7/n Also worth noting, I've previously shown the heterogeneity is high in meta-analysis of IVM for COVID-19 mortality, and that's almost entirely because there are 2 studies that show a massive benefit and a bunch of studies that show no benefit at all
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18/n Worse still, these appear to be picked almost entirely arbitrarily. The website claims to choose the "most serious" outcome, but then immediately says that in cases where no patients died or most people recovered a different estimate was usedpic.twitter.com/xspr31qd7m
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19/n Even a fairly surface skim shows that what appears to actually be happening here is that the authors choose the outcome that shows the biggest benefit for ivermectin
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20/n For example, the analysis includes this paper. The primary outcome was viral load, which was identical between groups Never fear however, because ivmmeta won't take "null findings" as an answer!pic.twitter.com/xW0WmYGaV9
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21/n If you dig through the supplementaries, what you find is that for "all reported symptoms" there was a large but statistically insignificant difference, represented in this graph of marginal predicted probabilities from a logistic model. It is mostly driven by an/hyposmiapic.twitter.com/h64IdG4LJF
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22/n If you eyeball "any symptoms", you get the results that ivmmeta included in their analysis But that's TOTALLY ARBITRARY. Why not choose cough (where there's no difference) or fever (where IVM did WORSE)
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23/n Also, hilariously, this study used the last observation carried forward method to account for missing data in symptom reporting. You can actually see this in the supplementaries - it's possible the entire result comes from a few people not filling out their diaries properlypic.twitter.com/rA7PO4o4hd
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24/n None of this should matter, because the trial found NO BENEFIT FOR IVERMECTIN, but this has been reported and included into ivmmeta dot com as a hugely beneficial resultpic.twitter.com/mjGBDnpVW5
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25/n This explains the bias I noted above - it's not publication bias, it's that the authors appear to have generally chosen whichever result makes ivermectin look better to include in their model Not really scientific, that!
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26/n But the fun doesn't stop there. The inclusion criteria for this website is any study published on ivermectin, which has led to what I can only call total junk science being lumped in with decent studies
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27/n Here's a study with impossible percentages in table 1 that used a comparator of 12 completely random patients as their control. They don't even say if these 12 people had COVID-19 Included in ivmmeta, no questions askedpic.twitter.com/3AlGdGcPnW
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28/n ivmmeta includes all of the studies I've been tweeting about recently including this one https://twitter.com/GidMK/status/1421368493975359490?s=20 … And this one https://twitter.com/GidMK/status/1420582871031373824?s=20 … And this onehttps://twitter.com/GidMK/status/1419557546872819719?s=20 …
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29/n I've now read through about 3/4 of all the studies on the website, and I would say at least 1/2 of them are so low-quality that the figures they report are basically meaningless
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30/n Moreover, sometimes the website just does stuff that is wildly strange Here's a study with no placebo control. They appear to have calculated a relative risk of...whether the patients in this hospital got treated with ivermectin? WHYpic.twitter.com/qH9PRewSPS
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31/n I could keep going - there's just so much there. Even just the basic concept of combining literally any number from any study and saying that it makes the model MORE ROBUST is so intrinsically flawed So. Many. Mistakes
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32/n But this thread is already too long, so to sum up - the website looks flashy - the methodology is totally broken - I would call this pretty pseudoscientific; all the trappings of science, with none of the rigor
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33/n If the authors do indeed want to make this into a reasonably adequate analysis, there are a few steps: 1. Separate treatment outcomes (i.e. analyze ONLY deaths in a model) 2. Rate QUALITY of included literature (i.e. don't aggregate trash with decent studies)
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34/n 3. Separate STUDY TYPES (i.e. don't include an ecological trial with no control group and an RCT) 4. Take out all the weird language about "probabilities" and heterogeneity, pretty much all of that is just flatly incorrect
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35/n Also, because people always ask when it comes to ivermectin - no, I've never been paid by any pharma companies for anything, I receive no pharma funding, and all of my COVID-19 work is unpaid anyway
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36/n Frankly, I don't want your money, give it to something more worthwhile like this charity that provides menstrual products to homeless women they're much more deserving than I amhttps://www.sharethedignity.org.au/
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37/n One final point - I honestly hope ivermectin works. Based on the current evidence, it looks like the benefit will be modest, but it's still not unlikely that it helps a bit. Problem is, current best evidence is also consistent with harm
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38/n Ugh, one other note - one shitty website that makes mistakes does not "disprove" ivermectin, just like the website never proved much itself. The question is still open in my opinion, regardless of ivmmeta
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39/n An addition - this was a very unfair thing to say about this piece of research, which is very well-done. The issue is not with these researchers, but the ivmmeta website itself and I should've been more clearhttps://twitter.com/GidMK/status/1422044424436011009?s=20 …
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40/n A brief update - this was an unfair point to make - the trial does indeed have a control group (such as it is), just not a very useful onehttps://twitter.com/GidMK/status/1422049090007797766?s=20 …
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41/n You can also see some more examples of where the authors of this pseudoscientific website contradict their own stated methodology in this brief thread from Dr. Sheldrickhttps://twitter.com/K_Sheldrick/status/1431507081496969222?s=20 …
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42/n And worth noting that we've come forward with serious concerns about fraud for 4 studies that remain up in the main analysis on the website Not scientific at all, but, well, not unexpected!
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43/n People keep directing me to this pseudoscientific website, so I might as well keep pointing out issues This study - Ahmed et al - found no benefit for ivermectin on duration of hospitalization, cough, or sore throat. So why is it presented as massively positive?pic.twitter.com/Xo9De14u0h
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44/n Well, in the ivermectin groups (there were two of them), of those who had a fever at the start of the treatment in one group everyone recovered. In the placebo group, 3 people still had a fever at day 5pic.twitter.com/L28viBtMOY
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45/n Now, obviously this contradicts ivm meta's stated methodology - they should use hospitalization length which is more severe than reported symptoms - but it's also quite funny because they've even excluded ONE OF THE IVERMECTIN GROUPS
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46/n In reality, this trial should have a point estimate above 1, because in this trial people treated with ivermectin stayed (non-significantly) longer in hospital than the placebo group, but the website is only interested in promoting ivermectin, not factspic.twitter.com/bDBVOuq0KC
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47/n You can even see just how dishonest this website is when looking at cough. It's debatable whether cough is more severe than fever, because there's no assessment in the paper, but the placebo group did better than ivermectin in this trial on cough (p=0.15)pic.twitter.com/0qfHZbtXKp
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