The paper in the Lancet by the ex-FDA official had a fascinating figure in it. The reason it's fascinating is that it showed how vicious Gamma really is (chart B). 
https://twitter.com/Freakoutery/status/1437747367961321481
The reason this is of interest is that the TOGETHER trial took place in Brazil, during a period of very high prevalence of the Gamma variant. bmj.com/content/374/bm…
As such, attempting to compare results from that trial, with other studies elsewhere is bound to show worse results. Vaccines show 10-20% worse performance against gamma than alpha.
When I first heard @PierreKory mention that to treat people with symptoms and comorbidities, people likely infected with Gamma, was outrageous, I didn't focus much on him calling Gamma particularly vicious. But this diagram definitely makes his point.
I dont think the TOGETHER trial was executed badly, or that there is fraud in the numbers or anything like that. What concerns me is more subtle. Here are some potential concerns, and I'd appreciate if anyone can tell me why I should not worry about specific ones.
Potential concern 1: Exclusion criteria does not include taking IVM.
Not sure if it was left out by mistake, or not mentioned, but in Brazil, where IVM is available over the counter, and promoted as effective on COVID, you must assume some people will take it? What am I missing?
Not sure if it was left out by mistake, or not mentioned, but in Brazil, where IVM is available over the counter, and promoted as effective on COVID, you must assume some people will take it? What am I missing?
Potential concern 2: giving a dose that was lower than what the proponents suggested in general, and for Gamma in particular, so the results were going to be controversial no matter what. Why not try a dose that proponents claim works, so that the results can settle the matter?
Potential concern 3: the principal investigator showed results without the paper being available, preventing any useful context from being added to the results. Some have been criticizing preprints, this isn't even that.
Potential concern 4: Allowing media and pundits to present the study as a "null" result, when the authors themselves computed that the chances of IVM being better than placebo were 76%. This makes getting the slides out ahead of the paper more suspect.
https://twitter.com/AbdenurFlavio/status/1429462407747940355?s=20
Overall, I don't understand why we can't do a large-scale trial, in early treatment, on a protocol actually advocated for by proponents of IVM, so we can make progress on the question. As things are, we lend credence to a feeling that *something is wrong*, which.. doesn't help us
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