Just as the Internet allows ordinary people to DIY their way through everything from stock trading to home repair, they now have access to tools to act as their own doctors, from caches of medical papers at sites like pubmed.gov to symptom-checkers to portals giving them instant looks at their own test results — everything they need, except of course the years and years of training, experience, and practice, and therein lies the rub.
. . .Doctors around the world have expressed frustration at the “populist treatment,” as it’s become common in Central and South America in particular for poor people to defy authorities and self-medicate with ivermectin. Experts frequently associate the drug with “pharmaceutical messianism,” i.e. politicians promising panacea cures, often in conjunction with rhetoric bashing experts and credentialed authorities.
Thus the revolt of the public plays out in medicine.
Of course the people may be right in the case of Ivermectin.
Of course…
Since I don’t subscribe to Taibbi’s substack, I can’t comment on his essay.
But for those interested in Ivermectin, and unafraid of being called a populist, I’d recommend this link to a compilation of research papers on Ivermectin: https://c19ivermectin.com/
The compilation is described as a “[d]atabase of all ivermectin COVID-19 studies. 101 studies, 64 peer reviewed, 62 with results comparing treatment and control groups.”
“…and therein lies the rub.”
NO, NO and NO. That’s not it at all. It is so much simpler. It is not the information availability, it is the death of expertise. For going on a decade now people that haven’t had their heads buried in the sand have seen thousands upon thousands of examples of people that are supposed to know the answers (and get paid commensurately) and have good internal Bayesian probability calculators get hosed on the results over and over again. THESE PEOPLE DO NOT, IN FACT, KNOW WHAT THEY ARE DOING. Yes, they are educated. Yes, they have armies of people to vouch for them. Yes, they are well-paid and have positions of authority. And when the going gets tough, when their expertise is needed and they have to perform on a deadline for big stakes, they are unable to perform.
Again, and again, and again. People are realizing that if the people that are supposed to know don’t know, they might as well take a shot at it. Their Bayesian predictability models figure internally, “well, my odds can’t be any worse than if I do my best to figure this out for myself.” And guess what….they’re more often going to find that the result they found for themselves turned out to be more effective, or if neutral, much much much less costly.
What we have is a society that has refined image and marketing to a high art form. But on closer examination the image is stuffed with straw and the high art was drawn by 8 year olds.
The experts are not trustworthy. Act accordingly.
I don’t know if you have read Gurri’s book, but I think that he would agree with you. Part of his argument is that experts of the past never had their many failures exposed, but nowadays they do. Another one of his points is that experts are often aware that they are at best taking educated guesses, but refuse to say so publicly, and refuse tot share their reasoning for fear that the lack of certainty will mean that their advice will be ignored by the public.
An interesting twist on this is that apparently experts in any domain are now like journalists and *will* be believed and followed, no matter how untrustworthy they may be, but only by *half* the population, and only *so long as* the issue becomes one that is perceived to have become politically polarized (no matter how absurd that may be in the context), with perceptions being that the progressives believe one thing, and conservatives believe the opposite. And so picking a position or belief becomes a way to signal that you one on the good team.
So, it’s not necessarily elites vs the public, as elites+experts vs *half* the public. Most of the time, it will end up being the same half, but not always. Also most of the time the elites / experts will have a party line, but sometimes each half of the public will have their own warring experts, which is like what happens with hired-gun expert testimony in trials. Heh, kind of like inserting Federalism into your “Constitution of Knowledge”.
With Ivermectin there is one thing that is worth mentioning. Ivermectin is an off patent drug developed by Merck. Merck recently developed a therapeutic for covid- molnupiravir. It has sold the US 1.7 million doses for $1.2 billion. Merck has simultaneously donated 4 billion doses to Africa all the while crapping on Ivermectin. They have an incentive to crap on Ivermectin, it is dollars per dose as opposed to hundreds of dollars per dose. What is more troubling to me is the extent to which our public health authorities seem to be holding out for perfect data, such as large scale RCT, for things like Ivermectin and HCQ which both seem to be effective at the onset of symptoms (moreso with Ivermectin). Those trials are expensive and are traditionally funded by Pharma and governments. I think we can see why Merck isn’t enthusiastic about conducting a large scale RCT. What is the NIH’s excuse. We are in the midst of a pandemic. We should be bringing all of our resources to bear. But time and time again our public health bureaucracies our hiding behind process excuses for everything from otc testing to off patent drugs. They do seem willing to move mountains when it comes to getting a new therapeutic for covid. To me that suggests regulatory capture of much of the public health bureaucracy by PHARMA. And that has had lethal consequences.
Perhaps it is capture, but another possibility is “the elites vs. half the public” signaling situation Handel mentions.
NIH is part of the elite. Promotion of Ivermectin has largely been done by the other team, moreover, effective treatment would undermine the promotion of vaccines, an elite cause.
You need to go deeper, why does one political half choose one arbitrary savior like vaccines and not the other? As richard does, follow the money.
I think the explanation may be more benign. Well, benign as in non-conspiratorical, proceeding from what seem to be good motives, even if the result is suffering and death.
There is a narrative in the medical/public health community that goes like this: Once upon a time, anyone could sell any drug for anything and the results were terrible. But then Congress created the FDA and things got much better. But the FDA’s power was very incomplete and that resulted in things like the thalidomide tragedy. There, thalidomie, a drug that had been approved as a sedative, was prescribed for morning sickness in pregnant women. It worked well but also turned out to cause very serious birth defects in a lot of babies. So Congress gave the FDA more power to keep drugs away from people unless they were proved to be “safe and effective”. The smart people at the FDA and in the universities drew up protocols and regulations to ensure that.
So for people in medicine/public health, the present incredibly expensive (and small c conservative) approval process is a very good thing that should not be changed lightly. Kind of an expert version of Chesterfield’s fence.
Please clarify “Chesterfield’s fence”.
I find zip in Google about it.
https://www.chesterton.org/taking-a-fence-down/
GK Chesterton.
Thanx!
Thanks, Jeff Allen. The original quote is:
“In the matter of reforming things, as distinct from deforming them, there is one plain and simple principle; a principle which will probably be called a paradox. There exists in such a case a certain institution or law; let us say, for the sake of simplicity, a fence or gate erected across a road. The more modern type of reformer goes gaily up to it and says, “I don’t see the use of this; let us clear it away.” To which the more intelligent type of reformer will do well to answer: “If you don’t see the use of it, I certainly won’t let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it.”
For those who are temperamentally conservative, “Chesterton’s fence” serves as a shorthand for “Don’t change things lightly. There is probably a good reason why they are the way they are.” I was suggesting that people in medicine and public health have the same “conservative” attitude toward FDA regulations, though it is more because, “Hey, smart educated people developed those regulations, so I assume they’re pretty good.”
I’m don’t have a lot of knowledge about what sort of studies have been performed on Ivermectin. I was responding in large part to this:
“I think we can see why Merck isn’t enthusiastic about conducting a large scale RCT. What is the NIH’s excuse.”
To the degree NIH is actually funding a large scale RCT trial, then my speculation is unwarranted. However if it is not, then I don’t think that particular benign storyline works (though another may in its stead).
An interesting theory… that is completely contradicted by the facts. The Covid vaccines were only approved under emergency orders and the pharmas were given legal immunity over negative reactions. So why is it that they push these expensive new untested and probably unsafe treatments while railing against cheap, long-used, and safe drugs that might work off-label? Follow the money.
https://blogs.sciencemag.org/pipeline/archives/2021/06/07/ivermectin-as-a-covid-19-therapy
Derek can be reliably predicted to voice current elite sentiment, to the point that I no longer give any Bayesian weight to his columns.