I read the negative paper (I had already read the positive one).
The positive one concludes, rightly I think, that there is evidence falling short of proof that IM is likely to be useful.
I am not at all happy with the negative paper.
1. Lots of highly emotive language against IM suggesting a lack of objectivity. Another thing suggesting lack of objectivity is that they put <did not find IM useful> in their list of strengths. I wonder who would find this a strength and why? Also sneering about studies done in low income countries did not endear them to me.
2. They really went all out, above and beyond the call of duty, trying to exclude papers. Again it did not seem like they were humbly and objectively seeking the truth. It seemed to reek of motivation. Having reduced the papers that qualified to a tiny number, then surprise surprise the result is N.S. Which they can then misrepresent (see next point).
3. Misstatement of the conclusion. Lack of statistical significance does not mean you showed the thing doesn’t work, especially given P=13% and RR=0.37. Given the small numbers the reduction in deaths would have had to have been enormous (~80%) to achieve significance.
4. I could not find a design of the study, published before they started. This is a concern, because they excluded studies of prophylaxis (prevention of infection), which is reportedly the strong point of IM. No convincing explanation was given for why they did this. Ironically they criticise other studies for not having prepublished designs.
5. It was interesting that every study that they quoted showed a large reduction in deaths. And they found fault with just about every one of them. Their own study showed a 63% reduction in deaths also, but was N.S.
I too would probably take IM if I had CV (or even was exposed) and could get access. ATM it seems likely it would be helpful and the downside seems low. IM has been in use for decades and billions of people—many with poor nutrition and otherwise vulnerable—have taken it. So it is not a great unknown in terms of side-effects.
Certainly this study does not show IM does not work, but it will be quoted as though it does. There have been studies of vitamin D and CV that are also poorly conducted and seemingly rigged to produce a N.S. result. E.g. you give vitamin D when people are late in the disease, knowing full well that it takes a couple of weeks for it to be metabolised into the fully active form.
E.g. you give vitamin D when people are late in the disease, knowing full well that it takes a couple of weeks for it to be metabolised into the fully active form.
The number I have in memory is that it takes roughly a week. If you think it’s longer, can you point me to a resource?
This is a concern, because they excluded studies of prophylaxis (prevention of infection), which is reportedly the strong point of IM.
Prophylaxis is a strong point given it’s potential effect but given that other studies found that currently the evidence for treatment effects is higher then the evidence for prophylaxis, focusing on the issue that’s more studied seems reasonable to me I consider the other points more concerning.
I too would probably take IM if I had CV (or even was exposed) and could get access. ATM it seems likely it would be helpful and the downside seems low.
At the moment that raises the question to me whether it makes sense to order Ivermectin from India (likely takes a month to arrive).
Given that Delta is enough to produce r>1 in the UK in summer while people are more outside and the UK has still a lot of restrictions while having 85% with one vaccination dose and 50% fully vaccinated, Delta Plus already having a mutation that makes it likely better at evade vaccines, a new wave in autumn seems very likely to me.
I read the negative paper (I had already read the positive one).
The positive one concludes, rightly I think, that there is evidence falling short of proof that IM is likely to be useful.
I am not at all happy with the negative paper.
1. Lots of highly emotive language against IM suggesting a lack of objectivity. Another thing suggesting lack of objectivity is that they put <did not find IM useful> in their list of strengths. I wonder who would find this a strength and why? Also sneering about studies done in low income countries did not endear them to me.
2. They really went all out, above and beyond the call of duty, trying to exclude papers. Again it did not seem like they were humbly and objectively seeking the truth. It seemed to reek of motivation. Having reduced the papers that qualified to a tiny number, then surprise surprise the result is N.S. Which they can then misrepresent (see next point).
3. Misstatement of the conclusion. Lack of statistical significance does not mean you showed the thing doesn’t work, especially given P=13% and RR=0.37. Given the small numbers the reduction in deaths would have had to have been enormous (~80%) to achieve significance.
4. I could not find a design of the study, published before they started. This is a concern, because they excluded studies of prophylaxis (prevention of infection), which is reportedly the strong point of IM. No convincing explanation was given for why they did this. Ironically they criticise other studies for not having prepublished designs.
5. It was interesting that every study that they quoted showed a large reduction in deaths. And they found fault with just about every one of them. Their own study showed a 63% reduction in deaths also, but was N.S.
I too would probably take IM if I had CV (or even was exposed) and could get access. ATM it seems likely it would be helpful and the downside seems low. IM has been in use for decades and billions of people—many with poor nutrition and otherwise vulnerable—have taken it. So it is not a great unknown in terms of side-effects.
Certainly this study does not show IM does not work, but it will be quoted as though it does. There have been studies of vitamin D and CV that are also poorly conducted and seemingly rigged to produce a N.S. result. E.g. you give vitamin D when people are late in the disease, knowing full well that it takes a couple of weeks for it to be metabolised into the fully active form.
The number I have in memory is that it takes roughly a week. If you think it’s longer, can you point me to a resource?
Prophylaxis is a strong point given it’s potential effect but given that other studies found that currently the evidence for treatment effects is higher then the evidence for prophylaxis, focusing on the issue that’s more studied seems reasonable to me I consider the other points more concerning.
At the moment that raises the question to me whether it makes sense to order Ivermectin from India (likely takes a month to arrive).
Given that Delta is enough to produce r>1 in the UK in summer while people are more outside and the UK has still a lot of restrictions while having 85% with one vaccination dose and 50% fully vaccinated, Delta Plus already having a mutation that makes it likely better at evade vaccines, a new wave in autumn seems very likely to me.