Posts
Comments
I was doubtful, now I stand corrected.
It wasn't really intellectually honest, to the point he received enough criticism from his own wife and granted that much
You can check out the initial few minutes of the following AMA
I don't feel like dealing with too many specifics here. One criticism I do take to heart if only because it came in one form from my wife is that despite my saying that I wanted to remain non judgmental and try to produce a document that the vaccine averse could actually receive without feeling denigrated in any way. I didn't try hard enough and certainly my guest Eric didn't try hard enough there. I would have to say we are guilty as charged and in truth, I'm not even sure it's the right target. I mean there's something patronizing about the claim that in order to reach the vaccine hesitant, you have to walk on eggshells. So as to not make them feel judged. Nevertheless, I do see the depressing results of the last podcast all around me. Those who were disposed to agree with me absolutely loved it and we're grateful. And those are worried about the Covid vaccines and taken in by what they've heard on Bret Weinstein's podcast or tucker Carlson, wherever thought Eric and I were totally clueless about the state of the conversation that's happening over there. I don't actually know what the solution is here because some people asked why not just have Brett on the podcast to talk about all this, But I think that would be a bad idea, not because I don't think they're adequate answers to the kinds of points he would raise. But like so many debates on fairly fringe topics, classic conspiracy theories, religious fundamentalism, many points can't be addressed in real time. Many anomalies can't be fully explained, right?
I agree he paints a bad picture but he's short on actual, time-bounded, predictions to evaluate his claims.
He shared some predictions in May, with a time frame of months/weeks to see some vaccine resistant variant.
I think Omicron counts as variant that is vaccine resistant, even though there's no peak in vaccinated deaths rates (deaths may be, but not rates as far as I can tell).
Some other people claim Omicron does not descend from the Wuhan strain, so even this might not be the variant Geert Vanden Bossche predicted.
Were you referring to some other prediction in particular?
A source on this has been Geert Vanden Bossche (see his FAQ).
I'm not 100% convinced he's right, but I have not found any credible attempt at debunking him either. (One such attempt is from Gorski, but it's almost name calling).
He may be right, in that case you might not be able to find any convincing counterargument either.
Long term we could assess the claim that "a slow rollout of a leaky vaccine" actually applies in the context of Covid, but we know it can be theoretically (link).
Short term, for your next dose in February, I'd weight different factors:
- There's going to be a limit on the number of doses that are effective.
What's currently going in Israel suggests that it's probably <4. - It seems uncontroversial that the effectiveness wanes with time, peaking few weeks after the dose, declining after few months.
- The risks of additional doses seem to compound (source)
I'm assuming this is your booster shot, so it looks you have one extra shot in your gun and you might want to time it for maximum effectiveness.
If you're under 40, healthy and male I would wait even at the current prevalence in most countries.
If you're older, or know to be particularly at risk, you might want to optimize the time of your next dose.
If you take it in February you may be immune for ~3 months. Feb-May don't seem as risky as Nov-Jan in most of the northern hemisphere. Maybe you want to wait until October? We'll also know more by then.
If you know to be at imminent risk (for example known comorbidities) then you know what Covid does in those cases and the tradeoff is less obvious, probably you want to go ahead right away.
Oops, link fixed, here it is again for convenience.
I understand you say these are large numbers, but I don't know what signal we can expect to see if they can't contain the outbreak. Number of travelers from China that need isolating?
Or do you expect that the number of deaths will be considerably high?
China keeps daily cases under 50 per million through 2022: ?% → 40%. [...] We’ll know if this is failing,
How do you know that we'll know if this is failing?
I'll go with 60% that by December 31st 2022 we'll have no credible reports (or even the OWID feed) say China had any day with 50+ cases per million, at least this puts an upper bound on the resolution.
This is the sum of three things:
- Even if >50/mil, Information doesn’t get out, not by December 31st 2022 at least
- China manages to mitigate effectively
- China is already mostly immune. See this comment thread on ACX
Last one has low probability, certainly lower than #1, but it’s still there.
But I’m curious, what makes you think we’ll know if China will fail to contain Omicron?
See a reproduction of Lawrie's metastudy here.
Even without both of those constributions the result doesn't meaningfully change.
I have not managed to see Hariyanto et al reproduced yet (any help welcome), so I don't know what effect removing Elgazzar from it would have on that specific meta-study.
For Bryant et al though this is the result with both Elgazzar's in:
This is the result with both Elgazzar's out:
RR moved, but the result is fundamentally the same.
Do you think it would change the result for Hariyanto et al?
Update:
A recent preprint compares Roman et al and Bryant et al: Bayesian Meta Analysis of Ivermectin Effectiveness in Treating Covid-19 Disease
Summary:
The two studies find similar RR (risk reduction as
)
Bryant found RR = 0.38 [CI 95%: (0.19, 0.73)]
Roman found RR = 0.37 [CI 95%: (0.12, 1.13)]
Roman et al should conclude there's not enough evidence because they can't rule out RR >= 1 at 95% confidence. Instead they conclude:
In comparison to SOC or placebo, IVM did not reduce all-cause mortality, length of stay or viral clearance in RCTs in COVID-19 patients with mostly mild disease. IVM did not have effect on AEs or SAEs. IVM is not a viable option to treat COVID-19 patients.
Bryant and Roman use similar methods, the difference in the confidence interval is because they picked different studies.
Bryant has different estimates for mild vs severe vs all cases. 0.38 is for all-cases to allow comparison with Roman batched all-cases together and has no breakdowns.
This third Bayesian (meta-?)meta-analysis concludes:
This Bayesian meta-analysis has shown that the posterior probability for the hypothesis of a causal link between, Covid-19 severity ivermectin and mortality is over 99%. From the Bayesian meta-analysis estimates the mean probability of death of patients with severe Covid19 to be 11.7% (CI 12.6 – 34.75%) for those given ivermectin compared to 22.9% (CI 1.83 – 27.62%) for those not given ivermectin. For the severe Covid-19 cases the probability of the 7 risk ratio being less than one is 90.7% while for mild/moderate cases this probability it is 84.1%.
In our view this Bayesian analysis, based on the statistical study data, provides sufficient confidence that ivermectin is an effective treatment for Covid-19 and this belief supports the conclusions of (Bryant et al., 2021) over those of (Roman et al., 2021).
The paper has also highlighted the advantages of using Bayesian methods over classical statistical methods for meta-analysis, which is especially persuasive in providing a transparent marginal probability distribution for both risk ratio 𝑅𝑅 and risk difference, 𝑅𝐷. Furthermore, we show that using 𝑅𝐷 avoids the estimation and computational issues encountered using 𝑅𝑅 , thus making full and more efficient use of all evidence.
Nice find. There's more data at GISAID, and it's quite comprehensive!
India's situation is messy because of the different states policies.
To properly do this one would need to control for incidence and lockdown policy state-by-state. Also some states have no approval for Ivermectin yet it gets used.
My best bet is that we'll get the cleaner data on whether it works from Europe, in particular from Slovakia and Czechia.
Even if EMA advises against Ivermectin, Slovakia approved it for both prophylaxis and treatment in late January 2021.
I could not find how widespread the slovak usage of Ivermectin is, but there are few points:
- Mobility report shows that Slovakia is not locking down, not effectively at least
- Bratislava airport has arrivals from all places (including UK), seemingly no closed borders
- Less than <40% of Slovakia population is vaccinated (vs >65% in UK, 47% in CZ)
- Cases in Slovakia keep going down, but Czechia seems to start going up
I've not found data on the delta variant incidence in Slovakia, maybe it didn't reach there yet. It's 98% of cases in UK, 30% in CZ.
If Slovakia sees a ramp up in delta cases the Ivermectin proponents will likely say it wasn't used enough/correctly, and the detractors will keep saying it was useless from the start.
On the other hand, if Slovakia does not see a ramp up in delta cases whilst keeping a low vaccination rate and no effective lockdown in place it'd suggest something else must be at work.
Saying it's Ivermectin will come off as reasoning from exclusion but it'd be my best-bet hypothesis.
The Medina study received some methodological complains, see the JAMA letter.
Ivermectin proponents seem to consistently push for a regimen of:
- high dosage (0.2mg/kg once-a-week for prevention)
- early usage, ideally as prevention
- usage with/after meals
If they're right one can imagine studies that see no effects either because of low dosage, late administration or administering it on empty stomach (the anti-parasite regimen), which the Medina study does.
Another meta-analysis (Bryant et al) has a very similar title but positive claims Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines.
The authors have put out an official rebuttal of the negative meta-analysis which is an interesting read and point to many of their perceived flaws.
The comments on the preprint of the negative study (Roman et al) are also interesting.
For instance:
Hi, I'm Dr.Niaee and I was surprised that even basic data from our RCT is completely mispresented and is WRONG. We had 60 indivisuals in control groups and 120 in intervention groups and even this simple thing is mispresented.
And:
after your "mistake" inverting the control and IVM arm of the Niaee study, the RR goes from 1.11 to 0.37 yet you dare to not change a single word in your conclusion
My current impression is that the negative study is not very high quality at the moment, for any reason among rush to publish, incompetence or malice.
For sake of argument I still have to look at what studies Roman et al did include that was omitted by Bryant et al and Hariyanto et al as that would reveal any pro-ivm biases.
- seriously, what are the chances that all three vaccines are both dangerous and equally so?
Malone/Weinstein say they seem to have minor differences, at least in mechanism/effect. Their point being that if you get the S p circulating you're in trouble. All the three seem to produce that effect.
- One must also consider the reaction of other experts [...] When experts in high places thought there was a risk of rare blood clots, they were often willing to halt [...]
Well done, this is a very well put and good point. I don't know what drove the craze on blood clot (very few instances too?) against AZ and J&J. It's weirdly inconsistent with the reaction on myocarditis for mRNA vaccines, they only (reasonably?) halted on young population? It looks like a different standard than for AZ/J&J.
There's also criticism of the Bryant and Lawrie paper.
What's an actual criticism of that paper from that article? That meta-studies are garbage-in-garbage-out? That's weak at best, the author seems to have spent no time in spot checking any of the papers included to check whether this actually happened.
The Japanese data is at the center of Byram Bridle's claims, which is systematically debunked ...
... by a nameless "Concerned Scientist". I don't want to play ranking authorities, but it's obvious someone is mad at Bridle enough to steal his name to put up that website. It's hard to read that website assuming good faith, at least Bridle seems courageous enough to argue his points in the open under his own name, like any "Scientist" should do, especially "Concerned" ones.
Regarding the spike protein toxicity, my understanding is that the claim is a bit more nuanced. A recent tweet from Malone says:
The SARS-CoV-2 spike protein is cytotoxic. That is a fact. Who says so? Multiple peer reviewed references. The Salk Institute.
It is the responsibility of the vaccine developers to demonstrate that their expressed version is not toxic. Show us.
And then links to this Salk article.
Basically claiming that we know SARS-CoV-2 spike protein is cytotoxic and unless proven otherwise it's fair to assume the version expressed by vaccines is similarly cytotoxic.
All the "fact-checker" linked from that website are "we have no evidence that [...]", and this is very much a case in which absence of evidence is not evidence of absence.
Thy disagree, but in which direction? The second chart seem to report numbers higher than the first chart but I'm not sure they are about the same data. What's your read? Can you put some links for the second graph source?
Is the risk of female reproductive harm from the vaccines any worse than the risk from infection?
That is a brilliant question. Data from Israel and UK (both high vaccination rates) should reveal useful, but I do wonder how much data is required to make that claim.
In the UK (ONS) 1.7 males died for each dead female in the 15-45 age bucket. It's 2.3 in the 20-25 age bucket. This suggests female (young especially) are less prone to be badly affected, but it says nothing of other fertility-related adverse reactions.
Regarding Ivermectin, see my top level reply.
Also from the FLCCC website, it looks like there is still no data about taking IVM during pregnancy.
The whole video is painful to watch, it gets more bearable after the 2:11 mark when Kirsch (the blue shirt guy) slows a bit down.
The following is a recap of what I've understood them saying and some unpacking. I'm not educated in anything medical and still have a bunch of open question. If you spot any error or know the answer to these questions please let me know.
TL;DW
They seem to be making 3 main points:
- Ivermectin prevents and treats SARS-CoV-2. It's extremely safe, common and cheap.
- Vaccines were rushed. Long term adverse reactions are unknown, some adverse reactions are now noticeable and worrying.
- Pharmaceutical companies have economical incentives to push for new drugs/vaccines and against out of patents ones. These incentives are skewing media reporting, social media policies and basic research to push pro-vaccine content, and to censor warnings on vaccine safety or potentially safer drug alternatives that might result in vaccines losing their Emergency Use Authorization (EUA).
Bret Weinstein's idea to solve the issue is to find some deep-pocketed sense-making individual or set of people who can buy the pharmaceutical companies out. He thinks that would kill the economical incentives and allow sense to be made.
That was, I think, a fair representation of what they were trying to say and I don't necessarily buy any of it.
Before I try to unpack it note that I've listened to Bret (the host) a fair bit, and he has a positive influence on my priors.
Robert Malone: I didn't know anything about him until I watched this. He sounds balanced, knowledgeable and well connected. His historical involvement with mRNA vaccinology checks out. His recent gigs are way less transparent.
Steve Kirsch: sounds obnoxious and cranky. I'd tend to be dismissive but both Malone and Weinstein seem to see past his style and to agree on his content. From the conversation it seems he's well off and financed some trials on Fluvoxamine out of his own pocket.
1. Ivermectin
It's many smallish studies, and if you think their biases cancel out you come out thinking an effect cannot be there by chance. I don't know of any big study, but at this point I buy that IVM is unreasonably good.
The probability that an ineffective treatment generated results as positive for the 55 studies to date is estimated to be 1 in 23 trillion (p = 0.000000000000043). The consistency of positive results across a wide variety of cases has been remarkable. It is extremely unlikely that the observed results could have occurred by chance.
Source: The mechanisms of action of Ivermectin against SARS-CoV-2: An evidence-based clinical review article, on Nature's The Journal of Antibiotics, quoting ivmmeta.com which collects a bunch of studies.
Other resources:
- Ivermectin for prevention and treatment of COVID-19 infection: a systematic review and meta-analysis, another metastudy by Bryant and Lawrie
- NIH has some official criticism to some of these studies. Typically that they're either small or non blinded.
2. Vaccines
Lack of animal trials
Malone claims the current vaccines skipped animal trials. Humans are the first animals. Some animal testing would have shown the spike protein is an actual active agent, in lack of this knowledge FDA just gambled it wasn't.
On LinkedIn he wrote:
Second big inconvenient truth is that the spike protein is the actual active agent, in terms of eliciting an immune response. And in the case of the traditional vaccines, the dose of spike protein is defined relatively precisely. With the genetic vaccines, it is not (to the best of my knowledge). I know of no data wherein the mean, median, range etc of total amount of spike protein produced in a patient after administration of the COVID genetic vaccine has been defined. Usually, the FDA is quite persnickety about such things, but I am not aware of this key variable having been determined. Therefore, the range and severety of adverse events potentially attributable to the level of expressed spike protein may reflect patient to patient differences in genetic transfer efficiency and subsequent spike expression.
Is the spike protein toxic?
I don't know.
They say "we now know", but I can't tell.
There's a bunch of papers that mention cytotoxicity but I'm not quite sure of what that means. Most of the related points they make seem speculations on top of this point, see next point
Free spike protein?
They claim the vaccine antigen/debris is supposed to stay around the injection point. I don't know why that would need to be the case.
They found circulation
(paper), and the worry seems to come from their claim that now you have the toxic S protein circulating.
That could explain coagulation problems, even though the mechanism is not clear to me.
They are particularly worried about the accumulation in bone marrow and ovaries 48h after taking mRNA vaccines.
They mention a cautionary tale, Thalidomide, Malone denounces the lack of reproductive toxicology.
They claim that the circuation wasn't originally made public say they originally found this via FOIA request to some Japanese authority (pdf).
Pfizer vs Moderna: dosage
Phase 3 trials are optimized to prove efficacy, not to find the minimal dose to have sufficient effect. I find this reasonable on its own.
Malone recommends Pfizer over Moderna as it has lower dosage and similar efficacy. Presumably because adverse reactions are proportional to dosage?
Antibody-dependent enhancement? (ADE)
ADE are new behaviors that viruses get after they bind to antibodies.
In particular the "tail" of the antibody can bind to things that virus alone can't bind to, so if you have circulating antibodies bound to the virus you can circulate the virus in many more places.
This happens in Dengue, you get a minor disease up on first infection, and risk a much worse one on re-infection.
Malone claims we don't yet see ADE induced by vaccines (which is good), but that all previous attempts to create an anti-coronavirus vaccine failed due to ADE.
I had no way to verify this yet.
Should you get vaccinated?
Kirsch has a post about this, collecting much of the material, the tone is similar as in the video.
In the video they go as far as saying that if you're young or a woman the risk/benefit seems to be against vaccination.
3. Pharmaceutical companies
The analysis sounds like a conspiracy.
One of the most glaring point in their favor is the standard that was applied to Remdesivir, a still-under-patent repurposed drug. FDA required a single study (n=1063) to give it EUA, which is a much lower standard than applied to IVM.
Of course it doesn't mean there is a conspiracy, but it might very well be the net-resulting force of one sided nudging.
This ended up much longer than I anticipated. I didn't like the style of all of this, but the content seems interesting.
Nobody is very likely an exaggeration, I suspect is severely under used, but I have no idea about the reversals.
Did you report to VAERS yourself or via your doctor?
How do you know whether your report made it through?
I've found a post from EMA claiming:
Batch ABV5300 was delivered to 17 EU countries and comprises 1 million doses of the vaccine.
but still no signal on how big is the batch single countries get.
If there's an actual risk of blood clot problems, we should see something similar reported in the UK, given the millions of doses they already used.
We don't see any similar reports coming from the UK. The opposite seems true (BBC).
Is the UK hiding this kind of news? I doubt.
Are there problem only outside of the UK?
If this is the case, "the story" might actually be some handling/logistic problem in the vaccines production/transportation/storage in other countries that turns some batches bad.
If this is the case we should see higher % of problems where the batches are mishandled.
I could not find numbers about this, it looks like at the first problem some countries are halting the distribution of entire batches.
A clearer smoking gun would be multiple people having blood clots problems after receiving doses from the same batch.
The size of the batch would help estimate how unlikely that event is.
Italy halted ABV5811 and ABV2856, but unfortunately I could not find how big these batches actually are. If you have any idea I'd be glad to know.
I'd feel completely safe to get a vaccine in the UK.
In lack of the specific batch information, I'd feel safe outside of the UK too.