The Burden of Proof for Pandemic Treatment

This article was first published in TrialSiteNews behind a paywall.

We hear time and time again that one inexpensive COVID-19 treatment or another should not be used because there is not enough evidence for it. In hindsight, these arguments did not deserve serious consideration. For those who demand “evidence” behind a working treatment for a pandemic disease, no evidence would ever be enough.

Medical practice is like engineering in that both use science. I could make an analogy between the COVID-19 early antiviral treatment and airplanes 100 years ago. Opponents to airplanes would have had many more arguments against them than the opponents of ivermectin today. They would have made a long list of deadly airplane accidents, something that opponents of ivermectin for COVID-19 cannot do. They would have argued that the combustion engine is for cars, not for planes.

Most importantly, they would have shown the paucity of academic papers in favor of airplanes. A meta-analysis of published studies would find out that a typical aircraft design was not flyable, and sometimes led to the death of the test pilot. Such meta-analysis would not have to cherry pick studies as Cochrane under new management has done. The aircraft opponents would have paraded an endless column of putative experts who have never seen an airplane and would testify that airplanes are impossible, ineffective, and unsafe. They would have had much more evidence to justify their position than the modern opponents of ivermectin. They would have also been backed by the influential railway and shipbuilding industries.

Back then, one would respond to them by saying that those who knew how to design, manufacture, or fly an aircraft had already designed, manufactured, or flew them. That those who whine are sore losers, unable to do so. That an airplane comprises an engine and wings, but also other parts, and should be built correctly and flied competently. That prospect of aircraft should have been evaluated not by averaging the results from all published designs but by the results of the best one.

Finally, one would say that those who think that airplanes are not sufficiently useful or safe were free not use them but should not stand in the way of those who wanted to build and use them. The most important difference today is that the opponents of ivermectin can prevent its use, and even to cause incorrect use. They do so by improperly influencing scientific journals, medical societies, and using the Big Tech monopoly to control the information flow between doctors and from doctors to patients.

Back to the COVID-19 treatment—the FDA, CDC, NIH, medical boards, and so on should be told that if they do not know the evidence, that does not mean that the evidence does not exist. That not all medical evidence is published in peer-reviewed journals. That a pharmaceutical company asking for approval for a new drug must provide evidence of its safety and efficacy to the FDA, but doctors prescribing an already approved drug do not. That proving that a new drug which is 10% more efficient than old one (but would be priced 10x the old one) requires RCT, but a treatment that increases the odds by 3–6 times does not. Further, such RCT would likely be unethical. That when a doctor sees that a certain drug combination saves from hospitalization 80% of the patients who otherwise would have been hospitalized, it is sufficient evidence for that doctor. Independent description of this effect by five doctors is reliable scientific evidence. The effectiveness of HCQ for COVID-19 was affirmed by thousands of doctors.

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