To give an overview of what I believe is a reasonable bounded-rationality basis to dismiss this objection:
I am not equipped to evaluate the claims in Alexandros's post in detail without significant effort and time investment (despite being a working academic in a quantitative field).
I'm not particularly worried about COVID and the societal excesses of the response seem to have already died down, so I personally don't see much value in learning about a surprising therapy for it. It seems unlikely to me that even if something like the contents of this post became widely accepted as truth, the societal response next time something COVID-shaped happens would be much beter.
Superficially, it seems there is no particular reason why something like Ivermectin (an antiparasitic that apparently works by disrupting the metabolism of fairly complex multicellular parasites) would work against COVID (a virus). I have a strong prior on most medicines claimed to have a minor beneficial effect on popular therapeutic targets actually being completely ineffectual (as this has been my experience).
On the other hand, the "parasite load" story seems superficially plausible.
Due to the culture-war dimension of Ivermectin, whose efficacy the red tribe in the US has entangled its social status with (no point in recounting the way this happened here), there is an obvious motivation for members of that tribe to produce compelling-looking arguments for its efficacy. Since Alexandros posts around this community, he seems a priori likely to harbour Red sympathies.
Moreover, there is a "contrarian" tribe that is motivated by taking down the rationality-orthogonal "trust the science" wing of the blue tribe, and therefore would also derive utility from successfully Eulering in favour of Ivermectin. Many people seem to talk about the abrasiveness of Alexandros's tone. This increases the probability that he's Red or Contrarian and would therefore have the motive to come to his conclusion.
In short, a situation that seems fairly symmetrical to "read this long and extremely compelling essay by a Harvard academic who is also a Twitter superstar using Science and Logic to prove that Blank Slatism is true". If you had unlimited time and resources or a particularly high stake in finding out whether desirable qualities of humans are genetic, sure, by all means you ought to read it and analyse the argument. For most everyone else, it would be more rational to ignore the essay, leave your prior largely unshifted and spend the time it would take to read on something with higher expected utility, like planning tomorrow's healthy breakfast or getting on top of your todo list.
Things that could convince me to take the essay more seriously:
Establish that the author does not stand to benefit from Ivermectin working, e.g. has impeccable blue tribe credentials.
Establish that rehabilitating Ivermectin would benefit me personally a great deal.
Propose a plausible mechanism by which Ivermectin (specifically!) might work against COVID. Some general handwaving like "it modulates the way the immune system operates" won't work; lots of drugs do that, so I don't see why specifically the one that the Blues are raging against and the Reds are swearing will prove once and for all they should actually be in charge should be the one that happens to modulate it just right.
Relatedly, but harder, shift my prior regarding medicines that purport to do anything more complex than targeting one particular well-understood metabolic pathway not working.
This article has nothing to do with rehabilitating ivermectin. I myself am not sure how well it works today and if I had to guess, it worked a lot better for pre-Omicron variants. Naturally recent data is a mess, so it's hard to know, and I really should do some digging before I say much more because I could be very wrong. On whatever the "red tribe" is - I frequently tweet out about how I could never support a president who allowed Fauci to run the pandemic. As recent immigrant to the US, I have very little interest in whatever partisan bickering y'all are engaged in, other than that I'd prefer if the country my children were born in doesn't implode.
Rehabilitating the rationalist community (the actual intent of the essay) would benefit everyone a great deal. Ivermectin is the perfect case-study of why the rehabilitation is needed.
Once again, the article has nothing to do with defending ivermectin, and everything to do with defeating bad arguments. If you are interested in some material on mechanism of action, my friend Joomi has written a pretty good piece - https://joomi.substack.com/p/misconceptions-about-ivermectin-dosing
There are many drugs we don't understand the mechanisms of, and I can personally confirm that some of these definitely work: https://en.wikipedia.org/wiki/Mechanism_of_action#Drugs_with_unknown_MOA . In fact, as you can read in Joomi's article, ivermectin's anti-parasitic action also is somewhat mysterious, but nobody doubts it works.
I'm not particularly worried about COVID and the societal excesses of the response seem to have already died down, so I personally don't see much value in learning about a surprising therapy for it.
Ivermectin is used as a weapon against the right in the culture war. Whether the right is actually correct, and whether the left made baseless attacks against the right for political reasons, will be important as long as we have a left and right around.
But I think it is clear what the collective knowledge about Ivermectin was at the time. Whether we later learned (or will learn) that it actually works against Covid (or not) will not change anything about how justifies these attacks were.
We had a time when the best meta-analysis as evaluated on LessWrong was pro-Ivermectin and the institutions were anti-Ivermectin.
The question of whether to follow the highest quality published metastudies or the institutions in cases where those differ is an important one. If the highest quality published metastudy was right about ivermectin and the institutions wrong that's a lesson for the future.
If the institutions are wrong and generally suppress the use of generics for important illnesses that suggests we should invest more money into studying whether generics are useful for problems that arise.
Lastly, if Ivermectin works for COVID there's a decent chance that it also works for other viruses. If we have another pandemic it's important to know whether we should run trials to test whether Ivermectin helps or don't run those trials.
I for my part am already fairly convinced that the left makes baseless attacks against the right for political reasons. (Of course, the converse is also true.) Is it that important whether there is one more or one fewer example?
"Baseless attacks for political reasons" was only a rough description. Maybe "baseless attacks for political reasons, that are highly signal-boosted by the media and social media", would be closer.
But again: this was definitely done for political reasons [0] at a time when the evidence was still inconclusive.
Whatever we found out between then and now doesn’t change anything about that.
[0] There are of course more benign motivations one could assume, e.g. protecting people from what was perceived as “false cures” that would end up harming people.
Just because the evidence was inconclusive doesn't mean that the attack was unimportant. For one thing, it's a signal that anyone who does try to do actual research and produce actual evidence in the future would be mercilessly attacked. Even if there's little evidence at the moment, this is a huge deal.
ersatz
defective eudaimonia maximizer
Jiro 2yr ago
Politically, what matters is who controls the institution that determines who is right. I could list a hundred things about which the left is wrong and yet which have been ascertained as true by consensus reality. It has always been so, those who are familiar with Roman history know how much who determines what is true has always been the decisive force in politics.
Skylab
Beware of he who would deny you access to information...
4bpp 2yr ago
"Due to the culture-war dimension of Ivermectin, whose efficacy the red tribe in the US has entangled its social status with (no point in recounting the way this happened here), there is an obvious motivation for members of that tribe to produce compelling-looking arguments for its efficacy."
The corollary to this is that the FDA itself went out of its way to smear Ivermectin as horse dewormer. The FDA tweeted the following over a year ago. Is it normal for the FDA to mock drugs like this?
"You are not a horse. You are not a cow. Seriously, y'all. Stop it."
This seems to me way worse than Bret Weinstein getting overly excited about Ivermectin and jumping the gun on a study that turned out to be no good.
So I have the opposite point in favor of Ivermectin, and in fact, Scott makes a similar point in saying that big pharma suppresses cheap old generic drugs all the time to get people to take their new expensive drugs. It's their marketing model. So we know at least millions of dollars of marketing are being spent to take down Ivermectin. Who is spending the big money in favor of Ivermectin?Nobody.
I don't understand the usage of "corollary" (a straightforward consequence of a previous nontrivial statement) here. Is that the word you were meaning to use?
The FDA tweeted the following over a year ago. Is it normal for the FDA to mock drugs like this?
No, but on culture war it is. This was already after Red cultural authorities had thrown their clout behind Ivermectin, no? The FDA, too, is a Blue technocratic institution; of course it would be tempted to put out communication that lowers the status of the Reds, and in this particular case there was the additional motivation for it that the Ivermectin push was a direct attack on the FDA's authority. One would therefore expect the FDA to attack it independently of whether it works, and so the FDA attacking it is not a signal for or against it working.
I thought it was unnecessary to rehash the backstory, but maybe not. My understanding was that it was associated with culture warring almost from the start: the Blue team occupied the "COVID is scary and untreatable, therefore we need lockdowns, mask-wearing and more powers for our technocrats" position. The Red team found the suggested conclusion unbearable, and tried to respond by attacking every point of the premise. One such push was against the "untreatable" part, and took the shape of asserting that a series of widely available remedies that ranged from completely implausible (bleach) to the merely seemingly random (hydroxychloroquine, ivermectin) worked against it (with the implication that if it did, the power grab by Blue authorities would be proven unjustifiable). Therefore, on the balance, up to this point the situation is still as I described: Reds would push Ivermectin regardless of whether it works, and the FDA would pan it regardless of whether it works, so neither observation tells us anything about it. The prior still is that a random drug with no evident mechanism of action on COVID would not work on it.
The "cheap old generic drugs suppressed for profit" argument is a better one, though (there, you would actually suspect more effort to suppress effective ones, as if someone takes a cheap old ineffective drug, they don't get cured and are still on the market for the more expensive one afterwards).
Skylab
Beware of he who would deny you access to information...
4bpp 2yr ago·Edited 2yr ago
corollary- a proposition that follows from (and is often appended to) one already proved.
If we grant that Ivermectin's effectiveness is a red tribe talking point, then it follows that Ivermectin's ineffectiveness is culturally important to blue tribe.
However- in a sane world, we would still expect a few Joe Rogan's and Bret Weinstein's to weigh in on their far out beliefs on a podcast. What we wouldn't expect in a sane world is for the FDA to snarkily take a side using a national institution of science, well before the fog of war had cleared.
However, the FDA receives much of their funding from Pfizer/Moderna/JnJ and there is a revolving door among board members.
I doubt Rogan is getting paid by Ivermectin advocates. There's no money in it. You could argue that he gains more followers by choosing the fault line, a kind of reverse audience capture.
I find it easier to place the cultural war aspect of Ivermectin into the category of, probably more effective than it appears since even the FDA will go out of its way to smear the cheap and safe drug as "horse dewormer."
Again, maybe I'm wrong but that was my internal assesment. It was odd to see someone making a symmetrical but opposite argument.
I find it easier to place the cultural war aspect of Ivermectin into the category of, probably more effective than it appears since even the FDA will go out of its way to smear the free and safe drug as "horse dewormer."
Yeah, I don't see how this follows. I would expect both P(FDA smears Ivermectin | Ivermectin doesn't work) and P(FDA smears Ivermectin | Ivermectin works) to be close to 1 under our conditions of Ivermectin's culture war role and the FDA, so P(Ivermectin works | FDA smears Ivermectin) is basically the same as the prior P(Ivermectin works).
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Notes -
To give an overview of what I believe is a reasonable bounded-rationality basis to dismiss this objection:
I am not equipped to evaluate the claims in Alexandros's post in detail without significant effort and time investment (despite being a working academic in a quantitative field).
I'm not particularly worried about COVID and the societal excesses of the response seem to have already died down, so I personally don't see much value in learning about a surprising therapy for it. It seems unlikely to me that even if something like the contents of this post became widely accepted as truth, the societal response next time something COVID-shaped happens would be much beter.
Superficially, it seems there is no particular reason why something like Ivermectin (an antiparasitic that apparently works by disrupting the metabolism of fairly complex multicellular parasites) would work against COVID (a virus). I have a strong prior on most medicines claimed to have a minor beneficial effect on popular therapeutic targets actually being completely ineffectual (as this has been my experience).
On the other hand, the "parasite load" story seems superficially plausible.
Due to the culture-war dimension of Ivermectin, whose efficacy the red tribe in the US has entangled its social status with (no point in recounting the way this happened here), there is an obvious motivation for members of that tribe to produce compelling-looking arguments for its efficacy. Since Alexandros posts around this community, he seems a priori likely to harbour Red sympathies.
Moreover, there is a "contrarian" tribe that is motivated by taking down the rationality-orthogonal "trust the science" wing of the blue tribe, and therefore would also derive utility from successfully Eulering in favour of Ivermectin. Many people seem to talk about the abrasiveness of Alexandros's tone. This increases the probability that he's Red or Contrarian and would therefore have the motive to come to his conclusion.
In short, a situation that seems fairly symmetrical to "read this long and extremely compelling essay by a Harvard academic who is also a Twitter superstar using Science and Logic to prove that Blank Slatism is true". If you had unlimited time and resources or a particularly high stake in finding out whether desirable qualities of humans are genetic, sure, by all means you ought to read it and analyse the argument. For most everyone else, it would be more rational to ignore the essay, leave your prior largely unshifted and spend the time it would take to read on something with higher expected utility, like planning tomorrow's healthy breakfast or getting on top of your todo list.
Things that could convince me to take the essay more seriously:
Establish that the author does not stand to benefit from Ivermectin working, e.g. has impeccable blue tribe credentials.
Establish that rehabilitating Ivermectin would benefit me personally a great deal.
Propose a plausible mechanism by which Ivermectin (specifically!) might work against COVID. Some general handwaving like "it modulates the way the immune system operates" won't work; lots of drugs do that, so I don't see why specifically the one that the Blues are raging against and the Reds are swearing will prove once and for all they should actually be in charge should be the one that happens to modulate it just right.
Relatedly, but harder, shift my prior regarding medicines that purport to do anything more complex than targeting one particular well-understood metabolic pathway not working.
This article has nothing to do with rehabilitating ivermectin. I myself am not sure how well it works today and if I had to guess, it worked a lot better for pre-Omicron variants. Naturally recent data is a mess, so it's hard to know, and I really should do some digging before I say much more because I could be very wrong. On whatever the "red tribe" is - I frequently tweet out about how I could never support a president who allowed Fauci to run the pandemic. As recent immigrant to the US, I have very little interest in whatever partisan bickering y'all are engaged in, other than that I'd prefer if the country my children were born in doesn't implode.
Rehabilitating the rationalist community (the actual intent of the essay) would benefit everyone a great deal. Ivermectin is the perfect case-study of why the rehabilitation is needed.
Once again, the article has nothing to do with defending ivermectin, and everything to do with defeating bad arguments. If you are interested in some material on mechanism of action, my friend Joomi has written a pretty good piece - https://joomi.substack.com/p/misconceptions-about-ivermectin-dosing
There are many drugs we don't understand the mechanisms of, and I can personally confirm that some of these definitely work: https://en.wikipedia.org/wiki/Mechanism_of_action#Drugs_with_unknown_MOA . In fact, as you can read in Joomi's article, ivermectin's anti-parasitic action also is somewhat mysterious, but nobody doubts it works.
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Ivermectin is used as a weapon against the right in the culture war. Whether the right is actually correct, and whether the left made baseless attacks against the right for political reasons, will be important as long as we have a left and right around.
But I think it is clear what the collective knowledge about Ivermectin was at the time. Whether we later learned (or will learn) that it actually works against Covid (or not) will not change anything about how justifies these attacks were.
We had a time when the best meta-analysis as evaluated on LessWrong was pro-Ivermectin and the institutions were anti-Ivermectin.
The question of whether to follow the highest quality published metastudies or the institutions in cases where those differ is an important one. If the highest quality published metastudy was right about ivermectin and the institutions wrong that's a lesson for the future.
If the institutions are wrong and generally suppress the use of generics for important illnesses that suggests we should invest more money into studying whether generics are useful for problems that arise.
Lastly, if Ivermectin works for COVID there's a decent chance that it also works for other viruses. If we have another pandemic it's important to know whether we should run trials to test whether Ivermectin helps or don't run those trials.
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I for my part am already fairly convinced that the left makes baseless attacks against the right for political reasons. (Of course, the converse is also true.) Is it that important whether there is one more or one fewer example?
"Baseless attacks for political reasons" was only a rough description. Maybe "baseless attacks for political reasons, that are highly signal-boosted by the media and social media", would be closer.
But again: this was definitely done for political reasons [0] at a time when the evidence was still inconclusive.
Whatever we found out between then and now doesn’t change anything about that.
[0] There are of course more benign motivations one could assume, e.g. protecting people from what was perceived as “false cures” that would end up harming people.
Just because the evidence was inconclusive doesn't mean that the attack was unimportant. For one thing, it's a signal that anyone who does try to do actual research and produce actual evidence in the future would be mercilessly attacked. Even if there's little evidence at the moment, this is a huge deal.
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Politically, what matters is who controls the institution that determines who is right. I could list a hundred things about which the left is wrong and yet which have been ascertained as true by consensus reality. It has always been so, those who are familiar with Roman history know how much who determines what is true has always been the decisive force in politics.
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"Due to the culture-war dimension of Ivermectin, whose efficacy the red tribe in the US has entangled its social status with (no point in recounting the way this happened here), there is an obvious motivation for members of that tribe to produce compelling-looking arguments for its efficacy."
The corollary to this is that the FDA itself went out of its way to smear Ivermectin as horse dewormer. The FDA tweeted the following over a year ago. Is it normal for the FDA to mock drugs like this?
"You are not a horse. You are not a cow. Seriously, y'all. Stop it."
This seems to me way worse than Bret Weinstein getting overly excited about Ivermectin and jumping the gun on a study that turned out to be no good.
So I have the opposite point in favor of Ivermectin, and in fact, Scott makes a similar point in saying that big pharma suppresses cheap old generic drugs all the time to get people to take their new expensive drugs. It's their marketing model. So we know at least millions of dollars of marketing are being spent to take down Ivermectin. Who is spending the big money in favor of Ivermectin?Nobody.
I don't understand the usage of "corollary" (a straightforward consequence of a previous nontrivial statement) here. Is that the word you were meaning to use?
No, but on culture war it is. This was already after Red cultural authorities had thrown their clout behind Ivermectin, no? The FDA, too, is a Blue technocratic institution; of course it would be tempted to put out communication that lowers the status of the Reds, and in this particular case there was the additional motivation for it that the Ivermectin push was a direct attack on the FDA's authority. One would therefore expect the FDA to attack it independently of whether it works, and so the FDA attacking it is not a signal for or against it working.
I thought it was unnecessary to rehash the backstory, but maybe not. My understanding was that it was associated with culture warring almost from the start: the Blue team occupied the "COVID is scary and untreatable, therefore we need lockdowns, mask-wearing and more powers for our technocrats" position. The Red team found the suggested conclusion unbearable, and tried to respond by attacking every point of the premise. One such push was against the "untreatable" part, and took the shape of asserting that a series of widely available remedies that ranged from completely implausible (bleach) to the merely seemingly random (hydroxychloroquine, ivermectin) worked against it (with the implication that if it did, the power grab by Blue authorities would be proven unjustifiable). Therefore, on the balance, up to this point the situation is still as I described: Reds would push Ivermectin regardless of whether it works, and the FDA would pan it regardless of whether it works, so neither observation tells us anything about it. The prior still is that a random drug with no evident mechanism of action on COVID would not work on it.
The "cheap old generic drugs suppressed for profit" argument is a better one, though (there, you would actually suspect more effort to suppress effective ones, as if someone takes a cheap old ineffective drug, they don't get cured and are still on the market for the more expensive one afterwards).
corollary- a proposition that follows from (and is often appended to) one already proved.
If we grant that Ivermectin's effectiveness is a red tribe talking point, then it follows that Ivermectin's ineffectiveness is culturally important to blue tribe.
However- in a sane world, we would still expect a few Joe Rogan's and Bret Weinstein's to weigh in on their far out beliefs on a podcast. What we wouldn't expect in a sane world is for the FDA to snarkily take a side using a national institution of science, well before the fog of war had cleared.
However, the FDA receives much of their funding from Pfizer/Moderna/JnJ and there is a revolving door among board members.
I doubt Rogan is getting paid by Ivermectin advocates. There's no money in it. You could argue that he gains more followers by choosing the fault line, a kind of reverse audience capture.
I find it easier to place the cultural war aspect of Ivermectin into the category of, probably more effective than it appears since even the FDA will go out of its way to smear the cheap and safe drug as "horse dewormer."
Again, maybe I'm wrong but that was my internal assesment. It was odd to see someone making a symmetrical but opposite argument.
Yeah, I don't see how this follows. I would expect both P(FDA smears Ivermectin | Ivermectin doesn't work) and P(FDA smears Ivermectin | Ivermectin works) to be close to 1 under our conditions of Ivermectin's culture war role and the FDA, so P(Ivermectin works | FDA smears Ivermectin) is basically the same as the prior P(Ivermectin works).
( P(W|F) = P(F|W)P(W)/P(F) = ~= (1/1) * P(W) = P(W) )
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