3: Alexandros Marinos continues his critique of my ivermectin post, and his broader ivermectin advocacy. I can’t remember if I’ve said this before, but I commit to writing a summary and response within four months of him being done, which as far as I can tell is not yet (yes, four months is a long time, but it’s a long series and I’m really busy this winter). His most recent post argues that the big COVID drug trials (TOGETHER, ACTIV-6, COVID-OUT) haven’t made their data public, and offers to donate $25,000 to a charity of my choice if I can get them to do so. I have no idea how to do this, but I agree that they should; if anyone from these trials wants to get in touch with me and talk about it and I would be interested in hearing what’s going on.
Wow. I gotta say many of the comments here are quite something.
Look folks - I got word through a backchannel that a summary post might get the issues I raise actually addressed. I thought that was reasonable, so I wrote that post. I didn't even submit it anywhere other than post it on my twitter.
So I randomly open up theMotte website today, to see that people are losing their goddamn minds that I wrote something on my substack. And as /u/jimmy mentions, not a single person addressed any object-level argument. I believe the sum total is zero. And before someone jumps in and says "ah that's because you make it so personal" I will say that the sum total was pretty poor before anyone characterized my writing as "making it personal".
Like, seriously, what the flying fajitas?
Look, this may look like a lot of wasted words to you. That's totally fine by me. To me, this has been a course in learning about the absolute state that "evidence-based medicine" is in. I don't learn well from books, I learn from projects. So this was that project where I learned about all the things I wrote. Writing raises the bar and makes me dig deeper. And in the course of it I generated several novel findings, like correcting the Strongyloides hypothesis, finding that a Cochrane meta-analysis had violated its own inclusion criteria for most of the studies it included, putting together the Latin American hypothesis, as well as a few more things I've not published yet.
You don't have to understand how my brain works, and I sure as hell don't, but I've learned to trust it and follow it wherever it wanders, because there's usually something of value.
But for the life of me I struggle to conceptualize the ethical system that the people criticizing me here are implementing. In what world is it OK for Scott to call people "known fraudsters", "gullible rubes who were bamboozled by pseudoscience", attack many scientists who never did anything to him, and falsely so, and even attack me as a conspiracy theorist -- unprovoked, to a massive audience, but me responding by sticking my neck out and making concrete falsifiable claims is what attracts the outrage?
Now, I want to be extremely clear -- It is Scott's right to do all those things, a right which I will defend. And it is my right to call them out, and record the errors for posterity, so that nobody can say that they were not pointed out. And yes, as several people pointed out (thank you!) my extremely serious concern, moreso than it is with Scott, is with the rationalist community letting an argument that is this flawed go unchallenged. It follows that I don't want to be like the people I criticize, so I took it upon myself to do the analysis and explain the problems, in excruciating detail. And to do all this knowing that going after the most well-known and popular thought leader in the broader rationalist community will not get me any brownie points, even if I'm right.
I am acting in the only way I can see as morally consistent, and while obviously not everyone will agree with me on that, accusing me of being obsessed with demonstrating that the rationality community is failing at holding its own to account is a bit of a weird flex. If I'm right, then this is obviously extremely important for most people in this community. And if I'm wrong, then surely you can show me how. And if you're unsure, or can't be bothered to find out, that's totally cool also.
But weaponizing the lack of interest in finding out if I'm right into an attack that assumes I'm wrong is a better demonstration of my entire point than I could ever have hoped for. I can't claim to know what kind of rationalist discourse will help us address the various existential risks coming our way, but I am pretty sure this ain't it.
Perhaps some of you can help me out. Back before this became politicized, Wikipedia stated that Ivermectin was being studied as an anti viral agent against two viruses. This is interesting to me, specifically because:
Both of them are positive single strand RNA viruses
COVID is also a positive single strand RNA virus
Those two viruses are both mentioned in the article to this very day.
Most proposed mechanisms that I've seen for Ivermectin's alleged effectiveness do not seem to target anything particularly unique to COVID.
What is going on there that allows that information to not be labeled pseudoscience?
Since millions of red tribe people have been slathering themselves with sheep bimectin for years now maybe someone can simply gather some data on this practice and let us know how it went. We should also give a hat tip and thank you for them volunteering to be the lab rats in this experiment and I have not heard of a single case of these people harming themselves with this bold experiment (surely blue tribe acolytes would have been all over it if it were as bad as Jimmy Kimmel suggested in his wheezy jokes), so THANK YOU red tribe volunteers!
There's something interesting going on in this discussion here, and in previous discussions on Alexandros's writing on this topic.
There's a lot of people pointing at how Alexandros is pretty critical of Scott/Scott's epistemics (and curiously missing his similar criticisms of the community's epistemics), rather than just focusing on whether or not Scott's conclusions are true and/or justified. Alexandros does seem pretty critical, so fair enough there. And there's a conversation to be had about how critical is appropriate, and how to figure out how critical is appropriate.
But that conversation isn't happening.
Instead, we're getting accusations that Alexandros is "attacking"/"grinding his axe against"/"picking on" Scott rather than sticking to the object level and minimizing "unnecessary heat"... in a way that sure looks a bit like "attacking"/"grinding axes against"/"picking on" Alexandros. You know, with insults including but not limited to "absolutely autistic", "creepy", and "fucking stalker". People showing up just to let everyone know that they don't care to talk to him because he's bad. And, of course, not one object level rebuttal yet as of when I'm writing this.
Is Alexandros acting like an obsessed stalker who once got attention from a girl, and letting his emotions pull him away from truth and honesty? Is Scott letting the fear of his "expert status" being challenged interfere with his neutral truth seeking? Are these questions both completely fair and valid, both out of line by virtue of attempting to address the person instead of the argument, or is there some principle saying that one can be asserted without argument while the other is unacceptable to question even with many pages of argument? And if so, what is that principle?
So far no one is addressing Alexandros's arguments about whether ivermectin works.
Or whether Scott's arguments against ivermectin are valid.
Or whether Alexandros's criticisms of Scott's (and the communty's!) epistemics are valid.
It's all focused on a rather uncharitable mind reading of Alexandros motivations. This isn't entirely a bad thing in itself since there's actually a lot to be gained by tracking the least-flattering-consistent-explanation of people's behaviors/beliefs, but it sure is interesting what happens when you apply this metric uniformly and judge those criticizing Alexandros on this metric.
To give an overview of what I believe is a reasonable bounded-rationality basis to dismiss this objection:
I am not equipped to evaluate the claims in Alexandros's post in detail without significant effort and time investment (despite being a working academic in a quantitative field).
I'm not particularly worried about COVID and the societal excesses of the response seem to have already died down, so I personally don't see much value in learning about a surprising therapy for it. It seems unlikely to me that even if something like the contents of this post became widely accepted as truth, the societal response next time something COVID-shaped happens would be much beter.
Superficially, it seems there is no particular reason why something like Ivermectin (an antiparasitic that apparently works by disrupting the metabolism of fairly complex multicellular parasites) would work against COVID (a virus). I have a strong prior on most medicines claimed to have a minor beneficial effect on popular therapeutic targets actually being completely ineffectual (as this has been my experience).
On the other hand, the "parasite load" story seems superficially plausible.
Due to the culture-war dimension of Ivermectin, whose efficacy the red tribe in the US has entangled its social status with (no point in recounting the way this happened here), there is an obvious motivation for members of that tribe to produce compelling-looking arguments for its efficacy. Since Alexandros posts around this community, he seems a priori likely to harbour Red sympathies.
Moreover, there is a "contrarian" tribe that is motivated by taking down the rationality-orthogonal "trust the science" wing of the blue tribe, and therefore would also derive utility from successfully Eulering in favour of Ivermectin. Many people seem to talk about the abrasiveness of Alexandros's tone. This increases the probability that he's Red or Contrarian and would therefore have the motive to come to his conclusion.
In short, a situation that seems fairly symmetrical to "read this long and extremely compelling essay by a Harvard academic who is also a Twitter superstar using Science and Logic to prove that Blank Slatism is true". If you had unlimited time and resources or a particularly high stake in finding out whether desirable qualities of humans are genetic, sure, by all means you ought to read it and analyse the argument. For most everyone else, it would be more rational to ignore the essay, leave your prior largely unshifted and spend the time it would take to read on something with higher expected utility, like planning tomorrow's healthy breakfast or getting on top of your todo list.
Things that could convince me to take the essay more seriously:
Establish that the author does not stand to benefit from Ivermectin working, e.g. has impeccable blue tribe credentials.
Establish that rehabilitating Ivermectin would benefit me personally a great deal.
Propose a plausible mechanism by which Ivermectin (specifically!) might work against COVID. Some general handwaving like "it modulates the way the immune system operates" won't work; lots of drugs do that, so I don't see why specifically the one that the Blues are raging against and the Reds are swearing will prove once and for all they should actually be in charge should be the one that happens to modulate it just right.
Relatedly, but harder, shift my prior regarding medicines that purport to do anything more complex than targeting one particular well-understood metabolic pathway not working.
This article has nothing to do with rehabilitating ivermectin. I myself am not sure how well it works today and if I had to guess, it worked a lot better for pre-Omicron variants. Naturally recent data is a mess, so it's hard to know, and I really should do some digging before I say much more because I could be very wrong. On whatever the "red tribe" is - I frequently tweet out about how I could never support a president who allowed Fauci to run the pandemic. As recent immigrant to the US, I have very little interest in whatever partisan bickering y'all are engaged in, other than that I'd prefer if the country my children were born in doesn't implode.
Rehabilitating the rationalist community (the actual intent of the essay) would benefit everyone a great deal. Ivermectin is the perfect case-study of why the rehabilitation is needed.
Once again, the article has nothing to do with defending ivermectin, and everything to do with defeating bad arguments. If you are interested in some material on mechanism of action, my friend Joomi has written a pretty good piece - https://joomi.substack.com/p/misconceptions-about-ivermectin-dosing
There are many drugs we don't understand the mechanisms of, and I can personally confirm that some of these definitely work: https://en.wikipedia.org/wiki/Mechanism_of_action#Drugs_with_unknown_MOA . In fact, as you can read in Joomi's article, ivermectin's anti-parasitic action also is somewhat mysterious, but nobody doubts it works.
I'm not particularly worried about COVID and the societal excesses of the response seem to have already died down, so I personally don't see much value in learning about a surprising therapy for it.
Ivermectin is used as a weapon against the right in the culture war. Whether the right is actually correct, and whether the left made baseless attacks against the right for political reasons, will be important as long as we have a left and right around.
But I think it is clear what the collective knowledge about Ivermectin was at the time. Whether we later learned (or will learn) that it actually works against Covid (or not) will not change anything about how justifies these attacks were.
We had a time when the best meta-analysis as evaluated on LessWrong was pro-Ivermectin and the institutions were anti-Ivermectin.
The question of whether to follow the highest quality published metastudies or the institutions in cases where those differ is an important one. If the highest quality published metastudy was right about ivermectin and the institutions wrong that's a lesson for the future.
If the institutions are wrong and generally suppress the use of generics for important illnesses that suggests we should invest more money into studying whether generics are useful for problems that arise.
Lastly, if Ivermectin works for COVID there's a decent chance that it also works for other viruses. If we have another pandemic it's important to know whether we should run trials to test whether Ivermectin helps or don't run those trials.
I for my part am already fairly convinced that the left makes baseless attacks against the right for political reasons. (Of course, the converse is also true.) Is it that important whether there is one more or one fewer example?
"Baseless attacks for political reasons" was only a rough description. Maybe "baseless attacks for political reasons, that are highly signal-boosted by the media and social media", would be closer.
But again: this was definitely done for political reasons [0] at a time when the evidence was still inconclusive.
Whatever we found out between then and now doesn’t change anything about that.
[0] There are of course more benign motivations one could assume, e.g. protecting people from what was perceived as “false cures” that would end up harming people.
Just because the evidence was inconclusive doesn't mean that the attack was unimportant. For one thing, it's a signal that anyone who does try to do actual research and produce actual evidence in the future would be mercilessly attacked. Even if there's little evidence at the moment, this is a huge deal.
ersatz
defective eudaimonia maximizer
Jiro 1yr ago
Politically, what matters is who controls the institution that determines who is right. I could list a hundred things about which the left is wrong and yet which have been ascertained as true by consensus reality. It has always been so, those who are familiar with Roman history know how much who determines what is true has always been the decisive force in politics.
Skylab
Beware of he who would deny you access to information...
4bpp 1yr ago
"Due to the culture-war dimension of Ivermectin, whose efficacy the red tribe in the US has entangled its social status with (no point in recounting the way this happened here), there is an obvious motivation for members of that tribe to produce compelling-looking arguments for its efficacy."
The corollary to this is that the FDA itself went out of its way to smear Ivermectin as horse dewormer. The FDA tweeted the following over a year ago. Is it normal for the FDA to mock drugs like this?
"You are not a horse. You are not a cow. Seriously, y'all. Stop it."
This seems to me way worse than Bret Weinstein getting overly excited about Ivermectin and jumping the gun on a study that turned out to be no good.
So I have the opposite point in favor of Ivermectin, and in fact, Scott makes a similar point in saying that big pharma suppresses cheap old generic drugs all the time to get people to take their new expensive drugs. It's their marketing model. So we know at least millions of dollars of marketing are being spent to take down Ivermectin. Who is spending the big money in favor of Ivermectin?Nobody.
I don't understand the usage of "corollary" (a straightforward consequence of a previous nontrivial statement) here. Is that the word you were meaning to use?
The FDA tweeted the following over a year ago. Is it normal for the FDA to mock drugs like this?
No, but on culture war it is. This was already after Red cultural authorities had thrown their clout behind Ivermectin, no? The FDA, too, is a Blue technocratic institution; of course it would be tempted to put out communication that lowers the status of the Reds, and in this particular case there was the additional motivation for it that the Ivermectin push was a direct attack on the FDA's authority. One would therefore expect the FDA to attack it independently of whether it works, and so the FDA attacking it is not a signal for or against it working.
I thought it was unnecessary to rehash the backstory, but maybe not. My understanding was that it was associated with culture warring almost from the start: the Blue team occupied the "COVID is scary and untreatable, therefore we need lockdowns, mask-wearing and more powers for our technocrats" position. The Red team found the suggested conclusion unbearable, and tried to respond by attacking every point of the premise. One such push was against the "untreatable" part, and took the shape of asserting that a series of widely available remedies that ranged from completely implausible (bleach) to the merely seemingly random (hydroxychloroquine, ivermectin) worked against it (with the implication that if it did, the power grab by Blue authorities would be proven unjustifiable). Therefore, on the balance, up to this point the situation is still as I described: Reds would push Ivermectin regardless of whether it works, and the FDA would pan it regardless of whether it works, so neither observation tells us anything about it. The prior still is that a random drug with no evident mechanism of action on COVID would not work on it.
The "cheap old generic drugs suppressed for profit" argument is a better one, though (there, you would actually suspect more effort to suppress effective ones, as if someone takes a cheap old ineffective drug, they don't get cured and are still on the market for the more expensive one afterwards).
Skylab
Beware of he who would deny you access to information...
4bpp 1yr ago·Edited 1yr ago
corollary- a proposition that follows from (and is often appended to) one already proved.
If we grant that Ivermectin's effectiveness is a red tribe talking point, then it follows that Ivermectin's ineffectiveness is culturally important to blue tribe.
However- in a sane world, we would still expect a few Joe Rogan's and Bret Weinstein's to weigh in on their far out beliefs on a podcast. What we wouldn't expect in a sane world is for the FDA to snarkily take a side using a national institution of science, well before the fog of war had cleared.
However, the FDA receives much of their funding from Pfizer/Moderna/JnJ and there is a revolving door among board members.
I doubt Rogan is getting paid by Ivermectin advocates. There's no money in it. You could argue that he gains more followers by choosing the fault line, a kind of reverse audience capture.
I find it easier to place the cultural war aspect of Ivermectin into the category of, probably more effective than it appears since even the FDA will go out of its way to smear the cheap and safe drug as "horse dewormer."
Again, maybe I'm wrong but that was my internal assesment. It was odd to see someone making a symmetrical but opposite argument.
I find it easier to place the cultural war aspect of Ivermectin into the category of, probably more effective than it appears since even the FDA will go out of its way to smear the free and safe drug as "horse dewormer."
Yeah, I don't see how this follows. I would expect both P(FDA smears Ivermectin | Ivermectin doesn't work) and P(FDA smears Ivermectin | Ivermectin works) to be close to 1 under our conditions of Ivermectin's culture war role and the FDA, so P(Ivermectin works | FDA smears Ivermectin) is basically the same as the prior P(Ivermectin works).
Without having read all that (the Scott article was already "more than you wanted to know" and this is definitely veering into "waay more than I ever could possibly have wanted to know"), this seems to be a useful article since it mostly starts from Scotts article and gives an "overview" (albeit a long one) as to why the author thinks he was wrong.
This seems generally good. And I can imagine that Scott was too harsh in excluding some not so great studies.
But then, directionally my takeaway from Scotts article (at the time it was written) was that Ivermectin actually had a small chance of actually being mildly useful and that it might actually have been a good investment of money and time to run some more well-done studies (though there were already a lot of badly run ones to muddy the water). Mainstream news on that topic on the other hand was that Ivermectin was nothing but "horse dewormer" that only idiots would take against Covid.
So I think that railing against Scott is kinda barking up the wrong tree (especially with the slightly combative tone of the article [0]). But then, we maybe just expect a lot more from Scott (and his long article) than he provided. In any case, it seems that nowadays this matters less as a practical concern (Paxlovid is kinda good) and it boils down more to a debate about epistemic practices.
[0] I only glanced at it ... as I said it's kinda long and my interest in the topic is not huge. But the tone strikes me as somewhat accusatory of someone who IMHO did a reasonable (if not perfect) job. But then, I also really like Scott as an author, so I might be biased.
If we have another pandemic it matters whether or not we spend resources on studies for generics like Ivermectin and Ivermectin in particular. With the current state of affairs, we likely won't run high-quality studies for Ivermectin to be used on a new virus.
I've read a fair bit of this but not all. My main takeaway from what I have read is that there is a decent chance that Ivermectin has a small positive effect but there isn't anything near enough quality to say that it has a pandemic-ending effect. Since I though that was the claim of the Ivermectin people I get a bit confused about why were are still spending so much time talking about it.
Is this intended as a critique of Alex or of Scott? After all, as CIC in a war based on a lie, Bush really was at least partially and negligently responsible for her son’s death.
With the caveat that I am not remotely qualified to judge the evidence here and am drawing tentative conclusions based on social-cue-based hueristics, Sheehan:Bush::Alex:Scott, although the comparison is actually more to the unfortunates depicted in the first three panels, ie the author and his friends and acquaintances. The joke is that we all have had the experience of being persistently haunted by less-than-optimal social interactions with no graceful solutions available. Certainly I've had the experience, and it's not a great one.
I don't know with confidence how much to ingest so I tried it topically for flu symptoms and found that Bimectin topical works wonders for Arthritis symptoms. No idea why but wow my shoulders feel great now - this is not medically actionable advice for anyone but myself
I have heard this from so many people that my prior is that a substantial minority of people have something wrong with them that ivermectin clears up, and getting rid of that something will improve your covid recovery noticeably. Something includes, yes, worms, but also many other kinds of funk hanging around the body.
So you do not need to keep on taking ivermectin, or have it present in your system when you get infected with covid. But also letting people take a course of it should be easy and not mocked by CNN or the FDA.
so you've heard ... vague improvement from many people. But feeling / vibes / personal health regularly changes, so a substantial number of people who take ivermectin (when they're sick or not) reporting they felt better afterwards, in a variety of ways that aren't really related, should be taken similarly to how people on TheMotte reported feeling better days after taking fisetin (which wasn't even supposed to do that, it was a long term anti-aging thing) - as a bunch of people looking too hard at nothing at all.
What does this response mean? You're still claiming it in either case? And ... how could ivermectin cure that many different subtle aliments that so many people have? Do any other drugs work like that? There are hundreds of pharmaceuticals and each one treats one or a few specific diseases. The only things that are 'broad-based cures' are things like vitamins or foods that have many components treating starvation etc.
I've said it before back on Reddit, and I'll say it again here: This guy seems to have a solid point to make about the efficacy of Ivermectin, but he keeps sullying it with personal attacks against Scott Alexander. He very clearly has an axe to grind against Scott, which is why he uses hyperbolic titles like "Scott Alexander wounds Rationalism!!!". His work has a great amount of light, but he adds a bunch of unnecessary heat either out of resentment towards Scott, in an attempt to clickbait, or both.
I was reasonably impressed by the last one (investigating Strongyloides incidence). It wasn't airtight, but it was good work and avoided personal attacks.
I'd gone into it expecting performative handwringing because of the Rationalism Wounded nonsense. The tenor of this summary suggests that such restraint was temporary, and he's back to scoring points as a controversial, yet brave independent-minded intellectual.
Scott reward for interacting with him is that Scott was able to fix an error in his article. To the extent that Scott cares about the truth that's valuable.
While I find the subject a little outside of my wheelhouse and not interesting enough to spend time and effort to decipher, "guy obsesses over something for a long time and writes a lot about it" is pretty much the core of what made /r/themotte fun to be in. While writing twenty (!) essays in a row on the topic is definitely weird, it's not as though Alexandros is chasing Scott around or constantly emailing him (to my knowledge). And, well, that sort of weird is almost what this space is for.
If someone here dedicated themselves to a massive personal research project to disprove statements that they figured to be harmful from someone they saw to be an influential public figure and wrote essay after essay on it I think the reception would be somewhat less cold if the figure weren't Scott.
Doing a lot of personal research and writing articles about a topic you're interested in is great! But obsessing about a particular author simply because they're the ones making the argument, isn't. In fact, it's pretty much anti-rationalist to attack the author instead of the argument. Spamming posts with hyperbolic clickbait headlines like "Scott Alexander has WOUNDED Rationalism with his Ivermectin article!!!" does little to improve Alexandros' actual argument.
I am fine with Alex keeping up his beating of this, er, horse. Right or wrong, go on. I have commented previously about how the media has not been fair at all to the pro-ivermectin viewpoint so someone has to keep that torch alive.
But he keeps on wanting to talk about how Scott has not properly dealt with his argument. He mentions Scott twice as many times as he mentions ivermectin. He even grants Scott the honor of being steelmanned.
True, but he's flogged the horse so much it is now driven into the Earth's mantle.
This Brazilian study he references that is so great and finds so much value - well because I am an obsessive bitch, I looked up where they did it. Okay, place seems legit. Hm, what is the parasitic status of Brazil? Well would you look at that:
Conclusions: The prevalence of intestinal parasitic infections is high in Brazil, and anthelmintic drugs should be administered periodically as a prophylactic measure, as recommended by the WHO.
There's also a charming little parasite called Strongyloides stercoralis or threadworm, where you contract the infection as a child, can be infected with it for years, and not know you are infected, but it's putting pressure on your immune system. Turns out this is prevalent in Brazil, too, and there's a paper from 2003 on Itajaí, the city where that ivermectin study was done:
Discussion
The city of Itajaí has the most HIV cases in the state of Santa Catarina, Brazil. Approximately 78 new cases of infection are reported per year per 100,000 inhabitants. The occurrence of strongyloidiasis in the state of Santa Catarina is relatively high, although only a few epidemiological studies on this region have been made.
What is the first-line treatment for threadworm? Could it be... take a guess... ivermectin?
2016 paper on the burden of infectious diseases in the Brazilian Southern state of Santa Catarina (this is where the port city of Itajaí is located):
An epidemiological study with an ecological design was conducted covering all nine regions of Santa Catarina state. The study was based on methodology from the GBD study for the world proposed by Murray et al. [9]. The infectious diseases included were HIV/AIDS, tuberculosis, hepatitis B, hepatitis C, Chagas disease, diarrheal diseases, encephalitis, schistosomiasis, malaria, meningitis, tetanus, syphilis and other sexually transmitted diseases as well as a group composed of other infectious diseases (including dengue fever, hantavirus, leprosy and others).
The highest rates [of HIV/AIDS] in the state were found in the regions of Foz do Rio Itajaí and Grande Florianópolis, which are located in the state's coastal region, have major tourist attractions and are home to Brazil's third largest port. Among Brazilian cities with over 50,000 inhabitants, the top three with the highest incidence rates of HIV/AIDS are located in such regions .
More than 90% of the disease burden was due to the early mortality component, YLL. The early mortality burden was quite high among children under 5 years of age. There was an unbalanced distribution of burden among the state's regions, with the highest rates found in the Foz do Rio Itajaí, Nordeste and Grande Florianópolis regions. The highest level of burden among the studied infectious diseases was attributed to HIV/AIDS.
Scott didn't convince me that ivermectin had its effect mostly due to its anti-parasitic action, I thought that before he delivered his verdict. And I'm sticking to it: ivermectin works by killing off parasites. People who have stressed immune systems due to parasitic infestation, and who contract Covid, have a double burden. Reduce that by killing the parasites, treat them for Covid, and I'm not surprised that they are less likely to be hospitalised and less likely to have fatal outcomes.
But I maintain, and I say this over and over again, ivermectin for otherwise healthy people who contract Covid does nothing.
While I agree with your general premise, Marinos has addressed Brazil specifically. Partway down. IIRC, the Brazil study is the only one that uses a different methodology for measuring parasite load. His method for "correcting" that removes significance from the existing meta analyses.
Marinos is making a credible argument from statistics and science. He ought to be able to do so without constantly taking shots at anyone. When he does so I've been reasonably impressed. The fact that he chooses not to leaves a bad taste in my mouth.
I trust Marinos less because I get the impression that he is using Scott (and the broader community) for clout-chasing. I don't see why that should make him more credible.
He ought to be able to do so without constantly taking shots at anyone.
He's not so much taking shots as being a bit of a sea-lion. I can understand how it's annoying, but aspies gonna aspie.
Why?
It's not just Scott, the sum total of hostility towards ivermectin, combined with the absolute refusal to debate Alexandros on the merits of the arguments comes off as "oh shit, he makes good points, that I don't know how to argue against". I'm not saying Scott has to talk to him, but it if he's so obviously wrong, shouldn't there be someone among the science trusting cloutsharks that would be happy to take him on?
It's an asymmetric strategy. Marinos will expend more time and effort constructing his castle than 99% of readers can spend attacking it. He's made that his brand--he makes money off of angry skeptics who want to signal they "do your own research."
But what about the other 1%? You make a good point about the absence of Trust Science clout-chasers. They don't seem too eager to take on his fortified position. If I had to guess, I'd say they're off on a different part of Twitter, building up their own forts, because that's their brand.
I'm honestly not sure I want to see those deboonkers come out and get into a slapfight with Marinos. I don't really trust them for the same reasons. They're showing up to make money and promote the brand. A showdown between two open partisans (pretending to be neutral) is less appealing than a polite conversation between two reasonable authors.
Truth-seeking is supposed to be a two-way street, and all I see from Marinos is one-way. Should some commenter point out "hey, strongyloides was theorized to stress the immune system, not kill through hyperinfection!" or "I reran the meta-analysis and got blah blah blah," does Marinos pick that up and signal-boost it? Does he have any reason to do so? His fame is based on giving reasonable arguments for ivermectin. He doesn't have to answer to random commenters unless he thinks he can score points off them. I've seen that happen on reddit, most clearly here and here. Note the lack of any concessions, just claims that he welcomes criticism, followed by grilling anyone who remotely indicates skepticism.
Should some commenter point out "hey, strongyloides was theorized to stress the immune system, not kill through hyperinfection!" or "I reran the meta-analysis and got blah blah blah," does Marinos pick that up and signal-boost it?
Scott didn't convince me, I thought parasite load was the reason before he came to his conclusion. And trawling through all the studies quoted in the meta-analysis showed that the best results were in places that also had high parasite infections. Same with the Itajaí study that Alexandros is touting: it's a big port city, has a lot of the kinds of fun social diseases you would expect in such a place, and being sub-tropical climate has a ton of those kinds of diseases and infestations as well. So dosing sick people with ivermectin would probably see an improvement for any illness, never mind Covid, and the study although it was thorough about co-morbidities, doesn't seem to have checked people for infestations by threadworm, parasites, etc.
Show me a study where it's "we tested patients beforehand for worms and parasites and their results came out clean, we gave the test group ivermectin and didn't to the control group, and the ivermectin group had better outcomes" and I'll be convinced. I'm not convinced yet.
I can get why it seems that way if someone is only absorbing the pathos.
If I pulled up Alexandros's blog today and saw he was still talking about it, I would say "oh, okay" and move on.
But Alex keeps on trying to drag Scott back into the argument. I get that Alex found someone who is not was not treating him like a freak and that was a relief, just like it was for Ralph Wiggum when he got a pity valentine from Lisa Simpson. And now Alex stalks Scott and demands Scott pay attention to Alex's latest argument.
I did a control-F for "scott" on this blog and got sixty-three matches. It shows up over twice as many times as "ivermectin."
So it is not "why are you still talking about ivermectin" and more "why are you still talking about Scott!"
Alex deciding to keep on holding onto this issue is fine. Right or wrong, it is A-OK for him to keep going on it.
But Alex demanding Scott's attention -- whether or not Alex is right -- needs to be shut down.
Speaking from the minority position, the duty is on Alex to behave in a fashion that makes people want to engage with him, instead of him constantly giving off danger signs that say "DO NOT TOUCH".
I am sure some goof will say HA HA YOU ADMIT YOU DO NOT CARE ABOUT WHO IS RIGHT, THEREFORE I WIN, and
you can never make sure you get the last word,
damn straight, I care much more about not ending up some stalker's new hobby.
Other than the obsession with the subject, I don't see signs of demanding Scott's attention. Using his name isn't much of an argument. Substack is not Reddit or Twitter where you get pinged every time someone mentions you. If you come from the view that Alex isn't trying to get Scott's attention, the constant chorus of "why don't you leave him alone" ends up coming off as trying to shut down the conversation on the topic.
Speaking from the minority position, the duty is on Alex to behave in a fashion that makes people want to engage with him, instead of him constantly giving off danger signs that say "DO NOT TOUCH".
Nah. Obviously there needs to be a balance, otherwise you're giving one side a blank check to never address valid criticism from upstarts. Currently I'm of the view that it's fine for Alexandros to keep writing, and for Scott to not respond, but comparing his reaction to Alexandros to his reaction to Nathan Robinson gives me a whiplash (well, it would, if I didn't know one of them has a lot more clout than the other).
I just pulled up Alex's post-summary page, and of his recent articles 6 are clearly about Ivermectin (maybe the others are too but not obviously from the title or summary).
Five of the six of them mention Scott in the title or summary. What. The. Fuck.
Maybe Alex does not know he is acting like a fucking stalker. Maybe no one has told him.
otherwise you're giving one side a blank check to never address valid criticism
I truly and honestly think it is bad that this issue has gotten so little debate.
But it is not Scott's fault that there is so little debate here. Scott has done much more to make sure Alex has his voice heard than anyone else. And the reward is to get constant articles written about him. No wonder no one else wants to engage with this loser.
Alex is picking on Scott because he can pick on Scott. If Alex attacks CNN, no one cares, there is no chance of CNN admitting they are wrong or even acknowledging Alex's existence. But Scott gave Alex some attention once, and the only possible victory Alex has left is getting Scott to admit that he was somehow unfair to Alex.
(Scott has dozens of old articles with the basic complaint "feminists spend most of their energy attacking men who deign listen to women instead of men who abuse women" and this is basically just that all over again.)
It is bad that Alex is in that situation where he cannot get a fair debate partner. But he needs to stop attacking the one person who showed him a shred of dignity once. Do not be the guy who stalks the girl that said hi to him at a party. It is creepy and it sets up bad incentives for anyone to ever talk to you.
I already conceded his behavior is a bit on the spergy side, but you're making a mountain out of a molehill. Again, is Scott pinged every time his name is mentioned? Is he forced to read those headlines via some Clockwork Orangesque torture device?
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Notes -
In Scott's latest Open Thread:
attn @AlexandrosM
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Wow. I gotta say many of the comments here are quite something.
Look folks - I got word through a backchannel that a summary post might get the issues I raise actually addressed. I thought that was reasonable, so I wrote that post. I didn't even submit it anywhere other than post it on my twitter.
So I randomly open up theMotte website today, to see that people are losing their goddamn minds that I wrote something on my substack. And as /u/jimmy mentions, not a single person addressed any object-level argument. I believe the sum total is zero. And before someone jumps in and says "ah that's because you make it so personal" I will say that the sum total was pretty poor before anyone characterized my writing as "making it personal".
Like, seriously, what the flying fajitas?
Look, this may look like a lot of wasted words to you. That's totally fine by me. To me, this has been a course in learning about the absolute state that "evidence-based medicine" is in. I don't learn well from books, I learn from projects. So this was that project where I learned about all the things I wrote. Writing raises the bar and makes me dig deeper. And in the course of it I generated several novel findings, like correcting the Strongyloides hypothesis, finding that a Cochrane meta-analysis had violated its own inclusion criteria for most of the studies it included, putting together the Latin American hypothesis, as well as a few more things I've not published yet.
You don't have to understand how my brain works, and I sure as hell don't, but I've learned to trust it and follow it wherever it wanders, because there's usually something of value.
But for the life of me I struggle to conceptualize the ethical system that the people criticizing me here are implementing. In what world is it OK for Scott to call people "known fraudsters", "gullible rubes who were bamboozled by pseudoscience", attack many scientists who never did anything to him, and falsely so, and even attack me as a conspiracy theorist -- unprovoked, to a massive audience, but me responding by sticking my neck out and making concrete falsifiable claims is what attracts the outrage?
Now, I want to be extremely clear -- It is Scott's right to do all those things, a right which I will defend. And it is my right to call them out, and record the errors for posterity, so that nobody can say that they were not pointed out. And yes, as several people pointed out (thank you!) my extremely serious concern, moreso than it is with Scott, is with the rationalist community letting an argument that is this flawed go unchallenged. It follows that I don't want to be like the people I criticize, so I took it upon myself to do the analysis and explain the problems, in excruciating detail. And to do all this knowing that going after the most well-known and popular thought leader in the broader rationalist community will not get me any brownie points, even if I'm right.
I am acting in the only way I can see as morally consistent, and while obviously not everyone will agree with me on that, accusing me of being obsessed with demonstrating that the rationality community is failing at holding its own to account is a bit of a weird flex. If I'm right, then this is obviously extremely important for most people in this community. And if I'm wrong, then surely you can show me how. And if you're unsure, or can't be bothered to find out, that's totally cool also.
But weaponizing the lack of interest in finding out if I'm right into an attack that assumes I'm wrong is a better demonstration of my entire point than I could ever have hoped for. I can't claim to know what kind of rationalist discourse will help us address the various existential risks coming our way, but I am pretty sure this ain't it.
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Perhaps some of you can help me out. Back before this became politicized, Wikipedia stated that Ivermectin was being studied as an anti viral agent against two viruses. This is interesting to me, specifically because:
Both of them are positive single strand RNA viruses
COVID is also a positive single strand RNA virus
Those two viruses are both mentioned in the article to this very day.
Most proposed mechanisms that I've seen for Ivermectin's alleged effectiveness do not seem to target anything particularly unique to COVID.
What is going on there that allows that information to not be labeled pseudoscience?
Since millions of red tribe people have been slathering themselves with sheep bimectin for years now maybe someone can simply gather some data on this practice and let us know how it went. We should also give a hat tip and thank you for them volunteering to be the lab rats in this experiment and I have not heard of a single case of these people harming themselves with this bold experiment (surely blue tribe acolytes would have been all over it if it were as bad as Jimmy Kimmel suggested in his wheezy jokes), so THANK YOU red tribe volunteers!
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There's something interesting going on in this discussion here, and in previous discussions on Alexandros's writing on this topic.
There's a lot of people pointing at how Alexandros is pretty critical of Scott/Scott's epistemics (and curiously missing his similar criticisms of the community's epistemics), rather than just focusing on whether or not Scott's conclusions are true and/or justified. Alexandros does seem pretty critical, so fair enough there. And there's a conversation to be had about how critical is appropriate, and how to figure out how critical is appropriate.
But that conversation isn't happening.
Instead, we're getting accusations that Alexandros is "attacking"/"grinding his axe against"/"picking on" Scott rather than sticking to the object level and minimizing "unnecessary heat"... in a way that sure looks a bit like "attacking"/"grinding axes against"/"picking on" Alexandros. You know, with insults including but not limited to "absolutely autistic", "creepy", and "fucking stalker". People showing up just to let everyone know that they don't care to talk to him because he's bad. And, of course, not one object level rebuttal yet as of when I'm writing this.
Is Alexandros acting like an obsessed stalker who once got attention from a girl, and letting his emotions pull him away from truth and honesty? Is Scott letting the fear of his "expert status" being challenged interfere with his neutral truth seeking? Are these questions both completely fair and valid, both out of line by virtue of attempting to address the person instead of the argument, or is there some principle saying that one can be asserted without argument while the other is unacceptable to question even with many pages of argument? And if so, what is that principle?
So far no one is addressing Alexandros's arguments about whether ivermectin works.
Or whether Scott's arguments against ivermectin are valid.
Or whether Alexandros's criticisms of Scott's (and the communty's!) epistemics are valid.
It's all focused on a rather uncharitable mind reading of Alexandros motivations. This isn't entirely a bad thing in itself since there's actually a lot to be gained by tracking the least-flattering-consistent-explanation of people's behaviors/beliefs, but it sure is interesting what happens when you apply this metric uniformly and judge those criticizing Alexandros on this metric.
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To give an overview of what I believe is a reasonable bounded-rationality basis to dismiss this objection:
I am not equipped to evaluate the claims in Alexandros's post in detail without significant effort and time investment (despite being a working academic in a quantitative field).
I'm not particularly worried about COVID and the societal excesses of the response seem to have already died down, so I personally don't see much value in learning about a surprising therapy for it. It seems unlikely to me that even if something like the contents of this post became widely accepted as truth, the societal response next time something COVID-shaped happens would be much beter.
Superficially, it seems there is no particular reason why something like Ivermectin (an antiparasitic that apparently works by disrupting the metabolism of fairly complex multicellular parasites) would work against COVID (a virus). I have a strong prior on most medicines claimed to have a minor beneficial effect on popular therapeutic targets actually being completely ineffectual (as this has been my experience).
On the other hand, the "parasite load" story seems superficially plausible.
Due to the culture-war dimension of Ivermectin, whose efficacy the red tribe in the US has entangled its social status with (no point in recounting the way this happened here), there is an obvious motivation for members of that tribe to produce compelling-looking arguments for its efficacy. Since Alexandros posts around this community, he seems a priori likely to harbour Red sympathies.
Moreover, there is a "contrarian" tribe that is motivated by taking down the rationality-orthogonal "trust the science" wing of the blue tribe, and therefore would also derive utility from successfully Eulering in favour of Ivermectin. Many people seem to talk about the abrasiveness of Alexandros's tone. This increases the probability that he's Red or Contrarian and would therefore have the motive to come to his conclusion.
In short, a situation that seems fairly symmetrical to "read this long and extremely compelling essay by a Harvard academic who is also a Twitter superstar using Science and Logic to prove that Blank Slatism is true". If you had unlimited time and resources or a particularly high stake in finding out whether desirable qualities of humans are genetic, sure, by all means you ought to read it and analyse the argument. For most everyone else, it would be more rational to ignore the essay, leave your prior largely unshifted and spend the time it would take to read on something with higher expected utility, like planning tomorrow's healthy breakfast or getting on top of your todo list.
Things that could convince me to take the essay more seriously:
Establish that the author does not stand to benefit from Ivermectin working, e.g. has impeccable blue tribe credentials.
Establish that rehabilitating Ivermectin would benefit me personally a great deal.
Propose a plausible mechanism by which Ivermectin (specifically!) might work against COVID. Some general handwaving like "it modulates the way the immune system operates" won't work; lots of drugs do that, so I don't see why specifically the one that the Blues are raging against and the Reds are swearing will prove once and for all they should actually be in charge should be the one that happens to modulate it just right.
Relatedly, but harder, shift my prior regarding medicines that purport to do anything more complex than targeting one particular well-understood metabolic pathway not working.
This article has nothing to do with rehabilitating ivermectin. I myself am not sure how well it works today and if I had to guess, it worked a lot better for pre-Omicron variants. Naturally recent data is a mess, so it's hard to know, and I really should do some digging before I say much more because I could be very wrong. On whatever the "red tribe" is - I frequently tweet out about how I could never support a president who allowed Fauci to run the pandemic. As recent immigrant to the US, I have very little interest in whatever partisan bickering y'all are engaged in, other than that I'd prefer if the country my children were born in doesn't implode.
Rehabilitating the rationalist community (the actual intent of the essay) would benefit everyone a great deal. Ivermectin is the perfect case-study of why the rehabilitation is needed.
Once again, the article has nothing to do with defending ivermectin, and everything to do with defeating bad arguments. If you are interested in some material on mechanism of action, my friend Joomi has written a pretty good piece - https://joomi.substack.com/p/misconceptions-about-ivermectin-dosing
There are many drugs we don't understand the mechanisms of, and I can personally confirm that some of these definitely work: https://en.wikipedia.org/wiki/Mechanism_of_action#Drugs_with_unknown_MOA . In fact, as you can read in Joomi's article, ivermectin's anti-parasitic action also is somewhat mysterious, but nobody doubts it works.
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Ivermectin is used as a weapon against the right in the culture war. Whether the right is actually correct, and whether the left made baseless attacks against the right for political reasons, will be important as long as we have a left and right around.
But I think it is clear what the collective knowledge about Ivermectin was at the time. Whether we later learned (or will learn) that it actually works against Covid (or not) will not change anything about how justifies these attacks were.
We had a time when the best meta-analysis as evaluated on LessWrong was pro-Ivermectin and the institutions were anti-Ivermectin.
The question of whether to follow the highest quality published metastudies or the institutions in cases where those differ is an important one. If the highest quality published metastudy was right about ivermectin and the institutions wrong that's a lesson for the future.
If the institutions are wrong and generally suppress the use of generics for important illnesses that suggests we should invest more money into studying whether generics are useful for problems that arise.
Lastly, if Ivermectin works for COVID there's a decent chance that it also works for other viruses. If we have another pandemic it's important to know whether we should run trials to test whether Ivermectin helps or don't run those trials.
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I for my part am already fairly convinced that the left makes baseless attacks against the right for political reasons. (Of course, the converse is also true.) Is it that important whether there is one more or one fewer example?
"Baseless attacks for political reasons" was only a rough description. Maybe "baseless attacks for political reasons, that are highly signal-boosted by the media and social media", would be closer.
But again: this was definitely done for political reasons [0] at a time when the evidence was still inconclusive.
Whatever we found out between then and now doesn’t change anything about that.
[0] There are of course more benign motivations one could assume, e.g. protecting people from what was perceived as “false cures” that would end up harming people.
Just because the evidence was inconclusive doesn't mean that the attack was unimportant. For one thing, it's a signal that anyone who does try to do actual research and produce actual evidence in the future would be mercilessly attacked. Even if there's little evidence at the moment, this is a huge deal.
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Politically, what matters is who controls the institution that determines who is right. I could list a hundred things about which the left is wrong and yet which have been ascertained as true by consensus reality. It has always been so, those who are familiar with Roman history know how much who determines what is true has always been the decisive force in politics.
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"Due to the culture-war dimension of Ivermectin, whose efficacy the red tribe in the US has entangled its social status with (no point in recounting the way this happened here), there is an obvious motivation for members of that tribe to produce compelling-looking arguments for its efficacy."
The corollary to this is that the FDA itself went out of its way to smear Ivermectin as horse dewormer. The FDA tweeted the following over a year ago. Is it normal for the FDA to mock drugs like this?
"You are not a horse. You are not a cow. Seriously, y'all. Stop it."
This seems to me way worse than Bret Weinstein getting overly excited about Ivermectin and jumping the gun on a study that turned out to be no good.
So I have the opposite point in favor of Ivermectin, and in fact, Scott makes a similar point in saying that big pharma suppresses cheap old generic drugs all the time to get people to take their new expensive drugs. It's their marketing model. So we know at least millions of dollars of marketing are being spent to take down Ivermectin. Who is spending the big money in favor of Ivermectin?Nobody.
I don't understand the usage of "corollary" (a straightforward consequence of a previous nontrivial statement) here. Is that the word you were meaning to use?
No, but on culture war it is. This was already after Red cultural authorities had thrown their clout behind Ivermectin, no? The FDA, too, is a Blue technocratic institution; of course it would be tempted to put out communication that lowers the status of the Reds, and in this particular case there was the additional motivation for it that the Ivermectin push was a direct attack on the FDA's authority. One would therefore expect the FDA to attack it independently of whether it works, and so the FDA attacking it is not a signal for or against it working.
I thought it was unnecessary to rehash the backstory, but maybe not. My understanding was that it was associated with culture warring almost from the start: the Blue team occupied the "COVID is scary and untreatable, therefore we need lockdowns, mask-wearing and more powers for our technocrats" position. The Red team found the suggested conclusion unbearable, and tried to respond by attacking every point of the premise. One such push was against the "untreatable" part, and took the shape of asserting that a series of widely available remedies that ranged from completely implausible (bleach) to the merely seemingly random (hydroxychloroquine, ivermectin) worked against it (with the implication that if it did, the power grab by Blue authorities would be proven unjustifiable). Therefore, on the balance, up to this point the situation is still as I described: Reds would push Ivermectin regardless of whether it works, and the FDA would pan it regardless of whether it works, so neither observation tells us anything about it. The prior still is that a random drug with no evident mechanism of action on COVID would not work on it.
The "cheap old generic drugs suppressed for profit" argument is a better one, though (there, you would actually suspect more effort to suppress effective ones, as if someone takes a cheap old ineffective drug, they don't get cured and are still on the market for the more expensive one afterwards).
corollary- a proposition that follows from (and is often appended to) one already proved.
If we grant that Ivermectin's effectiveness is a red tribe talking point, then it follows that Ivermectin's ineffectiveness is culturally important to blue tribe.
However- in a sane world, we would still expect a few Joe Rogan's and Bret Weinstein's to weigh in on their far out beliefs on a podcast. What we wouldn't expect in a sane world is for the FDA to snarkily take a side using a national institution of science, well before the fog of war had cleared.
However, the FDA receives much of their funding from Pfizer/Moderna/JnJ and there is a revolving door among board members.
I doubt Rogan is getting paid by Ivermectin advocates. There's no money in it. You could argue that he gains more followers by choosing the fault line, a kind of reverse audience capture.
I find it easier to place the cultural war aspect of Ivermectin into the category of, probably more effective than it appears since even the FDA will go out of its way to smear the cheap and safe drug as "horse dewormer."
Again, maybe I'm wrong but that was my internal assesment. It was odd to see someone making a symmetrical but opposite argument.
Yeah, I don't see how this follows. I would expect both P(FDA smears Ivermectin | Ivermectin doesn't work) and P(FDA smears Ivermectin | Ivermectin works) to be close to 1 under our conditions of Ivermectin's culture war role and the FDA, so P(Ivermectin works | FDA smears Ivermectin) is basically the same as the prior P(Ivermectin works).
( P(W|F) = P(F|W)P(W)/P(F) = ~= (1/1) * P(W) = P(W) )
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Without having read all that (the Scott article was already "more than you wanted to know" and this is definitely veering into "waay more than I ever could possibly have wanted to know"), this seems to be a useful article since it mostly starts from Scotts article and gives an "overview" (albeit a long one) as to why the author thinks he was wrong.
This seems generally good. And I can imagine that Scott was too harsh in excluding some not so great studies.
But then, directionally my takeaway from Scotts article (at the time it was written) was that Ivermectin actually had a small chance of actually being mildly useful and that it might actually have been a good investment of money and time to run some more well-done studies (though there were already a lot of badly run ones to muddy the water). Mainstream news on that topic on the other hand was that Ivermectin was nothing but "horse dewormer" that only idiots would take against Covid.
So I think that railing against Scott is kinda barking up the wrong tree (especially with the slightly combative tone of the article [0]). But then, we maybe just expect a lot more from Scott (and his long article) than he provided. In any case, it seems that nowadays this matters less as a practical concern (Paxlovid is kinda good) and it boils down more to a debate about epistemic practices.
[0] I only glanced at it ... as I said it's kinda long and my interest in the topic is not huge. But the tone strikes me as somewhat accusatory of someone who IMHO did a reasonable (if not perfect) job. But then, I also really like Scott as an author, so I might be biased.
If we have another pandemic it matters whether or not we spend resources on studies for generics like Ivermectin and Ivermectin in particular. With the current state of affairs, we likely won't run high-quality studies for Ivermectin to be used on a new virus.
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I've read a fair bit of this but not all. My main takeaway from what I have read is that there is a decent chance that Ivermectin has a small positive effect but there isn't anything near enough quality to say that it has a pandemic-ending effect. Since I though that was the claim of the Ivermectin people I get a bit confused about why were are still spending so much time talking about it.
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We all have our Cindy Sheehan.
Is this intended as a critique of Alex or of Scott? After all, as CIC in a war based on a lie, Bush really was at least partially and negligently responsible for her son’s death.
With the caveat that I am not remotely qualified to judge the evidence here and am drawing tentative conclusions based on social-cue-based hueristics, Sheehan:Bush::Alex:Scott, although the comparison is actually more to the unfortunates depicted in the first three panels, ie the author and his friends and acquaintances. The joke is that we all have had the experience of being persistently haunted by less-than-optimal social interactions with no graceful solutions available. Certainly I've had the experience, and it's not a great one.
Fucking Waminals, man.
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I don't know with confidence how much to ingest so I tried it topically for flu symptoms and found that Bimectin topical works wonders for Arthritis symptoms. No idea why but wow my shoulders feel great now - this is not medically actionable advice for anyone but myself
I have heard this from so many people that my prior is that a substantial minority of people have something wrong with them that ivermectin clears up, and getting rid of that something will improve your covid recovery noticeably. Something includes, yes, worms, but also many other kinds of funk hanging around the body.
So you do not need to keep on taking ivermectin, or have it present in your system when you get infected with covid. But also letting people take a course of it should be easy and not mocked by CNN or the FDA.
so you've heard ... vague improvement from many people. But feeling / vibes / personal health regularly changes, so a substantial number of people who take ivermectin (when they're sick or not) reporting they felt better afterwards, in a variety of ways that aren't really related, should be taken similarly to how people on TheMotte reported feeling better days after taking fisetin (which wasn't even supposed to do that, it was a long term anti-aging thing) - as a bunch of people looking too hard at nothing at all.
It is my prior, not my sure assessment of truth. It also fits the evidence.
What does this response mean? You're still claiming it in either case? And ... how could ivermectin cure that many different subtle aliments that so many people have? Do any other drugs work like that? There are hundreds of pharmaceuticals and each one treats one or a few specific diseases. The only things that are 'broad-based cures' are things like vitamins or foods that have many components treating starvation etc.
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I've said it before back on Reddit, and I'll say it again here: This guy seems to have a solid point to make about the efficacy of Ivermectin, but he keeps sullying it with personal attacks against Scott Alexander. He very clearly has an axe to grind against Scott, which is why he uses hyperbolic titles like "Scott Alexander wounds Rationalism!!!". His work has a great amount of light, but he adds a bunch of unnecessary heat either out of resentment towards Scott, in an attempt to clickbait, or both.
The only reason that feels hyperbolic is that most of us grew out of having expectation for rationalism. Change my mind.
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I was reasonably impressed by the last one (investigating Strongyloides incidence). It wasn't airtight, but it was good work and avoided personal attacks.
I'd gone into it expecting performative handwringing because of the Rationalism Wounded nonsense. The tenor of this summary suggests that such restraint was temporary, and he's back to scoring points as a
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Scott's reward for interacting with this guy is that this guy will now not leave him alone.
Scott reward for interacting with him is that Scott was able to fix an error in his article. To the extent that Scott cares about the truth that's valuable.
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While I find the subject a little outside of my wheelhouse and not interesting enough to spend time and effort to decipher, "guy obsesses over something for a long time and writes a lot about it" is pretty much the core of what made /r/themotte fun to be in. While writing twenty (!) essays in a row on the topic is definitely weird, it's not as though Alexandros is chasing Scott around or constantly emailing him (to my knowledge). And, well, that sort of weird is almost what this space is for.
If someone here dedicated themselves to a massive personal research project to disprove statements that they figured to be harmful from someone they saw to be an influential public figure and wrote essay after essay on it I think the reception would be somewhat less cold if the figure weren't Scott.
Doing a lot of personal research and writing articles about a topic you're interested in is great! But obsessing about a particular author simply because they're the ones making the argument, isn't. In fact, it's pretty much anti-rationalist to attack the author instead of the argument. Spamming posts with hyperbolic clickbait headlines like "Scott Alexander has WOUNDED Rationalism with his Ivermectin article!!!" does little to improve Alexandros' actual argument.
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I am fine with Alex keeping up his beating of this, er, horse. Right or wrong, go on. I have commented previously about how the media has not been fair at all to the pro-ivermectin viewpoint so someone has to keep that torch alive.
But he keeps on wanting to talk about how Scott has not properly dealt with his argument. He mentions Scott twice as many times as he mentions ivermectin. He even grants Scott the honor of being steelmanned.
True, but he's flogged the horse so much it is now driven into the Earth's mantle.
This Brazilian study he references that is so great and finds so much value - well because I am an obsessive bitch, I looked up where they did it. Okay, place seems legit. Hm, what is the parasitic status of Brazil? Well would you look at that:
There's also a charming little parasite called Strongyloides stercoralis or threadworm, where you contract the infection as a child, can be infected with it for years, and not know you are infected, but it's putting pressure on your immune system. Turns out this is prevalent in Brazil, too, and there's a paper from 2003 on Itajaí, the city where that ivermectin study was done:
What is the first-line treatment for threadworm? Could it be... take a guess... ivermectin?
Well would you look at that, part deux.
2016 paper on the burden of infectious diseases in the Brazilian Southern state of Santa Catarina (this is where the port city of Itajaí is located):
Scott didn't convince me that ivermectin had its effect mostly due to its anti-parasitic action, I thought that before he delivered his verdict. And I'm sticking to it: ivermectin works by killing off parasites. People who have stressed immune systems due to parasitic infestation, and who contract Covid, have a double burden. Reduce that by killing the parasites, treat them for Covid, and I'm not surprised that they are less likely to be hospitalised and less likely to have fatal outcomes.
But I maintain, and I say this over and over again, ivermectin for otherwise healthy people who contract Covid does nothing.
While I agree with your general premise, Marinos has addressed Brazil specifically. Partway down. IIRC, the Brazil study is the only one that uses a different methodology for measuring parasite load. His method for "correcting" that removes significance from the existing meta analyses.
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The reactions of Scott, his fans, and Trust The Science people to Alexandros' posts leave me convinced that Ivermectin probably works against covid.
And it's pretty fun to watch the counterarguments collapse to "why are you still talking about it!"
Why?
Marinos is making a credible argument from statistics and science. He ought to be able to do so without constantly taking shots at anyone. When he does so I've been reasonably impressed. The fact that he chooses not to leaves a bad taste in my mouth.
I trust Marinos less because I get the impression that he is using Scott (and the broader community) for clout-chasing. I don't see why that should make him more credible.
He's not so much taking shots as being a bit of a sea-lion. I can understand how it's annoying, but aspies gonna aspie.
It's not just Scott, the sum total of hostility towards ivermectin, combined with the absolute refusal to debate Alexandros on the merits of the arguments comes off as "oh shit, he makes good points, that I don't know how to argue against". I'm not saying Scott has to talk to him, but it if he's so obviously wrong, shouldn't there be someone among the science trusting cloutsharks that would be happy to take him on?
That's the thing about sealioning, though.
It's an asymmetric strategy. Marinos will expend more time and effort constructing his castle than 99% of readers can spend attacking it. He's made that his brand--he makes money off of angry skeptics who want to signal they "do your own research."
But what about the other 1%? You make a good point about the absence of Trust Science clout-chasers. They don't seem too eager to take on his fortified position. If I had to guess, I'd say they're off on a different part of Twitter, building up their own forts, because that's their brand.
I'm honestly not sure I want to see those deboonkers come out and get into a slapfight with Marinos. I don't really trust them for the same reasons. They're showing up to make money and promote the brand. A showdown between two open partisans (pretending to be neutral) is less appealing than a polite conversation between two reasonable authors.
Truth-seeking is supposed to be a two-way street, and all I see from Marinos is one-way. Should some commenter point out "hey, strongyloides was theorized to stress the immune system, not kill through hyperinfection!" or "I reran the meta-analysis and got blah blah blah," does Marinos pick that up and signal-boost it? Does he have any reason to do so? His fame is based on giving reasonable arguments for ivermectin. He doesn't have to answer to random commenters unless he thinks he can score points off them. I've seen that happen on reddit, most clearly here and here. Note the lack of any concessions, just claims that he welcomes criticism, followed by grilling anyone who remotely indicates skepticism.
Try it, and find out!
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Scott didn't convince me, I thought parasite load was the reason before he came to his conclusion. And trawling through all the studies quoted in the meta-analysis showed that the best results were in places that also had high parasite infections. Same with the Itajaí study that Alexandros is touting: it's a big port city, has a lot of the kinds of fun social diseases you would expect in such a place, and being sub-tropical climate has a ton of those kinds of diseases and infestations as well. So dosing sick people with ivermectin would probably see an improvement for any illness, never mind Covid, and the study although it was thorough about co-morbidities, doesn't seem to have checked people for infestations by threadworm, parasites, etc.
Show me a study where it's "we tested patients beforehand for worms and parasites and their results came out clean, we gave the test group ivermectin and didn't to the control group, and the ivermectin group had better outcomes" and I'll be convinced. I'm not convinced yet.
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I am more pro-ivermectin than the median or mean.
I can get why it seems that way if someone is only absorbing the pathos.
If I pulled up Alexandros's blog today and saw he was still talking about it, I would say "oh, okay" and move on.
But Alex keeps on trying to drag Scott back into the argument. I get that Alex found someone who
is notwas not treating him like a freak and that was a relief, just like it was for Ralph Wiggum when he got a pity valentine from Lisa Simpson. And now Alex stalks Scott and demands Scott pay attention to Alex's latest argument.I did a control-F for "scott" on this blog and got sixty-three matches. It shows up over twice as many times as "ivermectin."
So it is not "why are you still talking about ivermectin" and more "why are you still talking about Scott!"
Using someone’s name in an article whose whole topic is a piece they wrote is demanding their attention now? How so?
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Seems mostly* par for the course given the impact his piece had.
*) ok maybe a bit on the spergy side, but come on, we're all autistic here
Alex deciding to keep on holding onto this issue is fine. Right or wrong, it is A-OK for him to keep going on it.
But Alex demanding Scott's attention -- whether or not Alex is right -- needs to be shut down.
Speaking from the minority position, the duty is on Alex to behave in a fashion that makes people want to engage with him, instead of him constantly giving off danger signs that say "DO NOT TOUCH".
I am sure some goof will say HA HA YOU ADMIT YOU DO NOT CARE ABOUT WHO IS RIGHT, THEREFORE I WIN, and
you can never make sure you get the last word,
damn straight, I care much more about not ending up some stalker's new hobby.
Other than the obsession with the subject, I don't see signs of demanding Scott's attention. Using his name isn't much of an argument. Substack is not Reddit or Twitter where you get pinged every time someone mentions you. If you come from the view that Alex isn't trying to get Scott's attention, the constant chorus of "why don't you leave him alone" ends up coming off as trying to shut down the conversation on the topic.
Nah. Obviously there needs to be a balance, otherwise you're giving one side a blank check to never address valid criticism from upstarts. Currently I'm of the view that it's fine for Alexandros to keep writing, and for Scott to not respond, but comparing his reaction to Alexandros to his reaction to Nathan Robinson gives me a whiplash (well, it would, if I didn't know one of them has a lot more clout than the other).
I just pulled up Alex's post-summary page, and of his recent articles 6 are clearly about Ivermectin (maybe the others are too but not obviously from the title or summary).
Five of the six of them mention Scott in the title or summary. What. The. Fuck.
Maybe Alex does not know he is acting like a fucking stalker. Maybe no one has told him.
I truly and honestly think it is bad that this issue has gotten so little debate.
But it is not Scott's fault that there is so little debate here. Scott has done much more to make sure Alex has his voice heard than anyone else. And the reward is to get constant articles written about him. No wonder no one else wants to engage with this loser.
Alex is picking on Scott because he can pick on Scott. If Alex attacks CNN, no one cares, there is no chance of CNN admitting they are wrong or even acknowledging Alex's existence. But Scott gave Alex some attention once, and the only possible victory Alex has left is getting Scott to admit that he was somehow unfair to Alex.
(Scott has dozens of old articles with the basic complaint "feminists spend most of their energy attacking men who deign listen to women instead of men who abuse women" and this is basically just that all over again.)
It is bad that Alex is in that situation where he cannot get a fair debate partner. But he needs to stop attacking the one person who showed him a shred of dignity once. Do not be the guy who stalks the girl that said hi to him at a party. It is creepy and it sets up bad incentives for anyone to ever talk to you.
I already conceded his behavior is a bit on the spergy side, but you're making a mountain out of a molehill. Again, is Scott pinged every time his name is mentioned? Is he forced to read those headlines via some Clockwork Orangesque torture device?
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