A little medical judgment

 I found this article about Ivermectin a welcome relief.  As far as I can tell, the jury's still out on whether Ivermectin does any good in treating COVID, but the jury's equally out whether it does any harm.  It certainly is no ground for the extraordinary paroxysms of hysteria and vilification we've been witnessing.

The problem with a disease that all but a tiny fraction of people survive is that almost anything you can think of can be administered to patients, the vast majority of whom will recover.  Does Ivermectin work better than chocolate ice cream or, for that matter, an amulet worn around the neck?  I have no idea, and I don't much care, because unless you take absurd doses it's pretty cheap and extremely unlikely to hurt you.  It's no nuttier than many medical fads wholeheartedly embraced not only by the journalistic-industrial establishment but frankly by the AMA and rank-and-file doctors.  A low-fat, high-carb diet probably will turn out to be infinitely more dangerous than popping the occasional heartworm pill pilfered from your pup.

This nonsense is no way to conduct public health policy.  We've squandered more credibility than I thought possible in the last couple of years--and I would have said we'd done a pretty horrible job already for the couple of decades before that.  We've devolved into superstition and ad hominem attacks when we aren't sunk deep into outright fraud.

27 comments:

  1. The problem with a disease that all but a tiny fraction of people survive is that almost anything you can think of can be administered to patients, the vast majority of whom will recover. Does Ivermectin work better than chocolate ice cream or, for that matter, an amulet worn around the neck?

    Yes, this is a good point. It's hard to judge effectiveness given that we're talking about improvements in only marginal cases. As long as it's not killing additional people, what are you going to be able to tell about it?

    Again, locally, our test positivity rate is higher than it's ever been-- has been at these Delta rates since about August beginning. The previous peaks were shortly after testing began in 2020 and again at the depth of winter. But nobody's died since last winter. Hospital admissions have been 2-6 a week since the end of July, when before it was flat for months. The cases come and go, and at least here the Delta variant has been 100% survived by everyone who's had it -- and it's been a lot of people.

    Maybe it's the amulets.

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  2. Does Ivermectin work better than chocolate ice cream....

    Nothing works better than mint chocolate chip ice cream. Full stop.

    There's nothing like the power of the placebo effect, especially when we're dealing at the margin.

    Eric Hines

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  3. raven5:15 PM

    If it is being discouraged by the TPTB, it probably works...

    It was found to have anti viral qualities in studies done well before we were overtaken by the china flu. If I can find the link I will post it-

    The claims against safety are laughable- it is one of the most widely proscribed drugs in the world, being used to combat various parasitic diseases in African countries, which seem to be miraculously free from covid as well. BTW,the discoverer got a Nobel prize.
    The literature I have read on third world applications says it is so safe it can be administered by untrained village folk with some brief guidelines.

    The claims against efficacy may be purely financially motivated, as it is off patent and costs a few pennies per dose. Also, the Emergency Use Authorization claimed as a basis for distributing the vaccine are by law invalidated if there is a recognized treatment.

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  4. Is that right? I had read that the FDA approval was actually of a non-available version of the Pfizer vax to avoid ending the EULA. I’m not really sure how things like EULA work legally, though, and what might be rumor there.

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  5. This is an update to the Emergency Declaration (4th one, issued a few days ago):

    https://www.phe.gov/Preparedness/legal/prepact/Pages/4-PREP-Act.aspx

    See Section VII

    "The amended Section VII adds that PREP Act liability protections also extend to Covered Persons for Recommended Activities that are related to any Covered Countermeasure that is:

    a. licensed, approved, cleared, or authorized by the Food and Drug Administration (FDA) (or that is permitted to be used under an Investigational New Drug Application or an Investigational Device Exemption) under the Federal Food, Drug, and Cosmetic (FD&C) Act or Public Health Service (PHS) Act to treat, diagnose, cure, prevent, mitigate or limit the harm from COVID–19, or the transmission of SARS–CoV–2 or a virus mutating therefrom; or

    If it isn't an 'approved' treatment, then the liability protection is not there for the provider.

    Also interesting - this Emergency Declaration remains in effect until October 2024 unless rescinded.

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  6. It is dangerous in general to claim something works that does not. It prevents people from getting other treatments. Doctors generally discourage patients from taking unproven treatments because of long and bitter experience, not because they suddenly hate them or are trying to protect some self-interest. That does not always make the alternative treatments illegal, but it is worth noting. Doctors prescribing alternative treatments also make big money - useless and perhaps dangerous supplements are a big industry in America, as are book sales and speaking tours. It is ironic that people who complain about Big Pharma often spend a lot of money buying private treatments.

    You are correct that we don't know if it is more effective than chocolate ice cream. Therefore, encouraging people to hate medical science and hospitals because of myths from Joe Rogan and American Thinker (just for openers) also has long term consequences. This drumbeat against the "Medical Establishment" is going to have a bad effect on people already prone to paranoia, only looking for a target of who it is among the Great and Powerful that is against them. Fads can sometimes just be shrugged off as harmless, but sometimes cause real damage. We don't know where this one is going. Hysteria is equally among the skeptics as present.

    The Nobel Prize is irrelevant because it is for something else. Paul Krugman won a Nobel and he's an idiot on economics in general, even though he has a narrow expertise that is one of the best in that area.

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  7. AVI,

    I can tell you're finding all this distressing, and would like more deference to medical professionals. Your thoughts are duly noted.

    This article that I read today is something we've discussed occasionally, specifically, the problem of 'excess mortality.

    https://medicalxpress.com/news/2021-09-covid-doesnt-account-trend-unexplained.html

    They make a pretty good case for two things, I think: (1) there are a lot of cases of death that are arguably at least second-order effects of COVID, and (2) 'excess' death might not even be the right term, because it may just be that the death rate from many things is going to rise as a result of all this and remain higher than it used to be for quite some time.

    re: (1): "For example, a nursing home patient with Alzheimer's might recover from COVID-19, but lose the sense of taste or smell. Soon, that patient might stop eating. A couple of weeks later, that patient might die."

    That's plausible. So too the excess deaths from suicide, drug abuse, heart disease and diabetes if treatment was avoided due to fear of contracting COVID, e.g.:

    "In Texas, for example, when you tally the number of people who died of heart disease or hypertension between December 2019 and August 2021, you would expect to see about 53,000 total deaths, based on the average from previous years' CDC data. Instead, 60,264 Texans died of these afflictions during this time, about 7,500 more than would have been expected in a non-pandemic year."

    There's no clear data on causality there -- did people avoid treatment? -- but it's possible that they did; it's very likely that at least some did. And you see similar trends in diabetes, though the numbers are smaller than with heart disease as you would expect.

    But as regards (2), their argument is that the whole public health infrastructure is inadequate. That's not a small problem, but it is one that you'd have to lay at the feet of the public health technocrats who've built the thing. HHS is, by far, the most well-funded Federal agency -- far more than the military, which is such an infamous big-spender. They're the ones who've built what we have, which we are now told is so inadequate the this extra stress will now lead to tens of thousands of excess deaths for years to come.

    So who is going to tell us what we really do need? Congress? The same career HHS experts who got us here? Not the market, because we've already distorted market forces out of recognition with Obamacare and indeed with the 'public health' bureaucracy's control of mass spending decisions.

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  8. "It is dangerous in general to claim something works that does not. It prevents people from getting other treatments. "

    Like the "vaccine"? Adverse reactions to a point any other vaccine would (and has)have been instantly pulled, efficacy that is waning greatly after a few months and completely unknown long term effect's because none of the standard trials were done.(although some very concerning info is trickling out, about the effects on the immune system as a whole.) And using a non sterilizing vaccine in the face of a pandemic, guaranteed to force evasive mutations.

    So as long as the medical system does not deviate from the proscribed protocol, they are immune from lawsuit.
    So the hospitals get close to 20K fed-dollars for a covid admit, and close to 40k for a covid death.
    So the EUA is invalid if there is any other treatment.
    How many negative incentives do we need to start wondering what the hell is going on?



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  9. "Therefore, encouraging people to hate medical science and hospitals because of myths from Joe Rogan and American Thinker (just for openers) also has long term consequences." I call bigtime strawman on this. If people are hostile to some aspects of what has lately been passing for "medical science," it's not because Joe Rogan or American Thinker (or I) have been teaching them to hate medical science or hospitals.

    There will be people who (in my view) misjudge the effectiveness or risks of the vaccine and decline to take it. I know of no evidence whatever that they are more inclined to do so because they have been seriously convinced that Ivermectin works. They may be fervently hoping that Ivermectin works, because they are for whatever reason strongly disinclined to take the vaccine and yet find this virus quite alarming. That combination of fear and hope in potential COVID patients does not justify anyone in fudging or censoring the facts about either the vaccine or Ivermectin, and people who do so can justly be faulted for undermining the public trust in anyone who speaks publicly about the efficacy of medical treatments. Simple truth and rigorous analysis are still our duty here.

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  10. Anonymous6:51 AM

    @AVI, I also think you're being both unfair and overly emotional about Joe Rogan. He's not preaching "hate" for the "medical establishment", whatever you mean about either of those two things. He's not opposed to vaccination or other medical treatments-- he said that, in his opinion, young and healthy people don't have much to worry about dying from Covid. He thought that, if he got Covid himself, it would likely be mild and he'd worry about treating it if and only if he got the disease. And that's what actually happened. You have to come to grips with the fact that Joe Rogan was right about his personal situation and his personal decisions were, in retrospect, appropriate. Yes, he has a much higher risk tolerance than you do-- hey, he's an MMA fighter and smokes pot in public, both of which are much more likely to hurt/kill him than Covid. You should be complaining about those as much/more than his speech about the vax.

    It's true that quack medicine can hurt people-- but so can excessive panic. Joe Rogan was totally willing to take experimental medicines, like the monoclonal antibodies. He explicitly states he's not a medical authority. I haven't seen anything anywhere of him "promoting hate" of anybody.

    We have to be willing to look at the actual facts of the situation-- and I think it's undeniable fact that Joe Rogan was right when he thought he'd most likely get a mild case, if he caught it at all, and that there were excellent treatments available (e.g. the monoclonal antibody treatment he took, which has been shown to reduce risk of serious illness by about 85%) that he would take if needed. Whereas, the vaccines and other Covid policy methods are much more ambiguously supported with evidence than what actually happened to Joe Rogan.

    (FWIW: I got vaccinated as soon as possible, and I have also ensured that my family, including minor children, were vaccinated as soon as possible. In my extended family, we've lost two elderly people to Covid, and two more had serious strokes due to Covid. I'm neither denying the seriousness of the disease nor the usefulness of the vaccines. But any way forward as a society, we need to actually listen to people who disagree with us, and actually engage with the facts on the ground.)

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  11. Well, as Tex says, we don't really know if he was right about anything except being able to handle it. It's too small a sample to know if his treatment program worked, or if he didn't really need any program at all. Maybe he's just healthy.

    Today's NYT morning newsletter runs through a whole lot of what they describe as expert testimony that Delta really may not be more dangerous in final outcomes -- though more contagious -- than earlier variants. They provided areas where research conflits. They conclude:

    "For children and vaccinated adults without other major health problems, there are a lot of reassuring signs. Covid appears to present less risk than some other daily activities. Among Americans under 17, fewer than 500 have died of Covid since the pandemic began; many more — a few thousand every year — die in vehicle crashes.

    "As Wachter said about Covid this week, “Risk is low enough to live life, high enough to be careful.”

    "For people who do have a health condition that increases their risks — like severe obesity, a previous organ transplant or an active case of cancer — the calculations may be different."

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  12. Maybe he's just healthy--or maybe he's just lucky--or maybe he was unhealthy or unlucky enough to have been in danger, and some aspect of his treatment worked (my nominee is the antibody infusion). We can't conclude much from the fact that he survived the illness, because most people do, particularly people of his age.

    All we're really arguing about is whether it makes sense to vilify him for taking human-version properly prescribed Ivermectin. I say no: it's unjust, it's unscientific, and it undermines people's confidence in anyway we say at a time when we claim it's important that they listen to us.

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  13. @ raven. If you are putting "vaccine" in quotes, you have no idea what you are talking about, and there is no point in reasoning with you. It is not more dangerous than other vaccines, it would not be pulled in other circumstances, and you need to stop listening to whoever is telling you that.

    @ Anonyamous - Joe Rogan is a single individual, and we do not draw scientific conclusions from an experiment when n=1. Whether things went as he predicted or not is entirely irrelevant, for the reasons Grim and T99 noted. Most people survive anyway, so the recovery tells us almost nothing. I have no objection to him throwing the kitchen sink at the disease and getting treatment. That's his business. But he is putting this out as advice for other people and that is irresponsible on the basis of such limited information, and foolish for other people to consider that advice worth anything. It's like a testimonial for snake oil that you used to see in the old magazines.

    @ Grim - deference to the medical professionals. Yes, absolutely. Medicine is better than it has ever been, and better every decade than the one before. That some medical bureaucrats are fools is true and we should be cautious. Don't believe me, talk to the actual doctors that you know, or your acquaintances who work in hospitals. By your Texas example, there were 7,500 more of something(s) during the pandemic period. You are suggesting that they might be secondary Covid - a very slippery category - or that they might be because of treatment avoidance. Yet there isn't any evidence this is so. The closest thing that might come to it is the danger people have when the ICUs are full of Covid patients. Which they still are, BTW. Yet even that, finding anything other than anecdotes has been elusive. Most of the people dying of covid are not dying quietly somewhere down the road of debatable causes, they are dying drowning in their own fluids. It's not all of them, but it's enough to make possible subtractions from the total suspect.

    @ Texan99 - at least partly fair. I do react badly when anyone even indirectly suggests ivermectin might not be a problem. It's different when a treatment is something at the fringes of non-fatal conditions that people try, or copper bracelets when their cancer is hopeless. There are 1,000 Americans/day dying of this again. Vaccines are the treatment. If you don't think you know someone who is avoiding vaccines because they believe there's something else that works better, and also singing the praises of ivermectin, go back and read raven's comments on this very thread. The two are deeply connected by association; the specificity is irrelevant, because it was going to be something. It was first Hcq, now not recommended even though it might confer some small benefit because the side effect profile, especially for heart issues, was too high. And that was the safe, well-known, long-prescribed drug.

    So yes, in the abstract, our responsibility to to give only objective information. But in a situation when people are recommending random stuff for a disease that is killing people, I think it fair to start from the position of "Y'all remember that most of this stuff turns out to be crap and is sometimes dangerous, right?" When such obvious cautions are repeatedly ignored, you will find people starting to get hysterical, yes. That didn't happen in a vacuum.

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  14. For what it is worth.
    https://dreddymd.com/2021/08/29/japanese-medical-association-tells-doctors-to-prescribe-ivermectin-for-covid/

    Japan seems to have decided that Ivermectin works.

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  15. We can respond to people recommending unproven treatments, when better treatments are available, and we may even convince some people to adopt a more sensible approach. What we can't do is maintain credibility with those same people if we are not measured, reasonable, and honest in our criticism of anyone who happens to believe a treatment is effective, even though we disagree. There is never any excuse for hysteria.

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  16. AVI- check the vares data- what are we up to now, 10,000 + deaths vaccine related?
    By comparison, the flu shot kills maybe 25,30 people a year. To say the covid shot is no more dangerous is ridiculous.
    And I put it in quotes, for a specific reason- the mrna shot does not fit the definition of a traditional vaccine, and the CDC has been forced to redefine the very term vaccine, for it to fit.
    The data coming in from Israel, and the UK, and other heavily "vaccinated" places, is the jabbed are getting infected at the same rate as the unvaccinated, and ending up in the same straits as the unvaccinated.
    And that is the good news.
    The bad news is there is evidence to suggest, not prove, at this point, that the jab also inhibits antibody response to other viruses, OAS. This is not something I made up, there is a reason there has never been a successful vaccine against a coronavirus.
    This is the largest experiment ever undertaken , from a medical standpoint.
    One more thing- apparently the antibodies produced by the jab are distinct from others- and the Chinese are not using our "vaccine"-so we have just put a bio marker target right on our ass-the holy grail of bio warfare-kill only the enemy.
    Just food for thought- I hope I am wrong- otherwise this winter is really going to suck.

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  17. "The closest thing that might come to it is the danger people have when the ICUs are full of Covid patients. Which they still are, BTW"

    This is sensationalism, frankly. I checked Houston, a known hotspot, and it's been true for almost a month now that the percent of ICU beds that are occupied by Covid cases is 25%- not insignificant, but not out of line with a bad flu season. (let's keep in mind that there is financial incentive to fill beds with covid patients, also, which may be unwise) What are the other 75% of occupied beds in for? A lot of them are there because they didn't get timely treatment last year, and now are suffering for it, and some will die because of it. Also, we're forcing some people out of healthcare jobs at a time that staffing is of paramount importance. This seems insane, to put it bluntly. I'm sure you know that staffing is the real limiting factor in our healthcare system.

    As for off label use of drugs, maybe there are enough variables in play that we should leave that decision to a patient and their doctor? Just a thought.

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  18. Particularly for raven and AVI in this thread, but I think in general when there is an ongoing disagreement, links to sources that provide evidence for your claims would be most helpful for those of us considering your arguments.

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  19. I don’t know enough to make or adjudicate any claims about ICUs. My friend in Mobile, where COVID has been bad, says that things are still bad in much of the state — but Mobile, an early hotspot, has seen a 34% decline in hospital usage.

    https://www.al.com/news/2021/09/hope-for-alabama-hospitals-mobile-county-a-covid-hotspot-a-month-ago-sees-34-drop-in-patients.html

    But that’s anecdotal. I’m not sure how much we learn even from regional or national data.

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  20. The CDC updates hospitalization rates weekly. As usual, there's a lag, so you can't take the most recent week's rate too literally, but the curve does seem headed in the right direction. This chart gives data by age group, and can be adjusted to break out the age groups in more detail. https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html

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  21. Several of our neighbors have gotten a booster; we're considering doing the same sometime fairly soon. You can walk into any pharmacy and check the "immunocompromised" box. A couple of neighbors, man and wife, vaccinated, came down with minor cases recently.

    I have been posting on FB with specific information about where to get antibody infusions here in the Coastal Bend. A few people are paying attention. FB still allows you to post about antibody infusions.

    Censorship and mandates are no way to get the hesitating portion of the population on board. I expect a bloodbath in 2022, but we'll see how things work out. For now I'm just watching the California recall.

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  22. And I should also say, I do appreciate all those who are including links. Thanks!

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  23. raven9:14 PM

    Does the jab work as advertised? A few links pulled up in a few minutes- there are hundreds of reports like this. Don't know how to post the video, but the head of the CDC admitting in front of the camera that one can still get infected , get sick, and transmit covid post jab was really sort of astonishing vis a vis the narrative they have been pushing.


    https://www.cdc.gov/mmwr/volumes/70/wr/mm7031e2.htm?s_cid=mm7031e2_w

    https://www.bostonherald.com/2021/09/07/massachusetts-coronavirus-breakthrough-cases-jump-4415-last-week-more-than-600-fully-vaccinated-people-a-day

    https://twitter.com/Jim__Jackson/status/1434912296501981190

    https://www.precisionvaccinations.com/2021/08/11/israels-covid-19-vaccine-breakthrough-cases-exceed-50

    https://www.coronaheadsup.com/science/vaccine-breakthrough/uk-vaccine-breakthrough-rate-for-delta-infections-still-increasing/

    https://www.coronaheadsup.com/coronavirus/scotland-70-of-covid-deaths-and-58-of-hospitalizations-are-fully-vaccinated/



    Anecdotal- from an Doc. similar to many I have read on forums and blogs-

    "About 10 days ago I had to admit 2 members of a swing dancing band to the hospital. It was part of a larger superspreader event. Everyone in attendance had to show proof of vaccination I understand about 80 were there and yet we had 14 vaccinated breakthroughs from that event with 2 of them the band members having to be admitted. So far everyone is OK. But those 2 and 2 of the others got really really sick.

    It was in a large ballroom. Lots of singing, drinking, instrument playing, and dancing. Masks were not required because they were all vaccinated. They all thought they were good because there was a vaccine mandate for entrance. They thought wrong.

    Please be careful and take care of yourself."

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  24. Vaccination-breakthrough cases remain rare, nevertheless, and in their slight numbers are highly skewed toward the elderly and ill. Of the few breakthrough cases detected in hospitalized patients, many (perhaps half) are symptom-free, occurring in patients who are in for something else and randomly tested. The remainder are concentrated in the elderly, with median ages anywhere from 65 to 80 depending on the study, and generally involving significant co-morbidities such as heart disease, lung disease, obesity, and diabetes. This is not so much a knock on the vaccine as a recognition that some elderly immune systems don't respond well, and what might be a minor problem for most young healthy patients is a terrible assault on a weakened heart, lungs, or metabolism. https://www.mercurynews.com/2021/09/08/covid-risk-of-severe-breakthrough-cases-higher-for-seniors-and-people-with-underlying-conditions/

    Nor is there convincing data suggesting that masking/non-masking plays a detectable part in the breakthrough phenomenon. Vaccination clearly makes sense for people of a certain age or health, masking far less so if at all. Beyond that, we're in an area most properly reserved to personal judgment even for those who are convinced that coercion is reasonable in the service of the public good.

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  25. A resource for reviewing the recent literature of early treatment studies and the usage in countries around the world. Please note the uppermost paragraph.

    https://c19early.com/

    I like what Bret Weinstein said the other day regarding COVID treatment discussions: "We should all be skeptics"; to which his wife Heather Heying responded: "We should all be scientists".

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  26. raven2:44 PM

    This is a very interesting link to a Scottish Doc's blog- and why he is no longer commenting on covid 19- in effect, he says the data and the narrative has become so politicized he can no longer trust it.
    Really worth a read.

    https://drmalcolmkendrick.org/2021/09/03/i-have-not-been-silenced/

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  27. That's a good article, Raven.

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