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A reasonable response may be to assert that there are other differences between the groups of countries and regions with high-prevalence that may mask the effect. However, those other shared factors may also be invoked to explain the difference in the effectiveness of ivermectin. So unless a clear case is made to explain the discrepancy, the hypothesis is, at the very least, incomplete

While this is technically true, it doesn't really support the use of ivermectin until you know what those factors are. For example, poor countries also have lower average ages, and so that might explain why control groups in low-worm areas have relatively high death rates (assuming that is indeed true). If your story is true, that would indicate that ivermectin works among the young, but not the old. But, for one, the young don't need that much help, and more generally, if the factor is something else, then giving it to the young and not the old won't help much. If you can't make predictions, you're still in a crisis.

Basically, it's up to you to show that ivermectin works, in face of the low prior probability that any given drug treats any given disease, and even if you fully disproved the worm hypothesis, you wouldn't have proved that ivermectin works.

You do realize that there are thousands of hypotheses that are similar to the strongyloides one that could be raised against any conceivable drug or other health intervention? Let me give you some examples:

What if toxoplasmosis is responsible for the effectiveness of ivermectin? Afterall, toxo makes covid worse, and some studies report ivm helps with toxo. Do people have to debunk this too before using ivm?

Or, what if fluvoxamine doesn't help with covid, but instead helps with depression? Afterall, depression makes COVID a lot worse, and fluvoxamine is known to help with depression. Further, women suffer more from depression, and in several studies, the benefit of fluvoxamine seems to be disproportionately concentrated towards women. Do people have to debunk this before using fluvoxamine?

And what if there is some other, unknown effect, that Paxlovid has, which we are unaware of, which confounds or mediates the results of its clinical trials? How much research has been done on that question?

You see where I'm going with this. How is it not yet another isolated demand for rigor?

(1) If this is a genuine question, then yes. Back when this was first mooted, I came down on the side of "it's the anti-parasitic effect freeing up the immune system", before ever Scott addressed the question, because I grew up in an agricultural region where ivermectin was advertised morning, noon and night for treating various animal ailments.

(2) Yes, ivermectin is used to treat humans. FOR WORM AND PARASITE INFESTATIONS.

(3) No, you will not convince anyone except your partisans that Scott was wrong, wrong, wrong and you are right, right, right about this. When the list of trials was posted on ACX, I trawled through them all. All the positive results were also in countries that are Second or Third World regions, except for Florida. And duh, Florida. Flesh eating screwworms, anyone? A case from 2016 which is mainly in deer, but which can spread to livestock and to humans.

Hence you are not going to get your Canossa moment from Scott, with him going on social media everywhere to tender a grovelling apology to you. And even if he does change his mind, I'm not going to because see points (1) and (2) above. Scott did not convince me, I already held the opinion and was mildly chuffed to see him later come out on that side of the question.

This is your hobbyhorse, and while you may have a bee in your bonnet about it, please give it up. We've already had one of your partisans over on ACX to chivvy Scott into the grovelling apology, and as I said - it won't affect my opinion since I arrived at it independently. Ivermectin is not a miracle Covid cure. If people are suffering from existing medical problems, such as worm or parasitic infestations, then ivermectin in conjunction with other treatments probably helps by killing off the parasites and freeing the immune system of that burden to fight the virus. Ivermectin on its own in otherwise healthy people won't do anything.

I'm confused by this comment. Wouldn't it be more productive to directly address the points in OP's article instead of telling him to "give it up"? I'm sure AlexandrosM is not looking for internet strangers' permission to set the pace of his hobby research.

He's been banging on about this endlessly over on his own blog or Substack or whatever it is. Fine, that's his space and he can do what he wants there. But he's also constantly issuing challenges to Scott and now he's come on here, still chasing that car.

I'm not convinced by what he says, and I'm not eager to wade back into the same fight because I'm tired of the same old "Scott Alexander is wrong and should admit it publicly everywhere!" And by the looks of it, neither is anyone else on here as of now.

I understand that you do not like what Alexandros does with his time, but I question the value of sharing that dislike with others. I personally like what Alexandros is doing. We rationalists don't want to get too comfortable with authority figures (Scott Alexander) and then rush to their defense when apostates question their perceived authority. Critique is healthy for discourse.

And by the looks of it, neither is anyone else on here as of now.

I think you should speak for yourself. Judging by the upvotes on this post and the comments inside, I'd have to say this community still appreciates Alexandros' submissions.

Some even derive new understanding from it, https://old.reddit.com/r/slatestarcodex/comments/xf9drx/was_scott_alexander_right_that_strongyloides/iozt4b3/

yeah... holy fuck, I am currently reading scott's correction and it is "a reader informs me the t-test is overly simplistic"

This is not at all the case, like, this is not a "t test is overly simplistic" scenario, this is... not even wrong, it's not even saying 1 + 1 = 3 it's saying f(potato) + bird = 3.

... ok, this is very worrisome and, maybe I'm an n=1 here, but just this piece of evidence alone for me has resulted in a significant update as to how much I trust anything written by Scott

The problem isn't that he's making the argument, or even that he's making the argument repeatedly; the problem is that he's exclusively using this site as a sounding board for his hobby-horse and driving traffic to his blog. I don't have any problem with someone using this space to do either of these two things independently. Beej has always linked to his blog, and he has his hobby-horses. But he's also a regular contributor (and mod of the old subreddit), and his hobby-horses weren't single, narrow topics. Alexandros's contributions to this site so far have been one bare link to his Substack and 4 comments defending it. And all his Substack seems to talk about is how Ivermectin is actually a good COVID treatment.

Alexandros's contributions to this site so far have been one bare link to his Substack and 4 comments defending it.

I'm fine with it. It would be absurd if this community instituted a rule banning singular contributions like that. Each of us is free to volunteer our contributions on whatever topic we wish.

On the other hand, when Alexandros politely responds to people uncharitably making comments on himself (rather than his content) to the effect of saying "If you have found any particular errors in my piece, let me know.", they usually go silent - as if to silently admit that they do not care to address the content of the post. I'd think that this behavior is quite problematic for a rationalist community because it is more of an emotional behavior than rational behavior as far as discourse goes.

I still don't see where the problem is. The topic is important, and relevant to the community for at least 2 reasons (covid, and Scott), Alexandros seems to be coming over to have his arguments criticized, to see if he can correct or improve his work, which in my opinion is a laudable goal...

I suppose I can understand being fed up and wanting to move on, but seriously, in that case just ignore him. Block him if you have to.

In that case I think the correct response would be just to ignore the content and move on.

Having looked at the evidence as presented by Alexandros, (and others,), the signal from Ivermectin is much stronger than previously believed.

What's disturbing is the multibillion campaign against Ivermectin. The water has been deliberately muddied by bad faith players who stand to make substantial profits so long as Ivermectin is suppressed.

When I consider these two facts, 1. Solid signal from Ivermectin plus extremely safe, (a great Pascal's Wager.) and 2. There is a well funded disinformation campaign against Ivermectin from some of the most powerful institutions in the Western world with obvious conflicts of interest,

I think it's foolish to not have Ivermectin in your house in case of Covid. There's nothing to lose and everything to gain.

Because idiot people were dosing themselves up with no idea of how to translate between dosage levels for horses and for humans. It is possible to overdose on ivermectin, it is possible to get side-effects from it, and especially if people are using it without medical supervision.

My own view is that if you are dumb enough to want to take it, okay. It probably won't do much harm, but it won't do much good either. But it's not a miracle cure, and I wish people wouldn't try to portray it as such.

Evidence for this claim. And please do not link the Rolling Stones article saying that "Oklahoma's ERs are so backed up with people overdosing on ivermectin that gunshot victims are having to wait to be treated, a doctor says."

Why would anyone take horse Ivermectin when it is available for humans in pharmacies?

Why would anyone take horse Ivermectin when it is available for humans in pharmacies?

Because Youtube videos were telling them this was the easiest way to get it, without having to go to a doctor who would tell them "Ivermectin doesn't cure Covid, I am not writing you a prescription".

I am pretty sure Youtube censors anyone who talks about Ivermectin in a positive manner.

The water has been deliberately muddied by bad faith players who stand to make substantial profits so long as Ivermectin is suppressed.

You'll have to elaborate on this one. What?

extremely safe

If taken at a responsible dose, but you'll recall that most of the dunking on Ivermectin was when people were going out and taking megadoses and getting sick.

Why does the discussion around Ivermectin sound so much like the discussion around GameStop stock?

Why does the discussion around Ivermectin sound so much like the discussion around GameStop stock?

Because both are cases where the initial narrative was heavily influenced by "experts" in the media who were subsequently shown to be not only lying but to have a strong financial and political motive to lie.

but you'll recall that most of the dunking on Ivermectin was when people were going out and taking megadoses and getting sick

The Motte is "taking too much and getting sick."

The Bailey is "ha ha they are taking horse medicine" even when taking the human form in human doses prescribed by a human doctor. Like Joe Rogan got. https://www.newsweek.com/joe-rogan-don-lemon-cnn-ivermectin-sanjay-gupta-lying-1639240

you'll recall that most of the dunking on Ivermectin was when people were going out and taking megadoses and getting sick.

The original "Duke Lacrosse" Ivermectin Article published by Rolling Stone.

https://www.rollingstone.com/politics/politics-news/fda-horse-dewormer-covid-fox-news-1215168/

The main message which you seems to have worked on you subconsciously:

"Oklahoma's ERs are so backed up with people overdosing on ivermectin that gunshot victims are having to wait to be treated, a doctor says."

This never happened. Nothing like it happened. Yet despite their update to the story which you may have missed, the damage worked. Millions of people have some sense that their biases are confirmed: stupid southerners among their despised outgroup are overdosing on "horse dewormer." Only an idiot would take horse dewormer!

Of course it makes no sense. Ivermectin is available for humans in most states with a simple prescription. I got my prescription online after 5 minutes.

This article, and many others debunk it. The hospital denies the foundational facts of the Rolling Stone article.

https://townhall.com/columnists/timgraham/2021/09/10/rolling-stone-commits-horse-dewormer-fraud-n2595648

Rolling Stone issued their own update:

Update: One hospital has denied Dr. Jason McElyea’s claim that ivermectin overdoses are causing emergency room backlogs and delays in medical care in rural Oklahoma, and Rolling Stone has been unable to independently verify any such cases as of the time of this update.

So basically they are admitting that the lede in their original story was totally baseless. Rather than come out and say that, they pretend that it could be true, even though they found zero evidence for it.

...those who fell for the story included The Daily Beast's Justin Baragona, Daily Kos, Daily Mail, The Guardian, Newsweek, New York Daily News, The Hill, MSNBC contributor Jason Johnson, former CNN pundit Roland Martin, disgraced reporter Kurt Eichenwald, MSNBC host Rachel Maddow, and "Stephanie Ruhle Reports" producer Lauren Peikoff (who admirably fessed up and deleted her tweet, unlike Maddow).

So all of this goes back to the first point of contention. I don't believe that the editors of Rolling Stone are that stupid. And CNN, Guardian, Newsweek, The Hill, MSNBC, Rachel Maddow etc. Maybe some of them are. But it's a safe bet that some of them had financial interests in quashing Ivermectin in order to preserve the EUA upon which the neovaccines are founded. This looks like politics and money, not science.

There is very little if any evidence of people "taking megadoses and getting sick". There have been trials testing very large doses, far larger than those recommended by FLCCC, which are already much larger than standard antiparasitic doses, that have shown very little in terms of adverse effects, all of it transient. There is even a pre-pandemic case of a woman taking hundreds the time the recommended dose in an attempted suicide, and she walked out of the hospital 4 days later with no sign of lasting issues whatsoever. I'm not saying that people should go and take 100x doses. Only that ivermectin is one of the safest drugs we have, and even its most ardent opponents don't bother to make the case for a biologically-based downside anymore. I will steelman the opposing argument by saying that we don't know what its effects on the microbiome are, and I wouldn't feel comfortable taking large doses on an ongoing basis, but in terms of early treatment or post-exposure prophylaxis we have more than enough data to be incredibly comfortable with broad administration. Afterall, there's a reason it's available over the counter in many countries across the world. The potential for abuse is infinitesimal.

If you're interested in the deepest of deep dives on the topic, this is a good place to start: https://youtube.com/watch?v=ATiX0-2PEr4

As for the waters being muddied, one of the authors of an early and very influential meta-analysis has been caught on video admitting that he phrased his conclusions in a particularly cautious manner, recommending more studies needed to be performed, on the insistence of his funders, UNITAID. Of course, writing a conclusion you don't believe in because of the influence of third-party unnamed authors who control funding for the work is the definition of academic misconduct, but said academic is still respected and is now dedicating his time proving ivermectin results are explained by "fraud" (they're not).

(1) You'll be interested to hear that it's super unclear if worms help or harm in terms of COVID. Even the study that Scott quoted to illustrate how worms can harm the response to covid, has another section that discusses how worms might help by boosting the immune system.

(2) Yes, this is one of the things ivermectin does. For instance, did you know it has been found to kill mosquitoes that drink your blood upto 10 days after you took ivm? Weird, I know, but small molecules are strange like that.

(3) The Biber et al. study was in israel, had a positive result, and is squeaky clean of worms. now what?

If you have found any particular errors in my piece, let me know.