Cheap antidepressant shows promise treating early Covid-19
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I was a heavy cigarette smoker in my 20s, and over those years, I experienced worsening asthma and also worsening anxiety and depression.
Eventually I was prescribed an SSRI (Zoloft), and found that not only did my mood change, my asthma completely abated, even though I was still smoking just as much.
After a few months I decided I didn't like all that the SSRI was doing to my psyche, so when the prescription finished I tapered off it, and sure enough the asthma returned a few months later.
I've never enquired much as to what what was going on - I didn't speak to doctors or other people about it. But the correlation between SSRI intake and asthma abatement was very clear.
(And yes I know it was very stupid to be smoking as an asthmatic - I quit completely the following year and have stayed off them for coming-on 15 years. I've also been mostly asthma-free in that time, though it returned for a few months about 7 years ago, after a period of intense career-related stress, but then cleared up after I undertook some healing work that included both immune-system support and emotional healing.)
Check this random factoid out: "After about two weeks of 2,400mg NAC supplementation, cigarette usage appears to be reduced voluntarily by around 25%."
I personally take it for my liver. It does wonders to it, similarly to silybilin.
And you can still purchase it online:
https://www.bulksupplements.com/products/n-acetyl-l-cysteine...
https://www.lifeextension.com/vitamins-supplements/item01534...
An example letter sent by the FDA in July 2020: https://www.fda.gov/inspections-compliance-enforcement-and-c...
In mice, very high doses of NAC causes tumors to form. https://www.science.org/content/blog-post/n-acetyl-cysteine-...
More broadly, there is a lot of emerging evidence against directly taking antioxidant supplements. For example, it is well established that antioxidant supplementation counteracts the benefits of exercise in humans (free radicals are a cue the body uses to initiate recovery). https://www.emerald.com/insight/content/doi/10.1108/NFS-03-2.... You can find similar articles/studies for other antioxidants.
Another example: it has been known that many substances do prevent, but if you already have cancer, than your condition will worsen.
Back to NAC: it is healthy for you in the typical doses which is about 200-1000 mg I would say. If you take acetaminophen on the daily, then it is especially recommended.
In any case, I do not recommend taking it long-term, or not without breaks in-between. Take it for 2 months, stop for a month, take it for another 2 months, then stop for a month and so forth. You can do 1 month on then off, and so on. Up to you.
I have M.S. What herbs did she take?
I have MS as well. Propolis seems to be fine as immunomodulation goes. I also take ALA. There are conflicting results with regarding to resveratrol. You could take a look at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311642/ if you have not yet done so.
I'm so, so glad I can finally downvote friend-of-a-friend rumourmongering like this. Maybe this is something legitimate, but handwaving an entire anecdote on a forum like this, with no definite information except "a case" involving "a woman" and her "condition", is baffling.
Maybe don't listen to this user's suggestions about NAC without verifying something about it, which was too much trouble for them.
That's not the point! Perhaps it is on PubMed, but with the FUD-like "information" you've provided it's just a scary rumour about "herbs", and entirely unhelpful. Is MS even the illness at issue? Should people with that illness avoid cilantro? Milk thistle? Oregano?
>I will never forget it.
You have not remembered it!
So to answer your question: The formulation of tablets (labelled as ‘immunostimulant’) consisted of Echinacea purpurea 45 mg, Uncaria tomentosa 37.5 mg, and Tabebuia avellanedae and Plantago maritima 30 mg.
I only remembered the Echinacea one. It actually has been an issue in many of these cases, so I avoid it. As I said, immunostimulants for people with autoimmune disorder are usually not good. Immunomodulators can be, but that depends as well. For example allicin and propolis reduce production of inflammatory cytokines such as IL-6 and TNF-α, which from what I recall is good for MS.
Plus:
https://jamanetwork.com/journals/jamadermatology/fullarticle... (Activation of autoimmunity following use of immunostimulatory herbal supplements)
https://pubmed.ncbi.nlm.nih.gov/32553683/ (The effects of immunostimulatory herbal supplements on autoimmune skin diseases)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6144106/ (Drug-induced autoimmune hepatitis associated with turmeric dietary supplement use)
Tricyclics are TNF-alpha inhibitors. I believe that's the MOA in my case.
Been really disheartening to watch the politics around alternative treatments. Personally, I expect this to be attacked as well, but am hopeful! The stuff really does seem effective, particularly when combined with other drugs...
Things move from "alternative medicine" to being "medicine" when people do good, peer-reviewed science to actually study the effects and find them to be effective. "Alternative medicine" like ivermectine or hydroxychloroquine have no scientific, properly studied basis for being used.
There are more than 60 peer reviewed studies showing positive effect for ivermectin. Similarly the single trial that the media touted as "proof" that HCQ did not work administered what amounted to an overdose to terminally ill patients, in contrast to the recommended early/prophylactic regimen.
These lies have gone on for far too long - no thanks to irresponsible and, frankly, inexcusable censorship by fb, youtube et al on grounds of "misinformation".
This site[0] has been up for over a year now and the citation count has continued to grow.
It seems people are more interested in poo pooing proponents of ivermectin/HCQ than actually examining evidence. Medicine should not be a political team sport.
0. ivmmeta.com
Just use google directly to find the trials I’m talking about, instead of being blinded by the ivm meta site creators (who created a similar site last year for HCQ). IvmMeta mixes in poor quality studies with studies that actually found no significant effect for IVM and claims they all are pro IVM.
I couldn't help but notice your use of purposely vague and misleading weasel words such as "positive effect".
Meanwhile I recall reading one of those ivermectin studies presented on another discussion on HN, and it certainly raised some red flags regarding how it was put together. For instance, if my memory doesn't fail me, it relied on an astonishingly small sample (100 patients, all reported as mild cases, divided into control and treatment) and to make matters worse the control group was given hydroxychloroquine instead of a placebo, effectively comparing ivermectin to hydroxychloroquine.
In the end the study reported that the fatality rate in the control and treatment groups was the same, and the only claim was that the statistical analysis suggested more patients from the ivermectin group were discharged earlier, which could very well be just statistical noise. Other than this the paper reported no benefit at all.
So, this is what weasel words buy: they are used to hide facts and misguide people. So unless you actually substantiate your claims and point exactly the very best study you feel shows that said "positive effect" is and how it was quantified, I have to dismiss your claim as something between a baseless assertion and blatant misinformation.
But then you pull a bait-and-switch in your own comment, complaining about just one study, which you completely neglect to cite (so it could be made up, for all we know). You subtly outsource your opinion, trying to lend it an air of objectivity by saying that it "raised some red flags" (after you accused him of using weasel words). You couch the whole comment in an air of faux fairness by writing as if you are some judge called upon to arbitrate a dispute, who just has to rule a certain way because, of course, that's what the evidence requires. And you imply that your unsourced complaint about one study invalidates all such studies, therefore he must be wrong.
You accused him of being purposely misleading, but at least he offered a link, and he didn't try to trick people into thinking that a criticism of one thing invalidates other things, which you did.
Your whole comment is a textbook example of propaganda techniques. And then you wonder why people don't know what to believe anymore. It's like the whole Internet is a political, psychological battleground for public mindshare, and the truth doesn't matter at all.
I did more than that: I pointed out not only the use of weasel words but also that no assertion is substantiated in what boils down to a baseless appeal to authority.
Consequently, it's critical that, for the sake of objectiveness and to avoid spreading misinformation, these personal assertions cannot be backed up by handwaving and instead must be supported by concrete evidence, such as references to said studies, if they exist at all.
I suppose it would be easier to just point out a single paper out of said 60 that supported the thesis that ivermectin works.
Somehow, in spite of the claim that there are so many papers, it seems it's impossible to actually find a single one that does support the claim.
Actually it is. The whole point of that was to illustrate the importance of actually looking into what these papers actually said, if they exist at all, instead of pulling the appeal to authority card with numbers pulled out of thin air.
The OP asserted that ivermectin worked. He proceeded to state that 60 papers report it. Well... Where are they? Can anyone like me actually take a look at one of these supposedly decisive papers? I'd be happy if I could just check the best one out of the hypothetical 60.
>I couldn't help but notice your use of purposely vague and misleading weasel words such as "positive effect".
This isn't a weasel word, this is exactly the correct term to capture the uncertainty considering that there has to my knowledge not been a large scale double blind RCT. But there are, once again, over 60 studies showing positive effect which, individually, are not absolute proof that the medicine works, but together clearly show promise. Your bias is rather extreme and frankly I don't appreciate your dishonest insinuation that I am somehow arguing in bad faith. Again, I linked a collection of more than 60 positive studies. It is unlikely that every one is poor quality and/or fraudulent.
Here is the link again[0], maybe you could actually click the link before responding, as you should have done previously. And yes, I've read a number of them. I can also provide the following [1] which suggests (in silico) the mechanism of action of ivermectin is inhibition of protease, which is the target enzyme of at least one other drug under development by pfizer for treatment of covid.
If you think "positive effect" is a weasel word then perhaps you do not understand the scientific process. I'm not claiming with certainty that ivermectin works, only that in light of, again, some 60 studies showing positive effect, inneffectiveness is unlikely. While you check these sources, please also check your rabid bias.
[0]ivmmeta.com
When a medical doctor prescribes a drug for a purpose that is currently being studied scientifically, that is not "alternative medicine". Ivermectin is still being studied. Hydroxychloroquine was emergency authorized by the FDA.
Take for example acetaminophen (aka paracetamol/tylenol): it is borderline ineffective, has been superseded by ibuprofen for almost all use cases, and the required dosage for its tiny effect is also very close to dangerous levels. Yet it is still the go-to drug of parents, GPs and hospitals for a range of ailments from the common cold to post-operative pain. "Good old paracetamol" is in every medicine cabinet in the Western world. I've told my folks a hundred times that it simply doesn't work, but they use it for pretty much any condition. Mum even gave it to her old dog. It's trusted like oxo cubes, Campbell's soup or a nice cup of tea. And that's why it's the foremost cause of acute liver failure in the Western world. While it hasn't had it's approval removed yet, I wouldn't be surprised if it did some day, and I doubt it would be approved today if it were being introduced.
Even so: is it still very much "medicine", not "alternative medicine".
This is only really accurate in a small window of analysis. It's been shown that paracetamol + ibuprofen has synergistic effects for most pain-related issues and paracetamol is superior to ibuprofen for migraine headaches; furthermore, the obvious correct headache drug of choice is aspirin/paracetamol/caffeine, aka Excedrin, which is vastly superior to ibuprofen.
I won't argue that paracetamol has acute liver toxicity issues (the largest drug of overdose problems, though a lot of this is intentional rather than accidental), but ibuprofen is abused in a chronic fashion with buildup over time leading to renal failure and worse (pro/amateur athletes are particularly at risk of chronic abuse issues).
I won't argue that paracetamol is way more dangerous than people think, and there should be far more warning labels (which J&J fights against), but I would be genuinely shocked if it got its approval revoked; similarly, I'd expect it to be approved if it was around today as well - especially if we knew about the synergistic effects it has with aspirin and caffeine.
Unfortunately, it means just "trusting a peer reviewed study" is even harder than it should be. You have to dig into the study to see if it even makes any sense which can be very difficult. And you have to follow the money, not "even" if the study says what you think it ought to say, but especially when it says what you want it to say.
Very disappointing when you go digging in.
It really is, as there is absolutely no evidence it has any effect whatsoever and at best it only serves as a placebo. In short, it's snake oil. Worse: politically-motivated snake oil.
Complementary and alternative medicines (CAMs) are treatments that fall outside of mainstream healthcare.
> Are the people participating in the scientific studies of the drug participating in alternative medicine?
Well the placebo group taking sugar pills for their cancer are not exactly going 'by the book' or lamestream healthcare and the active group taking whatever ... well lets just agree to disagree shall we?
Please let me know when a reputable study that undergoes peer review in an established and respected journal reports that the drug does work as their fans and militants claim.
Until then, keep in mind that "alternative" in "alternative medicine" stands for "hand-waving". As the old adage goes, alternative medicine that works does have a special name. It's called medicine.
There is one ongoing right now: Oxford University's PRINCIPLE trial. Until results of that trial are reported, about the only accurate thing anyone can say is that current evidence is ambiguous.
https://www.principletrial.org/news/ivermectin-to-be-investi...
Note: This isn't a political statement or criticism. It's Human Comms and Human Behaviour 101.
Seems pretty political to me.
Again. These are properties of human behavior.
If the peer reviewed research shows them to not be effective, and if snake oil salesmen figure out a business model to fleece people with it, that’s when it becomes “alternative” medicine.
Perhaps Snake Oil [1] is worth a study or two.
[1] - https://www.organicfacts.net/health-benefits/oils/snake-oil....
It's a lot easier to work on AnotherCure(TM) for baldness, than touch this pile of political crap.
Can this system be improved? Definitely.
At least it can't be called a "horse dewormer".
The reference to "horse dewormer" is the fact that a substantial volume of people started actually ingesting horse dewormer bought straight from farm supply stores because ivermectin was listed as a component.
Demand for horse dewormer intended for this ad-hoc use grew so much that its availability was jeopardized, and in some cases ceased to be available to farmers who needed it to treat their cattle.
CNN used the term to falsely describe what Joe Rogan took to treat COVID - he did not take horse dewormer but a normal human dosage prescribed by a doctor.
Sure, there were reports of people taking horse dewormer and nobody objects that reporting, just the usage of the term in relationship to JR.
I understand what you’re referring in terms of “alternative medicine”, but that’s it’s own genre.
Once enough studies have been done, this off-label use for fluvoxamine will likely be blessed by the agencies that regulate these sorts of things and at that point it will become an approved treatment for long COVID symptoms. Most things spoken of as "alternative treatments" don't even get to the first stage of this process (since they can't be substantiated with evidence).
https://www.askdifference.com/therapy-vs-treatment/
Joe rogan explained what his doc gave him. He’s also had multiple doctors and researchers on his show providing information regarding treatments they are attempting. Frankly, Ivermectin and the like have more research than the vaccine, they’ve been deployed for longer and at least passed phase 1 trials, which the vaccine has not (only preliminary results).
https://www.modernatx.com/covid19vaccine-eua/providers/clini...
In terms of “off-label” drugs, the FDA approval process is there to protect against liability. Effectively, the government accepts some liability and in return medical companies get some protections. It’s highly likely you’ve taken drugs “off label” yourself.
https://www.goodrx.com/healthcare-access/medication-educatio...
Thus far, this research is promising. Similar to other treatments / therapeutics to covid19, and it has a known risk profile. Making it a potentially better alternative to the standard approach (stay hydrated if infected and vaccinate ahead of time if possible)
Off label drug use/ approval isn't about government liability. As far as I know, it has none. The noteworthy exception is the vaccine's, where the government has a special injury compensation fund, but I wouldn't call this liability . It IS about manufacturer liability, and insurance reimbursement.
That's very very unlikely. Even considering the Nobel prize for it. Simply because the sheer scale of the pandemic.
There are more vaccines in development and use against COVID than there are Ivermectin clinical trials in total.
> they’ve been deployed for longer and at least passed phase 1 trials, which the vaccine has not (only preliminary results).
That doesn't mean they are not safe. The phase 1 trials run to 2022 Nov, because there's a long follow up period.
Nothing can guarantee that there's not some mysterious missed interaction. It's probability is low and getting lower day-by-day. This tail risk is just not that important for safety. It makes very little sense to emphasize this, because we also don't know the long term interaction of Ivermectin and COVID-19.
This will be attacked by the alternative crowd.
Alternative medicine is nothing more than medicine that isn’t tested, because once it’s tested and proven it becomes, medicine.
The disease evolves to different stages using different mechanisms at each stage, which explains why certain medications only seem to work at really specific stages of the disease.
P. E. Marik, J. Iglesias, J. Varon, and P. Kory, “A scoping review of the pathophysiology of COVID-19,” Int J Immunopathol Pharmacol, vol. 35, p. 205873842110480, Jan. 2021, doi: 10.1177/20587384211048026.
https://pubmed.ncbi.nlm.nih.gov/34569339/
If someone knows a more recent review, this was almost a year ago (wow), I'd love to see it!
The mechanism of action how this helps is probably so simple that people who have over complicated thoughts cannot see the answer. Serotonin is made from tryptophan by the TPH enzyme. But Tryprtophan is also turned into kynurenine by an enzyme called IDO. This kynurenine pathway is crucial to resolving inflammation and the IDO enzyme is directly activated by inflammation.
When you take prozac so much serotonin builds up that it starts inhibiting the TPH enzyme and pushes more tryptophan down the kynurenine pathway and resolves inflammation.
Depression in probably most of the cases is an inflammatory disorder, which is why prozac helps some people with depression.
It has been shown that COVID-19 infection results in alterations of the kynurenine pathway. I will make a guess that prozac will end up helping some people but not everyone.
https://en.wikipedia.org/wiki/Misuse_of_p-values
I wish that people would stop disparaging attempts to contribute from people outside the specialized ingroup.
This stuff is hard, what counts as a hypothesis test for instance? Should datasets be locked and each view counted as a hypothesis? That's a very reasonable debate.
After cursory examination, I don't understand your point regarding the stackexchange link. As for hypothesis testing, I also fail to see how that is supposedly poorly defined.
Say you have a dataset with several variables and you’re looking for correlations between them. If 20 different groups separately download the dataset and test hypotheses, should their p-values be adjusted for multiple hypothesis testing?
So that doesn't justify considering assumptions made from erroneous conceptual understanding. This is where we disagree, I guess.
Is that really promising? Very close to margin of error if not within.
The study reached its statistical significance goal, and thus the study was ended as it would be immoral beyond that point to continue to give people placebos when they knew the drug was working. I'd suggest reading up on the Tuskegee syphilis study for the ethics behind why studies are ended early once treatments have been statistically validated.
This... is not how it's supposed to work.
There was a single hypothesis being tested here.
The bit "waiting for the trial to conclude" actually means "determine if the drug actually has any effect or not".
No matter how much you are interested in saving people's lives, or any other moralistic fallacy that might pop up, you can only help them if you give them treatments that actually work. Cutting short a study is falling short of the most basic requirement to meet that goal.
So now you are faced with a conundrum. You made sure that it has an effect to the degree you wanted. Now the math says that you either might get even surer by continuing the trial, or save 30% people from hospitalisation.
Also in treatment group just one person died while in control it was 12.
So what's it going to be? Making little bit more sure or saving few lives?
With a small enough sample, math can show that a coin flip gives tails 4 out of 5 times, specially if it's stopped too soon.
Don't you agree that stopping an experiment once we get the result we were hoping for and are looking for from the start does raise doubts regarding the conclusion?
And for a group of 1500 people it tells you how much confidence can you have. And it was more confidence than they demanded before starting the trial.
> Don't you agree that stopping an experiment once we get the result we were hoping for and are looking for from the start does raise doubts regarding the conclusion?
If you have a novel disease that's 99% fatal. And then you test a treatment that results in 30% people surviving 99% fatal disease. And you gathered enough data that that math tells you is enough to confidently claim that it isn't just a fluke.
Does stopping the trial and giving the medicine to the half of patients that you were keeping as a control group makes people raise doubts about efficacy of the drug or does that just make you not be called a second doctor Mengele?
Did they stop fluvoxamine trial? Or do they just mention that the effect was so strong that they could?
> He also cautioned against “play the winner” designs that increase the number of patients being randomized to arms that show the best results in an interim analysis. “That is most often used in early phase trials, like a Phase I or early Phase II trial where you’re really trying to identify the best dose level; such trials tolerate bias pretty well,” Sietsema said. “But you wouldn’t use a play- the-winner model in a Phase III trial because the potential for bias could lead to a wrong decision and the FDA would object.”
That sums up my concerns pretty well. This is being presented as a phase III clinical trial demonstrating safety and efficacy. For the level of effect they are testing for, I don't see how an adaptive trial is appropriate here.
Though it's like... isn't the vaccine in the initial phases like "80+% of hospitalizations prevented"? I guess it's good to have all these options but would be nice to just get good vaccine coverage.
Or were you trying to make a statement about the statistical validity of the result, because the outcomes differ by 5%? Because that's not how statistics work. A well constructed study of sufficient size can provide detect arbitrarily small differences in outcomes--you just need a bigger study size, the smaller the difference you want to detect. You would learn about this any 101-level statistics course, and a lot more useful information, too.
I think a large issue within that hurdle is that a lot of people simply won't want to learn, or apply the knowledge after learning.
I see this kind of error pretty frequently, and it's usually not a failure of mathematics... Most often, the person has some pre-existing negative emotional reaction to the stated conclusion, and their brain searches for something to criticize, in order to soothe those negative emotions.
I could only speculate as to why the original poster doesn't like hearing that an existing drug shows promise in treating COVID. Maybe they're a big Ivermectin booster, and they don't like the idea of another drug threatening their favorite?
OP is asking other posters to do quite a bit of homework for them... As in, "Is this study big enough?" <<YES>> "OK, but how big does it need to be to prove X?" ... At a certain point, it seems clear that OP is not arguing in good faith, because they feel compelled to make the critical statements, first, without understanding the topix.
I would caution you to not extend sympathy to OP's cause, simply because you happen to share a critical eye for this study. There is a HUGE difference between being right for the right reason, vs the wrong reason... and that's how we get crap like Ivermectin for COVID.
One sample had 79-86 out of 750 hospitalized, and the other had 117-123 out of 750.
Does that seem sufficient to demonstrate statistical significance?
Edit: found the actual numbers in the study
79 [11%] of 741 vs 119 [16%] of 756
p value was 0.9972 and the power was 92.40% it's a significant result.
"Variant B’s conversion rate (11.47%) was 30.08% lower than variant A’s conversion rate (16.40%). You can be 99% confident that variant B will perform worse than variant A."
That seems problematic. Did they stop the study because they had achieved statistical significance?
Is science allowed to research only one substance for specific purpose at any time to sufficiently avoid p-hacking for you?
Also if I read correctly they got >0.60 not >0.05
To be more precise without being too formal:
If there truly were no difference between them, you could be 99% confident that you would not get a result like this.
One third is pretty big when looking at it from a group perspective, but not really that big from a personal perspective.
If someone told me that taking a pill would reduce my chances of hospitalization by 5%, I would certainly be looking closely at the side effects.
Larger Number of people in the sample is a good start. However, bias is also a human element. Therefore you need that study reproduced independently, multiple times.
Researchers don't like this because studies are expensive and hard, and their boss is telling them to publish and get funding. The system is broken.
A cheap, simple observational study like this is merely a first step. No reasonable expert is claiming that this study proves anything worth making medical policy changes over. This study's sole purpose is to establish whether it's worth investing in further studies, or if we can just shitcan the idea now. Subsequent studies will cost more money, and involve larger samples, better controls, and get a lot more scrutiny from peers.
Time and money are finite resources. You have to have some kind of system for deciding where to spend those resources.
This is how medical science works. It's got a ton of pitfalls, but we still do it this way because so far nobody has come up with a better alternative.
I have no position on this particular study, but in general you can make your coding as simple and objective as you like and it won't do much about experimental bias. Objective processing of bad data isn't better than subjective processing of bad data.
This guy wrote a very good essay about data quality: https://desystemize.substack.com/p/desystemize-1
The essay you linked is very good, but it's actually illustrating my point... The mouse study ran into bias problems because they had to go and directly measure something in nature, and then turn that into a number. That introduces several opportunities for error.
But this SSRI/COVID study isn't doing that. They're literally just looking at patient records, and counting hospitalization vs current SSRI usage. They're not picking up mice to count ticks... They're exporting records to a spreadsheet, and summing columns.
Now, these guys might have problems with the quality of the records they're relying on... Who knows whether the records are accurate or not. But that's a problem of data quality, not experimental bias.
You might say "Who cares? Either kind of error undermines the results, just the same!" But it definitely suggests that the other guy doesn't know what he's talking about... Because if he did understand stats, he would have used the right terminology.
You're kinda right about one thing, though... I am definitely talking down to OP, and a couple of other folks.
I'm frustrated. There are real problems in how science uses statistics, and it sounds like OP & co have heard about those problems. But the way they talk about this study, they're just throwing crap against the wall to have something to say. They don't really seem to understand the problems they're talking about, or how those problems apply to the study we're currently talking about.
I should change my attitude, and stop taking out my frustrations on these folks. If they're wrong, I'm probably not going to change their minds by insulting them.
> But this SSRI/COVID study isn't doing that. They're literally just looking at patient records, and counting hospitalization vs current SSRI usage. They're not picking up mice to count ticks... They're exporting records to a spreadsheet, and summing columns.
> Now, these guys might have problems with the quality of the records they're relying on... Who knows whether the records are accurate or not. But that's a problem of data quality, not experimental bias.
Well, no, I have to disagree with this analysis. The mouse study described in that essay didn't run into bias problems, and the reason it didn't is that it was counting the ticks itself. But other tick-counting studies did have bias problems (due to bad methodology), and the Lyme-disease studies based on the bad tick-counting studies had the same bias problems (because they were using the bad data). The bias doesn't go away when you wash it through two publications instead of one. It's not a different kind of problem -- or even a different instance of the same kind of problem! -- and there's no reason to give it a different name.
Just a nitpick: it was not an observational study, it was a true experiment, because they controlled the treatment: it was assigned by researchers at random. It is by definition not an observational study which have a distinctive feature that it doesn't control for a treatment.
I mean take Remdesivir - https://www.nejm.org/doi/full/10.1056/nejmoa2007764 - statistically significant yet some other studies found it had no benefits. At least I don't think it was a slam dunk or promising in real life as day the vaccines.
Different studies can show different results for a lot of reasons... Sometimes, it's just random chance. Other times, it's due to bad study design, or poor experimental controls, or deliberate P-hacking. There's no way to tell from the results of a single study.
But that's not what this study is for, anyway... This is a preliminary observational study to look for possible drug candidates that might impact COVID severity. It's only suggesting potential future directions of investigation, not advocating for immediately dosing everyone with SSRIs... Medical policy changes won't happen until a much larger body of evidence has been established.
It's the nature of science that not all experiments produce correct results. Sometimes, we get it wrong--but that's why we have to keep repeating experiments, and trying different variations, before we trust a conclusion.
In the meantime, though, medical decision makers will weigh the costs vs benefits of proceeding with an experimental treatment... If the risks are low, and the need is great, they'll probably let the door open to more experiments. Most people seem to think that's a pretty sensible way to do things.
You’re right to be suspicious; data dredging 101.
Why isnt everyone having a cigarette each day to interfere with the ACE2 receptors?
I don't know what the point of my reply is other than to recommend to you to have some humility that you might not know stuff...
I recommend you take some stats courses if this does not make sense.
SSRI should not be used unless their potential benefit is greater than the potential risk of permanent sexual dysfunction.
Even short term SSRI administration can be very uncomfortable and lead to short term SSRI discontinuation syndrome.
I know doctors treat SSRI like „let’s try, might help, can’t hurt“ candy, but they really shouldn‘t.
This isn't a guarantee that they will affect everyone the same way, but you can't judge SSRIs by the period when you're starting them.
Probably not because the Ivermectin crowd is a whole lot of snake oil salesmen and they can’t profit from a drug that your doctor might suggest.
https://www.axios.com/covid-study-fluvoxamine-antidepressant...
it also refer as the original article in the Lancet as
https://www.thelancet.com/journals/langlo/article/PIIS2214-1...
--
Note: do not overlook
> only one patient in the fluvoxamine died, compared to 12 in the control group
https://www.nature.com/articles/s41398-021-01325-7
Some studies found links, some didnt, all depends on how you slice the data. I would imagine quite difficult to get a sense when the major risk factors (age and weight) are so dominant.
In my personal experience from both a multi-year experience with fluoxetine and (~5 years later) a short (~4-weeks-ish? I think?) experience with tramadol, there were serious side effects that lasted many months after I stopped taking the drug. I think I was still getting regular 'brain zaps' for almost a year.
Every medication requires weighing the expected benefits vs the adverser effects and risks. I'm not saying SSRIs/etc are bad. I just urge caution and respecting them like the powerful tools they are. Powerful tools - like SSRIs, opiates, or a table saw - are great if you need them, but you do need to understand them properly or you might loose a finger.
(that said, any SSRI side effects is almost certainly a better option than dying from covid, but... seriously... get vaccinated and do what you can (masks, limiting crowds, etc) so you - and the people you interact with - hopefully don't get covid at all)
[1] or anything that messes with serotonin like the SNRIs, SNDRIs, MDMA and related phenethylamines, or even stuff like the painkiller tramadol (it's also an SNRI)
SSRIs are incredible, opiates are also incredible, both true wonders of modern medcine, especially for those that need them and truly wonderful tools for doing what they do. But they can also be terrible, really terrible, particularly when handed out in pez dispensers.
"Further studies are needed to establish whether the anti-inflammatory effects of fluvoxamine observed in nonclinical studies also occur in humans beings and are clinically relevant in the setting of COVID-19."
When you take prozac so much serotonin builds up that it starts inhibiting the TPH enzyme and pushes more tryptophan down the kynurenine pathway and resolves inflammation.
Depression in probably most of the cases is an inflammatory disorder, which is why prozac helps some people with depression. It has been shown that COVID-19 infection results in alterations of the kynurenine pathway. I will make a guess that prozac will end up helping some people but not everyone.
Vaccines are part of a broader political debate, the problem in politics is people are picking sides. It's very rare to run into a person who doesn't support the vaccine mandates but did get vaccinated. People are generally either anti-vax & anti-mandate, or vaccinated and pro-mandates.
The antivax crowd uses the same persuasion techniques to discourage vaccination that media uses to convince young people that COVID poses any risk of mortality to those under 17. That is to say one or two extremely rare outcomes are trumpeted loudly in order to convince society at large of the danger that is virtually non-existent.
Or it's very rare for them to say so in the presence of fear mobs. Mixed opinions are far more common than their (in)visibility would suggest.
How do you tell?
I got the vaccine hoping it would make travelling easier and because I don't want to spend money on useless tests. Too bad I ended up having to get tested anyway.
That is, a bunch of stuff that is basically already floating around in our bodies / cells.
Vaccinated diseases, more so than other medical ailments, are subject to existing technology being “good enough” until it suddenly isn’t anymore. But that doesn’t mean new entries are untested; it means the economic envelope in which it makes sense to test them is just a different shape.
Even if they were new, they're just a bunch of the same sort of genetic material that is already floating around in our bodies, not some external foreign substance that interacts with our cells.
[0] https://publichealth.jhu.edu/2021/the-long-history-of-mrna-v... [1] https://www.nature.com/articles/d41586-021-02483-w
It’s not fun.
Clinical successes of alternative, outpatient treatments have been directly disparaged by the FDA. I have zero trust in the institutions meant to protect us.
Dr. Pierre Kory has been using this for months to treat both long-covid patients as well as vaccine injured patients.
I hate to bring this stuff up on a technical forum like this, but some very disgusting incentives are at play with our healthcare system and the pharmaceutical industry, that need correction.
I'm specifically talking about treatments that, if taken on early onset of symptoms, help prevent hospitalizations in the first place. Such treatments would have rendered the Emergency Use Authorization for novel expensive treatments, null and void.
And I'm not alleging a conspiracy. I'm concerned that Trump's project warp speed created incentives to suppress cheap alternative treatments to expensive EAU treatments.
I generally don't believe large conspiracies are that common. I do believe that poorly implemented incentives create conspiratorial appearing behavior with negative externalities.
I personally know people that directly suffered from the costs of these poor incentives, one vaccine injured friend that doctors refused to acknowledge her injury was related to the vaccine, and thus forced to pay out of pocket for several cardiologist visits and depend on her own sleuthing to finally start recovering months later. She had sudden heart issues with POTs symptoms right after her second shot. Healthy late 20s.
Side note: it's amazing to me that we are all of a sudden trusting big pharma...when two years ago, everyone knew the incentives were broken, that these same companies regularly compromised the integrity of doctors, regulatory committees, and media, all while creating health crises in the name of profit.
By participating in and distributing "covid news" you are perpetuating a harmful atmosphere to those attacked by the state.
Trigger words include "covid", "covid-19", "masking", "vaccine mandate", "vaccine", "mask mandate", "lockdown", "stay at home orders" and more.
Please exclude this harmful language from your vocabulary and please stop distributing "covid news" on hacker news.