I think the tales of hydroxychloroquine, ivermectin, and fluvoxamine are such fascinating examples of the problem with accepting low-quality evidence for drugs
The argument for use of HCQ and IVM has always been that they are reasonably safe (true) and so the plausible benefit outweighs any harms. Conversely, until the positive RCTs of fluvox came in, it was FAR less popular because it does have quite a few side-effects
But it appears, at least in the case of HCQ, that there is definitely no benefit and there is a reasonable chance of modest harm. In this case, using the drug has almost certainly caused unnecessary deaths
For ivermectin, the jury is still out, and we may yet see a benefit. But if it does turn out not to be helpful, we'll have two of the most commonly-used medications for Covid-19 that have, by definition, only caused harm
Meanwhile, if we'd ignored all calls about IVM and HCQ, and simply given people fluvoxamine despite the side-effects, we'd probably have done a lot more good. Better still, if we'd had the trial results for these treatments much earlier on
It just goes to show that it can be quite dangerous to rely on theory in the absence of any good evidence, because drugs that are theorized to work in a certain way often don't in practice
It also shows how important it is to start planning for the next pandemic, because ideally we should be able to start this sort of trial almost immediately, and include every phase of disease including early and mild
To be very clear - fluvoxamine is the odd one out, it has good evidence for efficacy

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More from @GidMK

16 Dec
Another new ivermectin study out recently. Apparently it is quasi-randomized and proof that suppressing ivermectin is a "crime against humanity"

Let's do some twitter peer-review 1/n
2/n The preprint is here, and it's a retrospective analysis of routinely collected clinical registry data from the city of Itajai in Brazil

3/n The design was very simple - take routine data on people who either had or had not elected to be part of an ivermectin distribution program, and controlled for a small number of confounding variables using either a propensity-score or regression model
Read 21 tweets
15 Dec
I do find the impact of ivermectin on people's basic critical thinking quite fascinating. This article is filled with obvious, easily checkable lies, but just look at the popularity
The primary claim is that an ivermectin researcher, Andrew Hill, received a grant for $40mil in exchange for lying about ivermectin
This claim centers around a grant awarded by UNITAID to the University of Liverpool for $32mil (the article incorrectly states $40mil) - UNITAID released a press release on the 12th of Jan, the preprint was published on the 8th. Dodgy, right?
Read 9 tweets
14 Dec

The paper has been retracted. Retraction notice not yet online nature.com/articles/s4159… Image
Also, worth noting that in this whole process the editors of Scientific Reports have been really good. The faults lie with the system, not individuals, who mostly appear to genuinely care about science and evidence
Read 4 tweets
13 Dec
One of the more hilarious things that the ivermectin crowd is currently doing is equating any funding ever received by the Gates Foundation as being purchased personally by Bill Gates
For example, @UNITAID. Various bizarre claims have been made that any funding from Unitaid is equivalent to receiving a personal bequest from Bill Gates
However, even a very cursory examination shows that the Gates Foundation contributes only a tiny fraction of the Unitaid budget. The main funder is France, followed by the UK
Read 8 tweets
7 Dec
Today, our letter about a paper in Nature Scientific Reports that claimed to find no evidence that staying at home reduced Covid-19 deaths was published

This is a depressing example of how scientific error-correction fails 1/n nature.com/articles/s4159…
2/n The original paper came out in March, amid the huge worldwide epidemics, and was immediately a massive hit. After 9 months, it has been accessed nearly 400k times and has one of the highest Altmetric scores of any paper ever Image
3/n The paper has also been, I think it's fair to say, one of the more impactful pieces of work during the pandemic. It is still regularly cited everywhere to support the idea that government restrictions against Covid-19 don't work ImageImage
Read 18 tweets
3 Dec
Abortion statistics are a fascinating example of bias, because there are a great many misconceptions about abortion that are nevertheless common

Try and answer the following questions without looking them up
(I'm using mostly US/EU/Aus stats here, while some of this is generalizable to other places, many of the stats will be very different particularly in low-income regions. Also, even within similar countries these stats can be quite different, so this is very general)
1. What is the most common age-group for people who have induced abortions?
Read 15 tweets

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