This article explores how evidence-based Medicine currently works in 2021 with ivermectin as a case study. I don't make any argument for or against ivermectin but look at the deeper issues about how we decide which drug and expert to trust. First I explore the status quo and then I will present Prediction-based Medicine as an alternative to the status quo.

The idea of Evidence based Medicine

In the last three decades the idea of Evidence-based Medicine arose. A large part of what Evidence-based Medicine is about is doctors reading the medical literature and making treatment decisions based on the evidence available in the literature.

There's no study that showed any benefit of doctors reading the medical literature, so instead of providing evidence that Evidence-based Medicine works based on the standards of evidence that Evidence based Medicine proposed, the framework gets accepted without empiric evidence and is only backed up by intellectual arguments. For a long-time that wasn't a real problem and everybody more or less agreed on what the dogma of Evidence based Medicine is supposed to mean.

Ivermectin

At the moment we have two meta-analyses about Ivermectin who went through competent peer review before getting published. With competent peer review I mean review by people who are competent and familiar enough with the subject to spot when control and placebo get exchanged in the reporting of one trial.

The two competently peer reviewed meta-analyses are published in Reviews in Medical Virology and American Journal of Therapeutics who have impact factors of 4.221 and 1.955 which suggests that both normal journals and not obscure ones that are willing to publish anything. Given that more prestigious journals are more likely to publish wrong data, calling for meta analysis is good enough and it doesn't make sense to require it to be published in more prestigious journals.

While the two meta-analyses conclude that there's moderate-certainty evidence for ivermectin working, authorities like the FDA, CDC, WHO and EMA reject ivermectin as a treatment.

As a doctor deciding how to treat a patient, the doctor has to make a decision what to trust. While we can make theoretical arguments about whom we should trust, it's essentially about the question in which authority you want to believe. There's no empiric evidence for a heuristic that's proven to help us decide whom to t...

Using Credence Calibration for Everything