Ionic zinc (the active ingredient) tastes terrible. It
basically removes your senses of taste and smell for a few hours, and
leaves a metallic residue on your tongue. Popular brands try to fix this
by adding binding agents that lessen the amount of ionic zinc produced,
which makes them useless.
The mechanism of action requires the ionic zinc to be coating the
cells it’s acting on. This means that zinc pills don’t work at all,
resulting in lots of people wasting their money. I assume this also
means that zinc lozenges don’t help for lower respiratory infections
(which COVID-19 is), which fits with my anecdotal experience.
Zinc can have permanent long-term consequences. The FDA warned
against zinc nasal sprays for removing some people’s senses of smell.
After three years of using zinc lozenges every winter, I feel like my
sense of taste has gotten permanently worse, but I can’t know for
sure.
And from the LW post:
The guy sounds to me like he knows what he’s talking about. But I
don’t have the technical expertise to really know. (I think I could
detect a mediocre bullshitter, but not necessarily a high level
one.)
WTF and then he writes up an essay because of the podcast and has
been doing trials on himself, basically encourage everyone to do it when
we have no idea if it works.
The evidence I’ve seen is that zinc as a treatment for a cold is very
questionable. You have to take it when symptoms first appear, and at
best it reduces the length of your cold by a day.
And if you are taking it all the time as a prophylactic against
COVID19, theres a chance it could permanently affect your senses of
smell or taste.
What is with the rat community and being all about drugging and
supplementing themselves? I don’t understand it.
It's even more complicated than that. Here are [two](https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.13057) [reviews](https://journals.sagepub.com/doi/10.1177/2054270417694291) that both show zinc is effective against the common cold... under certain conditions. First, as the commenter said, it has to be in the form of lozenges that you suck continuously all day, not pills that you swallow. And the lozenges have to contain zinc in the form of zinc acetate (best results) or zinc gluconate (mixed results), not zinc citrate. When you only include studies that meet these criteria (which is why previous meta-analyses failed to find an effect), the result is an average reduction in the duration of cold symptoms by two to four days, out of a seven-day average duration if untreated. So it's not the fabled Cure but it does make a big difference.
So, some problems here. The fact that it only works in suckable lozenge form implies its mechanism of action - which is unknown - requires the zinc to be in direct continuous contact with the infected surface of the respiratory system (the pharynx). That might explain why it isn't more effective against the cold: sucking lozenges probably doesn't help when the infection is in your nose instead of your throat (and zinc nasal sprays have been pulled from the market for causing permanent loss of smell). As the commenter says, that's bad news for treating a virus whose worst symptoms are in your lungs.
And because it's only sold as a "supplement" in the US, it's virtually unregulated (yay libertarianism! let the free market decide which treatments work!), so it's very hard to shop for effective lozenges even if you want them. And you certainly can't believe any claims on the bottle about what it's useful for, because they're mostly going to mislead you by citing the effects of nutritional zinc deficiency and its role in various body functions, which is irrelevant to whether it does anything if you take extra zinc with a normal nondeficient diet. But in particular, most of the unregulated supplements are going to be zinc citrate, which wasn't effective in studies - and anyone with some practical chemistry knowledge could have told you that. Zinc citrate is basically guaranteed ineffective for any purpose, by definition, because citrate is a little claw molecule that grabs metal ions like zinc and sequesters them so they can't participate in any chemical reactions.
Now that zinc has found its way into the pants-on-head conspiracy theory community, people are probably going to find new terrible ways to abuse it too. Short-term zinc overdoses, like if you only take lozenges for a few days when you have a cold, aren't really harmful because you just excrete the unused zinc. But if you decide to pop zinc continuously every day of the pandemic, for totally evidence-free prevention instead of just treatment, you can eventually manage to hurt yourself with zinc poisoning.
As for my personal experience... I'm not going to tell you, because it should be clear at this point that vague anecdotes from strangers on the internet are actually worse than no evidence at all. But I did ask my personal physician, whom I selected from a list because she describes herself as a practitioner of evidence-based medicine, and she said indeed her reading of the literature is that zinc lozenges are effective at reducing the duration of the common cold. On the other hand, I actually had a cold when I saw her, and she only recommended the usual cold & flu cocktails plus plenty of rest and fluids until I specifically asked about zinc.
tl;dr none of the caveats are actually going to matter to anyone who's rushing out to stockpile zinc pills, so my professional advice is to go buy zinc futures, or shares in supplement companies
When something only works under the light of the full moon, that is indicative of p-hacking.
Ditto for zinc acetate or gluconate or citrate thing. In solution it should be the same zinc ion either way edit: hmm i guess unless it isn't even disassociating?
If some of them don't work then that sounds like none of them work and it got p-hacked across irrelevant variables.
Bottom line, sounds very much like bullshit, and if there's something rationalists don't have that's a bullshit filter.
edit: looking at it some more it just sounds like even if it works that could well be by some undesirable mechanism having to do with fucking up your cells directly on the throat itself.
> When something only works under the light of the full moon, that is indicative of p-hacking.
> Ditto for zinc acetate or gluconate or citrate thing. In solution it should be the same zinc ion either way edit: hmm i guess unless it isn't even disassociating?
> If some of them don't work then that sounds like none of them work and it got p-hacked across irrelevant variables.
The result was reproduced among the studies that used acetate, and they had pretty good justification for looking at that variable non-artibrarily. Not just the obvious exclusion of citrate, but between acetate and gluconate:
> > Since there is evidence that acetate binds zinc ions less strongly than gluconate, zinc acetate has been proposed as a more suitable salt for lozenges than zinc gluconate 4, 5. Nevertheless, three studies with high doses of zinc as zinc gluconate also reported a statistically significant 21% to 48% reduction in the duration of colds 1, 21, 22 (see meta‐analysis in 2.
or if you really want to get into the weeds:
> > Zinc ion can form complexes with a number of substances, which has caused substantial problems with the lozenge formulations in a few trials. Farr et al.29 used a lozenge that contained 2% citric acid, which binds zinc ions and very little or no free zinc is released from such lozenges.3,4,6–9 The low-dose (<75 mg/day) zinc lozenges studied by Douglas et al.30 contained tartaric acid and sodium bicarbonate, which bind zinc ions.7,8 The Turner trial25 had two low-dose zinc acetate trial arms. The zinc acetate lozenges contained hydrogenated palm-kernel oil, cotton-seed oil, and soy lecithin, and Eby pointed out that most probably those substances formed insoluble reaction products with zinc at the high preparation temperatures used in the production.31 These concerns were not refuted by Turner. Finally, the first author of the Smith et al. study19 stated in a 1992 paper that the negative findings of the Smith et al. study most probably were explained by the presence of mannitol and sorbitol in the lozenges.20 The negative findings of the above studies were thus explained by flaws in the composition of the zinc lozenges. Evidently, problems in lozenge formulation cannot be compensated for by appropriate methodology at the level of randomisation and blinding. Furthermore, problems in lozenge formulation can lead to false negative conclusions about the potential effects of zinc lozenges but cannot lead to false positive conclusions.
(this touches on my point that US "supplements" are not regulated to actually contain their purported active ingredient in an active form, so what works in clinical studies may not relate to what happens with the bottle of lozenges you can buy at GNC) (EDIT: from one of the papers: "Therefore, the findings of this analysis should not be directly generalized to the wide variety of zinc lozenge formulations on the market.")
I mean p-hacking is more of a single-study problem; it's kind of inevitable that when you do a big meta-analysis there are going to be some studies that were conducted poorly or that tested the wrong variable, and you have to exclude and explain them. Even after all that, the conclusion is still pretty guarded: "patients may be encouraged to try them"
> > In conclusion, the trials included in this study were of high methodological quality: randomised, double-blind, and placebo-controlled. They were carried out over three decades by six different research groups. The evidence is thus very strong that zinc lozenges may shorten the duration of colds by approximately 33%. The optimal composition of zinc lozenges should be investigated in addition to the optimum frequency of their administration. Nevertheless, the current evidence of efficacy for zinc lozenges, in particular zinc acetate lozenges, is so strong that common cold patients may be encouraged to try them for treating their colds.
Ahh, right. Basically , good luck getting actual zinc ions on your throat without oversight as for a medication & findings are pretty conclusive that "lozenges don't work" even if zinc ion may be working
Does it invariably taste like shit? One other concern is that if it tastes like shit and placebo tastes okay, that's not just unblinding that's patients actively getting fed up with the treatment. How did they determine duration of the common cold, duration of the fever? I usually don't even get a fever with common cold any more.
> & findings are pretty conclusive that "lozenges don't work" even if zinc ion may be working
Maybe I'm misunderstanding your point but the finding was that lozenges do work, somehow; it's pills that don't.
> Does it invariably taste like shit? One other concern is that if it tastes like shit and placebo tastes okay, that's not just unblinding that's patients actively getting fed up with the treatment.
They actually addressed that in the papers:
> > Farr and Gwaltney34 speculated that the benefit reported by Eby et al.1 might have been explained by the bad taste of the zinc lozenges. ... there was no substantial difference between the zinc and placebo groups in the recorded adverse effects, and only a few drop-outs occurred.22–24 In the most recent trial by Prasad et al.,24 a few participants identified the lozenges, but when the analysis was restricted to those who remained blinded at the end of the study, the efficacy of zinc lozenges was no less.
---
> How did they determine duration of the common cold, duration of the fever?
> > Petrus et al. 15 reported both the mean duration of common cold symptoms and the duration of the longest cold symptom. We used the latter as the outcome for this analysis, since it is consistent with the outcome definition in the two studies by Prasad et al. 16, 17.
>it's about trying to optimize the running of the body
this always fascinates and confounds me. the body is by nature finite. capitalism demands infinities. the two are incompatible, and if you try to make the body infinite, it will begin to break down. it's simply not built to do one or two things hyperefficiently until no-death. I have a few friends who are into the whole Soylent-biohacking-supplements-optimal human performance thing, and I'm always like *why? Why do you give a shit?*
I think it boils down to fear of death, honestly. but who knows.
why do you exercise? having more energy and feeling your body work well is fun and supplements can help, especially for chronic diseases. There doesn't have to be a special reason to do things that make you feel good.
As a trans woman, having control over your body is great. There are plenty of valid reasons to dislike fascist-lite rationalists, but I don't think wanting to control your own body is one of them. It might not be world-changing, but it's fun and you can do self-experimentation, which makes it ideal to write about on the internet. I think the last part is why so many write about it.
It's the same reason they wrote a lot about polyamory back in the day - it was fun and they were doing it, so may as well write about it.
The problem though is that they don't seem to be getting any enjoyment out of experiencing better health. The way the opto-nerds talk about it, it's all in service of increasing their productivity so they can touch computers more betterfully.
yeah, if you're not getting enjoyment out of it, it's probably not good for you. I just think sometimes people say they're "optimizing" instead of having fun or having more time for other things because the idea that we live for the sake of capital is prevalent throughout society and in ratsphere (via Robin Hanson).
"I'm taking drugs because they're fun and do interesting things and have some marginal effects that improve my work" isn't nearly as socially acceptable as "I'm taking drugs because they improve my work", so I kind of think most people saying the latter secretly mean the former.
okay. i like soylent as a meal substitute sometimes because i'm lazy and cooking is hard and other protein shakes taste worse but i see your point. i just feel kind of personally attacked :p (that's a joke, i'm fine)
That's a big part of it but I think they've internalized the hyper-efficiency/optimization/utility maximization kool-aid to the point that anything not "productive" has to be expunged from life, and if it isn't productive (see HPMOR) but you still want to do it, you just invent a way to claim it's "productive."
Actually what sometimes floors me about IDW rationalists is the weird
way that they choose who to listen to.
I’ll be first to tell you I don’t know much about medicine. So when
I’m looking into what to do about Covid, I’m looking for people who know
things about medicine. I’m listening to Fauci at the CDC, I’m listening
to the guys at John Hopkins. I’d probably go to WebMD if I wanted a
quick answer.
These guys seem to do almost the opposite. They specifically ignore
those kinds of people in favor of people who know nothing about
medicine. The less their field is related to medicine the more they
value their advice. Like, I’m sure Paul Graham is pretty smart about
computers and business. That doesn’t give him any special insight into
diseases. Scott isn’t a medical doctor, he’s a psychiatrist.
That seem to fits in with the basic rationalist dogma, though. One high school dropout with a blog and a graph is more credible than so-called experts if they use the right jargon and offer an irrelevant metaphor by way of explanation.
I’ve often thought that there’s also a degree of laziness in that approach though. If you read something written by a subject expert, you’ll probably need to read some background or the terms used to get much that’s deeper than *wash your hands, idiot*.
A blog featuring a graphic and an easy to understand metaphor is pretty easy. The pretty graph shows that X thing and Y thing are related to Z thing. And you get some sort of ‘yeah it’s just like scoring goals makes sports more fun to watch’. You don’t need background, you don’t need terms (but invented words are fun) you just needs to skim that and parrot it as though you learned something.
I think there's a difference between Internet *rationalism* and autodidacts.
For one, an autodidact will generally try to read background on their topic of interest before even attempting to form opinions on any related topics. They'll read quality sources from experts in the field, not watch YouTube, listen to podcasts or read blogs from nonexperts. To be honest, if you're really an autodidact, you'll spend most of your time studying, not playing with half baked ideas on the Internet.
They'll also be well aware of the limits of what they actually know. There's nothing responsible about anyone giving advice on a topic that they haven't legitimately studied -- at least without a very strong
## I AM NOT PROFESSIONAL
Message that clearly states that they're giving an opinion that is not based on pro knowledge or experience. In short the real deal to me is at least humble enough to get the fuck out of the way especially when it's a topic with strong negative consequences. Someone just randomly interested in law isn't going to tell you what the law says and means or tell you to sue-- he'd probably tell you to get a real lawyer. It probably matters less in art, literature or politics, where nobody dies or loses a lot of money if they're wrong.
3 months of watching medical experts say stuff that's misleading/outright false and your response is "we should listen to the experts more?" If i'm a medical layman, how am i supposed to tell if the expert advice i'm getting is "don't wear masks :)"-quality advice or actually good advice?
Are you proposing we listen to random bloggers instead? Every epidemiologist has been telling us to hand wash, socially distance, avoid crowds, because that is unambiguously correct. The evidence on mask wearing is way, way more mixed, and depends on whether you're talking about surgical or cloth masks, about [reciever protection or source control](https://twitter.com/CT_Bergstrom/status/1246013181551493120), and whether people get a false sense of security from mask wearing. It's also affected by surgical mask shortages.
At the same time as medical experts have debates based on actual scientific literature, bloggers were asking such important questions such as "[why aren't we deliberately infecting people?](http://www.overcomingbias.com/2020/03/expose-the-young.html)", or ["lockdowns are an overeaction, trust me i'm a viral marketing expert"](https://www.reddit.com/r/SneerClub/comments/fn0trw/you_dont_need_a_special_degree_to_understand_what/).
[That last one](http://archive.is/yuaUq) is a good example of why you should not trust random bloggers. It looks like a well researched summary of the data, with lots of graphs and confident statements, and references to authorities linked throughout. Except that, as actual specialists instantly realised, it was [total fucking bullshit](https://twitter.com/CT_Bergstrom/status/1241522140559503360) that medium had to take down for straight up dangerous recommendations like "open public spaces up during a fucking pandemic".
>Are you proposing we listen to random bloggers instead?
I'll have you know, I read 1000 random bloggers, and about 3 were right less than a week before experts, so by bayesian math, I should be more skeptical of CDC reports than medium posts from techbros.
Full disclosure: I don't read beyond the first page of an official healthcare website, a medium post headline, or a twitter retweet. I also don't read random bloggers until after they're right.
From the linked SSC comment thread.
And from the LW post:
WTF and then he writes up an essay because of the podcast and has been doing trials on himself, basically encourage everyone to do it when we have no idea if it works.
The evidence I’ve seen is that zinc as a treatment for a cold is very questionable. You have to take it when symptoms first appear, and at best it reduces the length of your cold by a day.
And if you are taking it all the time as a prophylactic against COVID19, theres a chance it could permanently affect your senses of smell or taste.
What is with the rat community and being all about drugging and supplementing themselves? I don’t understand it.
Actually what sometimes floors me about IDW rationalists is the weird way that they choose who to listen to.
I’ll be first to tell you I don’t know much about medicine. So when I’m looking into what to do about Covid, I’m looking for people who know things about medicine. I’m listening to Fauci at the CDC, I’m listening to the guys at John Hopkins. I’d probably go to WebMD if I wanted a quick answer.
These guys seem to do almost the opposite. They specifically ignore those kinds of people in favor of people who know nothing about medicine. The less their field is related to medicine the more they value their advice. Like, I’m sure Paul Graham is pretty smart about computers and business. That doesn’t give him any special insight into diseases. Scott isn’t a medical doctor, he’s a psychiatrist.
https://www.youtube.com/watch?v=U1iCZpFMYd0