because I want to head off the Twitter theatrics which surrounded the last couple entries. We're off to a good start, though, with a much less melodramatic title.
I will edit this post as I complete my read.
Alright, I was pretty impressed by the article. Marinos discusses possible flaws in the original paper and gets them to the attention of the original author. But he doesn't stop there, and proposes a set of criteria to estimate whether parasitic hyperinfection showed up in third-world datasets. It's not ironclad, since all the sample sizes are small, but it's impressive considering the overall scarcity of data. This is definitely evidence that the strongyloides hypothesis is lacking.
I'm less impressed. He talks about hyperinfection, but that seems to be shifting the parameters. He seems to be taking "people with drastically severe worm infestations" as the baseline, rather than "people with some degree of infestation" as against "people who are parasite-free".
Did any of the original studies which claimed great results for ivermectin test beforehand to see if the patients being treated had parasitic infestations? From what I remember trawling through the entire JAMA list, the majority of the studies were horribly designed. A lot of them took a kitchen sink approach, giving the test groups a cocktail of the popular contenders at the time (including ivermectin but also including the other drugs being touted as miracle cures). A lot of them had messy results, at least one of them mucked up the control and test groups so badly it had to scrap the original study and start again.
For me, Occam's razor is the best approach to "does ivermectin work"? Yes, to some degree, if you already have a parasite/worm infestation as well as contracting Covid.
Hey there -- the JAMA paper made the claim that hyperinfections had a substantial effect on the mortality of ivermectin RCTs. This is the claim I focused on. And no, the studies did not test for strongyloides, as they did not test for a million other things that were not considered relevant at the time that the studies were put together.
I am not sure which studies you're talking about. No doubt some of the studies are bad, while others are very good (e.g. the Biber et al. study from israel). This kind of variation can be found in any field of inquiry (as is a certain amount of junk papers). I did not choose the studies in the JAMA paper, I simply investigated whether strongyloides could be seen as causal for the deaths in their control groups as the hypothesis stated.
If you have specific criticisms, please let me know.
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