Science

Article

Science is a recurring concept in the Astral Codex Ten archive, appearing 6 times across 6 issues between November 17, 2021 and October 01, 2025. The archive places it in contexts such as “Mainstream medicine has reacted with slogans like ‘believe Science’”; “Science is the simple truth, the hard physical reality behind the veil of establishment lies and corporate distortion”; “Science is observing the shadow and telling the Church to screw itself”. It most often appears alongside America, Donald Trump, God.

Metadata

Category: Concepts
Mention count: 6
Issue count: 6
First seen: November 17, 2021
Last seen: October 01, 2025

Appears In

- America (3 shared issues)
- Donald Trump (3 shared issues)
- God (3 shared issues)
- WHO (3 shared issues)
- ACX (2 shared issues)
- Catholic Church (2 shared issues)
- CDC (2 shared issues)
- China (2 shared issues)
- COVID (2 shared issues)
- Egypt (2 shared issues)
- facebook (2 shared issues)
- Italy (2 shared issues)

External Links

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Ivermectin: Much More Than You Wanted To Know

November 17, 2021 · Original source

But here’s my pitch: this is one of the most carefully-pored-over scientific issues of our time. Dozens of teams published studies saying ivermectin definitely worked. Then most scientists concluded it didn’t. What a great opportunity to exercise our study-analyzing muscles! To learn stuff about how science works which we can then apply to less well-traveled terrain! Sure, you read the articles saying that experts had concluded the studies were wrong. But did you really develop a gears-level understanding of what was going on? That’s what we have a chance to get here!

This is from ivmmeta.com, part of a sprawling empire of big professional-looking sites promoting unorthodox coronavirus treatments. I have no idea who runs it - they’ve very reasonably kept their identity secret - but my hat is off to them. Each of these study names links to a discussion page which extracts key outcomes and offers links to html and pdf versions of the full text. These same people have another 35 ivermectin studies with different inclusion criteria, subanalyses by every variable under the sun, responses and counterresponses to everyone who disagrees with them about every study, and they’ve done this for twenty-nine other controversial COVID treatments. Putting aside the question of accuracy and grading only on presentation and scale, this is the most impressive act of science communication I have ever seen. The WHO and CDC get billions of dollars in funding and neither of them has been able to communicate their perspective anywhere near as effectively. Even an atheist can appreciate a cathedral, and even an ivermectin skeptic should be able to appreciate this website. What stands out most in this image (their studies on early treatment only; there are more on other things) is all the green boxes on the left side of the table. A green box means that the ivermectin group did better than placebo (a red box means the opposite). This isn’t adjusted for statistical significance - indeed, many of these studies don’t reach it. The point of a meta-analysis is that things that aren’t statistically significant on their own can become so after you pool them with other things. If you see one green box, it could mean the ivermectin group just got a little luckier than the placebo group. When you see 26 boxes compared to only 4 red ones, you know that nobody gets that lucky. Acknowledging that this is interesting, let’s detract from it a little. First, this presentation can exaggerate the effect size (represented by how far the green boxes are to the left of the gray line in the middle representing no effect). It focuses on the most dire outcome in every study - death if anybody died, hospitalization if anyone was hospitalized, etc. Most studies are small, and most COVID cases do fine, so most of these only have one or two people die or get hospitalized. So the score is often something like “ivermectin, 0 deaths; placebo, 1 death”, which is an infinitely large relative risk, and then the site rounds it down to some very high finite number. This methodology naturally produces very big apparent effects, and the rare studies where ivermectin does worse than placebo are equally exaggerated (one says that ivermectin patients are 600% more likely to end up hospitalized). But this doesn’t change the basic fact that ivermectin beats placebo in 26/30 of these studies. Second, this presents a pretty different picture than you would get reading the studies themselves. Most of these studies are looking at outcomes like viral load, how long until the patient tests negative, how long until the patient’s symptoms go away, etc. Many of these results are statistically insignificant or of low effect size. I went through these studies and tried to get some more information for my own reference: Click to expand. # is how many people were in the smallest relevant group (eg if there were 20 people in placebo and 10 in ivermectin, it was 10). Dose is ivermectin dose x number of days. Tested w/ is what drugs were given alongside ivermectin; compare is what drugs were in the “placebo” group (I excluded some very common things like paracetamol). %-PCR7 is what percent of patients had a negative PCR test (indicating recovery) after 7 days (though if 7 wasn’t available, I accepted anything from 6-12); the (I) and (P) are ivermectin and placebo groups. R is the ratio - green if statistically significant, red otherwise. DaysPCR is how many days it took to get a negative PCR test. Days to -sym are how many days it took symptoms to resolve. -outc is some serious negative outcome in the study, either clinical worsening, hospitalization, or death. I was inconsistent which one I chose, trying to pick whichever I thought struck a balance between high sample size and severity. Since this was almost never significant, I made it blue if it favored ivermectin and orange if it favored placebo (which it never did; there is no orange). Lowest p is the lowest p-value in the study for one of the headline results. 1o+ is whether the primary outcome was positive or not. I made this very quickly and unprincipledly and I am sure there are a lot of errors; please forgive me. Of studies that included any of the endpoints I recorded, ivermectin had a statistically significant effect on the endpoint 13 times, and failed to reach significance 8 times. Of studies that named a specific primary endpoint, 9 found ivermectin affected it significantly, and 12 found it didn’t. But that’s still pretty good. And “doesn’t affect to a statistically significant degree” doesn’t mean it doesn’t work. It might just mean your study is too small for a real and important effect to achieve statistical significance. That’s why people do meta-analyses to combine studies. And the ivmmeta people say they did that and it was really impressive. All of this is still basically what things would look like if ivermectin worked. But of course we can’t give every study one vote. We’ve got to actually look at these and see which ones are good and which ones are bad. So, God help us, let’s go over all thirty of the ivermectin studies in this top panel of ivmmeta.com. (if you get bored of this, scroll down to the section called “The Analysis”) The Studies Elgazzar et al: This one isn’t on the table above, but we can’t start talking about the others until we get it out of the way. 600 Egyptian patients were randomized into six groups, including three that got ivermectin. The ivermectin groups did substantially better: for example, 2 vs. 20 deaths in ivermectin group 3 vs. non-ivermectin group 4. There were various other equally impressive outcomes. Unfortunately, it’s all false. Some epidemiologists and reporters were able to obtain the raw data (it was password-protected, but the password was “1234”), and it was pretty bizarre. Some patients appeared to have died before the trial started; others were arranged in groups of four such that it seemed like the authors had just copy-pasted the same four patients again and again. Probably either the study never happened, or at least the data were heavily edited afterwards. You can read more here. A lot of the apparent benefit of ivermectin in meta-analyses disappeared after taking out this paper (though remember, this isn’t even on the table at the top of the post, so it doesn’t directly affect that). Since the Elgazzar debacle, a group of researchers including Gideon Meyerowitz-Katz, Kyle Sheldrake, James Heathers, Nick Brown, Jack Lawrence, etc, have been trying to double-check as many other ivermectin studies as possible. At least three others - Samaha, Carvallo, and Niaee - have similar problems and have been retracted. Those studies were all removed before I screenshotted the table above, and they’re not on there. But everybody is pretty paranoid right now and looking for fraud a lot harder than they might be in normal situations. Moving on: Chowdury et al: Bangladeshi RCT. 60 patients in Group A got low-dose ivermectin plus the antibiotic doxycycline, 56 in Group B got hydroxychloroquine (another weird COVID treatment which most scientists think doesn’t work) plus the antibiotic azithromycin. No declared primary outcome. Ivermectin group got to negative PCR a little faster than the other (5.9 vs. 7 days) but it wasn’t statistically significant (p = 0.2). A couple of other non-statistically-significant things happened too. 2 controls were hospitalized, 0 ivermectin patients were. This is a boring study that got boring results, so nobody has felt the need to assassinate it, but if they did, it would probably focus on both groups getting various medications besides ivermectin. None of these other medications are believed to work, so I don’t really care about this, but you could tell a story where actually doxycycline works great at addressing associated bacterial pneumonias, or where HCQ causes lots of side effects and that makes the ivermectin group look good in comparison, or whatever. Espitia-Hernandez et al: Mexican trial which is probably not an RCT - all it says is that “patients were voluntarily allocated”. 28 ended up taking a cocktail of low-dose ivermectin, vitamin D, and azithromycin; 7 were controls. On day ten, everyone (!) in the experimental group was PCR negative; everyone (!) in the control group was still positive. Also, symptoms in the experimental group lasted an average of three days; in the control group, more like 10. These results make ivermectin look amazingly super-good, probably better than any other drug for any other disease, except maybe stuff like vitamins for treatment of vitamin deficiency. Any issues? We don’t know how patients were allocated, but they discuss patient characteristics and they don’t look different enough to produce this big an effect size. The experimental group got a lot of things other than ivermectin, but I would be equally surprised if vitamin D or azithromycin cured COVID this effectively. It deviated from its preregistration in basically every way possible, but you shouldn’t be able to get “every experimental patient tested negative when zero control patients did” by garden-of-forking-paths alone! But this has to be false, right? Even the other pro-ivermectin studies don’t show effects nearly this big. In all other studies combined, ivermectin patients took an average of 8 days to recover; in Espitia-Hernandez, they took 3. Also, it’s pretty weird that the entire control group had positive PCRs on day 10 - in most other studies, a majority of people had negative PCRs by day 7 or so, regardless of whether they were control or placebo. Everything about this is so shoddy that I can easily believe something went wrong here. I don’t have a great understanding of this one but I don’t trust it at all. Luckily it is small and non-randomized so it will be easy to ignore going forward. I’m not saying this is related, but I’m not saying it *isn’t* related either. Carvallo et al: This one has all the disadvantages of Espitia-Hernandez, plus it’s completely unreadable. It’s hard to figure out how many patients there were, whether it was an RCT or not, etc. It looks like maybe there were 42 experimentals and 14 controls, and the controls were about 10x more likely to die than the experimentals. Seems pretty bad. On the other hand, another Carvallo paper was retracted because of fraud: apparently the hospital where the study supposedly took place said it never happened there. I can’t tell if this is a different version of that study, a pilot study for that study, or a different study by the same guy. Anyway, it’s too confusing to interpret, shows implausible results, and is by a known fraudster, so I feel okay about ignoring this one. Mahmud et al: RCT from Bangladesh. 200 patients received ivermectin plus doxycycline, 200 received placebo. Everything was written up very nicely in real English, by people who were clearly not on 34 lbs of meth at the time. They designated a primary outcome, “number of days required for clinical recovery”, and found a statistically significant difference at p < 0.001: Okay, fine, they misspelled “recovery” once. But they spelled it right the other time! That puts it in the top 50% for ivermectin papers! The fraud-hunters have examined this paper closely and are unable to find any signs of fraud. @PubPeer on the Mahmud trial of ivermectin in covid patients.\n\nI have now reviewed the individual patient data master sheet.\n\nI did not find any irregularities and the summary data matches the published data.\n\n","username":"K_Sheldrick","name":"Kyle Sheldrick","profile_image_url":"","date":"Sat Jul 17 11:06:25 +0000 2021","photos":[],"quoted_tweet":{},"reply_count":0,"retweet_count":2,"like_count":12,"impression_count":0,"expanded_url":{"url":"https://pubpeer.com/publications/E1D65711EF28D14517731BEACB89C8#2","title":"PubPeer - Ivermectin in combination with doxycycline for treating COVI...","description":"There are comments on PubPeer for publication: Ivermectin in combination with doxycycline for treating COVID-19 symptoms: a randomized trial (2021)","domain":"pubpeer.com"},"video_url":null,"belowTheFold":true}" data-component-name="Twitter2ToDOM"> I think this paper is legitimate and that its findings need to be seriously considered. Serious consideration doesn’t always meant they’re true - sometimes if we have strong evidence otherwise we can dismiss things without understanding why. And there’s always the chance it was a fluke, right? Can something have a p-value less than 0.001 and still be a fluke? Szenta Fonseca et al: This is a chart review from Brazil. Researchers looked at various people who had been treated for COVID in an insurance company database, saw whether they got ivermectin or not, and saw whether the people who got it did better or worse. About a hundred people got it, and a few hundred others didn’t. The people who got it did not do any better than anyone else, and you’ll notice this is one of the rare red boxes on the table above. But we shouldn’t take this study seriously. Nobody took any effort to avoid selection bias, so it’s very possible that sicker people were given more medication (including ivermectin), which unfairly handicaps the ivermectin group. Also, it’s hard to tell from the paper who was on how much of what, and the discussion of ivermectin seems like kind of an afterthought after discussing lots of other meds in much more depth. This is another one I feel comfortable ignoring. Cadegiani et al: A crazy person decided to put his patients on every weird medication he could think of, and 585 subjects ended up on a combination of ivermectin, hydroxychloroquine, azithromycin, and nitazoxanide, with dutasteride and spironolactone "optionally offered" and vitamin D, vitamin C, zinc, apixaban, rivaraxoban, enoxaparin, and glucocorticoids "added according to clinical judgment". There was no control group, but the author helpfully designated some random patients in his area as a sort-of-control, and then synthetically generated a second control group based on “a precise estimative based on a thorough and structured review of articles indexed in PubMed and MEDLINE and statements by official government agencies and specific medical societies”. Patients in the experimental group were twice as likely to recover (p < 0.0001), had negative PCR after 14 vs. 21 days, and had 0 vs. 27 hospitalizations. Speaking of low p-values, some people did fraud-detection tests on another of Cadegiani’s COVID-19 studies and got values like p < 8.24E-11 in favor of it being fraudulent. And, uh, he’s also studied whether ultra-high-dose antiandrogens treated COVID, and found that they did, cutting mortality by 92% . But the trial is under suspicion, with a BMJ article calling it “[the worst] violations of medical ethics and human rights in Brazil’s history” and “an ethical cesspit of violations”. [update 2022: this section originally contained more accusations against Cadegiani. Alexandros Marinos does a deeper dive with information not available at the time I wrote this, and finds some of them were overstated or false by implication] Anyway, let’s not base anything important on the results of this study, mmkay? A defiant Flavio Cadegiani. Imagine a guy who looks like this telling you to take ultra-high-dose antiandrogens. Ahmed et al: And we’re back in Bangladesh. 72 hospital patients were randomized to one of three arms: ivermectin only, ivermectin + doxycycline, and placebo. Primary endpoint was time to negative PCR, which was 9.7 days for ivermectin only and 12.7 days for placebo (p = 0.03). Other endpoints including duration of hospitalization (9.6 days ivermectin vs. 9.7 days placebo, not significant). This looks pretty good for ivermectin and does not have any signs of fraud or methodological problems. If I wanted to pick at it anyway, I would point out that the ivermectin + doxycycline group didn’t really differ from placebo, and that if you average out both ivermectin groups (with and without doxycycline) it looks like the difference would not be significant. I had previously committed to considering only ivermectin alone in trials that had multiple ivermectin groups, so I’m not going to do this. I can’t find any evidence this trial was preregistered so I don’t know whether they waited to see what would come out positive and then made that their primary endpoint, but virological clearance is a pretty normal primary endpoint and this isn’t that suspicious. It’s impossible to find any useful commentary on this study because Elgazzar (the guy who ran the most famous fraudulent ivermectin study) had the first name Ahmed, everyone is talking about Elgazzar all the time, and this overwhelms Google whenever I try to search for Ahmed et al. For now I’ll just keep this as a mildly positive and mildly plausible virological clearance result, in the context of no effect on hospitalization length or most symptoms. Chaccour et al: 24 patients in Spain were randomized to receive either medium-dose ivermectin or placebo. The primary outcome was percent of patients with negative PCR at day 7; secondary outcomes were viral load and symptoms. The primary endpoint ended up being kind of a wash - everyone still PCR positive by day 7 so it was impossible to compare groups. Ivermectin trended toward lower viral load but never reached significance. Weirdly, ivermectin did seem to help symptoms, but only anosmia and cough towards the end (p = 0.03), which you would usually think of as lingering post-COVID problems. The paper says: Given these findings, consideration could be given to alternative mechanisms of action different from a direct antiviral effect. One alternative explanation might be a positive allosteric modulation of the nicotinic acetylcholine receptor caused by ivermectin and leading to a downregulation of the ACE-2 receptor and viral entry into the cells of the respiratory epithelium and olfactory bulb. Another mechanism through which ivermectin might influence the reversal of anosmia is by inhibiting the activation of pro-inflammatory pathways in the olfactory epithelium. Inflammation of the olfactory mucosa is thought to play a key role in the development of anosmia in SARS-CoV-2 infection This seems kind of hedge-y. If you’re wondering where things went from there, Dr. Chaccour is now a passionate anti-ivermectin activist: @Finneganporter in @BusinessInsider \n\nThe roots of #ivermectin mania: How South America incubated a fake-medicine craze that took the US by storm\n\n","username":"carlos_chaccour","name":"Dr. Carlos Chaccour ??????","profile_image_url":"","date":"Sun Nov 07 18:40:28 +0000 2021","photos":[],"quoted_tweet":{},"reply_count":0,"retweet_count":2,"like_count":9,"impression_count":0,"expanded_url":{"url":"https://www.businessinsider.in/international/news/the-roots-of-ivermectin-mania-how-south-america-incubated-a-fake-medicine-craze-that-took-the-us-by-storm/articleshow/87554081.cms","image":"https://bucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com/public/images/88d08e70-c9e2-46d4-a5df-96807b6c3a13_2000x1000.jpeg","title":"The roots of ivermectin mania: How South America incubated a fake-medicine craze that took the US by storm","description":"The popularity of unproven anti-parasitic drug ivermectin as a COVID-19 treatment is surging. Its use has roots in South America, where it was hyped by populist","domain":"businessinsider.in"},"video_url":null,"belowTheFold":true}" data-component-name="Twitter2ToDOM"> So I guess he must think of this trial as basically negative, although realistically it’s 24 people and we shouldn’t put too much weight on it either way. Ghauri et al: Pakistan, 95 patients. Nonrandom; the study compared patients who happened to be given ivermectin (along with hydroxychloroquine and azithromycin) vs. patients who were just given the latter two drugs. There’s some evidence this produced systematic differences between the two groups - for example, patients in the control group were 3x more likely to have had diarrhea (this makes sense; diarrhea is a potential ivermectin side effect, so you probably wouldn’t give it to people already struggling with this problem). Also, the control group was twice as likely to be getting corticosteroids, maybe a marker for illness severity. Primary outcome was what percent of both groups had a fever: on day 7 it was 21% of ivermectin patients vs. 65% of controls, p < 0.001. No other outcomes were reported. I don’t hate this study, but I think the nonrandom assignment (and observed systematic differences) is a pretty fatal flaw. I can’t find anyone else talking about this one. At least no one seems to be saying anything bad. Babaloba et al: Be warned: if I have to refer to this one in real-life conversation, I will expand out the “et al” and call it “Babalola & Alakoloko”, because that’s really fun to say. This was a Nigerian RCT comparing 21 patients on low-dose ivermectin, 21 patients on high-dose ivermectin, and 20 patients on a combination of lopinavir and ritonavir, a combination antiviral which later studies found not to work for COVID and which might as well be considered a placebo. Primary outcome, as usual, was days until a negative PCR test. High dose ivermectin was 4.65 days, low dose was 6 days, control was 9.15, p = 0.035. Figure 2 is apparently a photograph of the computer screen where they did this calculation. Gideon Meyerowitz-Katz, part of the team that detects fraud in ivermectin papers, is not a fan of this one: He doesn’t say there what means, but elsewhere he tweets this figure: It’s always a bad sign when your study features in an image with “NUMEROUS IMPOSSIBLE NUMBERS” in red at the top. I think his point is that if you have 21 people, it’s impossible to have 50% of them have headache, because that would be 10.5. If 10 people have a headache, it would be 47.6%; if 11, 52%. So something is clearly wrong here. Seems like a relatively minor mistake, and Meyerowitz-Katz stops short of calling fraud, but it’s not a good look. I’m going to be slightly uncomfortable with this study without rejecting it entirely, and move on. Ravakirti et al: Here we’re in Eastern India - not exactly Bangladesh again, but a stone’s throw away from it. In this RCT patients were randomized into an ivermectin group (57) and a placebo group (58). Primary outcome was negative PCR on day 6, because doing it on day 7 like everyone else would be too easy. As with several other groups, this was a bad move; too few people had it to make a good comparison; it was 13% of intervention vs. 18% of placebo, p = 0.3. Secondary outcomes were also pretty boring, except for the most important: 4 people in the placebo group died, compared to 0 in ivermectin (p = 0.045). On the one hand, this is one outcome of many, reaching the barest significance threshold. Another fluke? Still, there are no real problems with this study, and nobody has anything to say against it. Let’s add this one to the scale as another very small and noisy piece of real evidence in ivermectin’s favor. Bukhari et al: Now we’re in Pakistan. 50 patients were randomized to low-dose ivermectin, another 50 got standard of care including vitamin D. There was no placebo, but primary outcome was number of days to reach negative PCR, which it seems hard for placebo to affect much, so I don’t care. 5 controls and 9 ivermectin patients left the hospital against medical advice and could not be followed up, which is bad but not necessarily study-ruining. They never measured their supposed primary outcome of “days to reach negative PCR” directly, but they did measure how many people had negative PCR on various days, and ivermectin had a clear advantage - for example, on day 7, it was 37/50 for IVR and only 20/50 for control. Even if we assume all the lost-to-followup patients had maximally bad-for-the-hypothesis results, that’s still a positive finding. Nobody else has much to say about this one, certainly no accusations that they’ve found anything suspicious. Keep. Mohan et al: India. RCT. 40 patients got low-dose ivermectin, 40 high-dose ivermectin, and 45 placebo. Primary outcomes were time to negative PCR, and viral load on day 5. In the results, they seem to have reinterpreted “time to negative PCR” as the subtly different “percent with negative PCR on some specific day”. High-dose ivermectin did best (47.5% negative on day 5) and placebo worst (31% negative), but it was insignificant (p = 0.3). There was no difference in viral load. All groups took about the same amount of time for symptoms to resolve. More placebo patients had failed to recover by the end of the study (6) than ivermectin patients (2), but this didn’t reach statistical significance (p = 0.4). Overall a well-done, boring, negative study, although ivermectin proponents will correctly point out that, like basically every other study we have looked at, the trend was in favor of ivermectin and this could potentially end up looking impressive in a meta-analysis. Biber et al: This is an RCT from Israel. 47 patients got ivermectin and 42 placebo. Primary endpoint was viral load on day 6. I am having trouble finding out what happened with this; as far as I can tell it was a negative result and they buried it in favor of more interesting things. In a "multivariable logistic regression model, the adjusted odds ratio of negative SARS-CoV-2 RT-PCR negative test" favored ivermectin over placebo (p = 0.03 for day 6, p = 0.01 for day 8), but this seems like the kind of thing you do when your primary outcome is boring and you’re angry. Gideon Meyerowitz-Katz is not a fan: He notes that the study excluded people with high viral load, but the preregistration didn’t say they would do that. Looking more closely, he finds they did that because, if you included these people, the study got no positive results. So probably they did the study, found no positive results, re-ran it with various subsets of patients until they did get a positive result, and then claimed to have “excluded” patients who weren’t in the subset that worked. I’m going to toss this one. Elalfy et al: What even is this? Where am I? As best I can tell, this is some kind of Egyptian trial. It might or might not be an RCT; it says stuff like “Patients were self-allocated to the treatment groups; the first 3 days of the week for the intervention arm while the other 3 days for symptomatic treatment”. Were they self-allocated in the sense that they got to choose? Doesn’t that mean it’s not random? Aren’t there seven days in a week? These are among the many questions that Elalfy et al do not answer for us. The control group (which they seem to think can also be called “the white group”) took zinc, paracetamol, and maybe azithromycin. The intervention group took zinc, nitazoxanide, ribavirin, and ivermectin. There were very large demographic differences between the groups of the sort which make the study unusable, which they mention and then ignore. From there, they follow this normal and totally comprehensible flowchart: There is no primary outcome assigned, but viral clearance rates on day seven were 58% in the yellow group compared to 0% in the white group, which I guess is a strong positive result. This table… …looks very impressive, in terms of the experimental group doing better than the control, except that they don’t specify whether it was before the trial or after it, and at least one online commentator thinks it might have been before, in which case it’s only impressive how thoroughly they failed to randomize their groups. Overall I don’t feel bad throwing this study out. I hope it one day succeeds in returning to its home planet. Lopez-Medina et al: Colombian RCT. 200 patients took ivermectin, another 200 took placebo. They originally worried the placebo might taste different than real ivermectin, then solved this by replacing it with a different placebo, which is a pretty high level of conscientiousness. Primary outcome was originally percent of patients whose symptoms worsened by two points, as rated on a complicated symptom scale when a researcher asked them over the phone. Halfway through the study, they realized nobody was worsening that much, so they changed the primary outcome to time until symptoms got better, as measured by the scale. In the ivermectin group, symptoms improved that much after 10 days; in the placebo group, after 12, p = 0.53. By the end of the study, symptoms had improved in 82% of ivermectin users and 79% of controls, also insignificant. 4 patients in the ivermectin group needed to be hospitalized compared to 6 in the placebo group, again insignificant. This study is bigger than most of the other RCTs, and more polished in terms of how many spelling errors, photographs of computer screens, etc, it contains. It was published in JAMA, one of the most prestigious US medical journals, as opposed to the crappy nth-tier journals most of the others have been in. When people say things like “sure, a lot of small studies show good results for ivermectin, but the bigger and more professional trials don’t”, this is one of the two big professional trials they’re talking about. Ivermectin proponents make some good arguments against it. In order to get as big as it did, Lopez-Medina had to compromise on rigor. Its outcome is how people self-score their symptoms on a hokey scale in a phone interview, instead of viral load or PCR results or anything like that. Still, this is basically what we want, right? In the end, we want people to feel better and less sick, not to get good scores on PCR tests. Also, it changed its primary outcome halfway through; isn’t that bad? I think maybe not; the reason we want a preregistered primary outcome is so that you don’t change halfway through to whatever outcome shows the results you want. The researchers in this study did a good job explaining why they changed their outcome, the change makes sense, and their original outcome would also have shown ivermectin not working (albeit less accurately and effectively). I don’t know of any evidence that they knew (or suspected) final results when switching to this new outcome, and it seems like the most reasonable new outcome to switch to. Finally, their original placebo tasted different from ivermectin (though they switched halfway through). This is one of the few studies where I actually care about placebo, because people are self-rating their symptoms. But realistically most of these people don’t know what ivermectin is supposed to taste like. Also, they did a re-analysis and found there was no difference between the people who got the old placebo and the new one. I’m making a big deal of this because ivmmeta.com - the really impressive meta-analysis site I’ve been going off of - puts a special warning letter underneath their discussion of this study, urging us not to trust it. They don’t do this for any of the other ones we’ve addressed so far - not the one by the guy whose other studies were all frauds, not the one where 50% of 21 people had headaches, not the unrandomized one where the groups were completely different before the experiment started, not even the one by the guy accused of crimes against humanity. Only this one. This makes me a lot less charitable to ivmmeta than I would otherwise be; I think it’s hard to choose this particular warning letter strategy out of well-intentioned commitment to truth. They just really don’t like this big study that shows ivermectin doesn’t work. Also, the warning itself irritates me, and includes paragraphs like: RCTs have a fundamental bias against finding an effect for interventions that are widely available — patients that believe they need treatment are more likely to decline participation and take the intervention [Yeh], i.e., RCTs are more likely to enroll low-risk participants that do not need treatment to recover (this does not apply to the typical pharmaceutical trial of a new drug that is otherwise unavailable). This trial was run in a community where ivermectin was available OTC and very widely known and used. Nobody else worries about this, and there are a million biases that non-randomized studies have that would be super-relevant when discussing those, but somehow when they’re pro-ivermectin the site forgets to be this thorough. I think a better pro-ivermectin response to this study is to point out that all the trends support ivermectin. Symptoms took 10 days to resolve in the ivermectin group vs. 12 in placebo; 4 ivermectin patients were hospitalized vs. 6 placebo patients, etc. Just say that this was an unusually noisy trial because of the self-report methodology, and you’re confident that these small differences will add up to significance when you put them into a meta-analysis. Roy et al: We’re back in East India, and back to non-randomized trials. 56 patients were retrospectively examined; some had been given ivermectin + doxycycline, others hydroxychloroquine, other azithromycin, and others symptomatic treatment only. We don’t get any meaningful information about how this worked, but we are told that they did not differ in “clinical well-being reporting onset timing”. Whatever. Chahla et al: The first of many Argentine trials. 110 patients received medium-dose ivermectin; 144 were kept as a control (no placebo). This was “cluster randomized”, which means they randomize different health centers to either give the experimental drug or not. This is worse than regular randomization, because there could be differences between these health centers (eg one might have better doctors who otherwise give better treatment, one might be in the poor part of town and have sicker patients, etc). They checked to see if there were any differences between the groups, and it sure looks like there were (the experimental group had twice as many obese people as the controls), but as per them, these differences were not statistically significant. Note that if this did make a difference, it would presumably make ivermectin look worse, not better. The primary outcome was given as “increase discharge from outpatient care with COVID-19 mild disease”. This favored the treatment; only 2/110 patients in the ivermectin group failed to be discharged, compared to 20 patients in the control group. But, uh, these were at different medical centers. Can’t different medical centers just have different discharge policies? One discharges you as soon as you seem to be getting better, the other waits to really make sure? This is an utterly crap endpoint to do a cluster randomized controlled trial on. If you’re going to do cRCT, which is never a great idea, you should be using some extremely objective endpoint that doctors and clinic administrators can’t possibly affect, like viral load according to some third-party laboratory, using the same third-party laboratory for both clinics. This is such a bad idea that I can’t help worrying I’m missing or misunderstanding something. If not, this is dumb and bad and should be ignored. Mourya et al: We’re back in India. This is a nonrandomized study comparing 50 patients given ivermectin to 50 patients given hydroxychloroquine. No primary outcome was named, but they focus on PCR negativity. Only 6% of patients in the hydroxychloroquine group were negative, compared to 90% of patients in the ivermectin group! On what day did they do the test? Uh, kind of random, and they admit that “in [the hydroxychloroquine group], mean time difference from the date of initiation of treatment and second test was significantly longer (7.24±2.75 days) as compared to 5.22±1.21 days in [the ivermectin group] (p=0.021).” Since they assessed these groups at different times, we shouldn’t draw any conclusions from them getting different results. Except that as far as I can tell this should handicap ivermectin, making it especially impressive that it did better. But also, the ivermectin group was made mostly of people who had been asymptomatic at the beginning (70%), and the hydroxychloroquine group had almost no asymptomatic cases (8%) . They were giving the ivermectin to healthy people and the hydroxychloroquine to sick people! They admit deep in the discussion that this “may be a confounding factor”. So basically they got totally different groups of people, tested them at totally different times, and the two sets of test results differed. So what? So this is why normal people do RCTs instead of whatever the heck this is, that’s what. Loue et al: …this one isn’t going to be an RCT either. Loue tells a story about a cluster of COVID cases at the French nursing home where he works. He asked people if they wanted to try ivermectin; 10 did and 15 didn’t. 1 ivermectin patient died, compared to 5 non-ivermectin patients. The non-ivermectin group looked a bit sicker than the ivermectin group in the inevitable Table 1, though it’s hard to tell. One interesting possible confounder (not mentioned, but I’m imagining it) is that demented patients probably couldn’t consent to ivermectin and ended up in the control group. This is another case of “I’m not going to trust anything that isn’t an RCT”. Merino et al: Another (sigh) non-RCT. Mexico City tried a public health program where if you called a hotline and said you had COVID, they sent you an emergency kit with various useful supplies. One of those supplies was ivermectin tablets. 18,074 people got the kit (and presumably some appreciable fraction took the ivermectin, though there’s no way to prove that). Their control group is people from before they started giving out the kits, people from after they stopped giving out the kits, and people who didn’t want the kits. There are differences in who got COVID early in the epidemic vs. later, and in people who did opt for medical kits vs. didn’t. To correct these, the researchers tried to adjust for confounders, something which - as I keep trying to hammer home again and again - never works. They found that using the kit led to a 75% or so reduction in hospitalization, though they were unable to separate out the ivermectin from the other things in the kit (paracetamol and aspirin), or from the placebo effect of having a kit and feeling like you had already gotten some treatment (if I understand right, the decision to go to the hospital was left entirely to the patient). I think this study is a moderate point in favor of giving people kits in order to prevent hospital overcrowding, but I’m not willing to accept that it tells us much about ivermectin in particular. Faisal et al: This one was published in The Professional Medical Journal (mispelled as “Profesional Medical Journal” in its URL), so you know it’s going to be good! It describes itself as “a cross-sectional study”, but later says it “randomized patients into two groups”, which would make it an RCT - I think they might just be using the term “cross-sectional” different from the standard American usage. A hospital in Pakistan got 50 patients on ivermectin + azithromycin, and another 50 on azithromycin alone. Primary outcome was not mentioned, and the data were presented confusingly, but a typical result is that only 4% of the ivermectin group had symptoms lasting more than 10 days, whereas 16% of the control group did, p < 0.01. They do a really weird thing where they compare how long it took symptoms to resolve between IVM and control groups within each bin. That is, if I’m understanding correctly, they ask “of the people who took between 3-5 days for symptoms to resolve, did they resolve faster for IVM or control?”. This is an utterly bizarre analysis to perform, although it doesn’t affect the fact that their other results still seem to favor ivermectin. Maybe I’m confused about what’s going on here. I’ve mostly been letting people off easy on no placebo, but I as far as I can tell (not very far) this paper seems to be going off whether patients reported continuing to have symptoms to the hospital doing the study, and I think that is potentially susceptible to placebo effects. Additionally, there’s no preregistration, and even though they talk a lot about doing PCR tests they don’t present the results. This is by no means the worst study here but I still think it’s pretty low quality and I don’t trust it. Aref et al: This one is published in the International Journal Of Nanomedicine, even though I’m pretty sure that isn’t a real thing. In this case the “nanomedicine” is a new nasal spray version of ivermectin which is so confusing I cannot for the life of me figure out what dose they are giving these patients. This Egyptian study gives 57 patients intranasal ivermectin plus hydroxychloroquine, azithromycin, oseltamavir, and some vitamins; another 57 patients get all that stuff except the ivermectin. Primary outcome is not stated, but they look at various symptoms, all of which look better in the ivermectin group: 95% of ivermectin patients got negative PCRs at some time point, compared to 75% of controls, p = 0.004. I am pretty suspicious of this study, not least because it comes from Egypt which has an awful reputation for fake studies, and it returns extreme results that I wouldn’t expect even if ivermectin was actually a wonder drug. But I cannot find any particular thing wrong with it, nor did anyone else I looked at, so I will grudgingly let it stand. Krolewiecki et al: Another Argentine study. This one is a real RCT. 30 patients received ivermectin, 15 were the control group (no placebo, again). Primary outcome was difference in viral load on day 5. The trend favored ivermectin but it was not statistically significant, although they were able to make it statistically significant if they looked at a subset of higher-IVM-plasma-concentration patients. They did not find any difference in clinical outcomes. A pro-ivermectin person could point out that in the subgroup with the highest ivermectin concentrations, the drug seemed to work. A skeptic could point out that this is exactly the kind of subgroup slicing that you are not supposed to do without pre-registering it, which I don’t think this team did. I agree with the skeptic. Vallejos et al: Another Argentine study. It’s big (250 people in each arm). It’s an RCT. It tries to define a primary outcome (“Primary outcome: the trial ended when the last patient who was included achieved the end of study visit”), but that’s not what “primary outcome” means, and they don’t offer an alternative. Other outcomes: no difference in PCR on days 3 or 12. Hospitalization is nonsignificantly better in the ivermectin group (14 vs. 21, p = 0.2), but death is nonsigificantly better in the placebo group (3 vs. 4, p = 0.7). This isn’t even the kind of nonsignificant that might contribute to an exciting meta-analysis later. This is just a pure null result. I cannot find any problem with this study, and neither can anyone else I checked. This is the biggest RCT we’ve seen so far, so we should take it seriously. TOGETHER Trial: Speaking of big RCTs… This one hasn’t been published yet. There’s a video of a talk about it, but I am not going to watch it, because it is a video, so I am getting information secondhand from eg here. Apparently, it compares 677 people (!) randomized to ivermectin to 678 people randomized to placebo. 86 ivermectin patients ended up in the hospital compared to 95 placebo patients, p-value not significant. This was a really big professional trial done by bigshot researchers from a major Canadian university, and the medical establishment is taking it much more seriously than any of these others. When it comes out, it will probably get published in a top journal. When discussing Lopez-Medina, I wrote: When people say things like “sure, a lot of small studies show good results for ivermectin, but the bigger and more professional trials don’t”, this is one of the two big professional trials they’re talking about. This is the other one. Not coincidentally, it’s also the other trial that ivmmeta.com has a warning letter underneath telling you to disregard. Their main concern is that instead of truly randomizing patients to ivermectin vs. placebo, they did a time-dependent randomization that meant during some weeks more patients were getting one or the other. This is a problem because the trial takes place in Brazil, where different variants were more common at different times. Here’s their image: On the one hand, I have immense contempt for ivmmeta for letting all those other awful studies pass and then pulling out all the stops to try to nitpick this one. I have no idea if their proposed randomization failure really happened. And no doubt the reason they’re even able to investigate this is that this study is really careful and transparent - most of them don’t tell you anything about their randomization method. I would be shocked if other studies don’t have all these problems and worse. On the other hand, the point isn’t to be fair, it’s to be right. And this is a potential confounder. Not a huge one. But a potential one. I guess all we can do is try to bound the damage. Even if the confounding is 100% real and bad, there’s no way to make this study consistent with the crazy super-pro-ivermectin results of studies like Espitia-Hernandez and Aref. And even if we deny any confounding, we see the same slight pro-ivermectin trend - 86 hospitalizations vs. 95 - that we’ve seen in so many other studies. Nothing is going to make me believe that this isn’t in the top 33% of studies we’ve been looking at, so let’s add it as grist for the meta-analysis (though maybe not quite as much grist as its vast size indicates) and move on, angrily. Buonfrate et al: An Italian RCT. Patients were randomized into low-dose ivermectin (32), placebo (29), or high-dose ivermectin (32). Primary outcome was viral load on day 7. There was no significant difference (average of 2 in ivermectin groups, 2.2 in placebo group). They admit that they failed to reach the planned sample size, but did a calculation to show that even if they had, the trial could not have returned a positive result. Clinically, an average of 2 patients were hospitalized in each of the ivermectin arms, compared to 0 in the placebo arm - which bucks our previously-very-constant pro-ivermectin trend. Mayer et al: Not an RCT. Patients in an Argentine province were offered the opportunity to try ivermectin; 3266 said yes and become the experimental group, 17966 said no and became the control group. There were many obvious differences between the groups, but they all seemed to handicap ivermectin. There was a nonsignificant trend toward less hospitalization and significantly less mortality (1.5% vs. 2.1%, p = 0.03). While looking into this study, I learned the term “immortal time bias”. This means a period in between selection for the study and the beginning of study recording where patient outcomes are not counted. I think the problem here is that if you signed up for the system on Day X, and if you got sick before they could give you ivermectin, you were in the control group. See this Twitter thread, I have not confirmed everything he says. This only hardens my resolve to stay away from non-RCTs. Borody et al: Our last paper! …is it a paper? I can’t find it published anywhere. It mostly seems to be on news sites. Doesn’t look peer-reviewed. And it starts with “Note that views expressed in this opinion article are the writer’s personal views”. Whatever. 600 Australians were treated with ivermectin, doxycycline, and zinc. The article compares this to an “equivalent control group” made of “contemporary infected subjects in Australia obtained from published Covid Tracking Data”; this is not how you control group, @#!% you. Then it gets excited about the fact that most patients had better symptoms at the end of the ten-day study period than the beginning (untreated COVID resolves in about ten days). Why are these people wasting my time with this? Let’s move on. The Analysis If we remove all fraudulent and methodologically unsound studies from the table above, we end up with this: Gideon Meyerowitz-Katz, who investigated many of the studies above for fraud, tried a similar exercise. I learned about his halfway through, couldn’t help seeing it briefly, but tried to avoid remembering it or using it when generating mine (also, I did take the result of his fraud investigations into account), so they should be considered not quite independent efforts. His looks like this: He nixed Chowdhury, Babaloba, Ghauri, Faisal, and Aref, but kept Szenta Fonseca, Biber (?), and Mayer. There was correlation of 0.45, which I guess is okay. I asked him about his decision-making, and he listed a combination of serious statistical errors and small red flags adding up. I was pretty uncomfortable with most of these studies myself, so I will err on the side of severity, and remove all studies that either I or Meyerowitz-Katz disliked. We end up with the following short list: We’ve gone from 29 studies to 11, getting rid of 18 along the way. For the record, we eliminated 2/19 for fraud, 1/19 for severe preregistration violations, 10 for methodological problems, and 6 because Meyerowitz-Katz was suspicious of them. …but honestly this table still looks pretty good for ivermectin, doesn’t it? Still lots of big green boxes. Meyerowitz-Katz accuses ivmmeta of cherry-picking what statistic to use for their forest plot. That is, if a study measures ten outcomes, they sometimes take the most pro-ivermectin outcome. Ivmmeta.com counters that they used a consistent and reasonable (if complicated) process for choosing their outcome of focus, that being: If studies report multiple kinds of effects then the most serious outcome is used in calculations for that study. For example, if effects for mortality and cases are both reported, the effect for mortality is used, this may be different to the effect that a study focused on. If symptomatic results are reported at multiple times, we used the latest time, for example if mortality results are provided at 14 days and 28 days, the results at 28 days are used. Mortality alone is preferred over combined outcomes. Outcomes with zero events in both arms were not used (the next most serious outcome is used — no studies were excluded). For example, in low-risk populations with no mortality, a reduction in mortality with treatment is not possible, however a reduction in hospitalization, for example, is still valuable. Clinical outcome is considered more important than PCR testing status. When basically all patients recover in both treatment and control groups, preference for viral clearance and recovery is given to results mid-recovery where available (after most or all patients have recovered there is no room for an effective treatment to do better). If only individual symptom data is available, the most serious symptom has priority, for example difficulty breathing or low SpO2 is more important than cough. I’m having trouble judging this, partly because Meyerowitz-Katz says ivmmeta has corrected some earlier mistakes, and partly because there really is some reasonable debate over how to judge studies with lots of complicated endpoints. By this point I had completely forgotten what ivmmeta did, so I independently coded all 11 remaining studies following something in between my best understanding of their procedure and what I considered common sense. The only exception was that when the most severe outcome was measured in something other than patients (ie average number of virus copies per patient), I defaulted to one that was measured in patients instead, to keep everything with the same denominator. My results mostly matched ivmmeta’s, with one or two exceptions that I think are within the scope of argument or related to my minor deviations from their protocol. Placebo vs. ivermectin groups sometimes differed in size, which I’ve adjusted for and rounded off. Probably I’m forgetting some reason I can’t just do simple summary statistics to this, but whatever. It is p = 0.15, not significant. This is maybe unfair, because there aren’t a lot of deaths in the sample, so by focusing on death rather than more common outcomes we’re pointlessly throwing away sample size. What happens if I unprincipledly pick whatever I think the most reasonable outcome to use from each study is? I’ve chosen “most reasonable” as a balance between “is the most severe” and “has a lot of data points”: Now it’s p = 0.04, seemingly significant, but I had to make some unprincipled decisions to get there. I don’t think I specifically replaced negative findings with positive ones, but I can’t prove that even to myself, let alone to you. [UPDATE 5/31/22: A reader writes in to tell me that the t-test I used above is overly simplistic. A Dersimonian-Laird test is more appropriate for meta-analysis, and would have given 0.03 and 0.005 on the first and second analysis, where I got 0.15 and 0.04. This significantly strengthens the apparent benefit of ivermectin from ‘debatable’ to ‘clear’. I discuss some reasons below why I am not convinced by this apparent benefit.] (how come I’m finding a bunch of things on the edge of significance, but the original ivmmeta site found a lot of extremely significant things? Because they combined ratios, such that “one death in placebo, zero in ivermectin” looked like a nigh-infinite benefit for ivermectin, whereas I’m combining raw numbers. Possibly my way is statistically illegitimate for some reason, but I’m just trying to get a rough estimate of how convinced to be) So we are stuck somewhere between “nonsignificant trend in favor” and “maybe-significant trend in favor, after throwing out some best practices”. This is normally where I would compare my results to those of other meta-analyses made by real professionals. But when I look at them, they all include studies later found to be fake, like Elgazzar, and unsurprisingly come up with wildly positive conclusions. There are about six in this category. One of them later revised their results to exclude Elgazzar and still found strong efficacy for ivermectin, but they still included Niaee and some other dubious studies. The only meta-analysis that doesn’t make these mistakes is Popp (a Cochrane review), which is from before Elgazzar was found to be fraudulent, but coincidentally excludes it for other reasons. It also excludes a lot of good studies like Mahmud and Ravakirti because they give patients other things like HCQ and azithromycin - I chose to include them, because I don’t think they either work or have especially bad side effects, so they’re basically placebo - but Cochrane is always harsh like this. They end up with a point estimate where ivermectin cuts mortality by 40% - but say the confidence intervals are too wide to draw any conclusion. I think this basically agrees with my analyses above - the trends really are in ivermectin’s favor, but once you eliminate all the questionable studies there are too few studies left to have enough statistical power to reach significance. Except that everyone is still focusing on deaths and hospitalizations just because they’re flashy. Mahmud et al, which everyone agrees is a great study, found that ivermectin decreased days until clinical recovery, p = 0.003? So what do you do? This is one of the toughest questions in medicine. It comes up again and again. You have some drug. You read some studies. Again and again, more people are surviving (or avoiding complications) when they get the drug. It’s a pattern strong enough to common-sensically notice. But there isn’t an undeniable, unbreachable fortress of evidence. The drug is really safe and doesn’t have a lot of side effects. So do you give it to your patients? Do you take it yourself? Here this question is especially tough, because, uh, if you say anything in favor of ivermectin you will be cast out of civilization and thrown into the circle of social hell reserved for Klan members and 1/6 insurrectionists. All the health officials in the world will shout “horse dewormer!” at you and compare you to Josef Mengele. But good doctors aren’t supposed to care about such things. Your only goal is to save your patient. Nothing else matters. I am telling you that Mahmud et al is a good study and it got p = 0.003 in favor of ivermectin. You can take the blue pill, and stay a decent respectable member of society. Or you can take the horse dewormer pill, and see where you end up. In a second, I’ll tell you my answer. But you won’t always have me to answer questions like this, and it might be morally edifying to observe your thought process in situations like this. So take a second, and meet me on the other side of the next section heading. … … … … … The Synthesis Hopefully you learned something interesting about yourself there. But my answer is: worms! As several doctors and researchers have pointed out (h/t especially Avi Bitterman and David Boulware), the most impressive studies come from places that are teeming with worms. Mahmud from Bangladesh, Ravakirti from East India, Lopez-Medina from Colombia, etc. Here’s the prevalence of roundworm infections by country (source). But alongside roundworms, there are threadworms, hookworms, blood flukes, liver flukes, nematodes, trematodes, all sorts of worms. Add them all up and somewhere between half and a quarter of people in the developing world have at least one parasitic worm in their body. Being full of worms may impact your ability to fight coronavirus. Gluchowska et al write: Helminth [ie worm] infections are among the most common infectious diseases. Bradbury et al. highlight the possible negative interactions between helminth infection and COVID-19 severity in helminth-endemic regions and note that alterations in the gut microbiome associated with helminth infection appear to have systemic immunomodulatory effects. It has also been proposed that helminth co-infection may increase the morbidity and mortality of COVID-19, because the immune system cannot efficiently respond to the virus; in addition, vaccines will be less effective for these patients, but treatment and prevention of helminth infections might reduce the negative effect of COVID-19. During millennia of parasite-host coevolution helminths evolved mechanisms suppressing the host immune responses, which may mitigate vaccine efficacy and increase severity of other infectious diseases. Treatment of worm infections might reduce the negative effect of COVID-19! And ivermectin is a deworming drug! You can see where this is going… The most relevant species of worm here is the roundworm Strongyloides stercoralis. Among the commonest treatments for COVID-19 is corticosteroids, a type of immunosuppresant drug. The types of immune responses it suppresses do more harm than good in coronavirus, so turning them off limits collateral damage and makes patients better on net. But these are also the types of immune responses that control Strongyloides. If you turn them off even very briefly, the worms multiply out of control, you get what’s called “Strongyloides hyperinfection”, and pretty often you die. According to the WHO: The current COVID-19 pandemic serves to highlight the risk of using systemic corticosteroids and, to a lesser extent, other immunosuppressive therapy, in populations with significant risk of underlying strongyloidiasis. Cases of strongyloidiasis hyperinfection in the setting of corticosteroid use as COVID-19 therapy have been described and draw attention to the necessity of addressing the risk of iatrogenic strongyloidiasis hyperinfection syndrome in infected individuals prior to corticosteroid administration. Although this has gained importance in the midst of a pandemic where corticosteroids are one of few therapies shown to improve mortality, its relevance is much broader given that corticosteroids and other immunosuppressive therapies have become increasingly common in treatment of chronic diseases (e.g. asthma or certain rheumatologic conditions). So you need to “address the risk” of strongyloides infection during COVID treatment in roundworm-endemic areas. And how might you address this, WHO? Treatment of chronic strongyloidiasis with ivermectin 200 µg/kg per day orally x 1-2 days is considered safe with potential contraindications including possible Loa loa infection (endemic in West and Central Africa), pregnancy, and weight <15kg. Given ivermectin’s safety profile, the United States has utilized presumptive treatment with ivermectin for strongyloidiasis in refugees resettling from endemic areas, and both Canada and the European Centre for Disease Prevention and Control have issued guidance on presumptive treatment to avoid hyperinfection in at risk populations. Screening and treatment, or where not available, addition of ivermectin to mass drug administration programs should be studied and considered. This is serious and common enough that, if you’re not going to screen for it, it might be worth “add[ing] ivermectin to mass drug administration programs” in affected areas! Dr. Avi Bitterman carries the hypothesis to the finish line: First two images are with all relevant studies; second two are a sensitivity analysis that removes some of the most dubious. The good ivermectin trials in areas with low Strongyloides prevalence, like Vallejos in Argentina, are mostly negative. The good ivermectin trials in areas with high Strongyloides prevalence, like Mahmud in Bangladesh, are mostly positive. Worms can’t explain the viral positivity outcomes (ie PCR), but Dr. Bitterman suggests that once you remove low quality trials and worm-related results, the rest looks like simple publication bias: This is still just a possibility. Maybe I’m over-focusing too hard on a couple positive results and this will all turn out to be nothing. Or who knows, maybe ivermectin does work against COVID a little - although it would have to be very little, fading to not at all in temperate worm-free countries. But this theory feels right to me. It feels right to me because it’s the most troll-ish possible solution. Everybody was wrong! The people who called it a miracle drug against COVID were wrong. The people who dismissed all the studies because they F@#king Love Science were wrong. Ivmmeta.com was wrong. Gideon Meyerowitz-Katz was…well, he was right, actually, I got the worm-related meta-analysis graphic above from his Twitter timeline. Still, an excellent troll. Also, the best part is that I ignorantly asked, in my description of Mahmud et al above: And it was! It was a fluke! A literal, physical, fluke! For my whole life, God has been placing terrible puns in my path to irritate me, and this would be the worst one ever! So it has to be true! The Scientific Takeaway About ten years ago, when the replication crisis started, we learned a certain set of tools for examining studies. Check for selection bias. Distrust “adjusting for confounders”. Check for p-hacking and forking paths. Make teams preregister their analyses. Do forest plots to find publication bias. Stop accepting p-values of 0.049. Wait for replications. Trust reviews and meta-analyses, instead of individual small studies. These were good tools. Having them was infinitely better than not having them. But even in 2014, I was writing about how many bad studies seemed to slip through the cracks even when we pushed this toolbox to its limits. We needed new tools. I think the methods that Meyerowitz-Katz, Sheldrake, Heathers, Brown, Lawrence and others brought to the limelight this year are some of the new tools we were waiting for. Part of this new toolset is to check for fraud. About 10 - 15% of the seemingly-good studies on ivermectin ended up extremely suspicious for fraud. Elgazzar, Carvallo, Niaee, Cadegiani, Samaha. There are ways to check for this even when you don’t have the raw data. Like: The Carlisle-Stouffer-Fisher method: Check some large group of comparisons, usually the Table 1 of an RCT where they compare the demographic characteristics of the control and experimental groups, for reasonable p-values. Real data will have p-values all over the map; one in every ten comparisons will have a p-value of 0.1 or less. Fakers seem bad at this and usually give everything a nice safe p-value like 0.8 or 0.9.

Okay, fine, they misspelled “recovery” once. But they spelled it right the other time! That puts it in the top 50% for ivermectin papers! The fraud-hunters have examined this paper closely and are unable to find any signs of fraud. @PubPeer on the Mahmud trial of ivermectin in covid patients.\n\nI have now reviewed the individual patient data master sheet.\n\nI did not find any irregularities and the summary data matches the published data.\n\n","username":"K_Sheldrick","name":"Kyle Sheldrick","profile_image_url":"","date":"Sat Jul 17 11:06:25 +0000 2021","photos":[],"quoted_tweet":{},"reply_count":0,"retweet_count":2,"like_count":12,"impression_count":0,"expanded_url":{"url":"https://pubpeer.com/publications/E1D65711EF28D14517731BEACB89C8#2","title":"PubPeer - Ivermectin in combination with doxycycline for treating COVI...","description":"There are comments on PubPeer for publication: Ivermectin in combination with doxycycline for treating COVID-19 symptoms: a randomized trial (2021)","domain":"pubpeer.com"},"video_url":null,"belowTheFold":true}" data-component-name="Twitter2ToDOM"> I think this paper is legitimate and that its findings need to be seriously considered. Serious consideration doesn’t always meant they’re true - sometimes if we have strong evidence otherwise we can dismiss things without understanding why. And there’s always the chance it was a fluke, right? Can something have a p-value less than 0.001 and still be a fluke? Szenta Fonseca et al: This is a chart review from Brazil. Researchers looked at various people who had been treated for COVID in an insurance company database, saw whether they got ivermectin or not, and saw whether the people who got it did better or worse. About a hundred people got it, and a few hundred others didn’t. The people who got it did not do any better than anyone else, and you’ll notice this is one of the rare red boxes on the table above. But we shouldn’t take this study seriously. Nobody took any effort to avoid selection bias, so it’s very possible that sicker people were given more medication (including ivermectin), which unfairly handicaps the ivermectin group. Also, it’s hard to tell from the paper who was on how much of what, and the discussion of ivermectin seems like kind of an afterthought after discussing lots of other meds in much more depth. This is another one I feel comfortable ignoring. Cadegiani et al: A crazy person decided to put his patients on every weird medication he could think of, and 585 subjects ended up on a combination of ivermectin, hydroxychloroquine, azithromycin, and nitazoxanide, with dutasteride and spironolactone "optionally offered" and vitamin D, vitamin C, zinc, apixaban, rivaraxoban, enoxaparin, and glucocorticoids "added according to clinical judgment". There was no control group, but the author helpfully designated some random patients in his area as a sort-of-control, and then synthetically generated a second control group based on “a precise estimative based on a thorough and structured review of articles indexed in PubMed and MEDLINE and statements by official government agencies and specific medical societies”. Patients in the experimental group were twice as likely to recover (p < 0.0001), had negative PCR after 14 vs. 21 days, and had 0 vs. 27 hospitalizations. Speaking of low p-values, some people did fraud-detection tests on another of Cadegiani’s COVID-19 studies and got values like p < 8.24E-11 in favor of it being fraudulent. And, uh, he’s also studied whether ultra-high-dose antiandrogens treated COVID, and found that they did, cutting mortality by 92% . But the trial is under suspicion, with a BMJ article calling it “[the worst] violations of medical ethics and human rights in Brazil’s history” and “an ethical cesspit of violations”. [update 2022: this section originally contained more accusations against Cadegiani. Alexandros Marinos does a deeper dive with information not available at the time I wrote this, and finds some of them were overstated or false by implication] Anyway, let’s not base anything important on the results of this study, mmkay? A defiant Flavio Cadegiani. Imagine a guy who looks like this telling you to take ultra-high-dose antiandrogens. Ahmed et al: And we’re back in Bangladesh. 72 hospital patients were randomized to one of three arms: ivermectin only, ivermectin + doxycycline, and placebo. Primary endpoint was time to negative PCR, which was 9.7 days for ivermectin only and 12.7 days for placebo (p = 0.03). Other endpoints including duration of hospitalization (9.6 days ivermectin vs. 9.7 days placebo, not significant). This looks pretty good for ivermectin and does not have any signs of fraud or methodological problems. If I wanted to pick at it anyway, I would point out that the ivermectin + doxycycline group didn’t really differ from placebo, and that if you average out both ivermectin groups (with and without doxycycline) it looks like the difference would not be significant. I had previously committed to considering only ivermectin alone in trials that had multiple ivermectin groups, so I’m not going to do this. I can’t find any evidence this trial was preregistered so I don’t know whether they waited to see what would come out positive and then made that their primary endpoint, but virological clearance is a pretty normal primary endpoint and this isn’t that suspicious. It’s impossible to find any useful commentary on this study because Elgazzar (the guy who ran the most famous fraudulent ivermectin study) had the first name Ahmed, everyone is talking about Elgazzar all the time, and this overwhelms Google whenever I try to search for Ahmed et al. For now I’ll just keep this as a mildly positive and mildly plausible virological clearance result, in the context of no effect on hospitalization length or most symptoms. Chaccour et al: 24 patients in Spain were randomized to receive either medium-dose ivermectin or placebo. The primary outcome was percent of patients with negative PCR at day 7; secondary outcomes were viral load and symptoms. The primary endpoint ended up being kind of a wash - everyone still PCR positive by day 7 so it was impossible to compare groups. Ivermectin trended toward lower viral load but never reached significance. Weirdly, ivermectin did seem to help symptoms, but only anosmia and cough towards the end (p = 0.03), which you would usually think of as lingering post-COVID problems. The paper says: Given these findings, consideration could be given to alternative mechanisms of action different from a direct antiviral effect. One alternative explanation might be a positive allosteric modulation of the nicotinic acetylcholine receptor caused by ivermectin and leading to a downregulation of the ACE-2 receptor and viral entry into the cells of the respiratory epithelium and olfactory bulb. Another mechanism through which ivermectin might influence the reversal of anosmia is by inhibiting the activation of pro-inflammatory pathways in the olfactory epithelium. Inflammation of the olfactory mucosa is thought to play a key role in the development of anosmia in SARS-CoV-2 infection This seems kind of hedge-y. If you’re wondering where things went from there, Dr. Chaccour is now a passionate anti-ivermectin activist: @Finneganporter in @BusinessInsider \n\nThe roots of #ivermectin mania: How South America incubated a fake-medicine craze that took the US by storm\n\n","username":"carlos_chaccour","name":"Dr. Carlos Chaccour ??????","profile_image_url":"","date":"Sun Nov 07 18:40:28 +0000 2021","photos":[],"quoted_tweet":{},"reply_count":0,"retweet_count":2,"like_count":9,"impression_count":0,"expanded_url":{"url":"https://www.businessinsider.in/international/news/the-roots-of-ivermectin-mania-how-south-america-incubated-a-fake-medicine-craze-that-took-the-us-by-storm/articleshow/87554081.cms","image":"https://bucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com/public/images/88d08e70-c9e2-46d4-a5df-96807b6c3a13_2000x1000.jpeg","title":"The roots of ivermectin mania: How South America incubated a fake-medicine craze that took the US by storm","description":"The popularity of unproven anti-parasitic drug ivermectin as a COVID-19 treatment is surging. Its use has roots in South America, where it was hyped by populist","domain":"businessinsider.in"},"video_url":null,"belowTheFold":true}" data-component-name="Twitter2ToDOM"> So I guess he must think of this trial as basically negative, although realistically it’s 24 people and we shouldn’t put too much weight on it either way. Ghauri et al: Pakistan, 95 patients. Nonrandom; the study compared patients who happened to be given ivermectin (along with hydroxychloroquine and azithromycin) vs. patients who were just given the latter two drugs. There’s some evidence this produced systematic differences between the two groups - for example, patients in the control group were 3x more likely to have had diarrhea (this makes sense; diarrhea is a potential ivermectin side effect, so you probably wouldn’t give it to people already struggling with this problem). Also, the control group was twice as likely to be getting corticosteroids, maybe a marker for illness severity. Primary outcome was what percent of both groups had a fever: on day 7 it was 21% of ivermectin patients vs. 65% of controls, p < 0.001. No other outcomes were reported. I don’t hate this study, but I think the nonrandom assignment (and observed systematic differences) is a pretty fatal flaw. I can’t find anyone else talking about this one. At least no one seems to be saying anything bad. Babaloba et al: Be warned: if I have to refer to this one in real-life conversation, I will expand out the “et al” and call it “Babalola & Alakoloko”, because that’s really fun to say. This was a Nigerian RCT comparing 21 patients on low-dose ivermectin, 21 patients on high-dose ivermectin, and 20 patients on a combination of lopinavir and ritonavir, a combination antiviral which later studies found not to work for COVID and which might as well be considered a placebo. Primary outcome, as usual, was days until a negative PCR test. High dose ivermectin was 4.65 days, low dose was 6 days, control was 9.15, p = 0.035. Figure 2 is apparently a photograph of the computer screen where they did this calculation. Gideon Meyerowitz-Katz, part of the team that detects fraud in ivermectin papers, is not a fan of this one: He doesn’t say there what means, but elsewhere he tweets this figure: It’s always a bad sign when your study features in an image with “NUMEROUS IMPOSSIBLE NUMBERS” in red at the top. I think his point is that if you have 21 people, it’s impossible to have 50% of them have headache, because that would be 10.5. If 10 people have a headache, it would be 47.6%; if 11, 52%. So something is clearly wrong here. Seems like a relatively minor mistake, and Meyerowitz-Katz stops short of calling fraud, but it’s not a good look. I’m going to be slightly uncomfortable with this study without rejecting it entirely, and move on. Ravakirti et al: Here we’re in Eastern India - not exactly Bangladesh again, but a stone’s throw away from it. In this RCT patients were randomized into an ivermectin group (57) and a placebo group (58). Primary outcome was negative PCR on day 6, because doing it on day 7 like everyone else would be too easy. As with several other groups, this was a bad move; too few people had it to make a good comparison; it was 13% of intervention vs. 18% of placebo, p = 0.3. Secondary outcomes were also pretty boring, except for the most important: 4 people in the placebo group died, compared to 0 in ivermectin (p = 0.045). On the one hand, this is one outcome of many, reaching the barest significance threshold. Another fluke? Still, there are no real problems with this study, and nobody has anything to say against it. Let’s add this one to the scale as another very small and noisy piece of real evidence in ivermectin’s favor. Bukhari et al: Now we’re in Pakistan. 50 patients were randomized to low-dose ivermectin, another 50 got standard of care including vitamin D. There was no placebo, but primary outcome was number of days to reach negative PCR, which it seems hard for placebo to affect much, so I don’t care. 5 controls and 9 ivermectin patients left the hospital against medical advice and could not be followed up, which is bad but not necessarily study-ruining. They never measured their supposed primary outcome of “days to reach negative PCR” directly, but they did measure how many people had negative PCR on various days, and ivermectin had a clear advantage - for example, on day 7, it was 37/50 for IVR and only 20/50 for control. Even if we assume all the lost-to-followup patients had maximally bad-for-the-hypothesis results, that’s still a positive finding. Nobody else has much to say about this one, certainly no accusations that they’ve found anything suspicious. Keep. Mohan et al: India. RCT. 40 patients got low-dose ivermectin, 40 high-dose ivermectin, and 45 placebo. Primary outcomes were time to negative PCR, and viral load on day 5. In the results, they seem to have reinterpreted “time to negative PCR” as the subtly different “percent with negative PCR on some specific day”. High-dose ivermectin did best (47.5% negative on day 5) and placebo worst (31% negative), but it was insignificant (p = 0.3). There was no difference in viral load. All groups took about the same amount of time for symptoms to resolve. More placebo patients had failed to recover by the end of the study (6) than ivermectin patients (2), but this didn’t reach statistical significance (p = 0.4). Overall a well-done, boring, negative study, although ivermectin proponents will correctly point out that, like basically every other study we have looked at, the trend was in favor of ivermectin and this could potentially end up looking impressive in a meta-analysis. Biber et al: This is an RCT from Israel. 47 patients got ivermectin and 42 placebo. Primary endpoint was viral load on day 6. I am having trouble finding out what happened with this; as far as I can tell it was a negative result and they buried it in favor of more interesting things. In a "multivariable logistic regression model, the adjusted odds ratio of negative SARS-CoV-2 RT-PCR negative test" favored ivermectin over placebo (p = 0.03 for day 6, p = 0.01 for day 8), but this seems like the kind of thing you do when your primary outcome is boring and you’re angry. Gideon Meyerowitz-Katz is not a fan: He notes that the study excluded people with high viral load, but the preregistration didn’t say they would do that. Looking more closely, he finds they did that because, if you included these people, the study got no positive results. So probably they did the study, found no positive results, re-ran it with various subsets of patients until they did get a positive result, and then claimed to have “excluded” patients who weren’t in the subset that worked. I’m going to toss this one. Elalfy et al: What even is this? Where am I? As best I can tell, this is some kind of Egyptian trial. It might or might not be an RCT; it says stuff like “Patients were self-allocated to the treatment groups; the first 3 days of the week for the intervention arm while the other 3 days for symptomatic treatment”. Were they self-allocated in the sense that they got to choose? Doesn’t that mean it’s not random? Aren’t there seven days in a week? These are among the many questions that Elalfy et al do not answer for us. The control group (which they seem to think can also be called “the white group”) took zinc, paracetamol, and maybe azithromycin. The intervention group took zinc, nitazoxanide, ribavirin, and ivermectin. There were very large demographic differences between the groups of the sort which make the study unusable, which they mention and then ignore. From there, they follow this normal and totally comprehensible flowchart: There is no primary outcome assigned, but viral clearance rates on day seven were 58% in the yellow group compared to 0% in the white group, which I guess is a strong positive result. This table… …looks very impressive, in terms of the experimental group doing better than the control, except that they don’t specify whether it was before the trial or after it, and at least one online commentator thinks it might have been before, in which case it’s only impressive how thoroughly they failed to randomize their groups. Overall I don’t feel bad throwing this study out. I hope it one day succeeds in returning to its home planet. Lopez-Medina et al: Colombian RCT. 200 patients took ivermectin, another 200 took placebo. They originally worried the placebo might taste different than real ivermectin, then solved this by replacing it with a different placebo, which is a pretty high level of conscientiousness. Primary outcome was originally percent of patients whose symptoms worsened by two points, as rated on a complicated symptom scale when a researcher asked them over the phone. Halfway through the study, they realized nobody was worsening that much, so they changed the primary outcome to time until symptoms got better, as measured by the scale. In the ivermectin group, symptoms improved that much after 10 days; in the placebo group, after 12, p = 0.53. By the end of the study, symptoms had improved in 82% of ivermectin users and 79% of controls, also insignificant. 4 patients in the ivermectin group needed to be hospitalized compared to 6 in the placebo group, again insignificant. This study is bigger than most of the other RCTs, and more polished in terms of how many spelling errors, photographs of computer screens, etc, it contains. It was published in JAMA, one of the most prestigious US medical journals, as opposed to the crappy nth-tier journals most of the others have been in. When people say things like “sure, a lot of small studies show good results for ivermectin, but the bigger and more professional trials don’t”, this is one of the two big professional trials they’re talking about. Ivermectin proponents make some good arguments against it. In order to get as big as it did, Lopez-Medina had to compromise on rigor. Its outcome is how people self-score their symptoms on a hokey scale in a phone interview, instead of viral load or PCR results or anything like that. Still, this is basically what we want, right? In the end, we want people to feel better and less sick, not to get good scores on PCR tests. Also, it changed its primary outcome halfway through; isn’t that bad? I think maybe not; the reason we want a preregistered primary outcome is so that you don’t change halfway through to whatever outcome shows the results you want. The researchers in this study did a good job explaining why they changed their outcome, the change makes sense, and their original outcome would also have shown ivermectin not working (albeit less accurately and effectively). I don’t know of any evidence that they knew (or suspected) final results when switching to this new outcome, and it seems like the most reasonable new outcome to switch to. Finally, their original placebo tasted different from ivermectin (though they switched halfway through). This is one of the few studies where I actually care about placebo, because people are self-rating their symptoms. But realistically most of these people don’t know what ivermectin is supposed to taste like. Also, they did a re-analysis and found there was no difference between the people who got the old placebo and the new one. I’m making a big deal of this because ivmmeta.com - the really impressive meta-analysis site I’ve been going off of - puts a special warning letter underneath their discussion of this study, urging us not to trust it. They don’t do this for any of the other ones we’ve addressed so far - not the one by the guy whose other studies were all frauds, not the one where 50% of 21 people had headaches, not the unrandomized one where the groups were completely different before the experiment started, not even the one by the guy accused of crimes against humanity. Only this one. This makes me a lot less charitable to ivmmeta than I would otherwise be; I think it’s hard to choose this particular warning letter strategy out of well-intentioned commitment to truth. They just really don’t like this big study that shows ivermectin doesn’t work. Also, the warning itself irritates me, and includes paragraphs like: RCTs have a fundamental bias against finding an effect for interventions that are widely available — patients that believe they need treatment are more likely to decline participation and take the intervention [Yeh], i.e., RCTs are more likely to enroll low-risk participants that do not need treatment to recover (this does not apply to the typical pharmaceutical trial of a new drug that is otherwise unavailable). This trial was run in a community where ivermectin was available OTC and very widely known and used. Nobody else worries about this, and there are a million biases that non-randomized studies have that would be super-relevant when discussing those, but somehow when they’re pro-ivermectin the site forgets to be this thorough. I think a better pro-ivermectin response to this study is to point out that all the trends support ivermectin. Symptoms took 10 days to resolve in the ivermectin group vs. 12 in placebo; 4 ivermectin patients were hospitalized vs. 6 placebo patients, etc. Just say that this was an unusually noisy trial because of the self-report methodology, and you’re confident that these small differences will add up to significance when you put them into a meta-analysis. Roy et al: We’re back in East India, and back to non-randomized trials. 56 patients were retrospectively examined; some had been given ivermectin + doxycycline, others hydroxychloroquine, other azithromycin, and others symptomatic treatment only. We don’t get any meaningful information about how this worked, but we are told that they did not differ in “clinical well-being reporting onset timing”. Whatever. Chahla et al: The first of many Argentine trials. 110 patients received medium-dose ivermectin; 144 were kept as a control (no placebo). This was “cluster randomized”, which means they randomize different health centers to either give the experimental drug or not. This is worse than regular randomization, because there could be differences between these health centers (eg one might have better doctors who otherwise give better treatment, one might be in the poor part of town and have sicker patients, etc). They checked to see if there were any differences between the groups, and it sure looks like there were (the experimental group had twice as many obese people as the controls), but as per them, these differences were not statistically significant. Note that if this did make a difference, it would presumably make ivermectin look worse, not better. The primary outcome was given as “increase discharge from outpatient care with COVID-19 mild disease”. This favored the treatment; only 2/110 patients in the ivermectin group failed to be discharged, compared to 20 patients in the control group. But, uh, these were at different medical centers. Can’t different medical centers just have different discharge policies? One discharges you as soon as you seem to be getting better, the other waits to really make sure? This is an utterly crap endpoint to do a cluster randomized controlled trial on. If you’re going to do cRCT, which is never a great idea, you should be using some extremely objective endpoint that doctors and clinic administrators can’t possibly affect, like viral load according to some third-party laboratory, using the same third-party laboratory for both clinics. This is such a bad idea that I can’t help worrying I’m missing or misunderstanding something. If not, this is dumb and bad and should be ignored. Mourya et al: We’re back in India. This is a nonrandomized study comparing 50 patients given ivermectin to 50 patients given hydroxychloroquine. No primary outcome was named, but they focus on PCR negativity. Only 6% of patients in the hydroxychloroquine group were negative, compared to 90% of patients in the ivermectin group! On what day did they do the test? Uh, kind of random, and they admit that “in [the hydroxychloroquine group], mean time difference from the date of initiation of treatment and second test was significantly longer (7.24±2.75 days) as compared to 5.22±1.21 days in [the ivermectin group] (p=0.021).” Since they assessed these groups at different times, we shouldn’t draw any conclusions from them getting different results. Except that as far as I can tell this should handicap ivermectin, making it especially impressive that it did better. But also, the ivermectin group was made mostly of people who had been asymptomatic at the beginning (70%), and the hydroxychloroquine group had almost no asymptomatic cases (8%) . They were giving the ivermectin to healthy people and the hydroxychloroquine to sick people! They admit deep in the discussion that this “may be a confounding factor”. So basically they got totally different groups of people, tested them at totally different times, and the two sets of test results differed. So what? So this is why normal people do RCTs instead of whatever the heck this is, that’s what. Loue et al: …this one isn’t going to be an RCT either. Loue tells a story about a cluster of COVID cases at the French nursing home where he works. He asked people if they wanted to try ivermectin; 10 did and 15 didn’t. 1 ivermectin patient died, compared to 5 non-ivermectin patients. The non-ivermectin group looked a bit sicker than the ivermectin group in the inevitable Table 1, though it’s hard to tell. One interesting possible confounder (not mentioned, but I’m imagining it) is that demented patients probably couldn’t consent to ivermectin and ended up in the control group. This is another case of “I’m not going to trust anything that isn’t an RCT”. Merino et al: Another (sigh) non-RCT. Mexico City tried a public health program where if you called a hotline and said you had COVID, they sent you an emergency kit with various useful supplies. One of those supplies was ivermectin tablets. 18,074 people got the kit (and presumably some appreciable fraction took the ivermectin, though there’s no way to prove that). Their control group is people from before they started giving out the kits, people from after they stopped giving out the kits, and people who didn’t want the kits. There are differences in who got COVID early in the epidemic vs. later, and in people who did opt for medical kits vs. didn’t. To correct these, the researchers tried to adjust for confounders, something which - as I keep trying to hammer home again and again - never works. They found that using the kit led to a 75% or so reduction in hospitalization, though they were unable to separate out the ivermectin from the other things in the kit (paracetamol and aspirin), or from the placebo effect of having a kit and feeling like you had already gotten some treatment (if I understand right, the decision to go to the hospital was left entirely to the patient). I think this study is a moderate point in favor of giving people kits in order to prevent hospital overcrowding, but I’m not willing to accept that it tells us much about ivermectin in particular. Faisal et al: This one was published in The Professional Medical Journal (mispelled as “Profesional Medical Journal” in its URL), so you know it’s going to be good! It describes itself as “a cross-sectional study”, but later says it “randomized patients into two groups”, which would make it an RCT - I think they might just be using the term “cross-sectional” different from the standard American usage. A hospital in Pakistan got 50 patients on ivermectin + azithromycin, and another 50 on azithromycin alone. Primary outcome was not mentioned, and the data were presented confusingly, but a typical result is that only 4% of the ivermectin group had symptoms lasting more than 10 days, whereas 16% of the control group did, p < 0.01. They do a really weird thing where they compare how long it took symptoms to resolve between IVM and control groups within each bin. That is, if I’m understanding correctly, they ask “of the people who took between 3-5 days for symptoms to resolve, did they resolve faster for IVM or control?”. This is an utterly bizarre analysis to perform, although it doesn’t affect the fact that their other results still seem to favor ivermectin. Maybe I’m confused about what’s going on here. I’ve mostly been letting people off easy on no placebo, but I as far as I can tell (not very far) this paper seems to be going off whether patients reported continuing to have symptoms to the hospital doing the study, and I think that is potentially susceptible to placebo effects. Additionally, there’s no preregistration, and even though they talk a lot about doing PCR tests they don’t present the results. This is by no means the worst study here but I still think it’s pretty low quality and I don’t trust it. Aref et al: This one is published in the International Journal Of Nanomedicine, even though I’m pretty sure that isn’t a real thing. In this case the “nanomedicine” is a new nasal spray version of ivermectin which is so confusing I cannot for the life of me figure out what dose they are giving these patients. This Egyptian study gives 57 patients intranasal ivermectin plus hydroxychloroquine, azithromycin, oseltamavir, and some vitamins; another 57 patients get all that stuff except the ivermectin. Primary outcome is not stated, but they look at various symptoms, all of which look better in the ivermectin group: 95% of ivermectin patients got negative PCRs at some time point, compared to 75% of controls, p = 0.004. I am pretty suspicious of this study, not least because it comes from Egypt which has an awful reputation for fake studies, and it returns extreme results that I wouldn’t expect even if ivermectin was actually a wonder drug. But I cannot find any particular thing wrong with it, nor did anyone else I looked at, so I will grudgingly let it stand. Krolewiecki et al: Another Argentine study. This one is a real RCT. 30 patients received ivermectin, 15 were the control group (no placebo, again). Primary outcome was difference in viral load on day 5. The trend favored ivermectin but it was not statistically significant, although they were able to make it statistically significant if they looked at a subset of higher-IVM-plasma-concentration patients. They did not find any difference in clinical outcomes. A pro-ivermectin person could point out that in the subgroup with the highest ivermectin concentrations, the drug seemed to work. A skeptic could point out that this is exactly the kind of subgroup slicing that you are not supposed to do without pre-registering it, which I don’t think this team did. I agree with the skeptic. Vallejos et al: Another Argentine study. It’s big (250 people in each arm). It’s an RCT. It tries to define a primary outcome (“Primary outcome: the trial ended when the last patient who was included achieved the end of study visit”), but that’s not what “primary outcome” means, and they don’t offer an alternative. Other outcomes: no difference in PCR on days 3 or 12. Hospitalization is nonsignificantly better in the ivermectin group (14 vs. 21, p = 0.2), but death is nonsigificantly better in the placebo group (3 vs. 4, p = 0.7). This isn’t even the kind of nonsignificant that might contribute to an exciting meta-analysis later. This is just a pure null result. I cannot find any problem with this study, and neither can anyone else I checked. This is the biggest RCT we’ve seen so far, so we should take it seriously. TOGETHER Trial: Speaking of big RCTs… This one hasn’t been published yet. There’s a video of a talk about it, but I am not going to watch it, because it is a video, so I am getting information secondhand from eg here. Apparently, it compares 677 people (!) randomized to ivermectin to 678 people randomized to placebo. 86 ivermectin patients ended up in the hospital compared to 95 placebo patients, p-value not significant. This was a really big professional trial done by bigshot researchers from a major Canadian university, and the medical establishment is taking it much more seriously than any of these others. When it comes out, it will probably get published in a top journal. When discussing Lopez-Medina, I wrote: When people say things like “sure, a lot of small studies show good results for ivermectin, but the bigger and more professional trials don’t”, this is one of the two big professional trials they’re talking about. This is the other one. Not coincidentally, it’s also the other trial that ivmmeta.com has a warning letter underneath telling you to disregard. Their main concern is that instead of truly randomizing patients to ivermectin vs. placebo, they did a time-dependent randomization that meant during some weeks more patients were getting one or the other. This is a problem because the trial takes place in Brazil, where different variants were more common at different times. Here’s their image: On the one hand, I have immense contempt for ivmmeta for letting all those other awful studies pass and then pulling out all the stops to try to nitpick this one. I have no idea if their proposed randomization failure really happened. And no doubt the reason they’re even able to investigate this is that this study is really careful and transparent - most of them don’t tell you anything about their randomization method. I would be shocked if other studies don’t have all these problems and worse. On the other hand, the point isn’t to be fair, it’s to be right. And this is a potential confounder. Not a huge one. But a potential one. I guess all we can do is try to bound the damage. Even if the confounding is 100% real and bad, there’s no way to make this study consistent with the crazy super-pro-ivermectin results of studies like Espitia-Hernandez and Aref. And even if we deny any confounding, we see the same slight pro-ivermectin trend - 86 hospitalizations vs. 95 - that we’ve seen in so many other studies. Nothing is going to make me believe that this isn’t in the top 33% of studies we’ve been looking at, so let’s add it as grist for the meta-analysis (though maybe not quite as much grist as its vast size indicates) and move on, angrily. Buonfrate et al: An Italian RCT. Patients were randomized into low-dose ivermectin (32), placebo (29), or high-dose ivermectin (32). Primary outcome was viral load on day 7. There was no significant difference (average of 2 in ivermectin groups, 2.2 in placebo group). They admit that they failed to reach the planned sample size, but did a calculation to show that even if they had, the trial could not have returned a positive result. Clinically, an average of 2 patients were hospitalized in each of the ivermectin arms, compared to 0 in the placebo arm - which bucks our previously-very-constant pro-ivermectin trend. Mayer et al: Not an RCT. Patients in an Argentine province were offered the opportunity to try ivermectin; 3266 said yes and become the experimental group, 17966 said no and became the control group. There were many obvious differences between the groups, but they all seemed to handicap ivermectin. There was a nonsignificant trend toward less hospitalization and significantly less mortality (1.5% vs. 2.1%, p = 0.03). While looking into this study, I learned the term “immortal time bias”. This means a period in between selection for the study and the beginning of study recording where patient outcomes are not counted. I think the problem here is that if you signed up for the system on Day X, and if you got sick before they could give you ivermectin, you were in the control group. See this Twitter thread, I have not confirmed everything he says. This only hardens my resolve to stay away from non-RCTs. Borody et al: Our last paper! …is it a paper? I can’t find it published anywhere. It mostly seems to be on news sites. Doesn’t look peer-reviewed. And it starts with “Note that views expressed in this opinion article are the writer’s personal views”. Whatever. 600 Australians were treated with ivermectin, doxycycline, and zinc. The article compares this to an “equivalent control group” made of “contemporary infected subjects in Australia obtained from published Covid Tracking Data”; this is not how you control group, @#!% you. Then it gets excited about the fact that most patients had better symptoms at the end of the ten-day study period than the beginning (untreated COVID resolves in about ten days). Why are these people wasting my time with this? Let’s move on. The Analysis If we remove all fraudulent and methodologically unsound studies from the table above, we end up with this: Gideon Meyerowitz-Katz, who investigated many of the studies above for fraud, tried a similar exercise. I learned about his halfway through, couldn’t help seeing it briefly, but tried to avoid remembering it or using it when generating mine (also, I did take the result of his fraud investigations into account), so they should be considered not quite independent efforts. His looks like this: He nixed Chowdhury, Babaloba, Ghauri, Faisal, and Aref, but kept Szenta Fonseca, Biber (?), and Mayer. There was correlation of 0.45, which I guess is okay. I asked him about his decision-making, and he listed a combination of serious statistical errors and small red flags adding up. I was pretty uncomfortable with most of these studies myself, so I will err on the side of severity, and remove all studies that either I or Meyerowitz-Katz disliked. We end up with the following short list: We’ve gone from 29 studies to 11, getting rid of 18 along the way. For the record, we eliminated 2/19 for fraud, 1/19 for severe preregistration violations, 10 for methodological problems, and 6 because Meyerowitz-Katz was suspicious of them. …but honestly this table still looks pretty good for ivermectin, doesn’t it? Still lots of big green boxes. Meyerowitz-Katz accuses ivmmeta of cherry-picking what statistic to use for their forest plot. That is, if a study measures ten outcomes, they sometimes take the most pro-ivermectin outcome. Ivmmeta.com counters that they used a consistent and reasonable (if complicated) process for choosing their outcome of focus, that being: If studies report multiple kinds of effects then the most serious outcome is used in calculations for that study. For example, if effects for mortality and cases are both reported, the effect for mortality is used, this may be different to the effect that a study focused on. If symptomatic results are reported at multiple times, we used the latest time, for example if mortality results are provided at 14 days and 28 days, the results at 28 days are used. Mortality alone is preferred over combined outcomes. Outcomes with zero events in both arms were not used (the next most serious outcome is used — no studies were excluded). For example, in low-risk populations with no mortality, a reduction in mortality with treatment is not possible, however a reduction in hospitalization, for example, is still valuable. Clinical outcome is considered more important than PCR testing status. When basically all patients recover in both treatment and control groups, preference for viral clearance and recovery is given to results mid-recovery where available (after most or all patients have recovered there is no room for an effective treatment to do better). If only individual symptom data is available, the most serious symptom has priority, for example difficulty breathing or low SpO2 is more important than cough. I’m having trouble judging this, partly because Meyerowitz-Katz says ivmmeta has corrected some earlier mistakes, and partly because there really is some reasonable debate over how to judge studies with lots of complicated endpoints. By this point I had completely forgotten what ivmmeta did, so I independently coded all 11 remaining studies following something in between my best understanding of their procedure and what I considered common sense. The only exception was that when the most severe outcome was measured in something other than patients (ie average number of virus copies per patient), I defaulted to one that was measured in patients instead, to keep everything with the same denominator. My results mostly matched ivmmeta’s, with one or two exceptions that I think are within the scope of argument or related to my minor deviations from their protocol. Placebo vs. ivermectin groups sometimes differed in size, which I’ve adjusted for and rounded off. Probably I’m forgetting some reason I can’t just do simple summary statistics to this, but whatever. It is p = 0.15, not significant. This is maybe unfair, because there aren’t a lot of deaths in the sample, so by focusing on death rather than more common outcomes we’re pointlessly throwing away sample size. What happens if I unprincipledly pick whatever I think the most reasonable outcome to use from each study is? I’ve chosen “most reasonable” as a balance between “is the most severe” and “has a lot of data points”: Now it’s p = 0.04, seemingly significant, but I had to make some unprincipled decisions to get there. I don’t think I specifically replaced negative findings with positive ones, but I can’t prove that even to myself, let alone to you. [UPDATE 5/31/22: A reader writes in to tell me that the t-test I used above is overly simplistic. A Dersimonian-Laird test is more appropriate for meta-analysis, and would have given 0.03 and 0.005 on the first and second analysis, where I got 0.15 and 0.04. This significantly strengthens the apparent benefit of ivermectin from ‘debatable’ to ‘clear’. I discuss some reasons below why I am not convinced by this apparent benefit.] (how come I’m finding a bunch of things on the edge of significance, but the original ivmmeta site found a lot of extremely significant things? Because they combined ratios, such that “one death in placebo, zero in ivermectin” looked like a nigh-infinite benefit for ivermectin, whereas I’m combining raw numbers. Possibly my way is statistically illegitimate for some reason, but I’m just trying to get a rough estimate of how convinced to be) So we are stuck somewhere between “nonsignificant trend in favor” and “maybe-significant trend in favor, after throwing out some best practices”. This is normally where I would compare my results to those of other meta-analyses made by real professionals. But when I look at them, they all include studies later found to be fake, like Elgazzar, and unsurprisingly come up with wildly positive conclusions. There are about six in this category. One of them later revised their results to exclude Elgazzar and still found strong efficacy for ivermectin, but they still included Niaee and some other dubious studies. The only meta-analysis that doesn’t make these mistakes is Popp (a Cochrane review), which is from before Elgazzar was found to be fraudulent, but coincidentally excludes it for other reasons. It also excludes a lot of good studies like Mahmud and Ravakirti because they give patients other things like HCQ and azithromycin - I chose to include them, because I don’t think they either work or have especially bad side effects, so they’re basically placebo - but Cochrane is always harsh like this. They end up with a point estimate where ivermectin cuts mortality by 40% - but say the confidence intervals are too wide to draw any conclusion. I think this basically agrees with my analyses above - the trends really are in ivermectin’s favor, but once you eliminate all the questionable studies there are too few studies left to have enough statistical power to reach significance. Except that everyone is still focusing on deaths and hospitalizations just because they’re flashy. Mahmud et al, which everyone agrees is a great study, found that ivermectin decreased days until clinical recovery, p = 0.003? So what do you do? This is one of the toughest questions in medicine. It comes up again and again. You have some drug. You read some studies. Again and again, more people are surviving (or avoiding complications) when they get the drug. It’s a pattern strong enough to common-sensically notice. But there isn’t an undeniable, unbreachable fortress of evidence. The drug is really safe and doesn’t have a lot of side effects. So do you give it to your patients? Do you take it yourself? Here this question is especially tough, because, uh, if you say anything in favor of ivermectin you will be cast out of civilization and thrown into the circle of social hell reserved for Klan members and 1/6 insurrectionists. All the health officials in the world will shout “horse dewormer!” at you and compare you to Josef Mengele. But good doctors aren’t supposed to care about such things. Your only goal is to save your patient. Nothing else matters. I am telling you that Mahmud et al is a good study and it got p = 0.003 in favor of ivermectin. You can take the blue pill, and stay a decent respectable member of society. Or you can take the horse dewormer pill, and see where you end up. In a second, I’ll tell you my answer. But you won’t always have me to answer questions like this, and it might be morally edifying to observe your thought process in situations like this. So take a second, and meet me on the other side of the next section heading. … … … … … The Synthesis Hopefully you learned something interesting about yourself there. But my answer is: worms! As several doctors and researchers have pointed out (h/t especially Avi Bitterman and David Boulware), the most impressive studies come from places that are teeming with worms. Mahmud from Bangladesh, Ravakirti from East India, Lopez-Medina from Colombia, etc. Here’s the prevalence of roundworm infections by country (source). But alongside roundworms, there are threadworms, hookworms, blood flukes, liver flukes, nematodes, trematodes, all sorts of worms. Add them all up and somewhere between half and a quarter of people in the developing world have at least one parasitic worm in their body. Being full of worms may impact your ability to fight coronavirus. Gluchowska et al write: Helminth [ie worm] infections are among the most common infectious diseases. Bradbury et al. highlight the possible negative interactions between helminth infection and COVID-19 severity in helminth-endemic regions and note that alterations in the gut microbiome associated with helminth infection appear to have systemic immunomodulatory effects. It has also been proposed that helminth co-infection may increase the morbidity and mortality of COVID-19, because the immune system cannot efficiently respond to the virus; in addition, vaccines will be less effective for these patients, but treatment and prevention of helminth infections might reduce the negative effect of COVID-19. During millennia of parasite-host coevolution helminths evolved mechanisms suppressing the host immune responses, which may mitigate vaccine efficacy and increase severity of other infectious diseases. Treatment of worm infections might reduce the negative effect of COVID-19! And ivermectin is a deworming drug! You can see where this is going… The most relevant species of worm here is the roundworm Strongyloides stercoralis. Among the commonest treatments for COVID-19 is corticosteroids, a type of immunosuppresant drug. The types of immune responses it suppresses do more harm than good in coronavirus, so turning them off limits collateral damage and makes patients better on net. But these are also the types of immune responses that control Strongyloides. If you turn them off even very briefly, the worms multiply out of control, you get what’s called “Strongyloides hyperinfection”, and pretty often you die. According to the WHO: The current COVID-19 pandemic serves to highlight the risk of using systemic corticosteroids and, to a lesser extent, other immunosuppressive therapy, in populations with significant risk of underlying strongyloidiasis. Cases of strongyloidiasis hyperinfection in the setting of corticosteroid use as COVID-19 therapy have been described and draw attention to the necessity of addressing the risk of iatrogenic strongyloidiasis hyperinfection syndrome in infected individuals prior to corticosteroid administration. Although this has gained importance in the midst of a pandemic where corticosteroids are one of few therapies shown to improve mortality, its relevance is much broader given that corticosteroids and other immunosuppressive therapies have become increasingly common in treatment of chronic diseases (e.g. asthma or certain rheumatologic conditions). So you need to “address the risk” of strongyloides infection during COVID treatment in roundworm-endemic areas. And how might you address this, WHO? Treatment of chronic strongyloidiasis with ivermectin 200 µg/kg per day orally x 1-2 days is considered safe with potential contraindications including possible Loa loa infection (endemic in West and Central Africa), pregnancy, and weight <15kg. Given ivermectin’s safety profile, the United States has utilized presumptive treatment with ivermectin for strongyloidiasis in refugees resettling from endemic areas, and both Canada and the European Centre for Disease Prevention and Control have issued guidance on presumptive treatment to avoid hyperinfection in at risk populations. Screening and treatment, or where not available, addition of ivermectin to mass drug administration programs should be studied and considered. This is serious and common enough that, if you’re not going to screen for it, it might be worth “add[ing] ivermectin to mass drug administration programs” in affected areas! Dr. Avi Bitterman carries the hypothesis to the finish line: First two images are with all relevant studies; second two are a sensitivity analysis that removes some of the most dubious. The good ivermectin trials in areas with low Strongyloides prevalence, like Vallejos in Argentina, are mostly negative. The good ivermectin trials in areas with high Strongyloides prevalence, like Mahmud in Bangladesh, are mostly positive. Worms can’t explain the viral positivity outcomes (ie PCR), but Dr. Bitterman suggests that once you remove low quality trials and worm-related results, the rest looks like simple publication bias: This is still just a possibility. Maybe I’m over-focusing too hard on a couple positive results and this will all turn out to be nothing. Or who knows, maybe ivermectin does work against COVID a little - although it would have to be very little, fading to not at all in temperate worm-free countries. But this theory feels right to me. It feels right to me because it’s the most troll-ish possible solution. Everybody was wrong! The people who called it a miracle drug against COVID were wrong. The people who dismissed all the studies because they F@#king Love Science were wrong. Ivmmeta.com was wrong. Gideon Meyerowitz-Katz was…well, he was right, actually, I got the worm-related meta-analysis graphic above from his Twitter timeline. Still, an excellent troll. Also, the best part is that I ignorantly asked, in my description of Mahmud et al above: And it was! It was a fluke! A literal, physical, fluke! For my whole life, God has been placing terrible puns in my path to irritate me, and this would be the worst one ever! So it has to be true! The Scientific Takeaway About ten years ago, when the replication crisis started, we learned a certain set of tools for examining studies. Check for selection bias. Distrust “adjusting for confounders”. Check for p-hacking and forking paths. Make teams preregister their analyses. Do forest plots to find publication bias. Stop accepting p-values of 0.049. Wait for replications. Trust reviews and meta-analyses, instead of individual small studies. These were good tools. Having them was infinitely better than not having them. But even in 2014, I was writing about how many bad studies seemed to slip through the cracks even when we pushed this toolbox to its limits. We needed new tools. I think the methods that Meyerowitz-Katz, Sheldrake, Heathers, Brown, Lawrence and others brought to the limelight this year are some of the new tools we were waiting for. Part of this new toolset is to check for fraud. About 10 - 15% of the seemingly-good studies on ivermectin ended up extremely suspicious for fraud. Elgazzar, Carvallo, Niaee, Cadegiani, Samaha. There are ways to check for this even when you don’t have the raw data. Like: The Carlisle-Stouffer-Fisher method: Check some large group of comparisons, usually the Table 1 of an RCT where they compare the demographic characteristics of the control and experimental groups, for reasonable p-values. Real data will have p-values all over the map; one in every ten comparisons will have a p-value of 0.1 or less. Fakers seem bad at this and usually give everything a nice safe p-value like 0.8 or 0.9.

Movie Review: Don't Look Up

January 04, 2022 · Original source

So I don’t think it’s surprising that people have lots of conflicting narratives around science and power, and sit ready to deploy whichever one is more convenient for the situation at hand.

The interesting part is that both the Erin Brockovich narrative and the Idiocracy narrative can be summarized as “trust science”.

In the Erin Brockovich narrative, Science is the simple truth, the hard physical reality behind the veil of establishment lies and corporate distortion. If a thousand PhDs say one thing, and a humble grocery-bagger says another, but the grocery bagger is backed by reason and experimental evidence, then the grocery-bagger gets the mantle of Science, and the PhDs must gnash their teeth in vain. When God entered the world, it was through a poor Jewish carpenter, in order to humble all the kings and princes of the Earth; when Science enters the world, it’s through Swiss patent clerks, or Hungarian women from third-tier colleges, for the same reason. Magellan supposedly said that “the Church says the Earth is flat, but I know that it is round, for I have seen its shadow on the moon, and I have more faith in the shadow than in the Church.” Science is observing the shadow and telling the Church to screw itself.

In Partial, Grudging Defense Of The Hearing Voices Movement

May 25, 2022 · Original source

I don’t know whether there’s something to be gained from picking over experiences like these, but it’s natural and human to want to do it. Generations of Freudians made good livings by flattering their patients’ preconceptions that their dreams had to mean something. As a psychiatrist, I try not to engage with patients about the meanings of their hallucinations, because my words carry some sort of scientific authority and Science very much does not have an opinion on this. But somebody ought to do it, and “let mildly psychotic people do it for each other” seems like a good solution.

Your Book Review: The Weirdest People in the World

August 11, 2023 · Original source

The difference between Greece and Rome on the one hand, and Babylon and Egypt on the other, was that Greeks and Romans had written down their stories for us. Their stories had become our story. History was a narrative. Each of its chapters had a beginning, middle and end. How else would you tell it? Now, as we go farther back, we have less and less writing to rely on. Even when we have writing, on papyrus or stone, it isn’t self-interpreting – it’s not history the way Herodotus and Livy tell us history, with the explicit goal of recounting the past. Earlier still the texts die out completely, and we are left with stones and bones. Our knowledge of this history has to come from science: from archeology, anthropology (in the hope of using present societies to learn about past societies), and now also the new science of historical population genetics. Joe Henrich has done more than most to teach us our history using these tools. His marvelous book The Secret of Our Success told the human narrative from the point of view of the unique human capacity for cumulative culture1.

Inline links: book, 1

The question was always going to arise: how do we fit the big story of humanity, told by modern social science, together with the story of Europe told by narrative history? Henrich's latest book, The Weirdest People in the World, goes there2.

Inline links: 2

Y is correlated with X today Indeed this does seem to skip all the interesting, contingent bits: On the other hand, if you want to explain an all-important outcome like the take-off into modern economic growth, then you can't just mumble “one damn thing after another” or “irony and contingency”. That a hundred things randomly conspired to make the West Educated, Industrialized, Rich and Democratic is not a satisfying story. Why would the die rolls keep favouring this one place? (And you can't invoke the law of large numbers. There are only five continents in the world, and modern economic growth did not have to happen anywhere at all.) To get from Europe 1 AD to modernity, while paying reasonable attention to the many accidents along the way, there are really only two possible narrative genres. The first is the rock falling down a mountain. It starts with one big, random event. This then triggers other events, and they trigger others, and now you have an unstoppable landslide. But the chance is at the start. The second is the cyclist pushing his bike up a mountain. It takes an actor who deliberately over time overcomes one obstacle and dodges another, until eventually they get to the top, and from there it's a downhill ride. WEIRD belongs firmly in the landslide genre. The big event is the Marriage and Family Program of the Western Church. This sets off a landslide, which the later chapters detail: the decline of kin institutions, the rise of Italian communes and city-states in the middle ages, the idea of individual rights in the European law merchant, the development of Protestantism, and finally the trifecta of science, commerce and democracy. WEIRD psychology is there, as an unobserved helper, for each stage of this journey, but each stage also builds on the previous ones. It's not by chance that WEIRD tells the West's story as a landslide. First, this is part of cultural evolution's baggage of intellectual commitments. Homo culturalis doesn't figure out solutions to his problems by abstract thought; he's not a natural optimizer. Instead he feels his way towards solutions. In a now famous example from The Secret Of Our Success, nobody just sat down and worked out how to detoxify manioc. Cultures which did this job better just had an evolutionary advantage. Second, the “bicycle push uphill” story would threaten the clean causality of the natural experiment. Suppose the Western Church promulgated the MFP with the deliberate plan of creating WEIRD psychology and causing the take-off into modern economic growth. Okay, that's unlikely, but suppose it promulgated the MFP with a plan that was somewhat related to increasing human welfare (in this world, not the next). Then we might suspect two things: Maybe in doing so the Church was reacting to existing conditions: reading the human situation and responding “hey, what we need here is less intensive kinship”.

Inline links: detoxify manioc

Book Review: Deep Utopia

October 17, 2024 · Original source

(All of the above goes for appreciating the profound truths of Science too. We assume that all worthwhile science has already been discovered - or that everything left requires a particle accelerator the size of the Milky Way plus an AI with a brain the size of Jupiter to interpret the results. You will not be asked to help, but you can still try to contemplate the already-discovered truths and bask in their elegance.)

The Fatima Sun Miracle: Much More Than You Wanted To Know

October 01, 2025 · Original source

Interlude: The Anti-Clerical Union As mentioned briefly before, 1910s Portugal was in a period of transition. In 1910, a group of proto-socialist revolutionaries overthrew the monarchy. The monarchy and church had been in cahoots, so the revolutionaries cracked down on Catholicism, closing the monasteries and persecuting the churches. This was a bold move - only an upper crust of educated urbanites were proto-socialist, and 99%+ of the country identified as Catholic, albeit at various levels of religiosity. In the 1920s, conservatives would regain the upper hand, overthrow the proto-socialists and restore a pro-church dictatorship. Still, the small urban educated ruling class of 1910s Portugal was a hotbed of atheistic anti-church sentiment. Probably the child-seers of Fatima were only dimly aware of this, but their prophecies were a spark entering a powder keg, and many of the more worldly witnesses were aware of this context. While reading through Fatima-related documents, I came across some pamphlets by Grupo Anticlerical, one of the era’s leading atheist organizations. They are totally irrelevant to our primary goal of trying to figure out what’s up with the miracle. But I love them so much that I can’t resist adding one as an interlude. I have slightly edited the machine translation for clarity and readability: To defend the sacred freedom of conscience—guaranteed by the original Law of Separation of Church and State—from the furious attacks of implacable Jesuitism—the greatest enemy of all human happiness!—the Anticlerical Group was organized in this town, similar to what is being done in many parts of the country! This was necessary. They call us to fight. We present ourselves courageously! The great, formidable battle of progress against Ultramontane Reaction, of Freedom against Tyranny, of Truth against Lies is waged again with enthusiasm and ardor! The redemptive dawn that the Portuguese people saw emerge on October 5, 1910, is about to be eclipsed, intercepted by the immense flood of black cassocks!... But in the dark night that seeks to envelop Reason; where moral suffering takes on tragic proportions in a frightening asphyxiation, the Light will once again break through!... the consoling light of elevated spirits... and like a sinister scarecrow, the grim reaction will flee in terror! Liberal people! Hear us! This fight is terrible! Many of our people will perhaps be crushed and tortured on the battlefield, but what does it matter?! Every war against reaction is a holy war because it frees consciences from the clutches of their enemies!... It is the fight of Justice against Iniquity, of Love against Hate, of Good against Evil!... To the fight, then, for the Progress that makes life beautiful; for the Freedom that redeems the people; and for the science that guides us all as an eternal beacon to the Light of Truth! Gago Coutinho and Sacadura Cabral [two Portuguese aviators who had recently flown across the Atlantic] are prodigious spirits before whom our souls kneel religiously – boldly breaking through the air with the mathematical certainty of someone who knows the path to be taken to get from one point to another determined point; flying through the immense blue as sure of their route as any of us walking on earth, they showed us that Science is not an empty word! The power of their prodigious sextant, the fruit of immense scientific lucubrations, is more real and positive than the cross of Christ painted on their device, which could not even have saved them from falling due to lack of gasoline in the middle of the sea at the mercy of the waves. Their extraordinary journey, an adventure which moved us to tears, was the most resounding scientific victory of recent times! It was, above all, a powerful affirmation of science! Let us therefore make science our religion, for scientific religion is Freedom of Thought! To be a Free Thinker is to love immortal science, eagerly waiting for it to reveal to us the truth of the great enigmas of the Universe! And only it can reveal them! People! Let us always fight! From the victory of progress, science, freedom, and free thought, will result human happiness, joy, love, fraternity, respect for women, veneration for mothers, adoration for children, affection for the elderly, protection for the sick, the unfortunate, the tortured. The victory of reaction, of clericalism, of black, cruel and ferocious Jesuitism will result in: the gallows, the acts of faith with their human destruction, persecution, exile, robbery, arson, the deflowering of women, the killing of children, the monstrous torture of all free spirits! The history of so many crimes committed in the name of God horrifies us! The Inquisition, relentlessly slaughtering, tearing, and burning the flesh of so many victims, is still today, in the twentieth century, a sinister specter haunting us!... O most holy mothers! O holy, pious mothers who so love your sweet little children! Have compassion on your beautiful little children, sacred fruits of your blessed wombs: Love Freedom! Love Liberty, O loving mothers, immaculate saints of our altar! We pray for them... for your children, who are the light of your candid eyes, the life of your life... for little children... for all children, tender rosebuds that retrogression furiously lashes, – love Liberty!. And you, O parents! Heads of families who so tremble at your loved ones, snatch them from the merciless clutches of the reactionaries who twist their brains and kill their reason! Hear us all, men, women, and children; listen: Freedom writhes in horrible convulsions... it vibrates in space, echoing from mountain to mountain, an anguished cry for help!... It is Freedom that falls, annihilated! It is Freedom that dies in the bloody clutches of Jesuitism! The Miracle of Fatima, people, is a ridiculous lie, it is a comedy, it is not religion! Come on, liberals! Let us all rise up from this criminal apathy and, without delay, fight not the religious sentiment of the Portuguese people, such a good people, a race of heroes, but rather the exploitation that clericalism is inflicting on the people, foisting upon them, at a good price, images of the saint —trademarked to avoid competition from other vampires! —the shamelessness!—and leading them, through suggestion, to wallow and drink madly, the miraculous water, foul, filthy water, full of rot, pus, and pestilent microbes that the sore flesh of the sick leaves deposited there in the washings! We, all as one man, will fight the reaction, forcing it to retreat and thus, with our efforts, we will save the Republic and the Portuguese Land from its fatal annihilation! … …anyway, Interlude over, let’s get back to the miracle. 2: The Skeptical Explanations Re-invigorated by the rousing prose of Grupo Anticlerical, can we come up with a materialist explanation for the sun miracle? 2.1: Pilgrim, Avert Thine Eyes Starting in October 1917, doubters have focused on one obvious possibility: staring at the sun is harmful to your health. If you stare too long, you go blind. If you stare just slightly less long than that . . . maybe something strange happens? Just to get a particular theory out there: everyone knows that if you stare at a bright light source for a few seconds, you get a temporary afterimage - often pink or bluish-green - on your retina. Suppose the pilgrims stared at the sun. Their eyes would inevitably make microsaccades - small natural jerking motions - and the afterimage would appear somewhere slightly different than the true sun. This might look like the sun turning pink or blue and moving in a zig-zag pattern. Believers in the miracle counter this proposal in several ways. First, although it might explain the sun changing colors and dancing, it doesn’t give an explanation for spinning, sparkling, or falling to earth and threatening to crush everybody (exactly three times in a ten minute interval, no less). Second, although witnesses describe the sun changing color, they also describe everything around them changing color to match the sunlight, which doesn’t match localized afterimages. And one scientifically-minded witness specifically describes closing his eyes to see if there was a persistent afterimage; he says there was not. Third, there are no reports of eye injuries or blindness from a crowd that was, supposedly, staring straight at the sun for ten minutes. This is a good match to witness reports (that the sun was unusually pale and didn’t hurt to look at) and with Dalleur’s theory (that it wasn’t the sun). But it’s a bad match to any theory depending on eye injuries. Fourth, this would require Portuguese people to be total idiots. Everyone already knows bright lights cause afterimages. Surely if you stare at the sun for ten minutes and get some afterimages, you’re not going to freak out and start screaming about miracles and the end of the world. Even if the peasants had somehow remained ignorant of afterimages their whole lives, the scientists and doctors in attendance wouldn’t be fooled. If we are to keep this theory, maybe we should posit some retinal phenomenon much stronger than the ones we know. Everyone thinks they know how much an illusion can fool you - “yeah, okay, obviously the cookie that looks very slightly bigger will actually be the same size” - which is exactly why the really good ones, like the Checker Shadow Illusion, come as such a shock. Squares A and B are the same color. Source: Checker shadow illusion. There’s no way around it: we need to hear from someone who has stared directly into the sun. August Meessen was a physics professor at a Catholic university, which sounds like exactly the job profile we want for this sort of thing. He found himself sufficiently interested in the Fatima miracle to stare straight into the sun for a few minutes and record what happened. From his paper: In November 2002, I looked directly into the sun, at about 4 p.m. The sun was relatively low above the horizon and its light intensity was attenuated, although the sky was clear. I was able to look right into the sun and was amazed to see that the sun was immediately converted into a grey disc, surrounded by a brilliant ring. The grey disc was practically uniform, while the surrounding ring was somewhat irregular and flamboyant, but did not extend beyond the solar disk. It coincided with its rim. I stopped the experiment, since I wanted to be prudent, but I had experienced myself the initial phase of a typical “miracle of the sun” and I could explain it. The sun became grey, since my eyes immediately responded to its great luminosity by an automatic reduction of their sensitivity. This adaptation is not simply due to the bleaching of pigments in the colour-sensitive cones of the fovea, where the image of the sun is projected, but to secondary processes. By “initial phase”, he means the part where the sun looks pale and well-defined, like a full moon. This isn’t something I think needs explanation (see above), but he sure has explained it. Moving on: In a second experiment, realized at 3 p.m. in December 2002, I looked straight at the sun during a much longer time. After some minutes, I saw impressive colours, up to 2 or 3 times the diameter of the sun. They changed, but were mainly pink, deep blue, red and green. Further away, the sky became progressively more luminous. I stopped there, since I understood that these colours resulted from the fact that the red, green and blue sensitive pigments are bleached and regenerated at different rates. This is frustratingly vague. Are the “impressive colors up to 2-3 times the diameter of the sun” just the normal aftereffects of staring at a bright object? Or something surprising even to physics professors? And the spinning? What about the motions of the sun? I didn’t see them, because I didn’t look at the sun for a sufficiently long time or my brain knew already too much. Once, after I had been looking at a very long passing train, I had (for about 30 seconds) the illusion of an opposite motion. Joseph Plateau discovered that when we look at the centre of a spiral that is rotating at some given velocity about this point, and when we stop this rotation, we see a reversed rotation. It lasts for several minutes, although in reality, there is no motion at all. This is a good example of motional after-effects. The “dance of the sun” is initiated, however, by a spontaneous generation of apparent motion. This feels suspiciously like a just-so story. His explanation for the sun falling to earth to crush everyone - which he also did not see - is equally ad hoc: A very interesting study was recently devoted to this “zoom and loom effect”. It tends to appear when the brain is confronted with the two-dimensional retinal image of an object that is situated at some unknown distance. The brain will then consider the possibility that it could come closer, by performing an illusory mental zoom, where the apparent size of the object is progressively increased. This results from the fact that evolution preserved the tendency to take into account the possibility of a dangerous approach: a rapid evasive action could be beneficial for survival. If true, it sounds like you should be able to generate this effect not just by staring at the sun (ill-advised, causes blindness), but by staring at the moon. I would like to test this, but unfortunately I am writing this on the night of a new moon; I’ll check back in two weeks. Still, I am skeptical that no human being living before 1917 AD ever figured out that staring at a celestial body long enough would make it appear to fall to earth and crush you. Compare to much gentler illusions - like how the moon looks bigger right when it starts to rise - which everybody knows about. I was able to find a thirdhand report (Fr. Stanley Jaki → G. J. Strangfeld → consultation with bishop) of another sun miracle investigator, one “Professor Dr. Stöckl” in Germany, who made a similar experiment: After almost a minute (the time varies according to the condition of the atmopshere and the momentary condition of the eyes) one thinks to see a dark blue disk in front of the sun (this is already a sign of the highly excited state of the retina). According to my experience … this dark blue disk is somewhat smaller than the solar disk, so that the edge of that disk stands out as a ring beyond that dark blue disk. Then one has right away the impression that the solar disk rotates with great speed in one or the other direction. This I have experienced often enough. All this is a subjective appearance that has nothing to do with the external world. These reports are suggestive, but weaker than all but the barest Fatima testimonials. Dr. Messeen admits as much, saying that “I didn’t look at the sun for a sufficiently long time”. Can we find people even more committed - or reckless, or masochistic - than Professors Messeen and Stöckl? Absolutely yes: there was a whole subfield of late 18th / early 19th century psychophysicists who experimented with staring at the sun for long periods, many of whom went blind. Joseph Plateau (1801 - 1883, went blind in 18432) summarizes their work in his aptly-named On The Contemplation Of Bright Objects. He lists twenty-six scientists who tried staring at the sun for a really long time. Most describe what we now recognize as typical retinal afterimages, and Plateau spends most of his time talking about how long these last and what colors they pass through. The only one of Plateau’s sources who reports anything even slightly interesting to us is Robert Darwin (father of Charles; cf. Secrets of the Great Families). After stating that: The author has frequently observed that when he gazed at the midday sun for a long time, until its disk appeared pale blue, he saw a bright blue specter on other objects for more than two days. …he mentions how When looking at the meridian sun as long as the eyes can well bear its brightness, the disc first becomes pale, with a luminous crescent, which seems to librate from one edge of it to the other owing to the unsteadiness of the eye. Here is pallor, and at least a hint of motion. But it’s pretty different from spinning, and not really clear how it relates to the sun miracle. Gustav Fechner (1801 - 1887, went blind in 1839) may have stared for even longer; you can read more of his story - including his ensuing insanity and subsequent attempts to found a new religion - on Adam Mastroianni’s blog. But all that he records about his ill-fated experiment is that: …after looking at the sun through homogeneously colored lenses, if you close your eyes, the primary impression remains for a long time and the entire afterimage usually disappears without a complementary coloration having clearly emerged. These people are great, and they all sound like minor Sam Kriss characters. But after whole careers dedicated to staring at the sun much longer than any normal person would ever try, they report only the barest hints of odd phenomena. Indeed, if anything they saw less of interest to the Fatimologist than Profs. Messeen and Stöckl. Worse, all of these authorities saw their phenomena after seconds to minutes of deliberate staring. Surely if it had taken a minute of staring at the sun before anything happened, some of our eyewitnesses would have mentioned this; after all, several mention that they were starting to doubt after the child-seers’ deadline had passed a few minutes earlier. But by all accounts, the miracle was near-instantaneous. Although Messeen and Stöckl’s reports of miracle-like phenomena are intriguing, it doesn’t seem like they can be the whole picture. Let’s move on. 2.2: Aurora Borealis? At This Time Of Year? In This Part Of The Country? Localized Entirely Within Your Kitchen? Could the miracle at Fatima have been some kind of weird weather phenomenon? The main argument against is that if it were a common weather phenomenon, it would not have awed and terrified tens of thousands of people. But if it were a rare weather phenomenon, then the seers’ successful prophecy that the rare weather phenomenon would happen at solar noon on October 13 1917 becomes almost as impressive as an outright miracle. The argument in favor is that dozens of people have written books and papers about this possibility, we would feel remiss if we didn’t mention them, and anyway it gives us the opportunity to look at pretty pictures of interesting weather phenomena. This is a sun dog. It’s caused by ice crystals in the upper atmosphere that refract sunlight in a very specific way. It’s very cool, but aside from a resemblance to a wheel, it looks nothing like the miracle of Fatima. A sun dog doesn’t have any unusual colors, it doesn’t change size, and it doesn’t spin (I’ve embedded a YouTube video not because a still image would be misleading - it wouldn’t be - but just in case you want to see for yourself how completely motionless it is). It’s just a halo shape with two smaller illusory suns on either side of the real one - something which no one at Fatima reported. (source) This is a solar corona3; cloud iridescence is a related phenomenon. I don’t know how much work the exposure length is doing in this particular photo, but I’m guessing more than zero. Coronae are also very pretty, and might explain the description of wheels and colors. They seem surprisingly common for something that I can’t ever remember seeing, supposedly happening several times a year in most locations. But they don’t spin, the colors don’t change or stain the surrounding landscape, and they don’t fall to earth and crush people. Let’s keep this one as a backup option and move on. This is a dust storm. Steuart Campbell wrote a paper arguing that the miracle was caused by one of these, and I admit if I saw this I would start praying pretty hard. Dust storms can change the color of the sun (including unusual colors like green or blue). And very, very charitably, whirling dust could look like the sun itself spinning around, and the thickening and thinning of dust could look like the sun approaching or receding. But this would require a dust storm localized to a 20 mile region of Portugal which does not, technically, have any dust (and where it was, technically, raining at the time). Campbell proposes that perhaps a storm blew a 20 miles x 20 mile dust cloud from the Sahara out to the Atlantic, then onto Fatima for ten minutes during a break in the rain, then back to the Atlantic again. But I don’t think any dust storm has ever behaved in quite this way. If it did, it probably wouldn’t be at the exact moment predicted by child-seers months in advance. At this point, we might as well talk about literal meteors. The way I’m imagining it is this: as a meteor approaches Earth, it breaks up into three big parts and a host of smaller particles. They strike the atmosphere head-on, from the approximate direction of the sun. The small particles hit first and make a firework show. Then the three big pieces hit, producing multicolored fireballs (meteors can absolutely stain the sky bright colors - see the video). Finally, they burn out a few miles above the ground, , convincingly producing the appearance of the sun falling to earth and nearly striking the spectators. This could even explain the warmth and dry clothes - a local meteor strike produces a lot of heat! I like this because it’s the only one that takes seriously the facet of the event which most impressed the witnesses - the part where it looked like the sun was plummeting to earth and about to kill them. But against it: would a rain of micrometeorites really look like the sun was “dancing”, “spinning”, or “zig-zagging”? Aren’t most nearby meteor strikes very loud? (the Fatima event was, according to witnesses, silent) Don’t they usually break windows? Aren’t most meteor strikes of this size visible for hundreds of miles, not just the twenty miles from which we have witness testimonies? Wouldn’t the strike have to be remarkably head-on, and remarkable close to the position of the sun, in order to look like a solar phenomenon rather than a long streak? Aren’t most meteor fireballs visible for between a few seconds and a minute, not the ten minutes of the Fatima event4? And if there were some extremely unusual meteor strike that was the exception to everything, wouldn’t it still be pretty surprising for it to happen at the exact time and place predicted by child-seers months in advance? We come to the unpromisingly-titled Derivation of equations of the model of the dynamic behavior of the three-dimensional atmospheric cloud of electrically charged ice crystals under the influence of electrostatic forces, in which Artur Wiroski argues that Fatima was a three-dimensional atmospheric cloud of electrically charged ice crystals under the influence of electrostatic forces. Actually, he offhandedly mentions Fatima in three sentences, with the majority of the paper looking more like the image above - but he eventually makes it into a Guardian article where he emphasizes that yes, he is trying to explain the miracle of the sun. However, if I’m understanding him correctly, he says that his theoretical ice crystal phenomenon can only happen when the sun is at an altitude below 22 degrees. But during the Fatima miracle, the sun was at 42 degrees (and Dalleur’s mysterious light source was at 30 degrees), so none of this applies. I’ve tried to include pictures of all the phenomena I mention in this section. I failed for this one, because it’s never been spotted or photographed. It’s just some incredibly weird thing that one scientist says ice crystals might do if parameters were ever exactly right, with such a precise definition of “exactly right” that it’s never happened in real life. If it ever did happen, it probably wouldn’t be at exactly the moment predicted by child-seers several months in advance. 2.3: Everyone’s Mad Here Except You And Me Another common response calls the Sun Miracle a “mass hallucination”. Can 70,000 people really hallucinate the same thing? “Mass hallucination” on Wikipedia redirects to List Of Mass Panic Cases. The Miracle of the Sun is on there, but listed as “(disputed)” - the only item to earn such a parenthetical. The other fifty items mostly belong to three categories: A disease with unusual symptoms spreads through a population; doctors eventually pronounce it psychosomatic.

Inline links: https://substackcdn.com/image/fetch/$s_!Wkjz!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fcff92f63-ad21-42fa-ad6f-c412b71f8524_631x481.png, https://substackcdn.com/image/fetch/$s_!mhyb!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fa5fdf3d3-3e36-403e-95b9-f9fcbe7a06f0_1280x974.png, Checker shadow illusion, his paper, 2, Secrets of the Great Families, Adam Mastroianni’s blog, https://substackcdn.com/image/fetch/$s_!kvPF!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F30bf02a3-f57b-4a9f-a849-e7e318c65b6f_900x600.jpeg, source, 3, cloud iridescence, https://substackcdn.com/image/fetch/$s_!Y1Qt!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F9bbd9216-eb7d-4012-b114-bae56dbb0d4c_1024x681.webp, wrote a paper, 4, https://substackcdn.com/image/fetch/$s_!Id7a!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F3c37c56e-bdf1-46e2-8d29-d395987be105_851x310.png, Derivation of equations of the model of the dynamic behavior of the three-dimensional atmospheric cloud of electrically charged ice crystals under the influence of electrostatic forces, a Guardian article, List Of Mass Panic Cases

The Hindu milk miracle of 1995. Starting from the bottom: In 1995, a man in New Delhi noticed that an idol of the elephant-god Ganesh seemed to be really drinking the glass of milk left as an offering. The story went viral - or as viral as things could go in 1995 - and Hindus around the world noticed the same thing. There was “an increase in overall milk sales in New Delhi by over 30%”. Scientists investigated and determined that a sculpted stone elephant trunk could sometimes absorb milk through capillary action. This was a story about rumor, interpretation, and context, but not really “hallucination”. The drinking effect was real. The Halifax Slasher was a typical supercriminal story. Two women reported being attacked by a mysterious and oddly-dressed knifeman; others followed. “Vigilante groups were set up on the streets, and several people, mistakenly assumed to have been the attacker, were beaten up; business in the town was all but shut down”. Although there was a Halifax resident with a history of knife crime, “he was quickly ruled out of the 1938 attacks on account of his large nose, which none of the 1938 victims had described”. Eventually several of the victims admitted to having made it up, and the whole thing went away. Supercriminal cases most often result from people making things up. Occasionally, seemingly-honest people report seeing the supercriminal in poor lighting conditions across a dark alley or something. But even if we consider these to be “hallucinations”, it is usually the one or two most vulnerable people in a town at the time. I can’t find any examples of true “mass hallucinations” - entire towns seeing a nonexistent supercriminal or monster at the same time. Koro is the psychosomatic disease par excellence; I’ve written about it before here. Victims, always male, believe that their penis has disappeared or retracted into their body; they often blame penis-stealing witches. Koro occurs at some very low background rate in every society (including ours), but occasionally wells up into mass panics in primitive cultures that take witchcraft seriously and have traditions of worrying about this sort of thing. Still, I don’t think any panic ever affects more than half of a village’s males, and usually not at the exact same time; it’s a smoldering panic over days or weeks, not a single instant of horrified realization. Also, although I’m not sure and would love to learn more about this, I don’t think the koro victim is having a visual hallucination of not having a penis at all. I think they think their penis is much smaller or shorter than it should be - which only requires some sort of obsessive worrying and (perhaps motivated) mis-remembering of its normal length. None of these are “mass hallucinations” in the sense where the sorts of visual hallucinations typical of certain mentally ill people occur en masse in a crowd of thousands with >50% prevalence - that is, the type of mass hallucination that would be required to explain Fatima. As far as I know, there are no confirmed cases of this ever happening. Still, from the Hindu milk miracle, we can learn that religious people can miss a real phenomenon for a long time, then notice it all at once with great fanfare. And from the koro cases, we can learn that a rare phenomenon can become more common in situations of widespread belief and social pressure. Interlude: It Seems Like Years Since It’s Been Clear This is around the stopping point of the previous Substack discussion. I’ve tried to cover most of Ethan and Evan’s arguments, go through the chain of rebuttals and counter-rebuttals, and maybe pull on a few of the more tempting loose threads that they’ve left. As best I can tell, this level of investigation ends in a decisive victory for the believers. They have a stock of seemingly-unimpeachable testimonies; the skeptics have only a few leads that don’t seem on track to pan out. Eye damage can maybe produce a few odd effects, but - in the entire history of tens of billions of people living daily underneath a sun that they are able to view at any moment - we have not yet found anyone who reports the full constellation of Fatima experiences just from seeing the sun. No exotic weather phenomenon is a perfect match. Mass hallucinations are real but comparatively weak. At least this is my assessment. Skeptic blogs don’t agree. They propose one of these things (with no consensus as to which one) then act like they’ve debunked the miracle, then skip to the really important part: laughing at how obviously wrong it is. I’ve written before about my disappointment in the skeptical community and why it worries me, and here I feel it as acutely as ever. Sitting with my disappointment and trying to put it into words, I think my worries come down to a tangling of the Bayesian graph. The straightforward Bayesian way to do this is to start with some prior probability that there is a God who causes miracles (let’s say 1%), notice that the evidence for Fatima being a miracle naively seems very high (let’s say 90%), multiply out, and end up with a higher (8.3%) probability of God’s existence and a lower (8.3%) chance that Fatima in particular was miraculous. This is liberating. It lets you say “This piece of evidence is very strong, but my prior is very low, so even without being able to debunk the evidence, I continue to disbelieve.” But doing this the straightforward Bayesian way doesn’t work. First of all, what would it mean to naively (even before factoring in that you don’t believe in miracles) say Fatima seems 90% likely to be miraculous. Before factoring in that you don’t believe in miracles, surely the probability is much higher! But also, if you try this, then as soon as you find two similar miracles (I’ve been told the next two are the Eucharistic Miracle of Lancio and the Miracle of Pellicer’s Leg) your probability of God goes up to 88%! But I don’t think there’s any real atheist whose probability would rise in such a straightforward linear way. You need some kind of model where either it’s almost trivially possible to generate an arbitrary number of convincing-yet-false miracles, or it isn’t. But this doesn’t match the “virtuous” approach of addressing each miracle on its own terms - where you try to understand the Sun Miracle by learning things about the sun, or entoptic phenomena, or 1910s Portugal. And it does match the skeptical approach I’m complaining about, where you say “it’s probably swamp gas or something, lol, imagine being so dumb that you believe in miracles.” So I cannot object too strongly. Still, my greatest fear in this and all other problems of reasoning method is the trapped prior, where people take this too far and become impervious to evidence entirely. I think it’s worth untangling the whole Bayesian graph, trying to keep this whole structure in mind, if it prevents people from accidentally propagating an update down a logical chain, then propagating the same update back up the chain, again and again, ad infinitum, until they become arbitrarily sure of themselves. “We can be sure all miracle claims, even the convincing ones, are false, because there’s no God - and we can be sure there’s no God because all miracle claims are so risibly false.” Even if this is harmless - even if it turns out correct in the case of religion - it teaches such dangerous habits of mind that I’m willing to err in the direction of going way too far taking such claims seriously - at least in the “entertaining an idea without accepting it” sense. Everyone gets to decide what is and isn’t worth their time. I think deciding that these sorts of miracles aren’t worth your time is fine, as long as you’re propagating all the probabilities correctly and not accidentally treating your own hurriedness as a cause to update the rest of your belief graph. As for me, I don’t know, I just find this fascinating. In Evan’s skeptical take on the conversation, he starts strong, but after the topic switches to Part LXXVII of Dalleur’s discussion of photograph angles, he stops and asks: What the fuck are we doing? What are we talking about? What have I spent (conservatively) 18 hours of my life on? We’re addressing what Stanley Jaki called the most important event of the 20th century! We’re debating the existence of God, the most important question possible! If God is real, then nothing could be more important than establishing this: in the best case, we will come to believe; at worst, we will be able to tell St. Peter that our failure was honest and not from lack of trying. If He is not, then we can do whatever we want here on Earth, and surely one of the noblest ways to spend our short existence is expanding the frontiers of the known into the borderlands of mystery! In particular, if the God of Fatima exists, we are in deep trouble. I said I wouldn’t talk about exactly what the Virgin Mary told the child-seers, but the short version is that the First Secret was a very, very nasty vision of Hell. It looked exactly the way a ten-year-old child might expect: a lake of fire populated by ebon-skinned demons and horrendous tortures; the lead child-seer said that if the Virgin had not begun by promising that she personally would never go there, “she would have died of fright”. As it was, the consequences of the vision were grim. The child-seers got it into their minds that they could perhaps save sinners from the fire by “doing penance”. They drank only stagnant, scum-encrusted water, in the hopes that this might help some otherwise hell-bound soul; on some especially hot days, they ceased drinking water at all. When they found particularly painful ropes, they tied them around their bodies so hard that they bled (later, the Virgin mercifully told them they didn’t need to wear the ropes at night - they could stick to daytime only). After so many mortifications, they were easy prey for the Spanish Flu; two of the three perished before their tenth birthday. As they lay dying in the hospital, they were recorded as freaking out every time they saw a nurse or visitor with “immodest dress”, saying that they would not act in such a way if they knew how long Eternity was, or what awaited them there5. If all of this is the true opinion of the Lord of the Universe, we had better figure it out quick. If it isn’t, then the words of the Grupo Anticlerical: People! Let us always fight! From the victory of progress, science, freedom, and free thought, will result human happiness, joy, love, fraternity, respect for women, veneration for mothers, adoration for children, affection for the elderly, protection for the sick, the unfortunate, the tortured . . . O most holy mothers! O holy, pious mothers who so love your sweet little children! Have compassion on your beautiful little children, sacred fruits of your blessed wombs! …take on new meaning and urgency. I will admit my bias: I hope the visions of Fatima were untrue, and therefore I must also hope the Miracle of the Sun was a fake. But I’ll also admit this: at times when doing this research, I was genuinely scared and confused. If at this point you’re also scared and confused, then I’ve done my job as a writer and successfully presented the key insight of Rationalism: “It ain’t a true crisis of faith unless it could go either way”. But now that we’ve let Ethan, Evan, and the rest dig us into as deep a hole as possible, let’s try to dig our way out. 3: Our Lady Of Everywhere Else One question that Ethan, Evan, and Dalleur fail to ask is: what if people are basically always seeing the sun spin and change colors and and fall from the sky? What if this is the most common experience in the world? What if it’s a minor miracle every time you get more than a handful of people together and they don’t fall down in awe and terror at the manifestations of the sun? Goncado Xavier de Almeida Garrett is one of the star witnesses of the Fatima miracle, quoted above. His testimony comes from a letter written to Father Formigao, a local priest, about two months after the event. But although pro-Fatima sources quote the testimony at the beginning of the letter, they conveniently leave out what follows: I ask your excellency to please tell me if you confirm this narrative: the Bishop of Portalegre and Mrs. Maria de Jesus Raposo report that while they were with other people in Torres Novas, on the 20th of October at the end of the day, they saw the sun rotate and change its colors. They said this was different from Fátima and did not have the importance of October 13th. I would like clarification on the differences. It is urgent to know what the differences are, since they attended both […] Until now, no one saw the sun's sparkling rotations, and now everyone sees them many days and many times. Many days and many times? Remember, the Virgin Mary first appeared at Fatima on May 13. She promised to return on the 13th of each successive month until October, when she would perform a great miracle. But she never said she wouldn’t perform any miracles until October. So on the 13th of each month, a medium-sized crowd gathered. They didn’t leave disappointed. I won’t include every claimed supernatural occurrence, but here are the ones relevant to our subject: Olimpia de Jesus, about July 13: [On July 13], at her sister-in-law's house, when they heard the people shouting, he asked, "What's going on over there?" [Olimpia] looked at the sun and said, "The sun is different." The people came and reported that they had seen signs in the sun and in the sky. Joaquim Inacio Vicente, about August 13: This hour was a moment of terror for all who were there. Some lost their senses, others believed it to be the last day of their lives and their day of Judgment, and for some, afterwards, it was a wonder to see the admirable colors that successively took on the clouds that obscured the sun's rays—colors from bright red to pink and from there to blue—the color of anise, as several people declared to me minutes later in my home. Leonor de Avelar e Silva Constancio, about August 13: Everyone looked up at the sky, which was covered by a light cloud, like a very fine white lace, pink in places. The sun, which had been completely hidden for a moment, left us illuminated by a strange light, with yellow spots visible on the ground and above us all, and a great drop in temperature, as happens during a solar eclipse. Manuel Pedro Marto, about August 13 and September 13: [On August 13, he] saw a kind of luminous globe rotating in the clouds […] On September 13th, he also went to Cova da Iria. He was a little away from the children. He saw nothing, nor heard anything, but he heard that some people had seen extraordinary things in the atmosphere. Joaquim Xavier Tuna, about August 13 and September 13: On the 13th of August, I saw the sun lower in the sky at the hour of its appearance. It never lowered as much as that time, not even on October 13th. All the objects around me turned yellow. On September 13th, I saw a large cross emerge from the sun and head east. Its progress was not very hurried. Sometimes it appeared, sometimes it disappeared, until it disappeared from view. I also saw other things that I cannot explain. In the Lapas area, there were people who, at the same time, saw the cross. Then there was the great miracle on October 13. Remember, I was only able to find a handful of negative testimonies - people who said they didn’t see it. One was from a woman named Leonor das Dores Salema Manoel, who said she saw “nothing of what others saw”, at least at Fatima. But on the drive home from Fatima that evening6: I saw [the sun] pass through different colors that I can't remember and it turned green, very light green, like a green salad with a golden rim around it, and spinning. Very long rays seemed to touch the earth and the sun seemed to be separated from the sky. Then the sky took on pink flashes, changing to a yellowish hue around the sun, and further away, spots here and there. After a few long moments that I can't remember, it returned to normal and I couldn't look at it again. The next occurence was early the following year. From the parish inquiry’s interview with Jacinto de Almedia Lopes: He further said that on the day of Our Lady of Purification, that is, on the second of February, 1918, he about 3 o’clock in the afternoon, being in the same place, he noticed signs in the sun identical to those of the thirteenth of October, which he had not noticed on many other days when he had been there. And next, from a letter by Gilberto Fernandes dos Santos: I must inform you that I went to Fátima on [June 13, 1920]… at that very moment, the people were kneeling on the ground, shouting, praying loudly, weeping, begging forgiveness with their hands raised, because they were witnessing a solar phenomenon similar to that of October 13, 1917. And next, from Dr. Henrique Weiss de Oliviera, describing events on May 13, 1923: I ate my meal in a car on the road near Cova da Iria [in Fatima], from half past noon to one in the afternoon, and when I returned to the Chapel, I heard the groups I passed exclaiming in admiration about a marvelous phenomenon that they claimed was occurring in the sun toward which they were directing their gaze. Deeply doubting the repetition of the marvelous phenomena that had dazzled thousands of people, according to reliable reports, during the last apparition of Our Lady in 1917, I was about to pass on without even bothering to look. I remembered, however, that when I first went to Fátima on October 13th of last year, and upon hearing similar admiring rumors around me, I had seen nothing during my quick inspection, perhaps because I was filled with that spirit of doubt. I therefore wanted to be certain this time so that I could, with full awareness, give my testimony to whoever and whenever I was asked. And, having stopped near a group and stared at the sun, carefully shielding my eyes from the direct sunlight, so as not to see anything, they immediately advised me to insist that I would see something. It took a long insistence to finally see what amazed everyone and caused astonishment that I could not see it. And I saw with precise clarity, and twice, what the common people, in their imaginary language, very accurately likened to: almond blossom petals. They fell from a great height (no longer seeing them detach from the sun as the people around me saw them) For myself, I finally, and after a considerable time, concluded that there is no such natural phenomenon, neither known nor described, thus leaning toward the supernatural. Today I firmly believe that this was the case, because I have had testimonies that allow me to reconstruct the phenomenon as it appears to have occurred according to these testimonies. First, one could gaze at the sun for a long time and with impunity, seeing magnificent phenomena of beauty and color; then began an abundant rain of the aforementioned petals; and when I arrived, it was no longer possible to gaze at the sun, and the phenomenon, which had been quite lengthy, was at its end, which explains my difficulty in witnessing it now. And from Joao Amael, on October 13, 1925: I do not know why, I suddenly felt a desire to look at the sun. [I would hear] other educated persons admit having seen phenomena in the sun on that day and hour. I looked at the sun. Before that, nothing special could be seen. But now I looked at the sun without hurting my eyes, without any retina resisting. I became more intent. To my astonishment, the sight became even clearer. The sun turned on itself in a very small circle, and in the center it turned into a dark disk in rapid rotation. During some minutes, very impressive and overwhelming, I could clearly verify this strange process. Then, without revealing anything of what I observed, for fear of autosuggestion, I asked my companion to look at the sun and see whether it really appeared. And my companion was describing exactly the phenomenon, the same extraordinary phenomenon. The test was achieved. And I gained further assurance, when various other people later told me that they had seen what I saw clearly, at the same hour, as they kept looking at the sun, without the slightest sensation of pain. Amael’s report of a miracle in 1925 is the last recorded case I can find at Fatima. I don’t know if this was when the sun miracles stopped happening there, or when people stopped including them in the Critical Documents collection. In either case, there were plenty of other places willing to pick up the torch. 3.1: The Ghiaie Variations As far as I can tell, Fatima was only the second-largest crowd to have ever witnessed the Miracle of the Sun. The largest was a group of 200,000 - 300,000 people in Ghiaie, a tiny village near Bonate, Italy. On May 13th, 1944 - the same day of the year that the child-seers of Fatima saw their first apparition - a seven-year old girl went out to pick flowers and had a vision of the Virgin Mary. The Virgin promised to return to her for nine successive evenings; at some point (although I cannot follow this part of the story) she must also have promised to return four times the following week, as large crowds gathered in expectation. According to my source, on the ninth appearance: Many testimonies from the site of the apparition and from surrounding villages described an impressive solar phenomenon. The sun came out of the clouds, whirled dizzily on itself, and projected beams of yellow, green, red, blue, and violet light in all directions. The beams of light colored the clouds, fields, trees, and the stream of people. After a few minutes the sun stopped its whirling, and those phenomena began soon again. Many noticed that the disc had turned white like a Host. The clouds seemed to be lowering down on the people. Some noticed a Rosary in the sky. Others saw a majestic Our Lady with a trailing cloak. Some people, who were at greater distance, saw Our Lady's face looming in the sun. From nearby Bergamo many witnesses observed the sun become pale and radiate all of the rainbow's colors in all directions. They also noticed a large yellow light beam falling over Ghiaie, perpendicularly. The blog says there were similar solar phenomena during the tenth and twelfth appearances, as well as on the following June 13th and July 13th7. All of this is from a random Catholic blog; can we find clear testimonies? The miracle of Fatima was heavily promoted by Portuguese, Vatican, and American Catholics, leading to a large body of sources being available in English. The Ghiaie apparition has gotten less attention, and so I can find fewer testimonies, have had to clunkily machine translate some things, and had a harder time tracing the exact chain-of-transmission. Still, here’s what we’ve got, mostly from here: Don Giuseppe Piccardi: The people cried out to the miracle; I turned between the intrigued and the distrustful, and I saw the sun that-comes from the clouds - turned on itself and the speed of movement seemed to be skidding. At the same time I saw that he projected light beams, then, for me, almost constantly yellow gold. This color I contemplated it even when the sun was veiled with uncaught clouds. Slightly hard to figure out from the machine translation, but I think this is Bishop Adriano Bernareggi: At 6:00 PM I was at the Patronato for the feast of St. John Bosco. Just at that time I finished speaking in front of the church. Then I entered the church for the Benediction with the Blessed Sacrament. But most of the crowd remained outside because they said they had observed for about ten minutes the sun rotating on its axis, also suddenly changing color: yellow, red, blue. The sun could be observed without disturbance. The phenomenon was also observed in other places. I only noticed at the end of the service a yellow color in the houses, as when there is a partial eclipse of the sun at sunset. At 7:45 PM they said the phenomenon was repeated. I watched too. By staring into the dazzling sun, you could end up seeing the sun stand out clearly, giving the impression that it was rotating. Then everything took on a red color. But then it was clearly an optical phenomenon. Don Luigi Cortesi, a local seminary teacher who was a strong skeptic of the apparitions and even borderline-kidnapped the child-seer to convince her to recant: A shiver runs through me for a second. I react forcefully, forcing myself not to lose my mind, not to let myself be overwhelmed. I desperately squeeze my pupils and look at the sun: I see a large, clear spot without sharp edges, then, when my eye has adjusted, I see a disk of intense whiteness that seems liquid. Staring at the edges of the disk, I detect a dizzying rotation, like an electric circular motion, like a dizzying pinwheel, except that the direction of motion changes rapidly from left to right and then from right to left. I remember Fatima. Except this time, the sun revolves around a fixed axis, without moving in the sky. I return to the earth, to the crowd: I notice that the faces, the hands, the trees pierce through all the colors of the rainbow. It's natural, I think to myself: when the eye is offended by an intense light or an equivalent stimulus, it projects a stain on objects, which fades from red to violet and tints the objects it encounters with different colors; the stain disappears when the eye, rested, has returned to normal. In fact, a few minutes later, I no longer see those iridescent colors; every object has returned to its natural hue. The phenomenon of rotation leaves me dubious. A neighbor offers me his smoked glasses, and I look: the sun continues to rotate. He offers me a telescope, and I invert it, the screen, and look: the sun is still rotating. Then I can't take it anymore: even today, I'm not convinced that seeing a cosmic prodigy is worth losing my sight. Back then, I wasn't even convinced I was seeing a prodigy, since a plausible natural explanation for the phenomenon quickly emerged in my mind. However, urged by the neighbors to get excited, I remain silent. And I silence them by pinching and slapping the arms of those around me, which are stretched out towards the sky." From the parish bulletin of Tavernola, the exact author is slightly confusing but it was either written by or signed/confirmed by Piero Bonicelli, local provost: On the 28th in the evening of Pentecost, something happened that made a profound impression on everyone. At 6:00 PM sharp, a dimming of the sunlight was felt, accompanied by a sudden flash of lightning, first clearly observed by some bowling players. Looking at the sun, one saw first green, then bright red, then golden yellow, and then it spun around dizzily. At that spectacle, people poured into the streets... One can imagine their comments. The women recited the Holy Rosary, punctuated by the words: "Oh, how beautiful!" After ten minutes, the sun returned to normal. Comments? None. We await an explanation from the appropriate source. For now, we're content to hear the usual strong-minded people call us poor, deluded people, but don't you think this is a rather general illusion? In any case, for now, we're deluded: we'll see later. The parish priest of Tavernola, director of the bulletin, sending this issue requested by Father Piccardi, wrote on June 27, 1946: I must assure you that, as written, it is true, and I can also tell you that I was among those deluded that evening. To be prudent, I didn't go out into the street where people were shouting about a miracle, but from a slightly hidden window, I watched the sun change color and spin rapidly... illusion? Many of us here in Tavernola have been deluded. I can also tell you that I was pleased that such an illusion existed in Tavernola, since the people here have always had a great devotion to the Madonna. There may be more testimonies at this site, but they’re in very old scanned documents that it would be too time-consuming to stick into my machine translation pipeline. Another source says that “On February 24, 1994, [the TV show] ‘Detto tra noi' (Raidue), interviewed some witnesses, who confirmed the solar phenomena of May 21 1944 that were watched by many people“. I think a few hours extra work by an Italian speaker could produce at least five or ten extra Ghiaie testimonies, maybe many more. But as it is, we have enough to try something interesting: let’s recreate Dalleur’s analysis, but for Ghiaie. At 6 PM, the sun was shining from almost due west. For the sunlike light source producing the miracles to mimic the real sun, it would have also had to have been to the west of Ghiaie. If we assume it was the same distance as Dalleur’s Fatima light source, it would have been about 2-3 miles to the west of Ghiaie, which puts it above the village of Merate. We know from the last testimonial that the phenomenon was seen clearly in the village of Tavernola Bergamasca, which is about 22 miles from Ghiaie and 25 from Merate. An Italian source also reports sightings in Brescia and Piacenza, each about 35 miles from Ghiaie. So a Dalleur style analysis might conclude that this event also had a 25 - 35 mile visibility radius, similar to Fatima’s. …unfortunately a 25 mile circle centered on Merate includes the city of Milan, population 1.1 million, which produced no reports of unusual solar activity. And Milan had clear line-of-sight to Ghiaie and Merate, and so probably better viewing conditions than Tavernola, which (you can see from the map above) has some intervening hills. Might the miraculous light source have been like a spotlight, aimed in only one direction - that is, east to Ghiaie and Tavernola, but not southwest to Milan? This would contradict Dalleur’s Fatima analysis, since one of the most dramatic testimonies comes from the city of Minde, which is on the opposite side of the presumed light source from Fatima. I don’t really think it’s possible to maintain a theory where this phenomenon gets transmitted through normal geography. 3.2: Mary Such Cases At this point, the reader will get the general idea, and we can start moving faster, as there is a large amount of ground to cover. Heroldsbach, Germany, 1949: The Virgin appeared to four young girls. Rumors spread, crowds gathered, and on December 8th, 10,000 people saw another sun miracle. Here are about a hundred testimonies, gathered with typical German thoroughness. An expert meteorologist brought in to investigate summarized them as follows: If one now considers the testimony in detail, one encounters a surprisingly small agreement of the observations made. One witness has seen a red sun, the other a yellow, an orange or pink with blue and green, or a whitish sun. A silver one was also observed or all the colors mentioned in colorful change. One wants to have observed an oversized, the other a first small or normal, but then rapidly enlarging and rushing towards the viewer in a frightening way. Most of the witnesses noticed that the solar disk rotated very quickly in two or three phases of rotation for about a quarter of an hour. The Catholic Church condemned the apparition and miracle as fake, even going so far as to excommunicate the child-seers. Later they relented slightly and un-excommunicated them, but their official position is still that nothing supernatural happened - this sun miracle was merely an overly enthusiastic hallucination! Necedah, Wisconsin, USA, 1949: A housewife named Mary Ann Van Hoof claimed to have seen the Virgin Mary. This is among the less plausible visitations: Van Hoof, who was raised Spiritualist, also claimed to have seen Joan of Arc, George Washington, and Abraham Lincoln. The messages she channeled seemed less like tidings of peace and love than like a particularly unhinged Truth Social post, and included warnings about the Rothschilds. Still, rumors spread, crowds gathered, and on August 15 1950, 50,000 - 100,000 people showed up hoping for a miracle. As for what happened next, Wikipedia says that “witness accounts vary significantly”. WaPo says that “observers saw nothing unusual” and LIFE mentions nothing out of the ordinary. But other sources report sun miracles, and I was eventually able to track down three testimonials in a summary of articles from a local newspaper, which states that “after a rainy morning…”: It was about noon when Van Hoof came out of the house and a woman screamed, “By God, it’s really true,” and fell to her knees. Then it happened that the Rapids woman and so many in the crowd saw the sun, covered with a dark, greenish gray disk, spinning down toward the earth. And she testified, “I thought the end of the earth was coming and fell to my knees.” A Pittsville woman also described the sun spinning closer to the earth. “I and many other people, fell to our knees in awe.” The Daily Tribune visited the Oct. 7, 1950, event — a 25-minute “last” message from the Mediatrix to the “throng” of 50,000. Responding to this seventh vision, gasps were heard from women who again saw the sun behaving oddly. A Catholic priest told reporters he saw the sun whirl clockwise and jump. The Catholic Church condemned the apparition as fake, and declared van Hoof’s followers “a cult”. Lubbock, Texas, USA, 1988. Really? Really? Nothing could be more natural than for the Queen of Heaven to appear to kind-hearted shepherd children in Portugal. Even an appearance in war-torn West Germany makes a certain amount of sense. But Lubbock, Texas? I suppose this must have been how the cool Sanhedrin members felt when they learned the Christ hailed from Nazareth. But that doesn’t make it any better. Anyway, rumors spread, crowds gathered, and on August 15, 1988, about 10,000 people witnessed the Miracle of the Sun. Here is an indirect testimonial, a man describing his wife’s experience: A large crowd had gathered outside Saint John Neumann Church on that very hot August afternoon on the Feast of the Assumption. Mass was being said in the afternoon, and around the time of the Consecration, suddenly her cousin’s wife (a convert, if you remember) said “look at the sun”. When she did, the sun was pulsating, it would look like it was coming down to earth and then go back again, it spun around in circles, much the same as what took place in Fatima in 1917...and changed colors. She looked at it directly for 15 minutes or so without any damage to her eyes. As my wife looked around, the people in the crowd seemed to be bathed in various colors. During all this my wife even saw The Blessed Mother. The Blessed Mother was extending her arms in what appeared to be a welcoming gesture. But not everyone had the same experience that day: her cousin’s wife and our son saw and believed instantly, but her cousin and brother saw nothing at all. Why did some see these events and others did not? We don’t know...not enough faith? Or perhaps they had enough faith, and they didn’t need a sign! Here we have something special: according to the Los Angeles Times, one pilgrim took a poll about who saw what: A push was on to assemble evidence for the commission in a lawyerly way. Testimonies from 247 people present at the feast had been recorded. The statements were transcribed by volunteers and stored in a computer. Joe James himself indexed the information: 186 had witnessed the spinning of the sun; 75 had seen the Virgin; 64 Jesus; 18 an angel. How could anyone ignore the bulk of such documentation? We don’t know how the 247 people were selected, but very naively it seems like 2/3 of those present saw the sun spinning. This also matches the first person listing 2/4 family members. (the Catholic Church withheld judgment, refusing to either endorse or condemn the visions) Benin City, Nigeria, 2017. On October 13 2017, crowds gathered around the world to celebrate the 100th anniversary of the Fatima miracle. One such commemoration happened in Benin City, Nigeria, where 30,000 people attended the National Marian Congress and witnessed the re-dedication of Nigeria to Mary’s Sacred Heart. As the speakers commemorated the Fatima event . . . . . . someone pointed to the sky and shouted “It’s happening again!”. It was, indeed, happening again. You can read about ten testimonies here. I’ll quote just one, from Brother Joseph Obiemeka Azih: Immediately after the 3:00 p.m. Divine Mercy prayers, there were brief showers of rain. Then came sudden brightness of the sun, which was hitherto hidden behind layers of dark cloud. We also observed rather surprisingly the mysterious shooting of the sun forward and backward. Intermittently emitting of powerful bluish and golden colors of light from “Our Lady clothed with the Sun.” The sight was indescribably beautiful. We were busy staring at the bright sun steadily for more than twenty minutes without blinking an eye even for a second! People around us were dazzling and reflecting these bluish and golden colors on their dresses and faces. What a mystery! More than 30,000 people inside the arena were seen peering at “the dancing of the sun” bewildered. The miracle lasted for more than 45 minutes after which there was [a] heavy downpour which the Bishops present said [were] “showers of blessing.” I was able to confirm that some of the people whose testimonies were listed on the site are real Nigerian Catholics whose existence is attested in other sources. Two weeks later, there was another Nigerian commemoration of the Fatima anniversary, in Lagos, and a sun miracle happened at that one too. 3.3: Made You Gaze At Medjugorje Medjugorje (Bosnia, 1981) is in many ways a typical Marian apparition site, much like the ones on the list above. Child-seers, warnings to repent, sun miracles, you know the story by now. But in Medjugorje, the miracles keep happening. Pilgrims - or, more cynically, tourists - go there just to see the sun miracles, and many come back satisfied. You can find blogs by people who went to Medjugorje hoping to see a sun miracle, and on their first or fifth or eighth or whatever day, there’s a crowd of people, yelling and pointing at the sun, and they look up and see it too. Here’s an account from Catholic blogger Father Dwight Longernecker: I was an Anglican priest living in England, in 1985 when I was invited by a group of Anglicans and Catholics to visit Medjugorje. I didn’t want to go. Being a former Evangelical-fundamentalist I wasn’t too keen on apparitions of the Blessed Virgin. I opted out. They insisted. I dug in my heels. They said someone else would pay for it. I didn’t want to go. They cajoled and twisted my arm until I said ‘yes’ [...] On our second day there I sat on the balcony of our guesthouse with a large woman named Eleanor. As we began the rosary I looked up and the sun was a blaze of light in the sky. I looked down to the car parked below and the sun was reflected in the hood of the car as a blaze of light. Eleanor and I prayed the rosary together. I had my eyes closed. At 6:20 Eleanor gave me an elbow in the ribs and pointed. The sun was now a disc of white light in the sky like a Eucharistic host. Then as I watched it began to spin, first clockwise then anti clockwise. Sparks spit out from the rim of the sun like a firework. I looked down and the sun was a white spinning disc on the hood of the car. I don’t think this would have happened if it was just my eyes playing tricks on me. Plus, Eleanor saw it too. That’s why she gave me an elbow in the ribs. I am not sure how long this lasted, but when we spoke about it to our fellow pilgrims they said many people in the town square had reported the same phenomenon. Some of these tourists capture the phenomenon on video. Unfortunately, the videos are of three types: Videos of a bunch of people pointing at the sun, and shouting the word “Miracle!” in various languages, and obviously looking extremely excited, but the sun itself looks totally normal, and the person taking the video apologizes and says that their camera isn’t good enough to capture it.

Inline links: really drinking the glass of milk, Halifax Slasher, here, my disappointment in the skeptical community, why it worries me, lets you say, Eucharistic Miracle of Lancio, Miracle of Pellicer’s Leg, trapped prior, of mind, 5, key insight, 6, my source, 7, here, this site, https://substackcdn.com/image/fetch/$s_!kukw!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F192586f8-d450-4555-88ef-deb6bbe30416_842x613.png, Here, Wikipedia says, WaPo, LIFE, a summary of articles from a local newspaper, is an indirect testimonial, Los Angeles Times, https://substackcdn.com/image/fetch/$s_!7J80!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F643b310a-4f76-4de9-8434-c8449f29f686_581x226.png, here, a sun miracle happened at that one too, an account

(source) (source) (source) (source) (source) Most of these come from one topic in the forum, Sun Turned Purple? There are hundreds of other topics about optimal sungazing times, lists of benefits, and (of course) various people who got severe eye damage, and none of these people ever mentioned the color-changing swirling sun until this one topic, where one person says “has anyone else ever seen this?” and dozens of people agree that they have. Does that mean that lots of people might have seen it, and it’s just too weird to talk about? These comments show some clear resemblances to the Fatima account. They talk about a swirling motion and color changes8. Many focus on purple in particular, but that might just be primed by the topic name. Also, compare to Jose Garrett’s account of Fatima: Everything had the color of an amethyst: the sky, the air, everything and everybody. A little oak nearby was casting a heavy purple shadow on the ground. Still, the pattern of occurrences is confusing. Some of these people sungaze every day, but say they’ve only seen this once or twice. Others say they see it every time, and still others say they saw it the very first time they started sungazing. It seems like there must be plenty of variability - both between people (in their tendency to see it) and between times (in whether conditions are optimal to cause it). It’s still not obvious why some experienced sungazers go years without seeing it or never see it at all, but all 70,000 people at Fatima saw it immediately the first time they looked. This is our most promising lead yet, but still not perfect. Let’s move on. 5.2: Visual Release Hallucinations Some people at Fatima, Heroldsbach, and Lubbock saw things beyond just the spinning sun - complex visions of the cross, the Virgin, or other holy symbols. These confound optical/hallucinatory explanations and Dalleur-style “objective miracle” explanations alike. They seem to demand some sort of prophetic vision. Is there any way to reconcile them with a scientific/materialist story? Visual release hallucinations are a class of complex hallucinations caused by visual loss, common in cataracts and macular degeneration. The brain, denied useful input, takes a cue from chatbots and exam-takers and simply makes things up. Wikipedia describes the symptoms: Complex hallucinations may depict silent, non-interactive figures, whether multitudes of people, animals, or surreal objects, that appear life-like, as well as highly detailed landscapes or objects. The most common hallucination is of faces or cartoons. If anything, this paragraph undersells the weirdness of this condition: in its most famous variant, Charles Bonnet Syndrome, the hallucinatory content is specifically elves, fairies, and leprechauns (yes, they are dressed exactly how you would expect elves, fairies, and leprechauns to be dressed). Why elves, fairies, and leprechauns? There is no consensus theory. We know that humans have hyperactive agent detection - we see faces in the clouds, interpret dark trees as menacing giants, and imagine storms as punishment from wrathful gods. If whatever “noise” produces Charles Bonnet hallucinations is too small to resolve into a full-sized figure, maybe the brain resolves it into a tiny figure, and then - groping for a top-down prior to constrain what a tiny figure should look like - settles on elves or fairies or leprechauns. In a typical case, the condition does not affect reasoning, and patients are able to infer that their hallucinations cannot be real. In an atypical case, you get this website by someone who believes that their Charles Bonnet syndrome gives them special access to a non-material reality. If CBS patients can see leprechauns, can their hallucinations be shaped by other cultural archetypes - like religious beliefs? Unsurprisingly, yes. Here is an example of a CBS sufferer seeing the Devil. Here is an example of auditory CBS (maybe cheating?) centering around religious hymns. We cannot invoke CBS itself to explain visions associated with the dancing sun, because it typically develops months to years after visual loss (although there are scattered examples of it appearing on timescales as short as ten minutes). And most people who see the dancing sun see it quickly, before severe retinal damage has had a chance to occur, and without any long-term visual abnormalities. We would have to posit an entirely new kind of visual release hallucination, previously unknown to science, in which the temporary bedazzlement of staring at the sun counts as the sort of visual release that makes the brain start confabulating. Also, I haven’t made a formal study of the testimonies, but I don’t think every single person who sees the Virgin Mary at a Marian apparition has been staring at the sun. Some people just see her on the ground nearby. But of all the places to find supplemental evidence, I was able to get one story from Robert (father of Charles) Darwin’s book on his sungazing experiments: Benvenuto Celini , an Italian artist, a man of strong abilities, relates, that having passed the whole night on a distant mountain with some companions and a conjurer, and performed many ceremonies to raise the devil, on their return in the morning to Home, and looking up when the sun began to rise, they saw numerous devils run on the tops of the houses, as they passed along; so much were the spectra of their weakened eyes magnified by fear, and made subservient to the purposes of fraud or superstition. And another from, of all places, Facebook: (source) The swirling, colorful sun sounds like the miracle of Fatima. The “tree of life symbol” might be a Purkinje tree, an established entoptic phenomenon. As for the rest, your guess is as good as mine. For what it’s worth, evangelical Christians warn that Demons Enter By Sungazing. This could just be the evangelical Christian tendency to worry about demons being associated with every unusual spiritual practice. But those figures walking out of the lake will haunt my dreams. 6: And I Say, It’s All Right Here’s the most sensible story I can generate for the Sun Miracle of Fatima: There is some previously unknown optical illusion that potentially causes the sun to appear to change colors and spin. This phenomenon is rare and inconsistent, and usually appears only after someone has stared at the sun a very long time. This explains why it’s only reported in the wild by a few weird Redditors who stare at the sun on purpose every day. The appearance of this illusion is somehow modulated by cloud cover. In normal conditions (bright day, no clouds) it’s almost impossible to summon without long periods of sungazing. But when the sun is half-hidden by translucent clouds, the illusion happens much faster. This explains why the Fatima, Ghiaie, Benin City, Necedah, and Lubbock miracles - as well as some of the most impressive Medjugorje cases - all happened just after rain stopped and the clouds were just starting to clear. It also explains why Fatima witnesses say that the sun was “covered in gauze” or “blocked by smoked glass” or “had a diaphanous veil” or “looked like it was seen through a window”. It’s also why, during the most impressive instances of the miracle, people say they can stare at the sun without it being too bright or hurting their eyes. But like koro, the illusion is also modulated by expectations and social priming. Paying attention to the sun, expecting something weird to be there, is much more likely to generate the illusion than catching a casually glance of it. This explains why it is most common during Marian apparitions and other Catholic events full of people familiar with Fatima, and only very occasionally appears to weird Redditors who aren’t specifically looking for it. It also explains why Professors Messeen and Stöckl (who were specifically thinking about Fatima at the time) got better results than earlier scientists (who were observing without preconceptions). At Fatima, the basic illusion, the meteorologic conditions, and the social priming all came together to a point where 80%+ of the pilgrims saw the phenomenon quickly enough that they neither stopped looking nor perceived it as taking unreasonably long. The conditions lasted ten minutes, during which time the sun peeked out from behind the clouds three times; to people who had been staring at the (veiled) sun with their pupils dilated, this looked like the sun suddenly flaring up monstrously large and hurling itself towards Earth (and speculatively, maybe something similar is responsible for the changes in the Filipino video). A small number of mentally susceptible people, already in a vulnerable state because of this apparent miracle, influenced by a process similar to visual release hallucinations, saw additional visions, like the Virgin Mary or the Cross. Some distant witnesses remembered that someone had prophecied a nearby miracle for that day. Because they were not so distant as to have totally different meteorologic conditions, when they looked up at the sky trying to catch the miracle, they saw it too. After the miracle ended, the people who saw it were primed to see it again for the next few weeks - partly because they were looking at the sun expectantly, and partly because they were in a susceptible frame of mind (cf discussion of delusional parasitosis here, panic attacks here, or chronic pain here) - explaining Garrett’s claim that “now everyone sees [the sparkling rotations of the sun] many days and many times”. Even thinking about the miracle served as a form of priming, so further Marian devotions in Fatima and elsewhere became hotspots for miraculous activity. This theory avoids some of the pitfalls of its component parts: I previously said that entoptic phenomena / hallucinations / illusions couldn’t explain the miracle, because normal sungazers don’t report it. This new theory adds modulation by meteorologic conditions and social priming. Absent these factors, the miracle will only occur for a small fraction of sungazers after many minutes spent gazing (producing the scattered Reddit reports). Given these factors, it can occur en masse.

Inline links: source, https://substackcdn.com/image/fetch/$s_!kjJE!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F4d265b86-9dcd-4cee-97a6-43f288c7157b_857x130.png, source, https://substackcdn.com/image/fetch/$s_!LCXU!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Ffb4ba5d7-1af9-4bef-be3f-8e85908b563a_854x86.png, source, https://substackcdn.com/image/fetch/$s_!snSc!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fcfd83276-81e7-48be-9e4e-94a75f7cc406_861x154.png, source, https://substackcdn.com/image/fetch/$s_!daqR!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F28c56670-ffe1-4908-9ccb-9e82185f5379_850x92.png, source, Sun Turned Purple?, 8, Wikipedia, hyperactive agent detection, this website, Here, Here, scattered examples, https://substackcdn.com/image/fetch/$s_!xSbu!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fc386c06d-173d-44be-9c13-f74ad59ff3b2_698x421.png, source, a Purkinje tree, Demons Enter By Sungazing, here, here, here

Astral Codex Ten

Table of Contents

Atlas

Science

Science

Article

Metadata

Appears In

External Links

Source Context

Backlinks

Astral Codex Ten

Table of Contents

Atlas

Science

Science

Article

Metadata

Appears In

Related Pages

External Links

Source Context

Backlinks