Zobel said:

---

Inclusion criteria is a part of any meta analysis. Excluding studies for reasons like "this study is fraudulent and certainly never happened" or "this study has impossible numbers in the results" or "this study changed outcomes midway to produce a favorable result" is a good thing, not a bad one.

If you want to criticize the analysis done, you should do so on the basis of the exclusion criteria being used - that is to say, when a paper is excluded for a given reason, you should state why you think it should be included. Simply calling it selection bias is a waste of time.

---

Papers that were withdrawn were removed from the Ivmmeta study. The OP's author dismisses studies outright for various subjective reasons. He doesn't mention 43 of the studies and simply starts with 30 of the 73. Out of those thirty he dismisses studies for various reasons such as" I don't have a great understanding of this one but I don't trust it at all. Luckily it is small and non-randomized so it will be easy to ignore going forward." And "it's too confusing to interpret." And "it's hard to tell from the paper who was on how much of what, and the discussion of ivermectin seems like kind of an afterthought after discussing lots of other meds in much more depth." And "the study excluded people with high viral load, but the preregistration didn't say they would do that." Yet, the author keeps studies (Lopez-Medina) for which he has this to say:

"They originally worried the placebo might taste different than real ivermectin, then solved this by replacing it with a different placebo [in mid-study] ... Primary outcome was originally percent of patients whose symptoms worsened by two points, as rated on a complicated symptom scale when a researcher asked them over the phone. Halfway through the study, they realized nobody was worsening that much, so they changed the primary outcome to time until symptoms got better, as measured by the scale... In order to get as big as it did, Lopez-Medina had to compromise on rigor. Its outcome is how people self-score their symptoms on a hokey scale in a phone interview, instead of viral load or PCR results or anything like that."

Yet, in the end he kept the study. It happened to be one of the few, albeit larger studies, which did not find any Ivermectin efficacy in treating Covid. Hmmm. An open letter, signed by >100 physicians, concluding this study is fatally flawed can be found here. A subjective selection criteria is textbook selection bias.


https://jamaletter.com

Yeah, sorry I'm going to go with the MD who has run a blog reviewing medical research for over a decade, along with another epidemiologist who has made a career in meta-research.

Again, selection bias isn't "reasons I don't agree with." If he applies a consistent inclusion criteria, that's not selection bias. Removal of a study because it is small and nonrandomized is a valid reason, because the quality of evidence by a small, nonrandomized study is low. Removal of a study because the authors did not pre-register their trial is a valid reason, because it is one way to arrive at poor outcomes. If you'd like to understand a bit better about this topic, here is a great article.

https://slatestarcodex.com/2014/04/28/the-control-group-is-out-of-control/

You're welcome to perform your own meta analysis with your own inclusion criteria. For what its worth meta analyses are inherently subjective for this exact reason.

If you don't like Scott Alexander or Gideon Meyerowitz-Katz, how does the most prestigious and highest standard in evidence-based health care sound?

Cochrane says:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full

Quote:

---

Based on the current very low to lowcertainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use of ivermectin for treatment or prevention of COVID19 outside of welldesigned randomized trials.

---

An interview about this says:
https://www.cochrane.org/news/ivermectin-cochranes-most-talked-about-review-so-far-ever-why

Quote:

---

There is a lot of incorrect and misleading information available online about ivermectin. There are many meta-analyses and systematic reviews, some of which have shown extreme mortality benefits. However, unlike our Cochrane review, they have been more inclusive with regard to the studies that are available, and not been conducted using rigorous standards.

We set out to provide a reliable and unbiased summary of evidence for the work of clinical guideline committees and health officials. Before conducting this Cochrane review, we had no prior belief about whether ivermectin was effective , we simply wanted to ensure that clinicians, politicians, and the overall population could base decisions on the most current and trustworthy evidence available. By thoroughly examining and analysing the published studies, we showed that not all studies on which the ivermectin hype is based are actually suitable for investigating the effects of this medicine. Most of the eligible studies had flawed study designs and produced low-quality evidence. Based on this very small pool of limited-quality studies, we can only conclude that ivermectin cannot be considered a 'miracle drug' at this point. We hope that the information our review provides reaches clinical, scientific, policy and lay audiences so that they are aware of the uncertainty around the effects of ivermectin in COVID 19.

---

In other words, Cochrane found similar problems with the studies as Scott Alexander and Gideon Meyerowitz-Katz.

At some point people have to recognize the limits of their abilities to perform meta research. I am not a qualified meta researcher. Cochrane is. If you disagree with Cochrane, you're probably (almost certainly) wrong.

As another note, here is a correspondence written by Gideon Meyerowitz-Katz and others on this.

The lesson of ivermectin: meta-analyses based on summary data alone are inherently unreliable

Quote:

---

Relying on low-quality or questionable studies in the current global climate presents severe and immediate harms. The enormous impact of COVID-19 and the consequent urgent need to demonstrate the clinical efficacy of new therapeutic options provides fertile ground for even poorly evidenced claims of efficacy to be amplified, both in the scientific literature and on social media. This context can lead to the rapid translation of almost any apparently favorable conclusion from a relatively weak trial or set of trials into widespread clinical practice and public policy.

Most, if not all, of the flaws described above would have been immediately detected if meta-analyses were performed on an individual patient data (IPD) basis...

Any study for which authors are not able or not willing to provide suitably anonymized IPD should be considered at high risk of bias for incomplete reporting and/or excluded entirely from meta-syntheses...

...we believe that what has happened in the case of ivermectin justifies our proposal: a poorly scrutinized evidence base supported the administration of millions of doses of a potentially ineffective drug globally, and yet when this evidence was subjected to a very basic numerical scrutiny it collapsed in a matter of weeks. This research has created undue confidence in the use of ivermectin as a prophylactic or treatment for COVID-19, has usurped other research agendas, and probably resulted in inappropriate treatment or substandard care of patients.

---

One of the things I hope people learn is that the ugliness of the research / publication / scientific process isn't reason to abandon it. It is not that you shouldn't trust scientific publications or the scientific progress, its that it is often convoluted and messy.

Even things we say like "peer review" are no guard in and of themselves. There are many low quality journals that are more or less pay for publish and getting a peer review in them is not that hard. That doesn't guarantee good quality research. Preprints are even less reliable. It should be obvious at this point that fraudulent research can be published in peer review journals - how many high profile retractions have we seen?

This should make us skeptical. This should make us cautious. It should not make us abandon the fact that quality research is done, and that quality publications prove out.

The fact that shoddy research has been amplified condemns shoddy researchers. At the end of the day, if your analysis includes fraudulent research or poorly devised studies, you need to understand the impact of that on the conclusion of your analysis. It seems like you're unwilling to do that.

Zobel said:

---

Yeah, sorry I'm going to go with the MD who has run a blog reviewing medical research for over a decade, along with another epidemiologist who has made a career in meta-research.

Again, selection bias isn't "reasons I don't agree with." If he applies a consistent inclusion criteria, that's not selection bias. Removal of a study because it is small and nonrandomized is a valid reason, because the quality of evidence by a small, nonrandomized study is low. Removal of a study because the authors did not pre-register their trial is a valid reason, because it is one way to arrive at poor outcomes. If you'd like to understand a bit better about this topic, here is a great article.

https://slatestarcodex.com/2014/04/28/the-control-group-is-out-of-control/

You're welcome to perform your own meta analysis with your own inclusion criteria. For what its worth meta analyses are inherently subjective for this exact reason.

If you don't like Scott Alexander or Gideon Meyerowitz-Katz, how does the most prestigious and highest standard in evidence-based health care sound?

Cochrane says:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full

Quote:

---

Based on the current very low to lowcertainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use of ivermectin for treatment or prevention of COVID19 outside of welldesigned randomized trials.

---

An interview about this says:
https://www.cochrane.org/news/ivermectin-cochranes-most-talked-about-review-so-far-ever-why

Quote:

---

There is a lot of incorrect and misleading information available online about ivermectin. There are many meta-analyses and systematic reviews, some of which have shown extreme mortality benefits. However, unlike our Cochrane review, they have been more inclusive with regard to the studies that are available, and not been conducted using rigorous standards.

We set out to provide a reliable and unbiased summary of evidence for the work of clinical guideline committees and health officials. Before conducting this Cochrane review, we had no prior belief about whether ivermectin was effective , we simply wanted to ensure that clinicians, politicians, and the overall population could base decisions on the most current and trustworthy evidence available. By thoroughly examining and analysing the published studies, we showed that not all studies on which the ivermectin hype is based are actually suitable for investigating the effects of this medicine. Most of the eligible studies had flawed study designs and produced low-quality evidence. Based on this very small pool of limited-quality studies, we can only conclude that ivermectin cannot be considered a 'miracle drug' at this point. We hope that the information our review provides reaches clinical, scientific, policy and lay audiences so that they are aware of the uncertainty around the effects of ivermectin in COVID 19.

---

In other words, Cochrane found similar problems with the studies as Scott Alexander and Gideon Meyerowitz-Katz.

At some point people have to recognize the limits of their abilities to perform meta research. I am not a qualified meta researcher. Cochrane is. If you disagree with Cochrane, you're probably (almost certainly) wrong.

---

Scott Alexander is a psuedonym. He claims to be a psychiatrist. Maybe, but for someone demanding credentials its funny to see you citing anonymous people to support your claims. GMK, before starting his research, referred to ivermectin as "something else to debunk". Ivmeta acknowledges GMK has "made very valuable contributions identifying significant issues with some studies, which has helped to improve the quality of the ivermectin evidence base, and has improved the dose-response and treatment delay-response relationships."

The Ivmeta analysis incorporated GMK's recommended exclusions. Their response to GMK's criticisms are here:

https://ivmmeta.com/#tp

I haven't read Cochrane, but will do so.

Scott Alexander is his first and middle name. He has published his full name on academic papers on his blog. He wrote quite a long article about why he attempted to remain anonymous (because he is a practicing psychiatrist). He shut down the original website in protest of the NYT doxxing / outing him.

But seriously if anonymity is a problem, how are you justifying using the anonymous website ivmeta?

Zobel said:

---

Scott Alexander is his first and middle name. He has published his full name on academic papers on his blog. He wrote quite a long article about why he attempted to remain anonymous (because he is a practicing psychiatrist). He shut down the original website in protest of the NYT doxxing / outing him.

But seriously if anonymity is a problem, how are you justifying using the anonymous website ivmeta?

---

I'm the one who says to look at the facts and that appeals to authority are a logical fallacy. You stated, "Yeah, sorry I'm going to go with the MD who has run a blog reviewing medical research for over a decade, along with another epidemiologist who has made a career in meta-research." That's why I found it amusing that you then started citing anonymous psychiatrists in discussions about Covid treatment.

Sorry, no, this is not an appeal to authority. It's not his authority I'm appealing to. Appeal to authority is saying you should listen to him because he's a doctor. You should listen because he is offering detailed reasoning for every step in his analysis, showing his work, and relying on a clear standard of evidence, and you aren't because you can't.

The reason you are arriving at a different conclusion is because you aren't competent to review medical research. That's ok - I'm not either. But that is why other people who are competent to review medical research are arriving at the same conclusion as he is when presented with the same evidence.

Zobel said:

---

Sorry, no, this is not an appeal to authority. It's not his authority I'm appealing to. Appeal to authority is saying you should listen to him because he's a doctor. You should listen because he is offering detailed reasoning for every step in his analysis, showing his work, and relying on a clear standard of evidence, and you aren't because you can't.

The reason you are arriving at a different conclusion is because you aren't competent to review medical research. That's ok - I'm not either. But that is why other people who are competent to review medical research are arriving at the same conclusion as he is when presented with the same evidence.

---

There are plenty of extremely qualified persons who have "offered detail reasoning for every step of their analysis, showed their work, and relied on a clear standard of evidence" and who have concluded that "statistically significant improvements are seen for mortality, ventilation, ICU admissions, recovery, cases, and viral clearance with Ivermectin." You disagree and that is fine.You know as much about the medical research as I do (which is not saying much). It doesn't mean you are incorrect. At the end of the day, you can cherry pick studies based on your individual biases because all studies have limitations.

The good news is that many doctors are prescribing Ivermectin and seeing great results regardless of what competing researchers are claiming.

You have no idea who is qualified, partly because whoever runs ivmmeta and a group of other websites - one of which continues to promote HCQ even though it definitvely doesn't work - hides behind anonymity. You aren't capable of determining whether their analysis is good or bad.

Appealing to doctors getting great results is useless. That's why you do RCTs. And when you do RCTs, it doesn't work. And the better, bigger, and well designed the study gets the more clear it becomes that it doesn't work to treat COVID.

The accusation of cherry picking studies because of bias is hilarious given that IVMmeta had no problems listing numerous fraudulent studies until called out.

You should ask yourself why you have so much trouble accepting that ivermectin doesn't work, and why you and others who are pushing ivermectin are so credulous that you were taken in by fake studies. Not one or even two times but many times - studies which were simply fraudulent and in some cases didn't happen at all, were just copy pasted. Why doesn't that bother you? Why did ivmmeta include fraudulent studies?

Zobel said:

---

You have no idea who is qualified, partly because whoever runs ivmmeta and a group of other websites - one of which continues to promote HCQ even though it definitvely doesn't work - hides behind anonymity. You aren't capable of determining whether their analysis is good or bad.

Appealing to doctors getting great results is useless. That's why you do RCTs. And when you do RCTs, it doesn't work. And the better, bigger, and well designed the study gets the more clear it becomes that it doesn't work to treat COVID.

The accusation of cherry picking studies because of bias is hilarious given that IVMmeta had no problems listing numerous fraudulent studies until called out.

You should ask yourself why you have so much trouble accepting that ivermectin doesn't work, and why you and others who are pushing ivermectin are so credulous that you were taken in by fake studies. Not one or even two times but many times - studies which were simply fraudulent and in some cases didn't happen at all, were just copy pasted. Why doesn't that bother you? Why did ivmmeta include fraudulent studies?

---

I've provided 51 peer-reviewed studies regarding the efficacy of Ivermectin. I have trouble believing that 51 groups of doctors and scientists colluded to falsify data and then get it peer-reviewed and the peer reviewers also decided to join the conspiracy. Add that to the scientific fact that Ivermectin has anti-viral properties - there is a mechanism whereby Ivermectin could be effective - doctors didn't just suddenly decide horse dewormer would cure a novel coronavirus. I'm not pushing Ivermectin. Ivmmeta has been quite open that when presented with evidence that a study is fraudulent, they will remove it. They've done so. The weight of studies and evidence still favors Ivermectin efficacy. Why do you have trouble accepting that? Why do you rely on subjective dismissal of peer-reviewed studies?

Zobel said:

---

You realize that most of those studies have different endpoints? some measure viral load, some mortality, some hospital length, some are prophylactic. You can't lump them together like that uncritically. That's part of the problem. What does efficacy mean? You don't know, and ivmmeta doesn't tell you. It's p hacking all over the place.

You also realize that the studies which were fraudulent were peer reviewed? Peer review is no sure guard against fraud.

You are relying on an anonymous website run by people who have proven without a doubt that they will intentionally slant the way they present evidence in a misleading way, will present false studies unquestioningly, and will continue to present information on treatments that unequivocally do not work (ie hcq) without regard for the consequences.

52 groups of doctors aren't lying. Most simply have crappy studies (not randomized, not placebo controlled, p hacking, poor design). The rest can be explained by good old fashioned publication bias - an incomplete statistical picture due to underpowered results.

A proposed mechanism of action is meaningless. You have been told this multiple teams. You dont need an MoA to have an effective drug and a drug with a solid MoA and no clinical efficacy is useless. This is why drugs go through trials.

When you filter for fraud and higher quality evidence, the benefit goes away. This is the opposite of what you'd expect if the drug worked at all, much less if it was a miracle COVID cure like some less reputable doctors are claiming.

It's not an effective prophylactic and it's not an effective therapeutic for COVID. It is a miracle drug at treating worms.

Best of luck to you.

---

Nobody has claimed Ivermectin is a "miracle drug". The finding that it is not a "miracle drug" comports with the finding of the following peer-reviewed studies which all find Ivermectin has a positive effect on Covid patients at various stages of infection. Such hyperbole in the Cochrane findings, and the reference to Ivermectin solely as a "dewormer" knowing it has in-vitro antiviral characteristics and human uses, actually leads me to think less of those findings and the people who purposefully obfuscate the drug's uses.

https://ejmo.org/10.14744/ejmo.2021.16263/

https://www.biomedres.info/biomedical-research/effects-of-ivermectinazithromycincholecalciferol-combined-therapy-on-covid19-infected-patients-a-proof-of-concept-study-14435.html

https://www.longdom.org/open-access/safety-and-efficacy-of-the-combined-use-of-ivermectin-dexamethasone-enoxaparin-and-aspirina-against-covid19-the-idea-protocol-70290.html

https://journals.sagepub.com/doi/10.1177/03000605211013550

https://www.sciencedirect.com/science/article/pii/S2052297521000792

https://www.sciencedirect.com/science/article/pii/S1201971220325066

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30464-8/fulltext

https://ijclinmedcasereports.com/pdf/IJCMCR-RA-00320.pdf

https://academic.oup.com/qjmed/article/114/11/780/6143037

https://journals.library.ualberta.ca/jpps/index.php/JPPS/article/view/32105

https://www.sciencedirect.com/science/article/pii/S1341321X21002397

https://onlinelibrary.wiley.com/doi/10.1002/jmv.26880

https://jamanetwork.com/journals/jama/fullarticle/2777389

https://ijhcr.com/index.php/ijhcr/article/view/1263

https://www.clinmedjournals.org/articles/jide/journal-of-infectious-diseases-and-epidemiology-jide-7-202.php?jid=jide

https://www.clinmedjournals.org/articles/jide/journal-of-infectious-diseases-and-epidemiology-jide-7-202.php?jid=jide

http://theprofesional.com/index.php/tpmj/article/view/5867

https://www.dovepress.com/clinical-biochemical-and-molecular-evaluations-of-ivermectin-mucoadhes-peer-reviewed-fulltext-article-IJN

http://imcjms.com/registration/journal_abstract/353

https://www.ijsciences.com/pub/article/2378

https://www.sciencedirect.com/science/article/pii/S0012369220348984

http://www.iraqijms.net/upload/pdf/iraqijms60db8b76d3b1e.pdf

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242184

https://iaimjournal.com/wp-content/uploads/2020/10/iaim_2020_0710_23.pdf

https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06104-9

https://www.sciencedirect.com/science/article/pii/S1201971221001004

https://www.sciencedirect.com/science/article/pii/S2214750021000445

https://www.cureus.com/articles/56545-clinical-variants-characteristics-and-outcomes-among-covid-19-patients-a-case-series-analysis-at-a-tertiary-care-hospital-in-karachi-pakistan

https://onlinelibrary.wiley.com/doi/10.1002/jmv.27122

https://journals.ekb.eg/article_202150_0.html

https://onlinelibrary.wiley.com/doi/10.1002/jmv.27469

https://www.sciencedirect.com/science/article/pii/S2667276621001013

https://www.jiac-j.com/article/S1341-321X(21)00360-3/fulltext


[url=https://www.jcdr.net/articles/PDF/14529/46795_CE%5BRa%5D_F(Sh)_PF1(SY_OM)_PFA_(OM)_PN(KM).pdf]https://www.jcdr.net/articles/PDF/14529/46795_CE[Ra]_F(Sh)_PF1(SY_OM)_PFA_(OM)_PN(KM).pdf[/url]


https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247163

https://medicalpressopenaccess.com/upload/1605709669_1007.pdf

https://www.sciencedirect.com/science/article/pii/S0924857920304684

https://www.sciencedirect.com/science/article/pii/S015196382030627X

https://ejmed.org/index.php/ejmed/article/view/599

https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8415509/

https://www.cureus.com/articles/64807-prophylactic-role-of-ivermectin-in-severe-acute-respiratory-syndrome-coronavirus-2-infection-among-healthcare-workers

https://www.ijidonline.com/article/S1201-9712(21)00345-3/fulltext

https://www.cureus.com/articles/63131-ivermectin-as-a-sars-cov-2-pre-exposure-prophylaxis-method-in-healthcare-workers-a-propensity-score-matched-retrospective-cohort-study

https://onlinejima.com/read_journals.php?article=683

https://japi.org/x2a464b4/ivermectin-and-hydroxychloroquine-for-chemo-prophylaxis-of-covid-19-a-questionnaire-survey-of-perception-and-prescribing-practice-of-physicians-vis-vis-outcomes

Zobel said:

---

"ivermectin is effectively a "miracle drug" against COVID-19."

-Pierre Kory testimony to the US senate, head of the FLCCC that promotes ivermectin

https://www.hsgac.senate.gov/imo/media/doc/Testimony-Kory-2020-12-08.pdf

Quote:

---

Such hyperbole in the Cochrane findings

---

tell me you have no idea who Cochrane is without telling me you have no idea who Cochrane is.

---

I don't know who that is. There is no such hyperbole in any of the studies I've seen. It is hyperbole I've only seen used by Cochrane and now "Pierre Kory".

Zobel said:

---

"ivermectin is effectively a "miracle drug" against COVID-19."

-Pierre Kory testimony to the US senate, head of the FLCCC that promotes ivermectin

https://www.hsgac.senate.gov/imo/media/doc/Testimony-Kory-2020-12-08.pdf

Quote:

---

Such hyperbole in the Cochrane findings

---

tell me you have no idea who Cochrane is without telling me you have no idea who Cochrane is.

---

You haven't read the Cochrane summary of their Ivermectin study have you? For an arrogant ass, you are embarrassingly uninformed.

"Based on this very small pool of limited-quality studies, we can only conclude that ivermectin cannot be considered a 'miracle drug' at this point."

Google it.

Zobel said:

---

That is not the Cochrane review. That is an interview with one of the Cochrane review authors. You're confused - I linked both.

Here is the interview which contains the quote.
https://www.cochrane.org/news/ivermectin-cochranes-most-talked-about-review-so-far-ever-why

Here is the actual review.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full

I quoted the conclusion of the actual review earlier. I will quote it again here for your convenience.

Quote:

---

Based on the current very low to lowcertainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use of ivermectin for treatment or prevention of COVID19 outside of welldesigned randomized trials.

---

Might want to be a little slower on the name-calling and uninformed trigger. There is a reason that in the Cochrane review article the words miracle drug are in quotes.

At any rate it seems we have exceeded your capacity for discussion without name calling. No sense in continuing, I think everything that needs to be said has been. Good luck in your search for truth.

---

So the Cochrane website, in promoting it's Ivermectin study, quotes the author of the Ivermectin study saying "Based on this very small pool of limited-quality studies, we can only conclude that ivermectin cannot be considered a 'miracle drug' at this point". Cool. I've now seen Ivermectin referred to a miracle drug by two people now - Pierre Koy and an author of the Cochrane Ivermectin study.