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When virtually nothing was known in the beginning of all this, the panicked ignorance of certain academics and most politicians became the foundation for public health measures that destroyed lives and livelihoods. Reasonable, logical people with sensible solutions were told by the "elites" WE were the problem. Nay nay...I would say the true problem has always been with the aforementioned hypocrites.

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As an educated, non-medical professional, I pride myself in being able to discern a good argument... Covid has given me plenty of opportunities to practice. Regarding the question of Ivermectin, the arguments I hear from opponents are usually not based on personal experience, and often refer to non-specific large randomized controlled trials that are peremptorily described as negative. I also find the reticence to engage in a public debate with representatives of "the other side" problematic.

"The other side" is also comprised of highly credentialed professionals that are often shunned from mainstream media... all this is absolutely not helpful to win over critical thinking people who don't feel at ease with the way this one-size-fit-all solution is being pushed on us.

Here is a convivial discussion between two intelligent people on the topic of Ivermectin. You decide. Is this an elegant way to prove its efficacy or are those two dangerous radicals we need to be protected from??

https://rumble.com/v2835qb-ivermectin-saving-lives-in-africa.html

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The rumble.com/2835 link is a very good interview. 22 minutes. Part of the interview talks about how a 'randomized trial" would have been immoral when there are less than 30 individuals. It does bring into perspective how 'trials' / experiments might not always be appropriate, but provide good data/information nonetheless. Do watch it!

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404 Not Found error!

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You have to go up to Jolly Green's rumble link; I just referenced it; thought people would recognize it as an "abbreviation.." So not to confuse here is the full link https://rumble.com/v2835qb-ivermectin-saving-lives-in-africa.html

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Yes, very interesting link...

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Is that simple? Do you need a randomized trial to convince someone that a parachute saves lives? No, I do not. Is ivermectin (=early treatment asap = aka many other cocktails) working? Try it. I did it many times, and it works.

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Well said. I wish there was more openness to have discussion about ivermectin. I respect Dr Prasad, and value his opinions: I don't think he is claiming to be "Science" =:). Yet there are other equally credentialed medical professionals (maybe not all in the same specific field) who hold a different position on Ivermectin. Can both be right? Wrong? Perhaps Ivermectin really does "work" for some individuals but not others; I don't think that would be the only intervention for which that is true.

https://thetruthaboutivermectin.com/

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Sorry, but the academics don't know what a woman is; for them, boys or girls can switch overnight, and not only that, they are ok with the mutilation of their bodies. So, what you try to explain here is far beyond their comprehension.

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When did politics and medicine become one?

Why have Democrats demonised Republicans?

I just don't understand! Am I being illiterate?

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"One [Ivermectin] is a the panacea of right wing zealots and the other [masks] of left wing zealots.”

Dr. Pierre Kory is among the so-called “right wing zealots” who champion Ivermectin. However, just like Vinay Prasad, he is actually a Democrat. I wish Prasad wouldn't throw out ad hominum attacks upon those whom he disagrees:

From Pierre Kory's 5/20/22 opinion piece: https://www.foxnews.com/opinion/doctor-democrat-covid-censorship-pierre-kory

“I’m a lifelong Democrat. I voted for Barack Obama, Hillary Clinton and Joe Biden. I used to have an inherent aversion to Republicans … . But as the pandemic unfolded ... I met many new conservative colleagues and friends who put politics aside to focus on doing our best at the bedside. It made me more tolerant and understanding of their worldviews.

I used to view Democrats … as the champions of free speech … But now, ... medical boards are adopting policies that censor opinions ... Medical professionals who refuse to toe the party line risk censorship, cancellation, and even the loss of license … The trend is forcing doctors who exhibit critical thinking to face an existential choice: join the mob and support what many of us believe are dangerous policies without a sound scientific basis, or stand up and risk losing your livelihood.

Tribalism and polarization have made our political and medical discourse nasty and divisive. Doctors must be kept above the partisan fray, not forced to take sides and pick a jersey. ... we need to be apolitical to maintain credibility with everyone who comes to us seeking treatment. Progress and innovative medical breakthroughs in the future depend on freedom and medical choice now.”

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Polarization is a huge problem (so are VP's ad hominum's) and I'd love for doctors to be above the partisan fray. How would you suggest we follow Kory's advice? How can we operationalize being apolitical?

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Some ideas off the top of my head David, (and some influenced by my thoughts reading your paper "Effective ways to combat online medical and scientific misinformation: A hermeneutic narrative review and analysis")

1) Everyone in healthcare and politics should read Jonathan Haidt's "The Righteous Mind", Carl Sagan's "The Demon-Haunted World", and Gerd Gigerenzer and Muir Gray's novel "Better Doctors, Better Patients, Better Decisions"

2) There should be a separation of medicine and state just as there is separation of church and state. The state can no longer be involved in personal health care decisions. No involvement in abortion, euthanasia, and even (I'm reversing my stance on this after 20 yeas of thought) - vaccination. All medical decisions are between the patient and their physician with zero influence from politicians.

3) Medicine needs a return to the principles of EBM. We saw a rash of "shoot from the hip" medicine the last 3 years, based on the "precautionary principle" rather than evidence, and the results were a disaster. This should be a learning moment for public health to remember medicine relies on careful, rigorous evidence. It's crazy public health forgot the adage "Half of what you are learning in Med School is false, we just don't know which half yet" - though, unsurprising, as Public Health is dominated by PhDs and the occasional non-clinical MD coming from academic or administrative roles.

4) Medicine needs to exchange humility for arrogance. The history of medicine is littered with instances of doing more harm than good. Quoting David Sackett in his seminal paper "The Arrogance of Preventative Medicine" [1] (which should also be a must read for public health):

"There are simply too many examples of the disastrous inadequacy of lesser evidence as a basis for individual interventions among the well: supplemental oxygen for healthy premies (causing retrolental fibroplasia), healthy babies sleeping face down (causing SIDS), thymic irradiation in healthy children, and the list goes on."

The arrogance to think that all the mistakes of medicine are only in the past, that "we got it right this time, not like all those other times we got it wrong", to not leave room for doubt, to not question if the ideas you hold might be wrong, opens medicine to repeat the same mistakes of the past.

Even since Sackett penned that piece 20 years ago, countless mistakes continued to have been made including: the overdiagnosis of thyroid cancer in South Korea, Vioxx, the Pain Management obsession of the early aughts which contributed to the opioid epidemic, Pfizer's kickbacks for and promotion of Bextra and Lyrica, keeping kids out of school over Covid hysteria, etc.

5) Stop the obsession with misinformation, including trying to police what ideas people have about medicine, and instead focus on providing *better* information. Every second spent hunting for some wrongthink would be better spent shoring up your own information. Fix the inadequacies of peer review, focus on the replication crisis, find a way to better organize the pursuit of science, double check your work, have others triple check your work.

Let the evidence speak fit itself. Efforts to control so-called misinformation are more likely to backfire and erode trust. Consider how the efforts taken police discussion on the efficacy of a brand new vaccine wound up eroding faith in the traditional vaccines, sending vaccine hesitancy rates soaring in both Blue and Red areas making Andrew Wakefield impact seem tame by comparison.

This is a huge concession for me too, as I was confident that we should leverage tech to fight misinformation (I even wrote a letter to Mark Zuckerberg outlining some ideas after this post 9 years ago [2] - holy shit did I get Monkey Pawed!)

*side note, until I read that interview with Kory I was under the impression he was far right, so I think that speaks to the effectiveness of the official narratives "misinformation" campaign - even someone like me who spends a lot of time exploring the views of counter culture/contrarian/skeptics misjudged Kory.

[1] https://www.cmaj.ca/content/cmaj/167/4/363.full.pdf

[2] https://www.facebook.com/michael.dambrosio/posts/pfbid0fGo1hGV6P4iJgHwFoSA46oCn68tXXjazcY4VgLCACAa5g2CBp7ufyXvRN2a1RK8Ml

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Feb 8, 2023·edited Feb 8, 2023

I wish you would study the evidence in favor of ivermectin as thorougly as you did it with masking. Some of the so-called "negative" trials on ivermectin are a joke, as is rightly pointed out by ivermectin-enthusiasts. Inclusion up to 14 days after symptoms for the PRINCIPLE trial, when Molnupiravir or Paxlovid stick to about 3 days, for instance? It's completely ridiculous.

TOGETHER isn't great, either: https://c19ivm.org/togetherivm.html

It's hard not to be skeptical of such poorly executed RCTs.

And when it comes to prophylaxis, I'm not sure that masks ever had anything as promising going for them as those (admittedly unpublished) results:

https://www.medincell.com/wp-content/uploads/2023/01/PR-results-TTG-VF-EN.pdf

"The SAIVE Trial (NCT 05305560) is a Phase 2, multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical study, evaluating the safety and efficacy of ivermectin tablets taken orally for 28 days, under the oversight of a U.S. based independent Data Monitoring Committee. The study was conducted in Bulgaria between March and November 2022.

All participants were unvaccinated adults and had been exposed to the virus within 5 days of screening after documented close contact with a person who had a PCR-confirmed SARS-CoV-2 infection. Participants randomized to ivermectin group showed a highly statistically significant reduction (72%) of laboratory-confirmed infections between baseline and Day 28 (30/200) versus placebo (105/199), the study's primary endpoint, with p<0,0001. No safety signals related to daily intake of ivermectin, 200 microgram/kg on Day 1 then 100 microgram/kg daily from Day 2 to Day 28 were identified during the study."

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"And when it comes to prophylaxis, I'm not sure that masks ever had anything as promising going for them ..."

Here's an RCT that (eventually) got published: Shoumann [NCT04422561] gave IVM to household members of infected patients. The results: RR 0.13 [0.08 , 0.21] i.e. 87% effective in prevention of Covid! Hard to quipple much with that result, so Cochrane's 8/21 review claimed high risk for “measurement of outcome” and then ignored Shoumann since it “reported results .. in a way [?] that we could not include in our analysis”. Whatever that means!

Pierre Kory discusses Shoumann in this post: https://pierrekory.substack.com/p/the-criminal-censorship-of-ivermectins (scroll down to "Rejection #4).

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Feb 8, 2023·edited Feb 8, 2023

"Both masking and ivermectin failed to show how they might help people in a timely fashion. Both are failed interventions. One is a the panacea of right wing zealots and the other of left wing zealots.”

One problem with a meta-analysis (such as the BMC referenced by VP) is that authors might manipulate their study with their choice of inclusion criteria, primary endpoints, etc. (especially if not pre-specified). For example, back in August '21, Popp's Cochrane review excluded nearly all studies so that the remaining “n” was too small to have "power" (except for Shoumann RR 0.13 [0.08 , 0.21]. So, Cochrane dismissed it and hid it's Forest plot at the end (p.252) of their review.

Here's an excerpt from a post from Dr. Pierre Kory (a so-called “right-wing zealot”, although, like Vinay Prasad, he is also a Democrat) where he described how the July '21 Cochrane review gave the “right answer” about Ivermectin vs. Tess Lawrie's review (and also discusses Shoumann's trial).

https://pierrekory.substack.com/p/the-criminal-censorship-of-ivermectins

“Tess [Lawrie] proposed to Cochrane for her team to do a “Rapid Review of Ivermectin.” They initially accepted her proposed study protocol! She had a green light. But not for long. They changed tune fast, likely due to pressure from Gates or one of their Big Pharma funders. … all of a sudden, the Cochrane editors informed Tess that a “Rapid Review” was inappropriate and that a “Full Review” protocol should be followed. She quickly agreed to do so and submitted a Full Review ...

Pressure was on. The corrupted Cochrane Library was in a bind. Unsurprisingly, they then started accusing her of “conflicts of interest” because of her video plea to [British PM] Boris Johnson … They simply told her to go publish in another journal and instead assigned the Full Review work to a German team led by Popp et al.

I don’t know Popp but don’t have to. Popp proceeded to employ the identical tactics that the WHO research team did, a brazenly manipulated review which came to a very different conclusion than Tess’s team, i.e. instead, after dismissing most of the evidence base, they concluded that the evidence for ivermectin was of “very low certainty” and thus insufficient to support a recommendation. … Tess’s team masterfully tore apart the fraudulent Cochrane review here. It’s a must read for science and stat geeks. Note it remains on a pre-print server. … “Gold standard” eh? Whatever. Clown world."

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As usual, I am learning as much or more from the commenters here as from Vinay’s original post. Great points all around and worthy of further research and discussion. Thanks.

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October 2021, just as dropped my 11 yo daughter off at dance, she mentioned she wasn’t feeling well, but convinced me it was just because she was tired.

When I picked her up 4 hours later, she had a moderate fever, headache, and pain in her eyes.

A rapid test confirmed she had Covid, and out of caution, we alerted the dance studio.

My daughter danced in 4 different classes, with roughly 20 other dancers per class, in a confined small studio with poor circulation. None of the students had been masking since 2020.

Not one of the roughly 70 people present at the studio caught Covid from my daughter.

I propose that the black leotards protected everyone as it’s mechanistically plausible that the black fabric obtained an electrostatic charge that pulled the Covid virions to the leotard.

Can the CDC publish my MMWR?

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Shhh...I don't want to have to start wearing a black leotard to work :D

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My leotard protects you, your leotard protects me.

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:D and if someone pees on you while you are wearing the leotard you are more protected than if they were totally naked and peeing on you. (seriously, that was the DUMBEST meme floating around FB during peak Covid virtue signaling).

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Thank you for this analysis. Has there been a "Cochrane Review" of ivermectin, or any of the other alternative therapies for Covid?

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Feb 8, 2023·edited Feb 8, 2023

Yes. See my other {long) comment for a critique of the Popp 8/21 Cochrane review of IVM.

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There have been 2 systematic reviews, yes, one by Cochrane and one by an independent team:

https://journals.lww.com/americantherapeutics/Fulltext/2021/08000/Ivermectin_for_Prevention_and_Treatment_of.7.aspx

and

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

with widely different conclusions.

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Thanks "Moderate-certainty evidence finds that large reductions in COVID-19 deaths are possible using ivermectin. Using ivermectin early in the clinical course may reduce numbers progressing to severe disease. The apparent safety and low cost suggest that ivermectin is likely to have a significant impact on the SARS-CoV-2 pandemic globally." lww

"According to this review's living approach, we will continually update our search." updated https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub3/full.

Then we have Dr Kory https://pierrekory.substack.com/p/fraudulent-trial-on-ivermectin-published-859

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There do seem to be a lot of studies, each with their own biases and quality. We really do need a dispassionate view. Have no idea about the cited study with endpoints "Primary endpoints included all cause mortality and invasive ventilation requirement". Does IVM taken early work to avoid the hospital. The cited study lacks that data. IOW, when does IVM work best to avoid getting sicker?

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Feb 8, 2023·edited Feb 8, 2023

"Does IVM taken early work to avoid the hospital."

According to the FLCCC https://covid19criticalcare.com/ IVM (along with other supplements or meds) should be taken ASAP upon symptoms. The sooner the better (say within 0 - 5 days from symptoms), although it would still help later.

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What are your thoughts on FLCCC?

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Group with integrity and courage. Both Marik & Kory lost their mainstream medical careers over their stand. FLCCC publishes great resources on at-home prevention, early treatment,, and long-covid/vaccine injury treatment. These documents are updated frequently. They also put out a weekly Zoom & video.

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"Does IVM taken early work to avoid the hospital?"

...

Back in July '21, I did a deep dive into the 8/21 Cochrane Ivermectin [IVM] review. I noticed that Cochrane buried the results of a trial that showed prevention of Covid with IVM (in a tiny footnote in the summary, and in the Forrest plot at the very end (p. 252) of the paper).

Shoumann [NCT04422561] gave IVM to household members of infected patients. The results: RR 0.13 [0.08 , 0.21] i.e. 87% effective in prevention of Covid! Hard to quipple much with that result, so Cochrane claimed high risk for “measurement of outcome” and then ignored it since it “reported results .. in a way [?] that we could not include in our analysis”. Whatever that means!

Back in Sept '22, Alexandros Marino's wrote a post that discussed another short-coming of the Cochrane IVM meta-analysis: “The Cochrane Review on Ivermectin Violated Its Own Inclusion Criteria for 76% of the Patients It Included”

https://doyourownresearch.substack.com/p/the-cochrane-review-on-ivermectin In my Comment to Marino's post, I went into more detail about Shoumann (page numbers, etc and quotes) along with his response.

I would highly recommend Marinio's other IVM posts. He (and Pierre Kory who's got a book coming out soon on IVM) have written detailed critiques of the big trials that supposedly show IVM doesn't work (especially of the much lauded Together trial).

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Feb 8, 2023·edited Feb 9, 2023

Perhaps you should reconsider [canceling your subscription]? "Cancelling" those with whom you disagree will just isolate you into an information silo, an echo-chamber where you won't learn anything new, since you'll only hear information you already agree with.

Note: This comment was directed at the "deleted" above, not to VP.

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The challenge is VP has argued these points previously and others have argued against him. Yet VP does not engage those arguments, he keeps shadowboxing with strawmen. The worry is that SM is already that information silo and echo-chamber where you won't learn anything new because you'll only hear information you already agree with. How can that be improved?

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VP NEVER reads these comments...ever. This goes back to his very first Substack post. It is really too bad.

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I don't fault him for not reading the comments. But the same arguments have been made in peer reviewed lit, some directly arguing against him. For that there's no excuse.

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