Excerpts from a rebuttal to an article trying to hide behind the Cochrane Review:
A Cochrane review is not some magical method for determining absolute truth that is free from human judgement, which is the only truly pertinent fact here, because anything subject to human judgement is by definition subject to human error, and corruption. A Cochrane review essentially is a collection of standards and tests dictating the quality and quantity of evidentiary value assigned to a data point or collection based on characteristics such as the source’s size, sampling, biases, protocols, and so on. It also provides a series of statistical methodologies by which one can assign a value to data or data sets, and combine data from different sources.
There are at least two glaring flaws in this model:
1. Ultimately, the application of Cochrane standards relies upon the research capacity and integrity of whomever is performing the review, meaning that the failure of the reviewer to accurately document pertinent characteristics will compromise the results. (To take an obvious but extreme example, suppose an RCT was fraudulently conducted but written up in a manner that successfully eliminates any trace of the fraudulent activity (again, to pick an absurd illustration, swapping the drug being tested with something else in an attempt to ensure that the trial fails to observe a benefit in the tested drug), a reviewer’s ignorance of this will lead him to categorize the study as high-certainty evidence per the Cochrane review standards.
2. Cochrane reviews stipulate a hierarchy of evidence that while (let’s assume is) generally able to accurately capture the effect’s significance and certainty, it does so by assigning values to characteristics that are often situationally unwarranted, which can then falsely portray evidence as either weaker or stronger than it is. The prime example of this is probably the consideration of RCT’s as the ultimate “gold-standard” of studies, but there are plenty of other assumptions by the Cochrane standards that are somewhat unsound. To put this more succinctly, any formal, rigid formula used to assess something by definition lacks the flexibility to cope with situations where the available evidence will not conform to the exacting specifications demanded by the Cochrane standards, but where the evidence is obviously convincing and demonstrative to anyone with common sense.
These flaws when combined with broad systemic corruption in the scientific community results in a cult-like insistence of ignoring an avalanche of real-world experience & evidence in favor of following the officially prescribed method of evidence assessment, which is what has occurred regarding Ivermectin. Here is a “theoretical” example to illustrate this: Suppose there was a pandemic where the world was caught flat-footed. Doctors and scientists scrambling to find an effective treatment rapidly began testing different drugs to see if any seemed to be of help. Harried doctors on the front lines, noticing a potential signal of a potential drug that might be efficacious, quickly organize ad hoc trials, where they essentially give a group of people, usually either health care workers or patients, the option to take or refuse the new drug. These trials show insanely huge reduction in mortality, disease severity and prophylaxis. As word starts to spread around the world, a few countries engage in mass distribution of this drug to a substantial portion, or all, of their population, with a reproducible tight correlation between mass distribution and near eradication of the pandemic virus. None of the evidence in this “hypothetical” would be acknowledged by a formal, proper Cochrane review, because these are either “low quality” studies, or determined and judged to be nullities, due to lack of adequate procedural controls, proper pre-registration, and similar technical specifications that dotted all the “i’s” and crossed all the “T’s”.
With that introduction, let’s turn to the substance of this article. The author comically claims that being empaneled by a government is somehow a positive attribute for adjudicating the panel’s credibility regarding a controversial political topic. A govt panel is controlled by the govt, either directly or indirectly via some combination of legal, social, financial, and professional peer pressures, usually all of the above. Thus, you can be sure that the governments wishes and priorities will not be lightly disregarded.
Next, he claims that such scientists are “independent”. The virtue of independence is meant to say that the scientist is unencumbered by any external influences in executing his scientific analyses. The most powerful corrupting influence currently present emanates from the scientific community itself. Thus, unless a scientist is demonstrably acting independently of the scientific establishment (at minimum), he is presumed to be not independent of the crushing peer/social/govt pressure, as is the case here, where in addition to the default scientific community pressure, as mentioned earlier, the govt itself constituted the panel. That the panel rejected a drug purchased by the govt as a potential useful treatment is wholly irrelevant, because there is no political cost to having purchased a drug, even for a sizable cost, that maybe could have worked out, as the citizenry (especially one already whipped into a panicked frenzy) would tend to appreciate that the govt is acting so proactively and therefore not feel as though the govt had acted irresponsibly. In any event, absurd and unreasonable govt expenditures are a common and routine phenomenon that does not excite the passion or provoke the ire of the population. Ivermectin, on the other hand, is politically charged dynamite, as anyone remotely familiar with the current political climate and discourse surrounding Ivermectin readily appreciates. Representation from across the medical spectrum is likewise irrelevant because the medical establishment itself is a primary corrupting influence on the scientific process, and everyone working under the aegis of the govt is equally subject to the corrupting whims and diktats of the politicians and bureaucrats who wield its powers. This claim is ultimately useful only as representative of the delusional naivete of the author.
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Their [c19Ivermectin . com] work, however, speaks for itself. Even more compelling are the genuine world-class medical pioneers who are the driving academic force behind the Ivermectin campaign, who hold this website and its creators in high esteem.
In any event, this attack is not only dumb, it’s akin to attributing special relativity to some middling college physics professor while ignoring Einstein and claiming that the primary authority behind the theory is the no-name professor. The FLCCC, comprised of unimpeachably credentialed brilliant medical luminaries, presents a thorough overview and analysis of the evidence base and protocols for Ivermectin. The conundrum posed by the author is in truth a question of which experts should you trust: a govt empaneled committee who are essentially analyzing from comfortable perches in their ivory towers, who face no real threat of sanction for denying Ivermectin’s efficacy but face very real professional perils should they buck the medical/scientific/govt establishment, vs a group of brilliant doctors who have put their careers, social lives and reputations on the line while successfully using Ivermectin for a year and treated tens of thousands of patients directly and consulted for doctors worldwide who have collectively treated millions. Not much of a choice when you frame it honestly and accurately.
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If you look at their references for their Ivermectin research, you will find cited Lopez-Medina et al. This study literally engaged in deliberate scientific fraud. A panel dedicated specifically and solely to grading quality of evidence that cites an obviously fraudulent study lacks even a semblance of credibility. Period. There reference list is highly problematic for other the inclusion of other dubious references while omitting perfectly acceptable studies that were far less problematic procedurally than some of those included. Like Lopez-Medina. (At least they aren’t citing the Roman et al meta-analysis, which simply lied about the results of some of the studies whose results they were allegedly analyzing.) The FLCCC doctors, in a few of their weekly updates, explained the ins and outs of some of the ridiculous anti- studies. You can listen to an explanation of the evidence base from (formerly?) world-renown FLCCC President Dr. Pierre Kory here, and from expert WHO consultant Dr. Tess Lawrie here.
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In any event, this argument is rubbish, because one of the cornerstones of the current debate is the medical community’s censorship of dissenting opinions from mainstream journals and publications. Obviously, if the top journals simply refuse to publish any papers that would place the political narrative in serious jeopardy, you cannot adjudicate the credibility of a paper by where its published (or more to the point, where it is not published). A more viable approach to assess the credibility of a study by its provenance is to look at the authors – if they are highly credentialed and mainstream according to a Google search starting from before March 2020 who are not conforming to the establishment narratives, then they carry far more weight than those who do not meet these criteria. Ultimately, there is no substitute for sensible judgement, which is an intangible quality that some people have and some people don’t.
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This is functionally illiterate. A number of small trials all showing the same result is itself extremely high-powered evidence, because the chance of running, say, 30 independent trials with widely ranging characteristics and observing the same results are so infinitesimal as to be negligible. 25 small, individually underpowered studies are far more conclusive than one large trial, because while 25 trials with widely ranging characteristics can largely negate each other’s (potential) biases, one large study cannot overcome its own design flaws. (Yes, RCT’s can be designed quite horrifically while following every rule and standard, something which cannot be emphasized enough.) This is emphatically the case regarding Ivermectin, although you would have to look at the individual studies to get a sense of this, which the very website this author maliciously attacks provides, ie lists all of the studies with a summary of the basic results intelligible to a layperson.
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C19early.com is a compilation of every study for Ivermectin (and other treatments), ranked chronologically from most recently published. They include every study run, regardless of the results, and regardless of the statistical significance. (They still have up the fraudulent Lopez-Medina and Roman studies.) Their list is not designed to filter out low quality garbage. This author is being ridiculous, a competent person easily understands the nature and purposes of the website, and would use a little, you know, judgement and certainly not cherry pick the first study as representative. Furthermore, a number of low-quality studies taken together provides quite robust evidence in sufficient numbers, because, as previously stated, the odds of practically all the studies show efficacy if there wasn’t any are so remote as to be absurd speculation. Furthermore, there is a marked tendency to label any study that was run somewhat haphazardly as entirely devoid of any evidentiary value. This is, to put bluntly, moronic and disingenuous. Someone treating ill covid patients doesn’t have time to properly randomize sorting into evenly propensity score matched groups and all of the other minutiae necessary to run a “proper” RCT for a disease that will either start recovery or turn towards ventilation (or death) within a week or two. Furthermore, delaying the start of treatment in any event increases the risk that treatment will not be effective, which is both highly unethical and reduces the chance of seeing a statistically significant result especially when you have a low study subject population to begin with.
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Conclusion:
The Ivermectin evidence base, ranked in order of quality (ie, most improbable results if Ivermectin doesn’t work), is essentially:
1. The clinical experience of thousands of doctors worldwide successfully treating patients with Ivermectin & Ivermectin centered protocols. This includes a spate of court cases where judges ordered hospitals to administer (or not impede administration of by 3rd party physician of) Ivermectin to already ventilated patients for whom their hospital had no other treatments to offer and who all subsequently recovered (with the notable exception of the Mt Sinai case where the patient died amidst the inconsistently administered Ivermectin during the court wrangling).
2. The countries that mass distributed Ivermectin to part or all of their population with tightly correlated and reproducible “flattening the curve” of every covid metric (like Mexico, Peru, India, just to name a few), some of which had a control group of an untreated population or subsequent change of policy.
3. The numerous prospective control trials, both random and unrandom, showing Ivermectin’s brilliant efficacy. I personally think that Carvallo et al, which was an unrandom control prospective prophylaxis study (the subjects chose whether to accept Ivermectin by choice), is the most compelling – 237/400 or so in the control contracted covid vs 0/788 on Ivermectin – ZERO!! – a result so lopsided and stunning that cannot possibly be chalked up to chance, biases or any other nonsensical pathetic attempt to invalidate the study.
4. The small, individually underpowered retrospective observation trials.
5. In-vitro/in-silico demonstrations of Ivermectin wiping out covid, and everything else not mentioned above.
The Cochrane standards reject #1 outright, severely undervalue #2 because they are lacking one or more technical requirements, assign “low weight” qualification to almost all of the studies in #3 for not following proper academic protocol or for “risk of biases”, and basically exclude # 4 entirely as “noise”; while simultaneously incorporating straight up fraudulent studies like Lopez-Medina, poorly designed studies that dose too low, treat too late, use a demographic that already widely uses Ivermectin, and meta-analyses that are rigged by excluding all of the above while including all the aforementioned poorly designed junk studies, and have no mechanism for assessing the political corruption of the academic process.