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Comment by blhack | Hacker News Reader

To those who aren't aware of it, there was a recently completed (small) clinical study of hydroxychloroquine (and in some cases HCQ plus z-pack) just completed in France. The results are here: https://www.mediterranee-infection.com/wp-content/uploads/20...

They're miraculous. This is a well-studied, mass-produced drug which has been around for 70 years and appears to be highly effective at treating this virus.

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>They're miraculous.

Where are you seeing that? Because what I see is a very non-rigorous, non-randomized study. Also, what about this part:

>A total of 26 patients received hydroxychloroquine and 16 were control patients. Six hydroxychloroquine-treated patients were lost in follow-up during the survey because of early cessation of treatment. Reasons are as follows: three patients were transferred to intensive care unit, including one transferred on day2 post-inclusion who was PCR-positive on day1, one transferred on day3 post-inclusion who was PCR-positive on days1-2 and one transferred on day4 post-inclusion who was PCRpositive on day1 and day3; one patient died on day3 post inclusion and was PCR-negative on day2; one patient decided to leave the hospital on day3 post-inclusion and was PCR-negative on days1-2; finally, one patient stopped the treatment on day3 post-inclusion because of nausea and was PCR-positive on days1-2-3.

Really easy to have "miraculous" results when 20+% of your treatment group were excluded and also happened to be the ones with the most severe symptoms.

Medical doctor and statistician weighing in just to say: I agree fully with what you wrote. No miracles observed.

I don't mean and disrespect to you as a physician, but there appear to be many experts who disagree with you to the point of acting out their disagreement at scale. Chloroquine has become a standard part of treatment for this disease in several countries, and its continued use seems to imply its efficacy.

I don't think he said no one is using (or should use) it, just that the results aren't "miraculous".

Haha. Continued use seems to imply it's efficacy. This might be the most illogical post on Hacker News in some time.

I think we could have a whole website of things that were continued to be used without a shred of evidence of effectiveness.

We could also have a whole website of things people strongly believed were effective that RCTs absolutely demolished.

RCT? Sorry don't know that abbreviation.

Randomized controlled trial

Thanks

Miracle (noun): an extraordinary and welcome event that is not explicable by natural or scientific laws and is therefore attributed to a divine agency.

>there appear to be many experts who disagree with you to the point of acting out their disagreement at scale. Chloroquine has become a standard part of treatment for this disease in several countries, and its continued use seems to imply its efficacy.

The fact that experts agree that this drug should be used doesn't mean they agree that it is miraculous. And this certainly doesn't suggest they disagree with the parent MD/statistician.

It seems like such a strange nit to pick here over my use of the term miraculous. I don’t know what else you would call the results of the study I linked (supported by the reaction of many national health orgs). Yeah, maybe this isn’t the cure to this disease, and of course we need more testing, but the result as reported are incredibly hopeful. It seems to have hit a nerve with some people that I used the term “miraculous”, but I will continue to defend that term. We are looking at a virus that has disrupted the global order. Here is a study claiming incredible efficacy. That isn’t a miracle in the divine sense, but if definitely reports as being extremely helpful during a dire need.

You were wrong when you presented alleged evidence/argument that experts must necessarily disagree with the MD/statistician, above.

If doctors are using this, and not seeing an effect, why do they continue using it? Doctors are humans, and prone to irrationality of course, but they're also scientists.

Maybe my faith in the collective ability of the world medical professionals to evaluate their treatment techniques is misplaced, but I still have faith that these people are acting in accordance with their scientific training.

Maybe that's wrong, and I shouldn't be trusting these people. But if I'm not trusting doctors (and especially infectious disease experts who are writing papers about their findings), then who should I trust?

I think a lot of this distrust in institutions and doctors is going to get us into a lot of trouble. I wish people would start listening to these orgs.

Your post does not address my point. That's okay, if you simply wanted to say the things you said. There are things you've said that I agree with, and things which I strongly disagree with. In a conversation, I like to be careful about going down too many side tangents if certain fundamentals are not already mutually understood.

It seems like you disagree with my implication that use of something (in this case, chloroquine to treat covid-19, the use of which seems to be increasing daily) implies its efficacy.

Why? I'm modeling the doctors and health officials who are making these decisions as agents which are presumably continuously evaluating their decisions. So basically:

A lot of experts are taking this action -> assume the action has a desirable outcome -> believe what the experts are saying (in this case both their words and their actions seem to agree with each other, and point to the idea that chloroquine is an effective treatment of covid-19).

I am genuinely at a loss as to why this stance (my stance) is anything other than completely obvious.

No. Here, as in several places, you make unwarranted assumptions about other's thought processes. Remember that "efficacy" is a matter of degree. I try not to spend too much time and effort on strawmen.

I'm trying to understand you here. Is the assumption that doctors are taking actions based on previous experience with those sorts of actions unwarranted in your opinion? Or a strawman?

I'm sorry if but I'm having a difficult time figuring out what I have said that you disagreed with.

You seem sincere, and unlike prior comments to be approaching this in good faith. Maybe you even welcome criticism as a means of improving your thought process. I don't mean to be cryptic, and certainly don't mean to be rude, I just try to conserve energy and not get caught up in non-constructive arguments.

You don't seem to be taking people's statements at face value, but rather projecting additional meaning onto them, almost as if you conceive of fewer possible positions than there actually are, and pigeonhole us.

Consider my prior two statements in this thread which start with "the fact" and "you were". Do you agree that these statements were correct, on their own terms, in their own context, and independent of additional complexities involving degree if efficacy or various arguments for or against use, testing, or hopefulness?

Also, do you see that the people who disagree with your framing are not 'picking nits' nor are they having 'struck nerves'? Can you see other reasons why they might respond as they did?

Its use in the presence of a plausible mechanism, and in the absence of any good supporting data, does not indicate efficacy. It indicates that when a patient is circling the drain you throw things at the wall that could plausibly have some benefit.

If the control group still is positive for corona after 7 days in 90% of cases and we anticipate the intervention to get that number to 50%, with an alpha of 0.05 and a size of 24 in the intervention group, the study has a power of 0.957 and answers the question whether chloroquine stops viral shedding by day 7. This isn't cardiology where we need 50000 patients to find the significance.

Exactly! Reading the study, I don't see any hard evidence. Sounds like the next Forsythia.

> Sounds like the next Forsythia.

For those that don't get the reference: https://en.wikipedia.org/wiki/Contagion_(2011_film)

And that's exactly what it is.

Oh come on that isn't fair. Just do a simple google search for countries which have made chloroquine part of their standard treatment. The reference you're making here is to a person trying to exploit people during a pandemic with what was an obvious lie.

This is not that.

A country using an unproven treatment to quell panic is hardly unprecedented nor out of the realm of many governments and sorry for me to say the US as well.

"Lets all pray for God to cure us" comes to mind.

You are harping on the theme of 'a miracle cure' in this thread. I think you're highly irresponsible.

I wonder if anyone has tried forsythia against covid? I’m just saying... we’d all feel pretty foolish if we find out in a couple years that it is effective.

Edit: yeah, yeah... you downvote me, but I bet you secretly wiki'd forsythia to see if it's a real thing.

This one study is weak, agreed. However, some form of chloroquine+iodine has been used successfully in South Korea. I don't agree with the "miracle" hyperbole, but there is reason to be hopeful.

Mean age of control group is 15 years older than experimental too.

It's the other way around. The experimental group is older. That would suggest that HCQ would do even better if the ages were matched.

Luckily, it seems like a randomized study is underway.

The findings they're claiming are nothing short of miraculous, and I think the people who were behind the trial, as well as everybody else even remotely interested in this (the entire world, I would say) should and likely does support a broader trial.

Worth mentioning that, with China/Korea, now France deploys this drug to frontlines, in the best case scenario, which is the South Korea case, the death rate still sets at 1%, so still 10 times more lethal than flu.

We all want a miracle, but we need to be cautious about it.

I am more curious right now as whether this drug can work as a preventative medication for high risk individual to lower the chance for getting infected, TBH. That will help the medical stuff greatly.

South Korea is at 0.6% CFR, the true IFR will be lower than this again due to false negatives and biased testing against symptomatic people.

South Korea will max end up with a IFR of 0.2-0.5%, 2 to 5 times worse than the flu.

To those who aren't aware of it, the reason someone thought to try this is that this type of drug has shown intermittent promise in treating viral infections for years. But to date it has never really panned out in clinical trials. (If it had, we would all be taking chloroquine every time we caught a serious virus like the flu).

Doesn't mean it can't be beneficial this time for this particular virus; we should always keep trying. I'm just saying it's probably a bit early to be calling miracles based on one small study.

> To those who aren't aware of it, the reason someone thought to try this is that this type of drug has shown intermittent promise in treating viral infections for years.

No, the actual reason is that Chinese doctors noted a statistical abberation in their coronavirus patients: none of the patients had lupus. They called around and confirmed it, none of the hospitals had any patients with lupus. And the standard chinese treatment for lupus is... chloroquine.

https://www.jqknews.com/news/388543-The_novel_coronavirus_pn...

Chloroquine has proceeded from statistical anomaly, to successful case studies, to successful non-random trials, and now is in random trials. I'm not a doctor but I think there's a pretty good chance it'll be effective.

Yes, it is not officially approved yet, but it is being deployed in China, Korea, and other countries off-label. Right now there are no other options. I'd take chloroquine over nothing. Overall it is not pleasant but there are few dangerous side effects in the short term (retinopathy is a possible side effect if duration of treatment is on the order of months to years). It is an over-the-counter medication in a lot of the world, it is behind the counter in a lot of other places (including the UK).

(the US just likes making sure doctors get paid even if a medication is quite safe. There are a lot of medications like oral contraceptives that are routinely done over-the-counter in most other places that we insist are so wildly dangerous you couldn't begin and discontinue them if you noticed side effects. And on the flip side, there's lots of drugs like tylenol that we know to be horribly unsafe and yet they remain OTC anyway, or even in "abuse resistant" combination products. Chloroquine is a pretty standard antimalarial and places that have malaria don't think it's a big enough deal that you need a doctor to get it.)

Given the lack of other options, given the known nature of the drug, if I was in a hospital dying of COVID would I want to give it a shot? Yes. Same principle as experimental cancer drugs. Some chance is better than no chance.

Anyone we can treat with pharmaceutical interventions instead of ventilators frees up those ventilators for more critical patients. Even if they still have to remain under some degree of medical supervision, it frees up ICU beds.

chloroquine and remdesivir, have been designated for Expanded Access, or “compassionate use,” by the FDA. Hopefully to be FDA approved for the gp soon.

I would give it a shot too if I was sick, but that is a far cry from calling it a miracle.

It shows promise and should be pursued—and it is. Let’s not oversell it though.

> there's lots of drugs like tylenol that we know to be horribly unsafe and yet they remain OTC anyway

Interestingly, one of the other therapeutic leads that doctors are following up on is whether Tylenol is safer than ibuprofen for Covid patients. It got reported that it was, but it’s not yet clear how true that is.

This is not a rigorous study and doesn't pretend to be but those are sufficiently impressive results that it is still a cause for hope.

You need meticulous study design when you're looking for small effect sizes, with a large enough effect you can extract useful information even from flawed data.

[Message deleted because I agree I cannot backup my claim and I may be wrong.]

Can you explain more about this?

Yeah, you’ll need some serious source to backup this claim. Having a deal with a lab from the same country, that produces a drug you’ve been studying for decades in your lab and hospital isn’t something that justifies dumping on someone’s reputation. Especially if the person in question looks like he has enough papers published to justify his claims.

Ps: i do agree that his tone and style looks unorthodox. But results is the only thing we should care about.

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