SCOTT ALEXANDER: Much more than you wanted to know about Ivermectin.

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.

Alexander’s hypothesis is fascinating, though, well, it’s fascinating. But the more troubling thing is that, as he says, certain scientific arguments, even when supported by evidence, are now excluded so that people don’t seem to be The Wrong Kind, Dear. And that reliance on social ostracism over reasoned argument is (one of) the worst things about our current elite.

Plus: “I want a world where ‘I did a study, but I can’t show you the data’ should be taken as seriously as ‘I determined P = NP, but I can’t show you the proof.'”

Also:

So “believe experts”? That would have been better advice in this case. But the experts have beclowned themselves again and again throughout this pandemic, from the first stirrings of “anyone who worries about coronavirus reaching the US is dog-whistling anti-Chinese racism”, to the Surgeon-General tweeting “Don’t wear a face mask”, to government campaigns focusing entirely on hand-washing (HEPA filters? What are those?) Not only would a recommendation to trust experts be misleading, I don’t even think you could make it work. People would notice how often the experts were wrong, and your public awareness campaign would come to naught.

Indeed. As Alexander notes, once people have figured out that experts lie — and they do — it’s much harder to argue that “yes, but this isn’t the sort of lie they usually tell.”

Again, to have a high trust society, the people in charge of institutions must be trustworthy. When they’re untrustworthy but full of hauteur, they aren’t trusted entirely independent of whether they’re right or wrong this time.

Also: “And now let’s return to that first word, ‘hostile’. 95% of biology professors are Democrats. Plus medical organizations keep rubbing more and more salt in the wound. . . . If we want to make people more willing to get vaccines, or less willing to take ivermectin, we have to make the scientific establishment feel less like an enclave of hostile aliens to half the population.”

The problem is, America’s gentry class utterly depends on not simply feeling superior to the others, but on loudly denigrating the others, for its self-image. And it values its self image more than objective reality. Sadly, there appears to be no treatment or vaccine for that ailment, which is far more destructive than Covid.