A reasonable debate about Ivermectin

by CraigMichael3 min read27th Jul 202114 comments

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Covid-19Ivermectin (drug)
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Rebel Wisdom put together a good podcast, "Ivermectin, For and Against, with Tess Lawrie, Graham Walker & Gideon Meyerowitz-Katz."  Tess is for sure pro-Ivermectin and is the second author on a favorable Ivermectin meta-analysis. Graham and Gideon are skeptical of Ivermectin. Graham is an ER doctor. Gideon is an epidemiologist. 

Either way, want I wanted to hear was bonafide advocates and detractors talk with each other, and it accomplished that. 

FWIW If this was an Intelligence Squared debate, I came in to it hoping for a good performance from the pro-Ivermectin side. I felt, and still feel, like that "side" is being treated somewhat unfairly. I was disappointed, however, in that regard and am ow more skeptical of Ivermectin as a treatment and prophylaxis after  listening. 

Tess, while bright in many ways, may just not be the best advocate for Ivermectin.

At around 20:00, Tess is asked "What would convince you that Ivermectin doesn't work?" and she responds (paraphrasing from memory): "Ivermectin works." 

It gave me a flashback to the Billy Nye and Ken Ham debate when they were asked what would change their minds. Ken said “You know what? I’m a Christian, and I know God’s word is true, and there’s nothing he could say that will cast doubt on that.” While Bill said "We would need just one piece of evidence" and then gave several examples. 

Then somewhere around 55:00 in Tess is asked if there's anything that should be censored on social media, and the very real example of ”bleach therapy" is offered (that’s where parents are encouraged to give children bleach to prevent autism, not Trump telling you to drink bleach). Tess is unmoved by the example and still categorically against censorship. I wonder what she'd say about PhotoDNA?

I worry that someone like Tess is too biased here. It seems to me that the pro-Ivermectin side has a lot of PR problems. 

EDIT: Rebel Wisdom produced a well-researched background document on the topic. There is also a debate between Dr. Pierre Kory (pro-Ivermectin) and Dr. Luis Garegnani (skeptic) from June that is more congenial all around. 

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Another bad sign from Dr. Lawrie was at 18:20, when Fuller asks her why doctors may disagree, and her answer is basically: "my team synthesizes evidence." A more convincing answer would have been to dig into the disagreements and try to explain what her detractors might be missing. 

If you want to know what people who are against censorship have to say about other topics you could look it up. (They might not be Tess, but it might answer your question.)

Huh? I'm not sure how this didn't come across in my post. I'm against censorship, but I'm not an absolutist. I'm happy that PhotoDNA (and equivalent or better software) runs on the large platforms I use. There are lines to be drawn, at the moment they're ham-handedly scrawled while panicking about impression management when it comes to all things Covid.

Tess could be right about Ivermectin (I suspect she probably is to some degree), and I don't believe she should be censored. But effectively assigning a 100% probability to big questions (there's no chance I'm wrong, so there's nothing that will change my mind) is a huge red flag for me. Bill Nye isn't 100% certain that creationism is wrong. Richard Dawkins isn't 100% certain that God doesn't exist

If there's no evidence that will change someone's mind on an issue like this, it I will say with a high probability that they're not thinking rationally about that topic. 

But effectively assigning a 100% probability to big questions (there's no chance I'm wrong, so there's nothing that will change my mind) is a huge red flag for me. Bill Nye isn't 100% certain that creationism is wrong. Richard Dawkins isn't 100% certain that God doesn't exist

 

 

 

That's not what "assigning 100% probability" looks like. Look at anticipated behaviors, rather than what people claim to believe in.

Imagine, if instead of talking about a (seemingly, to you) difficult question like "Does ivermectin work?", it was a painfully obvious one like "Do you have a nose?". If she had been asked "What would convince you that you don't have a nose?" and she responded "I have a nose", would not the subtext obviously be "and I'm not going to entertain your motivated attempts to gaslight me into questioning what I can see clear as day"? Would not that "Fuck you, you need to show me something surprising before I even take you seriously enough to engage with your (seemingly) nonsense hypotheticals" response seem fitting?

It's not "assigning 100% probability" just because they don't take your ideas seriously. It's "assigning 100% probability" when no matter the evidence, the needle on their belief doesn't move. If you were to say "What if I gave you a mirror and it showed you to have no nose?", would she say "It wouldn't show that", or would she say "I would believe it's fancy CGI on a screen disguised as a mirror"? Because only the latter is claiming to ignore the evidence; the former is just predicting that the test won't show that. If you were actually hand her a mirror so that she could see her missing nose and the bleeding wound where it was, would stick to that rationalization or would she exclaim "OMG what happened to my nose!"? Because only the latter is actually ignoring the evidence, and the state of mind that produces "I have a nose" in almost everyone when asked that question would also give "OMG!" if it manages to be shown to be wrong.


She still might be overconfident, but you can't jump from "She thinks the chance of being wrong is too small to continue thinking about" to "She's *over* confident" until you can demonstrate what her proper level of confidence should be. And while you might not buy her arguments, I do expect that she has thought about it and would be ready to argue the case that the proper level of confidence is high.

Absent evidence that she hasn't actually thought things through, it strikes me more as "Not significant evidence", or rather "Evidence that either the question is overdetermined OR that she's crazy" than "red flag". It really looks like a failure of communication on both sides here.

She should have explained herself better: The equivalent of "Well, the thing is that all of the things which could prove to me that I have no nose are already tests I've done and they've all come back showing that I have a nose. I looked in the mirror right before I came here, for example. I'm feeling it with my fingers right now, as you can see. Theoretically it's possible to be wrong about anything, but it'd have to somehow be in a way that causes my nose to consistently show up where I expect it to be, and I can't imagine any realistic way for that to happen, can you?"

On the other side, they could have understood that this is what she (most likely) meant, and responded to "I have a nose" with "So you would then expect to see it if I handed you a mirror, right?" and try to do the work themselves to find a possibility that she hasn't already though through, and help clarify what her model actually is, what it's based on, and what predictions it makes.

It's also worth noting that Dawkins claiming he "doesn't absolutely know" and is "a six out of seven" isn't really demonstrative of the virtue of humility either. "Nothing is 100% certain" is what you're supposed to say when you're on team science, but it doesn't mean you're actively tracking that remaining uncertainty or doing anything other than giving lip service to the right ideas for that crowd. Watch any Dawkins debate and ask yourself whether he's really acting the way you'd expect him to act if he thought the betting odds on him being wrong were really as bad as 1 in 7. If *I* thought there was anywhere near a 1 in 7 chance of Christianity being more right than I was, I'd sure as hell be a little more respectful of it than Dawkins is!

Not a 1 in 7 chance that Christianity is right, a 1 in 7 chance that there is a God.

That's not what "assigning 100% probability" looks like.

Okay…

Imagine, if instead of talking about a (seemingly, to you) difficult question like "Does ivermectin work?", it was a painfully obvious one like "Do you have a nose?". If she had been asked "What would convince you that you don't have a nose?" and she responded "I have a nose", would not the subtext obviously be "and I'm not going to entertain your motivated attempts to gaslight me into questioning what I can see clear as day"? Would not that "Fuck you, you need to show me something surprising before I even take you seriously enough to engage with your (seemingly) nonsense hypotheticals" response seem fitting?

I’m not sure in what way this is intended to be a counter-argument?

The assumption here is that someone should have 100% certainty that they have a nose on their face (unless they’re Tyrion Lannister) and if they were questioned in such a way about it evidence to this it would be reasonable to say “I have a nose.”

So my problem is that she’s treating something that’s still being researched with this same level of certainty.

Not a 1 in 7 chance that Christianity is right, a 1 in 7 chance that there is a God.

If there is a god and we're simplifying complex things to the point of "Christianity is right" or "Christianity is wrong", then Christianity is right and Dawkins is wrong. The point stands that Dawkins has not been acting consistently with the idea that there's a 1 in 7 chance that he's wrong about the big one.

 

The assumption here is that someone should have 100% certainty that they have a nose on their face

No, the point is the opposite. 

Not only should people not have 100% certainty that they have a nose, they also don't have that certainty -- even when they make unqualified statements like "I have a nose" in response to "What could convince you that you don't?"

That's why they'll say things like "A mirror would show me to have a nose" rather than "Even if a mirror shows no now, I'll still know I have one".

So my problem is that she’s treating something that’s still being researched with this same level of certainty.

Yes, I see that. And you could be right that she's overconfident here.

However, ironically, you're being overconfident here. The fact that it's still being researched is not enough to prove a thing to be unknowable to those who have looked at the data and know how to properly analyze it. Read That Alien Message for an intuition pump about how far things can be taken in principle.

Her confidence being higher than you think should be possible means one of two things (or some combination). Either she's irrationally confident, or she's calibrated and better at discerning the truth than you realize can even be done. If you jump straight from "(S)he is more confident than I'd expect someone to be" to concluding "They're being irrational" without first examining and ruling out "They know things I don't", you are going to systematically throw away the perspectives that matter most.

You don't need a mirror to see your nose.

Huh? I'm not sure how this didn't come across in my post. I'm against censorship, but I'm not an absolutist.

It's fine. I too could have been more clear:

If you want to know what [free speech absolutists] have to say about [fill in the blank] you could look it up [or post a question].

Richard Dawkins isn't 100% certain that God doesn't exist

I'm not sure it's irrational to reject the existence of infinity. (And thus things which involve such a thing, whether it's infinite power, knowledge, or an infinitely high stack of turtles.*)

*If the earth is flat, what is it sitting on? (Might be in 'a history of time', perhaps the introduction.)


If there's no evidence that will change someone's mind on an issue like this, it I will say with a high probability that they're not thinking rationally about that topic. 

That (probably) makes sense. That being said, I think people thinking rationally might have 'stronger' (or more intense) positions than yours - though I don't know it in its entirety, so that's just a guess. (For instance, while I'm not a fan of misinformation, I think that parties (government or otherwise) that work to control speech may be a threat to...well everything? Like, how do you have democracy without freedom of information and speech?)

Given photoDNA is a black box consisting of (something like) hashes, have there ever been attempts to abuse that to restrict other types of pictures?


While I'm here:

If you poke around here, he might have had something relevant to say. I remember a quote at least:

http://www.aaronsw.com/weblog/ or https://web.archive.org/web/20210414043231/http://www.aaronsw.com/weblog/ if you like https.



https://web.archive.org/web/20200629030500if_/https://snew.notabug.io/r/all Here it is:

I think all censorship should be deplored. My position is that bits are not a bug
That we should create communications technologies that allow people to send whatever they like to each other.
And when people put their thumbs on the scale and try to say what can and can’t be sent,
we should fight back - both politically through protest and technologically through software
Aaron Swartz (1986 - 2013)

I don't think the website is run by someone who is dead, though for all I know he was involved with the project while alive. So what's the source?

That link (above 'bits...') goes here: https://web.archive.org/web/20201013131802/http://archive.is/d4NPt

You might find that article relevant. (If you get bored while reading stuff you've already heard/agree with, skip to the relevant section by scrolling; the article is relatively short, and what you're looking for will be towards the end.)

(I'm starting to think I should have made a linkpost, and directed you to that.)

Given photoDNA is a black box consisting of (something like) hashes, have there ever been attempts to abuse that to restrict other types of pictures?

The Wikipedia article suggests that as of 2016 there were plans to use it for "extremist content". 

I would mostly say the same thing here I said to ChristianKl above regarding censorship vs. 86ing. 

There are few technologists that I respect more than Aaron Swartz. But I wonder if he was alive now if he wouldn't have joined the ranks of people, like Richard Stallman, who built foundational Internet technology who are disappointed with the way it's turned out? 

Even if PhotoDNA some day 86s vague "extremist content" it's still better than the alternative of a Facebook-like algorithm trying to get people maximally engaged with KP because it's not filtered anywhere.

I don't know that open-sourcing it would be better. The value of open-source code as a security/integrity measure depends entirely on the number of competent people reviewing it. The first example that comes to mind is 7-zip's encryption issues from a few years ago. There's probably thousands of issues like this across commonly used applications and libraries that we're not aware of, because there's very little incentive for competent people to spend their free time reviewing code.

I'll say again - I don't believe Tess or Bret or anyone advocating Ivermectin as a Covid-19 treatment should be censored or 86'd for expressing that POV... and true to the analogy, even if people are 86'd from a bar one night, banning them for life is an entirely different thing that's way worse. 

I don't know that open-sourcing it would be better.

By open source...I meant everyone has access and can use it. If it's a tool necessary for complying with the laws around operating in the U.S., then it should probably be freely available. (I also don't like facebook, and possible barriers to someone coming up with an alternative seem undesirable.)

I'm also curious about how the algorithm works. Hashing, but for images, in a way that recognizes similarity...I could use that. In general, saving stuff to prevent link rot is a good idea. In practice, if you don't want to save everything, a way to:

  • recognize you've found what you're looking for
  • or something similar
  • which is automatic, and can do the filtering so I don't have to go back and look to see if it's right

would be pretty useful. (There is an obvious alternative, though it wouldn't be quite as space efficient.)


Even if PhotoDNA some day[...]

The temporal aspect (each version being available) would also reduce or prevent issues around updates.


There are few technologists that I respect more than Aaron Swartz. But I wonder if he was alive now if he wouldn't have joined the ranks of people, like Richard Stallman, who built foundational Internet technology who are disappointed with the way it's turned out?

I don't know a lot about Aaron Swartz (any good sources you'd recommend would be appreciated). From the little I do know, I think he wouldn't just be 'disappointed', I think he'd try to do something about it.


There's probably thousands of issues like this across commonly used applications and libraries that we're not aware of, because there's very little incentive for competent people to spend their free time reviewing code.

Yeah. In theory, if someone decides to fix something, then a lot of people can get the benefit. Unfortunately the same is true of laziness...


Facebook-like algorithm trying to get people maximally engaged

I can imagine facebook's algorithm trying that - stuff like this (choice of ads) is not encouraging. (Wayback link for those who abhor trackers, etc.)

I don't know a lot about Aaron Swartz (any good sources you'd recommend would be appreciated). From the little I do know, I think he wouldn't just be 'disappointed', I think he'd try to do something about it.

There’s an excellent documentary called The Internet’s Own Boy from 2014.

Towards the end there’s a long scroll of all the technologies and organizations he’s responsible for. It’s humbling. Sometimes I think I’m clever, and maybe I am, but there’s people so much better than me.

Then somewhere around 55:00 in Tess is asked if there's anything that should be censored on social media, and the very real example of ”bleach therapy" is offered (that’s where parents are encouraged to give children bleach to prevent autism, not Trump telling you to drink bleach). Tess is unmoved by the example and still categorically against censorship. I wonder what she'd say about PhotoDNA?

Hard cases make for bad law. Generally, with all civil liberty destroying policies they are defended on the basis of being useful about certain hard cases while they are in practice used whenever powerful people find it convenient to use them. 

Being moved by such examples is a sign of political naivity or generally not valuing civil liberties very much. Fuller is for censorship here like he's for censorship of telling the secrets of the powerful to the people in the case of Wikileaks. 

If you go back 20, or even maybe 10 years ago, I would completely agree with you here. A point I've made elsewhere is we're confusing engagement-based social media with speech platforms and news media. It's a category error that causes us to make a lot of mistakes

The way to think about Facebook is that it's a drug (behavioral addiction) that billions of people consume regularly, so we should think about it more like a casino or a bar. The only real exception being that the costs of mistakes are 1000x larger (or more), because it's used way more often than people go to casinos and bars.

If someone wanted to print and mail out pamphlets advocating bleach therapy, write a book, lobby for scientific study, even if they wanted to write an old-fashioned blog--I wouldn't particularly care. Maybe in some way I would support it as a someone is exercising their first amendment rights, and there is some virtue in that even if they're woefully incorrect.

I realize I used the word "censored" (mostly because David did, and there's really not better language in common use) but better term might be 86'd as it's used in bars. Meaning something like, "you're misbehaving in a bar in a way that is likely to endanger yourself or others, and we're now liable if we don't remove you."

In the context of Facebook this is saying "it's your right to create content advocating for bleach therapy, but when we at Facebook algorithmically freebase your content for maximum engagement we're worried about the externalities so we're 86ing it." That's just being a responsible digital bartender, or digital drug dealer... whatever metaphor you prefer.