Tag: Logic

Ivermectin: both sides are wrong

Do you think ivermectin cures COVID-19? Think carefully: in the age of culture wars, your answer defines your politics. If you think ivermectin is useful, you are an anti-vaxxer, Trump-supporting libertarian; If you think it isn’t, you are a godless, big-government cosmopolitan. Sorry, we don’t make the rules. 

Fine, but still, who is right? The truth is it’s still too early to say. The sorts of bold claims both sides are making are simply premature. The results of the TOGETHER Trial and the flaws recently detected in other trials weaken ivermectin’s case. On the other hand, one trial, that seems to have been well-conducted, points to it being mildly effective if taken at the onset of infection. Overall judgement? it may be useless, or it may be effective under certain circumstances.

But fixating on who is right misses the forest for the trees. Each side blames the other for Covid-19 deaths because of their supposedly wrong answer to this question. But, as it turns out, both sides are promoting deadly policies. 

The damage ivermectin’s die-hard supporters cause is plain to see. Dubbing it a “miracle cure” provides false confidence to the masses to disregard other effective measures. The damage caused by the other side is more insidious, but likely just as lethal. Let us explain why: when dealing with safe, cheap drugs even a moderate probability that they work is reason enough to recommend them. Sure, you may later discover some of the treatments weren’t effective, as may have happened with ivermectin, but that’s negligible compared to the damage of waiting and then discovering some treatments were effective all along.

When experts focus on a study’s flaws, discarding any merit it may otherwise have, what the public hears is: ignore this, vaccines are your only possible hope. 

The only way we’ll get out of this quagmire is probabilistic reasoning coupled with a cost-benefit analysis.

The best demonstration of this is in the FLCCC treatment protocol, which recommends a range of low-risk, potentially-useful repurposed drugs. While the TOGETHER trial showed that their ivermectin recommendation may have been ineffective, it also showed that Fluvoxamine, another drug in their protocol, reduced hospitalizations by 35%, and possibly cuts deaths dramatically (1 death vs 12 among those adhering to the protocol). Similarly, the FLCCC protocol recommended corticosteroids months before those became the standard of care. It is fair to assume that in the future more treatments in their protocol will be discovered to be effective.

So, regardless of the harmful, overconfident statements made by the FLCCC, doctors following their protocol saved lives, and the conservative, supposedly responsible, approach of their detractors has caused millions of deaths. 

So what went wrong?

In a word: incentives. The market is not incentivized to conduct the kind of large, costly clinical trials needed for high confidence results, when the treatment is a repurposed drug that costs a few dollars per patient. 

When the free market fails, the government should step in; after all, it has a massive public health incentive to find cheap, safe, and effective treatments. The trouble is that there is no single person within the government who has the authority, knowledge, and incentive to make the sorts of cost-benefit or probabilistic analyses needed in a pandemic. Authority-wielding politicians are not experts in health, statistics, or probability, and the few knowledge-wielding bureaucrats with the necessary expertise are mostly incentivized to not make mistakes, and don’t really care if one type of mistake exacts a far higher cost on society than the other. No one is at the helm.

Recommending a low-risk treatment that turns out to be ineffective wastes a modest amount of resources. Delaying a treatment that turns out to be effective may easily kill on a mass scale. But this gross asymmetry in results is not manifested in the decision-maker’s incentives.

So, they inevitably take the safe route of recommending we wait for more information and better quality trials. No one is ever blamed for such a “levelheaded” decision. But in a pandemic, there are no neutral options for decision makers.

This happens time and again. Our analysis of vitamin D is that it is likely highly effective at combating COVID-19. Given its low risk, it should be a top priority for health authorities to ensure no patient is left fighting the disease while being deficient in this essential hormone of the immune system. 

Meanwhile, the US National Institute of Health flounders, proclaiming that “There is insufficient evidence to recommend either for or against the use of vitamin D for the prevention or treatment of COVID-19”. But what is the risk in recommending it, exactly? 

The approach taken by both sides is lethal. Both need to change. 

To ivermectin’s supporters and the FLCCC:  we advise you to stop making overconfident claims on specific drugs. Bold claims such as these may cause people to ignore other effective treatments and they stake all the credibility of a balanced, probabilistic approach on one drug. If that drug turns out to be ineffective, the whole project is undermined. Instead, focus on the strong benefit of a protocol that uses multiple, promising low-risk drugs. 

To the skeptics: finding flaws in clinical trials is important and necessary work. But it’s more important to help fix the system so that conducting high quality trials on cheap, repurposed treatments becomes highly profitable. And in the meantime, remember not every flaw means a trial is useless. Help identify promising signals within imperfect trials that indicate the probable efficacy of low-risk treatments, and push for their immediate adoption, so the Fluvoxamine disaster is not repeated. 

The ever-present culture war around who is right and the rigid approach maintained by each side is killing people. Please stop. 


When Logic Goes Wrong: Survival Guide

Logic Is Dead

As discussed in a previous post, logic fails in the real world. Real-world problems do not lend themselves to logical reasoning since any non-trivial issue involves some uncertainty (Was the report accurate? Is the test result a false-positive?). When the problem is also complex, involving large amounts of information with intricate dependencies, then uncertainty can render the logical argument meaningless.

How Does Anyone Make Decisions?

Given these hurdles, how has humanity managed to make any progress at all? How do we deal with uncertain information in cases of high complexity? Continue reading

Every Logical Argument You Ever Made Was Wrong

Isn’t Logic Great?

Who doesn’t like logic? We idolize Sherlock Holmes’ ability to solve mysteries by “eliminating the impossible.” In arguments with friends, we try to prove we’re right using logic, rather than intuition or emotions. And we especially enjoy pointing out others’ logical fallacies–preferably using latin terms.

Don’t pat yourself on the back just yet. Finding logical fallacies is actually much less impressive than you might think. That’s because in the real world, all arguments violate the principles of formal logic.

Yes, perhaps every logical argument you have ever encountered was flawed.

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The Straw Man and Other Fallacies of Relevance

What do ad hominems, appeals to authority, red herrings and the straw man argument have in common? Each of these is an example of the Fallacy of Relevance.

Fallacies of Relevance are logical fallacies in which a key part of the argument is actually irrelevant to its conclusion. People often find these fallacies hard to detect.  Understanding how to construct and take apart an argument can help you avoid falling for such fallacies.

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Avoid Circular Reasoning with Rootclaim

Circular reasoning is a common logical fallacy. It is a form of the Fallacy of Presumption. In these fallacies, an argument sounds coherent and compelling, but is actually dependent on one or more faulty or unproven arguments . In circular reasoning, each claim loops around and rests on the assumption of one of the other claims. Thus, no single starting point is ever conclusively and independently established.

“Donald Trump says that he is trustworthy. But Donald Trump is a liar. You can’t trust liars. When Donald Trump says that he is trustworthy, he is lying.”

“Crooked Hillary is crooked because she’s untrustworthy. She can’t be trustworthy because she’s crooked.”

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